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Fire doors keep flames contained but smoke still problem in Texas hospital fire

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August 31, 2017

Just after lunch on a Wednesday, four days into the new year, someone decided to set the University of Texas Medical Branch’s (UTMB) John Sealy Hospital in Galveston, Texas, on fire.

The 12-story hospital, built in 1975, is in a complex of interconnected UTMB Health buildings. John Sealy is L-shaped, with a shaft of elevators sitting in the center core area that connects wings A–B on one side and wings C–D on the other.

Built before fire codes required patient care facilities to be fully equipped with fire suppression systems, the building is being retrofitted with fire sprinklers one wing at a time, one floor at a time, says Jack Tarpley, UTMB Health’s associate vice president for environmental health and safety. 

Alarm triggers automatic responses

The fire alarm system activated at 1:20 p.m. January 4, signaling smoke and heat in a waiting area on the second floor. Designed to provide families a quiet place to wait while patients were in surgery, the open area is off the elevator core. At the time of the fire, however, the area was unused because the wing it served was closed for renovations, including the addition of sprinklers, Tarpley recalls.

The second-floor wing on the other side of the elevator core housed John Sealy’s burn unit. On the first floor below the waiting area was the hospital entrance and lobby, which connects to other buildings, including a central food court. The floor above the fire was labor and delivery. The fire alarm activated on the central alarm panel, on the floor where the heat and smoke were detected, and on the floors above and below, says Tarpley.

Throughout the second floor, fire doors had closed automatically, sealing each wing from the flames. With the alarm’s activation, the elevator cars, as designed, recalled to the first floor. However, the smoke from the furniture-fueled fire infiltrated the elevator shaft.

First on the scene was the hospital’s fire marshal of the day, who also is an off-duty Galveston firefighter. The hospital employs the off-duty firefighters to take advantage of their expertise and to ensure that local firefighters are familiar with the hospital as well, Tarpley says. The marshal had entered the lobby, checked the alarm panel as he passed through to a stairwell, and was on the second floor within a minute or so of the alarm’s activation.

Incident command setup

As required under the hospital’s fire plan, UTMB police as well as staff from environmental services, property services, safety, facilities crew, and other first responders met within minutes at the main fire panel. Tarpley, whose office is in another building, says he arrived just as Galveston firefighters did.

The hospital’s fire marshal began coordinating his fellow firefighters and directing them to the fire as other staff throughout the building reacted according to the fire plan—all fire doors were closed and staff prepared to shelter and defend in place, as they are trained every quarter to do, Tarpley says.

Tarpley, meanwhile, was working with on-scene commanders and alerting hospital executives to what was happening. “It’s hard to fathom how literally in minutes, how fast everything happens,” he recalls.

As firefighters began laying fire water lines from connections in the stairwells into the second floor to breach the fire area, the smell of smoke began infiltrating other floors, going through the stairwells as well as the elevator shaft.

While the fire was contained, the smoke smell began to intensify and some staff members “felt like they needed to be outside the building,” Tarpley says, noting that drills train staff to use their own judgment.

The continued sound of the fire alarm and the smell of smoke quickly evoked the concern of patients as well. Indeed, it was someone visiting a patient who first alerted David Marshall, a UTMB vice president and the medical center’s chief nursing officer, to the fire. Less than 10 minutes after the initial alarm, Marshall says he received a text from a coworker, whose daughter had given birth the day before and was still in the labor and delivery unit on the floor above the fire. Almost at the same time, Marshall received a text from the hospital’s chief operating officer, and they, along with other staff, headed over to John Sealy to help with patients. 

A nurse for 34 years, Marshall says he has gone through decades of fire drills and training, including how to evacuate patients. But that training always involved a horizontal evacuation—taking patients from one wing to another or from one building through a passageway to another building. “Never vertically,” Marshall notes.

That was about to change.

Smoke prompts evacuation order

On the second floor and the floor directly above the fire, smoke was becoming heavier but was still moderate. Patients were evacuated immediately from the second floor burn unit.

Marshall said he navigated firefighters and hoses as he made his way up the stairwell to the third-floor labor and delivery unit to offer assistance. Several women were in labor, including one who had been given an epidural and could not move on her own. 

Out of “an abundance of caution,” a decision was made to evacuate the entire building along with a connected annex building. Overhead communication was used to send out the order, and staff went into action to help ambulatory patients down the stairs.

Fortunately, patients were not on every floor. Unfortunately, the patients John Sealy housed were in some cases quite vulnerable. Besides the burn unit and labor and delivery, the hospital housed high-risk obstetric patients on the 10th floor, pediatric ICUs on the ninth floor, mother-baby units on the seventh and eighth floors, intermediate nursery and newborns on the sixth floor, dialysis on the fifth floor, and a cardiac catheterization unit on the fourth floor. One surgical team was in the middle of a catheterization when the alarm sounded, says Marshall. The team finished and evacuated the patient on his mattress. 

Meanwhile, Marshall and others had to figure out how to move the woman in labor who had received an epidural. She was carefully strapped to an evacuation sled and guided down the stairwell by Marshall and others.

On the way down, they met a physician and a patient care technician carrying an adolescent patient with cognitive problems. The patient, who was being cared for in the ninth floor unit, was having difficulty dealing with the noise and stress of the evacuation and could not manage to walk down the stairs. So his doctor and the technician locked arms to form a chair; they made it as far down as the third floor before faltering under the weight, says Marshall. 

To allow the evacuation of the woman on the sled, the pediatric team stopped on the third floor—giving them a chance to rest and to call the patient’s mother, who calmed the teen enough to finish being carried down, relates Marshall. It took six people to get the woman in labor down the stairs, but she was safely evacuated, along with her husband who followed behind the team, he says. The staff worked to keep the distraught mother-to-be and her husband informed as to what was happening and where they were going.  

All hands on deck

Outside the building, teams were waiting with stretchers to transport non-ambulatory patients to care units in other buildings. Several babies and other children were taken to the Shriners Hospital for Children about a block away. 

By 2:00 p.m., about 110 patients had been evacuated from the building, where firefighters worked to finally knock down the flames in the waiting area.

There were no injuries and no deaths as a result of the fire or evacuation. “It was scary for everybody,” notes Tarpley. Yet while staff were “very attentive, they weren’t panicked.”

“It was great to see all hands on deck,” he observes.

“The message I’ve been giving is, ‘We did an incredible job,’ ” says Marshall. Everyone seemed to be working intuitively, responding to their training from previous drills.

Still, the work was just beginning. The recovery process was ahead, including figuring out just what happened and how to prevent it from happening again. Part of this would involve dealing with some sobering news—the state fire marshal ruled the fire was due to arson.

 

Residual smoke and humidity complicate cleanup after fire in aging building

In many respects, everything at the University of Texas Medical Branch (UTMB)’s John Sealy Hospital in Galveston went according to plan on January 4—or as much as anything could for a day interrupted by a fire and the evacuation of more than 100 patients from a 12-story building. 

There were no injuries or fatalities that day. The fire doors contained the flames, staff safely shepherded patients down stairs and outside as trained, and firefighters quickly doused the inferno on the second floor of the building, which had been constructed before fire codes required automatic fire suppression systems.

Even as congratulations of a job well done went out, fire inspectors began the work of determining what caused the blaze, and hospital officials and facilities staff launched into the next task at hand—disaster recovery and evaluation of lessons learned.

The Joint Commission requires a hospital to have an emergency operations plan (EOP) that includes not only how it will care for patients during an emergency, but how it will communicate to patients, staff, and others during the emergency; how it will recover from the event; and an evaluation of the effectiveness of its EOP.

Recovery begins once outside building

At UTMB, the Galveston campus rallied to assist when the fire broke out. Most immediately, evacuated patients had to be accounted for, evaluated, and settled into other care units, notes David Marshall, a UTMB vice president and the medical center’s chief nursing officer, who helped evacuate labor and delivery patients from the third floor, which was directly over the fire.

Patients who could be discharged were, while others were taken to intermediate patient care areas in other buildings on campus, he says. Babies evacuated from the sixth floor nursery and neonatal ICU were taken to Jenny Sealy Hospital nearby and to the Shriners Hospital for Children a block over. (An unused ICU was eventually converted to a temporary neonatal ICU.)

“Communication is critical in any event like that—the command center was up and running and trying to get information out campuswide,” says Marshall.

Within a day or so, the hospital had a simple webpage online dedicated to information on the fire and recovery. The site included a recap of events, which buildings were open, which buildings were closed or had limited access because they were attached to John Sealy, which parking garages were open, and whom staff should contact for more information.

There were also instructions for staff to access UTMB Health’s intranet system for more information, as well as reassurances and directions on how staff would get paid if they were instructed not to report for work. Over the next few weeks, the website was updated as buildings and floors reopened. 

New building, new fire training

With patients redeployed to other treatment areas, the fire plan faced a new challenge, notes Jack Tarpley, UTMB Health’s associate vice president for environmental health and safety. The staff from John Sealy now working in other buildings needed to know about fire protection and evacuation in their new work areas.

“We had to do an expedited training program,” Tarpley says, including setting up education sessions on how the fire alarms worked in the new buildings and conducting fire drills.

At the same time, Tarpley and other officials were evaluating what happened and why, and assessing the fire response.  

Two weeks after the fire, hospital officials posted a short request on the hospital recovery webpage for feedback from the UTMB community “while the events of the fire on January 4 are still fresh.” Although the feedback could be anonymous, officials encouraged staff to provide a name and contact information for follow-up information.

Media reports immediately after the fire noted that the blaze was difficult for firefighters because it was fueled by furniture and other combustibles in the area. While fire inspectors were still working on their report on the direct cause of the fire, the immediate evaluation was clear: Fire doors work.

“It was truly amazing to see it,” says Tarpley.

Blaze destroys waiting area

Tarpley describes the second-floor waiting area outside the center elevator core, which sits where the two legs of the L-shaped building meet, as a charred, melted mass after the fire. But the areas on the outside of the fire doors that kept the flames from spreading to either wing were untouched.

“It really does work,” he says of the fire barrier system.

The fire was contained. Smoke, however, went throughout the building. 

The Texas fire marshal’s report stated that black smoke was present throughout the second-floor compartment when Galveston firefighters arrived. Patients on that floor were evacuated, Tarpley says. Then, without a fire suppression system to automatically knock down the flames, firefighters were forced to open the fire doors to attack the blaze, allowing the smoke into the immediate area. With the fire located directly next to the elevator core, smoke also infiltrated the elevator shaft and began permeating floors throughout the building, Tarpley adds. 

Fire hoses were run from connections in the stairwells and, by necessity, the hoses propped open doors on the second floor, notes Marshall. That meant that as the stairwells were accessed by patients and staff to evacuate the building, the smoke spread even more. Fortunately, the heaviest smoke was on the second and third floors, with only light smoke and the smell of smoke elsewhere, says Tarpley.

Top-to-bottom cleaning

In the aftermath, the area of the blaze had to be entirely renovated. But the permeation of the smoke meant the entire building—all 12 floors—needed to be scrubbed, not just to remove the smell but also to ensure infection control. That would mean cleaning surfaces, furniture, and equipment. 

As soon as firefighters gave the go-ahead, UTMB had a contractor that specializes in fire recovery on-site to begin the intense cleanup program, says Tarpley. 

Air scrubbers were used that circulated and recirculated air through HEPA filters. “We had quite a few of those on every level,” adds Tarpley. The heating, ventilation, and air conditioning (HVAC) system had to be shut down, so large dehumidifiers were also brought in. 

Given the rising humidity in an unseasonably warm January, infection control was more of a concern, says Marshall. Any equipment that could not be cleaned or repaired, or any supplies that were contaminated, had to be thrown out and replaced. 

That HVAC system posed another problem. Since it remained in operation during the fire, the system had drawn in smoke, which had permeated the ductwork.

All of it had to be cleaned “top to bottom,” says Tarpley. 

The recovery command group, including Tarpley and Marshall, had daily meetings to get progress reports and to prioritize work so that units could return to service as soon as possible. Before any patient or care units were reopened, however, infection control experts took cultures throughout the care area to ensure it was clean. Waiting for the cultures to grow took time, notes Marshall, but was a necessary step to protect patients.

Don’t ask for too much

By the weekend, a couple of units reopened in the attached John Sealy annex. Others would follow as they were cleaned and approved for operation. Care was taken to admit primarily new patients into reopened units so that patients who had been evacuated were not moved again unless absolutely necessary, notes Marshall.

On top of the cleaning, insurance assessments also had to be made. 

For the first few days, staff and contractors worked around the clock, Tarpley says. He warns against this, citing lessons learned in the response and recovery to 2008’s Hurricane Ike, which did billions of dollars in damage in Galveston and other parts of the Gulf Coast in the same season that saw Hurricane Katrina barrel into New Orleans.

“You will burn people out,” he warns. “If you ask them, they will work around the clock. But you can’t do that to them.”

This time, UTMB worked for a more level response in the use of both human and material resources. 

“Be careful with the resources you have in your recovery—because if you don’t pace yourself, you’ll get into trouble in the long term,” Tarpley advises.

Part of that level response included offering counseling to staff and patients traumatized in the events surrounding the fire. A group session was set up in a conference room at the beginning, then individual counseling was made available later, says Marshall. In addition, employee assistance personnel made rounds on a regular basis, checking on workers.

As recovery operations progressed, updates were posted on the recovery website. 

Renovation schedule changed

Of course, the most complicated repairs were the burned-out area on the second floor, near a wing that had been closed for renovations, which were to include installation of fire sprinklers. 

Adding a sprinkler system to an existing building is complicated and costly, notes Tarpley, and the project to bring John Sealy up to the NFPA Life Safety and Health Care Facilities codes recently adopted by CMS was designed to go methodically, wing by wing and floor by floor. 

At the time of the fire, the project was about 65% complete, estimates Tarpley. After the fire, with John Sealy completely closed for cleaning and repairs, the logical decision was made to ramp up installation of the fire sprinkler system. By the beginning of March, the building was more than 90% sprinklered, says Tarpley. 

This was one upside to what could have been a tragic event—although the response to the fire is still ongoing. In part, this is because of news published earlier this month that fire inspectors have ruled the fire to be arson. Hospital officials would not comment on the investigation, which is being conducted by UTMB police. No arrests had been announced as of presstime. 

The hospital is still sifting through lessons learned, but changes will include assessments to security, acknowledges Tarpley, who became even more somber after being asked about the arson.

 “We find fault with everything we do because we want to do things better,” Tarpley notes, adding that overall it is still good to “take a step back” and acknowledge what went right. 

“I hope no one else ever has to do anything like this because it’s a horrific effort,” he says. But all in all, “you know this went well.”




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