Evacuation plans for OR fires often overlooked
Risk managers recognize that fire is a serious risk in the operating room and require appropriate prevention efforts and response plans. But some experts are warning that you might be overlooking an important element of that fire safety plan: how to get your staff, physicians, and patients out of danger when the fire is out of control.
Evacuation usually is included as part of a risk management plan for surgical fires, but that aspect often receives less attention than prevention strategies and techniques for extinguishing the fire, says Paula Graling, RN, MSN, CNOR, CNS, president of the Association of perioOperative Registered Nurses in Denver. Graling also is the clinical nurse specialist of perioperative services at Inova Fairfax Hospital in Falls Church, VA.
"We often see that they don't practice the evacuation plan as much as they should," she says. "If they practice it, many just go through the motions. You may find that if you really practice it, the experience can be enlightening."
Graling's surgical team had an enlightening moment recently during a fire drill when the scenario was an out-of-control fire that necessitated evacuating the patient. When the staff tried to move the bed out of the "burning" operating room, the bed would not unlock and was totally immobile. The team spent an extra 13 seconds trying to unlock the bed — a long time in a real fire — and then decided to improvise a stretcher from sheets, using six people to move the patient.
Afterward the team figured out why the bed would not unlock and agreed that in a real fire, they would quickly move to the secondary plan of a makeshift stretcher instead of delaying.
"If you're holding mock drills and not doing the evacuation, you're missing the opportunity to learn a great deal," she says. "You have to actually, physically go through the motions instead of just saying it's only a drill and talking through the plan. Saying, 'Now we would move the patient out of the room' is not the same as actually doing that and learning what can really happen."
The same lesson applies to other parts of your fire plan, Graling says. If you go through the actual plan, you may find out that the drapes don't pull down as you thought they would, the water for extinguishing the fire creates a fall hazard, or hospital remodeling has blocked the route where you planned to take patients during a fire.
Inova Fairfax conducts fire drills in the surgical department quarterly. They are held different times of the day when there are brief openings in the schedule. They require full participation and walking through the entire scenario including evacuation. Graling suggests that risk managers verify that staff and physicians know evacuation routes and that they are posted clearly. AORN will provide a fire safety tool kit to all its members in October that will include a template for creating evacuation maps, and Graling recommends working with your surgical managers to make sure the tool is put to good use.
"There should be an evacuation map on the back of every OR door, just like you see when you check into a hotel room," Graling says.
Create own maps and videos
You can create your own educational materials regarding OR evacuation, suggests Richard E. Gilder, RN, BSN, CNOR, BCNI, now a perioperative consultant and owner of The Gilder Co., a perioperative consulting firm in Dallas. When he was a clinical nurse with Presbyterian Hospital of Dallas, he became concerned that the OR teams did not seem aware of fire evacuation plans. He took it upon himself to educate them.
The hospital had regular fire drills, but Gilder concluded that they were not frequent enough to keep up with the turnover in staff. He also found that, as in most hospitals, there were very few "You are here" style maps showing the fire evacuation routes. The problem was compounded by the layout of the surgical department, with 24 suites, which required several evacuation routes depending on which room you were in at the time of the emergency.
The hospital had a written policy that outlined all of the different evacuation routes, and a few cryptic diagrams posted that Gilder says were not helpful in determining where you were or how to get out. The multiple evacuation routes were purposeful to avoid having everyone try to exit the same doors in an emergency, but it meant that no one really knew where they were expected to go.
Gilder put together schematic maps showing all five of the evacuation routes, plus one master map that showed the whole department and all five routes. The maps were simple to create, he says, with line drawings that show the different areas and how to evacuate from that particular part of the department.
He laminated the maps and posted the appropriate ones in each operating room, on the back of the door, and other areas. In common areas such as locker rooms and break rooms, he posted the master map that showed the whole department and all the evacuation routes. (See chart for example of the maps.)
"The maps were intentionally made simple, clear, and easy to understand," he says. "With one glance, you should be able to see where you were and how to get out."
Risk managers recognize that fire is a serious risk in the operating room and require appropriate prevention efforts and response plans.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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