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Friday 28 October 2016
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Fighting fire

Fire safety is important in any environment and making sure that you know the drill in your practice is essential for staff and patients

Modern life needs fire but despite harnessing its power and energy, uncontrolled fire can still cause mass destruction and loss of life. The effects of fire can be life-changing (and burdensome on the NHS and the economy). If fire can be prevented, escaped or extinguished, major health benefits are realised. The fire and rescue service (FRS) has a successful history of dealing with and preventing various emergencies, which has greatly reduced demand,1 but they have more to give. The Chief Fire Officers Association (CFOA) is driving improvements in both the regulation of fire safety (ensuring that people stay safe from fire) and the way FRS resources can be used as a ‘health asset’ to reduce all-round demand on general practices and the NHS.

Taking and observing fire safety measures
Practice managers are busy. They have diverse work combining personnel administration, payroll, finance, strategic planning and IT skills, as well as being responsible for fire safety. So it is helpful if fire law2 can be made simple as well as effective. Despite the complexities of the law (requiring fire safety measures to be taken or observed), the overarching principle of fire safety is to keep people safe from harm caused by fire. It does this by requiring measures to:

  • Reduce the risk of fires.
  • Reduce fire spread.
  • Provide means of escape (safe ways out of the building via corridors, stairs and exit doors).
  • Ensure that means of escape can be safely used whenever they are needed.
  • Fight (small) fires.
  • Detect (and give warning of) fire.
  • Arrange for action in case of fire, by:
  1. Instructing and training staff.
  2. Mitigating the effects of fire.  

Taking these measures will reduce the incidence of fire and (if fire does break out) will safely tackle it and evacuate people.

Theory into practice
Fire is prevented by separating ignition sources from combustible materials. This can be difficult in practice because electrical equipment (including light fittings) is often necessarily close to combustible that can catch fire. Care and maintenance of electrical equipment will reduce the likelihood of faults, which can lead to overheating and combustion. Fire spreads through readily available combustible material. Good housekeeping prevents fire spread, by limiting the availability of fuel.
Recommendation: Control the build-up of anything that can burn, reduce storage and move combustibles away from ignition sources.
When fire breaks out, there are three principal ways to escape:
1.    Turn away from it and walk to a place of safety.
2.    Pass the fire while it is very small.
3.    Pass the fire with a substantial barrier (fire doors/walls) between you and it.
Each practice manager should think about their workplace and which of these escape strategies work for each room. An overview of the safety measures needed to support each strategy is given here:
1. To use fire escape routes they need to be clear (free from clutter/obstructions), identified to visitors, eg, by using signs, if necessary (if the way out is obvious or commonly used, it may not be necessary to have a sign) and lit with emergency lighting (if they might be needed when it’s dark).
Recommendation: Know your escape routes, keep them clear and test emergency lighting monthly (if you have it).
2. Small fires will grow big, if they can. The person in control of the premises (including practice managers) should arrange for nominated people to safely tackle small fires (in light of instruction and training) and according to organisational expectation. If a fire extinguisher is appropriately and safely used, the risk to people, property, fire-fighters, and business continuity can be minimised.
Recommendation: Think about your tolerance to fire train some members of staff to use extinguishers safely (no-one else should use them).
3. Detecting and warning people about fire is fundamental to any escape strategy. In small premises, people can quickly detect and warn others about fire (see, smell and shout), but larger premises tend to require a fire alarm system and fire detection. Fire detection is fitted on ceilings because smoke and other fire gases are buoyant and rise until they meet an obstruction (ceilings and walls). Carbon dioxide detectors can be positioned on walls, close to the hazard because carbon monoxide diffuses through the atmosphere, emanating from the source. The alarm should signal people to leave the building but human behaviour can overrule common sense. One example is people who gather around a fire to watch it being tackled. People often assume that the alarm is a test or false alarm and therefore need a second ‘trigger’ before evacuating.
Studies of human behaviour show that when people have ‘invested’ in something eg, waiting their turn, they are less inclined to give-up that investment – even for a fire. The reaction of staff members can dictate the reaction of other people. A sounding alarm provides the first ‘trigger’ and trained staff will provide the second.
Recommendation: Test fire alarms from a different break glass call point in rotation once a week and test your fire plan with some trained staff to act as fire marshals to get people out.
4. All safety measures need to be tested and maintained (to ensure they will work when needed). An important safety measure is to ensure that all members of staff know what’s in place (keeping them safe) and what to do in case of fire. They are the eyes and ears of the practice and can report when measures fall below safe standards. Trained and informed staff can prevent fire, detect fire, raise the alarm and encourage evacuation. All of this mitigates the effects of fire.
Recommendation: Tell staff members what you have done (safety measures) and what you will do (including testing and maintenance) to keep them safe in the case of a fire.
Technical expertise may be necessary to ensure correct standards for some of the fire safety measures set out above.
All FRS are engaged in better regulation,3 which means that they will help and support those who are in doubt and trying to comply.4

More help from the FRS
The aging population presents challenges to all public services, including general practices.
Many deaths and injuries affecting older people are preventable, with the right interventions and signposting. Prevention is better than cure. CFOA is collaborating with healthcare professionals to reduce burdens on health services.
 NHS England, the Information Commissioners Office and CFOA agreed an Information Sharing Agreement on 24 July 2015 so that 46 English FRSs will be sent Exeter data5 of over-65’s data. All 46 services in England agreed to this sharing arrangement by submitting a named contact within their service. NHS England announced a data distribution date of the 21 September 2015. Early intervention trials have started in some areas eg, by the FRS fitting handrails and fall avoidance measures in homes, to reduce slips, trips and falls, and subsequent demand on general practices (and hospitals).
To support this work, and to foster greater collaborative working between primary care and FRSs, CFOA is funding the development of a Royal College of General Practitioners (RCGP) backed e-learning package for primary care professionals, including practice managers.
The package is aimed at increasing knowledge and skills relating to fire safety in general practices.
The module will be launched by the end of November 2015, and will be hosted on the RCGP website.

Jonathan Herrick, CFOA lead officer for better regulation.

1 Department for communities and local government. Fire Statistics Monitor: England April 2014 to 2015. 2015. (accessed 24 August).
2 In England and Wales: the Regulatory Reform (Fire Safety) Order 2005; in Scotland: the Fire (Scotland) Act 2005 and the Fire Safety (Scotland) Regulations 2006; in Northern Ireland: the Fire and Rescue Services (Northern Ireland) Order 2006 and the Fire Safety Regulations (Northern Ireland) 2010.
3 See the Better Regulation Delivery Office. (accessed 24 August).
4 CFOA. Fires safety law. (accessed 25 August).
5 Guidelines in practice. The Exeter system is central to general practice. 2002. (accessed 25 September).