In residential healthcare, the safety of residents during emergencies is paramount. Given the complexity of healthcare settings, where individuals may have varying mobility, cognitive, and health conditions, standard evacuation procedures often fall short.
This necessitates a bespoke approach to evacuation planning that meticulously considers each resident’s unique needs through Personal Emergency Evacuation Plans (PEEPs), appropriate prioritisation strategies, and tailored assistance requirements.
Why Tailored Evacuation Plans Are Essential
Residents in designated centres are particularly vulnerable to the effects of fire due to impaired mobility, cognitive disabilities, frailty, and use of medication, among other reasons. The potential impact from fire is greatly increased if providers do not mitigate against fire risk and do not have suitable fire prevention and oversight measures in place.
Experience from other jurisdictions has shown that implementing good fire safety management policies, effective fire precautions, and comprehensive staff training will help protect residents, children, staff, and visitors.
HIQA Fire Safety Handbook: Four Key Themes
Central to Developing a Fire Safety Culture
The HIQA Fire Safety Handbook identifies four intrinsically linked themes that are central to fire safety in designated centres:
Governance and Management
The registered provider must have a good fire safety programme with clear oversight, accountability, and resources
Risk Management
Comprehensive fire safety risk assessment to allow decisions on the full range of fire precautions required
Diverse Care Needs
Care, welfare, support, assistance, and evacuation needs of residents must be considered for fire precautions
Staff Knowledge
Staff must understand fire safety policies and procedures and know their role in evacuating residents
Identifying Assistance Needs
Pre-Admission Assessment
A critical first step in crafting an effective evacuation plan is assessing residents’ mobility and health conditions. The HIQA Fire Safety Handbook provides guidance on evaluating residents’ needs for assistance during an evacuation.
This assessment should be completed before the resident moves into the home, updated approximately 14 days after arrival once staff understand their specific needs, after any change in health, mobility, medication or behaviour, and at minimum every six months on an ongoing basis.
Resident Dependency Categories
Government fire risk assessment guidance suggests categorising residents based on their evacuation capability:
Independent
Mobility is not impaired in any way and the resident is able to physically leave the premises without staff assistance, or if they experience some impairment, they are able to leave with minimal assistance from another person.
- Can self-evacuate when alarm sounds
- May need verbal direction only
- Can navigate escape routes independently
Dependent
All residents except those defined as independent or very high dependency. This category also includes those with mental health problems regardless of their independent mobility.
- Requires staff assistance to evacuate
- May use wheelchair or walking aids
- May have cognitive impairment affecting response
- Requires evacuation equipment (ski sheets, chairs)
Very High Dependency
Residents whose care and/or condition creates a high dependency on staff, or where immediate evacuation would prove potentially life threatening.
- Bedbound or completely immobile
- Connected to medical equipment
- Bariatric residents requiring specialist equipment
- Residents where movement risks clinical harm
Visual Identification System
Once detailed PEEPs are written, summaries are usually compiled using a traffic light system. A practical aid for staff is to place a small colour-coded sticker above the bedroom door opening. This system can be enhanced with universally recognised symbols.
Note: This colour coding system helps both permanent and agency staff who may be unfamiliar with residents’ needs. Symbols such as wheelchair, evacuation mat, walking aid, deaf, blind, or bariatric indicators can enhance the system further.
Personal Emergency Evacuation Plans (PEEPs)
A PEEP is a customised evacuation plan tailored for residents who may be unable to self-evacuate due to physical or neurological impairments. The plan identifies the specific evacuation equipment required and the level of staff assistance necessary.
What PEEPs Must Include
Mobility assessment, preferred evacuation method, equipment required, number of staff needed, specific handling requirements, communication needs, and any behavioural considerations
Storage and Access
PEEPs should be grouped by building compartment and kept in a secure and discreet location, but one which ensures they are readily available to staff in an emergency
Review Requirements
PEEPs must be updated after any change in health, mobility, medication, or behaviour, and reviewed at minimum every six months to ensure accuracy
Exceptional Circumstances
In a fire emergency, normal rules of lifting and handling may not apply. A resident who is hoisted for daily care would not be hoisted for evacuation purposes
Bedroom Allocation Considerations
The evacuation needs of residents must inform their location within the home. Bariatric residents and others who could not be carried down stairs should not be placed on upper floor levels unless there is an evacuation lift that can be accessed from that floor.
Ideally, residents with significant mobility needs should be housed on the ground floor where possible, or in locations that allow for progressive horizontal evacuation without requiring stair descent.
PEEP Assessment Process
Mobility Assessment
Can the resident walk unaided? Do they use a wheelchair or walking aids? Can they transfer independently?
Sensory Assessment
Is sight or hearing significantly impaired? Will they respond to fire alarms? Do they need visual or tactile alerts?
Cognitive Assessment
Dementia, Alzheimer’s, or other conditions affecting response? May they resist evacuation or attempt to abscond?
Equipment Selection
Determine appropriate evacuation aids: ski sheet, evacuation chair, wheelchair, or manual carry techniques
Staff Requirements
How many staff members are needed? What training do they require? Who provides cover for absences?
Documentation
Record all findings, ensure PEEP is accessible, communicate to all staff, and schedule regular reviews
Implementing Fire Safety Measures
Beyond evacuation planning, implementing robust fire safety measures is essential for preventing emergencies. The Technical Guidance Document B (Fire Safety) 2006 (reprinted 2020) and HIQA Fire Safety Handbook highlight essential measures:
Fire Detection and Alarm Systems
Effective fire detection to I.S. 3218:2024 standard with appropriate alarm configuration for healthcare settings (staff alarm / two-stage systems where appropriate)
Clear Escape Routes
Escape routes must be maintained clear and unobstructed at all times, with appropriate signage and emergency lighting to I.S. 3217:2023
Fire Safety Equipment
Regular inspection and maintenance of fire extinguishers (I.S. 291:2015+A1:2022), fire blankets, and other firefighting equipment
Compartmentation
Areas at higher risk of fire must be enclosed in fire-resistant construction to support progressive horizontal evacuation
Fire Doors
Fire doors maintained in good condition with functioning self-closers, intumescent strips, and smoke seals
Staff Training
All staff trained in fire procedures, evacuation techniques, use of evacuation aids, and their specific roles during emergencies
Irish Regulatory Framework
Key Legislation and Guidance
HIQA Regulation 28: Fire Precautions
Requires designated centres to maintain adequate means of escape, fire detection systems, staff training, and documented fire safety policies
HIQA Fire Safety Handbook (2025)
Detailed guidance on fire safety governance, resident assessment, PEEPs, evacuation drills, and fire risk assessment for designated centres
Fire Services Act 1981 (as amended 2003)
Places duty on persons having control over premises to take reasonable measures to guard against fire outbreak and ensure occupant safety
Care and Welfare Regulations 2013/2016
Legal framework for developing evacuation prioritisation strategies and ensuring resident welfare in designated centres
Safety, Health and Welfare at Work Act 2005
Requires employers to have adequate emergency plans and procedures, providing all necessary measures for firefighting and safe evacuation
TGD B (Fire Safety) 2006 (reprinted 2020)
Technical Guidance Document providing guidance on fire safety requirements under the Building Regulations
Continuous Assessment and Improvement
The landscape of residential healthcare is ever-evolving, necessitating continuous reassessment and improvement of evacuation plans and fire safety measures. Plans must remain effective and responsive to the changing needs of residents and the latest fire safety standards.
Fire drills should reflect real-life scenarios and be carried out as often as is necessary to ensure everyone can be evacuated within the safe evacuation time, staff know the procedures, and evacuation becomes an automatic response to a fire alarm.
Enhance Your Understanding
To learn more about the intricacies of evacuation prioritisation and assistance requirements in residential healthcare settings, download Phoenix STS’s comprehensive guide:
Download Guide (PDF)Key Takeaways
- Tailored evacuation plans are essential: Standard procedures fall short in healthcare settings where residents have varying mobility and cognitive conditions
- Pre-admission assessment is critical: Evaluate residents’ evacuation needs before they move in and update regularly
- Categorise residents by dependency: Independent, Dependent, and Very High Dependency classifications inform evacuation strategy
- Personal Emergency Evacuation Plans (PEEPs): Create individualised plans for each resident requiring assistance, grouped by compartment
- Visual identification systems: Colour-coded door markers help all staff quickly identify resident needs during emergencies
- Bedroom allocation matters: Residents who cannot navigate stairs should be placed on ground floors or near evacuation lifts
- Staff training is fundamental: All personnel must be trained in procedures, equipment use, and their specific roles
- Regular fire drills: Drills must reflect real-life scenarios and be conducted frequently enough to ensure automatic response
Phoenix STS: Healthcare Fire Safety Services
Phoenix STS provides comprehensive fire safety training and consultancy specifically designed for Irish healthcare facilities, ensuring compliance with HIQA Regulation 28 and the Fire Safety Handbook.
Training
Consultancy
Planning Services
Ensure Your Facility is Prepared
Phoenix STS specialises in healthcare fire safety training and consultancy. Our CPD-accredited courses and expert assessments help nursing homes and healthcare facilities meet HIQA requirements while protecting residents and staff.
References
- HIQA Fire Safety Handbook: A Guide for Providers and Staff of Designated Centres (2025 Edition)
- HTM 84: Fire Risk Assessment in Residential Care Premises
- Care and Welfare of Residents in Designated Centres for Older People (Amendment) Regulations 2016
- Technical Guidance Document B (Fire Safety) 2006 (reprinted 2020)
- Completing PEEPs for Residents in Residential Care Homes
Disclaimer
This article is provided for general informational and educational purposes only. While every effort has been made to ensure accuracy, this content does not constitute legal or fire safety advice. Healthcare providers should consult with qualified fire safety professionals to develop evacuation plans appropriate to their specific premises and resident needs. Phoenix STS accepts no liability for actions taken or not taken based on this article.
