On October 5, 1989, a fire in a nursing home located in Norfolk, Virginia resulted in the death of 12 patients and required hospital treatment or relocation of 96 others. The fire began in a patient’s room on the second floor, and was probably caused by careless disposal of smoking materials, according to local investigators. Upon discovering the fire, the nursing staff immediately began to evacuate patients, activate the fire alarm system, close patient room doors, and notify the fire department. When the fire department arrived, they began an interior fire attack and soon knocked down the majority of the fire. Severe heat and smoke conditions still existed on the fire floor, so the firefighters began to evacuate patients from their rooms.
Nine patients on the second floor died during the fire, and following the fire, three additional patients died. Two of these fatalities were on the second floor, and one was on the third floor. Significant factors contributing to this incident included:
- The rapid growth and development of the fire within the patient room
- The absence of automatic sprinklers that could have prevented full room involvement or flashover
- The lack of compartmentation due to the open door to the room of fire origin
- The lack of automatic detection and failure of the fire alarm system to function properly