NFPA Journal - January/February 2020 - 48

BURN
TREATMENT
has emerged that keeps hospitals in
compliance with modern codes and
standards that include NFPA 101®, Life
Safety Code®, and NFPA 99, Health Care
Facilities Code.
Even by US standards, hospitals-and
other health care facilities-are subject
to a unique and especially rigorous
enforcement process compared to other
occupancy types that has created the
level of safety that exists in hospitals in
the US today.
"An office building, for example, may
get inspected every year or so by fire
engine company personnel from the
local jurisdiction, whereas in a health
care facility you have local jurisdiction
enforcement in addition to a state
agency coming in for licensure purposes, a validation survey process from
representatives of the [federal Centers
for Medicare & Medicaid Services], and
the accreditation process," Koffel said.
Solomon said the hospital accreditation process has essentially become the
"fourth entity" of hospital oversight in
the US, in addition to oversight from
local, state, and federal agencies. "To
remain an accredited hospital, there
are private organizations that look at
everything from infection control to continuing education for doctors to fire and
life safety," he said. "If the facility isn't
in compliance with the applicable codes
and standards, that accreditation can
be threatened, which could mean insurance companies won't pay for treatment
services at that facility, or Medicare and
Medicaid funding for patient treatment
and care may be jeopardized."
Experts say such a robust and multilayered system of oversight generally
doesn't exist in other countries-and
that's the main problem.
"Internationally, I don't think there's
the same level of inspection that we
see in the US," Koffel said. "From the
work we've done and facilities we've
seen outside the US, not as much time
is spent ensuring code compliance and
you tend not to have those multiple
layers of inspection."

What sets international
hospitals apart?
One way the fire problem in hospitals outside of the US can be further

48 | NFPA JOURNAL * J A N U A R Y / F E B R U A R Y 2 0 2 0

understood is by examining the
NFPA Fire & Life Safety Ecosystem,
a framework of safety comprising
eight components that must function
together in order to be effective: government responsibility, development
and use of current codes, referenced
standards, investment in safety, skilled
workforce, code compliance, preparedness and emergency response, and
informed public.
Failures in any of these components can lead to devastating fires in
hospitals and other occupancies. In
international hospital fires, it's often
the components related to building
construction, codes and standards, and
emergency preparedness and management that tend to fail.
"Hospitals in low- and middle-income countries often lack strict
building codes, certification processes,
and regulatory oversight," said Robyn
Gershon, an
NFPA.ORG/
BURNTREATMENT occupational and
environmental
Read the October
health and safety
2017 NFPA report
"Structure Fires
researcher at New
in Health Care
York University's
Facilities."
College of Global
Read a 2014 study Public Health.
from the Journal of
Clinical Anesthesia "Everything from
on international
poor construchospital fires.
tion to a lack of
emergency preparedness within the
hospitals can lead to adverse outcomes
in staff, visitors, and the most vulnerable population-patients-during fires
or other emergencies."
A breakdown in the code compliance
component of the Ecosystem was specifically cited after the September blaze
that killed 11 people in a hospital in Rio
de Janeiro.
"The hospital did have an approval
certificate issued by the fire department," Anderson Queiroz, NFPA's
representative in Brazil, told NFPA
Journal in an article on the incident
and other recent, deadly fires in the
country ("Brazil Burning," November/
December 2019). "But the department
doesn't make regular inspections to
check whether already-approved facilities continue to comply with the code ...
It's not uncommon for there to be a lack
of maintenance of certain fire protection

systems or a change of the facility's
layout without the necessary updates
to the design of fire protection systems.
There's a lack of accountability to make
sure facilities that are already approved
continue to comply with the code."
Experts say similar scenarios play out
at hospitals globally. While there may
be individual organizations that set
out to construct health care facilities
overseas using codes like NFPA 101 and
NFPA 99, there are often few, if any,
checks and balances in place in these
countries to ensure that certain details
aren't overlooked during the construction process or that compliance will
continue over time.
"I would suspect that even if facilities are using NFPA 99 and NFPA 101,
the systems and equipment are not
maintained and the requirements of
the codes are not well enforced, either
during construction or after the hospital is up and running," said Rich Bielen,
the NFPA staff liaison to NFPA 99.
"If those codes were being vigorously
enforced, we wouldn't be seeing the
fires we're seeing."
A good example, Solomon said, is a
fire that swept through Jazan General
Hospital in Saudi Arabia in 2015, killing
25 people. "It was built using some of
the fundamental provisions of NFPA
101," he said of the facility, which was
constructed in 2012. "But there were
deficiencies that ultimately proved fatal."
Koffel delivered a presentation on
the incident at the 2018 International
Summit and Exhibition on Health
Facility Planning, Design, and Construction. In it, he pointed to the main
factors that contributed to the fire's
severity, which included inadequate
smoke compartmentation, foam plastics left behind after construction, fire
pumps failing to work properly, and
corridor clutter-deficiencies that could
have been identified and potentially
corrected through a more rigorous
enforcement process in the Middle
Eastern country.
But making US codes and standards
work in some international health
care facilities can be harder than it
seems, if not impossible-even in an
area with a relatively robust regulatory
environment.
http://www.NFPA.ORG/burntreatment http://www.NFPA.ORG/burntreatment
NFPA Journal - January/February 2020

Table of Contents for the Digital Edition of NFPA Journal - January/February 2020
