On the northeast side of Manhattan in New York City is one of the nation’s busiest, and best known, academic medical centers: the Mount Sinai Hospital (MSH). In the broad spectrum of men and women of all ages occupying the hospital’s 1,171 beds are patients suffering from a mixed variety of medical conditions ranging in severity from “ambulatory” to “critical intensive-care”; most patients in the latter group cannot be moved from their beds. The hospital usually operates at 90 percent occupancy or higher and is highly respected for its broad spectrum of medical capabilities. One example: With over 50 active operating rooms and an emergency room that sees over 250 patients a day, it has one of the busiest cardiac catheterization labs in the entire United States.
The Fire Department of New York (FDNY), one of the busiest fire services in the world, has a similar reputation. The FDNY responds to literally thousands of fire alarms each year – including, significantly, over 300 alarms annually for hospital fires. The department’s extensive experience with hospital fires, combined with the complicated rescue needs of hospitals, are therefore of particular interest not only to other fire departments throughout New York State but also to departments in many other states throughout the country.
On 21 January 2009, a fire broke out in the MSH’s main hospital building. The FDNY response eventually reached three-alarm status, and over the course of the following 24 hours it became necessary to carry out one of the largest evacuations of hospital patients in FDNY’s history. Eventually, cloe to 450 patients were evacuated – both horizontally as well as vertically – from the medical center. Fortunately, no patient experienced serious effects from the evacuation, and all were relocated to appropriate MSH patient-care areas within 24 hours after the start of the fire.
That fire and its effects, though, would be felt by both agencies for many months after the blaze was extinguished. One positive effect of the evacuation was that it led to an even closer relationship between MSH and the FDNY. Almost immediately following the fire, representatives of MSH and FDNY met, not only to review what had happened but also to examine in much greater detail how hospitals and fire departments in general should respond to fires that break out in hospitals. The MSH and FDNY representatives looked at common practices throughout the hospital industry and, through a working committee, created a comprehensive list of “best practices” to improve the prevention of fires in hospitals and the emergency-response capabilities of fire departments.
A Plenary All-Agency Meeting; a Score of Helpful Recommendations The working committee – which included representatives from fire departments, hospitals, regulatory agencies, and hospital trade organizations – eventually scheduled a full one-day meeting to examine their findings and receive industry feedback. On 13 December 2010, that meeting was held (at MSH) and served, among other things, as a much-needed forum for evaluating industry best practices. The estimated 450 or so participants at the meeting represented fire departments and hospitals from 23 states. Hospital and fire officials from the City of London also took part, and shared their extensive experience from a 2009 study – by the United Kingdom’s National Health Service – of five hospital fires and the various difficult issues associated with each.
The results of the December 13 meeting have been summarized in a comprehensive White Paper – “Hospital Fire Safety and Prevention” – expected to be published later this year. Following is a list of some, but not necessarily all, of the best practices likely to be recommended from the experiences of both the United States and the United Kingdom:
- Install “high-rise building” types of systems/panels in hospitals;
- Use an effective patient tracking system during evacuations;
- Ensure that effective HVAC (heating, ventilation, air-conditioning) systems are available to the fire departments responding so that smoke can be controlled inside a facility;
- Cover all hospital areas with sprinklers (by a “reasonable” target date in the future);
- Ensure that a properly trained person, specifically designated to provide information (about both the fire and the hospital itself) to the fire department units responding, is available to meet the responders at a convenient location outside but close to the hospital when they arrive;
- Use the federal Hospital Incident Command System (HICS) as the predesignated standard at all hospitals for use during a fire, and ensure that the command staff are wearing easily recognizedentity vests;
- Install and use a dedicated radio network that can be used throughout the hospital by fire-service command leaders upon their arrival at the hospital;
- Pre-position, in each hospital building, a number of large, conveniently located, and easily readable building information cards that can quicklyentify particularly important and/or vulnerable areas, and potential dangers, in that specific building;
- Stock all hospitals, in advance, with the appropriate types and quantities of evacuation devices and systems likely to be needed by the hospital’s patients;
- Schedule frequent in-depth meetings, on a continuing basis, between hospitals and fire departments, at all working levels, to discuss common problems and develop closer working relationships;
- Schedule and carry out a broad spectrum of staff educational meetings and training drills for “shelter in place” situations in addition to evacuations;
- Develop a viable hospital-recovery/business-continuity plan that involves the fire department as well as the hospital itself; and
- Establish a wellentified “Fire Command Station” location in all hospital buildings.
Major Benefits Expected – Far Into the Future It is expected that the White Paper will not only describe each of the preceding recommendations in much greater detail but also recommend other helpful ways in which the hospital and fire industries should evolve. It also seems likely, though, that at least some of the recommendations spelled out above will require code and standard change(s) at the local, state, and/or federal levels of government.
The meetings already completed confirm the fact that there is a complexity about hospitals in general – and hospital fires in particular – that demands, today more than ever before, the adoption of the numerous preventive planning measures recommended above. It will be highly recommended to communities throughout the nation that their hospital and FD leaders meet and approve the best-practice recommendations.
The goal here, of course, is to ensure that future fires and/or fire-related incidents and events will not result in injuries, deaths, or hospital-service capabilities lost from the community. The evacuation, shelter-in-place, business continuity, and HICS recommendations – especially the need for reliable patient tracking systems – are issues that will be increasingly valuable in helping healthcare institutions respond quickly and more effectively to many other emergencies, of all types, for many years to come.
Footnote: A follow-up conference – “Partnership to Prevent Tragedy – II” – on Hospital Fire Safety is being planned by FDNY for 8-9 December 2011 in Manhattan.
For further information on the 9 December fire and its aftermath, visit fdnyfoundation.org
Theodore (Ted) Tully, AEMT-P, is President of STAT Healthcare, an Emergency Management consulting group. He previously served as Administrative Director for Emergency Preparedness at the Mount Sinai Medical Center in New York City, as Vice President for Emergency Services at the Westchester Medical Center (WMC), as Westchester County EMS (emergency medical services) Coordinator, and as a police paramedic/detective in Greenburgh, N.Y. He also helped create the WMC Center for Emergency Services, which is responsible for coordinating the emergency plans of 32 hospitals in the lower part of New York State.