EFFECTIVE DATE:04/20/2017 PAGE: 1 OF 18 ISSUED BY:ENVIRONMENT OF CARE APPROVED BY:ENVIRONMENT OF CARE, COMPLIANCE) DESCRIPTION: FIRE RESPONSEE SCOPE: Employees and contractors or any and all personnel providing services at all the hospital and outpatient centers and departments contained therein. DEFINITIONS: DISTRIBUTION: HOSPITAL-WIDE VERSION #:4 REPLACES: POLICY AND PROCEDURE COMMITTEE, JOSE PER A. Fire A fire is any situation where flame, or visible smoke is seen, and/or where a strong smell of smoke is noted. Where any staff member has a strong sense of, or feeling that a fire is occurring, that will be enough to implement this plan. Operation of the Fire Alarm System, either automatically, or by manual initiation is also considered a fire, even where no cause is later found. All fire alarms will be treated as fires, until the cause is found, or no cause can be identified. B. Hospital or Hospital Building 1. The Main Building is a healthcare occupancy, based on the 2000 edition Life Safety Code definitions (NFPA 101, Chapter 19). This building houses and facilitates treatment of in-patients who are unable to seek self-preservation because of treatment, mental or physical condition. 2. The Medical Office Bldg., Research Building, Childcare Center, Energy Center, Foundation Bldg. and Warehouse buildings are businesss occupancies, based on the 2000 edition Life Safety Code definitions (NFPA 101, Chapter 39) where occupants are able to seek self-preservation and patients are not housed overnight. C. R.A.C.E. is the standard acronym for the steps of the HOSPITAL fire response plan. The initials R.A.C.E. stand for: RDOMO (SVP ETHICS & R - Rescue persons from the room or area where the fire is located, and audibly spread the alarm calling "CODE RED". A -Activate the fire alarm system by pulling the fire alarm pull station in the area, and by phoning the Public Safety Control Center (EXT. 4911) and stating the situation and location. C -Close all doors, to rooms, in corridors, and at stairs. This prevents spread of smoke. E - Extinguish small fires, if practical, and without undue risk to life or evacuate horizontally when imminent danger exists.
PAGE:2 of 18 POLICY DESCRIPTION: FIRE RESPONSE D. Relocation (Horizontal Evacuation) This action is to be taken to move patients, if needed, from the immediate scene of the fire, through smoke or fire barriers, to an area of safety, on the same floor. E. Evacuation (Vertical Evacuation) This is the removal of all persons from a building. This is rarely done in hospitals - however, there must be a plan for its implementation. Evacuation would normally be done on the direction of senior management and/or the Fire Department. Evacuation should be considered as an extension of relocation, to move all patients outside of the building, or to alternate buildings. PURPOSE: A plan that is implemented when a fire has been discovered anywhere on hospital property to ensure safety of patients, employees and visitors.this fire plan describes the standard responses for all staff within all buildings on main campus to an activation of the Fire Alarm, or to conditions that indicate the presence of a fire in the area. In the event of a fire, the staff will follow the basic plan. Staff will use the key word "R.A.C.E." when referring to a fire in the hospital and will always relocate horizontally first in fire situation, then vertically if required. Staff in the Warehouse, Research Bldg., Childcare Center, Energy Center and Foundation Building will evacuate to the stairwells and/or outside, as appropriate. Areas of refuge outside should be greater than 330 feet away from the area of concern. Staff will use the same plans for fire drills as they do in actual events. Fire drills will be observed, to measure the effectiveness of staff response, as well as the response of building fire systems. Hospital Relocation and/or Evacuation will be done under the direction of the senior administrative staff member at the scene. The need for relocation or for evacuation will be based on the situation. Once the Fire Department is present, command authority will be relinquished to them. PROCEDURES FOR HOSPITAL AND BUSINESS OCCUPANCY BUILDINGS INCLUDING OUTPATIENT CARE CENTERS: The Fire Response Plan should be implemented: A. Upon activation of the fire alarm system, unless it is an announced as a test B. During a fire or suspected fire C. During a Fire Drill D. During training relating to fire preparedness, if so directed.
PAGE:3 of 18 POLICY DESCRIPTION: FIRE RESPONSE 1. Hospital Fire Response Plan: Staff Response at the Area of the Fire: All available Public Safety (Security) and Facility Operations staff should respond to the area alarmed. 1. General Response to a fire situation, or drill in the Main Building using RACE: R - A - Rescue people from the fire room or area. Remove the people from any room where a fire, smoke, or strong smoke smell exists. Close the door after everyone is out. Don t remove patients from the room of the fire on their beds, (except ICU gurney/beds) as they may jam in the doorway, and permit smoke to escape or enter. If patients are ambulatory - assist them out of the room. If they are non-ambulatory, use a wheel chair, ordinary chair, or blanket drag; or if trained staff is available use the Med Sleds ora lift and carry technique. Sound the alarm. The verbal alarm is "CODE RED". Avoid the use of the word fire, as it may cause unnecessary panic. Pull the nearest fire alarm pull station. This activates the alarm; and indicates the location of the fire automatically. It also activates the audible chime system and visual strobes. ---AND---- Call the Public Safety Control Center (extension 4911). This is a redundant system, to assure occupants are alerted. The Control Center officer will phone the Fire Department with additional information and assure the alarm was received. They will also page "Code RED" three times with the location of fire as additional direction to responding staff. C - E - Close Doors! This is a critical step, to minimize the spread of smoke. In most multiple patient death fires, the deaths have resulted from smoke inhalation. Closing all doors is a critical step to prevent additional deaths or illness. All room (i.e., corridor) doors should be closed, as quickly as practical, even if no smoke is seen. Patients should be returned to their rooms, or into other rooms, with closed doors. This is a primary task of all staff in all areas of the hospital during a fire emergency. Extinguish the fire, if it is reasonably safe to do so. In many cases the fire can be extinguished quickly by a fire extinguisher with little risk. Due to hospital staffing, most hospital fires are found while in the incipient stage. If the fire has grown to proportions that make it unsafe, or staff feels it is unsafe, do not attempt to extinguish the fire, should close the door, and wait for the Fire Department to respond. When defending in place, place wet towels underneath doors. 2. Relocation
PAGE:4 of 18 POLICY DESCRIPTION: FIRE RESPONSE If the fire situation is such that smoke invades other patient rooms, or the Fire Department directs that patients be removed from rooms adjacent to the fire area, patients will be relocated to areas beyond the fire and smoke barriers. The patients should be moved inside rooms in the relocation destination, unless this is impossible, to protect them from smoke. 3. Elevator Use Elevators should not be used in the building where the fire is located unless so directed by the Fire Department. It is acceptable when necessary to use elevators in the adjacent, fire separated buildings (through the fire separations) to move patients to other floors, where they may receive care more effectively. 4. Staff Location and Duties Remain where you are during a fire alarm or fire drill. To protect patients and staff, the fire and smoke doors will close automatically and fire sprinklers should activate. Staff should close doors and not open doors except to relocate patients (on command). Stay where you are - do not move from zone to zone to avoid smoke from spreading. Only a limited number of staff is designated to respond to the scene of the fire, all others should remain where they are unless there is danger. This is important, to reduce the spread of smoke and flame, and to maintain the compartmentation of the buildings. Do not return to your normal duty station if you are away from that area. No area should be without sufficient staff at any time to react to a fire emergency, so staff should not return until after the "All Clear". 5. Medical Gases Shut Off: DO NOT TURN OFF OXYGEN, except when told to do so by OA, Nursing Director or designee, Respiratory Therapy or the Fire Department, and after all oxygen dependent patients have been provided with portable oxygen, or relocated to areas where they can be served. Department plans specify who can shut off oxygen. 6. Observers During each drill, a drill leader from Public Safety will complete the Hospital Fire Drill (Critique) Observer Form. The Public Safety Department is held responsible for the completion of the forms during the drill. This form will be returned to the Public Safety Office and the Safety Officer within a day of the drill. Additional observers from affected units or departments are recommended to fill out a critique form. 2. Business Occupancy Buildings and Outpatient Care Centers Fire Response Plan: Staff Response at Area of Fire The plan is for locations outside the Main Hospital and for Outpatient Care Centers except for MOB which uses the hospital Fire Response section of the Plan. 1. Begin to move all ambulatory patients first along with staff to designated fire exit stairwells. If
PAGE:5 of 18 POLICY DESCRIPTION: FIRE RESPONSE patients are unclothed, or need preparation to move, they should be asked to dress, or prepare. 2. Staff should begin to check all rooms and areas, to assure no patients, visitors, or staff remains behind. Areas should be cleared from the more remote areas towards the fire stairs. Check in closets, and other areas where someone might hide. 3. Patients who cannot move by stair should be: A. (Most Ideal Scenario) Be moved through fire doors to an adjacent building B. Moved to stairwells with adequate space on landings, to hold the patients until fire department responds and after all ambulatory occupants have passed. C. (Used only as a last resort) Be guided at least one floor down from the area of the fire. NOTE: Non-ambulatory patient movement is never attempted during fire drills, and would only be done in a real emergency where the fire was on the floor on which the patient was held, and no alternate method of patient movement was practical. 4. The most trained person on the floor (or other designated person) should check all areas, and close doors, as practical. Suitable methods should be defined on each floor to designate areas that have been checked to assure no patients, visitors or staff is inside. The most trained person will be the last person off of the floor. 5. Staff and patients will be moved down the stairwells, to the outside, or to the interior of the Main Building, as deemed appropriate, depending on the condition of patients, and weather conditions. 6. Staff will gather patients and visitors at outside or designated locations (primary or secondary) so that a head count may be done, to assure that all patients, visitors, and staff are accounted for. A head count, and practical roll call will be done during each evacuation and alarm. 7. During Fire Drills, Public Safety will be responsible for completion of the Fire Drill (Critique) Observer Form, and getting a copy to the Safety Officer. Additional Duties for Business Occupancy Building: Upon hearing the Fire Alarm, or the call of Code Red staff will: 1. Fire captains will check all areas of the space to assure all patients, visitors and staff are gone. As
PAGE:6 of 18 POLICY DESCRIPTION: FIRE RESPONSE appropriate, space will be marked to verify clearance. Leave lights on, doors closed, but not locked. 2. Staff will gather all patients, visitors and staff at a predetermined location to verify that all have moved out of the building. The entrancee to an adjacent building may be an acceptable place to gather, to provide protection to the patients and staff. Areas of refuge should be at least 330 feet in distance from area affected by Fire. Staff Response Away From the Fire Zone: Hospital (Main Building) Staff in other areas of the hospital should take action upon announcement or activation of the fire alarm, and should: 1. Close doors: This is a critical step in all areas, to minimize the spread of smoke. Even if there is no smoke visible or no smoke odor, doors should be closed until the drill or activation is over. This includes all room doors, smoke and fire doors, doors to hazardous areas, and doors to stairwells. As practical, minimize staff using fire and/or smoke separation doors until the activation is cleared. 2. Check Equipment: Check fire extinguishers, pull stations, and other fire response equipment. This assures it is available and clear and helps reinforce the locations of this equipment. 3. Discuss relocation of patients: This might include checking what equipment is available to move patients. If the area with the fire is on the same floor, you should prepare to receive patients being relocated (e. g., identify empty areas in rooms, check what equipment you can use to assist them in moving patients, etc.). 4. Staff knowledge: Assure alll staff know their roles, and what they should be doing during the emergencyby questions and discussion, both in case of a fire in that unit, and in the case of a fire in another unit. Fire Drills in the Hospital (Main Building): In order to assure the safety of staff and patients, and that all staff know their roles, frequent fire drills are done throughout the hospital. In each fire drill, staff is expected to react the sameway as if they would in a fire situation: 1. At the scene of drill initiation, the staff should react asif they would be in a fire, reporting the fire, closing doors, and assuring fire extinguishers are available. They should also know where to relocate patients, and where to get equipment as needed.
PAGE:7 of 18 POLICY DESCRIPTION: FIRE RESPONSE 2. All other areas should also react as though the fire was adjacent to their area. They should close doors, and assure fire extinguishers are available. They should also discuss where they would relocate, and the methods, and routes to take for evacuating if needed. 3. Responding staff will respond to the scene of drill initiation, to assure systems, such as fire doors, dampers, fans, and similar systems are operating appropriately. 4. Public Safety reports on the drill, which evaluate response and knowledge. These reports should be sent to the Safety Officer, and aggregate data for Environment of Care Committee review. Special Staff Roles during Fire Emergencies: Volunteers: Volunteers generally are treated as visitor, and asked to go into rooms, and stay until the All-Clear is announced. Where practical, they go into patient rooms to reassure them, or into offices or other areas. Volunteers in certain areas may be asked to respond as staff does, they are specifically trained about what they should do. Students: Students are generally treated as visitors. Where there are long-term students they can be trained and used as staff. Public Safety: The Public Safety staff will be detailed, at the time of the alarm to report to the scene and bring extinguishers. Facility Operations: Designated facility operations staff will respond to the fire scene, to evaluate needs, control ventilation and smoke evacuation, monitor key utility systems, including the Oxygen system, and as appropriate to assist other staff in their response. The Facility Operations staff will confer with Public Safety and Administration to determine the necessary course of action. This includes relocation, discontinuing piped oxygen, and other actions. The Fire Department Officer on the scene will assume command of the fire scene on arrival, with the advice and recommendations of staff present. Patient Transport:
PAGE:8 of 18 POLICY DESCRIPTION: FIRE RESPONSE Patient transport staff will stand by with gurneys and wheelchairs to relocate patients as needed. If transport is needed, the Public Safety Officer on the scene will contact the Incident Command Center and request transport staff and equipment. Physicians: During fire emergencies (and drills) in the Main Building (Healthcare Occupancy) Physicians are requested to: A. If in a room with a patient, remain in the room pending the conclusion of the drill or fire emergency and continue to treat the patient. Close room doors, if practical, if not other staff will close them. B. If in a patient care area, go to the nursing station where they will be available for response to a medical emergency. C. If in another area (non-patient care area, including the dining room, and medical staff offices) remain in that location, until the all-clear, then return to your activity. Fire Alarm System: All main campus buildings have fire alarm systems to detect fires, (and allow staff to initiate the alarm) and to cause automatic responses throughout the affected buildings, including ringing bells and chimes, activating strobes to alert hearing impaired persons, closing fire and smoke doors, as well as other selected doors. The fire alarm system also transmits a signal to Public Safety One Systems automatically to assure they are aware of the alarm as quickly as possible. Finally, the fire alarm system is used to activate fire drills on each shift throughout all buildings except between 9:00 p.m. and 6:00 a.m. The fire alarm system can be set off automatically or manually. The signal is given automatically by smoke and heat detectors throughout the building, or by activation of the sprinkler system. The alarm can be activated manually by pulling the handle of the fire alarm Pull Stations.If a small fire is detected which has not yet set off an automatic alarm, it will save precious time if a Pull Station is activated. To activate a Pull Station, pull down the lever marked "pull". By doing so, you will automatically activate the alarm system in the hospital as well as the alarm system at the Public Safety One Systems. TheFacility Operations personnel reset the alarm box after an emergency or if someone accidentally or maliciously activates the alarm. It is important that everyone knows the location of fire alarm Pull Stations in his or her work areas. Each box is coded to aid in identification of the location of the fire. The code is marked on the pull station in the area. Pulling a fire alarm pull station, automatic activation of the smoke detectors, heat detectors, or water flowing in a sprinkler system may activate the fire alarm.
PAGE:9 of 18 POLICY DESCRIPTION: FIRE RESPONSE Fire Alarm System Testing: Alarm system testing is done regularly, and is preceded with an audible page system announcement. Fire bells rung for tests do not require response. If a real fire activates the system during testing, the alarm is announced by the audible page system. Fire Evacuation: Hospital Evacuation of a hospital is not anticipated in many cases, as the risks to the patients are very great and healthcare occupancy is designed around a Defend in Place concept. Evacuation should, however be planned as a foreseeable situation, and staff should know the basic plans for its implementation. In a fire situation, evacuation would imply that a fire had broken through several layers of compartmentation, and the building was no longer tenable. 1. Activate the Emergency Operations Plan; alert the Fire Department, EMS, and other receiving hospitals, to receive patients. 2. Move all patients to an adjacent smoke compartment, through horizontal exits, if practical (relocation). Where necessary, move patients into stairwells, and hold until evacuation can take place. Never leave patients unattended. 3. If patients cannot be moved via elevators in adjacent buildings, move them vertically using the fire stairwells. Patients that cannot walk should be transported on ordinary chairs, Med Sleds, or special stretchers. Never move patients in a stairwell on stretchers or gurneys. Where no other method is available, use a two-person carry. 4. Patients should be moved in the same order as for relocation, that is, ambulatory, non-ambulatory, and then surgical or special patients. 5. Where practical and safe, move patient records with the patients as a backup to PEDS. Where patient records are involved in the fire scene, contact the Fire Department Officer in command of the scene to retrieve them, if possible. 6. Because Nicklaus Children s Hospital has electronic records, where records are in the area of the fire, generally they will be only smoke or water damaged, and except in unusual circumstances, no attempt to move then should made, if there is a significant risk of injury to staff.
PAGE:10 of 18 POLICY DESCRIPTION: FIRE RESPONSE General Priorities for Patient Relocation: 1. Ambulatory patients will be moved, one-on-one by staff, and situated into rooms or buildings. 2. Non-ambulatory patients, without attachments will be moved next, on wheelchairs, or gurneys, if practical, and on ordinary chairs, or using blanket drags, Med Sleds, or multi-staff lifts as appropriate. They will be moved to the areas of refuge, and situated into rooms or buildings. 3. Critical patients, and those with monitoring, multiple IV's, active surgical patients, etc., will be moved last, when the maximum numbers of staff are available, and when gurneys, wheelchairs, or similar equipment (Med Sleds ) is most likely to be available. It may be necessary to move them to areas beyond the nearest area of refuge, to assure they have the appropriate medical services warranted by their condition. Fire Response Equipment: The facility is equipped with dry chemical and Halon ABC-type fire extinguishers and water mist extinguishers (near OR and MRI suites). It is important that all personnel familiarize themselves with the proper techniques of operating this equipment and what kind of fire each extinguisher may be used on. 1. Dry Chemical-ABC and Halon-ABC For use on burning wood, paper, cloth, rubber and many plastics, burning liquids for smothering action,or live electrical fires where non-conductive extinguishing agent must be used. 2. MRI Nonferrous - Water Mist Extinguishers (BLUE AND WHITE) Use caution when responding to fire calls in the MRI. Extinguishers and equipment must be nonferrous. Inform responding agencies about the magnets and dangers associated with them All extinguishers are used in basically the same way. P - A - S - S - Point the nozzle, pull the pin, and squeeze the handle Aim the nozzle at the base of the fire Squeeze the trigger Sweep at the base of the flames from side to side Nozzles should be pointed at the base of the fire not on the flames. All personnel should know where the equipment is located in their work area and with the location of
PAGE:11 of 18 POLICY DESCRIPTION: FIRE RESPONSE equipment throughout the hospital. All extinguishers are routinely inspected and recharged per NFPA 10 codes. If your extinguisher was discharged during a fire, contact the Facility Operations Department so the extinguisher can be replaced. General Information: Public Safety, Emergency Preparedness or designee or Operations Administrator (OA) present at the scene will assume charge of the response. When the Fire Department arrives, they will take control of the scene, operating with the advice and recommendations of staff. The person managing the response will: 1. Immediately proceed to the scene of the fire. If a drill, direct the authorized maintenance personnel to silence the alarm bells 2. In an actual emergency situation a. Assure staff have closed doors and patients are protected b. Evaluate cause of the alarm, with the assistance of other responsee staff. If no cause can be determined, or if the cause is not a fire or potential fire, the Fire Department will be notified of the findings by the Public Safety Control Center, or by informing the first Fire Department Officer arriving. c. If the cause of the alarm is a fire, smoke, or other emergency, evaluate the situation, to determine if patient relocation is required. d. Assist and direct, relocation of patients and staff, as needed. If not needed, meet the Fire Department and provide full information. 3. Once the situation is clarified and controlled, contact the Public Safety Control Center. As appropriate, the Public Safety Control Center will issue the "all clear" signal after the Fire Department advises that the emergency is over. Maintenance will reset the alarm system and bring it online. 4. Document the situation on a Fire Drill (Critique) Observers report or Fire Incident Report Form. In some cases, an administrator or available staff person will be assigned to coordinate the activities of hospital staff. This person, as part of the Disaster Plan, will coordinate
PAGE:12 of 18 POLICY DESCRIPTION: FIRE RESPONSE activities of personnel to meet the acute needs of the internal disaster, have physicians and other staff called as needed, inform department heads of emergency and need from their departments, retain outside intervention, and inform Administration of problems. Response Team Members: Public Safety or Facility Operations willl respond to all fire alarms to assess the situation, provide communications, and assist area staff as needed. A. Public Safety: Public Safety officers will respond to the identified scene of the fire (with extinguishers) to provide communications and assistance. Where an alarm can be identified as unfounded or as a system problem, the Public Safety Control Center Officer will communicate that information to the Fire Department. Where there is an identified cause, information will also be communicated to Facility Operations. B. Facility Operations Facility Operations staff will respond to the scene of the fire, to assist and assess the situation. Where no fire situation is found, they will arrange for the silencing of the alarms, upon request of the senior administrative person on the scene. As needed, they will also provide for control of ventilation and other utility systems to control the fire, or mitigate its effects. C. Administration The Administrator on Call (AOC) or Senior Administrative representative will respond to take administrative charge of the situation, and to make decisions about relocation, and other actions as recommended by the Fire Department or hospital staff. Alternative Communications: The fire alarm system is the primary method of alerting staff and others about the existence of a potential fire emergency. In addition, there are other communications systems that may be appropriate and are used: 1. Public address system The Public address system (audible page system) will be used in addition to the fire alarm system to alert staff to the location of the alarm, and will be used to announce the "All Clear" at the end of the situation. 2. Power Failure Stations Direct-connected outside telephones lines have been installed which do not pass throughh the hospital switchboard. If the phone system is not functioning, they may be operational.
PAGE:13 of 18 POLICY DESCRIPTION: FIRE RESPONSE Cellular phones are also available. On off shifts, weekends or holidays, the Public Safety Control Center will notify the OA s and Public Safety Officers on duty. If the fire is not confined or if theree are injuries to patients or personnel, the Safety Officer needs to be notified immediately. Horizontal Evacuation (Relocation) in Main Building: Due to compartmentation, hospital patients are usually safer in their smoke-tight room than they would be if relocated to other areas. In all but unusual situations, the hospital patient room doors will be closed, and the patient not moved. Staff should check in with them periodically to reassure them that they are safe and conditions are under control. In the event relocation is deemed necessary, patients would be moved from their rooms to rooms in fire or smoke compartments horizontally adjacent on the same floor. Patients should be moved using the priorities below, in wheelchairs and gurneys. Patients should not be moved on their beds, except in unusual conditions, and patients who must be moved on beds should be moved last to reduce the potential that a bed may become jammed and block the hallway or doors. Relocated patients should always be taken to a room, so that the compartmentation will continue to protect them. If they require specific services, such as oxygen, or monitoring, they should be relocated to areas where these services can be provided. Relocation will take place in this general order: 1. Ambulatory patients are usually able to move themselves to safety during an emergency. Assisting staff should wrap these patients in blankets and relocate them in a group to safety. 2. Wheelchair patients and limited ambulatory patients can be wheeled away from the emergency area. They may be capable of some limited self-assistance during relocation. These patients should also be wrapped in blankets and moved by a staff member to safety. 3. Bed patients (i. e., non-ambulatory) are those under regular, surgical, or critical care, confined to their beds and generally dependent upon others for evacuation. These patients should not be removed from their rooms in hospital beds. Staff should use gurneys, or wheeled carts for their movement. If carts are not available, and movement is critical, Med Sleds and blankets may be used for drag removals; sheets can be used if blankets are not available. Remove patients headfirst, always protecting the head. Never remove patients on mattresses. Place patients on carts or gurneys as soon as practical. When relocation is ordered by Administration or the Fire Department, all patients in immediate danger should be moved to the adjacent patient area on the same floor beyond fire doors. When leaving the emergency area
PAGE:14 of 18 POLICY DESCRIPTION: FIRE RESPONSE leave all lights on and remember to close all doors to help confine the fire and/or smoke. Evacuation: The unnecessary removal of patients is not desirable and unless imminent danger is apparent, this should be undertaken only upon authorization of the Administration or the Fire Officer in charge of the scene. In the event evacuation is ordered, you may be called to assist with patients regardless of your particular assignment. Patients exposed to immediate danger from smoke, toxic products of combustion, or fire must be relocated to safety first. Evacuation will begin with relocation; and then patients will be moved, first horizontally, from their locations of refuge, as staff and conditions warrant. Evacuation Routes (Stairwells and Elevators) Stairways The stairways closest to fire area are used for staff movement going DOWN. Stairways away from the fire area are to be used for all traffic goingup. Stairways are to be used as fire exit routes as appropriate, but patients will only be moved on stairs if necessary. Elevators Elevators will automatically return to the first floor, and hold. The elevators in the next building area (adjacent fire separated building) not involved in the fire may be used to move patients or staff, under the control of a designated person. Elevators are generally held for Fire Department use until released for patient evacuation and are to be operated by the designated person only. Elevators may be used to evacuate hospital patients with the agreement of the Fire Department. Evacuation Routes and Priorities (Patient Records) Other than PEDS: Evacuation Routes Evacuation routes will be defined at the time of the emergency, based on the location of the emergency and available resources. In general, patients will be moved on elevators in the building not involved in the emergency; however if a general evacuation is needed, all elevators may be used, at the direction of the Fire Department. Patient Records Patient records will be moved with the patients, if at all possible. Patient records should be placed with the patient on the wheelchair or gurney, or given to the patient to hold, if practical.
PAGE:15 of 18 POLICY DESCRIPTION: FIRE RESPONSE Evacuation / Relocation Department Duties Each department has a unit specific fire plan. In most cases this is a brief listing of the fire protection elements, relocation destinations (primary and backup) and other key data. Some department plans have more extensive details of how patients will be handled during a fire emergency, or response to special hazards contained in their areas. These are found in the individual department manuals or on the Portal and to be followed along with this fire plan. Nursing Units The nurse in charge will assume control in an emergency situation. He / she will assure all patient room doors are closed, and check all automatic doors to assure they close fully. If relocation is needed, they will designate someone to take the patients' records with them to assure patient identification and care if patients need to be moved to another area. Move patient's records with the patients if possible. Areas with Patients using Medical Gas Patients on oxygen require some special attention. Low flow oxygen patients may be moved without temporary oxygen tanks if necessary. High flow oxygen patients must have temporary portable oxygen tanks hooked up by respiratory therapy. Oxygen should not be turned off at main oxygen valves in an area until nursing and respiratory agree all patients are accounted for. Other Departments If personnel are outside their work area at the time of fire signal, they should remain where they are. Patient areas should never be below the minimum number of staff persons to respond to a fire situation with RACE. Staff in other areas should not return to their duty area during a fire emergency, as they may allow the spread of smoke or fire by opening smoke or fire doors, and may pass through the fire scene en-route to their normal duty area. All staff should respond to the emergency in the area they are in. All staff is responsible for closing of all doors, as well as responding to the alarm if the code words CODERED is heard. If you are in a patient area during a fire emergency (or drill) close doors, and report to the nursing station, or central area for further instructions. If moving patients - move them into a room, close the door, and wait with the patient for the All Clear. All other departments not specifically mentioned should remain in their work area unless fire is in their working area.
PAGE:16 of 18 POLICY DESCRIPTION: FIRE RESPONSE Equipment to be used for Evacuation If there is a need to relocate or evacuate equipment used for patient movement. (wheelchairs, gurneys, carts, etc.): patients, they are generally moved on the normal transportation Wheelchairs Wheelchairs are used to move ambulatory and minimally ambulatory patients, and some non-ambulatory patients. These are used for regulartransportation, and staff are trained and practiced in their use. Gurneys and Carts Gurneys and Carts are used to move non-ambulatory patients. These are used for regular transportation, and staff are trained and practiced in their use. Special Transportation Equipment (Med Sleds ) Some specialized transport equipment such as Med Sleds ) are available for non-ambulatory patients, and these may be utilized during relocations. Where necessary, staff is trained about the specific practices needed for their use. Improvised Equipment Improvised equipment is only to be used when regular transportation equipment is not available. In general, beds are not used to move patients, but in special circumstances, such as special care units, it may be less hazardous to the patient to move the entire bed. Where this is the case, enough staff must be used to control the equipment, so as not to be jammed or hung-up in doorways and (as necessary) to control the beds on ramps. Blanket drags, and multi-person carries are not expected to be carried out in a relocation of patients from one zone to another. They might be necessary in special circumstances, and wheree these may be needed, staff are trained in the safe use. Building Construction (Healthcare Occupancy) Hospital buildings are different than any other type of building. Due to the fact that patients cannot be expected to save themselves or to evacuate on their own, healthcare occupancies are designed to defend the patient (and staff) in place. Healthcare occupancies are designed in compartments, expanding in size. The five (5) elements that define compartmentation are: 1. Rooms Rooms are designed with intact walls, solid wood doors, and other elements to make the room a "fire-safe lifeboat". The room is designed to protect the patient for a minimum of one hour or more, from smoke or fire. In most situations, the patient, and the staff is safer in the room, than they would be moving away from the fire.
PAGE:17 of 18 POLICY DESCRIPTION: FIRE RESPONSE 2. Smoke Compartments Smoke Compartmentsare defined by the doors, generally near the middle of the unit and the fire doors. This normally breaks the unit or floor up into at least two compartments, with a smoke-tight membrane barrier, so that if necessary, you can move from one side to the other (horizontally) to an area of refuge. 3. Floor Separations Floor Separation assures a fire from one floor won't spread to another. The floor assemblies are generally rated for two hours. Penetrations of the floor are sealed, and protected so the fire, and or smoke won't get to other floors, or areas. 4. Building Separations Building separations are designed so that each building is physically separate where two adjacent buildings meet. These identified by the sets of doors you find along corridors where buildings come together. These provide a completion of the two-hour separation represented by the walls, and other elements. This means that when you move from one building to another, the fire, or smoke would not penetrate for at least two hours. 5. Exit Even though the building is constructed to resist fire and smoke, there must be effectivee exits. There must be two exits from all areas, one that must be a stair or direct exit, and the other may be a horizontal exit to another building or area. These exits must be kept clear and usable, and wide enough to get equipment and even beds through. Compartmentation The Main Building of Nicklaus Children's Hospital is designed to automatically close up into compartments during a fire emergency. These compartments are defined by the fire and smoke separation walls and doors (i. e., the doors that close across corridors during a fire alarm usually held open by magnets). Each floor that has patient housing and most patient care areas contain at least two smoke compartments. Staff should know where the fire / smoke separation walls and door are, that define the compartments in which the work and where they would move patients in case of an emergency. These compartments are an integral part of the multiple level unit-concept described above, and the unit that is least obvious to the staff. Other Buildings The compartments provide an additional level of fire safety in an emergency, as well as an area of refuge to move patients into as a first step in moving out of a fire endangered area without going vertically to the outside. Business occupancy buildings are designed to allow ease of exiting, into stairwells. Enclosed stairwells are separated from the building areas by fire rated walls. Doors on stairwells separate each floor from the stairwell
PAGE:18 of 18 POLICY DESCRIPTION: FIRE RESPONSE and separate floors, to help prevent smoke and fire from moving from floor to floor. Signs that are illuminated, even if power to the building fails, designate exits and paths to exits. Each floor is a separate fire zone, and the structure is designed to keep floors separate, so that fire or smoke will not travel from floor to floor. Openings between floors, such as elevator shafts, stairs, and utility openings are maintained closed, and sealed to keep smoke and fire from spreading.