In a February 2009 report, the National Fire Protection Association (NFPA) identified that during 2003-2006, municipal fire departments responded to an estimated 3,750 structure fires in medical, mental health, and substance abuse facilities, annually. These fires resulted in one civilian death, 57 civilian injuries, and $26.9 million in direct property damage. While no amount of money can account for the loss of a loved one, the United States Consumer Product Safety Commission (CPSC) assigns a statistical value per life of $5 million; and according to its Injury Cost Model, the estimated cost of a fire-related injury is about $56,000 per incident. Therefore, the average total estimated cost of these healthcare facility fires was $34.2 million.

Every well-managed healthcare organization should have, in effect and available to all supervisory personnel, written copies of a plan for the protection of all persons in the event of fire, for their evacuation to areas of refuge, and for their evacuation from the building when necessary.

All employees should be periodically instructed and kept informed with respect to their duties under the plan. A copy of the plan should be readily available at all times at nurses’ stations and in the telephone operator’s position or at the security center. The basic response required of staff should include the removal of all occupants directly involved with the fire emergency, transmission of an appropriate fire alarm signal to warn other building occupants and summon staff, confinement of the effects of the fire by closing doors to isolate the fire area, and the relocation of patients as detailed in the fire safety plan. Every plan should be periodically reviewed and updated accordingly.

For healthcare occupancies, the proper protection of patients should require the prompt and effective response of healthcare personnel. It is important to note that each facility has specific characteristics that vary sufficiently from other facilities to prevent the specification of a universal emergency procedure. A written fire safety plan should provide for the following:

1.     Use of alarms,

2.    Transmission of alarms to fire department,

3.    Emergency phone call to fire department,

4.    Response to alarms,

5.     Isolation of fire,

6.    Evacuation of immediate area,

7.     Evacuation of smoke compartment,

8.    Preparation of floors and building for evacuation, and

9.    Extinguishment of fire.

All healthcare personnel should be instructed in the use of and response to fire alarms. In addition, they should be instructed in the use of the code phrase (where used) to ensure transmission of an alarm under the following conditions:

1.     When the individual who discovers a fire must immediately go to the aid of an endangered person, or

2.    During a malfunction of the building fire alarm system.

Personnel hearing the code announced should first activate the building fire alarm using the nearest manual fire alarm box and then immediately execute their duties as outlined in the fire safety plan.

In addition to the plan described above, every hospital should have a comprehensive life safety plan such as the one pictured in the example that depicts fire protection features including the locations of fire-rated smoke barriers that divide floors into two or more smoke compartments. The life safety plan may also include locations of exits, horizontal exits, and areas of refuge.

While it is recognized that closed doors serve to maintain tenable conditions in a corridor and adjacent patient rooms, a fire or similar emergency may warrant relocation of patients to an adjacent smoke compartment. A smoke compartment is an area not exceeding 22,500 square feet, separated from other smoke compartments by a fire-rated barrier that is constructed to resist the passage of smoke. It is imperative that all healthcare personnel know the locations of smoke compartments and smoke barriers dividing compartments.

Healthcare facilities practice the “defend-in-place” strategy, whereby occupants are relocated to a safe location on the same floor rather than being evacuated because they are protected by active and passive fire protection features. The “defend-in-place” concept, which is exclusive to healthcare occupancies, allows for the relocation of patients from one smoke compartment to another on the same floor level without evacuation of the floor or building. When a fire alarm sounds in any building other than a healthcare occupancy facility, immediate evacuation of the building is necessary.

Where the building is protected by an automatic fire sprinkler system, closing corridor doors to patient rooms and other rooms will provide initial protection for life safety during an incipient fire. For a free burning fire not controlled by portable fire extinguishers or the building’s fire sprinkler system, relocation of patients to an adjacent smoke compartment may be necessary. It is expected that nursing staff will take initial steps toward relocation of patients until the fire department arrives and takes command of the situation.

The purpose of a fire drill is to test and evaluate the efficiency, knowledge, and response of institutional personnel in implementing the facility fire emergency plan. Its purpose is not to disturb or excite patients. Healthcare occupants have, in large part, varied degrees of physical disability, and their removal to the outside or even their disturbance caused by moving is inexpedient or impractical in many cases, except as a last resort. Similarly, recognizing that there might be an operating necessity for the restraint of the mentally ill, often by locked doors, fire exit drills are usually extremely disturbing, detrimental, and frequently impracticable. Infirm or bedridden patients should not be required to be moved during drills to safe areas or to the exterior of the building. Fire drills should be conducted without disturbing patients by choosing the location of the simulated emergency in advance and by closing the doors to patients’ rooms or wards in the vicinity prior to initiation of the drill. Relocation can be practiced using simulated patients or empty wheelchairs. Drills should consider the ability to move patients to an adjacent smoke compartment.

Fire drills in healthcare occupancies should include the transmission of a fire alarm signal and simulation of emergency fire conditions. Fire drills should be scheduled on a random basis to ensure that personnel in healthcare facilities are drilled not less than once every three months. Drills should be conducted quarterly on each shift to familiarize facility personnel (nurses, interns, maintenance engineers, and administrative staff) with the signals and emergency action required under varied conditions. When drills are conducted between 9 pm and 6 am, a coded announcement is permissible instead of audible alarms.

Your healthcare organization’s fire safety plans and practice through fire drills will save life and property.

 References

Flynn, J. D. (2009). Structure Fires in Medical, Mental Health, and Substance Abuse Facilties. Quincy, MA: National Fire Protection Association.

NFPA. (2009). NFPA 101^®, Life Safety Code^®. Quincy, MA: National Fire Protection Association.

BOILERPLATE

Robert Trotter is a Manager, Senior Life Safety Specialist with Smith Seckman Reid, Inc. — www.ssr-inc.com — a Nashville-based, engineering design and facility consulting firm with more than 40 years of experience. SSR specializes in a number of industries, including healthcare, and serves clients nationwide. Trotter has 30 years of combined experience in fire service, where he served as a fire marshal, and as a life safety consultant. He holds a degree in Fire Science and 26 professional certifications from the International Code Council, Inc.

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