Responding to a fire at a pediatric hospital

AORN Journal, April, 2002 by Catherine Hogan

Disaster preparedness programs established in health care organizations are an essential element in facilitating a formalized, effective response to major incidents or disasters. One author states that there are two categories of disasters--natural and man made. (1) Natural disasters are caused by extreme environmental conditions that give rise to catastrophic destruction and death. Manmade disasters are caused by human action or inaction and can have profound effects on civilians, governments, and economic stability. This article reviews one man-made disaster--a hospital fire at the Hospital for Sick Children (HSC), Toronto.

THE HOSPITAL

The hospital comprises three main structures--the annex building, atrium, and research center. The annex building was constructed in 1951, and the atrium was built and connected to the annex in 1993. The research center is a separate building connected to the atrium by a second floor pedestrian walkway. All buildings at HSC have the most current fire systems available. These systems use heat, smoke, and fire sensors; sprinkler systems; smoke evacuation windows; extraction fans; fire extinguishers; and fire barrier doors. The annex and atrium buildings were designed so that fire cannot spread through them quickly and so that, in the event of a fire, people can be evacuated quickly.

The hospital is a tertiary teaching hospital and the largest children's hospital in Canada, with a 375 inpatient bed capacity. It is located in downtown Toronto and covers approximately 2.5 million sq ft, which is one complete city block.

The hospital includes a level three nursery and a pediatric trauma emergency room, has multiorgan transplantation designation, and supports all medical and surgical pediatric services. The hospital averages 50,000 emergency visits, 275,000 outpatient visits, and 17,000 surgical procedures per year.

HSC'S DISASTER RESPONSE PLAN

Disaster response focuses on victim care. (2) In a hospital disaster, each patient must be accounted for along with any family members or friends visiting when disaster occurs. All staff members in the building need to be identified and accounted for to prevent casualties at the disaster site.

As part of HSC's disaster plan, the emergency management team has established direct lines of control, defined the duties of personnel with an assigned role, defined procedures and responsibilities for health care providers and engineering and plant staff members, and determined equipment and supply needs for each response function. They also have planned an emergency measures coordination center, which would be a command post for managing resources, analyzing information, and making decisions during a disaster.

The plan calls for the emergency management team to assume responsibility and control for incident-related activities. One individual on the team should assume the role of incident commander and oversee the technical aspects of the response. Staff members on each nursing unit should identify a person who will be responsible for maintaining direction and control at the unit level and interacting with the management team. Management team members determine short- and long-term effects of the disaster; interact with hospital staff members, family members, the media, and outside response organizations (eg, fire department, police department, ambulance service, Salvation Army); issue press releases; and order the evacuation or shut down of the hospital. Without a coordination center, adequate coordination fails and communication links are diminished within and among responding agencies involved in disaster control. (3)

Preparing for potential year 2000 (Y2K) problems had increased the hospital's readiness for a disaster. Preparation had taken more than one year, and it incorporated all areas of the hospital. Plans for each type of code were reviewed and refined, and "workaround plans" were created for scenarios, such as patient care without water or power. Extremely detailed plans for every unit and department were included in the disaster manuals, including disaster evacuation.

Hospital staff members participated in regularly scheduled fire instruction and monthly mock fire drills. As part of Y2K planning, medical supplies, equipment, and resources needed to treat patients had been increased for a possible Y2K disaster. These materials were stored in various locations throughout the hospital.

THE FIRE

On Sunday, Jan 9, 2000, at approximately 6 PM, patients, parents, and staff members at HSC were finishing the evening meal. Fire bells sounded in response to an explosion in a high voltage power transformer in the hospital basement. The explosion destroyed the containment vault and ignited a fire that precipitated an evacuation. The mild weather on the night of the disaster facilitated a barrier-free, swift response by fire, ambulance, police, and volunteer responders.

The explosion and subsequent high-intensity fire shattered windows in the atrium building, crumbled the loading dock, and knocked out power inside the hospital and for a six-block radius surrounding the hospital. Emergency backup power was restored inside the hospital in a matter of seconds; however, the fire burned out of control for two hours. Regular power was restored to the hospital 22 hours after the explosion. Smoke and soot from the fire quickly infiltrated the annex and entered the nine-story patient wards of the atrium.