Achieving a hospital safe from fire: from design to occupation

Last year in Health Estate Journal, Paul Beech (pictured on the right), an independent fire safety consultant and Eastwood Park fire safety trainer, raised his concerns about what he believed was a 'lack of response in healthcare facilities to changes in fire safety guidance', and considered the key changes to HTM 05-01 (2nd edn 2013) and HTM 05-02, and the implications to healthcare fire safety personnel. Here, in the second article, he discusses effective fire safety strategies, and focuses on the importance of incorporating fire safety as early as possible in the initial design process.

In a previous article I wrote about effective fire safety strategies; that they were no accident and necessary if fire safety is to be successfully managed in our hospitals.  I work in a number of hospitals and network widely with colleagues; I never cease to be surprised by the number of small fires we have in UK hospitals (as well as the relatively few highly publicised events) each having the potential to lead to highly destructive outcomes.

This article develops the theme of effective fire safety strategies, considering how fire safety must be incorporated into the initial design process.

Introduction

There are many factors involved in achieving a hospital safe from fire: effective structural and other fire precautions; the limitation and control of flammable and combustible materials; detailed evacuation strategies; staff awareness of the fire hazards in the workplace, and the ability of a hospital to respond to a serious fire incident.  But rarely, in my experience are they appropriately (and collectively) considered at the earliest design stage.

I find that far too often one is playing catch up with fire safety; trying to make fire safety fit an already consolidated design concept.  The result is often that one is faced with design teams (or their fire safety consultants) simply attempting to apply the recommendations of Firecode (HTM 05 02 in particular), and justifying a safe design on the basis that the recommendations of the document are met.  I do not concur that this approach will always lead to an acceptable outcome.

First of all, let’s consider paragraph 1. 15 of HTM 05 02.

This paragraph states – ‘It is therefore essential that the design team have a full understanding of the type of care being provided and the dependency of the patients, and that the client team fully appreciate the constraints imposed by the design on the movement and evacuation of patients, visitors and staff. The design team and approving authorities should not assume that a design which complies with the requirements in this document will be safe: it needs to be supported by a fully developed emergency plan. ‘

I do not think that this is a throwaway comment.  I think that it is carefully considered and identifies the importance of the layout of the building in respect of the evacuation process (the evacuation strategy). Suitable means for horizontal escape in hospitals is not just about the number of compartments and sub-compartments, but about their relationship to the vulnerability of patients, the distance  patients may have to be taken to a location where their care and treatment can continue, and the resources necessary for that care.  My experience leads me to believe that more successful provision for horizontal means of escape can be provided the sooner it is considered in the design process; indeed, I argue hospitals should be designed around the evacuation strategy for our most vulnerable patients, not the other way round – that of trying to make the evacuation strategy fit the building.

Integrated design – right from the start

As soon as the design process is to start, whether for a large new hospital, or an extension or substantial alteration to an existing hospital, every aspect of fire safety must be considered.  At least the outline of an evacuation strategy for each patient area must be visualized and seen to be achievable – this will start to influence departmental adjacencies and the extent of compartmentation and sub-compartmentation.

I lecture widely on fire safety in hospitals and am always looking for effective and valid ways to get my points across.  It can be difficult because of the existence of the Fireode series and other design codes.  All too often colleagues see meeting the recommendations for compartmentation and sub-compartmentation as providing adequate provision for horizontal means of escape.  Yet for me the evacuation strategy is no less important and should go hand-in-hand with the structural fire precautions at the design stage.  While fire and smoke will undoubtedly harm patients, relatively few fires in recent decades have resulted in large losses of life or serious injury (although I certainly believe that the potential exists).  Rather it is the evacuation process, the interruption to care and treatment, and the difficulty of continuing to provide treatment and care that harms (or has the potential to harm) the greater number of people.  For me, a well developed evacuation strategy that recognises the need for continuing treatment and care is just as important as the structural fire precautions – indeed, I argue that the structural fire precautions are there to facilitate the evacuation strategy rather than the evacuation strategy follow the structural fire precautions.

Needless to say all other aspects of fire safety are better considered at the earliest stages too.

How much do fire precautions cost?

Later in the article I use specific examples in order to explain in more detail why I feel that fire safety should be considered right at the start of the design process, but for now I just want to reflect on the cost of fire precautions.

One of the first things to be considered when building, extending, or altering healthcare buildings is the budget; and rightly so.  I should also add that I am all for reducing the cost of fire safety provision and limiting it only to what is necessary to meet the specification of my clients.  However, I am frequently informed of the cost of fire precautions – or at least how much it will now cost to change the design to incorporate fire precautions that were not considered at the earliest stage of design.  So, when I make my recommendations for further sub-compartmentation, say, to reduce the number of vulnerable patients first at risk and ease their resettlement in an area where their treatment and care is to continue, I am told how much it will cost to achieve this, yet, in many cases, had I been able to influence the design team sooner my recommendations could have been incorporated without any additional cost or inconvenience.

I have to admit to being a supporter of sprinklers in hospitals.  I think that they offer a greater guarantee of safety than purely structural solutions, and there are times when they are essential.  Frequently in the past I have been presented with (or am otherwise aware of) proposals when the only practical way of providing adequate fire safety is the installation of a sprinkler system.  Yet this outcome is not seen by the design team until after the budget has been set and the need for a sprinkler system is now seen as an additional, often unaffordable, cost.  Yet the cost of a sprinkler system can be offset to large degree buy a reduction in the cost of structural fire precautions that are not necessary should a sprinkler system be installed.

I am not suggesting that the cost of fire precautions should be lost, simply subsumed into an overall project cost without consideration, but I do think that recourse to stating the cost of fire precautions is too readily available to design teams as often they are seen as an add on rather than an integral part of the project design.

The specification

Inevitably, everyone involved in the design of a hospital wants an adequate degree of safety.  But, if I am not overdoing my point, most seem to think that just meeting the recommendations of Firecode is all that is necessary, so the specification for the new or altered hospital centres on Building Regulations compliance and Firecode.  If little early consideration appears to be given to business continuity once again it can be difficult, in my experience, to incorporate essential business continuity features that in the event of a serious fire will contribute to the continuing operation of the hospital.  Patient safety and care must also be seen in terms of disruption to a hospital where in the absence of business continuity and property protection measures emergency care services can be compromised, procedures and clinics cancelled or delayed, and patients may have to travel further to receive treatment as local services are disrupted.

Clients must develop a fully detailed design brief incorporating all aspects of fire safety including property protection and business continuity.

It is also important to remember that despite approval under the Building Regulations (the approval procedure for which often does not take full account of the fire safety management and fire response procedures and evacuation strategy for the building, concentrating rather more on the physical provision of fire precautions) the fire and rescue service may continue to have reservations (although none might have been expressed at Building Regulations approval stage) about the design of the building and will be empowered to challenge the Trust under the Fire Safety Order once it is completed and occupied.  While the design of the building and the development of fire safety strategy is very much a product of the design team and their fire engineers (with contribution from Trust officers responsible for fire safety), the Trust must be able to justify the design and respond to any concerns of the fire and rescue service accordingly.  The fire safety management duties of the Fire Safety Order should form part of the initial specification.

Fire Response Strategies

It’s the destination, stupid (maybe the journey too) I borrow from an election slogan used by Bill Clinton, former president of the United States, because I too want to make an appeal – for fully detailed fire response strategies.  It really is about the destination – and the journey – and not just the opportunity to move patients from a fire affected compartment or sub-compartment to an adjoining one.  All too often patient safety in the event of fire is focussed on the fire itself.  Obviously, you may think, after all, that’s where the danger is.  But is it?  Far too often hospital design is based, solely on the recommendations of HTM 05 02, even, on occasions without the full engagement of the Trust fire safety specialist or clinical teams who best understand the needs of patients.  But these recommendations serve a purpose – to form the basis of an effective evacuation strategy having regard for the vulnerability of the affected patients (it’s paragraph 1.15 again).  The provision of compartmentation and sub-compartmentation does a number of things: it reduces the number of patients first affected; it limits the spread of fire (at least during the early stages of a fire if it does not do so fully); and it provides areas on the same level that will remain unaffected by the fire into which displaced patients may be moved.  But that is far from the end of the matter.  Consideration must be given to the continuing treatment and other care needs of the patient.  I often hear nursing staff say that in the event of fire they will take their patients through one fire door (even two are stated on occasions), but rarely do I hear them state the pre-planned destination to which patients must be taken based on the condition and needs of the  patient.  So, once again, departmental adjacencies are important; the distance and nature of the route to a suitable destination where very vulnerable patients may be accommodated and cared for needs careful consideration; this will lead to an effective assessment of the physical and human resources necessary to carry out the evacuation safely and in a timely manner; and the fire response strategy must be recorded in detail as it can then form the basis of meaningful training.  After all, the time to first think about where and how to relocate displaced patients is not at the time of a fire incident, but beforehand allowing the procedure to be practised, tested, and revised as necessary.

How many compartments

Based on the recommendations of HTM 05 02, most hospitals will require three or four compartments per floor – these should be interconnecting.  And each compartment should be provided with a minimum of three exits – two of which should lead to separate compartments.  While this may not be essential in every case, if the building layout has been pre-determined without full consideration of the number and disposition of compartments necessary to facilitate effective evacuation strategies, layout changes can be necessary or compromises in fire safety may have to be accepted.

 

Storage for flammable liquids and medical gas cylinders

Seemingly less significant than some of the major structural requirements necessary for horizontal means of escape, an early consideration of the need to store flammable liquids and medical gas cylinders has benefits.  The time to consider such needs is not after the specification for rooms has been fixed and room layout and data sheets completed.  While I am not in favour of providing metal cabinets in all treatment areas for relatively small quantities of the flammable liquids, hand and skin sanitizers in particular (we should, of course, be doing our best to avoid the use or reducing quantities of those dangerous substances that cannot be replaced with the non-dangerous), adequate storage provision is necessary.  This may include lockable storage cabinets, sometimes metal cabinets, dedicated to the storage of flammable liquids.  The usually very small quantities of flammable medicinal products may have to be stored along with other non-flammable medicines.

 

Fire alarm systems

I have also found that some rather broad assumptions have been made about the design and provision of a fire alarm system without full consideration of the fire response and evacuation strategy.  Again, this can lead to counting the additional cost of provision, when a fire all system was always necessary, but considered in advance of these matters.

A detailed specification for the fire alarm system must be available to the design team early in the process.   This may not be the place to present too much detail about such a specification, but the detector technology (single or multi-sensor) should be specified, alarm signal loudness, the demarcation of alarm (not detection) zones, interconnectivity with existing fire alarm systems, and the location of main fire alarm panels and repeater panels can all be advised at the start of a project.

 

Conclusion – avoiding sub-optimal solutions

The early consideration of all aspects of fire safety is essential, ideally before final budgets are set, if we are to ensure patient safety and reduce the cost of fire precautions.  It is just too easy in my opinion to be obliged to accept sub-optimal fire safety solutions on the grounds that schemes have become too far developed to now change or on the grounds of costs that we not properly considered when the project was first considered.

 

Paul Beech

PaulforwebsitePaul Beech is an independent fire safety consultant and Managing Director of Fagus Fire Safety Consultancy Limited.  Fagus specialises in providing fire safety management support and fire safety design services to the healthcare and manufacturing industries.

Paul’s career in fire began when he joined the fire and rescue service in 1974.  Paul became actively involved in fire safety in the early 1980s when he was an inspecting officer and fire safety team leader.  He then lectured in fire safety at the Fire Service College for four years before taking on corporate responsibility for fire safety in Cheshire and then Shropshire Fire and Rescue Services.  Representing the Institution of Fire Engineers and Chief and Assistant Chief Fire Officers Association, Paul has sat on many Home Office and British Standard Committees dealing with fire safety.

On retiring from the fire and rescue service in 2005 Paul established Fagus.  Fagus quickly established itself in the healthcare industry and now supports a large number of NHS Trusts in a range of ways: as Fire safety Advisor, as Authorising Engineer (Fire), and providing other ad hoc services that include fire risk assessment, the development of fire safety management policies, and fire safety design advice for new construction. Paul is a FRACS accredited fire risk assessor.  For five years now Paul has provided the fire safety training for Eastwood Park.