The fire alarm is blaring in my ears in the ICU. I make eye contact with my resident, who has a blank stare on her face. It seems as if we are both saying, “I don’t see or smell any fire.” I return my attention to my computer within a second to finish my note, annoyed that the alarm is so deafening and the flashing lights are making me nauseous. I don’t even consciously consider the fact that there could be an actual fire — these alarms go off all the time with no fire in sight. Besides, I am currently in the ICU, so if there was a true fire we would receive instructions on what to do, right?
This is the current reality of fire alarms in our hospitals. We hear them and see them, but we don’t react to them. The desensitization to these alarms that could potentially save our lives and the lives of our patients is a critical public health issue. In order to restore the purpose of fire alarms, let’s first consider why we often don’t react to them in the first place, both in and outside the hospital.
Hospital fires can be caused by storage of flammable chemicals, heat-producing equipment, or defective electric wiring. The U.S. Fire Administration reported that in 2014-2016, there were approximately 5,800 medical facility fires reported in the country. These fires caused an estimated five deaths, 150 injuries, and $56 million in property loss per year. Yet, I was not able to track down data on the number of fires in medical facilities in more recent years; has comprehensive nationwide data not been published in the last 8 years? Are these fires not seen as enough of a threat? Are people responding appropriately? If my recent experience showed me anything, the answer to that last question is a definite “no.”
According to the Society of Fire Protection Engineers, anecdotal evidence suggests people often fail to respond to fire alarms, especially in facilities other than private homes. There are four main reasons for this: failure to see the signal as an alarm; unaware of the proper response; loss of confidence in the system because of the nuisance of alarms; and failure to hear the signal.
The reason that stands out the most to me is the loss of confidence in the system due to the nuisance of alarms, especially in the hospital. Hospital staff are exposed to a high volume of alarms and alerts on a daily basis — from codes or announcements over the speaker to beeping from malfunctioning IV drips or patient bed alarms. One study at Johns Hopkins found that, on average, there were 350 alerts per bed per day; in one ICU there were 771 alerts per bed per day. No wonder we feel these alarms are a nuisance.
Alarm fatigue is a scary issue. But why does this happen? Much research has been conducted on alarm fatigue in the hospital setting and the impact on patient safety. According to one study, 72% to 99% of alarms going off in the hospital setting are false. With an incredibly high number of false alarms going off all the time, healthcare professionals may feel sensory overload and then fail to react to these alarms. This is a similar situation with fire alarms in other settings as well — the greater the frequency with which they go off, the more urgency declines and people may fail to react.
Current solutions to this issue are limited. Some researchers suggest improving the accuracy of the sensors to decrease the amount of false alarms, or programming alarm technology to be able to discriminate when there truly is a fire, such as with a temperature change or actual smoke. These are hopeful steps we can take to limit the amount of false alarms and decrease sensitization in the hospital.
To be sure, these proposed fire alarm adjustments won’t fix all desensitization. There would have to be a massive cultural shift with education, funding, and urgency to change current attitudes towards fire alarms. Some would argue it may not even be worth it due to the much lower volume of medical facility fires today compared to decades or centuries ago. But if these updates have the potential to save just a few lives, it’s worth the effort.
So next time you hear a fire alarm in the hospital, please think twice before you ignore it. It may be a false alarm, and it may be just one among many alarms you’ve heard that day. But take an extra 30 seconds to assess the scene, and make sure you truly don’t smell smoke or sense any fire. Lastly, please talk about this issue to create urgency — we must change the current “desensitization to alarms” culture for your own safety and that of your patients.
Rachael Chait is an MD/MPH candidate in the University of Miami Miller School of Medicine class of 2025.
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