ICU fire evacuation preparedness in London: a cross-sectional study

Hospital fires present a sporadic but significant threat to patients and staff. This is especially so within an intensive care unit (ICU) setting, due to the complexity of moving acutely unwell patients reliant on invasive monitoring and organ support. Despite an average of 500 in-hospital fires reported to the UK department of health per annum, causing 65 injuries and 1-2 fatalities, the readiness of ICUs for urgent evacuation has not been assessed.

A cross-sectional survey of all 50 adult and paediatric ICUs within the London Postgraduate Deanery was conducted; neonatal units were excluded. The senior nurse at each unit was asked to complete a 90-question structured questionnaire, covering unit patient characteristics, design, equipment, training, and their evacuation plan. Thirty-five of 50 (70%) responded within 2 months of the study.

Significant weaknesses were reported in unit design, equipment, and planning. Unit design was compromised by inadequate fire doors (20%), ventilation cut-outs (17%), and escape routes (up to 60%). The ability to evacuate multiple patients simultaneously may be limited by a lack of portable monitoring equipment (49% of beds) and emergency drug supplies (20% of beds). Evacuation plans were often limited in their scope (96% expected to remain on their floor; 14% had plans to obtain medications after evacuation), and not rehearsed (60%). Staff training, while well provided for permanent staff, is less so for temporary staff (34%).

Forward planning for an urgent evacuation can be improved.