Fire safety in healthcare premises

Fire safety in healthcare premises
NHSScotland ‘Firecode’
Scottish Health Technical
Memorandum 83
Version 3
Fire safety in healthcare premises – General
fire precautions
This document forms part of
NHSScotland Firecode Edition No 4
NHSScotland, P&EFEx, April 2004
SHTM 83: Fire safety in healthcare premises-General fire precautions
Contents
About this publication
page 5
1.
1.1
1.4
General
Scope
Background
page 6
2.
2.2
2.7
2.12
2.18
2.24
Fire safety policies and staffing levels
Fire precautions policies
Fire safety signs and notices
Staffing levels
Fire safety audits
Competent persons
page 8
3.
3.1
3.5
3.8
3.10
3.11
3.12
3.14
3.19
3.21
3.23
3.24
3.25
3.26
3.28
3.29
3.30
3.34
Fire prevention
General
Smoking
Wilful fire raising
Good housekeeping
Combustible waste
General principles
Waste disposal and collection
Ease of access, particularly to external areas
Safe disposal of flammable liquids
Incineration
Aerosol containers
Storage of clinical waste
Underground premises
Textile materials
Lightning and its characteristics
The possible consequences of a lightning strike
The protection of structures against lightning
page 14
4.
4.1
4.2
4.7
4.10
Fire-fighting equipment
Fire-fighting equipment for use by staff
Fire-fighting equipment using halon
Existing halon extinguishers in healthcare premises
Total and partial flooding systems
page 23
5.
5.1
Fire safety training for all staff in healthcare premises
General
page 26
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5.2
5.7
5.9
5.12
Training requirements
Trainers
Recording and assessing training programmes
Fire drills
6.
6.2
6.4
6.13
6.14
How to respond to an outbreak of fire
Signs of fire
Immediate actions required
Dangers from smoke
Fire action notices, fire safety signs and other fire notices
page 31
7.
7.2
7.9
7.16
7.20
7.28
7.34
7.35
7.39
7.42
7.50
7.53
7.54
7.57
7.63
7.67
7.74
7.77
7.78
7.82
7.89
7.94
7.96
Fire hazards in hospitals and associated precautions
Main kitchens
Correct use of fat-fryers
Cleaning practices
Laundries
Radioactive substances and registration procedures
Ionisation smoke detectors
X-ray film storage
Physiotherapy departments
Magnetic resonance diagnostic equipment
Laboratories
Unattended apparatus
Fire appliances and hazard signs
Electronic data processing equipment
Commercial enterprises on hospital premises
Fire certificates
Management of domestic services
Estates departments
Fire hazards during building operations
Building maintenance
Engineering maintenance
Maintenance – general
Electrical services
page 34
8.
8.3
8.5
8.18
8.27
8.29
8.31
8.32
8.33
Use and storage of flammable substances
Storage of flammable substances
Flammable liquids
Medical gases
Restriction on use of storage accommodation
Notices
Access to manifold rooms and liquid oxygen storage areas
Fire detection system
Sterilizing agents
page 53
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8.34
8.39
8.40
8.47
8.50
Oxygen therapy – precautions
Hyperbaric oxygen chambers
Liquefied petroleum gases (LPG)
Disposable goods
Other potential hazards
Appendix 1 – Number and origin of fires occurring
in UK hospitals during 1989
page 62
Appendix 2 – Checklist: Preparing for a fire emergency
Knowing what to do
Escape routes
Evacuation
page 65
Appendix 3 – Fire action notices
page 57
Appendix 4 – First aid fire-fighting equipment for use by staff
page 75
Appendix 5 – Ionisation smoke detectors – radiation levels,
safe storage and disposal
Legislation
Detector radiation levels
Detector storage
Detector disposal
Fixed smoke detectors
page 61
Contents Help Index
Disclaimer
The contents of the various documents comprising NHS in
Scotland Firecode are provided by way of guidance only. Any
party making any use thereof or placing any reliance thereon shall
do so only upon exercise of that party’s own judgement as to the
adequacy of ‘Firecode’ in the particular circumstances of its use
and application. No warranty is given as to the accuracy of
‘Firecode’ and the Property and Environment Forum Executive,
which produces ‘Firecode’ on behalf of the NHS in Scotland
Property and Environment Forum, will have no responsibility for
any errors in or omissions therefrom.
The production of this document was jointly funded by
the Scottish Executive Health Department and
the NHSScotland Property and Environment Forum.
Guidance revised 1 April 2004.
All previous versions are superseded.
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About this publication
This Scottish Health Technical Memorandum (SHTM) is an important
component of NHSScotland Firecode. It covers a range of general fire safety
measures which apply throughout hospital premises. Although the main
purpose of the document is to provide guidance for hospitals, its general
principles may have relevance to other healthcare premises in appropriate
circumstances.
This version of SHTM 83 updates version 2.0 issued in December 1999 and
reflects Scottish legislation and practice; however, the principles contained are
the same as the version in England, Wales and Northern Ireland.
This SHTM should be read in conjunction with ‘Policy and principles’ issued by
the Scottish Office, Department of Health and other related Firecode
documents, as frequent reference is made to these documents. A number of
NHSScotland Fire Practice Notes (SFPNs) provide specific information on
hospital locations with particular fire hazards that are mentioned in this
document.
The primary remit of NHSScotland and healthcare bodies with regard to fire
safety is the safety of patients, visitors, and staff. For all premises under their
control, Chief Executives/Managers will need to select and implement a
combination of measures to achieve an acceptable level of fire safety, taking
the following into account:
•
all relevant legislation and statutes;
• the advice and approval of local building control and fire authorities.
REVISIONS
Some document references have changed to reflect Scottish versions recently
issued.
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1. General
Scope
1.1
This memorandum is concerned with the importance of general fire precautions
in healthcare premises. In particular, it draws attention to the key role of
management in devising and implementing policies and programmes for dealing
with the life-threatening situations presented by fire in an extremely vulnerable
environment, and for ensuring that staff at all levels receive appropriate and
regular training in fire safety and evacuation procedures. The trained staff
referred to throughout this document are those trained in fire safety procedures
and practices appropriate to the workplace, that is, they need not always be
regarded as trained professional staff, such as registered nurses.
1.2
The important role of staff in fire prevention and in responding promptly and
effectively in the event of a fire, is emphasised. It is stressed that prompt action
is the most crucial element in saving lives and minimising damage to property.
1.3
Guidance is provided on the use and storage of flammable substances and the
fire hazards of particular hospital departments. These matters are covered in
greater detail in the appropriate Scottish Fire Practice Notes (SFPNs) of
NHSScotland Firecode.
Background
1.4
Few people have first-hand experience of a serious fire, yet all appreciate the
threat it presents and the terror it brings when an outbreak becomes
uncontrollable. This effect is heightened when patients are involved whose
observation and mobility are impaired by illness or disability. A special
responsibility therefore devolves on hospital management in relation to fire
safety in their premises.
1.5
Statistics of fires occurring in hospitals must be treated with caution, as some
fail to get reported. However, Home Office figures indicate that between 2000
and 3000 fires occur in UK hospitals each year, of which about half start in
wards and in other patient care areas, and most are caused by the careless use
and disposal of smokers’ materials, by malicious fire-raising, and by faulty
electrical equipment. For further details see Appendix 1.
1.6
A “life-threatening” fire is one which leads to casualties and rescue, or where
evacuation is necessary. Fortunately, only a very small proportion of fires in
hospitals falls into this category. Occasionally a very serious fire occurs such
as that when 30 patients died at Coldharbour Hospital in 1972, and when seven
patients died at Warlingham Park Hospital in 1982. The potential for serious
fires of this sort indicates the need for adequate staffing in wards at night. The
dangers of smoke logging resulting from the lack of provision or ineffective use
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of fire doors, and the use of non flame-retardant bedding, contribute to the
seriousness of a fire. Comparatively few very serious fires occur, however, and
this is partly attributable to the vigilance, skill and fire safety training of the staff
who work in those locations.
1.7
Apart from the risk to life, a serious fire disrupts treatment and damages
property. While most hospital fires do not spread beyond the ward or room in
which they start, the financial and organisational consequences from fire
damage can be considerable, often costing many thousands of pounds,
particularly if specialised equipment is involved. With its limited resources
NHSScotland cannot afford the costs of fire damage, especially when so much
still needs to be done to improve fire precautions in hospitals, particularly in the
older stock.
1.8
The importance of structural fire protection is stressed in SHTM 81 – ‘Fire
precautions in new hospitals’ and in SHTM 85 – ‘Fire precautions in existing
hospitals’, however, the success of this form of protection can only be effective
after a fire has started. Equal, if not greater, attention should be paid to the
prevention of fire and to the need for speedy and effective response to an
outbreak. The provision of fire-retardant furniture, furnishings and textiles (see
SHTM 87 – ‘Textiles and furniture’) is another important measure. These
measures complement, but are not a substitute for, structural fire precautions.
1.9
The provision of adequate means of escape for patients and staff is a statutory
requirement. Means of escape becomes crucial once a fire has taken hold. In
the majority of hospital buildings the basic principle for escape in the event of
fire, is that the occupants can always turn their backs to the fire and travel away
from it directly by way of circulation spaces, other fire compartments, escape
routes and stairways to a place of safety, if necessary outside the building.
There is a requirement for alternative escape routes leading directly to a place
of safety. The application of this principle of escape is embodied in the concept
of progressive horizontal evacuation.
1.10
Fire safety in healthcare premises is the concern of all who work in
NHSScotland. Everyone from the Chief Executive downwards has a
responsibility to understand the characteristics of fire, smoke and toxic fumes,
to know the fire hazards of their working environment, and to practise and
promote fire safety and the need to react instinctively should fire occur. The
unpredictability of human behaviour, particularly in an emergency, should be
appreciated. Attention to fire safety will control the number of outbreaks, save
lives and reduce the resources spent restoring fire-damaged buildings and
equipment, thereby improving standards of patient care.
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2. Fire safety policies and staffing levels
2.1
The contents of this chapter should be read in conjunction with the guidance
contained in the Scottish Office, Department of Health’s-’Fire Safety Policy’.
Fire precautions policies
2.2
General managers and Chief Executives are required to have clearly defined
fire safety policies for all premises under their control. This will include a
carefully prepared programme for dealing with fire prevention, fire-fighting and
the movement or evacuation of patients in an emergency. The programme
involves the implementation of physical precautionary measures to prevent the
occurrence and spread of fires, and the provision of means for dealing with
such outbreaks in accordance with statutory and NHSScotland Firecode
requirements. The policies must also include the instruction and co-operation of
every member of staff, professional and administrative, to ensure a clear
understanding of their role in taking effective emergency action.
2.3
An essential ingredient of any fire safety policy is the preparation of an
operational strategy for immediate implementation when a fire emergency
arises. This must set the emergency procedures and is one of the most
important features of a fire policy, and it must be familiar to all staff.
Responsibility for drawing up and maintaining comprehensive fire precautions,
safety policies and programmes of improvement rests principally with the senior
management. They will be assisted by managers at each appropriate level, and
hospital fire safety advisers appointed in accordance with the guidance in the
Scottish Office, Department of Health’s-’Fire Safety Policy’.
2.4
Preparation of a fire safety policy requires teamwork because of the
complexities of a hospital organisation and there must be a multi-disciplinary
approach to the consideration of proposals for particular premises. Managers
and hospital fire safety advisers should consult with administrative, medical,
nursing and estates experts when formulating or amending fire safety policies.
The local fire authority may be consulted regarding fire emergency procedures.
2.5
Senior managers who delegate particular duties to supporting staff, should be
informed regularly that the arrangements continue to be satisfactory. Difficulties
and deficiencies must be brought to their notice without delay. It is important
that policies and plans produced in accordance with the foregoing paragraphs
are reviewed regularly so that physical changes in the hospital’s structure,
changes of function, procedures and other matters which have a bearing on fire
safety, can be taken into account promptly.
2.6
The operational strategy for dealing with a fire emergency must be prepared to
suit the circumstances of individual premises. For convenience, a checklist for
assisting line managers to prepare a fire emergency procedure is included in
Appendix 2.Contents Help Index
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Fire safety signs and notices
2.7
The Health and Safety (Signs and Signals) Regulations 1996 control the display
of safety signs. Reference should be made to NHS Estates publication ‘Way
finding’, HTM 65 – ‘Signs guide 2: fire safety signs’ issued with HTM 54.1 –
‘User manual’, 1993, and to BS5499: Part 1: 1990 (1995): ‘Specification for fire
safety signs’.
2.8
Statutory (blue/white) fire prevention notices and fire action notices are required
to ensure that the means of escape and fire precautions are maintained and
used in the manner intended. Other notices and signs are required to
supplement statutory provisions. Signs are standardised such that “prohibition”
signs are displayed as white on-red, “safety” signs as white-on-green, and
“hazard” signs as black on-yellow. At conspicuous positions in all parts of
hospitals and other healthcare premises, statutory notices and signs must be
displayed which state clearly and concisely the agreed main actions to be taken
upon discovering a fire and on hearing the fire alarm. In addition, notices giving
more detailed instruction about fire action must be displayed on notice-boards in
staff rooms and staff residential accommodation. Local circumstances will
determine whether statutory fire notices, safety signs and fire action notices
must be multilingual. Where available, pictograms should be considered.
2.9
Escape routes and fire exits must be prominently indicated by means of the
approved signs. It must be possible to read fire exit signs and notices during a
period of electrical power failure. Staff must familiarise themselves with those
appropriate to their workplace during their span of duty. They must also be
familiar with the locations and instructions relating to first aid fire-fighting
equipment and other equipment requiring action in the event of fire.
2.10
Management has a particular responsibility in respect of all staff, including
agency, bank and other part-time staff, employed in patient care areas of
hospitals. They must have an operational procedure which ensures that fire
safety training is given to such staff immediately at their first attendance in an
unfamiliar place of work, such as a ward or department. Staff must be shown
the necessary fire alarm call points, the fire stations accommodating first aid
fire-fighting appliances, the boundaries of the fire compartments, fire doors and
escape routes, and be given an explanation of the evacuation strategy for the
location.
2.11
An example of a fire action notice for display in all staff rooms, staff residential
accommodation and on notice-boards is contained in Appendix 3.
Staffing levels
2.12
The presence of an adequate number of staff who have received specialised
training in fire safety is the best first line of defence against fire. This is
particularly important at night when levels of activity in a hospital may be
reduced, staffing levels are lower, and detection of an outbreak of fire may be
delayed. Trained staff must be able to respond promptly and effectively to any
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fire emergency and this is a vital factor in limiting the consequences of an
outbreak where dependent patients are involved.
2.13
The medical and nursing needs of in-patients in a nursing management unit
usually mean that a minimum of two staff are required to be on duty at all times.
These staff must be trained in the methods of patient evacuation appropriate to
the clinical dependency of those under their care. This number may need to be
supplemented if the patients are highly dependent and to ensure that there are
at least two trained people quickly available at all times, for example during
meal breaks, to carry out evacuation procedures in the event of fire.
2.14
It is the responsibility of management to achieve an agreed safe level of staffing
sufficient to deal with the consequences of a fire in its early stages. All staff,
agency, bank or other part-time staff, must be trained in patient evacuation
methods. Any who have not been trained must be under the direction of fullytrained staff. Unless other specific arrangements have been made, the senior
nurse in the nursing management unit must be responsible for taking the
initiative until relieved.
2.15
It should be noted that the fire safety recommendations of NHSScotland
Firecode have been agreed with the Home Office Fire Services Inspectorate
and are devised on the assumption that these requirements will be met. It is the
responsibility of management to have an operational policy to ensure that in the
event of fire, additional personnel may be mobilised rapidly to assist in the fire
zone.
2.16
Where a Health Board has established one or more small premises located
remotely from its main sites, perhaps accommodating a few patients under the
care of a small number of nursing staff, it must have an operational policy which
takes into account the circumstances of the location and satisfies both the
requirements of this SHTM and the Scottish Office, Department of Health’s-’Fire
Safety Policy’.
2.17
In accordance with the ‘A Model Management Structure for Fire Safety’, a
Property and Environment Forum publication included in NHSScotland
Firecode, it is essential that a Nominated Officer (Fire) be appointed in hospital
premises who is primarily responsible for ensuring that trained staff, in
compliance with paragraph 2.13 above, will be available should an outbreak of
fire occur at any time. The provision of specialist hospital fire safety advisers
(refer to ‘Fire Safety Policy’) is a matter which the Health Board must consider
in the light of their particular circumstances. The SEHD strongly recommends
the appointment of competent hospital fire safety advisers to advise
management and to report on the means of fulfilling existing and forthcoming
statutory and Firecode obligations in all NHSScotland premises.
Fire safety audits
2.18
The Scottish Office, Department of Health’s-’Fire Safety Policy’ requires that
each Chief Executive/general manager must have for each of their premises an
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effective fire safety management system which provides means for installing
and satisfactorily maintaining an adequate level of fire precautions designed to
prevent the occurrence, ensure the detection and warning, and to stop the
spread, of fires. This programme should also include procedures for raising the
alarm in case of fire, for fire-fighting, and for the movement or evacuation of
patients and staff in an emergency, and appropriate means for formally
recording staff training in these matters.
2.19
Each Chief Executive/general manager is required to ensure that their Health
Board has a clearly defined fire safety policy and management system.
2.20
To assist with this mandatory requirement, it is recommended that Chief
Executives/general managers arrange for an annual audit of fire safety,
covering all of their premises. The purpose of the audit is to monitor
compliance with NHSScotland Firecode and other statutory requirements (Fire
Precautions Act 1971, etc.), to identify weaknesses in compliance, set up
remedial programmes, and to allocate sufficient resources within the framework
of their business plans. Local circumstances will dictate prioritisation of need.
The processes of a fire safety audit differ from those for risk assessment as
required, for example, by the procedures of SHTM 86. Risk assessment firstly
identifies fire hazards and the particular risks they present to the occupants of a
premises. Following a thorough assessment of the risks, effective fire
precautions are arranged to match the level of fire risk. A fire safety audit would
verify that these fire precautions, once in place, are being maintained
effectively.
2.21
Fire safety audits should examine and question all aspects of fire safety. They
may be carried out either by competent staff employed by the Health Board or
by external consultants. The audit should be systematic and cover all aspects
of fire safety, including physical precautions, staffing arrangements and
management systems. Where required, validation checks must be included in
the audits. For example, documentary evidence supporting the fire precautions
policy should be examined, the visual integrity of cavity barriers, fire stopping,
etc should be verified, and remedial actions set in train where necessary.
2.22
The fire audit team must have full access to the relevant staff, records, buildings
and plant.
2.23
The following guidance points to particular aspects which should be covered by
the audit:
•
the acceptance of responsibilities set for fire safety as required by the
Scottish Office, Department of Health’s-’Fire Safety Policy’, by the Chief
Executive/general manager;
•
written fire safety policies for all healthcare premises;
•
nomination of an Executive Director having responsibility for fire safety;
•
appointment of Nominated Officers (Fire);
•
appointment of Hospital Fire Safety Advisers;
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•
a rolling programme for installing and maintaining an adequate level of fire
precautions for each of its healthcare premises, for inclusion in the annual
business plans for each premises;
•
a regular review and updating of fire safety policies and emergency
procedures;
•
risk assessments in accordance with SHTM 86;
•
a procedure for reporting serious fires, in accordance with the Scottish
Office, Department of Health’s-’Fire Safety Policy’;
•
training of staff in accordance with the Scottish Office, Department of
Health’s-’Fire Safety Policy’, and SHTM 83;
•
procedures for alerting the fire brigade in the event of a fire in accordance
with SHTM 82;
•
regular testing and recording of the condition and effectiveness of fire
alarm and detection systems and extinguishment systems;
•
regular checking and recording of the condition of first aid fire fighting
equipment;
•
regular checking of the effectiveness of escape lighting;
•
the presence and validity of fire drawings, indicating means of escape,
physical fire precautions, etc;
•
applications for obtaining fire certificates for premises designated under the
Fire Precautions Act 1971;
•
the procedure for issuing hot work permits, and the control and use of
flammable materials, for example adhesives, etc, within hospital premises;
•
appropriate procedures for consultation with local fire and building control
authorities;
•
the correct procedure for the storage of flammable liquids;
•
practice of evacuation techniques involving the use of escape bed lifts;
•
provisions for commercial premises (SFPN 5);
•
provisions for housing in the community;
•
fire safety in staff residences (houses in multiple occupation);
•
the registration of nursing homes and private hospitals;
•
policies for purchasing flame-retardant textiles and furniture (SHTM 87);
•
compliance with the Fire Precautions (Workplace) Regulations as amended
by The Fire Precautions (Workplace) (Amendment) Regulations 1999.
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Competent persons
2.24
Paragraphs 2.17, 2.19 and 2.21 refer directly or indirectly to the use of a
competent person. Wherever a competent person in respect of fire safety is
recommended within an NHSScotland Firecode document, the following
definition shall apply:
Competent person: a person recognised as having sufficient technical training
and actual experience, or technical knowledge and other qualities both to
understand fully the dangers involved, and to undertake properly the statutory
and Firecode provisions referred to in this document.
A competent person may be a person employed by NHSScotland or a person
employed in an organization appointed to undertake work on behalf of
NHSScotland. In proper fulfillment of duties, a competent person would be
expected to have the necessary proficiency inter alia:
•
with relevant laws, regulations and codes of practice etc, and their
application to NHS premises;
•
for liasing with other professional staff;
•
for interpretation of technical drawings;
•
with passive and active fire precautions;
•
for assessing fire risks and applying effective countermeasures;
•
with fire-fighting equipment and its continuing effectiveness;
•
for organising, supervising and controlling the work of others.
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3. Fire prevention
General
3.1
The spread of fire can be limited by the incorporation of structural fire
precautions and the use of flame-retardant textiles and furnishing materials.
However, the likelihood of fires starting can be reduced significantly if suitable
preventive measures are adopted. Good practice in fire prevention is largely a
matter of awareness through training of the ways in which fires can start, and of
the upkeep of orderliness and tidiness in day-to-day activities, that is, ‘good
housekeeping’. The Nominated Officer (Fire) or an appointed deputy should
undertake the responsibility of walking the patient care areas of hospital
premises each day, to ensure that there is compliance with the guidance of this
section.
3.2
Hospitals contain much flammable material, but they are not in general
considered to constitute a high fire risk. Staff are always on duty and fire
incidents are normally discovered quickly, enabling prompt action to be taken.
In patient treatment and accommodation areas, for example, no time need be
lost if suitable first aid fire-fighting equipment is provided and staff on duty know
how to use it (if it is safe to do so).
3.3
Certain locations in a hospital, for example laboratories and pharmacies,
medical gas stores, main kitchens, laundries, boiler houses, workshops, stores,
and now shops in the foyer, etc, carry higher fire risks and fire loads, and it is in
such locations that fires may occur which can gain a hold and lead to
considerable damage. These areas should be located separately, but where
they are within or adjacent to areas to which patients or staff have regular
access, they require special attention when structural fire precautions, fire alarm
and detection facilities, and fire suppression measures are being planned.
3.4
Important aspects of fire prevention in hospitals include the need to recognise
fire risks from smoking, the increasing possibility of wilful fire raising, and the
application of ‘good housekeeping’ practices by all staff. These aspects are
dealt with in more detail in the following paragraphs.
Smoking
3.5
Smoking has shown a marked decline in recent years; however, statistics show
that a major cause of fires in hospitals is still from carelessness in the use and
disposal of matches and smokers’ materials.
3.6
A reduction in the number of fires caused through smoking is feasible if the
following advice is strictly followed:
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3.7
a.
apply careful vigilance to ensure that smokers do not cause fires by the
careless disposal of cigarettes and matches, or by falling asleep while
smoking. Be aware that elderly people and those with mental illness may
present a particularly high risk;
b.
sufficient and suitably-placed ashtrays or bins of an approved type
should be provided for the safe disposal of smokers’ materials, where
smoking is permitted;
c.
day rooms and other places where smoking is permitted should be
inspected at regular intervals during the day and periodically after they
have been vacated for the night, to ensure that discarded smokers’
materials have been removed and that they have not ignited other
materials;
d.
“smoking” and “no smoking” areas should be clearly marked by
appropriate signs and displayed in mandatory or prohibition format where
necessary. Smoking should be prohibited in main kitchens, stores, ceiling
voids, ducts and basements, and in parts of buildings where there is
combustible storage.
The clear aim should be to discourage and restrict smoking as far as
practicable, and detailed guidance on promoting no smoking policies on NHS
premises is contained in the Scottish circular MEL(1992)24.
Wilful fire-raising
3.8
Wilful fire-raising, accounts for about 20 per cent of hospital fires, and this
proportion is increasing. This form of malicious fire-raising is a particular hazard
in hospitals for people with mental illness. However, the nature of the
occupants means that they may not be fully aware of the consequences of their
actions. At other hospitals, fire raisers have set fire to premises without regard
to the safety of the occupants.
3.9
The activities of fire raisers can be frustrated by alertness on the part of staff to
persons acting suspiciously, and to the activities of known fire-raisers amongst
patients. Prompt removal of combustible rubbish, care in securing premises,
particularly stores containing flammable materials, volatile fluids, aerosol
canisters with flammable propellants, etc, will reduce the risks from arson. The
new Scottish Fire Practice Note 6 – ‘The prevention and control of wilful fire
raising in NHSScotland healthcare premises’ – should be consulted.
3.10
The free-access nature of many hospitals means that, in general, members of
the public have relatively easy access to vulnerable parts of hospital complexes.
The possibility of wilful fire raising from intruders, disgruntled employees and
others should be considered. Fire authorities have frequently drawn attention to
the need for better procedures for controlling waste disposal and for restricting
the unauthorised access to vulnerable parts of hospital premises.
3.11
Accumulation of waste material external to hospital premises can constitute a
serious fire risk. Unattended waste is an attraction to potential fire raisers.
Reports of fires originating in piles of combustible waste in hospital grounds are
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common. These fires may spread to damage property, and smoke may activate
adjacent automatic fire Contents Help Index alarm systems and cause tension
and irritation to patients and staff. Better control of access to areas having
unattended waste and prompt disposal of waste will reduce these risks.
Good housekeeping
3.12
Attention to ‘good housekeeping’ practices can reduce the likelihood of fire.
Some of the particular practices which should be observed are:
•
avoidance of the use of highly flammable materials and liquids wherever
practicable;
•
orderly methods of stacking in stores where linen, paper or plastic
packaging are used, to reduce the risk of fire spread, and to assist firefighting;
•
storage of equipment and packages in designated areas only –not in
plantrooms, services voids and shafts, corridors or lobbies;
•
regular checks to ensure that storage is never permitted in a hospital street
or an escape route, near a fire exit or fire-fighting equipment;
•
positively discouraging the drying of items over heaters having radiant heat
sources which can lead to dangerously high temperatures and possible
ignition;
•
regular checks for the accumulation of rubbish in “out-of-sight” spaces such
as lift wells, behind radiators, basements, dead-end corridors, etc. Waste
and unauthorised storage must be dealt with promptly;
•
regular cleaning of workplaces, machinery and equipment spaces, and
checks for the accumulation of fluff and grease deposits in laundries, main
kitchens and similar areas;
•
correct storage of cleaning rags and materials in non-combustible
containers after use;
•
when leaving places of work, checking for possible causes of fire, for
example electrical equipment left on or plugged in (over 20 per cent of fires
start in electrical equipment), gas appliances and other heating sources left
on. Vulnerable doors and windows should be secured against intruders;
•
when television viewing is concluded for the day, checking by staff that all
TV equipment is switched off and unplugged from socket outlets;
•
removal of un-fused multiple point adapters found in socket outlets by
estates department staff, and warning staff generally about their use;
•
prohibition of unauthorised adjustment or repair to electrical equipment, and
no use of official, unofficial, or private electrical equipment until it has been
checked and approved by the appropriate technical staff. The connection
of 13 amp plugs must be undertaken by technical staff;
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•
regular checking of electrical cables and cords for signs of wear, and the
immediate withdrawal from service of any suspect electrical equipment,
which must be reported to the officer responsible for electrical maintenance.
Combustible waste
3.13
The following paragraphs 3.14 to 3.23 relate only to the fire precautions aspects
of waste and its disposal.
General principles
3.14
It should be the aim of unit managers to have a policy for the prompt disposal of
waste from hospital activities accumulating over a 24-hour period. This will
entail the provision of secure places of storage for waste awaiting disposal. It is
expected that such receptacles as imperforate non-flammable or metallic bins,
both types to be supplied with well-fitting lids, will be provided for this purpose.
To deter wilful fire raising, loaded receptacles should be taken away to
designated secure places to await disposal, remote from patient care areas.
Unattended waste should not be stored or left in underground tunnels,
walkways and basement areas, on stairways or corridors. Escape routes must
be kept clear at all times. Waste disposal chutes, where provided, should be
maintained under constant supervision. Any redundant chutes which connect
basement zones with floors above may constitute a serious fire and smoke risk
and must be sealed off in the basement, and at each floor level, with fire- and
smoke-resisting seals.
3.15
An efficient procedure must be established for the collection and disposal, or
recycling, of combustible waste. Such waste might include, for example,
packing cases, packaging materials, clinical and food packaging and other
waste products left over from works activities, etc. The continuing increase in
the use of disposable items, many of which are of a combustible nature,
emphasises the need for diligence and for prompt removal to designated places
of storage and disposal.
Waste disposal and collection
3.16
Regular collection of waste material is essential, from wards and patient
treatment areas and from designated holding points. Staff must be instructed,
as part of their fire safety training, to place waste materials only in officially
provided containers, and at designated collection points. Whenever practicable,
at least one collection point should be provided for each department of a
hospital.
3.17
Paper or plastic refuse sacks must be mounted on fixtures with self-closing lids,
but these must not be located in corridors or escape routes. If located in a staff
or patient care area, refuse sacks should be completely housed in a noncombustible container, for example a metal bin with a well-fitting, self-closing,
metal lid, or in a fire-resisting enclosure.
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3.18
A conspicuous and durable notice should be exhibited nearby, warning smokers
against placing their spent materials in containers.
3.19
Arrangements must be made for the transfer of full sacks without delay to
secure holding enclosures for further disposal on a regular basis, as needs
demand.
3.20
Collection and storage spaces should be separate from occupied premises and
sources of ignition in incinerating areas. If necessary, they should be enclosed
by suitable fire-resisting construction where there are siting difficulties.
Safe disposal of flammable liquids
3.21
The safe storage of flammable liquids in healthcare premises is dealt with in
Health and Safety series booklet HS(G)51 ‘The storage of flammable liquids in
containers’. The quantities of flammable and highly-flammable liquids kept in
departments should be as small as is reasonably practicable for the day-to-day
purposes of the department.
3.22
The safe disposal of unwanted small quantities of flammable or highly
flammable liquids should be entrusted to competent persons acting with the
knowledge of the hospital fire safety adviser. It may be possible to achieve
disposal by safely burning highly-flammable liquids in suitable shallow metal
trays in the open air, at safe locations remote from buildings, flammable storage
areas and drains. The opportunity might be taken to combine this activity with a
staff training session in first aid fire-fighting. Highly-flammable liquids and many
solutions and reagents used in pathology laboratories must never be disposed
of down sinks, gulleys and drains, as this practice can cause explosions, injury
and damage.
Incineration
3.23
Certain items, such as paraffin wax and spent aerosol canisters, are not
suitable for disposal within incinerators because they can cause explosions and
thereby jeopardise the safety of operators and equipment. Some aerosol
canisters use flammable gases as propellants, and these can explode with
great force. “Ozone-friendly” spraying substances are available, some in nonpressurised containers, and the use of these should be encouraged.
Aerosol containers
3.24
Advice on the handling of aerosol cans was given in Health Equipment
Information No 76, January 1979. An extract is given below:
“HEALTH EQUIPMENT INFORMATION No. 76 – JANUARY 1979 20/79
Pressurised aerosol sprays: the safe disposal of empty cans and general safety
precautions. Because of the continuing reports of accidents and problems in
the disposal of pressurised aerosol cans, advice given in HEI No 17 (item
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18/66) and 22 (item 44/67) on their storage, use and disposal is re-issued and
amplified.
1. Hospital departments should hold only a number of cans required for
immediate use. Additional quantities should be kept in a cool store,
preferably one reserved for the storage of highly flammable substances and
having adequate low-level ventilation.
2. Cans should not be exposed to excessive heat, for example direct sunlight
or radiators.
3. Cans should be handled and stored carefully to avoid damage.
4. Aerosols should not be sprayed near naked flames or other sources of
ignition.
5. An aerosol can should not be operated when the can is inverted.
6. Manufacturers’ warnings printed on the container must always be observed.
7. Under no circumstances may aerosol cans be disposed of by incineration –
the resultant explosion may cause injury and considerable damage. Health
authorities should ensure that users do not place empty cans in refuse bins,
but keep them separately for eventual collection and disposal.
Further information on the safety precautions to minimise the fire/explosion risks
associated with aerosol cans is available from the Fire Protection Association,
Bastille Court, 2 Paris Garden, London, SE1 8ND.
Storage of clinical waste
3.25
The following documents provide guidance on the storage of clinical waste:
•
‘Safe disposal of clinical waste’, – HMSO, ISBN 0 11 886355 X – issued by
the Health Service Advisory Committee;
•
Scottish Hospital Technical Note No 3: Version 4.
Underground premises
3.26
Fires in underground premises, or parts of premises, can go unnoticed and
present a special hazard from the resulting build-up of smoke, toxic gases and
heat, due to reduced ventilating facilities. Access and fire-fighting may be
difficult.
3.27
The following fire precautions are applicable to underground or windowless
premises:
a.
flammable storage should be arranged in such a way that the fire-risk
potential is minimised;
b.
where possible, access should be arranged directly from the open air;
c.
areas containing significant fire risks should be segregated by fireresisting construction from the remainder of the premises, and be
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equipped with automatic fire detection or, where justified, with fixed firefighting equipment appropriate to the assessed risk;
d.
designated means of escape must be provided for occupants and
maintenance staff, and means of giving and receiving fire warnings must
be provided, as a separate zone, off the main hospital fire alarm system;
e.
ventilation systems should be so arranged as to minimise the risk of their
spreading fire, smoke and toxic fumes throughout the area or affecting
other parts of the premises;
f.
the local fire authority should be consulted as to the adequacy of smoke
outlets and access for fire-fighting.
Textile materials
3.28
Advice on the use of fire-resistant textile materials in healthcare premises is
given in SHTM 87 – ‘Textiles and furniture’.
Lightning and its characteristics
3.29
Lightning is the manifestation of the high-energy discharge which occurs
following a natural build-up of electrical charges in storm clouds. In the UK
there are about one million flashes to the ground in every decade. Activity
varies across the country. More flashes occur in the east than in the west, and
more occur in the south than in the north. In accordance with this pattern,
statistical data shows that the yearly average of ground flashes ranges from 0.1
to 0.6 per square km. The figure varies by 2:1 in step with the 11-year sunspot
cycle.
The possible consequences of a lightning strike
3.30
A ground strike produces a series of effects summarised mainly as electrical,
mechanical and thermal. A further effect is that of side flashing.
If, in the case of a factory premises, explosive or highly-flammable materials
(other than materials of such kind and in such quantity that the fire authority has
determined that they do not constitute a serious additional risk to persons in
case of fire) are stored or used in or under the premises, a fire certificate is
required. The local fire authority should be consulted
3.31
Lightning can cause injury and death in four ways:
a.
by directly striking a person, causing serious burns and death due to
termination of various main physiological functions;
b.
from fire and/or structural damage to premises, causing masonry, etc to
collapse;
c.
from side-flashing;
d.
from sudden large voltage gradients.
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3.32
Buildings struck by lightning often catch fire suddenly, especially if they are
inadequately or not protected by a lightning system. The resulting fire and
smoke can lead to injury of persons, including asphyxiation and death. The
damaged structure of the building may be so unsafe as to fall, causing further
injury or death.
3.33
The phenomenon of internal side-flashing between metallic parts of structures
can cause fire and damage. This may occur due to the absence of a protective
system, or one that is faulty through incorrect routing of protective conductors,
and from high impedance joints in an existing, badly-maintained system.
The protection of structures against lightning
3.34
The protection of structures against lightning is a specialist subject which is
beyond the scope of NHSScotland Firecode. It is fully covered in BS6651: 1999
‘Code of practice for protection of structures against lightning’. The BS provides
excellent background on important principles and practice, the need for
protection, and on how to assess the risk of a strike, and makes technical
recommendations about specific types of premises. It also provides an
appendix giving guidance on the protection of electronic equipment against
failure from lightning strikes. This topic may need to be addressed in respect of
the installation and reliability of fire alarm systems provided to accord with
SHTM 82.
3.35
Designers, estates staff and hospital fire safety advisers must be aware of the
fire and other consequences when lightning strikes a building. By referring to
BS6651, they must consider the need for, and the extent of, a lightning
protection system which, once installed, must be maintained in an effective
state throughout the life of a building. Reference should also be made to SHTM
2007 – ‘Electrical services: supply and distribution’. The design and installation
of an effective system must be entrusted to a company specialising in this type
of work.
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4. Fire-fighting equipment
Fire-fighting equipment for use by staff
4.1
Different classes of fire are defined in BS EN 2: 1992. The following is a brief
summary:
a.
class A fires involve solid materials, usually of an organic nature, in
which combustion normally takes place with the formation of glowing
embers;
b.
class B fires involve flammable liquids, oils, greases and fats;
c.
class C fires involve gases;
d.
class D fires involve burning metals.
It is essential that the provision and use of first aid fire-fighting equipment is
suitable for the fire risk involved. In most parts of the hospital, particularly
patient care areas, the fire is likely to be class A, and water will be the most
practicable extinguishing medium available. Appendix 4 gives guidance on the
selection of extinguishers and their use.
Fire-fighting equipment using halon
4.2
No halon fire-fighting equipment should remain in NHSScotland premises after
31st December 2003. To do so would be illegal
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5. Fire safety training for all staff in healthcare
premises
General
5.1
The management and organisation of fire precautions, including staff training, is
dealt with in NHSScotland Firecode ‘Policy and principles’. Efficient application
of fire safety procedures is subject to staff knowing what to do. NHSScotland
directly-managed units and hospitals are required under the provisions of
NHSScotland Firecode to provide effective training in fire prevention and in how
to respond to an outbreak of fire. This applies to all staff without exception.
Senior medical and managerial staff must lead by example. This requirement is
of vital importance, and it is the duty of senior managers of all disciplines to
ensure that their staff have both basic instruction in fire safety, and training
appropriate to the specific needs of their workplace. Every member of staff in
premises providing healthcare for the NHSScotland must:
a.
understand the character of fire, smoke and toxic fumes;
b.
know the fire hazards involved in the working environment;
c.
practice and promote fire prevention;
d.
know instinctively the right action to take if fire breaks out, or smoke is
detected;
e.
be familiar with the evacuation procedures and escape routes
appropriate to their location at their time of duty.
Training requirements
5.2
Fire, with smoke and toxic fumes, can develop rapidly and cause confusion and
panic. Training should emphasise the need for quick and disciplined responses
when an outbreak of fire is discovered. Basic fire safety procedures must be
included in all induction training for new staff at their first attendance at a
workplace, whenever there is a change of staff, or in the risks in case of fire at a
location. They must understand the action required of them in the event of fire,
that is:
a.
raise the alarm, inform the main telephone switchboard and request
assistance;
b.
remove patients (and others) in immediate danger to a place of safety;
c.
fight the fire, if it is safe to do so, with approved appliances;
d.
evacuate the area in accordance with the emergency evacuation plan;
e.
close all doors, windows, hatches etc to prevent further spread of fire,
smoke and toxic fumes.
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5.3
An effective fire-safety training policy will enable staff to learn about and
practise basic actions and appreciate the wider implications of the fire safety
strategy, including:
•
the reasons for fire and smoke compartmentation of buildings, and for
protected escape routes to the open air;
•
the importance of ensuring that the intended functions of fire/smoke doors
are not prejudiced by the dangerous practice of wedging them in the open
position;
•
the dangers of locking fire exit doors – no fire exit door on any escape route
to be secured by means of keys;
•
the requirement for a clear procedure for allowing contractors to work within
hospital premises;
•
the need to be familiar with escape routes, with site layout, with the internal
layout of the premises in which they work and in which they reside, and to
recognise the need to keep escape routes free of obstruction and rubbish;
•
the potentially fatal consequences of the spread of fire, smoke and toxic
gases;
•
the fire hazards of their local environment and the need for vigilance;
•
how to recognise signs of fire;
•
how to raise the alarm, initiate communication with the fire brigade, and how
to activate local procedures for dealing with a fire;
•
in general, when and how to undertake first aid fire-fighting, where
appliances are located, which appliance to use and how it should be
operated and used (reminder: all but the smallest fires should be left to the
fire brigade);
•
the circumstances in which patients (and others) should be removed to a
place of safety and how evacuation should be carried out.
Fire exit doors must afford immediate means of escape. There are a number of
proprietary methods of maintaining means of escape while providing security
from external access. Fire exit doors with special mechanical and break-glass
devices must be continuously alarmed to deter unauthorised use. BS5725 Part
1 provides standards for “panic” bolts and latches. Fire doors which need to be
held open for the efficient running of a unit may be held open by automatic holdopen devices which release the door on the activation of the fire alarm system.
5.4
Additional training must be provided to meet the special needs of particular
locations, and for staff who have special responsibilities. Examples are:
•
nursing staff, and any others who may have to assist, should receive
instruction and training in appropriate methods of evacuation, that is,
techniques for moving and assisting patients (and others) to evacuate
quickly in an emergency. The special problems of moving patients from an
ITU and similar locations, where highly-dependent people are cared for,
must be well rehearsed;
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•
telephone switchboard operators must be instructed and trained in the
actions they must take in the event of fire in the hospital, that is,
communicating with the fire brigade in accordance with guidance in SHTM
82;
•
estates staff must have precise instructions for dealing with the safe control
and isolation of services such as gas, water, electricity, ventilation, piped
medical gases, etc, which they may need to control during a fire. (This
applies also to staff in hospital main kitchens, for example.)
5.5
All staff, including part-time and agency staff, must attend a local fire-safety
training course to include the first aid fire-fighting and emergency evacuation
procedures appropriate to their actual place of work. This training should take
place immediately on appointment, be for at least one hour, and preferably
should be repeated at least once more in their first period of 12 months, and
thereafter once annually. Training for staff on night duty is particularly important
in view of the reduced level of staffing which applies at that time. To comply
with fire safety regulations in designated premises such as offices, shops and
factories (or hospital premises undertaking a ‘factory process’), staff must
receive instruction or training in what to do in case of fire.
5.6
Consideration should be given to the establishment of a fire training unit for the
purpose of training staff in fire safety procedures. Where it can be justified, this
should be within the boundary of a health authority or trust premises. It may be
economic to consider such a facility for a large hospital site, where it is to be
expected that a fire training unit should be under the care of the hospital fire
safety adviser. The unit would provide those parts of fire safety training which it
is impracticable to undertake at a work location, to supplement the latter.
Trainers
5.7
The Scottish Office, Department of Health’s-’Fire Safety Policy’ requires general
managers and chief executives to ensure that the Trust has a clearly defined
fire safety policy and management system. The primary responsibility for
ensuring that there is an effective policy for training all staff in fire safety
procedures rests with an executive director assisted by a senior member of
staff, who should receive suitable training prior to assuming their duties. A
suitable course for this purpose is available through the Property and
Environment Forum in conjunction with the Scottish Fire Service Training
School.
5.8
The specialised fire safety training of staff will be under the care of specialist
hospital fire safety advisers, who must decide what knowledge and skills are
required by staff to implement the fire emergency evacuation plan agreed for
the premises, to apply routine fire prevention measures, and to undertake first
aid fire-fighting. Together, these officers must define the standards of
performance to be achieved by staff in meeting the requirements of the
hospital’s fire safety policy, while retaining compatibility with day-to-day
operational functions. Priorities need to be identified and standards set which
are capable of satisfactory completion within a realistic timescale.
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Recording and assessing training programmes
5.9
To achieve the necessary standards of all-round competence, the training
programme should include practical sessions and fire drills to supplement
classroom instruction. It is essential that training sessions are well publicised
and that arrangements are made in good time for the release of staff. Records
must be kept of staff attending instruction, the dates and duration of the
instruction, the nature of training given, and names of those attending and those
instructing, in order to identify staff needs for training and to verify training
should the need arise.
5.10
Assessing the effectiveness of training schemes is important but often difficult to
carry out with certainty. Nominated officers (fire), in conjunction with hospital
fire safety advisers, should from time to time devise methods of testing staff. It
is likely that the practical performance of staff at training will offer the best
indication of a programme’s effectiveness and the degree to which staff have
assimilated instruction. The recording system must enable the nominated
officers (fire) to oversee training programmes effectively and check that training
targets have been met, including those for part time, agency and night-duty
staff.
5.11
The hospital fire safety adviser, or an assistant, is responsible for the detailed
recording of staff attendance at training sessions and their performance. In
certificated premises (Fire Precautions Act 1971), training records should be
held in the premises to which the fire certificate and the training relates. It is
recommended that this practice is extended to all parts of a healthcare
premises. Consideration should be given to discussing attendance at fire safety
courses at each annual round of staff appraisals.
Fire drills
5.12
The effectiveness of emergency plans for dealing with a fire and of various
aspects of fire safety training must be tested by means of practical fire drills,
preferably by both day and night. The frequency and organisation of such
exercises is a matter for local management in association with the local fire
authority, but it is recommended that they take place at least once a year and
simulate conditions in which at least one of the escape routes is deemed to be
obstructed by fire or smoke. Where there is a high turnover of staff, drills may
need to be carried out more frequently. The progress of drills should be
monitored by specially-nominated, competent staff. Records must be kept
giving details of the drills and their outcome. During these drills the fire alarm
must be operated by a member of staff who is told of the supposed outbreak,
and thereafter the fire routine must be rehearsed as fully as circumstances
allow. Drills should not endanger those taking part.
The fire brigade must be alerted beforehand to the precise timing of the alarm
call so that a true fire is not overlooked.
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5.13
A further drill should be carried out as soon as practicable afterwards if the
previous drill has revealed serious problems, if there are appreciable changes in
the staff employed, or if there has been any building work or change to the
premises which affects the means of escape.
5.14
In this SHTM, section 3 deals with the various aspects of fire prevention, and
section 6 deals with the action to be taken in the event of fire. They are not
intended as an exhaustive list for training purposes but they may assist those
concerned with fire safety training.
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6. How to respond to an outbreak of fire
6.1
The prime responsibility for dealing with a serious outbreak of fire rests with the
Fire Brigade, who are trained to take prompt and effective action. The Fire
Brigade must be called immediately a fire is detected or suspected, however
small it may appear. The first few minutes are crucial in the development of a
fire but staff should not attempt to fight a fire unless it is safe to do so. Specific
recommendations for arranging communication between hospitals and fire
brigades are given in SHTM 82 – ‘Alarm and detection systems’.
Signs of fire
6.2
The presence of fire may be indicated by smells of burning, crackling and
related fire noises, and smoke seepage, etc. A closed door, even one that is
not hot to the touch, may have a fire on the other side. Where it is suspected
that there is a fire on the other side of the door, the door should not be opened
as this will allow the fire to spread rapidly and may also cause the person
opening the door to receive serious burns.
6.3
The longer a fire remains undetected the greater the probability that it will
become a major life-threatening event, causing severe damage and disruption
to services. Vigilance and prompt action at all times will ensure early detection,
the immediate raising of the alarm and, if safe, effective first aid fire-fighting.
Immediate actions required
6.4
The immediate steps to be taken when an outbreak of fire is discovered are as
indicated in paragraph 5.2 and Appendix 3.
6.5
Raising the alarm is a vital first step in order that help can be obtained from
trained staff and the fire brigade. The main telephone switchboard must be
alerted to carry out detailed procedures for calling the fire brigade (see SHTM
82 ‘Alarm and detection systems’).
6.6
When fire is discovered, staff should primarily be concerned with the safety and
welfare of patients and others in the vicinity. The second step to be taken is to
remove any patients in the vicinity of the outbreak to an intermediate place of
safety in adjoining compartments or sub compartments which are fire-free, in
accordance with the pre-arranged policy of progressive horizontal evacuation.
6.7
The concept of progressive horizontal evacuation is to move patients in stages
away from the site of a fire. This will involve moving them initially to an
adjoining fire compartment or sub-compartment on the same level which has
been designed to protect its occupants from the immediate dangers of fire and
its associated effects. The patients from the evacuated area may be able to
remain there until the fire is dealt with. If the fire progresses and further
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movement of patients away from the area of fire becomes necessary, they can
be moved to the next adjoining safe area providing refuge, leading ultimately to
a final exit by the process of evacuation down available protected stairways or
escape bed lifts. This procedure will give sufficient time for non-ambulant and
partially ambulant patients to be taken down to a place of safety, should it
become necessary to evacuate an entire storey.
6.8
All escape routes must lead to a final exit providing access to a place of safety,
that is, the open air free from the effects of fire and smoke. There will be
particular difficulties in evacuating highly dependent or confused patients along
corridors and down stairways.
6.9
When all patients that are at risk have been removed from the immediate
vicinity of a fire, all doors to the affected room or area must be shut to contain
and delay the spread of flames, smoke and toxic fumes. This action may
reduce the supply of oxygen to the fire and thus help to control its spread.
6.10
Some common sense is required in applying these principles. In the case of a
very minor fire, for example a cigarette smouldering in a waste-paper basket,
prompt action with a hand-operated fire extinguisher may control the outbreak
immediately without the necessity of undue disturbance to patients. However,
this does not preclude the first step of raising the alarm since, if prompt firefighting action does not prove effective, any delay in notification could have fatal
consequences.
6.11
As stated in paragraph 6.1, staff should only tackle a fire if it is safe to do so.
Most small fires can be easily extinguished if attacked as soon as they start with
suitable first aid fire-fighting equipment in the hands of trained staff. (See
Appendix 4 for details of fire-fighting equipment and the types of fire for which
they are intended.) Fires in electrical equipment or installations should not be
tackled before the electrical supply has been switched off, preferably at a point
closest to the equipment involved.
6.12
Persons fighting a fire should always place themselves between the fire and the
nearest means of escape. If there is any doubt about personal safety, if a fire
becomes too difficult to fight or it cannot be contained, it should be abandoned
and left to the fire brigade.
Dangers from smoke
6.13
A high proportion of fires in hospitals originate in wards and involve textiles and
furnishings. In many fires, smoke and toxic gases present far greater hazards
than flames. Most deaths result from smoke asphyxiation and inhalation of hot
toxic fumes. Smoke and toxic fumes can spread very rapidly. They obscure
vision, affect breathing and mental and physical reactions. They can kill
patients and staff who are some distance away from the seat of the fire. Manmade materials without flame-retardancy properties used in furniture,
furnishings and textiles are particularly hazardous because, if ignited, they
produce large quantities of hot, dense black smoke with toxic fumes which will
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quickly interfere with evacuation and fire-fighting. SHTM 87 – ‘Textiles and
furniture’ deals with less harmful materials now available.
Fire action notices, fire safety signs, and other fire notices
6.14
Refer to paragraphs 2.7, 2.8 and Appendices 2 and 3.
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7. Fire hazards in hospitals and associated
precautions
7.1
In chapter 3, reference was made to certain hospital locations which may carry
higher fire risks and therefore require special attention when fire precautions are
being planned. This section considers these locations and their associated
services in more detail.
Main kitchens
7.2
Kitchens are classified as presenting a high fire risk, and a fire occurring in a
kitchen may result in serious and potentially long-term disruption to the catering
services, with an immediate effect on patients and staff. Equipment may be
costly to replace. Also refer to SFPN 4: ‘Hospital main kitchens’.
7.3
Outbreaks of fire in kitchens are mainly from overheated and poorly maintained
fat-fryers, faulty electrical or gas appliances and direct contact with naked
flame. With the introduction of cook-chill services, existing electrical circuits
must be adequate to cope with electrical demand where the reheating of
several containers may take place simultaneously. This is to prevent
overheating of electrical circuits. Similar care is necessary when re-heating
takes place in patient care areas.
7.4
Spontaneous combustion has been known to occur at very high temperatures in
frying equipment, especially when it has been left unattended, or due to
temperature thermostats which have been incorrectly set or are faulty. Fat-fryer
fires which arise in this way are particularly fierce, with rapid spread of fire and
smoke.
7.5
When oils or fats are heated above certain temperatures (see Table 1 below) a
flammable vapour is formed which can be readily ignited, for example by the
burners – more particularly by the naked flames of gas jets. Such ignition can
be terminated only by rapid lowering of the temperature or the exclusion of
oxygen for combustion. The large amount of oil or fat contained in many fatfryers is capable of supporting a fire for a period long enough to cause
considerable damage and to generate much smoke. For safe operation,
therefore, the temperature or cooking media must be held at levels below their
respective flash points (see Table 1 below). This is best achieved by the use of
reliable, automatically operating overriding thermostats. Even so, adequate and
suitable means of extinguishing a fire must be available close to every fryer, for
example at the least, an appropriate fire blanket with a foam AFFF or FFFP fire
extinguisher (see Appendix 4). Staff must be given training in the correct use of
foam extinguishers.
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Smoke Point
ºC (ºF)
Flash Point
ºC (ºF)
Fire Point
ºC (ºF)
Groundnut oil
202 (395)
250 (482)
335 (635)
Corn oil
199 (390)
243 (469)
321 (610)
Lard
205 (400)
275 (527)
326 (619)
Dripping
154 (310)
246 (475)
331 (628)
Hydrogenated cooking fats
190 (375)
228 (442)
331 (628)
Table 1 Approximate critical temperatures for various cooking oils and fats
Notes:
a.
normal frying temperatures fall within the range of 163ºC–188ºC (325ºF–
370ºF). Overheating degrades the oil or fat, causing it to darken,
thicken, foam and develop an “off” flavour;
b.
smoke point is measured in accordance with BS684: Part 1: Section 1.8.
The temperatures quoted refer to use while cooking; for fresh fats and
oils heated alone, smoke points may be some 30ºC (50ºF) lower;
c.
flash point is the lowest temperature at which vapours can be ignited in a
specific test method. Although combustion is not maintained at this
temperature, there is still a danger of explosion and/or fire. Fire point is
the lowest temperature at which self-supporting combustion can be
maintained under test conditions;
d.
auto-ignition (spontaneous ignition) temperature is that at which vapours
ignite in a heated vessel without an ignition source being present.
Autoignition temperatures are greater than the respective flash points but
do not correlate directly with fire points;
e.
the temperatures quoted in the table refer to oils and fats heated in the
pan alone. While cooking is in progress, flash points tend to be raised
slightly due to steam in the vapour. On the other hand, flash points can
be reduced markedly when oils and fats become degraded or
contaminated;
f.
in general, any temperature higher than the respective smoke points
should be regarded as potentially hazardous.
7.6
Appropriate first aid fire-fighting equipment must be provided throughout the
kitchen area. The selection and specification of such equipment should take
account of the kitchen environment and the particular hazards associated with
kitchen fires on particular appliances. (Refer also to Appendix 4.)
7.7
Fire blankets in accordance with Appendix 4 should be provided at convenient
points and all kitchen staff should be instructed in their use by the hospital fire
safety adviser. It is essential to apply the correct techniques when dealing with
fat-fryer fires. Fish-fryers have lids which may be lowered initially to smother a
fire. Under no circumstances should water be used to extinguish, or allowed to
come into contact with, fat fires. Consideration should be given to the use of
self extinguishing systems for deep fat-fryers (see SFPN 4 – ‘Hospital main
kitchens’).
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7.8
New kitchen staff should be trained in fire safety and be familiar with the
location of fire-fighting appliances. It is important that all catering staff receive
proper instruction on the correct method of operating fat-fryers safely as
detailed below.
Correct use of fat-fryers
7.9
Oil or fat should be maintained at correct levels. Overfilling increases splashing
when food is lowered into the fat, and low oil or fat levels may prevent the
thermostat from working correctly and seriously increase the risk of overheating
and fire.
7.10
Heating sources supplying pans should never be left operating when used oil or
fat is being drained from the pans.
7.11
Care is required when solid fat is introduced into empty pans. Until a sufficient
quantity of fat has melted to cover the sensitive elements of thermostats, these
devices may remain ineffective.
7.12
If the type of cooking fat or oil is changed, the new cooking medium may have a
different flash point from that previously used. Estates staff should be informed
when a change is made so that thermostat settings can be checked. Oils and
fats of different types should not be mixed.
7.13
A high standard of regular and effective maintenance is essential to reduce fire
risk. The most reliable apparatus will fail eventually if it is not regularly
inspected and overhauled, and if the controls are not correctly adjusted.
Incidents have occurred where deep fat-fryers have caught fire when cooking oil
has leaked from faulty pans on to the gas burners below, destroying the gas
valves and associated control equipment.
7.14
Correct functioning of both the normal controlling and the overriding thermostats
is extremely important. Operating temperatures should be checked, as should
diaphragms of relay valves, which can stiffen with age and fail to shut off gas
supplies.
7.15
Routine cleaning is essential, with particular attention being given to the
removal of fatty deposits from the hob and surrounding metalwork, the hood,
sides and back of the fryer, internal surfaces of ductwork, fan blades and any
filters.
Cleaning practices
7.16
Hoods should be constructed of sheet metal with smooth surfaces which can be
easily cleaned.
Fibreglass construction is unsuitable because of the possibility of excessive
release of smoke in the event of fire, and distortion and destruction of the hood.
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7.17
Equipment, working surfaces and structural parts must be maintained at a high
standard of cleanliness. Care should be taken in the use of cleaning materials,
which must not be allowed to come into contact with food products.
7.18
General refuse and discarded packaging must not be allowed to pile up in the
kitchen or to restrict escape routes.
7.19
Sacks of rubbish must not be left near the kitchen overnight unless they are in a
secure holding area.
Laundries
7.20
Laundries are classified as being a high fire risk. Most serious laundry fires
occur during ‘silent’ hours when staff are not present to raise the alarm.
Because of the high capital value of laundry plant and equipment and the critical
importance of the laundry service, an automatic fire protection system is
regarded as essential, except perhaps in very small laundrettes and existing
laundries nearing the end of their economic life.
7.21
The selection and specification of fire detection equipment should take account
of the laundry environment and the particular hazards associated with laundry
fires. For instance, a large proportion of laundry fires originates in smouldering
linen, and the early detection of smoke by means of smoke detectors is
essential. This will lead to the prompt attendance of fire-fighters, and avoid a
major conflagration.
7.22
Laundries suffer from this form of spontaneous combustion which is caused by
a build-up of heat at the centre of bulk loads of hot linen, through the slow
oxidation of the textile fabric within the load. Very little smoke or heat may be
produced for some time, perhaps a few hours, but eventually the material bursts
into flame.
7.23
The risk of spontaneous combustion is increased when hot work is taken
straight from a tumble dryer or calendar and tightly packed in trolleys or trucks.
The presence of residues of oil, grease, wax, soap, rubber or similar materials
on the fabric will further increase the danger.
7.24
Tumble-dried work has been a major cause of fires due to spontaneous
combustion, and special attention must be paid to the following operating
procedures:
a.
work should not be over-dried in the tumbler;
b.
work should not be left in the tumbler after the drying process is finished,
but should be unloaded immediately;
c.
tumblers must always be unloaded and left in an empty state overnight;
d.
tumble-dried work should be separated and folded as soon as possible
after removal from the tumbler. If this cannot be done, the work should
be removed from the tumbler and spread out in such a way that the heat
is quickly lost;
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e.
7.25
ideally, tumblers should be equipped with manual, or preferably
automatic, means for cooling the load at the end of the drying cycle.
NHSScotland laundries must have instructions for employees, displayed in
appropriate positions, on the safe operation of tumble dryers and the handling
of dried loads to reduce the potential for fire.
Where tumble dryers are installed within the common services areas
of nurses’ residential accommodation and other comparable locations, similar
instructions must be displayed.
7.26
Fluff collects in laundries and, if ignited, will result in the rapid spread of fire.
Fluff should not be allowed to accumulate. Regular cleaning of the more
accessible places in a laundry must also include the removal of fluff from
electric motors, heating coils, tumbler ducts and roof trusses.
7.27
The minute textile fibres comprising such fluff or lint are prone to spontaneous
ignition when impregnated with oil, wax or other greasy residues, particularly if
adjacent to sources of heat. The areas under calender beds, and around the
operating mechanisms of cabinet garment finishing machines, are particular
points of danger.
Radioactive substances and registration procedures
7.28
Section 104 of the Environmental Protection Act 1990 (EPA90) (now
superseded by the Environment Act 1995) removed Crown exemption from
NHSScotland hospitals in respect of registration under Section 1 of the
Radioactive Substances Act 1993 (RSA60) for the keeping and use of
radioactive material. The holding and use of radioactive material in
NHSScotland hospitals is controlled by an administrative agreement between
the Scottish Environment Protection Agency (SEPA) and the Scottish
Executive. From 1 January 1991, when S.104 of EPA 90 came into operation,
all NHSScotland hospitals were required to formally register under S.1 of
RSA60, and they should approach the relevant regional SEPA office to obtain
the necessary application forms.
7.29
There are a number of departments within hospitals which may use radioactive
substances, for example radiotherapy, nuclear medicine, radiology, oncology,
pathology and pharmacy. Other departments may use radioactive substances
for research projects in associated facilities. Radioactive substances are
normally kept in storage facilities, refrigerators, safes, etc which can be locked.
It is expected that this and the general protection afforded by the construction of
these departments will provide effective barriers against fire. Provided that
appropriate steps are taken to eliminate the use of flammable materials within
rooms, the risk of a fire should be low.
7.30
The use of radioactive substances will be embodied within local rules which
must indicate general principles and describe the means for complying with the
lonising Radiations Regulations 1985. These rules must contain contingency
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plans for any reasonably foreseeable incident and should include any risks
associated with an outbreak of fire.
7.31
Local fire authorities should be made aware of the normal locations of
radioactive sources in hospitals and the general nature and activity of the
sources involved. Suitable mandatory notices will indicate the presence of
radioactive sources and electrically-powered units which generate radiation, for
example X-ray units. The latter would not be considered as risks in fire
situations because they would be isolated from their mains power at the
incidence of a fire. It is important, therefore, to identify those locations where
there may be genuine risks from radioactive sources at the time of a fire.
7.32
The local fire authority must be kept informed of new or changed practices by
means of periodic reviews to maintain the effectiveness of agreed fire
emergency procedures. Fire Brigade personnel will normally be equipped with
suitable monitors and protective clothing to safeguard them against anticipated
risks, but the need for any further provisions must be considered at time of
review. Any protective equipment used at a fire must be monitored after use for
the presence of radioactive contamination and then dealt with in accordance
with agreed procedures. Nominated Officers (Fire) should ensure that suitably
qualified hospital personnel are available to give authoritative advice at times of
review and fire emergency.
7.33
During a fire emergency it may be necessary to evacuate patients who are
undergoing treatment or diagnosis by means of radioactive substances. Care
must be taken to avoid injury to these patients while they are being handled, or
to other patients, due to the presence of a radioactive substance. Special
arrangements must be considered for patients undergoing such therapy and the
need to segregate them from other patients and staff, particularly those who are
pregnant, during an evacuation process. These special requirements should
have been examined beforehand and form part of the pre-arranged evacuation
strategy.
lonisation smoke detectors Radiation levels, safe storage and
disposal
7.34
Some types of smoke detector used in automatic fire detection and alarm
systems contain radioactive materials. Radiation levels for each type of
detector, their storage and safe disposal after recovery, are controlled by
legislation. Appendix 5 to this SHTM provides guidance on this subject.
X-ray film storage
7.35
X-ray film produced in this country has a cellulose acetate base and is classified
‘non-flam’, although it will burn slowly. Prior to 1941, film made of cellulose
nitrate was available. This type of film is highly flammable and explosive at
slightly raised temperatures. However, the need to retain such film will be
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reducing every year and storage for small amounts only should now be
required.
7.36
‘Non-flam’ film has a similar degree of fire risk to products made from paper,
and steel cabinets are considered to be the most suitable containers for
storage. Naked lights and other igniting agents should not be permitted in the
storage area.
7.37
If film is not to deteriorate in storage, the storeroom temperature should not fall
below approximately 10ºC (50ºF) and low temperature type heating should be
used. Electric heaters should be of an enclosed convector type installed at a
high level and controlled by a room thermostat.
7.38
Cellulose nitrate film, where retention is still required, should be stored in totally
enclosed metal containers having tight-fitting lids and conspicuously marked
‘Highly Flammable’ in red lettering. Stocks exceeding 35 kg (80 lb) should be
stored in a room of fire-resisting construction of minimum one hour, and which
is reserved exclusively for this purpose. It must be well ventilated directly to the
outer air. The store should preferably be located remotely from healthcare
buildings, when its fire resistance may be reduced to half an hour. It should be
kept cool because nitrate film can decompose after lengthy storage, particularly
in a warm temperature. The door to the store must be permanently and
conspicuously marked ‘Film store – No Smoking’.
Physiotherapy departments
7.39
Fires have been attributed to the overheating of physiotherapy wax baths, which
have been left switched on overnight to reduce ‘warming up’ time the next day.
A time-switch may be used to control the power to socket-outlets supplying wax
baths. Timing devices must be regularly checked to ensure that the settings are
still correct.
7.40
Because of the highly flammable nature of wax, thermal safety devices must
form part of these appliances. A thermostat to control the temperature over a
range considered safe for the patient (maximum 50ºC) is required, with a
manually resetting type provided which is preset to trip at a safe temperature
(60ºC maximum). This will ensure that no overheating occurs when the bath is
empty or partly filled. The temperature limits of control are determined by
patient safety as well as fire risk. Operating temperature range should be 45–
50ºC. Overheating will occur at 55–60ºC. Automatic detection should be
considered where it is normal practice to leave electrical equipment in
unattended use.
7.41
The sterilizing of physiotherapy wax by heat can constitute a serious fire risk
unless carried out in suitable non-combustible surroundings under proper
supervision. Suitable fire extinguishing apparatus should be at hand, for
example a 10 litre (2 gallon) foam (type AFFF or FFFP) or a 4.5 kg (10 lb)
powder-type extinguisher. Staff must be trained in the use of foam
extinguishers.
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Magnetic resonance diagnostic equipment
7.42
The Department of Health document ‘Guidelines for Magnetic Resonance
Equipment in Clinical Use’ covers important aspects of magnetic resonance
diagnostic equipment in clinical use, with particular reference to safety of
personnel who may need to enter the room(s) concerned at the time of fire. It is
recommended that nominated officers (fire) and the specialist hospital fire
safety advisers are fully familiar with the contents of this document.
7.43
Strong magnetic fields are generated by magnetic resonance diagnostic
equipment and are located within a designated ‘controlled area’. Access to the
controlled area is restricted to authorised personnel. Unauthorised personnel,
including unauthorised staff, must be medically screened before entering the
controlled area. The strong magnetic field within the controlled area can affect
the operation of heart pacemakers, and cause a projectile effect on
ferromagnetic materials.
7.44
Within the controlled area an inner controlled area may be defined where the
magnetic field strength is even stronger. Before entering the inner controlled
area all personnel must take the following precautions:
a.
they must deposit mechanical watches, credit cards, magnetic tapes and
ferromagnetic objects at the reception area;
b.
they must remove from their clothing all ferromagnetic objects such as
pins, scissors, keys, tools, hair grips, certain spectacles that have
ferromagnetic parts, etc;
c.
ferromagnetic objects such as tools, gas cylinders, trolleys etc must not
be taken into the inner controlled area. Non-ferrous fire extinguishers to
special order are obtainable from a major UK manufacturer.
7.45
These restrictions on access to the controlled area have implications for fire
safety.
7.46
Fire safety procedures which specifically address the problems associated with
controlled access must be prepared in advance in association with:
7.47
a.
the “responsible person” who has the day-to-day responsibility for
magnetic resonance, as delegated by the general manager/chief
executive;
b.
the hospital fire safety advisers;
c.
the local fire authority.
The fire safety procedure must consider the effects of a fire in areas adjacent to
rooms accommodating the magnetic resonance equipment, specifically to
establish a ‘shut-down’ procedure which will make the equipment safe and allow
unauthorised personnel safe access into the controlled area. An authorised
person who can take responsibility for the controlled area must be available 24
hours a day to assist the fire brigade should a fire emergency occur.
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7.48
7.49
The types of magnet systems associated with magnetic resonance equipment
and their characteristics are listed below:
a.
resistive magnet systems: in the event of a fire affecting a magnetic
resonance diagnostic unit containing a resistive magnet, electric power
should be isolated immediately and the unit evacuated. When the power
is isolated, unauthorised personnel may enter if necessary;
b.
permanent magnet systems: the field associated with a permanent
magnet cannot be switched off. The fringe field is very low compared to
other magnets, up to a distance of one metre from the magnet. Nearer
than this the field strength increases rapidly, giving rise to intense forces
on ferromagnetic materials. A prominent warning notice should be
placed at the entrance to the controlled area and on the magnet to the
effect that the field is permanently energised;
c.
superconducting magnet systems: these involve the use of liquid helium.
With these systems the magnet must be quenched before it is safe for
the emergency services to enter the inner controlled area with
ferromagnetic material. Prominent warning notices must be provided.
Quenching involves the boiling off of large quantities of helium, and must
only be carried out by suitably trained and authorised personnel.
The cost and specialist nature of this equipment may be such as to justify the
installation of a permanent automatically operated fire extinguishing system.
This may be in the form of sprinklers or a carbon dioxide flooding system.
Before such a decision is made, the manufacturer of the equipment should be
consulted to establish which extinguishing agents are best suited to the
characteristics of the equipment.
Laboratories
7.50
Pathology laboratories are classified as high fire risk. Most fires in laboratories
arise from accidents with highly flammable substances.
7.51
Oxidising agents such as perchloric acid require particular care. Although most
of these agents are not flammable, they will oxidise many materials with which
they come into contact, particularly following spillage or leakage, and greatly
increase the risk of fire or explosion. The hazards of perchloric acid are dealt
with in DS164/75 and HN(76)95.
7.52
Explosions are also possible if flammable solvents or specimens treated with
such solvents are stored in domestic-type refrigerators, since accumulations of
flammable vapour can be exploded by the normal operation of the electrical
circuit. If it is necessary to store such solvents and treated specimens in
refrigerated conditions, a refrigerator designed specifically for the purpose
should be used.
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Unattended apparatus
7.53
Special precautions are necessary where equipment is left connected to the
supply during non-working hours, particularly where such equipment
incorporates heating facilities with a possibility of over-heating. In these
circumstances, a pre-set thermal cut-out should be provided in addition to the
normal thermostatic control. Automatic fire detectors should be considered for
rooms where it is normal practice to leave electrical equipment in unattended
use.
Fire appliances and hazard signs
7.54
It is essential that in laboratory areas, conveniently sited hand-operated first aid
fire-fighting equipment is available. Powder and carbon dioxide extinguishers
are considered to be the most suitable for laboratories.
7.55
In laboratories handling categories A, B1 and B2 materials, which may be highly
contagious, the laboratory doors must show an international bio-hazard sign. In
addition, doors on equipment and specimen cupboards must have labels
marked “Danger of Infection”.
7.56
Nominated officers (fire) or, where appropriate, hospital fire safety advisers,
must inform local fire brigades of special hazards associated with these
departments. In the event of a fire, the hospital fire safety adviser, an assistant
or any other responsible person in the department, should be contacted
urgently for advice.
Electronic data processing equipment
7.57
A fire in an electronic data processing (EDP) installation can lead to extensive
asset losses and serious business interruption. However, the occurrence of a
major fire is a rare event, and provided there are persons on the premises,
minor incidents involving EDP equipment can normally be dealt with by isolating
the electric power to the unit in question. For this reason frequent ‘backing-up’
of data should occur and duplicates of data files should be stored away from the
EDP room. Insurance companies often quote the greatest risk as that from
losing the databases, rather than the equipment itself.
7.58
Modern electronic equipment constitutes a relatively low fire hazard;
accordingly, any protection philosophy directed solely towards a fire originating
within EDP equipment is defective. Fires often originate outside the confines of
EDP installations, typically from electrical faults, wilful fire raising and smoking.
7.59
The infrequent occurrence of serious fires in large EDP installations does not
obviate the need for high standards of fire protection. There are three levels of
protection:
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a.
equipment protection: protection of EDP equipment from the effects of
fire by automatic detection and/or extinguishment located within EDP
cabinets;
b.
room protection: protection of EDP equipment from the effects of fire by
automatic detection and extinguishment by equipment located in the
room;
c.
building protection: protection of the premises that houses the EDP
installation.
7.60
Generally, fire protection measures are installed to prevent financial loss,
directly or indirectly (that is, through business disruption), and serious disruption
to an important service. The degree of fire protection should be commensurate
with the potential for such losses.
7.61
An equipment protection system is unlikely to be adequate for room or building
protection, as it is not intended to deal with fires other than those in EDP
equipment. A room protection system is likely to be inadequate for equipment
protection, and can only offer building protection if it is highly reliable in
operation, and is effective throughout all areas of the building that houses the
EDP installation. A building protection system will not normally operate at an
early enough stage to provide equipment protection, and may not be adequate
for room protection.
7.62
BS6266: 1992 provides detailed guidance on the protection from fire of EDP
installations. It applies specifically to new installations but its recommendations
may also be used as a guide to the adequacy of precautions in existing
installations. However, it should be noted that halon extinguishers and systems
must not be used and existing halon extinguishers be appropriately disposed of.
Although BS6266: 1992 recommends the use of halon fire extinguishment,
generally this is not recommended now for new installations within
NHSScotland in view of the international agreements stemming from the
Montreal Protocol. See also SFPN 5
Commercial enterprises on hospital premises
7.63
Commercial enterprises, particularly shops established in hospital foyers, etc,
may present unacceptable fire risks. Small shop units in hospitals have been
commonplace for a number of years. Recently, much larger complexes have
been installed principally, but not exclusively, within the main entrances of
hospitals. Income generation units other than shops, such as leisure and
business facilities, may also be considered as additional attractive commercial
undertakings. Such arrangements, and the variety of options to which suitable
hospital locations may be put, are rapidly increasing.
7.64
The introduction of such high fire risk and high fire loading of the form described
was not foreseen when NHSScotland Firecode was prepared originally. There
is now concern that these enterprises may seriously affect the fire safety of
existing patient care areas in hospitals by subverting the previously established
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fire safety criteria. Before they become involved with such schemes, hospital
managers should consider their effect on patient safety, irrespective of whether
the hospital complies with current NHSScotland Firecode guidance.
7.65
Joint action by the Department of Health and the Home Office Fire Service
Inspectorate established the need for further guidance, which resulted in
Scottish Fire Practice Note 5 – ‘Commercial enterprises on hospital premises’.
7.66
This SFPN must feature prominently in discussions at the inception of all
projects of this nature. Failure to apply its recommendations will lead to
wasteful delays when schemes are submitted for approval, as a necessary
prerequisite to the eventual issue of a fire certificate by the local fire authority.
Fire certificates
7.67
Offices and shops, as defined by the Offices, Shops and Railway Premises Act
1963, and factories, as defined by the Factories Act 1961, may require a fire
certificate which is issued by the local fire authority. Although hospitals are not
designated under the Fire Precautions Act 1971, certain premises or parts of
premises within a hospital are subject to designation as offices, shops and
factories, and an application by the occupier must be made for a fire certificate
using Home Office Form FP1 (Rev) 1993 – ‘Application for a fire certificate’.
Required under the Fire Precautions Act 1971 (as amended by the Fire Safety
and Safety of Places of Sport (Scotland) Act 1987).
7.68
The requirement for a fire certificate with respect to designated premises
depends upon the number of persons employed on certain functions and their
location within the designated premises.
7.69
Briefly, a fire certificate may be required if:
7.70
a.
more than 20 persons are at work at any one time;
b.
more than 10 persons are at work elsewhere than on the ground floor;
c.
there are two or more designated premises in a building and the
aggregate number of persons employed therein exceeds 20, or 10
elsewhere than on the ground floor;
d.
there are factory premises, irrespective of the number of persons
employed, in or under which explosives or highly flammable materials are
used or stored.
The following Home Office publications contain further guidance on fire safety in
designated parts of hospital premises:
a.
‘Guide to fire precautions in existing places of work that require a fire
certificate: factories, offices, shops, and railway premises’;
b.
‘Code of practice for precautions in factories, offices, shops and railway
premises not required to have a fire certificate’.
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These documents must be consulted for guidance on fire safety in designated
parts of healthcare premises.
7.71
The following list provides examples of locations within a hospital where an
application must be made for the issue of a fire certificate:
•
commercial enterprises (particularly shops);
•
central sterile supply departments;
•
theatre sterile supply units;
•
manufacturing pharmaceutical departments;
•
processing areas of medical photographic departments;
•
pathology laboratories;
•
hospital sterilizing and disinfecting units;
•
laundries (including their boiler houses);
•
boiler houses;
•
hospital and ambulance maintenance workshops;
•
electrical sub-stations (including standby generators);
•
radiotherapy shielding workshops (manufacturing);
•
radiological departments (recovery units);
•
renal units (maintenance and refurbishment);
•
workshops in psychiatric and other hospitals (industrial therapy);
•
central processing kitchens for supplying hospitals (cook/freeze meal
production).
7.72
Where the aggregate number of persons at work in designated parts of patient
care premises exceeds 20, or 10 elsewhere than on the ground floor, any office
accommodation associated with the patient care areas may be designated and
may require a fire certificate. However, the means of escape and other fire
precautions should be provided in accordance with SHTM 85 – ‘Fire
precautions in existing hospitals’, not the guidance in the Home Office and the
old Scottish Office publication ‘Guide to fire precautions in existing places of
work that require a fire certificate: factories, offices, shops, and railway
premises’.
7.73
The HSE is responsible for determining which premises are undertaking a
‘factory’ process and they should be consulted. It should also be noted that
compliance with the Fire Precautions (Workplace) Regulations as amended by
the Fire Precautions (Workplace) (Amendment) Regulations 1999 is required.
Management of domestic services
7.74
Cleaning policies and procedures should take account of any relevant factors
involving high fire risk, for instance the presence of dust, grease, etc on walls
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and internal surfaces of equipment which will aid the spread of flame and
production of smoke. Contracts for cleaning services between health
authorities and commercial undertakings should contain clauses to ensure that
contractors will comply with relevant statutory fire safety and NHSScotland
Firecode provisions as a prerequisite to obtaining a contract.
7.75
Ventilation hoods above deep fat-fryers are particularly prone to fire because of
the accumulation of fatty material. It is recommended that main kitchens and
kitchen equipment should be subject to a periodic “deep clean”. The need to
avoid an accumulation of rubbish is referred to earlier in paragraphs 3.10 and
3.14 to 3.18.
7.76
Documents which are of some relevance to fire precautions are DSM Advice
Notes 1 (Cleaning frequencies in acute and general hospitals) and 3 (General
guide to the management of domestic services in the NHS).
Estates departments
7.77
Works areas of estates departments are classified as high fire risk. Close cooperation between works staff and hospital fire safety advisers is necessary so
that the latter have advance notice of maintenance and other work to be
undertaken, particularly if hazardous processes are to be used. If outside
contractors are to be employed, this is particularly important where ‘hot work’ or
flammable processes may be involved; the need for additional temporary fire
safety measures to protect adjacent patient care areas should be considered.
Fire hazards during building operations
7.78
Premises undergoing alteration and extension, repair or maintenance, and
those under construction, are particularly vulnerable to fire, often from lapses in
safety precautions. Some contributory factors are:
•
structural fire and smoke barriers such as walls, doors, floors, fire protective
finishes which may be perforated, or ceilings which may be incomplete or
temporarily removed. Where necessary, steps should be taken to maintain
fire integrity by means of alternative arrangements;
•
accumulation of flammable rubbish such as surplus packing materials,
wood shavings and sawdust. Some building operations also generate fine
dust particles which may become explosive, or potentially explosive, under
certain conditions;
•
unauthorised and dangerous storage and use of combustible building
materials which may constitute a temporary high fire load in locations
adjacent to and forming part of inhabited patient care areas;
•
potentially dangerous processes and techniques during welding, the use of
flame-producing equipment, flammable liquids, adhesives, etc;
•
when fire detection and alarm equipment, and fire-fighting equipment, has
not been fully installed or commissioned;
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•
7.79
obstruction of existing escape routes by construction materials and
equipment.
A significant number of fires occur as a result of the activities of contractors.
Outside contractors present a greater fire risk than NHSScotland staff because
they are not as familiar with the premises as people permanently employed
there. They cannot be expected to appreciate the fire risks, the necessary
precautions, and what action to take in the event of fire. Contractors may have
to undertake work which may be more hazardous than that normally carried out
on the premises. Every effort should be made to ensure that contractors are
aware of the particular risks of working in a hospital environment. The use of
‘permit-to-work’ systems and ‘hot work permits’ etc is essential to define the
extent of agreed access arrangements, any limitations upon activities and
stipulations about fire safety.
Where building work is being carried out in occupied premises, patients, staff
and visitors may be put at risk by a fire originating in the area, or in adjoining
locations. Staff should be warned by the hospital fire safety adviser of the
increased fire and security hazards if remedial physical action is impracticable,
and instructed accordingly of any additional requirements.
7.80
The site activities of contractors should be strictly supervised and controlled,
even during small works and sporadic maintenance visits etc. Estates staff
must ensure that all necessary precautions against fire are taken. The hospital
Fire Safety Adviser should give guidance and keep in regular contact with such
activities to check compliance with the local fire safety policy.
At the completion of construction work, etc, new and existing fire resisting
structures should be closely inspected to ensure that full floor-to-ceiling and roof
fire integrity with the correct use of approved fire-stopping materials around
penetrating services, has been achieved.
7.81
The Department of the Environment booklet ‘Standard Fire Precautions for
Contractors Engaged on Crown Works’ is a useful checklist of fire precautions
which contractors should observe.
Building maintenance
7.82
Fire-protected areas, corridors, service voids, maintenance walkways and other
areas which provide means of escape must be carefully maintained so as to
provide the required resistance to fire, smoke and toxic fumes.
7.83
Fire doors should comply with the required rating for fire and smoke resistance.
III-fitting windows, doors, etc should be adjusted to prevent the admission of air
currents which could feed a fire and spread smoke.
7.84
Fire hazards can be introduced by painted finishes, decorative features and wall
displays. This is particularly so in the case of walls and timber surfaces in old
hospitals which over time may have accumulated many layers of oil-bound
paint. Oil-bound paints are flammable, and thinners, stripping liquids and
cellulose paints often contain highly volatile and flammable ingredients.
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Blowlamps and heat guns used for paint stripping may cause smouldering fires
in inaccessible places.
7.85
Painting processes may introduce hazards. Decanting of paint, thinners and
stripping liquids must not be carried out near to naked sources of ignition. Caps
and lids should be replaced on all containers when not in use. Only sufficient
quantities of paint for a day’s work should be drawn from store. Tins (including
empties) should be returned to store at the end of each day. During paint
stripping, deposits of stripped material must be collected at the end of each day
and disposed of safely. Rags which have become impregnated with paint,
thinners, stripping liquids, linseed oil, etc. should be collected daily and placed
in a non-flammable container with a lid, pending safe disposal, and these
should be removed from the premises at the end of each working day.
7.86
Care should be taken during painting work in the vicinity of pipes carrying
flammable liquids or gases. Aluminium-based paints should not be used.
Thermite can be evolved by the combination of iron oxides (rust) and aluminium
powder, and this can be ignited by a spark from a spanner dropping onto a hard
surface or by gas cylinders being knocked together.
7.87
When blowlamps are used in painting operations, or any other maintenance
work, craftsmen must be taught to observe the following precautions:
a.
never leave a lighted blowlamp unattended;
b.
check that flames from blowlamps do not reach surrounding combustible
material, particularly in roof spaces and inaccessible places, such as
eaves and within the framework of sash windows. Re-check before
leaving the premises, and ensure that there is no evidence of
smouldering behind woodwork;
c.
avoid using a blowlamp near curtains or drapes which might be blown on
to the flame and ignite;
d.
ensure that any burning paint strippings are immediately extinguished;
e.
have suitable first aid fire-fighting equipment available to extinguish any
fire which might be started.
The use of a heat gun in preference to a blowlamp should be considered a safer
option.
7.88
After maintenance work has been carried out, care should be taken to restore
the building elements to their former position and/or condition. Suspended
ceiling sections and access covers should be replaced properly. Failure to
observe these practices could result in smoke and toxic gases being freely
released into escape routes via ducts or voids. Work on pipes and ducts should
include the restitution of fire-stopping materials or dampers. The spread of
flame characteristics of surface finishes should not be reduced as a result of
maintenance work.
The guidance given in paragraphs 7.78 and 7.79 is equally applicable here.
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Engineering maintenance
7.89
Engineering maintenance should be in accordance with good practice, and
planned maintenance schemes should be applied as necessary for the various
items of plant encountered on hospital premises. Any engineering services
associated with fixed fire-fighting systems require particular attention.
7.90
Advice on the maintenance of fire alarm systems is contained in SHTM 82 –
‘Alarm and detection systems’. Records of maintenance done, and tests carried
out, must be kept at each premises.
7.91
Fire-fighting equipment should be maintained on a planned basis in accordance
with the advice given by fire equipment manufacturers. Records of
maintenance done and tests carried out must be kept at each premises.
7.92
Ventilation shafts, smoke hoods, fire/smoke control dampers (where fitted) and
mechanical extract systems such as roof louvers or shutters and fusible link
systems, should be inspected regularly and tested for correct functioning;
records should be kept. This is particularly important where they are designed
to keep an area free of smoke for evacuation purposes in the event of fire, or for
venting of fire, smoke and toxic gases after a fire.
7.93
Control and isolating equipment for engineering installations, that is, gas, water
and electricity, piped medical gases, etc, must be clearly labelled as to the
zones supplied and must be readily accessible to competent staff at all times.
Wherever practicable, service zones should be made coterminous with fire
compartmentation zones.
The use of a heat gun in preference to a blowlamp should be considered a safer
option. The guidance given in paragraphs 7.77 and 7.78 is equally applicable
here.
Maintenance – general
7.94
Dirt, rubbish and unauthorised storage, all of which can accumulate in service
ducts, voids, roof and plant equipment spaces, present a serious fire hazard.
These spaces must be inspected regularly and kept clean. Disused ducts,
services voids, rubbish chutes, etc should be sealed up if possible, but
ventilated as and where this is necessary.
7.95
Particular care should be taken when using liquefied petroleum gas (LPG)
appliances for maintenance purposes in corridors, passageways and assembly
areas. Where such corridors, etc, are part of an escape route, adequate
arrangements should be made to preserve the integrity of the means of escape.
Electrical services
7.96
Some 20 per cent of hospital fires involve electrical equipment and wiring.
Electrical installations must be maintained in accordance with good practice,
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and planned maintenance schemes should be applied as necessary. Electrical
engineering services associated with fire detection and alarm systems and fixed
fire-fighting systems require particular attention. Periodic testing and servicing
of electrical installations must include electrical resistance and earth continuity
tests as prescribed in the Regulations for the Electrical Equipment of Buildings
published by the Institution of Electrical Engineers (identical to BS7671:2001).
7.97
Where electrically-heated appliances such as film processing units, incubators
and drying rooms are liable to be kept switched on while premises are
unoccupied, a manual reset thermal cut-out should be provided in addition to
the control thermostat.
The guidance given in paragraphs 7.78 and 7.79 is equally applicable here.
7.98
Temporary wiring is potentially dangerous and should be avoided where
possible. Where its use is justified, it should comply with the Institution of
Electrical Engineers Regulations for the Electrical Equipment of Buildings
(identical to BS7671:1992). Permanent wiring must be used for installations
which will be required for more than three months.
7.99
Switchrooms should be free from storage of items other than electrical
components which may be required in an emergency. Fire precautions for
electrical sub-stations and switchrooms and for transformer chambers are
included in SHTM 2007 – ‘Electrical services: supply and distribution’.
7.100
Battery rooms should have adequate permanent ventilation direct to the outer
air and a prominent “No Smoking” notice displayed. Naked flames must not be
brought near batteries, particularly while they are being charged. The safety
arrangements must relate to the type of battery installed.
7.101
Improvised arrangements made during power failures can increase fire risk.
The provision of emergency electrical supplies is dealt with in SHTM 2011 –
‘Emergency electrical services’. In those parts of hospitals in which emergency
lighting is not installed, portable battery operated lanterns should be provided.
The integrity of escape lighting is of particular importance.
C
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8. Use and storage of flammable substances
8.1
This section provides general guidance on the use and storage of flammable
substances on healthcare premises.
8.2
Confusion can arise when applying the terms ‘flammable’ and ‘inflammable’
when describing products in common use. These words are synonymous and
to avoid possible confusion authorities concerned with fire safety recommend
that ‘flammable’ is used in all cases. This advice has been followed in this
memorandum.
Storage of flammable substances
8.3
Flammable liquids and other flammable substances, particularly foam plastics
and rubber, should be stored in a special enclosure reserved for the purpose.
Advice on storage procedures is obtainable from the local fire brigade and the
Health and Safety Executive. Detailed guidance on flammable liquids is
contained in Health and Safety Guidance HS(G)51 – ‘The storage of flammable
liquids in containers’. Anti-static precautions should be observed.
8.4
Storage shelves and other fixtures should be constructed of non-combustible
materials and storage facilities should be commensurate with the fire risk. If
large quantities of flammable liquids are involved, storage in a secure enclosure
in the open air is preferable to indoor storage.
Flammable liquids
8.5
Flammable liquids give off vapour which, under certain conditions, can ignite
and/or explode. Many fires are caused by the misuse, or careless use, of such
liquids and particular care is necessary in their handling and storage.
8.6
Quantities of flammable liquids sufficient only for immediate use should be kept
in hospital departments. Additional supplies should be held in a suitably
protected, cool, ventilated store. Containers should be sealed or capped
immediately after use and should not be left standing in direct sunlight or where
they may be knocked over. This applies particularly to volatile liquids in
common use such as methanol.
8.7
Flammable liquids should not come into uncontrolled contact with open flame
equipment or hot surfaces.
8.8
Space heating in laboratories by open flame methods and exposed
incandescent elements must not occur because of the likely presence of
flammable vapour. Work involving the use and release of highly flammable
liquids and gaseous vapours must be carried out in fume cupboards or fluidpouring cabinets, and in accordance with safety procedures.
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8.9
The use of flammable anaesthetics in hospitals is decreasing rapidly, but there
is a risk from electrostatic sparking in areas where flammable anaesthetic
agents are still in use. This matter and the associated anti-static precautionary
measures are dealt with in ‘Report of a working party to review the anti-static
requirements for anaesthetic areas’ (1990, Department of Health) and Health
Technical Memoranda 1 and 2.
8.10
Care should be taken in the use and bulk storage of liquids for domestic
cleaning and office use, for example floor cleaners, floor sealers and correction
fluids.
When flammable adhesives are used in laying floor coverings, smoking should
be prohibited and naked lights (for example gas pilot lights and fires which can
ignite flammable vapours) should not be used in the immediate vicinity or in
adjacent rooms and corridors. All windows in the room and doors which
communicate with the open air should be opened wide, and warning signs
posted. Surplus or discarded flammable liquids must not be poured down
drains, toilets, etc.
The guidance given in paragraphs 7.78 and 7.79 is equally applicable to the
activities of paragraphs 8.10 to 8.12.
8.11
Ignition sources should be prohibited in rooms and below the room or area
where work involving flammable adhesives is being carried out, because
vapours are heavier than air and may penetrate into ducts, etc or through some
floors. The smallest quantity of adhesive necessary for immediate purposes
should be brought into the room or building. These precautions should continue
until the floor covering is completed and evaporation from the adhesive has
ceased. Similar precautions are also necessary during the application of
flammable floor sealers.
8.12
Doors leading to stores containing flammable materials should be kept locked
when not in use and suitable signs displayed. ‘No smoking’ rules should be
rigorously enforced. Naked flames are the greatest and most likely hazard
where oils are in use. The use of welding equipment, blowtorches, etc should
be carefully controlled in the vicinity of flammable liquids.
8.13
Aerosol sprays require careful handling because they may contain a flammable
agent and, if the spray comes into contact with a naked flame, etc a “flamethrower” effect can result. Smoking during paint spraying must not occur.
Advice on the use, storage and disposal of aerosol cans is contained in
paragraphs 3.23 and 3.24.
8.14
The risks associated with cooking oils are dealt with in paragraph 7.5, and those
associated with paint, thinners and painting processes in paragraphs 7.84 to
7.88.
8.15
Fires resulting from dangerous practices and involving fatalities have occurred
in staff residences. The use of volatile fluids for cleaning purposes in the
presence of naked flames or incandescent heaters, or as a means of assisting
an open fire to light, must not occur.
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8.16
Petrol is a dangerous substance. It should be used only as a vehicle fuel and
must never be used as a cleaning agent. When it is proposed to use and store
petrol, the local authority and the Petroleum Regulations should be consulted.
Other flammable liquids such as methylated spirits and white spirit, while having
a legitimate use as cleaning agents, should nevertheless be used with care and
kept away from open flames, gas and electric fires.
8.17
Clothing which has come into contact with a flammable liquid is a particular
hazard and can be ignited by smokers’ materials or through close proximity to a
gas or electric fire appliance. Discarded swabs containing volatile liquids
should be disposed of in accordance with the correct procedures and not in
such a way that discarded smokers’ materials can ignite them in waste
receptacles etc.
Medical gases
8.18
Specific guidance on fire precautions relating to medical gases is given in the
‘Operational management’ volume of SHTM 2022 – Medical gas pipeline
systems. Section 8 ‘Cylinder management’ deals with storage and handling,
accommodation, fire detection systems, etc. Section 9 ‘General safety and fire
precautions’ deals with general safety, material compatibility, fire precautions,
etc. Guidance is also available from the gas supplier and any specific
recommendations should be followed.
8.19
Fire can occur when the following three elements are present at the same time:
flammable materials; an oxidising atmosphere; means for ignition.
8.20
Flammable materials should not be present in cylinder stores, manifold rooms
or liquid oxygen compounds; however, it may not be possible to avoid the
presence of flammable materials in the vicinity of the patient when medical
gases are being used. Flammable materials which may be found near patients
include some nail varnish removers, oil-based lubricants, skin lotions, cosmetic
tissues, clothing, bed linen, rubber and plastic articles, alcohols, acetone,
certain disinfectants and skin-preparation solutions.
8.21
An oxygen-enriched atmosphere may be present when medical oxygen, nitrous
oxide/oxygen mixtures and oxygen/carbon dioxide mixtures are used; nitrous
oxide also supports combustion.
8.22
Ignition sources are numerous and include:
•
open flames, burning tobacco and cigarettes, sparks and electrical sparks
(including those which may be produced by some children’s toys), high
frequency, short wave and laser equipment arcing and excessive
temperatures in electrical equipment such as hair-dryers;
•
cardiac defibrillator discharge;
•
static electricity.
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8.23
A mixture of breathing gases will support combustion. In an oxygen- or nitrous
oxide-enriched atmosphere, materials not normally considered to be flammable
may become flammable; flammable materials ignite and burn more vigorously.
Clothing may become saturated with oxygen or nitrous oxide, and become an
increased fire risk; when returned to normal ambient air, clothing takes about
five minutes to be free of the gas enrichment. Blankets and similar articles
should be turned over several times in normal ambient air following suspected
oxygen enrichment.
8.24
Oil and grease, even in minute quantities, are liable to ignite spontaneously in
the presence of high-pressure oxygen or nitrous oxide; no oil or grease should
be used in any part of the medical gas pipeline system. In particular, oil-based
lubricants should not be used and all fittings, pipes, etc. should be supplied
degreased, sealed and labelled for medical gas pipeline systems. Details of
these requirements are given in SHTM 2022 ‘Design, installation, validation and
verification’.
8.25
The flammable anaesthetic agents such as cyclopropane and ether are very
rarely used; cyclopropane is no longer available as a medical gas. Where
flammable agents are used, special precautions should be taken to minimise
the risk of fire or explosion. Detailed advice is given in BS5724: Part 1.
8.26
The siting and general structural principles for the design of liquid oxygen
storage accommodation are stated in SHTM 2022, ‘Design, installation,
validation and verification’, section 10, and for plantrooms and gas manifold
rooms in section 17. Cylinder storage should be as recommended in SHTM
2022 ‘Operational management’, section 8, ‘Cylinder management’. The
following paragraphs indicate the general precautions which must be taken to
minimise the risk of fire and explosion in accommodation of this kind.
Restriction on use of storage accommodation
8.27
Main stocks of oxygen, nitrous oxide, medical compressed air and other
medical gas cylinders should be stored in the designated cylinder store as
recommended in SHTM 2022, ‘Operational management’, section 8, ‘Cylinder
management’; no other materials should be kept in the store.
8.28
Cylinders should be stored in racks to BS 1319 and used in rotation as
received. As cylinders are emptied and taken out of use, heavy-duty tie-on
labels, clearly marked ‘EMPTY’, should be attached to empty cylinders. Empty
cylinders should be stored separately from the full cylinders. Manifold rooms
may be used for limited storage of cylinders only to the extent indicated within
this document. Detailed procedures for cylinder storage and handling are given
in SHTM 2022, ‘Operational management’, section 8, ‘Cylinder management’.
Notices
8.29
Smoking, welding, all work producing sparks, and naked lights, are prohibited
within or near the manifold room, plantroom and liquid oxygen compound area
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and the cylinder store. This prohibition also applies to the vicinity of the outlet of
the discharge pipe from medical gas safety valves. Safety signs (refer to
paragraphs 2.7 et seq) must be provided within and outside these areas to
indicate this requirement, for example, ‘SMOKING, WELDING AND NAKED
LIGHTS PROHIBITED – MEDICAL GAS STORAGE AREA’. In addition, a
notice clearly indicating the contents of these areas should be displayed.
Safety signs should be provided in accordance with the ‘Safety Signs
Regulations 1980’ and are available from the gas supplier.
8.30
Notices should be posted in wards and departments informing staff of the
location of those medical gas control valves which should be turned off in the
event of a major fire in the ward or department.
Access to manifold rooms and liquid oxygen storage areas
8.31
Access to the manifold room and liquid oxygen storage area should be
controlled. A duplicate key of each should be kept in a locked box with
transparent front cover at the main fire entrance, gatehouse or equivalent
building, so that in the event of a fire, the fire brigade may obtain a key
immediately on entering the hospital site. The transparent front of the box
should be labelled:
BREAK COVER TO OBTAIN KEY
FOR EMERGENCY USE ONLY
Fire detection system
8.32
Smoke detectors should be installed in plantrooms, medical gases manifold
rooms, and in ready-use medical gases cylinder stores in hospitals provided
with an automatic fire detection system.
Sterilizing agents
8.33
Ethylene oxide is a highly-flammable toxic gas. Because of its hazardous
nature, it should only be used in specialist units where appropriate safety
measures have been provided as an integral part of the accommodation. It is
about 12 times as dense as air, and mixtures of air in concentrations of 3% or
more by volume are flammable. For cold sterilizing processes, it should be
used only with a dilutant to reduce the flammability of the mixture. A 13%
ethylene oxide 85% CO2 mixture is frequently used. This mixture is flammable
in certain combinations with air, and those concerned with the handling and use
of this gas mixture should be made aware of the flammability hazards. The
following precautions should therefore be observed:
a.
avoid exposure to heat;
b.
ensure that the purging of equipment and venting of sterilized equipment,
including the venting of relief devices, is carried out in a safe area.
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Oxygen therapy – precautions
8.34
When oxygen therapy equipment is in use, fire and safety warning signs/labels
should be conspicuously displayed at the site of administration to alert the
patient, clinical staff and visitors that oxygen is being used, and of the need to
take precautions.
8.35
A suggested minimum text for a precautionary sign is:
OXYGEN IN USE
NO SMOKING
NO NAKED FLAMES
and the sign should contain the approved graphic symbols for “Hazard” and “No
Smoking”.
8.36
8.37
8.38
When oxygen is being administered in paediatric nursing units the text should
include the precaution:
ONLY TOYS APPROVED BY THE HOSPITAL FIRE SAFETY ADVISER
MAY BE GIVEN TO THE CHILD
Oxygen canopies and tents should be labelled, advising that oxygen is in use
and that safety precautions relating to its use should be observed. Labels
should be attached to the fabric of the canopy/tent in a position to be seen
easily by the patient, and also on the exterior in a position to be seen easily by
clinical staff and visitors.
Consideration may need to be given for signs in other languages.
Hyperbaric oxygen chambers
8.39
Hyperbaric oxygen chambers, which may still be used in some hospitals, may
be pressurised with oxygen up to three atmospheres (30 psi gauge – 2 Bar).
Pressurisation increases the fire risk still further and, in an emergency, it will
take an appreciable time to remove an occupant. Therefore, the most stringent
fire precautions to avoid ignition are necessary in and around hyperbaric
oxygen chambers, including the design of electrical services. Oxygen which is
exhausted or released from hyperbaric oxygen chambers should be dispersed
safely to prevent the possibility of high oxygen concentrations in the event of an
emergency release of oxygen from the chamber. This can be achieved by
piping outlets direct to the atmosphere, or by providing adequate mechanical
extract ventilation in areas communicating with chambers. Fire extinguishers
for use in the vicinity of hyperbaric chambers must have sufficient operating
pressure to be effective in the higher ambient pressures.
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Liquefied petroleum gases (LPG)
8.40
The Highly Flammable Liquids and Liquified Petroleum Gas Regulations (SI
1972-917) and the Home Office Fire Prevention Guide No 4 – ’Safe use and
storage of liquefied petroleum gas in residential premises’ must be consulted by
all who use LPG appliances; paragraph 3.8 and sections 8 and 9 are of
particular relevance. Health and Safety Executive Guidance Note CS 4 – ‘The
Keeping of LPG in cylinders and similar containers’ is also of relevance.
8.41
Commercially-marketed LPG is stored in liquid form, under pressure, in
suitably-tested cylinders or bottles. When LPG escapes in liquid form it
vaporises rapidly, forming a flammable gas-air mixture. Propane and butane
are the most common LPGs used for heating, cooking and lighting purposes.
They are appreciably heavier than air and if they escape they will descend to
floor or ground level and concentrate there unless adequate low-level ventilation
circulates and disperses them. Escaping gas can collect in drains, in pits, and
in ground depressions or under suspended floors at ground level. Dangerous
concentrations can explode in the presence of an ignition source.
8.42
The flammability limits of propane and butane in air are in the order of:
a.
propane – 2.2% (lower limit), 9.5% (upper limit);
b.
butane – 1.8% (lower limit), 8.5% (upper limit).
These are the percentages by volume of gas present in a gas-air mixture which
will produce an ignitable vapour. A concentration of gas less than the lower
limit, or greater than the upper limit, does not produce an ignitable vapour.
8.43
The release of about 1.0 kg of LPG into a room 3 m by 3 m by 3 m, when the
gas is thoroughly mixed with air, will create an explosive mixture throughout the
whole of the room.
8.44
The contents of LPG cylinders can be identified as follows:
a.
red cylinder – propane;
b.
blue or green cylinder – butane.
It is becoming standard practice to fit pressure relief valves to LPG cylinders,
but there may be some cylinders in use which do not have valves fitted. If
exposed to excessive heat, an unrelieved cylinder may explode, but this
possibility is virtually eliminated by the fitting of a relief valve. An ‘empty’
cylinder is still potentially dangerous. In this state the internal pressure is
approximately atmospheric and if the valve is leaking or left open, air can enter
the cylinder and may form an explosive mixture with the remaining gas.
8.45
Portable LPG heaters present particular hazards. They are not recommended
for use in patient areas and areas of high fire risk. Where they are in use, they
should be sited away from draughts and not placed within one metre of
flammable materials. Preventive maintenance procedures should be adopted
by estates departments and strictly observed.
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8.46
The maintenance of LPG installations and appliances, including portable
heaters, is the responsibility of specialist estates staff whose advice should be
obtained where necessary, and who can make arrangements with equipment
suppliers.
Disposable goods
8.47
The increasing use of disposable items made of paper, plastic and expanded
foam can significantly increase fire risk unless appropriate precautionary
measures are taken.
8.48
The storage of flammable disposable items should be restricted to amounts
which are required for current use. These must be kept in containers or
cabinets of non-combustible construction. Additional supplies should be kept in
storerooms that are constructed and equipped for the purpose of storing these
materials.
8.49
Safety Information Bulletins SIB(87)2 and SIB(88)9 deal with the additional fire
precautions necessary for “totally soft play equipment” made from polystyrene
foam. This guidance must be applied in healthcare premises.
Other potential hazards
8.50
Some additional attention to less obvious sources of fire is recommended. Oils
and fats left on combustible materials such as cotton, wool, rags, etc. will
oxidise and may lead to smouldering and spontaneous ignition.
8.51
Static electrical charges can build up to levels where they may suddenly
discharge to produce sparking, for example by the flow in pipes of dry gases,
dusts or combustible liquids (such as benzene or light petroleum) in association
with flammable vapour. Dust can present a real problem in some
pharmaceutical operations and explosions caused by a spark may occur,
especially where starch and dextrin are present. The problems of dry dust and
fluff in laundries, and the spontaneous combustion of compacted linen after
tumbler drying, are dealt with in Chapter 7.0 of this document.
8.52
Precautions are also necessary where flammable solvents are used in
connection with plastic splinting. Electric hairdryers should not be used to dry
such materials.
8.53
For advice on the safe disposal of flammable liquids, see paragraph 3.21.
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Appendix 1 – Number and origin of fires occurring in
UK hospitals during 1989
A1.1
A1.2
Principal statistics
Number of fires
2412
Confined to items first ignited
1701
Spread beyond item but confined to room
682
Spread beyond room of origin
29
Number of deaths
4
Number of casualties
128
Place of origin
Place of origin
Number of fires
% of total
Kitchen
430
17.8
Ward
382
15.8
Lounge, common-room, dining
274
11.4
Bathroom/WC
240
10.0
Access areas
207
8.6
Laundry
138
5.7
Bedroom
120
5.0
Storage areas
92
3.8
Other medical services
86
3.6
Offices
65
2.7
Boiler rooms, workshops, etc
42
1.7
Refuse room
28
1.2
Laboratory
23
0.9
Other
276
11.4
9
0.4
2412
100
Unknown
Total
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A1.3
Source of ignition
Source of ignition
Number of fires
% of total
Smokers’ materials
687
28.5
Deliberate fires
441
18.3
Cooking appliances
395
16.4
Lighting
150
6.2
Matches
141
5.9
Welding, cutting appliances
59
2.5
Wires and cables (fixed)
52
2.2
Specialised equipment
48
2.0
Tumble dryer
44
1.8
Wire and cables (leads)
41
1.7
Washing machines
25
1.0
Central heating
23
1.0
Space heating
21
0.8
Dishwashing machines
20
0.8
Others
247
10.2
Unknown
18
0.7
2412
100
Number of fires
% of total
At ignition
385
16
Within 5 minutes
1478
61
Between 5 and 30 minutes
402
17
Over 30 minutes
102
4
Unknown
45
2
2412
100
Total
A1.4
Time to initial discovery
Initial discovery
Total
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A1.5
Materials first ignited
Materials first ignited
Number of fires
% of total
Waste
566
23.5
Electrical insulation
397
16.5
Food
317
13.1
Other textiles
185
7.7
Bedding, mattresses
166
6.9
Unspecified waste
81
3.4
Raw materials
53
2.2
Structure
43
1.8
Other furnishings
31
1.3
Upholstery
26
1.1
Vegetation
18
0.7
Lagging
17
0.7
Fittings
15
0.6
Clothing on person
14
0.6
Decorations/soft toys
8
0.3
Cleaning materials
6
0.2
Other
421
17.4
Unknown
48
2.0
2412
100
Total
These figures, compiled by the Fire Research Station, relate to fires in hospitals
in the United Kingdom in 1989 which were reported to the fire service. Contents
Help Index
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Appendix 2 – Checklist: Preparing for a fire emergency
Knowing what to do
1.
Managers and their staff will be better prepared for a fire emergency if they
know:
a.
how to raise the alarm and call the fire brigade;
b.
how to get additional help in a fire emergency;
c.
how to evacuate their part of the premises;
d.
the location of fire-fighting equipment in every part of the health building.
at each location information should be prominently displayed;
e.
how to use the fire-fighting equipment in the local workplace, including
any special needs and precautions;
f.
how to deal with hazardous equipment during an emergency, for
example gas cylinders, etc;
g.
who will switch off main supply sources (gas, electricity, etc) and activate
emergency systems during a fire emergency (records must be kept upto-date);
h.
that during a fire in any part of the hospital, telephones should be used
for essential calls only.
Escape routes
2.
Managers are recommended to carry out the following actions in conjunction
with the hospital fire safety adviser:
a.
consider the layout of the component parts of each healthcare premises
and note the fire compartments, fire doors, escape routes, positions of
fire alarm call points, of each;
b.
ensure that the escape routes from each compartment within the
premises have been agreed with the local fire authority. These should
be marked on the plan;
c.
identify with the local fire authority the parts of the healthcare premises
and of neighbouring premises which could be used as safe-holding
areas, so that progressive evacuation can be achieved;
d.
note the location of any secured doors on escape routes and how exit
can be achieved quickly, at all times:
i
emergency exit doors must open outwards;
ii
sliding or revolving doors are not permitted if they are specifically
intended as emergency exits (but refer to (iii));
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iii
emergency doors should not be so locked or fastened that they
cannot be easily and immediately opened by any person who may
require to use them in an emergency.
e.
ascertain what features may obstruct escape routes or hinder
evacuation, for example carpets or non-slip floors along escape routes
will slow down evacuation;
f.
get to know the designated escape routes. Inform staff of any changes
that might affect their suitability, even temporarily, due to contractors
working, etc.
The information obtained from items (a) to (e), if displayed by means of a simple
diagram, will help staff gain an appreciation of the escape routes.
Evacuation
3.
The primary aims of evacuation are:
a.
to remove patients, staff and others from immediate danger;
b.
to keep the distance of any movement as short as possible;
c.
to avoid routes which in the particular circumstances may need to be
used by firemen and others involved in fire-fighting;
d.
to remove patients to a reception area remote from the fire and suitable
for their comfort and continued treatment, possibly for some hours, and
to take a roll-call. (Be prepared – always have a dedicated clipboard and
pen immediately available.)
These aims are broad guidelines. Fire is unpredictable and no two fires may be
the same. Initiative, common sense, a sound knowledge of emergency
procedures and a calm approach to an emergency will do much to ensure a
satisfactory outcome.
4.
The knowledge which managers have of the physical constraints of the parts of
the health premises for which they are responsible, the capabilities of their staff,
and the characteristics of the patients in their charge are essential to the
formulation of evacuation plans. The following points will need to be considered
when devising a plan. Plans will need to be reviewed and modified as
necessary to take account of changed circumstances:
a.
estimate the number of patients and staff who will need to be removed
from the fire compartment or premises in a fire emergency and the time
available for such evacuation;
b.
consider the degree of dependency of patients and estimate the degree
of surveillance and assistance they will require;
c.
estimate the number of staff available both during the day and at night to
cope with an emergency in each ward or part of the premises;
d.
when estimating the number of staff available, consider their capabilities
to cope with evacuation, that is, physical fitness, training and their likely
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performance under stress (especially part time, agency or night staff).
Moving sick people in an emergency is always very strenuous work;
e.
consider the patient-handling methods which would be appropriate in an
evacuation, bearing in mind building constraints on the escape route and
the types of patients. Discuss and agree these with the hospital fire
safety adviser;
f.
identify and note the location of equipment which could be used to aid
evacuation;
g.
in the light of the preceding factors, estimate the number of extra helpers
and their locations required to achieve the safe and speedy removal of all
patients;
h.
estimate the number of staff available within your premises who could
give assistance in an emergency elsewhere;
j.
know how to deal with patients on life-support equipment during an
emergency;
k.
know how to deal with patients whose behaviour is likely to be
obstructive during an evacuation;
m.
practice aspects of the escape plan regularly, including patient handling
techniques, and involve all members of staff.
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Appendix 3 – Fire action notices
The following is an example of a staff fire action notice for display in all staff
rooms, staff residential accommodation, and generally on notice boards.
Fire action
(name of hospital and unit location)
1.
2.
If you discover or suspect a fire:
a.
raise the alarm using the nearest break-glass alarm point. Know their
locations at your place of duty, and elsewhere;
b.
remove people from immediate danger;
c.
fight the fire (if it is safe to do so) using available fire-fighting equipment;
d.
close doors and windows in the immediate vicinity;
e.
notify the telephone switchboard operator of all information relating to the
fire. Ensure the fire brigade is called;
f.
evacuate the area if necessary, to the principles of the agreed fire
emergency plan.
If the fire alarm sounds:
a.
confirm that the fire is not in your own area/zone;
b.
close doors and windows;
c.
one member of staff from each department should report to the
appropriate fire alarm panel/control point and await instructions;
d.
do not go to the scene of the fire unless specifically requested;
e.
do not call the switchboard for information about the fire.
Your nearest fire alarm panel/control point is:
______________________________________________________________
In addition to the more detailed staff instructions, brief, clearly-printed, general
fire notices should be exhibited in conspicuous positions in all parts of the
hospital. The following is an example:
•
On detecting a fire, raise alarm immediately using the nearest break-glass
alarm point.
•
On hearing the fire alarm, proceed immediately to:
______________________________________________________________
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______________________________________________________________
______________________________________________________________
•
Take a roll-call of persons evacuated (be prepared – always have a
dedicated clipboard and pen immediately available).
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Appendix 4 – First aid fire fighting equipment for use
by staff
Type of Fire extinguisher
Type
Colour code
Class of fire
Extinguisher action
Method of use
Water
Red
Class A
Extinguishes mainly
by cooling the burning
material.
The jet should be directed at the
base of the flames and kept
moving across the area
of the fire. Any hot spots should
be sought out after the fire is
out.
Foam
Cream
Class B
Extinguishes by
forming a blanket of
foam over the surface
of the burning liquid
and smothering the
fire.
The jet should not be aimed
directly into the liquid. Where
the liquid on fire is in a
container, the jet should be
directed at the edge of the
container or on a nearby
surface above the burning
liquid. The foam should be
allowed to build up so that it
flows across the liquid.
AFFF
(Aqueous film
forming
foam)
FFFP
(Film-forming
fluoroprotein
foam)
FP
(Fluoroprotein
foam)
Cream
Classes A and B
Note: Some foams
are
not suitable for
use on
live electrical
equipment.
Extinguishes by
forming a fire
extinguishing
water film on the
surface of the burning
liquid. Has a cooling
action with a wider
extinguishing
application than water
on solid combustible
materials.
For Class A fires the directions
for water extinguishers should
be followed.
For Class B fires the directions
for foam extinguishers should
be followed.
Dry powder
Blue
Class B
Safe on live
electrical
equipment
although
does not readily
penetrate spaces
inside
equipment. A fire
may
re-ignite.
Extinguishes by
knocking down flame.
The discharge nozzle should be
directed at the base of the
flames and with a rapid
sweeping motion the flame
should be driven towards the far
edge until the flames are out. If
the extinguisher has a shut-off
control the air should be allowed
to clear; if the flames re-appear
the procedure should
be repeated.
WARNING: Dry powder does
t
l th
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not cool the
fire very well and care should be
taken to
ensure that the fire does not
start up again.
Dry powder
(Multi-purpose)
Blue
Classes A and B
Safe on live
electrical
equipment
although does not
readily penetrate
spaces inside
equipment. A fire
may re-ignite.
Extinguishes by
knocking down flames
and on burning solids
melts down to form a
skin, smothering the
fire. Has some cooling
effect.
Carbon dioxide
(CO2)
Black
Class B
Safe and clean to
use on live
electrical
equipment.
Extinguishes by
vaporising liquid gas
which smothers
flames by
displacement of
oxygen in the air.
The discharge horn should be
directed at the base of the
flames and the jet kept
moving across the area of the
fire.
WARNING CO2 does not cool
the fire very well; care should be
taken to ensure that the fire
does not start up again.
DANGER
Fumes from CO2 extinguishers
can be harmful to users in
confined spaces. The
area should therefore be
ventilated as soon
as the fire has been controlled.
Hose reel
(Drawings from
Appendix 4 need
to be inserted)
Class A
Note: Do not use
on live electrical
equipment.
Extinguishes mainly
by cooling the burning
material.
The jet should be aimed at the
base of the flames and kept
moving across the area of
the fire.
Fire blanket
Light duty
Heavy duty
(Drawings from
Appendix 4 need
to be inserted)
Classes A and B
Suitable for
burning clothing
and small fires
involving cooking
fats and oil and
burning liquids. In
addition to
the uses
mentioned for
light duty blankets,
suitable for
industrial use.
Resistant to
penetration by
molten materials.
Extinguishes by
smothering.
The blanket should be placed
carefully over the fire and the
hands shielded from the
fire. Care should be taken that
the flames are not wafted
towards the user or
bystanders.
Contents Help Index
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Appendix 5 - Ionisation smoke detectors – radiation
levels, safe storage and disposal
Legislation
1.
The relevant legislation which is currently in force is:
a.
the lonising Radiation Regulations 1985;
b.
Statutory Instrument No 953, dated 1980, headed ‘Atomic energy and
radioactive substances - the radioactive substances (smoke detectors)
exemption order 1980’ together with its amendment, Statutory Instrument
No 477 dated 1991.
Safety Information Bulletin No 29, reference SIB(86)44 issued by the
Department of Health, July 1986, headed ‘lonisation Chamber Smoke
Detectors: Notification Requirements of the lonising Radiation Regulations
1985’, should also be consulted.
Detector radiation levels
2.
Statutory Instrument No 953 defines two types of smoke detector containing
radioactive material which are covered by the exemption to the lonising
Radiation Regulations 1985, namely:
a.
Article 4(a) deals with smoke detectors containing americium 241, in
which the total radiation level is less than 40 kilobecquerels (1.08
microcuries); and
b.
Article 4(b) deals with smoke detectors containing radioactive material
emitting a radiation level above that of 4(a), but not exceeding 4
megabecquerels (108 microcuries).
3.
Modern smoke detectors containing americium 241 sources would normally
comply with Article 4(a).
4.
Old type smoke detectors, particularly those containing radium 226 sources,
may fall into the category of Article 4(b), in which case the requirements as
stipulated in Safety Information Bulletin SIB(86)44 should be followed.
5.
Essentially this requires that the Health and Safety Executive/HM Inspectorate
of Pollution be notified in writing of the presence of such detectors on the
premises. In practice, such detectors would normally be permitted to be
retained on site within fire detection and alarm systems, providing their
replacement was undertaken in a reasonable period of time within the life
expectancy of the equipment.
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Detector storage
6.
7.
The total number of ionisation type smoke detectors complying with Article 4(a)
which are unfixed and stored on the premises at any given time cannot exceed
500. Where the total quantity of such smoke detectors is less than 100, no
special storage facilities are required. However, above this number all
reasonably practicable measures should be taken to ensure that the detectors
are kept in a store which:
a.
is constructed, maintained and used so as to prevent the loss or
unauthorised removal of the smoke detectors;
b.
is constructed of non-combustible materials;
c.
does not contain, and is not located close to, any explosive or flammable
material;
d.
is clearly and legibly marked with the word “Radioactive” and the
radiation symbol conforming to the specification for a basic symbol to
denote the actual, or potential, presence of ionising radiation, as
published by the British Standards Institution (BS35 10:1968 (a)), or the
basic ionising radiation symbol published by the International
Organisation for Standardisation (ISO 361 :1975); and
e.
incorporates all reasonably practicable measures to maintain on the
premises clear, legible and up-to-date records on each smoke detector
kept on the premises, and its location.
The Statutory Instrument unfortunately fails to make clear the maximum number
of smoke detectors falling within Article 4(b) that can be stored on the premises
at any given time. It is reasonable to assume, however, that storage facilities
would be required to be of a standard not less than that required for the storage
of smoke detectors falling within Article 4(a) in quantities above 100. In
practicable circumstances definitive guidance should be sought from your local
SEPA Inspector.
Detector disposal
8.
9.
Smoke detectors falling within Article 4(a) may be disposed of by one of the
following means:
a.
sending them to, or causing or permitting their removal by, a person who
is authorised under section 6(3) of the Radioactive Substances Act 1960,
to dispose of them as radioactive waste, or under a description to which
the waste belongs;
b.
sending them to, or causing or permitting their removal by, a
manufacturer of smoke detectors of the same description as the waste;
c.
causing or permitting their removal as refuse by a waste collection
authority or their contractors.
Where the smoke detectors are disposed of as refuse by a waste collection
authority they need not be notified in advance provided that:
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10.
a.
the waste is dispersed within other refuse which is not radioactive waste;
b.
the detectors are mixed such that the total sum of kilobecquerels of
radioactivity in any 0.1 cubic metre of the whole mass of the waste and
refuse does not exceed 40 (1.08 microcuries).
The disposal of radioactive waste comprising of a smoke detector falling within
Article 4(b) is subject to the condition that it is disposed of by one of the means
referred to above, except that which permits their removal by a waste collection
authority or their contractors.
Fixed smoke detectors
11.
Exemption is granted without any limitation or condition in respect of the
keeping and use of the radioactive material contained within smoke detectors in
compliance with Article 4(a).
12.
With regard to smoke detectors falling within Article 4(b), exemption is granted
in respect of the keeping and use of these detectors provided the following
conditions are met:
a.
no incorporated source is mutilated;
b.
whenever there are reasonable grounds for believing or suspecting that
an incorporated source has been lost or stolen:
i
notification to that effect is given forthwith, by the quickest means
available, to a member of the police force and to the “Chief Inspector” (as
appointed under the Radioactive Substances Act 1960) and confirmed to
the latter in writing as soon as practicable;
ii all reasonably practicable measures are taken forthwith for the purpose
of recovering the source;
c.
whenever there are reasonable grounds for believing or suspecting:
i
that the immediate container, or the bonding forming part of an
incorporate source, is broken or damaged; or
ii that any radioactive material has become detached, or has escaped from
an incorporated source because of some defect therein;
notification to that effect is given forthwith, by the quickest means available, to a
“Chief Executive” and confirmed to him in writing as soon as practicable.
13.
Those persons within a health authority or trust hospital who are responsible for
safety and waste disposal matters should be aware of these procedures.
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