It is a telling statistic that there have been no chamber fire survivors since the 1989 Geisinger Medical Center fire, during which all six occupants were safely decompressed. In four of the subsequent six monoplace fires, patients had entered chambers with undetected prohibited items (personal warming device, cell phone or cigarette lighter) in their pockets. Of the remaining two, faulty wiring and an inappropriate communication system were to blame.
Three inside attendants and their 15 patients succumbed in three subsequent multiplace fires, and despite water deluge systems installed in two chambers. A prohibited item (personal warming device) in a patient’s pocket represented the ignition source for the Milan, Italy, fire. All eleven occupants died. A cigarette lighter in the pocket of an inside attendant was considered the cause of the Istanbul, Turkey, fire. All three occupants died. Regarding the most recent fire (2016 Jakarta, Indonesia) there is little cause for optimism that an independent expert analysis was commissioned. There is certainly no public evidence of any such process. That said, a senior police official was quoted as saying that one patient, a retired general, had taken his cell phone into the chamber, the model of which was known to suffer battery defects causing it to overheat, combust and explode. All four occupants died. This same official added that his country’s prevailing culture of deference likely precluded the screening/challenging such a high-ranking figure.
So, the emphasis on every in this blog’s title is very much intentional. Both patients and their attendants have been guilty of introducing prohibited items with fatal consequences. In addition, one early submission to the Hyperbaric Incident Monitoring System (HIMS) anonymous reporting initiative was that of an inside attendant who admitted to inadvertently taking a cigarette lighter into the chamber. This after having screened his patients for prohibited items. Fortunately, he was able to transfer it out of the chamber without adverse consequence.
Gowns are a good choice for patients as they lack pockets. When surgical scrubs are used by inside attendants and patients, their pockets can be readily removed. During one of our recent review and update courses, however, an attendee noted that their program rented scrubs from a commercial source, and that source might be unhappy if they were returned missing pockets. It was suggested that stitching pockets closed would be a reasonable alternative.
An effective chamber fire safety plan is a thoughtful construct of many parts. Given that most of the recent fires have been caused by introduction of prohibited items in the pockets of patients and staff, a strong argument can be made that front and center to any such plan is a universal no pockets policy.