Causes of Fire in hospital settings, Fire Safety norms, Triad for origin of fire, How to use fire extinguisher, Do's and Don'ts, triage,

1. Fire Hazard in Hospital Settings:
Role of an Anaesthesiologist
Dr. Pranav Bansal
Professor & Head
Department of Anaesthesiology
BPS Government Medical College for Women, Khanpur Kalan

3. Triad of Fire

4. Few Important Facts !!!
• The fire doesn't kills, but the smoke does!!
• Dangerous constituents of smoke include carbon
dioxide, carbon monoxide, particulate matter,
hydrocarbons, nitrogen oxides, asbestos (from
false ceilings), and other irritant organic chemicals
• Patients are more likely to succumb to ill-effects of
toxic gases in smoke as compared to general
healthy population
“ Where there is smoke, there must be some fire”

5. • The heavy particles in smoke deposit in
upper airway producing irritation & distress
enough to incapacitate a young healthy adult
within minutes
• A majority of the occupants in a Hospital are
incapable of self-evacuation which makes the
hospital fire a challenging scenario
Few Important Facts !!!

6. Vulnerable Places for Fire in a Hospital
Gas manifold (with O2 and N2O cylinders), liquid oxygen plant
Hospital Kitchen
Store Room (with stocks of chemicals, spirit, cotton bandages, etc)
Generator Plant with fuel storage facility
Operating Rooms
Sterilization/ Incineration plant
Any place with heavy wiring or electricity panels
(e.g. MRI Suite)

7. Classes of Fire Based on The Type Of Fuel
• Hospital Fire may be initially of
Class A, B, C, E or F types) and end
up in combination of many classes
on progression

8. Fire Encounters for an Anesthesiologist
Airway Fire
Patient on Fire
Operating Room Fire
Hospital on Fire

9. Role of an Anesthesiologist in Hospital Fire Settings
 Activation of fire alarms
 Attempts to extinguish fire whenever possible
 Winding up of ongoing operative procedures in Operation Theatres at
the earliest
 Active participation and team management in safe rescue of patients,
staff & colleagues from the operating room & ICU’s
 Resuscitation of patients with Inhalation injuries or burn injuries
 Transportation of critically-ill patients in ambulance to nearby hospitals

10. Fire hazard in Operating Room
Oxidisers Ignition Sources Combustible Substances
Oxygen Electrosurgical Units Patient (Hair, GI gases)
Nitrous Oxide Electrocautery Units Aerosol Derivatives
Surgical Lasers Spirit, Hand sanitizers
Fibreoptic Light Sources Linen (drapes, gowns)
Static Discharge Spark Dressings (gauze, sponges, adhesive tapes)
Electrical Panels Ointments, liquid petroleum jelly, paraffin, white wax
Plastic rubber products (BP cuffs, Tourniquets, gloves)
Anaesthesia Components (breathing circuits, masks, airways,
ET Tubes)

11. Airway fire
• Usually during Laser surgeries of Upper airway
• Early warning signs (flash/smoke/ burning smell)
• Immediately remove ETT and turn off gases/ disconnect
circuit
• Pour saline in airway
• Remove burning materials
• Mask ventilate, consider bronchoscopy and reintubate
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12. Fire on the Patient
• Early warning signs (flash/smoke)
• Turn off medical gas supply
• Remove drapes / burning material
• Extinguish flames with water, saline or fire
extinguisher
• Evacuate patient at earliest
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The role of Anaesthesiologist here may include that of Activator,
Responder, Rescuer and possibly a Fireman

13. Prevention of Operating Room Fire
• Periodic checking for Oxygen leaks in Anaesthesia machine
• Preventing pooling of prepping solutions (spirit) and
allowing drying of solutions before draping
• Configure surgical drapes to promote venting up of
medical gases
• Using moist gauze and sponges near ignition source
• Check for open electrical connections in O.T. to avoid
sparks
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14. Fire Safety Requirements in a Multi Storied Hospital as
per National Building Code (NBC), Part IV
1. Smoke sensors
2. Automatic fire alarm systems
3. Fire extinguishers
4. Hose reel on all floors
5. Automatic sprinkler system
6. Underground and terrace water storage tanks
7. One electric and one diesel pump
8. Emergency lighting, Fire Exit Plan and Sign Boards

15. Preparation for dealing with Fire Hazards
• Periodic drills for safe evacuation of patients and use of fire
extinguishers (CO2 cylinders and water hose)
• Simulations for improving Team Management skills
• Knowing location and handling of medical gases shut-offs,
electrical controls fire alarm system
• Fire escape plan pasted at every exit in the hospital facility
• Display of Emergency contact numbers on placards/ boards in
case of fire

16. On detection of Hospital Fire: R.A.C.E
 R-Rescue the patient
 A-Activate Building Fire Alarm System
 C-Confine
 E-Extinguish
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17. R-Rescue the Patients
• The Anaesthesiologist as a Team leader must assign roles to his
colleagues regarding priority of patient evacuation, route of exit and
common relocation points.
• Ambulatory patients should be instructed to leave via safe exit points
under their own power
• Use Wheel chair or stretchers for bed ridden patients & cover with
blankets
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18. •Use fire exits to reach Separate Building/ Block of Hospital or any
common assembly point for a brief period, before transportation
resources or receiving destinations are available
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R-Rescue the Patients

19. A-Activate Building Fire Alarm System
On detection of fire by:
• Smoke Sensors
• Sighting Smell/ smoke
• Witnessing Fire
• CCTV Camera monitoring
• Fire Alarms
• Code Red Warning
A notification of “Code Red” alerts hospital personnel to respond properly to a fire while keeping
patients, visitors, and the general public from undue alarm or panic

20. C-Confine
• Confine fire by closing doors and windows
• Electrical mains off
• Gas Shut Off
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21. E-Extinguish
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Aim
P.A.S.S. (Acronym for using Fire Extinguisher)

22. Do’s in case of fire in OR/ Hospital Settings
Inform all nearby staff, colleagues and fire extinguishing department
of the Hospital
Stop all surgical interventions or get them expediated at the earliest
Cover your face with thick napkins, towel etc. and body with drape,
blanket, etc.
Don’t waste time in changing OT dresses or collecting personal
belongings

23. Follow the Horizontal Evacuation as compared to
Vertical Evacuation in multi-storeyed building if fire is
confined or Partial evacuation is advised.
Carry all possible medicines, equipment and O2
cylinders necessary for resuscitation during
evacuation
Call to nearby hospitals for sending ambulances and
ensuring availability of beds in ICU’s and Emergency
wards
Do’s in case of fire in OR/ Hospital Settings

24. Don’ts in a Case of Hospital Fire
• Don’t use lifts for exiting from hospital
• Don’t use central air-conditioners (smoke travels
through ducts)
• Don’t leave non-ambulatory patient in hospital
premises (except on high dependency support
systems)
• Avoid Unnecessary delay in evacuation and
transportation
REMEMBER: The initial steps to protect hospitals against fires are
prevention and suppression. Complete evacuation of patients
should be avoided unless absolutely necessary