Common cause of fire in Hospitals

Common cause of fire in Hospitals

Fire safety in health care facilities—hospitals, nursing homes, clinics—presents a specialized response. Patients and families have trusted you with the safety of people who, in many cases, cannot help themselves.

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, 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. 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.

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.

Computerised 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.

a.     Acids

b.     Ethers

c.      Sprits

3. Gas Stores

1. LPG Cylinders
2. Oxygen Cylinders
3. Nitrous Oxides etc.

4. Plants

1. Laundry & sterilization plants
2. A/C Plants & ducts
3. ‘X’ Ray suits

5. Kitchen & Canteen

6. General Store

7. Car park area

8. Mattresses, bedding, furniture, Oxygen cylinders, Pipe Line carrying Oxygen or Nitrous oxide in Patients’ rooms.

 

A number of different materials and types of equipment are major contributors to hospital fires.

Major incident in India:

A. December 2011: AMRI Hospital, Kolkata, WB, India—91 Fatalities dead

1. The fire in this private hospital started in the basement, where highly flammable medical equipment was illegally stored.

2. Hospital staff abandoned the hospital when the fire started and did not try to rescue any patients.

3. The fire service arrived 90 minutes after the start of the fire. Windows and doors were locked; windows had to be broken to gain access.

4. Most deaths were a result of smoke inhalation.

B. October 2016, twenty two patients died and many others were injured in a major fire accident at a private hospital in Bhubaneswar.

Fire and Safety Association of India (FSAI) Karnataka chapter, which conducted a survey, has found out that over 4,000 hospitals in Karnataka are not following the standard fire safety rule.

It was also found that some hospitals in Bangalore are not even using extinguishers properly. P Lakshminarayana, Bengaluru chapter of FSAI, said, “To our shock, we found some hospitals hiding the extinguishers. Reason? Since it was red in colour, it did not suit their interior design. We really don’t understand what is more important? Lives or design? Also, the emergency doors are always kept locked or there were hospitals which had kept their old documents and papers at the door making them inaccessible.”

The problem as identified in different hospitals in India are appended hereunder-

a)                External firefighting and rescue operation are very difficult.

b)                Evacuation takes unreasonable time.

c)                Simultaneous rescue and firefighting 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)               Unserviceable water supplies;

l)                 Unserviceable fire protection systems and equipment

Fire from Electrical Equipment

Air Conditioners: “AHU/centralised AC units reported much fewer fires than split/window AC units”
Root Causes:
Ø Overuse, so the equipment heats up.- Domestic air conditioners are not meant for 24x7 operation.
Ø Not properly maintaining the AC units - A clean filter reduces fire risk as well.
Ø Poor electrical wiring - Provide industrial sockets and circuit breakers along with the right wire gauge.

Other Electrical Equipments and Switch Gears - ‘Switch gears, Light fittings, UPS systems, Laboratory equipments, Computers….’
Root Causes:
Ø Design issues / Equipment installation. - Mounting of distribution board/fuse box on wooden plank will not reduce electrocution risk but increase fire risk !
Ø Poor Maintenance - Major share of electrical mishaps happens during maintenance without work permits !
Ø Human Errors ‘ -Technical qualification, SOP, Training’

PREVENTION

The Fire Safety Audit Committee formed by the West Bengal Government in the wake of the devastating fire at AMRI Hospital in Dhakuria December 2011 has detected lapses in fire safeguards at almost all the establishment they have inspected, which has prompted the Government to come up with more stringent rules.

Minister for Fire and Emergency Services Javed Ahmed Khan said that the Government is going to mandate the appointment of a fire safety officer in all hospitals across the State.

1.      One of the primary considerations in preventing hospital fires is to prohibit the use of combustible structural (e.g., floors, walls, roofs, stairwells, fire escapes) and nonstructural (e.g., doors, windows, ceilings, fixtures, façade, insula­tion, mechanical and electrical conduits) components in the hospital facility.

2.      Materials used in the design and construction of hospitals must be noncombustible/nonflammable, must have ad­equate fire resistance ratings, and should not emit toxic gases/smoke during a fire. Fire resistance ratings are usually dependent on the layout, occupancy, and usage of the facility.

 Some examples of materials that emit toxic fumes during a fire and should be avoided are:

·        Polystyrene (for example, polystyrene decorative moldings)

·        Insulation spray foams, polyurethane and isocyanate foams

3.      ICUs and accident and emergency units should be located on the ground floor or first-floor level with dedicat­ed access ramps. Typically, high-traffic units (e.g., diagnostics) are located on the lower/ground floors. (Note: The configuration of an ICU ward is completely different from that of other wards.)

4.      The width of the corridor leading to the emergency exits (unobstructed) should be at least 2.4 m (7.9 feet). This will permit the transportation of hospital beds, mattresses, and so forth in the evacuation of non-ambulatory patients.

5.      Evacuation maps should be posted at the hospital’s main access points to clearly identify egress routes. It is important to note that the evacuation may not necessarily involve patients and personnel exiting the building; they may be required to move to an upper floor.

6.      Suggested requirements for installing and locating fire alarm–initiating devices are as follows:

·        The operable part of the Manual pull box should not be more than 1.07 m (42 inches) to 1.22 m (48 inches) above floor level.

·        Manual pull boxes should be located so that they are conspicuous, unobstructed, and accessible.

·        Manual pull boxes should be located so that the horizontal travel distance between boxes on any floor is not more than 61 m (200 feet).

·        Additionally, manual pull boxes should be located within 1.52 m (5 feet) of either side of a grouped opening

7.      The location of smoke and heat detectors depends on the type of detector being used and the geometry and occupancy of the space. Typically, the maximum coverage areas for smoke and heat detectors are 100 square meters (1,076.4 square feet) and 50 square meters (538.2 square feet), respectively.

8.      Regulations as per National Building Code 2005 : 

1. All high-rise buildings need to get NOC as per the zoning regulations of their jurisdiction concerned.
2. A road which abuts a high rise should be more than 12 metres wide, to facilitate free movement of Fire Services vehicles, specially the Hydraulic Platform and Turn Table Ladder.
3.Entrance width and clearance should not be less than 6 metres or 5 metres, respectively.
4. Atleast 40 per cent of the occupants should be trained in conducting proper evacuation, operation of systems and equipment and other fire safety provisions in the building, apart from having a designated fire officer at the helm.
5. The buildings should have open spaces, as per the Zonal Regulations.
6. Minimum of two staircases with one of them on the external walls of the building. They should be enclosed with smoke-stop-swing-doors of two-hour fire resistance on the exit to the lobby.

9.      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.

10.   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.

11.    One of the most critical aspects of 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.

·        Fire Panel operate on batteries, smoke/Heat detectors, Manual Call/Pull Box, Notification Hooters 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.

·        All mechanical systems, including sprinkler systems, smoke extractor systems, and water storage tanks, need to be designed to resist earthquakes.

12.   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)

·        Training on what to do if they hear the alarm and see the flashing lights.

Hospital engineering service provision for Fire Protection according to NABH:
1. Fire fighting installation approval must be obtained
2. Location of control room should be easily accessible.
3. Control panel & manned, PA equipment should be connected with detection system or fire alarm system.
4. Pumps and pump room
5. 2 separate pumps i. e .Electric and diesel pump should be available
6. Provision of Forced ventilation should be there.
7. Arrangement of filling Fire tenders
8. 4 way fire inlet must be present in case of emergency
9. Proper access for Fire tender to fire tanks
10. Fire Drill should be performed
11. Yard Hydrants should be available
12. Ring main and yard hydrants should be as per strategic locations.
13. 2 way fire heads to charge the ring main
14. Landing Hydrant & Hose reels
15. Wet riser system must be installed
16. First aid Fire fighting appliances must be in working conditions
17. First aid equipment cabinets
18. Provision of Escape routes - escape stair
19. Sprinklers system - basement & bldg. above 15 M in height
20. Automatic Smoke detectors / heat detectors
21. Provision of Fire Alarm System & Fire extinguishers

Remember the RACE Against Fire

RESCUE any individual directly threatened by fire. Patient safety is the primary consideration, so move patients who are in immediate danger away from smoke and flames. Place the patient in a nearby room, behind a closed door.

ACTIVATE the alarm if you discover a fire or respond immediately to the alarm if you hear it sound.

CONFINE the fire by closing doors to slow the spread of smoke and flame. Close the doors of patients’ rooms. In general, residents are safer in a closed room than in a smoke-filled hallway.

EXTINGUISH the fire only if the fire is small, and if you know how to operate a fire extinguisher. Be sure the area has been cleared and the fire department called.

¨Some typical example discharge times are.
¨2 Kg CO2 10 seconds*
¨5 Kg CO2 20 seconds*
¨3 litre Water 10 seconds*
¨9 litre Water 55 seconds*
¨3 litre Foam 10 seconds*
¨9 litre Foam 40 seconds*
¨4kg Powder 11 seconds*
¨9kg Powder 18 seconds*
¨1kg Powder 7 seconds*