F i r e Investigation & Analysis Unit
Post Incident
Summary Report
“Reducing
the
incidence
and
impact of
fire in the
community”
The Northern Hospital
Inpatient Units A & B
185 Cooper Street Epping
Fire on 16 August 2003
DISCLAIMER
The Metropolitan Fire and Emergency Services Board and its employees make no
representation as to the completeness, accuracy or suitability for any purposes of the
statements, information and opinions contained in this document and recommend that any
person reading the documents conduct their own investigations and/or seek their own
independent advice in relation to the matters contained in it.
The Metropolitan Fire and Emergency Services Board and its employees accept no
responsibility for any loss or damage, whether direct or consequential, suffered by any
person as the result of or arising from the reliance on the statements, information or
opinions in this document.
Furthermore, it is not the intention of this report to pass judgement on, or fix liability for, the
loss of property or the effects upon the occupants, following the fire.
COPYRIGHT
No part of this publication may be reproduced, stored in a retrieval system or transmitted in
any form or by any means–electronic, mechanical, photocopying, recording or otherwise–
without the prior written permission of the copyright owner.
Copyrighted materials reproduced herein are used under the provisions of the Copyright
Act (1968) as amended, or as a result of application to the copyright owner.
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Designed, researched and written by the MFB
Fire Investigation & Analysis Unit
433 Smith St, Fitzroy Nth, Victoria. 3068
Telephone: 613 9420 3883 Fax: 613 9420 3985
Email: fiaoffice@mfbb.vic.gov.au
DX: 211001
Post Incident Summary Report
Point of Interest:
Fire and sprinkler activation in a Hospital
Report No:
0300933
Inspection Date:
19 August 2003
Incident No:
2492
Date of Incident:
16 August 2003
Time:
04:08 hours
Site/Building Name:
The Northern Hospital
Address:
Suburb:
Council:
185 Cooper Street
EPPING
WHITTLESEA
Building Use:
Public Hospital
Type of Construction:
Walls: Concrete Floor: Concrete
Storeys Contained:
Two (2)
Floor Area:
1,641 m²
Sprinklers:
Yes
Alarm System:
Smoke detectors smoke stop doors
Mandatory System:
Yes
Injuries:
Nil
Estimated Loss:
$10,000
Building Replacement cost:
$2 million
Number of occupants:
20 patients and 12 staff
Supposed Cause:
Accidental
Area of Origin:
Unit B – Disposal room
No of Firefighters involved:
8
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Classification: 9a
Mandatory: Yes
Roof: Metal Deck
Heads Activated: One
Page 3
FIRE INCIDENT EVENTS
At approximately 3:45am, staff from Surgical Unit D, located on the first floor of the hospital directly
above Inpatient Unis A & B, reported the smell of smoke to the After Hours Coordinator. Following this
report, security staff performed a thorough search of Units C & D but failed to find any sign of a fire in the
vicinity. Security staff then began an external search to ascertain whether the smell of smoke was
coming from a fire outside the hospital. This search also failed to identify the cause of the smell.
At 4:08am, the fire alarm activated, notifying the Fire Brigade and alerting staff of the hospital via the
Emergency Warning and Communication System (EWIS). Relevant staff then responded to the Fire
indicator panel where they discovered; alarms had activated in Units A & B and fire doors in the vicinity
of these units and the Child and Adolescent Health Unit (CAHU), had closed. It was about this time
nursing staff on Unit B heard a loud popping noise and noticed water coming from under the door of a
disposal room in that unit. As a consequence, a decision was made to evacuate 20 patients from Unit B
into Unit A and CAHU.
Fire crews arrived within five minutes of being notified, to find; Unit B evacuated, a sprinkler head in a
disposal room, measuring 3 metres x 5 metres, operating and a fire involving waste linen extinguished.
Fire crews remained on scene for about an hour and a half, conducting salvage operations and
removing water from the building.
The fire destroyed a
quantity of waste
linen and damaged a
section of wall in the
disposal
room.
Smoke damage was
confined
to
the
disposal room and
water damage was
wide
spread
throughout Unit B.
The estimated cost of
damage was put at
$10,000.
It appears the fire
may
have
been
caused
by
a
cigarette, accidentally
discarded in a bag of
waste linen. Once
the fire started, it
would have gone
undetected because
the disposal room did
not contain a smoke
detector and was not The bags of linen in the disposal room and the path of flame and smoke travel
covered
by
the toward the service access hole cut in the wall.
building
airconditioning system, but ventilated directly to atmosphere. Consequently, the air pressure in the room
was lower than that in the passageway outside, preventing smoke and fumes from escaping through the
door. Fumes and smoke would have spread to units above through a service access hole cut in the wall
and/or through fresh air vents of Units C & D, once it had escaped to atmosphere.
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Page 4
ISSUES
Following the fire, an investigator from the MFESB Fire Investigation and Analysis Unit conducted an
inspection of the building. During that inspection, issues were identified relating to fire safety that could pose
a threat to occupants and assist in the spread of fire.
1.
The Fire Brigade was not notified of the fire when staff first smelt smoke.
Brigade comment: The sooner the Fire Brigade is notified of a fire the sooner fire crews can get on
scene and take the appropriate actions to minimise damage and disruption. Had hospital staff notified
the Fire Brigade when they first smelt smoke, fire crews could have been on scene 10 – 15 minutes
before the initial alarm was received. Conceivably, this may have been sufficient time for them to locate
and extinguish the fire prior to the activation of the automatic fire sprinkler system. As such, considerable
water damage and disruption would have been averted.
Time delays such as this become more critical in situations where many occupants are non-ambulant
and require assistance to escape, or could be susceptible and/or incapacitated further due to minor
quantities of smoke and fumes.
Alternatively, had the Fire Brigade been notified and the smell of smoke was determined to have
originated from a fire outside, the call would have been classified as a non-chargeable good intent
false alarm call.
Note: Following the fire, it was indicated that in addition to the 20 patients initially evacuated, 30 more
were moved to other units. This was done as a precautionary measure, due to the patients’ medical
conditions, the smell of smoke and the amount of water damage throughout Unit B. The last of these
patients were not repatriated until the following Tuesday.
2.
The design of the disposal room may have contributed to the fire not being discovered earlier.
Brigade comment: The room was not fitted with any fire protection equipment. Had a correctly fitted
and maintained smoke detector been installed, smoke would have activated it shortly after the fire
started, thereby alerting staff and the Fire Brigade. Also, the room vented directly to atmosphere, and
therefore, was not connected to the building’s air-conditioning system and smoke detectors protecting it.
And because the air pressure outside the room was greater than that inside, smoke and fumes were
prevented from entering the passage in Unit B. Had smoke been able to enter the passage, staff may
have noticed the fire earlier or smoke from it may have activated a smoke detector outside the room.
CONCLUSION
This fire has shown how a delay in notifying the Fire Brigade could result in greater damage and disruption.
Had the Fire Brigade been notified when the first smell of smoke was reported, fire crews would have arrived
much sooner than they did. This then may have resulted in the fire being discovered and extinguished prior
to the automatic sprinkler system operating and the need to evacuate patients. It has also highlighted
deficiencies in the design of the disposal room and how it impacted on fire safety. Had the room been fitted
with a smoke detector, early notification of the fire would have occurred and staff may have been able to
successfully deal with the situation using installed fire equipment.
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RECOMMENDATIONS
These recommendations, although not mandatory, have been made after considering the use of the
building, its size and type of construction and the number and type of people likely to occupy it. The Fire
Brigade believes that if the following are implemented, a greater degree of fire safety will be afforded to
the occupants, staff and members of the public.
1.
Ensure hospital emergency procedures and staff training reflects the importance of quickly notifying the
Fire Brigade when it is suspected there is a fire.
2.
Install smoke detectors in all rooms were combustibles, such as linen and refuse, are stored.
Chris James
Senior Station Officer
FIRE INVESTIGATION & ANALYSIS UNIT
Please note: In order to assess the effectiveness of this report and to make reports of this type more
meaningful, written / verbal contact will be made with the occupier / owners in the future. The time frame of
this follow-up will be dependent upon the issues highlighted and the complexity of the recommendations
made.
cc:
Sharon McNulty, The Northern Hospital
MFESB Director Fire Safety
MFESB Director Operations
ACFO, Northern Zone
J:\GROUPS\FIA\PIA'S\REPORTS\0300933 The Northern Hosp.doc
Commander Northern Zone
Building Commission
Australasian Fire Authorities
Council
Fire Protection Association Aust
Insurance Council of Aust
Interstate fire services
Robert Burnham General Manager
Northern Hospital
MFB O.I.C.,S.O. R. Wood
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