Damage limitation

Fire extinguishers

An adequate number of fire extinguishers should be provided of appropriate capacity and type to deal with the potential fire hazards, bearing in mind the risk of electrical fires from the equipment in use and potential solvent hazards in laboratory areas. More importantly, staff should be trained in their use without endangering themselves.

Smoke hazard

If 'first-aid' firefighting does not succeed in extinguishing the fire, the area will rapidly fill with smoke. Under such circumstances visibility will be profoundly reduced and staff should evacuate the area. Patients needing mechanical ventilation will be protected from smoke inhalation by their ventilator circuits and the piped gases. Since oxygen and air pipelines are rarely involved in fires, it is usually safer to leave patients connected to mechanical ventilation and the uncontaminated air source. They can be moved subsequently by the fire service with the help of doctors and nurses when the area is safe. Positioning essential equipment at each bed space in the same place will help staff to find emergency equipment more easily in poor visibility. Evacuation

In an ICU divided into compartments, total evacuation should only be needed in exceptional circumstances. It should be possible to move patients within the unit, away from the seat of the fire, whilst the fire is controlled. Movement of patients on mechanical ventilation and other mechanical support poses problems. A medical officer should decide which infusions and treatments can be stopped. He or she should also triage the patients before evacuation, so that those most able to withstand the stress of evacuation are moved first. A specific area of the hospital, some distance from the ICU but preferably on the same horizontal level, should be designated as the holding area for ventilator-dependent and other critically ill patients.

Joint exercises with the local fire services, using simulated patients, familiarize both the staff and the rescue services with the protocols, technology, and geography of the ICU. Using artificial smoke, from a smoke generator of the type used in theatrical productions, adds realism. A video of the event permits constructive discussion afterwards.

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