Hospital Fire-Safety Program
After a series of tragic hospital fires, authorities began to recognize the urgent need for hospital fire codes. Congress passed the Hill-Burton Act, which mandates fire safety and special fire-safety construction for hospitals. The New York City Building and the New York State Hospital Codes now have stringent regulations regarding fire-safety construction for hospitals.
The New York City Fire Department now requires the preparation of a fire plan for all hospitals within the city. This plan includes instructions for employees in event of fire and also suggests fire prevention and employee fire training programs.
Many hospital fires occur in old buildings of inferior construction. But even the most modern hospital is exposed to a variety of hazards which need attention. Attempting to solve this problem, we set out to establish a comprehensive fire-safety program for the Memorial Sloan-Kettering Cancer Center in New York City. Our program now embraces these four general areas: employee training, continued employee education, maintenance of our physical plant and strict enforcement of fire-safety regulations.
Safety plan developed
To put this program into action, we developed a fire-safety plan approved by the fire department which covers these broad areas:
- Preventive action in the event of a fire. This part of the plan is devoted to assignments and instructions to various individuals and departments.
- Evacuation procedures. This involves precise instructions and assignments for the orderly and speedy evacuation of patients.
- Fire prevention and control responsibilities. The duties of the fire marshal and other supervisory personnel are clearly and specifically outlined. Also included are the location and maintenance of fire fighting equipment, regular fire prevention inspections, and the testing of alarms and other important equipment.
- General rules of fire prevention. Also spelled out are fire prevention regulations for various departments, including smoking regulations, kitchen safety, electrical hazards, etc.
- The employee training program.
- A short description of our plant fire fighting facilities. Fire brigade assignments, covering all three shifts, are listed.
The fire plan follows the general guidelines laid down by the New York City Fire Department, but it was written specifically for our plant, Memorial Sloan-Kettering Center. This plan can be adapted for use by any hospital.
No matter how well designed a fire plan may be, it is useless unless each employee is trained to put the plan into operation. At Memorial, we carry on a year-round fire-safety training program for all employees. This program consists of daily classes, monthly classes, special classes and outdoor training sessions.
During monthly classes, employees are taught the correct procedure to follow if they discover a fire. Through the use of color slides and accompanying commentary, they learn:
- Quick and easy methods of removal of patients,
- Simple and direct methods of sounding an alarm by pulling the nearest interior fire alarm box and dialing a special fire number,
- How to confine a fire by closing all windows and doors,
- How to extinguish a fire by using the proper equipment.
We explain the various classes of fire and what equipment is most effective on each. We emphasize the importance of sounding an alarm before attempting to fight a fire. We demonstrate how to do this by the use of a dummy demonstration alarm box.
We explain the fire triangle and tell how it can be used and how the different extinguishing agents work.
Classes for new workers
The horror of a fire can never be overemphasized. To sufficiently impress new employees, we conduct daily short lectures for them. During these 10 to 15-minute sessions, we cover the main points of our fire emergency procedures. We give each new employee a sheet summarizing the actions they should take in the event of a fire. On the sheet a key word (RACE) is used. The word stands for Rescue, Alarm, Confine and Extinguish. These are the immediate actions we expect our people to take and the order in which to take them. The reason for these daily classes is that it may be a month or more before a new employee attends a monthly class.
We also conduct outside fire classes and we are expanding an outdoor training area. Here we build fires and let our people put them out, making sure they use the right equipment for the type of fire involved. Sometimes we will purposely give one of our employees an empty fire extinguisher. This tests the individual’s ability to respond quickly.
We also conduct special classes for our nursing department on evacuation carries or other problems unique to this department. In this area, we have had excellent cooperation from the New York City Fire Department, whose representatives have conducted some of these special classes for us.
To ensure that these special training programs will be continuing ones, we have established a special routine.
First, approximately two weeks in advance of the training session, an announcement is sent to all department heads and supervisors, stating the time and the place of the class. We ask for the names of the employees expected to attend the class. Attendance cards are then issued. After the class, the attendance cards are compared with the lists that were submitted. A report of attendance is then sent to each department head on a special form.
We also maintain a continuing firesafety educational program by various methods. Frequent, unannounced fire drills are conducted on all shifts. No one knows in advance when or where the drill will be held. The only exception to this is the notification of the switchboard operator a few minutes before the actual drill.
As a part of our education program we have created various posters, signs, reminders and so forth stressing fire safety. For example, one poster (suggested by our own employees) points out the hazards of placing wedges under doors to keep them open.
We also have a sticker that is placed at the base of each telephone. The sticker states the procedure to follow in case of a fire and has the number that is to be called.
From time to time, a fire-safety news bulletin is issued. This deals with topics of current interest. One bulletin recently provided information concerning the hazards involved in the use of oxygen.
During Fire Prevention Week, we set up displays in the hospital to bring home the message of fire safety. These displays usually provide photos of the results of various fires and exhibitions of available equipment. Educational material and brochures are also available. We do everything we can to encourage our employees to participate in our programs. Again, it must be stated that we have had much help and cooperation from the New York City Fire Department.
A third area in our fire-safety program is the physical plant. We have instituted a complete overhaul of our fire alarm system, which is tested daily. A man goes to a different alarm box each morning to make this daily test by pulling the alarm (allowing it to work silently by use of a special key), and then sounds one gong throughout the center. This informs us that the gong circuit is in working order. The results of these daily inspections are entered on a special form which is filed for review by the fire department.
One problem which we share with all hospitals is the problem of doors that are continually being chocked open. To solve this problem, we installed on each side of our doors a smoke detector connected to an electromagnetic door holder. Should a detector be activated by smoke, the system will ring the interior fire alarm, release the door so that it will close and shut down all fans.
At the start of our fire-safety program, we replaced soda-acid extinguishers with pressurized water extinguishers. The standpipe hose in all our buildings has been replaced, and a maintenance program which will replace all hose when it becomes worn or damaged or more than 20 years old has been initiated.
Smoke detector training
In addition to daily tests of our interior alarm system, several members of our electrical department have attended a special course at the plant of a smoke detector manufacturer. These men are now qualified to test and maintain our own smoke detection systems. We considered this essential because our hospital will eventually be completely equipped with smoke detectors and maintaining our own equipment will represent a tremendous saving in fire-safety expenditures.
Weekly fire prevention inspections are conducted in each of our buildings. We check to insure that all doors are in proper working condition (not chocked open), that the fire alarm boxes are not obstructed, that fire alarm cards are visible, that exit lights are lit and that exits are not blocked. Our men are constantly seeking out other fire-safety violations.
We have a fire cart on which we carry a variety of fire fighting equipment, including extinguishers, axes, hose, nozzles, self-contained breathing apparatus, forcible entry tools, gloves, hats and whatever else is deemed essential. Since all our buildings in the main complex are connected by tunnels, when a fire alarm sounds, the cart is wheeled to the endangered building and then transported to the fire floor.
The mere discovery of a fire or safety hazard is not enough. Immediate remedial action must be taken. We issue what we call a fire-safety deficiency notice which is sent to the department head involved. This notice describes the deficiency and requires action from him within a specified time—the sooner the better. One copy of the form is also sent to the department head’s division manager. This is a four-part form and the department head is required to return the appropriate part as soon as the necessary remedial action has been completed. To insure compliance, there is also a followup form which is sent to a department head if he has not responded within the required time. A copy of this also goes to his division manager.
It has been our experience that this deficiency form, together with the followup, is a most effective device in correcting most of the fire and safety problems we encounter. However, if a problem is too complicated for this form, we use interoffice memos.
Smoking violation action
Unlawful smoking is a problem in most hospitals and to control this problem, we developed a smoking violation form which is effective. When an individual is observed smoking in a prohibited area, he is politely asked to put out his cigarette or cigar and is then handed one of these cards, which very clearly cites the law on smoking as well as the penalty for violation.
In summing up, the following procedures can help you bring your fire emergency program up to date:
- Develop a comprehensive fire emergency and evacuation plan
- Institute an intensive and continuing fire-safety training program for all employees
- Establish and maintain a continuing fire-safety educational program for all employees by means of visual aids, such as posters, bulletin boards, special exhibits and displays and, most importantly, unannounced fire drills
- Update your physical plant and establish regularly scheduled maintenance of all fire emergency equipment
- Provide an enforcement system for all fire-safety regulations.