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By Gail Stout
It is important to have a basic understanding about how a fire occurs and behaves within a building. Essentially, fire is a chemical reaction. A carbon-based material (fuel) mixes with oxygen (usually a component of air) and comes in contact with something hot enough to heat this mixture so that combustible vapors are produced. If these vapors dissipate, then nothing happens. However, if they come in contact with an ignition source--such as open flame--a fire results. Depending on the combustibility of the ignited fuel, the fire may start as a slow-growth scenario with a long smoldering period or it may grow rapidly with almost no smoldering time. In either instance, once visible flames appear, the fire's destructive forces increase exponentially.
The flaming stage of a fire will start with a rapid rise in heat levels, initially along the room's ceiling, and then throughout the entire space. During the first two to three minutes, ceiling temperatures can reach 1,000°C (1,800°F). Over the next few minutes, these temperatures will spread throughout the room as the ceiling's layer of hot gases migrates. Ultimately, this gas layer acts like an oven's broiler, superheating and igniting all combustibles in the room. At that point, the room and all within it are completely destroyed.
The fire can then spread through open doorways and wall penetrations, or through concealed wall and ceiling cavities to other spaces in the building. Ultimately, if not suppressed, the fire can lead to a total loss of the building and its contents, not to mention the loss of lives.
Based on these realities, the preferred fire is the one that never happens; this is the only way to actually avoid fire losses. Common fuels in hospitals include paper, wood and plastic furnishings, textiles, chemicals, gases, and other combustible components of the building. Typical ignition sources include electrical and lighting equipment, heating and air-conditioning systems, cigarette use, cooking, office equipment, extension cords, food and beverage preparation, and warming equipment.
Fire prevention activities must therefore focus on limiting the interaction of fuels and ignition sources. This should start with a complete fire risk analysis survey of the property to identify all combustibles and potential heat-producing devices. The next step is to eliminate all unnecessary fuels and heat sources. Recognizing the reality that total elimination is impossible, then precautions should be taken to make sure that the two elements do not come together.
Common fire hazards often include:
Effective fire prevention ultimately becomes the responsibility of all who use the hospital. However, there should be a designated person or group of people with overall authority for monitoring and correcting deficiencies on an ongoing basis. Professional assistance from the local fire department, your insurance company, or a fire-engineering consultant specializing in the protection of hospital properties all can be valuable sources of help. They can conduct an initial fire risk analysis, recommend corrective actions and protection strategies, and assist in establishing a fire prevention program.
Unfortunately, not all fires can be prevented. Accidents, disasters--whether man-made or natural--and severe weather conditions with lightning strikes occur as do periodic arson attacks. The National Fire Protection Association (NFPA) in its published document, NFPA 101, the Life Safety Code, provides minimum requirements for the design, operation, and maintenance of hospital buildings and other structures for safety to life from fire and similar emergencies. The Code requires that new and existing buildings allow for prompt escape or to provide people with a reasonable degree of safety through other means.
The Life Safety Code follows two approaches. It defines hazards along with general requirements for the means of egress, fire protection features (e.g., fire doors), and building service and fire protection equipment (e.g., heating ventilating and air-conditioning systems, sprinkler systems or fire detection systems, localized extinguishers). Next, the Code sets out life safety requirements that vary with a building's use.
The Life Safety Code has different provisions, depending on the type of occupancy and whether the building is new or an existing construction. This code can be used in conjunction with a building code or alone in jurisdictions that do not have a building code in place.
The Life Safety Code's objective is to provide safety to life during emergencies. However, many requirements designed to protect people also protect property and equipment, reducing the dollar loss associated with fire. Also, requirements designed to provide prompt escape during emergencies make buildings pleasant for normal conditions as well. Spacious corridors and multiple exits, for example, are benefits in both areas. The Code requires unlocked and unobstructed exits, multiple exits, exit signs, fire doors, and regular fire exit drills.
All healthcare facilities receiving Medicare or Medicaid funding must comply with the Life Safety Code, according to federal requirements. Key provisions of the code include such directives as:
For more information, contact the NFPA at 1 Batterymarch Park, Quincy, MA 02269; telephone (800-344-3555), Web:www.NFPA.org. Also, contact your local fire department or insurance carrier. Professional expertise is also available from specialist engineers and consultants to help ensure that protection features are properly esigned, selected, andinstalled.
Nick Artium is the director of the Fire Safety Network, a Vermont-based international fire protection engineering and consulting group. He is also the principal committee member on the National Fire Protection Association Committee on the Protection of Cultural Resources. Paul Schneider represents Heritage Protection, Saratoga Springs, NY. Schneider's emphasis is primarily on security aspects. Reach Artium firstname.lastname@example.org or by calling (802) 388-1064. Schneider can be contacted at email@example.com or by calling (518) 584-7918.
KathyDonaldson, RN, CNOR
There is great potential for catastrophic fire to occur in operating rooms. Three factors, usually referred to as the fire triangle, are commonly present in the surgical setting. These elements, an oxygen-rich source, a fuel source, and an ignition mechanism, are present every time a surgical procedure is performed. If conditions are right, and these elements come together, a fire is possible.
Education is the key to preventing or quickly extinguishing a fire in the Surgical area. Staff should not only be knowledgeable of the locations of the fire safety equipment, but they should be skilled in their operation as well. As an operating room educator, my challenge was to have staff in a 16-bed suite remember the locations of all the fire extinguishers, gas shutoff valves, and fire alarm pull stations. To accomplish this, I devised a safety scavenger hunt. The safety hunt included the fire safety equipment as well as the malignant hyperthermia kit, ice machines, latex safe cart, spill kits, and crash carts. "Scavengers" are given a "game card" (refer to following example) and told to locate all of the above-mentioned equipment. The fire extinguishers and the shutoff values are each labeled with an identifying letter code. This code is then recorded in the appropriate space on the game card. This ensures that the staff must physically visit each location. A map is included with the game card because areas adjoining the operating room are used.
I have used this method to familiarize new staff with the operating room safety equipment for many years. It not only teaches them the locations of the equipment, but it takes them on a self-guided tour where they can become familiar with the nooks and crannies of the OR. The same safety hunt is repeated routinely for all staff members.
Note: A sample of the Safety Scavenger Hunt maybe found on page 58.
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