Fire tests a surgery center staff’s plans
Every same-day surgery program has a plan to deal with emergencies such as fires, but no one wants to have to use it, especially when you have more than 100 people in your building and eight patients in the operating rooms (ORs). It is nice to know, however, that one such plan worked when needed.
It was 11:40 a.m. on a Thursday when Teresa Craven, RN, nurse administrator of Fayetteville (NC) Ambulatory Surgery Center, was walking through a back hallway between the surgery center and the space under construction for the center’s expansion. She had just finished talking with the contractor about the renovation of space previously used by a diagnostic center. "I just happened to see smoke coming out of a fluorescent light fixture in the hallway," Craven says. "I stepped into the scheduling area and pulled the fire alarm, then headed back to the construction crew to let them know that there was fire because they have no alarms in their area. "When I went back into the surgery center, no one had moved!" she exclaims. "I said, This is not a drill, there is a fire,’ then people began to do everything they were supposed to do."
Although Craven’s staff do conduct fire drills during the workday, the drills usually are at the end of the day, when there are few people in the waiting room and no one in the ORs, she explains. Within minutes, the business office staff had escorted family members and patients in the waiting areas to a designated area outside the center. At the same time, Craven checked on the status of all patients in the ORs. She asked physicians to finish or get the patients to a point where they could be moved. At that time, five patients had just been sent to recovery, says Craven. Of the three remaining cases, two were completed and transferred to the hospital by ambulance, and the third was completed, with the patient sent to recover in the parking lot, she adds.
In the post anesthesia care unit (PACU), staff collected portable oxygen tanks, blood pressure machines, and two crash carts to move outside along with the PACU patients, Craven says. "We had one orthopedic patient in our 23-hour stay unit, and we were able to transfer her to the nearby hospital," she adds. Because her transfer agreements were in place and up-to-date, there was no delay getting ambulances to the hospitals with the three patients who were transferred, she says.
Once the evacuation was under way, Craven and her staff member who is designated as safety officer walked through the building to ensure that no one was left and to verify that all gas lines in the rooms were turned off. "We walked down different hallways in order to cover the area more quickly, but I wish that we had walkie-talkies so that we could stay in touch," Craven says. The walkie-talkies also would have come in handy throughout the rest of day when Craven was needed by the fire department in one area when she was in another. The walkie-talkies are now part of the surgery program’s equipment, she adds.
The fire department members were complimentary of Craven’s efforts, and they praised the fact that her patients and staff moved to the parking lot of an adjacent building several hundred feet away from the surgery center, she says. "There were no people in our parking lot to block the fire engines, ambulances, or other emergency vehicles," she says. Having everyone away from the building meant a little extra planning, she admits. "Our business office staff took chairs from offices and the lobby as they escorted family members out, so they could sit," she says. "We also took umbrellas that we keep on hand with us to provide shade," she adds.
One business office staff member grabbed the petty cash box so that cabs could be called to take patients and family members home. "This was very important since everyone’s car was in our parking lot and blocked by the emergency vehicles," Craven says.
The worst part was the cleanup, she says. "We had fire damage in only two hallways and our staff locker, but there was smoke throughout the entire building." As a result of the smoke, every surface in the center had to be wiped with a biochemical agent (Microban QGC manufactured by II- Rep Z, Braddock, PA), Craven explains. "Walls, ceilings, and floors were cleaned, and all of the fabric on furniture and carpets were cleaned as well," she adds. "We also had to send out all of our curtains, blankets, and scrubs to be cleaned."
Kenny Strickland, vice president of Highland Construction in Fayetteville, NC, is the contractor who oversaw the cleanup. "It’s important that the ductwork and interior cabinets of the air conditioning and heating systems be cleaned before any other cleanup occurs," he says. "If it is not cleaned first, then you are continually blowing more smoke, dust, and dirt back into the surgery center you’ve just cleaned."
A nearby hospital made the resterilization of every instrument go more quickly by making their facility available to handle the steam and gas sterilization at night, Craven says. "We even wiped down all of our packaged instruments," she adds. The cost for the environmental clean up was about $100,000, she says. The cost to repair the structural damage still hasn’t been totaled, she says. "We did close for a week to clean up, and we probably lost 250 to 275 cases that week to other facilities, but it was nice to learn that our preparations were well worth the effort," Craven says. "We also learned that the fire did start with an electrical short in the ballast of the fluorescent light fixture from which I first noticed smoke."
Family members, physicians, and patients were very happy with the staff’s handling of the emergency, she says. "Our staff members were so calm and professional during the entire event that no one felt afraid or panicked," she says. In fact, one of the most satisfied patients was the one who went directly from surgery to the parking lot, Craven says. "He was quoted in the local paper saying that it was the most unusual procedure he ever experienced, saying that he went to sleep in an operating room and woke up in a parking lot," she says.
For more on responding to a fire, contact: Teresa Craven, RN, Nursing Administrator, Fayetteville Ambulatory Surgery Center, 1781 Metromedical Drive, Fayetteville, NC 28304. Telephone: (910) 323-1647.