When a loved one or friend is sick and in the hospital, it can be a very challenging time, not only for the patients, but loved ones as well. The last thing that patients and families should need to worry about is whether or not their hospital is fire-safe.

Lessons Learned and Subsequent Code Improvements

During the night of April 5, 1949, a fire broke out in St. Anthony’s Hospital in Effingham, Ill. Without fire compartments and other standard features of modern fire protection, the blaze spread through the brick and wooden building at terrifying speed. Shortly after, the hospital was completely engulfed in flames. Because there were no proper escape routes, many patients perished in the fire. In all, 74 people died that night in what became the worst hospital fire in United States history.

Alarmed by the tragedy in Effingham, lawmakers soon got to work. Progressively throughout the entire country, regulations were passed to improve the level of fire protection in hospitals. A major step was taken in 1958 to update the Building Exits Code, which required a higher fire resistance for multi-story buildings and, for the first time, incorporated fire compartments to protect certain functional areas within a building. In 1966, a comprehensively expanded and revised standard was published by the National Fire Protection Association (NFPA) as the Life Safety Code (NFPA 101).

Reversing the trend of 60 years of hospital fire safety improvements, changes to the International Building Code (IBC) during the development of the 2015 edition represent significant reductions in the level of fire and life safety protection afforded to patients. Proponents of these changes cite the desire for reductions in operational maintenance expenses of health care facilities, which they have achieved by increasing risk of fire and smoke exposure.

Codes generally define a health care occupancy as a building, or any portion thereof, used on a 24-hour basis to house or treat four or more people who cannot escape from a fire without assistance. The buildings or portions of buildings in question include hospitals or other medical institutions, nurseries, nursing homes, and limited care facilities.

During 2006-2010, there were 6,240 fires in health care properties, which accounted for 1.2 percent of the 506,400 structure fires in the U.S., and resulted in an average of only six civilian deaths per year. Considering the vulnerability of occupants in these facilities, the statistics indicate that the fire protection features built into existing facilities are doing a very good job of minimizing the consequences of fires. The code improvements of the past 60 years have been impactful.

Addressing the Challenges in Health Care Facilities

Health care facilities pose unique challenges when it comes to moving and evacuating people. The basic features of health care fire protection, therefore, involve limiting the amount of patient movement. The residents of a health care facility can remain safe even when relatively close to a fire due to the following basic fire safety features being provided, as mandated by all modern codes:

• Corridor walls have been constructed properly to allow safe relocation, if needed, to an adjacent smoke compartment.

• Appropriate smoke barriers have been installed to create separate smoke compartments.

• Hazardous areas that are likely to sustain a well-developed fire are protected or enclosed.

• Approved fire detection and suppression systems have been installed.

This defend-in-place principle is not only desirable, it is necessary, especially in hospital intensive care units, cardiac care units, and operating room suites, where moving a patient could result in major health complications or even death. Subdividing each floor into two or more smoke compartments allows patients to be moved in the event of fire without having to leave the building or change floors.

Historically, the IBC and NFPA 101 have required every story used by patients for sleeping or treatment, and other stories with an occupant load of 50 or more, to be subdivided into at least two smoke compartments, as separated by 1-hour fire resistance rated smoke barriers. The maximum allowable square footage of each smoke compartment has been 22,500 square feet in each of those published codes.

Protection of Penetrations, Joints, and Openings

In any hospital construction, proper and effective firestopping is a major consideration. Firestopping functions to contain fires within the areas in which they start, preventing smoke, hot gases, and flames from spreading through the joints and penetrations in the fire-rated wall and/or floor assemblies. The purpose is to isolate the smoke and fire from patients who cannot exit the building quickly. In essence, firestopping affords enough time to put out the fire, which is key to protection of life safety in hospitals. Door and duct openings in fire resistance rated smoke barriers are also protected to prevent the movement of fire and smoke.

Sprinkler Protection Is Invaluable and Essential, but Not Infallible

Complete automatic sprinkler protection is required for all new health care facilities. Sprinkler protection is also required in smoke compartments in all existing facilities that undergo significant renovation. 

Automatic sprinkler systems are a very significant component of a building fire protection strategy. However, sprinkler systems have their limitations, and their performance can be affected by factors not linked to the initial design or installation of the sprinkler system. As NFPA statistic show, they are not always effective. Balanced fire protection, that is, a combination of detection, compartmentation, and suppression, is required to maintain the optimum level of fire protection and life safety, and has been demonstrated to work effectively.

Fire prevention and life safety is at its strongest when all of these components are effectively in place. The most recent research report on Fires in Health Care Facilities published by NFPA in 2012, covering the years 2006-2010, indicates that when sprinkler systems were present and the fire large enough, the sprinkler operated and was effective 86 percent of the time.

The same NFPA Report also identifies the top five reasons that sprinkler systems failed to operate or were ineffective during a fire:

• System shut off (38 percent)

• Inappropriate system for the type of fire (18 percent)

• Water discharged did not reach fire (12 percent)

• Lack of maintenance (12 percent)

• Problem with water supply or not enough water discharged (9 percent)

With statistics indicating that sprinklers operated and were effective in only 86 percent of incidents, this does not warrant elimination of other fire safety features.

Building Code Fire Safety Reduced, Fire Code Fire Safety Reductions Being Considered

The fire safety record has improved steadily over the years in health care facilities. What that tells us is that what we have been doing for the past 30+ years is working. What we have been doing to date will change in the 2015 IBC, with the approval of Code Change Proposal G76-12, which will allow an increase of 78 percent in the maximum size of a smoke compartment, with no compensating fire protection measures provided. At the same time, approved code change proposal G70-12 has increased the maximum size of care suites containing sleeping rooms from 5,000 square feet to 10,000 square feet, representing a 100 percent increase.

While these changes are very significant, they pale in comparison to proposal being made to the 2015 International Fire Code (IFC). To summarize, the changes being proposed to the IFC rely on the addition of sprinkler protection to eliminate almost all components of passive fire protection.

Some examples are:

• Eliminate all existing fire resistance rated corridor walls, even without sprinklers being retrofitted. (IFC article 1105.3.2, Code Change Proposal F239-13)

• Allow 80-square-inch unprotected hole in the wall between every patient room and the corridor, allowing unchecked fire or smoke spread. (IFC article 1105.3.4, Code Change Proposal F239-13)

• Discontinue maintenance of existing fire resistance rated egress corridors after sprinklers are retrofitted. (IFC article 1103.1, Code Change Proposal F212-13)

• Allow any existing smoke barriers to be treated as ½-hour fire rated, even if the original construction mandated 1-hour construction, thus eliminating the need for fire stopping and opening protectives. (IFC article 1105.5.2, Code Change Proposal F241-13)

• Cessation of maintenance of existing fire resistance rated construction after sprinkler retrofit, without specific review of whether overall fire safety would be decreased below IBC-allowable levels (e.g., due to inadequate means of egress) (IFC Section 1103, Code Change Proposal F212-13)

These, coupled with changes to the 2015 IBC, represent massive downward shifts in the level of fire and life safety protection afforded to patients.

The data clearly supports the fact that, since 1980, evolving code requirements relating to fire and life safety in health care facilities have been doing the right things for patient safety. The reduction in both the frequency and severity of fires in the U.S. health care system is not an accident. Rather, it is the result of targeted survey and surveillance programs working in conjunction with effective detection, suppression, and containment systems to keep hospitals patients, staff, and visitors safe.

The question that needs to be asked is: Are these current code change proposals taking us a step backwards with regards to hospital fire safety? Why would we mess with a good thing?

You are urged to participate in the ICC’s Public Comment Hearings being held Oct. 2-10 in Atlantic City (specific dates to be announced for International Fire Code change proposals). There is no charge to attend the hearings. Speak out against code changes that will diminish patient fire safety. If you are a code official participating in the hearings, please vote to disapprove changes that reduce patient safety.

This article comes from a white paper commissioned by the International Firestop Council, a not-for-profit trade association of manufacturers, distributors, and installers of passive fire protection materials and systems in North America. Its mission is to promote the technology of fire and smoke containment in modern building construction through research, education, and development of safety standards and code provisions. For more information, call 970-223-4985 or visit www.firestop.org.