Utrymning vid brand på rättspsykiatriska enheter i Sverige : Med fokus på personalens säkerhet

Sammanfattning

A forensic psychiatric unit is a care facility where patients have been convicted in court. If a person commits a crime and has a mental disability, the person can be sentenced to forensic psychiatric care instead of the prison. Forensic psychiatry can be provided as outpatient or inpatient care. The report focuses on inpatient care as it is these patients who are locked up in the units. The purpose of this work was to highlight the risks that the staff can be exposed to when evacuating in the event of a fire. The questions that formed the core of the work were linked to whether fire protection at the various units were sufficient, whether Boverket’s building regulations had shortcomings regarding this topic, whether the staff were sufficiently prepared if they must help patients evacuate and develop some suggestions for measures that can increase safety. The report was limited to forensic psychiatric units in Sweden, and the safety of the staff was prioritized. The work began with study visits to a forensic psychiatric unit and a fire department. This was followed by a literature review and, finally, two questionnaire surveys: one in which 70 employees within forensic psychiatry participated, and one in which representatives from six different fire and rescue services participated. Since there were very few studies that have been done on this subject, the literature study had to be broadened and include international studies and prisons where people also are locked up. The articles and books that were included in the study have mainly been found through the databases that LTU (Luleå University of Technology) and Halmstad University have, in addition, DiVA (Digital Scientific Archive) and LTU's library have been used. These sources were then reviewed to check the credibility of the authors as well as the legitimacy of the texts. The literature study highlighted several risk factors regarding the safety of the staff during an evacuation. These include the patients' mental state, the patients' ability to lock their rooms, inadequate routines, the function of the elevators in the event of a fire, internal alarm systems, locked doors and access to keys. In addition, studies have shown that the frequency of fires is higher within forensic psychiatric care compared to other healthcare services in Sweden. Patients' mental states can vary greatly and quickly, which means that it is not possible to predict how patients will act during an evacuation. During previous evacuations, patients have acted violently while others have been unaffected and refused to evacuate. This means that staff can be exposed to physical violence and extended evacuation times. Deficient routines and poor information regarding routines in the event of a fire have proven to be a systematic error in several units in Sweden. Not all staff have undergone the training that the workplace is supposed to provide, and there are staff who do not know what is expected of them in the event of a fire. This has led to internal alarm systems being used incorrectly during previous fires and the use of extinguishing equipment has taken longer than expected and in one reported case not being used at all. Staff and patients have also taken lifts that caused them to get stuck in a smoke-filled area as a result of the staff lacking knowledge of the lifts' safety functions in the event of a fire. A patient died during the fire at Sankt Sigfrid's Hospital because of the staff failing to unlock an escape route. In addition to this, patients can lock their own rooms from the inside. The staff can unlock these doors, but if the patient holds the lever on the inside, it can make it difficult for the staff and the evacuation time can be extended. The survey, which was conducted with the help of 70 employees at various forensic psychiatric units in Sweden, highlighted several uncertainties. In addition to the fact that not everyone had knowledge of what their responsibilities were during an evacuation, how the extinguishing equipment works and what the evacuation strategy looks like, the majority of the participants also answered that the patients' mental state can complicate the process of evacuation. A question was also included where the staff themselves could write about the risks and challenges they can imagine arising during an evacuation. These answers reflect what reality looks like in these units, what uncertainties exists and clarify how much impact the patients' varying mental states have. The responses from the survey that were sent to emergency services that are expected to perform interventions in forensic psychiatric units verified the uncertainty that exists in forensic psychiatry. For example, one employee replied that the staff should not help the patients evacuate, the emergency services belonging to the specific unit replied that the staff should help. The literature study showed that different units in Sweden have had deficiencies regarding fire protection, however, most have been rectified after various incidents have highlighted the deficiencies. These buildings are designed using analytical dimensioning in accordance with the requirements set by Boverket. This means that all units have different solutions regarding fire protection, and these solutions place different demands on how the staff at the units should act during a possible evacuation. Some of the report's suggestions on how to increase the safety of staff during an evacuation: Mandatory training for all employees before their first day at the workplace, these should include fire extinguishing equipment and evacuation strategies. Demands for a better flow of information between the various parties who design the building and those who will work in the building. Increase staff safety regarding violent patients by, for example, introducing batons that staff can use in self-defense purposes after they have undergone training on how to use them correctly and safely. This is mainly during an evacuation when the security measures, assault alarms and guards are not guaranteed. Smoke detectors in all areas and remote-controlled sprinkler system. In order to create the safe workplace that the law requires, more analysis of staff safety in the event of a fire in forensic psychiatric units must be carried out. In addition, safety measures will be introduced to ensure that all employees in forensic psychiatry, regardless of where in the country, feel safe in the workplace.