Incident Response Plan in Case of Fire Hazards - Essay Example

(by the About the building: The building is located in Andheri West Mumbai. It’s a of the art fully equipped hospital. It has around 25 doors and 15 emergencies exist. Burglar and fire alarms are located at every floor and at a point around 75 people are expected. 1. Hazard: Two dangers opening used to extend wires and duct to other rooms Who might be harmed and how Building workers, staff and other people As it case of fire or explosion the two opening may allows smoke to spread to other parts of the building Risk Ranking: Moderate Control measures: In the workplace there were portable fire extinguisher and sound fire alarm Further action: The two opening should be closed completely and allows the wires and ducts to extend to other room with ensuring no smoke could pass to other room 2. Hazard: CT radiation dose Who might be harmed and how Patients are the victims of CT radiation dose. CT makes up for the most diagnostic radiation exposure to all patients. There may be instances when multiple scans would be needed. This can be harmful and can put the patient at a high risk. The risk associated with radiation exposure against the advantages of examination need to be traded off before determining the dosage of radiation. ST scans that use IV contrast have a lot of risks associated with them. For instance, if barium extravagates, severe inflammation can result. Other potential hazards include pneumonia and burning in the stomach. Risk Ranking: High Control measures: Radiation doses should be carefully quantified based on the needs of the patient. Further action: Gastro gin can be used as an alternative measure. 3. Hazard: Alarm Hazards. This is essentially due to excess of equipment in the hospital. There is a huge variety of equipment in this hospital. This includes patient monitoring, ventilator, dialysis units and much other equipment Who might be harmed and how: Caregivers can be harmed. Patients can be harmed. As it case of fire or explosion the two opening may allows smoke to spread to other parts of the building Risk Ranking: Moderate Control measures: Exhaustion related to alarm should be avoided by setting alarm configurations to appropriate physiological values which can be quantified. Further action: Designs that reduce nuisance should be sought for. False and excessive alarms in particular should be keenly evaluated. An alarm enhancement system that makes the alarm volume more audible and can convey alarms remotely should be implemented. 4. Hazard: Cross contamination due to Flexible Endoscopes. Endoscopy is a diagnostic procedure which has set hospital care to a new trend. It is minimally invasive and has revolutionalized diagnostic measures in most modern hospitals. Who might be harmed and how: Medical personnel and patients are at a major risk. Patients are primarily at risk because of their unduly exposure to infectious diseases. This is due to failure and negligence of sterilization and cleaning procedures. Risk Ranking: Moderate Control measures: The large number of patients should be warned in advance of potential exposure to contaminated endoscopy equipment. Further action: A re-processing protocol should be made and implemented at the same time. It must be ensure that such a model specific protocol exists for every endoscopy model in the hospital. It must also be ensured that automated endoscope preprocessors are compatible with the disinfecting agents employed. The staff must ensure that the maintenance schedule is also followed and other carelessness should be avoided. 5, Hazard: Surgical fires. Janie Mc Call who is aged 65 years passed away in a flash fire while conducting a routine surgery in an operating room in September 2005. The incident took place at Heartland Regional Medical Center in Marion III. Who might be harmed and how: Surgeons, patients, staff, workers and nurses are at a potential major risk. It is estimated that at least 550-650 surgical fires take place every year. This makes it as dangerous and as frequent as other surgical mishaps for instance wrong-site surgery. The surgical fires are a result of combustion. This is due to the presence of a very oxygen rich atmosphere during surgeries exposing the head, face, busts, chest and back to it. Risk Ranking: High Control measures: The routine norm of infusing 100% pure oxygen through open delivery mechanisms should be stopped right away. This is especially for the head face chest and back surgeries. Further action: Hospitals should draft and execute a surgical fire prevention and implementation program. The members of surgical team should be well aware of all the components and phenomenon associated with surgical fires such as oxidizers, ignition sources, and fuel. The aforementioned 3 make up the fire triangle in an operating room. 6. Hazard: Needle sticks and other sharp injuries. Who might be harmed and how: Clinicians, patients, laboratory personnel, housekeeping staff and waste handlers. Needle sticks and sharps related injuries are quiet common in today’s life. Accidental needle sticks keep taking place and so is the case with other sharps-related injuries. The irony is this that these incidents keep happening irrespective of the common use of needles, intravenous administration sets, and other modes for protection against injuries. Exposure to sharp needles may lead to emergence of blood borne pathogens for instance HIV, Hepatitis, and C Virus. Risk Ranking: High Control measures: Use intravenous administration sets. Further action: Damage can also be avoided by making sure that the staff is completely trained and knows how to operate protective devices. They must make it a point to follow all procedures in the guideline to dispose of needles. The models that are chosen should be efficient, intuitive and should be easily compatible. If the injuries yet keep on happening, it is likely that the problem lies with the devices and not with the people using it. 7. Hazard: Air Embolism from Contrast Media Injectors Who might be harmed and how: Angiography is the x-ray imaging of our blood vessels. In this there is some contrast media that is injected into the patient’s vessels. It requires careful handling of the syringes. To improve upon the precision and control of injection, handheld syringes have been replaced by power contrast media injectors today. However there is major fatal hitch. Use of contrast media, increases the likelihood of injecting air in the vessels, potentially resulting in fatal embolism. Recent reports have indicated 32 cases, 3 of them fatal in the last 10 years. Risk Ranking: Low Control measures: Power injectors should be made with enough safety measures that can reduce the risk of air embolism. This may involve inclusion of systems that can detect air in the injection line or the presence of a used media syringe. Further action: To curb down the risk of embolism, it is important that contrast media injectors used should ensure installation of current safety measures and enabled on injectors. Warn the users beforehand that while the safety features are important, they will not prevent air injection in all cases. Vigilance is the best defense in this regard. Standard protocols should be established which should clearly delegate responsibilities for specific tasks (for instance tubing checks). This ensures that clinicians don’t make incorrect assumption about someone else’s needles. Clinician must inspect tubes and injectors for any air bubbles before going ahead with any injections. 8. Hazard: Elevated environmental temperatures. Who might be harmed and how: Building, workers, staff, patients. Elevated environmental temperatures can wreck havoc in the human skin and can cause burns. The effects of temperature change with the length of exposure time. Other factors such as humidity and breathability also have an important impact. Severe discomfort can crop up when temperature is as low as 122 degrees Fahrenheit while temperatures above 150 degrees Fahrenheit are considered to be suffocating. Temperatures above 212 degrees foresheet can trigger death. (NFPA: 1997; n.p) Risk Ranking: High Control measures: Use Fire alarms Further action: Monitor temperatures at all times. Hazard: Toxic conditions Who might be harmed and how: Toxic conditions are dependent on the kind of by products that are produced due to combustion Risk Ranking: Low Control measures: Keep a close check on all combustible material. Further action: Ensure that the staff follows all safety guidelines associated with the products. Hazard: Burn injuries and heat flux Who might be harmed and how: This is a measure of the amount of heat that is available which can be transferred to the human skin. Some 2500 kilo watts of heat per 3 minutes can be born without severe pain and this marks the upper limit. This is equal to holding an individual’s hand over a 100 watt bulb for as long as 3 minutes. The higher the temperature, more are the chances of burn injury taking place. Risk Ranking: Low-High (variable) Control measures: Take appropriate action as soon as the fire alarm is triggered. Further action: Place fire extinguishers at all exit and other appropriate locations. Other related Hazards: A fire situation can produce different kind of hazards. The conditions that have major impact are: 1. c) Smoke obscuration 2. d) Oxygen depletion 3. e) Exposure to fire gases Smoke obscuration: Smoke curbs a lot of things. They impair visibility, cause irritation and toxicity due to inhalation and arouse fear. All of these directly impact a person’s ability to escape. Normal oxygen in the atmosphere is close to 21% but when this percentage drops different physiological effects take over and harness a person’s ability to cope up with the threat. There are a lot of gases in the atmosphere whose optimum levels have to be kept in control to prevent undesirable situations from arising. Rising carbon monoxide levels in the hemoglobin are not a good sign. Exposure to carbon monoxide for a very long period of time may not be a good sigh and can prove to be fatal. It has been observed that carbon monoxide is the reason behind most of fire related deaths. They reduce the ability of an individual to acquire oxygen and survive in the short run. While pre-existing and physiological attributes of the components are related to the occupants who are witnessing the on-going fire outbreak. For instance the age or the physical setting of the place. The most crucial time interval for safety of individuals is the time after the discovery of the fire and its critical stage. It is in this stage that most measures have to be undertaken for the safety of humans. Important steps have to be taken in this interval for this is the only time in which action is conceivable. The action can vary. It can be automatic extinguishing the fire of evacuating the confinement of the fire, along with any occupants present there. There is a direct relation between the time of discovery of fire and the time available to take action. The sooner the fire is discovered, more time will be available to take action. The affects of the hazards can be nullified if pro-active actions are taken. The hazards don’t necessarily have to grow at the same rate as the fire. For instance an automatic suppression system or a detection system can slow down its rate. comments criticality rank frequency contingencies safeguards warning devices consequences possible accident trigger(s) location of hazard source of hazard Two holes should be closed low low Portable fire extinguisher and sound fire alarm noun noun Restrict people from escaping Fire and explosion Allowed smoke and flame to passed to other room At workplace Two holes on the wall 1 Gastro gin should be used low dependent Radiation doses should be carefully used Quantify radiation doses. CT radioactive alarms Kills tissues Pneumonia Inflammation, burning Inside X-Ray room Exposure to radioactive gases 2 Alarm enhancement systems could be used moderate moderate Design related nuisances should be avoided same Set appropriate quantifiable configuration settings of the alarm Incorrect checkup of the patient Fire related Fire, Damage to the body Inside the building Excess equipment in the hospital 3 Keep the patients informed. Moderate Moderate Use disinfectant agents Make sure to re-assess the protocol for diagnosis Warn the patient in advance Infectious diseases Infectious diseases Infectious diseases Patient’s room Cross contamination due to endoscopy 4 The members of surgical team should be well aware of all the components and phenomenon associated with surgical fires such as oxidizers, ignition sources, and fuel. High High Implement the plan Devise a plan Stop using 100% pure oxygen Fire Fire Fire At work place Surgical fires 5 The models that are chosen should be efficient, intuitive and should be easily compatible High High The models that are chosen should be efficient, intuitive and should be easily compatible The models that are chosen should be efficient, intuitive and should be easily compatible Use intravenous administration sets Emergence of blood borne pathogens for instance HIV, Hepatitis, and C Virus. Emergence of blood borne pathogens for instance HIV, Hepatitis, and C Virus. Emergence of blood borne pathogens for instance HIV, Hepatitis, and C Virus. Clinics, Labs . Accidental needle sticks keep taking place and so is the case with other sharps-related injuries. 6 Fatal embolism Fatal embolism Hospital Air embolism from contrast media injectors 7 Risk ranking: Formulae = Likelihood * impact 1. Two holes on the wall: Risk ranking = .5 * 2 = 1 2. Exposure to radioactive gases; Risk ranking = .75 * 4 = 2.25 3. Excess equipment in the hospital Risk ranking = 1.5 * 2 = 3 4. Cross contamination due to endoscopy Risk ranking = 2 * 2 = 4 5. Surgical fires Risk ranking = 2 * 2.5 = 5 6. Needle sticks Risk ranking = 2 * 3 = 6 7. Air embolism Risk ranking =3 .5 * 2 = 7 8. Elevated environmental temperatures Risk ranking = 2 * 4 = 8 9. Toxic conditions Risk ranking = 4.5 * 2 = 9 10. Smoke obscuration Risk ranking = 5 * 2 = 10 Tree Analysis: Success Tree: 1. 2. Failure trees: 3. 4. 5. Event trees Tree Math analysis: P (fire) = P (holes) * p (loose connections) = (0.2 + 0.05 – 0.2*0.05)*0.1 = 0.024 P (dying tissues) = 0.5* 0.5 =0.025 P (no infectious diseases) = 0.5*0.5 = 0.025 P (no fire) = 0.025*0.025 = 0.000625 P (event) = 0.3 Reliability Study: A large structure can be broken down into a smaller one and the system is the sum-product of its parts. Through this we can calculate the arrangement of the components and figure out how reliable the system is. A box is drawn for every component of the system. For instance, the organs in human being and this box is connected in the someway as the other components that interact with the system. Business continuity Plan Process: Organization’s drivers: The hospital’s prime driver is its vision to see the nation as a fully equipped modern state of the art health care forum. It aims to provide excellent health care facilities. Its prime driving force is its well trained and well qualified staff. They aim to provide outstanding facilities to the patients while ensuring complete recovery of the subjects. The organization deals with all avenues associated with health care and have well equipped labs. The labs are fully functional and infused with appropriate safety precautions. The hospital has been running successfully for the past 2 years. Its market share has been re-stored and debt has returned to pre-disaster level. Around 80% of ownership is maintained. Breaking point: Look at the table below. Typically going by the analysis, the break-even point is expected in 2.25th year. This is when the revenue would be offset against the profit and loss margin. Incident response plan in case of fire hazards and implementation: Humans have been a victim to hundreds of deaths in the past few centuries owing to fires. If proper action is taken and they are trained to behave in the right way, some of these irrevocable consequences of fires can be avoided. They should be taught how to deal with panicky situations, how to deal with emergency and to how to address their safety in such undesirable circumstances. Life safety is very important and given the context, it means trying to curb down un-necessary exposure to the harmful products due to combustion. There are three basic directions that need to be followed. The first one is to try stopping ignition, the second one is to control the outbreak of fire and the third one is to keep the humans safe from the byproducts of combustion. This can be done keeping in mind the concepts of either of the three of time, distance and shielding. The building up of fire: The smoke and heat don’t develop instantaneously. They develop over time to create a harmful hazardous environment. There are a lot of variables involved and each of these variables varies in different circumstances so the rate at which this happens can’t be exactly predicted. The fire starts of as small and slowly gradually intensifies thus invoking a very hazardous environment in the process. The fire can be detected by either of the 2, through automatic means or by personnel detection. The real focus should be on what stage after ignition and heat buildup has the fire been discovered. It is that stage which will have a major impact on the life safety measures that would be taken up. Factors which are relevant to the individual: It is not necessary that all the occupants at the site of the fire will react to it in the same way. The reaction of two different people will vary. The reaction of a single individual can also vary in different time frames, in different settings. It is not necessary that someone who reacts in a particular way at one point in time will react in exactly the same way three days from now. By reaction, it is meant, how humans react to smoke build up, to the flame, to the burns, to the hue and cry etc. There are some factors that help determine how humans react to fire situations typically. These factors are: 1. Age 2. Size 3. Pre-existing physical condition 4. Respiratory capacity 5. Medication, drugs and alcohol Where age is concerned, the kids and the elderly are less able to cope up with the affects of the fire. They are more likely to fall prey to the hazardous environment surrounding the fire and become a victim to all the fatalities. Statistics have revealed that the kids and elderly have the highest fatality rate. Where size is concerned, obese people are more likely to take in large doses toxic inhalation generated by the fire. As the size increases, so does the toxic intake capacity increases. Thus a large size may not be a very good factor. At the same time, thin sized people may be at a disadvantage in physical settings where there is no conditioning. The pre-existing health state of the individual will also be an important determinant in tackling and surviving in fire. This may include his cardiac conditions, his respiratory conditions, his aerobic conditions, his level of mobility; what is his weight? How flexible is he? Is he skeletal? Is he muscular? Does he carry any diseases with him? If so then what kind of diseases? Smoke inhalation is a major cause of fire related deaths. Thus a person’s respiratory capacity is an important factor for his survivability in such circumstances. Someone who indulges in smoking while have high levels of carbon monoxide in his hemoglobin. This will be critical to his intake of oxygen and his oxygen taking in capacity comes down. There are also chronic diseases like emphysema and asthma which will lower the respiratory capacity of the individual. Flu, pneumonia is certain other acute conditions which determine a person’s respiratory capacity. In each of these above mentioned conditions, survival in the case of fire will be very difficult and critical. An individual’s mental presence at the site of fire is also an important factor in determining his ability to cope up with the disastrous effects of fire. Some who is on drugs and has indulged in excessive intake of alcohol won’t have a very spontaneous mental aptitude at the site of fire- a factor which is very critical to survival. According to some recent estimates, around ten percent of fatalities were a result of alcohol and drugs. Those in this age group of 20-64 are more likely to be impaired then the general crowd. There are various ways in which people can react to a sudden outbreak of fire. It is a complex pattern of human behaviors under which they react. There are complex patterns involved and are related to a process called the Decision Process of the Individuals. Six basic techniques are used to decide what to be done in an emergency situation. These include: 1. Recognition 2. Definition 3. Evaluation 4. Commitment 5. Re-assessment 6. Validation Recognition process triggers off when an individual finds out clues related to the threat of a fire. The clues can be of variable nature. It may be his gut instinct that something isn’t right or something feels out of place. He has to rely on his intuition in most of these circumstances. The cues would be in most cases ambiguous but would be signaling a severe threat of fire. The threat stays unrecognized until smoke, flame or heat is seen by the naked eye. This is followed by the validation process. The validation process comprises of the efforts undertaken by the individual to figure out how serious the threat cues are. There are questions such as “should the building be evacuated” or “do we smell smoke” etc that begin running in his/her mind. Each of these questions needs to be addressed accordingly. The validation process is followed by the definition process which is attempts by the individual to associate information of the threat to some variable. The individual determines the qualitative nature of the threat. How serous is the threat? How much heat does he feel? Have the burns started cropping up? How big is the magnitude of deprivation? What is the time setting? According to his instinct does he follow a particular course of action? The evaluation process comprises of the cognitive and psychological activities which are necessary for an individual to react to threat. The ability to cope with stress and survival under pressure are critical in the way he would react against these dire circumstances. It will include the decision of what course of action to take. Should he run? Should he stay back to fight the fight. The time associated with this decision and its execution is very less and in most cases reduced to a few seconds. The mechanisms that an individual will adopt to start the behavioral activity he thinks would be needed after his evaluations constitute the commitment part. Re-assessment is the most important and most stressed out phase for the individual. This is because the last process just failed and he has to quickly re-evaluate. As he will hit through successive failures, frustration will keep growing and the likelihood of injury and risk also starts shooting up. It is at this point, that decisions are made in haste and are irrational. An individual’s reaction is not just his own in a fire setting. It can be impeded or accelerated or supported by the reaction of many other people who are associated with him in the event of a fire. There are various other actions that affect the way people react to fire. Some of these are Avoidance, commitment, affiliation and role. Avoidance: A person’s psychological point of view can also help relieve him of stress associated with these unpleasant situations. There is a sense of denial that prevails during the early stages of fire that sets him rolling. He is indignant and tries to deny the signals and the cues that he gets. They try to avoid the fire and treat it as a “false alarm”. Commitment: Sometimes negligence on the part of the people can also be a disclaiming factor. They may hear fire signals but continue working on any important project they may have been engaged with before the alarm, leisure activities or personal projects. They keep working irrespective of the dangerous warnings. Sometimes people will wrap up what they are doing first and then erode the danger area even when the alarm has been sounded. Sometimes people will ignore the warning first hand and enter the building undeterred as if nothing went wrong. People are big socialists. An individual not act for himself. In most cases, evacuation on the site is done unanimously. People would leave the work place together, whether they know the other occupants of the condiment or not. The speed of evacuation is dependent of the speed of the slowest occupant of that place. Parents won’t leave without their kids while co-workers tend to leave with each other. At the same time, a person’s role is also an important factor in deterring how he will react to the situation. Someone who is new to the building would obviously take more time to react for example, a visitor. In this case the visitor is more likely to turn and seek help from a more authoritative dependent such as a supervisor, security personnel or fire fighter for information. This helps them determine what follows next in the emergency. Cost benefits analysis: Incase nothing is done; the hospital will be suffering some major setbacks for some of its fire course. On the other hand, in house security measures would cost a fortune. The only viable option seems to be outsourcing security so that first hand training can be provided to the staff, workers and housekeeping. Initial costs would be high but it’s expected to settle down in subsequent years. Do nothing Outsource security In-house measures Patients We may lose out on patients. The business is likely to undergo major loss Useful to satiate the patients, in case they don’t trust us. It would increase their expenses. Staff Excess workload. They would be at the receiving end from the patients Training would be provided to them. Decrease in salary would follow Workers Risk associated would be huge as they would be the first sufferers Secure safe working environment Decrease in salary would follow Housekeeping Excess workload. Reduction in the total number of hours work load for each day Reduction in daily wages Utility & Insurance: The hospital is expected to be insured by the security providers and other legal entities. There are a lot of benefits associated with insurance. This includes financial security and provident source of funding for investment. It helps boost and encourage safety measures while investigating risks. However insurance comes with a cost. This cost includes the cost of paying staff and people who fake accidents just to avail insurance. Other costs include the cost of investigating the fraud and inflated claims by people. References: Bibliography: NFPA (1997). NFPA Fire Protection HandBook. N/A: NFPA. Cotee and Bugbee (1976). Principles of fire protection. NFPA : NFPA. (1997). Fire and Life Safety Educator. 2nd ed. IEFTA: IEFTA. Peter. (2009). Fire safety. Available: www.firesafety.gov. Last accessed 19th Jan 2010. NFPA (1997) NFPA-Fire Safety Available: www.nfpa.org. Last accessed 19th Jan 2010-01-19 IFSTA (1998 IFSTA-Fire Protection Available: www.ifsta.org Last accessed: 19th Jan 2010 Martin W Hodge gate “From care to action, making a sustainable world.” William Theodore De Bary “ Sources of Union tradition” http://www.ling.lancs.ac.uk/groups/slarg/lancawe/data/t3/126-SS04-CH-M-PG-MAN-Y-B-T3.txt , retreived May 2008 Bryan, R. Cole. (n.d.). TOTAL QUALITY MANAGEMENT AS A TOOL TO ENHANCE THE QUALITY OF HIGHER EDUCATION MANAGEMENT IN THE 21ST CENTURY. Retrieved March Friday, 2008, (n.d.). Retrieved Dec 23, 2009, from www.osha.gov Read More