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On Page 6 we publish a report on a disturbing fire in the Philippines capital Twenty-nine people were killed

when fire broke out in the intensive care unit of Manila's Lung Centre

and spread through the three storey building .

At the very least, the establishment seems to have been ill prepared - hundreds of patients, many of them still

connected to medical equipment, were evacuated into the car park ;staff have claimed that due to power failures,

evacuations had to be conducted using cigarette lighters

and that there were not enough wheelchairs to evacuate all the patients.

The hospital had no sprinkler system, fire hydrants, few fire extinguishers and not many fire exits.

Subsequent inspections in Manila found severe deficiencies in 29 other hospitals

common failures included lack of sprinkler systems, smoke detectors, emergency lighting and hydrants.

In July, we reported on the flaws in legislation, enforcement and funding of fire safety in Italy's hospitals that have

come to light after 11 people died in a hyperbarism chamber at a private institute in Milan.

An Italian association for promoting safety at work said:

"Managers of hospitals are generally doctors, rather than engineers, and as a consequence,

they pay more attention to health issues than to safety issues."

This view seems to have been reinforced by hospital fire safety experts as they gathered to discuss this issue

at Health Fire International 98 (see page 43). One survey on fire evacuation in Britain's hospitals found that

reasons cited for not carrying out evacuation training included objections from clinicians,

administration managers and ward staff. Interestingly,

five percent said that the reason for not carrying out such training was concern about litigation.

Others say that some managers of health care institutions consider emergency management structures,

staff emergency training, emergency action plans and fire drills both difficult to carry out when running a busy

hospital, and not necessarily cost effective.

But what about the loss of life and of expensive medical equipment?

The risks in hospitals are high any where in the world. Often these establishments are housed in converted

older buildings not necessarily designed for that purpose. The presence of hazardous materials and other chemicals. Oxygen, nitrous oxide, combustible (and expensive) medical equipment and supplies, large quantities of bedding ,

laundry and cooking facilities,a mass of electrical power supplies and wiring all in an environment that must be

precisely controlled in many fixed areas - compound the fire protection problem.

And added to this are the patients themselves. Patients are already stressed, disabled or incapacitated by

their ailments, and are often worried, disorientated, distracted.

They will have a poor knowledge of the hospital's layout and

tend to suspend their usual instincts of self preservation,

They have, quite literally, put their lives in the hands of others and patients can cause fires…

This is claimed to be even more true when mentally disturbed or geriatric patients are involved.

In many countries the statistical incidence of fatal fires tends to belie the sometimes

appalling lack of precautions. It is , nevertheless, true that sooner or later, circumstances will combine to create

another tragedy like that in Manila, which could be avoided or,at least, mitigated,

It is the duty of all those concerned in health care

establishments to focus not only on the health matters of those in their care,

but of the right of patients to be safe from fire.