Abstract: A hostile patient, who was required to be housed in a padded room, had returned from a smoke break. Her purse, containing cigarettes and a lighter, was placed in a safe place. The patient had a second lighter hidden in her body cavity, however, which she used to start a fire. After approximately 5 minutes, she reported the fire. The patient was then taken from the room. A helper dragged the mattress outside, which had ignited the floor covering and the pads on the walls of the "quiet room." The patient broke free and Employees #1 and #2, both nurses, tried to subdue and remove her from the area. The doors between facilities were locked and the nurses did not have their keys with them. The two nurses and the patient were found, without keys, in a locked kitchen with access to a storage area and another exit. Employee #1 and #2 were overcome by smoke and died.