Fire Safety Guidelines For Hospitals & Nursing Homes

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-à-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.

RECOMMENDATION OF

MINIMUM ESSENTIAL FIRE SAFETY MEASURES IN INSTITUTIONAL

BUILDINGS

PREVENTIVE MEASURES

 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.

Protective Measures

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.

1. 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.

2. 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.

3. 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.

4. 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.

5. To measure current in each circuit; load of each circuit & sub-circuits, distribution board must conform relevant I.S. Codes of practice.

6. Marking of distribution boards (main & branch) and circuits accordingly for easy identification & maintenance of the circuit.

7. Installation of lightning arrestor/ lightning masts on the building as per I.S. Code of practice.

8. To install modern starter and MCBs for Air-Conditioner control and other gadgets as per I.S. Code of practice.

9. 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.

10. Arrangement of proper air circulation system for dry type transformers.

11. 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.

12. To use fire retardant paint to all rooms decorated by the wooden panels.

13. 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.

14. 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.

Evacuation Procedure:-

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:-

1. To identify the Fire Escape Route in order to start evacuation procedure in orderly manner, during fire emergency.

2. To identify the location of Fire Fighting Equipments as installed in the premises and needs appropriate application.

3. 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:-

1. Chief Executive Officer or Head of the Organization will act as the commanding officer during emergency.

2. The commanding Officer has the primary responsibility to recognize hazards and prepare the fire order and fire operation plan & get them promulgated.

3. 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.

4. 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.

5. Floor managers/Matrons/floor supervisor will assist the evacuation supervisor in evacuation process.

6. 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.

1. Once detector actuated, the on duty staffs will act according to pre-determined plan.

2. The source of alarm must be monitored regularly.

3. Whole premises should be warned through the P.A. system in such a manner that should not generate any panic amongst the occupants.

4. The system should be incorporated to disseminate the information to other emergency support services.

5. Pre-determined area should be identified for refuge or assemble of the occupants (Patient).

6. The assembly or refuge area should have the facility of medical support for patient if needed.

7. The assembly or refuge area must have the access of the emergency vehicles like ambulance or fire service vehicles.

8. 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.

3. 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. 

3. 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.

3. 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):

1. R – remove anyone endangered by the fire to a safe area
2. A – activate the alarm
3. C – close all windows and doors; contain the fire
4. 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.

4. 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