Protecting healthcare facilities is unique for many reasons, including the fact that not all occupants are ambulatory. Therefore, staff training and a defend-in-place strategy—rather than evacuation—are vital parts of the fire protection plan. There are special concerns due to the occupants’ ability to respond to fire alarm signals on their own accord. As described in NFPA 101, Life Safety Code, “All healthcare facilities shall be designed, constructed, maintained and operated to minimize the possibility of a fire emergency requiring the evacuation of occupants. Because the safety of healthcare occupants cannot be ensured adequately by dependence on evacuation of the building, their protection from fire must be provided by appropriate arrangement of facilities, adequate staffing, and development of operating and maintenance procedures.”

Although locally adopted building codes are followed for building construction, fire protection requirements for healthcare facilities are derived from NFPA 101, Life Safety Code, and its referenced standards, NFPA 13 for sprinkler systems, NFPA 72 for fire alarm systems and NFPA 90A for HVAC equipment, among others. The Life Safety Code defines a healthcare occupancy as “an occupancy used for purposes of medical or other treatment or care of four or more persons where such occupants are mostly incapable of self-preservation due to age, physical or mental disability, or because of security measures not under the occupants’ control.” NFPA 99, Standard for Health Care Facilities, is also used, but not for fire protection features.

However, the requirements of other federal organizations, such as the Department of Veterans Affairs (VA), the Joint Committee on Accreditation of Healthcare Organizations (JCAHO) and Centers for Medicare and Medicaid Services (CMS) (formerly Health Care Finance Administration), must also be considered.

For example, the VA has a Fire Protection Design Manual that is useful for contractors to interpret specific fire protection requirements. According to Peter A. Larrimer, a safety and fire protection engineer with the VA in Pittsburgh, the VA does not have any requirements that differ from the prescribed Life Safety Code. However, the Fire Protection Design Manual explains VA’s interpretation of the requirements and specifies what is acceptable for a fire protection system installed in a VA facility. “The manual is intended to reduce the amount of problems that occur due to each individual’s interpretation of the codes. We have tried to spell out what we want for fire protection systems to avoid problems that could delay occupancy.” VA engineers design the fire protection systems, and as with most other fire protection projects, the jobs are awarded to the lowest bidder. On a typical project, the VA only communicates with the general contractor, not the individual contractors, so this manual guides interpretation of requirements. For example, for sprinkler systems, the manual says, “Install quick response sprinklers (QRS) in all areas, except where prohibited (e.g., high temperature areas as defined in NFPA 13, elevator shafts, or elevator machine rooms). On retrofit projects, replace existing standard sprinklers with QRS within the smoke compartments being modified.”

Another example: For fire alarms, you must “provide institutional style (key to operate or locking covers) pull stations in psychiatric area. Provide covers on pull stations in child care centers to prevent children from initiating unwanted alarms. Coordinate with the facility.” This Fire Protection Design Manual is available on the VA Web site, www.va.gov.

Healthcare facilities must be accredited to accept Medicare and Medicaid. The Joint Committee on Accreditation of Healthcare Organizations (JCAHO) and Centers for Medicare and Medicaid Services (CMS) (formerly Health Care Finance Administration) both have requirements for fire alarm and sprinkler systems, including testing and maintenance requirements that healthcare facilities must follow to become or maintain accreditation. CMS is a federal agency within the U.S. Department of Health and Human Services. It provides direction and technical guidance for the administration of the Federal effort to plan, develop, manage and evaluate healthcare financing programs and policies. An example of JCAHO requirements can be found in the JCAHO Statement of Fire Safety for Assisted Living Facilities. Both organizations reference the requirements of the Life Safety Code.

NFPA 101 provides requirements for compartmentation, on-site fire protection including fire alarm and automatic sprinkler systems, exiting and staff training. The barriers used delay or prevent fire and smoke from spreading to different areas. In most cases, building fire rating requirements and use of smoke detectors in conjunction with automatic door closers allow patients to be isolated from smoke and fire long enough for staff to evaluate the necessity to evacuate. If necessary, they can move patients to other areas offering better fire and smoke protection rather than moving them out of the building. Doors in exit passageways, stairway enclosures, horizontal exits, smoke barriers or in hazardous-area enclosures are allowed to be held open only by automatic release devices. Activation of the building sprinkler system or fire alarm system will release all the doors either in the smoke compartment or in the entire facility.

The Life Safety Code requires healthcare facilities to be provided with full-coverage, supervised sprinkler systems, with quick-response sprinklers being required in smoke compartments containing patient room areas. The VA allows CPVC piping for sprinkler systems, although, according to Larrimer, they experience a lot of pipe breakage. This is primarily due to too few hangers being used for the CPVC piping. “Finding locations for additional hangers is a challenge in the ‘busy’ ceiling configurations typical in hospitals,” Larrimer said. Obstructions to sprinkler discharge can be a problem. In a hospital, items like privacy curtains and signs can present an obstruction, as well as storage material on shelving.

Fire alarm systems include requirements for manual detection but allow the fire alarm boxes in patient sleeping areas to be eliminated if located at nurse’s stations or other constantly attended areas. Manual stations are often locked when located in psychiatric or child care areas to reduce nuisance alarms.

Detection devices include duct detectors, smoke detectors used to close smoke doors or elevator lobby or machine room smoke detectors. In nursing homes, an automatic smoke detection system is required in corridors throughout smoke compartments containing patient sleeping rooms and in spaces open to corridors, with two exceptions. If patient sleeping rooms are protected with system smoke detectors, corridor smoke detectors are not required. Corridor smoke detectors can also be eliminated where patient room doors have automatic door-closing devices with integral smoke detectors on the room side and these detectors provide occupant notification.

The International Building Code (IBC) separates fire alarm requirements by what is referred to as a “Use Group.” Manual fire alarm systems and an automatic fire detection system are required in Group I occupancies. Manual stations in patient sleeping areas of Groups I-1 and I-2 can be eliminated if located at all nurse’s stations or other constantly attended staff locations. A supervised, automatic smoke detection system is mandated for waiting areas open to corridors.

Hospitals typically require full-coverage smoke detection as well as sprinklers. However, corridors in nursing homes, drug detoxification centers and spaces open to the corridors are required to have an automatic fire detection system with two exceptions: corridor smoke detectors are not required where patient sleeping rooms are equipped with system smoke detectors and these detectors provide visible indication in the corridor outside of the patient sleeping room as well as an audible and visible signal at the nurse’s station and, where patient sleeping rooms have automatic door-closing devices with integral smoke detectors on the room side of the door with alerting functions.

Maintenance of fire alarm and sprinkler systems is a key problem. The VA uses in-house staff for older systems, but uses contractors for newer addressable systems. Training of staff and contractors is vital. Such simple things as not knowing where sprinkler valves are located are common problems they face. Some typical problems experienced include contractors not performing tests properly, not being ready for final acceptance tests, and not properly documenting fire alarm and sprinkler tests, including proper operation of the fire safety function tests like air handler shutdown and damper operation.

James “Skip” Gregory, bureau chief for the Office of Plans and Construction for the Florida Agency for Health Care Administration (AHCA) said, “Improperly maintained systems is one of our biggest concerns. Our inspectors find both fire alarm and sprinkler systems are being not maintained as required by NFPA standards. Another major issue we face is due to different interpretations of the codes between local AHJs and our staff.” NFPA standards that cover inspection, testing and maintenance include NFPA 25, Inspection, Test and Maintenance of Water-Based Fire Protection Systems, NFPA 72, National Fire Alarm Code.

However Corey Robinson, CET, an electronics technician and supervisor for fire alarm and sprinkler test, inspection and installations for a major central Florida hospital does not find maintenance to be the biggest problem. They have an active preventative maintenance program that includes changing air filters frequently and using qualified contractors to perform tests. Since hospitals are constantly updating equipment to keep up with the latest technologies, fire alarm systems are affected by the alterations necessary to the building. This requires major coordination between hospital engineering staff and contractors. Contractors are responsible for providing fire watches in areas under construction. Corey said, “Getting engineers, fire alarm vendors and AHJs on the same page so systems pass the first time is the real challenge.” Since the 2001 terrorist attacks, with security a greater concern, they now use manual means to close dampers and doors in smoke compartment to prevent spread of potentially dangerous airborne agents.

Protecting healthcare facilities can offer many unique challenges. However, two aspects seem similar to every other type of fire protection system. With proper coordination between qualified designers, contractors, AHJs and facility staff, most installation and construction problems can be easily overcome. EC