NFPA 101: Life Safety Code Module 3: Health Care / Ambulatory

Health Care Occupancies

Defines as occupancies used to provide medical care or other treatmtent simultaneously, to >=4
patients on an inpatient basis, where patients are mostly incapable of self-preservation due to age,
physical/mental disability, or security measures outside occupant control.

Unlike other occupancies, wholesale relocation and evacuation of occupants (patients) is the least
desirable emergency action. Defend in place strategy is used to avoid the movement of patients outside
during a fire. Those patients close to a fire are particularly, such as by moving them to smoke
compartments on the same floor.

New health care occupancies must be protected throughout by approved supervised automatic sprinkler
system. Nonsprinklered smoke compartments undergoing major rehabilitation are required to be
sprinklered. Those undergoing minor rehabilitation are not required to be sprinklered. Major
rehabilitation is modification of >50% area or >4500 sqft of the smoke compartment.

18/19.1.3 modify provisions of 6.1.14 for multiple occupancies. Spaces may be classified as other
occupancies, but the non-health care occupancy may not provide housing or treatment services
simultaneously to >=4 inpatients or provide customary access to patients incapable of self-preservation.

All means of egress from health care occupancy traversing non-health care occupancy must conform to
the health care occupancy requirement. Exit through horizontal exits into other occupancies that do not
comply with health c are egress requirements but do comply with egress requirements for that other
occupancy are allowed only if the exit complies with 18/19.2.2.5 and if the occupancy does not contain
high hazard contents. The health care and other occupancy must be separated by minimum 2-hour fire
rated barrier.

Locking of doors in health care facilities is allowed if for the clinical needs of patients, such as psychiatric
units and memory impaired patients. Only one locking device is permitted for each door. Rapid removal
of occupants must be possible either via (1) remote control of locks from within the locked smoke
compartment, (2) all locks are keyed by keys carried by staff at all times, or (3) other reliable means
available to staff at all times.

There are security needs for areas such as nurseries, pediatric units, and infectious control areas. Lock
are permitted for these security need areas if the staff can unlock the room at any time, smoke
detection is provided or door can be remotely unlocked, building is protected by automatic sprinklers,
electrical locks release upon loss of power, and locks release with smoke or sprinkler system.

Special units can have disguised egress doors, to reduce escape chances. These disguised doors may or
not be locked. Staff must be available and able to readily open and unlock the door.
Projections into the required width of corridors are permitted for wheeled equipment assuming the
corridor width is not reduced to <60 inches, training addressed relocation of equipment, and wheeled
equipment is limited to equipment and carts in use, medical emergency equipment not in use, and
patient lift and transport equipment.

Where corridor width is at least 8 ft, projections are permitted for fixed furniture assuming that

 the fixed furniture is securely attached to the wall,

 fixed furniture does not reduce the corridor width to <6 ft,
 fixed furniture is located on only one side of the corridor and such that it does not obstruct
access to building services and fire protection equipment,
 the fixed furniture groupings do not exceed 50 sqft area,
 the fixed furniture groupings are separated from each other by at least 10 ft,
 either protected by electrically supervised automatic smoke detection or the fixed furniture
spaces allow direct supervision by the staff from a nurse’s station or similar space

Corridor width requirement have exceptions for noncontinuous projections <=6 inches deep and >38
inches above the floor. For projections exceeding the 4 inches permitted by accessibility codes, an
encroachment must be added below this 4 to 6 inch projection within 27 inches of the floor such that it
can be perceived with a cane.

The required corridor width need not be maintained clear and unobstructed at all times. Maximum 4.5
inch projections are permitted by 7.3.2.2. Wheeled equipment (including equipment and carts in use,
medical emergency equipment not in use, and patient lift and transport equipment) can be parked
temporarily in the corridor between uses, but not stored in the corridor for a long period of time.

Means of egress arrangements must comply with Section 7.5 and

18/19.2.5.

Two exit access doors, complying with remoteness

requirements, are required when sleeping room exceeds 1000
sqft or when non-sleeping room exceeds 2500 sqft.

New construction must also with common path of travel

requirements.

Every habitable room must have an exit access door leading directly to an exit access corridor, unless
otherwise allowed in 18/19.2.5.6.

 Exit access from a patient sleeping room with <=8 patient beds is allowed to pass through an
intervening room, equipped with an automatic smoke detection system, before reaching exit
access corridor.
  Rooms with a direct exit to the outside ground level do not require an exit access door leading
to the exit access corridor.
 Rooms within sleeping suites, complying with 18/19.2.5.7, do not require an exit access door
leading to the exit access corridor.
 Rooms with nonsleeping suites, complying with 18/19.2.5.7, do not require an exit access door
leading to the exit access corridor.
 Non patient care suits must comply with requirements of the appropriate occupancy

Patient care suit: defined for health care occupancies as a series of rooms or spaces or a subdivided
room separated from the remainder of the building by walls and doors.

Sleeping suites may be <=5000 sqft for existing suites without automatic sprinklers, <=7500 sqft for new
or existing suites with automatic sprinklers and either smoke detection or staff supervision, <=10000 sqft
for new or existing suites with automatic sprinklers, smoke detection, and staff supervision. Nonsleeping
suites may be <=10000 sqft for existing suites without automatic sprinklers, <=12500 sqft for new or
existing suites with automatic sprinklers and either smoke detection or staff supervision, <=15000 sqft
for new or existing suites with automatic sprinklers, smoke detection, and staff supervision.

Travel distance within a suit to a suite exit access door must be less than 100 ft, with no limit on the
number of intervening rooms.

Where a second exit access is required, it can lead to an exit stair, an exit door to the exterior, an exit
passageway, or an adjoining suite. One exit access door must be to the corridor.

18/19.2.5 details requirements for sleeping rooms.

Intervening rooms, rooms or spaces serving as part of the

required means of egress from another room, include the
circulating space within a suite connecting all sleeping
rooms. The number of intervening rooms along an egress
path is not limited.

Sleeping suites must be arranged to allow for direct staff

supervision from a normally attended location within the
suite, such as with glass walls. Where direct supervision is
not possible, smoke detection is required.

Passing through an adjoining patient care suite is permitted

as part of the second means of egress from a suit if
required.

All new health care occupancies require automatic sprinklers throughout. In existing nonsprinklered
smoke compartments, renovation of >50% or >4500 sqft requires automatic sprinklers throughout the
smoke compartment. 19.4.2. require existing high rise health care occupancy buildings to be sprinklered
within 12 years of adoption of the code

In new buildings, sprinklers are not required in clothes closets <6 sqft in area in sleeping rooms if the
back wall of the closet is within distance of the sprinkler, per NFPA 13.
Small kitchens for resident use can be open to the corridor. Where residential cooking equipment is
used for food warming or limited cooking, or where residential/commercial cooking equipment is used
to prepare meals for <=30 people, one cooking facility is permitted to be open to the corridor, assuming
conditions of 18/19.3.2.5.3 are met.

Within a smoke compartment, residential/commercial cooking equipment used to prepare meals for
<=30 people is permitted, assuming conditions of 18/19.3.2.5.3 are met

Where cooking facilities are protected per Section 9.2.3 and the facility is not open to the corridor, the
facility area will not be classified as a hazardous area per Section 18/19.3.2.1

All areas that contain combustibles in sufficient quantities to product a life threatening fire must be
separated from exit access corridors by partitions, with a minimum 1/2 hour fire resistance rating
corridor partitions for nonsprinklered existing health care occupancies.

Spaces open to the corridor may be unlimited in area if:

 Spaces are not used for sleeping rooms, treatment rooms, or hazardous areas
 Corridors are protected by an electrically supervised smoke detection system, or the smoke
partition is protected throughout by quick response sprinklers
 The space is protected by an electrically supervised smoke detection system, or the entire space
is arranged and located to allow direct supervision by facility staff (e.g. from a nurse’s station)
 The space does not obstruct access to required exits

Waiting areas are permitted to be open to the corridor if:

 The aggregate waiting area in each smoke compartemnt is <=600 sqft

 The waiting area is protected by an electrically supervised smoke detection system, or the area
is arranged and located to allow direct supervision by facility staff (e.g. from a nurse’s station)
 The waiting area does not obstruct access to required exits

Nurse’s stations are permitted to be open to the corridor with no additional requirements

Gift shops <=500 sqft are permitted to be open to the corridor or lobby

In a limited care facility, group meeting or therapeutic spaces are permitted to be open to corridor if:

 The space is not a hazardous area

 The space is protected by an electrically supervised smoke detection system, or the area is
arranged and located to allow direct supervision by facility staff (e.g. from a nurse’s station)
 The space does not obstruct access to required exits

In sprinkled smoke compartments, corridor walls are permitted to terminate at the ceiling, where the
ceiling is constructed to limit the transfer of smoke too noncorridor areas. Architectural, exposed,
suspended grid acoustical tile ceiling with penetrations such as sprinkler piping and HVAC ducts is
capable of limiting smoke transfer. No fire resistance rating is required for corridor walls in sprinkled
smoke compartments.

In nonsprinklered existing smoke compartments, corridor walls must have a minimum 1/2 hour fire
resistance rating, such as gypsum, wood lath and plaster, metal lath and plaster. The corridor wall must
be extended above a lay-in tile ceiling or concealed space to limit passage of smoke, but need not be a
smoke barrier/partition.

Corridor doors in sprinkler protected smoke compartments are not fire doors but are required to resist
smoke passage and be self-latching and have positive latching (catches closed automatically when door
is closed). Corridor doors without sprinkler protection must either be a 1-3/4 inch thick solid bonded
wood core door or be able to resist fire for 20 minutes. Maximum clearance under either sprinklered or
nonsprinklered doors cannot exceed 1 inch, and protective plates or covers are not limited. Fixed
windows and vision panels must comply with NFPA 80.

Corridor doors must be self-latching and have positive latching. Roller latches are permitted by NFPA
101 for psychiatric settings to prevent patients from hanging themselves, but are prohibited in the
United States for new and existing corridor doors by Centers of Medicare and Medicaid Services.
Hazardous area protection for health care occupancies detailed in 18/19.3.2.1. New health care facilities
must have automatic sprinkler protection, and hazardous areas must have 1 hour rated fire barriers
and/or smoke partition. 18.3.2.1.2/18.3.2.1.3 list facilities considered hazardous for new facilities.
Existing health care facilities, hazardous areas are required to be protected by a 1 hour fire rated barrier
or provided with automatic sprinklers. 19.3.2.1.5 lists areas considered hazardous for existing facilities.

Protection of hazardous areas cannot be downgraded, such as if a recently built health care facility was
determined to be considered existing, per Section 4.6 on reducing features from new to existing.

Doors for 1 hour fire rated barrier protecting hazardous contents must be minimum 45 minute fire
protection rated, self/automatic closing, and positive latching.

Door for smoke partition separations must be capable of resisting the passage of smoke, self/automatic
closing, and positive latching.

18/19.3.7, subdivision of building spaces, refers to the practice of providing smoke barriers to divide a
floor into two or more smoke compartments. Allows relocation of patients by horizontal, rather than
vertical, travel between smoke compartments as necessary for the defend in place strategy, avoiding the
risks of vertical evacuation.

Existing smoke partitions:

Maximum area of 22500 sqft, or 40000 sqft if

compartment has quick response sprinklers
and all patient rooms are limited to housing a
single patient

Overall maximum dimension of 150 ft x 150

ft or travel distance to a smoke barrier of 150
ft (200 ft is sprinkler protected)

Smoke barrier wall rating of at least 1/2 hour

Single doors are allowed in the means of

egress corridor

Pairs of doors can swing in one direction only

Doors similar to 20 minute fire door

assembly, but not required to latch

Wired glass allowed if already existing, fire

rated glazing allowed
New smoke compartment criteria:

Maximum area of 22500 sqft, or 40000 sqft

if compartment has quick response
sprinklers and all patient rooms are limited
to housing a single patient

Maximum travel distance to smoke barrier

of 200 ft

Smoke barrier wall rating of at least 1 hour

Pairs of doors swinging in opposite

directions required across corridor

Doors similar to 20 minute fire door

assembly, but not required to latch

Fire rated glazing allowed

 Ambulatory Health Care Occupancies

Defines as occupancies used to provide services or treatments simultaneously to >=4 patients. Provide
on an out-patient basis treatment/anesthesia for patients (or patients themselves have an illness/injury)
that render patients incapable of taking action for self-preservation under emergency conditions
without assistance.

Provides a bridge between health care and business occupancies, based on business occupancy
requirements, with additional requirements for patients incapable of self-preservation.

Requirements entirely in Chapter 20/21. Equivalencies are recognized by NFPA, such as Fire Safety
Evaluation System FSES of NFPA 101A. Neither the FSES for business and or for health care can be used
for ambulatory occupancies.

Ambulatory occupant load factor recently changed from 100 to 150 sqft/person. Recall occupant load is
the gross area in sqft divided by this 150 sqft/person factor.

Ambulatory care must be separated from other tenants in the building by a minimum 1 hour fire rated
barrier with 1.75 inch thick solid bonded core wood or equivalent self-closing door. Smoke barriers with
1 hour fire rating are required to subdivide areas greater the 10000 sqft.

Residential Board and Care Occupancies

Defined as occupancy used for the lodging and boarding of >=4 not related by blood or marriage to the
owner or operators for the purpose of providing personal care services. Differentiating it from other
occupancies is the lack of ability of occupants to evacuate building in fire and the level of personal care
services. Personal care is defined as assistance with many daily living activities, such as bathing, dressing,
or paying bills, but does not include home type nursing care or medical care.

Evacuation capability is used to determine the applicable requirements only for existing board and care
facilities, not new facilities. Evacuation capability is defined in 3.3.81 as ability of occupants, residents,
and staff as a group either to evacuate a building or to relocate to safe location, based as resident ability
to evacuate and staff ability to provide assistance. Authority Having Jurisdiction determines procedure
for determining evacuation capability, including actions related to this determination such as drill timing
and rating of residents. A timed drill program, like in NFPA 101A Chapter 6, can be used for this purpose.
Chapter 32/33 are organized by facility type.

32/33.2: small facilities, residents<=16

32/33.3: large facilities, residents>16

32/33.4: Apartment building housing board and care

Evacuation capability subdivided into three classes:

Prompt: ability of occupants, including staff, to move reliably to a point of safety in a timely manner that
is equivalent to the capacity of a household in the general population

Slow: ability of occupants, including staff, to move reliably to a point of safety in a timely manner, but
not as rapidly as the capacity of a household in the general population

Impractical: inability of occupants, including staff, to reliably move to a point of safety in timely manner

Ongoing evaluation by AHJ is required to ensure facility use is within limitations and design of facility

Some requirements are applied relative to the location of the LED. Two floors levels are permitted to be
considered as part of the LED when separated by <=3 stair risers.

Door locking arrangements are permitted where the clinical needs of residents require specialized
security measures or where residents pose a security threat, assuming that:

Staff can unlock doors at all times

Building protected by automatic sprinklers

Provisions are made for the rapid removal of residents

32/33.2.3.5.2 for omitting sprinkler protection in conversions cannot be used

Doors in the means of egress can be locked if provisions exist for rapid removal of residents using
remote control locks, staff carry keys to all locks at all times or have other means to unlock at all times,
and only one locking device is permitted on each door

Small Facilities requirements are based on lodging and rooming houses, similar to Chapter 26:

All new facilities must be sprinklered. Existing facilities must be sprinklered if impractical evacuation
capability. Nonsprinklered existing facilities with slow evacuation capability have other limitations.

Every sleeping room and living area must be provided with access to a primary and secondary means of
escape per 32.2.2, like other residential occupancies. Secondary means of escape requirement
exempted for sprinklered buildings. In existing facilities, each story of the facility must have at least two
means of escape, one means meeting requirements for a primary means of escape, and other means of
escape can be a window if facility has prompt evacuation capability.

Any space where there is storage/activity having fuel conditions exceeding those of a one/two-family
dwelling and has potential for fully involved fire must be protected per 32.2.3.2. Spaces are not
hazardous merely for having furnaces, cooking, or laundry equipment. Spaces requiring protection
include areas for cartooned storage, food, household maintenance items in wholesale quantities, or
mass storage of resident belonging.

All new small residential board and care occupancies must be sprinklered with the exception for
conversions for prompt evacuation capabilities. For existing buildings, all facilities with impractical
evacuation capability must be sprinklered. In otherwise fully sprinklered existing buildings, alternatives
to sprinklering the attic include heat detection system and alarms to notify the occupants to egress.

Corridor walls must have a minimum 1/2 hour fire resistance rating, sleeping room doors must be
substantial, and vision panels must be fixed fire window assemblies or wired glass.

New large facility requirements disregard evacuation capability. Existing large facilities base
requirements on those of hotels, with the exception of impractical evacuation capabilities necessitating
following health care requirements.

Table 32/33.3.1.3 set allowable construction type for large facilities. Existing large facilities with
impractical evacuation capabilities can meet requirements of Chapter 19 limited care facilities rather
than Section 33.3.

New large board and care facilities require smoke detection systems in corridors and spaces open to
corridors, and smoke alarms are required in sleeping rooms, outside sleeping areas, and on all levels.
Existing large board and care facilities require smoke detection system in all corridors, and also in living
areas if not protected by automatic sprinklers and if having impractical evacuation capabilities

All new large facilities must have automatic sprinklers. All existing high rise buildings must have
automatic sprinklers.

32/33.4 address minimum requirements for apartment buildings where 1+ apartment units are used for
board and care. These requirements add on to Chapter 30/31 requirements for apartment buildings.

The operating features provisions of 32/33.7 apply to both new and existing facilities. Staff response to a
fire include availability, actions, and management of a fire. Board and care facility staff are charged with
preserving safety of charges by informing those not in jeopardy and helping relocate those who are.
Resident training in emergency procedures is required.