Fire safety in healthcare facility

1. HOSPITAL FIRE PREVENTION &
EVACUATION –WHO GUIDELINE
DR LEE OI WAH
KETUA PENOLONG PENGARAH KANAN (PERUBATAN)

2. HOSPITALS DON’T BURN !
Hospital Fire Prevention and Evacuation Guide
• Prevention
• Suppression
• Evacuation
• Evacuation training drills

3. MAIN CAUSES OF HOSPITAL FIRES

4. CASE STUDIES OF HOSPITAL FIRES
1. How combustible were the structures and interior furnishings of
hospital ?
2. What provisions were in place for limiting the spread of the fire?
3. What provisions were in place for early discovery of fire?
4. What provisions were in place for notification of the fire service
and hospital personnel? Are regular fire drills conducted for staff
members and the fire service?
5. What provisions were in place for prompt extinguishing of the
fire and prompt evacuation of patients?

6. FIRE TRIANGLE
• Combustible
material
• Source of ignition
• Maintaining burning
process
• Oxidizing agent
• Start & continue
the fire
• Falsh point of
various materials

7. 5 CLASSES OF FIRES
• Class A: Fires that involve ordinary combustible materials such as wood, cloth,
paper, rubber, and many plastics.
• Class B: Fires that involve flammable liquids, combustible liquids, petroleum
greases, tars, oils, oil-based paints, solvents, lacquers, alcohols, and flammable
gases.
• Class C: Fires that involve energized electrical equipment, such as power tools,
wiring, fuse boxes, appliances, TVs, computers, and electrical motors.
• Class D: Fires that involve combustible metals such as magnesium, potassium,
titanium, zirconium, lithium, and sodium.
• Class K: Fires that involve combustible cooking oils and fats used in commercial
cooking equipment.

8. PRINCIPLES OF PREVENTION
• Prohibit the use of combustible structural and non-structural
components/building materials in the hospital facility (new facility vs existing
facility)
• As-built drawings or building plans
• Design considerations - number of floors , egress

9. BUILDING MATERIALS
• Must be non-combustible or non-flammable.
• Have adequate fire resistance ratings.
• Should not emit toxic gases or smoke during a fire
• Existing facilities may be retrofitted to increase their fire resistance and
formation of fire compartments.
• Remove or Protect flammable materials (fire-retardant paints, fire-insulating
materials).
• Fire retardant glass doors, windows, ceiling tiles and wall finishes.
• Fire doors and frames between each fire-proof compartments.

10. NUMBERS OF FLOORS
• The aim of design of new facilities is to reduce the vertical height and the
numbers of floors of the bulding (favours horizontal evacuation rather than
vertical evacuation).
• ICU and ED should be located on the ground floor or first floor with access
ramps.
• High traffic units should be located on the lower or ground floors – eg diagnostic
units.

11. EGRESS
• Minimum of two(2) independent egress routes and exits for every location on
every floors.
• Exit routes should be located as far away from each other as possible so that if
one exit route is blocked by smoke or fire, the alternate route can be used.
• Width of corridors leading to exit should be unobstructed with width at least 2.4
m for transportation of hospital beds (non-ambulatory patient).
• Desirable for accesss for fire-fighters- designated stairwells or window access.
• Evacuation maps to be posted at hospital’s main access points.
• Clearly identify egress routes and exits.

13. FIRE ALARM SYSTEMS
• Manual activated alarm initiating devices (eg break glass) installed at area with
high presence of staffs.
• Smoke and heat detectors in low-traffic areas away from staffs or personnels
which will trigger automatic alarm system.
• Smoke detectors will generally detect fire earlier than heat detectors.

14. FIRE SUPPRESSION
• Fire extinguishers(ABC dry chemical, Carbon Dioxide, Halon, Dry powder,Class K
extinguisher)
• Water sprinkler systems
• Mist sprinkler systems
• Water hose reels
• Smoke extractors

16. EVACUATION
• Aims to save lives .
• A comprehensive evacuation plan should be in place and all staff members are
aware of and experienced in carrying it out.
• A final resort performed once the preventive and suppression measures failed to
contain the fire and lives are under immediate threat.
• Hospital Incident Command System (ICS) will be used throughout the duration of
the evacuation response.

17. DISASTERS REQUIRING EVACUATION

18. TYPES OF EVACUATION
Emergency move –evacuate immediately or patients and staffs
may die, no time to prepare
Evacuate as quickly and safely as possible; limited time to
prepare (1-2 hrs); follow procedure
No immediate danger; sufficient time for systematic evacuation
procedures ( many hrs to several days)
Do not move patient, but begin to prepare for evacuation.
IMMEDIATE
RAPID
GRADUAL
PREPARE
ONLY

19. PREPARE ONLY INSTRUCTION
• 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
equipments.
• Locate and secure patient’s medical records and medical supplies.
• Ready evacuation transport equipment such as wheelchairs,blankets or gurneys.
• Set in motion a system to move people to designated assembly points.
• Await further instruction; do not evacuate unless given the authorization to do
so.

20. MOVEMENT DURING EVACUATION
• Horizontal : move patients in immediate danger away from the threat but
keeping them on their current floor.
• Vertical : usually involves the complete evacuation of a specific floor in the
hospital and evacuated out of the hospital if necessary.
• Shelter in place : remain in their units and awair further instruction.

21. EVACUATION ROUTES
• Establish clear evacuation routes.
• All staffs should have working knowledge of evacuation routes and which to
take based on typeof evacuation as instructed by hospital’s Incident
Commander.
• Assigned staffs(warden or safety officers) to direct patients and visitors to
orderly and calm evacuation.

22. LEVEL OF EVACUATION
• Complete vs Partial evacuation
• Complete evacuation warranted in :
i. Fire , smoke, and/or toxic fumes
ii. Structural damage to the facility
iii. Potential exposure to hazardous materials
iv. Terrorism or violent, armed visitors
v. Credible bomb threat

23. PATIENT PRIORITIZATION EVACUATION MODELS
• 3 models :
a. Geographic model
b. Resource model
c. Acuity model

24. Types of model Pros Cons
Geographic model • Allows for partial evacuation that will not disrupt
entire hospital
• Allow unit to stay together throughout evacuation
• Requires considerable evacuation time
Resource model • Uses available resources effectively
• Effective streamlining evacuation process (top-
down or bottom-up)
• Requires significant real-time planning & logistic
management
Acuity model • Evacuates the most mobile patients first-greatest
good for the greatest number of patients
• Require shorter amount of time for partial
evacuation
• May lead to Icu patients having to wait long
periods for appropriate transport vehicles
PATIENT PRIORITIZATION EVACUATION MODELS

25. PRRIORITY RATINGS FOR IMMEDIATE EVACUATION
OF PATIENTS
1
• Patients in immediate danger
2
• Ambulatory patients
3
• Patients in general care units requiring transport assistance
4
5
• Patients in intensive care units
• Patients in the operating room (surgical procedure that had been initiated
should be completed to a point safety before patient is moved)

26. RESOURCE MODEL EVACUATION
• ICU patients will be evacuated as transport resources become available
• ICU patients should be the first to leave the assembly point and the highest
priority to transfer to other hospitals

27. RAPID EVACUATION
• Entire patient care units may be moved sequentially or in parallel

28. GRADUAL EVACUATION
• May not need to send patient to assembly points
• Patient may be directly send from units to staging area to be transported out .

29. SPECIAL HAZARDS DURING EVACUATION
• Oxygen and medical gases
• Smokes/fumes
• Electrical equipments
• Lighting
• Water

30. EVACUATION TRANSPORT EQUIPMENT
• Blankets
• Wheelchairs
• Beds
• Canvas stretchers/Litters/Gurneys
• Backboards
• Sked Stretchers
*** a sufficient amount of equipment should be available at each floor ,
stored in easily accessible areas and well-maintained.

31. HOSPITAL INCIDENT COMMAND SYSTEM
STRUCTURE(HICS)

32. STAFF ASSIGNMENT

33. RELOCATION & STAGING AREAS

34. PROCESS OVERVIEW

36. GENERAL TRAINING OF STAFFS
• General training of all staff should include, but not be limited to, the
following:
i. Training on how to lift and move patients.
ii. Training on how to use fire extinguishers.
iii. 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
iv. Training on what to do if they hear the alarm and see the flashing lights.

37. GENERAL TRAINING OF STAFFS
• General training of all staff should include, but not be limited to, the
following:
i. Training on how to lift and move patients.
ii. Training on how to use fire extinguishers.
iii. 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
iv. Training on what to do if they hear the alarm and see the flashing lights.