Evacuation - Nursing Homes

[stevew]

I have for some time been concerned about the safety of residents and staff in an evacuation situation.   Areas of concern include:
The use of manual handling techniques in an emergency.  
Employers reluctant to accept liability for any injury incurred by an employee incurred whilst moving a resident.
The lack of risk assessing the location of the resident in respect of providing them with safe evacuation in an emergency.  
Residents that present a significant problem generally due to their weight.
Employers failing to provide staff with the appropriate 'tools' to carry out a safe and  effective evacuation in a reasonable length of time.  
Not providing the 'tools' encourage staff to think that residents they cannot move should be left in their room irrespective of the level of risk to the person

I do not think that the problem is limited to my clients.  

Why have the CSCI and Fire Authorities not expressed a similar concern?
Are they oblivious or are they aware but would rather sweep the matter under the carpet?

I would welcome other views and/or experiences

I would also appreciate direction to any company that could provide a suitable lighweight trolly or similar to move residents.

[carol 123]

Steve,

I believe that you have expressed a situation that is just too uncomfortable for owners, csci (or whoever they are these days), government and fire authorities to address. The fact is that in any significant fire in a residential/nursing home the chances of the staff being able to mount a fully successful evacuation is slim. The logistics of moving immobile, dependant, confused and frail people with limited, and often temporary, staff is really not practicable.
It is for this reason that in many states in the USA, (and there is not much that I support uncle sam on these days), defend in situ is considered the most effective course of action. The idea of confining a fire to a single room, quite apart from writing off that resident, is dependent on the being no gaps left for services and perfect FR all around the room. In reality this is a pipedream.
There is an unholy gentlemans' agreement between all parties...adequate protection is just too expensive!

[stevew]

Carol

Thanks for your comments

[Brian Downes]

Effective evacuation planning & training is a huge issue for Care & Nursing Homes.
In my experience very few tackle the issue in an effective and proffessional manner.
I would cynically say that the problem is the costs and time involved in all aspects of the issue, such as:-
 
Proffesional advice in planning and implementing  the strategy (Risk Assesment)
Training the managers in incident management
Training the staff in manual handling and use of evacuation aids
Cost of Providing evacuation aids.
Staffing with sufficient staff to implement the plan
Exercising the plan

It is my opinion that CSCI turn a blind eye, to or don't fully understand these issues. CSCI seem to not want to put pressure on Homes in case beds are lost in the sector.

Staffing levels seem based on national guidance for care needs not emergency evacuation plans.

How can two or maybe three staff who may be middle aged females of varying fitness levels have the physical ability to sustain evacuation of upto 10 or more residents?

The position of my, mainly rural, fire brigade is that we expect the staff to sustain evacuation in areas that are tenable to them, but few homes would be capable of demonstating this capability.

Many await the report into the tragic fire in Scotland to see if this issue is addressed as part of that report.

Rant over, you are not alone worrying about this issue. Fire Authorities and CSCI do seem to turning a blind eye as enforcement is too difficult.

[stevew]

As I see it we can forget about any help from the CSCI or fire authorities on the matter.  Owners still place any general observation from fire authorities as above that from an independent assessor iwithout question.  So much for the risk assessment approach.

Carol and Brian,  you have both confirmed the reasons behind the complacent approach.  Now how do we convince CSCI and fire authorities to support a nationwide action plan to raise awareness?

I am currently dealing with a proposed 55 bed nursing home where I will be
recommending all beds are provided with wheels, doors and corridors wide enough to take a bed.  With effective staff training this will at least be a start.

[Brian Downes]

Steve,
          Bed evacuation is usually for hospitals with nice wide corridors and large bays to put beds.
I suspect the problem with bed evacuation in a Nursing Home [I assume you will be going for progressive evacuation] is where do you put all the beds you have evacuated?
Assuming you have 8 or 10 beds to a compartment, and evacuate with a buffer compartment between compartment of origin and residents, you could need parking for 20 or 30 Beds.
You would also need bed lifts if you have to move vertically, or you will have to transfer your residents to other aids for going down stairs.
 I accept bed evacuation would probably be less tiring for staff but those nursing homes I have dealt with, that take the job seriously, go for mattress evacuation for bedridden, and evaci chair for sitting residnets.
 Parking problems are eased, and vertical evacuation is feasible without further transfer.

Regarding enforcement by CSCI, The Care Homes Regulations 2001, section 23, requires the registered person after consultation with the fire authority to ...(4) (e) carry out fire drills

The legal duty of care is on the registered person, the enforcing authority is CSCI. If my fire authority were 'consulted' we would advise the registered person to take independent proffesional advice to develop proper procedures. The work involved in dealing with these issues is too detailed and time consuming to be dealt with by general advice from fire authorities, and is more properly dealt with by the private sector.
My authority would always comment on any proper plans prepared by private consultants. We do try to respond very positively to Homes who take the trouble, and spend the cash, on proper advice and planning.

My fire authority still see the primary legislation in Care Homes to be The Care Standards Act, and CSCI's responsibility although we do deal with workplace regs. Proper support on these issues from CSCI is patchy at best, as their inspectors have little grasp of fire safety issues.

I understand that the situation may change under RRO, I have heard a rumor that  effectively section 23 become the responsibility of Fire Authorites.

With all due respect, I assume you are a private advisor, you should not be looking for detailed advice from the fire authority, you should be able to determine what is required for the home drawing on your own training and experience.

You may wish to consult with the fire service on a general basis when you have finished your plan.

[stevew]

Thank you for your comments Brian

I prefer the idea of matress to bed evacuation.  All I have to do now is to convince the client that such measures form a vital part of the premises fire evacuation strategy.
 
I am a private consultant having done my time in the fire service.  I think that in respect of an long standing existing registered nursing home I have every right to ask both the fire service and CSCI the following question.  
What evacuation procedure have they been accepting over many years of regular inspection?

Out of interest my ex-employers have since April 2004 only been inspecting registered premises under the FP Workplace Regs.

My moan is that the perception can be. Who are you to advise me on matters that has been accepted by the authorities over many years?  What has changed?
Uphill task.

Steve

[Brian Downes]

Steve,
          The points you make are voiced by care home owners to my colleagues and I on many occasions in protest at their complete failure to manage their home properly.
 I generally reply that the Registered Person has the duty to provide the fire safety arrangements not the fire service.
It is the home owner who must demonstrate the duty of care.
Modern legislation is increasingly moving that way.
Many home owners take the view that their duty is to provide very little in the way of fire safety unless 'caught out' by the fire service.
I conceed that many Brigades use half trained box tickers to carry out inspections, who often miss key issues, or give sometimes poor or costly advice.
This does not help the situation when a competent officer raises important issues.
At the end of the day it is the Registered Person who has the duty of Care.

[Ken Taylor]

In these days of fire risk assessment, it is easy for others to simply say that it's a management issue and for management to hope that they never have a fire or, if they do, that the brigade arrive in time to affect a rescue. 'Ski-sheets' were one response but I wonder how many of those are around these days. If you are considering new-build, I would suggest having an evacuation lift or other designed method for achieving evacuation of persons in beds or wheel-chairs.

[johnv]

We hade a Fire Inspection in December 2004, the first for about 6 years but only because the local service was being audited by the Audit Comission.
The inspector who came was a local sub-officer so I assume she was not a box ticker!
We provided a copy of our own Fire Risk Assessment to the inspector which she said was fine and apart from a few points picked up on the inspection, we were glad to receive the guidance and on the whole the process was fairly painless.
My point is that within our risk assessment we state that evacuation of residents will only be contemplated once all staff are out of the building and the senior peron in charge feels that it is safe to re-enter the building and move to a point of safety, behind two fire doors, any resident that can be moved and to wait for ultimate rescue by the Fire and Rescue Services.
We have 44 rooms and 47 residents on 2 floors. Most of our residents are bed bound and none of the rooms have doors that are wide enough to take the beds through. Equally the corridors are not wide enough to wheel the beds down. On an average day we have about 25 staff in the house 9am to 5pm. This goes down to about 12 between 5pm and 8pm and from 8pm to 8am we have 8 or 9 night staff aged between 27 and 70.
This all seemed to be perfectly acceptable to the inspector so who is paying lip service, my employers or the Fire and Rescue Services?
It would be great to have a home where all the doors were wide enough for the beds and also the corridors were wide and straight but when you are adding capacity to an existing property planning regulations mean a limit on the space you can add and the economics mean that most space will have to go into the residents' rooms.

The above comments and opinions are mine and should not be seen as a representation of the opinions of my employer.

[Brian Catton]

Interesting stuff this. Some of you willknow the phrase used in the green guide. If the premises are more akin to a hospital-----. I think it is useful to go back to that phrase. If the home is not designed for mainly bedridden patients then additional control measures have to be put in place. Forgivr me if I have missed it but no one appears to have mentioned additional compartmentation, so that nurses only have to deal with a few residents in the first instance. Are the staff all competent and trained. Are staff ratios sufficient? Have sprinklers being considered? I do not know who did your risk assessment but if what you say is true whatever happened to duty of care to the patients. I would not like to stand in front of a coroner and tell him or her that the staff were waiting for the fire service. Good discussion.

[pd]

John V

I was saddened to hear your tale. If it is accurate, and I've no reason to doubt it, it demonstrates what we have come to.
Whoever did the FRA was wofefully neglectful...will they change it when the RRO makes them consider the risks to all persons 'lawfully on the premises'?
The response of the Inspector, though wrong, does though reflect the noises coming out of govenment in that the risk should be carried by the 'responsible person'.
These mixed messages are very dangerous. On the one hand the government want de-regulation and on the other they will throw up their hands and say, "we gave FRS the power to enforce."
Cowardice by the government who, in my opinion, have abrogated their responsibility to lead in favour of leaving it to the Courts to apportion blame when either party gets it wrong.

[Brian Downes]

John V
          Very Interesting...my money is on box ticker! If I were commenting to CSCI on your procedures I would suggest that all staff leaving the building and then maybe re-entering to evacuate residents would not satisfy the requirements of the regulations.
Early warning, compartmentation, staff training in responding to a fire and comprehensive evacuation procedures should enable staff to make a measured and appropriate response.I would suggest Staff bolting to safety and maybe returning to spare a thought for the residents hardly demonstrates a duty of care. In reality I suspect the staff would in fact try very hard to save the residents in the event of fire.

[Brian Downes]

John V
           I forgot to add that with 8 or 9 staff on at night in your home you should stand a good chance of managing an incident effectively if the home is well designed and procedures are sound.
 In my experience many homes have only two or three staff, and some of those may be 'sleep in',  on delayed response.
Age and fitness of staff is a very relevant issue. I would suggest that staff do need to be physically able to implement emergeny evacuation techniques.Staff may be able to manage day to day transfers with aids and lifts, but can they drop and drag residents in emergencies?

[Brian Catton]

There are a lot of ifs Brian. Your point about the design is very relevant though. 8 or 9 staff may be able to evacuate 4 or 5 residents from an effectively designed and maintained sub compartment by lowering cocooning in a sheet and sliding. I would suggest that even in an emergency you do not want to risk staff injuring themselves and adding to the casualty list. It can be done with good training to build confidence. Ideally by a Fire Advisor who is a trained moving and handling risk assessor and trainer.