This document is a paper I wrote a few years ago. The idea of patient safety, proper egress is a joke!
Monday, February 22, 2010
Allen Hancock College
FT 104 Building Construction/ Fire Protection
Pages 11, 12, 13, 14, 15, 16, 17
There are many problems with accessibility and design in a high rise building. Fires such as the MGM Grand Fire located in Las Vegas NV., and the Great Night Club Fire located in Chicago. The problems I am going to address about accessibility and design are numerous.
For some time I have thought that the egress of a high rise building or high rise hospital buildings where inadequate. I have recently had the opportunity to interview safety officers from local hospitals. I find hospital representative quoting compliance with NFPA Life safety 101, Fire Code Part 9 Title 24, Americans with disabilities, and compliance with the California Hospital Building Safety Board. I have conducted interviews with two different safety officers at two different hospitals both with similar evacuation methods in the event of fire or major earthquake. (For this report I will refer to them as hospital A and hospital B). Both Hospitals stated that they have blankets and backboards to take patients down the stairs. Hospital “A” said that they would put more people into their tower to assist with the evacuation. Hospital “B” showed me a picture of a special chair called the Stair Pro, sold by Stryker; designed for two people to carry a patient down the stairs. Hospital “B” even went so far as to say they have tested their chair from the fourth floor to ground level with an estimated time of three minutes to carry one patient with two people caring the patient down stairs in the chair, this did not include unhooking the patient from IV’s, monitoring devices, moving the patient from the bed onto the chair or backboard. I myself have worked in a hospital located in Palm Springs California. Our policy was to take the patients downstairs by means of a blanket or backboard. All hospitals in California are governed by the California Hospital Safety Board; they are all passively lying about patient safety, egress, and accessibility. All hospitals within the United States are by design death traps! In the Great Night Club Fire there was not enough exits within the building with Panic Bar Hardware. That fire caused people to pile up in the doorway trapping people inside and not allowing emergency services to get inside. (See Picture 1) In the event of a fire the first thing that is done is to shut down the elevator. At the hospital I worked at in Palms Springs CA, the elevator was linked to the fire alarm system is designed to go to the ground level and stop with the doors open in the event of a fire. This is good for anyone in the elevator but does nothing to help the patients on the upper floors. The hospitals are designed more to let people in, and not let then out especially in the event of a fire! All hospitals including the one I have previously worked at, to the best of my knowledge have never tested their full response with full evacuation of all patients and staff. All hospitals have approximately 30 to 50 patients per floor with approximately 12 to 15 staff members per floor on average on all upper floors. Hospital “B” stated that they had about 10 backboards and only one chair per floor. None of this includes the evacuation of monitoring equipment or other accessories that might have to stay with patients. Moving equipment will increase the amount of time and personnel it take to transport patients to the outside ground level.
In a hospital that has 15 staff members per upper floor may run in the event of a major catastrophe, the laws of attrition may apply in the presents state of mind, some staff members will be running for the door and will not remain on the floor to help patients exit the building safely. A floor starts out with approximately 12 to 15 staff members once an earthquake or fire begins there are only 10 staff members on a floor that is not been injured or have left, leaving ten people to get minimal of thirty patients to safety. I estimate it will take about eight minutes from starts to finish to remove one patient under ideal conditions from the upper floors to the ground and outside to a staging area. With the present size of stair wells and lack of escape methods, staff to evacuate patients in a timely manner, a hospital fire will look more like the MGM Grand Fire with people dead in their rooms do to smoke inhalation or The Great Night Club Fire with people stacked up dead in the stairwell. With emergency personal coming up the stairwell and hooking up the fire hose to the stand pipes this causes a trip hazard for anyone trying to get out especially carrying a patient. This just increases the chances of falling down the stairs and piling up bodies on the landing blocking the exit trapping people. Under the title Accessibility it speaks of a balcony, smoke proof enclosure or stairwell landings as a safe place of refuge. I see it as an excellent place to trip over a person in a wheelchair on a stairwell landing, or just eject them from their chair down the stairs; thus just one more way to create a trip hazard. Balconies have always been a great way to trap people on the upper floors that can’t be reached with the ladder truck. Not all fire departments have first alarm ladder trucks available and rely on joint response from other departments. Most ladder trucks only extend 100’ to 125 feet and require a great deal of manpower to remove non ambulatory patients down an aerial ladder.
In our studies we discuss climate control HVAC Units. I find these systems are good under normal working conditions; however, when a fire occurs they become an excellent conduit to transfer, and to communicate fire embers, charged gases from one area of a building to another. This turns one active burn into many. All HVAC Units need to have dampers that shut when a fire is detected sealing the ducting. This will reduce the amount of charged gases and embers reaching other parts of a building past fire walls. This should be apart of the design in all large office buildings or hospitals as a working standard! The standard should also include electrical circuit interrupters that cut power to the HVAC System. We need to have larger hallways to accommodate the Stand Pipe in the hallway at a right angle connection facing into the main building reducing hose flex, while allowing safe passage of people at the same time. At the present time I do not believe we have national, state or local building, fire codes to adequately cover this.
All hospitals built today need to be built with an escape route that will accommodate the patients escaping while remaining within their beds, with the monitoring equipment attached so they may be safely transported to ground level while still allowing emergency services to travel up the escape without interference.
It is apparent that the present evacuation plans from above ground floors are inadequate. The plans that are in place will not provide safety for the patients and staff. Some form of escape elevator or tower needs to be implemented and retrofitted to existing structures.
Unfortunately I lack the funds to fully prove my Idea and copy write an idea that Idea have to resolve this. I have discussed my idea with a few inspector. All have agreed it is good, but again no funding to correct the above.