Prevention and detection

Design considerations

The design of the ICU can make a major contribution to fire safety. Ideally, the ICU should be divided into compartments so that fire, heat, smoke, and gases are contained and their spread delayed.

Fire and smoke doors are an essential component of fire compartments, but to work they must be closed in the presence of fire. This is best achieved by automatic devices which operate in response to activation of smoke alarms or heat detectors. Permanently closed doors on main thoroughfares are often wedged open. In these circumstances the fire doors will be useless. Smoke detectors should be placed in each compartment of the unit, including staff rooms, offices, and store rooms.

Individual patient rooms should be designed as separate fire compartments. Fire compartments should provide 30 min of containment or protection, increasing to 1 h for high-risk areas such as stores and kitchens. Any opening within the compartment must be protected by fire-resistant materials, and door seals and ventilation grills must be smoke and heat proof. Ideally, two evacuation routes should be included in the design of an ICU. Each should be wide enough to permit easy maneuvering of beds and should not become obstructed by stores or equipment. If the unit is not at ground level, an appropriate escape route to the ground should exist. Lateral movement, at the same level, through fire barriers is acceptable, gaining protection time for each barrier passed.

Air conditioning in the ICU should provide a slight positive pressure, preventing ingress of smoke from fires outside the unit. The exception will be in isolation units which require a negative pressure system. Air conditioning should not entrain or spread smoke around the patient area. The system should be separate from the main hospital system and should not automatically close down in the event of a fire elsewhere in the hospital. However, smoke and heat detectors should be fitted within the ducting and other parts of the system. These should shut the system down if smoke or hot gases enter. This will prevent the spread of smoke and fire within the ICU. The control unit for the air conditioning should be located within the ICU. Service ducts should also be capable of isolation to prevent ingress of smoke.

The generation and spread of fire and smoke within the unit can be limited by ensuring that disposable items are stored within cupboards or bins whose doors and lids are kept closed. Safe storage facilities for oxygen cylinders should also be provided. Furniture and furnishings should be fire resistant and conform to the relevant safety standards.

Oxygen

Oxygen and medical air are usually supplied to the ICU by pipelines. The decision to disconnect the oxygen supply should only be made with the agreement of medical or nursing staff in conjunction with the fire service and hospital engineers. The design of the pipeline supply should be such that it can be isolated from the rest of the hospital. Portable oxygen cylinders should be available as a back-up for each patient.

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