A pre-dawn fire swept the top three floors of a hospital in Costa Rica's capital Tuesday, killing at least 18 people as it engulfed the central staircase of a building without adequate fire exits or a sprinkler system.
Medical personnel smashed their way through windows as they tried to help patients escape, while some of the sick fled on their own. People could be seen on live television climbing onto ledges of the five-story building or tying bed sheets to window frames to lower themselves to safety.
One of the victims was identified as nurse Patricia Fallas, 42, who was helping patients evacuate the fifth floor when she died of smoke inhalation. She was holding a lit flashlight when her body was found, Fire Chief Hector Chavez said.
The fire — the second this year at the 62-year-old Calderon Guardia Hospital — raised questions about safety precautions in other medical facilities throughout the Central American country.
The 2:20 a.m. fire broke out in a medical storage area on the fourth floor of the five-story building, and quickly spread to the fifth and third floors, destroying the neurosurgery and men's surgery departments, the fire chief said. Of the 18 victims, 16 died on the fifth floor, and the two others on the fourth.
Some of the hospital's 522 patients hid under their beds.
"I was with my mother on the fifth floor ... it was terrible," said Luz Marina Chinchilla, sobbing. She was able to escort her mother safely out of the building.
Cristobal Hidalgo, a hernia patient on the fifth floor, said he was awakened by screams and "saw that smoke was coming in."
"I went into the hallway and there was more smoke, hot smoke. It was tremendous," he said. "You couldn't see anything and it was suffocating."
Dr. Eduardo Saenz said he smelled smoke and carried one patient out in his arms.
Officials feared the death toll would rise as the search for victims continued, Costa Rican Red Cross official Alexander Poras said. Survivors were taken to other hospitals.
The cause was not immediately known. Costa Rican news media reported that a gas leak was believed to be the source, but Chavez would not confirm that, telling The Associated Press the investigation was ongoing.
Like most other medical facilities in Costa Rica, the Calderon Guardia Hospital lacked an adequate evacuation plan. It also lacked safety measures required under recently implemented national fire regulations — including fire hoses, emergency lighting, and a fire escape.
The hospital alarm system failed to sound, and two small staircases designed for evacuations reached only to the third floor. Fire fighters and Red Cross rescue workers used hydraulic ladders to evacuate people.
"This is a case that should make people think," Chavez said. "Unfortunately, this building did not have the proper fire prevention tools."
Calderon Guardia is one of Costa Rica's main hospitals, receiving patients from all over the country. In January, a small fire broke out in the building but no one was injured. The hospital's fire alarms also failed to work then, officials said.
The only hospital with adequate fire-detection equipment in Costa Rica is the Alajuela Hospital, inaugurated last year in the city of the same name, about 10 miles northwest of the capital, Chavez said.
President Abel Pacheco declared three days of national mourning and announced the formation of a committee to investigate safety measures at all hospitals after state health officials asked him to declare a national emergency in the state hospital system.
"I am shaken. This is a painful scene and it is terrible," Pacheco told reporters. Pacheco acknowledged that "the system has defects," but he added that Costa Rica "is a poor country and we can't do everything with excellence."