RCA of Fire in Hospitals & Medical Locations

Hospitals are unique environments with diverse activities, equipment, and infrastructure that increase the likelihood of fire incidents. Factors such as the presence of flammable materials, extensive use of electrical equipment, and the constant flow of patients and staff create a complex ecosystem where fire safety is paramount. Additionally, patients in hospitals often have limited mobility or cognitive impairments, which can further complicate evacuation procedures during a fire emergency. The fire accidents in hospitals reported last month are depicted in figure 1.

• Medical Location & Groups: Location intended for purposes of diagnosis, treatment (including cosmetic treatment), monitoring and care of patients.

• Group 0: Medical location where no applied parts are intended to be used.
• Group 1: Medical location where applied parts are intended to be used as follows:

1. A) Externally;
2. B) Invasively to any part of the body, except where Group 2 applies.

• Group 2:  Medical location where applied parts are intended to be used in applications such as intracardiac procedures, operating theatres and vital treatment where discontinuity (failure) of the supply can cause danger to life.

NOTE: An intracardiac procedure is a procedure whereby an electrical conductor is placed within the heart of a patient or is likely to come into contact with the heart, such conductor being accessible outside the patient’s body.

Fundamental of fire

The Fire Triangle is a simple way of understanding the components of fire. Each side of the triangle represents one of the three components needed to start a fire – oxygen, fuel and heat. Fire is a chemical reaction and without one of these components, fire cannot exist or be sustained.

The air that surrounds us contains approximately 21% oxygen. Air supporting a fire must be at least 16% oxygen content to burn.

Fuel is considered as any material capable of burning and is characterized by its moisture content (how wet the fuel is), size, shape, quantity, and the arrangement in which it is spread over the landscape.

• Main sources of fuel: Any kind of combustible material – grass, shrubs, trees, houses, propane tanks, wood piles, decks.

A heat source is responsible for the initial ignition of fire, and heat is also required to      maintain the fire and permit it to spread. Heat allows fire to spread by removing the moisture from nearby fuel, warming surrounding air and preheating the fuel in its path.

• Main sources of heat: Lightning, cigarettes, heating effect of current, small engine sparks, matches, magnifying glass.

A fire occurs when all three of these components react together in time and space. A fire can be put out, prevented or the impacts reduced by removing, reducing or separating these elements. (Refer figure 2)

The news of electric shock or electric fire killing people gives pain and forces everyone to find the solution but in a day or two, we again forget and wait for another accident to happen. There are too many tales that different parts of the country have to tell each day without fail (many cases are even not reported or recorded). National Crime Records Bureau (NCRB) data w.r.t fire due to electrical short circuit is shown in table 1.

Main causes of electrical fire hazard

Electrocution & electrical fires in electrical installation may be broadly caused by:

• Over currents (overloads and short circuits)
• Harmonics
• Earth fault
• Electric arcs in cables and loose connections
• Failure of protection device or wrong selection of protection device
• Wrong selection of cables or wires
• Mismatch of illumination fittings rating and lamps used
• Use of extension cord for heaters or any other heavy loads
• Use of outlived (outdated) or damaged equipment
• Over voltages (Lightning) & arcing ground
• Consumer has become prosumer
• Inadequate design for earthing / grounding
• Improper or no verification and testing (commissioning or periodical)

Basic of short circuit in the electrical system

Electrical fires very often take place in residential sector. This is because most of the people do not account for the rating of the appliances while placing or connecting them. Being an individual, most of us are not aware about the parameters we need to consider while purchasing the product. The only thing that people look for is the cost effectiveness that in turn leads to extreme situation resulting in electrical fires. Major reason for electrical fire in LV system is short circuiting i.e., flowing of current through unintended path.

A short circuit is an abnormal connection between two nodes of an electric circuit intended to be at different voltages. This results in an electric current limited only by the equivalent resistance of the rest of the network that can cause circuit damage, overheating, fire or explosion (refer figure 3).

This high current generates high heat and presence of fuel or any other flammable materials may result in the fire hazard as governed by fire triangle in figure 2.

Short circuit happens mainly due to degradation of insulation. As the wire gets old, the insulation gets degraded, due to which there is a chance of short circuiting (figure 4) & this may lead to fire.

Common causes of fire in hospitals

Fires in hospitals not only endanger lives but also disrupt essential medical services, underscoring the importance of understanding their causes. Let us understand the main causes of fire in hospitals.

• Electrical Faults and Overloading: Hospitals often grapple with outdated electrical systems, inadequate maintenance, and overloading of circuits, increasing the risk of electrical fires. The city’s frequent power fluctuations and voltage surges further exacerbate these issues, posing a constant threat to hospital infrastructure.
• Inadequate Fire Safety Measures: Despite regulatory requirements, many hospitals lack comprehensive fire safety measures, including proper installation and maintenance of fire detection and suppression systems. Deficiencies in fire alarms, sprinkler systems, fire extinguishers, and emergency lighting compromise the ability to detect and contain fires effectively.
• Kitchen Facilities: If you use cooking fats, there is acute need to dispose of these properly so they don’t build up and cause a fire. And as always, practise good fire safety by having a working smoke detector in your kitchen. To prevent fires in your kitchen, keep an eye on electrical appliances and never leave them unattended.
• Specialized Medical Equipment: In recent years, there have been an increasing number of hospital fires caused by specialized medical equipment. Due to their high-powered energy output, lasers and electrosurgical tools are common ignition sources. These fires involve oxygen tanks, surgical clothing, and flammable sterilizing liquids. Hospital staff must be aware of the potential fire hazards these types of equipment pose and take precautions to prevent them. Lasers and electrosurgical tools should be used in well-ventilated areas, and must be avoided from oxygen tanks, surgical clothing, and flammable liquids. If possible, these items should be stored in fire-resistant cabinets or containers. (Refer figure 5)

• Alcohol-based Hand Rub: These are commonly used in hospitals to prevent the spread of infection. However, these products can be highly flammable and must be kept at least six feet away from potential ignition sources. In recent years, several hospital fires have been caused by improper storage or use of hand sanitizer, resulting in significant damage and even loss of life. To prevent such tragedies, all staff must be properly trained in safely storing and using hand sanitizers. Additionally, hospitals should consider investing in non-flammable alternatives to alcohol-based products, which can provide the same level of protection without the same fire risk. With proper precautions in place, we can help to ensure that hospital fires are a thing of the past.
• Flammable Materials and Hazardous Substances: Hospitals store various flammable materials and hazardous substances essential for medical procedures, including oxygen cylinders, alcohol-based sanitizers, and chemical reagents. Improper storage practices, inadequate ventilation, and failure to segregate incompatible substances increase the risk of fire and chemical hazards within hospital premises. (Refer figure 6)

• High Patient Load and Congestion: Hospitals often operate at or above their capacity, leading to overcrowding and congestion in patient wards, corridors, and waiting areas. In the event of a fire, overcrowded spaces impede evacuation efforts, hinder access for emergency responders, and escalate the risk of panic among patients and staff.
• Poor Infrastructure Planning and Design: Many hospitals face challenges related to inadequate infrastructure planning, compromised building design, and lack of compliance with fire safety norms. Structural deficiencies, insufficient fire-rated materials, and inadequate means of egress contribute to the rapid spread of fires and hinder evacuation procedures. (Refer figure 7)

• Non-compliance with Fire Safety Regulations: Despite the existence of fire safety regulations and guidelines, compliance levels among hospitals vary significantly. Factors such as lax enforcement, bureaucratic hurdles, and financial constraints often impede efforts to upgrade fire safety infrastructure and implement preventive measures.
• Impact of Environmental Factors: Environmental conditions, including air pollution, extreme temperatures, and seasonal changes, influence the risk of fire incidents in hospitals. Airborne particulate matter, combined with electrical sparks or heat sources, can ignite fires more readily, posing additional challenges for hospital fire safety. Moreover, during the summer months, increased demand for electricity and heightened usage of cooling systems strain the city’s power grid, amplifying the risk of electrical fires.

  Case studies and lessons learnt

• Vivek Vihar Hospital Fire (2024): On the night of May 26, a devastating fire broke out at the Baby Care New Born hospital, a private neonatal nursing home in East Delhi’s Vivek Vihar, leading to the tragic deaths of eight newborns. The fire, which reportedly started at the front of the building, where oxygen cylinders were stored, engulfed the small nursing home and spread to the buildings on either side.

• Bhandara District Hospital Fire (2021): In January 2021, a tragic fire at the Bhandara District Hospital in Maharashtra claimed the lives of ten infants in the Neonatal Intensive Care Unit (NICU). The fire was reportedly caused by an electrical short circuit in the hospital’s equipment, highlighting the vulnerabilities associated with outdated electrical systems and inadequate fire safety measures in healthcare facilities.
• AMRI Hospital Fire, Kolkata (2011): One of the most devastating hospital fires in India occurred at the AMRI Hospital in Kolkata in December 2011, resulting in the deaths of 91 people. The fire started in the hospital’s basement due to a short circuit and spread rapidly due to inadequate fire safety measures, including blocked emergency exits and insufficient firefighting equipment.

Main crux of the enquiry reports of fire accidents

Investigation revealed faulty wiring and overloading of electrical circuits due to inadequate infrastructure upgrades.

Improper storage of oxygen cylinders in close proximity to heat sources, coupled with inadequate ventilation, contributed to the explosion. Improper handling and storage of hazardous chemicals, coupled with inadequate ventilation, led to the spill and subsequent fire.

Inadequate training of hospital staff in emergency procedures, coupled with malfunctioning fire alarm systems, led to confusion and delay in evacuation efforts. The incident highlighted the importance of timely response and effective communication during fire emergencies.

Preventive measures and mitigation strategies

To mitigate the risk of fires in hospitals, concerted efforts are needed at various levels, including:

• Strengthening Regulatory Oversight: Enhancing enforcement of fire safety regulations, conducting regular inspections, and imposing stringent penalties for non-compliance to compel hospitals to prioritize fire safety measures.
• Investment in Infrastructure Upgrades: Allocating funds for the modernization of electrical systems, installation of advanced fire detection and suppression systems, and retrofitting existing hospital buildings to meet fire safety standards.
• Comprehensive Fire Risk Assessment: Conducting periodic fire risk assessments to identify potential hazards, assess vulnerabilities, and prioritize corrective actions based on the likelihood and severity of fire incidents.
• Implementation of Fire Safety Protocols: Developing and implementing robust fire safety protocols, including emergency response plans, evacuation procedures, and staff training programs tailored to the specific needs of medical locations.
• Upgrading Fire Detection and Suppression Systems: Investing in advanced fire detection systems, including smoke detectors, heat sensors, and fire alarms, to facilitate early detection of fires and prompt activation of suppression measures.
• Enhanced Maintenance and Inspection: Establishing routine maintenance schedules for electrical systems, HVAC equipment, and medical devices to prevent malfunctions, identify potential hazards, and ensure compliance with safety standards.
• Strict Storage and Handling Procedures: Enforcing strict guidelines for the storage and handling of flammable materials, chemicals, and medical gases to minimize the risk of ignition and prevent accidental spills or leaks. (Refer fig 8)
• Training and Awareness Programs: Providing comprehensive training to hospital staff on fire safety protocols, evacuation procedures, and the proper handling of hazardous materials to improve preparedness and response capabilities.
• Public Awareness Campaigns: Educating patients, visitors, and the community about fire safety measures, evacuation routes, and the importance of cooperation during fire emergencies to foster a culture of safety within healthcare facilities.
• Collaboration with Fire Departments: Establishing partnerships between hospitals and local fire departments to conduct joint training exercises, share resources, and develop emergency response plans tailored to the unique challenges of hospital environments.

Conclusion

Fires in hospitals pose significant risks to patients, staff, and infrastructure, necessitating proactive measures to address the root causes and mitigate the associated hazards. In India, where healthcare facilities grapple with a myriad of challenges, prioritizing fire safety is paramount to ensure the continuity of essential medical services and protect public health.

By addressing systemic vulnerabilities, enhancing regulatory oversight, and fostering a culture of safety, hospitals can reduce the incidence of fires and create safer environments for patients and healthcare professionals alike. In the context of fire safety in hospitals in India, the selection and proper functioning of Miniature Circuit Breakers (MCBs) and Residual Current Devices (RCDs) play crucial roles in mitigating fire risks. In medical locations of Group 0 any Arc Fault Detection Device (AFDD) used shall be subject to a risk assessment.

Medical fires can occur any time if all three of the following elements are present:

• Ignition source: electrosurgical units, lasers, and fibre optic light, electrical gadgets
• Fuel source: surgical drapes, alcohol-based skin preparation agents, flammable chemicals
• Oxidizer: oxygen, nitrous oxide, room air
  

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Dr. Rajesh Kumar Arora obtained his B. Tech. and M.E. degrees in Electrical Engineering from Delhi College of Engineering, University of Delhi. He completed his PhD in grounding system design from UPES, Dehradun. He is also a certified Energy Manager and Auditor and has worked in 400kV and 220kV Substations for more than 14 years in Delhi Transco Limited (DTL). He has also worked as Deputy Director (Transmission and Distribution) in Delhi Electricity Regulatory Commission (DERC). Presently he is working in D&E (Design and Engineering) department of DTL. His research interests include high voltage technology, grounding system, protection system, computer application and power distribution automation.