Hospitals' Emergency Evacuation Plans: Fire Safety Protocols

Hospitals are complex buildings with unique fire risks, and so, in the event of a fire, the evacuation procedure must be carefully considered and planned. The safety of patients, staff, and visitors is paramount, and the evacuation process must be managed to ensure the swift removal of people from danger while also accounting for the specific needs of those inside the hospital. The design of the hospital, the nature of the fire, and the location of patients and staff are all factors that influence the evacuation process. Effective communication and training are key to a successful evacuation, and the procedures used must be regularly reviewed and practiced to ensure familiarity and preparedness.

Hospitals should have clear fire safety and evacuation procedures in place

Hospitals are complex environments, and the nature of their design and patient makeup means that no two hospitals will have identical fire safety and evacuation procedures. However, there are clear guidelines that hospitals should follow to ensure the safety of patients and staff in the event of a fire.

Firstly, hospitals should be designed to prevent fires from spreading. This includes the concept of 'compartmentation', where hospitals are divided into 'compartments' or 'zones' that can withstand a fire for a specific amount of time, giving occupants a chance to evacuate and allowing emergency services to respond. This design feature enables hospitals to employ a ''horizontal phased evacuation', where those who are able to leave the building without assistance are evacuated first.

Secondly, hospitals should have clear procedures for when a fire occurs. This includes a set evacuation sequence, with those in immediate danger being the top priority. In the case of a fire, this would mean evacuating those closest to the fire first, followed by those above and then below. Evacuation procedures should also take into account the specific needs of the hospital's patient population, such as the presence of non-ambulatory or critical care patients, and staff should be fully trained to handle various scenarios, including the use of fire extinguishers.

Effective communication is also essential to successful fire safety and evacuation procedures. Staff should be aware of where patients are and their conditions at all times, and the nature of the fire alarm (whether it is a test, drill, or genuine fire) should be clearly communicated to staff before or during the alarm. Alarms should be ''coded' to indicate the vicinity of the fire, with continuous alarms indicating a fire in that zone and intermittent alarms indicating a fire in an adjacent zone.

Finally, hospitals should regularly evaluate and improve their fire safety and evacuation procedures. This includes conducting regular drills and training sessions to ensure staff are prepared and confident in their roles during an emergency. Hospitals should also learn from real-life examples and worst-case scenarios to adopt an outcome-focused readiness mindset.

Communication is key, both before and during a fire

Communication is key to ensuring the safe evacuation of a hospital during a fire. Effective communication before and during a fire can help to minimise danger and save lives.

Before a fire occurs, staff should receive comprehensive training on fire safety and evacuation procedures. This includes educating staff on the different types of fire alarms and their meanings. For example, hospitals use coded alarms to indicate the vicinity of a fire, with continuous alarms signalling a fire in the same zone, and intermittent alarms indicating a fire in an adjacent zone. Staff should be aware of these distinctions so they can react appropriately, without causing unnecessary panic or disruption. For instance, it would be inappropriate to attempt to evacuate an unstable patient during a simple fire drill.

Additionally, hospitals should ensure clear communication channels between staff and patients. Staff should always be aware of each patient's location and condition, enabling them to make informed decisions during an evacuation. Hospitals should also establish clear protocols for different scenarios, such as whether to shelter in place or evacuate, and the order in which patients should be evacuated. These protocols should be regularly reviewed and practised through drills and training sessions to ensure staff are prepared for various eventualities.

During a fire, effective communication becomes even more critical. Clear and timely communication between staff, patients, and emergency services can help to coordinate evacuation efforts and ensure everyone's safety. Hospitals should have designated guides or leaders who can direct the flow of evacuees along safe routes, both within the facility and outside. These guides can also prevent people from re-entering dangerous areas.

Furthermore, hospitals should maintain open lines of communication with emergency services, providing them with up-to-date information on the situation. This includes assessing the building's integrity, critical infrastructure, and environmental factors to determine if an evacuation is necessary and if so, the scale and sequence of evacuation. For example, in the event of a fire at the Royal United Hospital in Bath, doctors used fire extinguishers to put out the fire, and all patients were safely evacuated within 15 minutes. Effective communication and training likely played a significant role in this successful evacuation.

Evacuation orders depend on the threat level and patient proximity to the fire

Evacuation procedures in hospitals during a fire depend on several factors, including the threat level and patient proximity to the fire. Hospitals are designed with fire safety in mind, including 'compartmentation' or 'zoning', which helps contain fires and provides time for a controlled evacuation.

When a fire occurs, a set procedure is followed to ensure patients are evacuated safely. The threat level is assessed, and if there is an immediate threat to patients and staff, an immediate evacuation is ordered. In the case of a fire in an ICU or operating theatre, staff trained in using fire extinguishers may attempt to tackle the fire, and an evacuation is started.

The evacuation sequence depends on the proximity of patients to the fire and their medical condition. Patients in the zone of the fire are evacuated first, followed by those in adjacent zones. In multi-storey hospitals, patients on the compromised floor and those above are evacuated first, followed by those below. The most resource-intensive and critical patients are prioritised for evacuation first, followed by ambulatory patients.

Communication is vital during a hospital fire. Staff are trained to handle fires and are aware of patient locations and their conditions. The nature of the fire alarm is communicated to staff, with coded alarms indicating the vicinity of the fire. This helps staff react appropriately and evacuate patients without compromising their safety.

The decision to evacuate is based on a careful assessment of building integrity, critical infrastructure, and environmental factors. Hospitals aim to provide appropriate medical care to patients during an incident, but if the building is severely damaged or there is a risk to patient safety, an evacuation is ordered.

ICU and theatre staff face challenges when deciding to evacuate patients

Evacuating a hospital during a fire is a complex process that requires careful planning and coordination. ICU and theatre staff face particularly challenging decisions when determining whether to evacuate their patients without compromising their safety or that of the staff themselves.

In the event of a fire, ICU and theatre staff must first assess whether the fire is located within their zone or an adjacent one. A continuous fire alarm indicates a fire in the same zone, while an intermittent alarm signals a fire in a neighbouring area. Upon confirmation of a fire, staff in these critical areas must immediately investigate, and if trained and safe to do so, attempt to extinguish the fire and initiate an evacuation.

The decision to evacuate ICU and theatre patients is challenging due to the vulnerability of these patients. Many are unable to move without assistance, and their medical conditions may require continuous monitoring or specialised equipment, such as ventilators. Evacuating these patients requires a focused approach and the difficult judgement of whether the benefits of evacuation outweigh the risks of moving them.

In some cases, it may be safer to shelter in place, especially if patients are unstable or moving them would compromise their care. However, this decision is complex and depends on various factors, including the integrity of the building, the threat to patient safety, and the hospital's ability to continue providing appropriate medical care. For example, during Hurricane Katrina, physicians initially chose to shelter in place, but subsequent flooding caused catastrophic damage, necessitating an evacuation.

To prepare for such challenging decisions, ICU and theatre staff must undergo comprehensive training to handle various fire scenarios. This includes mandatory fire training, such as selecting and safely using fire extinguishers, as well as regular drills and exercises to familiarise themselves with emergency procedures. Effective communication is also vital, with clear and timely information shared between staff, patients, and emergency services to coordinate an efficient response.

Fire alarm systems are coded to indicate the fire's vicinity

Fire alarm systems are designed to meet the fire protection requirements of a location, which are usually based on the minimum security standards set by model building codes, insurance agencies, and other authorities. These systems are coded to indicate the fire's vicinity through a range of methods, including tones, strobes, and voice messages.

In the United States, fire alarm evacuation signals typically consist of a standardized audible tone, with visual notifications in all public and common-use areas. The NFPA 72, 18.4.2 (2010 Edition) established Temporal Code 3 as the standard audible notification in modern systems, consisting of a repeated three-pulse cycle. Voice evacuation, which provides clearer instructions on what to do, is the second most common audible notification.

In the United Kingdom, fire alarm evacuation signals generally use a two-tone siren with visual notifications in public and common-use areas. Fire alarm sounders can be set to different frequencies and tones, depending on the country and manufacturer.

Within hospitals, continuous fire alarms indicate a fire in a particular zone, prompting immediate investigation, fire-fighting efforts, and evacuation if necessary. An intermittent alarm, on the other hand, indicates a fire in an adjacent zone, requiring staff to prepare for a potential evacuation.

Fire alarm systems also have other safety features. For example, they can recall elevators to prevent them from delivering people to dangerous areas and shut down HVAC systems to prevent the spread of smoke. Additionally, some systems have internal or external dialers that automatically contact monitoring centers or alarm receiving stations, streamlining the fire response process.

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