[
Fire safety in hospitals has traditionally been based on a prescriptive approach. Here David Charters reviews those guidelines and examines how and when variations to that guidance can be implemented.
The NHS is a vast concern with over 1000 hospitals, employing around one million staff. On average there are approximately 1000 fires reported each year with about 50 injuries and a small (single figure) number of fatalities, these often involving fire as a form of suicide in mental health institutions.
Analysis of fire statistics and fire risk performance indicators show that the NHS sets a high standard when compared to other occupancy types. Although hospitals have a high potential for risk, this does not take account of all of the factors, such as training, fire precautions and effective fire fighting that should be considered in assessing actual risk. The ‘probability of occurrence’ is in line with other occupational areas currently not classified as high-risk premises, and the majority of fires that occur in the NHS are dealt with by trained staff.
The provision of healthcare has evolved over time, but rarely, if ever, has the rate of change been so rapid. The dynamics behind this are many and varied, including:
– increased demand
– new treatments
– finite financial resources
One of the main ways of balancing these factors has been to alter patterns of patient care, including an increased use of day surgery, flexible high technology diagnostic techniques and a new emphasis on primary care. These changes in healthcare provision have important implications for the design of facilities; they need to be efficient, effective and safe, while providing a pleasant environment and offering value for money. They also need to be inherently flexible spaces, as the pace of change in medical techniques mean that treatments used in day one of a facility’s life will not necessarily be the same in later years.
The extensive, existing suite of the principal guidance for hospital premises – Firecode – is described below and is being consolidated and updated.
Design of new hospitals.
HTM 81 is being updated to provide guidance which, if followed, will satisfy the functional requirements of Part B of the Building Regulations and provide a high degree of safety in the event of fire.
Fire Safety in hospitals cannot normally be based on immediate and total evacuation of the building, as is the case in most other occupancy types. Patients with restricted mobility or who are bed bound cannot readily negotiate escape routes. For this reason, fire precautions for hospitals are intended to give early warning of fire, minimise the area involved, and allow any initial evacuation to be as far as an adjacent ‘safe’ area (progressive horizontal evacuation).
HTM 81, like many codes and guides, is prescriptive in nature. Many situations in hospital design are typical and for these, the use of Firecode is the logical, most cost effective and safest solution. But the prescriptive approach by its nature cannot be used to examine real situations to determine the likelihood of a fire occurring, its development and its consequences. There are often situations when a comparably safe – or even safer – solution can be achieved by the use of fire engineering techniques. The provisions of Firecode recognise this. HTM 81, for example, says:
“There is no obligation to follow the guidance in this document. A fire safety engineering approach that takes into account the total fire safety package can provide an alternative approach to fire safety.”
Fire safety engineering
Over the past decade an alternative, more fundamental and potentially much more powerful approach to prescriptive guidance – fire safety engineering – has been applied. Initially, it was used only on major, complex projects but as developers, engineers and architects became familiar with the discipline, its use has become more widespread. The growth in the application of fire engineering has recently been enhanced through the publication of British Standard 7974:2001 Code of practice for the application of fire safety engineering principles in the design of buildings. In particular, the methods in Part 7 Probabilistic risk assessment are well suited to the design of healthcare projects, as they provide a high degree of flexibility while ensuring that the ‘defence in depth’ enshrined in Firecode is maintained.
Fire safety engineering is now more generally employed in healthcare projects. But as there are potential pitfalls as well as benefits to this approach, there may be a need for specific healthcare guidance and data in future. Further research is required to assess the applicability of fire safety engineering to the design of healthcare premises. This should include identifying:
– where fire safety engineering is and is not applicable and beneficial
– appropriate models and data for healthcare premises
– gaps in the knowledge base and
– further areas for development and/or promulgation
Fire safety management.
Fire safety management guidance in the form of Policy and Principles was first published in 1987, and by HTM 83 in 1982. Both of these publications focused on aspects of the management of fire safety in healthcare organisations, including statutory requirements, roles and responsibilities of all staff within a healthcare organisation, reporting and monitoring of incidents, and staff training.
A new document, Firecode: The management of fire safety in healthcare, has brought all the management elements together and updated them. It builds upon the Department of Health Fire Safety Policy statement, which requires those responsible for fire safety in healthcare premises in England to:
– comply with prevailing statutory legislation
– comply with mandatory requirements
– implement fire safety precautions through investment in the estate and personnel
– comply with monitoring and reporting mechanisms appropriate to the management of fire safety
– develop partnerships with other agencies and bodies in the provision of fire safety
This document provides the framework for the implementation of this policy.
Fire risk assessment.
The NHS has a large estate of existing premises, some of which have significant amounts of backlog maintenance. So a qualitative, flexible prescription method was used to identify areas of high hazard and/or inadequate precautions, and to provide one or more prescriptive solutions. This qualitative approach, which concentrates on specific risks in-situ and the measures taken to reduce their potential, is relatively easy and consistent to apply, taking only a matter of hours to survey and days to report. But this cannot address non-standard situations, limits options for upgrade and is not applicable to new designs.
The Fire Precaution (Workplace) Regulations cover a large number and wide diversity of premises, so HTM 86 – an easy-to-use, widely applicable qualitative form of fire risk assessment – was introduced. This is intended to be replaced by one of the suite of guides to support the Regulatory Reform (Fire Safety) Order. This qualitative fire risk assessment provides a general five step process and some general guidance on standards, and so is easy to apply to a wide range of buildings by the non-expert. This approach is likely to be embraced in whole or in part but some consider it to be difficult to apply to complex buildings, and that it involves a high degree of subjectivity if suitable benchmarks are not available.
In order to strategically address other aspects of fire risk in healthcare facilities more effectively, a better assessment of the actual nature of the risks is required. Quantified Fire Risk Assessment (QFRA) has historically been used for a small number of projects with high potential consequences for society, largely because it is complex and time consuming. Recent research has shown that equally rigorous methods can be developed, producing solutions that are quick, simple and robust. The application of these methods to healthcare facilities should lead to much greater flexibility, as well as better management of fire risks and reduced costs.
Evacuation and fatigue
One of the analytical methods that healthcare fire engineering is not yet fully benefiting from is that of evacuation. Evacuation methods developed for other building types may not be applicable to many healthcare premises, and what information is available tends to be dated and derived from a small sample of experiments. A deeper and more quantified understanding of the evacuation of patients would therefore help to realise further benefits for revised prescriptive requirements, and for fire engineering solutions.
The efficient and safe performance of healthcare sites is one of the greatest challenges facing the designers and operators of healthcare premises. They face many risks in striving to achieve an effective healthcare estate, including:
– risks to patients visitors and staff
– risks to the availability of treatment and
– risk of financial loss
Fire is one of the hazards that can result in all three of these risks being realised. But as this article shows, there is plenty of guidance available for designers and managers.