It's hard to imagine that a simple decision on whether to extinguish a small fire or solely evacuate a fire compartment within a health-care facility would stir up extensive controversy. In the health-care profession, it’s widely known that large fuel tank and electrical transformer fires should be extinguished only by trained firefighters. However, what if the fire is a small trashcan fire and can be easily extinguished by a trained health-care professional? On this decision, most health-care facilities are torn.
To fully understand the debate, some important aspects must first be considered. The most important aspect is one that even most fire professionals know very little about. That is, knowing what the safety and health risks are of using a fire extinguisher, for all involved parties (patient, staff and bystanders) depending on extinguisher, time and location used.
The health effects of common ABC or multipurpose dry chemical extinguishers have been overlooked since their initial common use (approximately 40 years ago). When asked, various fire professionals could not tell what the health effects were.
The dry chemical extinguishers insulate class A fires by melting at approximately 350 to 400 degrees. The powder coats the surface it’s applied to, breaking the chain reaction of class B fires, and is said to be safe for class C fires because it is a nonconductor of electricity.
Many fire safety professionals simply skip over the topic as they don’t understand it, or worse, think they do and give out incorrect information. Although most understand how the dry chemical extinguishes fire, one fire safety professional stated that since ABC extinguishers work by preventing the chemical reaction and not by removing oxygen, there are no health risks. This was a very shocking and incorrect statement, spoken by a fire professional with no formal medical training.
A case study in the European Journal of Trauma reviewed the outcome of a patient who inhaled dry chemical extinguisher spray into his or her lungs during a car accident and resulting fire. It explains that the extinguishing powder in this case was preventing the lungs from exchanging oxygen, resulting in hypoxia. Extended, severe hypoxia causes the body to build up with lactic acid, resulting in cardiac arrest. Another possible cause of death from dry powder extinguishers is theorized to be acute respiratory distress syndrome, where the powder causes the lungs to build up with fluid.
A rather important factor, however unknown, is what amount of extinguisher powder, and thus what amount of exposure, would cause these life-threatening situations. There’s little to no research on this specific subject. Just as it is unknown what amount of extinguisher powder will kill you, another area that is lacking statistics is the number of people killed from ABC extinguishers. The Journal of Toxicology does track fire extinguisher deaths; however, it reports only a few deaths, but thousands of injuries required hospitalization. Researching this area, physicians and anatomic technicians were consulted. They agreed that if the primary cause of death was known to be a cardiac arrest, most likely an autopsy would not be performed. If one was performed, it would confirm their theory of cardiac arrest as the primary cause of death once they found the lactic acid and heart damage. The dry chemical powder from the extinguisher would probably never be found or linked to the cause of death. This shows that the accurate number of deaths directly caused by extinguisher inhalation is still impossible to know.
Let’s walk through a typical fire extinguishing scenario. Since a dry chemical extinguisher should never be used on a person or even with a patient in the same room, the first step is to evacuate the room. Once all patients have been removed from the room, a thorough search must be done to ensure that everyone else is out of the fire room. As a fire and emergency management consultant, I train health-care professionals daily who forget the acronym of PASS, which is used to operate an extinguisher. PASS stands for: Pull out the pin, Aim at the base standing away from the fire, Squeeze the handle and Sweep at the base of the fire.
Once the fire is extinguished, health-care professionals should leave the room and close the door. Most do not do this. Instead, they stare at what was burning trying to tell if it’s out. Health-care professionals are not qualified to deduce when a fire is completely extinguished and not simply smoldering. Either way, a health-care professional’s next step is to leave the room and close the door (which should be tagged as the fire door). Firefighters will handle the rest with their advanced training and tools to extinguish and confirm that the fire is out.
The next aspect to consider, is how well trained your staff is. For health-care professionals to extinguish a fire, they must receive adequate, continual training in the field of fire suppression, and judgment on which fires are too large and must be handled by fire professionals. During their training, they must practice using every type of fire extinguisher used in that building. Staff must be trained in safety and the health risks of using fire extinguishers, for all involved parties (patients, staff and bystanders) depending on the type of extinguisher, length of time and location used.
Another dimension to consider (since it will be federal law in three years), is if your health-care building is fully outfitted with sprinklers. If so, then your building is designed to at least contain, if not fully extinguish, the fire in the room of origin. If you get everyone out of the room, your building is designed to extinguish itself.
Another consideration may be based on your life safety surveyor. If your facility’s life safety survey stance is to extinguish, your surveyor will ask staff members extensive life-safety questions on fire suppression as they conduct a walk-through of your building.
Knowing the health hazards of improper use of fire extinguishers, and that most professionals have inadequate training of their use, we return to the question at hand. Should trained health-care employees extinguish or evacuate?
Health-care professionals do not have the advanced training and knowledge to safely extinguish even a small fire. By attempting to, they risk the safety of themselves, patients, visitors and co-workers in the vicinity. Modern building construction, which uses self-containing smoke/fire barrier doors and sprinkler systems in certain areas, if not all, decreases the necessity even further. In this age of advanced building systems, the training of health-care professionals in extinguishing fires, equates to more risk than it’s worth.
By: Jon Taluba / emergency management consultant.
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