The combined efforts of multi-disciplined management involved in the tiered structure of fire-safety management within the NHS is unparalleled in any other world healthcare organisation.
Apart from compliance with fire-safety legislation, the NHS has its own ‘Fire Code’ consisting of a suite of ‘Hospital Technical Memorandums’ (HTMs). These highly technical documents serve as the foundation blocks on which the whole of the Fire Defence Strategies of the various NHS Trusts are formed, setting out almost everything there is to know about fire safety and defining the standards of fire safety to be achieved and maintained. This includes anything from the syllabus for the training of all staff in fire safety to structural fire-protection requirements and the management of fire safety throughout the whole of the NHS estate.
NHS Fire Code is unique and the envy of the world and is seized upon by non-NHS professionals to gain guidance, information and knowledge about fire safety in healthcare facilities.
The NHS, being the largest healthcare organisation in the world, is extremely complex to run and control. To achieve the highest standards of fire defence in the NHS, it takes not just expertise and guidelines but commitment, enthusiasm, effort, dedication and strong, persuasive negotiating skills by NHS Fire Officers to be able to achieve results.
The only way to ensure the fire-defence plan works is to periodically hold fire-safety audits and realistic fire-evacuation exercises in all areas of healthcare except in theatres and critical-care units where very limited drills can be enacted. In these cases the only real first option is to have in place fire plans that are ‘Defend in Place’ and ‘call for immediate reinforcements’ from ‘specific staff that understand the routines and procedures that take place in these areas’.
To effectively work out a ‘Defend in Place’ strategy to immediately stop a fire at source (which could amount to a ‘High Risk Fire Fight’) or abandon all attempts and effect a (pre-planned/practiced) ‘Crash out Evacuation’ (fire within the unit which cannot be contained by structural fire protection), the production of fire-risk assessments and fire action plans must be carried out by a team of professionals, e.g. fire officers, surgeons, anaesthetists and specialist nurses etc.
To give this strategy a good chance of success, the provision of first-aid firefighting appliances must be triple the norm, with the best available extinguishers installed for staff to be able to effectively deal with an outbreak of fire. That is to say, 5kg capacity aluminium-bodied CO2 extinguishers (heavier, but easier to operate and have more firefighting power, 89b rating on a class B fire as opposed to a 55b rating with a 2kg capacity CO2 extinguisher), while 3-litre water-spray extinguishers are also very easy for staff to operate. These extinguishers should be strategically deployed in clusters of three, to enable staff to effect ‘swarm attacks’ on outbreaks.
It goes without saying, all specialist staff employed in these areas must be given opportunities to be able to attend ‘live fire’ extinguisher training, to give them the chance to understand the safe operation, performance, limitations and characteristics of the appliances and to impart a degree of confidence in their ability to use them effectively.
In very recent times the NHS has suffered at least half a dozen major fires, which have cost the nation millions of ill-afforded pounds and the loss of vital services in healthcare. In fact, as far as I can recall, these fire outbreaks, along with many others the NHS regularly suffers, is unprecedented in the past few decades, in terms of financial loss and loss of services.
Does this huge loss of services and cost mean that the standards of fire-safety provision in the NHS has stalled in certain areas? With the advent of the ‘Regulatory Reform (Fire Safety) Order 2005’ this should be anything but the case, especially now that we are required to carry out regular in-house fire-risk assessments and that Fire Authorities are now the ‘enforcers’ of this very far-reaching fire legislation. Also, we now have in place, in addition to NHS Fire Officers, certain managers designated to act as the ‘Responsible Person’ who in turn appoint ‘Fire Wardens’ to assist them to discharge their responsibilities and obligations, especially with regard to new staff fire training, fire prevention and assisting in carrying out localised fire drills.
Are the fire-risk assessments and reports that are carried out ‘Suitable and Sufficient’ for healthcare and done by really ‘competent’ NHS Fire Officers or by ‘outside consultants’, and if so, are competency checks carried out? Is the responsible person given help and assistance to follow up and put into place the requirements of the assessment findings and are sufficient funds made available by the trust board to enable this to happen within a managed programme of prioritised work?
Is the risk-assessment document filed electronically by the responsible person (out of sight and out of mind) or are hard copies made available for all to peruse? Or is the fire officer, or whoever is responsible for producing the document, guilty of sending it electronically instead of delivering the printed document(s) personally and explaining the contents and requirements to the responsible person, as they really should do?
The NHS is responsible for the fire safety and well-being of more people in the UK than any other organisation.
Planning strategy, to afford staff their fire-training needs and ‘fire skills’, and monitoring the state of readiness in all areas, to ensure staff are able to respond immediately, positively and effectively to a fire condition, and carry out their fire action procedure in the right order and that managers and fire wardens have command and communication skills that are vital in such situations, should start with NHS Fire Officers.
Fire officers are increasingly being bogged down in their offices, on their computers, doing work that should be done by support staff instead of being out and about, visiting wards and departments and building first-class working partnerships with their colleagues, answering questions, dispelling myths, giving advice and guidance and reminding them all (nicely) not to contravene!
Of course fire officers spend lots of time carrying out fire-risk assessments, and then go back to their office to type up the report as a legal document instead of handing their findings to support staff to type up for them, which would allow them more time to spend around hospital sites on ‘courtesy calls’, which amounts to ‘informal fire-safety knowledge gaining’ or to plan fire exercises.
Together with the above paragraphs, if more independent ‘fire-safety audits’ were carried out at NHS sites, in addition to fire-risk assessments, maybe the NHS would have suffered much less than was inflicted during the five London fires and the devastating fire that occurred at Worthing Hospital.
A good question to ask is: how many Trusts carry out fire-safety audits? Fire Code HTM 05-01 2.21 refers: Along with fire exercises the next best tool to assess the degree of efficiency of fire defence in all areas within the NHS is the fire safety audit. Firesafe focused Trust Boards do of course arrange for independent audits to be carried out and the results fed directly back to the Chief Executive.
The audit is carried out by project officers who are tasked to leave ‘nothing unturned’ and can either be employed by the Trust, or a neighbouring Trust.
Some may ask: why do we need to have fire audits when fire-risk assessments should pick up deficiencies, or surely the Fire Service Inspectors come and do an audit to ascertain compliance? The fact is the Fire Service do not visit every NHS site but audit randomly (or specifically target a particular site, because of well-known failings in fire safety).
NHS conducted fire audits verify (or not), amongst other things, that the fire strategy and arranged fire precautions are being satisfactorily maintained, that staff fire training is efficiently carried out, is adequate and effective, and that records of all fire-safety equipment maintenance are satisfactory.
The NHS Trust Fire Strategy Plan(s) must be very comprehensive and have in place detailed written and practised procedures to cover every known or envisaged problem(s) that will be thrown up if a major fire (or other peril) causes a forced full evacuation of a whole complex or wing of a building, or because of a threatening fire and its effects in an adjacent building.
Extreme difficulties and challenges present themselves during these very traumatic events and lessons are always learned in the aftermath.
When fire exercises are taking place, the aspect that warrants most scrutiny is the command, direction, control and communication procedures that are in place. The direction and coordination of the efforts of the staff tasked to carry out specific functions and send the required feedback to the control point on progress, or requests for further assistance, be it for more personnel or evacuation equipment/aids, stop people from doing things, or emergency medical aid, should be closely monitored for flaws/weakness. Clear and unambiguous progress reports/situation reports are vital in a crisis.
Many scenario features should be factored into major fire exercises, in an endeavour to make it as realistic as possible and to afford staff the time to practice the full rehearsal of the fire and evacuation policy as fully as circumstances allow and within a specific window of time.
The first scenario feature is to carry out a preliminary risk assessment for health and safety angles and to work out what unnecessary disruption to essential services the exercise will present and to arrange to put in place measures to minimise the effects. Then immediately before the start of the exercise a dynamic risk assessment should be carried out to check for anything that may have been overlooked – this should be done after the pre-brief with the relevant disciplines organising group (the o group).
A golden rule during the event is: don’t move the goalposts. It’s not fair to staff; the drill is not to try to catch them out!
Most hospital fire exercises do not involve the movement of inpatients in general hospitals but have staff acting up, but if patients are evacuated in limited action exercises, it is essential that their written consent with signature is first obtained, plus the approval of their medical consultant.
The fire exercise scenario and risk assessments should take into account locomotive and logistical facets, the effects of fatigue or stress on staff, gradients, stairwell widths and obstacles as well as the safe-practice procedure for isolating piped medical gases and movement from the area of portable oxygen cylinders, drug trolleys and drip hangers etc. and safe procedures for gas leakage, nuclear radiation leakage, bio/chemical hazards and other problems that could occur as a result of fire or explosion.
During a major fire in a hospital, the switchboard becomes inundated with frantic calls from patients’ relatives, the media are alerted and swarm like locusts at the hospital entrance areas trying to obtain information. Off-duty staff have to be called in. Persons have to be denied entry into the hospital. Key managers have to liaise with the emergency services. Arrangements have to be put in place for movement of displaced patients to other hospitals (safe havens); triage, patient tracking, and forwarding of patients’ essentials, medications etc. has to take place.
All of these situations call for the robust management and direction of large numbers of staff to cope with a rapidly deteriorating situation, and any member of staff can be roped in to help whatever their job title, and that is why there is no argument that admin/clerical workers only need to be taught the very basic fire-safety awareness. They need to understand what other disciplines have to do in a fire emergency and they need to be fully aware of the fire-defence plan as a whole.
In a rapidly deteriorating fire condition, it becomes a very noisy situation: alarms are sounding, patients may be shouting and wandering about. The very first few minutes and seconds are spent by those in charge determining the extent and seat of the fire. Is it out of sight in a storage cupboard or roof space? Are staff trained in spotting remote fire-alarm LEDs indicating, for example, fire in roof space, in addition to what the fire alarm panel is showing? Good staff training in these areas enable them to rapidly make decisions on what immediate actions they must take and prioritise such things as ‘Order of Movement’ of patients, initially to ‘Fire Refuge Points’ or if immediate, first-aid firefighting can take place – ideally both, staff numbers permitting.
Over the years we conducted scores of evacuation exercises and drills in all areas of the NHS, military and private-sector hospitals, and other healthcare facilities.
The use of whistles effectively enable those in charge to immediately effect command, control and direction of others in noisy environments. If persons in charge do not take dynamic charge of subordinates, others will! Order, order = disorder. Whistles work.
All of the above actions and procedures can be rehearsed during fire exercises, but of course when the situation gets as bad as described above, the major incident plan would have kicked in. And that’s another episode!
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- The traditional 9-litre water-jet extinguisher has a 13a fire extinguishing rating. The 3-litre water-spray extinguisher (with additives) also has a 13a rating and is lighter in weight and much easier for staff to use swiftly to attack class A fires. Three staff simultaneously carrying out a ‘swarm attack’ with this type of extinguisher can effectively bring to bear the equivalent of a 39a fire extinguishment performance rating.
- E.g. Chase Farm Hospital, Great Ormond Street Hospital, Northwick Park Hospital, Royal Marsden Hospital, University College Hospital
- Total analysis