WHEN SMOKE OR FIRE breaks out in a hospital, every second counts. For a safe, smooth response, you and your colleagues must be familiar with and follow all aspects of the facility's fire emergency procedure.
The senior nurse in a patient-care unit is usually responsible for assuming command and delegating tasks to others during a fire emergency. If that's you, here are your primary responsibilities:
- Give the hospital and fire department prompt and accurate information about the type of fire, its location, and the number of patients, staff, and others in the immediate fire area.
- Remain available to communicate as needed until a more senior person relieves you.
- Stay calm and issue instructions in a clear and orderly manner. This will help others stay calm and follow instructions.
RACEing to control the emergency
When smoke or fire is detected, two mnemonics can help you remember the vital steps to follow. Right away, you need to implement the RACE protocol: rescue, alert, confine, and extinguish and evacuate.
Rescue. Size up the fire scene and determine whether entering the immediate area is safe. If it is, remove everyone from the immediate fire scene.
Alert. Activate the nearest hospital fire alarm pull station. This alerts the fire department and the rest of the hospital and identifies the location of the alarm for the fire department. Also call the hospital's fire emergency extension to report the fire details and exact location by building, unit, and nearest room number.
Confine. When the fire alarm sounds or a fire code is called, close the doors to all rooms and the fire doors at each entrance to the unit to further confine the fire.
As you close doors to patient rooms, count everyone in the unit so you can give the fire department an accurate census. Assess patient safety and provide reassurance as you go.
When oxygen is in use, shut off the wall supply by removing the flowmeter or turn off the zone valves if doing so is safe.
Extinguish. Only after the previous steps are completed should you try to extinguish a fire—and only a small fire, such as a fire in a trash can. Use the appropriate type of fire extinguisher and the PASS method. See PASS the fire extinguisher! for a look at extinguisher types and the proper technique for using an extinguisher.
Evacuate. If you believe the fire isn't contained behind the fire door, initiate an evacuation following your facility's evacuation plan. The type of fire emergency determines which of the following evacuation options is appropriate.
- Lateral, or horizontal, evacuation means securing patients from immediate danger on the same floor, usually on the opposite side of the building.
- Vertical evacuation means moving patients down, typically at least two floors below the fire level.
Details on evacuation
Any evacuation is labor-intensive. Keep in mind that a lateral evacuation is usually easier and should be attempted first, if doing so is safe.
Unless the fire department gives the okay, don't use the elevators. Use all transport equipment at your disposal and all available personnel. Direct staff or visitors to help ambulatory patients. Evacuate patients who can't walk by wheelchair or stretcher. If adequate transport equipment isn't immediately available, you can wheel patients out in their hospital beds.
If no transport equipment is available during a horizontal evacuation or if a vertical evacuation is called, staff can use one of the following methods to drag or carry nonambulatory patients.
- Dragging. Two or more responders on either side of the blanket work in unison, as shown above. Those in front need to maintain a safe elevation to prevent the patient from sliding off.
- Cradle-in-arms carry. Two rescuers help the patient sit up on the side of the bed and stand at each side of the patient. Placing her arms over their shoulders, they clasp their hands behind her back and under her knees and carry her in unison.
- Chair carry. With the patient in a bedside chair, two rescuers on either side simultaneously lift the chair and carry her to safety.
Practice is key
By knowing your facility's fire emergency plan and practicing the key components, you'll be ready to respond safely and with confidence if fire ever breaks out.
PASS the fire extinguisher!
Fires are classified according to the fuels involved:
- Class A: wood, paper, rubber, textiles, or plastics
- Class B: flammable liquids, gases, oils, solvents, paints, or greases
- Class C: live or energized electrical wires or equipment
- Class D: combustible metals such as magnesium, titanium, or potassium
- Class K: a kitchen fire involving combustible cooking oils and fats.
Most hospitals use multipurpose Class ABC extinguishers so you won't have to find a specific type during a fire emergency. If a work area contains any special hazards not covered by a Class ABC extinguisher, the facility should provide the appropriate type and educate the staff on its uses.
Before a fire emergency:
Find out where all the fire extinguishers in your unit are located and how to use them. You need regular education sessions and practice to master their use. You also should know the facility's evacuation plan for your unit. Your first attempt at evacuating patients shouldn't be during a fire emergency. A fire drill lets the staff practice responding.
During a fire emergency
Always keep yourself between the fire and the exit and if the fire gets out of control, leave immediately. If the fire is contained to one area, use the PASS method to put it out with a fire extinguisher:
- Pull the extinguisher's safety pin straight out of the squeeze handle.
- Aim the hose at the base of the fire.
- Squeeze the handle to discharge the material onto the fire.
- Sweep the hose from side to side across the base of the fire until it's fully extinguished.
The Joint Commission. Environment of Care Handbook
, 2nd edition. Joint Commission Resources, 2004.
Schultz CH, et al. Implications of hospital evacuation after the Northridge, California, earthquake. The New England Journal of Medicine
. 348(14):1349–;1355, 2003.
U.S. Department of Labor, Occupational Safety and Health Administration. Evacuation Plans and Procedures eTool.http://www.osha.gov/SLTC/etools/evacuation/portable_relation.html
. Accessed October 26, 2007.