It may seem ironic that you would be at greater risk to your life in a hospital in the event of a fire. But the reason is quite simple: In the equipment and materials that they handle everyday, hospitals have a wide array of items that can trigger and sustain a devastating blaze and bring with it a cocktail of thick black noxious smoke. This, in a place where every inmate is infirm, requiring help from at least one other person, if not more; those in the ICU, labour and neonatal wards, and operation theatres are worse off.
This is where the hospitals’ reluctance to put in place a basic fire safety protocol becomes a disastrous mistake. Let’s first examine the hazards. The rooms housing X-ray, MRI and other scanning equipment have intense electromagnetic radiation and are prone to fire hazards. Electrical appliances are in abundance — a key cause for a majority of fires where ‘short-circuit’ is the template explanation.
Hospitals also stock oxygen and nitrogen — gases that feed fires, turning sparks into infernos — and other combustible gases, fuel, chemicals, alcohol-based medicines and gauze, cotton and linen.
Providing more tinder to hospital fires is a large quantity of synthetic materials, from curtains to IV bags, all of which are flammable. And when they catch fire, they emit fumes that are different from, say, that of a domestic fire. Carbon monoxide is the most common toxic smoke, which when inhaled replaces oxygen in the blood. That, however, is relatively less dangerous compared to hydrogen cyanide produced by burning plastics like PVC and phosgene emitted by vinyl that can cause pulmonary oedema — fluid accumulation in the lungs and death.
What complicates things when there is a fire in a hospital is the condition of the primary group of persons in need of support. By definition, the inmates are in need of support. Those with special needs require much more attention. Some patients are not ambulatory, while there are many who are kept largely isolated due to high risk of infection — cancer patients undergoing chemotherapy and bone marrow transplant, post-op cases are among these.
Evacuating hospitals is such a strenuous task that the hospital fire prevention and evacuation guide prepared by the Pan American Health Organisation and the World Health Organisation, ‘Hospitals Don’t Burn’, stresses that evacuation is the absolute last step. “Special attention should be focused on proper prevention and suppression techniques to avoid this worst-case scenario,” says the guide.
It is thus clear that prevention is the most basic step. The guide, Hospitals Don’t Burn, throws light on this. The primary task is to prohibit the use of combustible components in doors, windows and ceilings, facades, insulation and electrical and mechanical conduits. The suppression techniques come next, which include fitting an integrated system of fire sensors, alarms and sprinklers that respond jointly and placing individual fire extinguishers at strategic spots identified through a fire audit.
Those government hospitals across the country, built decades ago, before the awareness of basic fire safety plans evolved, would have to undertake a massive effort to replace and retrofit, which would sure cost money. This investment, bound to be quite high is, however, not a valid reason for not fire-proofing the hospitals. “What is the associated ‘price tag’ of a person’s life? What is the cost of not providing protection against fires?” asks the WHO guide.
There are enough codes that clearly spell out the basic system to be followed. The key then is to implement them. For a hospital, a fire safety compliance certificate should be as essential as the medical degree is for a doctor. But officials whom Express spoke to said almost all of the hospitals have failed to comply with the basic measures, and notices have been issued to them. In our country, however, notices lead to more notices, one for every default. What is required is a punitive measure that makes even bribing an unviable alternative.
It is not pragmatic to slap closure notices on hospitals; every single one of them needs to function, especially in a country like India where there is a chronic shortage of healthcare facilities. Instead, the hospital should be taken over by government — in idea and effect, nationalisation is perhaps the worst punishment in these liberalised days.
But what about the ones the government runs? Government hospitals are equally callous when it comes to fire safety, a situation that raises uncomfortable questions about the moral authority of a government that is trying to implement a norm that it does not follow. The moral dimension mandates that the government take a lead in ensuring that the patients who end up in the care of its hospitals are not reduced to an NCRB statistic.
Why are fire audits and drills crucial?
What to watch out for in case of a fire?
Fire exit signboards
Self-glow tapes that lead to the exit
‘Refugee areas’ on each floor and assembly points
Fire-plans on each floor
Battery-operated PA system