In brief
When fire breaks out in a hospital, it is often impossible to take bedridden and intensive care patients out of the building by the stairs. The hospital evacuation plan therefore relies on progressive horizontal evacuation: patients are first moved to the fire-resistant neighbouring compartment on the same floor and, if necessary, from there to lower floors and outside. What decides whether the plan works is whether it is written down and tested who will move which patient and how, with the few staff of the night shift.
Why is a hospital evacuation plan different?
In a factory, evacuation means everyone walking on their own feet to the nearest exit. In a hospital, however, a significant share of the occupants cannot walk, some are connected to ventilators and monitors, and some are on the operating table. At night, the number of staff caring for these patients is a fraction of the daytime number. If the hospital evacuation plan is not built around this reality, it stays on paper.
Three separate pieces of legislation shape evacuation planning in hospitals:
| Legislation | Main provision for hospitals |
|---|---|
| Regulation on the Protection of Buildings from Fire | Definition of progressive horizontal evacuation (Art. 4); division of inpatient floors into fire compartments (Art. 49); escape distance in relation to the horizontal evacuation area (Art. 32) |
| Regulation on Emergencies in Workplaces | Emergency plan, firefighting, rescue, protection and first aid teams, a drill at least once a year |
| Regulation on the Implementation of Hospital Disaster and Emergency Plans (HAP) | All hospitals providing inpatient treatment; at least one tabletop and one field exercise a year (Art. 16) |
From an OHS point of view, the emergency plan defines employees and the duties they will carry out; the HAP covers the hospital's entire operation in a disaster. If the two are prepared separately, two different duty lists will emerge in the same fire. Write the evacuation section once and use the same text in both plans. For the general structure of the emergency plan, see our article on how to prepare an emergency plan.
Horizontal evacuation and the fire compartment
The Regulation on the Protection of Buildings from Fire defines progressive horizontal evacuation as occupants moving away from the fire and taking refuge in a fire-resistant neighbouring compartment on the same floor level. In hospitals, this principle is also built into the design of the building:
- Inpatient floors larger than 300 m² in hospitals are divided into two or more fire compartments, or protected horizontal evacuation areas are created. In calculating the horizontal evacuation area, the occupant load is taken as 2.8 m² per person (Art. 49).
- In hospitals with a horizontal evacuation area resistant to fire for at least 60 minutes and protected against smoke, the escape distance is measured to the exit door of the corridor leading to that area. At least one protected escape route is reachable from every horizontal evacuation area (Art. 32).
- Patient bedrooms or suites with an occupant load of more than 15 people have two doors remote from each other; hospital corridors may not be narrower than 2 metres (Art. 49).
Before writing the plan, extract the following from the architectural drawings and from the site: the compartment boundaries and fire doors on each floor, which compartment will be the refuge for which, and how many people the horizontal evacuation areas can hold. A simple check calculation:
If a ward has 24 inpatients, 6 staff at night and 10 companions, at least 40 people will move to the neighbouring compartment. 40 × 2.8 = 112 m². If the refuge area cannot provide this capacity in addition to its own occupants, a second target compartment is specified in the plan.
For horizontal evacuation to work, the fire doors must be able to close. A door wedged open, or with a bed or cabinet placed in front of it, removes the compartment.
Evacuation order: who is moved first?
The evacuation order should be written into the plan and tested in drills. The approach widely used in practice is as follows:
| Priority | Patient group | Method | Who directs? |
|---|---|---|---|
| 1 | Patients in the room of fire origin and adjacent rooms | Removed from the room immediately whatever their condition, door closed | First responding staff member |
| 2 | Walking patients and companions | Guided on foot to the neighbouring compartment | One staff member leading |
| 3 | Those who can be moved by wheelchair | By wheelchair to the neighbouring compartment on the same floor | Nurse and care assistant |
| 4 | Bedridden patients | By bed, stretcher or evacuation sheet | Two or more staff |
| 5 | Intensive care and ventilated patients | With portable oxygen and monitor; protection in place if necessary | Physician and intensive care team |
Taking walking patients out first clears the corridor and frees staff and space for seriously ill patients. The patient in the room of fire origin, however, comes first whatever their condition. Adapt this order to each ward's own conditions and write it down ward by ward.
Evacuating bedridden patients and intensive care
The method for evacuating bedridden patients is chosen according to the floor layout and staff numbers:
- Moving in the bed: The fastest method for horizontal evacuation; but door and corridor widths must allow the bed through, and the bed wheels must not be locked.
- Stretchers and evacuation sheets: Used for evacuation down the stairs to a lower floor. If evacuation sheets or sledges have been placed under the mattresses in advance, the patient can be moved in a single action.
- Lifts: Ordinary lifts are not used for evacuation in a fire. If there is a firefighting/evacuation lift, the plan states in what circumstances and by whom it will be used.
Moving patients also carries a musculoskeletal risk for staff. We explain handling techniques in our article on patient lifting and transfer.
Intensive care evacuation requires a separate sub-plan:
- Protection in place first: Intensive care is, where possible, a fire-resistant compartment in its own right. If the fire is in another department, closing the doors and monitoring the situation is often safer than moving the patients.
- Portable support: For each bed, the location and charge status of portable oxygen, a transport ventilator and a monitor are known.
- Medical gas: Shutting off the oxygen line in the fire zone at the zone valve prevents the fire growing in an oxygen-enriched atmosphere. Who will close the valve, and that affected patients are first put on portable oxygen, are written into the plan in sequence.
- Operating theatres: If surgery is in progress, the decision to evacuate is taken by the responsible surgeon and the anaesthetist; the operating theatre has its own short instruction.
Roles on the night shift
Evacuation plans are usually written with the day staff, but fires break out at 03:00. Test the plan with the night staff, and tie duties to positions rather than names:
| Position (night) | Evacuation duty | Deputy |
|---|---|---|
| Ward nurse in charge | Floor evacuation lead; directs the order and the head count | Senior nurse |
| Duty physician | Medical decisions for intensive care and seriously ill patients | Duty physician from another ward |
| Care assistants and nurses | Moving patients, closing compartment doors | Support from other wards |
| Security guard | Access control, meeting the fire brigade, lift control | Switchboard |
| Duty technician | Electricity, ventilation and medical gas shut-off points | Hospital technical manager |
| Switchboard | Calling the fire brigade and management, announcements | Security |
Under the Regulation on Emergencies, an adequate number of support staff are assigned to the firefighting, rescue, protection and first aid teams and these people are trained. If the team list consists only of day staff, the team effectively does not exist on the night shift. For training support staff, see our article on support staff training.
Hospital fire drills
The Regulation on Emergencies requires a drill at least once a year; the HAP Regulation provides for the plan to be tested every year with at least one tabletop and one functional (field) exercise. To make a hospital fire drill realistic:
- Night drill: Hold at least one drill with the night staff, or with night-staff numbers.
- Real movement: Carry out real movement with volunteer staff or mannequins using beds, stretchers and evacuation sheets; time it.
- Compartment check: Observe whether the fire doors close and whether the capacity of the horizontal evacuation area is sufficient.
- Evaluation: Record what went wrong and update the plan. For planning and reporting the drill, see our article on how to run an emergency drill.
Using extinguishers and responding to a fire in its early stages require practice; we explain which extinguisher to use on which fire in our article on types of fire extinguisher. Preparing the evacuation section for hospitals and care homes ward by ward is the subject of our emergency plan service, and hands-on firefighting and evacuation training for staff that of our fire training service. For other OHS topics in healthcare facilities, see our healthcare facilities page.
Frequently Asked Questions
Why are patients not taken outside immediately in a hospital fire?
Carrying bedridden and intensive care patients outside by the stairs takes a long time and carries a separate risk for the patients. Hospitals are therefore divided into fire-resistant compartments; patients are first moved to the neighbouring compartment on the same floor. Evacuation outside is carried out as a second stage if necessary.
How large should the horizontal evacuation area be?
The Regulation on the Protection of Buildings from Fire takes the occupant load as 2.8 m² per person when calculating horizontal evacuation areas. The refuge area must be able to take the incoming patients, staff and companions in addition to its own occupants.
How many times should a fire drill be held in a hospital?
The Regulation on Emergencies requires a drill at least once a year. The HAP Regulation provides for the plan to be tested every year with at least one tabletop and one field exercise. It is recommended that at least one of the drills be held with the night staff.
How are intensive care patients evacuated?
Protection in place is considered first; if the fire is in another department, the doors are closed and the situation monitored. If movement is needed, patients are moved to a safe compartment on the same floor with portable oxygen, a transport ventilator and a monitor, under the direction of the physician.
An emergency plan that really works on site, with scenarios, support teams, evacuation diagrams and an annual drill.
Bursa SİSTEMER OSGB Technical Team — written from the field experience of our OHS specialists and workplace physicians. Legal information is valid as of the publication/update date; contact us for an assessment specific to your business.