The need to evacuate an intensive care unit (ICU) or operating theatre complex during a fire or other emergency is a rare event but one potentially fraught with difficulty: not only is there a risk that patients may come to significant harm but also that staff may be injured and unable to work.
The Intensive Care Society and the Association of Anaesthetists have published new 2021 guidelines regarding fire safety and emergency evacuation of ICUs and operating theatres.
These guidelines have been drawn up by a multi-professional group including frontline clinicians, healthcare fire experts, human factors experts, clinical psychologists and representatives from the National Fire Chiefs Council, Health and Safety Executive (HSE), NHS Improvement, Medicines and Healthcare Products Regulatory Authority (MHRA), and representatives from relevant industries.
The guidelines recommend a number of changes to training and preparation, including:
- Clinical staff of all grades should receive multidisciplinary training in their place of work as part of annual mandatory training, covering the management of a fire and evacuation of their work area. Nominated clinical staff should be trained to select and use fire extinguishers.
- Designing new and refurbished ICUs and operating theatres is an opportunity to incorporate mandatory fire safety features. New strategies covered in these guidelines include modern sprinkler systems, emergency low level lighting and oxygen pipelines designed so that the oxygen supply to an ICU area affected by a fire to be cut off without interrupting the oxygen supply to the whole ICU.
- Ventilation of ICUs and clinical areas where high-flow nasal oxygen and non-invasive respiratory support are in use should be good enough to prevent oxygen enrichment of the ambient atmosphere: the recommended minimum ventilation rate of these areas is 10 air changes per hour.
- Laminated fire and emergency evacuation action cards, specific for that clinical area, should be placed next to all manual fire call points so that they can be followed in the event of a fire or if an emergency evacuation is required for another reason..
- Cylinders should be stored, handled and used according to the gas supplier’s instructions, using the correct sequence of actions when administering oxygen and using an oxygen cylinder bed bracket at all times.
- Major incident planning should include plans for internal incidents, where the staff themselves are victims and unable to work and where ICU and theatre suites become unusable for patient care. All staff involved in a fire or similar emergency should be supported following the event and assessed by their occupational health team before restarting work.