Fire Safety - Burns Bundle: Fire Simulation 2

Published 15/02/2024

Fire Simulation 2




RIJ CVC, Left radial arterial line, one peripheral cannula


Sedatives, Noradrenaline, 1L crystalloid.


COETT, ventilation circuit


SIMV, TV 450ml RR12 FiO2 0.6


Mapleson C (Waters circuit), CD O2 cylinders, transfer bag, torch.

Fire equipment – fire blanket, fire extinguishers, assembly point sign.

Fire action cards and evacuation policy.

Clinical setting

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

Potential Clinical Course

  • 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

Key steps

  • 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

Info Sheet For Faculty

  • Initial settings: SpO2 92% on FiO2 0.6

ETCO2 4.5kPa


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

Faculty Roles:

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