Mac’s Safety Space: Egress and the art of mobility

By Steve MacArthur, Hospital Safety Consultant

I am basing this on no more than a question that was asked of me, but it did prompt some thoughts about the introduction of technology as a function of mobile units (CT, PET MRI, etc.) and how those arrangements might come into play as a function of fire response plans, egress and any other life-safety related topics (I suppose one would have to include discussion of fire alarm and suppression systems equipment). And, as these types of mobile equipment/ technology arrangements find their way out into the ambulatory care settings, the “opportunity” for scrutiny during survey becomes more and more woven into the fabric of compliance (nice turn of phrase, that).

While this applies generally to any location in which you might have mobile technology (well, mobile technology that can actually hold occupants), my question is this: To what extent do you evaluate the fire response plan as a function of trailer-mounted patient care/diagnostic equipment and to what extent are you including those types of environments in your fire drill program?

Certainly, holding fire drills in “special” environments—MRI, surgery, areas providing hyperbaric oxygen therapy—is gaining scrutiny as fire response protocols can be a little tricky, and I think the same could be applied the mobile stuff, particularly (though by no means exclusively) in the outpatient setting. I recognize that a lot of these environments would be considered business occupancies based on the usual interpretation of NFPA 101 Life Safety Code and so would nominally fall under the requirements for annual drills in business occupancy locations.

But (and isn’t there always one of those when I bring up something new), is that “enough” to ensure that a safe evacuation is a high-reliability undertaking in the event of an emergency?

That’s definitely going to be a very variable equation, but I think that it merits at least some attention over time. Maybe annually is overkill. Maybe there’s a value in walking them through the process every once in a while. I’m thinking you may look at things differently depending on whether or not the mobile environments have automatic suppression systems, or if patients undergoing the procedure are capable of walking under their own power.

Again, from a numbers perspective, I get that you can chalk it up to a business occupancy and call it a day, but I think it’s worth some conversation. Ultimately it’s about providing the safest possible environment—not because there’s a code that speaks to one element or another, but because codes and regulations can’t possibly account for every nuance in the environment. But we can!

About the Author: Steve MacArthur is a safety consultant with Chartis Clinical Quality Solutions (formerly known as The Greeley Company) in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Healthcare Safety Leader. Contact Steve at