Fire Safety Guidelines For Hospitals And
Nursing Homes
Hospitals
and Nursing Homes have certain special features which are not identical to
other categories of Buildings. As per National Building Code (NBC) Hospital
Buildings, Nursing Homes, Sanatoriums have been categories under Group-C
“Institutional Building”.
The
Institutional Buildings are having some high risk areas with special problems
relates life risk of both ambulatory and non-ambulatory patients. It is
therefore necessary to understand the types of hazards associated with the
Institutional Buildings vis-Ã -vis life safety concept.
Life
Safety from fire in Hospitals relies on a “Defined – in- Place” principle.
Horizontal exits or smoke barriers are required to sub-divide each storey of a
Hospital to provide an area of refuge on each floor. In case of emergency the
objectives should be “Keep the fire away from the Patient rather than more the
patient away from the fire”.
Hazard
Analysis:-
A.
Equipment’s
Hazards
With the rapid technological advancement in
medical science, hospitals and nursing homes are now equipped with a vast array
of new equipment like.
Computerized Axial Topography scanners,
Magnetic Resonance Imagers (MRI), lasers. Sophisticated Diagnostic and
Treatment Equipment, Heaters, boiler etc.
B.
Chemical
Hazards
1.
Flamable
chemicals
2.
Alcohols
3.
Solvents.
4.
Acids
5.
Ethers
6.
Sprits
C.
Gas
Stores
1.
LPG
Cylinders
2.
Oxygen
Cylinders
3.
Nitrous
Oxides etc.
D.
Plants
1.
Laundry
& sterilization plants
2.
A/C
Plants & ducts
3.
‘X’
Ray suits
E.
Kitchen
& Canteen
F.
General
Store
G.
Car park area
H.
Mattresses,
bedding, furniture,
Oxygen
cylinders, Pipe Line carrying Oxygen or Nitrous oxide in Patients’ rooms.
The problem as identified
during the inspection in different hospitals of this metropolitan city are
appended hereunder-
a) External
fire fighting and rescue operation are very difficult.
b) Evacuation
takes unreasonable time.
c) Simultaneous
rescue and fire fighting operation to be done mainly within the building.
d) Building
being fully air-conditioned, heat and smoke traps inside the building during
fire.
e) Smoke
venting problems & Danger of flash over.
f) Large
number of occupants with unpredictable human behavior is in case of fire.
g) Special
care is required for non-ambulant patients.
h) Special
care is required to keep escape routes clear from smoke and heat.
i) Hazards from increasing use of interior finish
decoration and Compartmentation with combustible materials.
j) Multi occupancy hazards, high fire loads;
k) Inadequate
water supplies;
l) Inadequate/unserviceable
fire protection systems and equipment
Exit Requirement:-
Vertical
evacuation of patients within a health care facility is difficult and time
consuming. Therefore horizontal movement of patients is primary important.
Smoke barriers and smoke compartments is important for fire safety in health
care facilities. This smoke barrier allows for horizontal evacuation of
patients to an area of refuge on the same floor and this horizontal exit shall
be provided with at least one fire & smoke check door with two hours fire
barrier walls. It is always preferable that the refuge floor space shall have
direct connectivity to the fire escape staircases/ramps for safe evacuation
from the building.
All
required exits that serve as egress from hospitals or infirmary sections shall
not be less than 2 M clear width including patient bed room doors to permit
transportation of patient on beds, litters or mattresses. The minimum width of
corridors serving patients bedrooms in buildings shall be 2.4 M.
Compartmentation:-
It is experienced that smoke is the cause of
most fire deaths, proper protection against smoke must be installed and
properly maintained in health care facilities. All such buildings must be
sub-divided into separate smoke compartments into which the patient can be
moved with having to leave the building or change of floors.
SERVICE DUCTS/SHAFTS:-
a) Service
ducts / shafts shall be enclosed by walls of two hours doors of one hour fire
rating. All such ducts/ shafts shall be properly sealed and fire stopped at all
floor level.
b)
A vent opening at the top of the service shaft
shall be provided having between on-forth and one-half of the area of the
shaft.
c) Fire,
Smoke and other toxic products of combustion tend to spread vertically within a
building. Special effort is required to prevent fire on one level from
threatening the occupants in the upper floors, this is important in hospitals
and nursing homes.
d) Dedicated
A.H.U. shall b provided for individual floor with supply & return duct as
far as possible Fire Dumpers shall be provided in the supply and return ducts.
In case of fire the A.H.U.
shall be tripped & fire damper shall be closed. For the above, necessary
interlocking with Fire Detection System to be provided.
Therefore,
all shafts should be provided with fire rated enclosures of 1 hour fire
resistance rating for vertical openings connecting not more than three floors.
Opening to shaft should be limited and such openings must be protected.
MINIMUM ESSENTIAL FIRE SAFETY
MEASURES IN INSTITUTIONAL
1. Good housekeeping in all area, specially
stores, kitchen, electrical installation,transformer house and waste disposals
etc. should be maintained.
2. No Smoking Zone (while applicable in office,
store, depot etc) shall be enforced rigidly.
3. All electrical installations shall be
periodically checked & tested by competent electrical engineers, while all
loose electrical wiring if any shall be replaced immediately.
4. Appropriate M.C.B. shall be installed where
necessary in the electrical installation as per Indian Electrical Rules.
5. All old electrical wiring especially in the
zone of insignificant and abundant area shall replace with the new ones.
6. The basement if any should not be used as store
room / material dumping / in patient ward or any other purpose which will cause
Fire / Smoke.
7. Lift
shaft and stair lobby / landing shall be free from any obstacles / obstruction.
8. Use of LPG gas cylinders not more than 320 kg
come into a gas bank, to be installed with separate place with barrier and
precaution as per IS : 6044.
9. Trained
staff in dealing with the fire fighting extinguisher / appliance / Evacuation
procedure shall be engaged. Fire fighting drill and evacuation drill should be
held on regular basis.
10. Building should come into a modular by making
corridors horizontal & vertical exits from the origin of the fire place to
a safe area easily and also by incorporating Fire & Smoke Check Door in the
lobby approaching to stairways and lift.
11. One
senior personal preferably from administration may co-ordinate & look into.
12. On site Emergency / Evacuation plan shall have
to be prepared and update at regular interval.
13. Fire Notice, Fire order, Exit sign, Floor Nos.
shall be displayed at conspicuous places as per requirements of NBC Part IV.
14. Arrangement
should be made for proper checking, testing and maintenance of all fire
protection and detection system to keep them in properly working condition at
all the time.
15. Electrical
Safety Audit should be carried out at regular interval as per Indian Electrical
Rules.
1. Water Reservoir exclusively for fire fighting
shall be made available as prescribed in National Building Code (NBC) Part IV.
2.
Replenishment of the reservoir may be
incorporated with deep tube well with auto facility.
3. Fire Hydrant Ring main with Yard Hydrant &
Wet Riser system with landing valve shall be installed as per NBC Part IV &
IS: 3844.
4. Hose Box containing two nos. 15 M long Hose
& 1 No. Branch Pipe with Nozzle to be installed near each Yard Hydrant
& Landing Valve.
5. First-Aid Hose Reel 40 M long to be provided
near each landing valve tapped off from the Wet Riser.
6. Sprinkler system to be provided for all the
floors & other places / areas as applicable as per NBC Code.
7. Fire
fighting extinguisher should be provided within the building as per IS: 2190
and person having
work station in that area should be trained to use the same if required
initially in case of emergency.
8.
The main Fire Pump and one stand by pump of
capacity minimum 2280 LPM and head of the pump will be such that 3.5 Kg/cm2
pressure is available at the furthest/highest landing valve, to be installed.
Auto start facility should be incorporated in fire pump. Accordingly, Jockey
Pump of Capacity 180 LPM shall also be installed.
9.
The
Stand by pump of equal capacity must be available on alternate sources of
supply, preferably diesel operating
pump.
10.
Fire Detection & Alarm System for the
entire Building shall be provided as per IS: 2185
11.
Public
Address System with Two way communication System
12.
Emergency
power supply shall be provided to the following equipment and system.
A.
Illumination
of means of escape route.
B.
Fire Alarm Panel & P.A. Console.
C.
Fire
Pumps
D.
Fire
Lift
E.
Bore
Well.
General recommendations for the Electrical
Installation respect of Hospitals/Nursing Homes
The
following recommendations are made for different electrical installations
(H.T./L.T.) rectification/correction at Hospitals/Nursing Homes premises, in
line with the “Central Electricity Authority (Safety) Regulations”, 2010 and
relevant provisions of I.S. Code of practice.
Important measures for LV/MV/HV
installation.
- To install MCB in all distribution
circuits (main and branch) along with incomer MCB in the distribution
board so that all the circuits are controlled from one point of the said
installation.
- Periodical checking and measurement of
existing earth pit/grid resistance, earth to neutral voltage, and
measurement of unbalance current in the system and to take measure
accordingly.
- Segregation of power cables from telephone
line, cable line & other non power line if any, by erection of cable
tray and laying dressing, clamping of cable, use of FRLS wire, separately
with cable tag making, ferrule making for maintenance of the installation.
- Necessary
gadgets are to be fitted in each floor/room for fire alarm as well as
tripping of the circuit breaker for isolation of supply of the
installation.
- To
measure current in each circuit; load of each circuit & sub-circuits,
distribution board must conform relevant I.S. Codes of practice.
- Marking
of distribution boards (main & branch) and circuits accordingly for
easy identification & maintenance of the circuit.
- Installation of lightning arrestor/
lightning masts on the building as per I.S. Code of practice.
- To
install modern starter and MCBs for Air-Conditioner control and other
gadgets as per I.S. Code of practice.
- To
install dry type transformer by replacement of existing oil type
transformers and preferably to replace all oil type circuit breaker by
V.C.B.
- Arrangement of proper air
circulation system for dry type transformers.
- To
remove all sorts of storage materials causing hindrance for accessibility
to the electrical control gadgets as well as exit in case of emergency. No
material shall be stored in the sub-station rooms.
- To use fire retardant paint to all
rooms decorated by the wooden panels.
- To
fix up responsibility to the personnel operating different electrical
gadgets during or after office hours in view of safety, mode of operation
and saving of energy.
- L.T.
Distribution Panel (Main) of the Transformer should have proper rating
A.C.B., at the Incoming Side (Main Incomer) and all outgoing Feeders must
have proper rating A.C.B. / M.C.C.B., with adequate protection system and
outgoing Feeders L.T. cables should be of sufficient current
rating in respect of M.C.C.B./ M.C.B. connected with it L.T. cables are
preferred to run through “Cable Duct” of the building. There should be
Floorwise/ Sectionwise Distribution Board in all floors, with sub-circuit
protection incoming & outgoing M.C.B./ M.C.C.B. of appropriate rating, as
per connected / working load required.
The
installation in multi-storied building should be carried out and maintained in
such a manner as to prevent danger due to shock and fire hazards in accordance
with the relevant I.S. code of practice.
All
ducts provided for power cable and other services shall be provided with “fire
barrier” at each floor crossing. No other service pipe shall be taken along the
duct provided for the Power Cable.
15. Outdoor
canopy/ soundless type D.G. Sets as Standby Power supply, having proper
interlocking system between Generator supply & Licensee supply.
16. For the
“Emergency Sections” of the Hospital/Nursing Home “U.P.S. System” is preferred.
17. Preparation
of layout, single line diagram of the total HT installation and distribution
diagram of all MV/LV installation after incorporation of above recommendation.
18. All
electric supply lines & apparatus shall be of appropriate rating and shall
conform to the relevant I.S. Codes of practice.
19. All
type of electrical installation work shall be carried out by Govt. Licensed
Electrical Contractor in terms of CEA (Safety) Regulation, 2010.
20. Recommended for
electrical safety officer in terms of safety regulation.
21. List of
Electrical Licensed persons to operate the HV/MV Equipments to be displayed and
to enter the name in the register in terms of Safety Regulation.
STANDARD OPERATING
POCEDURE
Main Objective:-
i)
To
protect the occupant.
ii)
To
protect the Assets.
iii)
To
secure the continuity of operations.
iv)
To
protect environment.
Occupants
Characterization:-
Staff:-
The
number of staff in Hospitals/Nursing Homes depends on the shift system. During
the day time the availability of staffs are usually maximum. Whereas minimum at
night hours.
Patients:-
The
number of patient in each ward/floor is variable depending on the capacity of
Hospital/Nursing Home. Usually all patient need assistance to evacuate, some
patient are able to walk when supported by staffs. Patients are assumed to be
sleeping at night and to be awaked during the day. The patients are not
familiar with the building.
Therefore
the evacuation of the patient is highly depending upon the ratio between the
number of patient and staff available to assist in evacuation. So staffs have
to be trained in fire fighting and evacuation tactics. The use of portable fire
extinguishers and fix installations like fire hydrants and hose reels is
important, so that they are able to put the fire out when occurs. The staff
should relies upon because this alert them, therefore the system should be well
maintained.
Fire
Fighting Facilities:-
The
sprinkler installation are effectively limit the spread of fire thereby protect
against untenable smoke and fire spread. The risk is reduced to at least by
67%.
Fire
and Smoke Check doors restrict the spread of smoke and heat within the area of
origin thereby lower the risk by about 33%.
Automatic
Detector cum Alarm system alerts the outbreak of fire and help in early
detection and thereby minimize the response time.
The evacuation
procedure depends on detection, reaction and travel time.
Detection:-
The
detection time is determined by the time of actuation of the smoke detector.
Calculated detection time for automatic detection system is varies in manned
and unmanned area.
Reaction:-
After the actuation of the detector
system usually the staffs interpret the situation before responding, if the
staffs are trained properly how to respond the fire alarm, the reaction time
will be very short. But staffs attending the healthcare units the response time
should not be more than 30 sec.
Travel time:-
The following steps
generally involved in healthcare units for evacuation of patients.
•
The
staff moves to the patient in wards.
•
The
staff prepares the patient or transportation
•
The
staff assists the patient to move to a safe area
•
The
staff and patient queue at the exits
The Key Elements of
Standard Operating Procedure:-
- To
identify the Fire Escape Route in order to start evacuation procedure in
orderly manner, during fire emergency.
- To
identify the location of Fire Fighting Equipments as installed in the
premises and needs appropriate application.
- Conduct
of fire fighting drills at regular interval to enable the in-house fire
fighting team to respond any emergency in systematic and discipline
manner.
Fire Command
Structure:-
- Chief
Executive Officer or Head of the Organization will act as the commanding
officer during emergency.
- The
commanding Officer has the primary responsibility to recognize hazards and
prepare the fire order and fire operation plan & get them promulgated.
- To
supervise the regular training to the hospital staff (non-medical &
medical) of the hospitals and keep them informed about the fire emergency
evacuation plan.
- Medical Superintendent will act as a
occupant/patient evacuation supervisor and formulate the emergency
evacuation plan and impart training to all the staffs (medical &
non-medical) regarding the emergency evacuation procedure.
- Floor managers/Matrons/floor supervisor will assist
the evacuation supervisor in evacuation process.
- The Chief Engineer/ Maintenance Engineer
will act as a head of the fire fighting team and his responsibility to
maintain all the fixed fire fighting installation system and constitute
the fire fighting team. He should also impart the training about the operation
and maintenance of fire fighting installation and conduct training at
regular intervals.
ACTION BY SECURITY /
DESIGNATED FIRE FIGHTING STAFF :-
A) Inform the fire brigade through any one of the
following phone numbers:
B) Alert the occupants by using public address
system & give them proper guidance for safe evacuation from the building.
C) Operate the grounding switch to bring fire elevator
to ground floor level.
D) Evacuate the occupants by using fire exits and
emergency exits only and assemble them in a safe place.
E) Switch off the power supply of the building
excepting emergency light / fire lift / fire alarm panel, pa & talkback
panels.
F) Fight the fire using nearest suitable
extinguisher or water from nearest hose reel / hydrant point depending on the
size of fire.
G) Guide
the fire force, on their arrival to the seat of fire.
H) Incase of causalities, call ambulance or mobile
trauma care unit.
I) Ensure that the people who are physically
constrained, unconscious, disable and woman are evacuated.
A.
Procedure for Calling the Fire Brigade:
a)
When calling the Fire Brigade give clear
information.
1.
Name & Address of the premises where fire
has actually broke out.
2.
Nearest
land mark & name of the access road.
3.
Character
to the Building and type of occupancy.
4.
Nearest
water body is available.
5.
Telephone
No. of the caller & of the particular premises if known.
B. Procedure to be
followed for Raising the Alarm:
All occupants/
employees should be aware of how to raise the alarm.
- Once detector actuated, the on duty
staffs will act according to pre-determined plan.
- The source of alarm must be
monitored regularly.
- Whole premises should be
warned through the P.A. system in such a manner that should not generate
any panic amongst the occupants.
- The system should be
incorporated to disseminate the information to other emergency support
services.
- Pre-determined area should be
identified for refuge or assemble of the occupants (Patient).
- The assembly or refuge
area should have the facility of medical support for patient if needed.
- The assembly or refuge
area must have the access of the emergency vehicles like ambulance or fire
service vehicles.
- Roll call should be taken
to ensure that all occupants/ patients are evacuated from the danger zone
and the missing person should be notified to the Fire Service and Police
Authority.
C. Procedure for Fighting the Fire:
Once a fire has been
detected, a suppression system to extinguish the fire is required to minimize
damage and avoid evacuation. A variety of firefighting equipment can be
installed in different locations in the hospital to combat specific types of
fires, with special consideration to the patients occupying each area and the
medical equipment housed in those areas.
1.
Fire Extinguishers
Fire
extinguishers are labeled with standard symbols and letters representing the
classes of fires that they are equipped to fight.
The following are
important considerations before you attempt to fight a fire:
·
Make sure that everyone else is leaving the area, someone has
sounded the alarm, and someone has called the fire department.
·
Ensure that you have an unobstructed escape route at your back.
·
Verify that the fire is small, confined, and not spreading.
·
Make sure that you know what is burning and that you have the
appropriate type of extinguisher to fight the fire.
·
You are knowledgeable regarding the use of the extinguisher.
·
Make sure that you keep your back to a clear exit and stand 2 to 3
meters (6 to 8 feet) away from the fire.
·
Your safety is paramount; if the fire is out of control, leave the
area immediately.
Fire wardens (or health
and safety officers) and hospital staff should be trained on how to use fire
suppression devices. Regular training sessions should be undertaken as part of
the medical facility’s scheduled safety and evacuation simulations.
The four steps in using
a fire extinguisher can be remembered through a simple acronym: PASS.
The minimum
requirement, and the least expensive option, for a firefighting system is a
fire alarm system with smoke detectors and a fire suppression system with fire
extinguishers. There are other fire suppression devices that can be installed
in a hospital to improve the facility’s resilience to fire hazards. These
include water sprinkler and mist sprinkler systems, water hose reels, and
smoke extractors.
1.
Water Sprinkler Systems
·
These systems have a water droplet diameter greater than 1 mm, and
the cumulative surface area coverage for 1 liter of water is approximately 3
square meters.
·
Typically, in fire sprinkler systems, the full network of pipes is
constantly charged with water.
·
The sprinkler head is a heat-sensitive valve that releases water
once the temperature exceeds a fixed temperature, generally 30DegC above the
ambient temperature.
·
Each sprinkler head operates independently and will activate only
once sufficient heat reaches the valve. Therefore, only the sprinklers closest
to the fire will operate, maximizing the available water pressure to the
location of the fire.
·
Sprinkler systems cause less water damage than the hoses used by
the fire service to combat a fire. Sprinkler
2.
Water Hose Reels
- Water hose reels should be located
on every floor of the hospital, to provide a realistically accessible and
controlled supply of water to fight a fire.
- Fire hoses are connected to the
main water supply or an independent water storage system.
- Fire hoses are typically 18 m to 36
m (59 to 118 feet) in length and have an internal diameter of 13 to 19 mm
(0.5 to 0.7 inches). The size of the hose reel used is dependent on the
size of the medical facility, as there needs to be sufficient length to
overlap adjacent hoses.
- Fire hose reels are all similar in
their operation. The general procedure for their use is as follows:
- Ensure that the nozzle/jet is in
the closed position.
- Turn on the main valve.
- Pull the hose off the drum, toward
the fire.
- Open the nozzle/valve and direct
the stream of water toward the fire.
- Use fire hose reels only to fight
Class A fires.
- Canvas fire hose reels are
typically located close to fire hydrant points and are intended for use
only by the fire service’s emergency response team. It is important to
ensure that the hose’s nozzle/valve fittings correspond to those used by
the local fire service.
3.
Smoke Extractors
The rapid spread and accumulation of smoke usually poses one of
the highest risks to human life in the event of a fire. One of the means of
minimizing this danger is by incorporating special smoke extraction systems,
usually in the initial design of heat, ventilation, and air-conditioning (HVAC)
systems.
·
Smoke extraction systems are mechanical systems that can be
manually or automatically activated once the alarm is triggered.
·
These systems are designed to remove hazardous smoke from the area
of the fire and prevent the spread of smoke to other areas of the building
through the closing of specific vents and the high-pressure pumping of air to
designated areas to to prevent the ingress of smoke.
- Smoke
extractor systems tend to be quite costly to incorporate in existing
facilities.
4.
To accomplish this, staff members should be
instructed in the use of hand held extinguishers and hose reels.
5.
Certain members of staff may be designated as a
firefighting team as part of the emergency procedures & their function
would be to assess and "if safe to do so" tackle the fire with the
available equipment until the Fire Brigade arrive
Important Considerations
It is
important to note that all mechanical suppression systems, including sprinkler
systems, smoke extractor systems, and water storage tanks, need to be designed
to withstand earthquakes. Damage to mechanical systems is common during
earthquakes because these systems tend to have rigid connections and fittings
that fail in the event of seismic movements and forces. Water tanks in
particular can worsen the effects of earthquakes on health care facilities if
they are not properly designed.
- Planned
Preventative Maintenance
One of the most critical aspects of an effective suppression
system for combating fires is planned preventative maintenance. Regular checks
should be performed and documented as part of a health care facility’s
management system. When an equipment item has been checked, it should be tagged
and signed off for safe use with an indication of any action taken and the
next scheduled check date.
- Recommends that smoke detectors be replaced every 10
years. However, if they operate on batteries, smoke detectors should be
checked as part of standard hospital maintenance, usually every month.
- Water sprinkler systems require
planned preventative maintenance as well as robust reactive maintenance
procedures. Generally, individual sprinkler heads are virtually
maintenance free; therefore, costs are related to maintaining the system
through weekly tests and upkeep of water supplies and pump equipment.
- Hose reels should be checked and
signed off monthly.
- The hospital administration should
ensure that canvas hose reels are certified for use by the fire service
each year.
· Ad hoc inspections of
equipment should be carried out after its use in an incident such as a fire.
The
following main elements of a onsite emergency plan which need to be prepared by the Commanding Officer/C.E.O./Head of the
Hospital / Nursing Homes.
1. Drawing up emergency procedures
2. Conducting evacuation drills
3. Conducting Regular fire safety
inspections
4. Checking maintenance and servicing of
fire equipment
5. Conducting Staff training
6. Imparting information to employees
7. Keeping of records
8. Drawing up emergency Planning.
- Evacuation
This is a crucial component of the aim to save lives in emergency
situations in hospitals. A comprehensive evacuation plan needs to be in place
that all staff members are aware of and are experienced in carrying out. It is important to note that there is no fixed methodology for
evacuations; the procedure will vary for each individual health care facility.
Recall that evacuation procedures are undertaken only as a final
resort action for the hospital. In the case of a fire, evacuation is performed
once the preventative and suppression measures described earlier have failed to
contain the fire and lives are under immediate threat.
At the Sound of the Fire Alarm
- Once the fire alarm is triggered,
there need to be designated personnel to investigate the reason for the
alarm (and the possibility of a false alarm) and to identify the level of
the threat. They must also determine whether the fire is a small one that
can be suppressed or whether evacuation is necessary.
- These designated personnel must
communicate with the hospital telephone operator, who will inform the rest
of the staff what sequence of evacuation (if necessary) needs to be
followed.
Notification of External
Agencies
If there is a fire threat and the decision to evacuate is made,
there should be a designated person responsible for notifying the entire
facility of the evacuation order, using appropriate systems such as overhead
pages, emails, text messages, and internal hospital communication systems with
loudspeakers.
The procedures of the hospital emergency operations center (EOC)
should include immediate notification of appropriate agencies such as the
Ministry of Health; fire, police, and/or army services; and national disaster
offices. For instance, in the event of a fire, consider posting conspicuous
notices, at various locations in the hospital, of agencies to be notified.
Fire and bomb threats, for example, may necessitate immediate or
rapid evacuation depending on the level of danger. Natural disasters with
adequate warning periods, such as hurricanes and floods, may require only a
gradual evacuation of the health care facility.
The following actions may be needed when the “prepare only”
instruction is issued:
- If you hear the fire alarm or see
flashing lights, close all fire doors in your area.
- Ensure that egress corridors are
clear to allow movement of patients and equipment.
- Locate and secure patients’ medical
records and medical supplies.
- Ready evacuation transport
equipment such as wheelchairs, blankets, and gurneys.
- Set in motion a system to move
people to designated assembly points.13
· Await
further instructions; do not evacuate unless given the authorization to do so.
Evacuation Routes
Evacuation routes should be clearly established. All hospital
staff should have working knowledge of the evacuation routes and which one to
take, based on the type of evacuation and as instructed by the hospital’s
incident commander.
Specifically assigned staff members, sometimes referred to as
“wardens” or “health and safety officers,” should then direct patients and
visitors to orderly and calmly evacuate.
Evacuation planning must take into consideration all spaces around
the hospital compound. This will help in the development of emergency transit
routes, assembly areas, holding areas, and so forth.
Number of Staff
Standard acceptable ratios of number of medical staff to number of
patients have been established. These ratios are dependent on the level of care
required for each patient. Examples of nurse to patient ratios are shown in the
table below.
- Staff ratios are based on the
hospital’s protocol and the country’s statutory regulations.
- Generally, all other departments
(e.g., biomedical) may have one person on duty after regular working hours
or all personnel in the department would be on-call.
- Every shift should have health and
safety officers or wardens on-site who are trained and knowledgeable regarding
fire response and evacuation procedures. The minimum number of wardens on
duty is determined according to the health care facility’s emergency
protocol.
- In some instances,
volunteers can assist with the gradual or rapid evacuation of a hospital.
Evacuation Transport
Equipment
In the event of an evacuation, it is essential to have
transportation equipment available for patients. This equipment may include the
following:
- Blankets
- Wheelchairs
- Beds
- Canvas Stretchers
- Backboards
- Sked Stretchers18
Some of the equipment, such as backboards and sked stretchers, is
usually not stored in the hospital. These materials may be supplied by the
national disaster office, the fire service, or the defense force/army.
There are important practical notes to remember when using
transportation equipment in a hospital evacuation, as follows:
- A sufficient amount of equipment
should be available to evacuate each floor of the facility.
- Equipment should be stored in areas
that are easily accessible at all times; it should not be stored in locked
closets.
- All transportation equipment should
be part of the facility’s regular planned preventative maintenance program.
- Fire
Drills
Upon the sound of the fire alarm, it is expected that hospital
staff will activate a practiced system or sequence of activities in response.
Each health facility should have a unique system that has been tailored to meet
its needs.
An evacuation/response plan should be discussed and developed by
the hospital administration and the engineering and medical teams. The plan
should include regularly scheduled training for all staff.
General training of all staff should include, but
not be limited to, the following:
· Training on
how to lift and move patients.
· Training on
how to use fire extinguishers.
· 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):
- R – remove anyone endangered by the
fire to a safe area
- A – activate the alarm
- C – close all windows and doors;
contain the fire
- E – evacuate
- Training on what to do if they hear
the alarm and see the flashing lights.
Specific training defines the roles and responsibilities of each
staff member. For example, in the case of a fire alarm, who notifies the fire
service and the rest of the hospital?
Fire drills are designed to ensure that, through regular training
and simulations, staff members will:
· Have knowledge and understanding of the fire safety plan so that
they can act swiftly, safely, and in an orderly manner.
· Be knowledgeable regarding fire protection. Frightened individuals
cannot act sensibly and intelligently, and they may do things to harm
themselves or those around them.
- Have increased
self-confidence and power to fulfill their responsibilities in the event
of a fire.
It is important to note that all training simulations and fire
drills need to be scheduled and performed regularly, and performance
evaluations need to be completed and used to improve subsequent training
drills.
- General
Evacuation Responsibilities of Different Departments
The following table provides a sample summary of key evacuation
responsibilities for various departments in a hospital. Depending on the
hospital’s administrative structure, these responsibilities may fall under the
department listed or may be better assumed by another department. For smaller
hospitals, many of these responsibilities may need to be combined under one
department or ICS function. All of the responsibilities listed are in addition
to the general responsibilities otherwise included in the hospital’s emergency
operations plan.
Department
|
Responsibilities
|
Admitting
|
Patient Tracking
|
I. Assist in assembly point (AP) check-in and
discharge II. Assist in discharge site check-in and discharge
|
Other
|
I. Assist patient destination team
|
Biomedical
Engineering
|
I. Identify all available equipment for
internal and external patient transport II. Transport appropriate medical
equipment to AP
|
III. Troubleshoot
malfunctioning equipment during evacuation IV. Track any equipment that
leaves the facility
|
Blood Bank
|
I. Inventory available blood products
|
II. Identify coolers
and other resources available to support blood transport III. Transport blood
products to AP
|
Facilities
Maintenance
|
I. Activate emergency systems to commandeer
elevator banks II. Monitor system utilities
|
III. Assist with AP
site setup
|
IV. Assist with
patient transport as needed
|
Case Management
|
I. Assist patient destination team
|
II. Identify
non–acute care patients who can be discharged to skilled nursing facilities
III. Staff discharge site as needed
|
IV. Support family
assistance center as needed
|
Emergency Department
|
I. Provide stafing assistance in the AP
emergency resuscitation and stabilization area II. Respond to
injuries/illness during evacuation as requested
|
III. Provide staff
to support loading teams
|
Environmental
Services
|
I. Set up AP and discharge site
|
II. Provide staff
for patient transport
|
Food/Nutrition
Services
|
I. Transport emergency supplies to AP and
discharge site and distribute supplies as needed
|
Health Information
Systems
|
I. Retrieve or track medical records before
transfer of patients to other facilities II. Assist receiving institutions
with obtaining medical record data
|
Human Resources
|
I. Provide staff resources
|
II. Assign AP
representative
|
III. Track staff who
travel to other facilities
|
IV. Monitor
emergency challenges to labor agreements
|
Interpreter Services
|
I. Provide interpreter staff at the AP and
discharge site II. Assist with translation in the family assistance center
|
Materials Management
|
I. Manage the patient transport process
|
II. Transport
medical supplies, linens, and other needed items to the AP and discharge site
|
Pharmacy
|
I. Transport medications and IV fluids to the
AP and dispense as needed
|
II. Support
discharge site with needed medications and dispensing if possible
|
Security
|
I. Communicate with outside agencies II. Lock
down facility and secure roads III. Unlock all stairwell doors
|
IV. Manage access
to/from secure units V. Clear evacuation route
|
VI. Manage
routes/checkpoints
|
VII. Check units
after closing (if possible)
|
VIII.Support care
units and family waiting areas at the AP IX. Assist with transport of
psychiatric patients
|
X. Provide staff to
manage ambulance flow
|
Respiratory Therapy
|
I. Deploy staff to critical care units for
internal and external transport II. Transport respiratory equipment to the AP
|
III. Provide
emergency care as needed in the AP resuscitation and stabilization area
|
Telecommunications
|
I. Use overhead paging system to communicate
information as appropriate II. Set up phone bank at AP, discharge site, and
family support center
|
