Fire drills in healthcare are meant to prove that residents can be moved to safety. In too many centres, however, the drill introduces a different risk: staff are asked to act as practice patients while colleagues drag, slide or carry them using evacuation equipment. The intention is usually good. Managers want a realistic exercise. Staff want to practise properly. The problem is that a cooperative staff member is neither a safe training load nor a realistic substitute for a resident who may be unconscious, frightened, confused, bariatric or unable to assist.

This is not a minor training preference. Using staff as practice patients can expose employees to avoidable manual handling risk, create false confidence about evacuation performance, damage evacuation equipment and produce drill records that do not really test the centre's emergency plan. In a nursing home, hospital ward, disability service or other designated centre, the drill has to be realistic enough to test the plan, but safe enough not to injure the people carrying it out.

This article explains why healthcare providers should move away from staff-as-patient drills, what HIQA and Irish safety law actually require, and how to build a safer and more credible drill programme using manikins, proper planning and clear evidence.

The Legal Starting Point

For designated centres for older people, the key fire safety requirement is Regulation 28 of S.I. 415/2013. It requires the registered provider to take adequate precautions against fire, provide means of escape, maintain fire equipment and building services, train staff in fire prevention and emergency procedures, and use fire safety management and fire drills at suitable intervals so that staff, and residents so far as reasonably practicable, know what to do in the case of fire.

Regulation 28 does not say that staff must be placed on evacuation sheets as practice patients. It does not say that residents with reduced mobility must be used in drills. It requires awareness, training, drills and safe evacuation arrangements. Those aims can be met without turning a member of staff into the training load.

The employer also has duties under the Safety, Health and Welfare at Work Act 2005. Training is a work activity, and the duty to protect employees applies during training just as it applies during ordinary work. Section 19 requires workplace risks to be assessed. A practical evacuation drill that involves dragging or carrying a person is not outside that duty because it is called training.

Manual handling law is also relevant. Regulation 69 of the General Application Regulations 2007 requires employers to avoid manual handling where possible and, where it cannot be avoided, to reduce the risk by appropriate measures. If the same training outcome can be achieved with a rescue manikin, it is difficult to justify exposing a staff member to the risk of being dropped, twisted, dragged or injured during repeated practice runs.

What HIQA Expects From Fire Drills

HIQA's Fire Safety Handbook is clear that fire drills should be specific to the centre and fully completed. Management should know the objective of the drill, review what worked, gather feedback and repeat drills where the exercise shows that improvement is needed. The point is not to perform a ritual. The point is to prove whether the procedure works.

The handbook says drill programmes should consider the size, layout and bed capacity of compartments, the largest compartment, reduced night-time staffing, evacuation equipment, residents or children with special requirements, incapacitated staff, escape stairways, fire containment and blocked or narrow escape routes. That is a practical list. It is also a reminder that a drill built around one cooperative staff member is often too narrow to prove much.

HIQA also says drills should be carried out during different shifts to check that procedures still work with the minimum number of staff on duty, usually at night. All staff should participate in fire drills. Participation, however, does not require one employee to be used as the person being moved. A staff member can participate by carrying out the evacuation role they would have in a real incident.

Why Staff as Patients Gives Poor Evidence

A staff member lying on an evacuation sheet is usually a helpful participant. They know what is about to happen. They brace themselves. They hold their head in a safer position. They shift their weight to make movement easier. They may give feedback if they feel uncomfortable. In a real fire, the resident may do none of those things.

That matters because the drill is meant to test real capability. A resident may be unconscious, heavily dependent, distressed, confused, unable to understand instructions or resistant to movement. A resident may have pain, contractures, fragile skin, oxygen therapy, pressure equipment or a body shape that makes movement more difficult. If the drill is performed with a fit colleague who unconsciously assists, the staff team may come away believing the evacuation plan is stronger than it is.

The risk is not only that the drill injures somebody. The deeper risk is false assurance. Management may record a successful evacuation time, but the time may not reflect the time needed to move the residents who actually live in the centre. HIQA inspectors are increasingly interested in whether drills test the real evacuation strategy, not just whether a form has been filled in.

The Manual Handling Risk

Healthcare staff already carry a high manual handling burden. Routine work may involve assisting residents to stand, transfer, wash, dress, reposition or mobilise. Fire evacuation practice adds unusual forces: low-level pulling, awkward postures, corridor turns, thresholds, stairs, time pressure and team movement. When the load is a live colleague, the movement can change suddenly.

Using staff as the training load can create risk for both sides. The handlers may suffer back, shoulder or knee injury. The staff member acting as the patient may be jolted, dropped, twisted, struck against a door frame or injured during a stair descent. The fact that the person volunteered does not remove the employer's duty to assess and control the risk.

There is also a fairness point. Staff may feel pressure to take part because a manager asks, because colleagues are watching or because the practice has always been done that way. A safe system should not rely on an employee feeling able to refuse an unsafe drill.

Use Manikins for the Physical Movement

The training principle is simple: a staff member is not a training aid. Equipment familiarisation should be carried out with a rescue manikin, not a colleague. The first time a team uses an evacuation sheet, mattress or chair with a live person should not be during a real fire, and it should not be during a rushed drill where the equipment is still unfamiliar.

The same applies to stair equipment. The first live descent must not be the first descent ever performed. Staff need controlled practice, clear safe working limits, and enough handlers for the resident's weight and the manufacturer's instructions. The point of a drill is to build competence, not to create a manual handling injury.

Rescue training manikins are the safer and more useful option for assisted evacuation drills. They provide weight, bulk and body mechanics without exposing a staff member or resident to being dragged or carried. They can be placed in awkward positions, moved repeatedly, used on evacuation sheets or ski pads, and selected to reflect different dependency levels.

Manikins are not perfect, and they should not be presented as a full representation of every resident. They do, however, solve two important problems. They remove avoidable injury risk to live participants, and they give a more honest test of handling effort because they do not help the staff team. That makes the drill harder, but more useful.

Where a resident can participate safely and willingly in a low-risk awareness exercise, that may be appropriate. For example, some residents may take part in alarm familiarisation, route awareness or supported movement to a nearby point, if it is suitable for them and does not compromise dignity or welfare. That is very different from using a resident, or a staff member pretending to be a resident, as a load for repeated evacuation equipment practice.

Progressive Horizontal Evacuation Has to Be Tested Properly

Most nursing homes and many healthcare buildings rely on progressive horizontal evacuation. Staff move people from the affected room or compartment into an adjoining protected area on the same level, rather than trying to take everyone outside immediately. That strategy depends on fire-resisting construction, working fire doors, enough staff, usable evacuation equipment and clear decision-making.

A poor drill can hide weaknesses in that strategy. If staff choose the easiest room, use a colleague who can help, clear the route beforehand and run the drill with extra people available, the result will look better than the real emergency. A proper drill should gradually work towards the more difficult situations: the largest compartment, awkward bedroom layouts, reduced staffing, residents who need two-person assistance and the equipment that would actually be used.

This does not mean every drill must be severe or disruptive. A balanced programme can include short knowledge drills, equipment practice, tabletop exercises and full compartment drills. The important point is that the provider knows what each exercise is testing. If the objective is evacuation capability, then the load, staffing and route must be realistic enough to give useful evidence.

What a Better Drill Programme Looks Like

A better programme starts with the fire risk assessment and evacuation strategy. The provider should identify the most difficult compartments, residents who need assistance, night-time staffing levels, available equipment, routes, doors, stairways and safe placement areas. The drill programme should then test those assumptions in stages.

The first stage is knowledge. Staff should know the alarm response, compartments, fire doors, call points, evacuation equipment and who takes charge. The second stage is equipment competence. Staff should practise with evacuation sheets, ski pads, chairs or mattresses using manikins and instructor feedback. The third stage is a timed scenario that tests communication, role allocation, equipment collection, resident movement and placement in a place of relative safety.

The drill should use normal staffing levels for the shift being tested. If the night-time plan depends on three staff, the drill should not be run with six. If a compartment contains residents who need two-person assistance, the manikins and scenario should reflect that. If the largest compartment is the challenge, the largest compartment should eventually be tested.

Records That Prove Learning

The record should show more than attendance. A useful drill record includes the date, time, shift, scenario, compartment tested, staffing level, equipment used, assumed resident needs, evacuation time, staff involved, observations, defects, learning points and corrective actions. If a drill identifies a problem, the record should show what happened next.

That evidence is particularly important where a centre relies on night staff to begin evacuation before additional help arrives.

It should also be easy to follow during a HIQA inspection.

Examples of useful findings include slow access to evacuation equipment, uncertainty over who checks the alarm panel, a door that does not close, a route narrowed by storage, staff unsure how to secure a ski sheet, poor radio communication or a resident profile that no longer matches the evacuation plan. These findings should not be treated as embarrassment. They are the reason the drill exists.

The provider should also update PEEPs, staff training plans, equipment locations and the fire safety risk assessment where the drill shows that the existing arrangement is weak. HIQA's handbook presents fire drills as a quality improvement tool. The paperwork should therefore show improvement, not just repetition.

Changing an Existing Practice

If a centre has used staff as practice patients for years, the change should be managed openly. Staff should be told why the approach is changing: not because the previous team did not care, but because better equipment and better understanding of manual handling risk are now available. The message should be simple. Staff are there to practise the evacuation role, not to become the person being dragged.

The first practical step is to stop high-risk staff-as-patient exercises immediately, especially stair descents and repeated pulls along corridors. The second is to review the fire drill risk assessment and evacuation equipment training records. The third is to source suitable manikins or arrange an external drill provider who brings them. The fourth is to brief managers so that the new method is applied consistently across day, evening and night staff.

There should also be a short review of evacuation equipment. Training should not wear out the only equipment needed for a real emergency. Some centres use separate training sheets or provider-supplied equipment for drills, while keeping operational equipment checked, clean and ready. Whatever method is chosen, staff should still practise with equipment that is sufficiently similar to the equipment they would use in an emergency.

Provider and Training Provider Responsibilities

The registered provider and person in charge should set a clear rule: no staff member or resident is to be used as a live load for assisted evacuation practice unless a competent risk assessment specifically justifies it. In most cases, that justification will not exist because safer alternatives are available.

Training providers should be able to explain their method before they arrive. They should use suitable manikins, understand people moving and handling principles, work within the centre's evacuation strategy, provide written risk controls, keep group sizes realistic and document the drill properly. A provider who insists that staff must act as patients because that is how they have always done it should be challenged.

Phoenix STS provides compartment fire evacuation drills using rescue manikins, smoke simulation where appropriate, timed observations and written reports. We also provide evacuation equipment training for staff who need practical competence with ski sheets, evacuation pads, chairs and other aids.

Frequently Asked Questions

Does HIQA require staff to be used as practice patients?

No. Regulation 28 requires suitable training, fire drills and awareness of the fire procedure. HIQA's handbook expects realistic centre-specific drills, but it does not require staff to be used as the evacuation load. Safer methods, including rescue manikins, can provide better evidence.

Can residents take part in fire drills?

Residents can be involved so far as reasonably practicable and where it is safe and appropriate. That may include alarm familiarisation, route awareness or supported participation. Residents with reduced mobility or high support needs should not be used simply to make a drill look realistic.

Why are manikins better than staff?

Manikins remove avoidable injury risk to staff and provide a more honest handling challenge because they do not assist the movement. They can also be used repeatedly and placed in scenarios that would be unsuitable for live participants.

Should every drill be timed?

Not every awareness exercise needs to be a timed compartment evacuation, but providers should include timed drills where evacuation performance is being tested. The time should be interpreted with the fire strategy, resident dependency, staffing level and compartment layout in mind.

How often should healthcare fire drills be carried out?

Regulation 28 refers to suitable intervals. HIQA's handbook says drills should be carried out during different shifts and should test whether procedures work with minimum staffing, usually at night. Frequency should be risk-based, with extra drills where the drill shows problems, staff turnover is high or the centre changes.

Contact Phoenix STS

For safer healthcare fire drills, evacuation equipment training or a review of your current drill programme, contact Phoenix STS on 043 334 9611 or use the Phoenix STS contact page.

This article is for general information only and is not legal advice. Fire drill arrangements should be based on the centre's fire risk assessment, resident profile, evacuation strategy, staffing levels and competent advice.