28 September 2008


If as an experiment you put people in a room, give them an exam to do and then set the fire alarm off, the first thing they do is try to get more information. If there is no more information it is only those who have been trained what to do who take action. Nurses are particularly good. They are taught what to do when the fire alarms go off. They close doors and do all the things one should do in a fire.

Dr Grumble has spent much of his life in hospitals and but it was many years before he had any fire training. Inevitably he has encountered quite a few hospital fires. Many hospitals he has worked in have been old and poorly designed from the fire protection point of view. In some ways some of the newer hospitals have been worse. The hospital where Dr Grumble currently works has had some problems meeting the latest fire regulations. Dr Grumble has never thought that it would be possible to evacuate patients safely in the event of a major fire. The fire officer agrees.

Many years ago Dr Grumble worked in a hospital on the South Coast. It was old. From the fire point of view it was quite hazardous. To be fair the hospital authorities realised this and decided to have smoke detectors installed. They put one in the doctors' mess. Unfortunately the obstetrics SHO, a rather comely girl, smoked . Every night she would have a bedtime smoke and in response a horrible klaxon would sound.

In those days Dr Grumble worked a one in three rota. That meant that he worked ordinary working hours from about 8am to 7pm and he would also work every third night and every third weekend (day and night). It was tiring and you didn't get much sleep. So when Dr Grumble went to bed usually in the early hours of the morning he was often desperate for sleep.

One night at about 2am, just as he was trying to get some shut-eye, that wretched klaxon sounded. Even though he had the hots for her, Dr Grumble cursed the obstetrics SHO. He took two pillows and placed one over each ear. Then he bound the two tightly against his head with dressing gown cord. He didn't worry about how he would hear his bleep for emergencies. He was simply too exhausted. He lay on his bed with the penetrating noise of the klaxon somewhat dulled and tried to get some sleep. But it was never really going to work. And then through the muffled sound of the klaxon he heard somebody thumping on his door. Wearily he staggered to the door and opened it to find himself engulfed in acrid smoke. There was a real fire. He needed to escape. How would he get out? Dr Grumble was upstairs, the smoke was thick and downstairs it seemed even thicker. Then the lights went out.

Complete power failure in a hospital is rare. Dr Grumble can remember sewing up abdominal incisions by torch light but modern hospitals have generators that kick in very quickly in the event of a power failure. And then a worrying thought struck Dr Grumble. If he had no power quite possibly the intensive care unit had no power. And in the ITU there were several patients whose lives depended on there being power. Dr Grumble was the most senior person in the hospital. He needed to get to the ITU and see if they were in trouble. But how was he going to get down the stairs in the pitch dark and with all that thick acrid smoke? He took out a towel, quickly wet it, wrapped it around his head leaving a gap for his eyes and using his pen torch for light made his way down the narrow staircase keeping as low as he could to avoid the smoke. Fortunately he made it to the main corridor of the hospital. There there was more room for the smoke to rise and things were easier.

Already patients in beds were being rushed outside into the fresh night air. But Dr Grumble couldn't stop to help. He needed to get to the ITU at the other end of the hospital. He dashed there as fast as he could using all the little short cuts he knew from frequent cardiac arrest calls. When he got to the ITU gasping from a mix of exertion and smoke inhalation his fears were confirmed. The place was in pitch darkness apart from some torch light. The ventilators had stopped, syringe drivers were frozen and the nurses were bagging the patients. This did not look good. And then a wonderful thing happened. The fire brigade arrived. They were calm and professional. Just as Dr Grumble likes to appear in a crisis (even if he does not feel at all like that inside). But what could they do? There was no fire at this end of the hospital. The problem was just lack of power. But the fire brigade know about these things and they knew what we needed most. Light. And suddenly there was light. Almost immediately they erected bright lamps which enabled us to see what we were doing. Now it was just a matter of bagging the patients and somehow getting their drugs delivered. And then another miracle. Quick as lightning the fire brigade brought in a generator and somehow rigged it up to bring the power back to the sockets. Clever that. Dr Grumble was very impressed and very grateful. He was too busy ever to thank them. He thanks them now.

You may think Dr Grumble showed some dedication as did all those involved that night but he was not as dedicated as the radio presenter in the video below.


Dr Michael Anderson said...

A total power failure on ITU? I shudder at the thought!

Dr Grumble said...

The reason it occurred was that an oxygen pipe running alongside the main power supply ruptured so the cabling was destroyed. The emergency generator kicked in but the power couldn't get through to the ITU.

PhD scientist said...

Mrs PhD once participated in a (local) power failure in Theatre when a saline bag leaked onto the anaesthetic machine, fusing the sockets and the lights.

As she tells it, the consultant surgeon and his reg stood there in the puddle of conductive saline, in their neatly earthed conductive surgical bootees, discussing whether it would make a case report... until she shoo-ed them out. {Having grown up on a farm she had been taught not to stand in conductive fluid when there is an electrical short going on.)

Of course, that incident didn't cause a fire... luckily.

Talking of hospital fires, did you spot this story yesterday, Dr G? Scary stuff. If ever there was a building where one would want the fire precautions to be first class, a hospital would be it.

Dr Grumble said...

Yes. It was a coincidence that this post was published just before another hospital fire.

Dr Grumble does agree that hospitals need to be extra safe when it comes to fire protection. He first became aware of this as a student when he was in a hospital which had a modest tower block. He asked how patients were supposed to be evacuated in the event of a fire and discovered that you were supposed to put them on mattresses and slide them down the stairs. It was of course a non-starter for the ITU patients. And it was unrealistic for many of the others too. One day there will be a terrible disaster.