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DESIGN WITH FIRE IN MIND:FIRE SAFETY FOR HEALTHCARE FACILITIES

‘FIRE’ - a seemingly harmless 4-letter word but in reality, fire has destroyed properties and investments worth hundreds of million dollars each year - a devastating loss to the industry and nation, which effects productivity and overall GNP. Most of all, fire has caused unnecessary loss of lives. Hence,

fire safety is a crucial part of the building industry. Of all types of building occupancies, healthcare facilities are the most vulnerable as far as life safety is concerned.

By Mr Tay Hao-Giang FIFireEB. Sc. (Hons), M.Sc. Fire Safety Engineering.

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Lately, there has been increasing fire incidents across the world i.e. Grenfell Tower fire in London, hospitals fires in India and Malaysia, and the Marina Zen high-rise façade cladding fires. While overall fire statistics have reduced worldwide, it is strange that major fire disasters, which have never been encountered before, are on the rise globally with high casualty rates. For construction industry, the occupancy risks group has been divided into various categories according to Uniform Building By-laws 1984 – institutional,

hotels, offices, shop, factory, places of assembly, storage, residential and healthcare – with each occupancy category has its own unique fire risks and hazards, hence the required fire protection. When it comes to healthcare facilities, considerations need to be taken into account when designing hospitals, institutions and homes to ensure their safety. For instance, a fire detection system using bell or siren as audio warning device cannot be effectively perceived by the occupants at institutions for hearing impairment and those living at old-aged homes where the sensitivity of hearing has degraded over the years. Similarly, ‘KELUAR’ / ‘EXIT’ signage or emergency lighting illuminating escape path are irrelevant to institutions housing visually-impaired occupants. Hence, a normal approach in Uniform Building By-law (UBBL) 1984 (Amendment 2012) or Fire Regulations compliance will not and cannot ensure life safety aspect. At best, the design is only legislative requirement compliance but may not be safe for occupancy. In addition, many older hospitals still in operation today tend to have a high probability of fire risks due to fire hazards cumulating over the decades and insufficient fire protection as they may have been built before the enactment of Building Regulations. Though modern hospitals are better protected, they tend to have more synthetic building materials as many furnishings are highly combustible and generate lots of smoke particles, which are toxic with suffocating effects.

FIRE RISKS IN HOSPITALSFor hospitals, which housed large volumes of patients and intricate medical equipment, fire safety issues are much more complex compared to other healthcare facilities. Intensive Care Unit (I.C.U.), Operating Theatre, serious accident, coma, and disabilities plus M.R.I./CAT scan wards need to be treated carefully as each ward has life safety risks of its own, which requires careful planning to avoid any mishap or disaster in the event of full scale fire incidents involving mass evacuation. While patients can be easily evacuated using hospital beds, there may be limited portable life support units, which may hinder the evacuation process. For phase evacuation with temporary refuge areas, the designated area (at times when the lift lobby is used) needs to be large enough to accommodate the number of beds assigned to this refuge area. Architects also need to consider the rational approach for surgeons or the firefighters when evacuating patients and surgical staff who are in the midst of delicate and high risk surgeries. Can the surgery be stopped and patients moved within the allowable window before the environment becomes untenable? What to do if there is a gas leakage or a fire breaks out within the operating theatre itself since no sprinkle or fire protection systems are installed due to the expensive medical equipment in the room?

FINANCIAL RISKS FOR HEALTHCARE FACILITIESWhen a hospital had a fire incident, not only will there be lives lost but also serious financial implication as well. There will be financial direct losses, depending on the degree of damaged sustained, including inflation weighted renovation cost and high investment expansive replacement cost of medical equipment. The hospital may also face legal action from families of patients injured or perished in the fire, resulting in bad publicity that affects business continuity as the loss of reputation and goodwill will take a long time to recover.

OLD-AGED HOMES / RETIREMENT VILLAGE OCCUPANCY RISKSMost senior citizens’ response to fire alarm signal is slow and their movements may be impaired during emergency evacuation, which will prolong pre-movement and evacuation

36 people perished in the 2013 Moscow psychiatric hospital fire.

(Source: en.trend.az)

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OUTLOOKtime affecting RSET (Required Safe Egress Time). The caretaker-to-occupant ratio is often unbalanced, making assisted rescue operation at times not effective.

SPECIAL ORPHANAGE OCCUPANCY RISKSThis group is the most vulnerable since mostly are children, aged from pre-kindergarten to secondary school, who lack fire safety knowledge that have led to fire incidents caused by young children playing with matches. Most homes are ill-equipped with first aid fire protection equipment and at times, sleeping floor density exceeded safety factor due to lack of space with means of escape route often narrowed or blocked by storage of combustibles.

INSTITUTION AND HOMES FOR THE SPECIAL OCCUPANTSInstitutions and homes catering to individuals with disabilities as need to be specially designed so the all the occupants can escape safety from their respective homes. Loud fire alarm signal or bright flashing light should be no used in homes for autistic children as they find these as emotionally intrusive. Hence, our prescriptive Uniform Building By-law is only minimum legislative requirement for compliance. Architects, engineers, building owners, developers and contractors needs to improvise to provide functional fire safety and life safety design through understanding of the needs of the occupants and with considerations in accordance with the actual requirement of the building.

ESSENTIAL FIRE ENGINEERING FOR MODERN CONSTRUCTION DESIGNHospital designs should adopt “application of scientific and engineering principles for the protection of people, property and the environment from FIRE” with full understanding of significant changes in modern fire behaviour. With the presence of synthetic material, modern fire burns easily, propagates through open compartments, decrease visibility which increase evacuation time and require longer fire extinguishment. The designs also need to consider human behaviour with irrational action during any panic situation to avoid stampede. Hence, prescriptive-based designs or even performance-based

designs need to be supplemented by E.R.P (Emergency Response Planning) and E.R.M (Emergency Response Management), so it can implement E.R.P. when the time comes. Hospitals will also need E.R.T (Emergency Response Team) to be the first responder instead of waiting for firefighters. Under Fire Regulation, since the implementation of Fire Certificate under Fire Service Act 341 1988, all building owners must take responsibility for the fire safety of their own buildings. They are supposed to be self-sufficient to ensure all passive and active fire protection designs and systems comply with UBBL, and also be in full operation conditions. Fire Risks encountered in hospitals include hospital beds, chairs and tables, oxygen supply outlet at the hospital bedhead, house cleaning chemicals, and high electric power for operation theatres - out of which, one of the common denominators is human error and carelessness. Prescriptive “Deem-to-satisfied” fire safety design according to Building Regulations and Codes is a minimum legal design requirement and may not be sufficient to cater for modern fire risks

and life safety. A holistic functional fire safety engineering design approach is the way forward for a modern hospital design to safeguard the lives of patients and at the same time, protects the investment. For modern fire safety engineering designs, hospitals should be designed not with mass evacuation as fire safety strategy but adopts a “Zero-Fire” objective with essential “Fire Prevention Pre-Fire” scenario management approach, instead of preparing for “Post Fire” scenario and sustain damages even though the fire is eventually extinguished. That is provided the fire incident involve no casualty rates or it will be complicated. The way forward is to maintain all active and passive fire protection systems; carry out fire risk assessment annually not only for UBBL compliance but fire risks mitigation. Investing in fire prevention is not only for business continuity but also for property protection and build a resilient business. Of course, no one can prevent a fire incident (Murphy’s Law), but at least by adopting the appropriate and essential risks management, you are well prepared to handle a crisis better and can recover faster.

In 2016, a short-circuit reportedly caused the fire which engulfed the ICU ward of SUM Hospital in Odisha, India, killing 20 people and more than 100 injured. (Source: The Indian Express)