A five-alarm fire at a Massachusetts assisted living community in which nine people died and at least 30 were injured is a “realistic reminder” for senior living providers to make sure they have evacuation plans that are practiced and up to date, according to one expert.

The cause of the Sunday fire at Gabriel House in Fall River, MA, about an hour and a half south of Boston, remains under investigation.

Stan Szpytek, president of Fire and Life Safety Inc. and a former deputy fire chief and fire marshal, told McKnight’s Senior Living that he was “horrified” to see the death toll, adding that multiple fatalities in buildings equipped with properly working fire suppression systems “has never occurred,” according to statistics from the National Fire Protection Association. 

A news release from the Massachusetts Department of Fire Services detailed the response by the Fall River Fire Department to Gabriel House. Firefighters observed heavy smoke and flames coming from the three-story building’s entrance, with residents trapped inside, some hanging out of windows waiting to be rescued.

“Smoke kills more people than fire does everyday in America,” Fall River Fire Chief Jeffrey Bacon said during a press conference. “I think the lesson that can be learned here is that, listen to your smoke detectors and react, because smoke is a very deadly force.”

Fall River investigators and the state fire marshall’s office are working to identify the cause of the fire.

The fire response drew 50 firefighters to the scene, including 30 off-duty firefighters and multiple neighboring fire departments. Several residents were declared deceased at the scene, and many more were transported to local and regional hospitals in varying conditions. Five firefighters sustained non-life-threatening injuries, and all were released from the hospital Monday.

“This is an unfathomable tragedy for the families involved and the Fall River community,” Bacon said in a statement on Monday morning. “On behalf of the Fall River Fire Department, I want to express our heartfelt condolences to the loved ones who are grieving this morning.”

According to the state, 70 residents lived in the community, which opened in 1999 and has 100 units. A family notification center was set up at a nearby hospital chapel. 

The New York Times reported that the fire was contained to one wing of the building but that the building sustained smoke damage throughout. The building reportedly had sprinklers and fire alarms, but fire officials were unable to confirm whether all systems were working properly. During a press conference, Bacon said that Gabriel House underwent quarterly inspections by the state Department of Health, according to Boston.com. CBS News reported that the last official state inspection of Gabriel House was conducted Oct. 15.

During a news conference Monday afternoon held by the Fall River firefighters union, firefighters complained about inadequate firefighter staffing levels and said that their rescue efforts were hampered by window air conditioning units that they had to push out, forcing them to move to smaller windows for rescues in some cases.

In recounting rescue efforts by first responders, residents interviewed by NBC10 Boston said that staff members did little to help.

Fall River Mayor Paul Coogan described Gabriel House as an “old building,” adding that it would be up to the owner to determine next steps. All residents were displaced from the building. WJAR reported that 35 residents were relocated to the Timao Center, the city’s homeless overflow shelter, after the fire and city officials were working to move them into other facilities. Twenty of the most medically fragile residents were going to a nearby nursing home. 

Gabriel House is owned by Gabriel Care, which is controlled by Dennis Etzkorn, who owns multiple Massachusetts facilities, including Gabriel Care Adult Foster Care in Fall River, GAC Western Mass in Worcester and Plymouth Center for Behavioral Health, according to GoLocalProv News. In 2012, Etzkorn and his adult foster care business were indicted for alleged kickbacks totaling more than $1.2 million made in exchange for the referral of new clients enrolled in a Medicaid program. Prosecutors did not pursue charges after a court determined that investigators obtained certain evidence illegally. The case was closed in 2015.

Etzkorn has not responded to multiple requests for comment from various media outlets.

“This just doesn’t happen in buildings with properly installed and maintained fire sprinkler systems,” Szpytek told McKnight’s Senior Living. “If the building was fully sprinklered and equipped with a fire alarm system, where both systems were properly operating, the big question is, why were there so many fatalities? The fire chief clearly alluded to smoke being a major factor in the fire.”

Szpytek, who is the life safety/disaster preparedness consultant for several senior living organizations, pointed out that assisted living regulations regarding sprinklers vary from state to state, and older communities may only have partial sprinkler systems that do not cover living units.

He advised providers not just to be ritualistic, but to be realistic in their disaster preparedness efforts, including “curve balls” such as a blocked exit in their emergency drills. He also stressed the importance of developing relationships with first responders before a crisis occurs.