Vertical Evacuation Simulation of Critically Ill Patients in a Hospital

Introduction: The world's new social environment dictates the need for preparedness should a disaster occur. One caveat in the realm of disaster preparedness is the vertical evacuation of hospital patients. Little data regarding the evacuation of patients are available, and the consequences of not being prepared could be devastating. Therefore, if the vertical evacuation of critically ill patients was thrust upon a community hospital, the response of emergency services and ancillary staff is largely unknown. Methods: The vertical evacuation of 12 simulated critically ill patients from the fourth floor of a newly constructed and vacant critical care unit was undertaken by local fire fighters, on-staff nursing, residents, and ancillary staff, all under the direction of the hospital Emergency Management Committee. Four randomly selected groups of firefighters, two teams consisting of three personnel and two teams of four personnel, were timed and had vital signs assessed prior to ascending to the fourth floor to retrieve a patient and upon each subsequent decent. Each team, dressed in full turnout gear, retrieved three patients. Each simulated patient was fashioned with mock endotracheal tube, intravenous lines, monitor, and a Pleurovac® was attached in three of the four patients. Vital signs were analyzed for significant changes or patterns due to exertion and or stress during the drill. Evaluations were distributed to all participants upon completion of the drill. Results: Mean values for the vital signs of the members of each team showed minimal increases from baseline to completion with the exception of heart rate. A decrease in systolic blood pressure was present in both of the four member teams. Subjective evaluation by the firefighters, indicated a “minimal” increase in exertion. Mean extraction time was 14.7 minutes. Patient transfer and evacuation was completed without complication to the patients or staff. Only one firefighter requested a replacement. Completed evaluations indicated above average or outstanding performance on organization, commitment, security, and care. Comments included statements regarding equipment management during transport, better communication, stairwell width, difficulty with ventilating intubated patients, improvement of evacuation time, and organization as drill progressed; three member teams, spatially, worked better than four. Conclusion: This drill reflected an impressive level of preparedness by firefighters, nurses, and ancillary staff both physically and organizationally. Should a vertical evacuation of critically ill patients be necessary, a four firefighter extraction team and accompanying nurse and respiratory therapist would be able to evacuate one patient at a rate of 3.75 minutes per floor.