|Year : 2021 | Volume
| Issue : 1 | Page : 147
Factors influencing hospital emergency evacuation during fire: A systematic literature review
Ali Sahebi1, Katayoun Jahangiri2, Ahmad Alibabaei3, Davoud Khorasani-Zavareh4
1 Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences; Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of E-Learning, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Workplace Health Promotion Research Center, Department of Health in Emergencies and Disasters, Shahid Beheshti University of Medical Sciences, Tehran, Iran
|Date of Submission||24-Oct-2020|
|Date of Acceptance||08-Jan-2021|
|Date of Web Publication||26-Oct-2021|
Velenjak, Shahid Shahryari Squair, Daneshjoo Blvd., Tehran
Source of Support: None, Conflict of Interest: None
Background: Although the hospital is known as a safe place for treating patients, due to various reasons, it is prone to several internal hazards, including fire. This study aimed to identify the factors affecting hospital emergency evacuation during fire. Methods: This was a systematic review conducted according to the PRISMA guideline. Thematic Content analysis was utilized to analyze and extract results. We found the studies investigating the factors affecting hospital emergency evacuation during fire through a comprehensive search in various data resources (MEDLINE, Web of Science, Google Scholar, Embase, ProQuest, Scopus, IRANMEDEX, SID, ISC, and Magiran) and other sources from the beginning of January 2000 to the end of December 2019. Thematic Content analysis was also employed to analyze. Results: At first and based on the initial search, 4484 studies were identified, and 48 articles were finally included in the study. Based on the results; five main themes along with 10 sub-themes were identified. The themes included the incident's characteristics, response measures, hospital preparedness, hospital residents, and hospital building, and the sub-themes were emergency evacuation features, fire characteristics, command, operation, patients' and staff's characteristics, planning, logistics, and structure and design hospital. Conclusions: Based on the results of the present study, hospital preparedness as one of the most important factors can reduce the hospital evacuation time. Therefore, hospitals can ensure a timely and more effective response in emergency evacuation during fire by improving their preparedness.
Keywords: Disasters, emergencies, emergency evacuation, fire, hospitals
|How to cite this article:|
Sahebi A, Jahangiri K, Alibabaei A, Khorasani-Zavareh D. Factors influencing hospital emergency evacuation during fire: A systematic literature review. Int J Prev Med 2021;12:147
|How to cite this URL:|
Sahebi A, Jahangiri K, Alibabaei A, Khorasani-Zavareh D. Factors influencing hospital emergency evacuation during fire: A systematic literature review. Int J Prev Med [serial online] 2021 [cited 2022 May 25];12:147. Available from: https://www.ijpvmjournal.net/text.asp?2021/12/1/147/329355
| Introduction|| |
Hospitals as one of the most important healthcare institutions have a vital role in providing services under both normal circumstances and emergencies.,, Although hospitals are known as a safe place to treat patients, they are prone to internal and external disasters. A damage to the hospital structure or the occurrence of a disaster may jeopardize the provision of care services and the health of hospital residents and ultimately lead to the complete evacuation of the hospital. The incidence of a disaster in a hospital may be associated with many physical injuries because of the long evacuation time of hospitals. Hospital evacuation is a process with special complexities as they have generally tall and colossal buildings.,
From 2000 to 2017, more than 150 hospitals were emergency evacuated in the United States. Studies showed that 16% of these evacuations were related to man-made threats, and 13% were due to internal factors from which fires accounted for about 40% of intrahospital threats. Hospitals because of using electrical equipment, medical gases, and flammable liquids are susceptible to fire. Hospital fire, due to limitations in relocating patients, is a special event that usually associated with high casualties. So, in managing the hospital fire, many challenges including the complex process of transferring of patients are encountered.,,
Hospital evacuation while keeping the safety of its residents is a complex process. Many hospital residents are those with impaired mobility the transferring of whom to a safe place can be very difficult for staff. One of the most important differences between evacuating a hospital and other buildings is that hospitalized patients are often disabled and need the help of other people to relocate. Despite all these issues, evacuating a hospital should be fast and safe to prevent harm to the residents, a large number of whom must be evacuated within the shortest time., However, a safe hospital evacuation during fire is time-consuming due to patients' limited mobility.
The hospital emergency evacuation is a difficult process due to the insecure translocation of critically ill patients who should be evacuated without any disruption in their treatment. So, identifying the factors affecting hospital emergency evacuation can boost the managers' and staff's knowledge and skills and help to design and implement a secure and rapid hospital evacuation program during fire. Therefore, the aim of the present systematic review aimed to characterize these factors.
| Methods|| |
The present study was conducted via the two methods of systematic review and thematic content analysis. At first, a systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines to acquire the articles related to the research purpose. The protocol of this review was registered in the International Prospective Register of Systematic Review (PROSPERO) under the code of CRD42020164943. According to the PRISMA protocol, a search strategy was designed and performed screening, study selection, quality evaluation, and data extraction, respectively. The phases of study selection and qualification and data extraction were independently conducted by two researchers. In the case of any disagreement between these researchers, a final decision was made through group discussion. For thematic content analysis, the six-phase content analysis framework of Braun & Clarke (2006) was used. The six steps of content analysis included familiarity with the data, generation of initial codes, searching for themes, reviewing themes,defining themes, and finally writing the draft” replacement with “The six steps of content analysis included data familiarization, generating raw codes, searching for topics (themes), reviewing and definingtopics, and finally writing the draft.
Data resources and search strategy
To comprehensive search in this study, data resources including MEDLINE in (PubMed, Web of Science, Google Scholar, Embase, ProQuest, Scopus, IRANMEDEX, SID, ISC, and Magiran, conference and congress papers, key journals (Prehospital and Disaster Medicine, Disaster Medicine and Public Health Preparedness) and reference list of selected articles and systematic reviews were employed. The MeSH terms, consulting with scientific experts, and terms in related articles were used to extract valid keywords. The English keywords and their Persian equivalents used in this study included “Emergency Evacuation”, “Urgent Evacuation”, Evacuation, “Evacuation Time”, “patient Evacuation”, “Medical Facility”, “Health Center”, “Healthcare Center”, “Tertiary Referral Center”, “Tertiary Care Center”, Hospital, “Health Facility”, Fire, Event, Incident, Disaster, and Emergency. At first, the initial search syntax for PubMed by using the operators, keywords and search fields, and then, designed the syntax for other databases based on this structure was written. The number needed to read (NNR) index was used for search syntax evaluation. NNR index is defined as the ratio of the number of retrieved articles to related articles. The period of the search was from the beginning of January 2000 to the end of December 2019. Published articles gathered in English and Persian. Examples of the used search strategy have been mentioned in [Appendix 1].
All Persian and English studies about the hospital emergency evacuation during a fire, published from the beginning of January 2000 to the end of December 2019 were included. The studies dealing with the assessment of fire safety in hospitals, emergency evacuation regardless of the type of the incident and disasters, emergency evacuation of buildings other than hospitals, hospital emergency evacuation for reasons other than fire, decision-making during an emergency evacuation, emergency evacuation in hospital external fires, and a general evaluation of hospital emergency evacuation in various incidents and disasters were excluded.
In order to manage search results, all articles were inserted into EndNote X7 software, and after removing duplicates, their titles and abstracts were screened based on the eligibility criteria to identify potentially relevant articles. In the next step, two researchers (AS, KJ) independently studied the full texts of the possibly related articles with details and finally selected qualified articles.
At this step, two researchers (AS, KJ) independently evaluated the quality of the selected studies using different tools including the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for observational studies. This tool has 22 items, and each item is scored from 0 to 2 (the minimum and maximum scores are 0 and 44, respectively). Accordingly, the quality of studies was divided into three categories including low (0–15 points), moderate (16–30 points), and high (44–points). The Center for Evidence-Based Management (CEMBa)) was used for case studies. This tool has 10 items, and each item is scored from 0 to 1 (the minimum and maximum scores are between 0 and 10, respectively). The scores of 0-2, 3-6, and 7-10 indicated poor, moderate, and high qualities, respectively. Consolidated Standards of Reporting Trials (CONSORT) was used for trials studies. This tool contains 25 items, and each item is scored from 0 to 2 (the minimum and maximum score is 0 and 50, respectively). The scores of 0-16, 17-33, and 34-50 indicated poor, moderate, and good qualities, respectively. The Modified STROBE was used for the studies that were not assessable by the mentioned standard quality assessment tools [Appendix 2]. This tool contains 9 questions, and each question is scored from 0 and 1 (the minimum and maximum scores are 0 and 9, respectively). The scores of 0–2, 3–6, and 7–9 indicated poor, moderate, and high qualities, respectively.
Data extraction and analysis
Two researchers (AS and KJ) extracted the final studies data independently, in the pre-prepared checklist. The checklist included the first authors' name, the record type, year, place, and design, as well as the findings. Thematic content analysis was used to analyze the data. Initially, the first author (AS) studied the results of 48 qualified articles. In thematic content analysis method, in addition to the headings obtained from the studies, the text of the results was also studied and coded accordingly. For coding, all the codes and basic concepts related to the factors affecting hospital emergency evacuation during fire, were extracted. Then they were, carefully studied line by line, several times to identify initial codes. Afterwards, the first and second authors (AS, KJ) examined all the identified codes in terms of similarities and differences, and then similar codes were classified under one category to form a sub-theme. In the next step, the sub-themes that had a similar concept were placed together to form a theme. Finally, a draft of the summarized designed findings was discussed by all the authors, and necessary amendments were applied until reaching an agreement on the draft.
| Results and Discussion|| |
| Search results|| |
Initially, a total of 4484 studies were obtained in the primary search, and after removing duplicates, the titles and abstracts of 2976 studies were screened. After omitting irrelevant articles, the full texts of 147 possibly related studies were reviewed, and finally, 48 articles entered the final phase of the study [Figure 1].
|Figure 1: PRISMA Flowchart of systematic literature review of identifying the factors influencing on emergency evacuation in hospital fire|
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Among the final studies, 29 were journals, 13 conference papers, four book sections, and two theses. Eight studies had been conducted in the United Kingdom, eight in the United States, eight in China, four in Italy, one in the Netherlands, two in Sweden, two in Iran, five in India, two in Japan, and one in each of Spain, Germany, Canada, Belgium, Russia, Turkey, Portugal, and Taiwan. In terms of study design, most of the studies had been conducted with the simulation method. Regarding the quality assessment results, 23 and 25 studies had medium and good qualities, respectively. The selected studies' characteristics have been shown in [Table 1].
|Table 1: The extracted articles' specifications in a systematic review on the factors affecting hospital emergency evacuation during fire|
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Thematic content analysis
Based on the systematic literature review and thematic content analysis, the factors affecting emergency evacuation during hospital fire were divided into five main themes and 10 sub-themes. The themes included the incident's characteristics, response measures, hospital preparedness, hospital residents, and hospital building, and the sub-themes were emergency evacuation features, fire characteristics, command, operation, patients' and staff's characteristics, planning, logistics, and structure and design hospital [Table 2].
|Table 2: Factors affecting emergency evacuation during hospital fire based on the systematic literature review and thematic content analysis|
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Based on our research, various factors such as fire characteristics, command, operation, patients' characteristics, planning, and logistics can have significant roles in emergency hospital evacuation during fire.
The present systematic review showed that fire characteristics such as its location, the extent of the smoke, temperature, and visibility affect hospital emergency evacuation. The results of a study in China showed that items such as fire location, heat, ventilation system, and type of burning materials affect emergency evacuation during fire in metro. Following a fire in a hospital, the smoke and, heat rapidly disseminate throughout the building. Inhaling smoke is usually the primary cause of death in this situation. On the other hand, smoke reduces visibility so that people cannot track the evacuation routes during the evacuation, and as a result, they encounter obstacles delaying the evacuation. In conclusion, fire characteristics (heat, smoke, etc.,) affect the emergency evacuation process, and hospitals should appropriately adjust their responses corresponding to such characteristics. So, it seems necessary that hospitals developing their emergency evacuation plans based on possible fire features according to the type of available inflammable materials.
According to the results of this study, the command has an important role in hospital emergency evacuation during fire by coordinating intra-organizational communications. The results of a study in the USA showed that the emergency evacuation of a hospital is a complex process requiring inter and intra organizational coordination and communications. So, using an incident command system (ICS) is important to coordinate activities, optimally use resources, and accomplish a successful emergency evacuation,, even in pre-hospital phase., Also, we observed that notification as one of the components of command plays an important role in hospital emergency evacuation. Rapidly informing personnel inside the hospital, supportive organizations, and patients' families of the incident are essential. The results of a review in 2015 showed that communication and relationships with society are important factors affecting hospitals' emergency evacuation. Following disasters, emergency evacuation can cause anxiety in all the people involved. Either misinformation or the lack of information exaggerates anxiety and on the other hand delays evacuation. In line with our findings, the results of previous studies emphasize on the role of command in the emergency evacuation of the hospital. Since evacuating a hospital is a complex process which requires the attendance of other organizations including police, firefighting, and pre-hospital emergency, the presence of a command system through inter and intra organizational coordination and communications can facilitate the evacuation process.
In this study, we demonstrated that operation was one of the most important and necessary measures in hospitals' responses to emergency evacuation. A study in the United States showed that many patients need constant medical care during relocation, and in other hand, people who lose their family members or patients amid emergency evacuation will require psychological consulting. Another study showed that one of the most essential elements of response measures is to prioritize patients for translocation. The results of a study in Japan showed that an inappropriate prioritization can lead to overcrowding in the evacuation route, which slows patient translocation speed and extends the evacuation time. So, it can be said that although the primary goal of hospital emergency evacuation is to relocate as many people as possible within the shortest time, adequate attention should be paid to the healthcare and treatment of the patients who may need such measures during evacuation.
Among other factors influencing hospital emergency evacuation during fire were patients' characteristics which determine the number of required personnel and the equipment necessary for translocation. We here found that patients' familiarization with emergency exit routes affected evacuation time. Another study in China noted patients' insufficient awareness of emergency exit routes delayed evacuation and reduced their speed. On the other hand, adequate patients' awareness of the emergency evacuation facilitates personnel's performance during the process. Also, the results of other studies have shown that guiding patients by personnel can reduce evacuation time. In overall, in line with other studies, human characteristics, risky behaviors, should take into account. Overall, these results indicate that the familiarity of patients with hospital emergency evacuation facilitates the process. So, it is recommended that hospitals provide patient education along with staff training programs, which both are important factors in emergency evacuation planning.
The present review proved hospitals need to develop an evacuation plan with the incorporation of important components such as exercise and training, for emergency evacuation during fire. A case study about a fire in an operation room in India found that holding fire drills could improve hospitals' response to fire, minimize the incidence of potentially fatal problems, and create a more secure environment for patients and personnel. Other studies have also emphasized on educating personnel about fire safety plans, firefighting, evacuation of patients based on triage, and identification of vulnerable patients to boost. The knowledge and performance of hospital personnel in managing fire and ensure patients' and staff's safety., Most of the studies reviewed here emphasized on the need for having an emergency hospital evacuation plan during fire. The results of other studies have shown that a successful emergency evacuation depends on previous planning. Therefore, healthcare centers, especially hospitals, should develop operational emergency evacuation plans and make sure that these plans are readily available and regularly exercised and updated., Therefore, employing evacuation plans and strategies by health centers can lead to a safe transfer of patients to other medical organizations. In line with the results of other studies, our findings highlighted the role of planning in hospital emergency evacuation, and therefore, it seems necessary for hospitals to developing required emergency evacuation plans. As these plans are developed based on available standards, it is possible to achieve appropriate planning by continuous monitoring and implementing these standards.
This study showed the necessity of the logistics, both medical and non-medical equipment, during the emergency evacuation of the hospital after a fire. Other studies have shown that most patients faces many challenges, especially patients in critical care units are unable to move and vertical evacuating. On the other hand, there may be a shortage of transportation equipment for patients with critical conditions as they need special devices to move. Similar to the results of previous studies, we highlighted the role of equipment, especially transportation equipment, in the emergency evacuation of hospitals. This is because most patients are not able to evacuate alone and require devices such as wheelchairs and trolleys. As hospital buildings have a complicated design and structure, it is necessary for hospitals to adequately provide a variety of patient transportation equipment with different applications based on the number of patients and the type of their diseases.
Strengths and limitations
This study systematically evaluated all factors affecting hospital emergency evacuation during fire, and this was a strength and unique feature in our research. From the limitations of this review was different methodologies of the selected studies, which due to their importance and relevance to the topic, it was not possible to exclude them. Another limitation was the unavailability of the full texts of three articles that were excluded from the study.
| Conclusion|| |
The results of the present review study showed that a variety of factors including the incident characteristics, response measures, hospital preparedness, hospital residents' features, and the hospital building were effective on hospital emergency evacuation during fire. Data synthesis revealed that hospital preparedness was one of the main factors in hospital emergency evacuation during fire, addressed by the most reviewed studies. As a vital parameter, it is critical to improve the level of hospital preparedness to shorten emergency evacuation time. In conclusion, hospitals can use the results of this review study to be prepared and perform a prompt and effective emergency evacuation in case of fire.
This article is part of a PhD thesis with the Ethical approval and study permission with ID of IR.SBMU.PHNS.REC.1398.170 approved by Shahid Beheshti University of Medical Sciences.
Financial support and sponsorship
The study was financially supported by Shahid Beheshti University of Medical Sciences, Tehran.
Conflicts of interest
The authors declare that they have no conflict of interest.
| References|| |
Sandra K, Meital N, Ofer M, Limor AD, Sara G, Bruria A. Facilitating emergency hospital evacuation through uniform discharge criteria. Am J Emerg Med 2017;35:681-4.
Kazemzadeh M, Shafiei E, Jahangiri K, Yousefi K, Sahebi A. The preparedness of hospital emergency departments for responding to disasters in Iran; A systematic review and meta-analysis. Arch Acad Emerg Med 2019;7:e58.
Nasr Isfahani M, Davari F, Azizkhani R, Rezvani M. Decreased emergency department overcrowding by discharge lounge: A computer simulation study. Int J Prev Med 2020;11:13.
Iserson KV. Vertical hospital evacuations: A new method. South Med J 2013;106:37-42.
Jang JH, Cho J-S, Lim YS, Hyun SY, Woo J-H, Choi WS, et al
. Disaster response to a mass casualty incident in a hospital fire by regional disaster medical assistance team: Characteristics of hospital fire. Disaster Med Public Health Prep 2020:1-4. doi: 10.1017/dmp. 2020.164.
Boonngam H, Patvichaichod S. Fire evacuation and patient assistance simulation in a large hospital building. IOP Conference Series: Materials Science and Engineering. United Kingdom: IOP Publishing: 2020.
Sharma A, Mace S. Reviewing disasters: Hospital evacuations in the United States from 2000 to 2017. Prehosp Disaster Med 2019;34(s1):s22.
Shafiei E, Yousefi K, Sahebi A. Lessons learned; Hospital emergency evacuation in Ilam, Iran. Trauma Mon 2019;24:3-4.
Benesova S, Bradacova I, Jager T. Evacuation of persons from selected departments in high-rise buildings of healthcare facilities. Commun Sci Lett Univ Zilina 2016;18:117-22.
Huang D, Lo S, Yang L, Gao L, Lo JT, editors. Hospital evacuation under fire: Risk identification and future prospect. 2019 9th International Conference on Fire Science and Fire Protection Engineering (ICFSFPE). Chengdu, China: IEEE: 2019.
Noh J, Chung HS, Jin HM, Hur J, Kim MJ, Kang CM, et al
. Tabletop simulation exercise of critically ill patient evacuation from a hospital fire. Prehosp Disaster Med 2019;34(s1):s171.
Bagaria J, Heggie C, Abrahams J, Murray V. Evacuation and sheltering of hospitals in emergencies: A review of international experience. Prehosp Disaster Med 2009;24:461-7.
Hunt AL, Galea ER, Lawrence PJ, Frost IR, Gwynne SM. Simulating movement devices used in hospital evacuation. Fire Technol 2020;56:2209-40.
Poppenborg J, Knust S. Modeling and optimizing the evacuation of hospitals based on the MRCPSP with resource transfers. EURO J Comput Optim 2016;4:349-80.
Golmohammadi D, Shimshak D. Estimation of the evacuation time in an emergency situation in hospitals. Comput Ind Eng 2011;61:1256-67.
Tekin E, Bayramoglu A, Uzkeser M, Cakir Z. Evacuation of hospitals during disaster, establishment of a field hospital, and communication. Eurasian J Med 2017;49:137-41.
Akıncıtürk N. An evaluation of hospital evacuation strategies with an example. Int J Appl 2015;5.
Yaghoubi T, Ardalan A, Khorasani Zavareh D, Khankeh H, Nejati A, Ebadi A. Decisionmaking on hospital emergency evacuation in disasters and emergencies: Findings from a systematic review. Iran Red Crescent Med J 2017;19:e14214.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009;6:e1000097.
Maguire M, Delahunt B. Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. All Ireland J Higher Educ 2017;9.
Curti S, Gori D, Di Gregori V, Farioli A, Baldasseroni A, Fantini MP, et al
. PubMed search filters for the study of putative outdoor air pollution determinants of disease. BMJ Open 2016;6:e013092.
White RG, Hakim AJ, Salganik MJ, Spiller MW, Johnston LG, Kerr L, et al
. Strengthening the reporting of observational studies in epidemiology for respondent-driven sampling studies: “STROBE-RDS” statement. J Clin Epidemiol 2015;68:1463-71.
Venkataseshan J, Pandit S, Saini A. Fire accidents in neonatal nursery: Prevention and management. Indian J Pediatr 2011;78:1404-6.
Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. Trials 2010;11:32.
Alonso-Gutierrez V, Cuesta A, Alvear D, Lázaro M. The impact of a change on the size of the smoke compartment in the evacuation of health care facilities. Fire Technol 2018;54:335-54.
Alonso-Gutierrez V, Ronchi E. The simulation of assisted evacuation in hospitals. InFire and Evacuation Modelling Technical Conference. Torremolinos, Spain, Torremolinos:2016.
Carey MG. Smoked out: Emergency evacuation of an ICU. Am J Nurs 2007;107:54-7.
Catovic L, Alniemi C, Ronchi E, editors. A survey on the factors affecting horizontal assisted evacuation in hospitals. Journal of Physics: Conference Series. Nancy, France: IOP Publishing: 2018.
De-Ching H, Shen-Wen C, Chien-Hung L, Po-Ta H, Yi-Ting S, Huei-Ru S. A study for the evacuation of hospital on fire during construction. Procedia Eng 2011;11:139-46.
Dhaliwal N, Bhogal RS, Kumar A, Gupta AK. Responding to fire in an intensive care unit: Management and lessons learned. World J Emerg Med 2018;9:154-6.
Femino M, Young S, Smith VC. Hospital-based emergency preparedness evacuation of the neonatal intensive care unit-the smallest and most vulnerable population. Pediatr Emerg Care 2013;29:107-13.
Gildea JR, Etengoff S. Vertical evacuation simulation of critically ill patients in a hospital. Prehosp Disaster Med 2005;20:243-8.
Gretenkort P, Harke H, Blazejak J, Pache B, Leledakis G. Interface between hospital and fire authorities-A concept for management of incidents in hospitals. Prehosp Disaster Med 2002;17:42-7.
Hogan C. Responding to a fire at a pediatric hospital. AORN J 2002;75:793-6.
Hoondert P. State of the art fire safety concept for evacuation of different types of vulnerable patients in Dutch hospitals: Specific egress times for different groups of (vunerable) hospital patients: Delft University of Technology Faculty of Architecture and the Built Environment Building Technology: FELLOW/fse:2017.
Hunt A, Galea ER, Lawrence PJ. An analysis and numerical simulation of the performance of trained hospital staff using movement assist devices to evacuate people with reduced mobility. Fire Mater 2015;39:407-29.
Iadanza E, Luschi A, Merli T, Terzaghi F, editors. Navigation Algorithm for the Evacuation of Hospitalized Patients. Singapore: Springer Singapore; 2019.
Jafari M. Evacuation planning and emergency management study of Robert Wood Johnson University Hospital. Rutgers University Center for Advanced Infrastructure and Transportation; 2005.
Johnson D, Luscombe M, Groves J. Evacuation of an intensive care unit after a fire. Media War Confl 2007;8:14-6.
Kelly FE, Hardy R, Cook TM, Nolan JP, Craft T, Osborn M, et al
. Managing the aftermath of a fire on intensive care caused by an oxygen cylinder. J Intensive Care Soc 2014;15:283-7.
Lee PH, Fu B, Cai W, Chen J, Yuan Z, Zhang L, et al
. The effectiveness of an on-line training program for improving knowledge of fire prevention and evacuation of healthcare workers: A randomized controlled trial. PLoS One 2018;13:e0199747.
Löfqvist E, Oskarsson Å, Brändström H, Vuorio A, Haney M. Evacuation preparedness in the event of fire in intensive care units in Sweden: More is needed. Prehosp Disaster Med 2017;32:317-20.
Manion P, Golden IJ. Vertical evacuation drill of an intensive care unit: Design, implementation, and evaluation. Disaster Manag Response 2004;2:14-9.
McCarthy PM, Gaucher KA. Fire in the OR—Developing a fire safety plan. AORN J 2004;79:587-600.
Murphy GRF, Foot C. ICU fire evacuation preparedness in London: A cross-sectional study. Br J Anaesth 2011;106:695-8.
Rahouti A, Datoussaid S, Lovreglio R. A sensitivity analysis of a hospital evacuation in case of fire. InFire and Evacuation Modelling Technical Conference.Malaga, Spain: Semantic Scholar;2016.
Rispoli F, Iannuzzi M, De Robertis E, Piazza O, Servillo G, Tufano R. Warning! fire in the ICU. Prehosp Disaster Med 2014;29:339-40.
Samoshin DA, Istratov RN. The parameters of pedestrian flows in hospital during fire evacuation. Proceedings of 13th
International Conference “Interflam 2013”. Royal Holloway College, University of London, UK:2013.
Tzeng HM, Yin CY. Environment of care: vertical evacuation concerns for acutely ill patients and others with restricted mobility. InNursing forum 2014;49:209-12.
Wei X, Lv W, Song W, Wang D. Evacuation analysis of a hospital based on fds+ evac software. 2011 International Conference on Remote Sensing, Environment and Transportation Engineering. Nanjing, China: EEE: 2011.
Wigmore T. Evacuation of the ICU due to fire. J Intensive Care Soc 2014;15:281-2.
Yokouchi M, Hasegawa Y, Sasaki R, Gaku R, Murata Y, Mizuno N, et al.
Operations analysis of hospital ward evacuation using crowd density model with occupancy area and velocity by patient type. In2017 Winter Simulation Conference: IEEE:2017.
Zhang W, Yao Z, editors. A reformed lattice gas model and its application in the simulation of evacuation in hospital fire. 2010 IEEE International Conference on Industrial Engineering and Engineering Management; IEEE: 2010.
Zhang G, Li C, Lu S, editors. Analysis of Fire Evacuation in Highrise Hospitals from a Highrise Hospital Fire Case. 2019 9th International Conference on Fire Science and Fire Protection Engineering (ICFSFPE). Chengdu, China:IEEE:2019.
Bongiovanni I, Leo E, Ritrovato M, Santoro A, Derrico P. Implementation of best practices for emergency response and recovery at a large hospital: A fire emergency case study. Saf Sci 2017;96:121-31.
Uehara S, Tomomatsu K. Evacuation simulation system considering evacuee profiles and spatial characteristics. Fire Saf Sci 2003;7:963-74.
Ahmadzadeh F, Shokri M. Investigation of factors affecting to emergency evacuation of medical centers in emergency conditions and disaster preparedness, A case study. Fire incident in Takhte Jamshid hospital of Alborz province. 4th
Comprehensive Conference on Disaster Management & HSE; Tehran university: Permanent Secretariat of the Conference: CIVILICA: 2017. [persian].
D'Orazio M, Bernardini G, Longhi S, Olivetti P. Evacuation aid for elderly in care homes and hospitals: An interactive system for reducing pre-movement time in case of fire. Ambient Assisted Living: Springer; 2015. p. 169-78.
Gupta S. A Machine Learning based Path Guidance System for Safe Evacuation of a Hospital Building in Case of Fire. Kharagpur: Indian Institute of Technology; 2019.
Gwynne S, Galea E, Parke J, Hickson J. The collection and analysis of pre-evacuation times derived from evacuation trials and their application to evacuation modelling. Fire Technol 2003;39:173-95.
Liu S, Lv C, Guo J. Crowd Evacuation Simulation of a Single-Floor Building Based on Multimode Evacuation Ways. Fourth International Conference on Transportation Engineering.Chengdu, China: ASCE Library: 2013.
Loria G, Choudhry N, Sharma K. Fire management in hospitals. Apollo Med 2012;9:74-6.
Shastri BA, Raghav YS, Sahadev R, Yadav BP. Analysis of Fire Protection Facilities in Hospital Buildings. Advances in Fire and Process Safety.Singapore, Springer. 2018.
Silva JF, Almeida JE, Rossetti RJ, Coelho AL. A serious game for EVAcuation training. In2013 IEEE 2nd International Conference on Serious Games and Applications for Health (SeGAH). Vilamoura, Portugal: IEEE: 2013.
Johnson CW. The Glasgow-hospital evacuation simulator: Using computer simulations to support a risk-based approach for hospital evacuation. Technical report. University of Glasgow; 2005. P.18.
Wei-Wen T, Kuo-Hsiung P, Che-Ming H. Performance-based fire safety design for existing small-scale hospitals. Procedia Eng 2011;11:514-21.
Jiang ZM, Zhang PH, Shang RX, Tian XL. Investigation and simulation on human evacuation behaviour in large hospital building in Shenyang. Procedia Eng 2014;71:101-6.
Acar YA, Mehta N, Rich M-A, Yilmaz BK, Careskey M, Generoso J, et al
. Using standardized checklists increase the completion rate of critical actions in an evacuation from the operating room: A randomized controlled simulation study. Prehosp Disaster Med 2019;34:393-400.
Yang P, Li C, Chen D. Fire emergency evacuation simulation based on integrated fire–evacuation model with discrete design method. Adv Eng Softw 2013;65:101-11.
Rahmani A, Salem M. Simulation of fire in super high-rise hospitals using fire dynamics simulator (FDS). Electron J Gen Med 2020;17:em200.
Nguyen MH, Ho TV, Zucker J-D. Integration of smoke effect and blind evacuation strategy (SEBES) within fire evacuation simulation. Simul Model Pract Theory 2013;36:44-59.
Augustine J, Schoettmer JT. Evacuation of a rural community hospital: Lessons learned from an unplanned event. Disaster Manag Response 2005;3:68-72.
King MA, Dorfman MV, Einav S, Niven AS, Kissoon N, Grissom CK. Evacuation of intensive care units during disaster: Learning from the Hurricane Sandy experience. Disaster Med Public Health Prep 2016;10:20-7.
Balikuddembe JK, Ardalan A, Khorasani-Zavareh D, Nejati A, Kasiima S. Factors affecting the exposure, vulnerability and emergency medical service capacity for victims of road traffic incidents in Kampala Metropolitan Area: A Delphi study. BMC Emerg Med 2016;17:1.
Balikuddembe JK, Ardalan A, Khorasani-Zavareh D, Nejati A, Raza O. Weaknesses and capacities affecting the Prehospital emergency care for victims of road traffic incidents in the greater Kampala metropolitan area: A cross-sectional study. BMC Emerg Med 2017;17:29.
Hicks J, Glick R. A meta-analysis of hospital evacuations: Overcoming barriers to effective planning. J Healthc Risk Manag 2015;34:26-36.
Kolifarhood G, Khorasani-Zavareh D, Salarilak S, Shoghli A, Khosravi N. Spatial and non-spatial determinants of successful tuberculosis treatment outcomes: An implication of Geographical Information Systems in health policy-making in a developing country. J Epidemiol Glob Health 2015;5:221-30.
Petinaux B, Yadav K. Patient-driven resource planning of a health care facility evacuation. Prehosp Disaster Med 2013;28:120-6.
Rahouti A, Lovreglio R, Jackson P, Datoussaïd S. Evacuation data from a hospital outpatient drill the case study of North Shore Hospital. Collect Dyn 2020;5:142-9.
Sadeghi-Bazargani H, Abedi L, Mahini M, Amiri S, Khorasani-Zavareh D. Adult attention-deficit hyperactivity disorder, risky behaviors, and motorcycle injuries: A case-control study. Neuropsychiatr Dis Treat 2015;7:2049-54.
Sharma R, Kumar A, Koushal V. Response to a fire incident in the operation room: A cautionary tale. Disaster Med Public Health Prep 2020;14:284-8.
Davudian Talab A, Azari G, Badfar G, Kiani H, Parvin S. Effectiveness of safety training on knowledge and practice of operating room personnel regarding fire prevention. Int J Hosp Res 2017;6:14-8.
Bajow NA, Alkhalil SM. Evaluation and analysis of hospital disaster preparedness in Jeddah. Health 2014;6:2668.
Kreinin A, Shakera T, Sheinkman A, Levi T, Tal V, Polakiewicz J. Evacuation of a mental health center during a forest fire in Israel. Disaster Med Public Health Prep 2014;8:288-92.
Rozenfeld RA, Reynolds SL, Ewing S, Crulcich MM, Stephenson M. Development of an evacuation tool to facilitate disaster preparedness: Use in a planned evacuation to support a hospital move. Disaster Med Public Health Prep 2017;11:479-86.
Rabbani M, Zhalechian M, Farshbaf-Geranmayeh A. A robust possibilistic programming approach to multiperiod hospital evacuation planning problem under uncertainty. Int Trans Operat Res 2018;25:157-89.
[Table 1], [Table 2]