Fire management in hospitals

Apollo Medicine 2012 MarchArticle on Quality

Volume 9, Number 1; pp. 74–76

© 2012, Indraprastha Medical Corporation Ltd

Fire management in hospitals

Gaurav Loria*, Nipun Choudhry**, Karan Sharma†

*Coordinator, Quality Apollo Group, Consultant, Quality Apollo Clinics, Hyderabad, **Deputy Chief Medical Administrator (Academics), †Executive-Medical Services, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi – 110076, India.

ABSTRACT

Fire safety is so important to all hospital administrators, employees, and designers that the leadership in the hospital field should make every effort to keep abreast of current developments in the fire safety field. Each of these person’s actions, no matter how routine, may have an important bearing on the total fire safety environment of the hospital’s occupants.

Keywords: Evacuation, exits, fire

Correspondence: Mr. Gaurav Loria, E-mail: gauravloria@gmail.comdoi: 10.1016/S0976-0016(12)60125-2

FIRE MANAGEMENT IN HOSPITALS

December 9, 2011, a regular day when I woke up and was getting ready to go for an internal hospital survey in Kolkata. I realized in some time that it was not a regular day. We have woken up to see the nation’s worst fire disaster in a premier private hospital in Kolkata. We were shocked as the news reader was reading, ‘94 people, mostly patients of intensive coronary care unit (ICCU), intensive care unit (ICU), intensive therapy unit, and critical care units, and orthopedic department were asphyxiated to death’.

Flashes of few questions that were going on in all our minds were—What could have gone wrong? Whose fault was it? Was the evacuation plan not in place? Was the plan not tried and tested? Were the staff not trained and sensitized?

Fire is an ever-present risk in any organization especially more in a healthcare setup due to the kind of chemicals, materials, and consumables used, and the type of occupants who are mainly vulnerable/fragile.

Thus, every healthcare setup needs to plan how the occupants will be kept safe in case of fire or smoke.

Fire prevention, fighting, and evacuation of a hospital are entirely different processes than is recommended for most other buildings and involves special considerations. Due to the fact that so many patients may be medically unstable and dependent on mechanical support equipment, complete evacuation of the facility in case of fire is to be

initiated only as a last resort, and must proceed in a planned and orderly manner.

The hospital should focus on getting the first things set right first:• Risk assessments based on their structure, geography,

climate, type of building material, etc.• Reduction on those identified risks.• Safe and unobstructed fire exits.• Availability of early detection and suppression systems

in the hospital.Testing of the above plan periodically to ensure readiness

is another important factor to ensure safety at all times.

Fire Safety Committee

A multidisciplinary committee should be formed which should comprise members from all disciplines such as admin-istration, fire safety, security, medical, nursing, maintenance, and oxygen plant. The committee should look into all aspects of fire safety and initiate actions whenever required. The committee should be given full authority to make and imple-ment their decisions ensuring safety of the occupants as the focal point.

The committee should devise the action plan to reduce fire risks in the hospital; to educate staff on fire pre-vention and fighting and should assign responsibilities for implementation.

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Fire management in hospitals Article on Quality 75

© 2012, Indraprastha Medical Corporation Ltd

Risk Assessments

The safety officer, head—security and safety, in coordina-tion with the facility management team should conduct the facility inspections at least once in a year and identify the fire hazards associated with the facility and the high-risk areas in regard to fire.

A hazard vulnerability analysis (HVA) should also be conducted by the fire safety committee to identify the quan-tum of hazard associated as regard to fire safety in the facility.

A facility inspection report should be compiled at least once in a year and should be presented in the hospital fire safety committee. However, continuous steps should be taken to ensure safety against fire in the hospital.

Fire Safety Plan

There should be a written evacuation plan which should be available to all staff, employees in the facility. The plan should define the procedures to take in an emergency.

The plan should also include a pictorial diagram of the facility to show the routes to be taken from any point in the facility. Every staff member who works at the facility (on rolls or contractual) should be trained on the plan when they are first hired and periodically thereafter. Training should include evacuation routes, location, and proper use of fire extinguishers and fire alarm pull stations, procedures for evacuation of patients, etc. and fire reporting procedures and special operational procedures needed to shut down, secure, or make safe, certain critical equipment.

The staff should also be sensitized on the fact that it is their responsibility to ensure that the patients are evacuated first in the event of a disaster. The staff should be able to triage and identify the vulnerable patients, children, elderly, ICU patients, etc. who need help first. They should also be trained on evacuation procedures of bedridden, critical care, and/or other persons with special needs.

The staff should also be aware on how to respond to and report a fire.

The plan should be reviewed on an annual basis to update or remove any item which may require modification due to changes in the occupancy, construction, use of the space, or other changes which would invalidate the plan.

The hospital should have a safe mechanism for storage and consumption of hazardous material which also includes inflammable material mainly in the areas such as main stores, laboratories, kitchen, laundry, gas plants, oxygen banks, and diesel storage areas.

FIRE PREVENTION

It is always the responsibility of every manager, supervisor, and employee to observe report and check any condition or act that may be a potential cause of fire. The slogan ‘prevention is better than cure’ is equally applicable to fire. The main points to be observed in fire prevention are as follows:1. Old and frayed electric cables, damaged switch boards,

loose fixtures, and sparking appliances should be reported in writing to the maintenance department by the department, managers, and supervisors concerned for immediate repair/replacement. Follow-up action should be taken until the work is complete.

2. Welding/hot works by maintenance department/con-tractors should not be allowed without written permis-sion of safety officer/shift security officer. Departments should ensure that welding is not permitted in their departments unless fire personnel are present to provide fire-fighting cover. It should also be ensured by manager/supervisor that a radius area of 20 feet from the point of welding is cleared of all inflammable material such as petrol/thinner oil, cardboard paper, plastic cloth, and dry wood. Furniture that cannot be removed should be covered with asbestos sheets or wet hessian cloth or tin sheets.

3. Cleaning of hands/feet with petrol/thinner/diesel should not be permitted. The concerned department may ensure this. Chemicals and oil stored in material store should be divided into small stocks with adequate spacing in between.

4. The senior supervisor/in-charge food and beverages department should be personally responsible for opera-tion and safety of liquid petroleum gas installation in the canteen kitchen. He should ensure that all valves on the main feed pipeline and regulators on the gas stoves are shut, when not in use.

5. Excessive paper, plastic, cardboards, and wooden scrap should not be allowed to accumulate in the office. Super-visor housekeeping should ensure that prompt action is taken on complaint by the department concerned.

6. Used bandage/cotton, etc. should not be allowed to accumulate.

7. Unauthorized fires should not be lit in the hospital premises. An authorized fire should be completely snuffed before close of work.

8. The electric main switch of all offices not occupied should be switched off when not in use.

9. Private electric appliances like heaters and immersion rods should not be allowed inside the hospital.

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76 Apollo Medicine 2012 March; Vol. 9, No. 1 Loria et al

© 2012, Indraprastha Medical Corporation Ltd

10. Duplicate keys of all offices, stores, and departments should be deposited with the security, and kept in the duplicate key box. All department concerned should complete this action.

11. Fire-fighting equipment should not be removed or misused for industrial/administrative purposes.The staff should be trained to use the following world-

wide accepted acronym to ensure that they follow all the basic rules during a fire incident:R—Rescue: Patients or person if in immediate danger.A—Alarm: Raise alarm.C—Confine: Close doors and windows to contain the fire.E—Extinguish/Evacuation: Use fire-fighting equipment if trained in its use.

Fire safety learning is crucial to all the personnel of hospitals including hospital administrators, employees, and designers, and the leadership in the hospital field should continuously make every effort to keep along side of cur-rent developments in the fire safety field. The actions of

each of these persons, no matter how routine, would have an important holding on the total fire safety environment of the occupants of the hospital.

Fires continue to occur in hospitals. Fortunately, most of the fires are small, are discovered early, and are extin-guished promptly. However, no one can predict just when one of these minor occurrences will get out of hand and cause a major disaster.

REFERENCES

1. JCIA Standards for Hospitals 4th edn. ISBN: 978-1-59940-

434-9;201–3.

2. These steps help prevent hospital fires and fatalities, THE

MOPERM f/flSMTAl, Vol. 105, No. 1, July 1965 Public

Health Service Publication No. 930-D-21.

3. Life Safety Code Handbook 8th edn. Ron Cote, July 2000.

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