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WHY FIRE SAFETYThe hospital, as an Institution is prone to fire because of:- Having many heat-dissipating equipments, Combustible gasses /fuel, chemicals, used in differentareas.A lot of electrical wiring, high voltage connections.Fire prone articles like gauze, cotton, linen, books andregistrars.Heavy Equipments and electrical gadgets.that are inflammable and prone to hazardous incidents.proper precautions has to be taken while planningthe infrastructure.Adequate measures need to be considered, designed andpractised to ensure safety to all. Indicators like architectural designs, interior designs,electrical wiring, appropriate equipment planning andproper waste management are considered while planningsuch safety measures.
RECOVERY AND RESILIENCY• Internal effort within an organization to ensure that all critical business and service functions are resistant to disruption by fire i,e.• Business Continuity• Recovery Plans• Insurance Coverage• Continuity of operations• Continuity of services
4 phases of a SOP TEMPLATE comprehensive emergency management approach• Mitigation/Preparedness activities of the threat/event. State several objectives/strategies for: - Hazard reduction and resource issues - Preparedness and resource issues• Response/Recovery from the threat/event. State several objectives/strategies for: - Hazard control and resource issues - Hazard monitoring - Recovery
SOP TEMPLATE• Notification procedures - Within facility, system - Other - (gov, external etc.)• Specialized staff training, references and further assistance - Texts and manuals on specific issues and procedures• Review date
9 STEPS PROCESS FOR FIRE SAFETY1 2 3 4 Develop Hazard Develop Standard Implement Form Vulnerability Operating Mitigation and Emergency Analysis & Procedures Preparedness Management Complete Activities Operating Unit Develop Strategies Committee for Mitigation, Take Actions to Templates Establish Roles, Preparedness, Reduce Impacts, Assign Determine Threats Response & Build Capacity Responsibilities and Impacts Recovery 5 Report Results of Mitigation and Preparedness to Emergency Management Committee On-going Monitoring6 7 8 9 Develop Implement Annual Emergency Conduct Staff Emergency Evaluation Operations Education & Operations & Corrective Plan Training Plan, Conduct Actions Organizational Understand Roles, Critique Review and Refine the Concept of Build Competencies Emergency and Confidence Rehearsal or Operations Actual Event Management Program
PLANING AND MANAGEMENT INFRASTRUCTURE ELECTRICAL SYSTEM INTERIOR DEGINING PLANNING PLANNINGFIRE SAFETY TRAINING FIRE SAFETY EQUIPMENT/SERVICES AND PRATICES PLANING SAFETY/ SECURITY FIREPROTECTION FIRE PRTECTION EQUIPMENTS EQIPMENTS SYSTEM
INFRASTRUCTURE PLANNINGArchitectural designs, interior designs,electrical wiring,Appropriate equipment planning andproper waste management are taken in toconsideration at the stage of planning forfire safety.
ARCHITECT & LAYOUT PLANNINGFollowing points must be kept in mind duringbuilding planning.There is sufficient open space around thebuildingSufficient open space between two buildings soas to minimize fire spread possibilities from or toneighboring structures.Also there should be enough space formovement and parking of fire fighting vehicles,ambulances, etc in the premises and wide roadapproach to the building.Considering the size & number of occupancy,lobbies, staircases, ramps, etc should besufficiently wide to ensure easy movement oftraffic and quick evacuation during emergencies.
ARCHITECT & LAYOUT PLANNINGThe design of the building structure should be so planned thatit allows pressurised exclusion of smoke in case of fire or anysmoke leak. Must have enough doors and windows for proper ventilation.Adequate emergency rescue aids and suitable refuge areashould be incorporated in the design.Ideally, a heavy-duty elevator especially for use of fire fightingpersonnel only and used in case of emergency only should beincorporated.The building should be so designed that it can resist damagesdue to earthquakes to a fair extent.Safe and easy means of access should be provided to and inevery place of work /in patient area.This should enable access to all including the disabled to moveeasily.In case of an emergency, safe and rapid exit should beprovided for all occupants.Each building must have separate fire exit, staircase withproper signage.
INTERIOR DESIGNINGThe critical areas like Labs X-Ray, OT, ICU etc whereheavy equipments are installed should be well protected andextra precautionary measures should be implemented insuch critical areas, Interior should have fire proof doors, windows, walls androof covered with fire proof materials.The floor should be so designed that they are free fromobstructions, are slip-resistant & even.Openings in floors should be securely fenced or covered.Staircases, ramps should be provided with substantialhandrails and other suitable support means to preventslipping, wherever necessary.Easy access for the servicing and maintenance of plant,machinery and buildings should also be incorporated in adesign.The building should be so designed that it can resistdamages due to earthquakes to a fair extent
INTERIOR DESIGNINGThe interior designer also needs to incorporate theenvironment safety measures such as:-Adequate natural light, fresh air and colour therapy onwalls and lights.The designs should be such that there is minimal use ofcombustible materials like gases, petrol or kerosene.The designs should use plenty of good quality fireretardant material for interior furnishing and decorationpurposes.Appropriate waste management systems also need tobe designed to prevent accidents due to hazardouswaste.The gas and oxygen pipelines must be made of copper.
ELECTRICAL ENGINEERINGFor electrical wiring designs and AC plant:-•The electrical wiring could be enclosed in metal/ heavy gaugescrewed conduits.•The cable passing from one floor to the other should besuggestively sealed off effectively to minimize fire-spreadpossibilities.•Good quality copper cables well covered, switches , plugs andsockets to be used for good conduction and heat resistance.•There should not be any loose wire hanging.•A master control switch for each floor should be located at theground floor for easy switching off of systems in case ofemergency.•It is highly advisable to use individual air- conditioning orspace heating systems for each floor in large buildings.•However in case of centralized systems that is generallypreferred in hospital infrastructures; care should be takento provide appropriate automatic fire dampers for each floor inthe common ducting system.
MACHINERY DESIGNS•Proper cooling facilities to dissipate heat should beprovided for equipments/plants/machinery generatingheat.•Boilers, plant rooms, freezers, manholes and similarconfined spaces should have effective means to ensuresafe access & exits.•All equipments should be earthed properly to dissipatethe static charges to the earth.•Incorporate totally enclosed switchgear systems/miniature circuit breakers instead of ordinary fuses.•Always emergency power supply arrangements need tobe designed & incorporated in case of total system switch-offs during emergency.•Appropriate fire fighting equipments, fire detection,smoke and heat detection alarms should be incorporatedin the design.•The fire-fighting equipment as per quality standards andnorms should be used..
FIRE PROTECTION SYSTEMS SYSTEM CENTRAL LOCALFire Water Hydrant System Fire ExtinguishersFire Protection System Fire FightingFire Detection System Equipments.
FIRE TETRAHEDRONThe four Elements which required fire to spread is called “FIRETetrahedron”
CLASSIFICATION OF FIRE TYPE A TYPE Bwood and paper. liquids and gases. FIRE TYPE C TYPE K TYPE D Energized Oils & Fats Combustible Metals electricity.
WATER – HYDRANT SYSTEMThere is a separate water tank under/over ground to be exclusively used forFire hydrants.Each building has got a fire hydrant connected to the tank by steel water pipes.The hydrants have hose pipes and various nozzles to be fitted in to hose on one side and the other side is attached to hydrant. Fire Hydrant Hose Pipe Nozzles
PROTECTION SYSTEM1.Protection System mainly contains dry chemicals and acids,Coming on contract it releases Foam which covers the flame there by cutting down the Oxygen supply.The type of foam used are, CO2, Foam Chemicals.2.Sprinkler system"Sprinkler system" means a system of piping designed in accordancewith fire protection engineering standards and installed to control orextinguish fires.The system includes an adequate and reliable water supply, and anetwork of specially sized piping and sprinklers which areinterconnected.The system also includes a control valve and a device for actuating analarm when the system is in operation.The sprinklers are fitted on the roof of the building SPRINKLERSSprinkler on roof
LOCAL PROTECTION LOCAL EQUIPMENT FIRE FIGHTINGFIRE EXTINGUISHER EQUIPMENTS (Fire Hose Box, Fire Man Axe, Fire Beater, Fire Hook, Fire Bucket,)
TYPE OF EXTINGUISHER Class A – ordinary combustibles (wood, cloth, paper) Class B – flammable liquids, gases, greases Class C – energized electrical equipment Class D – combustible metals B C DA
TYPE OF EXTINGUISHERThe National Fire Prtection Association (NFPA) classifies firesinto five general categories (U.S.):Class A fires are ordinary materials like burning paper,,cardboard, plastics etc.Class B fires involve flammble or combustible liquids such asgasoline, kerosene, and common organic solvents used in thelaboratory.Class C fires involve energized electrical equipment, such asappliances, switches, panel boxes, power tools, hot plates andstirrers. Water can be a dangerous extinguishing medium forclass C fires because of the risk of electrical shock unless aspecialized water mist extinguisher is used.Class D fires involve combustible metals, such as magnesium,titanium, potassium and sodium as well as reagents such asalkyllithiums, Grignards and diethylzinc. These materials burnat high temperatures and will react violently with water, air,and/or other chemicals.Class K fires are kitchen fires ie. Ghee and oils..
BASIC TYPES OF EXTINGUISHERS The two most common types of extinguishers in laboratories are pressurized dry chemical (Type BC or ABC, left) and Carbon dioxide.
INSTALLATION AND General Requirements Wall Mounted, easy to locate and visible from a distance so that they are readily accessible. Only approved extinguishers shall be used (ISI) Fire Fighting equipments in the vicinity. Inspect Extinguishers once a month. The pressure is at the recommended level in the gauge in green zone The extinguisher is not blocked by objects that could interfere with access in an emergency. The pin and tamper seal (if it has one) areGAUGE intact. There are no dents, leaks, rust, chemical deposits and other signs of abuse/wear and tear.
MAINTENANCEMaintain extinguishers in a fully chargedand operable conditionVisually inspected monthlyMaintained annuallyHydrostatically tested periodically to ensurethat the cylinder is safe to use.If the extinguisher is damaged or needsrecharging, get it replaced immediately.Recharge all extinguishers same time afteruse regardless of how much they were used.
FIRE SAFETY RULESThe “National Building Code of India”, 1980,issued by the Indian Standards Institution,serves as excellent references to safetymanagement for infrastructures.The Tariff Advisory Committee of the GeneralInsurance Industry and the Metropolitan City hastheir own requirement. Government Authorities recognize fire hazardswith large buildings and have developed rulesand regulations for fire protection and firefighting requirements in large buildings.Fire Clarence is not given by the authority ifthese rules are not complied with by the owneras it is mandatory under Law..
TRAINNING IN USE OF EXTINGUISHERS Employees designated to use fire fighting equipment should be trained in:- i)Use of extinguishers ii) Associated Hazards Initially and Annually iii) General principles of fire extinguisher use iv)Where portable fire extinguishers have been provided for employee use in the workplace, employees must be provided with an educational program. v)Employees designated to use extinguishers must receive instruction and hands-on practice in the operation of equipment
FIRE FIGHTING EQUIPMENT MANAGEMENTThe employer should ensuremaintenance and inspection offire fighting equipment at leastannually, Ensure safeoperational condition of theequipment.Training of employees in use offire extinguishers.Portable fire extinguishers to beinspected at least monthlyRespirators shall be inspectedat least monthly
PERSONAL PROTECTION EQUIPMENTSThe personal protection equipments includeGloves, Canister Gas Mask, Breathing Apparatus Set,Resuscitator, Aluminized Suit, Helmet, Goggle, Shower& Fountain, Emergency Kit, Safety Torch, Siren, WindSock, Stretcher, Gum Boot, Face Shield, Ear Muff, EarPlug, Apron, Blanket, PVC Suit, Plus Pressure Suit,Safety Belt, Safety Net, Rope Ladder, Traffic Control &Road Safety Devices, Safety Sign & Posters.These are only used by trained “Fire Fighters” of FireDepartment.
SECURITY EQUIPMENTThese are used by ‘FIRE MEN’ onlyand includes:-Hand Held Metal DetectorsDoor Frame Metal DetectorsCCTVAlarm SystemsAccess Control system
INTERNAL EMP SHOULD BE:• For All-hazards• Comprehensive Emergency Management• Dynamic and continuously updated• Compatible with standard EM concepts, yet unique to the particular facility• Include involvement with community and external entities• Fully supported by management
EM PROGRAM GOALS– Continuity of care.– Safety of patients, families and staff.– Support to community (and Nation).– Preservation of vital records and property.
INTERNAL DISASTER ACTION PLANIt is activated when the hospital buildings are effected in disaster.Action plan should clearly mention:• Alternate site (dharmashala,Temple,Schools,Playground nearby)• Folding tents, cots, trolleys for temporary shelters• Identify a nearby tent house to provide beds,blankets• TPT for transportation of cases to alternate sites or hospital• First aid and drug kits, potable lights.• Portable communication system.• Identify local voluntary organization, who can provide services ofcare,food and water.
ACTIONS FOR MINOR FIREThe building is being evacuated (fire alarm ispulled)The fire department is called (dial 101).The fire is small, contained and not spreadingbeyond its starting point.The exit is clear, and you can fight the fire with yourback to the exit.You can bend down to avoid smoke.The proper extinguisher is immediately available athand.Aware of the instructions and know how to use theextinguisher. In major fire start Evacuation.
EVACUATIONPlanning evacuation:Emergency Preparedness Committees and integration with region oroperational area plansIdentification of alternative locationsCommunicationsTransport optionsCache of supplies or resourcesEmployee safety and well-beingIntense focus on facilities’ ability to respondEvacuation must be done in partnershipPersonnel were sent with NICU, ICU, and psychiatric patients, stablepatients were not accompaniedPatients moved using backboards, walking, wheelchairs, blankets,sheets.Stairs only to be usedNo special equipment used
Increased need for wheelchairs, walkers, adult diapers, colostomysupplies and personal hygiene items, soft foods, clothing changes,portable oxygen and medicines.Evacuation requires a command structure to best manage the situationSafety of the patients, visitors and staff - All are at risk!Coordination and tracking are neededStaff health and safety while meeting the hospital’s medical mission arethe highest priorities in responding to any type of incident.Evacuation can be coordinated by a central Emergency OperationsCenter (EOC) or independently by the affected facility and had equalsuccessShould have a secondary evacuation plan in the absence of area EOCEvacuation from any cause requires accountability for patients and forstaffFamily members who are with patients or staff in a crisis situationPriority for relocation will depend on the stability of the patients and theresources available
OPTIONS IN EVACUATIONS1. Shelter in place2. Horizontal or lateral movement3. Vertical evacuation4. Complete facility evacuation5. The situation may require all methods1.Shelter-in-PlaceStay in the facility but minimize the hazardous impactExample: distance from a hazardous spill, isolated fires, security breachFire location2. Horizontal or Lateral EvacuationsMoving to other wings in the facility, beyond fire doors, into a safety zoneEasier movement of beds and equipmentFaster in initial phasesFurther evacuation may not be necessary or shelter-in-place option may be ordered
3. Vertical Evacuations•Complex•Cumbersome•Increased physical risks•Depending on cause for the evacuation, elevators andescalators may be prohibited or out of operation4. Who is Evacuated FirstGreen - WalkingYellow - Chair assistRed - Full assist in stretcher and accompanyThe basic concept of triage in a disaster circumstance is to dothe greatest good for the greatest number
FACILITY AND UTILITY CONSIDERATIONS4. Evacuation devices (evacuation chairs and sleds) ormanual carries may be required•Most evacuations can be controlled .•In a controlled evacuation, exit at direction of IncidentCommand Center, Fire or Police or authority in charge•Lateral / horizontal first•Vertical second•Evacuees can be staged in outside areas to facilitatetransportEvacuations may require rapid shut down of ventilationsystems, power, water, gas and other infrastructure controlsfor the protection of everyoneRisks include: explosion, flooding, electrocution, toxic gases
AREAS OFTEN NEED A SPECIFIC PLANThe nature of the patients or residents of thefacility may require more specific plans andtechniquesExamples: •Sensory impaired (sight, hearing) •Specialty units: dialysis, operating rooms, ICUs, psychiatric care, hyperbaric oxygen chambers •Pediatrics facilities, NICU •Extended care units
EVACUATION FROM THE OPERATING ROOMCancellation of OR casesIn evacuation procedures: •Stabilization and premature closure of case •Airway management with alternative means •Life support mechanisms •Transport options from OR •Management in alternative environment •Transfer to stable environmentKnow the routes and clear the corridorGather transport stretchers & devicesConclude procedure as soon as possibleMaintain life supportsMaintain anesthetic state
Take necessary meds with patient to continueanesthesia during transportControl bleedingSterile towels/covers over surgical sitesRemove intravenous solutions from poles - placein transport with the patientDisconnect unnecessary leads, lines or otherequipmentIf time permits: •Gather minimal number of instruments for transport •Take additional intravenous solutions •Secure equipment for transport •Don’t delay
COMMUNICATION AND TRANSPORTATION OF PATIENTS •Private cars •Public buses •Hospital vans •AmbulancesCommunications intermittent but all evacuationsrelied on functioning communicationsPay phones, cell phones, intermittent landlines, hamradios, ambulance radios, hand-held radios
SECURITY CHALLENGES IN EVACUATIONSSecurity staff in most hospitals are: •Private guards (hospital or contract) •Unarmed and have no powers of arrest •Expected to restrain violent patients or visitors or act as deterrentsTrend of minimal staffing and inadequate coverage witha dependency on local law enforcementFacilities may need to make do with on site securityLaw enforcement agencies may be overrun with urgentrequests for multiple types of assistance and noprioritizationTraining must include exercises and realistic planningand models
SUMMARYEvacuation requires planningMost evacuations are controlledMultiple resources are requiredSpecific needs must be consideredDepartmental plans should be specificEmployee and patient safety requires trainingEvacuations may need to include families and visitorsAccountability is important in considering the safety forall involvedSecurity will have to be managed internally at least ininitial phases
hospiad Hospital Administration Made Easy http//hospiad.blogspot.com An effort solely to help students and aspirants in their attempt to become a successful Hospital Administrator. DR. N. C. DASBased on Extracts from Internet.