In the event of a fire, Care Home residents are unlikely to be able to make their own way to a place of relative safety due to physical or neurological impairment. PEEPs (Personal Emergency Evacuation Plans) are intended to identify the evacuation equipment required and the level of staff assistance necessary to evacuate a resident, typically from their bedroom.
PEEPs should be carried out for each and every resident. The completion of PEEPs is subjective; if staff from different Care Homes were to complete an assessment for the same resident, without any guidance to work to, they would probably all produce different assessments.
This article and the supporting PEEPs template prepared by Marpal Ltd, intends to help Care Home Managers and Care Groups achieve a consistent approach, when completing PEEPs in accordance with recognised guidelines.
Note: PEEPs provide only part of the solution; each home will also need a documented Fire Evacuation Strategy.
What the guidance defines as independent, dependant and very high dependency residents
Residents within Care Homes who can evacuate without any staff assistance are few and far between, it is therefore essential to plan in advance for an emergency evacuation and identify the level of staff assistance and type of aids required.
Although most Care Homes tend to classify risk as low, medium or high, HM Governments’ Fire Risk Assessment guidance suggests the following categorisation:-
- Independent: the mobility of residents is not impaired in any way and they are able to physically leave the premises without the assistance of staff or, if they experience some impairment, they are able to leave with minimal assistance from another person.
- Dependent: all residents except those defined as independent or very high dependency. This category also includes those with mental health problems regardless of their independent mobility.
- Very high dependency: those residents whose care and/or condition creates a high dependency on staff or where immediate evacuation would prove potentially life threatening.
Considering the above definitions, it is clear that residents will very rarely be classified as independent (low risk).
The rules for emergency evacuation
When choosing a method of evacuation and evacuation equipment, the speedy and safe evacuation of the residents is the main objective.
In the event of a fire, the evacuation of residents is deemed ‘an exceptional circumstance’. Within reason, the normal rules of lifting and handling do not apply e.g. a resident who is hoisted for day to day care would not be hoisted for evacuation purposes, unless they are too heavy to manually transfer in to a wheelchair or similar evacuation aid.
Similarly, a resident who normally uses a Zimmer frame may be better served for evacuation purposes by a wheelchair with staff assistance.
Please note that the purpose of a PEEP is not to document the day to day lifting and handling needs of the resident.
Physical, neurological and general medical issues to consider
The issues below should be considered and where relevant issues are identified, they should be documented within the residents’ PEEP.
Physical issues to be considered:-
- Does the resident suffer from strokes, cerebral palsy, muscular dystrophy, multiple sclerosis or similar condition that would affect their ability to self-evacuate?
- Can the resident sit safely within a wheelchair or tilt chair?
- How much does the resident weigh? If you’re likely to only have two members of staff available could they manoeuvre the resident in to either a wheelchair or on to an evacuation mat and ultimately carry the resident down a staircase?
- Residents receiving end of life care or those that are extremely frail will need consideration in line with company policy and procedure, should moving the resident potentially result in a fatality.
- Severe hearing impairment – Whilst a high proportion of residents may have poor hearing, those registered as deaf should be recorded.
- Severe sight impairment – Loss of sight or severely impaired sight in one eye e.g. following an operation may not be critical, however, where both eyes are affected, this should be recorded.
- Would the resident be able to either walk down or move down the staircase on their bottom?
- If the resident is a wheelchair user, can they self-transfer with minimal staff assistance?
Neurological issues to be considered:-
- Does the resident suffer from Alzheimer’s, Dementia, Parkinson’s disease, Huntington’s disease, dyspraxia or other condition that would affect their ability to self-evacuate.
- Some residents may attempt to access stairs and final exits upon the activation of the fire alarm system and attempt to abscond, any such tendency should be recorded.
- Residents who may resist an evacuation should be identified.
- Unusual habits should be noted e.g. residents who prefer to sleep in lounge or dayroom areas.
- Residents who may become distressed by the alarm and any sudden activity (particularly prevalent in Homes catering for residents with autism).
- Does the resident suffer from conditions such as agoraphobia or similar condition that would hinder the movement of the resident?
General Medical Issues to be considered:-
- Medication that the resident receives and whether or not this could make them unresponsive or unable to evacuate e.g. medication to aid sleep.
- Does the resident have asthma or any similar breathing problem? (they will need their inhaler with them when evacuated).
- Is the resident diabetic? (an emergency blood sugar boosting food such as glucose tablets may be required).
- Whether or not the resident is attached to medical equipment that could delay or prevent their evacuation.
- Does the resident have a heart condition?
- Evacuation equipment provision and its location
Once the needs of the resident have been identified, there is a plethora of evacuation equipment available to assist staff in the evacuation of residents. Both staff and residents are often uncomfortable with using evacuation chairs as there is a perceived higher risk of falling down the stairs, neurologically impaired residents may also attempt to kick out and grab on to handrails etc. Evacuation mats and evacuation bed mattresses tend to be preferred in Care Homes.
At night, for residents who need a dedicated aid such as a wheelchair or an evacuation mat, it is recommended that staff place these aids within the residents’ bedroom.
The equipment needs to be available in an emergency, hence the positioning of wheelchairs in a store is inappropriate as they may be inaccessible in the event of a fire, and there would be a time delay transporting the equipment.
Within a Care Home, there should be at least 1 evacuation mat in every upper floor level stair enclosure and adjacent to external doors that, upon having evacuated to the external area, a resident would then need to be carried up or down a flight of external steps.
If it is necessary to take residents down stairs, it may be appropriate to carry very light weight residents down the stairs in their own wheelchairs, if they are not neurologically impaired and will remain calm during the process. This method is quicker and less stressful for the resident, note however, unlike evacuation chairs/mats, the residents’ wheelchairs will not contain restraint straps. This option would need to be risk assessed on a resident by resident basis.
Sharing of information with Staff
The PEEPs will be of little value to staff if they are unaware of the content.
Once the detailed PEEPs have been written, summaries are usually compiled and broken down in to a traffic light system of risk/dependency (typically; low (green), medium (orange) and high risk (red)). A simple aid memoir to staff is to place above the top corner of the bedroom door opening, a small corresponding colour coded sticker.
This colour coding system can be enhanced by adding similarly sized, universally recognised symbols alongside the colour coding e.g. wheelchair symbols, evacuation mat, walking aid, deaf, blind, very heavy resident (hoist), etc. This type of enhanced system will help both permanent and agency staff who may be unfamiliar with the residents needs.
Location within the Home
Once the evacuation needs of the residents have been established, the location of the resident within the Home needs to be considered.
Bariatric and any other residents who could not be carried down stairs by staff, should not be placed on upper floor levels (unless there is an evacuation lift that can be accessed from within their fire compartment).
Very high risk residents should be placed within a ground floor level bedroom, ideally with patio or French external doors, or alternatively, place these residents in small fire compartments, adjacent to exit doors.
Avoid placing too many high risk residents in one fire compartment as this may significantly extend the required evacuation time for the compartment (the aim is to be able to evacuate a compartment in around 2 ½ minutes).
Also consider the number of escape routes available and avoid placing high risk residents in ‘dead end’ corridors.
Having considered the above issues and made all possible improvements within the Home Managers control, the Home Manager should ascertain whether or not each residents’ bedroom can be evacuated from a fire source room within 2 ½ minutes of the alarm being raised. If there is any doubt whether or not this time would be met, physical alterations to the building may be required e.g. additional corridor sub division doors or sprinkler protection.
PEEPs template for residential care homes
Marpal have developed a free easy to use template with pre-loaded drop down text options to enable comprehensive PEEPs to be completed quickly and consistently across Care Groups.
The information given above is for general information purposes only and considers the authors own experience whilst providing fire safety advice within the Care Sector and by reference to information available on the subject matter. Notwithstanding the above, there may be other issues to consider that are not identified within this document.
Posted by: Adrian Gouldin Bsc (Hons) MRICS GIFireE, Marpal’s Head of Fire Safety & IFE registered Fire Risk Assessor.
For further information on Fire Safety, please contact Adrian Gouldin by phone (01332 668877) or email ([email protected]).