A fire alarm at Brockton Hospital presents the Brockton (MA) Fire Department with fire suppression and patient evacuation challenges.
BY BRIAN F. NARDELLI
On February 7, 2023, at 0700 hours, the Brockton (MA) Fire Department (BFD) fire alarm office received the master box for Brockton Hospital at 680 Centre Street. The initial response was two engine companies, one ladder company, and the shift deputy chief. On arrival, the first-due engine company reported multiple detectors activated in the area of the main support building near the electrical room.
The first-due lieutenant made his radio report to the fire alarm office. Hospital staff told him that there was smoke in the building’s lower level in the rear. This was reported to the responding deputy chief, and a full assignment was ordered, adding two more engine companies and a ladder company to the box, a standard response for any report of smoke or fire.
As the deputy chief arrived on scene, he was confronted with other workers reporting heavy smoke at the rear of the building. The deputy ordered all apparatus responding that were not already on scene to the rear of the building.
I had been in my office early that morning to go over some paperwork for an upcoming city meeting. I was listening over the radio as this situation began to unfold. It appeared that the incident was expanding with a serious fire condition and the potential for a serious life safety hazard. Knowing that so many people who were sick, injured, or working could be in this building, I thought the meeting paperwork could wait.
Brockton Hospital is a 216-bed hospital that was originally built in 1896 as one small single building. Over the past 120-plus years, it has been expanded to five connected buildings, today consisting of a mix of Type I and Type II construction and occupying a site of approximately 30 acres on the east side of Brockton. The building is equipped with sprinklers but, ironically, not in the electrical room, the location of the fire.
The hospital services more than 40 communities on the South Shore of Massachusetts, providing moderate surgery, cardiac catheterization, magnetic resonance imaging (MRI), computed axial tomography scans, and emergency services, to name a few. The hospital is anchored on the opposite side of the city by a second hospital providing similar services. Brockton Hospital is an integral part of health care in the community and a major employer in the South Shore area.
At the time of the fire, 187 patients and more than 120 staff (doctors, nurses, aides, cafeteria workers, and so forth) were in the building. Brockton is a multisystem hospital that was just beginning its day at the time of the fire, which worked to our advantage regarding the operating room suites and cardiac catherization unit, which had not opened yet.
On arrival, I spoke with the on-scene incident commander (IC) and received a briefing on the situation. What I observed was quite incredible. Emanating from the building up a pedestrian ramp that led to the main electrical room was black, green, and purple smoke. The IC told me that they were attempting to shut down the two electrical feeds entering this room. A generator was supplying power to the hospital.
I assumed command and sent the deputy chief to work with the crews on the floors as operations. Initially, I struck a second alarm, which would bring two more engines and one more ladder. I also requested five ambulances to stand by. At this time, it appeared that if we could terminate the power and get the fire under control, we could keep the patients in place (photo 1).
One major concern was creating a strong line of communication among the hospital maintenance, nursing, and executive teams. This facility is regularly preplanned for fire. I requested a representative of each team report to the command post (CP) at the C side of the building. The director of maintenance and the vice president of nursing were at the CP in minutes, along with the emergency management director, which made the exchange of information much smoother. Since the utility company was able to shut down the two separate feeds entering the electrical room, the first-due companies started to stretch a 2½-inch line down the pedestrian walkway to the room. Maintenance provided maps of the hospital so we could determine the potential for fire spread, especially through the conduit that exited the electrical room. Hospital maintenance personnel shut down the HVAC system. I then ordered a third alarm (Figure 1).
The director of maintenance informed me that the electrical maps showed that the generator conduit and the wiring attached to the building ran through the electrical room, which on-scene electricians confirmed. This was a game changer regarding a potential full evacuation and caused a major pivot in the operation. Extinguishment was put on hold.
While discussions continued over the state of the building’s power service, the operations deputy chief and the safety chief, who were inside the building, reported smoke and carbon monoxide levels were increasing. Fire crews were moving patients in the building to shelter them in place; this would not work in the long run if the fire was not controlled. Critical cues in the fire service are very important and will sometimes push your decision making in a certain direction.
Having a strong relationship with your city or town leaders is imperative, and their strong support can assist you, especially when working with high-level business executives in your community. The mayor arrived at the incident and stayed close enough to be supportive but understood the enormity of the incident and allowed the professionals to run it.
I was coming closer to deciding on a total shutdown and a complete evacuation. Once we confirmed this power dilemma, evacuation was the only option. Hospital executives were briefed on the situation at the CP. Evacuation needed to be very closely coordinated with firefighting efforts.
The hospital would be split in two, the “clean side” and the “dirty side.” Firefighting was on the “dirty side” of the building (the C side), and evacuation would be out through the “clean side” of the building (the A side), which had an adequate drive-through area.
As evacuation decisions and briefings were going on, many of the local chiefs and their personnel summoned by the third alarm were arriving. Our chief officer relationships are very strong, which made decision making easy. I set up a staging area about a half mile west of the hospital in a large, open parking lot. I assigned two local chiefs to oversee emergency medical services (EMS) and structural staging. I was keenly aware that since the elevators were not operating, we would need many strong backs to assist in removing patients down the stairs, potentially down five floors. All apparatus requested on any alarm after the third would report to staging and be deployed as needed to the hospital for evacuation (photo 2).
On arrival, the crews were told to bring their scoop stretchers (a two-part clam shell-style, rigid-frame gurney that comes apart at the top and bottom) and their collapsible stair chairs. Packaging would be interesting since every patient would need a different style of packaging and movement. The hospital has a 12-bed intensive care/critical care unit; it would be critical to reduce the out-of-hospital time for those patients. Movement down the stairs would have to be closely coordinated with the medical staff because of this operation’s treacherous nature and the severity of some patients’ illnesses.
When dealing with any type of incident at a hospital, you are dealing with a miniature city within the city, with many types of pitfalls. Early on, a deputy chief suggested calling for the hazmat team to work with hospital personnel in securing any hospital gases, the MRI area, and the morgue and perform atmospheric metering and so forth. This was invaluable to the overall operation. They were able to move around the building and accomplish the many tasks they were assigned.
(1) Photo by Rob Reardon.
Figure 1. Brockton Hospital’s First Floor
Source: Figure courtesy of author.
(2) Photo by Rob Reardon.
(3) Photo by Marc Vasconcellos.
(4) Photo by Rob Reardon.
I had initially requested five ambulance strike teams consisting of five ambulances each. I assigned two local chiefs, one for the EMS sector and one for the transportation sector; they would report to the A side lobby, through which all patients were being moved out.
The first-due deputy chief was assigned to the evacuation operation on the upper floors. He would work with safety and EMS to safely remove patients from above. A BFD deputy chief was placed in command of the firefighting operations once we were able to shut down the generator.
It was a daunting task searching the building for portable oxygen bottles and auxiliary power units for patients who would need them once the generator was shut down. Firefighters used portable battery light towers for illumination.
Reports from the floors were that the smoke conditions on the floors were increasing, with the safety chief reporting that he had smoke pushing from electric panels on floor five. This was more than likely coming through the conduit that originated in the electrical room. The movement of patients on the upper floors was commencing, with sheltering in place and preparing for eventual evacuation.
We do not live in a vacuum; that was evident with the amount of press that had arrived on site. One of the chiefs in the area had immense experience as a public information officer (PIO) and working with the media. We gave that chief all our social media information; he, in turn, gave constant updates over social media throughout the incident. The PIO chief also set up media staging and kept the media apprised of any upcoming briefings.
In discussions with the hospital executive staff, I made it very clear that the press needed to be briefed. Keep in mind, at this point we had approximately 187 patients in the hospital along with countless staff. If we did not make the families of those patients feel as though we had this under control, they would all be on their way to the hospital, which would not work out well for anyone, especially our professionals trying to do their jobs (photo 3).
As the generator was shut down and the firefighting began, the five ambulance strike teams arrived and we began evacuation. I made one of the local chiefs my liaison officer; he stayed with me. My fire prevention deputy worked closely with building maintenance to give our team constant updates.
It appeared that the fire was more extensive than originally estimated. Two 2½-inch lines with solid-bore nozzles were stretched. Fire was found to have extended out of the electric room through conduit into adjacent rooms and up into the cafeteria. This fire spread was difficult to contain in some areas because of multiple ceilings and differing construction materials.
During fire suppression, two 2½-inch lines from the engine fed the sprinkler system. A liquid oxygen line that ran close to the electrical room had ruptured during firefighting, but the maintenance staff quickly shut it down (photo 4).
(5) Photo by Rob Reardon.
(6) Photo by Marc Vasconcellos.
Evacuation on the A side was proceeding smoothly, and I instructed the EMS section to work with staging and order strike teams as necessary. In the lobby on the A side, the transport officer would assign the EMS crews and their patients their hospital destinations, and patients would be loaded onto waiting ambulances lined up on the building’s A side (photos 5-6).
I stayed in contact with structural staging and ordered additional alarms as needed to assist with patient movement. Constant communication and flow among all parties was imperative. Communication with the hospital’s vice president of nursing and emergency management director gave me real-time patient information from the hospital.
Once we requested the strike teams, that triggered the director of Region Five (covering southeastern Massachusetts) EMS and her deputy to respond. They were ordered to the A side to work with the EMS sector to coordinate bed availability with other hospitals in the area. The Region Five personnel have ongoing relationships with all the area hospitals, making transition to the other hospitals seamless.
I continued to strike additional alarms, which would each bring two engines and one ladder to move patients off the floors, and additional strike teams were requested by EMS. This drained local resources for ordinary emergency response. Our partners at the county communications system worked directly with our local chiefs to coordinate the fire service mobilization plan, which would assist in covering our local surrounding communities.
In approximately one hour, BFD crews contained the fire and continued with some major overhaul after that. The damage was extensive and would have lasting effects on the entire hospital.
The fire had spread across some ceilings adjacent to the electrical room and caused extensive damage to the entire electrical room itself. The smoke and carbon monoxide had dissipated throughout the hospital but still lingered.
Once the fire was under control, I ordered crews into the building to open all windows, a daunting task since many of them had been installed at different times with different locking systems. The maintenance crew was instrumental in getting us the correct tools to perform the job. This endeavor took us about an hour to complete but made an incredible difference in ventilation. The building had been built piece by piece over more than 120 years, which created many challenges throughout the operation, but the maintenance staff was of great assistance.
Moving critical care patients from the ICU was at times difficult since so many resources were needed. Firefighters arriving on structural fire apparatus were ordered to park out on the main road and walk up to the hospital to receive floor assignments for patient movement. Certain floors needed more crews than others because of the acuity and complexity of the packaging needed for the patients. The EMS section had made the flow on the “clean side” such that crews and equipment would enter on one side at a certain door and exit with their patient through the main lobby and receive the patient’s destination as they exited. The hospital’s EMS medical director worked closely with our EMS section to ensure proper triage.
One instrumental decision that the EMS section made early on was to move all patients who could walk to the School of Nursing (next to the hospital) and await removal until the end of the evacuation. This was a great triage decision. Evacuation continued long after the fire was extinguished and the day drew on and light became sparse. Portable lighting became necessary in certain areas of the building to keep all safe during evacuation.
(7) Photo by Edward R. Williams Jr.
Briefings are critical for all involved; a strong CP makes all the difference when coordinating many agencies. Everyone has a stake in the game and needs to be heard. The fire service works under a very strong incident command structure and all information should be relayed to the other entities involved. Briefings with key people from the hospital, the utilities, EMS, and so on is key.
As the evacuation began to wind down, another media briefing was on the horizon. We had made it clear that we expected the evacuation to take more than eight hours and figured a second briefing would be in order around 3 p.m. This would include the hospital’s executive staff, me, and city leaders including the mayor, who had been steadfastly supportive of our decisions and had been with us throughout the day.
When the evacuation was complete, we had transported 172 patients using more than 91 ambulances and calling 10 alarms, which brought 26 pieces of structural apparatus and their crews, two state rehab units, and an incident support unit (a mobile command post). No firefighters or patients suffered any injuries throughout the entire operation. Two patients, one in labor and one with active chest pain, threw us a few curveballs, but our incredible professionals swiftly took care of them.
It is important to close out incidents such as this with a briefing with all members involved. We held a “hot wash” before personnel were demobilized (photo 7).
As the IC at this operation, I can tell you that it was a success because of the great people who were involved in it. Everyone stayed in their lanes and did their jobs: our recruit class that assisted with patient movement, the fire department ambulances that responded from as far as 40 miles away, and the entire command staff. Everyone understood the goal and performed admirably to accomplish it.
BRIAN F. NARDELLI is a 27-year veteran and chief of the Brockton (MA) Fire Department, where he started as firefighter. He has taught fire and emergency medical services personnel for more than 30 years and is an adjunct instructor for the Massachusetts State Fire Academy, teaching strategy and tactics, engine company operations, and command and control.
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