Did rapid ramp up during pandemic derail fire safety in hospitals?

A fast ramp-up during the Covid-19 pandemic may have also led to the overlooking of some parameters for makeshift hospitals, feels the industry.

Earlier this month, eight Covid-19 patients asphyxiated to death in under two minutes at an Ahmedabad hospital that was located close to one of the busiest commercial business districts of the city. It all began with a table fan, reportedly plugged into the same socket as medical equipment, causing a short circuit in the intensive care unit of Shrey Hospital.

Fire and architectural experts have raised alarm as many such small and medium hospitals lack a renewed no objection certificate (NOC) for fire safety. Ahmedabad alone has witnessed six fire incidents at hospitals in the past 16 months. Yet, only 91 of 2,022 hospitals and clinics renewed their fire safety audits and secured NOCs from the fire department, according to sources in Ahmedabad Fire and Emergency Services. 

Joy Chakraborty, chief operating officer at Hinduja Hospital, and chairman (health care) at the Confederation of Indian Industry (western region), said hospitals were required to ramp up quickly to fight the pandemic, and this may have led to certain parameters being overlooked. “Even after the best infrastructure is put in place, there can be incidents of fire. It is equally important to maintain the infrastructure, and ensure periodic drills and employee training," he said. 

A recent fire in Vijayawada, for example, happened at a makeshift Covid-19 facility in a hotel premise. 

Audits by municipalities, too, have slowed down because of the lockdowns and distancing norms. Experts believe that while the National Building Code (NBC) warrants strict fire safety norms for hospitals, which make constructing one highly capital intensive leading to many cutting corners, the mushrooming of fly-by-night medical centres for fighting Covid has added to the industry’s woes.

When it comes to meeting fire safety norms, hospitals also adhere to local civic body by-laws, Raghunanda Aiyangar of Synergic Designs, who has expertise in building hospitals, said. "Big corporate hospitals have deep pockets. So, they have the ability to buy huge chunk of land and follow NBC and local civic body norms for fire safety. But that’s not the case with small and medium hospitals and clinics. Since they don't want to go outside the city, as their clientele is largely local, they build within the city limits and cut corners," Aiyangar said.

According to experts, norms under NBC for hospitals include installation of what is known as ‘active’ and ‘passive’ fire-fighting systems. "Even if a premise has one bed, norms require fire hydrants, sprinkler systems, glow lights, exit signs, smoke detection alarms, public announcement systems, and proper ventilation in terms of active fire-fighting systems. Passive fire-fighting systems include a clear lobby and staircase, which should be wider by not less than 2 metres. Areas like computer or server rooms should have CO2 flooring and ample load capacities, too, in terms of passive systems," Sajjan Kumar, a retired fire officer with New Delhi Municipal Corporation, said.

If a hospital building is over 15 metres high, there needs to be access for water tenders that can move around the building. Power load, which could lead to short circuits like the one in Shrey Hospital, also needs to be taken care of, said Atul Garg, director, Delhi Fire Services. "Over 70 per cent of fire cases in hospitals take place due to power overload," Garg said, adding Delhi is better placed than other cities in this regard.

As a remedy, experts like Aiy­angar and Kumar suggest special by-laws for hospitals within city limits.  "Policies need a relook. Hospitals should be where people are and, therefore, there should be special by-laws for them," Aiyangar said.

Policy flip-flops are also a matter of concern. A 2016 government order in Hyderabad exempted smaller buildings (less than 15 sq. m) from inspection by fire department officials after several hospitals complained of corruption and harassment by officials. This opened a pandora's box. After the 2016 order, an industry insider said, the fear of inspections was gone. 

According to reports, around 90 per cent of the 1,700 odd hospitals in Hyderabad, perhaps the worst Covid-affected city of Telangana, were not compliant with fire safety norms. Several hospitals under the Greater Hyderabad Municipal Corporation submitted self-declaration forms to attain NOCs. As such, NABH-accredited hospitals need to do periodic audits by a local authority-approved agency. 

Alok Roy, chair, FICCI (health services committee), and chairman, Medica Group, said that after a fire incident at Emami's AMRI hospital in Kolkata, periodic monitoring of fire safety compliance by hospitals has become even more stringent there. 

A hospital industry veteran felt that fire safety norms, though important, largely stay on paper and are not put to practice. "There is corruption among fire officials, but the real problem lies in unplanned construction." The person, who is a hospital administrator himself, said that the problem becomes acute for smaller establishments in densely populated areas. "The government should start leveraging technology to keep a tab on fire safety compliance. A model can be worked out whereby fire insurance premiums can be linked to the level a compliance an establishment has. This would shake things up.”