Fire In ICU

Reviewed and revised 19 February 2015


Approach to Fire in ICU has 3 key goals:

  1. protect patients and staff
  2. manage fire hazard
  3. identify cause and prevention

Following a fire conduct a review of incident and response to identify cause of fire and any issues with management with subsequent review of fire policy and implementation of staff education and simulation exercises




  • Remove all patients and staff from immediate danger area with safe disconnection of lines, monitoring and equipment and manual ventilation of patients, if safe to do so


  •  activate fire alarm
  • notify switchboard (e.g. “respond red confirmed”), stating exact location and nature of fire
  • Activate unit fire drill
  •  take instructions from the designated area fire warden


  • shut all doors and windows
  • turn off oxygen outlets


  • If fire is smaller than a waste basket attempt to extinguish, if trained and safe to do so
  • use appropriate extinguishers (CO2 and dry powder) and fire blankets


  • if fire uncontrolled evacuate patients via fire exits
  • Evacuate visitors, then the most stable patients first and most unstable last while continuing essential organ support, monitoring and essential medications
  • Staff should evacuate after all patients have been removed and rooms checked, if safe to do so
  • Depending on the extent of the fire this may be:
    — Horizontal evacuation through at least one set of fire doors to another part of the ICU or an acute care area on the same floor
    — Vertical evacuation via stairs to the floor below
    — Out of building evacuation
  • evacuate to predesignated areas (assembly points)
  • Liaison with ED, OT, HDU, CCU and other high care areas in the hospital and/or neighbouring hospitals for ongoing care of the evacuated patients


Appropriate use = PASS

  • Pull the lockpin from its place
  • Aim the nozzle at the base of the flames
  • Squeeze the handles together; and
  • Sweep from side to side at the base of the flames

Do not use a fire extinguisher unless there are two trained staff and it is safe to do so

References and links

Journal articles

  • Kelly FE et al. Managing the Aftermath of a Fire on Intensive Care Caused by an Oxygen Cylinder. JICS 2014 vol. 15 no. 4 283-287 [Free Full Text pdf]
  • Sankaran K, Roles A, Kasian G. Fire in an intensive care unit: causes and strategies for prevention. CMAJ. 1991 Aug 15;145(4):313-5. PMC1335634.

FOAM and web resources

  • Safe Anaesthesia Liasion Group, 2013. Promoting Fire Safety on Intensive Care and in Theatre. (pdf)

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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