Since watching *The Dark Knight *many years ago, I’d wondered what the protocol would be for a hospital if a hospital caught on fire big time. The evacuation would be extremely difficult given that many patients are hooked up to complex devices, some of which can’t be unplugged, not to mention that some patients would be in surgery.
I asked a nurse friend of mine, who said that the response, in the event of a major blaze, would simply be that the staff, and anyone who could run, would just run out of the hospital. Those left behind to die, would just have to die - too bad. However, she works at a hospital in Asia, and maybe that’s not the protocol in the West.
If the hospital’s fire is extinguished rapidly, would doctors and nurses charge rushing back in, for instance, to complete a surgical operation on a patient whose abdomen is lying sliced open in the operating room?
What kind of patients cannot survive even a few minutes’ inattention, or could not survive being transferred to another hospital? (The ones on “iron lungs,” for instance, would be the clear-cut example.)
Anymore, much of the medical equipment used in hospitals has battery backup–that’s what they use when transporting a patient from one floor to another, but it’s also handy when you need to move somebody to another facility in a hurry.
U.S. hospitals, at least all major facilities, have extensive pre-planning for incidents ranging from fires to terrorist attacks, including plans to move patients to alternate sites. See, for example, this fire at a Florida hospital. The Massachusetts Dept of Public Health is one of several that has an evacuation planning guide available online. Depending on the situation, you may shelter in place (for areas away from a containable fire), evacuate to other floors or buildings on the campus, or rally every ambulance at that end of the state to move patients to other facilities.
It wasn’t a fire, but you may find it useful to read some of the reports on how the staff at St. John’s Regional Medical Center in Joplin, Missouri, handled the evacuation necessitated by a direct tornado strike on the building in 2011. (See here or here, among others.)
At the hospital where I worked we had regular fire drills. The building was designed to inhibit the spread of a fire, with fire doors on all wards and along the main ‘street’ (these were normally held open by electro magnets which released if the alarm went off). Every section had fans to extract the smoke and prevent it from spreading into the rest of the building. Smoke is likely to kill more people than the actual fire.
Each ward had at least two and usually three exits at the same level; either into the ‘street’ or adjacent wards. All beds have wheels and patients would be evacuated in situ. Intensive care beds were equipped with the ability to carry any lifesaving equipment, but each patient would be accompanied by a nurse whose job it was to monitor their condition. It was assumed that the FB would have the fire under control long before evacuation became necessary, but there was a plan to deal with that eventuality too. An internal spiral ramp was available to take patients from upper floors without using the lifts.
Any medical people in an area not directly affected stayed put, but the rest of us had to leave and assemble in the grounds. There were a number of trained people whose job it was to prevent the fire from spreading.
The local fire brigade joined in the exercises and could be there with three pumps and a turntable ladder within ten minutes of the alarm going off.
I’ve worked in the medical world (outside patient care) for years & agree with bob++ that there are* detailed* plans in place for fire or other events. Buildings are constructed to contain fires. There are plans to evacuate horizontally–to another building, rather than “down”–when possible. Oxygen is to be turned off only by those who ensure patients get oxygen to go. (The acronym for reaction to a fire is RACE; “R” stands for Rescue & the others escape me now.)
Flooding is a more common problem in the Texas Medical Center. Slow moving tropical syestems can be worse than hurricanes. During Tropical Storm Allison it was learned that putting electronics hardware in the basement could cripple a hospital for weeks after the emergency power went off. And putting the emergency generators in the basement was a dreadful idea; nurses had to take pedi patients downstairs, using flashlights. A couple of hospitals had few problems because they’d taken action after the previous tropical storm…
Huh, I’ve been taught that A goes before R, because of the danger of getting caught in rescue attempts. But then, most of my safety training is from chemical plants.
Roughly - those who can help save themselves, the patients who are ambulatory, or can wheel their own chairs, or need minimal help, go first to safety.
Those who are doomed by the circumstances you have to leave to die - and yes that is very hard and can be traumatizing.
Those needing more extensive help to move you then work on moving, until you can no longer perform any more rescues.
Who chooses? Could be nurses (in ER’s triage is commonly done by nurses) or could be doctors.
The Memorial Hospital story goes beyond triage. There were mistakes made, euthanasia was performed by scared, tired health care workers, and a total lack of preparedness caused a nightmare top occur.
Here is a Pulitzer Prize-winning article from The New York Times about the same story at the New Orleans hospital. The writer later expanded the story into a book.
I asked a nurse friend of mine, who said that the response, in the event of a major blaze, would simply be that the staff, and anyone who could run, would just run out of the hospital. Those left behind to die, would just have to die - too bad.
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You say this like it’s a bad thing.
Actually, hospitals have detailed plans in place in the event of fire for rescue, evacuation etc. It’s a Joint Commission* requirement.
*despite what you might think, this does not refer to a marijuana growers’ group, but to the Joint Commission on Hospital Accreditation.
The ‘Rescue’ refers to removing someone from imminent danger if possible. You’re not expected to do a hospital version of Hacksaw Ridge before sounding the alarm.
mmm
If you go google “hospital evacuation <any city>”, you’ll probably find a whole lot more news articles on partial and full evacuations than you’d ever expect.
I have a feeling that the problems in New Orleans were more symptomatic of New Orleans/Katrina in particular than of hospital evacuations in general.
Many (most?) US hospitals have fire sprinklers installed. Those will generally keep a fire controlled until the Fire Department arrives, and often can keep the fire from spreading to other parts of the building.
So all the nurses would have to do in such an emergency is evacuate the patients to another wing of the building until they put the fire out. And they probably couldn’t move back anyway, if it was a major fire, so they’d be re-positing patients all over inside the hospital to fit them all in the un-burned wards.
Every hospital I have ever been in looked impossible to burn down. They’re all concrete-wall-divided structures, like giant apartment buildings. Fires do not spread easily in such a building, especially if there’s any sort of fire suppressant system.
Fire drills are wise since an area of a hospital can burn, and there are things in a hospital you really, really do not want to get hot. But the idea of a really widespread fire in a hospital just seems unlikely to mefrom what I’ve seen of how they are built, and I am sure that’s deliberate.
A firefighter friend basically said the same thing. That properly installed and functioning sprinklers basically put him out of business. “Fortunately” (he likes responding to fires), there are lots of places that don’t have them.
Then that’s the difference: I’m used to rescue referring to someone who is already suffering from whatever. Already in the water, already being electrocuted, already whatever. off to look up Hacksaw Ridge
Also worth noting: Hospitals have plenty of ‘fire doors’ that are designed and placed to compartmentalize the building in case of fire. You don’t have to haul Mrs. Huffwinkle from the 9th floor to the parking structure; you only have to push her into a different zone on the same floor (unless there is a Towering Inferno, in which case the Huffwinkle clan will be on the horn with their attorney before the embers are cool).
mmm
