START

❶ Call for help – extra staff to monitor patient and source additional equipment.

❷ Liaise with local coordinator to activate appropriate local plan (Box A):

• If immediate evacuation necessary → 4-3

❸ Get additional light into theatre (Box B).

❹ Ensure ventilation continues:

• Manual ventilation if required.
• Consider moving to spontaneous ventilation.
• Maintain anaesthesia.

❺ Check the pulse and blood pressure manually if monitors have failed.

❻ Check mains oxygen supply intact. If failed → 4-1

❼ Unplug unnecessary equipment. Use correct socket for essential equipment (Box C).

❽ Assess reliability of power supply, duration of surgery and patient condition:

• Consider stopping surgery immediately.
• Consider continuing surgery until patient is stable and wound is closed (may be temporary closure).
• Consider evacuation to theatre with intact mains supply → 4-3

❾ Prepare recovery facilities. Consider theatres, recovery, ICU.

Box A: ACTION FROM LOCAL COORDINATOR

Local coordinator should activate any local incident plan and urgently establish and brief teams on: 

• Extent of failure. 
• Likely duration of failure. 
• Interruption to other services (eg oxygen, water). 

Box B:  SOURCES OF ADDITIONAL LIGHT

• Open doors and blinds. 
• Hand torches, portable lights, mobile phones, laryngoscopes. 

Box C: TYPES OF POWER SUPPLY

• Standard power socket: not protected. 
• SPS: Secondary supply (red socket) for devices that can sustain brief periods of loss of power (eg those with internal battery back-up). 
• UPS: Uninterrupted supply (blue socket) for instantaneous and continuous protection.  This supply is limited therefore avoid using UPS sockets unless absolutely necessary. 
• Devices’ internal battery backup: this may not supply all functions of the device and duration may be variable. 

Box D:  CRITICAL CHANGES

Mains oxygen failure → 4-1

Emergency evacuation → 4-3