Introduction
Hospitals are under constant threat from internal and external hazards. A fire can cause substantial structural damage, necessitate evacuations which can compromise patient care and fires are unfortunately common. A few hospital fires in 2023 alone, some with fatalities, that were not related to conflict areas or war zones: Kingston Hospital, London, United Kingdom,Reference Mills 1 Cambridge Memorial Hospital, Ontario, Canada, 2 Brockton Hospital, Boston, Massachusetts, United States of America,Reference Sudborough 3 Libya International Hospital, Benghazi, Libya,Reference Mohammed 4 Robănescu Children’s Hospital, Bucharest, Romania,Reference Dumitrescu 5 and Changfeng Hospital, Beijing, Republic of China. 6 In 2021, a fire in Johannesburg’s Charlotte Maxeke Hospital, South Africa, necessitated the evacuation of over seven hundred patients.Reference Press 7 In May 2024 a deadly fire swept through a Newborn Baby Care Hospital in India, killing six newborn children.Reference Suri and Magramo 8 On Sunday, July 13, 2025, 9 died and 30 were injured in the Gabriel House assisted living facility in Fall River, Massachusetts, United States of America.Reference Debussmann 9 Most of these fires resulted in significant structural damage and had financial and patient care implications. A fact sheet published by the United States National Fire Protection Association shows that hospitals and mental health care premises accounted for roughly 44% of fires at health care settings between 2011 and 2015 in the United States. 10
On March 1, 2023, the Wexford Fire Services was alerted to a fire between 15:42 and 15:45 at Wexford General Hospital (WGH) on Newtown Road, Wexford, Republic of Ireland. Smoke had been spotted rising from the hospital roof on the third floor, believed to be from a malfunctioning piece of machinery in the plant room. The fire alarm was manually triggered by hand when the origin of smoke in the hospital building was identified. Responding to the emergency, the Fire Brigade dispatched to the scene 5 fire engines, 1 high-reach appliance, and 1 water tanker with accompanying firefighters. The fire was localized to a plant room, which houses designated mechanical equipment. Swift decisions and actions from senior management staff led to WGH undergoing a near full evacuation.Reference Halpin 11 The evacuation efforts involved coordination between the hospital, the Irish National Ambulance Services, the Irish Police Services (An Garda Siochána) and nearby health care facilities (proximity hospitals). Roofs and wards suffered structural damage from the fire, and the facility also suffered smoke and water damage from the incident. The hospital Emergency Department was closed. A crisis incident management team was quickly established for logistical, staff, patient, and equipment organization. More than 200 patients were successfully evacuated and relocated to different hospitals in Kilkenny, Cork, and Dublin in less than 24 hours.Reference Halpin 11 Afterward a detailed incident review was conducted, and rebuilding activities were later undertaken. The hospital Emergency Department was reopened on July 25, 2023.Reference Slater 12 This was the largest hospital evacuation in the history of the Health Services Executive.Reference Slater 12
Although no deaths or injuries resulted, questions about the effectiveness and efficiency of the entire fire protection operation (both manually and automated), and of the minimization of damage to the facility and equipment should be investigated. The objective of this research study is to identify areas of improvement of the hospital fire protection system through the lived experiences, as described by Van Manen, of the WGH responding clinical and nonclinical staff into textual expression of its essence.Reference Van Manen 13 ,Reference Ajjawi and Higgs14 Through their prior experiences, education, and training, as explained by Heidegger, Hermeneutic (interpretive) Phenomenology methodology was utilized.Reference Ajjawi and Higgs 14 –Reference Neubauer, Witkop and Varpio 16 Thus, the aim of this study by adapting Gadamer’s iterative qualitative structural methodology is to understand the thoughts and perceptions of WGH staff who were on duty during the fire through group interviews to arrive at themes and subthemes to improve future hospital fire protection systems.Reference Saunders, Sim and Kingstone 17 , Reference Alsaigh and Coyne 18
Methodology
This Hermeneutic Phenomenological research study was conducted in focus group discussions and structured interviews amongst participant stakeholders (PSH) by convenience sampling of staff who were on duty the day and night of the fire. Gathering both positive and negative perceptions from PSH will enable an overall view of the entire incident response. Raw data analysis will lead to extraction of codes and themes from discussions, allowing for in-depth code and theme review. Theoretical saturation was achieved when recurring data themes became evident.Reference Saunders, Sim and Kingstone 17 Discussions were analyzed with this identification of recurring codes extracted into an infographic and detail tables.
The sole principal investigator (G. Rust) led and conducted in-person interviews at WGH, County Wexford. Different PSH were targeted, aiming to include Medical and Allied Health Professionals, Nursing Staff, Porters and Orderlies, Housekeeping, Administrative staff, Security, and Management-level staff. These discussions were critically reviewed to obtain information about views, perceptions, and lived experiences of the entire response to the WGH fire. The PSH group were assured that they could withdraw from the study at any time without penalty or fear of retribution. Participation in this study was completely voluntary. Ethical approval for this study was obtained from the South East Regional Research Ethics Committee (RECSAF 5.6, S.I. 190/2004≈2018). All information provided was kept confidential and anonymous.
Intentions and purpose of this study were explained, and consent was obtained from PSH. Discussions were conducted in English, audio-recorded, and simultaneously transcribed into digital text. Rapport was established to allow for open dialogue with fixed structured questions to aid in discussion continuity. No distressing reactions were observed or brought to the attention of the principal investigator. Contact details for relevant support services were made available to participants at consenting.
Results
There were 19 WGH staff who volunteered to participate in the study, June 5-7, 2024. (Table 1). The general fire protection breakdown leads the discussion with the PSH (Figure 1). On review of discussion contents, several codes and themes were repeated and were drawn into Figure 2, dividing positive from negative lived experiences.
Figure 1. Analysis of fire incident at health care facility.
Figure 2. Key POSITIVE and NEGATIVE findings from discussions.
Table 1. Participant stakeholder demographics n = 19
Knowledge gained is encompassed in Luck, Leadership, Level-headed, Liaison, Look-back and Learn (L5) (Table 2).
Table 2. L5 Positive Themes: Luck, Leadership, Level-headed, Liaison, Look-back and Learn
Luck
The outcome from the fire incident response at WGH was remarkably positive and garnered great confidence in PSH. However, PSH did allude that the time of day the fire happened was to their advantage. The fire occurred during work time hours on a weekday and with daylight present it allowed for early detection of rising smoke. The response was also well-staffed as full staff capacity was at hand during work hours.
Some PSH suggested an evening fire would not have had such a good outcome. Especially when staffing may not have been at full capacity (weekends, bank holidays, or night shift), the response and outcome could then have been different. A positive individual factor noted by several PSH was how staff willingly stayed overtime to assist in the overall response.
Leadership
Initial leadership was taken by the WGH manager, who declared the fire a disaster incident, thus recruiting and mobilizing all necessary personnel. Unfortunately, some PSH felt that the declaration of a disaster incident did not filter through to ward-level staff fast enough—many only heard of the fire in a delayed manner. Multiple PSH mentioned an incident command being established, and a gold commander position initially taken up by the hospital manager. Once the fire chief arrived, the incident commander position was transferred to the chief. An incident command post was established in the administration sector of the hospital, allowing for scene evaluation, decision-making discussions, evacuation plans, referral to set hospital protocols and Emergency Operation Plan, and centralized discussions with close proximity hospitals for the safe transfer of patients.
Of note, the intensive care unit and accident and emergency department PSH particularly spoke of their medical consultants taking the lead within their wards. A sense of calm was upheld, decisions made with the best interest and protection of patients, and that leadership from the intensive care and emergency medicine consultants was of the highest order.
Level-headed
Almost every participant stakeholder mentioned the sense of calm during the response. It was a composed and poised response with a deep understanding that the safety of the patients was at the forefront. Some PSH mentioned previous experience with fire training (including drills and practice scenarios) and drew from these experiences to complete tasks at hand efficiently. Such as a decision to use fire exit stairs as an egress route from two particularly affected wards nearest to the fire origin with patients who could walk or be carried (pediatric patients were evacuated in this way). Evacuation of maternity patients and newborn babies who were successfully transferred to a location away from the fire.
Liaison
The managerial staff had a strong working relationship with their line managers and ward-level staff. Being a smaller hospital has set up positive relations between managers and staff to allow for easy decision-making and approach to the incident. Most PSH were positive in their review of assistance provided from other services, including the National Ambulance Services, who was responsible and performed patient transfers. Patient transfers left from the emergency department at the ambulance bays, where a designated National Ambulance Services officer delegated patients to ambulances and to proximity hospitals. Fire Ireland were quick to respond to the scene, with their commander stepping into the Gold Commander role and assisting with the evacuation of the patients. Furthermore, Gardai assisted with directing traffic and civilians descending to the scene for information at the hospital’s main entrance.
Lookback and learn
WGH has followed the disaster medicine cycle (Disaster, Response, Recovery, Mitigation, Preparedness) to learn from this incident and mitigate future problems.Reference Ciottone 19 , 20
Negative lived experiences captured in Table 3 resulted in 6 separate codes: Alarms, Begrudge, Communication, Directive, Emergency Plan, Flow (ABCDEF). There were 12 themes to address hindrances at the immediate incident and those on review of the overall hospital response and participant stakeholder suggestions for improvement during the discussions (Table 3).
Table 3. ABCDEF problem themes: Alarms, Begrudge, Communication, Directive, Emergency Plan, Flow
Alarms
Reactions to fire alarms should, at any given triggering, garner reactive responses—of concern and activity. It is often, however, quite the opposite. Reactions are minimized; alarms are ignored. Fire alarms that repeatedly sound without actual cause or when triggered by a minor incident are termed Fire Alarm Fatigue. 20 Manual alarm triggering at the WGH fire was required to signal noise alarms as the smoke was billowing outside the hospital grounds. No smoke detector automatically triggered alarms. There was no noise alarm alerting staff in the emergency department as PSH only saw a different light-up screen on the wall fire panel. This was their single indication that something was wrong. Manual contact via telephone call was made with the fire station by a lead security officer. There is no automatic communication or alerting system with the nearby fire department.
Begrudge
A “sequela” was that the initial collegiality and support from the proximity hospitals dissipated over time. There was a loss of empathy and initial understanding from the proximity of hospitals. PHS indicated that proximity hospitals were questioning the extended closure of the emergency department, the restricted review of patients, and an overall begrudged questioning ensued, eclipsing the initial supportive atmosphere that had been garnered at the start. This was difficult for the PSH to grasp and still leaves them perplexed.
Communication
Staff alert systems in terms of communication have been a key identified code and theme that has come out through this research. Staff participants noted that there was no means of communication when the incident was initially declared, and first of all, only word-of-mouth was used to communicate incident information. They further felt that a simple hospital-wide text message system to all personnel would have been a good means of communication for an event as large as this. Other communications followed later that day via emails that were sent to work email addresses, despite some staff not having access to these emails off-site. Most people said that social media played a significant role in their understanding of the development of this disaster, as people were posting on various social media platforms and dispersing information via that sphere.
Directive
A key theme identified by the intensive care unit staff participants in particular was how the oxygen to their ward was immediately cut when the alarm was triggered manually near the plant room, which is the epicenter of some pipelines and oxygen supplies to some wards. Oxygen was cut off without any prior notification to the ICU. They were not informed of this and felt that a warning would have been absolutely necessary as many patients in ICU are oxygen dependent.
Assembly points are poorly identified, and participants had poor knowledge of where their designated assembly point is located. One department in the main hospital was familiar with their assembly point, made use of it, and was the only department to mention that they had done so.
A roll call of all the staff on the premises at the time was not done in any formal manner. An informal and unofficial group text by departments was done for some departmental roll calls. This system of informal roll call is not sufficient even in a small setting such as WGH and would be more complex in any facility of a larger size.
Emergency Plan
The hospital Emergency Operations Plan had not been updated prior to this event for a number of years, and no physical drills had ever included any of the PSH at the WGH site. Online fire training was mentioned by some of the nursing and security staff, but none of the medical doctors had any awareness of online fire training.
Flow
Flow out of the hospital at the time of the major incident was of key importance as many patients were in close range of the plant room fire. Two wards were a mere floor below where the smoke originated. A disruptive communication process started when patients were being transferred, and transfer letters (detailed transcriptions of the patient’s medical history, reason for admission, current medications, and plan going forward) were being written in very shorthand and scribbled on paper to be transferred with the patients. This was obviously inadequate. After realizing that patient case information was not being relayed to the proximity hospitals adequately, an executive decision was made to have patients transferred with their entire files from WGH, with all their notes and ongoing plans.
Facility egress was an additional bottleneck. There is 1 major parking lot inside the facility grounds of WGH, with staff, visitor, and patient motor vehicles all stuck with a single entrance and exit route to the facility. A one-way, one-gate access and exit flow is currently in use at WGH from the main road. The traffic was gridlocked with many people and emergency services trying to both exit and enter the hospital grounds during the incident.
Limitations of Study
Phenomenological research relies on the researcher’s interpretation of the data obtained from the lived experiences of the WGH staff. This study controlled for this through the extraction of objective codes and themes. Data validity and reliability were controlled through the consistent use of the codes until theoretical saturation. The small number of participants may not be generalizable for the specific PSH population the study participants represented but all PSH categories were represented. This may limit the applicability of the study findings. The timing of the study may have led to study participants’ lack of recall or inconsistent recall of specifics of their role in the fire protection system. As perception and not a formal analysis of the staff’s individual and collective response through the lens of fire protection system policy and procedure analysis, the data from this study can accompany an after-action report to further improvements.
Discussion
Hospitals are the ideal setting for fire incidents. It encloses all 3 key parts of The Fire Triangle: Energy, Fuel, and Oxygen.Reference Wood, Hailwood and Koutelos 21 Combustion can spark from a variety of sources and fire safety should be a fundamental area of knowledge for all hospital staff.
Most WGH staff did find the acute response to the hospital fire as a positive experience. While luck played a role in the response on March 1, 2023, staff identified strong leadership, a calm and level-headed approach to decisions and professional liaison with fellow service providers, and an extensive list of positive themes. Essential to success in this fire protection system was the establishment of an incident command post and identifying an incident commander. PSH noted quick-thinking and opportune decision-making such as creating an alternate egress route by breaking through the parking area fence. This diverted traffic away from the single hospital entrance/exit by the Irish Police to allow expedient and efficient flow of first responder traffic and prevented bystanders from potential harm.
Alarm fatigue played a significant role in the reaction that PSH had to the fire alarm on the day of the incident. The term alarm fatigue has become vogue since being coined in 2004, and most health care professionals will know that so many loud and sounding alarms (often simultaneously) are triggered for numerous reasons and require the attention of an attending human workforce. Alarm fatigue is defined by The American Association of Critical-Care Nurses as: “a sensory overload that occurs when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarm sounds and an increased rate of missed alarms.”Reference Gaines 22 In 2020, the Agency of Healthcare Research and Safety in the United States of America conducted a critical analysis and identified a safety culture issue amongst staff who were suffering from alarm fatigue. A key outcome found that a combination of factors leads to alarm fatigue. These included the number of alarms that needed a response, the alarm triggering rate, number of false alarms, and the noise level of each alarm. This analysis clearly shows that reducing the number of total alarms, reducing false alarms, reducing the total alarm noise level, and changing the safety culture may help address alarm fatigue overall. However, more research is required as “…these initiatives often involve multiple components; it is difficult to know which intervention(s) have the greatest impact.”Reference Hall, Shoemaker-Hunt and Hoffman 23
PSH largely described a loss of moral support from nearby proximity hospitals once the acute phase of the fire incident had dissipated. Mentioning a “sense of begrudging” and “questioning attitudes” from proximity hospitals lead to a tension in relationships. Liu et al. state that keeping a strong morale during and after a crisis is an important communication tool to ensure employee wellbeing. Liu et al. further explain that strong community ties and respectful interorganizational communication and relationships are imperative to weather any crisis.Reference Liu, Fowler, Roberts and Herovic 24
Communication during such an incident is obviously crucial. It must be done swiftly, be concise, and correct to ensure staff and patient safety. These lines of communication run both inside the hospital between different departments as well as with services external to the hospital. Segmental information sharing with internal stakeholders (hospital staff) must be accurate and timely, else the information being relayed becomes out of date and impedes procedural responses since the information and the current situation are not in sync.Reference Lillian 25 Furthermore, Hunt et al. also stated that back-up channels for communication must be considered by management (such as handheld radios or text messages to staff phones) should the need arise for instant internal relaying of information.Reference Lillian 25 PSH themselves suggested a text-messaging system to alert all staff of an incident and its unfolding. Some mentioned that a public address or similar announcement system should be included for potential implementation. More research on this suggestion is warranted, as concerns could be raised for causing hysteria or mass-scale panic among people. In contrast, Liu et al. found that face-to-face (i.e., word-of-mouth) communication via line managers, team leaders, and directors was preferred by their cohort of study participants. However, the example used in the publication concerned “huddles” to share information, but this would not be safe and efficient in an adrenaline-high or rushed scenario of an active fire.Reference Liu, Fowler, Roberts and Herovic 24
The clear and concise communication to have oxygen cut when a fire in a plant room was identified is imperative. No one relayed this decision before it was implemented to those wards that use oxygen for patients, including the intensive care unit. A UK “Fire Safety and Emergency Evacuation Guidelines” states that knowing the location of and how to use Oxygen Shut-off Valves (also called Area Valve Service Units or AVSUs) is key to prevent oxygen explosions in fires. Activating the AVSU will halt the oxygen supply to all patients on that oxygen pipeline, many of whom may rely on it for their survival. Such a decision must be made exclusively by the most senior clinical staff member available, such as a departmental or ward consultant. The aforementioned guideline additionally advises stopping any high-flow oxygen and ensuring availability of portable oxygen.Reference Kelly, Bailey and Aldridge 26 PSH did acquire adequate portable oxygen supply with assistance from orderly staff.
Assembly of staff at designated points during a fire is essential and this requires frequent education and training to maintain competencies. Only 1 department knew their own point of assembly and made use of it during the WGH fire. Assembly points form part of an evacuation plan and are important in any fire protection system. Hunt notes thoughtfully that these should be wheelchair accessible.Reference Lillian 25 Staff roll call must be undertaken, especially in the setting of changes or rotating training doctors, leave of absence, number of trapped and/or people requiring rescue. PSH suggested an electronic clock-in system rather than the informal approach currently used. Some PSH were not even included in any roll call while others came back into work to assist without the knowledge of senior management that they returned to the hospital grounds.
Drills, table-top exercises and PSH being well-acquainted with the facility Fire Safety and Evacuation Plan are paramount to a safe outcome and successful evacuation. The systemic review portrayed by Sahebi et al mentions an Indian study showing clearly how routine fire drills can improve hospital responses to fires by minimizing risk and knowing hospital emergency plans.Reference Sahebi, Jahangiri, Alibabaei and Khorasani-Zavareh 27 Focal points to implementing “Best Practices” included training staff on the updated disaster planReference Liu, Fowler, Roberts and Herovic 24 and practicing drills even when they are stressful and disorganized. This is potentially of benefit to staff in the end as it recreates a realistic atmosphere.Reference Lillian 25 Nurse Ervine further explains that even if the drill is chaotic for participants, all drills should be planned by a knowledgeable facilitator and be well-executed, aiming to collect meaningful data and evaluate feedback in a debriefing session.Reference Ervine 28
Studies suggest that hospital facilities and community service providers should use the same systems to allow for easier updating and communication.Reference Liu, Fowler, Roberts and Herovic 24 , Reference Lillian 25 Managing too many different systems may present a significant challenge when relaying patient transfer information across multiple platforms, which can result in a lack of vital patient information. The executive decision to transfer patients to proximity hospitals together with their individual patient files was the correct decision at the time of this crisis. This expedited transfers and confidently relayed all relevant patient information to proximity hospitals in writing.
Finally, the Hermeneutic methodology lends itself well to the lived experiences of WGH staff. Subsequent discussion and data analysis presented areas of improved fire protection system, allowing this study to stand out from available reportings of hospital fires. Peer-reviewed medical journals such as the Disaster Medicine and Public Health Preparedness journal “Reports from the Field” category or other journals’ similar format represent raw data not drawn from lived experiences, but interpret the data and present opinions of the authors, or summarize outcome analysis without a scientific exploration of the data. 29 , Reference Jang, Cho and Lim 30
The Southeast Texas Regional Advisory Council (SETRAC) after-action report of the January 26, 2022, fire at the Lyndon Baines Johnson Hospital in Houston, Texas, utilized standard analysis of health care preparedness capabilities during a virtual meeting with SETRAC members and representatives. 31 The recommendations of this after-action report did not address the lived experiences of hospital staff but focused more on the response to the hospital incident from the perspective of the responding agencies to improve future agency fire protection systems.
Conclusions
The Hermeneutic Phenomenology methodology utilized in this study specifically learning from the lived experiences of those who were on duty during the WGH fire can improve the fire protection system at hospitals based on the knowledge gained as encompassed in the L5 and ABCDEF findings.
Acknowledgements
Wexford General Hospital Staff—thank you for your time and inputs.
Michael “Mick” Molloy, MD—thank you for facilitating relationships with the Wexford General Hospital staff.
This manuscript is the result of a study conducted in the framework of the Advanced Master of Science in Disaster Medicine (EMDM—European Master in Disaster Medicine), jointly organized by CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health of the Università del Piemonte Orientale (UPO) and REGEDIM—Research Group on Emergency and Disaster Medicine of the Vrije Universiteit Brussel (VUB).
Author contribution
GSR: Conceptualization, data curation, formal analysis, methodology, project administration, writing original draft, review, and editing.
ESW: Supervision, writing review, and editing.
Competing interests
The author(s) declare none.
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