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The station nightclub fire: Revisiting the lessons

mark handler

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THE STATION NIGHTCLUB FIRE: REVISITING THE LESSONS

http://www.fireengineering.com/articles/print/volume-165/issue-1/features/station-nightclub-fire-revisiting-lessons-full.html

On February 20, 2003, in West Warwick, Rhode Island, the fourth deadliest nightclub fire in United States history occurred in The Station nightclub. More than two-thirds of the 462 people in attendance were either killed or injured (100 dead, 230 injured). A live band that was using fireworks as part of its act ignited foam insulation that had been installed around and over the stage. The fire department was notified about 40 seconds after the fire was ignited and arrived on scene in less than five minutes. In that short time frame, fire had engulfed the club, and fire was showing through the roof. The damage was done.

Before the fire had cooled, the investigations began. The National Institute of Standards and Technology (NIST) and the National Fire Protection Association (NFPA) as well as state and local agencies conducted in-depth analyses of the fire, the evacuation, and the processes that may have failed to protect the concertgoers that night. This article will review some of the lessons learned from this event and the ensuing investigations. We'll also explore actions that have been taken since the fire to avoid such a disaster in the future.

How could this many people die in a building this small (less than 4,500 square feet) where the longest distance to an exit was less than 60 feet? Was there a delay in notifying the crowd of the fire or a delay in the crowd's reaction? Were there problems with the egress system that prevented escape? Did the materials that ignited burn so quickly that people didn't have time to exit the building? As with most disasters, there is no single answer. Rather, there was a series of breakdowns that resulted in this tragic loss of lives.

In response to these issues, NIST conducted an in-depth investigation including two real scale mockup fire experiments of the platform area, which was about 20 percent of the total area of the building. According to NIST, there were three overarching reasons for the large loss of life, which follow (with each cause's code issues).

1. Hazardous mix of building contents. This fire's ignition resulted from pyrotechnics being used in close proximity to polyurethane foam, which was attached to the walls and ceiling around the stage. It is widely believed that this foam was purchased by one of the building owners more than two years before the fire to be used around the stage as sound-deadening material. The purchasing documents indicate that the foam was not treated with any fire retardant; whether treated foam would have changed the outcome is debatable. The fire consumed the foam quickly, generating large quantities of dense black smoke. As the foam burned, it spread fire to the wood-frame structure; it became a "typical" building fire. The speed at which the fire burned was a significant factor in the large loss of life and can be primarily attributed to the pyrotechnics and the polyurethane foam.

The code issues. The use of untreated polyurethane foam was and continues to be a violation of NFPA and International Code Council (ICC) model codes as well as the regulations in use in Rhode Island at the time of the fire. The pyrotechnics used that night were not permitted by the local fire department or the fire marshal's office; this, too, was counter to model codes and the state regulations. Had the club adhered to the codes in effect at the time of the fire, neither the pyrotechnics nor the polyurethane foam would have been used. Without these factors, the fire would not have occurred.

The fact that the code was violated for more than two years indicates an overall lack of enforcement, which isn't unique to one jurisdiction; it's an issue in many communities around the United States. For regulations to be effective, there must be a viable enforcement program in place. This includes adequate staffing, training, and support. Adopting the latest model codes is a good start, but without well-trained staff in sufficient numbers to conduct regular inspections, the codes become just another book on the shelf. Without support from elected and appointed leaders in the community, the inspector becomes a hollow voice.

2. The inadequate capability to suppress the fire during its early stage of growth. A basic premise of fire prevention is the early suppression and containment of unintentional fires. For The Station nightclub fire, the only suppression capability was portable fire extinguishers. Unfortunately, the extinguishers were not in a location readily available to staff or patrons who might have been able to extinguish the fire or slow its growth.

Had a sprinkler system been installed, it certainly would have provided significant time for the crowd to exit the building and, according to NIST experiments, would have maintained a tenable environment in the club. The NIST experiments used quick-response sprinkler heads; three of them activated less than 40 seconds after ignition. The flowing sprinklers lowered the temperature in the room and prevented any significant fire growth.

It's important to note that the fire department was on scene within 5½ minutes of ignition. Even with that outstanding response time, there was little they could do to slow the fire. Because of the rapid fire growth, the only efficient ways to effect early suppression are actions by automatic sprinklers and the staff or patrons using portable fire extinguishers.

The code issues. At the time of the fire, both the International Building Code and the NFPA Building Code would have required the installation of an automatic sprinkler system for new construction because the occupant load exceeded 300. However, there was no requirement to retrofit existing occupancies of this size and type in either model code. As a result of The Station nightclub fire, the NFPA changed its requirements for new construction to mandate automatic sprinkler systems in all nightclubs; bars with live entertainment; and assemblies with festival seating, dance halls, and discotheques. They also changed the requirements for existing buildings to require automatic sprinklers to be installed in buildings with those venues where the occupant load exceeds 100. The ICC response was to reduce the threshold for requiring sprinkler systems in assembly occupancies similar to The Station nightclub to those with an occupant load of 100 or with an assembly area of 5,000 square feet or more. Because the two codes use different language to describe these occupancies, it's difficult to draw a direct comparison, but both organizations took quick action to address the issue.

3. The inability of the exits to handle all of the occupants in the short time available. The Station nightclub had three viable exits; the main exit consisted of two double doors to the exterior. However, patrons had to travel through a single three-foot exit door to get to the exits. In addition to the main exit, there were two other doors, each three feet wide, leading to stairs on the building's exterior. There was also a door leading outside from the kitchen, but its presence wasn't obvious to the club patrons, and none of the model codes would recognize it as an exit.

The exits' capacities were calculated to be about 420 persons (not including the kitchen exit). Although this was slightly less than the actual number of persons in the club at the time of the fire, it's likely that far more people would have escaped under less extreme circumstances. The rate of fire growth and smoke production from this fire isn't normally contemplated when determining egress requirements for this type of occupancy. However, NIST's postfire analysis determined that around two-thirds of the patrons attempted to escape through the main exits.
 
The code issues. Historically, model codes require the main exit in assemblies to be designed to accommodate half of the occupant load because most people will attempt to use the same route to exit a building as they used to enter. For The Station nightclub fire, this is where the crush occurred. Patrons attempting to escape the club became jammed in the doorway leading to the exterior, preventing others from getting out. Many of the fatalities occurred at or near the main exit.

There is no indication that any instructions were given to the patrons about additional available exits. If the crowd was aware of the other exits, it's likely that far more people would have survived, and fewer would have been injured trying to escape. Many who couldn't get to the main exit crashed through the glass in an adjacent sun room to escape, causing minor to severe injuries from the glass.

The code issues. The analysis of this fire is consistent with historical information from other emergencies and social science: People tend to go out of an unfamiliar facility the same way they came in. Although model codes recognize this by requiring the main exit (the main entrance) to be sized to accommodate a minimum of half of a facility's design occupant load, this may not be enough. NIST recommended that the model code organizations change their requirements to mandate the main exit be designed to accommodate two-thirds of the occupant load. Thus far, that recommendation hasn't been implemented.

There are, however, other methods to address the situation. The NFPA and ICC inserted requirements in their documents to mandate trained crowd managers for public assembly occupancies. These individuals are expected to point out secondary exits, guide the crowd to the nearest exit, and maintain order. If the training has been developed through a valid process including a job task analysis using competent subject matter experts, the crowd managers should be able to prevent such a catastrophe in the future. The National Association of State Fire Marshals has endorsed such a training program; it is scheduled to become available in February 2012.

The NFPA also mandates training for staff at assembly occupancies in the use of portable fire extinguishers and other fire suppression equipment. This is because the earlier a fire is extinguished, the less damage will occur. For small incipient fires, fire extinguishers can mitigate the hazard and avoid any substantial loss.

Although The Station nightclub fire may not be the last fire disaster in our country, we must take advantage of the lessons learned from this fire and its ensuing investigations. Failure to act on these lessons will place the public at unnecessary risk, and another community will suffer an extraordinary and totally avoidable loss. Look around your jurisdiction and judge your progress:

Has your jurisdiction adopted the latest model codes? If so, are the latest requirements intact, or have special interests avoided certain obligations through local amendments?

Is your building department staffed with well-trained plan review and inspection personnel?

Is your fire prevention office staffed with enough well-trained inspectors?

Does your elected leadership support the public safety mission, including plan review and inspection?

No community deserves to suffer the effects of a disaster like The Station nightclub fire. It is up to those of us in the fire service to remain vigilant, apply the lessons learned, and remind our community members when the memories of such a catastrophe begin to fade. Only then can we avoid another tragedy like this one.
 
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