ECRI Institute, one of the leading patient safety and medical technology research organizations, places health technology cybersecurity at the top of its just-released 2019 Top 10 Health Technology Hazards.
Hospital Fire Safety: how to manage risk
In January 2008, all patients and staff were evacuated after a fire broke out at the Royal Marsden Hospital in Chelsea. The fire was fought using 25 fire engines and around 125 firefighters. As a result of the fire the entire roof of the Chelsea Wing of the hospital was burned through and the top floor was also affected. Five operating theatres and at least two wards were put out of action. Fortunately nobody was killed and there were no serious injuries. Later that same year, six fire engines and about 30 firefighters fought a fire at Great Ormond Street Children’s Hospital. In 2009 the NHS published a report on these and three other fires in London Hospitals in 2008-20091.
More recently, in December 2011, More than 50 people were evacuated from Winchester’s Royal Hampshire County Hospital after a large fire broke out. But it’s not only the fabric of the building that can catch fire, in March 2012 a patient undergoing surgery at a hospital in North Yorkshire was set on fire during the procedure when a solution used to clean the skin ignited. Also, believe it or not, hospitals are victims of arson with 28 such instances in 2008, and in September 2012 a person was charged with setting fires in two hospitals in Kent.
As you can see, fires in hospitals are not uncommon but, of course, we know this and the NHS Firecode provides guidance on how to design hospital buildings in a fire safe manner. It tells you how to provide fire compartmentation; how to install fire protection measures such as fire detection and alarm systems and sprinklers; and developing fire plans and fire management processes.
Benefits of staff training
The NHS report on the London fires noted the positive benefits of good staff training; where staff had received training on their role in evacuation plans, they occurred largely without incident. This was irrespective of whether the incident required a full or partial evacuation of the hospital.
Having established that staff are the key to a successful hospital fire plan, what actually can you do to enhance the fire safety in your hospital or healthcare facility? Well, firstly carryout a comprehensive fire risk assessment, ensure that it is part of your management strategy and emergency plan.
You need to consider all the factors that could lead to an incident and take appropriate steps to mitigate them, for example, as I mentioned arson earlier, make sure the all waste is stored in a secure area before it is taken away for disposal. Hospitals are busy places but all escape routes must be kept clear as should all final exits. Escape routes should be appropriately signed as per British Standard BS 5499 and all emergency lighting should comply with BS 5266.
Means of detection and warning in case of fire should be given a high priority, factoring the need to warn those with hearing or visual impairments; the use of visual alarm devices or vibrating pagers should be considered. What suppression is required should also be considered. The correctly selected and positioned portable fire extinguisher can be quickly used to extinguish a small fire before it grows. Do you need sprinklers? In large hospitals, consider fixed suppression for computer rooms. All these factors should be part of the risk assessment and emergency plan.
Third party certified firms
All your fire protection measures should be designed, installed and maintained by competent persons. The Fire Industry Association’s view is that using a Third Party Certified firm is the only real way of having some confidence that you are getting a competent person.
Once you’ve got all that in place, if the fire alarm goes off, what do you do? Evacuate? While in a small premises the ‘all out’ plan is probably right but that won’t work for a complex site like a hospital where you have people of varying levels of mobility and some that can’t be moved at all.
That’s where the evacuation strategy comes into play, whether a horizontal, vertical or a ‘stay put’ strategy, you need to have this planned. Remember, when the Fire and Rescue Service (F&RS) arrives they are there to fight the fire and not to evacuate the patients; that’s your job. The NHS report referred to earlier showed that a well-planned and rehearsed plan helps everyone safely evacuate if there is a fire.
I said if there is a fire because fire detection systems are designed to detect ‘fire like phenomena’ which means that when the alarm is activated, it may not necessarily be a fire. Fire Services across the country are changing how they respond to automatic fire alarms and, in many cases, unless there is a confirmation of a ‘real’ fire, they will not attend. This needs to be factored into your plan, you need to know your local FRS’s policy for automatic fire alarms and if you operate multiple facilities, what the policy is for all the facilities; it may differ between Fire Services.
You will need to consider an investigation time before the signal is transmitted, look at what detection type you use and modify it to your situation or modify what you do. For example, the simplest way to reduce false alarms in hospitals is to make sure ward toasters are nowhere near a fire detector. Advice on managing false alarms and the FRS response to automatic fire alarms can be found on the FIA’s Cut False Alarm Costs website – www.fia.uk.com/en/cut-false-alarm-cost
If any maintenance or upgrade work is being carried out, there are simple things you can do to reduce the chance of a fire or an unwanted fire signal; make sure that hot work is managed on a permit system and, if necessary, isolate the fire alarm or cover the detectors in that area. This also applies if the work is liable to cause a large amount of dust. Of course, remember to uncover the detector heads once the work is done.
As mentioned earlier arson is a problem, so ensure that access to areas with large amounts of flammable/explosive liquids, gases or solid is strictly controlled - do not leave waste lying around - bag it and store it securely; you do it for biohazards, so do the same for fire hazards.
Staff are the key
As you have seen, there are simple and logical ways of managing fire safety in complex buildings such as hospitals, and the NHS report on fires in London and its conclusions illustrate that your staff are the key to your fire plan. Staff should know who the hospital fire safety officer/team are and they should be well trained in the emergency strategy and evacuation plan, with a clear understanding of their role in the event of a fire.
In addition, staff should keep an eye on fire safety in the same way as they do for health and safety to be able to notice a potential fire hazard and report it for appropriate action to be taken. The fire alarm is their friend, not the annoying noise that goes off at odd hours. A portable fire extinguisher is not just a can that sits on the wall but a tool they can use to prevent a small fire spreading.
To download a Best Practice Guide to fire safety for Responsible Persons and more advice on managing false alarms visit www.fia.uk.com