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A fire emergency evacuation plan (FEEP) is a written document which includes the action to be taken by all staff in the event of fire and the arrangements for calling the fire brigade. General Fire Notice For small premises this could take the form of a simple fire action sign posted in positions where staff and relevant persons can read it and become familiar with its contents. Staff Fire Notice High fire risks or large premises will need more detailed emergency evacuation plan which takes account of the findings of the risk assessment, e.g. In certain cases you should nominate persons to implement the fire action plan and give them adequate training in fire fighting and evacuation procedures. You need to consider how you will arrange the evacuation of the premises in the light of your risk assessment and the other fire precautions you have or intend to put in place.
In most premises, the evacuation in case of fire will simply be by means of everyone reacting to the warning signal given when a fire is discovered, then making their way, by the means of escape, to a place of safety away from the premises. In some larger complex premises, the emergency arrangements are designed to allow people who are not at immediate risk from a fire to delay starting their evacuation. This strategy may be considered in blocks of flats were each flat is a minimum 60 minutes fire resisting compartment. You should only plan to use defend in place or phased evacuation schemes, or a staff alarm system, if you have sought the advice of a competent person and the fire and rescue  service.
On discovering a fire, it is the duty of every person to sound the nearest fire alarm immediately.
The plan should instruct all personnel upon on hearing the fire alarm to act in accordance with the agreed FEEP strategy and if a fire warden’s scheme is in force they, on hearing the alarm, should proceed to pre-determined positions to assist members of the public and staff to leave the building by the nearest safe route. Lifts and escalators should not be used due to possible electrical failure unless they are part of a Personal Emergency Evacuation Plan.
The Fire Service should also be informed immediately, either by switchboard operator or person discovering fire, dependant on conditions. Work Time – Switchboard operator to be conversant with the emergency evacuation plan, also should ensure necessary extensions switched through, when switchboard is unattended. Other Times – Remainder of Staff (Cleaners, caretakers etc) also to be conversant with procedure. In premises where members of the public or persons unfamiliar with layout of the premises are present there should be means available to identify the key escape routes.
The Responsible Person where necessary to safeguard the safety of employees should nominate employees to implement certain fire safety measures which will include the fire evacuation. A senior official in each building [Chief Fire Warden] should be given the responsibility of maintaining a high standard of fire precautions and the overall responsibility for the action in the event of fire. Procedure for nominated staff to assist employees and members of the public to nearest exits.
Another consideration when selecting the location for an assemble site is to fully understand the fire emergence evacuation plan. The assemble point should be far enough away from the building not to put staff in danger of radiated heat and falling debris. Be close enough to ensure that the nominate person who is in charge of the assemble point; can communicate with the nominated fire liaison person who should be located near the main entrance. The area chosen should be larger enough to accommodate all the staff, if this cannot be found you may have to consider additional sites.
It should not be in an enclosed area and the staff should be able to disperse without the need to pass close to the premises on fire.
Inclement weather needs to be considered and some form of shelter or other weather protection may be necessary as the staff are most likely to have evacuated without collecting their out of doors clothing. A nominated fire team, if available, or any trained competent person should, where possible, attack fire with appropriate equipment however fire fighting is always secondary to life safety. The emergency evacuation plan should be the subject of frequent training so all employees are familiar with its contents and there should be regular evacuation drills. The fire emergency evacuation plan must be included in the instruction and training you need to give your employees. In order to assist disabled or sensory-impaired people to escape from fire it may be necessary for staff to be trained in the correct procedures to cope with this eventuality. You should arrange all the necessary contacts with external emergency services and make them familiar with your fire action plan. There should be senior person nominated to meet the fire and rescue service when they arrived to provide them with any information they require.
In case of a fire requiring evacuation, please pull the nearest fire alarm and exit the building in a calm and orderly fashion. From the "You Are Here" marking there will be arrows leading to all the exits available to you. Never use an elevator in the event of a fire, also try to avoid the tunnels if at all possible unless it is your only option. A EnlargeThe summary is integrated in that it includes data on one page from multiple (and now unnecessary) parts of a traditionally organized chart. This is known as a simultaneous evacuation and will normally be initiated by the sounding of the general alarm over the fire warning system. It may be appropriate to start the evacuation by initially evacuating only the area closest to the fire and warning other people to stand by.


It may also be considered in hospitals or nursing homes were patients are connected to life supporting equipment and cannot be moved.
In any case the senior official should ensure that Fire Service is called in the event of an outbreak of fire. They could include schematic drawings and most importantly emergency escape and exit signs. You may require one on each floor or department with a chief fire warden coordinating their actions to make sure all persons are accounted for in the event of a fire. The person who is in charge of the assemble point should report to the person who as been nominated the fire service liaison person indicating all persons accounted for or whose missing and where they were last seen. Calculate the number of staff that would need to assemble and if it was a multi-occupied building you would need to co-operate with the other occupants. Open areas are ideal like pedestrian areas also car parks could be considered but be aware of the dangers.
You are required to carry out this fire training and it is recommended that you keep a record of the results of that training. Advice on the specific needs of disabled and sensory-impaired people can be obtained from organisations representing the various groups.
If a fire is severe enough to warrant evacuation, pull one of the pull stations on your way out to warn others in the building. More importantly, however, it is integrated in that the relationships between problems, medications and measured flowsheet parameter results are evident on a single page, and their changes (compensated or decompensated, improving or progressing) are readily apparent over time. In addition notices giving clear and concise instructions of the routine to be followed in case of fire should be prominently displayed.
This is normally done by immediately evacuating the floor where the fire is located and the floor above. In such circumstances a staff alarm can be given (by fire records, personal pagers, discreet sounders or a coded phrase on a public address system etc). The concept allows the occupants to stay put and allow the fire service to extinguish the fire.
They also require special training above the needs of the normal employee, this training could be in house or by an external fire training organisation.
Regular drills should be carried out using varying escape routes assuming the normal evacuation route is not available.
You will also find a directional arrow, and a "You Are Here" marking on the map, use this this information to orientate yourself.
Only consider using a fire extinguisher if you are trained to do so, and if you can safely do so without risk to yourself or other persons. Following the staff alarm, a more general alarm signal can be given and a simultaneous or phased evacuation started. They should be competent in the use of fire extinguishers and be capable of extinguishing small fires. It is important for everyone to familarize themselves with the exits in buildings they occupy. The general alarm may be activated automatically if manual initiation has not taken place within a pre-determined time.
In the case of patients connected to life supporting equipment then a decision would have to be made which option is the best, stay or move, either way the patient would be at serious risk.
They should have some knowledge of fire prevention and be able to identify possible fire hazards to prevent fire from occurring. Finally, new medications or dosage changes and newly ordered lab or imaging tests are entered into the column for the next visit (again, with colons to indicate that results are pending).The clinical example on page 36 describes the case of a hypothetical middle-aged female patient with a fairly complicated set of problems and shows how the integrated summary would be completed over several visits. The fire warning system should be capable of  giving two distinctly different signals (warning and evacuation) or give appropriate voice messages. Finally they should have an in depth knowledge of the FEEP and their role in implementing it.
Horizontal Phased EvacuationIn hospitals, and care homes the floor maybe divided into a number of fire resisting compartments and the occupants are moved from the compartment involved in fire to the adjacent compartment and if necessary moved again. The integrated summary is a single concise page kept topmost on the left side of the chart, opposite the most recent progress note, readily available for quick review prior to evaluating the patient. Depending onto the fire situation it may eventually be necessary to consider vertical evacuation.
Because of the extra time this type of evacuation takes, other fire precautions maybe be required. For any problems that require the monitoring of clinical parameters over time, I enter those parameters directly across from (or near) their listed problem. The middle panel on the left is the problem list, where problems are organized by disease or organ system following some sensible order (see the box).
I also list the suggested reassessment frequency for a stable, compensated patient, where needed.
The three panels on the left side of the page contain relatively static data that rarely change; the three panels on the right contain more dynamic data that change with each visit. For example, as I conduct a new patient history, if the patient tells me about chronic hepatitis first, I may enter this problem about one third of the way down the list.


These responses are all easily correlated to (and hence integrated with) the medication dosages immediately above and the problem or disease listed to the left.Screening and prevention. This might span six weeks in a patient with severe hypertension whose medication is being aggressively titrated or six years in a healthy patient getting yearly mammograms. The lower right panel of the integrated summary records interval screening exams and tests, their recommended frequencies and their results. I also document last menstrual period and lactation here to remind me of drug contraindications in patients who are at risk of conception or who are breast-feeding.Plan. At the very bottom of the lower right panel are a few lines to abbreviate the interventions done today, tests to follow up, next appointment interval and other plans. Often, this is sufficient to guide my next visit without even referring to my previous progress note.Making it your own. She gives a history of hypertension (HTN), familial risk for coronary artery disease (CAD) and smoking (all of which are added to the problem list), and her exam shows wheezing leading to a new diagnosis of chronic obstructive pulmonary disease (COPD). The use of an integrated summary considerably reduces the time needed to address problems at every stage of the assessment. The past medical history (PMH) section is filled in from her history, and the immunizations heading helps to remind me that (now that she has been diagnosed with COPD) she is a candidate for pneumococcal polysaccharide (PPS), which is given. For returning patients, I can quickly refresh my memory of their health status, review my prior plan and make a preliminary task list for today’s appointment, usually in less than a minute. It takes only a few seconds during my interview to record today’s data into the flow sheet, write any medication adjustments into the medication list and record an abbreviated plan.
Integrating the problem and medication lists to the flow sheet, I choose the parameters of blood pressure (BP), basic metabolic panel (BMP) and heart rate as appropriate to monitor, and the new diagnosis of COPD suggests adding metered dose inhaler (MDI) frequency and peak flow. Integrated flowsheet values documenting bradycardia and restricted peak flow assist me in recognizing that atenolol is now contraindicated, for which I substitute hydroclorothiazide (HCTZ), and that albuterol is needed, as shown in the next column of the medication list.
Having a single page facilitates compulsively keeping my lists of problems, medications, lab results and screening tests due up-to-date. For a few patients with complex problems, I must keep separate traditional (though organized) medication and problem lists when they exceed the space allotted on the integrated summary.When sending patients to consultants or the emergency room, or when giving records to patients who are moving away, I often copy just the integrated summary. When dictating admission notes, I often do so from just this one page without the need to resolicit information from the patient or search through the chart. The problem list is further expanded to show that the patient heeded my recommendation to quit smoking. However, because the integrated summary is a concept, not a fixed layout, it can be customized to suit physicians’ documentation preferences.
The abbreviated plan section also shows that a one-time oral steroid burst (prednisone) was prescribed.
Requiring only a little practice, the integrated summary is a valuable tool that can help physicians improve the quality and efficiency of patient care.
It also records that the previously acceptable low-density lipoprotein (LDL) result of 130 in last month’s screening column is no longer adequate in light of DM and records the new entry of hyperlipidemia.
It also shows that prophylactic aspirin has been recommended now that the patient has other CAD risk factors with DM. Flowsheet parameters of glucose, glycohemoglobin (HbA1c), urine dipsticks, ophthalmic and podiatric screens, as well as liver function tests (LFTs) to monitor statin therapy are added and ordered as indicated by the colons. The results of last month’s tests are recorded in the preceding column of the flow sheet after the colons, and the flowsheet parameters measured today are recorded in the current column. The integrated flow sheet shows the home glucometer readings are suboptimal in response to the glyburide dose recorded above, and an augmented twice-daily dose is recorded in the next column.
The problem list is expanded to annotate the results of major quantifying hospital tests including head computed tomography scan (CT), echocardiogram (ECHO) and adenosine thallium cardiac perfusion scan (AdThal). I update her medication list to reflect that digoxin was started in the hospital for rate control, warfarin was substituted for aspirin for anticoagulation, and that metformin was added for her yet suboptimal glucometer readings.
Her flow sheet is modified by adding new monitoring parameters for rhythm, digoxin level and International Normalized Ratio (INR). Hospital admission lab results are added to the preceding column, and colons mark the pending results of tests ordered today. The screening section shows a flexible sigmoidoscopy is scheduled, and the plan section documents a one-week follow-up.A EnlargePast medical history. The lower left panel of the integrated summary contains a summary of pertinent past medical history. Its organized structure allows drugs to be grouped vertically by organ system and horizontally by temporal order of initiation.
Grouping like agents (and leaving blanks above and below to add future agents for other systems) makes it easier to associate groups of drugs to a corresponding problem and choose when to titrate existing drugs or add a new agent.



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