Which action would the nurse take when evacuating patients during a fire in the health care facility?

Guidelines for evacuation procedures to be followed in case of an internal disasters to protect patients, staff and/or visitors.

Policy:

The purpose of this policy is to outline guidelines for evacuation procedures to be followed in case of an internal disaster where patients, staff and/or visitors would have to be evacuated as a result of a disaster, which threatens the well being of building occupants.

Procedure:

Evacuation maps are positioned in the halls at critical points.  Evacuation routes are indicated on the evacuation map.   Patients threatened by smoke, heat, flame or other immediate danger will be removed to a safe location at the direction of the highest-ranking official at the scene. Staff will follow the RACE procedure: Rescue, Alarm, Contain and Evacuate. It is unusual to evacuate an entire medical center. Most times a side to side horizontal evacuation is sufficient to meet patient care needs. Only under the order of the City of Long Beach Fire Department or Hospital administration would an entire medical center evacuation occur.

I. Responsibilities

A. The Administrator-on-Call or the Incident Commander if responsible for:

1. Initiating the Evacuation Plan in collaboration with Long Beach Fire Department, Long Beach Police Department, Facilities Management Director, Security Manager or Nursing Supervisor.
2. Identifying safe locations to direct evacuees.
3. Initiating the "All Clear" once the emergency is over.
4. Arrange transport or transfer of patients to an area of safety or alternative care site designated by the Incident Commander and Inpatient Unit Leader (HICS Job Action Sheets)

   B. Employees are responsible for:          

1.  Assisting in the evacuation as directed by the Administrator-on-Call, Incident Commander or CNE.
2. Conducting themselves in a safe and rational manner during evacuation proceedings.

II. Decision to Evacuate

The decision to evacuate an area of the hospital (horizontal evacuation) or the entire hospital (vertical evacuation) will be made by one of the following in collaboration with the others listed below:

• Long Beach Fire Department (in the case of unsafe building structure due to fire or after earthquake if Facilities Director deems hospital unsafe for inhabitation)
• Administrator-On-Call or Incident Commander
• Nursing Supervisor
• Facilities or Security Director
• Department Manager or Supervisor of affected area
• Long Beach Police Department
• Both Long Beach Fire Department with Long Beach Police Department in the situation of hostage crisis, bomb threat or civil unrest

III. General Procedures

• Patients in immediate danger should be moved first.
• They should follow a lead nurse into a safe area.
• Move patients who are closest to danger first (non-ambulatory and ambulatory).
• Direct ambulatory patients toward a safe area.
• Have wheelchair or walker dependent patients escorted to a safe area.
• Move stretcher or completely non ambulatory patients with Paraslyde, Ferno Evacuation chairs, mattresses or blankets.

A. Horizontal Evacuation

For in-patient areas, which require limited evacuation, the following shall be included:

1. Follow evacuation maps, if appropriate.
2. Obtain evacuation devices from the DRC cache in the Parking Garage- Sleds and Ferno Evacuation Chairs can be used for evacuation of the medical center. Bariatric sized equipment should be considered in the evacuation of bariatric patients.
3. Move ambulatory patients, visitors and unneeded staff horizontally (on the same floor) to an area of refuge beyond a set of fire doors and close the doors upon completion.
4. Move patients in order of most easily relocated or most ambulatory to most critically ill. Critically ill patients should be moved by House Staff and Nursing in conjunction with the Long Beach Fire Department, if feasible.
5. Use wheelchairs to move these patients. Wrap patient in blanket before placing patient in wheelchair.  After getting them to a safe area, patients should be removed from the wheelchairs, if possible, and made comfortable.  The wheelchairs should then be taken back for other patients.

   a. Check with your supervisor to see if specialized evacuation equipment is available for your area (e.g. aprons to transport babies, Weevac evacuation sled in NICU, evacuation chairs). You need to know the location and proper method for using such equipment in an evacuation. Remember, two people to carry a person down the stairs may use chairs.

   b. Neonatal Intensive Care Unit has specific evacuation equipment appropriate for the population (baby Weevac sled and kangaroo pouches)

6. An assigned person should check each room of the evacuation area to assure all persons have left the area.
7. Track numbers of patients who have been evacuated and keep track of each unit – House Supervisor will be asking for numbers of patients evacuated from each unit

B. Vertical Evacuation

1. Vertical evacuation shall be used if horizontal evacuation is not an option. The priority for evacuating patients shall be the same as described in horizontal evacuation.
2. Evacuation shall be to a lower floor except at street level or lower in which case evacuation should be out of the building.
3. Wheelchair cases are to be evacuated to the elevators, providing smoke and fire conditions permit, and the use of the elevators is authorized by the Fire Department Official on the scene. Elevators may not be used for evacuations unless advised by the Long Beach Fire Department prior to using.
4. Check with your supervisor to see if specialized evacuation equipment is available for your area (e.g. aprons to transport babies, evacuation chairs). You need to know the location and proper method for using such equipment in an evacuation. Remember, two people to carry a person down the stairs may use chairs.
5. Use stretchers if available; if not, place patient in blanket on floor, roll in top corners of blanket and pull the patient head foremost to a safe area on the same floor or if vertical evacuation is indicated, use an authorized elevator.  In the event elevators are not to be used, patients are to be evacuated down the nearest stairway by means of evacuation sleds and chairs.

III. Education & Training

New hire staff receive emergency preparedness training at hospital orientation. All staff receives emergency preparedness training annually with the self-learning manuals. During department orientation and training, staff learns about their department's role in emergency preparedness, emergency response plan and department specific evacuation plans. Evacuation and fire route training occurs every year at St. Mary Medical Center for staff familiarity of fire doors, exits, meeting places and stairwells.

1. If you discover a fire or smoke, follow R.A.C.E. Procedures.
2. The Security Officer stationed in the Security Command Center will immediately notify the Philadelphia Fire Department (PFD) by dialing 9-9-1-1 when an alarm is transmitted.
3. WHEN THE FIRE ALARM SOUNDS, follow R.A.C.E. Procedures. and listen to the fire alarm announcements
4. DO NOT USE THE ELEVATORS.  see note on special procedures
5. Feel the door leading from your office to the corridor before opening it.  If it is hot or smoke is seeping in, do not open the door.  If you become trapped in your office and cannot reach the fire exit, keep the door closed and seal off any cracks. Use the telephone in your office to call the PFD by dialing 9-9-1-1, or security at 811, and give the name and address of the building, as well as your floor and the office number.
6. If the door feels cool, open cautiously.  Be braced to slam it shut of you feel heat pressure against the door.  If the corridor is clear, proceed with the building evacuation instructions.
7. PHYSICALLY CHALLENGED:  A responsible person or persons who work in the same area as the disabled should be assigned to assist in the event of fire.  The disabled are to be taken to the fire exit and remain on the landing until assisted by the PFD.
8. If caught in smoke or heat, stay low where the air is better.  Take short breaths through your nose until you reach an area of refuge.

IMPORTANT:

Be sure the fire exit doors are kept closed at all times so smoke cannot enter the stairway.

 

These exits are not to be used for any type of storage.  They must remain clear and well lighted at all times.  If at anytime, you observe fire exit doors being tied or propped open, please report it to the Department of Environmental Health & Safety.

Evacuation: Hospital Buildings

In buildings where immediate building evacuation is not required, patient, visitor, employee, and staff evacuation shall be initiated only when a danger due to fire or smoke has been identified or code red confirmed has been announced in their area.

If evacuation is required, it shall be conducted per the following guidelines:

• Horizontal Evacuation - Horizontal evacuation is preferred over vertical evacuation.  Patients will be moved to an adjacent safe smoke compartment on the same floor, away from the Fire Scene.
• Vertical Evacuation - Only if necessary and as directed, patients will be moved to another floor - typically a floor below the Fire Scene.  If evacuation to a lower floor becomes necessary, use of the elevators will be coordinated with the PFD based on the location of the fire and the amount of smoke in the area of the elevators.
• Complete Patient Evacuation - Should the emergency condition be of a severity such that the building is endangered, and cannot continue to be occupied, a complete evacuation shall be initiated.  Directions given to evacuate the building by the PFD Incident Commander shall be carried out in an orderly fashion to ensure that the patient care is not compromised due to the evacuation. Patient receiving locations shall be coordinated with the Hospital Incident Command structure.

General Patient Evacuation Guidelines

• Patients are to be evacuated horizontally by stretcher, wheelchair, or other method of transportation to an adjacent smoke compartment.  Patients in immediate danger (due to smoke or fire) shall be removed first.
• Ambulatory patients should be accompanied or directed to an adjacent smoke compartment. 
• Non-Ambulatory patients should be moved using wheelchairs or stretchers when available to an adjacent smoke compartment.  
• Critical patients, who will require the most resources to move, can be kept in their closed patient room until they can be safely moved. These patients may be the last to be evacuated, if they are not being directly affected by fire or smoke.
• Patient evacuations shall be coordinated with nursing to ensure patient needs are met at the location to which they are being relocated.