Environmental emergencies in theatre and critical care areas: power failure, fire, and explosion

In 2012, a fire broke out in the intensive care unit (ICU) of the Royal United Hospital, Bath, when a faulty oxygen cylinder placed on a patient bed ignited. The patient sustained burns to the lower limbs, the cubicle sustained substantial structural damage, and the ICU rapidly filled with smoke, necessitating evacuation. Recent studies have highlighted weaknesses in a number of London ICUs due to failures of unit design, equipment, escape routes, drills, and evacuation planning. In the 11 yr between 1994/5 and 2004/5, some 10 662 fires were reported in National Health Service (NHS) facilities costing an estimated £14.6 million. Roughly 500 per annum involved acute care facilities and resulted in 651 injuries and 17 fatalities. In addition to burns and smoke inhalation, a number of other traumatic injuries were sustained during evacuations. These incidents show that environmental emergencies such as power failure, fire, and explosion have the potential to lead to substantial patient morbidity and mortality, and also endangering staff and facilities. Key to the successful management of these environmental emergencies are comprehensive and regular staff training and credentialing, inspections and auditing for environmental risks and evacuation obstacles, and simulations and exercises designed to reveal shortcomings in institutional protocols.