Are Hospitals a Place of Life Saving or a Death Trap?
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ecent fires across countries especially in Maharashtra and that too during pandemic and post-pandemic periods have highlighted the importance of fire safety and the cause of fire now has been shifted from electric to the chemical used to air condition to even the oxygen which is a life-supporting system but can become hazardous in case of high concentration (Oxygen Enriched Area- OEA). The most recent fire at Bhandara and Ahmednagar (both Maharashtra) have also brought to notice of the authorities that any fault (electric/electronic) in the several medico electronic equipment can cause severe damage.
Looking at the growth of the population rate and urbanization, not only the number of hospitals is increasing but the height of the hospital is also in demand. The hospital which was an earlier ground structure now has gone up to 30 meters in height and is expected to reach a height of 45 meters, mainly in metro cities. The composition of Nursing Homes is also increasing. The earlier single unit as nursing homes was there but nowadays, the nursing homes are found in commercial buildings occupying one or two floors of the said building. Above that, these nursing homes tend to have separate access and hence single staircase cut-off from other areas (commercial or residential) are found.
National Building Code of India – 2016, Part 4 (NBC-Part 4) categorize these occupancies as Group C and as such necessary provisions are spelt out for such type of occupancies. Whereas, if such hospitals (nursing homes) when housed inside the commercial or residential building (say on the 2nd or 3rd floor), then one needs to think under which occupancy they need to be grouped. Though, provisions of (NBCPart 4) categorize certain buildings into mixed or multiple occupancies and prescribed them to comply with the stringent provisions.
However, Clause 1.2 of Part 4 on other hand recommends the provisions of NBC-Part 4 for those buildings having heights above 9 meters or floor plates of more than 500 m2. The challenge is how to deal with these nursing homes housed on the 2nd or 3rd or even only on the 4th floor. What height is considered for such nursing homes when their existence is limited to one floor only? Above and all, in Maharashtra, the local building bye-laws do not mandate fire approval for all those buildings which are below 24 meters or floor plates below 500 m2 but then they are compelled to do so for want of registration under the Nursing Home Act.
All said and done but then one cannot compromise with the fire safety and it is each one’s responsibility to create “fire-safe” atmosphere for the patient so admitted to these hospitals/nursing homes. The said place is the place of life and cannot become the place of death.
Keeping all this in mind, the following guidelines are recommended for hospitals/ nursing homes which are in addition to fire prevention, protection and life safety measures recommended in NBC-Part 4 including additional safety measures prescribed for Institutional Building in Clause 6.
PART–A: GENERAL FIRE SAFETY NORMS FOR NURSING HOMES OCCUPYING ONLY A FLOOR OR PART FLOOR OF THE BUILDING
1) The application should be accompanied by the previous year’s Registration Certificate & Owner or Occupier shall obtain No-Objection Fire Certificate from the fire authority.
2) A floor plan showing the interior layout, exits, and fire extinguishers certified by the
The doctor/Owner of the Nursing home shall be submitted.
3) Entry/exit doors, preferably opening outside the premises of the Nursing Home are expected.
4) Sufficient numbers of openable windows/ glass panels shall be provided to the premises. Due to any reasons, if it is not possible to open and grills are being installed, then it shall be fabricated in such a manner that the lock can be opened with the help of a key in case of emergency.
5) Continuous corridor shall be provided which shall be connected to the exit.
6) Common corridors, staircases & open spaces shall be maintained free from, obstructions, encroachments & storage so as to afford easy means of egress/ ingress in the event of an emergency. The conditions shall also be adhered to by the society, owner or occupier of the building.
7) False ceiling suspenders/runners shall be preferable to non-combustible material. If the false ceiling is already existing all due care shall be taken to ensure that electrical fittings like spotlights, decorative items, wirings etc are indicated with fluorescent paint signage. good/IS materials so that they may not catch fire due to overheating.
8) Escape routes shall be e indicated with fluorescent paint signage.
9) All electrical installations shall be periodically checked & tested by competent electrical engineers, while all loose electrical wiring if any, shall be replaced immediately.
10) Appropriate M.C.B. shall be installed where necessary in the electrical installation as per Indian Electrical Rules.
11) Approved type of electrical circuit breaker shall be provided at the main electrical distribution board.
12) The main electric board shall be provided at an easily accessible place.
13) Wherever cabins are fully/partly enclosed with timber partitions same shall be painted with fire retardant paint.
14) If the facility has a Central Air Conditioning System, then:
- The AC ducts shall be constructed of substantial metal gauge per IS: 655:1963 for metal air ducts (revised).
- Whenever ducts or electrical wiring passes through the walls, the opening around the ducts or electrical work shall be sealed with fire-resisting material such as vermiculite cement.
- The material used for insulating the duct (inside or outside) shall be non-combustible material such as glass wool, spun glass with neoprene facing etc.
- Escape routes like the staircase, common corridor, lift lobby, etc. shall not be used as a return air passage. The conditions shall also be adhered to by the society, owner or occupier of the building.
15) Only electrical appliances shall be used in the pantry. Gas Cylinders not more than 02 shall be allowed to be kept in the Nursing Home at any given time. More emphasis shall be given to the PNG/CNG connection.
16) If provided with PNG/CNG Connections, the use of a Gas Cylinder shall be prohibited.
17) The entire Nursing Home premises shall be provided with an automatic smoke detection system as well as a manual fire alarm system along with the control panel & hooters and its panel shall be installed in the security cabin / easily accessible/audio-able and can be responded.
18) Fire Extinguishers as per IS 15683 to be installed as per IS 2190 mentioned in the given above table shall be provided.
19) Security & In house staff shall be well acquainted with the layout of the premises & fire fighting arrangements.
20) Display all emergency support functionaries’ numbers and evacuation maps on all floors and at strategic locations.
21) Good housekeeping in all areas, especially stores, kitchen electrical installation, transformer house and waste disposals etc. should be maintained to avoid the incidence of fire.
22) No Smoking Zone shall be enforced rigidly for the entire Nursing Home.
23) Trained staff in dealing with the firefighting extinguisher/appliance/ Evacuation procedure shall be engaged. Firefighting drills and evacuation drills should be held regularly.
24) One senior person preferably from administration may coordinate & look into it.
25) One site Emergency/Evacuation plan shall have to be prepared and updated at regular intervals.
26) Fire Plan, the Exit sign, Floor Nos. shall be displayed in conspicuous places.
27) Schedules for periodic checking, testing and maintenance of all fire protection and detection systems shall be fixed and displayed at all times and shall be done accordingly to keep the firefighting system in proper working condition at all times.
PART – B GENERAL GUIDELINES FOR EXISTING HOSPITAL BUILDINGS
I. PREVENTIVE MEASURES
1) Entrance gates and access roads shall be kept free from any obstructions.
2) Available open spaces shall be kept free from any obstructions/encroachment for the free movement of fire appliances.
3) All the staircases shall be kept in use and shall be maintained free from any obstruction.
4) All the corridors / common passages/lift lobbies shall be maintained free from any obstruction at all times.
5) Good housekeeping in all areas, especially stores, kitchen electrical installation, transformer house and waste disposals etc. should be maintained.
6) No Smoking Zone (while applicable in offices, stores, depots etc.) shall be enforced rigidly.
7) Cooking shall be restricted to permitted areas only with prior approval from the concerned Local Fire department authority. L. P. Gas Cylinders shall not be used within the Hospital Building. It shall be placed in a separate gas cabin on the ground floor with piping to the desired place.
8) Cooking shall be restricted in the Basement.
9) Use of L.P.G. gas shall be restricted in the basement.
10) Ventilation provided to the staircase/corridor/lift lobby shall not be blocked in any case.
11) All corridors shall be preferably ventilated to outside air at every floor level.
12) Basement if provided shall be used for the designated purpose only. It shall be used for car parking or storage of non-hazardous / non-inflammable material. Any activity in the basement shall be got approved by the Local Fire Brigade Authority.
13) The basement, if any, should not be used as a store room/material dumping/inpatient ward or for any other purpose which will cause Fire/Smoke.
14) No storage shall be done in the electric meter room, or lift machine room.
15) Electric wiring shall be laid in metal / PVC conduit, continuously bonded to earth. Nothing shall be stored within a radius of one meter from any electric wiring.
16) Electric cable duct shall be sealed at every floor level with vermiculate or appropriate material.
17) Chemical storage shall be segregated from other storage and only the required quantity shall be stored with prior approval from the fire brigade and local ward authorities.
18) Oxygen and other medical gas cylinders shall be stored separately at the ground floor level with prior approval from the Local Fire Brigade and concerned authorities.
19) All the firefighting installations provided in the building shall be maintained in good working condition all the time and the dedicated trained staff shall be deputed who shall be available on the premises round the clock to tackle any emergency.
20) Staircase/corridor lighting/fire lift/fire fighting installation shall be on an independent electric circuit and it shall be provided with an alternate source of power supply either from a separate sub-station or through D G Set.
21) All the Hospital staff including maintenance staff, medical and nursing staff shall be trained in basic fighting skills and evacuation procedures.
22) Regular mock drills and evacuation drills shall be carried out at the interval every three months and a log of the same shall be maintained.
23) In general fire extinguishers as per IS 15683 shall be provided as follows:
- Electric meter room: One Co2 Type 4.5 kg.
- Lift machine room: One ABC Type 4 kg.
- Corridor at every floor: One ABC Type 4 kg & one water Co2 type 9 ltrs
- Canteen / kitchen / pantry: One ABC Type 4 kg e) L.P. Gas cabin: One ABC Type 4 kg
- L.P. Gas cabin: One ABC Type 4 kg
- Chemical / pharmaceutical store room: One ABC Type 4 kg / Co2 Type 4.5 kg
- DG Set area 01 Foam Type for every 50 sq. mtr area.
24) Hospital Building in which fire fighting installation is provided, shall be tested/inspected by Govt. an approved licensed agency and a certificate to that effect shall be submitted to Fire Brigade authorities twice in a year i.e. in January & July.
25) All electrical installations shall be periodically checked & tested by competent electrical engineers, while all loose electrical wiring if any, shall be replaced immediately.
26) Appropriate M.C.B. shall be installed where necessary in the electrical installation as per Indian Electrical Rules
27) All old electrical wiring especially in the zone of the insignificant and abundant areas shall replace with new ones.
28) Trained staff in dealing with the fire fighting extinguisher/appliance/Evacuation procedure shall be engaged. Firefighting drills and evacuation drills should be held regularly.
29) One senior person preferably from the administration may coordinate & look into it.
30) One site Emergency/Evacuation plan shall have to be prepared and updated at regular intervals.
31) Fire Notice, Fire order, the Exit sign, Floor Nos. shall be displayed at conspicuous places as per requirements of NBC Part IV.
32) Arrangements should be made for proper checking, testing and maintenance of all fire protection and detection systems to keep them in proper working condition at all times.
33) Electricity Safety Audit should be carried out at regular intervals as per Indian Electrical Rules.
34) Every high-rise Hospital Building shall depute Fire Officer having the required qualification and experience.
II. PROTECTIVE MEASURES
1) Water Reservoir exclusively for firefighting shall be made available as prescribed in National Building Code (NBC) Part IV.
2) Replenishment of the reservoir may be incorporated with a deep tube well with an auto facility.
3) Fire Hydrant Ring main with Yard Hydrant & Wet Riser system with landing value shall be installed as per NBC Part IV & IS:13039 &n 3844.
4) Hose Box containing two nos. 15 M long Hose & 1 No. Branch Pipe with Nozzle to be installed near each Yard Hydrant & Landing Valve.
5) First-Aid Hose Reel 30 M long to be provided near each landing valve tapped off from the Wet Riser.
6) Sprinkler system to be provided for all the floors & other places/areas as applicable as per NBC Code & IS 15105
7. Firefighting extinguishers as per IS 15683 should be installed within the building as per IS: 2190 and a person having a workstation in that area should be trained to use the same, if required, initially in case of emergency.
8. The main Fire Pump and one stand-by pump of a capacity minimum of 2280 LPM and the head of the pump will be such that 3.5 kg/cm2 pressure is available at the farthest / highest landing valve, to be installed. Auto start facility should be incorporated into the fire pump. Accordingly, a Jockey Pump with of Capacity 180 LPM shall also be installed.
9. The Stand by pump of equal capacity must be available on alternate sources of supply, preferable to a diesel operating pump.
10. Fire Detection & Alarm System for the entire Building shall be provided as per IS: 2185.
11. Public Address System with Two-way communication System.
12. Emergency power supply shall be provided to be following equipment and systems – Illumination of means of an escape route, Fire Alarm Panel & P.A. Console, Fire Pumps, Fire Lift E. Bore Well
PART C: GENERAL INSTRUCTIONS FOR HOSPITAL AND NURSING HOME STAFF
I. IN THE EVENT OF EMERGENCY – ALL MOBILE PERSONS:
1) Do not panic.
2) Protect yourself and Alert others
3) Close windows and doors behind you (ensure no one is left inside)
4) Proceed to the nearest emergency exit, quickly. Don’t waste time collecting belongings.
5) Don’t run, walk fast.
6) Use the staircase. Don’t use LIFT.
7) Walk on the left side of your staircase.
8) Don’t talk when you walk.
9) Proceed to the assembly area near the building on the ground floor.
10) If you find smoke, crawl by covering your nose & mouth with a wet cloth.
11) Obey the instructions of your Floor Marshall.
12) If your clothes catch fire, then Stop, Drop and Roll on the Ground.
13) Do not enter the building till the Emergency is called off.
14) If you are trapped/handicapped and need help, try to attract the attention of the rescue team by making a loud noise.
15) Call fire service immediately (101)
16) Give your name, Tel. no. and exact address with nearby landmark when informing the Fire service.
17) Ensure that the people who are physically constrained, unconscious, disabled and women are evacuated/removed safely.
II. PROCEDURES TO BE ADOPTED IN CASE OF FIRE – HOSPITAL STAFF
1. Evacuate the occupants by using fire exits and emergency exits.
2. Switch off the power supply of the building except for the emergency light/fire lift/fire alarm panel / PA system.
3. Fight the fire using extinguishers or water/fire fighting arrangements like hose reel etc.
4. Guide the fire force, on their arrival to the seat of the fire.
WHAT YOU MUST DO IF A ROOM IS FILLED WITH SMOKE?
- GET LOW AND GO if you are in a room filled with smoke
- Yell FIRE and R-A-C-E! Immediately begin the fire plan
- Instruct your residents and patients to stay low and crawl to the door
- Smoke fills a room from the ceiling down. The safest air is near the floor
- Instruct them to touch the exit door with the back of their hand to check whether it is hot or not
- If the door is hot, tell them NOT to open it. Go to another exit. If that door is cool, open it slowly and leave the area.
- If an exit is unsafe to use, the patient or resident should shut the room door and block off the bottom of the door with a towel or blanket.
- They should be taught to cover their nose and mouth with wet cloth and to yell for help. They should yell or signal from a window if they can.
- If there is a phone in their room, they should call 101 and tell the fire department where they are blocked in, with smoke and a hot door.
II. PROCEDURES TO BE ADOPTED IN CASE OF FIRE – HOSPITAL STAFF
1. Evacuate the occupants by using fire exits and emergency exits.
2. Switch off the power supply of the building except for the emergency light/fire lift/fire alarm panel / PA system.
3. Fight the fire using extinguishers or water/fire fighting arrangements like hose reel etc.
4. Guide the fire force, on their arrival to the seat of the fire.
PART D – GENERAL INFORMATION
I. FIRE EXTINGUISHERS
Every nursing home and hospital must have fire extinguishers. There are several kinds of fire extinguishers:
- An “A” type fire extinguisher can only be used to put out fires on some common things like paper, wood and cloth. CAN NOT be used on oil, grease or electrical fires.
- “B” type fire extinguisher can be used to put out fires on liquids and gases like gas, oil and grease. It can be used on kitchen grease and fat fires. It CAN NOT be used on electrical fires.
- C” type fire extinguisher can be used to put out electrical fires
ABC. – “ABC” type fire extinguisher is the BEST of all. It puts out all kinds of fires. Since an ABC fire extinguisher can be used on any type of fire, it is highly recommended that these be in every hospital and nursing home. They can be bought at almost every home improvement store for very little cost. All fire extinguishers must be checked regularly to make sure that they are fully charged and ready to use in case of an emergency.
II. PLANNING FOR A FIRE EMERGENCY
Be Able to Evacuate Your Patients and Residents Quickly and Safely: All hospitals and nursing homes must have stairway exits that are marked with signs that are lit up so that all can see them. Nursing assistants must tell patients and residents to use the stairs and NOT the elevator if a fire starts in the area and they have to be moved to another floor of the facility for safety. Everyone must use the stairs. If a patient or resident cannot walk down the stairs, the nursing assistant and other healthcare providers or a fireman must carry them down the stairs or gently slide the person down the stairs so that they can leave when they are in danger.
III. KNOW AND PRACTICE YOUR FIRE RESPONSE PLAN.
All health care providers must know how to respond to fires and other emergencies. All hospitals and nursing homes have a fire safety plan. If a fire starts must all follow the Fire safety / Evacuation plan.
It is also helpful to teach our patients and residents about fire safety and the proper response if a fire starts. They should know: How to leave their room and area? Patients and residents must be shown the escape route. They must also be told to use the stairs and NOT the lifts.
They will also have to know what to do if a fire is blocking the doorway of their room. If a fire is blocking their room, they should shut the door to keep the fire out. They should also put a towel or blanket at the bottom of the door to keep the smoke out of their room. It is also a good idea to yell for help or signal for help at the window.
- Every facility should have written fire procedures that are understood and practised by all staff. Staff should be responsible for knowing and carrying out their part of the plan. That includes doctors, nursing staff, kitchen staff, maintenance, volunteers, and others.
- Response procedures should be practised regularly
- There should be a clear “code word” agreed upon beforehand for the facility to alert other staff in case of fire.
VI. QUICK RESPONSE
- Call out the code to alert staff
- Activate the fire alarm.
- Evacuate everyone in immediate danger
- Close doors to contain smoke and fire.
- Once the fire is contained to the room of origin behind closed doors, never reopen the door or reenter the room to extinguish the fire.
- Close all doors to patient rooms.
- In evacuating, make sure no patient is left behind.
PART E: FIRE EMERGENCY PREPAREDNESS PLANNING
1. Emergency actions should include a written plan listing, in detail, the procedures to be taken in the event of a fire.
2. Emergency Plan:
a. The facility information describes key elements of the facility that is useful for new employees and response agencies, such as local fire departments.
b. Employees must know how to report an emergency. This may include the activation of pull alarms or notifying the facility security centre. Consideration must be given to methods of notifying local agencies such as the fire department.
c. Alarms and signals to alert employees must be identified; this may include audio alarms, highly visible lights, and/or a public address system. Management and employees must know what actions to take when an emergency alarm is activated.
d. All emergency phone numbers should be identified, listed in the emergency preparedness plan, and posted. Emergency phone numbers should include facility numbers, local agencies, and emergency facility personnel. Consideration should also be given to the recovery of operations.
e. All responsibilities should be clearly defined for management and employees. Management must determine its strategy for responding to fire emergencies.
f. A chain of command should be established to minimize any confusion. Personnel must be identified to coordinate emergency response actions.
g. Detection and alarm systems should be identified and described. Testing and preventative maintenance procedures should be included.
h. Diagrams should be developed for critical information. Evacuation routes, exit doors, fire extinguishers, and other critical elements should be visually displayed to all employees. If the fire sprinkler system or standpipe system is used, all critical controls/valves should be identified.
i. Assembly areas should be established for all employees. Accounting for employees can be performed in assembly areas. All assembly areas should be established at safe distances from fire hazards and clear of emergency vehicle traffic and activities.
j. Search and rescue procedures must be established. Only trained and authorized personnel should attempt search and rescue.
k. Procedures for shutting down equipment during emergencies should be established. Equipment operators must know the proper actions to take during an emergency.
l. Recovery strategy should include plans to restore the operations. This should include a list of contractors who can provide equipment and services for operations. Additional consideration should be given to temporary contractors who can provide manufacturing services.
3. Employees must know the emergency routes in their work areas and be familiar with the plant layout. All employees must receive a guided tour of evacuation routes and emergency exits during orientation.
4. Operators must know their specific procedures when an emergency arises. Safe shutdown procedures for equipment should be established to prevent equipment damage and additional hazards. Evacuating employees to a safe location is a top priority.
5. The alarm system to notify employees of emergencies and evacuations must be recognizable during emergency conditions. Horns, sirens, public announcement systems and other alarm devices must alert employees of an emergency.
6. All alarm systems and fire protection systems must be maintained and tested on a regular basis. It is recommended that alarms be tested weekly.
7. The emergency preparedness plan should be a working document used for training and practice. The plan must be updated to reflect any changes in the workplace.
8. Emergency routes and exit doors should be clearly posted on a wall diagram to show employees the primary and secondary emergency routes for evacuating the building. The diagram should show the employee’s current position and emergency routes. Each department should display this diagram in a highly visible area.
9. Emergency evacuation drills must be conducted to ensure employees are knowledgeable and trained on emergency plans.
Every facility should have an established set of procedures to handle fires and related emergencies
Option 1: Full evacuation of the facility:
No employees are permitted to fight a fire — they are to immediately evacuate upon notification by an alarm or other device. This option provides the most employee protection; however, if a local fire department is not within proximity, major property damage may result.
Option 2: Deal with incipient fires:
(An incipient fire is one that is in the initial stage and can be controlled or extinguished with portable fire extinguishers.)
All employees must be trained to utilize fire extinguishers for incipient fires: Initial training should be conducted when the employee is hired and refresher training provided annually. This alternative provides the opportunity to prevent a small incipient fire from becoming a larger one. Employees must clearly understand their limits when this option is selected. There is a risk associated with an employee attempting to extinguish a fire that has passed the point of being an incipient one. Employees may sustain injuries if they are not properly trained.
Option 3: Designated employees to fight an incipient fire in their general areas:
With this option, the level of training is virtually the same as Option 2; however, only designated employees are trained and expected to fight an incipient fire. Additionally, the method of training must be hands-on. If none of these options is practical, the facility may choose to organize the fire brigade. If so, management must then decide between these two options.
Option 4: Organized fire brigade to fight incipient stage fires only:
If this is the choice, the following are required: (i) specific procedures, training, and leadership structure; and (ii) all necessary protective clothing and firefighting equipment. Training and education in special hazards must be provided, along with training in standard operating procedures and the use of equipment. A higher, specialized level of training should be provided for the brigade leaders and instructors. This option poses a risk of injury to fire brigade members.
Option 5: Organized fire brigade to fight both incipient stage and interior structural fires:
If it is decided that the fire brigade should fight both incipient stage and interior structural fires, the facility must satisfy all the items required in Option 4. In addition, brigade members must pass a physical examination, attend educational sessions at least quarterly — with hands-on training at least annually – – and have protective clothing and breathing apparatus provided. This selection, the equivalent of a professional fire department, poses the highest risk of injury for brigade members. As such, only properly-trained brigades should assume this role.
If your facility elects to form a fire brigade, members should be organized and trained to make the best use of the fire protection equipment available and to operate it effectively during an emergency.
The fire brigade should help evacuate all personnel not involved in handling the emergency and be able to assist the fire department to control the emergency. The following factors may influence your decisions regarding the size, complexity, and organization of a fire brigade: (i) Property size, (ii) Property accessibility; (iii) Building size; (iv) Building construction; (v) Building contents; (vi) Fire protection equipment on hand; (vii) Fire hazards; (viii) Personnel safety; and (ix) Proximity, quality, and responsiveness of local fire authorities.
PART G: SECURITY & IN HOUSE STAFF SHALL BE WELL ANSWERABLE TO THE FOLLOWING QUESTIONS
- What precautionary steps are in place for emergencies?
- Are there smoke detectors, how many, and are they all working?
- How often do they have the fire extinguishers checked and if they know where they are located?
- Are safety procedures adequate? Are stairways and exits marked?
- Is it easy to move from one place to another?
- Are halls and toilets wide enough for wheelchairs?
- Are there any floor hazards like being too slippery or having a thick carpet?
- Is there an emphasis on allowing residents to be as independent as they can be?
- Are you aware of the prevention of fire and how to act when a fire starts?
- Is the building well maintained? Make sure that paper and other storage items do not block doors or hallways needed for escape.
- Check to make sure there is an evacuation plan in place that involves all staff and is practised regularly.
- Are there safety systems in place such as alternative exits, smoke detectors, and sprinklers?
- Check on the staff-to-patient ratio. How many staff per resident during the day and especially at night or on weekends and holidays? Is supervisory staff available to carry out an escape plan if there is a fire?
- Are there guidelines for people who smoke such as a separate room or staff supervision?
- Does all emergency support functionaries’ numbers and the evacuation map display on all floors and at strategic locations?
Ref:
National Building Code of India-2016, Part 4
NDMA Guidelines – Hospital Safety 2016
Fire Safety Guidelines for Hospital & Nursing Homes, 2012, West Bengal
Indian Standard 12433 (Part 1 & 2)
G.O.Ms.No.2 Dated:03.01.2011 issued by Municipal Administration & Urban Development
(M1) Department, Govt of Andhra Pradesh
Fire & Life Safety Practices, Hospital-2008, Oregon State Fire Marshal.
