Code 1001 (1972)

evacuation the result of pre-planning training and in-service education and evacuation such as this does not simply happen it happens because urgency situation hospital patients and those inpatient care facilities in most cases depend on you for their lives in an emergency experience proves that adequate training and practice result in knowledge retained during a crisis while book-learned procedures may be forgotten a procedure plan can be excellent in theory yet completely ineffective in an emergency if it has never been rehearsed and drilled there is no substitute for training and drilling in affecting a set course of action to be used in a time of disaster Fire Department files can illustrate numerous cases where loss of life and property damage could have been minimized as the institution personnel been trained in emergency procedures the purpose of training and drilling is to condition you to react instinctively and effectively to a given emergency situation [Applause] good morning my name is deputy chief ranking we in the fire service know well the meaning and advantages of pre-planning this is why we strongly feel that all hospital personnel and those working in nursing homes and institutions must be involved in pre-planning for any emergency in an institution for the relocation of patients and for the possibility of an evacuation we are together this morning to train and practice methods of moving patients to safety first we must discuss several important topics that are necessary for a successful evacuation we are looking at the third floor of your building you must know where the exits are in your respective working areas the stairways will serve as your vertical access point and the smoke barrier doors will be your horizontal evacuation separations you must know where the fire alarm station is the location of fire extinguishers and standpipe hose lines an area where the patients may be moved to in the event of an evacuation or relocation as it will be in most cases in the event of a fire or emergency the following order of action is recommended first remove any patient in immediate danger second sound the fire alarm to alert the fire department and the staff this is second only to the rescue of patients in immediate danger third close all doors fire and smoke fire doors doors to patient treatment and utility rooms fourth extinguish the fire if possible fifth begin relocation of patients and prepare for evacuation if necessary last reassure all patients the following order of removal for patients is suggested those in immediate danger all ambulatory patients under supervision bed patients close to danger area bed patients connected to life-saving devices who must be removed in their beds you will have to pre-plan for each type of patient vertical or horizontal movement will depend on the type of building an emergency situation it must be remembered that horizontal evacuation in a high-rise building can only be used when a patient can be taken to an area which is protected by fire or smoke fire your doors or through a corridor to an adjacent building protected by an approved fire separation if this is not possible then vertical evacuation will be necessary by use of stairways and fire escapes in the event of an emergency occurring in the evening or early morning hours there will be less health because auxilary personnel are not available this must be considered in your emergency plan your institution's fire brigade is most important because it will help carry the workload until the fire department arrives there is one more thing I would like to call to your attention there is no one set plan for an emergency in a patient care facility it will depend on the type of emergency but training pre-planning and knowing how to handle patients in the event of an emergency will make the job that much easier for you and the staff the universal carry is a method of removing a patient from the bed or into a blanket on the floor it is a quick and effective method for removing a patient who is in immediate danger this carry can be used by anyone regardless of the size of the patient when you approach the bed stay low because if there is a smoke condition the smoke will have a tendency to rise by staying close to the floor you will not have to breathe the smoke and heat now spread the blanket sheet or spread on the floor place one third of the blanket under the bed leave about eight inches above the patient's head grasp the patient's ankles and move the legs until they drop over the bed at the bend in the knees place your hands on each shoulder of the patient slowly pull your hands toward you until the patient is in a sitting position encircle the patient with your arms place your arms underneath the patient's armpits and lock your hands together in front of him slide the patient's slowly to the side of the bed and lower to the blanket if the bed is in a high position allow the patient to slide down one of your legs always protect the patient's head gently lower the head to the blanket wrap the blanket around the patient at the patient's head grip the blanket with your hands above each shoulder do not let the head snap back place the patient in a half sitting position and pull the blanket toward you the blanket will slide easily on the floor allowing you to move the patient to safety the cradle drop is a patient removal that may be used with success providing that you are similar or larger in size than the patient with the blanket on the floor one third of it under the bed slide one arm under the patient's head and grasp the opposite shoulder position your other arm under the patient's legs at a point midway between their knees and body pull the patient to the edge of the bed do not jerk the patient out into midair but gently pull him toward you by rocking back into a sitting position and lowering to the blanket protect the patient's head by lowering this part to the blanket last wrap the blanket around the patient grasp the blanket above each shoulder of the patient do not let the head snap back place the patient in a half sitting position and pull the blanket toward you the double cradle drop is recommended for two rescuers to use on patients who cannot sit up or where one person cannot handle the patient with the blanket on the floor one third of it under the bed a you handle the top half of the patient be you handle the bottom a slide your arm under the patient's head and grasp the opposite shoulder your other arm goes completely under the body at the waist line B slide your arms under the legs on both sides of the knee and extend through to support this hair firmly don't jerk the patient out into midair but together gently pull her toward you by rocking back into a sitting position and lowering to the blanket protect the patient's head by lowering this part to the blanket last wrap the blanket around the patient together move to the patient's head and grasp the blanket above the shoulders do not let the head snap back leave the patient in a prone position and pull the blanket toward you the universal carry the cradle drop and double cradle drop are designed so that you are always lowering the patient therefore you do not require great strength if vertical evacuation is necessary by going down either interior stairways or outside fire escapes in most cases a helpless patient may be taken downstairs by one person with the patient wrapped in a blanket drag him headfirst in a half sitting position to the top of the stairs it is most important that the blanket be wrapped tightly to protect the patient it will make the descent easier you take a position on the stairs one two or more steps lower than the patient this position will vary depending on the height of the patient and yourself place your arms under his armpits and join hands in front of him back slowly down the stairs maintaining close contact at all times with one of your legs against his back the patient's lower body will be on an incline with the stairs in this position it is easy to move the patient the swing carry is the best method for to train people to move a patient no blanket is needed if the patient is lying in bed there are different actions to know which are dependent upon the position you take to clarify this the upper part of the body will be a and the lower part be the grasp the ankles and move legs off the bed a face the patient and place your hands on each shoulder pull your hands toward you until the patient is in a sitting position after she is sitting up continue to move the legs out until they are at a right angle to the bed sit on the bed take the patient's arm place it over your shoulder join arms and back of the patient do not hold on to the patient just each other place your shoulder under the patient's armpit join your hands like this under the patient's knees together lift the patient and walk forward in a normal manner the patient may be lowered feet first when an area of safety is reached remember always protect the head the swing carry is a method of moving a patient that the nursing staff can use in their normal routine of handling patients if someone has a cast on the lower part of his body the extremity carry can be used on most patients provided they are able to be placed in a sitting position again to train persons may employ this method with success each person has special moves to complete so we shall refer to the upper body as a and the lower B a place your hands on each shoulder of the patient pull the patient slowly into a sitting position B take the patient's ankles and move the legs until one is clear of the bed if moved further it will be difficult for your partner to get his hold on the patient B simply back in between the patient's legs far enough to grasp the ankles place your hands to the outside of the legs allowing your thumbs to stay on top a move to the rear of the patient and circle him with your arms place your arms underneath his armpits lock together in front slide the patient to the edge of the bed and maintain closed contact when in position a give the signal to move out together gently pull the patient forward carry him to safety by walking in a normal way be it is most important you keep your arm straight down when carrying the patient emotionally disturbed patients who are not ambulatory present a special evacuation problem the chair lift is a method that requires a straight back chair and one or two rescuers with the patient in a chair and the absence of restraining straps use a bedsheet to anchor the patient to the chair the bedsheet encircles the patient about chest high and you tied in back at a chair the knot is simple similar to the knot you use and starting to tie your shoelace now tuck the loose end of the sheet between the patient's body and the seat around him for two people you're a you face the chair in the rear of the patient be you take a position in front of the chair face forward a put your foot against the chair and tilt toward you be you stoop down and grasp each side of the front legs now lift the chair together and walk if you are alone tilt the chair toward you and back out many people in patient care facilities are medically classified as able to walk unfortunately this description of a patient's physical condition is not true in an emergency situation for instance an elderly person may be able to walk at a very slow shuffle but in any emergency this type of patient will need assistance to be moved quickly in the side assist hold you approach the standing patient from the side take her arm and place it in back of you pull the patient's arm with your hand that is opposite the patient until her body is tight against you you hold her arm securely at all times you encircle the patient's body with your other arm and take her for the patient will feel secure in your grasp and may be controlled very easily as you can see the patient cannot fall forward or backward if the exit path is narrow where the patient is disturbed emotionally it may be to your advantage to use the bear hug assist on the patient approach the standing patient from the rear place your hands between the patient's body and arms take hold of the wrists keep your hands on top your thumbs to the inside fold your arms to encircle the patient around the test your arms will now be in the bear hug position the patient may be moved forward by you in a confident manner most important is that you keep your head to one side of the patient's head so she can let you for removal infants I suggest the following procedure with a blanket or sheet on the floor place two babies in each bassinet use diapers or small blankets for padding for bassinets can be placed in the middle of a blanket or sheet first fold the blanket over one end fold the corners in then roll the sides in to form a pocket together grasp the corners and pull the blanket two people can drag eight babies to safety if necessary one person can do the job in an emergency where you have children and cribs and it becomes necessary to relocate them place as many as possible in one crib and move them to safety I would like to call to your attention that carries or methods of removal that we have just finished are for use in all hospitals nursing homes and mental care facilities these are simplified methods designed for anyone working on staff who may be called upon in an emergency you have noticed that the methods of removal that we've discussed in practice are designed for one or two rescuers because in many instances the initial response in the first several minutes maybe only a few people there are other acceptable methods of removal of patients but time does not permit us to discuss them we feel that the carry is discussed in practice today we'll cover most situations you may face these patients are your responsibility they depend on you for many different services during their stay in a hospital nursing home or mental institution but in an emergency their very lives may depend on each one of you your instinct your training your ability to carry out an evacuation everyone who works in a patient care facility has two responsibilities the first is to his profession whether he is the administrator or director doctor nurse nurse's aide volunteer technician maintenance worker housekeeper or dietitian but in time of disaster everybody has one responsibility the safety of the patients and their removal to safety can you afford to gamble with the possibility of fire have you ever said to yourself I've been here for years and we've never had a fire and this is a new building it is brick and concrete it can't burn how familiar these statements are but these are your thoughts you may be tragically wrong all too often an apathetic attitude is taken toward fire safety many people believe that it can't happen here but it does happen every day how well-prepared are you in case of fire [Music] you