Last week’s devastating fire at the SUM Hospital in Bhubaneswar brings out all the lacunae in our hospitals’ fire safety systems. Everything needs a makeover: Safety regulation, fire-fighting equipment, rescue protocols and prevention mechanisms
The AMRI hospital fire of Kolkata in 2011, which took the lives of 90 people, is a milestone in the infamous annals of hospital fires in India. The tragic deaths apart, it served to throw up several lessons for hospital administrators and fire safety regulators. The list is long but chief among them were these: Hospitals have a multitude of flammable materials, each with different degrees of combustibility, each reacting differently to heat and fire.
Smoke, as deadly a killer of immobile victims as fire itself, spreads insidiously through chutes, vents and interstitial spaces. Space is necessary for fire tenders to operate. Smoke detectors are a necessary first line of defence. Electrical and electronic installations ought to be sequestered and fire-proofed. Evacuation passages should be clutter-free. Basements are not storage areas. Fire drills are not comedies. Fire safety professionals ought to be employed full-time.
And then, add to that list remedies even a schoolboy can suggest: Fire-fighting equipment is mandatory. Fire extinguishers must work.
Take that litany and superimpose it on last week’s fire at Bhubaneswar’s Institute of Medical Sciences and SUM Hospital, which killed 26 hapless patients, and it will fit like a surgical glove. And then SUM. The fire was sparked from faulty electrical wiring in a storage area in the dialysis ward and smoke spread unseen to the ICU in the gap above the false ceiling. When noticed, it triggered absolute bedlam with doctors, paramedics and orderlies rushing to the exits they knew about, leaving disoriented patients to navigate through thick black smoke.
There were no smoke alarms, no emergency exits, no water in the hydrants, no overhead tanks, no circuit breakers, not a trace of any disaster response system. Yet, SUM has a modicum of a claim to being a modern hospital. Only, in the tradition of many new hospitals in India, it gave attention to appointing itself with modern technological appurtenances rather than invest in fire-fighting systems, whose success lies in never having to be used.
The SUM tragedy brought to the nation’s focus the sum total of all failures relating to hospital fire safety. The hospital had been operating without mandatory fire certification for three years and had its registration renewed as recently as July despite that. Yet, SUM was not unique in operating in the nether spaces of safety regulation.
In the aftermath of the Bhubaneswar tragedy, all the southern states scurried to audit fire safety in their hospitals and the findings would be laughable if they weren’t macabre. The day after Bhubaneswar’s manic Monday, Express asked its photographers to take pictures of dysfunctional or post-expiry fire extinguishers in hospitals across the south. The pictures, uploaded at newindianexpress.com tell their own story. In Odisha, a fire audit was commissioned in 2013, but its findings were never released nor implemented. Only eight of the 1,800 hospitals in Odisha have fire safety clearance. While the picture in the State capital is grim enough, it is frightening in the districts and rural areas: The VIMSAR hospital in Burla, for instance, has 1,000 beds but only eight fire extinguishers. The Sambalpur district headquarters hospital has none.
In metropolitan Chennai, where the authorities rushed to audit hospitals after the SUM fire, an affidavit submitted to the High Court by the TN Fire and Rescue Services Department lay bare the situation: Government hospitals in the State capital operating out of G+4 buildings do not have fire certification, and in the worst case, not one of the 105 hospitals in Tiruvannamalai has bothered to comply. These are only the extreme cases. Disregard for fire safety is the norm with a majority of hospitals, both in private and government institutions, in cities as well as district headquarters.
Karnataka hastened to launch a week-long audit of all health facilities in the State two days after the SUM fire but betrayed a disarming lack of preparedness ahead of its findings.
How many hospitals in the State lack fire certification? The fire department does not have the data. The audit presumably will have to start from scratch. We only know that 44 high-rise hospitals have no NOCs.
How many private and how many government? No data.
Kerala has had the good fortune of not suffering even one hospital fire in the last five years, but has at the same been innocent of the need to audit its 1,280 government hospitals and 2,000 private hospitals. It is now hastening to do so.
State Fire and Rescue Services boss A Hemachandran said a three-member mission has been sent to Odisha to study the SUM fire. Kerala’s innocence to fire safety percolates down the bureaucracy.
At the Medical College and General Hospital in Kozhikode, for instance, there are no fire safety systems bar a few fire extinguishers and the hospital secretary and divisional fire safety officer do not know if the facility has a mandatory certificate of approval from the Department of Fire and Rescue. At the Kozhikode Medical College, the largest medical care centre in the Malabar region catering to over 10,000 patients, even the new building for multispecialities has no functioning fire safety system.
In most states, statutory fire safety protocols are expected to be monitored — even if they are not — by the fire service if the height of the building exceeds 15 m, as per the National Building Code. Lesser hospitals are left to the monitoring devices of the local civic authorities, and it is here that fire safety is an unheard of danger.
In many cases, the fire service does not have the power to shutdown a hospital if it does not toe the line. That power is vested with other agencies of the bureaucracy, which leaves the errant hospitals to continue to operate within the interstices, much like the fire that ravaged Sum Hospital.
(With inputs from S V Krishna Chaitanya, Sushmitha Ramakrishnan and Ram M Sundaram in Chennai; Bijay Chaki and Hemant Rout in Odisha;Rajitha S and Jayendra Chaithanya T in Hyderabad; Suraksha P in Bengaluru; P S Dileep in Vijayawada; and M S Vidyanandan and Kiran Murali in Kerala)