Barros Luco Hospital in Chile

Major fires in public places such as nightclubs, shopping centers, markets, hotels, and hospitals have had significant social repercussions in many countries, and emphasize how important it is to raise public awareness in order to reduce or minimize risks, and to have preparedness plans to respond to such emergencies in an appropriate manner.

A study of these unfortunate events reveals a set of common factors, including a lack of awareness or ignorance of the dangers, reactions of panic and stampedes, inappropriate use of flammable and toxic materials, the absence or ineffectiveness of basic safety measures, flawed regulatory frameworks, and lack of evacuation drills.

Fires in Healthcare Facilities

Hospital fires have been the cause of tragedies throughout the world. Many lives have been lost, essential supplies and medical records destroyed, and property and equipment damaged, at an inestimable cost. Hospital fires in some countries have resulted in national regulations being adjusted and improved to mitigate the future occurrence and severity of such tragedies. However, the loss of lives and property in hospital fires remains high in Latin America and the Caribbean.

PAHO/WHO’s Emergency Preparedness and Disaster Relief Department has undertaken the preparation of the Fire Safety and Hospital Evacuation Guidelines: Hospitals Don’t Burn! to present safety strategies that should be implemented in healthcare facilities in a bid to save lives and protect property, equipment, and medical supplies.

Guiding Principles for Safety against Fires in Hospitals

Fire prevention should be a critical consideration in the safety design of all facilities (e.g. the combustibility of construction materials and furnishings, and the spread of fire and smoke).

In the event of accidental or malicious fires, fire suppression equipment needs to be readily accessible. In addition to availability, staff members at the facility need to have a working knowledge of how to use the equipment and prevent panic.

Moving all patients, visitors, and staff out of dangerous and/or damaged facilities as safely as possible is always the goal of an evacuation. It is important to recognize that a person’s attention to detail and processes will not be ideal during an evacuation. Understanding key principles will help staff make good decisions during a chaotic event:

  • Safety is always the primary concern.
  • Every effort should be made to include evacuation considerations when designing or retrofitting hospital facilities.
  • Simplicity is key. The staff will need a simple plan to follow in an emergency.
  • Flexibility is vital because procedures must be adaptable to a variety of situations.
  • Self-sufficiency at the unit level is important because timely instructions from hospital directors may be difficult or even impossible, requiring employees at every level to know immediately what to do in their area.
  • It may be necessary to evacuate patient holding sites before transportation is available or other sites are prepared to receive patients. If the medical facility cannot accommodate a horizontal safe site, then assembly points located away from the main clinical areas should be identified and designated.
  • Individual patient care units should stay together at the assembly points whenever possible (instead of splitting patients into separate groups according to their ambulatory status). The unit teams are familiar with their patients and will be better able to manage them in a chaotic situation away from the care unit.
  • EMS and other external patient transport providers should not normally be asked to enter the hospital premises in order to evacuate patients because of the risks, time delays, and inefficiency involved in transporting large numbers of people. Instead, patients being evacuated should be escorted to ambulances and other vehicles in rapid-transit staging areas.
  • When hard choices have to be made, managers and staff should focus on the “greatest good for the greatest number.”

Many healthcare facilities in this Region do not have evacuation procedures in place; nor do they have adequate fire protection or properly functioning fire suppression devices. In the effort to guarantee the safety of healthcare facilities, it is paramount that all new and existing facilities should be designed to prevent fires from starting or spreading, with ample resources to fight fires and a comprehensive, practicable evacuation strategy.