Fire Safety - Burns Bundle: Fire Simulation 2

I:          You are the nurse / doctor looking after the patient

S:         The patient has returned from a transfer to CT for chest imaging.

B:         75 year old male with CAP and septic shock

A:         The bed sheets have started to smoulder and the room is filling with smoke

R:         You recognise there is a fire and call for help

• Initially
  • A Oral ETT
  • B SpO2 92%, FiO2 60%, SIMV 450mL x 12bpm, ETCO2 4.5kPa
  • C HR 93 bpm AF, BP 98/65 mmHg, noradrenaline at 0.3mcg/kg/min
  • D Propofol 8ml/hr, alfentanil 4 mL/hr
• Oxygen cylinder has been placed on the bed for transfer and has been left on despite being disconnected from the transport ventilator.
• The nurse has noticed that the bedsheets are smoldering, then burst into flames.  Thick black smoke fills the room.
• The rest of the bed catches fire.  Nurse needs to get help by pulling emergency buzzer
• Nurse in charge = fire warden.  Activates fire point and gets evacuation cards to coordinate response
• The patient’s legs start to get burnt causing an increasing tachycardia and BP
• The patient requires evacuation from the room
• Fire attempted to be extinguished – blanket, fire extinguishers.  Able to put fire out on bed, but curtains now on fire
• Evacuate the patient through to PACU using waters circuit/transport ventilator
• Assess need to evacuate rest of the unit and interruption of O2 supply
• Establish on vent in PACU
• Assess patient – ABC, burn assessment

Assess staff for injuries – transfer to ED if necessary

• The nurse should call for help either by pulling the arrest buzzer or shouting for help - FIRE
• Help should arrive and leave to activate fire call point, get evacuation reference cards
• Nurse in charge – evacuation coordinator/fire warden
• Trained personnel to use fire extinguishers – location, type
• Plan the evacuation – PACU is the closest level 2/3 location.
• Consider oxygen use – locate oxygen cylinders to aid evacuation, shut off valves, Waters circuit/transport ventilator
• Alert relevant staff – evac fire card – COTD, ICU cons, theatre coordinator
• Clear way to PACU for mass evacuation
• Close fire doors if not already
• Plan unit evacuation

• Initial settings: SpO2 92% on FiO2 0.6

ETCO2 4.5kPa

RR12

Reduced breath sounds both bases

HR 98bpm AF

BP 98/68

• Initial deterioration after fire:

SpO₂ 89% on FiO₂ 0.6

ETCO₂ 3.5kPa

RR 26

HR 148bpm SR

BP 145/88

Desynchrony with ventilator

• On transfer:

SpO₂ to 100% if using FiO2 1.0 or Mapleson C (Waters Circuit)

ETCO₂ 3.0kPa

RR - manual

HR 150bpm AF

BP 150/90

• After transfer to PACU

SpO₂ to 92 on FiO2 0.6 once back on ventilator

ETCO₂ 4.0kPa

RR - 24

HR 150bpm AF

BP 150/90

Bedside Nurse 1:

• You are an experienced ITU Nurse
• You are helping settle the patient after the transfer when you notice the oxygen cylinder in the bed being on.
• You notice that the bedsheets are smoldering and then catch fire.
• You call for help when instructed.

Nurse in charge:

• You are also a fire warden.
• You hand out fire evacuation policy and action cards
• You confirm there is fire and relay this information to switchboard via 2222 / fire call point when directed
• You can operate the oxygen shut off valves if needed.
• You explain horizontal evacuation destination is PACU.

PACU consultant:

• Arrive and offer help, take handover

HiLLO: 1, 2, 4, 5