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Fire Hazards

Causes of Hospital Fires

causes of fires
Source: National Fire Protection Association

The potential for fire in a hospital setting can occur from many different sources such as heat-producing equipment, storage of flammable chemicals, and faulty electrical wiring.

There are several different types of equipment and materials that are major contributors to fires in hospitals.

The eight leading causes of hospital fires in the United States are shown in the chart on the right (these figures are based on data from the National Fire Protection Association).

Electrical Equipment

Hospitals have a lot of electrical equipment and often have overworked sockets and cables. Power strips must be plugged directly into an outlet and NOT daisy-chained (linking power strips together).

Kitchen Facilities

Fires in kitchen facilities are common because of cooking fats, electrical ovens, toasters, and open flames.

Cigarettes

While cigarettes are banned in healthcare facilities, people might sneak them indoors or, while smoking outdoors, don’t properly dispose of them.

Specialized Medical Equipment

Lasers and electrosurgical tools are an ignition hazard, especially near oxygen tanks, surgical clothing, and flammable sterilizing liquids.

Hand Sanitizers

Alcohol-based hand rubs are used all over hospitals. However, they are flammable and need to have a 6-foot distance between the sanitation station and any ignition sources.

Gas Cylinders and Medical Oxygen Compliance

Gas cylinders and medical oxygen need to be properly stored and secured.

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1. How far away should alcohol-based hand sanitation stations be from any ignition source?

a. 3 feet
b. 6 feet
c. 12 feet
d. 20 feet

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Additional Areas of Concern

Extension Cord Daisy Chains

Because of the need to have equipment plugged in, hospitals should not use extension cords to chain the equipment together. Extension cords are a violation, and they can become overheated, sparking a fire.

exit door
Carts, wheelchairs, and medical equipment must not block fire exit doors.
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Fire Door Compliance

Hospital fire doors must close or latch correctly. Be sure they do not have holes in them, which would cause them to no longer be fireproof.

Fire Exit Obstructions

Carts, wheelchairs, and medical equipment must not block fire exit doors.

Portable Fire Extinguishers

Employers must ensure portable fire extinguishers are in areas that are not obstructed, are properly mounted, and have not been previously discharged. Employers must also ensure that portable fire extinguishers are not past due inspection.

2. If a fire door has holes in it, it is _____

a. still fireproof
b. less effective
c. no longer fireproof
d. more effective

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Five Classes of Fires

classes of fire

Class A: Fires that involve ordinary combustible materials such as wood, cloth, paper, rubber, and many plastics.

Class B: Fires that involve flammable liquids, combustible liquids, petroleum greases, tars, oils, oil-based paints, solvents, lacquers, alcohols, and flammable gases.

Class C: Fires that involve energized electrical equipment, such as power tools, wiring, fuse boxes, appliances, TVs, computers, and electrical motors.

Class D: Fires that involve combustible metals such as magnesium, potassium, titanium, zirconium, lithium, and sodium.

Class K: Fires that involve combustible cooking oils and fats used in commercial cooking equipment.

3. ______ involves fires that involve energized electrical equipment, such as fuse boxes, TVs, and computers.

a. Class A
b. Class B
c. Class C
d. Class K

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Fire Suppression

How to Use a Fire Extinguisher

Fire Extinguishers

There are five different types or classes of fire extinguishers, each of which extinguishes specific types of fire. Newer fire extinguishers use a picture/labeling system to designate which types of fires they are to be used on. Older fire extinguishers are labeled with colored geometrical shapes with letter designations. Both of these types of labels are shown below with the description of the different classes of extinguishers.

Additionally, Class A and Class B fire extinguishers have a numerical rating which is based on tests conducted by Underwriter's Laboratories that are designed to determine the extinguishing potential for each size and type of extinguisher.

Fire Extinguisher Types

4. Which class of fire extinguisher should be used on fires involving ordinary combustibles, such as wood and paper?

a. Class A
b. Class B
c. Class C
d. Class D

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Fire Sprinklers in Hospitals

Fire Sprinklers

Fire sprinklers must be installed throughout a healthcare facility. These systems are installed following NFPA 13: Standard for Installation of Sprinkler Systems and are maintained according to NFPA 25: Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems.

NFPA 25 outlines the required inspection, testing, and maintenance (ITM) frequency and procedures. Major system components are required to be inspected quarterly, semi-annually, and annually. At each of these intervals, specific items must be maintained and tested. There are also weekly and monthly inspection requirements for items that must only be visually inspected—these components include gauges, valves, private hydrants, and fire pumps.

From 2009-2013, only 4% of fires went beyond the point of origin, thanks to the increase in fire sprinklers. Today, 79% of hospitals are protected by fire sprinklers, and it has greatly reduced the spread of fires and fire-related death in hospitals.

5. _____ of hospitals are protected by fire sprinklers, and it has greatly reduced the spread of fires and fire-related death in hospitals.

a. 50%
b. 65%
c. 79%
d. 95%

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OSHA Fire Safety Requirements

OSHA Fire Safety requirements include:

exit routes
Fire doors must never be blocked or locked when employees are inside.
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Exit Routes

Every workplace must have enough exits suitably located to enable everyone to get out of the facility quickly.

Considerations include the following:

  • type of structure
  • the number of persons exposed
  • the fire protection available
  • the type of industry involved
  • the height and type of construction of the building or structure

In addition, fire doors must not be blocked or locked when employees are inside. Delayed opening of fire doors, however, is permitted when an approved alarm system is integrated into the fire door design. Exit routes from buildings must be free of obstructions and properly marked with exit signs. See 29 CFR Part 1910.36 for details about all requirements.

6. When are delayed openings of fire hazard doors acceptable?

a. When an approved alarm system is integrated into the fire door
b. Fire doors should never have delayed openings
c. Only if the doors have a way to stay open automatically
d. Fire doors should always stay closed

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Emergency Action Plans

emergency action plan
When required, employers must develop emergency action plans.
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Emergency and Fire Action Plans must be provided in accordance with 29 CFR 1910.38 when required by another OSHA standard.

When required, employers must develop emergency action plans that:

  • Include procedures for evacuating patients.
  • Describe the routes for workers to use and procedures to follow.
  • Account for all evacuated employees.
  • Remain available for employee review.
  • Include procedures for evacuating disabled employees.
  • Address evacuation of employees who stay behind to shut down critical equipment.
  • Include preferred means of alerting employees to a fire emergency.
  • Provide for an employee alarm system throughout the workplace.
  • Require an alarm system that includes voice communication or sound signals such as bells, whistles, or horns.
  • Make the evacuation signal known to employees.
  • Ensure emergency training occurs annually.
  • Require employer review of the plan with new employees and with all employees whenever the plan is changed.

For more information about emergency action plans, see OSHAcademy course 717 Emergency Action Plans.

7. When should emergency training occur?

a. When firefighters require it
b. Once a week
c. Once a month
d. Annually

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types of evacuation
There are specific evacuation types, depending on the situation.

Types of Evacuation

Time frames for evacuation may differ depending on the nature of the threat and the amount of time that can be taken to prepare for moving hospital patients. Specific types of evacuations are as follows:

Immediate: "Emergency move" – evacuate immediately or patients and staff may die; no time to prepare.

Rapid: Evacuate as quickly as possible; limited time to prepare (1 to 2 hours); follow procedures.

Gradual: No immediate danger; sufficient time to evacuate (sometimes hours to several days)

Prepare Only: Do not move patients, but you can start to prepare for evacuation.

8. In ______ evacuation, you must evacuate immediately, or staff and/or patients may die.

a. rapid
b. gradual
c. immediate
d. prepare only

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Fire Prevention

classes of fire
The Fire Triangle
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There are three main ingredients that constitute a fire: heat, fuel, and oxygen. The image to the right referred to as the “fire triangle,” shows how these three components interact to create a fire.

Fuel is any combustible material that can be used as the source of ignition of the fire, as well as to keep it burning.

Oxygen is an oxidizing agent that reacts with the fuel to start and continue the fire. Lower concentrations of oxygen result in slower fuel combustion.

Heat: Fires require oxygen and fuel reacting with each other at a temperature exceeding a threshold temperature, referred to as the “flashpoint.” Different materials and chemicals have different flashpoints, some at low temperatures and some high. The lower the flash point temperature of a compound, the more easily the compound ignites.

9. What components are referred to in the "fire triangle?"

a. Knowledge, safety, and fuel
b. Heat, education, and training
c. Training, oxygen, and heat
d. Heat, oxygen, and fuel

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Fire Prevention Plan Provisions

evacuation plan
Sample Fire Prevention Plan

Here are the minimum provisions of a fire prevention plan:

  • List of all major fire hazards, proper handling and storage procedures for hazardous materials, potential ignition sources and their control, and the type of fire protection equipment necessary to control each major hazard.
  • Procedures to control accumulations of flammable and combustible waste materials.
  • Procedures for regular maintenance of safeguards installed on heat-producing equipment to prevent the accidental ignition of combustible materials.
  • Name or job title of employees responsible for maintaining equipment to prevent or control sources of ignition or fires.
  • Name or job title of employees responsible for the control of fuel source hazards. In addition, when you assign employees to a job, you must inform them of any fire hazards they may be exposed to. You must also review with each employee those parts of the fire prevention plan necessary for self-protection.

For more information about Fire Prevention Plans, see OSHAcademy course 718 Fire Prevention Plans.

10. Which of the following should be included in a fire prevention plan?

a. Phone number of employees responsible for the control of fuel source hazards
b. Procedures to control accumulations of flammable waste materials
c. Emergency contact information
d. Date of an emergency

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Planning Considerations

planning
New healthcare facilities should be designed using guidelines for fire prevention.

One of the primary considerations in preventing hospital fires is to prohibit the use of combustible structural (e.g., floors, walls, roofs, stairwells, fire escapes) and nonstructural (e.g., doors, windows, ceilings, fixtures, facade, insulation, mechanical and electrical conduits) components in the hospital facility.

New facilities should be designed using building codes and guidelines for fire prevention, and the materials used should have adequate fire resistance ratings. (These ratings refer to the duration, usually in hours, that a given material can withstand fire at a specific maximum temperature before losing its integrity, including its strength and insulation capabilities.) In the case of both structural and nonstructural components, fire resistance ratings/durations can vary from 30 minutes to more than 4 hours.

Real-Life Hospital Fires

May 1929: Cleveland Clinic, Cleveland, Ohio, USA—125 Fatalities

The fire started in the clinic’s basement, caused by improper storage and ventilation of 70,000 sheets of X-ray films. Toxic fumes from burnt film spread rapidly throughout the hospital’s vents. Although no one died directly from the fire, people died as a result of the toxic fumes released.

July 2005: Calderón Guardia Hospital, San José, Costa Rica—19 Fatalities

This 62-year-old hospital is one of the busiest in San Jose. The fire started on the fifth floor; patients in the neurosurgery ward and the intensive care unit (ICU) were trapped. Fire escapes extended only to the third floor. Patients tied bedsheets together and used them as ropes to climb out of the windows. The fire alarm did not signal that there was a fire; also, the facility had no evacuation plan and had insufficient signage and lighting.

December 2011: AMRI Hospital, Kolkata, India—91 Fatalities

The fire in this private hospital started in the basement, where highly flammable medical equipment was illegally stored. Hospital staff abandoned the hospital when the fire started and did not try to rescue any patients. The fire service arrived 90 minutes after the start of the fire. Windows and doors were locked; windows had to be broken to gain access. Most deaths were a result of smoke inhalation.

11. What is the primary consideration in preventing hospital fires?

a. Increase training
b. Prohibit the use of combustible structural components
c. Close proximity to firefighting services
d. Knowledge of firefighting techniques

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Fire Drills

fire drills
Fire drills are an important and necessary component of an emergency action plan.
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Fire drills are designed to ensure that, through regular training and simulations, staff members will:

  • Have knowledge and understanding of the fire safety plan so that they can act swiftly, safely, and in an orderly manner.
  • Be knowledgeable regarding fire protection. For example, frightened individuals may not act intelligently, causing harm to themselves or those around them.
  • Have increased self-confidence and power to fulfill their responsibilities in the event of a fire.

Notification of External Agencies

If there is a fire threat and management decides to evacuate, there should be a designated person responsible for notifying the entire facility of the evacuation order, using appropriate systems such as overhead announcements, emails, text messages, and internal hospital communication systems with loudspeakers.

12. What is the purpose of fire drills in a healthcare facility?

a. Make OSHA happy
b. Increased self-confidence
c. Avoid fines
d. Prepare patients

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