The number of long-term care hospitals for the elderly is increasing along with the growing number of the elderly population in South Korea(1). Long-term care hospitals for the elderly are spaces where the elderly and patients with impaired mobility can live, but such places face a high risk of great damage in the event of a fire, as revealed in several recent accident cases. The fire that engulfed the Miryang Sejong Hospital in January 2018 led to the largest number of casualties (death: 47; injuries: 143) caused by fire in long-term care hospitals for the elderly in South Korea. This large number of casualties can be attributed to problems(2) such as inadequate management of fire preventive blocks like fire doors and vertical penetrations, large number of patients unable to evacuate by themselves, delayed reporting to 119, and insufficient personnel to manage critically ill patients. This trend has been observed even more recently, for example, when fire struck Gimpo Nursing Hospital in 2019 (death: 2; injured: 47) and Yoonho Hospital in Goheung in 2020 (dead: 3; injured: 27).

Current institutional measures to ensure fire safety in long-term care hospitals for the elderly include consent for firefighting at the time of issuing building permits, self-inspection of firefighting facilities, and a mandatory certification system for nursing hospitals. However, existing systems focus only on fire extinguishing equipment and training plan inspections; that is, there is no evaluation standard for evacuation plans, the number of persons assisting in evacuation, evacuation and fire- prevention facilities, responses to fire, firefighting activities, preparation of fire safety manuals, firefighting education, and firefighting training specific to long-term care hospitals for the elderly.

To solve the above problems, this study tries to establish fire safety evaluation standards and present fire safety evaluation indices for long-term care hospitals for the elderly. The study focuses on the importance and priorities of the fire safety evaluation items for long-term care hospitals for the elderly.

This study analyzes the importance and priorities of the fire safety evaluation items and presents fire safety evaluation standards (draft) for long-term care hospitals for the elderly. For this, the study first derives the structure of the analytic hierarchy process (AHP) survey from previous studies related to fire safety in long-term care hospitals for the elderly(2-14), literature reviews(15), and a review of special fire investigation items (Table 1). An AHP survey then questions 44 experts on firefighting (professors of firefighting-/architecture-related departments, firefighting officials, and firefighting engineers, managers, and architects) to assess the importance and priorities of the fire safety evaluation items for long-term care hospitals for the elderly. Finally, based on the AHP questionnaire survey results, the study presents fire safety evaluation indices for long-term care hospitals for the elderly.

AHP analysis follows a problem-solving model. It constructs a hierarchical structure based on major and detailed factors of problems and calculates the importance of each item through pairwise comparison depending on the evaluator’s knowledge, experience, intuition, subjective judgment, and mathematical processing techniques(20-22). AHP analysis generally adopts the following procedure in five steps: Step 1: hierarchical structure design; Step 2: pairwise comparison between individual elements through surveys; Step 3: calculation of relative importance; Step 4: consistency check; and Step 5: determination of relative weights of individual elements.

For AHP analysis, the hierarchical structure of the problem to be solved should first be designed (Step 1). To this end, this study derives the elements related to fire safety evaluation standards for long-term care hospitals for the elderly by examining the data of previous studies and the literature, and reviewing the special fire investigation items for designing the AHP hierarchical structure and enhancing the completion of the hierarchical structure.

Finally, the AHP hierarchy is divided into 4 upper layer items and 15 lower layer items (see Table 2 and Figure 1). The four upper layer items are “refuge and fire prevention plans for evacuation” (A), “results of inspection of firefighting facility operation” (B), “possibility of fire-extinguishing activities of the fire brigade” (C), and “fire safety management and prevention” (D). The lower layer of the refuge and fire prevention plans for evacuation (A) consists of four items: “critically ill patients’ evacuation support plan” (A.1), “designation of evacuation areas in each floor and utilization plan” (A.2), and “adequacy of establishment of the refuge path plan” (A.3). The lower layer of “results of inspection of firefighting facility operation” (B) consists of four items: “results of inspection of the operation of the automatic fire detection system” (B.1), “results of inspection of the operation of indoor fire hydrants” (B.2), “results of inspection of the operation of the automatic fire extinguishing equipment (sprinkler, etc.)” (B.3), and “evacuation instrument inspection and utilization plan” (B.4). The lower layer of the “possibility of fire-extinguishing activities of the fire brigade” (C) consists of four sub-items: “securing a firefighting mobilization route” (C.1), “fire engine mobilization time” (C.2), “fire brigade activity space around the building” (C.3), and “possibility of expansion of combustion to adjacent buildings” (C.4). Finally, the lower layer of “fire safety management and prevention” (D) consists of three sub-items: “writing of and education on a customized fire response manual” (D.1), “regular fire suppression and evacuation drills” (D.2), and “inspection of facilities on firefighting, construction, electricity, etc.” (D.3).

Individual elements are compared pairwise through expert surveys (Step 2). The survey results are then analyzed through the following steps (Steps 3-5).

First, a pairwise comparison matrix A (preference of item j over item i) based on the questionnaire survey is obtained, and W (column vector), the relative importance of matrix A, is calculated through λ_max, the largest value among the characteristic equations (Step 3). The consistency ratio is calculated through consistency verification using λ_max. Values whose consistency ratios exceed 0.2 are not analyzed (Step 4). Finally, the relative weights of individual elements are determined (Step 5).

The survey uses methods such as e-mail, SNS, and in-person questionnaires. All respondents participating in the survey were provided detailed explanations about the purpose of the survey, with an outline of the AHP and the derived AHP hierarchy and items. Following the questionnaire survey, 49 sheets were collected, from which 44 were considered for data analysis, excluding 5 whose consistency ratios exceeded 0.2.

The survey respondents’ personal information is provided in Table 2. By occupational group, 9 professors of firefighting-/ architecture-related departments, 16 firefighters, and 19 firefighting engineers/managers and architects participated in the survey. Most of the survey respondents were experts in various fields with work experience of not less than 10 years.