* Please fill out the highlighted areas as applicable for your individual unit or area. Please be sure to thoroughly read the plan as it has been substantially updated. Upon completion, please save a copy for yourself and submit an electronic copy to Melissa Vink with UCDHS Fire Prevention at melissa.vink@ucdmc.ucdavis.edu for review.
Once reviewed, the Fire Prevention Department will send the final version back to you and maintain a copy in our files.

HOSPITAL (Patient Care) UNIT / AREA NAME: ________________
This Fire and Relocation / Evacuation Plan is to be used by staff* to protect visitors and themselves from fire or other emergencies requiring evacuation from the building. In conjunction with the fire evacuation signs posted throughout the building, this plan satisfies the requirements of Section 3.09 of the California State Fire Marshal’s
Regulations and meets the requirements of The Joint Commission.
* Staff includes all UC Davis Health System employees, faculty, licensed independent practitioners, contract workers, etc.
Report all fires , even if fire is immediately contained.
Dial 911 from a landline or 734-2555 from a cellular phone .
This section is filled in by UCDHS Fire Prevention Department
Fire Component Yes No
Area is constructed of non-combustible structural materials, principally concrete and steel.
Corridor doors should be in the closed position during a fire emergency.
Automatic Fire Sprinklers are installed in area.
Fully sprinklered
Partially sprinklered; Define areas with sprinklers:
______________________________________________________
Smoke Detectors are installed in the area.
Manually activated red fire alarm pull stations are located in the exit routes of this area.
Audible fire signal installed in building.
Type = (fill in) ______________________ e.g. Chime, automatic voice message
Visual fire signal (e.g. strobe lights) installed in area.
Fire Extinguishers in area.
A / B / C Type (for use on most fires)
Other (fill in) __________; for use on (fill in)__________________
X
X
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HOSPITAL (Patient Care) UNIT / AREA NAME: ________________
Familiarization
Become familiar with the floor plan for the area and know the locations of:

Manual Pull Stations (MPS), fire extinguishers, and telephones

Exit routes and exit doors.

Adjacent smoke compartments.
TRAINING
The Fire and Relocation/Evacuation Plan consists of two essential elements, both of which must be present for it to succeed:
1. Written guidelines & posted information - The plan contains general information applicable to the entire building, as well as specific guidelines and floor plans for each clinic within the building. Fire evacuation signs located in each building and near the exit stairwells are designed to complement the plan.
2. Employee training - Your training is essential to the success of this plan.
Without training the fire plan will not work for you or your associates, so take time to learn and practice the procedures on a regular basis.
GENERAL FIRE PROCEDURE
If a fire occurs, you should follow the R.A.C.E
. procedure:
R - RESCUE
A - ALARM
C - CONFINE
E - EXTINGUISH
Rescue

Rescue anyone (this includes yourself) who is in immediate danger from the fire. Remove these people to the closest safe area, simultaneously notifying other staff of the fire and its location. Know where alternate exits are located .
Alarm

If you are the first person to discover a fire, communicate your discovery to other staff in the area, activate the closest fire alarm activating device; call 9-1-
1 from the nearest safe location. If you are involved in rescue, send someone to call 9-1-1.
Page 3 of 14

HOSPITAL (Patient Care) UNIT / AREA NAME: ________________
Confine

Confine the fire by closing all of the doors in and around the fire area. This will help keep fire and smoke from contaminating the exit paths during evacuation.
It also helps to keep the fire to a much smaller area and aids in preventing it from spreading to other areas.
Extinguish

There is no better time to control and extinguish a fire than in its early stage.
Utilize fire extinguishers, acronym P.A.S.S.
, if you discover a fire in its earliest stage. If a fire is well developed, however, the best thing to do is close the doors around it and get out. Do not place yourself at unnecessary risk –your greatest value is as a rescuer, not as a firefighter.
P-PULL
A-AIM
Stand back from the fire and pull the pin.
Aim the nozzle at the base of the flame
S-SQUEEZE Squeeze the handle
S-SWEEP Sweep the nozzle from side to side at the base of the flames until the fire is completely extinguished.
The Sacramento Fire Department is responsible for extinguishing fires at the
Medical Center . You should never hesitate to call 9-1-1 . Remember that a fire, even a small fire, presents an extreme risk to patients and staff, so don’t hesitate
– act immediately!
As a Reminder:

All fires will require an investigation as to the cause.

A report must be taken by UCDHS Fire Prevention Department investigator after each event.

Wait for an ALL CLEAR from UCDHS Fire Prevention or the Sacramento Fire
Department before re-occupying a building/area after a fire.
Page 4 of 14

HOSPITAL (Patient Care) UNIT / AREA NAME: ________________
To be filled in by Unit or Area Manager in consultation with UCDHS Fire Prevention
BUILDING ASSEMBLY AREA
Primary Relocation Site*:
Alternate Relocation Site:
Evacuation Staging Area  Pavilion Lobby or Tower Lobby

ED (for ICUs only)
* Relocation Site = Adjacent or other smoke compartment(s) identified for relocation with adequate resources and utilities to manage patients.
Movement will begin with relocation of patients most affected by the emergency in the following order:
1. Patients in immediate danger
2. Ambulatory patients
3. Non-ambulatory patients
Relocation/Evacuation Movement Priority:
1. Horizontal from the danger area to a safe area on the same level.
2. Vertical to a lower (or higher) floor, as necessary
3. To the Staging Area(s) on first floor (Tower Lobby, Pavilion Lobby, or
Emergency Department) to prepare for evacuation to another facility; only upon direction from Incident Commander.
If you are the first person to discover a fire or other emergency necessitating a building evacuation, call 911 (from a landline) or 916-734-2555 (from a cellular phone). Communicate your discovery to other staff in the area and activate the closest fire alarm device. For response to criminal activities, refer to 1.a. below. If you are involved in rescue, send someone to call 9-1-1 . a. For criminal activities, such as a bomb threat, active shooter, or hostage situation, call 911 from a land line. Unless directed by emergency responders (fire or police), do not activate the fire alarm system. i. For a bomb threat, turn off all two-way communication devices, such as two-way radios, cell phones, and Vocera.
Code Green, Internal must be initiated for any incident that triggers the relocation or evacuation of patients.
All Staff (including nurses and physicians) will take personal belongings, such as purse or wallet, car keys, and cell phone, if items are immediately available .
Page 5 of 14

HOSPITAL (Patient Care) UNIT / AREA NAME: ________________
RELOCATION / EVACUATION PROCEDURE (for any unit/area with direct patient care)
1. Direct family and visitors to the nearest exit as they are to evacuate to the outside of the building.
2. If relocation is necessary, move patients and staff horizontally into adjacent smoke compartments and close the smoke barrier doors to provide separation from the emergency. Generally, in most emergency situations, patients are held in the relocation site(s) until conditions stabilize.
3. Group patients according to ambulatory status. Assign personnel to move specific groups. Patients will be relocated to the Relocation Site in the following order - unless otherwise notified by the Incident Commander or the Sacramento City Fire Department.
3.1 Patients in immediate danger
3.2 Ambulatory patients (moved in small groups by staff).
3.3 Non-ambulatory patients who do not require life support equipment
3.4 Non-ambulatory patients who require life support equipment.
3.4.1 It may be necessary to move these patients to areas beyond the nearest area of refuge to assure they have the appropriate medical services warranted by their condition.
4. Nursing staff and physicians will quickly assess the patient needs before relocating / evacuating, items to consider include, but are not limited to:
4.1 Coordinate with Respiratory Therapy to transfer oxygen and/or ventilator dependent patients to portable oxygen units. Bag patients as needed on portable oxygen.
4.2 Turn off oxygen, air, suction, and flow meters at the wall.
4.3 Disconnect/discontinue non-essential equipment from patient
(monitors).
4.4 If patient on dialysis, disconnect, clamp and tape dialysis lines with assistance from Dialysis Nurse
4.5 Send infusion pumps and/or feeding pumps with the patients, if possible.
4.6 Place belongings in the clothing bag with the patient's name and medical record number. Place all Patient's medications (including IVs and IV medications), prosthetics and special patient need items in a labeled bag inside the clothing bag.
Page 6 of 14

HOSPITAL (Patient Care) UNIT / AREA NAME: ________________
5. If the entire unit is to be vacated,
5.1 Shut off oxygen zone valves.
5.2 Take the crash cart and portable defibrillator with the patients to the safe area, if safe to do so.
5.2 Shut off oxygen zone valves.
6. Pediatric / Infant / Intensive Care Nurseries will move infants/toddlers/children by carrying them or by using isolettes, warmers, bassinets, cribs, blankets, or staff may use the kangaroo aprons, such as
“Safe Babies Apron”, where available.
7. Non-ambulatory patients will be moved using beds, stretchers, wheelchairs or litters.
8. VERTICAL: When vertical relocation is required, patients must be moved to different floors or to the first floor. Vertical relocation must be accomplished in the following order:
8.1. Elevators - Elevators may be used. If smoke is detected in any elevator lobby on any floor, the elevators will automatically proceed to the first floor and will remain out of service with the doors open until overridden by the Sacramento Fire Department or UCDHS Fire
Prevention. Elevators that serve the fire area are generally held for
Fire Department use. The elevators in other building wings, however, are separated by smoke compartment walls and should be used under the direction of the AOD, Nursing Supervisor, or other emergency response personnel.
8.2 Ramps may be used for vertical relocation. The ramps are accessed from the North-South wing.
8.3. Stairwells - if patients cannot be moved horizontally to locations where there is an operational or safe elevator, move them vertically using the exit stairwells. Transport non-ambulatory/critical patients using vertical evacuation equipment (i.e., ParaSlyde or evacuation chairs are available on Davis 10, 11, 12, and 14). In an emergency, it may be necessary to improvise with available equipment. Where no other method is available, use a two-person or three-person carry.
8.4 If an individual cannot be moved vertically using the stairwells, they are safest left in their room with the door closed. Immediately report the name and location (floor and room number) of the person to the fire department/ emergency responder.
8.5 <<Delete 8.5 and 8.6 text if not applicable to unit>> Patients in
Davis Tower floors 10 to 14 cannot be relocated horizontally to the
University Tower or East Wing; if the entire floor must be vacated, patients must be moved vertically to a lower floor.
Page 7 of 14

HOSPITAL (Patient Care) UNIT / AREA NAME: ________________
8.6 Assign personnel to relocate specific groups. Patients will be relocated to the pre-identified Relocation Site(s) unless otherwise notified by the Incident Commander.
8.6.1 Davis Tower 10 (PICU) evacuate to (identify possible areas in Pavilion (ie PACU), or University Tower /
East Wing on floors 6, 7, 8)
8.6.2 Davis Tower 11 evacuate to (identify possible areas in University Tower or East Wing on floors 6, 7, 8)
8.6.3 Davis Tower 12 evacuate to (identify possible areas in University Tower or East Wing on floors 6, 7, 8)
8.6.4 Davis Tower 14 evacuate to (identify possible areas University Tower or East Wing on floors 6, 7, 8)
8.7 Non-ambulatory patients will be evacuated using ParaSlydes,
Stryker Chairs, beds, wheelchairs or litters.
8.7.1 Evacuation equipment, including ParaSlydes, is located in
Room 14776 on Davis 14, Room 12776 on Davis 12, Room
11776 on Davis 11, and Room TBD on Davis 10.
9
8.7.2 Instructions for use of ParaSlydes are located in outer pocket of storage bags.
To prevent duplication of efforts during the evacuation, staff should apply tape across the door and door jam to indicate that the room has been evacuated.
10. Once patients are taken to the Relocation Site(s), the Incident Commander will coordinate the placement of patients into new areas with the assistance of Administration and Bed Control, as needed.
11 When Incident Commander, UCDHS Fire Prevention, or the Sacramento
City Fire Department declares the evacuated area to be safe and free from any hazards, the Incident Commander will coordinate re-occupancy of the unit(s).
12. If patients need to be evacuated to other facilities, the Memorandum of
Understanding for Patient Transfers will be implemented. Patient transfers to other facilities will be coordinated by the Incident Commander.
13 For evacuation of an entire wing or the whole facility, complete Attachment
2 to provide transportation requirements for patients in the unit to the
Hospital Command Center and move patients to the Staging Area. a. Ambulatory patients should be moved to the Tower Lobby or Pavilion
Lobby (as directed by the Incident Commander) for transport by bus, van or other multiple-passenger vehicle b. Non-ambulatory/critical patients should be moved to areas near the
Emergency Department (ED) entrance for transport via ambulance
Page 8 of 14

HOSPITAL (Patient Care) UNIT / AREA NAME: ________________ c.
Print the patient’s medical records to send with them. At a minimum, the
“Snap Shot” and “Demographics” information in EMR will be printed plus other information, as needed. If EMR is not available, the pertinent information will be written on the Transfer Record. d.
Fill in HICS Form 260 “Patient Evacuation Tracking Form and make copy. Send one copy with patient and keep one copy for records.
Page 9 of 14

HOSPITAL (Patient Care) UNIT / AREA NAME: ________________
Area-Specific Instructions: Copy or Delete this section, as applicable.
OPERATING ROOM AND POST ANESTHESIA CARE UNIT
Refer to (or copy) information in P&P 1637 -- or --- Copy and paste applicable text into Relocation/Evacuation Procedure #4.
1. Nursing staff and physicians will quickly assess the patient needs before evacuating:
2.1 Move only those patients in immediate danger.
2.2 Obtain portable oxygen tanks for each room.
2.3 Surgeons need to effect hemostasis and cover open wounds appropriately
2.4 Transfer patient to gurney.
2.5 Transport portable equipment with patient as needed
2.6 Turn off oxygen zone valves.
EMERGENCY DEPARTMENT:
Copy and paste applicable text into Relocation/Evacuation Procedure #4.
1. If the Emergency Department must relocate or evacuate patients in the ED: a. Determine status of patients receiving treatment in the ED;
2. b. Triage patients to determine suitability for discharge, relocation to another location within the hospital, evacuation and/or transfer to on-site clinics for interim care, or evacuation and transfer to another hospital. Use attachment 2 to document patient type and transport needed for those patients identified for transfer. c. Discharge as many patients as possible. d. Based on the level of relocation/evacuation required, either prepare the patient for transfer to another facility or move the patient to a holding area in the ED to await in-house admission. e. Assign all available staff to the relocation site to care for patients and/or prepare patients for transfer to other facilities. f. Document actions and decisions on a continual basis.
For evacuation of an entire wing or the whole facility, the Emergency Department will receive non-ambulatory/critical patients from the hospital units to prepare for transfer to another facility via ambulance.
Page 10 of 14

HOSPITAL (Patient Care) UNIT / AREA NAME: ________________
++++++++
Additional Resources that may be requested for the relocation/evacuation of patients, including:

Lift Team to assist with evacuating patients

Patient Transport to assist in evacuating patients

Other medical services (physicians and nursing) to assist in maintaining emergency patient care

Respiratory Therapy Staff to assist with oxygen needs

Pharmacy (medications)

Clinical Engineering Staff to assist in obtaining additional equipment (such as portable suction machines, IV Poles, Defibrillator, Cardiac Monitors, etc).

Linen (blankets)

Central Processing or Distribution (supplies)

Code Blue Team (if needed)

Trauma Team (if needed)

PO&M (special utility needs such as medical gas).

Blood Bank.
Page 11 of 14

HOSPITAL (Patient Care) UNIT / AREA NAME: ________________
COMMUNICATION PLAN
Hospital CONTACT LIST
To be filled in by Unit/Area Manager
Nursing Supervisor
Name
Pager Number
Patient Care Resources
Name
Phone Number
Name
Phone Number
Nursing Supervisor
916-762-5364
Bed Control and Staffing Office (24/7)
734-7083
E-mail Address
Relocation Site CONTACTS - if applicable
Relocation Site
Contact Name
Phone Number
Cell Phone
E-mail Address
Relocation Site
Contact Name
Phone Number
Cell Phone
E-mail Address
Relocation Site
Contact Name
Phone Number
Cell Phone
E-mail Address
Relocation Site
Contact Name
Phone Number
Cell Phone
E-mail Address
Page 12 of 14

HOSPITAL (Patient Care) UNIT / AREA NAME: ________________
UNIT / AREA CONTACTS
DEPARTMENT CONTACT LIST
To be filled in by Unit/Area Manager
Unit Name
Name
Phone Number
Cell Phone
E-mail Address
Unit Name
Name
Phone Number
Cell Phone
E-mail Address
Unit Name
Name
Phone Number
Cell Phone
E-mail Address
Unit Name
Name
Phone Number
Cell Phone
E-mail Address
Unit Name
Name
Phone Number
Cell Phone
E-mail Address
Page 13 of 14

HOSPITAL (Patient Care) UNIT / AREA NAME: ________________
SACRAMENTO CAMPUS EMERGENCY CONTACT INFORMATION
UC DAVIS FIRE PREVENTION
Phone Number – Front Desk (916) 734-3036
UC DAVIS POLICE DEPARTMENT
Phone Number – Landline
Phone Number – Cellular Phone
911
(916) 734-2555
MEDICAL CENTER SAFETY (EH&S) CONTACT:
Name Bob Lawson
Phone Number (916) 734-2740 or (916)-734-3355
E-mail Address robert.lawson@ucdmc.ucdavis.edu
MEDICAL CENTER EMERGENCY PREPAREDNESS CONTACT:
Name
Phone Number
E-mail Address
Glynis Foulk
916-734-8261 glynis.foulk@ucdmc.ucdavis.edu
UCDMC UC DAVIS PARKING & TRANSPORT
Phone Number (916) 734-8117
Pager Number (916) 762-1230
UCDMC IT/TELECOMMUNICATION
Phone Number
Hospital Operator
(916) 734-8700
(916) 734-7020
UCDMC PATIENT ESCORT
Phone Number (916) 703-4315
**************** Delete for Buildings with no Academic or Research Staff **************
SAC RESEARCH & ACADEMICS SAFETY (EH&S) & EP CONTACT:
Name UC Davis Campus Safety Services
Phone Number 530-752-1493
SOM LABORATORY SAFETY OFFICER (DAVIS):
Name Diane Hoffmann
Phone Number (530) 304-0006 cell
E-mail Address dehoffmann@ucdavis.edu
Page 14 of 14