In many buildings, there may be some options with respect to the appropriate evacuation strategy to be used. However, in a health care facility the most common strategy is to defend the occupants in place.
By definition, a health care occupancy is one in which the patients or residents are not necessarily capable of self-preservation during a fire emergency. Relocation of patients during an emergency requires considerable resources and time and potentially places patients at risk due to injury or the disruption in providing medical care. When evacuation is not a viable option, how does one provide an acceptable level of safety from fire? The purpose of this article is to provide an overview of the life safety requirements in US-based codes for health care occupancies.
Will Sprinklers Provide Life Safety?
Prior to the 1991 Edition of NFPA 101, the Code permitted new health care occupancies to be built with or without automatic sprinkler protection. However, in 1987 the American Hospital Association commissioned an evaluation regarding the relative effectiveness of smoke detectors and automatic sprinklers in providing life safety to the occupants in a health care occupancy.
Based upon the risk assessment performed and subsequent full scale fire tests that validated the results of the modelling , the American Hospital Association (AHA) recommended that the NFPA Committee on Safety to Life require automatic sprinkler protection for all new health care occupancies and any portion of a health care occupancy undergoing major renovation. Furthermore, AHA proposed that fast-response sprinklers be installed in all smoke compartments containing patient sleeping rooms. Today, building and life safety codes in the USA consider sprinkler protection as one of the critical fire protection and life safety features in new health care occupancies.
Based upon the modelling and full scale fire tests, fast response sprinklers are capable of maintaining tenability at the bed level in a typical patient sleeping room for most reasonably credible fire scenarios. However, to achieve an acceptable level of life safety and so as not to rely on a single protection feature, codes also require other protection strategies. Within the room of origin, these protection strategies include controlling ignition sources (smoking and portable heaters) above and beyond normal code provisions that address electrical equipment and systems. Loose hanging fabrics, such as draperies and cubicle curtains, are required to be flame retardant. The finish materials applied to the walls and ceilings of the room are regulated with respect to their ability to contribute to the spread of flame and the smoke that is released when the materials burn. Some codes will also regulate the ease of ignition and the heat release rate for newly introduced upholstered furnishings and mattresses. The combustibility and quantity of decorations is also limited to restrict the use of items that can be easily ignited or contribute to the growth of the fire.
Compartmentation.
With respect to compartmentation, the spread of smoke from a fire in a room separated from a corridor should be restricted from spreading into the corridor. Recognising that the sprinkler system will control the fire during many, but not all, fire incidents, the corridor wall is required to resist the passage of smoke. The door to the corridor is also required to resist the passage of smoke and to be equipped with latching hardware that will keep the door closed during a fire event. Although self-closing devices are effective in containing fire and smoke to the room of origin, corridor doors in health care occupancies are not required to be self-closing. The codes recognise the functional needs to keep the doors open and the presence of trained staff to close the door during a fire emergency.
Rooms or spaces that are not separated from the corridor as indicated are typically limited in use (may not be a hazardous area), may be limited in size, may require visual supervision by staff, and may result in a requirement for smoke detection in the space or possibly throughout the corridor of the smoke compartment in which the room/space is located. For existing buildings, some codes will also allow restrictions on the fuel within the space as a compensatory feature to the space being open to the corridor.
There are some limitations on what equipment and furnishings may be in the corridor itself, again an attempt to minimise the likelihood that the corridor can be an avenue for fire and smoke spread. The corridor should also not be used as a source of supply air or a means of returning air to prevent the HVAC system from spreading smoke through the corridor. Patient treatment and sleeping should not occur within the corridor, thereby reducing the likelihood of patients being exposed to fire or smoke while in the corridor and potentially having no immediate place to which they can be relocated.
Due to the nature of the occupants, it is critical that health care occupancies be designed, constructed, and operated in a manner that minimises the need to relocate patients/residents during a fire emergency. Staff require adequate resources to fulfil the responsibilities assigned in the emergency plan. So that staff can make the correct decisions, they need to understand the fire protection features of the building and what role they will play during a fire emergency.
Limited Relocation.
If the previously mentioned features do not result in an adequate level of life safety during a fire incident, patients/residents may need to be relocated. However, the codes establish the need for smoke compartments in health care occupancies to limit the number of patients/residents that might be exposed to a fire and thereby need to be relocated. Smoke barriers are a construction feature that, in addition to having a fire resistance rating, are also constructed to resist the passage of smoke.
The doors protecting openings in a smoke compartment are to be constructed similar to a door having a 20-minute fire protection rating, however the door is not required to have a latch by some US codes. In a cross corridor situation, some doors would require a bottom latch and some codes have chosen to omit the latch, which may keep the door from closing completely. The weight of the door, the resistance offered by the closing device, and the fact that the fire will typically be somewhat remote from the smoke barrier results in a door, even without a latch, being effective in controlling the spread of smoke.
Whereas some patients may need to be relocated from the smoke compartment of fire origin, codes generally limit the travel distance to the doors in the smoke compartment. The travel distance limit is intended to represent a reasonable distance that staff may need to carry or drag a patient until the patient is relocated into an area of refuge. In addition, adequate space must be provided on the other side of the smoke compartment for the patients/residents who might be relocated from the adjacent smoke compartment. The smoke compartments must also be arranged so that patients/residents can continue to move towards an exit without returning to a smoke compartment from which they were relocated. Effective smoke compartmentation reduces the need for the vertical movement of patients/residents during a fire.
Staff’s Critical Role.
In many cases, compliance with the code requirements related to construction, egress, fire protection systems, ignition sources, and contents and furnishings will result in an acceptable level of safety. However, the facility’s emergency plan and the staff’s ability to execute the plan, based on training and drills, will also be major factors in determining whether the consequences caused by a fire incident are considered acceptable. There have been numerous fires in health care facilities in which the response by staff has either resulted in a positive outcome or the response, or lack thereof, has contributed to a less desirable outcome.
During a survey of a health care facility, an administrator once told me that his staff was well trained and could evacuate the facility in slightly more than three minutes. He was referring to a fire event and not some external disaster that might result in the need to quickly evacuate the building. I was less than impressed by the statement. While staff might have adequately trained to execute an evacuation in the stated time period, that should not have been the emergency plan and their training should not have been limited to total evacuation of the building. Based upon the location of the facility, it is unlikely that staff would really evacuate patients to the exterior during certain months of the year. Such an evacuation would also result in essentially discontinuing the delivery of patient care and treatment. Clearly the administrator, and most likely the facility staff, did not understand the construction features of the building and how they can be used to help protect patients/residents in the case of a fire.
The administration of a facility needs to stress the importance of proper training and preparedness to all facility staff. Staff need to understand that they will play a significant role in the outcome of any emergency event, including a fire. Staff need to fully understand their responsibilities as outlined in the emergency plan. Use fire drills to not only ensure that staff can execute their responsibilities but to also evaluate the effectiveness of the emergency plan. If the plan calls for the patients/residents to be evacuated across a smoke barrier, does the plan provide for adequate resources to relocate those patients/residents in a timely manner? If not, how can the resources be increased or the plan revised to adequately deal with the emergency with the resources that will be available.
Summary.
Due to the nature of the occupants, it is critical that health care occupancies be designed, constructed, and operated in a manner that minimises the need to relocate patients/residents during a fire emergency. Part of the operational considerations is a well trained staff with adequate resources to fulfil the responsibilities assigned in the emergency plan. So that staff can make the correct decisions, they need to understand the fire protection features of the building and what role they will play during a fire emergency. Staff also needs a basic understanding of fire growth and development so they have an appreciation for how much time is available to protect or relocate the patients/residents. Recent US fire experience has shown that a properly designed, constructed, and maintained health care facility with an adequate number of property trained staff will result in an acceptable outcome for most fire scenarios in a health care occupancy.
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