Document Type : Original Article
Authors
1 Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of E‑Learning, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Workplace Health Promotion Research Center, Department of Health in Emergencies and Disasters, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
BACKGROUND: Fire is one of the most important threatening factors for hospitals and needs special
attention. The present study was conducted to explain the factors affecting hospital emergency
evacuation following fire based on hospital administrators’ experiences.
MATERIALS AND METHODS: This was a qualitative study conducted employing the content analysis
approach. Participants included 22 hospital administrators in Tehran, Lorestan, Kurdistan, and Ilam
provinces. The participants were purposefully selected and included until reaching principle of data
saturation. Data were collected through in‑depth semi‑structured interviews from November 2019
to August 2020 and analyzed by the content analysis method.
RESULTS: Factors affecting hospital emergency evacuation during fire were categorized into five
main categories and 17 subcategories including response to incident (five subcategories of fire nature,
emergency evacuation, service provision, coordination and communication; and collaboration and
companionship), human factors (two subcategories of individual characteristics and competencies),
hospital preparedness (three subcategories of planning, safety and security; and information
management system), environmental factors (two subcategories of hospital design and infrastructure;
and weather condition), and finally ethical values (five subcategories of human dignity, trust, altruism,
responsibility and accountability; and empathy).
CONCLUSION: The results of this study indicated that during fire in Iranian hospitals, several factors
in addition to available standard guidelines affect the emergency evacuation process that need to
be considered. Hospital emergency evacuation during fire is a complex process and necessitates a
full and high‑level hospital preparedness, so using the results of this study can be used to develop
and practice evacuation plans and improve the hospital preparedness.
Keywords
- Alibeigi M, Goli NA, Safarabadi M, Choghaee M, Eyni E, Jokar A.
Assessing the level of preparedness of Arak teaching hospitals
for dealing with natural disasters and unexpected events in 2016.
J Adv Pharm Educ Res 2019;9 Suppl 2:111.
2. Jahangiri K, Rostami N, Sahebi A. Challenges of utilizing the
primary health safety index tool for assessing the vulnerability
of healthcare centers to disasters. Adv J Emerg Med 2020;4:e1.
3. Rezaei F, Mohebbi‑Dehnavi Z. Evaluation of the readiness of
hospitals affiliated to Isfahan University of medical sciences in
unexpected events in 2017. J Educ Health Promot 2019;8:14.
4. Shafiei E, Yousefi K, Sahebi A. Lessons learned; hospital
emergency evacuation in Ilam, Iran. Trauma Mon 2019;24:3‑4.
5. Zurimi S, Yudhastuti R. Evaluation of the implementation fire
emergency response in hospital of Jombang District. Am Sci Res
J Eng Technol Sci 2016;17:15‑33.
6. Aslani AM, Habibi E. Evaluation of fire risk by frame method and
studying the effect of trained crisis management team of fire risk
level in hazrat rasoul‑E akram hospital of fereydunshahr in 2016.
Sci J Rescue Relief 2018;9:46‑55.
7. Jahangiri M, Rajabi F, Darooghe F. Fire risk assessment in the
selected Hospitals of Shiraz University of Medical Sciences in
accordance with NFPA101. Iran Occup Health 2016;13:99‑106.
8. Khalili R, Nabeiei P, Yarmohammadian MH, Etemad S. Training
hospital managers as to fire management. J Health Manag Inform
2015;2:27.
9. Rahmani A, Salem M. Simulation of fire in super high‑rise
hospitals using fire dynamics simulator (FDS). Electron J Gen
Med 2020;17:Em200.
10. Sharma R, Bakshi H, Banerjee A. Fire safety hazards: How safe
are our hospitals? Indian J Community Med 2020;45:104.
11. Bongiovanni I, Leo E, Ritrovato M, Santoro A, Derrico P.
Implementation of best practices for emergency response and
recovery at a large hospital: A fire emergency case study. Safe
Sci 2017;96:121‑31.
12. Shastri BA, Raghav YS, Sahadev R, Yadav BP. Analysis of fire
protection facilities in hospital buildings. in: advances in fire and
process safety. Singapore. Springer; 2018. p. 183‑90.
13. Tekin E, Bayramoglu A, Uzkeser M, Cakir Z. Evacuation of
hospitals during disaster, establishment of a field hospital, and
communication. Eurasian J Med 2017;49:137‑41.
14. Mirakbari M, Amouzad Khalili H, Majidi SA. Investigating fire
patterns and methods to improve its safety in the country’s
hospitals; A review study. J Hosp 2020;19:51‑9.
15. Hicks J, GlickR. Ameta‐analysis of hospital evacuations: Overcoming
barriers to effective planning. J Healthc Risk Manag 2015;34:26‑36.
16. Ventura GM. Development of patient evacuation resource
classification system (PERC) using systems engineering to assist
hospital evacuations in a disaster. Disaster Med Public Health
Prep 2020;First View: 1‑10.
17. Hunt AL, Galea ER, Lawrence PJ, Frost IR, Gwynne SM.
Simulating movement devices used in hospital evacuation. Fire
Technol 2020;56:2209‑2240
18. Bish DR, Agca E, GlickR. Decision support for hospital evacuation
and emergency response. Ann Oper Res 2014;221:89‑106.
19. Golmohammadi D, Shimshak D. Estimation of the evacuation
time in an emergency situation in hospitals. Comput Indust Eng
2011;61:1256‑67.
20. Rahmani A, Salem M. Fire risk assessment in high‑rise hopitalls in
accordance with NFPA 101. Rev Latinoam Hipertens 2018;13:243.
21. Zou B, Lu C, Li Y. Simulation of a hospital evacuation including
wheelchairs based on modified cellular automata. Simul Model
Pract Theory 2020;99:102018.
22. Sheikhbardsiri H, Yarmohammadian MH, Khankeh HR,
Nekoei‑Moghadam M, Raeisi AR. Meta‑evaluation of published
studies on evaluation of health disaster preparedness exercises
through a systematic review. J Educ Health Promot 2018;7:15.
23. Graneheim UH, Lundman B. Qualitative content analysis in
nursing research: Concepts, procedures and measures to achieve
trustworthiness. Nurse Educ Today 2004;24:105‑12. - 24. Rahmanian E, Nekoei‑Moghadam M, Mardani M. Factors
affecting futures Studies in hospitals: A qualitative study. J Qual
Res Health Sci 2019;7:361‑71.
25. Korstjens I, Moser A. Series: Practical guidance to qualitative
research. Part 4: trustworthiness and publishing. Eur J Gen Pract
2018;24:120‑4.
26. Sciences RECoSoPHNRC‑SBUoM. Official Letter. Shahid Beheshti
University of Medical Sciences, Tehran, Iran; 2020.
27. Yokouchi M, HasegawaY, SasakiR, GakuR, MurataY, Mizuno N,
et al., editors. Operations Analysis of Hospital Ward Evacuation
using Crowd Density Model with Occupancy Area and Velocity
by Patient Type. 2017 Winter Simulation Conference (WSC). Las
Vegas, NV, USA: IEEE; 2017:.
28. Hunt A, Galea ER, Lawrence PJ. An analysis and numerical
simulation of the performance of trained hospital staff using
movement assist devices to evacuate people with reduced
mobility. Fire Mater 2015;39:407‑29.
29. Sharma R, Kumar A, Koushal V. Response to a fire incident in the
operation room: A cautionary tale. Disaster Med Public Health
Prep 2020;14:284‑8.
30. Femino M, Young S, Smith VC. Hospital‑based emergency
preparedness: Evacuation of the neonatal intensive care unit‑the
smallest and most vulnerable population. Pediatr Emerg Care
2013;29:107‑13.
31. De‑Ching H, Shen‑Wen C, Chien‑Hung L, Po‑Ta H, Yi‑Ting S,
Huei‑Ru S. A study for the evacuation of hospital on fire during
construction. Proced Eng 2011;11:139‑46.
32. Iadanza E, Luschi A, Merli T, Terzaghi F, editors. Navigation
Algorithm for the Evacuation of Hospitalized Patients. World
Congress on Medical Physics and Biomedical Engineering 2018.
Prague, Czech Republic: Springer; 2019.
33. Rahouti A, Datoussaïd S, Lovreglio R, editors. A sensitivity
analysis of a hospital evacuation in case of fire. In: Fire and
Evacuation Modelling Technical Conference. Malaga, Spain:
Semantic Scholar; 2016.
34. Yaghoubi T, Ardalan A, Khorasani Zavareh D, Khankeh H,
Nejati A, Ebadi A. Decision‑making on hospital emergency
evacuation in disasters and emergencies: Findings from a
systematic review. Iran Red Crescent Med J 2017;19:e14214.
35. Balikuddembe JK, Ardalan A, Khorasani‑Zavareh D, Nejati A,
Kasiima S. Factors affecting the exposure, vulnerability and
emergency medical service capacity for victims of road traffic
incidents in Kampala Metropolitan Area: A Delphi study. BMC
Emerg Med 2016;17:1.
36. Balikuddembe JK, Ardalan A, Khorasani‑Zavareh D, Nejati A,
Raza O. Weaknesses and capacities affecting the Prehospital
emergency care for victims of road traffic incidents in the greater
Kampala metropolitan area: A cross‑sectional study. BMC Emerg
Med 2017;17:29.
37. D’Orazio A, Grossi L, Ursetta D, Carbotti G, Poggi L. Egress from
a hospital ward during fire emergency. J Homepage 2020;10:1‑10.
38. Kelly FE, Hardy R, Cook TM, Nolan JP, Craft T, Osborn M, et al.
Managing the aftermath of a fire on intensive care caused by an
oxygen cylinder. J Intensive Care Soc 2014;15:283‑7.
39. Davudian Talab A, Azari G, Badfar G, Kiani H, Parvin S.
Effectiveness of safety training on knowledge and practice of
operating room personnel regarding fire prevention. Int J Hosp
Res 2017;6:14‑8.
40. Ikpae BE, Dienye P, Dan‑Jumbo A. Evaluation of Fire Safety
Preparedness among healthcare providers in BMSH. Niger Health
J 2018;18:14‑22.
41. Sadeghi‑Bazargani H, Abedi L, Mahini M, Amiri S,
Khorasani‑Zavareh D. Adult attention‑deficit hyperactivity
disorder, risky behaviors, and motorcycle injuries: A case‑control
study. Neuropsychiatr Dis Treat 2015;11:2049‑54.
42. Yeturu SK, Annapurani R, Janakiram C, Joseph J, Pentapati KC.
Assessment of knowledge and attitudes of fire safety – An
institution based study. J Pharm Sci Res 2016;8:1281.
43. Ardalan A, Kandi Keleh M, Saberinia A, Khorasani‑Zavareh D,
Khankeh H, Miadfar J, et al. 2015 estimation of hospitals safety
from disasters in IR Iran: The results from the assessment of 421
hospitals. PloS One 2016;11:e0161542.
44. Kazemzadeh M, Shafiei E, Jahangiri K, Yousefi K, Sahebi A. The
preparedness of hospital emergency departments for responding
to disasters in Iran; a systematic review and meta‑analysis. Arch
Acad Emerg Med 2019;7:e58.
45. Hokmabadi R, Mahdinia M, Zaree R, Mirzaee M, Kahsari P. Fire
risk assessment by FRAME in a hospital complex. J N Khorasan
Univ Med Sci 2017;9:173‑82.
46. Simsek Z, Akinciturk N. An evaluation of hospital evacuation
strategies with an example. Int J Appl 2015;5:109‑21.
47. Murphy GR, Foot C. ICU fire evacuation preparedness in London:
A cross‑sectional study. Br J Anaesth 2011;106:695‑8.
48. Tzeng HM, Yin CY. Environment of care: Vertical evacuation
concerns for acutely ill patients and others with restricted
mobility. Nurs Forum 2014;49:209‑12.
49. Huang D, Lo S, Yang L, Gao L, Lo JT, editors. Hospital Evacuation
under Fire: Risk Identification and Future Prospect. 2019 9th
International Conference on Fire Science and Fire Protection
Engineering (ICFSFPE). Chengdu, China: IEEE; 2019.
50. Jamalimoghadam N, Yektatalab S, Momennasab M, Ebadi A,
Zare N. Hospitalized adolescents’ perception of dignity:
A qualitative study. Nurs Ethics 2019;26:728‑37.
51. Baillie L. Patient dignity in an acute hospital setting: A case study.
Int J Nurs Stud 2009;46:23‑36.
52. Tehranineshat B, Rakhshan M, Torabizadeh C, Fararouei M.
Patient dignity in iranian clinical care settings as perceived
by physicians, caregivers, and patients. J Multidiscip Healthc
2020;13:923‑33.
53. Kang SH, Skidmore M. The effects of natural disasters on social
trust: Evidence from South Korea. Sustainability 2018;10:2973.
54. Zhang G, Li C, Lu S, editors. Analysis of Fire Evacuation in
High‑rise Hospitals from a High‑rise Hospital Fire Case. 2019 9th
International Conference on Fire Science and Fire Protection
Engineering (ICFSFPE). Chengdu, China: IEEE: 2019.
55. Top M, Tekingunduz S. The effect of organizational justice and
trust on job stress in hospital organizations. J Nurs Scholarsh
2018;50:558‑66.
56. Ward P. Trust and communication in a doctor‑patient relationship:
A literature review. Arch Med 2018;3:36.