New Delhi, Dec. 9: India’s apex agency that grants accreditation to hospitals had warned the AMRI hospital earlier this year that its fire evacuation plans were inadequate despite approvals from city authorities and mock drills, the agency’s officials revealed today.
More than 80 persons, all but three of them patients, died from asphyxiation at the AMRI hospital early today in what may be India’s worst hospital disaster that has exposed paltry levels of preparedness for emergency evacuation.
The National Accreditation Board for Hospitals and Healthcare Providers (NABH) had kept the hospital’s application for re-accreditation from November 10 of this year in abeyance because of certain “non-conformities” to expected standards, NABH officials said.
“What has happened is unimaginable,” said Girdhar Gyani, chief executive officer of the NABH and secretary general of the Quality Council of India. “We had specifically indicated to the hospital that its evacuation plans need to be strengthened.”
“There was another serious issue — the hospital did not have the required safety certification from the Atomic Energy Regulatory Board for two new machines it had procured,” Gyani told The Telegraph. The AMRI hospital had first received accreditation from the NABH during 2008 which, following a mid-term review at 18 months, had remained valid until November 10 this year, he said.
Hospital management specialists and architects involved in the design of hospitals have expressed surprise at the high number of fatalities among patients, despite the hospital having all the “right papers” from local fire and municipal authorities.
“There are standard codes for fire safety and emergency response by hospital staff that should have been in place,” said Meeta Ruparel, the director of Aum Meditec, a Mumbai-based hospital management consultancy, who had highlighted the need for fire safety in hospitals in India eight years ago.
The National Building Code of India issued by the Bureau of Indian Standards specifies several layers of safety precautions that should prevent the loss of life during fires, said Shamit Manchanda, a New Delhi-based architect who has designed several private and government hospitals.
“Ramps are crucial in the evacuation of bed-ridden patients during fires when staircases don’t help and lifts don’t work,” said Manchanda. A hospital roof should also have a “refuge area” where patients can be moved from upper floors, said another architect involved in hospital design. “The risk of asphyxiation is reduced on the open terrace and patients get extra time,” the architect said.
The NABH is not a regulatory agency and can merely ask hospitals to provide the approvals it has received from local fire and building regulatory authorities, NABH officials said. “Beyond that, we examine their evacuation plans, mock drills, and staff training,” said Deepti Mohan, an assistant director at the NABH.
“But how (hospital) staff will react in an actual emergency, we'll never know until something happens,” she said.
Hospital building design and “best-practice” manuals demand that after appropriate fire-fighting infrastructure and equipment — from ramps to evacuate patients to appropriate numbers of fire-extinguishers — are in place, the staff needs to be periodically trained to respond to emergencies.
“This calls more than just distribution of guidelines and manuals,” Ruparel said. “Each member of the staff needs to know exactly what he or she should do when a fire breaks out and be trained to do it efficiently through regular drills,” she said.
A senior consultant doctor who has been at AMRI for about 10 years said he had observed sections of security and nursing staff conduct a mock fire drill and take classroom lessons over the past year.
“It is very sad — I lost two of my patients — one in the ICU, one outside,” said the doctor who requested anonymity.