Code Red: Why Hospitals Are One of the Hardest, and Highest-Stakes, Buildings to Evacuate in Australia
By Dr. Rashid Khan, Founder of EvacTracker
When a fire alarm sounds in an office building, the response, however imperfect, is broadly understood. People leave. They walk to the assembly point. They wait.
When a fire alarm sounds in a hospital, the response is entirely different. And far more dangerous.
Hospitals contain patients who cannot walk, patients who cannot be moved, patients whose lives depend on machinery that cannot be transported, unconscious patients, patients in surgery, patients in the middle of a procedure, and patients in neonatal intensive care units who cannot regulate their own body temperature. They contain oxygen lines and pressurised gases that change the dynamics of fire entirely. They operate twenty-four hours a day, with different staff configurations across every shift. And they are, by their very nature, places where the people most in need of protection are simultaneously the least able to protect themselves.
It is a combination that makes hospital evacuation one of the most complex emergency management challenges in existence. And in Australia, it is a challenge that occurs far more frequently than most people realise.
How Often Do Australian Hospitals Actually Evacuate?
Hospitals in Australia use a standardised emergency code system, and Code Red, the fire response code, is one of the most frequently activated. In large metropolitan hospitals, Code Red activations can occur multiple times per week, the majority of them caused by false alarms from equipment, steam, or cooking activities rather than actual fire. But each activation requires the same initial response: doors mechanism activated, oxygen isolated, staff positioned, patients accounted for.
In the case of a genuine fire requiring partial or full evacuation, the complexity increases dramatically. Unlike commercial buildings, where the question is simply ‘how quickly can we empty the space,’ hospitals must answer a far harder question: ‘which patients can be moved, how, by whom, to where, and in what sequence, while continuing to provide the clinical care that some of them cannot survive without.’
This is not a theoretical challenge. It is one that hospital staff across Australia practise for, plan for, and in some cases, live through.
When Plans Meet Reality
In 2013, a fire broke out at Hasan Sadikin Hospital in Bandung, Indonesia. The blaze tore through a ward housing patients who, due to their medical conditions, could not be moved quickly. More than twenty patients died. The tragedy was not simply the result of a fire; it was the result of what happens when the systems around a hospital cannot respond at the pace and complexity an emergency demands.
In Australia, we have been fortunate not to experience hospital fires of that scale in recent decades. But complacency would be a mistake. Our hospitals face growing pressure: patient volumes are rising, staffing ratios are stretched, and the built environment of many hospitals, particularly ageing or older facilities, was not designed with modern emergency management thinking in mind.
During the 2019 to 2020 Black Summer bushfire season, hospitals across New South Wales and Victoria faced conditions none had planned for in their standard emergency frameworks. Smoke infiltration triggered alarm systems across multiple sites simultaneously. Air quality emergencies required decisions about whether to shelter in place or evacuate. Patient transport was constrained by road conditions and helicopter availability. Staff who had been working extended shifts during the crisis were being asked to make evacuation decisions with limited information and no unified communication platform.
What those events revealed was not a failure of individual competence or institutional will. It was a failure of systems specifically, the absence of real-time, cross team information sharing that would allow a hospital to make coherent, coordinated decisions under pressure.
“In a hospital, the question is never simply whether to evacuate. It is how to protect everyone including those who are non-ambulant.”
The Unique Demands of Hospital Emergency Management
Every element that makes a hospital evacuation difficult also makes it a perfect case study for why real-time technology is not a luxury but a necessity. Consider the variables involved.
Patient dependency is the first and most critical. A hospital’s evacuation plan must account for patients across a spectrum of mobility and medical dependency, from ambulatory patients who can walk out independently to ventilated ICU patients who require a team of clinicians, specialised equipment, and a receiving clinical environment simply to be moved ten metres. This requires a tiered, role-specific response that is completely unlike the uniform ‘everyone leave now’ instruction of a commercial evacuation.
Staff configuration changes every shift. The people responsible for executing an evacuation at 2 am are different from those on duty at 2 pm, may have different training levels, and may have different familiarity with the specific patients in their care that day. Communication systems that rely on people knowing the right phone numbers, the right chain of command, and the right protocols from memory are inherently fragile.
Physical complexity is another factor. Large hospitals are, in effect, small cities. Multiple buildings, multiple wings, underground connections, roof-level plant rooms, and hundreds of separate spaces mean that a fire in one location may have highly unpredictable effects on evacuation routes elsewhere.
And finally, continuity of care is non-negotiable. Even in the most serious evacuation, some patients will need to remain in place with clinical staff attending to them. The evacuation plan must account for who stays, who goes, and how both groups are supported simultaneously.
What Technology Enables in a Hospital Context
When I think about the application of EvacTracker in a hospital environment, I think first about the problem that I have seen cause the most harm in emergency responses of all kinds: the absence of a shared operational picture.
In a hospital Code Red, a ward nurse needs to know which exit is clear. A floor warden needs to know which patients on their ward have been accounted for and which have not. A hospital emergency manager needs to know the status of evacuations across every ward simultaneously. And clinical staff need to know that the decisions being made about patient movement are coordinated, not duplicated or contradicted by different teams acting on different information.
EvacTracker provides that shared picture. Real-time dashboards allow emergency coordinators to see the status of evacuations across every zone of a hospital simultaneously: who has been evacuated, who is awaiting assistance, and where resources need to be directed. Role-specific guidance means that the message a ward nurse receives is different from the message a fire warden receives, because their responsibilities are different and their actions need to be different.
The reduction in communication time matters enormously here. Our data shows that EvacTracker reduces the time to reach all relevant parties from 20 to 25 minutes to approximately 9 minutes. In a hospital, where the deterioration of a patient’s condition can be measured in minutes, that compression of response time has direct clinical and safety implications.
Perhaps most importantly, EvacTracker creates a system that works across shift changes. Because the platform, not the individual, carries the knowledge of who is in the building, where they are, and what their status is, the response capability of the hospital does not vary with who happens to be on duty. Every shift has access to the same quality of information and guidance.
Compliance Is Not the Same as Preparedness
Australian hospitals operate under rigorous accreditation and regulatory frameworks that require documented emergency management plans, regular drills, and staff training. These requirements exist for good reason, and hospitals generally meet them.
But as I have written before, compliance is not defined by what is written down. It is defined by what works in practice. A plan that exists in a folder, tested twice a year in a scheduled drill under controlled conditions, is not the same as a system that performs under the pressure of a real Code Red at 3 am in a 600-bed tertiary hospital with a full census.
The gap between those two things, between documented preparedness and operational readiness, is exactly the gap that EvacTracker is designed to close. Not by replacing the expertise of hospital emergency managers and clinical staff, but by giving them the real-time information and communication infrastructure that allows their expertise to translate into effective action.
Because in a hospital, more than anywhere else, the cost of getting it wrong cannot be counted in property damage or reputational harm alone. It is counted in the well-being of people who came to us at their most vulnerable and who deserve, without qualification, every possible advantage when the alarm sounds.