he emergency action plan. A sprinkler head in the laundry storage area eventually extinguished the fire. The smoker, however, needed to be hospitalised due to smoke inhalation as a result of the fire. The floor was evacuated, the fire service responded but minimal damage occurred.
Health care facilities may also have flammable and combustible liquids or gases in different areas of the facility. Laboratories, operating theatres and casualty, maintenance areas, pharmacies as well as supply areas may stock certain products that when exposed to heat may ignite. Also shipping and receiving areas may have combustible waste that needs to be disposed of.
In the Journal Patient Safety in Surgery, Batra and Gupta described how the use of an alcohol-based substance in the presence of electrosurgical equipment created a fire in an operating theatre.
The basic philosophy which needs to be vigilantly followed is to keep heat, fuel and oxygen apart.
Fire protection in health care facilities includes what is needed to protect the patient, workers, visitors and others from the danger of fire. This includes, but is not limited to: the preparation and keeping up-to-date a number of required and essential documents; systems to detect smoke or heat; automatic fire suppression systems such as automatic sprinkler systems; mechanisms to notify the local emergency services that an alarm has been activated; systems to notify staff, patients, visitors and others to evacuate; a system of designated primary and secondary emergency escape routes from all areas of the building; designated external emergency assembly areas; a system to account for evacuated patients, staff, visitors and others; mechanisms to provide continuity of care during an evacuation including agreements with other facilities to provide shelter as necessary; staff training on evacuating patients; regular drills and exercises involving the local emergency services; fire related doors including self-closing mechanisms to limit the spread of smoke and fire by-products; stairways that are protected from smoke; and a compilation of safety data sheets that is readily available and describes the properties of hazardous substances used in the facility.
Although the 14 above-mentioned points are examples of essential fire protection elements, it would take more than a journal article to provide detailed information on each one. We would, however, like to call your attention to a few.
It is essential that there are designated emergency escape routes from all areas of the facility to a place of safety. These routes need to be clearly marked, continually unobstructed, well lit, and unlocked. In consultation with the local fire service, the emergency action plan may call for a phased evacuation, not evacuating all patients and staff at once. In some facilities there are designated areas of refuge (with specific engineering criteria) where evacuees wait for assistance from the emergency services.
An emergency escape route may be part of a normal passageway. Often times the secondary emergency escape routes may be passageways and doors that are not in constant use. In some locations, during the winter season, the doors leading outside may be obstructed by snow. It is essential that all designated escape routes are regularly inspected by a designated person and are continually unobstructed.
Evacuation in a health care facility includes both ambulatory and non-ambulatory patients, although during a fire emergency, ambulatory patients may become non-ambulatory due to fear or stress. Moving non-ambulatory patients in beds may not be feasible. In a number of facilities an evacuation sheet is used. It is essential, however, that health care facility staff are trained in how to evacuate a patient using a drag sheet or other evacuation mechanisms that the facility uses.
Patients, staff, visitors and others need to be accounted for once outside of the building. A means of accounting for who is missing needs to be set up and described in the emergency action plan. There also needs to be a means of rapidly