Stavanger, Norway | 12 - 15 May 2022 10th EORNA Congress Clinical Case Studies 37 nurses, one Health Care Assistant (HCA), one gynaecologist, one surgeon, one midwife and one porter, were about to start a caesarean section. All of them were provided with appropriate Personal Protective Equipment (PPE), consisting on FFP2 mask and eye-protective screens. While preparing the sterile equipment, the scrub nurse commented to the HCA that she was ‘smelling something, but I can’t identify what it could be’. The HCA replied that ‘it can be anything, as with the ffp2 and the COVID-19 aftereffects, I cannot tell what that smell is or where it is coming from’. The mom-to-be, a non-Spanish speaker young woman, was anaesthetised with spinal anaesthesia at 17:35. Five minutes later the c-section started and the baby was born at 17:38. Right at that moment, a phone call was made to the nurses’ bleep. An orthopaedic surgeon rang shouting: “leave the operating room now! There´s a fire!” What would you do if you receive such a call and the fire alarms aren’t ringing? If you were staff in the hospital, would you have thought to alert the OR staff? The circulating nurse, alerted the rest of the team, because none of the fire alarms were ringing, and took the leadership of the situation. The porter took the baby into the incubator and pushed it to the street, together with the father of the baby, followed by the midwife. The gynaecologist, surgeon and scrub nurse closed the wound as fast as possible. Anaesthetist, HCA and circulating nurse managed to transfer the woman into a stretcher immediately the wound was covered. As the brand-new mom did not understand well what the staff were saying, she remained calm. Once she was being pushed through the OR doors, the nurses managed to inform her about the fire and where the baby was taken to. On their way to the fire exits, many other patients were led to the outside of the hospital by the staff of the ICU and the wards. Safety doors were locked behind them, containing the fire and a thick smoke. During the evacuation patients and staff were calm, until they found the street access locked. For two long minutes, they were held in front of the doors, trying to figure out how to open the doors. At this point, what would you think it would have been the best decision to make to unlock the doors and comfort the patients? Luckily, police and fire brigade were already forcing the doors until they opened them, letting the staff and the patient leave the hospital and look for the meeting point outside. The whole hospital was evacuated in less than 15 minutes, including intubated ICU patients. What do you think that happened afterwards (short-term, midterm and longterm measures taken)? Our patient, her husband and their baby got together in the gym of the nearby school. Critical patients were transferred immediately to the reference hospital, in Albacete, 50 km away from Hellín, as well as those Ward patients that could not have been discharged at that time. COVID-19 patients were gathered in a defined area, to avoid other patients or the helping people to get infected before they were transferred to other nearby hospitals. Special mention to Hellín citizens, who had an amazing proactive attitude towards patients and staff, bringing chairs, duvets and food to everyone who needed it. A&E was moved to a nearby Heath Care Centre for about 15 days, until it was safe to re-enter into some non-affected areas of the hospital building. After that, the clinic assessment offices were reconverted into A&E boxes. All the PPE had to be replaced, as they were stored in the basement, as well as the linen and staff uniforms. Hospital managers carried out a deep investigation about the source of the fire and why the safety devices in place did not work as they should. Six months later, the reconstruction work in the damaged areas ended. The fire safety committee updated the fire planning and stablished a compulsory an annual fire safety training for the staff. Conclusion: • Proper preventive maintenance should be done to the building safety devices, in order to avoid risk for patients and staff. • Staff should attend to mandatory fire safety training with enough frequency to keep up to date their knowledge about the fire protocols in the institution. • Definition of responsibilities for fire management, adequate fire risk assessment and an updated fire planning save lives.
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