Healthcare

Technical guidance for fire safety in Healthcare Premises

Section 1: Fire Risks and Preventative Measures

The primary strategy for fire prevention in healthcare settings is the systematic separation of flammable materials from ignition sources.

Housekeeping and Waste Management Accumulation of combustible materials must be monitored carefully. Waste should be kept in suitable containers, and external wheeled bins must be secured in a compound to prevent arsonists from moving them against the building. Skips should normally be placed at least 6 metres away from any part of the premises.

Specific High-Risk Areas

Laundries: These are high-risk areas often located in basements. Owners must avoid overloading machines, clean exhaust filters regularly, and ensure laundry chutes have automatically operated smoke and fire dampers.
Kitchens: Large catering facilities require automatic fire suppression systems for cooking ranges. Extraction ducting and grease traps must be cleaned regularly to prevent grease fires.
Storage: Combustible materials (e.g., paper records, wheelchairs, foam mats) should be kept in dedicated fire-resisting storerooms. Combustibles must never be piled against electrical equipment, and voids (including roof spaces) must never be used for storage.

Dangerous Substances and Equipment

Flammable Liquids: Quantities up to 50 litres may be stored in a fire-resisting cabinet or bin; larger amounts require a dedicated store.
LPG and Medical Gases: LPG cylinders should only be used in exceptional circumstances and stored upright in secure, well-ventilated locations. Medical oxygen cylinders should preferably be stored outside, and the fire service must be informed if they are kept on-site.
Machinery and Vehicles: Planned preventative maintenance is required to prevent friction or overheating. Electric vehicle charging points (e.g., for wheelchairs) should be in well-ventilated areas, ideally against a fire-resisting wall, due to the production of explosive hydrogen gas.
Heating: Fixed convector or fan heaters are preferred over radiant heaters. Portable fuel-burning heaters should only be used if supported by the FRA.

Structural Safety

Managing Building Work: Refurbishments require a permit-to-work system for "hot work" (e.g., welding) to ensure monitoring for at least an hour after completion.
Insulated Core Panels: Polymeric cores in modern cladding can melt and produce toxic smoke. Damage to the metal skin must be repaired immediately to prevent core exposure to fire.
Textiles and Furniture: Bedding, curtains, and upholstered furniture provided by the organisation should meet the ignition-resistance standards in HTM 87.
Compartmentation: High-risk areas (e.g., kitchens, laboratories, boiler houses) should be separated from patient areas by at least 30 to 60 minutes of fire-resisting construction.

Section 2: Fire Detection and Warning Systems

The purpose of these systems is to alert staff and occupants quickly enough to allow safe evacuation before routes are compromised by smoke.

Observation and Detection In sleeping areas, ward layouts should allow staff to observe between 30% and 60% of beds from the staff base to ensure early detection. Most healthcare premises require an electrical fire warning system. Automatic Fire Detection (AFD) is essential in high-risk rooms (kitchens, boiler rooms), unoccupied areas, and bedrooms.

System Features

Manual Call Points (MCPs): These should be conspicuous (red), fitted at 1.4m height, and positioned so that no one travels more than 45m to reach one.
Specialised Alarms: Visible beacons or vibrating pagers are required for those with hearing impairments. Voice alarms may be used to provide clearer instructions and reduce panic.
Staged Alarms: Complex buildings often use staged alarms (an 'alert' signal followed by an 'evacuate' signal) to allow for managed evacuation.

Testing and Maintenance A named responsible person must supervise the system. MCPs should be tested weekly using a test key, while a competent person must carry out professional servicing every six months. Systems must have a backup power supply capable of operating for 24 hours and sounding the alarm for 30 minutes.

Section 3: Firefighting Equipment and Facilities

Portable Equipment Owners must provide extinguishers suitable for the classes of fire (A through F) present. For general Class A risks, provide one water-based extinguisher for every 200m² of floor space, with a minimum of two per floor. They should be located on escape routes near exits, with a maximum travel distance of 30m. Extinguishers require a monthly visual check and annual professional maintenance.

Fixed Systems and Facilities for Firefighters

Sprinklers: These are highly effective for life safety. If a system is shut down for maintenance, owners must implement compensatory measures like extra fire patrols.
Access: Access roads must allow fire engines to approach within 18m of building inlets.
Rising Mains and Shafts: Taller buildings (over 18m) require firefighting shafts (protected lobbies and stairways) and rising mains to assist firefighter intervention.
Foam Inlets: These are often fitted to allow for extinguishing fires in high-risk basements or plant rooms.

Section 4: Escape Routes and Strategies

The evacuation strategy in healthcare is heavily dependent on patient mobility and staff assistance.

Evacuation Strategies

Single Stage Evacuation: Appropriate for "independent" patients who can leave the premises quickly and unaided.
Progressive Horizontal Evacuation (PHE): This is the standard for most healthcare premises. It involves moving patients from the area of the fire through a fire-resisting barrier into an adjoining protected compartment on the same level. Compartments are limited to 2,000m² (3,000m² for single-storey).
Delayed Evacuation: Reserved for areas like ICUs or operating theatres where immediate movement is dangerous. Patients remain in a room with enhanced fire resistance (at least 30 minutes) while the fire is dealt with.

Design and Capacity

Widths: Routes for independent patients should be at least 1,100mm. If patients are evacuated on beds or trolleys, the minimum width is 1,500mm, increasing to 3,000mm for "Hospital Streets".
Travel Distances: These are benchmarks based on dependency.
- Dependent Patients: 15m (single route), 30m (more than one route).
- Independent Patients: 18m (single route), 45m (more than one route).
- Total travel within a compartment: Max 60m.

Escape Route Features

Inner Rooms: These should be avoided as bedrooms. They require a vision panel, a 500mm ceiling gap, or AFD in the access room to warn occupants.
Subdivision of Corridors: Corridors over 30m long should be subdivided with fire doors to limit smoke spread.
Stairway Protection: All stairways in buildings with dependent patients must be designed as protected stairways. External stairs require fire-resisting glazing for any windows or doors within 1.8m horizontally or 9m vertically.
Final Exits: Doors must open in the direction of travel and be easily openable without a key or code, except in specific secure environments (e.g., secure psychiatric units).

Help for People with Special Needs Owners must provide Personal Emergency Evacuation Plans (PEEPs) for disabled staff and regular patients. Refuges (areas of temporary safety) must lead to a protected escape route and should not rely on the fire service for rescue.

Section 5: Emergency Escape Lighting

Emergency lighting must illuminate escape routes, exit doors, changes in floor level, and firefighting equipment when normal lighting fails.

Coverage: Required for internal windowless routes, windowless toilets over 8m², and areas used during darkness.
Duration and Testing: Systems should have a 3-hour duration. Maintenance includes a daily visual check, a monthly function test, and an annual full discharge test.
Way-Guidance: Low-level photoluminescent tracks can assist partially sighted people or those escaping through smoke.

Section 6: Signs and Notices

All safety signs must be pictograms; text-only signs are not compliant.

Positioning: Exit signs should be positioned so the next sign is always in sight along the route. They should be fixed above doors at a height of 2.0m to 2.5m.
Mandatory Notices: These include "Fire door keep shut" labels on self-closing doors and "Fire Action" notices posted at call points and in staff areas detailing emergency procedures.
Illumination: All signs and notices must be illuminated to ensure they are conspicuous and legible.

Section 7: Management, Training, and Recording

Good management is essential to ensure preventative measures remain effective.

Records and Policy If employing five or more people, you must record the significant findings of the FRA, including identified hazards, preventative measures, and the emergency plan. Large organisations should have a senior/board-level manager responsible for fire safety policy. A log book must be maintained for all tests of alarms, emergency lighting, and drills.

Emergency and Contingency Plans A written plan should cover how people will be warned, evacuation procedures for individual wards, staff duties, and procedures for meeting the fire service. Contingency plans are needed for when safety systems (like sprinklers) are out of order.

Staff Training All staff must receive basic fire safety induction and annual refresher sessions. Training must cover alarm recognition, evacuation procedures for different patient dependencies, the importance of fire doors, and the location of escape routes. Staff expected to physically move patients require specific manual handling training with evacuation equipment.

Fire Drills Drills should be held at least annually to test the emergency plan and familiarise staff and patients with procedures. One drill should assume a major exit is "blocked" to test alternative routes. Drills should include night-time simulations to test lower staffing ratios

Whilst every effort has been made to ensure the information within these pages are accurate and not misleading, LESH Consulting Ltd cannot accept any liability for any loss or liability arising from the use of any such information.