Rescue Dilemma

David J. Fenton shows how patients in hospitals and nursing homes can be evacuated in emergencies.


It is 3 A.M. and you have been alerted for a fire in a hospital in your first-due area. The hospital was built many years ago and has been renovated. As a result of the renovations, the layout has been changed but on previous inspection visits you were able to navigate hallways easily. Each...


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It is 3 A.M. and you have been alerted for a fire in a hospital in your first-due area. The hospital was built many years ago and has been renovated. As a result of the renovations, the layout has been changed but on previous inspection visits you were able to navigate hallways easily. Each inspection resulted in no violations. The only problem has been the number of times the automatic fire alarm has gone off, summoning the fire department.

7_96_rescue1.jpg
Photo courtesy of the Port Washington Volunteer Fire Department
These photos taken at the Sands Point Nursing Home fire in Port Washington, NY, in November 1991 depict an immediate evacuation underway. Fire on the roof is advancing as the nursing home's residents are evacuated.

The run is an automatic alarm in the intensive care unit (ICU). You think to yourself, another routine run. As your first-due apparatus enters the hospital grounds, however, a security guard is frantically waving you to the front door. Nothing is showing in the front of the building but the guard says there is a small fire in the ICU. You and your crew enter the lobby of the hospital, noticing the smell of something burning. A quick look at the alarm annunciator panel shows both smoke detectors and water flow alarms are sounding in the ICU. The night charge nurse in the lobby tells you there is a large fire in the ICU, several patients are burned and there are still patients in the fire area.

Recognizing the need for a swift evacuation of the patients, you and your crew continue to the fire area. The next-arriving companies are stretching lines, laddering the building and reporting heavy smoke in the rear of the hospital. Entering the ICU on your hands and knees, confronted by heavy smoke and high heat, you notice there is very poor water flow from the sprinklers. Your crew has started to perform search and rescue, and have found several patients still alive but connected to respirators and other pieces of medical equipment attached to the walls.

Your crew wants to know what to do, and current conditions will not let you shelter the patients in place. The chief is calling you on the portable radio asking for a situation report. As the officer on the fire floor, what will you do? How do you safely disconnect the life support equipment and evacuate the patients without killing them? If you leave them, they will die.

Knowledge of the health care facilities you cover and how they operate will help you in handling an emergency at the facility.

Every accredited health care facility must have an internal and external disaster plan. Because this article concerns incidents at a facility, we will discuss internal disaster plans. (External disaster plans concern incidents that occur away from facilities and result in large numbers of victims being brought to emergency rooms.)

7_96_rescue2.jpg
Photo courtesy of the Port Washington Volunteer Fire Department
A resident is evacuated on a hospital bed.

On your next inspection, ask to see a copy of your hospital's internal plan. If the staff can find a copy, you may be shocked at its contents. Some plans may simply state, "In case of fire, close the fire doors and notify the fire department."

Most facilities have never exercised their internal disaster plans. If they have, hospital employees probably played the part of patients. As a result, truly immobile victims have not been a part of any exercises. The rationale against using real patients is obvious; no one wants to risk injuring or killing a real patient in a drill.

If there is an internal disaster at a health care facility, two types of evacuations can be performed: immediate and delayed. In a best-case scenario the patients would be sheltered in place while the emergency is handled. There are exceptions. If there is a fire, evacuations may need to be done immediately and quickly. The Sands Point Nursing Home fire in Port Washington, NY, on Nov. 19, 1991, offers an example of an immediate evacuation. This was a major incident in the Port Washington Volunteer Fire Department's district.

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