Roof fire offers insights to fine-tune your response plans

Roof fire offers insights to fine-tune your response plans

A fire on the roof of a New Hampshire hospital proved the need to keep tabs on projects involving hot work and flammable materials.

The small blaze occurred on November 18, 2008, during roof repairs at the Alice Peck Day Memorial Hospital in Lebanon, NH, which is predominately an outpatient facility with a surgery unit, laboratory, urgent care center, and birthing center. Staff members from several departments were evacuated as a result of the fire.

The interaction between the hospital employees and firefighters offers lessons for other medical centers sharpening their fire plans, especially those with roof work coming up in their maintenance schedules.

Roof work warrants extra precautions

Fires can be tougher to extinguish when roof work is under way because the fires are more difficult for firefighters to get to.

Lebanon Assistant Fire Chief Jeffrey Libbey says it’s a good idea to notify the local fire department when roof work is being done at your facility.

In some communities—including Lebanon—the fire department requires permits and notifications before work begins.

Libbey advises facilities performing roof work to take the following fire prevention measures:

Have the safety or facilities manager speak with the contractor to go over the details of the job, and issue a bulletin to the local fire department notifying it about when the work will be done

• Have portable fire extinguishers on the roof
• Consider having a firefighter on the premises during hot work (i.e., activities involving open flames or sparks, such as welding or grinding)
• Make sure staff members know to pull a fire alarm and call 911 if they smell smoke or see fire
• If a fire breaks out in the kitchen, have staff members close down vents and turn off exhaust fans that might spread smoke to other areas

In the case of the Lebanon fire, workers were using torches to dry insulation prior to installing a piece of membrane roof. Some insulation began smoldering and dropped into a space between the roof and a suspended ceiling, sending smoke into the hospital’s kitchen.

An employee pulled a fire alarm and called “Code red: kitchen” over the public address system three times, as hospital procedure dictates, after seeing smoke. Fortunately, the damage was limited to the insulation, and no patients needed to be evacuated out of the building.

A surgery in progress at the time of the fire continued, and patients remained in the building along with their caregivers. All nonessential staff members and visitors, including kitchen and cleaning crews, were evacuated.

Firefighters respond en masse

The hospital also had luck working in its favor: On the day of the incident, the fire department had extra personnel on duty conducting an EMT refresher course, enabling more firefighters to respond. Because of sick days, vacations, and other factors, most fire departments are staffed such that an engine arrives on the scene and a ladder truck follows later upon request.

“We were able to have 15 or 16 guys on scene, and we were able to ladder [to] the roof immediately, which is not always the case,” Libbey says.

The roofers sprayed the insulation with an extinguisher and stopped the smoldering before it got out of control, says Jonathan Stark, facilities manager at Alice Peck Day Memorial Hospital.

Although the fire was out by the time firefighters arrived, it took an hour for them to clear out the smoke and for the hospital to resume normal operations.

Communication pays dividends

The hospital’s smoke and fire-door system worked perfectly, containing smoke to the kitchen area, says Libbey.

During the partial evacuation, hospital staff members checked that corridor doors closed properly and verified that for the fire department. Accounting for all patients and staff members inside and out of the building allows firefighters to address the fire and smoke faster, Stark says.

Communication with nurses is another key component to a successful response. Nurses can administer care and calm patients who aren’t evacuated.

“The nurse managers need to be well informed during an incident so that they can communicate confidently [with patients],” Stark says.

Stark and Libbey say patients need face-to-face updates and assurance that a situation is under control, even if they smell smoke. Patients should also be told that if the situation becomes serious, they will be evacuated safely.

Three ideas to improve your plan

Under EC.04.01.01–EC.04.01.05, The Joint Commission (formerly JCAHO) requires hospitals to review and improve their fire response plans. The November fire uncovered three logistical wrinkles that will be addressed in the hospital’s fire response plan, Stark says, which other medical centers might want to consider as well:

• During the evacuation, the switchboard was left unattended. In future evacuations, the switchboard will be evacuated as per procedure, but the facilities manager will request the fire department declare that area clear as soon as possible—in advance of the all-clear signal that ends the evacuation—so operators can get back to fielding calls as soon as it’s safe.
• Some fire responders parked their vehicles near the entrance of the facility’s urgent care center, which led to strong diesel fumes lingering inside. “This could have been prevented through better communication with our local fire department,” Stark says.
• Realistic fire drills are essential for keeping staff members sharp and at the ready (refer to EC.02.03.03). “When you conduct your drills, have the employees call the code and pull the alarm,” Stark says. “This will make them less hesitant to do so if a real incident occurs.”

Stark’s point is a good one, considering how many of us through childhood and school years were constantly told never to pull a fire alarm box. Promoting fire alarm use represents a change in behavior for some staff members.