Field hospitals

Advice and generic guidance to Fire and Rescue Services to support the implementation of Field Hospitals

General This note is in response to the need for temporary ‘field hospitals’ to accommodate the potential large numbers of patients that may require hospital treatment due to the COVID-19 outbreak. It is anticipated the information within this note will be updated regularly due to the pace of change, and as more information becomes available.

NFCC thanks the London Fire Brigade (and particularly the fire engineering team), and NHS partners for assisting with this guidance.

Due to the immediate and critical need for such facilities, and the nature of the premises that will be used, Fire and Rescue Services (FRSs) should understand that no existing guidance or regulation fully supports these kinds of improvised facility. For example, compliance with Approved Document B or the suite of Health Technical Memoranda should not be expected, and a pragmatic, proportionate and common-sense approach should be taken to support the national requirement in these unprecedented circumstances. However, the need for reasonable fire safety measures should still be considered.

The Project Director for the field hospital should employ a competent fire safety professional who will be expected to utilise their knowledge and experience to implement mitigating measures to control and support the risk in event of fire. It is essential FRSs are part of the planning and implementation of these facilities at the earliest possible opportunity with all stakeholders, this is key to reaching agreement on the fire safety issues.

As each field hospital is likely to be unique, standardised guidance applicable to different sites cannot be provided and fire safety measures should be tailored to each individual project.

Areas of consideration

The following learning points and areas of consideration are offered following the experience of the London project (the Nightingale field hospital at the ExCel Exhibition Centre).

Premises and site considerations

  • The project should have competent fire engineer/professional(s) to ensure mitigation measures are implemented due to potential lack of passive/active measures and the ability for a normal evacuation strategy to be applied.
  • Compartmentation – Review the existing compartmentation and consider what can realistically be implemented and any additional mitigating measures.
  • Breaches of compartmentation to supply oxygen – consider suitable routes to minimise the impact on compartmentation and ensure appropriate fire stopping is in place.
  • Consider the fixed installations already in place e.g. suppression systems. How can such systems reduce the risk from fire but also consider if they could lead to an additional hazard (see next point below)?
  • Ventilation – Ventilation may be used to clear smoke and assist the emergency response, but consider if a COVID contamination hazard could exist in the air due to airflow being drawn from the main care area.
  • Fire Prevention – review ignition sources and fuel management, position combustibles/storage in areas with fixed installations and/or consider the use of car parks and remote areas for storage etc.
  • Existing on-site security and management teams need be retained where possible as they should have a good understanding of layouts and the premises/site.
  • Existing signage should be assessed and adjusted where required and new signage applied e.g. oxygen pipework identified, additional escape routes, hazards identified.

Site management

  • Review the on-site staffing response as it may form part of the mitigation for the lack of passive and active measures.
  • Recommend an on-site incident response/investigation team with an on-arrival grab pack for the responding FRS.
  • There should be an on-site management plan formulated by the Responsible Person, to consider the response to a range of foreseeable events e.g. from an automatic fire alarm up to a large or major incident involving a full/systematic evacuation, with specific roles as applicable for on-site staff. • Hydrants must not be obstructed, should be tested and clearly marked. Also consider any on-site alternate bulk firefighting water provision or options.
  • Phased Horizontal Evacuation may not be viable due to the lack of compartmentation. • Plans with clear fire access routes should be available at the entry point and other agreed locations.
  • FRS access should be reviewed to prevent any conflict with other site users e.g., Ambulance, Military or goods vehicle movements. • All staff e.g., NHS, Military, volunteers, should be provided with suitable updated awareness/familiarity training on basic actions in case of fire.
  • Consider additional fire extinguishers or other small extinguishing media being provided and positioned appropriately e.g. at Nursing stations. • Area shut off valves for oxygen should be clearly marked and easily identified /accessed. The final terminal unit connections are in plastic pipe and will quickly degrade in a fire situation, this may lead to rapid fire growth.
  • Oxygen enrichment may be a problem and personal measures by staff operating in this environment need to be considered e.g. emollient creams and alcohol hand rub are a heightened risk and the source of ignition from static and will need consideration.
  • The use of local personnel worn oxygen concentration devices by specific staff may need to be considered.

Operational response generic considerations

  • Consider an appropriate pre-determined attendance (PDA) considering the occupancy and site and increased risk through oxygen and other hazards.
  • Consider adding a Hazardous Materials (HAZMAT) Officer if available to the PDA due to clinical hazards and waste, water runoff, and decontamination for committed firefighting crews etc. This should also consider decontamination arrangements with other services.
  • Consider adding a Protection Officer if available to the PDA to support the incident commander (IC) and to liaise with Fire Control Room. • Consider adding a national inter-agency liaison officer (NILO) if available to the PDA to support the IC with inter-agency liaison.
  • Consider adding any other specialist officers or resources to the PDA to support the IC. • Local fire stations and officers should familiarise themselves with the site prior to the facilities going live (the FRS will be familiar with the venue, but the field hospital presents different hazards).
  • A tactical plan for the field hospital should be considered and established by local crews e.g. for crews to enter via the ‘dirty’ side of the building so ‘clean’ areas are not compromised (which leads to decontamination considerations).
  • Prepare for tri-service plan/major incident procedure/JESIP. • Consider ‘social distancing’ protocols (where practical) for responders at a larger incident.
  • Liaise with Police and security due to the potential for the site to be a target e.g. large occupancy, high media interest, oxygen in high quantities and multi-agency staff on site. If defensive measures such as hostile vehicle mitigation barriers are in place/to be installed, consider the impact on attending emergency response. • Consider decontamination sector/procedures if crews are committed to patient area/the ‘dirty’ side of the incident.
  • Consider water run-off (environmental and HAZMAT). • Re-check water supplies, access to hydrants and fixed installations. • Consider a dedicated RVP for FRS – on-site escort to meet and greet from RVP and direct to incident.
  • Site considerations – the site will attract a large staffing requirement; London have taken all the local hotels to accommodate the design/construction/security teams and the NHS staff requirement to facilitate 24/7 care. • Consider preparing a revised and updated Site-Specific Risk Information (SSRI) record to inform all operational crews.

Further information and Peer Review

The NFCC Building Safety Programme (BSP) Team want to hear from any services who are involved in these projects to share information and further inform best practice.

If you would like further information about this project, or if you have any queries regarding premises converting to temporary wards please contact the team at the address below.

To support FRS in their approach to these facilities, the NFCC BSP Team are also offering a Peer Review process.