Choosing Fire Extinguishers for Health Care Facilities

Jun 1, 2007 12:00 PM, By Craig Voelkert

Many fire hazards exist within health care facilities. Today, more than ever, it is necessary to prevent as well as suppress fires, if and when they occur in that environment.

The number of fires that occur each year in a surgical setting, such as hospitals and ambulatory care centers, as a percentage of the total number of surgical procedures performed in the United States, is extremely low. However, the risk merits the inclusion of surgical fire reduction into the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) patient safety goals.

The presence of a heat source combined with intensified oxygen concentrations and the likely presence of flammable vapors (skin preparation solutions and metabolic gases) in direct proximity to an incapacitated patient present a significant level of risk. Surgical fires that occur near the patient's face often involve the airway itself. In seconds, a life-threatening situation can arise with little or no time to react. For these reasons, efforts toward fire prevention must receive primary consideration, followed by effective response procedures in the event of unanticipated incidents.

Every surgical suite should have an Electrical Safety Program to prevent a life-threatening situation when there is little or no time to react. When developing a program to promote the safe use of electrosurgical units, there are a few recommended strategies:

• Evaluate equipment purchases carefully. Select equipment based on compatibility with specific organizational needs. Involve representatives of the medical staff, nursing staff, materials management and biomedical and engineering services in the process. Ensure that the equipment will function effectively in the clinical setting and can be fully serviceable.

• Operate electrosurgical units in accordance with the manufacturers' specifications. Obtain a complete set of operating manuals for each type of device. Develop and attach the manufacturer's operating instructions to each unit.

• Train all personnel in accordance with the operating guidelines. This includes all medical staff using or assisting with operations using electrosurgical units. Staff who clean the devices also need to know how to identify if a device is intact and operational.

• Select and install appropriate emergency response equipment in each surgical area. This should include one or more fire extinguishers in each operating room. These extinguishers must be installed so the staff has unobstructed access during an emergency.

Should a fire occur, employee training, suppression technologies, first responder tactics and mutual aid infrastructures provide layers of “defense-in-depth” response as an incident grows in size and magnitude. The first step in these various levels of defense, after prevention, is the portable fire extinguisher. They offer speed, portability and rapid knockdown of electrical fires. Proper selection, maintenance and training are essential.

These elements can be summarized by a concept that has been used by fire equipment distributors in the U.K. referred to as the “Triangle of Safety.”

The “Triangle of Safety” is reliant upon each of the key elements. For example, the best selection of equipment coupled with the best maintenance program results in system failure without an effective training program. Or, an effective training program with the best equipment available results in system failure if maintenance is not performed according to the given recommendations. Additionally, an effective training program and proper maintenance will still result in system failure if the proper equipment is not put into service.

Proper equipment: Five health care areas to evaluate

• Operating Rooms. An abundance of Class A (ordinary combustibles) materials are present in bedding, draperies and plastics. CO₂ is not effective on these fires; therefore, it is recommended that a water mist fire extinguisher be used on operating room fires because these units use de-ionized water that will not carry dust throughout the surgical suite. In addition, the water mist fire extinguisher does not use a cardiac sensitizer as found in halon and halogenated agent fire extinguishers. The water mist extinguisher discharges in a soft pattern for limited exposure to patients, poses no concern over thermal shock (CO₂ is discharged at -110 degrees F, which may cause tissue to freeze); and meets UL/ULC and National Fire Protection Association (NFPA) requirements for use around Class C fires (fires involving live electrical equipment).

• MRI Facilities and Patient Wards. Water mist is the best choice because this fire extinguisher:

  • uses all non-magnetic construction as the standard for both units;

  • has been tested by an independent laboratory to be safe in three TESLA environments;

  • works effectively on Class A fires safely in the presence of live electrical equipment;

  • costs less for initial purchase than Halon alternatives; and

  • costs less for training than Halon alternatives.

• Heliports/helipads. The Film Forming Fluoro-Protein Foam (FFFP) Wheeled Exting-uisher is recommended for helipad fire protection because it meets the requirements of NFPA 418 for helipads (the helipad classification has to apply to the particular installation under NFPA 418 guidelines). It is made using a stainless steel shell — painted red — and will not corrode from the foam and water. It may also eliminate the need, depending upon the helipad classification, for expensive foam systems.

• Data Processing Centers, Telecommunications Records Storage, Collection and Server Rooms. The halotron or water mist fire extinguishers are good choices for data processing and records collection fire protection because they carry a Class A rating (the Model 397 has a 1A rating while all other options have a 2A rating) and the Halotron I extinguishers leave no residue, beneficial in an environment filled with expensive servers and other telecommunications equipment. Data processing and records information is valuable and cannot be regained if an extinguisher discharge becomes a messy situation. However, both the halotron and the water mist extinguisher leave no residue, are listed for Class C use (fires involving live electrical equipment); and can be used for live fire training without violation of EPA mandates for agent release (unlike Halon 1211).

• Intensive Care Units (ICU). The water mist fire extinguisher is recommended for ICU's due to the abundance of Class A materials that are present in bedding, draperies and plastics, and because of the advantages listed above.

• Shipping/Receiving Docks. The ABC Dry Chemical Fire Extinguisher is recommended for shipping/receiving dock fires because of its firefighting capability for a variety of fire hazards that might be present in that environment. In addition, the ABC Dry Chemical extinguisher offers more Class A firefighting capability and range for the abundance of Class A materials, such as truck tires, insulation, corrugated boxes and packaging material that are commonly found in that area. Moreover, ABC extinguishers provide protection from fires involving Class B hazards (flammable liquids) with the presence of trucks, forklifts and other equipment. It also requires greater Class B ratings and discharge range, and the discharge results in less concern for clean-up and nuisance dust hazards.

Manufacturer's recommended maintenance: Must be in accordance with NFPA 10

Once the proper equipment has been chosen, it must be maintained properly in order to be effective. NFPA 10 requires inspections of extinguishers at 30-day intervals. These inspections are a “quick check” of the unit to ensure reasonable confidence in its operation. NFPA 10 — 2002 Edition has detailed information on how and what to check on the extinguisher during a 30-day inspection. NFPA 10 also requires annual maintenance to be performed on every extinguisher. According to NFPA, annual maintenance is a thorough examination of the unit and should be performed only by “…trained persons having the available appropriate servicing manual(s), the proper types of tools, recharge materials, lubricants and manufacturers replacement parts or parts specifically listed for use in the fire extinguisher.”

If the facility is currently performing annual maintenance “in house” by full-time employees, facility managers may want to re-evaluate their approach. Employees trained, equipped and solely dedicated to this function can be effective; however, if this is not the case, the maintenance program will be inadequate. It may be more advantageous to contract this work to fire equipment distributors who have trained professional technicians, the appropriate parts, manuals and supplies to do the job properly. In any case, it is imperative that the maintenance be performed in accordance with NFPA 10, local codes and the manufacturer's maintenance manual. Some manufacturers offer warranties of up to 12 years as long as the equipment has been maintained by an authorized distributor and the maintenance has been performed in accordance with the manual. As part of the “Triangle of Safety,” even the most expensive equipment and comprehensive training will be wasted if proper maintenance is not performed.

Effective training: Necessary for fire protection and required by OSHA

Fire extinguisher training is necessary for effective, safe extinguisher use, and is required by OSHA. Live fire-training exercises, still considered the most effective method for training employees on using extinguishers, are becoming increasingly difficult to perform. Even stricter air quality standards and employee scheduling make conducting live fire-training exercises onsite nearly impossible. Some fire extinguisher manufacturers still offer live fire training at offsite facilities on a limited basis, and there are many industrial fire schools throughout the country. In addition, fire equipment distributors will often offer specialized or customized extinguisher training that is tailored to a facility's particular needs and schedule. Every effort should be made to ensure that the equipment being used for training is the same equipment available in the facility.

Many training options are available today that were unavailable 15 years ago. With the widespread use of the Internet, fireextinguisher.com provides a free training overview of classes on fire and proper extinguisher use, and will issue a certificate upon successful completion.

An employee-training program should be customized to fit the company's policies on emergency response, the employee's needs and the particular situation. Training should stress the importance of calling the fire department immediately and confirming safe evacuation routes.

By using the “Triangle of Safety” as a guide when discussing fire protection equipment, health care facilities can optimize the effectiveness strategy of their fire protection strategy.

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Craig Voelkert is vice president of sales/special hazards for Amerex Corp.

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