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ICU fire evacuation preparedness in London: a cross-sectional study
1Critical Care Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK. george.murphy@medsci.ox.ac.uk
Insights
Hospital intensive care units (ICUs) have significant weaknesses in fire safety and evacuation planning. Most units are not fully prepared for urgent patient evacuation, highlighting a critical need for improved readiness and training.
Area of Science:
- Critical Care Medicine
- Hospital Safety
- Emergency Preparedness
Background:
- Hospital fires pose a significant risk to patients and staff, particularly in intensive care units (ICUs) due to patient acuity.
- Despite annual fire incidents causing injuries and fatalities, ICU readiness for urgent evacuation remains unassessed.
- The unique challenges of moving critically ill patients necessitate a thorough evaluation of ICU evacuation preparedness.
Purpose of the Study:
- To assess the current state of emergency evacuation readiness in adult and paediatric intensive care units.
- To identify specific weaknesses in unit design, equipment, planning, and training related to fire evacuation.
Main Methods:
- A cross-sectional survey of 50 intensive care units in the London Postgraduate Deanery.
- A 90-question structured questionnaire administered to senior nurses, covering patient characteristics, unit design, equipment, training, and evacuation plans.
- A 70% response rate (35 out of 50 units) was achieved within two months.
Main Results:
- Significant deficiencies were found in unit design (e.g., inadequate fire doors, escape routes) and essential equipment (e.g., portable monitoring, emergency drugs).
- Evacuation plans were often limited in scope, with many units planning to stay on their floor and lacking post-evacuation medication plans.
- A majority of units (60%) had not rehearsed their evacuation plans, and training for temporary staff was less comprehensive (34%) than for permanent staff.
Conclusions:
- Intensive care units exhibit substantial weaknesses in critical areas of fire safety and emergency evacuation preparedness.
- Improvements are urgently needed in unit design, equipment availability, evacuation plan scope, and staff training, especially for temporary personnel.
- Enhanced forward planning and regular drills are essential to improve the safety and readiness of ICUs for urgent evacuations.
Background:
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.
Methods:
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.
Results:
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%).
Conclusions:
Forward planning for an urgent evacuation can be improved.
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