Archives For patient safety

 

 

From this article, “Preemptive Strike” (Fire Chief, May 2011), by Gerald Hughes we see the purpose of fire prevention and how balanced fire protection is required to maintain the highest level of fire protection and life safety.  Utilizing the well-known fire triangle, Hughes inserts three points of prevention and how they can break up that fire triangle.  Fire prevention and life safety is at its strongest when all of these components are effectively in place.  Hughes calls this the Fire Prevention Triangle, and states that “it illustrates how human actions and engineering principles combine to have a synergistic effect on the prevention and extinguishment of unwanted fires”.

 

 

1.  Engineering Principles –  By understanding fire, its patterns and behavior, structures and facilities can be engineered so that the threat of fire or loss of life is grossly minimized.  
     1.  Active suppression – on-site equipment that suppresses/extinguishes fire, this could include  fire extinguishers, fire sprinkler systems, and standpipes.

     2.  Passive resistance – structural elements created to separate human beings from fire, these are fire rated walls and smoke barriers, protected openings in these walls, fire stopping, and flame retardants.

     3.  Early detection – installed systems that provide advance warning of fire, this can be as simple as a smoke alarm or as complex as a full fire alarm system.

2.  Human Responsibility  –  support of fire prevention and firefighting
     1.  Fire inspections – to determine compliance with fire codes, and create pre-plans

     2.  Code enforcement – to enforce the correction of violations

     3.  Firefighting – to suppress fires, and investigate to determine cause and origin

 

3.  Fire Safety Education – center of an effective fire prevention program
     1.  Public education – disseminates fire/life safety messages to the public, creates awareness, trains building managers on the proper maintenance of engineered systems (fire walls, sprinkler systems, and fire alarms)

     2.  Training – technical training providing fire inspectors with the skills needed for effective job performance

 

Just as in the original fire triangle, if you take one of these items away, then it all falls apart (in the case of fire triangle, the fire is extinguished).  This illustration aptly demonstrates the necessity of balanced fire protection.  For example, if a facility was to install active suppression (i.e., a fire sprinkler systems), then eliminate its passive fire protection, then that level of protection between fuel and heat has been removed, and risk of fire and life loss is increased.  Furthermore, if the public education and training component is missing, whereas building owners or facility managers are not educated as to the necessary inspection and maintenance of the engineered systems (active suppression, passive resistance, early detection) then the whole prevention triangle is at risk of falling apart, and the three elements of fire move ever closer together, once again increasing fire and life loss risk.

Even with this knowledge, in an effort to increase profits, the health care industry is attempting to remove these components and rely primarily on active suppression (which, in itself, is not 100% successful).  Removing the fire prevention control of, passive resistance, and with no guarantee of proper systems maintenance the fire elements – fuel, heat and oxygen – are permitted to come together, virtually unhindered.

With these systems missing how safe will your local health care facility be to the members of your community?  Take action now!
    

 

If fire sprinklers are so great, why do buildings equipped with fire sprinklers still burn?   This short video clip from FM Global  gives us an answer to this question:

 

 

This video shows three possible scenarios that could negatively affect fire sprinkler performance, design deficiencies (from changed use of occupancy space), system impairment, early system shut-down.  These are all probable scenarios.  If any of these were to take place, the occupants of the facility would be in grave danger.  However, this is a primary reason to have redundancy in life safety systems, this is why fire protection features work together and are not stand alone.  If a sprinkler system should fail, a fire could be held in check by a fire barrier, and the damage compartmentalized.

In the upcoming International Fire Code Committee Action Hearings, the healthcare industry will try to institute code chagnes that eliminate fire and smoke barriers, thus removing a level of safety for patients that may be incapable of self preservation.  These proposed changes include:

  • Elimination of fire resistance rated corridors (IFC 1105.3.2)
  • Allowance of unprotected openings in corridor smoke barriers (IFC 1105.3.4)
  • Discontinuing maintenance of existing smoke and fire barriers (IFC 1103.1)
  • Treat  existing smoke barriers as ½ hour rated, not requiring any fire stopping or opening protectives (IFC 1105.5.2)
  • Consider glass walls in sprinkled buildings to be 1 hour rated (IFC 1103.4.1)

The Patient Fire Safety Coalition is committed to speaking against these code changes, and standing up for the safety of the many patients that visit our nations hospitals.  If you are interested in joining the fight you can sign up to receive updates to this site so that you can stay informed and have the most current patient fire safety information, you can attend the code hearings and let your voice be heard, and you can contact us at info@patientfiresafety.org for more information and assistance in this.

Reviewing 9 of the most deadly hospital fires, reveals several recurring factors, including:cleveland_clinic

  • heavy fuel load
  • lack of compartmentation (to limit fire and smoke spread)
  • lack of fire sprinkler protection
  • no early warning system (fire alarm)
  1. Cleveland Clinic (1929) – 120 killed

More than 120 people lost their lives when flammable items (nitrocellulose x-ray film, in this case) was stored to close to a heat source. Contributing factors to these deaths included:

  • improper storage of flammables – stored too closely to other types of flammables and a heat source
  • lack of fire sprinkler protection – not required at the time, potentially could have held the fire in check
  • unprotected openings between floors – allowed the fire, heat, smoke, and toxic gases to travel up and through several levels

2.  Mercy Hospital (1950) – 41 killed

When a patient in the St. Elizabeth’s Women’s Psychopathic Building at Mercy Hospital lit her curtains on fire, 40 elderly women were killed and one attendant.  Contributing factors to these deaths included:

  • incendiary/arson fire – fire intentionally set
  • barred windows – hindered fire department rescue efforts
  • flammable wall coverings – combustible fiberboard was used for the corridor ceilings

3.  St. Anthony Hospital (1949) – 74 killed

Seventy-four lives were claimed when a fire, which started in a laundry chute, quickly spread throughout the facility.  Contributing factors to these deaths included:

  • combustible laundry chute construction
  • lack of fire alarm or fire sprinkler systems
  • open corridors and stairs
  • lack of smoke barriers

4.  Hartford Hospital (1961) – 16 killedhartford_hospital_patient

A fire starting in a trash chute spread through the facility igniting the flammable interior finishes resulting in 16 deaths.  Contributing factors to these deaths included:

  • flammable/combustible interior finishes – large amounts of plastics, linoleum, and fabrics throughout
  • dead-end corridors – occupants had to travel through fire/smoke to escape
  • partial fire sprinkler protection – fire sprinklers present on only 3 floors
  • undivided, concealed spaces – spaces above ceiling allowed the rapid and uninhibited travel of smoke
  • unprotected openings – smoke door was held open allowing smoke and fire to fill up an entire floor

 

5.  Missouri Facility (1974) – 8 killed

Eight lives were lost when a fire broke out in this Missouri facility, with a heavy fuel load, and staff that was not adequately trained. Contributing factors to these deaths included:

  • heavy fuel load – patient rooms contained large amounts of foam, mattresses, couches, and bedding
  • improperly functioning fire alarm system – fire alarm alerted staff in the halls, but did not alert the fire department
  • partial fire sprinkler protection – in laundry and trash rooms only
  • unprotected openings – staff left the doors to patient rooms in the open position

6.  Michigan Hospice (1985) – 8 killedhartfor_hospital

When a fire started from a patients recliner and began to spread, 8 lives were lost.  Contributin factors to these deaths included:

  • heavy fuel load – patients were allowed to bring items from home
  • unprotected openings – fire and smoke spread through the ventilation systems and stairwells, smoke doors were left open

7.  California Hospital (1985) – 5 killed

A patient smoking while trying to shut down his oxygen supply ignited a fire that quickly spread, taking 5 lives.  Contributing factors to these deaths included:

  • careless smoking
  • unprotected opening – patients door was left open, permitting spread of fire

8.  New York Hospital (1993) – 3 killed

A medical equipment malfunction contributed to the death of 3 patients.  Two of the patients were in the room of origin, and the third was two rooms down.  His door had not been properly shut, as had all the other patient rooms.  Contributing factors to low mortality rate:

  • fire alarm system was in place
  • fire sprinkler protected corridors
  • trained staff
  • auto closing doors and rated walls – limited fire and smoke spread

9.  Virginia Hospital (1994) – 6 killed

This fire started in a patients bedding, and was fed from an open oxygen line, until the oxygen zone was shut off.  Contributing factors to these deaths included:

  • unprotected openings – door to the room was left open
  • lack of fire alarm detection devices – no smoke alarms in the patient rooms
  • lack of fire sprinklers and working fire department connection
  • undivided concealed spaces – spaces above ceiling permitted smoke movement and seep down

balanced_fire_protectionAs we can see from this short history these fires spread and took lives, not due to one system operating or malfunctioning but, due to multiple systems that are inteded to work together and create redundancy not being in place.  Hospitals are supposed to be a place of safety, refuge, and healing.  It is only when the facility takes a balanced approach to life safety that your loved one remains truly safe, and real healing can take place.

 

 

 

 

For more information on the above mentioned fires download the report, “Major Hospital Fires” from the National Fire Protection Association.