VOLUME 30, ISSUE 2

Anesthesiologists provide a safe environment for patients during the perioperative period including emergencies of all kinds. However, despite scheduled fire drills and annual compliance training we felt ill prepared when a fire event occurred on the same floor as our ORs, PACU, and ICU. Standard fire safety training includes very little information specific to the perioperative environment. Although the small fire in our hospital was contained and no injuries resulted, there was considerable smoke and nearly all employees on other floors were evacuated. Patients from our OR and PACU were prepared for evacuation but only 2 were actually sent to an adjacent hospital by a connecting bridge. We would like to share lessons we learned from this experience.

The first priority when the alarm sounds is to obtain accurate, timely, and updated information regarding the location and type of fire, whether it is contained or developing, and what evacuation routes are available. All decisions depend on this information. Significant risks are associated with transporting critically ill, anesthetized, or emerging patients. As long as smoke and fire are contained and escape routes clear, it may be safer to remain in place but ready for evacuation if necessary.

Rapid evacuation is complex for perioperative and critically ill patients. Need for portable monitors, oxygen tanks, and medications quickly develop as the entire healthcare team contemplate the safest evacuation route and destination for each patient. Quick access to a sufficient number of portable monitors and oxygen tanks to cover all operating room and recovering patients should be available.

A clear decision of an evacuation route and destination is necessary based on patient status: anesthetized, emerging from anesthesia, or level of critical care support. It is important to designate a person to keep track of where patients are transferred if they are not all sent to one location. A fully stocked anesthesia cart should be evacuated with the patients such that appropriately sized endotracheal tubes, LMAs and laryngoscopes with blades and other supplies are readily available. Consideration should also be given to the availability of controlled substances and emergency medications during transport and at the evacuation destination.

Careful thought must be given to transport of patients with airway devices still in place. Allowing emergence and extubation may delay evacuation if unexpected complications arise such as airway obstruction, delirium, or uncontrolled pain. If evacuation is needed before wound closure, plans must be developed for hemostasis and for prevention of contamination of the wound; consider large occlusive dressing, ABD, ACE wraps, and antiseptics.

In order to prepare for care of perioperative patients during a fire event it is first necessary to recognize the potential for such an occurrence. Fires of this nature are fortunately rare but this makes it more difficult to respond appropriately.

Remarkably, during this same year a major fire occurred in a central area of an adjacent hospital that resulted in isolation of patients in the labor and delivery, pediatric ICU, and neonatal units from other parts of the hospital. These patients, nurses, and other healthcare providers arrived at our hospital mostly unannounced via a connecting bridge. The first notice for our anesthesiology staff came when we were requested to see a woman in labor who was in our Day Surgery Unit. As more patients and staff arrived we organized to care for these patients. As is the case when a fire occurs within your facility, information was critically important. Initially women in labor went to the Day Surgery ward while pediatric patients were brought to the Recovery Room. One of our operating rooms was set up as a “crash room” in case anyone required resuscitation. Patients were quickly triaged to determine if any of them required support or monitoring. It was recognized that some had potentially communicable illness and others were potentially vulnerable to infection. Those with the communicable illness were moved to an isolation room. Supplemental oxygen and monitors were provided for those in need. We continuously circulated among the patients to assure that relevant histories were complete, appropriate monitoring and support was provided, and that the patients’ physiological status had not deteriorated. Obtaining complete medical information was made more difficult as the two hospitals did not have compatible Electronic Medical Records. EMS personnel soon arrived to transport the patients back to areas of their hospital unaffected by the fire. Appropriate medical personnel were notified of the possible exposure of vulnerable patients and in follow-up it was learned that none of the exposed patients became ill.

The bridge connecting our hospital to another hospital provided this ready evacuation route. For most hospitals a more likely scenario would be for patients to be moved from one ward to another within the same hospital. We are provided with training for moving patients away from danger but not much information is made available regarding how to deal with patients moved to our area. Our experience identifies some of the issues that must quickly be considered when patients are evacuated into your area. All hospital environments are unique and will need different plans. Forethought and availability of equipment makes the necessary decisions easier if the need arises.

Please, send comments to: lwoodson@utmb.edu