Aids to assist evacuation of a care home

[kurnal]

I am working on evacuation plans for a couple of local care homes.
Looking to progressive horizontal evacuation, nice wide corridors, nice narrow matresses,  many of the residents are bedridden so the best method for night time evacuation will be on the mattress if we can do it . We have 3 staff available and smallish protected areas- biggest is 8 beds. A few air mattresses though.

In the past we used mattress straps and skid sheets as evacuation aids in the old cottage hospitals- is this still a reasonable option and does anybody know where evacuation aids may be sourced? Tried googling without much success. Many suppliers seem hung up on manual handling regs and talk about 7 handlers for these things nowadays. We used to do it with 2 and I believe this is still a reasonable goal in a real emergency.

Any views would be welcome.

[slubberdegullion]

kurnal,

I guess it can be assumed that the beds do not have wheels and cannot be moved.  I understand that generally the residents' like the place to look like a home and not a hospital.

I'm not surprised at the views on manual handling you've come across.  Not because I, too, am hung up on the regs but because I recognise that a large part of the world has gone health and safety bonkers!  See below:



Am I right in supposing the procedure would be, in the worst case, 8 bedded room for example, one staff member dealing with the fire and the other two moving the other residents out of the compartment to safety - probably just out the room in the first instance?  These two would lift the mattress down with the resident on it then drag it out?

I can't help you in sourcing what you're looking for but what about having a couple of evac+chairs available instead - they're good for on the flat.  I understand that it would take extra time to transfer the resident from bed to chair then, outside the room, from chair to some receiving point, but the travel time might be reduced to compensate, being on wheels.

Hmmm, I don't know though.  The more I think about it, the more cumbersome (and expensive) this seems and the more reasonable your method seems.  I guess the skid sheet is because you're on a carpet - what about if the skid sheet is long enough you wouldn't need straps.  If each bed had something like half a salvage sheet (a clean one, not straight off the pump!) ready for deployment next to it, the staff could lower the mattress onto that with a good bit of extra sheet at the bottom that they could grab hold of and pull.  Could even stitch in a rigid pole for a handle at the bottom end.  Could even patent it and sell it round the world.

No, maybe not, just imagine all the claims for bad backs coming in.

Sorry I'm not much help - just burbling on tonight. Some one else will have something for you.  

Whatever the solution the staff will have to be well versed in it and well practised.  You don't want the first time they've got to do it to be when the next bed is on fire.

Stu

[kurnal]

Heres the scenario I am trying to set up- modern home 2 storey 41 residents 4 staff minimum, (we are lucky most have less staff) 4 protected areas on each floor 3 staircases.  

What I have in mind is this:

1-fire alarm sounds
2-All staff report to fire alarm panel roll call checking all doors closed as they go.
3-If cannot get to panel due to fire alternative control point outside main entrance via any available route.
4-On arrival at panel matron calls roll issues radios.
5-Checks panel information and silences alarm - not reset.
6- Matron sends 2 staff to affected zone and 1 person to call Fire Service
7- Matron stays at command point to meet fire service (5 mins away from nearest retained station)
8- 2 staff assess situation on arrival at zone- start to evacuate zone- if fire confirmed.
9- If no sign of fire open doors using door procedure to check.
10- If fire confrimed radio matron,  3rd staff member sent to help supervise residents in stage 1 evacuation point
11- Matron starts telephone tree for more help from local staff
12- When evacuating bedroom zone start with those nearest fire, furthest from exit, easiest to evacuate, easiest to supervise
13- If sleeping/ or sedated or non ambulant  do not try to wake or dress residents- use matress straps to secure resident in matress and 2 persons to drag matress 1 at head 1 at heel. Skid sheet under matress will help
14- there are 8 evacuation chairs per floor- these used for residents who do not need to be evacuated on matress and to rest residents in first stage evacuation area
15- when zone evacuated to stage one, move to stage 2- behind second set of fire doors away from fire.
16- consider if safe to check room of origin- if occupied- subject to door check.
16- as telephone tree brings in more staff they start evacuating zones next to fire- more relaxed and using chairs from other floor.
17- fire brigade arrive and take command


Any comments  welcome.

[BHCC]

That all sounds fine kurnal but are local Fire Service have told us that we have to have a means of vertically evacuating residents as they cannot guarantee immediate arrival. We have had to move all our residents who cannot transfer themselves into an evac chair to the ground floor and close one of our carehomes.

The building that has been closed had no protected areas and the evac chairs could not be used on the staircases as the landings were too small.

Staffing levels at night were 2 for 22 residents.

The good thing is that a new purpose built unit is under construction! Who says the RRO is a bad thing!!!

[slubberdegullion]

Oh I see what the straps are for - I thought they were to pull the mattress.  Wouldn't strapping them in take up a fair bit of precious time.  They wont have long these poor hard working staff members.

Item 12 will be a hard call for them at a time of real stress.  I'd take time to discuss with them during training who they should go for first under various circumstances.  Make it absolutely clear they shouldn't try to save the unsaveable yet, at the same time, they should target the most vulnerable.  The near contradiction makes it difficult to judge.

I hate these rooms with a large number of residents.  The nightingale wards in hospitals can have even more people in them but at least they have wheeled beds and more staff immediately available.

Is there only one way out of this 8 bedded room?  And are there beds near the exit?

Stu

[messy]

Assuming that the Matron is the more experienced or more qualified member of staff (and a manager), is it wise to have her hanging about at the RVP waiting the best part of 10 minutes to meet and brief the fire crew when she might be better use controlling matters inside?

A subordinate member of staff could be used athe RVP and any relevant info on updates etc radioed to him/her if necessary

[beltandbraces]

Hi Kurnal

Try WWW.Hospitalaids.co.uk

Phone 01604 586501

[Redone]

Google 'Albacmat'

[Chris Houston]

I recognise that a large part of the world has gone health and safety bonkers!  See below:

http://i119.photobucket.com/albums/o128/slubberdegullion2/Sign.jpg

Some would argue that laws to protect our health and safety are a good thing.

The sign is obvioulsy a photoshopped joke.

[Redone]

Couple of observations Kurnal.

We have stopped sending two staff, all staff have individual responsibility to read the (nearest) panel and proceed to the address and start the investigation, Senior takes charge on arrival... if the fire service are required, person sent to call, Senior stays... caller dials 999, then named off duty senior (who then instigates calling staff in via staff tree), then unlocks front doors.

We have hand held radios throughout on the floor plus two per level for other staff to pick up in emergencies.

The fire service pick up the handheld by the fire panel and are guided in by the staff, we don't have the staffing levels to lose someone at the door for 5 min's.

The initial number of residents that the staff can realistically evacuate to the adjacent zone inside 15 minutes determines the size our zone.

[kurnal]

Thanks for the links Beltandbraces and Redone- this is just the sort of kit I was thinking of. Will look into it.

Stu- I misled you - the rooms are all singles- the homes are designed to the draft green guide standards with protected areas of between 4 and 8 bedrooms on bedroom corridors between fire doors, two way travel throughout , but no self closers on bedroom doors. (These are now being fitted)

BHCC- yes we will provide a single evac+chair - as I see it there is no time limit for evacuation of the building once all relevant persons are at least two doors away from the fire.

Messy Yes I see where you are coming from. However I hope matron will be taking a more strategic position- bringing and directing resources rather than leading from the front. Whether that is reasonable when we are so short of staff is open to debate I think.

Whilst its the Responsible persons job to devise an effective emergency plan, It is still the duty of the fire service to attend fires and their attendance time will be scrutinised in the courts in the event of a serious incident. I dont think its reasonable to discount the fire service attendance.

I note that since last years flooding incidents CSCI are expecting managers to have an off site evacuation plan set up.

[Paul2886]

Couple of observations Kurnal.

We have stopped sending two staff, all staff have individual responsibility to read the (nearest) panel and proceed to the address and start the investigation, Senior takes charge on arrival... if the fire service are required, person sent to call, Senior stays... caller dials 999, then named off duty senior (who then instigates calling staff in via staff tree), then unlocks front doors.

We have hand held radios throughout on the floor plus two per level for other staff to pick up in emergencies.

The fire service pick up the handheld by the fire panel and are guided in by the staff, we don't have the staffing levels to lose someone at the door for 5 min's.

The initial number of residents that the staff can realistically evacuate to the adjacent zone inside 15 minutes determines the size our zone.

And whilst the staff are attending the affected zone the fire alarm continues to ring confusing the unattended residents who may be tempted to wander around the building opening up the very fire doors that help create compartmentation, even getting into the lifts. The problem with 'all hands to the affected zone' as you suggest would be a problem in most care homes. If you have a several residents in the lounge for instance, and its remote from the affected zone, then surely  a member of staff should be assigned to ensuring they all stay put. I have conducted and witnessed many practice evacuations in care homes for a number of years and as you're all aware is a massive problem. It all boils down to staff awareness of the fire detection system and knowing how to use the time of an evacuated head, and the containment of the fire to the point or place of origin. It has proved more beneficial in most cases to assign two members of staff to check the affected area after meeting at the information panel. I could go on and on regarding this matter and invite all others to respond with any observations or points on this matter.

[Ken Taylor]

Ski-sheets tend to date from the time when floors were of lino or polished wood - so you could have problems with some of today's modern carpets. (Practice drills with these are best carried out with volunteer staff rather than residents) Have you considered using simple wheel-chairs (push type) for the horizontal bit? As for the vertical bit, presumably you don't have a usable lift in this one. Where there is a conventional lift, consideration should be given to the possibility of conversion to evacuation standard - particularly for 2-storey premises where the implication of conversion would be less. I've also seen an external enclosed chute from 1st to ground floor - but this could well have manual handling and care implications!

[Redone]

No easy topic, for sure.  Agree about the alarms potential for confusion amongst residents PaulM, to cover this we silence the alarm once the cause as been determined.  This is done within about 90 seconds.

We do send staff to reassure residents from the affected area, but only after operations at the fire area are adequate for the risk of persons at risk from the fire.  Drills have shown this time delay to be about 3 - 7 minutes...  the exception to this is EMI wings, where a member of staff stays with these particular type of residents, whilst physically checking the EMI wing.  Residents won't be a problem opening compartment doors in the fire zone corridor, as we have suffcient numbers of staff on the spot.  External doors are alarmed, again we have suffcient staff in the zone corridor to respond... To be honest this has only happened once in 11 years, about 98% of our residents need assistance to go anywhere, which is a bonus regards wandering residents, but a bugger to empty the building with.

I could never approve the sending of two staff, whilst many hands are at an assembly point chomping at the bit, the designed in delay of getting hands to work would be easy meat for a good Solicitor should the evacuation go pair shaped, and there's been plenty of those this year.  We gain comfort and confidence in numbers in what we are trying to achieve and the staff prefer it.

[Marek]

Hi Kurnal as an ex fire officer and now a consultant  & trainer specialising in RCP's the response to the alarm as you describe is fine, it is also pleasing to see that you silence the alarm when all staff are accounted for at the panel.
The new guide recommends that the protected area (that is  all bedrooms within a corridor section) is evacuated within 2½ minutes of the alarm operating - from my experience this is not realistic or achievable. In some case it would take 2 carers this long to move one of their residents, not even allowing for the response time to the alarm.
In addition the guide suggests that rooms where it is not possible to move a resident (because of medical conditions or treatment) that it is made into a temporary refuge by upgrading the protection to 1 hour, plus a carer to stay in the room if in the effected area.
This 2½ minutes needs to be challenged, why have 30 minute doors to rooms. The fire door is to contain the fire within the room and protect the corridor; also in the case of the temp refuge scenario it is suggesting that there is a raging fire threatening the door from the corridor side, which in essence suggests combustibles within the corridor and all ½ hour doors into rooms being open.
Notwithstanding this, I do recognise the difficulties that staff have, there is a lot of expectation put upon them. Where I have come across homes that have corridors with 8-10 bedrooms I have recommended that where possible the corridor be further subdivided with the provision of a SCFD with vision panel on an EMR. This has, where actioned, been welcomed by staff when the reasoning behind it has been explained.
I beleive you have had the response regarding the Ski Pad and Evac Chairs.
With regards to staff responding to the zone area, where possible 3 are sent to check the area, 1 to reprt back thereby always having 2 staff together, more staff can be sent should there be a need. When there are minimum staff levels on duty the F&R should be called as a matter of priority - staff in my opinion should always work as a team, co-ordinate their checking of fire zones, (see the inquest reports on the chaotic situation at the BUPA home fire in Redcare wher 2 residents rooms were missed).
I would be interested to know how Fire Authority inspectors are approaching this 2½ minute statement, because as I stated at the beginning this is not realistic or achievable. If you think otherwise may I suggest that you visit a care home and witness the difficulties and time it take carers to move residents to and from from the dining room.
That is why homes have a higher level of AFD, Fire Separation, SCFD's, etc. Plus training that includes practical evacaution sessions.