Up in Flames: Revisiting Safety Norms

Bone and Joint Hospital in Barzulla area of Srinagar caught fire on March 4, Friday throwing into question the safety norms in public buildings 

WHAT shall one make of the assessment which describes the recent accident of humongous fire at Barzulla bone and joint hospital as a “wake – up call”? Shall it be assumed as a hint and clue pointing the negligence and state of slumber of concerned agencies and authorities towards the comprehensive safety of hospitals and by analogy to public buildings like schools, colleges, universities, malls, shrines, mosques? This is what has been hinted at, at least partially by some of the agencies entrusted with overall evaluation and estimation of safety parameters of hospitals. A statement from fire and emergency department reads that “Around 70 percent Government as well as private hospitals in the UT do not have basic fire safety measures in place. They lack smoke & fire management system and in many health institutions, unreliable fire management systems have been noticed”. That is the scenario of hospital safety for you, for me and for all of us. This is how poorly our hospitals are assessed to perform when weighed against the scale of safety and security. It needs to be borne in mind that hospitals aren’t picnic sports or holiday resorts, where one ventures in pursuit of joy, adventure or thrill. It is a place to which we rush in hours of health crisis, medical emergency and state of utter helplessness. The very idea of hospital invokes in us a sense of reliance, relief and escape from the suffering we are caught in. Stated in other words, hospitals are meant to be niches of safety, security, dependence, reliability and care of supreme order. But shall the thought not pause us to think for a while that the places we rush to in search of shield and safety, are themselves unsecured and susceptible and vulnerable to various natural and man-made disasters.

The recent episode of fire at Bone and Joint hospital awakened us to one of the dozens of safety lapses which our hospitals might be harbouring and which might culminate in disaster/s of unforeseen and unaffordable magnitude if not given due attention and plugged the earliest.

One lacuna of unforgivable proportion which underlies human response is our proclivity for reactive instead of proactive measures. Because the fire engulfed Bone and Joint Hospital recently, now all attention seems to be diverted to the fire audit and fire fighting systems in place at hospitals. And this reaction usually comes at the cost of ignoring other safety parameters or considering them less hazardous till they cause a damage and destruction of higher proportions, some other day. So let us expand our canvas and try to identify the broader contours of “Safe Hospitals”, and this description shall, by extension and little customization apply to all the buildings of public usage, as alluded to above. But before we can proceed with suggestions to ensure proper safety measures, our first task is to define hospital safety in most comprehensive and inclusive way possible.  Hospital safety can be defined as the sum total of all procedures adopted and measures taken to ensure the safety and security of Patients, Staff, Attendants and visitors. This safety implicitly assumes in definition its extension both to tangible and intangible aspects of safety and security. When we try to conceptualise the tangible vectors of hospital safety, we come across three broad categories: the structural safety of hospital, the safety of patients, staff and attendants and the safety of equipment installed inside a hospital.

The structural safety of hospitals in turn involves making hospitals cope-up and mitigate the unforeseen calamities like earthquakes, ensuring proper fire fighting mechanism in place and foreseeing any possible future floods and to design hospitals such that they withstand these contingencies. Let’s see how earthquakes influence the structure of hospitals and how can various structural features be added or subtracted to ensure that in any case of earthquake occurrence, damage to life and property is reduced to the minimum. The first point of departure is to consult structural engineers and seismic resistant structure experts before any structure is raised on ground. Their opinions and expert advices need to be incorporated into the weaving of building at each step. Well, this is a routine standard process and these things are scrupulously observed while a structure like hospital, college etc is under construction. But what happens later is that these buildings are left in a state that can be described as “seismic ignorance”. It is not enough to have a seismic resistant place in building, but it calls for frequent timely inspections, evaluations, assessments and identification of faults and flaws, if any. Living in earthquake-prone region as we are, and given the unpredictable nature of earthquakes, all necessary measures ought to have taken to avoid any mishap. But as we get to know from experts, though our hospitals and constructed with the hindsight of meeting any earthquake related emergency, but there are many flaws like emergency exists do not function properly or remain blocked, even in events of earthquake. In similar vein, the absence of ample emergency exits and multi-flooring of hospitals multiplies the magnitude of damage in event of earthquake. A professor in Structural Engineering and specialist in Seismic Micro-zoning said on conditions of anonymity that most of our hospitals constructed in past, including the main three-storied main building of government SMHS hospital lack the necessary structural features necessary to provide them a degree of resistance in instances of earthquake.

This applies more radically to colleges, shrines, mosques and malls too, which house a large number of people at any instant of time.

Fire safety of hospitals has caught our imagination once again, with the eruption of fire at Bone and Joint Hospital, Barzulla. Earlier, the fire safety and safety audit became talk of the town when the famous Shrine of Dastgeer Sahib, Khanyar was gutted down in massive fire.  But the fervour decayed and even on this date, the holy shrines, which consist of entirely wooden structures are ill equipped to fight any fire related emergency. The fire extinguishers installed therein have usually been found dysfunctional and even if they happen to function, where are the people who know how to use these devices, if the need arises. Same holds true about schools, colleges, universities and other places where people in large numbers assemble together. But there’s some topicality about fire safety of hospitals and that is associated with the fact that whereas students in schools and people in mosques can move on their own, run and rush and save themselves, the patients in hospitals aren’t usually able to move on their own and rely entirely on the mercy of others to move and escape them in any event of fire emergency, lest they be charred and marred by fire. This brings us to the crucial question that do we have smoke detectors, fire alarms and proper fire fighting equipments in place in hospitals? When you see a fire extinguisher hanging by wall in any hospital draped by a sheath of dust, that shall alarm you and all of us that the magnitude of negligence is beyond forgiveness. What do experts say on the resilience of our hospitals to meet the emergency situation of fire.

A statement from the fire and emergency department in the wake of the recent incident reads “there are no fire-fighting measures, no emergency power supply and the public address system is also dysfunctional. Time and again, we use to advise the hospital authorities to install adequate fire safety equipment in their premises and conduct mock drills at regular intervals, but least interest is shown on their part to conduct mock drills which are necessary to prepare the hospital staff to control fire”. Let’s not get stuck in blame games, mudslinging and passing on the buck but rise up to the challenges which hospital safety posits in its multifarious forms and dimensions.

There are other equally important, but less talked about parameters of hospital safety. How often do we speak of the awkward and at times rudimentary behaviour of hospital staff towards attendants? Gripped in stress and anxiety, as these attendants usually are, their distress multiplies manifold while they withstand the rude behaviour of hospital staff. But the coin has other side too and that seems much darker. The incidents of attendants beating doctors have been on the rise and no civilised society shall leave any space for these gore episodes. A single patient is accompanied by multiple attendants and that has a cascading effect in setting problems on roller coasters in any eventuality and in otherwise normal situations too. The highly disproportionate doctor-patient ratio, the safety and security of equipment installed in a hospital, the frequent incidents of theft at hospitals, the oft-reported medical negligence all come under the ambit of hospital safety and there are many other aspects that call for separate space for discussion.

Let it be reiterated that safe hospitals do not imply only safety against fires, for we have witnessed a fire in one of our hospitals recently, but it calls for comprehensive inclusion of all the parameters discussed above. And while we talk about safety, it shall not be restricted to hospitals, but shall include in its scope all structures of public importance.

• Views expressed in the article are the author’s own and do not necessarily represent the editorial stance of Kashmir Observer 

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