Multi-Company Training: Health Care Occupancies - Part I

May 16, 2003
One of the most dreaded alarms to be broadcast over our radio is the one involving a health care occupancy.
One of the most dreaded alarms to be broadcast over our radio is the one involving a health care occupancy. For this article we will focus upon hospitals or medical centers as they are more commonly referred; and the overwhelming need to train on-site at these facilities. Even though many of these facilities are now protected by an automatic sprinkler system, there remain a large number of facilities that do not have sprinkler protection.

Hopefully your community medical center has a well-maintained automatic sprinkler system. Even so, it remains essential for firefighters to go there and train because smoke, even from a small fire contained by an automatic sprinkler system, will present critical challenges due to the health conditions of the patients. The purpose for such training is obvious, so let's list the more critical reasons:

Reasons for Training:

- There are patients who are incapacitated and unable to exit the occupancy without assistance.

- There is not enough medical staff to assist with moving patients into a place of refuge, or if necessary, out of the building. Here, you might be surprised to learn the staff-to-patient ratio, especially from 11 P.M. to 7 A.M. Plan on having firefighters participating in evacuation activities.

- Should there be smoke in patient rooms or in the hallways, firefighters equipped with full protective clothing and SCBA's will be required to perform the evacuation.

This list could become quite extensive; bottom line is rescue and evacuation!

Pre-Incident Planning:

- Firefighters should have a Pre-Incident Plan for such occupancies, to include:

- A diagram of the occupancy illustrating the floor plan

- The diagram should include stairwells, especially those having stand pipes

- Number of elevators and their location. Elevators in safe area's may be utilized to evacuate patients from upper floors

- The location of the main entrances to be utilized by firefighters

- The Pre-Incident Plan should conform with the hospital's emergency plan

- A pre-determined location to establish a command post is essential

- The ability to communicate is essential! Test your radio's in different sections of the building: multiple floors, stairwells, basement, etc.

- The fire protection features should be identified, i.e. Fire Department Connection

- All firefighters should be familiar with the over-all plan, and be familiar with the building. This may be accomplished by conducting tours of the occupancy.

- The Pre-Incident Plan should be carried on all apparatus

- The Pre-Incident Plan should identify the total number of beds available for patient care, as well as identifying the special care wards which will require particular attention, such as: cardiac care, intensive care, pediatrics, nursery, dialysis, pulmonary, cancer, mental, etc. Identify the number of beds available for patient care in each individual ward as a break down of the total number of available beds, and establish the Pre-Incident Plan toward total occupancy.

- Once the Pre-Incident Plan has been established, and firefighters completed familiarization tours, its time to test the plan by conducting drills. It is important that the drill include the medical staff performing the tasks they would perform in an actual event as well as for all emergency responders.

Identify Critical Agencies:

- In addition to the firefighters and medical staff, identify the other agencies who's services would be required to assist at an actual incident:

- Communications Center: In conducting this type of drill, utilize the radio channels which will be used in an actual event. This should include having a medical staff person activating the alarm at the hospital. While another member calls 911 with vital information, then the 911 operator dispatching the call over the radio. (Note: Track the sequence of the receipt of the alarm from the facility, being certain that the correct location in the building was identified. The time in which the alarm is activated and routed to the communication center is critical)

- Law enforcement (They will be required to direct traffic away from emergency equipment and hose lines, as well as performing security functions)

- Mutual aid companies (In actual event you'll need them! So integrate them into your drills)

- Emergency Medical Services to include private services in your community. One common plan utilized by hospitals is to take advantage of the compartmentalization features of the building, and relocate patients from the hazard area into another section of the building not affected and protected by fire doors. There will be some patients who will require cardiac monitoring, as well as other medical equipment carried on Advanced Life Support Units. Should this vital equipment be required to sustain the lives of patients, then the equipment will be there. In addition, should patients have to be evacuated from the hospital temporally, or transferred to another hospital, the units will be available; therefore include them in the drills.

- Local and state emergency management. These people have a wealth of resources, which will be essential to a successful operation; I would advise that you include them, at least at the local level, in all drills.

- Local Red Cross and Salvation Army. These agencies are there to not only assist with the immediate needs of the patients, they also assist with the families of the patients who will rush to the hospital upon hearing of the event through the media.

- Air Ambulances, in the event a patient(s) requires an immediate transfer to another hospital for continued critical care.

- There are other resources available to each community that could provide a service in such an event identify them and include them in you drills.

- Local media representatives: Maintain a listing of the media that reports events in your community. Having a contact person at each one of these agencies is desired. Invite them to the drill! They will be there in an actual event I can assure you, so get to know them. They will provide positive coverage of the agencies involved in the effort to be prepared for an incident. Even if they are not planning to participate/cover the drill, it is important that you notify them of the date and the time of the drill, and to verify to them that it is a drill. Otherwise, radio and television stations will begin to receive calls from the public of emergency responders surrounding the medical facility, and could report the drill as "Breaking News" which will send family members of the patients rushing to check on their loved ones.

- Do not forget the local elected officials! Have a firefighter assigned to them to keep them informed and available to the media. This will pay off at the budget hearings!


This information presented in this article may seem like impossibility in your community, or in any community for that matter. Having emergency responders converging upon a medical center for a full dressed rehearsal may seem impossible. Let me assure you, it can be done and has been done just as I have described, because we have pulled it off on several occasions at a large medical center in our community. In the next article, we will discuss how to plan and conduct the drills in finer detail.

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