Ensure fire safety audit at neonatal facilities
After a deadly fire tragically cut short the lives of more than six newborn children at a private neonatal intensive care facility in East Delhi in May, the National Neonatology Forum, a national body dedicated to neonatal care, issued a detailed advisory on fire safety measures required to be followed strictly by all intensive-care units dedicated to the most vulnerable of patients — the newborn.
If only the Maharani Laxmi Bai Medical College in Jhansi, Uttar Pradesh, had followed this advice, there would not have been a repeat of the tragedy on November 15, on an even larger scale, at the neonatal intensive care units (NICU) of the government hospital in the Bundelkhand region.
As per the preliminary reports, the cause of the fire was an electric short circuit in the extension board, probably due to overloading of the circuit. The small fire soon turned into a blazing inferno in the oxygen-rich environment. While 39 babies were moved to safety, 10 died from the smoke and burns.
Electrical short circuit is the single biggest cause of accidental fire in the country — out of 8,491 accidental fires in 2021 reported by the National Crime Records Bureau, electrical short circuit contributed to 1,808 cases. In 2022, out of 7,566 accidental fires, 1,567 were caused by electrical short circuits.
The causes of short circuiting are many. Ageing and outdated wiring, for example, can get heated up more easily, particularly if they are not of standard quality. They need to be replaced in old buildings. Similarly, faulty or underrated plugs, sockets, power cords, appliance wiring, or even a defect in the appliance could cause a short circuit.
Of course, it is not just age that leads to wear and tear. Sometimes, the wire or its insulation may get damaged by pests or insects or during an attempt to screw or hammer a nail into the wall. Loose wires are another cause but the most common is overloading of the circuit. Exceeding the rated load could lead to overheating and melting of the wire insulation, eventually leading to a fire. It is for this reason that safety devices like circuit breakers are a must. Were there no circuit breakers at the NICU? Or were they not used as they trigger shutdown in case of overloading?
An NICU is most susceptible to fires because of two reasons. One is the continuous need and usage of a large number of life-saving medical equipment to treat premature babies or babies with a variety of infections, or other health problems. There is a reluctance to service or repair equipment at the first sign of trouble because these cannot be spared. In addition, there is every chance of overloading of the circuit, unless it is regularly checked to ensure that it can take the load. Doctors say that compared to yesteryears, the number of electrical and electronic equipment being used in hospitals today is manifold — and this can well overload the system, unless regularly audited and upgraded.
The other reason is the nature of some of the machines used in the neonatal units such as oxygen concentrators, that can cause the fire to spread rapidly, or even cause an explosion. So much so that fire safety in an NICU requires constant and regular maintenance and audit of not just fire safety equipment and alarms, but also the medical appliances and the support systems. Added to all this is the highly vulnerable condition of these babies. NICUs need a higher degree of fire safety.
Ironically, in March this year, the Union Ministry of Health had issued a directive to all healthcare organisations, emphasising the importance of fire safety. This was followed by an advisory by the National Accreditation Board for Hospitals and Healthcare Providers reminding hospitals to take due cognisance of the directive.
Following the fire in the Delhi hospital on May 25, the National Neonatology Forum issued an advisory specifically aimed at hospitals caring for newborns on the special fire safety requirements of NICUs. It obviously went unheeded or else we would not have witnessed another distressing tragedy in Jhansi.
According to reports, the Jhansi hospital’s NICU ward had the capacity to cater to only 18 newborns, but the hospital was treating as many as 49 —stretching the facilities well beyond the limits. Short circuits caused by overloading is the obvious result in such cases. Detailed investigations are still on, but going by the initial reports, the state government must take the primary blame for failing to provide adequate healthcare facilities that would have prevented overcrowding of the NICU in the hospital.
The tragic death of newborns should at least now force all state governments and healthcare providers to comply fully with all fire safety laws and regulations, and ensure that hospitals meant to save lives do not become deathtraps.
— The writer is a consumer rights and safety expert
