Info on health care occupancies

Published on October 5, 2004
Nursing homes of all manner fall into the broad category of a "health care occupancy."  A health care occupancy is generally defined 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." Health care occupancies might include the following: hospitals, limited care facilities, and nursing homes among others.

A nursing home is specifically described in NFPA 101®, Life Safety Code®, as "a building or portion of a building used on a 24-hour basis for the housing and nursing care of four or more persons who, because of mental or physical incapacity, might be unable to provide for their own needs and safety without the assistance of another person." The term nursing home includes nursing and convalescent homes, skilled nursing facilities, intermediate care facilities, and infirmaries in homes for the aged.

Health care occupancies are characterized by the presence of persons who are considered to be incapable of using available exits to relocate within or evacuate the building. Such occupants may be unable to use the exits because they are bed-ridden or otherwise immobile, wired to monitoring or life-sustaining equipment, debilitated, recovering from surgery, or disabled in some other way.

Since most, if not all, occupants in health care occupancies are generally considered incapable of self-preservation, code provisions are based upon the "defend-in-place" concept. This concept uses a complete fire protection package, which incorporates any combination of building construction, sprinkler systems, detection and alarm systems, horizontal movement, compartmentation, and staff training, to provide occupants with enough protection to enable them to survive a fire while remaining in the building.

NFPA code provisions mandate that a considerable number of safety systems and features be present in order to keep everyone safe should a fire occur. The level of safety provided is not the result of any single safety system or feature, but rather is achieved through the combination of multiple safeguards that are provided. 

NFPA has a number of codes and standards that work in harmony to prevent the type of life-loss that occur in nursing homes. Three of these documents are:

The following elements provide an outline of the most basic requirements and criteria as found in NFPA 101®, Life Safety Code®, 2003 edition.

  • Compartmentation
    Barriers, such as walls, smoke barriers, partitions, and floors, separate building spaces. These barriers delay or prevent fire and smoke from spreading from one compartment to another.
  • On-site fire protection
    • Fire alarm systems – this includes means for detection of a fire, initiation of the alarm and/or suppression systems, and notification of occupants, especially the staff.
    • Automatic sprinkler systems – sprinkler systems are required in all new health care occupancies and many existing occupancies, especially when a facility undergoes major renovation.
    • Portable fire extinguishers – extinguishers must be provided in all health care occupancies and must be used only by properly trained personnel.
  • Exiting
    • Strategy – Unlike other types of occupancies, movement and evacuation of all patients is not practical and is reserved as a measure of last resort. The related exit provisions must keep this thought in mind.
    • Relocation – Often times, it is preferable to transport patients to a separate smoke compartment. This is referred to as horizontal relocation.
    • Occupant Load - the number of people anticipated to be in the building. This calculated value is used to derive the number of exits and the width of these exits.
    • Number and arrangement of exits-in general terms, at least two exits need to be provided from each building. In a health care occupancy, two exits are required to be provided for each floor or section of a floor. Depending on the level of compartmentation in the facility, there could be several exits, including horizontal exits, accessible from each floor.
    • Exit signs – signs are needed to identify exits and direct the ways to get to those exits. This includes location of such signs and how to illuminate them.
    • Emergency lighting – When a fire occurs in a building, visibility is one key factor that could affect how the staff react to an emergency situation and their ability to take appropriate action.
  • Staff training
    The action taken by staff in a health care occupancy is an integral part of the life safety features required. The proper response from staff in terms of numbers, actions, and management of the fire can readily influence the outcome of a fire.

    Since health care staff is a key factor in the success of the emergency action plan, it is important to regularly evaluate their ability to perform critical functions to protect patients in place or to perform rapid relocation of those who are threatened by the fire. Emphasis must be placed on training the staff to sound an alarm, to rescue patients (as needed), and to close all doors. The Code requires eight specific actions with respect to this part of the "defend-in-place" concept.

    All health care staff must be periodically instructed, through fire drills and written instructions, in the proper procedures for emergency relocation and/or evacuation.  The purpose of a fire drill is to test and evaluate the efficiency, knowledge, and response of institutional personnel in implementing the facility fire emergency plan. Its purpose is not to disturb or excite patients. Fire drills should be scheduled on a random basis to ensure that personnel in health care facilities are drilled not less than once in each 3-month period. Many health care facilities conduct fire drills without disturbing patients by choosing the location of the simulated emergency in advance and by closing the doors to patients' rooms or wards in the vicinity prior to initiation of the drill.
  • Furnishings & contents
    The purpose of interior finish requirements is to slow the fire spread across these surfaces to allow additional time for occupants to relocate or evacuate the building.
    • Interior finish – exposed surfaces of walls and ceilings within buildings.
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