See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/322359045

Analysis of Fire Protection Facilities in Hospital Buildings

Chapter · January 2018

DOI: 10.1007/978-981-10-7281-9_15

CITATIONS READS

3 3,711

4 authors, including:

Bikarama Prasad Yadav

University of Petroleum & Energy Studies
20 PUBLICATIONS   27 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

FIRE AND SAFETY JOURNAL View project

All content following this page was uploaded by Bikarama Prasad Yadav on 31 March 2019.

The user has requested enhancement of the downloaded file.

Analysis of Fire Protection Facilities
in Hospital Buildings

B. Abhishek Shastri, Y. Sivaji Raghav, R. Sahadev

and Bikarama Prasad Yadav

Abstract Hospitals are considered to be safer places where injuries are treated
rather than generated. Even though hospitals follow safety measures and monitor
the reports of accidents happened, there is always a boundless chance for a new
accident to happen because hospital environment is charged with compound
inherent risks. Apart from risks, hospitals are a combination of numerous hazards in
different parts of the building like biological, chemical, physical, and fire hazards
[1]. There have been major incidents in hospitals reported in the past, including the
fire accident that occurred in AMRI, a hospital located in Kolkata, which killed
almost 90 people in the year 2012 [2]. It is one of the recent accidents happened in
hospitals in India. In the morning of May 15th, 1929 Cleveland hospital in USA
encountered a massive fire accident followed by poisonous gas release from
burning nitrocellulose X-ray film ignited by a nearby light bulb [3]. Around 125
people died in this disaster since there was no proper evacuation strategy and lack
of fire protection systems. Fire accidents taking place in hospitals are not easily
controllable, and casualties are more because the evacuating techniques are typi-
cally diverse as most of the patients cannot move out by themselves. And if the
accident happens nearby anesthesia care [4] or intensive care, patients inside the
wards may not be aware of fire and could not respond properly to call for help. This
is why a fire accident is always very precarious in a hospital. This paper emphasizes
about the hazards associated with fire in the hospital environment, proper evacu-
ation in case of fire, and appropriate fire fighting equipment. Evacuation plan and
fire extinguishing equipment should be easily approachable, readily usable, and
maintained properly in regular intervals, and competent persons in evacuation
techniques should be available. The constructions of buildings also play a signifi-
cant role in case of evacuation. Proper guidelines followed during the construction
of a hospital building can also help in avoiding various hazards which may turn into

B. Abhishek Shastri
Y. Sivaji Raghav
R. Sahadev
B. P. Yadav (&)

Department of Health, Safety and Environment Engineering, University of Petroleum
and Energy Studies, Bidholi, Dehradun 248007, India
e-mail: bpyadav@ddn.upes.ac.in

© Springer Nature Singapore Pte Ltd. 2018 183

N. A. Siddiqui et al. (eds.), Advances in Fire and Process Safety,
Springer Transactions in Civil and Environmental Engineering,
https://doi.org/10.1007/978-981-10-7281-9_15
184 B. Abhishek Shastri et al.

disasters. The aim of this paper is to identify hazards and provide long-term and
short-term control measures to deliver safety for the staff members and the patients
who have the right to be treated with dignity and also protect them during any
unexpected situations.

Keywords Hospital fires
Evacuation
Emergency
Fire safety

Fire hazards Healthcare

1 Introduction

The very first requirement in a hospital is that it should do the sick no harm. In
order to fulfill this, administration in hospitals needs to conceptualize and regularize
certain set of criterions to function and should not, in any situation, deviate from
safety standards depicted by governing bodies. Starting from the construction of
hospitals to their functioning, several procedures are to be followed to avoid haz-
ards, specifically fire. Hospitals have variety of materials that can contribute toward
a happening of fire. And the persons inside a hospital also are of various physical
and mental characteristics that have dissimilar reactions toward fire. Considering
the general population inside a hospital, it constitutes of patients ongoing treatment
under supervision. While some patients can rationalize a situation, there are some
patients who cannot [5]. Evacuation during fire accidents becomes difficult for these
patients. In the past, it has been witnessed that hospitals are susceptible to fire
hazards and are proven to have tedious evacuations with high fatalities.
This paper is a quantitative and qualitative approach toward possible fire sce-
narios in hospitals, incidents, and mitigating techniques. The purpose of this piece
is to deliver long-term as well as short-term solutions to fight fire hazards in
hospitals.
Effective safety management system requires implementation of meticulously
planned logistics and readiness in case of an emergency [6]. The past accidents
happened in hospitals reflect poorly on the implementation of proper safety pro-
tocols and inadequacy of emergency response (Table 1). Safety must be made as a
value for the organization.

2 Methodology

This investigation focuses on minor data significant to fire accidents in hospitals

globally. A survey over mishaps in hospital fires till the present scenario was done
through rereading the internet, articles, newspapers, investigation, and other reports.
In the history of fire building, heterogeneous fire incidents were perceived.
A detailed study on fire incidents of 13 hospital buildings were used here. All the
incident cases were constructed on some norms to be designated. For example, one
Analysis of Fire Protection Facilities in Hospital Buildings 185

Table 1 Prominent hospital fires

Date Hospital Place Injuries and
deaths
February 18, Manhattan State Hospital [7] New York City 25 deaths
1923
1948 Highland Hospital [8] Asheville, North 9 deaths
Carolina
April 4, 1949 St. Anthony’s Hospital [9] Effingham, Illinois 70 deaths
January 7, 1950 Mercy Hospital [10] Davenport, Iowa 41 deaths
December 23, Doctor’s Memorial Hospital Minnesota 8 deaths
1956
July 14, 1960 Guatemala Mental Hospital Guatemala 225 deaths
[11]
1945 Hartford Hospital [12] Connecticut 20 deaths
February 12, Shelton Hospital [13] Shrewsbury 21 deaths, 14
1968 injured
July 5, 1972 Coldharbour Hospital [13] Sherborn, England 30 deaths
December 9, Moscow Hospital [14] Moscow, Russia 46 deaths
2006
April 26, 2013 Moscow Psychiatric Hospital Moscow, Russia 36 deaths
[11]
2013 Psychiatric Hospital in Luka Novgorod Region, 37 deaths
[11] Russia
2014 A hospital in Jangseong South Korea 22 deaths
Country

of the norms included higher rate of injuries and casualties. As a result, number of
people were killed and injured during fire incidents happened. Also, the hospitals
while handling fire accidents have to meet the faults and glitches. In Fig. 1, the blue
area denotes three fire accidents before 1950; the red area denotes six fire accidents
which occurred between 1950 and 2000; and the green area denotes four accidents
chosen after 2000.

3 Evaluation and Outcomes

Considering all the 13 incidents, administrations of these hospitals took similar

erroneous actions in fire safety management. A total of eight mistakes were
excerpted by reviewing these fire accidents [11]. The mistakes include the
following:
1. Absence of mechanized fire fighting systems.
2. Non-compliance of law enforcement.
186 B. Abhishek Shastri et al.

Fig. 1 Accidents considered for study

3. Myopic planning.
4. Maintenance and management of fire fighting appliances.
5. Incompetency of hospital staff regarding safety issues.
6. Combustible materials used and stored in the building.
7. Poor accident management methodology.
8. Legal and administrative bottlenecks regarding security and safety systems.
9. Insufficient or non-availability of mechanical aids for patients during emer-
gency evacuation.
10. Inability of patients to evacuate the building [15].
Prior to the year 1950, it was found that the foremost reason of higher number of
victims in hospital fire incidents which had occurred was due to the lack of
installation of automatic fire fighting appliances. Fire at early stages is sensed by
automatic sprinklers, and if occurred, smothering is done with extinguishing media.
In simple arguments, automatic systems alarm the inhabitants in the building or
public, once they sense the source of fire. They offer a longer timescale for
inhabitants to evacuate the building. Also, the extinguishing media captivates
nitrous fumes. Hence, water spray by automatic sprinklers is efficient in decreasing
the degrees of risk from this danger. Water spray cool down combustible substances
below their ignition points and provides high level of moisture, although only an
insignificant proportion of the fresh gases are captivated in water. Similarly, there
was no provision of suppression systems, fire and smoke detectors, and alarm
systems. Hospitals equipped with automatic fire system always have a good chance
of escaping damage. Unfortunately, there were problems in planning maintenance
and management of fire safety systems [16].
Analysis of Fire Protection Facilities in Hospital Buildings 187

Health and Safety Management System Management Assessment Tool:

Management leadership: Demonstrate commitment to improve safety and health.
Employee participation: Encouraged to communicate openly with management
and report safety and health concerns.
Hazard identification and assessment: Processes and procedures are in place to
continually identify workplace hazards and evaluate risks.
Hazard prevention and control: Processes, procedures, and programs are
implemented to eliminate or control workplace hazards.
Fire Safety and emergency awareness using education and training: On hazard
recognition and control.
System evaluation and improvement: To check the effectiveness of the imple-
mented system, its performance should be monitored in order to improve health and
safety in organization.
These six health and safety management system assessment tools can be effec-
tively and efficiently implemented to fulfill the needs of organisations.

4 Solutions

• Hospitals being most sensitive to hazards and accidents, fire safety needs to be
implemented since the time of construction according to the National Building
Code and other safety standards.
• Eliminating storage of hazardous waste and use of hazardous gases or chemicals
inside the hospital by controlling from an isolated area.
• Every hospital building must have at least four emergency exits and a maximum
of six [17].
• High rise buildings should be easily reachable by road [18].
• Equipment operation and maintenance through regular inspection.
• Hospital buildings must be inspected in every 6 months, and the inspection
process should be filmed.
• An air ambulance must be available, helps in rescuing large number of people.
• A map should be present in all the rooms of the hospital guiding the people
about their location.
• Automatic sprinkler and alarm systems shall be installed according to NFPA 14.
• Length of the hospital main entrance should be at least 30 m.
• Hospitals buildings must be earthquake proof.
• Provision of underground ground water should be present so that water can be
drawn in case emergencies to extinguish or control the fire.
• All the walls in the hospital buildings shall be coated with fire-resistant coatings.
• Canteen buildings should be constructed away from the hospital.
188 B. Abhishek Shastri et al.

4.1 Evacuation Duties

A competent person shall be assigned the authority for evacuation process and he
shall be responsible for executing the evacuation plan and taking onsite decisions
[19]. Specific departments must also have evacuation responsibilities. And the
responsibilities are discussed below [20];
Employees of the Hospital
If case of a fire accident, employees should not wait for the instructions and shall
take away the patients in immediate vulnerability. Patients shall be moved to a
nearby harmless zone on the same level if there is a facility for horizontal evacu-
ation. If patients are not within the reach of direct danger and the alarm is active,
employees shall wait for evacuation orders. Patients should never be left unat-
tended. For reporting pre-assigned disaster response assignments, the employees
must ensure that patients under someone else’s care should be taken charge of
before they go to report. For an instance, conducting proper hand-off before the
patient is left alone for any purpose during emergency [21].
Security Department and Human Resource Department
Workers of the hospital’s security unit shall instantly initiate a head count and
communicate orders required under emergency situations. Radio or telephone can
be used as a means of communication. A variety of duties for the security head
includes but not limited to:
• Ensuring the presence of officers in the anterior entry of the hospital building to
facilitate the responders and lead them to the hazard.
• Ensuring the presence of officers to look after the entrances/exits and initiate
lock-down processes assigned for the building.
• It is to be verified that officials follow the manuals given for security and
emergency operations processes.
• Patients and visitors along with the staffs should be addressed with intercoms or
other alternate communication facilities.
A representative out of the labor pool shall be appointed to communicate the
building’s emergency operations unit. During the disaster situation, normal visiting
hours should be suspended. It is expected that a number of people including family
members, visitors, and nearby residents will volunteer their help during an emer-
gency. The human resource department of the hospital shall undertake the
responsibility to cope up with the influx and allocate workers to list the helpers and
also allot them to specific areas [22]. A variety of duties of a planning officer shall
include:
• Communicating with the representatives assigned at the hospital for head counts
under emergency and hand out emergency orders.
• Control centers and staging areas to be managed and established for everyone
inside the building (patients, visitors, workers, volunteers, students, etc.).
Analysis of Fire Protection Facilities in Hospital Buildings 189

• Recording fitness levels of the volunteers assigned to assist patients up and

down the floors using stairs.
• Ensuring that the assigned workers are providing the emergency unit with
details of family members of the patients and volunteers that are in the facility
and assigning to stay with relatives of victims in the hospital waiting area.
• Facilitate sign-in of volunteers with their credentials, contact details, and list any
special talents (especially fluency in other languages) [23].

5 Summary

There are several concerns in fire safety of a hospital building. Provision of fire
prevention and protection plans must be prepared and communicated to prevent
losses due to fire. According to the studied data, few hospitals with high-tech
protection systems were not competent enough in fire safety management. Faults
and difficulties identified in these fire accidents are as follows:
1. Absence of mechanized fire fighting systems.
2. Non-compliance of law enforcement.
3. Myopic planning.
4. Maintenance and management of fire fighting appliances.
5. Incompetency of hospital staff regarding safety issues.
6. Combustible materials used and stored in the building.
7. Poor accident management methodology.
8. Legal and administrative bottlenecks regarding security and safety systems.
It can be concluded that hospital management has a prime responsibility toward
safety of patients by implementing control measures to fire accidents. Impact of fire
could be reduced with proper and ideal safety management in hospital building.
Every single employee of a hospital shall follow her/his responsibility during fire
emergencies and try to save as many potential victims as possible without waiting
for instructions.

References

1. Gestal, J. 1987. Occupational hazards in hospitals: Accidents, radiation, exposure to noxious

chemicals, drug addiction and psychic problems, and assault. British Journal of Industrial
Medicine 44 (8): 510–520.
2. Nagral, S. 2012. Fire in a hospital. Indian Journal of Medical Ethics 9: 76–77.
3. Gregory, K.L., V.F. Malinoski, and C.R. Sharp. 1969. Cleveland clinic fire survivorship
study, 1929–1965. Archives of Environmental Health: An International Journal 18 (4): 508–
515.
4. Muchatuta, N.A., and S.M. Sale. 2007. Fires and explosions. Anaesthesia & Intensive Care
Medicine 8 (11): 457–460.
5. Childers, A. 2010. Prioritizing patients for emergency evacuation from a healthcare facility.
 190 B. Abhishek Shastri et al.

6. Boyd, A., et al. 2014. Emergency planning and management in health care: Priority research
topics. Health Systems 3 (2): 83–92.
7. Abrahams, R. 1929. Tribute to Dr. Gustav Scholer. Psychiatric Quarterly 3 (1): 131–132.
8. Tekulve, S. 2014. Guests on earth: A novel by Lee Smith (review). Appalachian Heritage 42
(1): 109–114.
9. Groves, A. 2006. St. Anthony’s Hospital Fire, Effingham-April 4, 1949.
10. Robert Solomon, P. 2012. To lock or not to lock? Environment of Care® News 15 (8).
11. Ong, W.C., and Z. Suleiman. 2015. Fire safety management problems in fire accidents in
hospital building. Advances in Environmental Biology 43–47.
12. Riccitelli, M., and I.J. Kennedy. 1961. The historical development of proprietary nursing
homes in Connecticut. Journal of the American Geriatrics Society 9 (8): 705–713.
13. Bowes, P. 1976. Casualties attributed to toxic gas and smoke at fires: A survey of statistics.
Medicine, Science and the Law 16 (2): 104–110.
14. Ong, W.C., and Z. Suleiman. 2015. Problems in implementation of fire safety management in
Malaysia government hospital. Advances in Environmental Biology 47–51.
15. Zhu, K., Y. Yang, and Q. Shi. 2016. Study on evacuation of pedestrians from a room with
multi-obstacles considering the effect of aisles. Simulation Modelling Practice and Theory 69:
31–42.
16. Wabo, N.C., P. Örtenwall, and A. Khorram-Manesh. 2012. Hospital evacuation; planning,
assessment, performance and evaluation. Journal of Acute Disease 1 (1): 58–64.
17. Bailey, Norman T.J. 1956. Statistics in hospital planning and design. Applied Statistics 5 (3):
146.
18. Hardy, O.B., and L.P. Lammers. 1977. Hospitals, the planning and design process. Aspen
Publishers.
19. Albert, D.E., Innovalarm Corporation, 2007. Enhanced fire, safety, security and health
monitoring and alarm response method, system and device. U.S. Patent 7,173,525.
20. Malhotra, H.L. 1987. Fire safety in buildings. Borehamwood: Department of the
Environment, Building Research Establishment, Fire Research Station.
21. Robson, L.S., Judith A. Clarke, Kimberley Cullen, Amber Bielecky, Colette Severin, Philip L.
Bigelow, Emma Irvin, Anthony Culyer, and Quenby Mahood. 2007. The effectiveness of
occupational health and safety management system interventions: a systematic review. Safety
Science 45 (3): 329–353.
22. Cagliuso, N.V., N.E. Leahy, and M. Sandoval. 2010. Developing the hospital emergency
management plan. Health Care Emergency Management: Principles and Practice’, Jones and
Bartlett, Sudbury, MA, 89–110.
23. Fernandez, L.S., 2007. Volunteer management system design and analysis for disaster
response and recovery. The George Washington University.

View publication stats