FIRE SAFETY GUIDELINES

FOR
HOSPITALS
AND
NURSING HOMES

Page 1 of 12
Preamble:-

Hospitals and Nursing Homes have certain special features which are not identical to other categories of
Buildings. As per National Building Code (NBC) Hospital Buildings, Nursing Homes, Sanatoriums
have been categories under Group-C “Institutional Building”
The Institutional Buildings are having some high risk areas with special problems relates life risk of both
ambulatory and non-ambulatory patients. It is therefore necessary to understand the types of hazards
associated with the Institutional Buildings vis-à-vis life safety concept.
Life Safety from fire in Hospitals relies on a “Defined – in- Place” principle. Horizontal exits or smoke
barriers are required to sub-divide each storey of a Hospital to provide an area of refuge on each floor.
In case of emergency the objectives should be “Keep the fire away from the Patient rather than more the
patient away from the fire”

Hazard Analysis:-

A. Equipment’s Hazards

With the rapid technological advancement in medical science, hospitals and nursing homes are
now equipped with a vast array of new equipment like.

Computerised Axial Topography scanners, Magnetic Resonance Imagers (MRI), lasers.

Sophisticated Diagnostic and Treatment Equipment, Heaters, boiler etc.

B. Chemical Hazards
1. Flamable chemicals
2. Alcohols
3. Solvents.
4. Acids
5. Ethers
6. Sprits
C. Gas Stores
1. LPG Cylinders
2. Oxygen Cylinders
3. Nitrous Oxides etc.
D. Plants
1. Laundry & sterilization plants
2. A/C Plants & ducts
3. ‘X’ Ray suits
E. Kitchen & Canteen
F. General Store
G. Car park area
H. Mattresses, bedding, furniture,
Oxygen cylinders, Pipe Line carrying Oxygen or
Nitrous oxide in Patients’ rooms.
Page 2 of 12
 The problem as identified during the inspection in different hospitals of this metropolitan city are
appended hereunder-

a) External fire fighting and rescue operation are very difficult.

b) Evacuation takes unreasonable time.
c) Simultaneous rescue and fire fighting operation to be done mainly within the building.
d) Building being fully air-conditioned, heat and smoke traps inside the building during fire.
e) Smoke venting problems & Danger of flash over.
f) Large number of occupants with unpredictable human behavior is in case of fire.
g) Special care is required for non-ambulant patients.
h) Special care is required to keep escape routes clear from smoke and heat.
i) Hazards from increasing use of interior finish decoration and Compartmentation with
combustible materials.
j) Multi occupancy hazards, high fire loads;
k) Inadequate water supplies;
l) Inadequate/unserviceable fire protection systems and equipment
Exit Requirement:-
Vertical evacuation of patients within a health care facility is difficult and time consuming. Therefore
horizontal movement of patients is primary important. Smoke barriers and smoke compartments is
important for fire safety in health care facilities. This smoke barrier allows for horizontal evacuation of
patients to an area of refuge on the same floor and this horizontal exit shall be provided with at least one
fire & smoke check door with two hours fire barrier walls. It is always preferable that the refuge floor
space shall have direct connectivity to the fire escape staircases/ramps for safe evacuation from the
building.
All required exits that serve as egress from hospitals or infirmary sections shall not be less than 2 M
clear width including patient bed room doors to permit transportation of patient on beds, litters or
mattresses. The minimum width of corridors serving patients bedrooms in buildings shall be 2.4 M.

Compartmentation:-

It is experienced that smoke is the cause of most fire deaths, proper protection against smoke must be
installed and properly maintained in health care facilities. All such buildings must be sub-divided into
separate smoke compartments into which the patient can be moved with having to leave the building or
change of floors.

SERVICE DUCTS/SHAFTS:-

a) Service ducts / shafts shall be enclosed by walls of two hours doors of one hour fire rating. All
such ducts/ shafts shall be properly sealed and fire stopped at all floor level.

b) A vent opening at the top of the service shaft shall be provided having between on-forth and one-
half of the area of the shaft.

Page 3 of 12
 c) Fire, Smoke and other toxic products of combustion tend to spread vertically within a building.
Special effort is required to prevent fire on one level from threatening the occupants in the upper
floors, this is important in hospitals and nursing homes.

d) Dedicated A.H.U. shall b provided for individual floor with supply & return duct as far as
possible Fire Dumpers shall be provided in the supply and return ducts.

In case of fire the A.H.U. shall be tripped & fire damper shall be closed. For the above,
necessary interlocking with Fire Detection System to be provided.

Therefore, all shafts should be provided with fire rated enclosures of 1 hour fire resistance rating
for vertical openings connecting not more than three floors. Opening to shaft should be limited
and such openings must be protected.

RECOMMENDATION OF
MINIMUM ESSENTIAL FIRE SAFETY MEASURES IN INSTITUTIONAL
BUILDINGS

Preventive Measures

1. Good housekeeping in all area, specially stores, kitchen, electrical installation, transformer
house and waste disposals etc. should be maintained.
2. No Smoking Zone (while applicable in office, store, depot etc) shall be enforced rigidly.
3. All electrical installations shall be periodically checked & tested by competent electrical
engineers, while all loose electrical wiring if any shall be replaced immediately.
4. Appropriate M.C.B. shall be installed where necessary in the electrical installation as per
Indian Electrical Rules.
5. All old electrical wiring especially in the zone of insignificant and abundant area shall
replace with the new ones.
6. The basement if any should not be used as store room / material dumping / in patient ward or
any other purpose which will cause Fire / Smoke.
7. Lift shaft and stair lobby / landing shall be free from any obstacles / obstruction.
8. Use of LPG gas cylinders not more than 320 kg come into a gas bank, to be installed with
separate place with barrier and precaution as per IS : 6044.
9. Trained staff in dealing with the fire fighting extinguisher / appliance / Evacuation procedure
shall be engaged. Fire fighting drill and evacuation drill should be held on regular basis.
10. Building should come into a modular by making corridors horizontal & vertical exits from
the origin of the fire place to a safe area easily and also by incorporating Fire & Smoke
Check Door in the lobby approaching to stairways and lift.
11. One senior personal preferably from administration may co-ordinate & look into.

12. On site Emergency / Evacuation plan shall have to be prepared and update at regular
interval.
Page 4 of 12
13. Fire Notice, Fire order, Exit sign, Floor Nos. shall be displayed at conspicuous places as per
requirements of NBC Part IV.

14. Arrangement should be made for proper checking, testing and maintenance of all fire
protection and detection system to keep them in properly working condition at all the time.

15. Electrical Safety Audit should be carried out at regular interval as per Indian Electrical Rules.

Protective Measures

1. Water Reservoir exclusively for fire fighting shall be made available as prescribed in National
Building Code (NBC) Part IV.
2. Replenishment of the reservoir may be incorporated with deep tube well with auto facility.
3. Fire Hydrant Ring main with Yard Hydrant & Wet Riser system with landing valve shall be
installed as per NBC Part IV & IS: 3844.
4. Hose Box containing two nos. 15 M long Hose & 1 No. Branch Pipe with Nozzle to be
installed near each Yard Hydrant & Landing Valve.
5. First-Aid Hose Reel 40 M long to be provided near each landing valve tapped off from the
Wet Riser.

6. Sprinkler system to be provided for all the floors & other places / areas as applicable as per
NBC Code.
7. Fire fighting extinguisher should be provided within the building as per IS: 2190 and person
having work station in that area should be trained to use the same if required initially in case
of emergency.
8. The main Fire Pump and one stand by pump of capacity minimum 2280 LPM and head of the
pump will be such that 3.5 Kg/cm2 pressure is available at the furthest/highest landing valve,
to be installed. Auto start facility should be incorporated in fire pump. Accordingly, Jockey
Pump of Capacity 180 LPM shall also be installed.
9. The Stand by pump of equal capacity must be available on alternate sources of
supply, preferably diesel operating pump.
10. Fire Detection & Alarm System for the entire Building shall be provided as per IS: 2185
11. Public Address System with Two way communication System
12. Emergency power supply shall be provided to the following equipment and system.

A. Illumination of means of escape route.

B. Fire Alarm Panel & P.A. Console.
C. Fire Pumps
D. Fire Lift
E. Bore Well.

Page 5 of 12
 General recommendations for the Electrical Installation in respect of
Hospitals/Nursing Homes etc.
The following recommendations are made for different electrical installations (H.T./L.T.)
rectification/correction at Hospitals/Nursing Homes premises, in line with the “Central Electricity
Authority (Safety) Regulations”, 2010 and relevant provisions of I.S. Code of practice.

Important measures for LV/MV/HV installation.

1. To install MCB in all distribution circuits (main and branch) along with incomer MCB in the
distribution board so that all the circuits are controlled from one point of the said installation.

2. Periodical checking and measurement of existing earth pit/grid resistance, earth to neutral
voltage, and measurement of unbalance current in the system and to take measure accordingly.

3. Segregation of power cables from telephone line, cable line & other non power line if any, by
erection of cable tray and laying dressing, clamping of cable, use of FRLS wire, separately with
cable tag making, ferrule making for maintenance of the installation.

4. Necessary gadgets are to be fitted in each floor/room for fire alarm as well as tripping of the
circuit breaker for isolation of supply of the installation.

5. To measure current in each circuit; load of each circuit & sub-circuits, distribution board must
conform relevant I.S. Codes of practice.

6. Marking of distribution boards (main & branch) and circuits accordingly for easy identification
& maintenance of the circuit.

7. Installation of lightning arrestor/ lightning masts on the building as per I.S. Code of practice.

8. To install modern starter and MCBs for Air-Conditioner control and other gadgets as per I.S.
Code of practice.

9. To install dry type transformer by replacement of existing oil type transformers and preferably to
replace all oil type circuit breaker by V.C.B.

10. Arrangement of proper air circulation system for dry type transformers.
11. To remove all sorts of storage materials causing hindrance for accessibility to the electrical
control gadgets as well as exit in case of emergency. No material shall be stored in the sub-
station rooms.
12. To use fire retardant paint to all rooms decorated by the wooden panels.

13. To fix up responsibility to the personnel operating different electrical gadgets during or after
office hours in view of safety, mode of operation and saving of energy.

14. L.T. Distribution Panel (Main) of the Transformer should have proper rating A.C.B., at the
Incoming Side (Main Incomer) and all outgoing Feeders must have proper rating A.C.B. /
M.C.C.B., with adequate protection system and outgoing Feeders L.T. cables should be of
Page 6 of 12
 sufficient current rating in respect of M.C.C.B./ M.C.B. connected with it L.T. cables are
preferred to run through “Cable Duct” of the building. There should be Floorwise/ Sectionwise
Distribution Board in all floors, with sub-circuit protection incoming & outgoing M.C.B./
M.C.C.B. of appropriate rating, as per connected / working load required.

The installation in multi-storied building should be carried out and maintained in such a manner
as to prevent danger due to shock and fire hazards in accordance with the relevant I.S. code of
practice.

All ducts provided for power cable and other services shall be provided with “fire barrier” at
each floor crossing. No other service pipe shall be taken along the duct provided for the Power
Cable.

15. Outdoor canopy/ soundless type D.G. Sets as Standby Power supply, having proper interlocking
system between Generator supply & Licensee supply.

16. For the “Emergency Sections” of the Hospital/Nursing Home “U.P.S. System” is preferred.

17. Preparation of layout, single line diagram of the total HT installation and distribution diagram of
all MV/LV installation after incorporation of above recommendation.

18. All electric supply lines & apparatus shall be of appropriate rating and shall conform to the
relevant I.S. Codes of practice.

19. All type of electrical installation work shall be carried out by Govt. Licensed Electrical
Contractor in terms of CEA (Safety) Regulation, 2010.

20. Recommended for electrical safety officer in terms of safety regulation.

21. List of Electrical Licensed persons to operate the HV/MV Equipments to be displayed and to
enter the name in the register in terms of Safety Regulation.

Page 7 of 12
 STANDARD OPERATING POCEDURE
Main Objective:-

i) To protect the occupant.

ii) To protect the Assets.

iii) To secure the continuity of operations.

iv) To protect environment.

Occupants Characterization:-

Staff:-

The number of staff in Hospitals/Nursing Homes depends on the shift system. During the day time the
availability of staffs are usually maximum. Whereas minimum at night hours.

Patients:-

The number of patient in each ward/floor is variable depending on the capacity of Hospital/Nursing
Home. Usually all patient need assistance to evacuate, some patient are able to walk when supported by
staffs. Patients are assumed to be sleeping at night and to be awaked during the day. The patients are not
familiar with the building.

Therefore the evacuation of the patient is highly depending upon the ratio between the number of patient
and staff available to assist in evacuation. So staffs have to be trained in fire fighting and evacuation
tactics. The use of portable fire extinguishers and fix installations like fire hydrants and hose reels is
important, so that they are able to put the fire out when occurs. The staff should relies upon because this
alert them, therefore the system should be well maintained.

Fire Fighting Facilities:-

The sprinkler installation are effectively limit the spread of fire thereby protect against untenable smoke
and fire spread. The risk is reduced to at least by 67%.

Fire and Smoke Check doors restrict the spread of smoke and heat within the area of origin thereby
lower the risk by about 33%.

Automatic Detector cum Alarm system alerts the outbreak of fire and help in early detection and thereby
minimize the response time.

Page 8 of 12
Evacuation Procedure:-

The evacuation procedure depends on detection, reaction and travel time.

Detection:-

The detection time is determined by the time of actuation of the smoke detector. Calculated detection
time for automatic detection system is varies in manned and unmanned area.

Reaction:-

After the actuation of the detector system usually the staffs interpret the situation before responding, if
the staffs are trained properly how to respond the fire alarm, the reaction time will be very short. But
staffs attending the healthcare units the response time should not be more than 30 sec.

Travel time:-

The following steps generally involved in healthcare units for evacuation of patients.

• The staff moves to the patient in wards.

• The staff prepares the patient or transportation
• The staff assists the patient to move to a safe area
• The staff and patient queue at the exits

The Key Elements of Standard Operating Procedure:-

1. To identify the Fire Escape Route in order to start evacuation procedure in orderly manner,
during fire emergency.

2. To identify the location of Fire Fighting Equipments as installed in the premises and needs
appropriate application.

3. Conduct of fire fighting drills at regular interval to enable the in-house fire fighting team to
respond any emergency in systematic and discipline manner.

Fire Command Structure:-

1. Chief Executive Officer or Head of the Organization will act as the commanding officer during
emergency.
2. The commanding Officer has the primary responsibility to recognize hazards and prepare the fire
order and fire operation plan & get them promulgated.
3. To supervise the regular training to the hospital staff (non-medical & medical) of the hospitals
and keep them informed about the fire emergency evacuation plan.
4. Medical Superintendent will act as a occupant/patient evacuation supervisor and formulate the
emergency evacuation plan and impart training to all the staffs (medical & non-medical)
regarding the emergency evacuation procedure.
Page 9 of 12
 5. Floor managers/Matrons/floor supervisor will assist the evacuation supervisor in evacuation
process.
6. The Chief Engineer/ Maintenance Engineer will act as a head of the fire fighting team and his
responsibility to maintain all the fixed fire fighting installation system and constitute the fire
fighting team. He should also impart the training about the operation and maintenance of fire
fighting installation and conduct training at regular intervals.

ACTION BY SECURITY / DESIGNATED FIRE FIGHTING STAFF :-

A) INFORM THE FIRE BRIGADE THROUGH ANY ONE OF THE FOLLOWING

PHONE NUMBERS:

B) ALERT THE OCCUPANTS BY USING PUBLIC ADDRESS SYSTEM & GIVE

THEM PROPER GUIDANCE FOR SAFE EVACUATION FROM THE BUILDING.

C) OPERATE THE GROUNDING SWITCH TO BRING FIRE ELEVATOR TO

GROUND FLOOR LEVEL.

D) EVACUATE THE OCCUPANTS BY USING FIRE EXITS AND EMERGENCY

EXITS ONLY AND ASSEMBLE THEM IN A SAFE PLACE.

E) SWITCH OFF THE POWER SUPPLY OF THE BUILDING EXCEPTING

EMERGENCY LIGHT / FIRE LIFT / FIRE ALARM PANEL, PA & TALKBACK
PANELS.

F) FIGHT THE FIRE USING NEAREST SUITABLE EXTINGUISHER OR WATER

FROM NEAREST HOSE REEL / HYDRANT POINT DEPENDING ON THE SIZE OF
FIRE.

G) GUIDE THE FIRE FORCE, ON THEIR ARRIVAL TO THE SEAT OF FIRE.

H) INCASE OF CAUSALITIES, CALL AMBULANCE OR MOBILE TRAUMA CARE

UNIT.

I) ENSURE THAT THE PEOPLE WHO ARE PHYSICALLY CONSTRAINED,

UNCONSCIOUS, DISABLE AND WOMAN ARE EVACUATED.

Page 10 of 12
A. Procedure for Calling the Fire Brigade:
a) When calling the Fire Brigade give clear information.
1. Name & Address of the premises where fire has actually broke out.
2. Nearest land mark & name of the access road.
3. Character to the Building and type of occupancy.
4. Nearest water body is available.
5. Telephone No. of the caller & of the particular premises if known.

B. Procedure to be followed for Raising the Alarm:

All occupants/ employees should be aware of how to raise the alarm.

1. Once detector actuated, the on duty staffs will act according to pre-determined plan.
2. The source of alarm must be monitored regularly.
3. Whole premises should be warned through the P.A. system in such a manner that should
not generate any panic amongst the occupants.
4. The system should be incorporated to disseminate the information to other emergency
support services.

C. Pre-determined area should be identified for refuge or assemble of the occupants (Patient).

D. The assembly or refuge area should have the facility of medical support for patient if
needed.

E. The assembly or refuge area must have the access of the emergency vehicles like ambulance
or fire service vehicles.

F. Roll call should be taken to ensure that all occupants/ patients are evacuated from the
danger zone and the missing person should be notified to the Fire Service and Police
Authority.

G. Procedure for Fighting the Fire:

1. In the early stages of a fire it may be possible to successfully contain it or extinguish it with
first aid fire fighting equipment.
2. To accomplish this, staff members should be instructed in the use of hand held
extinguishers and hose reels.
3. Certain members of staff may be designated as a fire fighting team as part of the
emergency procedures & their function would be to assess and "if safe to do so" tackle the
fire with the available equipment until the Fire Brigade arrive

H. Procedure for Assisting the Fire Brigade:

a) When the Fire Brigade arrives they need proper assistance and information as much as
possible in order to take the best course of action. The type of information required
includes:

1. Exact location of the fire;

Page 11 of 12
 2. Type of materials involved in fire;
3. Details of missing persons;
4. Location of nearest fire hydrants;
5. Location of all access doors to the building.
6. Location of any special risks adjoining to the fire location;
7. Keys for access into any locked areas.

The following main elements of a onsite emergency plan which need to be prepared by the Commanding
Officer/C.E.O./Head of the Organization.

1. Drawing up emergency procedures

2. Conducting evacuation drills
3. Conducting Regular fire safety inspections
4. Checking maintenance and servicing of fire equipment
5. Conducting Staff training
6. Imparting information to employees
7. Keeping of records
8. Drawing up emergency Planning.

Page 12 of 12