On the 16 April 2021, a devastating fire wreaked havoc at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). What started as a small, localized fire in a storeroom soon spread into a raging runaway storm which engulfed large areas of the Level 3–4 parking areas of the green and orange blocks of the hospital. Poor maintenance of infrastructure, an ageing building, theft of fire hydrant couplings together with forces of nature meant the fire spread.
Billowing plumes of black toxic smoke soon engulfed much of the hospital. Unstable infrastructure and a fire that was difficult to control necessitated the activation of a much dreaded “Code Red” of the disaster management plan. As the hospital at the time had over 1000 patients admitted and large parts of the hospital were affected by the smoke, a call to evacuate the entire facility was made at about 7 pm that Friday night. The organized chaos which ensued tested our most detailed plans and resources.
Evacuation of patients and staff from areas most adjacent to the areas of the fire, which included high care, ICU and psychiatry, was fraught with both danger and anxiety for patient safety. Staff of CMJAH – doctors, nurses, management and support staff – worked tirelessly throughout the night to move patients from each successive ward to the main entrance of the hospital and then to various hospitals across the Gauteng Province. The challenge of doing this during the night added to the challenge of safely accommodating patients in other facilities. Many CEOs, clinical managers and senior clinicians from hospitals in Gauteng were woken up during the night to assist in accommodating patients who were arriving at their hospitals by ambulance throughout the night and the next day.
The movement and accommodation of patients from CMJAH was challenged by negative sentiments of additional workloads being “dumped” onto already overworked, short-staffed hospitals. However, the redeployment of all levels of CMJAH staff from Saturday 17 April to every hospital that had accepted our patients assisted in easing the tensions.
Throughout the night and the next day patients were moved out of CMJAH. This could not have been accomplished without help from the public and private EMS services – Joburg Metro, Netcare 911, ER 24, Tshwane District EMS, Saaberie Christy Ambulance, St Johns Ambulance and many others – which arrived on the scene voluntarily and offered services pro deo for the entire duration of the evacuation. Yet another demonstration of public–private partnership engagement benefitted all our patients. In addition, volunteers who arrived throughout the night with much needed water and snacks for patients and staff once again demonstrated the Ubuntu of the South African public to help unselfishly when most needed.
The successful evacuation of 821 patients, the remainder of the patients who had been admitted having been discharged during the night, from CMJAH in a 24-h period without a single loss of life, was no mean feat and is testament to the resilience, dedication and hard work of all involved.
The “postmortem meeting” on the following day and subsequent days allowed us to reflect on and highlight many challenges and issues which need to be addressed going forward:
The status of fire safety and adherence to compliance – Many hospitals were built more than 30 years ago, and the fire compliance regulations have changed substantially since then, raising challenges with current compliance requirements. This is exacerbated by limited maintenance, the theft of hydrant couplings and fire extinguishers, fire exits being blocked by broken equipment and furniture, and insufficient early warning systems.
The need for on-going structural repair and maintenance to ensure facilities are safe for both staff and patients.
The need for on-going teaching and training on disaster management especially fire-training, first aid and evacuation. Unfortunately, COVID-19 has largely affected the plans for training, teaching and drills to prepare staff. This is mandated by law and needs to be escalated to be a priority throughout Gauteng Province, especially as all health-care facilities have ageing infrastructure. Online resources need to be utilized to ensure that these requirements are met at least from a training perspective.
Communication needs to be improved across all levels, including within the hospital, between hospitals, departments and importantly to the public.
The mental strain on all staff. Being away from your hospital “family” and the support structures in every unit has meant that staff feel left out in the cold. Furthermore, in the aftermath of the COVID pandemic stress and the threat of the third wave, the emotional stress for staff members cannot be underestimated. Occupational health services play a critical role in disaster situations and debriefing should be readily available for all staff.
The impact of losing a major teaching platform for both undergraduate and postgraduate teaching. While all undergraduate students have been accommodated at other platforms, this has highlighted the need for strengthening the extended teaching platform and not be over reliant on the three major teaching hospitals. It has also brought into the conversation the possibility of using private facilities for teaching and training, particularly for certain levels of postgraduate training and blended learning for the undergraduate level.
The loss of highly specialized clinical services, particularly oncology, transplantation and dialysis as well as services such as ICU, neonatal and maternal care has placed an enormous strain on similar capacity that is available in Gauteng. Therefore, the need for all academic hospitals in Gauteng to develop highly specialized and sub-specialist units is growing exponentially.
On a positive note, various opportunities have emerged from this disaster. The evacuation of staff and patients to hospitals within the various clusters has meant that services in some district and regional level hospitals are being reviewed and supported, hopefully with a view that this continues beyond the “fire”. An example is a review of the Hillbrow Community Health Center, with the referral of patients to appropriate levels of care to regional and district hospitals rather than to tertiary and central hospitals. It has also highlighted the shortfalls and support needed at these facilities if they are to function effectively. Furthermore, it is hoped that the silo mentality which many of us work under (both from a specialty and general hospital point of view) will be somewhat dissolved by working together for the betterment of all our patients – after all they are ALL our patients and not hospital specific.
We have realized that all training plans are just plans, until they are tested in a real-life situation. We will never know how effective they are until that “Code Red” is called and they have to be placed into action.
Finally, this is only the beginning of the aftermath of the fire. As of writing, CMJAH has still not opened its doors to patients. Much uncertainty lies ahead ….