Multi-Company Training: Health Care Occupancies - Part II

As reviewed in my previous article concerning Health Care Occupancies, these facilities pose a considerable risk and challenges to both the occupants as well as the firefighters charged with providing fire protection. In preparing for an incident involving such occupancies, the fire department must establish a "pre-incident plan."

These plans may appear to be in good order on paper. However, if left untested in the form of a Multi-Company drill, the true test will occur when an actual alarm sounds. Upon this occasion, the plan either works, as it is intended or it fails...with possible catastrophic results.

The first phase in conducting a Multi-Company drill at such a facility is to contact the facilities risk management director or the person responsible for the over-all safety at the facility. Schedule a meeting in which you and your line officer's have an opportunity to fully explain your goals and stress the importance of establishing a positive working relationship. It is also ideal to have one individual (generally a training officer) to serve as a contact person for the fire department. Should the risk management director be agreeable to conducting a Multi-Company drill, then it's time to start planning.

To illustrate my points of this training drill, I will share how our first large-scale drill was formalized and initiated at a large medical facility in our jurisdiction.

For several years my fire department has had an excellent working relationship with the medical facility personnel and our EMS providers. However, while there was a working relationship between the risk management and maintenance department, there had been challenges concerning code enforcement issues. Therefore, it was with considerable difficulty that we convinced the risk management people that we would be entering the facility for the purpose of familiarization and pre-incident planning, not code enforcement.

Nevertheless, with some reservations, the director did allow firefighter's to enter the facility for the purpose of pre-incident planning. Along with an agreement that the firefighter's were not there to conduct code enforcement. Unfortunately, this can be a touchy subject here; do not ignore obvious code violations, but if you're the contact making the agreement, you are the one who should discuss the violation(s) with the director in private and assist them in correction. Keep in mind that when asking to enter a property for familiarization and pre-incident planning, you are an invitee. When conducting code enforcement, you are a licensee. When an issue involving codes becomes to complex, get your code enforcement people involved, let them handle the code issues!

Following the familiarization tours, modifications were made to the pre-incident plan, but without an opportunity to test the plan during an actual drill it remained unproven.

Following a couple of years and several risk management director changes, a gentleman called my office one morning and identified himself as the new director of risk management. He asked me to come over to his office for a meeting to discuss training issues and his facility. It seems that this director had been given considerable latitude to make some changes and identify the critical factors, which would occur should an actual fire or other emergency occur at the facility.

Here's what we discussed:

Coordination and communication of the medical facilities staff and firefighter's
We already aware of certain sections of the building where our radio's did not transmit and we had informal methods to overcome these issues Such was learned over time when responding to actual alarms in different locations inside the facility.
The risk management director wanted to know how the medical staff would react during an incident, and their how their actions integrated into the efforts of emergency responders.
So, not one, but three drills were planned so as to challenge each shift at the medical facility (3), as well as each shift for the fire department (3 - 24/48).
- Furthermore, the drills would be conducted in an unannounced method so as to gather as much actual tasks of personnel as possible.
  Following several planning meetings involving all emergency responders,(including representatives from local police and mutual aid fire companies) the dates were established

Side Note: Do not pad your drills by placing your best people in the most critical positions - they will not be there when the actual alarm comes in - plan on utilizing the people normally assigned to the apparatus, no more -no less. This is the only manner in which to truly test the pre-incident plan as well as the performance of personnel

All medical occupancies are required to conduct a given number of drills each year, both internal and external drills. Interestingly enough, many choose to conduct such drills by simulating the arrival of emergency responders and having their staff perform as if the emergency responders were involved. This is a source for considerable stress when an actual alarm occurs because the medical staff, at least in some cases, has a false sense of their roles and responsibilities.

Here was our plan for the first complex internal drill at this facility:

A section of rooms on the third floor were scheduled for renovation, and no patients would be in this immediate area.
This would give firefighters an opportunity to carry their hose and equipment into the building, make the connections to the standpipe system, then make an advance on a simulated fire in one of the rooms. (We decided against charging the attack lines to prevent any unnecessary water damage.)
The facilities fire alarm system would be pulled nearest the simulated fire room, then allowing the alarm to be transmitted to the local 911 system. Where your dispatch center will dispatch the call and state: "This is a drill! All units respond in a non-emergency status." (I haven't been arrested for this tactic, but careful planning must go into such an effort. Be certain you have the appropriate authority to conduct a fully unannounced drill in your organization).
As previously stated, there would three drills involving all three shifts at the medical facility as well as the three fire department shifts. The drills would be conducted over a two-week period on different days. The first drills would be on a Tuesday afternoon at 2:30 PM. The second drill was planned for a Thursday night at 8:30 PM. Then the final drill would be conducted the following week at midnight.

The drills went very well, as the nursing services supervisors were notified just prior to the activation of the facilities fire alarm system, giving the staff an opportunity to prepare the patients and family. When the alarm was pulled, the medical facility announced the location of the alarm as would be the routine, further announcing that firefighter's would be responding to a drill with the medical staff, and stressing that "This a drill!"

Firefighters met security officers at the loading docks dressed in full protective clothing and SCBA's while carrying hose and connections for the standpipe. Due to the magnitude of this facility, the security officer's would escort the firefighters down the long corridors of the ground floor. (These corridors utilized only by the facilities staff, was a part of the pre-incident plan) then identify the door to the stairwell to be utilized to access the location of the simulated fire on the third floor.

The incident plan should also include drawings of the floor plans, which should also be utilized by firefighter's to verify the correct location. Because the medical facility will soon be surrounded by fire and police units, a member of the fire department should notify the local television and radio stations beginning approximately 15 minutes (or more depending upon the media in your area) prior to the drill.

Otherwise, someone will notify the media and you'll have television helicopters flying overhead reporting an emergency at the facility. This will panic the families of the patients and the staff who will either call or rush to the facility. We have also included the media in such drills and have gone as far as placing them on the apparatus and responding with the firefighters.

Be creative when conducting Multi-Company training and involve the personnel who will be expected to perform together during an actual event. Make friends and train together, you'll need the support.

In the next article, I will discuss our second large-scale drill at this facility - this time, utilizing the entire sixth floor.

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