START

❶ Consider if patient can be safely moved: if not see Box A.

❷ Stop any operative procedure as soon as safe.  Pack and cover wounds.

❸ Transfer patient to bed or trolley. Transfer on operating table in extremis.

❹ Evacuate non-essential staff. Consider calling for help but be aware their own safety may preclude their attendance.

❺ Airway: Consider tracheal intubation to improve airway security if time allows.

❻ Breathing/ventilation options:

• Minimise oxygen usage: lowest flows possible.
• Self-inflating bag +/- supplemental oxygen.
• Mechanical ventilator or C-circuit require higher flows.

❼ Circulation:

• Ensure adequacy and security of i.v access.
• Take adequate supplies of fluid ± infusion sets.
• Take vasopressor(s) and/or resuscitation drug box.

❽ Maintenance of anaesthesia:

• Intermittent bolus propofol simplest and quickest.
• Infusion if time allows – remember mains cable for pump if available.
• Consider taking stocks and pump to make infusion later.
• Take blankets and/or warming devices if possible.

❾ If time allows, assemble adequate supply of drugs (Box B).

❿ Take existing monitoring and mains cabling.

⓫ Agree and communicate staff and patient muster points (Box C).

Box A: UNABLE TO MOVE PATIENT

• Ensure adequate depth of anaesthesia. 
• Ensure adequate reserve: 100% oxygen, low flow, fill vaporiser. 
• Ensure adequate neuromuscular blockade if relevant. 
• Evacuate all staff, including anaesthetist when indicated. 
• Inform rescue services and theatre coordinator. 

Box B: DRUGS

• Drugs may not be readily available at muster point 
• Aim to take: 
  • Oxygen 
  • Propofol /other hypnotic  
  • Neuromuscular blockade 
  • Vasopressor(s) 
  • Analgesics 
  • i.v. fluid
  • Neuromuscular reversal if extubation anticipated

Box C: MUSTER POINT

• Able bodied → adjacent safe zone 
• Anaesthetised/sedated patient → area with appropriate access to oxygen and medications, e.g. theatre, recovery or critical care area in a safe zone. 
• Inform rescue services and relevant coordinator of location. 

Box D: ROUTE

• Ensure route avoids original hazard and any consequent ones. 
• Caution using lifts, especially in fire.