Fire safety officers have expressed “serious concern” about overcrowding in the emergency department at University Hospital Limerick and have threatened legal action.
In one month alone there were 16 breaches of a cap on the maximum number of patients and trolleys allowed in the hospital’s emergency department.
University of Limerick Hospitals Group chief executive Prof Colette Cowan said if the hospital was forced to stay within the caps, it would "force a decision to close or divert services outside the Midwest which will affect the public, creating clinical risk and a threat to life or limb".
Documents released under Freedom of Information legislation reveal a series of warnings from the chief fire officer that were prompted by a complaint about the emergency department, which led to an inspection from authorities.
Michael Ryan, Limerick's chief fire officer, wrote to Prof Cowan on March 28th last informing her that a complaint about overcrowding in the emergency department was received by the fire service on the March 20th.
The letter says that the assistant chief fire safety officer carried out an inspection on foot of the complaint six days later.
“During this inspection, it was noted that 38 patient-occupied trolleys were located in various aisle locations within the care/observation areas of the emergency department,” it says. “This figure exceeds the safe number of trolleys in the emergency department set out in the fire safety notice, namely 29”.
A fire safety notice had been served the previous December.
“It is a matter of serious concern that the safe number of trolleys in the emergency department specified in the fire safety notice has been exceeded. In the interest of the safety of patients, staff and visitors, it is essential that the number of trolleys is restricted to 29 at all times in the emergency department,” the letter states.
“Failure to comply with this condition will leave the fire authority with no option but to consider taking such enforcement action it considers necessary in the protection of life and property.”
Prof Cowan responded on April 8th, saying the emergency department serves a population of 400,000 people that is “socially deprived” alongside “high numbers of frail elderly people”.
“In comparison to other major centres in Galway, Cork and Dublin, we have 200-250 less inpatient beds yet UHL is the second busiest hospitals for emergency attendances.”
She said she was “willing to increase the number of trolleys at ward level despite the industrial relations backlash” if the fire team was willing to assess that situation.
Prof Cowan wrote again to the chief fire officer on the May 1st informing him that the cap on the allowed number of patients in the emergency ward was breached three times in April and the cap on the number of trolleys allowed was breached 13 times.
Eight days later the chief fire officer responded and said the issue was a matter “of ongoing concern”. He said that the information provided showed that “the number of occasions that the fire safety notice has not been complied with is greater than that previously considered by the fire authority”.
He said that if the fire regulations were not complied with going forward, legal action would ensure in the district court.
In a statement, the hospital said it is "committed to working closely with Limerick City and County Council on these matters".
“A key consideration is the low probability of a fire occurring balanced against the high probability of a critically ill patient presenting to ED at a time when the hospital is already operating above capacity and there are more patients on trolleys in ED than is specified in the fire officer’s cap,” it said.
“It is imperative that staff are trained on what to do in the unlikely event of a fire. A series of fire training sessions have been held specifically for our ED staff - most recently in October 2019.”
The hospital’s statement says that 62 staff have received fire training and three nurse managers have been trained as fire marshals.
"Drills have taken place in ED in the event of the activation of our Major Emergency Plan. This provides for the clearing of ED within 15 minutes and can be applied to the scenario of a fire evacuation. It should be noted that the main corridor running through ED is always kept clear to facilitate such an evacuation."
A spokeswoman for the Irish Nurses and Midwives Organisation said “overcrowded corridors aren’t just bad for staff wellbeing and patient care, they’re a serious fire hazard”.
“We are seriously concerned for the safety of our members and their patients should a fire break out. It’s hard to think of any other workplace where this sort of hazard would be tolerated,” she said.
Fianna Fáil health spokesman Stephen Donnelly said the situation was “a shocking indictment of the failure of this Government and Minister for Health Simon Harris”.
Mr Harris said it was clear there was a capacity issue in Limerick and that a 60 bed extension would open late next year. “In the meantime we have provided additional funding to the HSE for the midwest to provide more home care packages, more transistional care.”
