Topic: NFPA Codes & Standards Process Updates

#101Wednesdays: Medical Facility Occupancy Classification

The 2012 edition of the Life Safety Code was recently adopted by the U.S. Centers for Medicare & Medicaid Services, a federal agency under the U.S. Department of Health & Human Services. In over-simplified terms, this means medical facilities, such as hospitals, nursing homes or skilled nursing facilities (SNFs), ambulatory surgical centers (ASCs), and free-standing emergency departments (EDs), must comply with the 2012 edition of NFPA 101 in order to receive Medicare or Medicaid reimbursement. (I'm not an expert on Medicare or Medicaid, so I'll stick to the Code issues.) NFPA 101 is an occupancy-based code, so it's very important to classify occupancies correctly. Otherwise, the wrong requirements will be applied. This could result in occupants being provided with insufficient life safety features, or conversely, a building owner spending more money than necessary on life safety features that aren't warranted. Three occupancy classifications exist in the Code that could apply to medical facilities; they are: Business Occupancies, Ambulatory Health Care Occupancies, and Health Care Occupancies. The NFPA 101 definitions and a brief description of each, as they apply to medical facilities, follow. Business Occupancy. An occupancy used for the transaction of business other than mercantile. While this might not sound like a medical facility, the definition does capture the correct classification for facilities such as doctors' offices, dentists' offices, and urgent care clinics, provided that no more than three occupants are incapable of self-preservation at any time (as will become apparent momentarily). In these types of medical facilities, patients are fully capable of evacuating under their own power in the event of an emergency. The occupant life-safety risk is no different than that found in an office building. Granted, when I was a call-fire fighter/EMT back in the day, we ran the occasional ambulance call to the local doctor's office, usually for someone who was brought there because they weren't feeling well, only to find out they were having an MI (myocardial infarction, or heart attack… I remember some of what I learned in EMT school nearly 30 years ago!). While those patients were incapable of self-preservation due to their medical condition, that did not make the doctor's office anything other than a business occupancy. Those patients simply went to the wrong facility. (They should have dialed 911 and gone to the hospital.) 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 renders the patients incapable of taking action for self-preservation under emergency conditions without the assistance of others (3) Emergency or urgent care 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 The big difference between business occupancies and ambulatory health care occupancies is the presence of four or more patients who are incapable of self-preservation because of a variety of reasons. The other key to this definition, and what differentiates it from health care, is the phrase “on an outpatient basis.” This means that a doctor has not signed an order admitting the patient to a facility for longer-term care with housing and sleeping accommodations. When patients are outpatients, they receive medical treatment or observation and are then subsequently admitted to a facility as inpatients, or they go home. Part (1) of the definition describes something like a dialysis clinic. The treatment renders the patient incapable of self-preservation because of the lack of ability to evacuate without the assistance of staff due to being hooked up to a dialysis machine. Part (2) of the definition describes something like an ASC, in which the patient walks into the facility, is then rendered incapable of self-preservation by anesthesia for a procedure, is moved to a recovery area for observation, and then walks out of the facility, typically on the same day. A dentist's office could be classified as ambulatory health care if, at any time, four or more patients are rendered incapable of self-preservation. Part (3) of the definition, which was new in the 2003 edition of the Code, can apply to an emergency department (ED), whether it is attached to a hospital, or a detached, free-standing facility. If attached to a hospital and classified as ambulatory health care, it must be separated from the remainder of the building by two-hour fire barriers (see 18.1.3.4 of the 2012 edition and 18.1.3.5 of the 2015 edition). The advantages to classifying an ED as ambulatory health care include: it is not subject to suite size limitations applicable to health care occupancies, patient rooms can be open to the corridor, and the health care occupancy corridor protection requirements don't apply. Again, the key is the patients in the ED are outpatients; once four or more inpatients who are incapable of self-preservation are present, the facility is classified as health care. 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. Health care occupancies are like ambulatory health care occupancies in that they contain four or more patients who are incapable of self-preservation; however, health care patients are inpatients, rather than outpatients, and are provided with housing and sleeping accommodations to facilitate extended care. Examples are hospitals, nursing homes (SNFs), and limited-care facilities, which could include something like psychiatric hospitals. These facilities are provided with the highest level of life safety features due to the number of patients expected to be unable to evacuate themselves on an around-the-clock basis. For health care occupancies, the Code utilizes a defend-in-place strategy, in which patients are moved from the area of fire origin to an adjacent, protected smoke compartment, without requiring vertical travel in the building. While all three of these occupancies provide varying degrees of health care services, the protection requirements for life safety from fire vary significantly, all dependent on the occupant risk. It's important to note that it's always the authority having jurisdiction's (AHJ's) responsibility to determine occupancy classification. The AHJ always has the authority to apply the Code in the manner it deems appropriate. My discussion is based on how the Code is intended to be applied as developed by NFPA's Technical Committees on Safety to Life. If you have any thoughts on the occupancy classification of medical facilities, please post them in the comments below. Thanks for reading, and until next time, stay safe! Got an idea for a topic for a future #101Wednesdays? Post it in the comments below – I'd love to hear your suggestions! Did you know NFPA 101 is available to review online for free? Head over to www.nfpa.org/101 and click on “Free access to the 2015 edition of NFPA 101.” Now you can follow me on Twitter: @NFPAGregH
Wildfire Community NJ

NFPA wildfire standards revised for 2017

Over 2016, NFPA's Wildland and Rural Fire Protection Standards Committee held its “second draft review” of public comments to ensure the standards remain relevant in their field. As explained by NFPA, the standards development process encourages public participation in the development of its standards. All NFPA standards are revised and updated every three to five years, in revision cycles that begin twice each year. This public participation to the standards began in 2015 for the 2017 revision cycle of NFPA 1144: Standard for Reducing Structure Ignition Hazards from Wildland Fire, and NFPA 1143: Wildland Fire Management. The committee's work culminated in a review meeting in Nashville, TN, over September 29, 2016. Revisions and clarifications were made to the standards and will be presented to NFPA's Standards Council in 2017. I spoke with the committee staff Liaison, Tom McGowan, who shared highlights of the committee's deliberations and new revisions for each standard below. NFPA 1144 – Standard for Reducing Structure Ignition Hazards from Wildland Fire • Clarified definitions including defensible space, fire resistive, ignition-resistant material, immediate landscaped area, noncombustible material, slope, structure ignition zone, water supply, wildland/urban interface and intermix. • Map elements to also include hydrants, cisterns, and water sources • Structural assessment will include an evaluation of the site for conflagration hazards. • Significant revisions to construction design and materials of the structure and components supported by ASTM testing standards and specific compliance elements found in chapter 5:  Roof design and materials Vents for attics, subfloors, and walls All projections including balconies, carports, decks, patio covers, enclosed roofs and floors Exterior vertical walls Exterior openings NFPA 1143 - Wildland Fire Management • Revised terminology from Wildland Fire Control to Wildland Fire Management to be more representative of the document's intent. • Aligned training and qualifications with NFPA or National Wildfire Coordinating Group (NWCG) • Aligned incident management chapter to National Incident Management System (NIMS) • Clarified the terminology and redefined fire suppression subsections including size-up, fire engagement and management, and mop-up and demobilization. • Revised responsibilities of Public Information Officer (PIO) to comply with NIMS. • Revised responsibilities of Safety Officer to participate in tactics and planning meetings as outlined in NIMS. • Clarified required documentation for Finance and Administration. • Updated NWCG publications reference material. The revised editions for 2017-2019 will become available in mid-2017. We encourage you to learn more about NFPA's various wildland fire standards and to utilize them in your local risk reduction activities. I share my thanks to the members of NFPA's Wildland and Rural Fire Protection Standards Committee for their volunteer work over the past two years as well. Photo Credit: (second) NWCG photo library, April Deming, NPS 2014_09_09-19_36_23_966-CDT
6a00d8351b9f3453ef01bb08925db1970d-120wi

Should you sleep with your bedroom door closed? NFPA's Educational Messages Advisory Committee will discuss this issue at its March 2016 meeting

Recent media coverage and new Underwriters Laboratories (UL) research has brought to the forefront again the issue of whether fire and life safety educators should be saying people should sleep with bedroom doors shut to be safer from fire. NFPA's Educational Messages Advisory Committee (EMAC) has reviewed the issue in the past and determined that if residents sleep with bedroom doors closed, it is important that they have interconnected smoke alarms. EMAC will meet March 30-31 at NFPA headquarters in Quincy, MA and is slated to discuss the topic again. And whether or not sleeping with the bedroom door closed should be added to EMAC messaging. EMAC will review new UL research documents, media clips, and other documentation submitted before making a determination on NFPA's official position. NFPA is accepting comments for revision to the EMAC document through February 26, 2016. UL research shows how a closed door can keep smoke out of a bedroom longer as well as change the flow of heat and toxic gases, acting as a shield for someone trapped and unable to get out of a fire. NFPA stresses the importance of having a working smoke alarm inside each bedroom, outside each separate sleeping area and on every level of the home. For the best protection, smoke alarms should be interconnected so when one sounds they all sound. Read the full story and watch the videos of each of the UL tests for more information.
Operating room

Does NFPA 99 require smoke purge in operating rooms?

One question that I have received quite often since the publishing of the 2012 edition of NFPA 99, Health Care Facilities Code, is whether or not windowless anesthetizing locations still require smoke purge systems. The answer to this is that the 2012 edition does not require it. What had previously been in NFPA 99 and previously NFPA 56A was language that remained essentially the same for years and was in the 2005 edition as follows: “6.4.1.2 Supply and exhaust systems for windowless anesthetizing locations shall be arranged to automatically vent smoke and products of combustion. 6.4.1.3 Ventilating systems for anesthetizing locations shall be provided that automatically (1) prevent recirculation of smoke originating within the surgical suite and (2) prevent the circulation of smoke entering the system intake, without in either case interfering with the exhaust function of the system.” My research shows this requirement to have first appeared in NFPA 56A in the 1960 edition. The way it was presented and worded has been slightly altered throughout the years but the intent that the smoke and products of combustion be vented and that recirculation be prevented had remained. When NFPA 99 was reorganized for the 2012 edition the requirement was not incorporated in the new Chapter 9, Heating, Ventilating, and Air Conditioning. In the current revision process the technical committee on Mechanical  Systems has proposed language that specifically states smoke purge is not required in windowless anesthetizing locations. The main substantiation for this is that the requirement is considered to be a relic as when it was first incorporated into an NFPA requirement the use of flammable anesthetics was common and therefore the fire hazards in these rooms was much higher.
1 ... 7 8 9

Latest Articles