Hospital Fire Safety: NFPA

Requirements for
Protection and Compliance
March 10, 2020

Learn the NFPA systems and essential

fire safety guidelines for hospitals and
other medical facilities
A 2013 study published in the Journal of Clinical Anesthesia concluded
that “Fire happens with alarming frequency and [with] potentially
devastating consequences in hospitals around the world.” NFPA
Journal summarized the study and global news reports that show how
poor hospital fire safety leads to hundreds of deaths in Algeria, South
Korea, Brazil, China, India, and Russia. Hospitals in the United States,
however, are much safer.

US fire departments respond to about 1,100 hospital fires annually, and

the most current National Fire Protection Association (NFPA) data show
that less than one death per year occurs in these fires. The reason for
this exceptional safety record? The United States’ strict adherence to and
enforcement of building and fire codes and standards.

The two primary codes that outline requirements for healthcare

occupancies and hospital fire safety are NFPA 99: Health Care Facilities
Code and NFPA 101: Life Safety Code.* This article explains how these
documents define healthcare occupancies while providing an overview of
the requirements that keep these facilities safe.

Click to download the QRFS Hospital Fire Safety Checklist.

*All code references in this blog are from the most current editions of
NFPA. However, The Centers for Medicare & Medicaid Services (CMS)
guidelines for healthcare facilities are still based on the 2012 edition of
NFPA 101.

Defining health care environments

NFPA 101: Life Safety Code defines several types of healthcare-related
facilities: hospitals, ambulatory care centers, and doctor’s offices. These
all have their own requirements and are defined as follows:

From the 2018 edition of NFPA 101

3.3.150 Hospital. A building or portion thereof used on a 24-hour basis for the
medical, psychiatric, obstetrical, or surgical care of four or more inpatients.

3.3.196.1 Ambulatory Health Care Occupancy. An occupancy used to provide

services or treatment simultaneously to four or more patients that provides, on an
outpatient basis, one or more of the following: (1) treatment for patients that
renders the patients incapable of taking action for self-preservation under
emergency conditions without the assistance of others; (2) anesthesia that rends
the patients incapable of taking action for self-preservation under emergency
conditions without the assistance of others; (3) treatment for patients who, due to
the nature of their injury or illness, are incapable of taking action for self-
preservation under emergency conditions without the assistance of others.

3.3.196.3* Business Occupancy. An occupancy used for the transaction of business

other than mercantile. [A.3.3.196.3 … Doctors’ and dentists’ offices are included,
unless of such character to be classified as ambulatory health care occupancies.]

3.3.196.7 Health Care Occupancy. An occupancy used to provide medical or other

treatment or care simultaneously to four or more patients on an inpatient basis,
where such patients are mostly incapable of self-preservation due to age, physical
or mental disability, or because of security measures not under the occupants’
control.
 Th
e Johns Hopkins Hospital is certainly defined as a hospital under NFPA
101. Source: Business Insider
Understanding functional systems in
hospitals
Hospitals function like a dynamic, living organism, made up of multiple
systems working together. It is critical to the success of facility operations
that various systems remain in working condition, including gas,
ventilation/HVAC, electrical, communications, plumbing, fire protection,
and operations. Each system is classified by the risk its failure poses to
losing lives or causing injuries or discomfort. NFPA 99 outlines four risk
categories:

From the 2018 edition of NFPA 99

4.1* Risk Categories. Activities, systems, or equipment shall be designed to meet

Category 1 through Category 4 requirements, as detailed in this code.
4.1.1* Category 1. Activities, systems, or equipment whose failure is likely to cause
major injury or death of patients, staff, or visitors shall be designed to meet
Category 1 requirements as detailed in this code.

4.1.2* Category 2. Activities, systems, or equipment whose failure is likely to cause

minor injury of patents, staff, or visitors shall be designed to meet Category 2
requirements, as detailed in this code.

4.1.3 Category 3. Activities, systems, or equipment whose failure is not likely to

cause injury to patients, staff, or visitors, but can cause discomfort, shall be
designed to meet Category 3 requirements, as detailed in this code.

4.1.4 Category 4. Activities, systems, or equipment whose failure would have no

impact on patient care shall be designed to meet Category 4 requirements, as
detailed in this code.

Each category of system must meet the applicable requirements of NFPA

99, and specific systems may have a separate standard for installation
and maintenance.

Gas and Vacuum Systems. The installation of these systems is outlined

in Chapter 5 of NFPA 99. Additionally, cryogenic fluids for oxygen supply
must comply with NFPA 55: Compressed Gases and Cryogenic Fluids
Code.

Electrical Systems. All electrical installations must comply with NFPA 70:
National Electrical Code (NEC)® and the specific requirements of
Chapter 6 of NFPA 99. When generator sets are utilized where an
alternate power source is required, they must be installed and
maintained following NFPA 110: Standard for Emergency and Standby
Power Systems.

Information Technology and Communications Systems. Fiber and

copper installations must comply with NFPA 70: National Electrical Code
(NEC). All other requirements for these systems are outlined in Chapter 7
of NFPA 99.
Plumbing. These systems must comply with the requirements listed in
Chapter 8 of NFPA 99.

Heating, Ventilation, and Air Conditioning (HVAC). These systems are

addressed in Chapter 9 of NFPA 99. Ductwork and air supply must be
installed in accordance with NFPA 90A: Standard for the Installation of
Air-Conditioning and Ventilating Systems. All gas systems other than
medical equipment must be provided with ventilation that meets
requirements in NFPA 55: Compressed Gases and Cryogenic Fluids Code.

Other areas. Other spaces within a hospital setting should be protected

per the following standards and requirements:

 Hyperbaric facilities should be constructed and protected

following Chapter 14 of NFPA 99.
 Laboratories and clean rooms shall comply with NFPA 45:
Standard on Fire Protection for Laboratories Using Chemicals.
 Waste and linen chutes must meet the requirements of NFPA
82: Standard on Incinerators and Waste and Linen Handling
Systems and Equipment.

To
promote hospital fire safety and prevent surgical fires, “the U.S. Food and
Drug Administration has launched an education program for medical
professionals using safeguards found in NFPA codes and standards.”
Source: NFPA Journal
Fire safety guidelines for hospitals
Individual fire protection and life safety measures are part of a system.
No single fire protection feature can be effective without other
supporting elements. For example, a fire sprinkler system without an
alarm or compartmentation may not be able to do its job adequately.
Without an alarm, there would be no notification that a fire is occurring
and that action should be taken. Without compartmentation, the fire
could grow unimpeded, and it might quickly overcome the capabilities of
a fire sprinkler system.

In the following paragraphs (and our downloadable hospital fire

safety checklist), we examine the NFPA codes and standards references
that ensure fire protection and life safety systems work as intended.
These items include compartmentation, fire sprinklers, specialized fire
suppression systems and extinguishers, fire alarms, backup power,
and safety operations and plans.

Compartmentation in medical facilities

Chapter 18 of NFPA 101 outlines the construction and design
requirements for a medical structure. Many of these specs focus on
compartmentation, which is a passive fire protection system that
prevents or slows the spread of fire by walling it off. Included in the rules
is the required fire rating of walls, doors, and corridors for patient rooms,
operating areas, special hazard spaces, and egress paths.

These surfaces must remain intact to ensure that their required fire-
resistance rating is in place. Any openings in a fire-resistance-rated
wall must be adequately sealed or protected. This requires
appropriately rated fire doors, windows, and transfer grilles.

From the 2018 edition of NFPA 101

8.3.3.1 General. Every opening in a fire barrier shall be protected to limit the
spread of fire from one side of the fire barrier to the other.

As hospital facilities are maintained and updated, various trade workers

and equipment have to penetrate the fire-rated walls; these holes may
be for IT/communications cables, ductwork, or a myriad of other items.
Each opening that penetrates the fire-rated barrier must be properly
sealed and fire-stopped. And areas that are prone to penetrations should
be documented and frequently inspected.

From the 2018 edition of NFPA 101

8.3.4.2* Firestop Systems and Devices Required.

8.3.4.2.1 Penetrations for cables, cable trays, conduits, pipes, tubes, combustion
vents and exhaust vents, wires, and similar items to accommodate electrical,
mechanical, plumbing, and communications systems that pass through a wall, floor,
or floor/ceiling assembly constructed as a fire barrier shall be protected by a
firestop system or device.

Fire sprinklers in hospitals

Fire sprinklers must be installed throughout healthcare occupancies.
These systems are installed following NFPA 13: Standard for the
Installation of Sprinkler Systems, and they are maintained according
to NFPA 25: Standard for the Inspection, Testing, and Maintenance of
Water-Based Fire Protection Systems.

NFPA 25 outlines the required inspection, testing, and maintenance (ITM)

frequency and procedures. Major system components are required to be
inspected quarterly, semi-annually, and annually. At each of these
intervals, specific items must be maintained and tested. There are also
weekly and monthly inspection requirements for items that must only be
visually inspected—these components include gauges, valves, private
hydrants, and fire pumps.

Read our series about commercial fire sprinkler inspection requirements to

learn more.

The primary concern for facility managers is ensuring that these

inspections, maintenance, and testing are completed by a qualified fire
sprinkler professional and documented. Careful recordkeeping of
sprinkler system ITM is a critical component to ensuring system
reliability, and it is required for any form of agency accreditation.

S
ource: DTNEXT
Fire extinguishers and specialized fire suppression
systems
Fire extinguishers are required throughout the building. These must be
selected, placed, inspected, tested, and maintained following the rules
in NFPA 10: Standard for Portable Fire Extinguishers.

Any commercial kitchen and cooking facilities in a medical facility must

be protected with a hood and fire suppression system, which requires
semi-annual inspections, testing, and maintenance. Additionally, the
filters and exhaust ductwork that make up the hood system require
regular cleaning—the frequency of which is based on the amount of
grease that is used in the cooking process. These specific requirements
are outlined in NFPA 96: Standard for Ventilation Control and Fire
Protection of Commercial Cooking Operations.

Hospitals are provided with an exception to protecting cooking

appliances when “residential” cooking equipment is employed for light
use, food warming, and reheating. This allows for using appliances such
as microwaves, hot plates, or toasters without requiring them to be
under a hood or protected with a dedicated fire suppression system.

Fire alarms in medical facilities

NFPA requires a fire alarm system throughout the facility. NFPA
72: National Fire Alarm and Signaling Code, outlines the installation and
ITM requirements for these systems. A facility manager should
understand the basic operation of fire alarms and what the various
signals may mean. Quarterly, semi-annual, and annual system inspection,
testing, and maintenance are required, and diligent records must be
maintained of all ITM work and results.

Generator sets and alternate power sources

NFPA 99 introduces the term EES: essential electrical systems.

From the 2018 edition of NFPA 99

3.3.51* Essential Electrical System. A system comprised of alternate sources of

power and all connected distribution systems and ancillary equipment, designed to
ensure continuity of electrical power to designated areas and functions of a
healthcare facility during disruption of normal power sources, and also to minimize
disruption within the internal wiring system.

Based on the risk category of the healthcare space (see above), an

alternate power source, such as a generator, may be required to maintain
the EES:

 Category 1 spaces required a Type I EES.

 Category 2 spaces can utilize either a Type I or a Type II
EES.
 Category 3 and 4 spaces do not require an EES.
Where required, the EES must meet the requirements of NFPA
110: Standard for Emergency and Standby Power Systems, for a Type 10,
Class X, Level 1 generator set.

The alternate power source used to maintain an EES must be maintained

following the requirements of Chapter 8 of NFPA 110. This testing
requires the generator set to be run least 12 times per year, and the
critical operating components must be visually inspected. Records of
these run times and visual inspections must be maintained and made
available to the inspecting authority having jurisdiction (AHJ).

From the 2018 edition of NFPA 99

6.7.4. Record Keeping. A written record of inspection, performance, exercising

period, and repairs shall be regularly maintained and available for inspection by the
authority having jurisdiction.

Operations and plans

Healthcare facilities must maintain emergency and evacuation plans, and
employees must be regularly trained on these plans and their roles
within them. Emergency plans should include instructions for fire
emergencies and general building evacuations.

Quarterly evacuation drills are required for each shift, and records of
these drills must be maintained. Additionally, hospital staff should be
aware of and sustain general housekeeping standards. These activities
include maintaining clear access to exits, enforcing “no smoking”
policies, making sure decorations in halls and patient rooms are fire
resistant and do not exceed allowed limits, and ensuring soiled linens
and trash are regularly emptied and not permitted to accumulate
beyond allowed maximums (0.5 gallons per room, 32 gallons total in a
protected area).