TIME TO GO Surgical team members prepare to move a "patient" during a planned fire drill at Southcoast Health System in New Bedford, Mass.

Are flames likely to erupt in your ORs? No. Could they? Yes, and that's why it's vitally important to run effective fire drills once a year, however remote the possibility of using the practiced responses. Here's how to ensure your staff gets the most out of preparing for when every second really does count.

Announce it, don't just pull the alarm. It's easy to run a conventional fire drill: Just pull the alarm and watch surprised surgical team members scramble. But that's not an effective way to practice fire safety. First, your surgical team won't get anything out of the unannounced drill, other than perhaps memories of what they did wrong and anxiety from the confusion of undefined roles. Most professionals also don't appreciate being set up to fail by "gotcha" moments, even if there are lessons to be learned from their mistakes. Announcing when drills will occur might seem counterintuitive, but having staff participate in the planning and timing of the practice runs creates team buy-in and lets them practice proper fire response protocols instead of reacting incorrectly to an ill-timed surprise.

Plan ahead. Conduct a tabletop drill with leaders from each of your facility's departments. Get the local fire marshal involved at this point: He'll be more than happy to participate and will provide valuable insights on planning and producing effective drills. For example, we were na??ve to how quickly we had to move during fire emergencies. Our town's marshal provided a sense of urgency and seriousness as we discussed who would do what and when. He told us fire toxins can kill in a matter of minutes, and patients had to be out of the surgical department before his fire team arrived and laid hoses across exits where we planned to roll stretchers. Those are things we hadn't considered.

Set expectations. Have department heads discuss their needs for the drill and specifically for when patients need to be moved to safety. You might be surprised that even though nurses, techs, surgeons and anesthesia providers are all interested in getting patients out of ORs as quickly as possible, they have various goals in mind during the process. Anesthesia providers, for example, focus solely on securing patients' airways before they're moved. Techs and nurses, meanwhile, want to know where the equipment they'll need for the safe transport of patients is stored and how they can best access it. Moving forward with these different perspectives in mind will help you plan a drill that meets the evacuation needs of each surgical team member.

Run it like it's real. Set aside an hour one morning before cases start. Gather staff beforehand to outline their roles in the emergency response and discuss how the drill should proceed. In each OR, point out where anesthetic gases are turned off and who's responsible for doing so. Identify who'll grab equipment and who'll prepare patients for transport. Identify who'll be responsible for securing the surgical schedule, staff list, and vendor and student sign-in sheets. That person should conduct a headcount in the agreed-upon meeting area to ensure the ORs have been evacuated and that everyone is accounted for.

Assign teams to each OR where they should "perform" specific cases. Let them know exactly when the fire alarm will be pulled and where the "fire" will be located. Have staff members lay on stretchers so their colleagues get a feel for moving "patients" through the hall and around corners in a controlled but urgent pace. Let staff know they must pull OR doors when the rooms are evacuated.

Drills are dry runs, but instill a sense of seriousness to the proceedings. Your staff should respond with urgency and move at a pace reserved for a real emergency. Going through the motions or joking around during the drill's critical moments renders the time useless. Another important point: Have a member of your staff actually pull the fire alarm. It's something they've probably never done before and it takes more force than they might think.

Debrief. This is a critical step. Take a few minutes to discuss the drill with the surgical team in the meeting area as soon as the event concludes. What went right? What could have gone better? Did staff have the equipment they needed, and were they able to move patients to safety in a timely manner? It's during this time, when things are still fresh in everyone's mind, that you'll identify key areas of needed improvement. For example, we had communication issues due to glitches in the hospital's intercom system that needed to be fixed. That was a highly valuable discovery that could have been quite challenging if we had to navigate without it during a real fire.

Practice makes perfect
Announced and planned fire drills are extremely effective. You'll find that staff are engaged in the process, take away many valuable lessons and discuss the event for days afterward, sharing ways to improve. Staged drills let them go through fire responses successfully, giving them confidence in their emergency-response roles.

BEFORE AND AFTER Set the scene before the drill (left) and discuss how things went afterward in the designated meeting area.