Life safety from fire in

the hospital
Richard M. Patton

Reprinted from The Patton Report, June, 1.97o.

Used with permission.

I listoricall y , tin' most common solution to life safet y from

fire has been a structural solution. With the advent of
fireresistiye construction (reinf)rced concrete, protected
stee l ) t h e r e w a s a belid that fire life safet could be
y

assured through a structure that would not burn. Un-

fortunately, however, content fires and fires involving
combustible interior sheathing and trim readil y produce
sufficient heat and toxic gas to snuff out life long before
the structure itself was endangered.
Public reaction to disasters has now placed us at a
stage of structural fire safet y based on these five factors:
A. Fireresistant design
B. Cmnpartmentation (limitation of spread of fire)
C. Use of relativel y slow-burning interior trim, sheath-
ing and paneling
D. An adequate number of enclosed exitwavs
E. Isolation, or special protection for special hazards—
enclose a carpentr y shop with fireresistive construc-
tion, sprinkler it—or both.
In hospitals and other occupancies where occupants can-
not readil y flee a fire, the value of exitways is reduced.
They are installed, but many occupants cannot use them.
In order to compensate for this, more emphasis is placed
On compartmentation, Fireresistant compartmentation is
employed to the extent that ever y room becomes an en-
closure to contain a fire or, if the fire escapes, an enclosure
to safel y contain the occupant.
Today this is the basic life safet y from fire concept for
a hospital. First, contain the fire. As a backup, if the fire
escapes, contain the man in a safe refuge. Note, however,
that this basic plan runs counter to the normal reaction
of the normal human being. When a fire occurs in a fire-
resistant enclosed room, the conversion of solids to gases
will create an internal pressure within the room that will
send smoke through the cracks around the door into the
corridor. The normal human reaction is to open the door
to see what is going on in there. The fire is no longer
contained. The next reaction usuall y is to try to put the
fire out. Today's fire control equipment provided to fire
discoverers virtually insures that efforts to control the
fire will fail a high percentage of the time.
Once a fire passes from a "small stage" to a "substan-

Mr. Patton, a loss control consultant, is president of

Patton Fire Protection and Research, Inc., Freehold,
New Jersey.

12 The Building Official and Code Administrator, February, 1971

tial" stage, it will produce heat at such rapidly increasing
rates that it will spread suddenly and explosively through-
out the room because when the surface temperatures of
exposed combustibles are raised to their ignition points
by the general beat content of the room, the fire ‘yill flash
over all surfaces. The fire often will spread with a rapidity
and intensity that is completely alien to the man accus-
tomed to friendly fires in fireplaces or outdoor fires where
heat is harmlessly exhausted to the atmosphere. This
change in the nature and intensity of the fire invariably
amazes the amateur fire fighter who is then quite likely
to panic and flee, leaving the door open (Ed. note: 7'he
BOCA Basic Code requires automatic door closers).
The secondary line of defense for the nonmobile occu-
pancy is the fireresistive room enclosures—the sanctuaries
—for the occupants. When the occupant remains calm,
keeps his room door closed to the fire and opens the win-
dow to let in fresh air, the probability of survival is very
good. However, the normal reaction of the normal human
being is to try to leave his room and flee through the
smoke- and heat-filled corridor to the outdoors. Isolation
in a room during a fire must be particularly devastating
to sick people confined to bed, especially if the window
is closed. Note that the present basic concept for fire life
safety through structural design runs counter to normal
human behavior in some important ways. This is why
fire protection engineers constantly throw up their hands
in amazement at the "weird" behavior of so many people
under fire conditions. They simply don't behave the way
they are supposed to behave. The problem, however, is
not that people are inherentl y unreliable, but that we are
establishing a concept of fire safety that runs counter to
the reactions of the people involved. This is why fires
such as the recent one in the Marietta, Ohio nursing home
occur periodically.
What is the solution? The solution lies in replacing the
defensive concept of trying to enclose and trap the fire
with the positive concept of fire suppression. Note. that
even very small scale compartmentation will permit a
fire of substantial size to freely develop, so it is far better
to put the fire out. The fire suppression concept (sprin-
klers ) has been the backbone of industrial fire protection.
There is no structural solution that has had the relia-
bility and cost-effectiveness of automatic fire suppression.
It is now time to incorporate fire suppression as the basic
solution to fire in structures where protection of human
life, not property, is the primary need.
I am recommending the concept of composite protec-
tion for all new hospitals. This concept includes fire sup-
pression as the primary control for fire, structural design
(fireresistance and subdivision) as the secondary control,
and horizontal exits as the last resort of all new hospital
construction. But it would be a mistake to simply super-
impose the existing industrial, property protection ori-
ented sprinkler system on top of the existing excessively
compartmented hospital. The blending of suppression
with structural design should be accomplished with more
finesse. The sprinkler system must be more economical
and even more reliable. The added safety of suppression
will permit some relaxation in structural requirements.
With these thoughts in mind, I propose the following
basic fire life safety design for hospitals. There are three
The Building Official and Code Administrator, February, 1.971
commonly employed suppression s y stems—sprinklers, fire
brigade (or trained emplo y ees) and the public fire de-
partment (paid or volunteer). The suppression concept
I propose requires three things: a ) that all three s y stems volt
be employed; b) that the reliabilit y of each be im-
proved; c) that the y be coordinated and simultaneously
initiated.
The industrial sprinkler system is reputed to have an
unreliability record (failure rate) of 3.8 percent. But this
is an inaccurate statistic in that many successes are not
reported, while presumably all failures are. However,
there is no doubt that industry is accepting a failure rate
for property protection that is not acceptable in a hospital
where lives are concerned. How can the reliability of the
sprinkler system be improved? Fire records also indicate
that the sprinkler s y stem that is electrically supervised
has a reliability in excess of 99 percent. Further, there is
clear indication that if electric supervision of the system
is combined with an inspection and maintenance contract
with a reputable sprinkler contractor and if, in addition,
the sprinkler s y stem is engineered rather than designed
lw the "book", as is customary, a rdiabilite that is very
close to 100 percent can be achieved. True, this is only
near, not total, perfection, but there is no structural solu-
tion that achieves perfectitm either. Because large piping
and huge water supplies are not needed for a hospital
sprinkler s y stem, it is quite possible to install a 99 percent
plus reliable system more economically than the presently
accepted industrial model which is reputed to be 96.2
percent reliable. It is this concept of mechanical suppres-
sion which I recommend.
Near perfect mechanical protection, however, is still
not enough. It must be teamed with a concept of human
fire suppression that is as reliable as we can make it. The
one glaring weakness in connection with the public fire
department is that too often the professional fire fighter
remains imalerted as the fire destroys lives and property.
A direct electrical connection (or through central sta-
tion) from the sprinkler system to the fire department will
correct this. A fire department that is given earl y notifica-
tion of a fire in a light hazard occupancy can perform a
superb job of fire control.
The third fire control system is the brigade—or em-
ployee with the extinguisher. Here is the notoriously bad
actor—that man or the team that opens the door to let
the trapped fire loose, that fails to control the fire, that
fails to call the fire department until it is too late. Surely
it is best not to count too heavily on this human suppres-
sion s y stem. Not so. There is one reason—and only one
reason—for the consistent failure of the amateur fire
fighter. We have equipped and trained him for failure.
We have established conditions under which a high rate
of failure is a certainty. The February, 1970 issue of
Fire Technology, the magazine of the Society of Fire
Protection Engineers, contains a report by Salzberg, Ved-
y
arka and Maatman on "Minimum Water Requirements
for Suppression Room Fires." The test program described
demonstrated that room size fires in which flashover has
already occurred, spreading fire completely throughout
the room, can be readily extinguished by water in the
form of a spray with an application rate of only seven
Continued on page 14
13
Continued from page 13
GPM. Extinguishment was achieved with an extremely
modest total quantity of water of fourteen to twenty gal-
lons. This is a very modest water requirement indeed. It
is available in just about every dwelling, let alone every
hospital. However, what is the tool we provide the non-
professional with to fight these readily controllable fires?
The answer is that we give him an extinguisher that puts
out exactly two and one-half gallons of water with a
duration of discharge of approximately 50 seconds. Clear-
ly this is inadequate. Further this discharge is in the
form of a straight stream, not a spray. The report cited
above also demonstrated that even twenty GPM was
inadequate for room size fires when used as a straight
stream. I repeat these statistics for emphasis. With seven
GPM and a spray nozzle, room size fires are readily con-
trolled in two or three minutes. But, if a straight stream
is used, twenty GPM is inadequate. An extinguisher puts
out two and one-half to three GPM in a straight stream
and is fully exhausted in less than one minute. Some
types of extinguishers are fully discharged in as little as
ten seconds. It is as clear as the nose on an elephant that
we are supplying the amateur with a fire suppression tool
that is guaranteed not to control a high percentage of the
fires he is likely to encounter.
The concept which I propose for the amateur fire
fighter is a very simple one. Give him a tool that he knows
how to use, one that can produce the six to ten gallons
of water a minute that is needed to achieve fire control
for room size fires and give him the three minutes or more
of operating time that he needs to do the job. A light-
weight hose that is flexible, easily operated and equipped
with a spray nozzle will promptly and efficiently extin-
guish the type of fires that the amateur encounters in the
hospital. Further, the water spray will knock down the
heat quite rapidly and permit the amateur to get close
to the fire so that he can 'do a job on it.
One further thing must be done. Just as the sprinkler
is wired to the fire department, so must we wire in the
fire fighter. When we give the fire fighter a tool that can
control the fire that he is likely to encounter, we also
have given him a tool that c. an be electrically supervised.
Just as water flow in a sprinkler system can cause an
alarm to be transmitted to the public department, so can
water flow in the hose station. One word of caution is in
order with regard to the hose, however. Present under-
writer approved hose intended for use by building occu-
pants is large, bulky, heavy when filled with water, in-
flexible, and extremely difficult to handle and put into
operation in confined areas, and has other disadvantages
as well. It can be handled by a professional fire fighter,
but, ironically, the professional always brings his own
hose. There is a need for fire hose that can be put into
operation and be easily handled by one nurse. This rules
out all presently approved fire hose. Again, it is im-
portant that we not permit antiquated concepts and regu-
lations to stand in the way of providing the fire safety
that is so badly needed.
Note that when I talk about fire suppression, I am not
just talking about a sprinkler system. I am talking about
an improved sprinkler system, a fire brigade and a fire
department that will all be simultaneously initiated.
14 The Building Official and Code Administrator, February, 1971
Today 'many people pay little more than lip service to
safety. Some of the blame for this must be shared by those
safety "experts" who argue that when it comes to human
life, the cost of protection has no place in the considera-
tions. "When life is at stake, you don't argue dollars,"
they say. This philosophy, more often than not, is a cover
up for the fact that costly recommendations are being
submitted without evidence of their worth. There is no
inexhaustible supply of money for safety purposes. Those
who believe that safety does not have to be economically
acceptable usually end up by demanding too much and
obtaining too little. Maximum safet y can be achieved only
by gaining maximum value for each safety dollar spent.
Note that a level of absolute safety is never achieved.
When a level of optimum safety per dollar expended is
reached, additional dollars may bu y additional safet y , but
the law of diminishing returns applies here as it does in
all other areas of expenditure.
The effects of this law can be seen in structural fire
protection for hospitals. Because the structural fire safety
has its limitations, disasters have occurred in the corn-
partmented "fireproof" building, and after each disaster,
additional structural requirements have been applied,
each adding to the cost but providing reduced increments
of additional safet y . It is clear, however, that the inclu-
sion of extremely reliable suppression systems will dra-
matically improve the overall fire safety of the hospital.
In fact, if we could guarantee an absolute certaint y of
fire suppression, instead of high reliability, the need for
all structural requirements would be voided. Total reli-
ance on suppression with complete elimination of struc-
tural requirements, of course, is not being recommended.
This could prove to be as bad, and possibly worse, than
the present practice of putting all the eggs in the struc-
tural basket. When reliable suppression systems are intro-
duced, the question at hand is this—"What is the proper
level of structural protection for a hospital in conjunction
with high quality suppression systems?" In short, what
is the proper level of composite protection? The gain in
safety per dollar expended on suppression will be great,
because the present level of fire suppression reliable is
low. The reduction in safety through the reduction in
structural protection expenditures will be low because of
the redundancy and limited value of some of the struc-
tural requirements. Thus, on a trade-off basis, there is a
potential for both savings and safety gain. There are also
gains to be made in greater freedom of design and effi-
ciency of the physical plant layout. Time and study will
reveal the point of maximum safety per expended dollar.
There is one more thing the suppression concept can
accomplish. It can also bead off more restrictive struc-
tural and occupancy requirements in the future. For
instance, at present, there is a great deal of concern over
the toxicity of the products of combustion produced by
the burning or the decomposition of some plastics and
other building materials. Present laboratory tests that pass
on the acceptability of building materials measure the
rate of flame spread and the amount of smoke generated
( obscuration) but do not deal with toxicity. Some of the
chemicals used to reduce the flame spread of some mate-
rials, thus qualifying the materials as "firesafe" can actu-
ally increase the toxicity of the gases produced. How-
ever, NVIlerl we consider the total fire loading in a hospital
occupancy, the combustible contents ma y be more sig-
nificant than the combustible portion of the structure
itself. But the combustibilit y of the contents (furniture.
supplies, ('tc.), generall y is not regulated. The contents
Call provide the primary fuel which will cause the com-
bustible sheathing and trim, if anY, to also burn and
release ver y toxic gases if that is the nature of the mate-
rials.
Details on the Marietta nursing home fire are sketchy,
but there is reason to believe that this is exactl y what
happened—there was a content fire that also involved
carpeting. Because heat rises, combustibles burn in in-
verse relationship to their height above floor level. There-
fore, carpeting ma y have had the least role in the spread
of fire at Marietta. If this is so, the reader ma y ask, "NVIty
then has there been so p inch concern about floor covering
since this fire?” I think the real reason is that carpeting
was the only "built in - structural feature that could be
labeled "nonapproved - . If it were not for the carpeting
in the 11111 - Sing 110111C, there would have been a disaster
in it completel y standard fireresistive compartmented
structure. There was also no corridor smoke barrier, but
this could only have reduced, not prevented, loss of life.
So if it were not for the carpeting, the structural system
itself would have to be blamed for the failure.
But it was the s y stem that failed. Note that the fire
was a classic fireresistive, compartmented structural fire
having the following characteristics:
A. Tlw fire, wi tell clisco ‘ •ered, was small and contained
one fireresistive cobiele.
B. Under conditions of stress, the door to the involved
room was left open.
The Building Official and Code Administrator, February, 1971
C. The fire spread to the hallway.
D. There were the usual fire suppression weaknesses.
E. Li nder panic conditions, people did not think to
close doors to the corridor, and open windows to
tile outdoors.
F. During the high stress conditions, there was a delay
in a call to the fire department.
‘Vho can bliu»e humans for failing under the stress of
the conditions? The concept of controlling a fire by trap-
ping it, or enclosing each human it) his own cubicle if
the fire escapes, deminals too much of the people in-
volved. It was a s y stem failure, of course, because a fire
control concept that does not effectively deal with the
critical needs of putting the fire out before it becomes
a holocaust is like permitting a tiger to stalk the halls
read y to enter anv open door to kill. If we do not deal
with the s y stem, there will be additional tragedies, and
each time there will be it searching for a "cause" on which
to Itang (lilt's hat and another area for tighter regulations.
There \Oil also be charges leveled against employees and
hospital administrators who , fail to control the fire with
equipment that often is not capable of controlling fire,
who do not think to calml y close doors under panic con-
ditions and who have human reactions under great stress.
There will also be innocent victims who die needlessly.
I do not argue against reasonable controls on the com-
bustibilit y of carpeting. What I do sav is that the carpet-
ing is being used as a reason not to examine the validity
of prese»t concepts of structural fire safety. A new con-
cept of prompt, positive fire suppression not onl y will
guarantee the maximum practicable level of human safety
from fire, it will permit the widest practical latitude in
St ructural desig», arrangement of operations and use of
materials.
15