12 Nov Effective fire precautions for healthcare premises

The response to the COVID-19 pandemic by the healthcare profession rightly deserves the global accolades and thanks given by the media and public alike says Peter Stephenson, Business Development Manager, Warringtonfire.

Hospitals provide a cornerstone of support to the community for emergency and general medical care including, but not limited to, maternity, orthopaedic and intensive care. Especially in demanding times like these, the demand for healthcare services is growing, patients have ever-increasing expectations about the safety and quality of healthcare treatments and services, and in addition, regulations are becoming more and more complex.

To allow hospitals and healthcare providers to function effectively a key factor regarding fire safety is the protection of patients, visitors, and healthcare workers from the effects of fire. For the implementation of effective fire precautions in healthcare premises, healthcare providers and design teams will need to select a combination of appropriate measures to produce a fire-safe design which should be detailed within a building specific fire strategy and should consider and include the following points:

• All relevant statutory regulations applicable to the hospital/scheme.
• All relevant guidance contained within local and international fire codes relevant to the hospital/scheme.
• The advice provided by and approval of the local Authority Having Jurisdiction (AHJ).
• Recommendations, requirements, and advice provided to the healthcare provider (end user), their fire safety managers and advisers.

The fire strategy developed for a healthcare premises should be maintained as a `living’ document to provide accurate information for current and future users of the building and should be supported by an appropriate regime of on-going fire risk assessment to maintain a high-level of fire safety management, such as recommended in BS 9997: 1999 (Fire risk management systems – Requirement with guidance for use).

Fire safety is one of the highest pressures and significant components of healthcare facility management. The reality is that there is no room for error; process, procedures, training, and maintenance regimes must be effectively implemented to ensure patient safety. The people inside these facilities — unlike a shopping mall, office, school, or sporting arena — are often sick, requiring care, disabled, or elderly. Facility managers must therefore be vigilant in keeping their patients safe. Fortunately , attention to detail and routine safety checks can help to minimise the risk of fires occurring and their impact or prevent them altogether. Fire safety in healthcare facilities requires vigilance and routine monitoring on the part of the facility management team. The seemingly monotonous practice of regularly checking cooking equipment, electrical wires, oxygen tanks, and fire extinguishing equipment can absolutely make the difference between life and death.

Fire Strategy

The importance of a robust fire strategy for the success of a hospital project and its future operations should be fully understood by all stakeholders within the built environment including the client and project/design team. Ultimately the building design will require formal approval by the Authority Having Jurisdiction (AHJ) and in the Middle East this will involve approval by the local Civil Defence Department.

A fire strategy is not just a key design document providing guidance to all disciplines on the code or engineered approach to be adopted during the design and construction process, but it also details the management procedures to be implanted by the end user/occupier of the building. Guidance on fire safety management for a hospital building requires specific consideration as it is often a design assumption that the management of the building will be to a high standard. Within hospitals the evacuation strategy and the fire alarm cause and effect require careful consideration particularly in conjunction with the fire compartmentation strategy and the provision of places of relative safety as many hospital users may have difficulty in self evacuation due to their medical condition. A copy of the fire strategy should be formally handed over to the occupier as it will ensure that relevant information is passed on to persons having responsibility for any future expansion plans, maintenance, fire safety etc. The fire strategy is a ‘living’ document and should be referenced for any future building alterations and/or changes to management procedures.   

A fire strategy should consider all aspects of fire safety and protection in a unified manner, allowing flexibility whilst ensuring that the key objectives have been met. The strategy should ensure that all key features of the building, occupancy and processes have been appropriately and properly covered.

An important factor when developing a fire strategy for a hospital is to record and set objectives, not necessarily performance or legislatively driven but which should consider:

• Life safety – considering the occupants of the building particularly patients under medical care, the likely number and type of visitors, contractors and in the event of a fire incident the responding firefighters.
• Property – the building structure, height and type, the fabric, fixed and movable assets. Many hospitals have specialised equipment to operate that may require additional fire protection.
• Business – the business mission, confidence, long and short-term operations.
• Environment – long term, locality, external and internal.
• Brand protection.

Many codes and much legislation has evolved following fire events often resulting in large loss of life. Codes often inherently mitigate risk from lessons learnt and provide guidance on basic fire safety concepts such as:

• Occupancy type
• Construction type
• Travel distances
• Number, size, and location of exits
• Time to escape
• Fire Department access requirements
• Fire safety management

Although a code compliant solution can be recorded in a fire strategy a risk and hazard assessment should be carried out and can follow a qualitative or quantitative assessment methodology, risk profiling can be incorporated to accompany a hazard assessment and fire modelling can also be undertaken to support the overall analysis.

The use of compartmentation and passive fire protection within a hospital is often a key consideration to allow the movement of patients at greatest risk of injury in a fire scenario away from the fire into an adjacent safe compartment before being evacuated to a place of ultimate safety.

Passive Fire Protection and Compartmentation

Passive fire protection is an integral part of the fabric of a building and as mentioned earlier, fire compartmentation often plays a key role in providing safe areas for patients to be moved into prior to a full evacuation of the building depending on the evacuation strategy and severity of the fire. It is the primary preventative measure taken to protect against the spread of fire, heat and smoke, and to ensure structural stability and a safe means of escape.

The key elements of passive fire protection, which should be considered throughout the design and construction of a building, and within the building products themselves are fire resistance, reaction to fire, and smoke leakage. Incorporating materials, systems and assemblies that adhere to these passive fire protection principles and of course, to the corresponding regulations, will support the containment of fire, and therefore protect life. These measures also act to maintain the integrity of the building structure, minimising damage and costs, and supporting faster recovery of building use.

The application of passive fire protection measures is required by law, though these regulations vary by region and in many cases, are newly adopted. These newer requirements may be unfamiliar to builders and contractors, or the extent to which they should be implemented within the design may be unknown. Other builders and contractors may still feel that previous regulations were adequate and therefore choose to disregard current obligations.

Regardless of legal implications, the fundamental point in passive fire protection measures is that they save lives, money and reputation. Proper investment in appropriate protection at the design and build phase could lead to enormous savings over the lifetime of the building. To gain a full appreciation of this, third party consultants can provide support in creating and/or validating a compliant fire protection strategy that achieves design objectives while aligning with building plans and budgets.

It can be beneficial to bring in consultants at an early stage as the implementation of passive fire protection measures can be divided into three categories within a building’s lifetime prior to the occupation phase, namely,

• Fire strategy requirements
• Product testing and certification
• Site application, site-based destructive and non-destructive testing, and inspection

Application of appropriate measures at any stage is important to support the mitigation of damage and the protection of life.

Evacuation Strategy 

Evacuation of any hospital or healthcare site is much more complicated than evacuating a normal building. Evacuating a hospital will involve moving immobile and high dependency patients, which must be done as quickly and safely as possible.

Hospitals and Health Care Trusts have a legal responsibility to ensure adequate means of escape from fire is available and that suitable and sufficient firefighting equipment is provided and maintained in accordance with the statutory requirements they are subject to.

In an emergency evacuation situation in a hospital, many patients will be unable to walk independently out of the building. To safely evacuate patients who are immobile or have a high dependency on staff it may be necessary to use evacuation aids.

There are many different types of evacuation aids for adults, children, and infants. Evacuation chairs allow patients to be moved safely and swiftly along escape routes both horizontally and downstairs. Evacuation mats and evacuation sheets can be fitted directly onto hospital beds and allow patients to be slid to safety. There is also a range of specialist devices to safely evacuate babies and infants.

Effective  communication with patients with reduced mobility or medical care requirements about the hospital evacuation plan is vital to its success. Where staff or regular visitors have disabilities, it is prudent for the building manager to tailor an evacuation plan to their individual needs – a  Personal Emergency Evacuation Plan (PEEP) – this would also apply to patients recovering from medical care as their needs will require regular often daily assessment. This does not only apply to permanent disabilities; temporary injuries such as sprained ankles and mobility difficulties associated with pregnancy must also be addressed.

As mentioned above if a building hosts occupants with physical disabilities, the evacuation procedure should consider them. Keeping means of escape routes clear at all times is an all-important part of fire safety and becomes even more vital when considering the space required to manoeuvre a wheelchair, patient bed or similar. If hospital wards containing patient beds and wheelchair users are located above the ground floor, adequate systems, and facilities such as evacuation lifts, ramps or carry-down procedures should be installed and implemented to permit their safe evacuation from the building.

This feature originally appeared in Security Middle East magazine.