Fire-proofing patient and staff safety

Hospitals can be very large and complex buildings that pose more fire risks than other environments. Will Lloyd, technical manager of the Fire Industry Association, analyses the risks and steps to take to ensure safety

In a shocking lack of knowledge regarding fire safety, news of four hospitals within the UK reached national press this year. The reason? They all lacked sufficient fire protection.

The Sun reported that the hospital in Coventry was hit with £380 million bill after it was revealed that builders had failed to fire-proof it. Of course, this is no fault of the doctors and other medical staff working in the building, but it does highlight the dangers that a fire could do to a building and how important it is to comply with fire regulations.

Regardless of the type of building, the fire regulations for England and Wales are all part of a piece of legislation called the Regulatory Reform (Fire Safety) Order 2005. This legislation sets out all the responsibilities of the owner of the building (called the ‘responsible person’ in UK legislation).

In simple terms, the ‘responsible person’ must ensure the safety of all of the people within the building. In a hospital setting, the real crux of the matter is the sheer volume of vulnerable people within the hospital building that must be protected in the case of fire, along with all the staff and visitors to the hospital. As a legal responsibility, the ‘responsible person’ must carry out a fire risk assessment to manage the risk to the vulnerable people.

What are the main risks for fire?
Hospitals can be very large and complex buildings. The main risks for fire in a hospital are the main risks of fire everywhere, but with hospitals there are more risks. There’s the risk of patients with limited mobility as well as all the flammable substances that most buildings do not contain, such as chemicals and oxygen supplies, and all the flammable materials within a pharmacy or an operating theatre. Even if one simply considers the sheer volume of curtains and bedding within a hospital, that presents a risk too, because naturally cloth is flammable.

The Department for Health has published a wide range of guidance for hospitals on the potential risks involved, called ‘Fire safety measures for health sector buildings (HTM 05-03)’. This guide is essential reading for a responsible person as it outlines some important factors to consider in terms of fire safety, and is both thorough and comprehensive. The guidance outlines almost everything that one should consider in terms of fire safety – from general fire safety, to more specific aspects such as provisions for textiles and furnishings, escape lifts, and fire detection and alarm systems. All of these guides are available to download from, but the Fire Industry Association (FIA) is also available for practical and technical advice and guidance regarding fire risk assessments and fire alarm systems over the phone.

Of course, a great consideration is the patients themselves and the danger present to them in the event of a fire. Due to limited mobility, a plan should be drawn up for progressive horizontal evacuation, whereby each floor or section of the hospital acts as a different ‘compartment’ for a fire. When the fire approaches a nearby compartment, staff and patients should evacuate that compartment, rather than evacuating everybody from the whole building at once. This is why passive fire protection – insulation from fire within the walls, doors, and windows is vital – as it blocks fires from travelling from one compartmented area to another.

This is the reason that fire doors are such an important part of trying to contain the fire in the room behind the doors. Fire doors are designed to help stop the spread of fire beyond the doors; it helps in the event of an evacuation situation to keep the fire contained within the designed ‘compartment’ of the building.

However, in a hospital, fire doors are often propped open or bashed into by hospital trolleys. But this can be exceptionally dangerous as it increases the risk of fires spreading through the building. Keeping the doors closed keeps the fire safely behind the door, allowing for a greater escape time. Therefore, it is vital not to prop fire doors open with hospital trolleys or cause damage to them as this reduces their effectiveness.

Additionally, hospital trolleys banging into manual call points (the button that activates the fire alarm) is one of the prime causes of false alarms in hospitals. Research sponsored by the FIA from earlier this year, entitled ‘Investigations into the causes of false fire alarms’, highlighted that despite this problem being exceptionally common, it is something that can easily be remedied. The solution is to ask a specialist fire alarm company to install a special plastic cover to go over the call point, which should protect the it from getting banged or knocked by busy staff with trolleys.

Not only do false alarms cause time to be lost investigating the cause, they also cause distress to patients who may be worried that there is a real fire on the premises. It is therefore recommended that alarms have a delay before sounding. During this time, a team should investigate the cause of the alarm – and confirm if the fire is real or false. If a fire is confirmed, the evacuation plan including progressive horizontal evacuation should be followed.

Having a sound fire plan
Understanding the evacuation plan and having a robust system for the event of a fire is a necessity. Perhaps even more important is the need to communicate this plan to the staff. Communication is key, particularly in a situation where fire alarms need to be tested. Best practice states that a fire alarm should be tested weekly – but it is vital to inform staff of the test to minimise disruption and allow the staff to reassure patients that it is not a real fire alarm.

This is why the best advice anyone could give in regards to fire safety is just to remain vigilant; keep the fire risk assessment up-to-date and follow its recommendations to the letter. The fire risk assessment forms the entire basis of the fire safety management strategy for the building, and should be reviewed on a regular basis. Talk to staff and make fire safety an integral part of caring for patients. Staff should all be involved.

As a minimum, fire safety training should be carried out once a year, but it depends on the needs of the staff and patients as well as the type of training – staff should be made aware not just of the evacuation procedure, but of how to use evacuation equipment such as sleds, chairs, or other equipment designed to evacuate the immobile.

Additionally, portable fire extinguisher training is such an important part of the strategy; if staff are trained to know how to use a fire extinguisher, they can combat small fires (no larger than a waste paper basket, for example), which will prevent the fire getting bigger and becoming a problem. Training staff how to use the equipment in a practical sense and letting them use it in a mock-fire situation will help increase their confidence and help them to provide better care for the patients overall.

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