Fire Safety 1711045801

Healthcare
Fire Safety
According to the Na�onal Fire Protec�on Associa�on, an average of five fires

break out per day at our na�on's health care facili�es, and more than 8,000
hospital fires occur each year. If not acted upon quickly and effec�vely, the
results can be catastrophic. This course takes a closer look at protec�ng both
pa�ents and hospital staff from poten�al fire hazards in the healthcare se�ng.
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OSHAcademy Course 174 Study Guide
Healthcare: Fire Safety
Copyright © 2021 Geigle Safety Group, Inc.
No portion of this text may be reprinted for other than personal use. Any commercial use of this
document is strictly forbidden.
Contact OSHAcademy to arrange for use as a training document.
This study guide is designed to be reviewed off-line as a tool for preparation to successfully complete
OSHAcademy Course 174.
We hope you enjoy the course and if you have any questions, feel free to email or call:
OSHAcademy
15220 NW Greenbrier Parkway, Suite 230

Beaverton, Oregon 97006
www.oshatrain.org
instructor@oshatrain.org
+1.888.668.9079
Disclaimer
This document does not constitute legal advice. Consult with your own company counsel for advice on compliance with all applicable state and federal
regulations. Neither Geigle Safety Group, Inc., nor any of its employees, subcontractors, consultants, committees, or other assignees make any warranty or
representation, either express or implied, with respect to the accuracy, completeness, or usefulness of the information contained herein, or assume any
liability or responsibility for any use, or the results of such use, of any information or process disclosed in this publication. GEIGLE SAFETY GROUP, INC.,
DISCLAIMS ALL OTHER WARRANTIES EXPRESS OR IMPLIED INCLUDING, WITHOUT LIMITATION, ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A
PARTICULAR PURPOSE. Taking actions suggested in this document does not guarantee that an employer, employee, operator or contractor will be in
compliance with applicable regulations. Ultimately every company is responsible for determining the applicability of the information in this document to its
own operations. Each employer’s safety management system will be different. Mapping safety and environmental management policies, procedures, or
operations using this document does not guarantee compliance regulatory requirements.
Revised: November 1, 2021

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Course 174
Contents
Course Introduction ..................................................................................................................................... 1
Module 1: Fire Hazards ................................................................................................................................ 2
Causes of Hospital Fires ........................................................................................................................... 2
Electrical Equipment ............................................................................................................................ 2
Kitchen Facilities .................................................................................................................................. 2
Cigarettes ............................................................................................................................................. 3
Specialized Medical Equipment ........................................................................................................... 3
Hand Sanitizers .................................................................................................................................... 3
Gas Cylinders and Medical Oxygen Compliance .................................................................................. 3
Additional Areas of Concern .................................................................................................................... 3
Extension Cord Daisy Chains ................................................................................................................ 3
Fire Door Compliance .......................................................................................................................... 4
Fire Exit Obstructions ........................................................................................................................... 4
Portable Fire Extinguishers .................................................................................................................. 4
Five Classes of Fires.................................................................................................................................. 4
Fire Suppression ....................................................................................................................................... 5
Fire Sprinklers in Hospitals ....................................................................................................................... 7
OSHA Fire Safety Requirements .............................................................................................................. 7
Exit Routes ............................................................................................................................................... 8
Emergency Action Plans ........................................................................................................................... 9
Types of Evacuation ............................................................................................................................... 10
Fire Prevention ....................................................................................................................................... 10

Course 174
Fire Prevention Plan Provisions ......................................................................................................... 11
Planning Considerations ........................................................................................................................ 12
Real-Life Hospital Fires........................................................................................................................... 12
Fire Drills ................................................................................................................................................ 13
Notification of External Agencies........................................................................................................... 13
References ............................................................................................................................................. 15
Course 174
Course Introduction
According to the National Fire Protection Association, an average of five fires break out per day at our
nation's health care facilities, and more than 8,000 hospital fires occur each year. If not acted upon
quickly and effectively, the results can be catastrophic.
Employers should train workers about fire hazards in a hospital setting and about what to do in a fire
emergency. If employers would like workers to evacuate, then training should be provided on how to
escape. If employers expect workers to use firefighting equipment, employers should provide them
with appropriate equipment and training on how to use the equipment safely.
This course takes a closer look at protecting both patients and hospital staff from potential fire hazards
in the healthcare setting.
Copyright © 2021 Geigle Safety Group, Inc. Page 1 of 15

Course 174
Module 1: Fire Hazards

Causes of Hospital Fires
The potential for fire in a hospital setting can occur from many different sources such as heat-producing
equipment, storage of flammable chemicals, and faulty electrical wiring.
There are several different types of equipment and materials that are major contributors to fires in
hospitals.
The eight leading causes of hospital fires in the United States are shown in the chart below (these
figures are based on data from the National Fire Protection Association).
Electrical Equipment
Hospitals have a lot of electrical equipment and often have overworked sockets and cables. Power
strips must be plugged directly into an outlet and NOT daisy-chained (linking power strips together).
Kitchen Facilities
Fires in kitchen facilities are common because of cooking fats, electrical ovens, toasters, and open
flames.

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Cigarettes
While cigarettes are banned in healthcare facilities, people might sneak them or, while smoking
outdoors, don’t properly dispose of them.
Specialized Medical Equipment
Lasers and electrosurgical tools are an ignition hazard, especially near oxygen tanks, surgical clothing,
and flammable sterilizing liquids.
Hand Sanitizers
Alcohol-based hand rubs are used all over hospitals. However, they are flammable and need to have a
6-foot distance between the sanitation station and any ignition sources.
Gas Cylinders and Medical Oxygen Compliance
Gas cylinders and medical oxygen need to be properly stored and secured.
Quiz Instructions
After each section, there is a quiz question. Make sure to read the material in each section to discover
the correct answer to these questions. Circle the correct answer. When finished, go online to take the
final exam. This exam is open book, so you can use this study guide.
1. How far away should alcohol-based hand sanitation stations be from any ignition
source?
a. 3 feet
b. 6 feet
c. 12 feet
d. 20 feet
Additional Areas of Concern
Extension Cord Daisy Chains
Because of the need to have equipment plugged in, hospitals should not use extension cords to chain
the equipment together. Extension cords are a violation, and they can become overheated, sparking a
fire.

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Fire Door Compliance
Hospital fire doors must close or latch correctly. Be sure they do not have holes in them, which would
cause them to no longer be fireproof.
Fire Exit Obstructions
Carts, wheelchairs, and medical equipment must not block fire exit doors.
Portable Fire Extinguishers
Employers must ensure portable fire extinguishers are in areas that are not obstructed, are properly
mounted, and have not been previously discharged. Employers must also ensure that portable fire
extinguishers are not past due inspection.
2. If a fire door has holes in it, it is _____
a. the holes must be less than 1 inch in diameter

b. the holes must be plugged
c. the door may no longer be fireproof
d. the door must open inward to the space
Five Classes of Fires
Class A: Fires that involve ordinary combustible materials such as wood, cloth, paper, rubber, and many
plastics.
Class B: Fires that involve flammable liquids, combustible liquids, petroleum greases, tars, oils, oil-
based paints, solvents, lacquers, alcohols, and flammable gases.
Class C: Fires that involve energized electrical equipment, such as power tools, wiring, fuse boxes,
appliances, TVs, computers, and electrical motors.
Class D: Fires that involve combustible metals such as magnesium, potassium, titanium, zirconium,
lithium, and sodium.
Class K: Fires that involve combustible cooking oils and fats used in commercial cooking equipment.

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3. Which class of fire involves ordinary combustible materials such as wood, cloth, paper,
rubber, and many plastics?
a. Class A
b. Class B
c. Class C
d. Class K
Fire Suppression
There are five different types or classes of fire extinguishers, each of which extinguishes specific types
of fire. Newer fire extinguishers use a picture/labeling system to designate which types of fires they are
to be used on. Older fire extinguishers are labeled with colored geometrical shapes with letter
designations. Both of these types of labels are shown below with the description of the different classes
of extinguishers.
Class A and Class B fire extinguishers have a numerical rating which is based on tests conducted by
Underwriter's Laboratories that are designed to determine the extinguishing potential for each size and
type of extinguisher.

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4. Which class of fire extinguisher should be used for fires that involve flammable liquids
including grease, gasoline, and oil?
a. Class A
b. Class B
c. Class C
d. Class D

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Fire Sprinklers in Hospitals
Fire sprinklers must be installed throughout a healthcare facility. These systems are installed following
NFPA 13: Standard for Installation of Sprinkler Systems and are maintained according to NFPA 25:
Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems.
NFPA 25 outlines the required inspection, testing, and maintenance (ITM) frequency and procedures.
Major system components are required to be inspected quarterly, semi-annually, and annually. At each
of these intervals, specific items must be maintained and tested. There are also weekly and monthly
inspection requirements for items that must only be visually inspected—these components include
gauges, valves, private hydrants, and fire pumps.
From 2009-2013, only 4% of fires went beyond the point of origin, thanks to the increase in fire
sprinklers. Today, 79% of hospitals are protected by fire sprinklers, and it has greatly reduced the
spread of fires and fire-related death in hospitals.
5. _____ of hospitals are protected by fire sprinklers, and it has greatly reduced the spread
of fires and fire-related death in hospitals.
a. 50%
b. 65%
c. 79%
d. 95%
OSHA Fire Safety Requirements
OSHA Fire Safety requirements include:
• Adequate exit routes for evacuation during fires and other emergencies [29 CFR 1910.34)].
• Employers must provide exit routes in accordance with OSHA Standard on Exit Routes 29 CFR
1910 Subpart E, including:
o An adequate number of exit routes [29 CFR 1910.36(b)].
o Exits must discharge to a safe area [29 CFR 1910.36(c)].
o Exits must be of adequate capacity and width [29 CFR 1910.36(f) and 29 CFR 1910.36(g)].

Course 174
o Exits must be clearly lighted and marked [29 CFR 1910.37(b)].
o An employee alarm system is provided [29 CFR 1910.37(b)] and complies with 29 CFR
1910.165.
Exit Routes
Every workplace must have enough exits suitably located to enable everyone to get out of the facility
quickly.
Considerations include the following:
• type of structure
• the number of persons exposed
• the fire protection available
• the type of industry involved
• the height and type of construction of the building or structure
In addition, fire doors must not be blocked or locked when employees are inside. Delayed opening of
fire doors, however, is permitted when an approved alarm system is integrated into the fire door
design. Exit routes from buildings must be free of obstructions and properly marked with exit signs. See
29 CFR Part 1910.36 for details about all requirements.
6. When are delayed openings of fire hazard doors acceptable?
a. When an approved alarm system is integrated into the fire door

b. Fire doors should never have delayed openings
c. Only if the doors have a way to stay open automatically
d. Fire doors should always stay closed

Course 174
Emergency Action Plans
Emergency and Fire Action Plans must be provided in accordance with 29 CFR 1910.38 when required
by another OSHA standard.
When required, employers must develop emergency action plans that:
• Include procedures for evacuating patients.
• Describe the routes for workers to use and procedures to follow.
• Account for all evacuated employees.
• Remain available for employee review.
• Include procedures for evacuating disabled employees.
• Address evacuation of employees who stay behind to shut down critical equipment.
• Include preferred means of alerting employees to a fire emergency.
• Provide for an employee alarm system throughout the workplace.
• Require an alarm system that includes voice communication or sound signals such as bells,
whistles, or horns.
• Make the evacuation signal known to employees.
• Ensure emergency training occurs annually.
• Require employer review of the plan with new employees and with all employees whenever the
plan is changed.
For more information about emergency action plans, see OSHAcademy Course 717 Emergency Action
Plans.

Course 174
7. When should emergency training occur?
a. When firefighters require it

b. Once a week
c. Once a month
d. Annually
Types of Evacuation
Time frames for evacuation may differ depending on the nature of the threat and the amount of time
that can be taken to prepare for moving hospital patients. Specific types of evacuations are as follows:
Immediate: “Emergency move” – evacuate immediately or patients and staff may die; no time to
prepare.
Rapid: Evacuate as quickly as possible; limited time to prepare (1 to 2 hours); follow procedures.
Gradual: No immediate danger; sufficient time to evacuate (sometimes hours to several days).
Prepare Only: Do not move patients, but you can start to prepare for evacuation.
8. In ______ evacuation, you must evacuate immediately, or staff and/or patients may die.
a. rapid
b. gradual
c. immediate
d. prepare only
Fire Prevention
There are three main ingredients that constitute a fire: heat, fuel, and oxygen. The image to the right
referred to as the “fire triangle,” shows how these three components interact to create a fire.
Fuel is any combustible material that can be used as the source of ignition of the fire, as well as to keep
it burning.
Oxygen is an oxidizing agent that reacts with the fuel to start and continue the fire. Lower
concentrations of oxygen result in slower fuel combustion.

Course 174
Heat: Fires require oxygen and fuel reacting with each other at a temperature exceeding a threshold
temperature, referred to as the “flashpoint.” Different materials and chemicals have different
flashpoints, some at low temperatures and some high. The lower the flash point temperature of a
compound, the more easily the compound ignites.
9. What components are referred to in the “fire triangle?”
a. Oxygen, energy, and fuel

b. Heat, energy, and fuel
c. Energy, oxygen, and heat
d. Heat, oxygen, and fuel
Fire Prevention Plan Provisions
Here are the minimum provisions of a fire prevention plan:
• List of all major fire hazards, proper handling and storage procedures for hazardous materials,
potential ignition sources and their control, and the type of fire protection equipment necessary
to control each major hazard.
• Procedures to control accumulations of flammable and combustible waste materials.
• Procedures for regular maintenance of safeguards installed on heat-producing equipment to

prevent the accidental ignition of combustible materials.
• Name or job title of employees responsible for maintaining equipment to prevent or control
sources of ignition or fires.
• Name or job title of employees responsible for the control of fuel source hazards. In addition,
when you assign employees to a job, you must inform them of any fire hazards they may be
exposed to. You must also review with each employee those parts of the fire prevention plan
necessary for self-protection.
For more information about Fire Prevention Plans, see OSHAcademy course 718 Fire Prevention Plans.

Course 174
10. Which of the following should be included in a fire prevention plan?
a. Phone number of employees responsible for the control of fuel source hazards
b. Procedures to control accumulations of flammable waste materials
c. Emergency contact information
d. Date of an emergency
Planning Considerations
One of the primary considerations in preventing hospital fires is to prohibit the use of combustible
structural (e.g., floors, walls, roofs, stairwells, fire escapes) and nonstructural (e.g., doors, windows,
ceilings, fixtures, facade, insulation, mechanical and electrical conduits) components in the hospital
facility.
New facilities should be designed using building codes and guidelines for fire prevention, and the
materials used should have adequate fire resistance ratings. (These ratings refer to the duration, usually
in hours, that a given material can withstand fire at a specific maximum temperature before losing its
integrity, including its strength and insulation capabilities.) In the case of both structural and
nonstructural components, fire resistance ratings/durations can vary from 30 minutes to more than 4
hours.
Real-Life Hospital Fires
May 1929: Cleveland Clinic, Cleveland, Ohio, USA—125 Fatalities
The fire started in the clinic’s basement, caused by improper storage and ventilation of 70,000 sheets of
X-ray films. Toxic fumes from burnt film spread rapidly throughout the hospital’s vents. Although no
one died directly from the fire, people died as a result of the toxic fumes released.
July 2005: Calderón Guardia Hospital, San José, Costa Rica—19 Fatalities
This 62-year-old hospital is one of the busiest in San Jose. The fire started on the fifth floor; patients in
the neurosurgery ward and the intensive care unit (ICU) were trapped. Fire escapes extended only to
the third floor. Patients tied bedsheets together and used them as ropes to climb out of the windows.
The fire alarm did not signal that there was a fire; also, the facility had no evacuation plan and had
insufficient signage and lighting.
December 2011: AMRI Hospital, Kolkata, India—91 Fatalities

Course 174
The fire in this private hospital started in the basement, where highly flammable medical equipment
was illegally stored. Hospital staff abandoned the hospital when the fire started and did not try to
rescue any patients. The fire service arrived 90 minutes after the start of the fire. Windows and doors
were locked; windows had to be broken to gain access. Most deaths were a result of smoke inhalation.
11. What is the primary consideration in preventing hospital fires?
a. Increase training
b. Prohibit the use of combustible structural components
c. Close proximity to firefighting services
d. Knowledge of firefighting techniques
Fire Drills
Fire drills are designed to ensure that, through regular training and simulations, staff members will:
• Have knowledge and understanding of the fire safety plan so that they can act swiftly, safely,
and in an orderly manner.
• Be knowledgeable regarding fire protection. For example, frightened individuals may not act
intelligently, causing harm to themselves or those around them.
• Have increased self-confidence and power to fulfill their responsibilities in the event of a fire.
Notification of External Agencies
If there is a fire threat and management decide to evacuate, there should be a designated person
responsible for notifying the entire facility of the evacuation order, using appropriate systems such as
overhead announcements, emails, text messages, and internal hospital communication systems with
loudspeakers.

Course 174
12. What is the purpose of fire drills in a healthcare facility?
a. Make OSHA happy

b. Increased self-confidence
c. Avoid fines
d. Prepare patients

Course 174
References
1. “OSHA Fact Sheet: Safety in the Workplace.” Occupational Safety and Health Administration
(OSHA). https://www.osha.gov/OshDoc/data_General_Facts/FireSafetyN.pdf
2. “Healthcare Wide Hazards: Fire.” Occupational Safety and Health Administration (OSHA).
https://www.osha.gov/SLTC/etools/hospital/hazards/fire/fire.html
3. “Emergency Exit Routes.” Occupational Safety and Health Administration (OSHA).

https://www.osha.gov/OshDoc/data_General_Facts/emergency-exit-routes-factsheet.pdf
4. “Hospital Fire Prevention and Evacuation Guide.” World Health Organization.

https://bit.ly/3g73nB0

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Healthcare

According to the Na�onal Fire Protec�on Associa�on, an average of ﬁve ﬁres

Contact OSHAcademy to arrange for use as a training document.

15220 NW Greenbrier Parkway, Suite 230

Revised: November 1, 2021

Course Introduction ..................................................................................................................................... 1

Module 1: Fire Hazards ................................................................................................................................ 2

Causes of Hospital Fires ........................................................................................................................... 2

Electrical Equipment ............................................................................................................................ 2

Kitchen Facilities .................................................................................................................................. 2

Specialized Medical Equipment ........................................................................................................... 3

Hand Sanitizers .................................................................................................................................... 3

Gas Cylinders and Medical Oxygen Compliance .................................................................................. 3

Additional Areas of Concern .................................................................................................................... 3

Extension Cord Daisy Chains ................................................................................................................ 3

Fire Door Compliance .......................................................................................................................... 4

Fire Exit Obstructions ........................................................................................................................... 4

Portable Fire Extinguishers .................................................................................................................. 4

Five Classes of Fires.................................................................................................................................. 4

Fire Suppression ....................................................................................................................................... 5

Fire Sprinklers in Hospitals ....................................................................................................................... 7

OSHA Fire Safety Requirements .............................................................................................................. 7

Exit Routes ............................................................................................................................................... 8

Emergency Action Plans ........................................................................................................................... 9

Types of Evacuation ............................................................................................................................... 10

Fire Prevention ....................................................................................................................................... 10

Fire Prevention Plan Provisions ......................................................................................................... 11

Planning Considerations ........................................................................................................................ 12

Real-Life Hospital Fires........................................................................................................................... 12

Fire Drills ................................................................................................................................................ 13

Notification of External Agencies........................................................................................................... 13

Copyright © 2021 Geigle Safety Group, Inc. Page 1 of 15

Module 1: Fire Hazards

Copyright © 2021 Geigle Safety Group, Inc. Page 2 of 15

Specialized Medical Equipment

Gas Cylinders and Medical Oxygen Compliance

Additional Areas of Concern

Extension Cord Daisy Chains

Copyright © 2021 Geigle Safety Group, Inc. Page 3 of 15

Fire Door Compliance

Fire Exit Obstructions

Portable Fire Extinguishers

2. If a fire door has holes in it, it is _____

a. the holes must be less than 1 inch in diameter

Five Classes of Fires

Copyright © 2021 Geigle Safety Group, Inc. Page 4 of 15

Copyright © 2021 Geigle Safety Group, Inc. Page 5 of 15

Copyright © 2021 Geigle Safety Group, Inc. Page 6 of 15

Fire Sprinklers in Hospitals

OSHA Fire Safety Requirements

OSHA Fire Safety requirements include:

o An adequate number of exit routes [29 CFR 1910.36(b)].

o Exits must discharge to a safe area [29 CFR 1910.36(c)].

Copyright © 2021 Geigle Safety Group, Inc. Page 7 of 15

o Exits must be clearly lighted and marked [29 CFR 1910.37(b)].

Considerations include the following:

• the number of persons exposed

• the fire protection available

• the type of industry involved

• the height and type of construction of the building or structure

6. When are delayed openings of fire hazard doors acceptable?

a. When an approved alarm system is integrated into the fire door

Copyright © 2021 Geigle Safety Group, Inc. Page 8 of 15