PEEPs for Healthcare Facilities

Patient-Specific PEEP Needs

Categories of Patients Requiring PEEPs

Dynamic PEEP Considerations

• Admission assessments: Every patient admitted should have mobility and evacuation needs assessed within 4 hours
• Deterioration protocols: PEEP must be updated when patient condition changes significantly
• Post-operative reviews: Reassess after surgery, as mobility and consciousness levels change
• Shift handovers: Evacuation needs must be communicated at every handover
• Ward transfers: PEEP follows patient but must be reviewed for new environment

Clinical Considerations for Safe Evacuation

Medical Equipment Continuity

Life-Sustaining Equipment

• Ventilators: Portable ventilators or manual ventilation (bag-valve-mask) available for each ventilated patient
• Oxygen therapy: Portable oxygen cylinders with sufficient capacity; check pressure regularly
• Suction equipment: Battery-powered suction for patients with tracheostomies or secretion management needs
• Infusion pumps: Battery backup or manual delivery methods for critical medications (inotropes, insulin, pain relief)
• Dialysis: Plans for patients mid-dialysis; medical decision on disconnection vs continuation
• Cardiac monitoring: Portable monitors for patients requiring continuous ECG observation

Medication Management During Evacuation

• Emergency medication grab bags prepared for each clinical area
• Time-critical medications identified (insulin, anticoagulants, cardiac drugs)
• Controlled drugs procedures that allow emergency removal from CD cupboard
• Patient’s own medications accompany them during evacuation
• Cold chain preservation for medications requiring refrigeration

Infection Prevention and Control

• Isolation patients: Maintain PPE use by evacuating staff; designate separate area in evacuation zone
• Immunocompromised patients: Protect from exposure during evacuation; consider timing to minimise crowds
• Source isolation: Patients with infectious conditions should evacuate after others where possible
• Pandemic considerations: During disease outbreaks, balance infection risk against fire/emergency risk
• PPE grab bags: Emergency PPE available for evacuating infectious patients

Mental Capacity and Consent

• Best interests: For patients lacking capacity, evacuation decisions made in their best interests under Mental Capacity Act 2005
• Restraint and restriction: Physical intervention to evacuate must be proportionate, necessary, and in patient’s best interests
• Mental Health Act: Patients detained under MHA must be accompanied by appropriate staff; detention continues during evacuation
• Advance decisions: Consider any advance decisions to refuse treatment, but immediate life-preservation takes precedence
• Family involvement: Where possible, involve family in evacuation planning for patients with communication difficulties

Clinical Documentation During Evacuation

• Patient identification: Wristbands must remain in place; if evacuating to another facility, full patient details required
• Medical records: Summary of key medical information, allergies, current treatments (consider electronic systems access)
• Drug charts: Current medication record essential for continuing care
• Care plans: Summary of immediate care needs and treatment plans
• Contact information: Next of kin details for notification and decision-making

Equipment Requirements for Healthcare PEEPs

Patient Evacuation Equipment

Clinical Emergency Equipment

Per Ward/Unit Emergency Grab Bags

• Airway equipment: Bag-valve-masks in multiple sizes, airways, suction catheters
• Oxygen: Portable oxygen cylinders with regulators and masks
• Monitoring: Portable pulse oximeters, blood pressure monitoring
• Emergency drugs: Anaphylaxis kit, cardiac arrest drugs, pain relief, anti-emetics
• IV access: Cannulas, giving sets, saline flushes
• Wound care: Dressings, bandages for any patients with wounds or drains
• Diabetes management: Blood glucose monitoring, fast-acting sugar, glucagon

Specialist Clinical Equipment

• Portable ventilators: For ICU/HDU patients requiring mechanical ventilation
• Portable suction: Battery-powered suction units
• Defibrillator: Automated External Defibrillator or manual defibrillator for critical areas
• Infusion pumps: Battery backup or spare batteries; syringes for manual delivery if needed
• Neonatal equipment: For maternity units and neonatal intensive care (incubators with battery, resuscitation equipment)

Equipment Storage and Accessibility

• Strategic placement: Evacuation equipment stored in accessible locations, not locked away
• Clear signage: Equipment locations clearly marked with pictorial signs
• Staff awareness: All clinical staff know equipment locations on their ward/unit
• Regular checks: Daily checks for critical equipment; weekly for evacuation aids
• Replacement planning: Budget for equipment replacement; obsolete equipment removed

Charging and Power Requirements

• All rechargeable equipment on charging when not in use
• Visual indicators showing charge status checked daily
• Spare batteries available for critical equipment
• Generator backup for essential equipment if mains power fails
• Regular testing of battery life under working conditions

Staffing and Roles During Healthcare Evacuations

Staff Responsibilities by Role

Staffing Level Considerations

Day Shifts (Higher Staffing)

• More staff available for simultaneous patient evacuation
• Senior clinical decision-makers present
• Easier to call additional assistance from other departments
• More equipment readily available

Night Shifts (Reduced Staffing)

• Fewer staff may mean sequential rather than simultaneous evacuation
• May need to prioritise patients more rigorously
• On-call consultants may need to attend
• Consider mutual aid from other wards/units
• Site manager and senior nurse on call must attend

Weekends and Bank Holidays

• Similar challenges to night shifts
• Porters and support services may be minimal
• Plan for clinical staff to perform more manual handling
• Ensure adequate evacuation equipment available

Training Requirements

All Clinical Staff (Annual Training)

• Fire safety awareness and evacuation principles
• Location and use of evacuation equipment
• PEEP procedures for their clinical area
• Manual handling refresher including emergency evacuations
• Participation in fire drills

Senior Staff (Additional Training)

• Clinical prioritisation and triage
• Incident command and coordination
• Business continuity and escalation
• Communication with emergency services
• Post-incident debrief facilitation

Specialist Training

• Evacuation chair operators: Competency-based practical training
• Bariatric equipment users: Specialist moving and handling
• Critical care staff: Transport of ventilated patients
• Mental health staff: Managing distressed patients during evacuation
• Paediatric staff: Evacuating babies and children safely

Facility-Specific Guidance

Acute Hospitals

General Wards

• Horizontal evacuation priority: Move patients to adjacent fire compartment before attempting vertical evacuation
• Progressive evacuation: Evacuate affected area first; prepare adjacent areas for secondary evacuation if needed
• Bay-by-bay approach: Systematically evacuate each bay, maintain patient tracking
• Side room patients: Don’t forget patients in isolation or side rooms
• Day spaces: Check lounges, dining areas, treatment rooms

Critical Care Units (ICU/HDU)

• Staff-intensive evacuation: One ventilated patient may require 3-4 staff
• Equipment-dependent: Portable ventilators, monitors, infusion pumps all needed
• Receiving area: Pre-designated area with piped oxygen, suction, electrical supply
• Mutual aid: Anaesthetic staff and other critical care staff may be required
• Prioritisation: Most stable patients evacuate first to release staff for more dependent patients

Operating Theatres

• Procedure-dependent decisions: Anaesthetist decides if safe to wake/evacuate mid-surgery
• Critical point procedures: Some surgeries cannot be interrupted safely; wait for safe stopping point if possible
• Anaesthetic evacuation: Patient remains intubated and ventilated during evacuation
• Recovery patients: May be able to evacuate mobilising patients first
• Receiving theatre: May evacuate to another theatre suite as temporary refuge

Emergency Department

• Mixed patient groups: Walking wounded, major trauma, minor injuries all present
• Self-evacuation: Many patients can leave independently
• Resuscitation room: Requires similar approach to critical care
• Ambulance liaison: Coordinate with ambulance service; divert incoming patients
• Public flow: Manage public in waiting areas; direct to exits

Maternity Units

• Labouring women: May not be able to mobilise; midwife stays with woman
• Immediate postnatal: Women within hours of birth require assistance
• Neonatal unit: Babies in incubators require battery backup or hand ventilation
• Partners/birth companions: Can assist but require direction
• Premature babies: Require temperature control; use transport incubators

Mental Health Units

• Detained patients: Legal requirements continue; staff escort required
• Absconding risk: Prevent patients leaving unsupervised during evacuation
• Distress management: Some patients may become acutely distressed by alarms/evacuation
• Self-harm prevention: Maintain observations during evacuation
• Least restrictive: Balance safety with least restrictive approach

Care Homes and Nursing Homes

Residential Care Homes

• Familiar environment: Evacuation very distressing for residents with dementia
• Progressive horizontal evacuation: Use fire-resistant compartments; rarely need to leave building
• Resident involvement: Many residents can mobilise with assistance
• Personal belongings: Consider glasses, hearing aids, walking aids
• Medication continuity: Ensure regular medications available

Nursing Homes

• Higher dependency: More residents requiring full assistance
• Bed-bound residents: Use evacuation sheets/sleds for horizontal movement
• Clinical needs: Some residents on oxygen, PEG feeds, catheterised
• Staffing challenges: Often lower staff ratios than hospitals; may need emergency service assistance
• Refuge strategy: Use adjoining fire compartments as temporary refuge areas

Specialist Care Settings

• Learning disability services: Communication adaptations; visual supports; avoid overwhelming
• Autism services: Routine disruption distressing; sensory considerations (alarms, lights)
• Brain injury units: Some residents lack insight; may resist evacuation
• End-of-life care: Preserve dignity; pain relief continuity

Primary Care and Community Settings

GP Surgeries

• Mostly self-evacuating: Patients generally mobile
• Treatment room: Patients mid-procedure may need assistance
• Home visits: GPs should assess home evacuation capability
• Emergency bag: Grab bag available for evacuating with essential items

Community Hospitals

• Rehabilitation patients: Mix of abilities; many mobilising with aids
• Staff support: Physiotherapists, OTs can assist with mobilisation
• Lower acuity: Generally less equipment-dependent than acute wards
• Respite care: Liaise with families re: patient needs

Dialysis Units

• Mid-treatment dilemma: Medical decision to disconnect vs continue
• Haemodynamic instability: Some patients hypotensive during dialysis
• Vascular access: Protect fistulas/lines during evacuation
• Wheelchair transfer: Most patients can transfer to wheelchair

CQC Compliance and Regulatory Requirements

What CQC Expects

Regulatory Fundamentals

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

• Assess risks to health and safety (including fire risks)
• Do all that is reasonably practicable to mitigate risks
• Ensure persons providing care have necessary qualifications, competence, skills and experience
• Ensure proper and safe management of premises and equipment

Regulation 17: Good Governance

• Systems to assess, monitor and improve quality and safety
• Seek and act on feedback from patients and staff
• Maintain accurate, complete, and contemporaneous records

Fundamental Standards

• Person-centred care: PEEPs must reflect individual needs and preferences
• Dignity and respect: Evacuation procedures preserve dignity
• Safe care and treatment: Risks properly assessed and mitigated
• Safeguarding: Vulnerable people protected during emergencies
• Adequate staffing: Sufficient numbers of suitable staff
• Premises and equipment: Properly maintained and suitable

CQC Inspection Preparation

Evidence CQC May Request

• Fire risk assessment and evidence of actions taken
• PEEP policy and procedures
• Sample of individual patient PEEPs (anonymised)
• Training records and competency assessments
• Fire drill records and learning outcomes
• Equipment maintenance logs
• Business continuity plans
• Staff handover documentation showing PEEP information
• Incident reports and learning from evacuation incidents
• Governance meeting minutes discussing fire safety

What Inspectors May Observe

• Staff knowledge of PEEP procedures
• Availability and condition of evacuation equipment
• Clarity of evacuation routes and signage
• Fire doors not propped open or obstructed
• Staff-to-patient ratios adequate for safe evacuation
• Patient records showing mobility assessments
• Communication systems for raising alarm
• Refuge areas appropriately equipped

Questions Inspectors May Ask Staff

• “Which patients on your ward/unit have PEEPs?”
• “Can you describe how you would evacuate [specific patient]?”
• “Where is the evacuation equipment stored?”
• “When did you last practice using an evacuation chair?”
• “What would you do if the fire alarm sounds during night shift?”
• “How do you know if a patient’s PEEP needs updating?”

Documentation Standards for Healthcare PEEPs

Individual PEEP Documentation Must Include

Central PEEP Register

• Organised by ward/unit and easily accessible
• Updated in real-time as patient conditions change
• Available to all clinical staff but GDPR compliant
• Includes summary information for rapid reference
• Flags time-critical reviews or equipment needs

Integration with Clinical Systems

• PEEP status visible on electronic patient records
• Automatic alerts when mobility assessment overdue
• Handover systems include PEEP information
• Ward boards display patients with PEEPs (discreetly)
• Bed management systems consider evacuation capability

Emergency Procedures and Scenarios

Fire Alarm Activation – Immediate Actions

1. Alarm ConfirmationSenior staff confirm whether alarm is genuine emergency or false alarm. If uncertain, treat as real. Call switchboard/security for confirmation.
2. Immediate Safety ActionsClose doors to affected area to contain fire/smoke. Ensure all patients in immediate danger are moved to safety. Do not use lifts.
3. Rapid AssessmentWard manager or senior nurse quickly identifies: How many patients need evacuation assistance? Do we evacuate horizontally or vertically? How many staff available? What equipment needed?
4. Call for AssistanceAlert other departments if additional staff needed. Site manager, matron, or duty manager should attend. Consider calling porters, security, off-duty staff if major incident.
5. Systematic EvacuationFollow pre-planned PEEP procedures. Allocate specific staff to specific patients. Independent patients evacuate first (clears routes). Assisted patients next. Most dependent patients last (with full team).
6. Equipment and Medication GrabDesignated staff retrieve emergency equipment bags, essential medications, portable oxygen. Grab patient notes if time permits.
7. Roll CallAt assembly point/receiving area, confirm all patients accounted for. Report any missing patients immediately to fire service. Check patient wellbeing and clinical needs.
8. Clinical ContinuityIn receiving area, prioritise patients requiring immediate clinical intervention. Resume time-critical treatments. Monitor patient observations. Maintain infection control where possible.

Horizontal vs Vertical Evacuation

Horizontal Evacuation (Preferred in Healthcare)

• Definition: Moving patients through fire doors into an adjacent fire-resistant compartment on the same floor
• Advantages: Faster, requires less equipment, maintains patients on same level, can use beds, less physically demanding
• When to use: First response in most hospital fires; fire contained to one compartment
• Receiving area: Adjacent ward bay, corridor, or compartment with fire doors closed

Vertical Evacuation (When Horizontal Insufficient)

• Definition: Moving patients to a different floor via staircases
• Challenges: Slower, requires evacuation chairs/carrying, cannot use beds, physically demanding, higher risk
• When necessary: Entire floor affected, smoke spread beyond compartments, structural damage
• Method: Use evacuation chairs for patients who cannot walk; multiple staff required per patient

Scenario-Based Responses

Post-Evacuation Procedures

1. Patient safety check: Assess all patients for any deterioration or injuries sustained during evacuation
2. Clinical prioritisation: Identify patients requiring immediate medical attention
3. Family notification: Contact next of kin if patients moved to different location
4. Documentation: Record evacuation in patient notes; note any clinical incidents
5. Equipment recovery: Retrieve evacuation equipment for cleaning and return to service
6. Staff debrief: Gather staff to discuss what worked and what didn’t
7. Formal debrief: Structured review within 72 hours involving all disciplines
8. Learning and improvement: Update PEEPs and procedures based on lessons learned
9. Incident reporting: Complete formal incident reports as required
10. Patient and family support: Recognise trauma of evacuation; provide reassurance and support

Common Challenges in Healthcare PEEPs

Learning from Incidents

• Incident reporting: All evacuation events formally reported through incident system
• Root cause analysis: Significant incidents investigated using RCA methodology
• Thematic analysis: Review multiple incidents to identify patterns and system issues
• Action plans: Clear actions with owners and timescales to address identified risks
• Sharing learning: Disseminate lessons across organisation and wider health system
• Monitoring effectiveness: Check that implemented actions have resolved issues

Fire Drills in Healthcare Settings

Planning Effective Healthcare Fire Drills

Frequency Requirements

• Each department/ward: Minimum of two drills per year
• All staff: Participate in at least one drill annually
• Night shifts: At least one drill annually including night staff
• New departments: Drill within first month of opening
• After major changes: Drill after significant building works or procedure changes

Types of Healthcare Fire Drills

• Full evacuation drill: Actually move patients to receiving area (usually one or two patients)
• Partial evacuation drill: Test procedures but don’t actually move patients
• Table-top exercise: Discussion-based scenario without physical movement
• Equipment testing: Practice with evacuation equipment without patient involvement
• Desktop scenario: Senior staff work through command and control decisions

Patient Involvement

• Gain consent from patients to participate in drills
• Select stable patients with capacity to consent
• Brief patients on what will happen
• Stop drill immediately if patient becomes distressed
• Have clinical staff present throughout
• Document patient involvement and any concerns

Drill Scenarios to Test

• Fire in patient bay – horizontal evacuation to adjacent area
• Fire blocking main corridor – alternative route needed
• Fire on ground floor – vertical evacuation required from upper floor
• Night shift with minimal staff – test mutual aid protocols
• Multiple dependent patients – test prioritisation and resources
• Critical care patient evacuation – test equipment and clinical continuity

Drill Evaluation and Learning

Documentation Requirements

• Date, time, and location of drill
• Names of participants and absentees
• Scenario tested
• Equipment used
• Time taken to complete evacuation
• Observations and assessment of performance
• Issues identified and lessons learned
• Action plan with responsibilities and timescales
• Signature of person leading drill

Quick Reference Summary

Essential Actions for Healthcare Facilities

1. Assess every patient’s evacuation needs within 4 hours of admission
2. Create individual PEEPs for all patients who cannot self-evacuate
3. Update PEEPs immediately when patient condition changes
4. Ensure adequate staffing levels for safe evacuation at all times
5. Maintain evacuation equipment in accessible locations with regular checks
6. Train all staff in PEEP procedures and equipment use
7. Conduct regular fire drills testing realistic scenarios
8. Maintain comprehensive documentation for CQC compliance
9. Learn from every incident and near-miss
10. Integrate PEEPs into all clinical processes and handovers

Critical Success Factors

• Clinical leadership: Senior clinicians champion PEEP systems
• Person-centred approach: Each PEEP reflects individual needs
• Dynamic updating: PEEPs change as patient conditions change
• Staff competence: All staff trained and confident in procedures
• Adequate resources: Sufficient equipment, staffing, and training
• Regular testing: Frequent drills expose weaknesses before real emergencies
• Continuous improvement: Learn from experience and implement changes