Fire in the patient-care facility : rehearsal for survival. (1970s)

I couldn't lift them by myself. I just wish I had known how to lift them. It happened so fast. It couldn't have been more than a minute and the whole place was in flames. >> When the fire started, they called down here to maintenance for help. But when I'm here by myself, I'm not supposed to leave the boiler room. >> I went to call for help to call in an alarm. But at first, I couldn't find the directory. And by the time I notified maintenance and everyone else and got back to the room, it was all in flames. >> This is a fairly new building, concrete and steel. We thought we were prepared. We never really thought a fire could do much damage. >> Our nursing home is so understaffed normally. We just weren't prepared to handle anything like that. >> We have what we consider an excellent fire emergency plan, but we lost two people in that fire anyway. Healthc care facilities are subject to fires of all kinds in many different areas. Boiler rooms, maintenance shops, kitchens, laboratories, and supply areas. But the fires that potentially are the most tragic are those that occur in patient care areas. And while most hospital and nursing homes have comprehensive fire plans designed to cope with these emergencies, they may fall short of complete success, usually for two simple reasons. First, the plans do not stress the importance of the crucial first few moments after discovery of the fire. And second, then based on the proven fact that the individual most likely to discover a fire involving a patient is not the chief engineer, the security officer or the administrator, but the nurse on the floor and personnel who function in the patient care area. Any effective plan must be designed for implementation by these individuals in the first few moments of the fire. >> [music] >> There is no way to teach personnel exactly how to react since each fire emergency situation is different. But an attempt can be made to show how to make effective decisions when confronted with a patient area fire by presenting some guidelines for handling both fire and patient in the first crucial moments. You will be presented with various fire situations. Then you will be given time to decide what you would do in the given situation. Finally, you will be shown the desirable course of action given the facts presented. Night is an unfortunate time for a fire emergency. Because of reduced staff, the individual may not have immediate backup support and may be forced to rely solely on her own judgment and ability. This nurse has been confronted with a waste basket fire at night in a patient's room. Please turn off the projector and decide what you would do in her place. One choice of action might involve picking up the waste basket to remove it from the patient area into the bathroom or some other safe place. But this is a dangerous choice. The waste can is hot and if it is dropped, the fire will spread and the nurse herself could receive a burn incapacitating her from further usefulness. Moving the waste basket then is not a good plan. A better approach is to use some object in the room to extinguish the fire. A folded blanket is a good choice since it's both safe and effective. Using the blanket as a shield to protect herself from heat. The nurse moves in and covers the waist basket with the blanket, pushing the flames away from her as she does. She does not throw the blanket. Once she has covered the fire, she leaves it covered so it will not start again and proceeds to assist the patient from the room. Using available materials is probably the best approach for dealing with fire emergencies because it takes the least amount of time. Many materials commonly found in the hospital room will do the job. They must, however, cover the fire area and contain the smoke. A blanket or sheet towel, a coat or robe, a pillow or chair cushion, or even the water from the pitcher might be used. Even with small, easily contained fires like the simple waste basket blaze, fire officials should be notified so they can make sure it is out, investigate its cause, and make recommendations concerning the incident. The basic idea in confronting a fire emergency is to improvise and use whatever is available. Bed fires are even more frightening. Stop the projector and decide what you would do if confronted with this situation. This fire involves the patient directly, so the nurse must deal with it instantaneously by grabbing the blanket, using it as a shield, and keeping her eyes on the fire at all times, pushing the fire away from herself and away from the patient's face. If the nurse had simply pulled the blanket up from the foot of the bed, she would have pushed the flames into the patient's face. Once the fire is smothered, the patient can be moved from the room, being careful not to disturb the bed covers. But this is not the end of the nurse's responsibilities in this situation. The nurse should also see that the mattress is removed from the patient's room right after the incident and placed outside for at least 24 hours. Any fire involving a mattress presents a more complex problem. Materials burning in a waste basket or on top of a mattress represent a surface fire. But should the fire penetrate the outer covering of the mattress, the fire is no longer surface and will not be completely extinguished with normal surface methods. It can smolder traveling back and forth along air pockets inside the mattress and sometime later when conditions are right burst into flame. Should a patient be put back in bed with the same mattress after a fire incident, he may become a fire victim again, minutes later or hours later after the incident is forgotten. Unfortunately for those who have to deal with them, fire emergencies are often very complex. They can involve more than one object in a room and they can reach considerable size in a short period of time. Please stop the projector and decide how you would proceed if this were your responsibility. With this fire, attempts to put it out may prove unsuccessful, but they can be made anyway to contain the blaze or to gain time. The patient must then be removed from immediate danger since he might succumb to smoke if the nurse had decided to go for help first. During the removal, the nurse should be sure the door is closed after leaving the room with the patient. Once the patient is safe, the next step is to deal with the fire and the first action is turning in an alarm. Once others are alerted, the nurse can be assured of additional help. When the nurse returns to the fire emergency, she should first feel the door to make sure it is safe to enter the room again. If the door feels hot, she should leave it closed. Place towels at the base of the door and wait for professional help to arrive. For if she were to open it, a blast of intense heat and smoke could be fatal and allow the fire to escape from the room where the door can find it to the corridor and adjacent rooms. But if the door is not warm, the nurse should open it cautiously and enter the room if it appears safe to do so. Extinguishers may be carried or dragged if heavy, whichever saves time. All hospital personnel should be familiar with the operating instructions of the fire extinguishers used in their facility before they are forced to use them. Extinguisher should be directed at the edge of the fire and worked toward the middle. The operator should never turn her back on the fire while using the extinguisher. If she must move, she should back off. Once the fire is controlled, the patients injuries can be attended to more thoroughly. Factors which can complicate a fire emergency are many. They can be physical or medical. Examples of physical factors that can result in a more complex situation include the presence of more than one patient in a room or other physical objects that can hinder the rescue and perhaps drafts from windows. And of course, once the fire has started, another physical factor, smoke with toxic gases will complicate matters by rapidly obscuring vision and affecting the respiration of the patient and the rescuer. Nurses and other professionals are quick to think of the consequences of medical complications in an emergency. Examples include intravenous therapy, oxygen respirators, and other support systems, urinary drainage hookups, traction and restraint devices, and many other kinds of medical equipment involved in the patients medical treatment. The patient himself can be the focus of the problem. He may have undergone recent surgery or for a variety of reasons or conditions, he may be unable to cooperate. While the rescuer, because of her healthc care training, may be reluctant to tamper with medical instrumentation, she must remember that although she should use her professional judgment in this situation, as in any other, in a fire emergency, medical conditions must become secondary to the immediate life-threateners, smoke and fire. What damage is done may be treated comprehensively after the patient is removed from danger. The nurse has a definite and critical role in first aid firefighting in the patient care area. Unless the fire is a small one, her first action is removing the patient from an immediate life-threatening situation. Her second action involves communication. She must turn in the alarm to obtain help. Her third action is firefighting, but she must remember that her job encompasses first aid firefighting only. When it is necessary to transport patients from imminent danger, they need not be carried great distances. 20 ft may be all that is necessary. This stage is generally known as emergency removal. If the fire emergency dictates, the next step is removal to a staging area which entails the transport of patients to a safety zone or holding area perhaps at the end of a corridor. Remove from the fire scene by fire doors where they can be safely grouped under the supervision of another nurse. The final stage, evacuation, the transportation of patients from the staging area to an area outside the building, is always a last resort. The fire plan should include arrangements to take evacuated patients to a place that affords shelter and supervision with quick and decisive action by floor personnel in the first minutes after discovery of the fire. This step may never be necessary. Usually it is the nurse or some other patient care professional, the nurse's aid, the orderly, the housekeeping staff member who by circumstance will be shouldered with the initial responsibility for the fire emergency. And that is why these personnel must understand the nature of the fire emergency and the need for effective decisionmaking and prompt action. [music] >> [music]