Minutes of the Liverpool Society of Anaesthetists Meeting
7th November 2014
'Fire in the ITU'
Dr Rowan Hardy & Dr Mike Osborn, Royal United Hospital, Bath
The meeting was opened by the President, Dr Ewen Forrest, who firstly spoke of the very sad news about the recent death of Dr John Harrison, Consultant Anaesthetist and Intensivist at Aintree University Hospital. He paid tribute to Dr Harrison and spoke about the importance of all of our colleagues in making our working lives so much more satisfying. He felt that the consequent loss was felt by the whole of the anaesthetic community when a member is no longer with us who still has so much to contribute.
Dr Forrest then introduced the speakers and Dr Rowan Hardy began the first part of the talk. He began my describing the routine nature of the evening of Tuesday 22nd November 2011 when he was on-call for the ITU and arrived late at 19:00 due to an over-running list. Unusually there was only one ventilated patient on the whole ITU and another patient was about to be transferred to Bristol with anaesthetic support for the further treatment of a liver abscess. During the handover ward round at approximately 19:20, there was a massive explosion and a fire started to rage at the end of the bed of the patient about to be transferred. There was a very loud roaring noise from a broken oxygen cylinder and it suddenly became apparent that this was the source of the fire. The fire alarm was immediately activated and in the meantime, despite the cylinder being kicked off the bed, the bedclothes, curtains and ceiling tiles quickly caught fire. The patient was dragged off the bed. The room filled with black acrid smoke and the staff rapidly did their best to evacuate the Intensive Care Unit to the Emergency Department being on the same floor. The fire was put out by members of staff using fire extinguishers before the Fire Service arrived 15 minutes after the fire alarm had been activated.
Dr Hardy then described the aftermath of the incident over the next seven days. The lesser affected area of the Intensive Care Unit was rapidly cleaned and repainted over-night and reopened at 11:00 the following day. The area locally involved in the fire was sealed off for Police and HSE investigation but even that was reopened seven days later.
Dr Hardy went on to describe the investigation of the fire. There had apparently been three other oxygen cylinder fires in the UK in the previous two years and the inquiry into this incident took 20 months. The conclusion was that the fire had started in the valve of the oxygen cylinder. He described the requirements for combustion which comprise fuel, oxygen and an ignition source. The inquiry thought that the likely fuel was the lubricant oil on the O ring of the valve and the ignition source was possible contaminants in the oxygen. He spoke in further detail about the valve of which there are 650,000 in use.
Dr Hardy discussed the patient whose bed had been set on fire who subsequently died three months later. She had sustained burns on her legs and the Coroner said that the fire had certainly contributed to her death. No other patients on the ITU suffered any ill-effects from the fire despite inevitable smoke inhalation.
Dr Hardy then spoke about the changes that had happened in Bath subsequent to this incident. Fire training had changed, with Fire Officers giving training in the areas in which staff worked rather than by traditional lectures. Evacuation policies in the ICU and Theatres had also been rewritten. There had been changes so that the Fire Service would arrive a little faster. Oxygen cylinders are now stored on bed brackets rather than on the beds themselves. This had been a national recommendation circulated through the AAGBI and the RCA. There was also ongoing discussion through the Health & Safety Executive about further measures that should be taken nationally.
Dr Hardy finished his part of the talk by showing some pictures of the event itself with evidence of the heat generated in the short period of time that the fire had taken place.
Dr Osborn started his talk by speaking about the normal psychology of critical care which he thought was just as unpleasant as the medicine itself. He described the trauma/stress reaction which was a natural response to acute threat or prolonged duress. It was clear evidence that we have all evolved from a brutal past where people far more frequently experienced events that involved actual threat of death or serious injury which were often longer lasting than a matter of seconds. The psychological response can involve feelings of intense fear, helplessness or horror and the state of heightened arousal may be helpful in increasing the chances of survival. In today’s society, these threats are extremely infrequent and when they do occur, they are usually very short-lived and therefore the persistence of symptoms of trauma/stress is actually very unhelpful. They do get better 97% of the time but when they persist they can develop into post -traumatic stress disorder. Symptoms of this may be the persistent re-experience of the event and constant avoidance of stimuli associated with the trauma and a numbing of general responsiveness. There are also persistent symptoms of hyper-arousal that were not there before the incident. This then seems to degenerate into a vicious circle where the more people try and avoid the symptoms, the greater that they seem to intrude with sudden unpredictable flashbacks causing long-term psychological sequelae.
Dr Osborn then looked at the environment of critical care where members of staff can be involved in intense, challenging, dramatic and emotionally draining events at times under pressure. This can lead to secondary trauma symptoms such as compassion fatigue and burnout. This is characterised by intrusive thoughts, avoidance of the workplace, hyper-arousal causing insomnia and exhaustion, further worsening symptoms.
Dr Osborn thought that the vast majority of staff were very resilient but can develop symptoms after a major event such as a fire. Exacerbating factors can be a feeling of being out of control during the event, exposure to substantial stress either prior or subsequent to the event, or lack of social support either from family, friends or on the Unit itself can worsen this.
Dr Osborn then looked at the intense experiences of the staff and patients caught up in the fire. All felt the heat, were blinded by the smoke and struggled to breathe. The memory of the event is strong and life-long. He described some of the things that can help people get over the event. In the immediate aftermath, people should allow the emotional response to diffuse and not immediately rush home to try and relax. In the short-term people should remember to do the basics well such as, eat, drink, exercise, unwind and talk. They should also be compassionate to themselves and beware of shame and guilt and the worry that they can generate. In the longer-term, discussing the event with others involved, to make sure that their recollection of events and their part in it was correct was also helpful. People with inaccurate recollections may come to the wrong conclusions about their actions leading to unjustified shame or guilt.
Dr Osborn concluded his talk by stating that going back to the scene of the event and talking about it can be very helpful to people and avoids bottling things up which then express themselves in totally unexpected ways.
There was some time for questions and Dr Chris Parker gave the vote of thanks.
Liverpool Society of Anaesthetists
12th November 2014