4-3

Emergency evacuation

Anaesthetised or sedated patient requires unplanned transfer because of environmental hazard (e.g. flood, fire, smoke, structural collapse, noxious gas).

START.
1
Can patient be moved?
2
Stop and pack
3
Transfer to bed/trolley
4
Evacuate non-essential staff
5
Airway
6
Breathing / ventilation options
7
Circulation
8
Maintenance of anaesthesia
9
Drugs
10
Monitoring
11
Muster points
12
Evacuate
Box A UNABLE TO MOVE PATIENT

Ensure adequate depth of anaesthesia.

Ensure adequate reserve: 100% oxygen, low flow, fill vaporiser.

Ensure adequate neuromuscular blockade if relevant.

Evacuate all staff, including anaesthetist when indicated.

Inform rescue services and theatre coordinator.

Box B DRUGS

Drugs may not be readily available at muster point.

Aim to take:

Oxygen

Propofol / other hypnotic

Neuromuscular blockade

Vasopressor(s)

Analgesics

i.v. fluids

Neuromuscular reversal if extubation anticipated

Box C MUSTER POINT

Able bodied → adjacent safe zone.

Anaesthetised/sedated patient → area with appropriate access to oxygen and medications, e.g. theatre, recovery or critical care area in a safe zone.

Inform rescue services and relevant coordinator of location.

Box D ROUTE

Ensure route avoids original hazard and any consequent ones.

Caution using lifts, especially in fire.