Hospital fire safety in India: Challenges, gaps, and role of RegTech

The recent report indicates a significant number of hospitals operate without valid fire safety clearance. What does this reveal about fire safety compliance across India’s public healthcare institutions?

The recent fire incident exposes systemic failures including poor enforcement capacity, the way the law is written and enforced, there is a huge difference, regulatory capacity is highly restrained. The practice is often seen as a liability rather than practice.  in fire safety compliance within India’s public healthcare institutions. The problem begins with the hospitals bypassing, in part or full, the norms, codes, and practices relating to fire safety. Despite national guidelines from the National Building Code (NBC) and the National Disaster Management Authority (NDMA), which mandate features like open safety spaces, dedicated staircases, evacuation procedures and regular drills, enforcement remains inconsistent. This leads to serious hazards of (a) ever-present triggers of likely fires; (b) difficulties in the evacuation of patients and staff in the event of fires; (c) presence of substances used in building construction, furnishings, and hospital practices in a manner that fire gets escalated and aggravated; (d) delays in beginning the firefighting measures; and (e) discoordination and lapses in the course of firefighting and evacuation.

Data scrounges around these issues, cracking open the crisis in healthcare facilities. A 2021 survey of  484 government hospitals in Maharashtra found that 90% lack fire NOCs, with over 80% never undergoing fire safety audits. A data set presented to Karnataka’s legislative council showed that only 14 of the 2,878 government hospitals and 315 of the 5,850 private hospitals in the state abide by fire safety norms. In Nagpur, 165 of the registered 504 hospitals operate without mandatory fire NOCs, while 157 lack fire safety arrangements entirely. 

Nationally, an NDMC study (2010-2019) found 50% of hospital fires in government hospitals and 49% in private facilities, with 50% of hospitals non-compliant with safety practices. The study revealed that electric short circuits cause 78% of hospital fires, with air conditioners being the most common source. This pattern persists because fire prevention devices are frequently installed only to obtain operational permission with little follow-up to maintain functionality.

Current regulations press on compliance obligations at the construction/licensing stage rather than continuous monitoring. The National Building Code focuses on structural fire protection and initial certification, but lacks effective provisions for periodic audits and ongoing complaints verification. While NBC 2016 recommends periodical fire safety inspections by key personnel, there are no clear-cut provisions in fire safety legislation regarding the scope, objectives, methodology and periodicity of fire safety.

The 2025 regulatory landscape is, however, moving towards proactive approaches. The NBC 2016 revision includes new mandates and periodic safety certificates and IoT-based monitoring, while NDMA guidelines now require annual fire safety inspections by an accredited professional. Again, the lack of implementation haunts the intent behind the policy, as evidenced by Delhi’s  78 hospital fires from January 2023 to May 2025 in hospitals and nursing homes. Without mandatory third-party audits and stricter penalties, such tragedies will persist, eroding the trust of people in the country’s healthcare systems. 

Why is fire safety compliance still treated as a one-time, reactive process in hospitals rather than a continuous, proactive system?

One of the major reasons why fire-safety compliance is ill-treated in India is that it remains reactive rather than proactive. Actions are taken post-fatal incidents. There is laxity in the surveillance system, which fails to serve renewal notices upon hospitals when the hospital’s license to function has expired. The lack of regulatory capacity in the country ensuring adequate compliance faces a grim dearth. This has resulted in hospitals continuing without auditing and renovating their safety equipment and practices, eventually leading to disastrous fires.

Applicable Regulations and Legislative Framework:

Hospitals in India are governed by a comprehensive set of statutory regulations and legislations that ensure safety, quality, and ethical compliance in healthcare operations. These include the Atomic Energy Act, 1962 and the Atomic Energy (Radiation Protection) Rules, 2004 (covering radiation safety and monitoring), the Environment (Protection) Act, 1986 and Bio-Medical Waste Management Rules, 2016 (mandating segregation, disposal, and reporting of biomedical waste), and the Solid Waste Management Rules, 2016 (for waste segregation). Fire safety and emergency preparedness are governed by the Bureau of Indian Standards Act, 2016 along with the Code of Practice for Selection, Installation and Maintenance of First-Aid Fire Extinguishers. Compliance is also mandated under the Narcotic Drugs and Psychotropic Substances Act, 1985 (for narcotics control and reporting), the Indian Pharmacy Act, 1948 and Pharmacy Practice Regulations, 2015 (for documentation and patient record maintenance), the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994 and its Rules (for genetic counselling and diagnostic procedures), and the Indian Medical Council Act, 1956 along with its Professional Conduct Regulations, 2002 (for maintaining medical records, certificates, and public health notifications).

Mandatory Licenses, Approvals, and Registrations:

Hospitals are required to obtain multiple approvals before and during operations to ensure compliance with sector-specific laws. Key approvals include NOC for radiotherapy equipment and commissioning approval from the Atomic Energy Regulatory Board (AERB) before energising radiological equipment; licence/registration for diagnostic X-ray equipment; authorisation for procurement and use of radioactive sources; and approval of a Radiological Safety Officer. Additionally, registration is required under the Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994; registration of pharmacists under the Pharmacy Act, 1948; and certificate of recognition for storing and using narcotic or psychotropic substances under the NDPS Act, 1985. Hospitals must also obtain a retail/wholesale drug licence and blood bank licence under the Drugs and Cosmetics Act, 1940 and Rules, 1945, along with NOC from the State Blood Transfusion Council (SBTC) for operating a blood storage centre. Facilities engaging in organ or tissue transplants must secure registration under the Transplantation of Human Organs Act, 1994, while those providing mental healthcare services must hold a licence under the Mental Healthcare Act, 2017 and State Mental Health Authority Rules, 2018.

Fire services in the country are state-specific and municipal, leading to varying enforcement of NABH and NDMA guidelines. Hospitals often secure initial Fire No-Objection Certificates (NOCs) as a ‘one-time’ formality but neglect ongoing audits. The NBC 2016 emphasises structural protections at the construction stage but lacks binding provisions for periodic inspections, scope or frequency, despite key recommendations for key personnel oversight. This tick-box mentality views compliance as a licensing hurdle rather than a lifecycle commitment. 

Financial and operational pressures in resource-strapped public and private hospitals prioritise patient care over maintenance. Top management often ignores staff pleas for upgrades like alarms or drills, as reported in an NDMA study. Proactive measures such as quarterly drills or electrical overhauls are deprioritised amid budget shortfalls, with smaller facilities citing high retrofit costs as a barrier. 

What are the most common fire safety gaps observed in hospitals, such as blocked exits, non-functional alarms, or overloaded electrical circuits, and how do they endanger patients, visitors, and healthcare staff?

The most common causes of fires in hospitals include the presence of combustible materials like cotton beddings, sanitisers, oxygen pipeline connections in patient rooms and operation theatres and chemicals in laboratories. Faulty electrical wiring or frayed wires often cause electrical short circuits in hospitals. In modern constructions, these wires are concealed, making it difficult to track the source of the fire.

Apart from these, below mentioned problems are the most significant when looking back on recurring reasons for such incidents:

Physical Infrastructure Deficiencies

• Blocked and Inadequate Exits: Many investigations following recent incidents found shoes and people blocking NICU fire exits, with one gate locked entirely. Exit routes obstructed by two-wheelers, sacks, and equipment prevent seamless emergency egress. The Murshidabad Medical College fire in 2016, which killed 50 people, occurred partly because the main emergency exit gate was locked.​
• Non-Functional Fire Detection and Alarm Systems: Hospitals frequently lack automatic detection systems on all floors. Fire alarms and water sprinklers are often non-functional, with equipment not serviced regularly. 
• Inadequate Fire Suppression Systems: Missing automatic sprinkler systems in all building areas remain common. Fire hydrant lines are sometimes redundant, with insufficient numbers of fire extinguishers or extinguishers past their service dates. One audit in Maharashtra found over 30% of extinguishers past their service date.​
  

Electrical System Hazards

Electrical failures constitute the primary cause of ICU and hospital fires. Common triggers include circuit overload, overheating, aging equipment components, poor connections, loose joints, exposed wires, and socket overload. Faulty electrical wiring or frayed wires cause electrical short circuits, and in modern constructions, concealed wires make it difficult to track fire sources.​

Indiscriminate use of air conditioners, medical equipment, and computers leads to extreme tripping points and wire overloading, with no mandatory inspection of power supply systems in many facilities. Design-related safety codes do not specify the location of oxygen outlets with respect to electrical sockets, creating additional hazards.​

Oxygen-Related Fire Risks

Most critically ill patients require continuous oxygen support, but oxygen-related hospital fires have caused hundreds of deaths worldwide, particularly during the COVID-19 pandemic. As a strong oxidizer, oxygen increases fire risk significantly when its concentration exceeds 23%. Common causes of oxygen cylinder explosions include damaged valves, aging cylinders, cylinder collisions, and leaking pipelines. Any small spark in a high-oxygen environment can quickly ignite fires that are intensified by flammable materials like instruments, chemical reagents, and bedding.​

Staff Training and Preparedness Gaps

Emergency evacuation plans are often absent or not practiced through regular drills. Staff remain inadequately trained on fire extinguisher use and emergency protocols. Even when firefighting equipment is available, lack of staff knowledge renders it ineffective during actual emergencies. The absence of designated fire safety officers in many facilities compounds these challenges.​

As hospitals increasingly adopt RegTech for compliance, what new roles or skill sets are emerging in hospital fire and safety management?

Across sectors, industries are adopting digital compliance tools to stay on the right side of the law. Hospitals, if not already, should resort towards Regulatory Technology for compliance .The following roles/skills can emerge from deploying technology-based compliance management systems:

• Digital Fire Safety Complaints Officer: Beyond traditional fire safety officers, hospitals now require professionals who can manage a digital complaints platform, interpret real-time data analytics and integrate fire safety systems with building management infrastructure.
• IoT-based Safety System Administrator: Professionals who monitor and manage IoT-enabled sensors, smart detectors and connected fire safety devices require an understanding of different platforms used in the fire safety network.
• AI / ML Fire Risk Analysis: Specialists who develop and maintain Artificial Intelligence and machine learning models for predictive fire risk assessment, evacuation duration prediction and real-time set detection, must analyse data patterns to identify risk before fires occur.
• Fire Safety Data Compliance Managers: Individuals responsible for maintaining digital logs should ensure regulatory compliance through software platforms and manage the documentation required by accredited bodies like NABH and other regulatory authorities.

Emergency Response Coordinators with Digital Integration Skills: Professionals who manage command centres integrating fire alarms, public address systems, access control and IoT monitoring for coordinated emergency responses.

How can hospital management teams ensure that staff and facility personnel are effectively trained to use digital fire safety compliance tools?

Hospital management teams must implement comprehensive strategies to train staff and facility personnel on digital fire safety compliance technologies.

Structured Training Program Development

• Needs Analysis and Role-Based Training: Conduct a thorough needs analysis to identify knowledge and skill deficits across different roles. Design customised training modules for clinical staff, facilities personnel, administrative staff, and fire safety officers, recognising that different roles require different levels of technical proficiency.​
• Multi-Modal Learning Approaches: Implement blended learning combining in-person training sessions, online modules, video tutorials, interactive simulations, and hands-on practice with actual equipment. Online fire safety training courses typically take 45-60 minutes and provide CPD accredited certification upon completion.​

Digital Platform Selection and Accessibility

• User-Friendly Interface Design: Select software solutions with clear, simple, and well-organized interfaces that can be easily navigated by users with varying technical competencies. Ensure the platforms adhere to accessibility standards like WCAG (Web Content Accessibility Guidelines) to accommodate individuals with disabilities.​
• Mobile Accessibility: Choose solutions that provide mobile device access, enabling staff to receive notifications, participate in training, and respond to alerts from anywhere in the facility.​
• Implementation Strategies
• Phased Rollout with Pilot Programs: Begin with pilot implementations in specific departments or units before hospital-wide deployment. This allows for system testing, staff feedback collection, and iterative improvements before full-scale adoption.​
• Integration with Existing Systems: Ensure digital fire safety tools integrate seamlessly with existing hospital management systems, electronic health records, and building management platforms to minimize disruption and facilitate adoption.
  

What is the average cost per bed to install fire safety compliance technologies ? Or is there another metric to track this? This is to show that the actual cost of installing such systems is lower than dealing with the consequences of a fire, loss of lives and revenues.

Exact cost per bed varies by hospital size and system complexity but all data show fire safety is relatively inexpensive compared to the cost of a disaster. The cost is not standard owing to the requirements of a facility. However, industry guides estimate basic fire systems at Rs. 50-Rs.250 per square feet. of floor area. On top of that, specific components cost roughly: fire-alarm panels run Rs. 1.2-15 lakh depending upon sophistication and complete sprinkler/supperssion systems might be on the order of Rs. 1.5-25 lakh. Spreading these toals over beds gives perhaps Rs 1-5 lakh per bed at most for a well-equipped hospital. By contrast, building a new hospital often costs Rs. 5-90 lakh per bed, so fire systems add only a few percent to total capex. 

Actual government spending confirms this order of magnitude. In Tamil Nadu, for example, about Rs. 37 crore was spent to upgrade fire-fighting equipment in 34 government medical colleges.The total cost is a fraction of either the hospital’s per-bed construction cost or the losses from a fire. Indeed when a fire strikes, damages to property, compensation and business interruption can run into crores. Jaipur’s government announced Rs. 10 lakh compensation per fatality, not to mention rebuilding costs- a stark contrast to the relatively modest investment required for robust fire-systems in advance. 

How long does it typically take to install such systems and train employees on their proper use and maintenance? Again, this is to disprove the common argument that it would take too much time and effort to put such systems in place.

Hospital administrators argue fire compliance takes too long or disrupts services, but in practice installations and training can proceed quickly if planned. For critical systems (alarms, sprinklers and pumps), a dedicated contractor can usually finish a retrofit or new installation in a few weeks to a few months, depending on size. In fact, after Jaipur’s SMS Hospital fire, municipal auditors gave hospitals just 3 days to fix identified lapses, showing that immediate action is possible. Even complex tasks like rewiring or adding stairwell pressurisation can be phased to minimise downtime. New digital compliance platforms or apps can be deployed rapidly: they often plug into existing networks and require minimal on-site work.

Training is similarly swift. An e-learning module takes just hours per person and live workshops or drills can be run over oa day or two. In practice, hospitals can plan a rollout of new fire safety tools and concurrent staff training over a quarter or two, rather than years. With clear schedules and management support, most hospitals could install the needed systems and train all relevant personnel within 6-12 months.

Modern fire-safety upgrades don’t have to drag on. The common objection that “we are too busy to implement these systems” does not hold up: the downtime is far smaller than the risk of remaining vulnerable to a devastating fire. The international healthcare systems fare much better as they stick to standard compliance practices no matter the cost and time imbibed, if India wants to retain its stature of being the world’s pharmacy with great healthcare facilities, it cannot lose patients to fire-based fatalities.