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Life Safety From Fire in the Hospital

Life Safety From Fire in the Hospital

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Published by Richard M Patton

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Published by: Richard M Patton on Jan 05, 2010
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Life safety from fire in
the hospital 
Richard M. Patton
Reprinted from The Patton Report, June,
with permission.
I listoricall
, tin' most common solution to life safet
fire has been a structural solution. With the advent of 
fireresistiye construction (reinf)rced concrete, protected
e w
a belid
that fire life safet
could be
assured through a structure that would not burn. Un-
fortunately, however, content fires and fires involving
combustible interior sheathing and trim readil
sufficient heat and toxic gas to snuff out life long beforethe structure itself was endangered.
Public reaction to disasters has now placed us at a
stage of structural fire safet
based on these five factors:
Fireresistant design
Cmnpartmentation (limitation of spread of fire)
Use of relativel
slow-burning interior trim, sheath-
ing and paneling
An adequate number of enclosed exitwavs
Isolation, or special protection for special hazards—enclose a carpentr
shop with fireresistive construc-
tion, sprinkler it—or both.
In hospitals and other occupancies where occupants can-not readil
flee a fire, the value of exitways is reduced.
They are installed, but many occupants cannot use them.In order to compensate for this, more emphasis is placedOn compartmentation, Fireresistant compartmentation is
employed to the extent that ever
room becomes an en-
closure to contain a fire or, if the fire escapes, an enclosureto safel
contain the occupant.
Today this is the basic life safet
from fire concept fora hospital. First, contain the fire. As a backup, if the fire
escapes, contain the man in a safe refuge. Note, however,
that this basic plan runs counter to the normal reaction
of the normal human being. When a fire occurs in a fire-resistant enclosed room, the conversion of solids to gases
will create an internal pressure within the room that willsend smoke through the cracks around the door into thecorridor. The normal human reaction is to open the door
to see what is going on in there. The fire
no longercontained. The next reaction usuall
is to try to put the
fire out. Today's fire control equipment provided to fire
discoverers virtually insures that efforts to control the
fire will fail a high percentage of the time.Once a fire passes from a "small stage" to a "substan-
 Mr. Patton, a loss control consultant, is president of Patton Fire Protection and Research, Inc., Freehold,
 New Jersey.
The Building Official and Code Administrator,
February, 1971
tial" stage, it will produce heat at such rapidly increasing 
rates that it will spread suddenly and explosively through-
out the room because when the surface temperatures of exposed combustibles are raised to their ignition points
by the general beat content of the room, the fire ‘yill flashover all surfaces. The fire often will spread with a rapidity 
and intensity that is completely alien to the man accus-
tomed to friendly fires in fireplaces or outdoor fires where
heat is harmlessly exhausted to the atmosphere. This
change in the nature and intensity of the fire invariably amazes the amateur fire fighter who is then quite likely to panic and flee, leaving the door open
(Ed. note: 7'he
 BOCA Basic Code requires automatic door closers).
 The secondary line of defense for the nonmobile occu-
pancy is the fireresistive room enclosures—the sanctuaries
 —for the occupants. When the occupant remains calm,
keeps his room door closed to the fire and opens the win-
dow to let in fresh air, the probability of survival is very 
good. However, the normal reaction of the normal human
being is to try to leave his room and flee through the
smoke- and heat-filled corridor to the outdoors. Isolation
in a room during a fire must be particularly devastating 
to sick people confined to bed, especially if the window 
is closed. Note that the present basic concept for fire life
safety through structural design runs counter to normal
human behavior in some important ways. This is why 
fire protection engineers constantly throw up their handsin amazement at the "weird" behavior of so many people
under fire conditions. They simply don't behave the way they are supposed to behave. The problem, however, is
not that people are inherentl
unreliable, but that we areestablishing a concept of fire safety that runs counter to
the reactions of the people involved. This is why fires
such as the recent one in the Marietta, Ohio nursing home
occur periodically.
 What is the solution? The solution lies in replacing the
defensive concept of trying to enclose and trap the fire
 with the positive concept of fire suppression. Note. that
even very small scale compartmentation will permit a
fire of substantial size to freely develop, so it is far betterto put the fire out. The fire suppression concept (sprin-
klers ) has been the backbone of industrial fire protection.
 There is no structural solution that has had the relia-
bility and cost-effectiveness of automatic fire suppression.
It is now time to incorporate fire suppression as the basic
solution to fire in structures where protection of humanlife, not property, is the primary need.
I am recommending the concept of composite protec-tion for all new hospitals. This concept includes fire sup-
pression as the primary control for fire, structural design
(fireresistance and subdivision) as the secondary control,
and horizontal exits as the last resort of all new hospitalconstruction. But it would be a mistake to simply super-
impose the existing industrial, property protection ori-
ented sprinkler system on top of the existing excessively 
compartmented hospital. The blending of suppression
 with structural design should be accomplished with more
finesse. The sprinkler system must be more economicaland even more reliable. The added safety of suppression
 will permit some relaxation in structural requirements.
 With these thoughts in mind, I propose the following basic fire life safety design for hospitals. There are three
commonly employed suppression s
stems—sprinklers, fire
brigade (or trained emplo
ees) and the public fire de-
partment (paid or volunteer). The suppression concept
I propose requires three things: a ) that all three s
be employed; b) that the reliabilit 
of each be im-
proved; c) that the
be coordinated and simultaneously 
 The industrial sprinkler system is reputed to have an
unreliability record (failure rate) of 3.8 percent. But this
is an inaccurate statistic in that many successes are not
reported, while presumably all failures are. However,
there is no doubt that industry is accepting a failure rate
for property protection that is not acceptable in a hospital
 where lives are concerned. How can the reliability of thesprinkler system be improved? Fire records also indicate
that the sprinkler s
stem that is electrically supervised
has a reliability in excess of 99 percent. Further, there isclear indication that if electric supervision of the system
is combined with an inspection and maintenance contract
 with a reputable sprinkler contractor and if, in addition,the sprinkler s
stem is engineered rather than designed
lw the "book", as is customary, a rdiabilite that is very 
close to 100 percent can be achieved. True, this is only 
near, not total, perfection, but there is no structural solu-
tion that achieves perfectitm either. Because large piping 
and huge water supplies are not needed for a hospital
sprinkler s
stem, it is quite possible to install a 99 percentplus reliable system more economically than the presently 
accepted industrial model which is reputed to be 96.2
percent reliable. It is this concept of mechanical suppres-
sion which I recommend.
Near perfect mechanical protection, however, is still
not enough. It must be teamed with a concept of human
fire suppression that is as reliable as we can make it. Theone glaring weakness in connection with the public firedepartment is that too often the professional fire fighterremains imalerted as the fire destroys lives and property.
 A direct electrical connection (or through central sta-
tion) from the sprinkler system to the fire department will
correct this. A fire department that is given earl
tion of a fire in a light hazard occupancy can perform a
superb job of fire control.
 The third fire control system is the brigade—or em-
ployee with the extinguisher. Here is the notoriously bad
actor—that man or the team that opens the door to letthe trapped fire loose, that fails to control the fire, that
fails to call the fire department until it is too late. Surely 
it is best not to count too heavily on this human suppres-
sion s
stem. Not so. There is one reason—and only one
reason—for the consistent failure of the amateur fire
fighter. We have equipped and trained him for failure.
have established conditions under which a high rate
of failure is a certainty. The February, 1970 issue of 
Fire Technology,
the magazine of the Society of Fire
Protection Engineers, contains a report by Salzberg, Ved-
arka and Maatman on "Minimum Water Requirements
for Suppression Room Fires." The test program described
demonstrated that room size fires in which flashover has
already occurred, spreading fire completely throughout
the room, can be readily extinguished by water in theform of a spray with an application rate of only seven
Continued on page 14
The Building Official and Code Administrator,
February, 1.971
Continued from page 13
GPM. Extinguishment was achieved with an extremely 
modest total quantity of water of fourteen to twenty gal-lons. This is a very modest water requirement indeed. It
is available in just about every dwelling, let alone every 
hospital. However, what is the tool we provide the non-
professional with to fight these readily controllable fires?
 The answer is that we give him an extinguisher that puts
out exactly two and one-half gallons of water with a
duration of discharge of approximately 50 seconds. Clear-
ly this is inadequate. Further this discharge is in the
form of a straight stream, not a spray. The report cited
above also demonstrated that even twenty GPM was
inadequate for room size fires when used as a straight
stream. I repeat these statistics for emphasis. With seven
GPM and a spray nozzle, room size fires are readily con-
trolled in two or three minutes. But, if a straight streamis used, twenty GPM is inadequate. An extinguisher putsout two and one-half to three GPM in a straight stream
and is fully exhausted in less than one minute. Some
types of extinguishers are fully discharged in as little as
ten seconds. It is as clear as the nose on an elephant that
 we are supplying the amateur with a fire suppression toolthat is guaranteed not to control a high percentage of the
fires he is likely to encounter.
 The concept which I propose for the amateur fire
fighter is a very simple one. Give him a tool that he knows
how to use, one that can produce the six to ten gallonsof water a minute that is needed to achieve fire control
for room size fires and give him the three minutes or more
of operating time that he needs to do the job. A light-
 weight hose that is flexible, easily operated and equipped
 with a spray nozzle will promptly and efficiently extin-
guish the type of fires that the amateur encounters in the
hospital. Further, the water spray will knock down the
heat quite rapidly and permit the amateur to get close
to the fire so that he can 'do a job on it.One further thing must be done. Just as the sprinkler
is wired to the fire department, so must we wire in the
fire fighter. When we give the fire fighter a tool that can
control the fire that he is likely to encounter, we also
have given him a tool that c
an be electrically supervised.
 Just as water flow in a sprinkler system can cause an
alarm to be transmitted to the public department, so can water flow in the hose station. One word of caution is in
order with regard to the hose, however. Present under-
 writer approved hose intended for use by building occu-
pants is large, bulky, heavy when filled with water, in-
flexible, and extremely difficult to handle and put into
operation in confined areas, and has other disadvantages
as well. It can
be handled by a professional fire fighter,
but, ironically, the professional always brings his
hose. There is a need for fire hose that can be put into
operation and be easily handled by one nurse. This rules
out all presently approved fire hose. Again, it is im-
portant that we not permit antiquated concepts and regu-
lations to stand in the way of providing the fire safety 
that is so badly needed.
Note that when I talk about fire suppression, I am not
just talking about a sprinkler system. I am talking about
an improved sprinkler system, a fire brigade and a fire
department that will all be simultaneously initiated. Today 'many people pay little more than lip service to
safety. Some of the blame for this must be shared by those
safety "experts" who argue that when it comes to human
life, the cost of protection has no place in the considera-
tions. "When life is at stake, you don't argue dollars,"
they say. This philosophy, more often than not, is a cover
up for the fact that costly recommendations are being 
submitted without evidence of their worth. There is no
inexhaustible supply of money for safety purposes. Those who believe that safety does not have to be economically 
acceptable usually end up by demanding too much and
obtaining too little. Maximum safet
can be
achieved only
by gaining maximum value for each safety dollar spent.
Note that a
level of absolute safety is never achieved.
 When a level of optimum safety per dollar expended is
reached, additional dollars may bu
additional safet
, but
the law of 
diminishing returns applies here as it
does in
all other areas of expenditure.
 The effects of this law can be seen in structural fire
protection for
hospitals. Because
the structural fire safety 
has its limitations, disasters have occurred in the corn-
partmented "fireproof" building, and after each disaster,
additional structural requirements have been applied,
each adding to the cost but providing reduced increments
of additional safet
. It is clear, however, that the inclu-
sion of extremely reliable suppression systems will dra-matically improve the overall fire safety of the hospital.
In fact, if we could guarantee an absolute certaint
fire suppression, instead of high reliability, the need for
all structural requirements would be voided. Total reli-
ance on suppression with complete elimination of struc-
tural requirements, of course, is not being recommended.
 This could prove to be as bad, and possibly worse, than
the present practice of putting all the eggs in the struc-
tural basket. When reliable suppression systems are intro-
duced, the question at hand is this—"What is the proper
level of structural protection for a hospital in conjunction
 with high quality suppression systems?" In short, what
is the proper level of composite protection? The gain insafety per dollar expended on suppression will be great,
because the present level of fire suppression reliable is
low. The reduction in safety through the reduction in
structural protection expenditures will be low because of 
the redundancy and limited value of some of the struc-
tural requirements. Thus, on a trade-off basis, there is
potential for both savings and safety gain. There are also
gains to be made in greater freedom of design and effi-ciency of the physical plant layout. Time and study will
reveal the point of maximum safety per expended dollar.
 There is one more thing the suppression concept can
accomplish. It can also bead off more restrictive struc-
tural and occupancy requirements in the future. For
instance, at present, there is a great deal of concern overthe toxicity of the products of combustion produced by 
the burning or the decomposition of some plastics and
other building materials. Present laboratory tests that pass
on the acceptability of building materials measure the
rate of flame spread and the amount of smoke generated( obscuration) but do not deal with toxicity. Some of the
chemicals used to reduce the flame spread of some mate-
rials, thus qualifying the materials as "firesafe" can actu-
ally increase the toxicity of the gases produced. How-
 The Building Official and Code Administrator,
February, 1971

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