The guidance (which can be downloaded here) is for ‘completing [a] specific FRA for temporary wards provided for Covid-19 treatment or care’, and should be used ‘in conjunction with’ Fire safety measures for health sector buildings (Health Technical Memorandum 05-03) Operational provisions Part K – Guidance on fire risk assessments in complex healthcare premises.
It begins by stating the possible risk factors for temporary wards, including patients ‘who have very high dependency’; areas that are ‘not specifically designed for patients, which may not meet guidance on fire compartmentation and progressive horizontal evacuation’; and ‘large numbers of patients supplied with oxygen [of] up to 10 litres per minute’.
Additionally, such wards might have ‘oxygen concentrations exceeding those generally found in the atmosphere’, though there is ‘less risk if effective ventilation’ is provided or rooms are of ‘large volume i.e. high ceilings’. Other risk factors relating to staff include those ‘who may not normally work together’, those ‘who may not be familiar with the area’, and those ‘not trained in fire safety, progressive horizontal evacuation or oxygen isolation for the specific area’.
The guidance then provides a table outlining information to be provided, such as the responsible person; the address of the ward; the specific area; the name of the assessor and the date the ward was checked; the person consulted on risks; and the suggested review period, recommended to be daily or weekly ‘depending on risk’.
A significant findings and action plan allows for specification of the area or location; relevant findings; action required; interim control measures; the risk rating; the person responsible for completing the assessment; and the date completed. The guidance then breaks down into five steps for an FRA, each with a risk rating, a yes or no answer and comments and hazards observed.
The first – identifying hazards – looks at ignition sources, asking whether ‘reasonable measures’ have been taken to ‘prevent sources’, before asking if electrical equipment is ‘kept to a minimum in appropriate areas’, and whether the ‘use of products which on coming into contact with Oxygen may ignite’ including petroleum jelly, sprays, hair and body oils, are ‘controlled’.
Next, it asks if the use of portable electrical equipment including mobile phones, laptops and electronic weighing scales are ‘not permitted close to patients’, before asking what ‘reasonable steps’ have been taken to reduce risks from static electricity ‘in oxygen rich areas’, such as ‘using cotton fabrics where possible’.
On fuel, it asks if there are ‘reasonable steps to prevent the accumulation of waste materials’, and if use of oil, grease, paper or other combustible materials are ‘kept to a minimum’; before asking if use of textiles and furniture is also ‘kept to a minimum’, or where used ‘has a suitable level of fire performance’.
Next, questions on oxygen are asked, including: ‘is the area well ventilated either naturally or mechanically so as to prevent an accumulation of oxygen?’; ‘are there suitable controls over the storage and use of oxygen cylinders?’; are there suitable controls for medical gas pipeline system such that it can be easily isolated in an emergency?’; and ‘are staff trained in isolating oxygen, including procedures for ensuring continuing supplies for patients?’.
The second step identifies those at risk, with the numbers to be added and their type – defined as dependent, very high dependency, medical, cleaning and other staff, or others to be defined. The third step focuses on evaluating, removing or reducing and protecting from risk, with causes and ignition sources to be detailed.
This also sees a range of questions asked, including: ‘are risks from patients contaminated by oil or grease (emollient) coming into contact with high oxygen concentration and spontaneously igniting avoided?; whether alcohol is ‘permitted to evaporate’ from hand sanitisers before patients are treated; and whether risks from electrical equipment ‘causing ignition in oxygen rich’ environments are minimised.
Other questions include whether all staff are advised to avoid having such equipment in a ‘potentially oxygen enriched atmosphere’, and whether suitable fire extinguishers and blankets are ‘easily available’. Questions on means of escape include whether patients can be easily moved away from a fire; whether routes are free from obstruction; whether routes are available to use at all times; and whether systems are in place for safe storage and use of oxygen cylinders.
Step four outlines recording, planning, informing, instructing and training, asking questions including whether there is a tried and tested emergency plan that has been discussed with relevant staff; whether this identifies ‘how and by whom’ oxygen supplies can be isolated; whether it identifies alternative oxygen supplies for patients; whether it identifies locations to move patients to; and if there is a staff information sheet covering fire risks for all new staff.
Other staff related questions include whether they are provided with induction training including fire safety; whether staff are trained in dangers of oxygen rich environments and oxygen safety; whether medical staff are trained in safe use of oxygen and cylinders; whether staff are trained to use fire extinguishers; whether suitable extinguishers and blankets are ‘easily accessible’’ and whether the aforementioned plan identifies who would call the fire and rescue service, and access routes.
The final step discusses the review including dates, any changes, previous actions completed and new actions identified, while it also provides a risk value matrix ranked in terms of likelihood, value and severity of outcome. Likelihood ranges from neglible to low, moderate, high and extreme, the value ascending from one to five, and the severity of the outcome discusses the nature of each.
A neglible risk is followed by low, which sees ‘slight damage to property, minor injury to occupants’ and ‘first aid required’; while moderate sees ‘moderate damage to property, partial evacuation required, injury to occupants’ and medical attention required. High sees ‘large scale’ property damage, a complete evacuation required and occupants requiring hospitalisation; while extreme sees ‘major loss of property [and] major loss of life’.
The document warned users to ‘beware of low likelihood but high severity’, with a number ranking system outlined for risk ratings and actions: those ranked from one to three would just need recording and reviewing a year later; from four to six would be considered moderate and require additional controls to be implemented within a year; and those from eight to 12 high risks requiring interim measures to be implemented immediately, with full controls within three months.
Finally, those ranging from 15 to 25 would be considered ‘extreme’ risks that require a ‘cease’ of use of the area ‘until additional controls have been applied’. The document concludes with a list of fire safety information points for staff in such wards, asking them questions relating to the fire safety provisions and important information they should know or ask about.