Patients and medical staff smashed windows and tied together sheets to flee a blaze that killed at least 18 people in a Costa Rican hospital built without adequate fire exits or a sprinkler system.
The pre-dawn fire swept through the top three floors of the five-story Calderon Guardia Hospital in the Costa Rican capital of San Jose on Tuesday, engulfing the central staircase of the building.
The victims included three nurses. The body of one nurse, Patricia Fallas, was found with the flashlight -- still lit -- that she had used to guide patients to safety.
Video footage showed patients and staff scrambling down improvised ropes of bedsheets from the hospital's upper floors. Built in the 1940s, the hospital had no emergency stairs.
"It was a fatal trap," said Rodrigo Charpantier, a surgery patient on the fourth floor. "When we tried to leave by the stairs we couldn't and had to throw ourselves out a window."
Of the 18 victims, 16 died on the fifth floor, and the two others on the fourth.
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."
Hidalgo found his way to a window someone had broken and leaped out. Fortunately, he landed on a nearby roof.
The fire raised questions about the lack of safety measures in facilities throughout the country.
The 2:20am blaze 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, Fire Chief Hector Chavez said.
Fire fighters and Red Cross rescue workers used hydraulic ladders to evacuate people from the fire, which was brought under control three hours later.
About 520 patients were in the building at the time. At least 18 were killed and authorities feared the death toll would rise as the search for more victims continued, Chavez and Costa Rican Red Cross official Alexander Poras said.
At least 150 surviving patients were transferred to other hospitals, sent home or attended in an adjacent building of the facility. Officials did not release the exact number of injured or their conditions.
The cause of the fire was not immediately known. Costa Rican news media reported that a gas leak was believed to be the source.
Costa Rican 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.
He acknowledged that "the system has defects," but he added that Costa Rica "is a poor country and we can't do everything with excellence."
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