Hospitals in India are no safe havens; as much as those clean white sheets, sanitised needles and phenol-cleaned floors might fool one into believing they are. The recent fire at the SUM Hospital in Bhubaneswar isn’t the only incident that validates this sorry reality.
“In Delhi, there are hospitals like Lok Nayak Jai Prakash Narayan, GB Pant, BR Sur Homeopathic and Baba Saheb Ambedkar in which there is a pending issue of NOC due to non-compliance by the hospital authorities. We have tried to explain and resolve the matter at all levels,” says GC Misra, director, Delhi Fire Services.
The problem, he explains further, is that the buildings constructed prior to the passing of the Delhi Fire Prevention and Fire Safety Act, 1986, follow a different set of guidelines. These older structures need to ensure that the gate should be at least six metres wide, there have to fire extinguishers on every floor along with rubber tube hoses, wet-risers for water supply within the building and a standby fire generator for providing power to them, a fire alarm system, compartmentation (fire walls or fire separation) of the building, and a sprinkler system that comes into operation accordingly.
In newer buildings, hospitals have to factor in many other conditions, for instance, the width of the staircase now has to be at least two metres.
RC Sharma, who has spent four decades in fire departments across the country, says that 90 percent of deaths due to fires occur because of smoke (carbon monoxide) and not out of burns.
He points out that once the hospital has acquired its NOC, there are no follow-ups with the fire department in terms of maintenance of equipment like fire alarms and sprinklers.
Moreover, doctors and nurses aren’t repeatedly trained in the evolving evacuation measures. “Private hospitals are centrally air-conditioned and, mostly, don’t have openable window sections. This can lead to a spread of smoke through the duct. Also, there are oxygen pipelines styled like gas pipelines, which greatly add to the risk during a fire,” he explains.
The air handling unit, which bears a big fan and is present on every floor, needs to be checked and cleaned regularly. In government hospitals, the problems faced are different. There is a fear that expensive fittings and medicines might be pilfered so some sections, including staircases, are kept locked.
There is always less capacity and more patients and hence the corridors are flooded with people and stretchers. As a result, informs Sharma, hospitals construct storage rooms and benches to accommodate.
Now, if there are more than three or four patients who are to be ushered out in case of a fire, there is no respite. The third high-risk category is that of the multiple nursing homes across the country that spring open inside commercial buildings.
Dräger, a German multinational company that engages in fire safety and hospital safety equipment, offers holistic fire-detection solutions. Ajit Keshari, who is its east zone director and is based in Kolkata, says that government hospitals are only allowed to buy the technically-qualified cheapest products, and as a result, a lot of scrap gets bought.
“After the fire incident at AMRI hospital in Kolkata in 2011, we have not witnessed the trend of procurement of high-tech fire safety equipment,” he says. Some of Dräger’s products that can ease the risk are the Escape Mask that costs between Rs 10-15,000 and should necessarily be supplied to those on higher floors.
The other is the self contained breathing apparatus that can be tied to the back and comes attached to a mask, which costs between Rs 70-80,000. Speaking of equipment, even the firemen in India don’t always have thermal imagining cameras that allow them to see through the smoke and quickly identify the source of fire.
Fire-safety is an excessively decentralised issue and its cost is borne by the municipality. Still, the National Disaster Response Force (NDRF) feels that there should be greater preparedness towards disaster in highly vulnerable places like hospitals.
“We do regular drills in the metro, for the railways, in schools and colleges, then why shouldn’t hospitals be more responsive? Awareness is important and we are yet to receive a request to carry out a mock drill in a hospital,” says Anil Shekhawat, stationed at NDRF’s Guwahati base.
On asking the president of the Indian Medical Council, Jayshree Mehta, what should be done, she said that it is the state government’s and the corporation’s responsibility to ensure that such incidents don’t take place because the hospital is engaged in medical emergencies round the clock.
To make matters worse, fire departments across the country are understaffed; in some cases, the strength is just 50 percent and in such cases, the team that reaches the site of fire first doesn’t even have a minimum strength of six (one driver, one in-charge and four fire men), informs Sharma.
In places like Gurgaon, which is home to five-star private hospitals like Fortis, Medanta and Artemis, fire fighters are hired on contract and hence show up in civil uniform, sometimes even without gum boots and gloves.
Thankfully, there are some who take strict precautions in this regard. Bengaluru’s private hospitals like Columbia Asia and Ramaiah Memorial conduct training programmes and drills for doctors and the nursing staff.
“In newly constructed ICUs, the wiring is kept separate from the piping and special care is taken of the storage room that carries oxygen tanks and is highly combustible. Naturally, nitrous oxide, solvents and disinfectants add to the burden,” says Dr Abhijit Bhograj, endocrinologist at Colombia Asia, Bengaluru.
He points out that hospitals that are certified by the National Accreditation Board for Hospitals and Healthcare Providers (NABH) are stricter about fire safety. The long list of NABH guidelines include that there shouldn’t be combustible material of any kind stored or used in any building or section thereof used for institutional occupancy, except as necessary to normal occupancy and use of the building; a bare minimum quantities of flammable material such as chloroform, ethyl alcohol, spirit, etc shall be allowed to be stored and handled; the handling of such liquids shall not be permitted by unauthorised persons, and bulk storage of these items, will be governed by relevant rules and safe practices. In such places, one also finds sprinklers with the recommended 68 degree centre head after every three metres.
By nature, hospitals are centres of cure and not prevention. In case of fire safety, there isn’t even a cure.