Patients in hospitals and nursing homes depend on the staffs of health-care facilities to evacuate them in the event of an evacuation. It is the staffs’ responsibility to prevent fire, know what to do if fire strikes, know how to implement rescue and evacuation in a fire emergency.
Introduction
Evacuating a hospital or a nursing home is a big risk, hazardous and laborious process that has always been a nightmare for the management and staffs of the health-care facilities. Many of their occupants are immobile, partially incapacitated, or in an altered state of consciousness due to sleep, illness, or medication. Should a fire occur, patients wait help from the nursing staffs. The patients are physically move by the staffs and the responders, one by one to places of safety, either through the horizontal exits or down the stairs. Hence, health-care facilities must designate the minimum number of staffers that must be on duty at all times. Generally, each nursing staff cares about 6 to 10 patients in a hospital environment. The staffs must be proficiently trained to prevent fire, know what to do if fire strikes, know how to implement rescue and evacuation in a fire emergency.
Fire Safety
Health-care facilities are designed to be fire safe. Yet, these facilities may never be totally free from the destructive forces of fire, earthquake, terrorism or any other catastrophe that can occur without warning. The patients in health-care occupancies spend 24 hours a day, seven days a week, in areas containing a high-potential fuel load of combustibles and oxygen, while other hazardous areas, such as laundries, storage areas, kitchens, operating rooms, outpatient centers, offices, and laboratories, aren’t occupied outside normal business hours. Fires in unoccupied areas pose another problem, as they may remain undiscovered until they’ve grown quite large unless the building is protected by an approved automatic fire alarm or fire-sprinkler system. Even small fires can produce heavy volumes of smoke, and nursing home patients are less able than the general public to tolerate such conditions.
For these and other reasons, health-care facilities should be designed and constructed to protect occupants from fire effects. Patient areas in many hospitals and nursing homes are sub-divided into small rooms by built-in fire separations, coupled with other fire protection methodologies that will help to keep fire and smoke from spreading, often know as compartments. A fire in these rooms can often be controlled by the fire-sprinkler system, or with one or two hose lines from the building's standpipe system. Compartments in health-care facilities are essentially addressed using a five-unit concept: the room, the smoke compartment, the floor assembly, the building construction type, and the exits. All of these have to meet specific requirements to ensure that the building will hold up long enough to allow the staffs and responders in assisting occupants to evacuate, relocate, or defend in place.
Evacuation Plan
Many nursing homes and most hospitals are large, complex multi-story buildings, with a mixture of construction types and layouts that can confuse patients, visitors and firefighters alike. The health-care facilities staff and firefighters must work together to save the lives of the patients who depend on them. The most effective way to do this is to create a pre-incident plan that incorporate all the fire safety features and the means of emergency egress that are available within the building, and train together to implement it during an emergency. In such cases, a pre-fire plan drawing would enable fire departments to response to the right access point and proceed rapidly to find a specific room even without staff assistance.
The best tactical option for ensuring the occupants’ fire safety is extinguishment. The staffs should be trained to extinguish or evacuate, as appropriate. While the nursing staff adopt the “defend-in-place” approach by moving patients to areas of refuge and closes fire doors to reduce smoke and heat infiltration into patient rooms, firefighters must immediately begin to extinguish the blaze. They should also evaluate the fire-scene conditions and the actions the facility’s staff has taken, and determine whether further movement of patients is necessary.
Evacuation Methods
In general, the evacuation strategy for health-care facilities assume smoke detectors, sprinkler systems and aggressive fire suppression will extinguish most fires, minimizing the possibly of evacuation. If evacuation becomes necessary, the preferred method would be to move patients from one area of a building to another area or building on approximately the same level that provides safety from smoke and fire. This method is often referred to as “horizontal evacuation”. It is an effective approach to move patients to designated places of safety within the same level of the building quickly.
On rare occasions or, if the building is not designed and constructed to protect occupants with the “defend-in-place” concept, it may be necessary to move patients completely out of the building. Much of the total evacuation process involves labor-intensive in carrying patients, one by one down the stairs, if the “normal lifts” are not working during emergency as they are often consider not safe for fire egress. If there is no contingency plan to handle mass evacuation when the situation calls for, such large-scale evacuation process becomes even more difficult and hazardous. Much agony and time that would takes the works of several fire companies to empty the total building population. And the fire won’t wait while smoke spread!
Means of Egress
While most hospitals and nursing homes are designed with the “defend-in-place” strategy to protect their patients from the fire effects and minimizing the possibly of an evacuation, health-care facilities management should also need to have contingency plan to handle large scale evacuation when the situation calls for. What constitutes adequate care in terms of providing means of escape from a building in the event of a fire or a mass evacuation?
Health-care facilities management recognizes difficulties in moving and carrying patients down several flights of stairs and the need for different equipment to help move patients down faster. The following are some of the evacuation measures for exit strategies for buildings of health-care facilities:
Horizontal exits, which use fire barriers, separation, and other means to help contain the spread of fire on a floor, enable occupants to evacuate from one area of a building to another area or building on approximately the same level that provides safety from smoke and fire.
Vertical spiral exits specially designed into the structure for bed and wheel chair patients, which use the concept of the multi-story car park spiral driveway, normally located at both ends of the building that will lead to the ground level. This means of egress enable helpers to push the bed and wheel chair patients through the horizontal exits at each level to the vertical spiral exits and down to the ground level.
Evacuation lift specially designed to protect against heat, flame, smoke, and water, overheating of machine room equipment and loss of electrical power from the impact of effects from fire emergencies. Such lift designated for evacuation enable bed patients of the ICU or other critical units to be brought down from the upper floors to the ground quickly. Selected staffs are trained to operate such lift during emergency.
Firemen lift is designated for firefighters to transport their heavy fire fighting equipment to the fire floor to fight the blaze. Such lift can also be used to bring down the wheel-chair patients and the mobility impaired during emergency.
Fire escape stairs are an approved route to safety for most occupants of buildings – but have inherent limitation for egress in health-care facilities evacuation because it is believed that more than 60% of patients in a hospital have difficulty or no ability to walk down stairs unassisted. Though firefighters and hospital staffs are trained to carry people, one by one down the stairs as efficiently as they could, such evacuation process is slow, laborious and hazardous.
Evacuation chair helps moves patients down flight of stairs much easier but not necessary quicker. The same stairway is also use by firefighters to gain access to the fire floor.
Fire escape chute system allows all occupants including the disabled with minimum assistance to slide down to the ground quickly and in relative safely. The multi-entry installation of the escape chute system has worked well as part of the evacuation operations in health-care facilities for vertical escapes when the lifts are not working. It allows occupants to gain access at each floor, meaning that several levels can be simultaneously evacuated. The single-entry chute can be mounted on the rooftop, corridor, balcony or window and allows occupants to gain access from that floor.
Summary
Evacuation in health-care occupancies presents health-care management and emergency responders with a unique set of tactical problems. There is no doubt that care-giving or nursing staff must try to evacuate patient at once, since there is very little time for other actions. Compared to the old method, provision of different equipment to help move patients away from danger and down faster is a phenomenal.
One of the concepts many healthcare facilities adopt in an emergency fire situation is “RACE”. Rescue patients or residents in harm’s way at once, meaning moving them away from danger in the safest and quickest way. Activate the alarm to seek help from the Fire Brigade. Contain flames and smoke from spreading to other rooms by closing doors. Extinguish the fire if possible or evacuate, as appropriate.
This article contribute by Escape Consult Mobiltex (S) Pte Ltd. For more information on the fire escape chute system, visit website: www.escapeconsult.com
