Fire standards are key for EDs

The fire safety standards set forth by The Joint Commission, which have low compliance rates, should receive special attention from ED managers. Observers note that the ED is a frequent site for unexpected fires, especially when set by patients. In addition, smoke moves quickly through an ED because of the open architecture, and many of the patients are very sensitive to smoke, so it is not tolerated well.

"That's an accurate statement," says George Mills, MBA, FASCHE, CEM, CHFM, CHSP, a senior engineer with The Joint Commission. "There is much less 'compartmentation' in the suite-like ED. If there is a fire in a room with four walls, it will be contained." If patient rooms are not defined, you lose the ability to compartmentalize, he says.

Given this added danger, what are the responsibilities of the ED manager? Mike McEvoy, PhD, REMT-P, RN, CCRN, EMS coordinator in Saratoga County, NY, says, "I would say two things are important to do: One, have someone in the ED who is responsible for surveying these sorts of compliance issues — what are the standards, are the fire extinguishers where they need to be, are exits blocked?" This individual should check these items on a routine basis, he adds.

"The second thing, which is really hard to do — but very important — is to periodically conduct a drill where you actually practice evacuation and move large numbers of patients," he says. McEvoy recognizes this practice is difficult to do with live patients, but says all EDs have quiet times when there are opportunities to practice moving simulated patients with ventilators and multiple IVs. "When you do that, you gain comprehensive appreciation for what would happen," he says.

Even the ICU had a drill

For ED managers who question the practicality of doing this type of drill, McEvoy has the following response: "We even did it in an ICU. We evacuated an entire portion onto another floor just to see if we had the equipment and supplies available to do that."

Kathy John, MSA, ARN, CHSP, CHEP, chairwoman of the Atlanta Metropolitan Medical Response Healthcare Section, says, "You may be able to reduce supplies in the hallways if there are too many, so there's less in the way if you need to quickly evacuate." In addition, she notes, "It's a requirement that the fire extinguishers be checked monthly and annually, so the ED manager needs to be aware of the location and who is responsible to test the equipment according to the [standards of the] National Fire Protection Agency."

The ED manager "needs to know and understand what the requirement is and who is responsible for it," John says. "They also need to understand the storage requirements around sprinkler heads. For example, they must make sure not to store anything too close to the sprinkler heads, because it makes them less effective."

Finally, she says, the manager needs to educate staff about the hospital fire plan as well as the evacuation plan: meeting places inside or outside the department in case of a fire; who turns off the medical gases; what to bring with them in case of evacuation (i.e., charts, medications); and how to do it. "I'm big on the team approach and everybody knowing their role, such as taking a head count when everyone gets outside, because the fire department will need to know if everyone got out," John says.