A Hospital's Life Safety Lessons
In the calm early hours of December 24, 2015, fire broke out in the Pediatric Care Unit (PCU) at Jazan General Hospital in Saudi Arabia. Staff evacuated the PCU and the children's incubator area first as the fire rapidly spread throughout the first floor and smoke spread to the upper levels in a matter of minutes.
But despite the staff's efforts, 25 people were killed and another 124 were injured by the blaze, which began at a time when few security members or facility management personnel were on duty.
The incident was the latest in a series of disasters in 2015 in Saudi Arabia, following a crush during the Hajj in Mecca that killed 769 people and a crane collapse in Mecca's Grand Mosque that killed 110.
Twitter users immediately took to the social media platform to express their outrage over the Jazan fire, blaming the Saudi government and officials for a poor response to the blaze, which they allege ultimately caused the high number of fatalities.
"The disaster at Jazan General Hospital is the result of great negligence and the health ministry and health minister specifically and the hospital administration, interior ministry, and civil defense are all responsible before God," one Twitter user said, according to Reuters.
Users were especially critical of the government because the Jazan fire was not the first of its kind in the Kingdom. Several hospital fires preceded it, but did not attract media attention because the fires were contained and there were a limited number of casualties.
Public opinion of the Saudi Arabia Ministry of Health has not been high in recent years, and the Jazan fire did nothing to help restore confidence in its services.
The ministry announced that it would accelerate the investigation into the cause of the Jazan fire and would make the results public. It also said that if it uncovered any negligence, countermeasures would be taken, and the ministry itself would bear responsibility for the fire.
Prince Mohammed bin Nasser bin Abdulaziz, the governor of Jazan Region, created a committee to investigate the Jazan fire. Following a review of the incident, the committee released its findings in January 2016: the fire was caused by an electrical short circuit in the incubators area on the first floor of the hospital.
The investigation revealed that hospital staff managed to evacuate all patients on the first floor of the hospital, which included the nursery, obstetrics, gynecology, and intensive care.
"However, the smoke density and escalation to the upper floors caused deaths on those floors due to asphyxiation," the committee said in a statement. "The main reason for the smoke escalation, which led to the occurrence of deaths, is the existence of geometric errors in the building's design and implementation; as fire isolation segments were not provided on the dropped (or false) ceiling, which might have prevented the spread of smoke from one area to another."
Additionally, the committee found that defects in the specifications of the materials used in the building's ceiling may have increased the smoke density. It also said that the materials used in the ceiling's oxygen extensions (pipes facilitating the flow of oxygen) did not meet the correct specifications, which caused them to melt and allowed the fire to spread.
The committee also identified errors in the hospital's fire alarm system, which was not connected to its air-conditioning system. This resulted in the air conditioning continuing to run after the fire started around 2:30 a.m., spreading smoke inside the facility.
The hospital's safety systems, including fire pumps and alarm systems, were riddled with defects due to poor maintenance, the committee said.
"An auditing is currently underway for all procedures related to the building construction…that is to be added to the strict statutory actions, which will be taken against all those proven involved in the poor design and implementation of the building," the committee said.
After these findings were made public, Minister of Health Eng. Khalid bin Abdulaziz Al-Faleh said it was clear that there was some negligence by officials at Jazan Health Affairs Directorate. The director general and other directorate officials were fired.
The Jazan fire and the public disclosure of the committee's findings offered a rare opportunity for security professionals to learn from a real life incident. Following are some key takeaways for healthcare security professionals.
Negligence. The Saudi Arabia Civil Defense Agency had warned officials of a number of irregularities in the safety measures at Jazan prior to its official opening in 2009.
For instance, the agency warned of dangers, such as the lack of an emergency generator and of electric cables that were interconnected with the sewage drainage system. The warnings by the agency further revealed that the contractor hired to construct the hospital committed several engineering errors. These included the lack of ceiling insulation, weakness of materials used in the oxygen extensions, and poor maintenance of the hospital's alarm systems in general.
Instead of addressing these warnings, Jazan hospital was opened in 2009 to relieve pressure on other hospitals in the region that serve 1.3 million people. By failing to address the agency's safety concerns, hospital executives and the government contributed to the spread of the fire and the high number of deaths and injuries.
To prevent this kind of negligence in the future, the Saudi government determined that it should not accept a building as completed until all the checks and coordination with the relevant regulatory authorities have been met.
Security performance. The Ministry of Health indicated in its investigation that the poor performance of hospital staff in the evacuation process led to an increase in deaths and injuries from the fire.
The investigation also suggested that there was a lack of experience in safety and security management at the hospital. For instance, the hospital did not have an incident command team, mechanisms to open emergency exits, or fire extinguishing systems.
The high number of deaths and injuries from the incident, many of which resulted from the spread of smoke in the hospital's upper floors, were also caused by the slow response to the fire.
The evacuation area was congested with cars and bystanders, hampering the evacuation process and attempts to rescue the injured. This state of chaos and unplanned participation by bystanders in the evacuation process exposed a number of people to possible injury and death.
All of these findings highlight the importance of an updated evacuation plan, periodical training on the correct execution of the plan, training on crowd management, and plans for dealing with unexpected participation by bystanders in the evacuation process. They also address the need to secure emergency exits and remove all obstacles from them, along with any obstructions in the evacuation zone, to facilitate the evacuation process.
The findings showcase the need for rapid coordination between safety and security management and the country's civil defense agency to minimize injuries, as well as the need for a multidisciplinary incident command team.
Furthermore, the findings identified the importance of fire detection system inspections, reports on inspection findings, and implementation of recommendations to address those findings.
Senior management. After the Jazan fire, reports noted that the presence of officials from the Ministry of Health for the Emirate region and hospital senior management in the evacuation area had a positive impact on strengthening the links between senior management and the victims.
Their presence helped speed up the decision-making process during the emergency and reduced rumors about the fire, which were spreading rapidly over social media.
A lesson learned from the incident was that the presence of facility senior management can facilitate response and rescue efforts as well as strengthen the relationship with employees and those injured in the incident.
Official speakers. One problem related to the officials who responded to the fire was that they gave conflicting and contradictory statements about the incident.
In one example, a fire department spokesman gave information in a television interview that was irrelevant. His statement was seen as an attempt to avoid answering the questions posed by the interviewer. This evasive behavior did nothing to increase trust or confidence with the public.
After the Jazan fire, it became apparent that only authorized media spokespersons—who are qualified and experienced— should be allowed to talk to the media. These individuals should be fully informed about the incident, and must be qualified to give statements.
Social media. A great deal of conflicting information was posted and shared via social media, which helped spread the news of the fire while also allowing rumors to spread and quickly grow.
During the first four hours of the fire, Twitter interactions with the words "fire Jazan hospital" reached 200,000. Users also spread misinformation that the doors to the hospital had been locked or chained, preventing people from being evacuated.
Because of this, the committee urged that social media and its impact be taken into account in future incidents to avoid the spread of rumors and false information.
Reopening. Jazan General Hospital is critically important because it provides healthcare to a large number of patients in the region. And, as evidenced by the committee's report, the damage from the fire made it difficult to reopen in a short time.
To help speed up the reopening, the Ministry of Health hired a contractor to renovate the hospital to restore healthcare services as soon as possible.
The ministry also appointed a safety and security director for the region and hired a consulting office to conduct tests after the reconstruction to ensure the safety of the facility by testing its fire extinguishers, fire alarm networks, and other safety equipment.
In the investigation report, the committee underscored that the safety of healthcare facilities is a top priority for the ministry. To prove this point, the ministry hired three consulting firms to conduct an overall audit of all government healthcare facilities in the Kingdom to ensure engineering and systems safety, with a priority given to the Jazan region hospitals.
"The survey will be completed within six months, and the corrective plan will be implemented accordingly," the committee said. "The contracts of safety and security will also be separated from the maintenance contracts for all facilities, which will help in the advancement of this aspect."
The complexity of the Jazan fire also shows the need for fast and accurate evacuation procedures for patients and staff when a fire occurs. Workers must be trained to deal with incidents to ensure that evacuation procedures are executed properly.
The ministry of health is making training a top priority, launching a program to educate all employees in ministry facilities on evacuation techniques and handling internal disasters efficiently.
"Special focus will be given to the Jazan region and borders areas, and a specialized team will commence training the medical and supporting teams in Jazan on fire extinguishing, evacuation, dealing with hazardous materials, and electrical security and safety," the committee explained.
While some accidents cannot be avoided, risks can be reduced through preparation, training, and technology. Such programs can prevent the high casualties and public outrage seen with the Jazan fire.
Ibrahim Abdulaziz Al Essa, CPO (Certified Protection Officer), is the COO office manager at King Saud University-Medical City in Riyadh, Saudi Arabia. He is a board member of the Riyadh Chapter of ASIS International.