Re­duc­ing hos­pi­tal fire haz­ards

Ex­perts cite im­por­tance of hav­ing a plan in place and ed­u­cat­ing staff

Modern Healthcare - - FRONT PAGE - Joe Carl­son

Hos­pi­tal fire fact: If a small blaze broke out next to an MRI ma­chine, would-be fire­fight­ers couldn’t use a tra­di­tional red metal ex­tin­guisher be­cause pow­er­ful mag­netism might yank it right out of their hands.

Here’s an­other: In many hos­pi­tals, the staff most likely to cause fire code prob­lems are from the in­for­ma­tion tech­nol­ogy depart­ment, be­cause of tech­ni­cians’ pen­chant for punch­ing holes through fire walls to run new wires in hid­den ar­eas.

And fi­nally: Ex­perts es­ti­mate that 550 to 650 pa­tients a year na­tion­ally catch on fire dur­ing surgery, even though a pri­mary cause—use of oxy­gen—can be avoided in most sit­u­a­tions by us­ing non­flammable med­i­cal-grade air in­stead.

As hos­pi­tals grow in com­plex­ity and adopt new life-sav­ing tech­nolo­gies and clin­i­cal pro­ce­dures, ex­perts say health­care providers need to bear in mind that progress also brings new le­gal and pa­tient-safety risks. Fire is a ma­jor one.

Ad­vice on how to han­dle fire haz­ards and mit­i­gate le­gal risks runs the gamut, from de­vel­op­ing de­tailed emer­gency re­sponse plans to reg­u­larly in­spect­ing for struc­tural prob­lems or process-changes that could save a life. But nearly in uni­son, ex­perts say the most im­por­tant pre­cau­tion is staff train­ing on the fire plan.

The im­por­tance of such prepa­ra­tions was cast in stark re­lief Dec. 9, when surg­ing flames en­gulfed the 180-bed AMRI Hos­pi­tal in Kolkata, In­dia, killing 93 peo­ple and re­sult­ing in charges of cul­pa­ble homi­cide against seven hos­pi­tal em­ploy­ees, ac­cord­ing to the As­so­ci­ated Press.

A re­port in the Chris­tian Sci­ence Mon­i­tor quoted news­pa­pers in east­ern In­dia as say­ing that the state-of-the-art hos­pi­tal lacked exit doors and an evac­u­a­tion plan and had sealed win­dows. The lo­cal me­dia also said the fire depart­ment took up to 90 min­utes to ar­rive on the scene af­ter the fire started.

Mean­while, a study re­leased last week by the New York City Fire Depart­ment re­ported that be­tween 2004 and 2006, health­care provider fa­cil­i­ties na­tion­ally av­er­aged 6,400 fires a year, with those open 24 hours a day ac­count­ing for 89% of the in­ci­dents. The fires caused five civil­ian deaths, in­juries to 175 peo­ple and about $34 mil­lion in an­nual prop­erty loss.

The AMRI fire came only one day af­ter Hart­ford (Conn.) Hos­pi­tal ob­served the 50th an­niver­sary of a fire that left 16 dead in the large med­i­cal cen­ter, which hos­pi­tal of­fi­cials say re­mains the dead­li­est U.S. hos­pi­tal fire in five decades. “That truly was one of our dark­est days,” Hart­ford Hos­pi­tal Pres­i­dent and CEO Jef­frey Flaks says.

On Dec. 8, 1961, some­one flicked a cig­a­rette ash down a trash chute at Hart­ford Hos­pi­tal, even­tu­ally ig­nit­ing a col­umn of flame that blew out a pro­tec­tive door on the hos­pi­tal’s ninth floor and cre­ated what in­ves­ti­ga­tors later called “a wall of flame” on the pa­tient floor, ac­cord­ing to an ac­count of events pub­lished last week in the hos­pi­tal’s staff news­let­ter.

“The aware­ness, the un­in­tended con­se­quences of the fire, the pos­i­tive things that re­sulted from it, they res­onate to­day,” says Flaks, a 2001 Modern Health­care Up & Comer. “Truth­fully, we look back at that event and study it very closely. … It’s not sur­pris­ing that it was pos­si­ble that a fire like that could oc­cur.”

Trash chutes and cig­a­rette smok­ing in hos­pi­tals across the U.S. were re­stricted or out­right banned soon af­ter, and sprin­kler sys­tems were man­dated—progress that Flaks cred­its to the thor­ough and trans­par­ent in­ves­ti­ga­tion of the fire led by the Hart­ford Hos­pi­tal pres­i­dent at the time, T. Ste­wart Hamil­ton.

To­day, the 157-year-old Hart­ford Hos­pi­tal main­tains an un­com­monly large staff of five full-time fire­fight­ers and two part-timers to cover a cam­pus that in­cludes 45 pa­tient-care build­ings spread across about 70 acres.

Hart­ford Hos­pi­tal fire mar­shal Michael Gar­rahy says the fire trig­gered changes in lo­cal and statewide fire poli­cies, in­clud­ing a rule that dead-end cor­ri­dors can­not stretch for more

than 30 feet and a re­quire­ment that all ar­eas of the build­ing have at least two ex­its, in­clud­ing one hor­i­zon­tal egress and one ver­ti­cal.

But le­gal and in­dus­try ex­perts say hos­pi­tal fire safety means much more than al­low­ing for es­cape from a burn­ing build­ing. Of­ten in a hos­pi­tal fire, the pa­tients can’t move them­selves and aren’t sta­ble enough to be moved any­way—that’s why they’re in the hos­pi­tal.

That means that hos­pi­tals, un­like most build­ings, are built to al­low pa­tients to stay in­side the fa­cil­ity dur­ing a fire.

Ex­perts say that fact places an in­or­di­nate amount of im­por­tance on fire walls, com­part- men­tal­ized spa­ces and flame-re­sis­tant doors and hinges—an­other les­son from Hart­ford, where a fire­fighter who was able to leap from an eight­story fire lad­der into a ninth story win­dow closed at least four pa­tient doors on the burn­ing floor.

“One of the things we learned from that was, when the doors were closed, ev­ery­one lived. When they were open, peo­ple died,” Flaks says.

Robert Solomon, divi­sion man­ager for build­ing and life-safety codes at the National Fire Pro­tec­tion As­so­ci­a­tion, says that in most cases, a com­plete evac­u­a­tion of a build­ing out onto the street would be called for only as a last mea­sure in a cat­a­strophic event.

The more com­mon so­lu­tion hos­pi­tals train for is to have staff triage pa­tients, de­cide who must leave and how far they can go, and then clos­ing ev­ery door be­hind them.

How­ever, that kind of “de­fend in place” men­tal­ity coun­ters what most peo­ple learned in grade school, where stu­dents typ­i­cally learn to fol­low their teach­ers out the near­est door of a build­ing. That’s one rea­son why plan­ners, ad­min­is­tra­tors and even the national fire code it­self place so much em­pha­sis on reg­u­lar train­ing.

“Write the plan and prac­tice, prac­tice, prac­tice. Keep drilling. You don’t have time to pull the book off the shelf when you need it,” says Suzanne Lough­lin, co-founder and ex­ec­u­tive vice pres­i­dent of Firestorm So­lu­tions, a New York-based risk-man­age­ment and dis­as­ter­plan­ning con­sul­tancy in New York. “What’s crit­i­cal is that you have good com­mu­ni­ca­tions with the first-re­spon­der com­mu­nity … They need to know what your plan is.”

Col­bey Rea­gan, a lawyer with Waller Lans­den who has ad­vised hos­pi­tals on le­gal fire-safety is­sues, says that in his ex­pe­ri­ence, in­ad­e­quate fire-safety drills are a com­mon le­gal com­pli­ance prob­lem for hos­pi­tals. “It can be dif­fi­cult to run a fire-safety drill in a hos­pi­tal,” he adds.

In ad­di­tion to lo­cal fire codes, nearly all hos­pi­tals are legally gov­erned by the re­quire­ments of

AP PHOTO

Res­cue work­ers lower a pa­tient to safety dur­ing a fire Dec. 9 at the 180-bed AMRI Hos­pi­tal in Kolkata, In­dia. The blaze killed 93 peo­ple.

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