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A safe diagnosis
The evacuation challenges posed by healthcare buildings are outlined by Richard Rankin
HE HEALTHCARE sector presents building designers with a different challenge in terms of fire safety design, compared to other types of buildings. In hospitals and other healthcare facilities where all manner of health services are provided, from complex

operations to specialist services and particularly in patient access areas, a complete evacuation of the building may not be the most appropriate or practical course of action. Patients with restricted mobility or mental disabilities, and those who use wheelchairs, are under medication

or are confined to a bed, may be unable to negotiate escape routes particularly stairways without help. Patients who are dependent on electrical or mechanical equipment for their survival cannot always be disconnected and moved rapidly without serious consequences.

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NFPA 101: Life safety code, and the UK Department of Health guidance, Health Technical Memorandum (HTM) 05-02: Guidance to support functional provisions in healthcare premises. e HTM guidance, in particular, sets out specic measures to meet the functional requirements of Part B (Fire Safety) to the Building Regulations 2000 in England and Wales for healthcare buildings. Published in January 2007, it replaced the previous guidance, HTM 81: Fire precautions in new hospitals and HTM 85: Fire precautions in existing hospitals. Although HTM 05-02 has no statutory force, it forms a code of practice which recognises the re safety issues in healthcare premises and allows current statutory regulations to be applied sensibly within a framework of understanding. to combat the inherent problems with moving these type of patients. For example, the time required to evacuate is longer, since it is often necessary to move not only the patient, but also any necessary equipment, such as ventilators, monitoring equipment and support sta, as one unit. e re safety design of such a building should seek to maximise the protection to the patients and allow for extended pre-movement and travel times. e use of evacuation bed lifts within each compartment should also be considered as a viable means of moving patients to lower oors within a hospital. Such a strategy should be particularly considered in high-rise hospitals where, for example, mattress evacuation down a signicant number of ights would be extremely dicult. Since it is unlikely that there will be capacity to accommodate all occupants who require evacuation by lift at any one time, sucient areas of safe refuge should be provided to accommodate those who may need to wait for an escape lift to become available. As such, refuge provisions should consider: the number of occupants likely to be awaiting evacuation by lift the number of occupants reaching escape lifts through progressive horizontal evacuation the capacity of each escape lift at that point (taking into account the space requirements for sta, life support and other associated equipment for highly-dependent patients) ere are other emergencies, such as bomb threats and earthquakes, which require an entire building evacuation. In such cases, particularly in high-rise buildings, lifts can be used simultaneously with exit stairs to reduce the evacuation time.

Fire evacuation
e basic re evacuation strategy for dependent or highly-dependent patients should be to move them, on their bed or in a wheelchair, to a safer area on the same oor. ere are three main stages of evacuation, adopted as circumstances dictate: stage 1: horizontal evacuation from a sub-compartment where the re originates, to an adjoining sub-compartment or compartment stage 2: horizontal evacuation from an entire compartment where the re originates, to an adjoining compartment on the same oor stage 3: vertical evacuation to a lower oor which is substantially remote from the oor of re origin (at least two oors below) or to the outside In addition, there are three re conditions which determine when the evacuation of a healthcare building is necessary or should be considered: in an extreme emergency, where there is an immediate threat to life safety from re or smoke in an emergency where no immediate threat to life is posed, but where re or smoke is likely to spread from an adjoining area as a precautionary measure, where there is no immediate threat to life or safety, but where a re is present on an adjoining oor or in an adjacent building In extreme emergencies, people who are in immediate danger should be the rst to be evacuated, followed by ambulant patients and then the remaining non-ambulant patients. is approach known as progressive horizontal evacuation is referenced in international design codes, such as the US standard,

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Horizontal principles
e principle of progressive horizontal evacuation is to move occupants from the re-aected area through a re-resisting barrier to an adjoining area on the same level, which is designed to protect the occupants from the immediate dangers of re and smoke. e safe area known as a refuge enables occupants to either remain there until the re is extinguished; to await further evacuation to another similar adjoining area; or to be evacuated down the nearest stairway. If the need arises to evacuate an entire storey, this procedure should give sucient time for non- and partiallyambulant patients to be evacuated down stairways to a place of safety (see Figure 1). High-rise hospitals and hospitals with very highly-dependent patients present dierent challenges, sometimes requiring additional re safety provisions

Figure 1: Typical arrangements for compartmentation to facilitate progressive horizontal evacuation

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these compartments to allow progressive horizontal evacuation) and active re safety provisions (such as automatic re detection and suppression systems, zone smoke management, evacuation lifts, and pressurisation of compartments which are adjacent to a re-aected room) may allow such patients to remain in-situ.

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Training imperative
Sta training forms an essential part of the re strategy in healthcare buildings. Sta should be familiar with the concept of progressive horizontal evacuation. ey also need to have an understanding of re risks and know what to do in the event of a re, so that safety procedures can be applied eectively. It is imperative that healthcare organisations provide appropriate levels of re safety training. is applies to all sta, including temporary and part-time personnel. Sta should receive training when they rst join the organisation, with refresher training provided periodically. A re safety manual should also be developed to assist sta training and to identify the design intent of the building, including the roles and responsibilities of management in an emergency evacuation. A manual is an essential tool in managing the re safety of an occupied building. It should contain both design information and operational records for the premises. e manual should initially be created by the design team (for new buildings), as it needs to provide details of assumptions and decisions made during the design stage which led to the nal building design. This should include explicit assumptions made in respect of ongoing management arrangements once the building has become occupied. Good re safety design of healthcare buildings requires a combination of passive and active re safety provisions, as well as good management, training and understanding of a buildings re strategy. However, building designers should also consider the dependency of the occupants, and take into account the location of highly-dependent patients, providing them with the appropriate re safety provisions they deserve

Smoke management
Active smoke management strategies can be developed to prevent smoke spread into adjacent compartments or sub-compartments. Prescriptive guidance generally relies on re and smoke barriers to contain the re to the area of origin. e buildings heating, ventilating and air-conditioning system can be zoned and utilised to achieve pressure dierentials between re-aected areas and adjacent compartments, in order to further reduce the risk of smoke spreading from the compartment of re origin. Such an approach can be particularly benecial for operating theatres, where moving a patient may be life threatening.

The protection of patients may include extended pre-movement and travel times

Indeed, by combining passive protection (for example, compartmentation and sub-compartmentation by re and smoke barriers, and the arrangement of

Hospital evacuation plans should address high-dependent patients and those with restricted mobility

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Richard Rankin is a senior re engineer with Exova Warringtonre Consulting

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