Human factors


Developing a live fire exercise for theatres


Kris Birney, a registered ODP, discusses the planning and development of a multi-agency live fire exercise within the operating theatre suite at a large acute NHS hospital as part of its obligatory assurance processes. This article discusses how the exercise was developed and implemented and examines what went well and areas that were identified to improve both patient and staff safety.


This paper aims to discuss the development and implementation of a live fire exercise developed with multi-partner agency partners at an acute trauma unit hospital, which is part of a large NHS Trust within the southeast of England and supports the delivery of healthcare to a population of greater than 600,000. The hospital, in which the exercise was undertaken, has eleven operating theatre suites – eight of which are connected as one large suite. A full range of surgical specialties are undertaken at the selected hospital site. The exercise’s aim was to test the hospital’s


response to a fire in the six elective operating theatres. The objectives developed were to test the engagement with the operational clinical site management (CSM) and the County Fire & Rescue Service (CFRS) and to exercise test command and control with multiagency partners following the Joint Emergency Services


Interoperative Principles (JESIP), engaging in joint decision making and situational awareness, at both the Bridgehead at operational commander level, and in the Incident Control Centre (ICC) at tactical commander level. JESIP is the standard for managing the local, multi-agency response to emergencies, from pre-emergency (planning), through to the emergency response and recovery.1


It promotes


joint working to identify and respond, when clear, robust decisions and actions are required with minimal delay, in a rapidly changing environment. Like all NHS Trusts within NHS England,


the Trust has a responsibility under the Civil Contingencies Act (2004)2


and its contract with


commissioners to exercise test emergency plans and to work, train and co-operate with multi-agency partners (NHSE 2015, NHSE 2019a, NHSE 2019b).3-5


Method


Initial discussions were held when undertaking the annual review of fire planning between the emergency planning team and the theatre department, regarding the fact that, although the plans were in place, they had never been tested in the real environment. The theatre department was keen to test this with their staff, as part of implementation of in situ simulation training for human factors. Human factors are a term described as a way of detecting safety issues relating to both technical designs of equipment, the non- technical skills and resource management of humans.6


A planning meeting took place between the


Emergency Planning Team and theatre practice development facilitator, which discussed what the issues were with theatre staff knowledge of their fire plan; obstructions in corridors; the numerous fire doors; and the fact the theatre suite is subterranean with minimal window space. Coincidently during this time, CFRS had


contacted the Emergency Planning Team regarding exercising opportunities within the hospital (specifically clinical areas), so a small tabletop exercise was arranged with the theatre clinical coordinator, emergency planning, Interserve (our estates and facility providers) and the fire service, working through a scenario- based around the geographical layout of the area, and critical points such as rendezvous points (RVP), hydrants and availability of maps of the area on arrival, command and control, and alerting. The tabletop exercise identified several questions that would require review. This included: l Confusion about the mechanism in place to record numbers of staff and patients present


July 2023 I www.clinicalservicesjournal.com 43


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