Written: February, 2006
Reviewed: 6/09
Revised: 1/13 Ambulatory Care Division
LSU Health Sciences Center- Shreveport, LA
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When Code Red or fire drill is called over paging system each floor is to follow their specific plan as follows:
1 st
floor, Pediatric Hematology/Oncology Clinic and Library/Registration/CT Scan/Phlebotomy
The following persons are responsible for the following:
RNs Assure doors to Treatment Room are closed.
Remove items from passageway (crash cart, EKG machine etc…).
LPNs
Monitor the doors to keep patients from moving around in hallways.
Reassure patients.
Remove carts etc… from passageways.
Close all doors.
Radiology
Lab/Techs
Monitor doors to stairwells to keep patients from coming into the various hallways.
Reassure patients.
Remove carts etc… from passageways.
Close all doors.
Monitor doors to stairwells to keep patients from coming into the various hallways.
Reassure patients.
Monitor phones for incoming calls related to fire (try to keep line free).
Close all doors.
Hospital Admit
Techs (HAT)
& Aids
Maintenance
Custodian
Assure passageways are clear in area.
Reassure patients and instruct them to not walk in hallways.
Monitor elevators to prevent people from getting on during drill.
Station at stairwell near lobby to decrease personnel movement.
Direct patients/guests/staff to closest outside Exit.
If you discover a fire:
R Rescue - Escort or carry patients in immediate danger of fire/smoke to a safe place.
A Alarm - Pull the handle at the nearest red pull station.
Call UPD at 5-3UPD giving the exact location and nature of fire (mattress).
C Confine – shut off flow meters and close all doors in the fire area as you leave the room.
E Extinguish – get and extinguisher and fight the fire if possible (do not place yourself in danger).
Extinguisher Usage
P Pull – Pull the pin on the extinguisher.
A Aim – Aim at the base of the fire.
S Squeeze – Squeeze the leaver.
S Sweep – Sweep the foam from side to side.
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Adult Hematology/Oncology Clinic, 2 nd
floor
The following persons are responsible for the following:
RNs Assure doors to Treatment Room are closed.
Remove items from passageway (crash cart, EKG machine etc…).
Monitor the doors to keep patients from moving around in hallways.
Reassure patients.
Remove carts etc… from passageways. LPNs
Close all doors.
Monitor doors to stairwells to keep patients from coming into the various hallways.
Reassure patients.
LPNs – North Hall Notify FWCC 2 nd
floor lab of alarm or actual emergencies.
Hospital Admit
Techs
Aides
Monitor phones for incoming calls related to fire (try to keep line free).
Assure passageways are clear in area.
Reassure patients and instruct them to not walk in hallways.
Monitor elevators to prevent people from getting on during drill.
Station at stairwell near lobby to decrease personnel movement.
Station at exit door to service elevator/outside walkway to decrease personnel movement.
If you discover a fire
R Rescue - Escort or carry patients in immediate danger of fire/smoke to a safe place.
A Alarm - Pull the handle at the nearest red pull station.
Call UPD at 53UPD giving the exact location and nature of fire (mattress).
C Confine – shut off flow meters and close all doors in the fire area as you leave the room.
E Extinguish – get and extinguisher and fight the fire if possible (do not place yourself in danger).
Extinguisher Usage
P Pull – Pull the pin on the extinguisher.
A Aim – Aim at the base of the fire.
S Squeeze – Squeeze the leaver.
S Sweep – Sweep the foam from side to side.
If instructed to evacuate patients :
1. If possible move patients to the elevated walkway and use the stairwell outside to move to the first floor. If the fire prevents moving to that side of the clinic progression will be down the north stairwell to the outside.
2. All staff and patients will assemble in the parking lot directly behind FWCC.
3. First priority during evacuation is to evacuate the ambulatory patients; then utilizing all resources available, carry the non-ambulatory patients down the stairs.
4. Each area should assure that the charts of patients still in clinic are carried to the assembly area outside (i.e. Treatment Room nurses take the charts from there, LPNs take the charts from their carts and the ones from the rooms as they evacuate the exam rooms, Nurse Aides from the
Vital Sign area etc.).
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F-16-FWC
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5. Hospital Admit Technicians are to work together in the assembly area to get an accurate head count of the staff and patients who are out of the building, utilizing the clinic charts and patient census forms.
Surgical Oncology, 3 rd
Floor
RNs
LPNs
Assure doors to Treatment Room are closed.
Remove items from passageway (crash cart, EKG machine etc...).
Monitor the doors to keep patients from moving around in hallways.
Reassure patients.
Remove carts etc... from passageways.
Close all doors.
Monitor doors to stairwells to keep patients from coming into the various hallways.
Reassure patients.
Radiology Techs Remove carts etc…from passageway.
Hospital Admit
Techs
Aides
Close all doors.
Monitor doors to stairwells to keep patients from coming into the various hallways.
Reassure patients.
Monitor phones for incoming calls related to fire (try to keep line free.
Assure passageways are clear in area.
Reassure patients and instruct them to not walk in hallways.
Monitor elevators to prevent people from getting on during drill.
Station at stairwell near lobby to decrease personnel movement.
Station at exit door to service elevator/outside walkway to decrease personnel movement.
If you discover a fire
R Rescue - Escort or carry patients in immediate danger of fire/smoke to a safe place.
A Alarm - Pull the handle at the nearest red pull station.
Call UPD at 53UPD giving the exact location and nature of fire (mattress).
C Confine – shut off flow meters and close all doors in the fire area as you leave the room.
E Extinguish – get and extinguisher and fight the fire if possible (do not put yourself in danger).
Extinguisher Usage
P Pull – Pull the pin on the extinguisher.
A Aim – Aim at the base of the fire.
S Squeeze – Squeeze the leaver.
S Sweep – Sweep the foam from side to side.
If Instructed to Evacuate Patients/Guests
Use the stairwell in the front lobby or hallway leading to the front lobby to move clinic patients and guests to the first floor or outside. OR/Endoscopy suite patients and staff will use the stairwell located in the FWCC PACU area.
1. All staff and patients will assemble in the parking lot directly behind FWCC.
2. First priority during evacuation is to evacuate the ambulatory patients; then utilizing all resources available, carry the non-ambulatory patients down the stairs.
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F-16-FWC
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3. Each area should assure that the charts of patients still in clinic are carried to the assembly area outside (i.e. OR/Endoscopy nurses take the charts from there, Radiology Techs take the charts for patients in Radiology area, clinic nurses take the ones from the rooms as they evacuate the exam rooms, Nurse Aides from the Vital Sign area etc.).
4. Hospital Admit Technicians are to work together in the assembly area to get an accurate head count of the staff and patients who are out of the building, utilizing the clinic charts and patient census forms.
FWCC Operating Room and Endoscopy Fire Safety Plan
Preventive Measures
The use of holsters provided with each cautery pencil is mandatory to prevent inadvertent activation of the pencil.
Protective Measures
In the typical OR/Endoscopy Suite, there are many measures available to protect the patient and staff from fire. These include the dissemination of information about fire emergency procedures, and the location of "safe area," fire alarms, sprinkler, and fire extinguishers. Fire alarms, extinguishers, stairwells/exits, smoke and fire barrier doors, and shut off valves, are color coded on the diagrams.
Policies and Procedures
1. The FWCC PACU Coordinating Nurse will be responsible for the general management of the unit until
Hospital Administration, Safety, and the fire department arrives. All available personnel will assist the coordinator.
2. Four basic activities are encompassed by hospital-wide fire emergency procedures:
R Rescue - Escort or carry patients/guests in immediate danger of fire/smoke to a safe place.
A Alarm - Pull the handle at the nearest red pull station.
Call UPD at 53UPD giving the exact location and nature of fire.
C Confine – shut off flow meters and close all doors in the fire area as you leave the room.
E Extinguish – get and extinguisher and fight the fire if possible (do not place yourself in
danger).
The four basic activities encompassed by hospital-wide fire emergency procedures and listed above (RACE) should be modified for use in the OR/Endoscopy Suite to provide for the needs of medically compromised patients. The attending or senior surgeon must determine which steps would present the lesser hazard.
The OR and Endoscopy Suite fire emergency will deal with minimizing harm to patients and staff.
3. If the fire does not begin in the OR/Endoscopy Suite immediate vicinity (behind restricted doors), but is threatening the Surgical and Endoscopy suites, the FWCC PACU Coordinating Nurse shall communicate with Hospital Administration to determine the status of the emergency and whether evacuation will be necessary. If a fire occurs nearby, the immediate problem will be to keep smoke out of the OR and
Endoscopy suites. All doors to the Surgical and Endoscopy suites shall be kept closed.
4. The FWCC PACU Coordinating Nurse will coordinate planning with the surgeons and anesthesia charge person to make sure that each member of the surgical team understands what is to be done and who is to perform each task.
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5. First, protect the patient and the staff, then the medical record, the facility and its equipment, and last general environment.
If the patient is exposed to fire:
( See Emergency Procedure for Fighting Fires on Surgical Patient )
1. Remove any burning materials from the patient to protect against direct burn and inhalation of hot or toxic gases (e.g. those produced by burning plastic). Simultaneously, the anesthesia staff (faculty, resident, CRNA) should shut off oxygen or nitrous oxide from all nearby sources. If spontaneous breathing is absent or ineffective, the patient shall be ventilated manually. It is better to remove the patient from the anesthesia machine for a few minutes than to have the high oxygen or nitrous concentrations cause fatal burns.
Anesthesia staff must have alternate methods of anesthetizing the patients if gas cannot be used (e.g. medications).
2. In the event of an endotracheal tube fire, the tube shall be disconnected from the gas source immediately and then removed by the anesthesiology personnel managing the patient. (See Emergency Procedure for Air
Way Fire Management).
3. If the fire continues directly on the patient, smother the flames with linen drapes or towels. Avoid using fire extinguisher on the patient. Dry chemical fire extinguishers leave residue that may cause post-op granulomas.
4. Anesthesia shall be reestablished as soon as possible after the fire is out. If other areas of the room are burning, remove the patient to a safe area to provide oxygen and anesthesia.
5. Notify OR Director and Supervisor/Endoscopy Manager, Safety Office, Hospital Administration/House
Manager, Quality Management. A variance report must be filed and forwarded immediately to Quality
Management.
Extinguishing equipment fires
Fire in the OR/ Endoscopy Suite may also be caused by equipment malfunction. It is essential that equipment fires be extinguished correctly because improper methods may cause a greater hazard than the fire itself. There are several guidelines to follow when extinguishing equipment fires:
1. If the fire involves equipment connected to an oxygen outlet, the room oxygen valves shall be closed from the shut off valve located in the sterile core. Each valve is marked with its respective room number (see floor diagram). The patient shall be manually ventilated until it is safe to re-administer oxygen.
2. If the fire involves electrical equipment, it shall be disconnected from the outlet or de-energized from the circuit breaker panel if possible. DO NOT USE WATER TO EXTINGUISH ELECTRICAL FIRES!
The fire extinguishers in the OR/Endoscopy Suites are approved for all type fires.
After the fire
After a fire, preserve, identify, and label all burned or charred surgical materials including drapes, disposables, and equipment for the Safety Officer. These items are needed for the investigation to determine the cause of the fire.
FLAMMABLE ANESTHETIC GASES ARE PROHIBITED IN THE OR SUITES.
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EVACUATION
The following protocol shall be followed if the need for evacuation is determined:
1. The Safety Office designee, Hospital Administration and/or the Fire Department will notify the FWCC
OR/Endoscopy Suites that evacuation is necessary.
2. The FWCC PACU Coordinating Nurse will notify the anesthesiologist, surgeon in charge, and attending that evacuation is required.
Note : All equipment and supplies for wound closure will be obtained from the supply closet, main OR,
or CMS.
3. The CMS Director/Supervisor and physical plant will be notified of the need to supply essential items for wound closure (e.g. portable suctions, electrical extensions, etc.).
4. FWCC PACU is the first option for horizontal evacuation followed by the 3 rd
floor clinic space.
A. The FWCC PACU Coordinating Nurse makes an assessment of all available rooms, prior to the move.
B. If the fire is within the OR/Endoscopy area or on the 3 rd
floor, patients and staff should evacuate using
the north stairwell exit located in FWCC PACU.
Note : Evacuation locations will only be utilized to get patients stable enough for wound closure
and transport to main OR and Endoscopy Clinic for completion of procedure (if indicated).
EMERGENCY PROCEDURE: FIGHTING FIRES ON THE SURGICAL PATIENT
1. In the event of a small fire on the patient, immediately:
Pat out or smother small fires or remove the burning material from the patient.
2. In the event of a large fire on the patient, immediately:
A. Stop the flow of breathing gases to the patient.
B. Remove the burning material from the patient.
1) Have another team member extinguish the burning material
2) If needed, use a fire extinguisher to put out a fire involving the patient,
C. Care for the patient.
1) Resume patient ventilation.
2) Control bleeding
3) Evacuate the patient if the room is dangerous from smoke or fire.
D. If not quickly under control, notify other OR staff and the fire department that a fire has occurred.
Isolate the room to contain smoke and fire.
4) Examine the patient for injuries and treat accordingly.
E. Finally, save involved materials and devices for later investigation.
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EMERGENCY PROCEDURE: EXTINGUISHING AIRWAY FIRES
At the first sign of a tracheal tube fire, immediately and rapidly:
1. Disconnect the breathing circuit from the tracheal tube.
2. Remove the tracheal tube.
A. Have another team member extinguish it.
B. Remove cuff-protective devices and any segments of burned tube that may remain smoldering in the airway.
3. Care for the patient.
A. Reestablish the airway and resume ventilating with air until certain that nothing is left burning in the
airway; then switch to 100% oxygen.
B. Examine the airway for the extent of damage and treat the patient accordingly.
4. Save involved —materials and devices for later investigation.
Administrative Offices, 4 th
Floor
All Staff
Administrative
Assistants
Fellows
Assure doors to offices and conference rooms are closed.
Remove items from passageway.
Monitor the doors to keep visitors from moving around in hallways.
Reassure guests.
Monitor phones for incoming calls related to fire (try to keep line free).
Monitor elevators to prevent people from getting on during drill.
Station at stairwell to decrease personnel movement.
If evacuation is necessary, be prepared to take role of the 4 th
floor personnel.
Close all doors.
Proceed to clinic to assist with patients.
If evacuation is necessary, be prepared to work with clinic staff and escort or carry patients in immediate danger of fire/smoke to a safe place.
If you discover a fire:
R Rescue - Escort or carry patients in immediate danger of fire/smoke to a safe place.
A Alarm - Pull the handle at the nearest red pull station.
Call UPD at 53UPD giving the exact location and nature of fire (mattress).
C Confine – shut off flow meters and close all doors in the fire area as you leave the room.
E Extinguish – get and extinguisher and fight the fire if possible (do not place you in danger).
Extinguisher Usage
P Pull – Pull the pin on the extinguisher.
A Aim – Aim at the base of the fire.
S Squeeze – Squeeze the leaver.
S Sweep – Sweep the foam from side to side.
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Fire Plan – Code Red (Fire) Assignments
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If Instructed to Evacuate Patients/Guests
1. Help as needed to evacuate patients.
2. Use north and/or south stairwells to evacuate patients/guests/staff.
3. Go to back parking lot and check in with one of the Administrative Assistants so there is a proper head count.
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