The Right Response
Preparation, training, and automatic sprinklers add up to a success story in a Connecticut nursing home fire
NFPA Journal®, January/February 2010
By Robert Solomon + Robert Duval
NFPA 101®, Life Safety Code®, imposes a great deal of responsibility on the staff of a health care facility to take appropriate action during a fire event. This responsibility extends to several areas, including knowing the duties and responsibilities of each staff member, when doors are to be closed, when patients have to be relocated to other areas within the building, and when patients may have to be evacuated to the exterior of the building. Previous fire investigations by NFPA have shown that an improper staff response—or, in some cases, no response—can be disastrous. When the staff response is textbook-correct, however, patients can face a much lower risk of injury or death.
All indications are that the staff of Regency House, a short- and long-term nursing facility in Wallingford, Connecticut, did everything right in its response to a fire early last year. That response started with the fire plan overseen by Patrick McDonald, administrator; Peter C. Brail, director of physical plant; and Shelley Jackson, RN, director of nursing. From planning and preparation to the actual execution of a fire plan—and with help from an automatic sprinkler system—the Regency House staff provided an ideal example of how a health care facility can act decisively and correctly in response to a fire.
Wallingford is a suburban community located about 20 miles north of New Haven, Connecticut. At 9:57 p.m. on March 5, 2009, the Wallingford Fire Department received an automatic fire alarm from the Regency House. This alarm was followed by a phone call from the facility, with the caller reporting smoke in a corridor near the kitchen area. The initial response was Engines 1, 2, and 8, with Truck 1 and Rescue 7. Based on the type occupancy and the report of smoke in the building, the shift commander, Captain Richard Gibson, requested an additional engine (Engine 4), two ambulances, and a paramedic unit.
The Regency House is a single-story, 130-bed, skilled-nursing facility originally constructed in 1962 as a home for veterans. A partial basement houses mechanical equipment and other ancillary functions associated with operation of the facility. The building is constructed with masonry exterior walls and a wood-frame roof with a built-up-type roof covering. Interior partitions are constructed of gypsum board on wooden or metal studs. A new wing being added to the southwest side of the facility was under construction at the time of the fire but was not involved in the fire event.
The occupied portions of the facility contain automatic sprinkler protection. The original portion of the facility (approximately 33,000 square feet, or 3,066 square meters) is protected with an ordinary hazard pipe schedule sprinkler system installed at the time of construction. The new wing is provided with a wet-pipe sprinkler system designed to provide a 0.10 gpm/square foot density with a corresponding design area of 2,046 square feet (190 square meters). The hydraulic nameplate shows a demand of 407 gpm at 46 psi. A dry-pipe sprinkler system is installed in the wood-frame canopy at the entrance of the building. Sprinklers installed throughout the facility are predominantly 165-degree pendent-type. The fire alarm system is equipped with smoke and heat detectors and manual pull stations throughout the building, and is connected to a central station monitoring service.
Upon arrival, Gibson reported a working fire with smoke in the corridors and a report of a fire in the dishwashing area of the kitchen. Firefighters advanced a hose line into the building through the main lobby doors and moved toward the kitchen seeking the seat of the fire. Fire units outside the building located the fire department connection (FDC) for the sprinkler system, and connected an engine to the FDC to supplement the sprinkler system water supply.
Firefighters moved into the dishwashing area in the kitchen and discovered a single sprinkler operating. Using a thermal imaging camera, firefighters located a heat source in the floor beneath a sink and the wall behind the sink. They advanced into the basement below the kitchen and found small pockets of fire in the basement ceiling and pipe chase under the sink. These fires were extinguished as firefighters performed overhaul operations and began working on removing smoke from the corridors.
Upon arrival of initial fire units, facility staff met fire officers at the front of the building and reported on conditions inside the facility. Regency House staffers were sheltering patients in their rooms in the C and D wings. There were 110 patients in the facility at the time of the fire, 48 of whom were in the affected portion of the complex. Smoke doors located at the smoke barrier wall next to the kitchen entrance from the corridor closed upon activation of the fire alarm, and staff members closed patient room doors to further isolate occupants from the smoke in the corridors. The facility staff contemplated moving the patients to another wing, which would have required them to go outside of the building. This plan did not have to be implemented, however, as all of the potentially affected patients were kept in their rooms and monitored by staff. At no point were the patients thought to be in jeopardy from the effects of the fire.
Once the fire was located and extinguishment was underway, ventilation of the smoke became a priority. At 10:20 p.m., Ladder 8 was added to the assignment to help with ventilation. Skylights in the corridor outside the kitchen were removed, and positive-pressure ventilation fans were placed in the corridors to help remove smoke. Wallingford FD Chief Peter Struble arrived at the scene at 10:22 p.m.
Based on the potential for multiple injuries, three additional ambulances were asked to stand by. The local medical control dispatch was contacted to check on the availability of additional ambulances and hospital beds in case patients, staff, or firefighters had to be transported from the scene.
There are several nursing facilities, ranging from small to large, in the Town of Wallingford. This unusual concentration of facilities provides many options in the event patients have to be relocated. In a model that could benefit other communities and their nursing and health care facilities, the fire department was practiced in responding to emergencies at such facilities and in taking appropriate action. Firefighters train frequently on fire and other emergencies in these complexes, working with facility staff on the protocols to be followed. Since 2004, the Wallingford Fire Department and the Regency House staff have conducted such exercises on an annual basis.
The medical director at Regency House happened to be in the facility at the time of the fire and helped the staff monitor the conditions of the patients during and after the incident. The fire department maintained a fire watch engine on scene until the sprinkler system was placed back in service and ventilation was completed.All fire department units cleared the scene at 4:12 a.m. There were no reported injuries to patients or responders.
The Wallingford Fire Marshal’s office, along with the Office of the Connecticut State Fire Marshal, conducted an investigation, and the fire was found to have been unintentional, the result of a plumber working with a torch on an existing copper pipe that was being removed and replaced with PVC beneath the dishwashing area of the kitchen. The plumbing work involving the torch had begun around 8 p.m. and was completed at approximately 8:30 p.m. This work resulted in heat transfer to wooden rafters in the basement ceiling. The wood floor joists in the area, along with adjacent combustibles, smoldered for as long as two hours, eventually igniting and spreading heat and fire upward through a wall cavity and pipe chase between the basement and the kitchen.
The staff response
The Regency House staff on the night of the fire included 6 skilled nurses, 12 certified nursing assistants, and 2 facility staff.
On-site staff was immediately made aware of the fire, and the emergency response plan was implemented. The staff reactions were swift and appropriate, and included the types of actions that staffers had drilled on in previous years.
Staff response included ensuring that there were no imminent threats to the patients; repositioning staff to the area of the fire where the process of closing patient room doors began; and assigning a staff member who was dedicated to meeting the arriving fire department units. Facility staff members also worked to maintain a clear path in the corridor.
Subsequent actions included notification of the nursing supervisor and a limited activation of the off-duty staff call back/phone tree system. The judgment of the staff was to continue to monitor the conditions of the fire and to make sure that the patients were not threatened by its effects.
Arriving fire department units, in consultation with the staff, agreed to the defend-in-place/shelter-in-place actions that had been taken. This allowed the fire department to locate the seat of the fire and dispatch firefighters to the kitchen and basement to complete extinguishment and overhaul of the fire area. The staff maintained a continuous round of surveillance of the patients, checking in on them at least once an hour and providing reassuring information about the fire.
Every shift of the Regency House staff conducts a drill of the facility emergency plan once every quarter. The drill for two of those shifts includes activating the building fire alarm system. Staff members put into practice the procedures and duties associated with the written plan. As previously noted, one of the annual drills is conducted with a response to the facility by the Wallingford Fire Department.
In October 2008, the Regency House staff, as a part of its quarterly training and drilling activities, received a presentation on the February 2003 fire at the Greenwood Manor nursing home in Hartford, Connecticut. Sixteen residents died in this intentionally set fire, and dozens more were injured. The NFPA report on this fire showed fault with the response by all but three of the staff members who were on duty the night of the fire. Greenwood Manor staffers did not follow the written emergency plan and, in some cases, had never actually practiced the plan. Fundamental actions such as closing room doors did not occur, and the staff never relocated to the wing where the fire occurred.
The nursing staff at Regency House clearly took those lessons to heart, and its actions last March ensured that the facility’s patients were properly protected and sheltered during the fire.
Robert Solomon is NFPA department manager for building and life safety codes. Robert Duval is NFPA senior fire investigator.
Why staff training is a critical element in fire safety planning
Since 1969, the federal government agency that oversees the operation and regulatory function of the long-term care industry has relied on NFPA 101®, Life Safety Code®, for the fire and life safety needs of the residents of these facilities. The Centers for Medicare/Medicaid Services (CMS), an agency in the U.S. Department of Health and Human Services, relies on the requirements of the 2000 edition of NFPA 101 as a part of its survey process when evaluating a facility’s fire protection and fire safety elements. The Life Safety Code requirements are further supplemented by select CMS rules to keep the occupants and staff safe and to keep the building’s fire protection features functional.
According to American Health Care Association data, some 1.68 million certified beds are available in some 15,700 facilities in the United States for the long-term-care needs of individuals requiring housing and nursing care. The owners and operators who offer these services are responsible for residents’ nursing care, as well as their nutritional needs and physical well-being. Since many of the occupants are incapable of self preservation, the code provisions for such facilities offer a wide range of protection measures.
Although building construction, interior finish, sprinkler systems, fire alarm systems, and configuration of the means of egress all play a vital role in keeping residents safe, another “system” that is equally important is the facility staff. While all of the aforementioned built-in systems are crucial to the safety of the residents, an improper response by the staff can result in an undesirable, even disastrous, outcome. The role of the on-site workforce at the time of a fire necessitates a number of actions that range from closing room doors, meeting arriving fire department personnel, relocating residents, and even providing updates and reassurance to residents on the status and extent of the emergency. These responsibilities must be developed, practiced, and implemented as a part of the relocation and evacuation plan for the facility.
A successful outcome when a fire occurs is often a direct result of the staff planning and drilling, and the cooperation that transpires during an emergency.