Fire and more fire: on hospital ICU fires, patient safety

Cuttack is not an anomaly. It is the latest entry in a ledger of preventable deaths in Indian hospital ICUs. In 2016, 22 people died in a fire at a private hospital ICU in Bhubaneswar, which did not have the mandatory fire safety clearance. Following this tragedy, fire safety audits were made compulsory for such facilities. Last year, the Odisha government allocated about ₹320 crore for fire safety improvement across hospitals in the State. But this did not prevent the fire at the government SCB Medical College and Hospital, Cuttack, apparently caused by a short circuit in the ICU of the trauma care unit. Some reports suggest the fire may have started in a ventilator, which was later found heavily charred. The accident, which occurred in the early hours of Monday, claimed 12 of the 23 ICU patients. Although the hospital had a firefighting unit, its personnel arrived after more than 30 minutes, reportedly because staff did not alert them early. Additionally, the fire hydrants could not be operated by staff. Nevertheless, water is not the right medium to fight electric fires, which are best extinguished using carbon dioxide, a method that requires trained personnel. Last October, six patients were killed in an ICU fire in Rajasthan. In 2024, newborns died in an ICU fire in Jhansi, Uttar Pradesh. Two similar accidents were reported in Maharashtra in 2021. An audit in Jhansi revealed hazards including exposed wiring, inadequate earthing and electrical circuits not matching power load requirements — the last being a leading cause of electrical fires in India.

ICUs have intrinsic safety risks, as their oxygen-rich environment can turn even a spark into an inferno. ICUs are also packed with electrical equipment, and the personnel are not always well trained in their safe handling. State-of-the-art medical equipment comes with advanced electronics and variable frequency drives that generate what are called “harmonic currents”. These currents flow within circuits and typically have no safety devices such as circuit breakers. Harmonics create silent, persistent overheating and insulation degradation and are a severe fire hazard. Today’s electrical practice lays down that every time a new ventilator is wheeled into an ICU, the wiring, protection and load capacity must be re-evaluated. Older facilities need an electrical upgrade before cutting edge equipment can be installed. As patients in ICUs are often sedated, intubated, and connected to machines, staff must be trained to ensure their safe evacuation. Until India treats hospital fire safety as a matter of criminal accountability rather than bureaucratic paperwork, the fires will keep burning and the bodies will keep mounting.