ists.
What managers need to consider about fire prevention is keeping apart the three elements that when combined in the right proportions can create fire or explosions. The three elements are heat (also known as source of ignition), fuel (also known as combustible or flammable materials in solid, liquid or gas form) and oxygen (bearing in mind the level of oxygen we need to breathe is the same level that supports fire).
An essential element of fire risk assessment, if properly done by an appropriately trained competent person identifies, assesses and proposes control measures to either eliminate or control the risk and follows up where and when these elements, in combination, may increase the risk of fire. For example, bedding is common in a health care environment, and is a source of fuel. Oxygen is ever present, and may be more concentrated around some patients, but the risk of fire is minimal if there are no sources of heat. Therefore bedding, either laundered or soiled, should always be stored away from sources of heat.
In health care facilities areas, such as laundries, laboratories, pharmacies, heating plants and waste disposal areas may have elevated fire risks as the potential for the combination of fuel and heath may be elevated. Even health care facilities that may be designated smoke free campuses may be at risk from ignition from open flames such as cigarette lighters, matches or discarded cigarettes due to a perceived urgent need to smoke by staff, patients, visitors or contractors who will try to find an area where they can smoke unobserved.
Consider the following situation that occurred in a health care facility.
A fire occurred in a hospital where a cleaning worker, rather than brave the cold and move to a designated smoking area outside of the hospital campus, would frequently go into a linen storage area to sneak a cigarette. One day she lost her live cigarette in a partially full laundry bin which caught fire. A great deal of smoke first activated the alarm system initiating an activation of the 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; stairw