Nursing Home Fire Tragedy Averted Thanks to Good Planning and Training
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Nursing home fires gain national attention when they claim lives. And the more tragic a fire, the more attention it gets. What doesn’t make news is the fire that could be disastrous but is controlled by the competent response of the nursing staff and the fire department. One such fire occurred in Charlotte at the Hospitality Care Center last Aug. 12.
A nurse on the skilled nursing wing of the one-story, fire-resistive nursing home heard yells of “fire” coming from behind the partially open door of room 151 at approximately 8:28 p.m. Upon entering, the nurse discovered the patient standing in the middle of the room and a stack of clothing burning on the bed. The patient resisted the nurse’s attempt to lead her out of the room. With smoke building rapidly the nurse knocked the patient to the floor and dragged her out of the room, closing the door behind her. She pulled the patient into a nearby room, closed that door, went to the nurses’ station directly across the hall and paged the code for fire with the location, “Doctor Red, Skill.”
One mistake
Then an error was made. Instead of pulling the fire alarm and calling the fire department, the nurse grabbed a fire extinguisher and entered room 151. She abandoned this effort when heavy smoke and heat met her a few feet inside the door. She retreated and reclosed the door.
The head nurse, hearing the page, reached the nurses’ station within 30 seconds and dialed 911. Another staff member pulled the fire alarm to sound local bells and close corridor smoke doors.
Because smoke from the mattress fire was seeping around the door and filling the corridor, the staff initiated evacuation of the skill unit using various emergency rescue carries they had learned in fire training. The slideremoval blanket drag was the primary carry employed. The patients nearest the fire were evacuated first, taken out the rear exit door beside room 151. But as smoke filled the corridor, patients were taken down the hall in either direction away from the fire and out other exits onto the lawn behind the building.
Fire department response
Charlotte Fire Alarm Headquarters received the head nurse’s call at 8:30 p.m. First alarm was dispatched with three engine companies, a ladder company, a manpower squad and a district chief—a total of 22 fire personnel. Engine 14 arrived in front of the building in two minutes and reported nothing visible.
As the captain and one fire fighter entered to size up the situation they were met by a nurse who informed them of the fire’s location. Seeing that evacuation was under way, the captain had his crew advance a l 1/2-inch line through the front door as he radioed the report of a working fire with evacuation in progress. He ordered the Engine 6 crew to lay in their 4-inch supply line.
Arriving at 8:37 p.m. District Chief Robert Pace found evacuation continuing, with the fire knocked down but a large quantity of smoke in the skill unit. To assist the 12 staff members in the evacuation and care of the 30 patients in the immediate area of the fire as well as the 67 other patients in the building, Pace called two more engine companies. To help clear the smoke, a utility truck carrying industrial-size fans was also called.
Patient welfare
Because the lawn on which the evacuated patients were lying was wet, quick attention was given to relocating these people to the intermediate care facility on the opposite end of the building. Had the weather been more severe, a full second alarm might have been required just to relocate the patients. Because the staff had the fire contained, several of the first-alarm companies were free of fire fighting activities to concentrate on the welfare of the patients. Pace declared the working emergency under control at 8:47 p.m., just 19 minutes after the fire was discovered.
The proper actions of 10 nurses and nursing aids, a cook and a laundry employee were no accident. These employees had been trained and drilled to respond properly to fire emergencies. Although they made mistakes, their collective performance was sufficient to avert a disaster.
photos by Inspector Jim Ray
Monthly fire drills
In Charlotte, training is presented regularly at all health care facilities by three fire inspectors in the education section of the fire prevention bureau. Fire drills are conducted by them on a monthly basis. Training includes the application of fire prevention techniques, a review of emergency procedures, the rescue of patients from fires in their rooms, fire extinguisher use and execution of emergency removal carries. This training is aimed at specific objectives and exercises that require staff participation. Nurses practice identifying fire hazards, extinguishing bed fires, covering burning trash cans, operating fire extinguishers and removing each other from beds and rooms.
One unannounced fire drill is conducted on each shift each quarter. This is done by radioing fire alarm to expect a call from the facility. The fire inspector then enters the building and usually selects a staff member who is presented with a hypothetical fire situation, to which they are expected to respond as they would to an actual fire. Each step of the procedure is timed as the staff works to complete the necessary steps. (The only exceptions to actual fire response are that patients are not subjected to emergency removal, the fire department does not respond and, in some institutions, the fire alarm is not actually pulled.)
When the procedure has been completed the fire inspector advises fire alarm that the drill is complete and ascertains if the 911 call was made correctly. He then holds a short critique with the staff and leaves a copy of the fire drill report.
Training was recent
In addition to regular training exercises and drills during the year, an evacuation drill had been conducted last June 10 at Hospitality Care. Approximately 20 staff members occupied the beds of residents who had been moved to another area. Ten staff members executed the standard procedures for a room fire. Then, under direction of a head nurse, they evacuated the employee-patients as imaginary fire and smoke spread into the corridor. Ironically this situation was simulated in the same wing of the building just a few rooms away from where the fire occurred two months later. The staff members who had participated in the drill were convinced training they received enabled them to handle the fire effectively.
Some of the fire fighters due on the first alarm participated in part of the drill, while in service and before being called away on an alarm. Although the fire was handled well by both staff and fire fighters, more participation in drills by fire department personnel would benefit both groups in promoting smooth working relationships during emergencies. Future drills will therefore involve more fire fighters.
Briefing precedes drill
Immediately before the evacuation drills, staff and fire fighters are briefed in what is about to occur and why it is being done. To minimize confusion, the duties of the different groups are defined and a film reviewing the emergency removal carries is run to refresh memories. With a final note about safety and rescuers protecting patients’ heads while removing them, participants take their positions and the drill commences.
The standard procedures for a small fire are followed and then evacuation is initiated. Fire fighters become involved a few minutes after the call is made to the fire department, and the drill is terminated when all staff posing as patients are evacuated from the endangered area. All personnel then gather to discuss their performance. As in a fire critique, heavier accent is placed on their correct actions to avoid discouraging staff members who have little experience in this type of evaluation.
Radio and television news reporters were swarming over Hospitality Care the night of the fire, but because there were no deaths or injuries there was hardly mention of the fire the next day. To draw attention to health care staff training the news media was invited to attend an evacuation drill held the following week at Wesleyan Nursing Home. A local television station covered the drill, which brought good publicity to both the fire department and the nursing homes. This has helped us encourage other health care institutions to conduct similar drills.
Recognizing staff efforts
One week after the fire, a critique was held with those involved at Hospitality Care Center. Other staff members who stood to learn from the review were also present. Immediately before the critique Chief Jack Lee presented awards to the 12 staff members involved and congratulated them as heroes. The media had also been invited to this presentation, but the wave of interest in nursing home fires had subsided and no news stations sent representatives. Lee told the staff that had it not been for their initial actions in controlling the emergency, fatalities would have occurred. If that had happened, he continued, “this room would be full of bright lights and cameras,” with reporters inquiring into what went wrong”. “We would not be celebrating.” □ □
