12 Jul Nothing more terrifying
A major fire in a hospital or healthcare facility is horrific and there has been too many global incidents resulting in loss of life in recent years. Having worked in the fire industry for over 30 years and had responsibility for licensing, registering, auditing and providing detailed fire safety design strategies for a variety of healthcare premises, Peter Stephenson, Business Development Manager for Exova Warringtonfire, is ideally placed to illustrate why the importance of a robust fire strategy cannot be under stated.
The UAE fire & Life Safety Code 2017 (UAE Fire Code) defines Healthcare Premises as an occupancy used to provide medical, psychiatric, surgical, therapeutic treatment for people and typically includes the following premises based on risk:
- Limited Care Facilities
- Nursing Homes
- Mental Asylums
- Ambulatory health care centers
The risk profile of each of the above uses can prove challenging to a design team and the fire engineer with the responsibility of developing a robust fire strategy for the relevant building.
Apart from the guidance given in the UAE Fire Code other international guidance and best practice is available to a design team including, but not limited to the following:
NFPA 99 2018: Health care facilities code
NFPA 99 provides performance criteria for health care facilities that follow a risk-based approach, where it is the risk posed to patients and staff, not the type of building, that defines safety guidelines. Provisions govern installation, inspection, testing, maintenance, performance, and safe practices for facilities, material, equipment, and appliances — including medical gas and vacuum systems.
One important factor to remember with the evolution of fire codes is the lessons learnt from past incidents and embracing technological advancement and innovation. As an example, the major changes to the 2018 edition of NFPA 99 broadens the codes scope and helps practitioners work more efficiently to ensure health care safety and includes:
- Requirements addressing the risk assessment in Chapter 4 which have been revised to clarify the responsibility for conducting a risk assessment and determining risk categories.
- Chapter 5 includes requirements that now allow for the use of oxygen concentrators as central supply sources for piped medical gas systems.
- Corrugated medical tubing is now a permitted material for medical gas and vacuum systems.
- Chapter 6 is completely reorganised to group related requirements, allowing for the deletion of duplicated requirements for different types of EES.
- Chapter 7 now includes requirements for wireless phone and paging integration as well as for clinical information systems.
- Chapter 14 compiles all of the requirements for inspection, testing, and maintenance for hyperbaric facilities into one section.
- A new Chapter 15, Dental Gas and Vacuum Piping Systems is dedicated to the application of piped gas and vacuum systems for these systems that do not always readily fall under the requirements for medical gas and vacuum as addressed in Chapter 5.
- Requirements for fire extinguisher selection are included in Chapter 16 for spaces unique to health care facilities.
In the UK, Health Technical Memoranda (HTMs) give comprehensive advice and guidance on the design, installation and operation of specialised building and engineering technology used in the delivery of healthcare.
The focus of HTM guidance remains on healthcare-specific elements of standards, policies and up-to-date established best practice. They are applicable to new and existing sites, and are for use at various stages during the whole building lifecycle. Healthcare-specific technical engineering guidance is a vital tool in the safe and efficient operation of healthcare facilities. HTM guidance is the main source of specific healthcare-related guidance for estates and facilities professionals and consists of the following parts:
Operational Provisions Part A (HTM 05-03) should be read in conjunction with other Health Technical Memoranda in the firecode guidance:
- Part B – Fire detection and alarm systems
- Part C – Textiles and furnishings
- Part D – Commercial enterprises on hospital premises
- Part E – Escape lifts in healthcare premises
- Part F – Arson prevention in NHS premises
- Part G – Laboratories on healthcare premises
- Part H – Reducing false alarms in hospital premises
- Part J – Guidance on fire engineering of healthcare premises
- Part K – Guidance on fire risk assessments in complex healthcare premises
- Part M – Fire Safety in Atria
There’s nothing more terrifying than the thought of a major fire in a hospital or healthcare facility thus hospital fire safety is of paramount importance, demanding the highest level of expertise and knowledge to prevent a fire occurring.
Typically a healthcare premises will have a department responsible for developing an operational plan that concentrates on preventing fires and minimizing their impact. This operational plan should be part of the overarching fire strategy developed by the fire engineer forming part of the original base build.
A key factor is ensuring the engagement of fire engineering expertise with a realistic understanding of the operational needs of the modern healthcare environment, particularly considering and understanding the vulnerability of patients, the demands on staff time, the constraints of funding and that the risk of fire is one of many risks that have to be assessed, balanced and managed.
There are many international organisations within the fire safety arena that promote and support best practice within the healthcare sector. A good example from the UK is the National Association of Healthcare Fire Officers (NAHFO) (www.nahfo.com) which monitors and adapts to legislative changes, financial challenges and promoting statutory compliance and best practice.
The fire engineer provides a holistic approach adding value from initial design concept through fire strategy development and implementation to operational procedures, fire safety/action plans, fire safety training and fire safety audit.
Designing an effective plan
Most fire safety plans are designed so that everyone in a building can quickly respond to and exit the building in the event of an emergency alarm. Unfortunately, when considering the risks and occupant profiles with a healthcare facility designing a hospital fire safety plan can be complicated. At any given moment, there could be upwards of several hundreds of patients confined to beds and wheelchairs who can’t effectively escape unaided. Hospital fire safety plans have to be carefully designed to ensure that all of the patients, as well as the doctors, nurses, surgeons, other hospital staff and visitors are able to evacuate quickly and safely in the event of a fire.
Like any fire safety plan, a hospital fire safety plan should include working and regularly maintained fire protection systems. These systems should be readily available and include first aid firefighting equipment such as fire extinguishers along with an operational fire sprinkler system, a fire alarm system
and suppression systems to protect important hospital equipment. This will be the foundation of ensuring safety for patients and staff.
Unfortunately, given the nature of hospital environments, simply having the proper hospital fire protection systems in place isn’t enough. Having a hospital fire safety plan is critical to keeping everyone safe in the event of an emergency. Without one, hospital fires can quickly descend into chaos with no or little priority given to those at greatest risk in a fire scenario.
Hospital fire safety plans
As with most aspects of fire safety, a hospital safety plans should acknowledge the risks found in the premises and be communicated to all staff and be rehearsed on a regular basis, ensuring that all staff working on shifts are included in the training. A Fire Safety Plan should consider the following key areas and should be consider the key findings of all risk assessments available:
Means of Warning – This stage of a hospital fire safety plan is crucial. As soon as possible, assign a person or a group to activate the emergency response system – call the fire department, activate a manual pull station, send out a code over the PA system. The initial actions in an incident during the first few minutes of a fire can literally be the difference between life and death. Automatic fire detection systems will enhance the earlier detection and warning of an incident.
Evacuation – The first priority in most hospital fire safety plans is to ensure everyone can safely leave the building in an emergency. Since some patients may not be able to walk or be bedridden, this step may include moving cots or beds, lifting and carrying patients, pushing wheel chairs or even dragging people across the floor on carry sheets.
During the rescue phase of a hospital fire safety plan, communication and organization are key. It is important that key personnel are designated leaders and everyone has specific roles which can be rehearsed during training sessions.
Fire Containment – Once the alarm and evacuation stages are in action, and if safe to do so, a focus on containment of the fire can greatly assist with an evacuation and limiting smoke and fire spread. In most hospitals it is common to find fire doors fitted with automatic self-closing devices but it is important that training regimes highlight the importance of ensuring that each one is closed after the last person in the room escapes. Confining the fire is one of the most important steps of any hospital fire safety plan, as it limits the movement of heat and smoke as people are moved to a safe location.
Firefighting – If safe to do so, and if possible, initial fire-fighting by trained staff using portable fire extinguishers can reduce the development of a fire and it’s potential spread. This stage of a hospital fire safety plan should be undertaken only if evacuation has already started and the Civil Defence department are on their way. It is imperative that whoever is operating a fire extinguisher has a clear exit in case the fire spreads too quickly.
It can be seen that having an effective hospital fire safety plan can keep patients and staff safe from the effects of a fire, protect the on-going operations within the hospital and protect the building and critical equipment. Like most building fire safety plans it should be regularly rehearsed as part of a wider staff training programme and be amended in-line with any significant findings from fire or other health and safety risk assessments.