We have taken a different approach with this blog than what we normally do. Security camera video obtained by various Brazil news outlets gives an inside perspective from the very beginning of this event when the fire started. I worked with several of my NFPA colleagues, including one who is fluent in Portuguese to help understand what we were seeing and hearing from the government officials who were interviewed. We have included links to those news stories that include the video.
When deadly incidents like these occur, the usual questions arise. Why did it happen? How do we prevent future tragedies? While we don’t know yet why it happened, we do know that benchmarks exist to prevent loss of life and property in the health care environment.
Buildings and facilities that care for the sick and injured, require additional code provisions in order to protect vulnerable hospital patients from fire. Although many of the Hospital Badim victims were elderly, the risks remain largely the same for any patient whose medical condition makes them incapable of self-preservation. During a fire event, patients are essentially dependent on the facility’s building construction features, fire protection systems, emergency management plan, and staff.
According to initial and ongoing news reports out of Rio, an emergency generator that was located in the basement level is considered to be the cause and origin of the fire. The generator was located in an open area that housed vehicles and building materials. It was a space that was either normally not occupied or that apparently had a relatively small building population that worked in that space. Security camera video on this level showed some type of arcing or sparking coming from the generator at approximately 5:45 PM. Although it is not known if the generator was operating, this is the first indication that something was amiss. In addition, four 250-litre (approximately 265 gallons total) diesel fuel storage tanks were located adjacent to the generator. Other security cameras on different levels of the hospital showed clear signs of smoke migration into different spaces and offices. Even in the midst of having clear signs of a significant fire, there seemed to be no sense of urgency, at least initially as the events unfolded on the basement level. Several attempts were made to control or extinguish the fire with portable fire extinguishers, but those efforts were not successful. Approximately 15 minutes into the fire event, it appears that decisions were being made to begin relocation or evacuation protocol for the staff, as well as patients.
At some point, a large flame can be seen coming out of the basement area and shooting above the street level. Thick black smoke accompanied this part of the fire while at the same time it was migrating throughout multiple levels of the facility. Although TV news coverage, photos and video allow us to make some assumptions about the incident, we obviously do not know the complete circumstances behind the fire or the hospital’s fire protection features, construction, or emergency plan. These are all important elements that should be considered as part of the formal investigation into this particular fire; and, for the record, should always be part of a comprehensive plan for fire and life safety in health care facilities.
Whenever a large loss incident like this occurs, NFPA has an obligation to share information about the various NFPA codes and standards that exist to prevent such tragedies-even when they occur beyond the borders of the United States. NFPA 101, Life Safety Code; NFPA 99, Health Care Facilities Code; and NFPA 110 Emergency and Standby Power Systems are among the documents that have the most relevancy to this fire. NFPA 101 establishes a comprehensive and holistic method to health care fire safety. Known as the “total concept” approach, the code mandates a combination of controls over building construction types and construction materials, extensive use of crucial fire protection systems including fire alarm and automatic sprinkler systems, and reliance on a properly trained and drilled staff who are able to take life-saving measures to protect patients as part of the emergency planning concept. When even one of these three elements are not at the level it needs to be, less than desirable outcomes are inevitable.
Likewise, NFPA 99 also establishes supplemental criteria that allows health care facilities to plan for a wide variety of emergency contingencies including total evacuation of the facility. As noted previously, it is presumed that the occupants that the facility is there to serve will largely be incapable of self-preservation. It is for this reason that total building evacuation is literally a measure of last resort when it comes to hospital fire safety. However, for those extraordinary conditions, NFPA 99 provides requirements for comprehensive emergency plans including plans for such a contingency. At some point during the Rio de Janeiro fire, the decision was made to evacuate the facility. This required a carefully coordinated effort between hospital staff, first responders, and even groups of ad hoc volunteers from the neighborhood who worked to move the patients to adjoining buildings and structures. These actions, no doubt, helped to save many lives during the fire.
As in any fire investigation, determining the cause and origin is a key part of the process. With video evidence of a problem with the emergency generator, investigators could utilize standards such as NFPA 110 to help determine if the system was in proper working and operating order. It is not known if the generator was in operation at the time that the fire started or if it was an idle position. Other requirements of NFPA 110 include having the generator located in a separately housed space or compartment with fire-resistance rated construction — a circumstance that was clearly not the case in this particular fire. In addition to these provisions, NFPA 110 also covers requirements for ongoing inspection, testing and maintenance (ITM) of the generators. ITM records are likely to be reviewed as well.
Other video evidence shows smoke spreading from the basement level to all floors of the building, the circumstances of which must be evaluated and understood. Codes like NFPA 101 establish very conservative rules to minimize the number, type and size of unprotected vertical openings to avoid such avenues for smoke spread. This particular area was closely scrutinized following the 1980 fire at the MGM Grand Hotel Las Vegas where many of the fatalities occurred on the upper levels of the building, far away from where the fire originated on the first floor. Preventing smoke movement and migration to upper levels is normally controlled through a combination of HVAC fan shutdown, fire and smoke dampers, and by ensuring that vertical penetrations for everything from exit stairways, to pipe and electrical chases, to building expansion joints are properly sealed and protected to all but eliminate the possibility of vertical smoke movement.
In the US, fatalities from a fire in a hospital are rare, although that hasn’t always been the case. In NFPA’s report, U.S. Structure Fires in Health Care Properties, the U.S. averages two deaths per year in these occupancies. Incidents that have occurred over the years have prompted changes to NFPA 101, NFPA 99, NFPA 110, and other standards. As a result, current standards address important issues such as emergency management, egress requirements, hazard vulnerability and risk assessments, construction requirements, emergency power supply systems and many other safety practices designed to make health care facilities safer.
The history and knowledge gained through lessons learned from previous fire events, can be used to design a comprehensive fire safety plan for your facility. Unfortunately, there will be more lessons learned from the Hospital Badim fire; but hopefully as we move forward and work to reduce loss of life due to fires at health care facilities, the lessons learned from this incident can be applied globally.