Guidelines for Fire Prevention in a Hospital - Dr.P.K.Verma

A fire within hospital premises, where patients are receiving treatments is a serious threat to life. There may be a considerable number of bedridden patients, patients on life support system, OPD patients, visitors and hospital staff members of various categories at any given point in time. Therefore Fire Prevention is a priority in this case and dictum "Prevention is better than cure" holds its importance and is most appropriate here.

The general mindset of medical administrators is that whenever there is a fire in the hospital his responsibility is over by informing the Fire Station does not suffice according to law.

The Hospital Management is responsible for fire risk assessment and fire prevention and all the measures relating to same must be carried out on the premises according to law. Steps must be taken to remove any hazards that are identified.

• Identify combustible material inside the hospital and the interior furnishings.


• Plan provisions in place for early discovery of the fire.


• Plan provisions in place for limiting the spread of the fire.


• Plan provisions in place for notification of the fire service and hospital personnel.


• Formulate a Standard Operating Procedure (SOP). Conduct regular fire drills involving the staff members and the local fire service for the prompt extinguishing of the fire and prompt evacuation of patients.


• Maintain record/logbook of steps taken to prevent fire risk and its management.


• Observe the guidelines of NABH for Fire Safety.

Proper Hospital Fire Safety Plans should be in place -The fire safety plans are built around an acronym –RACE.

R – Rescue. First and foremost step in case of fire is to get everyone out of the hospital building as efficiently as possible. As some patients may not be able to walk, cots or beds may have to be moved, patients may have to be lifted and carried, pushing wheelchairs or even dragging people across the floor on sheets. During mock exercises/fire drills, these procedures should be practised to make sure everyone on staff are familiar with the proper procedure for handling a fire.
A – Alarm. After noticing the fire raise ALARM immediately to alert people and get help as quickly as possible. This is crucial. Call (or tell someone to call) the fire department, activate a manual pull station; activate the FIRE CODE over the PA system. Mobilise the internal and external resources and activate the crisis management centre.

C – Confine. After raising the alarm, all-out effort should be made to confine the fire as well as possible. All the doors should be closed, after ensuring that there is no person in the room. Confining the fire limits the movement of heat and smoke.
E – Extinguish. The hospital staff should be trained in the use of fire extinguishers. If not all then at least some volunteers should be designated Fire Wardens in each floor and given the required training. They should start extinguishing the fire as quickly as possible once the evacuation has already started and the fire department is on their way.

1.Disaster Management Plan:- Every hospital must have a comprehensive Disaster Management Plan, taking into accounts various types of emergency situations that can present themselves inside the hospital premises, caused by man-made or natural disaster leading to mass casualties. Also prepare Standard Operating Procedure, specific for each disaster/crisis. This specific SOP for Hospital Fire prevention should spell out the coordinated response of all participating agencies, internal and external, in case of any disaster at the hospital. The SOP should also categorically indicate the action to be taken by individuals involved.

2.Mutual Aid Agreement:- The emergencies may be of such magnitude that it may not be possible to handle the same through the resources available at the hospital and may require the involvement of various external agencies. Hence written mutual aid agreements should be initiated to ensure the prompt response of adequate rescue and firefighting, security, law enforcement and medical services from elsewhere. The following external agencies could be of assistance in responding to an emergency:

• Police and/or security services;


• Local fire department;


• External Public & Private Hospitals;


• Ambulance Providers e. Government authorities;

All other participating agencies including external hospitals, with whom mutual aid agreement has been established, should have contingency emergency plans of their own to provide for initial response and subsequently receiving of casualties. They should be classified according to their effective receiving capacity and specialized features, such as neurosurgical ability or burn treatment.

3.Medical Coordinator:- Senior most doctor / CMO present in the hospital at the time of the location of fire will assume the Duties & Responsibilities of MEDICAL COORDINATOR. His role will start after the incidence has been reported and will be responsible for a clinical aspect of the whole operation. He will announce the CODE RED through the public address system and will also inform and activate all the Internal and External Resources. He will activate the Triage Team and till the time the Crisis Management Centre is activated, he will organize and make efforts to contain the fire and try to minimize the loss to life & property. He will be responsible for the clinical aspect of the entire operation. 4. Key Contact Numbers:- Telephone numbers of persons and external agencies to be contacted in case of emergencies should be available without any hindrance.

4.Chief Fire Warden/Fire Officer:- Every hospital is advised to designate a senior person as Chief Fire Warden or employ a fire officer for taking appropriate preventive measure before the incidence and active participation with his team to control/extinguish the fire during the operation along with any other non-clinical aspect of the effort. He will be responsible for the nonclinical aspect of entire operation, i.e. preventive measures, firefighting and evacuation.

5. Mock exercises/drills:- The mock exercise/fire drill involving all the agencies, internal and external, should be conducted regularly and the same should be documented. This will lead to coordinated response when actually required and build up self-confidence.These exercises should be monitored by independent observers/critics.

6. Regular Checking up of Preventive Measures installed:- Senior and responsible staff members should be assigned the duties and responsibilities of checking and maintaining various preventive measures installed at the hospital. Appropriate FORMATS should be developed for the same. Entries should be made on the Log Book after every periodical check.

7.Hospital Emergency Code:- Staff should be aware of the Emergency Code announced over a public address system of a hospital to alert staff to various classes of on-site emergencies. This way essential information is quickly and with minimal misunderstanding is conveyed to staff while preventing stress and panic among visitors to the hospital. Such codes are usually displayed on placards throughout the hospital or are printed on employee identification badges for ready reference. Generally Code RED is for fire in the hospital.

8.Maintenance of Disaster Management Stores:-

a. Storing of appropriate inventory in appropriate quantity.

b. Inventory Management (checking of the expiry date of medicines, the pressure in the O2 Cylinder, charging of electronic equipment, etc).

c. Evacuation Transport Equipment such as stretchers/Litters/Gurneys, Backboards, Sked Stretchers, Wheelchairs, Beds, Blankets, Canvas- a sufficient amount of equipment should be available at each floor, stored in easily accessible areas.

d. Disaster Management Store Room should be regularly checked for cleanliness, ambient temperature and there should be no seepage or rodents, etc. and well-maintained.

9.General Training of Staff:- All the Staff members of the hospital must be trained in Fire Fighting regularly through internal and external agencies. General training of all staff should include, but not be limited to, the following: a. Training on how to lift and move patients. b. Training on how to use fire extinguishers. c. Training on how to evacuate patients, screen them, calm them and track them. d. Training on what to do if they see a fire. For example, the RACE acronym specifies actions to be taken in a fire (although not in a specific order; the hospital’s incident commander determines the appropriate actions to be taken in a given situation): i. R–Remove anyone endangered by the fire to a safe area ii. A–Activate the alarm iii. C–Close all windows and doors; contain the fire iv. E–Evacuate (Training on what to do if they hear the alarm and see the flashing lights). e. The staff should be we well familiar of the egress routes and general plan of the hospital.

10.Documentation:- Appropriate formats should be developed to log daily/weekly/ monthly/quarterly checking of the firefighting equipment. Mock drills/exercises conducted should be logged.

ACKNOWLEDGEMENT:
1. Hospital Fire Prevention and Evacuation Guide, Pan American Health Organization:
http://eird.org/pr14/cd/documentos/espanol/CaribeHerramientasydocumentos/Saludyestac
ionesdesalud/HospitalsDontBurn_high.pdf
2. Common Fire Hazards for the Healthcare Industry:
http://www.elitefire.co.uk/common-fire-hazards-healthcare-industry/
3. Hospital Fires (2012-2014)
https://www.usfa.fema.gov/downloads/pdf/statistics/snapshot_hospital.pdf
4. HOSPITAL EVACUATION PLANNING GUIDE:
http://www.mass.gov/eohhs/docs/dph/emergency-prep/hospital-evacuationtoolkit/planning-guide.pdf
5. Juta's Manual of Nursing - Volume 1 - Page 711 - Google Books
https://books.google.co.in/books?isbn=0702156655,Anne Young, C. F. Van Niekerk, S
Mogotlane - 2003 - Medica

Dr.P.K.Verma is MBA, M.D. in Aviation Medicine with vast experience in the field of Aviation Medicine. He has worked as Consultant – Aviation Medicine and Administration, Medanta – The Medicity & Chief Administrator-Airport project, Indraprastha Apollo Hospital, New Delhi.