AUTHOR: Jaime Gutierrez

Recent Incidents at Latin American Hospitals Demonstrate the Need for Risk Reduction and Response Planning

For about a year now, much of the world has been focused on fighting the Coronavirus. The pandemic has certainly challenged healthcare providers and hospitals; our gratitude for all their efforts since COVID-19 began spreading throughout the globe cannot be overstated. The coronavirus has affected the healthcare industry in a way that modern society has not seen before, but it’s important to note that the idea of risk is not new to medical people or those charged with management of healthcare properties.  Patients, staff and visitors rely on those who run medical facilities to ensure that all safety measures are being taken to keep those receiving care, working in or visiting a hospital free from harm.  Fires can and do occur in the medical environment and given high occupancy rates, foot traffic in healthcare settings and the vulnerability of patients, hospital fires can have a significant impact on a community. Just think about how complex it must be to safely evacuate patients, staff and others when an unfortunate incident occurs. In Chile’s capitol city of Santiago, healthcare officials were forced to move from thinking what to do in case of fire to actually springing into action when a fire broke out at San Borja Hospital, forcing the evacuation of 30 patients with COVID-19 this past weekend. Infected patients were transported to other health centers in the city, an undertaking that was extremely difficult given that at least eight patients were intubated and listed in critical condition. The emergency incident coincided with a spike of coronavirus cases in Chile, so as you can imagine the healthcare system was already working at maximum capacity when the fire alarm sounded early in the morning. The epicenter of the fire was located in a third floor pediatric area of one of the hospital’s warehouses. Approximately 40 fire trucks and more than 150 firefighters responded; flames and dense columns of smoke were visible from many points in the Chilean capital. Firefighters joined forces with police officers, members of the army, and doctors to evacuate patients to a parking lot and other safe havens outside of the hospital. Appropriate sanitary measures were taken due to the coronavirus. Fortunately, thanks to this effective deployment strategy, there was no loss of life but the Ministry of Health in Chile confirmed that the fire damaged 4 floors of the hospital, as well as boilers, electrical installations and other service systems. Right after the New Year, there was another horrible hospital emergency in Morelia Michoacan, Mexico that took the lives of at least 36 people who were hospitalized in the COVID area. A leak began in a supply pipe and was reported immediately on a Friday. Apparently, the pipe froze from low temperatures but was not addressed by the institute’s authorities until on Sunday when a white cloud appeared in the lower area of the tanks. According to news reports, staff members began to hit the pipe that was frozen, ultimately causing a fissure that prompted the lethal leak. Around the same time, fire broke out on the fourth floor of the Adolfo López Mateos hospital in the City of Toluca, Mexico. Medical staff and patients were immediately evacuated, including those being treated for COVID-19. After the incident, the Secretary of Health of the State of Mexico reported that the incident, caused by a short circuit, was minor. The fire was controlled quickly without injuries and hospital personnel were allowed to return to their normal duties in a reasonable amount of time.                That was not the case at the Federal Hospital of Bonsucesso in Rio de Janeiro last fall. A fire there prompted more than 200 patients to be evacuated and urgently transferred elsewhere. Doctors and nurses relocated patients in mobile beds with the help of firefighters, but unfortunately during the rescue operation, two women who were hospitalized for coronavirus died. A mechanical workshop that was located nearby became a temporary nursing location for a few hours; and in the days that followed, the doctors’ union denounced the hospital, pointing to a lack of protocol for evacuating patients and health professionals. In the summer of 2019, staff from the “Hospital de Alta Especialidad” in Zumpango, México, within the metropolitan area of Mexico City, were evacuated when fire broke out. One of the panels of the hospital caught fire after a short circuit occurred between a luminaire and a ceiling in a patio area. Civil Protection personnel cordoned off the affected area and worked with medical personnel to evacuate hospitalized patients who were in the building next to the fire. The municipal fire department responded and State of Mexico Red Cross ambulances assisted in evacuating and protecting patients, relatives and hospital personnel.  Within 25 minutes, the incident was under control. Thanks to the preparedness steps taken in advance and the security protocols that were successfully applied during the incident, the elderly and patients were allowed to re-enter the hospitalization building to continue their care, while the affected area was isolated. Preplanning and safety measures helped hospital authorities and responders protect patients and preserve the majority of the facility. These are just a few examples of hospital fires of note in Latin America. There have been many throughout time, all around the world, that have resulted in tragedy. I hope the few I have mentioned in this blog underscore the reality that Latin America is not exempt from such incidents. Hospital fires cause loss of life, property, equipment, essential supplies and hospital records – and leave economic and business/care continuity challenges in its wake. Each of these events share a common thread – ignorance or dismissal of danger signs, panic reactions or stampede tendencies. The incidents also showed inappropriate use of flammable and toxic materials, the absence or ineffectiveness of basic security measures, deficiencies in regulatory framework, and a concerning lack of training in evacuation planning, among other proactive safety measures. All of these safety components and a few others need to be addressed if we are going to reduce risk. Safety is a system, and one that should be taken very seriously especially in hospitals where many occupants will be unable to evacuate on their own or without assistive equipment. Healthcare officials, regulatory leaders and responders should use the recent spate of incidents in Latin America and the NFPA Fire & Life Safety Ecosystem to evaluate whether they are connecting the dots on hospital safety. In 2016, the US Centers for Medicare & Medicaid Services (CMS) did just that. In May of that year, CMS required health care facilities to meet requirements of the 2012 editions of NFPA 101® Life Safety Code and NFPA 99 Health Care Facilities Code. Since 1970, hospitals, nursing homes, ambulatory surgical centers and related facilities in the U.S. have needed to demonstrate that their fire and life safety programs satisfied different editions of NFPA 101 in order to meet the requirements of the Conditions of Participation (COP), as defined by CMS. Health care providers that participate in federal reimbursement programs are required to meet the COP expectations. Then in September of 2016, CMS announced that its emergency preparedness rule would require a coordinated set of requirements to be established by various providers. The emergency preparedness spectrum extends to the public who rely on the various organizations that provide different levels of medical and social wellness care as well as to the staff and physical plant assets that are part of the delivery system. Per the rule, hospitals, transplant centers, critical access hospitals and long-term care facilities must carefully evaluate their emergency and standby power systems. Specifically, they must be inspected, tested, and maintained in accordance with the 2010 edition of NFPA 110 Standard for Emergency and Standby Power Systems, as well as the 2012 editions of both NFPA 99 and NFPA 101. NFPA can help healthcare authorities proactively navigate the changes that are needed to ensure that Latin America’s hospitals and other health facilities have a solid safety infrastructure. Visit nfpa.org/cms for training, certification and other related resources. This blog is also available in Spanish.  
Fire truck in Mexico City

The Mexico City Subway Station Fire Raises Questions About Maintenance and Updating

Here in Mexico City, where I am based for my role as NFPA development director for Latin America, there is significant buzz about the fire at the Buen Tono substation of the Mexico City Metro.A female police officer died when she fell during the incident, and the subway system that typically, during non-COVID times, serves 4.6 million commuters daily was severely disabled. Saturday’s incident has frustrated commuters and is raising important questions about necessary maintenance and upgrades. Given that I am charged with advancing government responsibility, fire and life safety infrastructure, code compliance, and emergency response strategies (among other safety considerations) in Mexico City, I, too, have a lot of questions including the obvious one, “how did this fire happen?” According to news reports, the fire broke out in Mexico City’s downtown substation and persisted for nearly 12 hours. It damaged six service lines including three of the system’s oldest and busiest lines which reportedly may not be repaired for three months. In addition to the police officer that perished, more than 30 people, including Metro workers, on-site police and a firefighter went to the hospital for treatment for smoke inhalation and other concerns. Mexico News Daily reports that a former director of the Metro said the substation had not been modernized in the last 20 years. “These installations should have been replaced 20 years ago [or] at least changed gradually [but] that wasn’t the case,” Jorge Gaviño said in a television interview. “They’re old, obsolete systems that definitely have to be given adequate maintenance to avoid … risks to passengers.” The news outlet quotes Gaviño as saying the Mexico City Congress will ask the Metro system’s management to supply the maintenance records of the substation so that they can be analyzed to determine why the fire broke out and how a similar event can be avoided in the future. NFPA research shows that between 2014-2018, fire departments in the United States responded to an estimated 1,100 fires per year in or at rapid transit stations. Since 1983, NFPA has produced NFPA 130 Standard for Fixed Guideway Transit and Passenger Rail Systems to help jurisdictions address some of the very design, maintenance and safety requirements that I suspect may be identified here in Mexico City.  A Fixed Guideway Transit Systems Technical Committee was first formed in 1975 and began work on the development of NFPA 130 with one of the primary concerns centered on the potential for entrapment and injury of masses of people who routinely use mass transportation facilities. During development of the document, several significant fires occurred in fixed guideway systems. The committee noted that the minimal loss of life during these incidents was due primarily to chance events more than any preconceived plan or the operation of protective systems. So, they focused on developing material on fire protection requirements to be included in NFPA 130. In 1988, the standard was expanded to include automated guideway transit (AGT) systems – fully automated driverless transit systems which are automatically guided along a guideway. In subsequent years, new chapters on emergency ventilation systems, egress calculations in accordance with NFPA 101® Life Safety Code®, and protection requirements that address emergency lighting and standpipes were factored in. In other words, as new incidents, issues and best practices arose, the standard changed and so, too, should have the design and maintenance of the Metro station in Mexico City to ensure passenger safety and business continuity. Over the years, NFPA has served as a safety resource for organizations like the National Transportation Safety Board (NTSB) in the United States. In 2015, NFPA staff offered safety insights to NTSB when an electrical malfunction filled the busy Metro subway station in downtown Washington, DC. That incident produced thick, black smoke and left many riders stranded after their train stopped in a tunnel. When all was said and done, a woman was dead and nearly 70 others were sent to the hospital. According to The Washington Post, authorities believed a train, which had just left the L’Enfant Plaza station, came to a halt about 800 feet into the tunnel because there was “an electrical arcing event” that occurred about 1,100 feet in front of the train. The event filled the tunnel with smoke because the arcing involved cables that power the third rail; arcing is often connected with short circuits and may generate smoke. There did not appear to have been a fire during that incident but nonetheless, questions about ventilation and maintenance were brought up in the aftermath of that incident, just as they will and should be brought up now by authorities in Mexico City. I also learned this week that the issue of train safety will be the subject of an NFPA Journal in Compliance column that is scheduled to run next month, and  my colleagues at the Fire Protection Research Foundation explained that although they do not have research on this topic, others do, including: NIST – Fire Safety in Passenger Rail Transportation Brandforsk/RISE: Model Scale Railcar Fire Tests Victoria University - Fire Development in Passenger Trains (Thesis) International Association for Fire Safety Science (AFSS) As the former Metro director of the Metro Jorge Gaviño said to the media, “We have to find out if … this regrettable accident was foreseeable or not.”  I stand ready to help Mexico City authorities if they need NFPA insights to get public transportation safely back on track. This blog is also available in Spanish.

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