Fire Safety in Hospitals
Fire safety of hospitals is of paramount relevance considering the safety of the patients. Healthcare Executive provides a guiding manual for healthcare administrators and hospital staff to prevent a fire disaster in the hospital.
The ever-increasing requirement for space, particularly in metropolitan cities, has led to the creation of vertical constructions. Laws exist at different levels, fusing different types of constraints to designers and occupiers of the building. A large number of guidelines do exist, but it's not known to everyone in the domain.
Fire can be calamitous, especially in a hospital where a large number of people who need to be evacuated may be physically weak– immuno-compromised, on life support, and incapable of moving on their own. Take the case of AMRI Hospital in Kolkata. The fire accident led to the death of almost 94 people.
How not to Design a Hospital
The basement floor of the hospital was used as a storage area of diesel, motor oil and wooden furniture storeroom. The fire started from the basement. All the doors, exterior finishes, windows are constructed by glass materials. The outer glasses were not opening or breakable. Besides, fire sprinklers, fire smokers, vent opening on the top were also not provided. According to news reports, one of the primary reasons for loss of life was the lack of ventilation inside the cubical shape building. It made the building hot, and smoke covered the entire building and blocked all escape routes. Patients could not make their way out due to suffocation, breathing difficulty and vision obscurity. If the building had been provided with proper vent openings and required firefighting equipment, it would have reduced the volume of fire and smoke.
According to the National Building Code, buildings should be designed, constructed, equipped, maintained and operated as to provide adequate means of egress to avoid unnecessary danger to life and safety of the occupants from fire, smoke, fumes or panic during the period necessary for escape.
"We follow the 'part 4' of 'National Building Code of India – 2005' on 'Fire & Life Safety' covers the requirements for fire prevention & life safety about fire and fire protection of buildings. The Code specifies construction, occupancy and protection features that are necessary to minimize danger to life and property from fire. Our hospital is NABH accredited; we follow the NABH guidelines to prevent fire," explains Sharad Garud, General Manager, HN Reliance Foundation Hospital.
What is Fire Prevention and Control Infrastructure of HN Reliance Foundation Hospital?
The hospital has updated NOC from the state Fire Department.
It has a multidisciplinary safety committee with a senior person as the chairman of the safety committee. The safety committee meetings are held at least once in 3 months.
The organization has a formally appointed Fire Safety Officer-in-charge of all concerns related to Fire Prevention & Safety. The Fire Safety Officer should be preferably from Fire Engineering and Security Staff and aware of all fire safety protocols.
It also has a written plan for Fire Prevention and Safety and has a Fire Safety Manual approved by the safety committee.
It also has an Emergency Command Centre that becomes functional immediately whenever there is an emergency. There are a written protocol and written constitution for the committee. The Fire Command Centre is also updated with the name of the members. A designated person has the responsibility of informing all the Emergency Command members.
What does a fire safety manual comprise of?
Garud also points out the significance of a fire safety manual.
It has plan for fire prevention & control, systems for fire prevention and control, maintenance schedules/ SOPs for operations related to fire prevention and control, Inspection protocols for fire safety installation, codes for the announcement of fire-related emergency, procedures and communication protocols for the same, Responsibilities of different departments in case of fire, Procedures, frequency & protocols for mock drills, Constitution of Fire Fighting & Evacuation Teams, Evacuation Plan and Electrical Safety & System. A multidisciplinary committee, which has a fire Safety Officer as a member, usually holds facility rounds at least once a quarter for non-clinical as well as clinical areas.
Fire Exits
At HN Reliance Foundation Hospital, the fire exits are well defined and end on the ground floor or refuge area or any safe place decided by the management. The Fire Signages are appropriate and placed at the right locations. Emergency fire signages are glow in dark signages. The Fire Signages are visible and are bilingual, with one local language. The egress routes are free from any materials that would cause hindrance in the evacuation. The Fire Doors have a proper fire rating and open outside. The Fire Doors preferably have panic bars.
The Fire Alarm systems are adequately tested and maintained, and a record is kept for the same. The Emergency Exit signs are displayed prominently. The staircases are used for evacuation are pressurized in case of a fire emergency. We have dedicated fire corridor. There are also dedicated fire lifts having unique construction and pressurized with positive pressure to avoid smoke entry. The HVAC system has appropriate fire dampers to prevent the spread of the fire that functions correctly in case of fire. The dampers are tested and have a regular preventive maintenance schedule. All the equipment have an organized preventive maintenance schedule that is recorded and stickers put on the computer showing the date of preventive maintenance check and the next time for maintenance. The appropriate type and several fire extinguishers have been installed according to the kind of fire that could take place like Kitchen, MRI, Electrical room, data centre area The Fire Extinguishers have a regular preventive maintenance schedule and stickers are put showing the date of checking and the next scheduled date for verification. Approx. 10% of Fire Extinguishers are used every year for checking the same.
Renovation and Old Hospitals
During the renovation of running a hospital, SWOT Factors plays a vital role to prevent fire in the building.
A wide variety of strategic planning methods are available today, but the common element in each is to identify an organization's SWOT factors: its strengths, weaknesses, opportunities, and threats. In response, the organization develops a plan to improve and optimize its performance. Planning a new facility—or renovations to existing facilities— can be a response to any of the SWOT factors. The project can capitalize on a perceived strength within the community. It can reduce the weakness caused by outdated structures or poor location of a facility. It can aid in an expansion of services or withstand a threat by a competitor. When and if a strategic imperative for construction or renovation results from the strategic planning, the construction planning phase can begin. The construction planning phase for a project consists of two types of plan: master facility planning and project predesign planning.
Anil Menon, Head of Projects, Jaslok Hospital points out that for an old hospital like Jaslok, which was set up several decades ago, integrating new norms and guidelines is definitely a challenge. So, what we do is that we conduct training classes for our employees, in addition to strengthening our infrastructure. Disasters usually happen when people don't even open the vents," explains Menon. He also points out that during renovation, the hospital sticks to measures prescribed by NABH to prevent infection control. It takes at least 5 to 6 years, more for a working hospital to make any change to the infrastructure.
Further, for a hospital working in metro, there are several other issues like access to water and also open spaces for evacuation. "One of the major mistakes that hospital planners do is to maximize beds while constructing a hospital. They often ignore other support systems. At Jaslok Hospital, we have demolished our doors, to ensure smooth entry of fire brigade and also added fire staircases," he concludes.