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Warding against fire: hospital safety and training
Fire safety and training is vital for a hospital. Not only does it mean the hospital complies with the law, but it also helps to protect anyone visiting, staying in, or working in the premises, making sure they are not being put at unnecessary risk.
Training is essential, as it shows personnel what to do in the event of a fire and how to evacuate patients if necessary. Not only that, though, it also promotes awareness of fire hazards and how to identify them.
Fire safety is there because, in a fire, certain people in a hospital would not be able to evacuate on their own. So it’s a legal requirement that a fire safety management programme is put in place in all health care facilities, which guards against the outbreak of fire and protects the hospital’s occupants if a blaze occurs.
A programme must include: a fire safety management structure, with clear roles for all key personnel; strict housekeeping practices and fire prevention activities and practices; routine checking, testing and maintenance of fire protection systems and equipment; development and testing of clearly defined procedures for an emergency; training of staff in fire safety and evacuation – prevention, theory and emergency actions to take; and maintenance of records relating to equipment, systems and training, and trial evacuations.
There are a number of fire risks in a hospital, but the main ones are: smoking – careless disposal of cigarettes in prohibited areas, smoking in toilets and other prohibited areas; contractors – hot and electrical works, which require permits and must be controlled by the designated person(s) on-site. Other risks in this situation could be careless storage/disposal of painting equipment and working with gas; arson – fires have been lit to distract staff from burglary, or started by disgruntled patients waiting in emergency rooms; compartmentation compromised – if breached, floors, doors, ceilings, walls and windows may no longer be able to prevent spread of fire; fire doors – present risk if damaged (intumescent strips should be in place, with gaps between doors assessed correctly). They should be able to close automatically when fire alarms are sounded; electrics – an “electrical permit to work” system should be in place, with equipment assessed, approved and documented by technical services. Sockets should not be overloaded, with any use of extension cables approved first. Damaged appliances or wiring should be reported, not repaired by staff.
Gases – appropriate storage and transportation of medical and industrial gases must be practised, with restricted access to areas where stored; kitchens – deep-fat fryers pose a risk, so appropriate fire extinguishing systems should be in place. Ducts in kitchens must be cleaned and certified, with storage of oils and fats controlled and emergency shut-off valves for gas/electrics in place.
Waste – appropriate, designated facilities must store rubbish, with bins able to be locked and secured to prevent arson; flammable liquids – have flashpoints above 32°C (89.6°F) and must be stored in a secure and well‑ventilated area. Only daily supplies should be kept in wards; furniture and fittings – must be assessed for flammability and emissions.
Risk of fire might be more difficult to control in some hospital areas, such as places accessible to the general public. Certain patient areas are also high-risk, especially those where they are dependent on assistance to evacuate, or attached to life support equipment.
In a hospital, in England and Wales, the main duty holder is the “responsible person(s)”, anyone with control of the premises. This is similar in Scotland and Northern Ireland, where anyone with control of the premises must take steps to prevent fire and mitigate its detrimental effects. However, the main responsibility is on the building owner, employer and management in the Republic of Ireland. From there, responsibility cascades down and the “responsible person” could actually be the staff nurse in charge at the time.
In England and Wales, the Regulatory Reform Order (Fire Safety) 2005 (RRO) came into force on 1 October 2006. This replaced fire certification under the Fire Precautions Act 1971, plus many existing laws, including the Fire Precautions (Workplace) Regulations 1997.
RRO 2005 stipulates a general duty to ensure, so far as is reasonably practicable: the safety of employees; that non-employees take such fire precautions as may reasonably be required in the circumstances, to ensure that the premises are safe; a duty to carry out a fire risk assessment
The main duty holder is the “responsible person”, but this is extended to any person who has control of the premises. They are required to: consider who may be especially at risk; eliminate or reduce fire risk, as far as is reasonably practical, and provide general fire precautions to deal with any risk; take additional measures to ensure fire safety, where flammable or explosive materials are used or stored; create a plan to deal with any emergency and, where necessary, record any findings; maintain general fire precautions and facilities provided for use by firefighters; keep any risk assessment findings under review.
Meanwhile, employees, visitors and others in the building must make sure their actions, or non-actions, do not result in other people being exposed to danger from fire.
In Scotland, fire safety is covered in the Fire (Scotland) Act 2005 and the Fire Safety (Scotland) Regulations 2006, but both impose obligations on “duty holders” and neither can be considered in isolation.
Any “process” fire precautions, such as risk assessment, fall under the jurisdiction of the UK Parliament. These precautions are designed to prevent outbreak and fire spread from work processes, taking into account the type of risk from whatever work activity and process is being assessed. This is different to general fire safety, which covers warning, firefighting and escape.
The 2006 Regulations say managers should assess the risk of harm from fire and keep those risk assessments in continual review. Part 3 of the Fire and Rescue Services (Northern Ireland) Order 2006 and the Fire Safety Regulations (Northern Ireland) 2010 came into effect on 15 November 2010. Duties these impose fall into seven general categories: carrying out fire safety risk assessment of premises; identifying fire safety measures necessary as a result of the fire safety risk assessment; implementing fire safety measures using risk reduction principles; putting in place fire safety arrangements for the ongoing control and review of the fire safety measures; complying with specific requirements of the fire safety regulations; keeping fire safety risk assessment and outcome under review; record keeping.
Normally, the fire safety officer, or a designated safety professional, is responsible for organising and delivering the training. But a fire consultant might be employed to carry it out. Giving staff training sessions in fire prevention and emergency procedures might also be necessary, particularly to account for evacuating large numbers of ill patients. Local management must check that staff attend training, just as staff have a responsibility to attend themselves, but ultimately the “responsible person” will be held accountable.
It is a legal requirement that all staff – permanent, temporary, part-time, contract and voluntary – train in fire safety. But training will help a hospital protect itself against fire, allowing staff to understand how fire spreads, how to raise the alarm, use fire extinguishers and save lives.
Training also promotes good housekeeping, defect reporting, knowledge of using evacuation equipment and emergency plans, how to carry out fire drills and what legislation fire safety falls under.
Fire safety can vary from area to area and can be broken down into two: active and passive.
Active fire precaution measures are systems which must activate in an outbreak of fire. It includes fire detection and alarm systems, emergency lighting, firefighting equipment and fire evacuation equipment.
In ward areas, staff must have training and the right equipment and means to evacuate people, while in outpatient areas staff must know how to direct patients to a place of safety.
Passive fire safety covers the structure and building, which must include features to contain fires or slow the spread. It also includes provision of escape routes and exits, fire resistance to the building structure and access to, and around, the building.
All staff should learn about specific fire hazards within their area of work and how to assist in an evacuation.
While fire safety training in hospitals can be generic, evacuation procedures are specific to the area in which they are developed.
A good example of this would be within a spinal unit: if an evacuation was necessary, stringent steps would have to be taken to ensure no further harm, such as the use of spinal boards with head blocks.
Hospitals must also provide the means to evacuate, with aids such as evacuation sheets, evacuation chairs and other items identified in the risk assessment.
General training will cover: legislation; theory of fire – fire triangle; classes of fire; combustion, convection, radiation and fire spread; active and passive fire safety; analysis of hospital fires; types of fire hazards; fire prevention measures and emergency procedures; and home fire safety.
There is also an area of practical training on using fire extinguishers, evacuation equipment and the evacuation process itself.
Fire wardens will also be trained to carry out their roles appropriately, with the aim of being able to understand and contribute to hospital fire risk assessments and emergency planning procedures. This training covers: legislation; fire safety warden role and responsibilities; fire science; hospital fire precautions; hospital fire engineering; and fire alarm and evacuation strategy.
What does a typical hospital fire risk assessment involve?
People at risk and fire hazards must be identified, before evaluating the associated risks and deciding if the existing fire safety measures are adequate. The fire safety risk assessment information must be recorded, with details on how best to eliminate, or mitigate risks, with an action plan of how to achieve that.
The fire safety risk assessment should be reviewed, regularly, to account for fires or near misses, changes in use of equipment, building alterations, new equipment and many other issues. Patients and visitors (human factors) do complicate the risk assessment process, as they are always unpredictable and therefore extremely difficult to assess. Patients can be confused and visitors can be upset or irate, bringing a whole host of complications to consider.
A Control of Contractors’ Policy should be in place to guide on fire safety surrounding contractors on-site, who are not immediately employed by the hospital.
Risk of budget cuts
There have been big improvements in hospital fire safety: detection methods and evacuation aids have advanced, and building regulations have become more stringent, reducing the chance of fire starting in the first place.
This is good news for hospital staff and users, who rely on the fact that they will be protected against the risk of fire. But the risk of budget cuts does present a problem: funding is vital to maintain the quality of fire protection, keeping up-to-date with the latest techniques, training and equipment.
As new technology and building standards improve, it would be reasonable to hope and expect that fire safety will also improve. New hospitals and refurbishments all assist in protecting life and property, and worldwide research is on-going into how new technology can help to advance fire safety.
But this is an area where most understand its importance, especially those who have experienced a fire for themselves. After all, even a small fire can be devastating to a hospital.
While management do understand the human and financial cost of a fire, we now need all hospitals to make the link between emergency planning and business continuity, to fully prepare fire safety and training systems for the future.