"In Case of Fire: Are You Prepared?", (c) Jeffrey White, PE, FacilityCare.com, August 2007

Hospitals and other health facilities must meet special fire safety system requirements because of the presence of various gasses; radiological, chemical and biological hazards; special equipment; and numerous different occupancy types within the building. In order to achieve a fully integrated and safe operating fire system specialized for healthcare facilities, measures such as structural fire protection, architectural construction, staff training and an emergency preparedness plan must be considered in addition to standard sprinkler and standpipe systems, fire alarm and smoke control systems, egress signs and manual fire extinguishers.

How Hospitals Differ

There are several reasons why fire safety systems in hospitals are different from those installed in other building types and must be specialized for healthcare facilities. One major reason is that patients usually are not capable of evacuating themselves from the source of the fire. This is why containing the fire and smoke to a specific area or room of origin is of the utmost importance. Another crucial difference between hospitals and other buildings is the numerous different types of occupancies. A hospital consists of patient rooms, office space, computer/server rooms, laboratories, cafeterias and auditoriums, each with a different set of hazards. The presence of oxygen and other gasses also adds another level of concern, as does the presence of sensitive equipment, such as magnetic resonance imaging (MRI) equipment.

For these reasons, fire suppression options and code requirements for hospitals vary widely from other building types. For example, healthcare facilities must be of noncombustible construction and must be designed with fire and smoke barriers at specific locations. In addition, the system selection differs from other buildings due to the sheer number of various hazards and required levels of protection in healthcare facilities. A single hospital may have a dozen or more suppression systems within its walls, whereas an office building might have only one or two. Each of these systems must be carefully chosen to match the expected type and size of fire.

Many systems and construction features are dictated by local state codes and specific National Fire Protection Association (NFPA) standards, such as NFPA 99, Standard for Health Care Facilities, and NFPA 101, Life Safety Code. These standards outline prescriptive and performance-based requirements to provide an acceptable level of life safety from fire, electrical and other hazards. Other requirements dictated by The Joint Commission or the facilities underwriter must also be met. These codes and standards should be considered the minimum acceptable level in the design process.

The design of fire safety systems for hospitals is also dictated by the level of importance of operation and reliability. Most healthcare facilities are commissioning their new buildings prior to occupancy. This means running all systems through any and all anticipated scenarios to ensure proper system operation. The primary concern involving installation is during a renovation when the hospital must remain in operation during construction. Not only do clean construction practices need to be followed, but systems or sections of systems that may be shut down or taken out of operation for a period of time must be placed back in operation as much as possible at the end of the workday. It is imperative that proper safety measures such as a fire watch are put in place while the system is down and that systems are put back in operation and verified once the construction is complete.

In terms of design, some recent trends include the use of clean agent suppression systems in sensitive areas, such as operating suites and MRIs. Water mist systems are also being used in some areas to provide an economical alternative to gaseous agents when protecting sensitive documents or equipment.

The ideal fire safety system for any hospital is one that is well documented and easy for the staff to use. Overly complex systems are more prone to maintenance problems and failures and much more likely to cause confusion between staff and firefighters as well as code enforcement officials. While more complex systems cannot be avoided in large healthcare facilities, documentation and training are essential. The proper training and maintenance schedule, along with the proper budget, must be provided to the facility's staff and closely followed.

Planning for Emergencies

Every fire safety system should also include an emergency preparedness plan that documents important information on procedures for responding to an emergency, such as fires, earthquakes, terrorism, and in the case of hospitals, mass casualty events. The document should follow the National Incident Management System (NIMS) and should outline standard operating procedures and guidelines, provide for fire drills, include a list of key contacts with addresses and nighttime phone numbers, and establish a chain of command and appropriate officers. The document may contain maps or plans of egress routes and locate safe havens.

Narratives of building systems operation with detailed procedures should also be included. Such a narrative might read like this: “During a fire event in zone 1, smoke fan SEF-1 and air handler AHU-2 shall operate to maintain a positive pressure around zone 1. Fire department overrides are located adjacent to the fire alarm control panel in the main entrance.”

A drawing showing the location of the zone and associated equipment and a sequence of operation should be included as well.

Defending Against a Fire

All the various fire safety elements must work flawlessly together — from the fire safety system to the emergency preparedness plan. The first line of defense in a fire-related emergency is the hospital staff. Following the RACE fire plan — Rescue, Alarm, Contain, Extinguish — the staff puts the entire system into operation. First, before activating the fire alarm system, they must move all patients in immediate danger to a safe location. The alarm system will then notify the facility personnel and the fire department of the floor and zone of the fire. In many cases, smoke detectors in the area may also be doing this automatically.

The ultimate goal is to contain the fire and smoke. A primary means of containment is the staff closing doors and other openings that could allow the fire to spread. Additional containment will be provided by automatic smoke and fire dampers and sprinklers or other suppression systems. Finally, the fire must be extinguished, either by trained staff with manual fire extinguishers or by the fire department.

Large fire events may also require larger-scale evacuations, operation of smoke control systems, and a coordinated effort between the fire department and the facility personnel that maintain and operate the building systems. An emergency preparedness plan and fully functioning fire safety system are the keys to ensuring a smooth and adequate response to a fire.

Choosing the Design Team

There are several important factors healthcare facility managers should consider when selecting a design firm to develop a fire safety system for their facility. First, facility managers should select a team with experience in healthcare facility design because it is important that the team not only be aware of specific prescriptive code requirements, but also have the capability of providing performance-based design solutions that could save money and ultimately work better than a prescriptive-based design.

The design team should consist of an architect; mechanical, electrical and plumbing (MEP) firm; structural engineer; and hospital planners working together collaboratively. Because a true fire safety system is not just a fire alarm or sprinkler system, but an integration of all active and passive fire control features, its design requires the combined expertise of all of these parties.

Conclusion

Well-functioning fire safety systems are essential to a hospital's daily operations. With the different code regulations, occupancies and potential hazards particular to healthcare facilities, a specialized fire protection system for the facility that can be executed by the staff is critical. Selecting a design team with experience in hospital design, along with choosing an appropriate system and developing a comprehensive emergency preparedness plan will better ensure that healthcare facilities are ready in case of fire emergencies.