Why The Life Safety Code?

10100[1]Why do we need the Life Safety Code? This is a question that I am frequently asked by individuals who do not understand what all the fuss is about that is placed on compliance with a code when the nation hasn’t had a fatality in a hospital due to fire in a long time. The answer to that question is simple: Without the Life Safety Code, our hospitals would return to a condition where tragic results will occur from fires and other emergencies.

 It wasn’t until 1970 that a national organization adopted the NFPA 101 Life Safety Code and required hospitals to be in compliant with it. The Health Care Financing Administration (HCFA), the fore-runner of the Centers for Medicare & Medicaid Services (CMS) chose the Life Safety Code over other codes and standards because it addresses the building and staff preparedness to cope with fires and emergencies. Prior to HCFA adopting the Life Safety Code, compliance with it was only regulated on a local or state level, and in many situations, compliance with the Life Safety Code was only a recommendation, not a requirement. As a result, there were significant losses of life with fires in hospitals prior to this time period.

 Cleveland Clinic, Cleveland, OH

In May, 1929, a fire in a lower level storage area, which contained nitrocellulose X-ray film killed more than 120 people, mainly due to the toxic and explosive gas which was a result of the combustion of the film. There were no sprinklers in the storage area and unsealed openings between the floors allowed the toxic and explosive gas to travel upward.

 Saint Anthony Hospital, Effingham, IL

In April, 1949, at least 74 people died in this 100-bed hospital located in the small rural community in central Illinois. The fire apparently started in the lower level where the laundry chute discharged the soiled linens, and spread upward via the open chute and through the building. The building was constructed with combustible materials, and did not have any smoke compartment barriers, nor any smoke detection or fire suppression systems.

 St. Elizabeth’s Mercy Hospital, Davenport, IA

41 people lost their lives in a 1950 fire in the female psychopathic hospital, caused by a deranged patient. The windows were barred and the doors were locked and staff was unable to quickly evacuate the patients. The building was constructed with combustible materials, and was not protected with sprinklers.

 Hartford Hospital, Hartford, CT

In December, 1961, 16 people died as a result of a fire that started in the trash chute at the Hartford Hospital. The building was constructed with non-combustible materials, but had interior finishes which were combustible. When the fire erupted through the chute door on the 9th floor, combustible ceiling tiles, wall coverings and flooring ignited, trapping many patients and staff in dead-end corridors. Sprinklers were present in other areas of the hospital, but not on the 9th floor where all the victims were located.  

 With the requirement starting in 1970, that all hospitals receiving Medicare reimbursement have to comply with the Life Safety Code, deaths in hospitals fires began to diminish, but were not all eliminated all-together.

 SAC-Osage Hospital, Osceola, MO

In December, 1974, 8 patients died as a result of a fire at the SAC-Osage Hospital. 6 patients died of smoke inhalation, and 2 patients died when a supply valve to their oxygen tent was inadvertently shut off. The facility was only 5 years old at the time, and was constructed to federal and state fire prevention codes in affect at the time. The fire was thought to have started from smoking materials igniting combustibles in a patient’s room.

 Hospice of Southeastern Michigan

In December, 1985, a fire that started in a recliner in a patient’s room led to the death of 8 people in this hospice facility. All of the fatalities were in rooms were the doors to these rooms had not been fully closed and latched.  Smoke spread through the bathroom ventilation system from room to room.

 Riverside General Hospital, Riverside, CA

In November, 1986, 5 patients died in the Riverside General Hospital after a fire started in a patient room and spread out into the corridor. According to reports, the patient was smoking in his room and attempted to shut off his oxygen supply, but failed. Evacuation of the patients in the area of fire was not able to be completed due to heavy smoke from the fire.

 Maimonides Medical Center, Brooklyn, NY

3 patients died in a fire in September, 1993 at the Maimonides Medical Center, in Brooklyn, NY. According to a newspaper article, the fire started in a faulty respirator supplying oxygen to an elderly patient. The article said that hospital engineers had worked on the respirator hours before the fire, after nurses and other workers complained that it was giving electrical shocks. Investigators said that an electrical fault in the machine caused the fire, which was fuled by pure oxygen, and created a blast so fierce that witnesses said it sent a fireball through the 7th floor hospital window.

 Southside Regional Medical Center, Petersburg, VA

On December 31, 1994, a fire that started in a patient’s room in the Southside Regional Medical Center, in Petersburg, VA, resulted in the deaths of 5 patients. The fire apparently was started by smoking materials, which spread to bedding linens and mattress. Smoke spread into the corridor because the door to the room of origin was left open. According to reports, the fire alarm transmission to the fire department was delayed because the connection was taken out of service at the time of the fire. The room and the corridor were not protected with sprinklers.

 Great progress has been made over the years on fire safety in hospitals. In the five-year span between 1980 to 1984, fire departments in the United States responded to an estimated 7,100 hospital fires annually resulting in an average of 5 deaths per year. In a similar time span between 2006 to 2010, US fire departments responded to an average of only 1,400 fires per year that resulted in less than 1 death per year. The significant change in this statistic is attributed to the implementation of smoking bans in hospitals. In 1980 to 1984, 35% of the fires were started by smoking materials, as compared to only 7% of the fires were started by smoking materials during the period 2006 to 2010. During this same time period, 60% of the fires were started by cooking equipment.

 Fires will continue to occur in healthcare facilities, and we need to be prepared for them. While smoking bans have cut down the number of fires started by careless use of smoking materials, it hasn’t eliminated them. Most healthcare professionals will admit that patients are still sneaking cigarettes without the staff’s knowledge. Add in the factor of heat producing devices around high oxygen environments (such as cauterizing pens in surgery), fire will continue to happen.

 During the time period between 1980 to 1984, sprinklers were present in less than half of the reported fires in hospitals, while such fire suppression equipment was noted in 79% of the reported fires during the time period 2006 to 2010. During this same time period, damage from fire was limited to the room of origin in 97% of the reported fires.

 The lesson we have learned is sprinklers save lives. When coupled with early fire detection, and a capable, trained staff on fire response procedures, our hospitals are safer today than they have ever been. But we still average 3.8 fires per day in hospitals in the United States. We need to be prepared and ready to face that situation when it occurs. Without the Life Safety Code, we will have far more tragic results than we have today.