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Bronx Hospital Fire Shows Why Emergency Training Is Critical

By Deanna Martin, senior communications specialist at the American Society for Healthcare Engineering

Health care leaders find few things scarier than thick smoke billowing out of a busy hospital as fire engines rush to the scene. But thanks to quick-responding staff members, thorough emergency plans, and equipment that functioned properly, leaders at the Montefiore Medical Center in the Bronx in New York City say a recent fire there looked much worse than it was. This incident, which caused no injuries or deaths, can serve as a reminder to facilities across the country of the importance of drills and provide lessons learned as hospitals evaluate their emergency plans.

“What could have been an absolute disaster turned out to be a shining example of extraordinary teamwork,” said Susan Green-Lorenzen, RN, senior vice president for operations at Montefiore. “Our staff handled this beautifully.”

The fire broke out on the afternoon of November 9 in a basement cogeneration plant. A fitting on an engine failed, spraying diesel fuel all over a hot engine, said Ed Pfleging, PE, vice president of facilities and engineering for Montefiore. The fuel ignited, causing a tremendous amount of smoke in a short time. Smoke detectors activated properly, and the engineering staff and foam sprinkler system quickly put out the fire. The smoke traveled up a ventilation shaft to exit the hospital at street level, and the hospital’s internal ventilation system shut down as it should have when the alarms went off. “This is everybody’s worst nightmare, but from an engineering system standpoint, everything couldn’t have worked better,” Pfleging said.

The fuel was the only thing that burned and the fire only lasted three to four minutes, Pfleging said. But the smoke exiting the building at street level could be smelled in first floor emergency departments and second floor intensive care units. Clinical staff horizontally evacuated patients to other areas of the hospital as the hospital’s emergency plans stipulate.

The adult and pediatric emergency departments had about 150 patients total at the time of the fire, and two intensive care units housed about 20 patients—including five who were on ventilators, Green-Lorenzen said. Some patients were escorted out of the building and triaged on the street for about 10 minutes until they were relocated to other areas. The most critically ill patients from the emergency departments were moved to the main lobby, while others were moved to the children’s hospital lobby and other designated spaces. The critical care units were moved to a preoperative space and a cafeteria—all according to the hospital’s emergency plans.

A central command center was established and staff members from other parts of the hospital came to join a work pool that leaders dispatched to fetch needed supplies and equipment, such as electrical cords for medical equipment. A pharmacy station was quickly set up since some patients needed medication right away. Nurses kept extremely detailed records to keep track of patients. Other staff members brought refreshments and water, making sure patients and their visiting family members were comfortable.

Although staff felt some anxiety during the fire response, staff members remained composed and the overall mood was very calm and orderly, Green-Lorenzen said. Power and utilities were maintained throughout the emergency, Pfleging said. Within a few hours the hospital was running as normal and the only damage was to the exterior of the engine.

Thankfully, hospital fires are rare events, but each one can offer lessons to improve safety in the future, said Chad Beebe, AIA, SASHE, director of codes and standards for the American Society for Healthcare Engineering (ASHE) of the American Hospital Association.

“It is good to see that the emergency plans worked well after the fire caused by this engine fitting issue,” Beebe said. “The fire serves as a reminder of the importance of staff training and emergency planning.”

The hospital is investigating the cause of the fitting failure and is also critiquing its own practices to look for lessons learned from the event. For example, leaders may begin storing certain items in areas that are designated as emergency evacuation sites. Retrieving power strips and extension cords from lockers in hospital lobbies and other emergency areas would have been more convenient than sending staff members to get that equipment from other locations.

Hospital leaders credited the staff with following emergency procedures well while staying calm. “Certainly we’re going to continue to make fire safety and drilling a high priority,” Pfleging said.