This content includes information linking Environment of Care and Life Safety Code deficiencies and their impact on patient care and patient safety.

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LS.02.01.10: Building and fire protection features are designed and maintained to minimize the effects of fire, smoke, and heat

Clinical Impact

Fire Safety: Background

Fire safety impacts both the lives of the occupants and the physical structures.

Fire Safety: Intent of the Life Safety Code

In our healthcare buildings we strive to protect the occupants by managing fire risk. We also benefit by protecting our financial investments in these healthcare buildings, which allows the organization to continue to achieve its mission and serve patients.

Over the years the healthcare building have benefited from the Joint Commission requirement of complying with the National Fire Protection Association (NFPA) Life Safety Code (NFPA 101-) and the associated Life Safety Chapter. Part of the process also includes the proactive use of the Statement of Conditions provided to all Joint Commission accredited organizations.

The specific focus here is on minimizing the effects of fire, smoke and heat. Healthcare buildings are built with a series of fire barriers, designed to restrict the movement of fire in a building. Fire barriers are a system of walls, floors, doors, fire windows, fire dampers, and managed penetrations. The fire barrier is not a single component. If a fire door fails, the fire barrier fails; if there are unprotected openings (i.e. holes) in the fire rated walls, the fire barrier fails. 

Most fire-related deaths are not caused by burns, but from smoke inhalation. Property damage is directly related to the fire conditions. Maintaining the integrity of fire barriers first protects the built environment and by default those occupants living in it. [NOTE: In a later module we will explore smoke barriers that are designed to protect occupants lives from smoke inhalation.]

If a fire barrier is more than walls, just what is a fire barrier? As mentioned above a fire barrier is several components, that when properly maintained protect the structure and its occupants. Each component has been tested to establish how much protection can be anticipated.

For example, the fire door is required to have certain features to ensure it will pass testing agency tests, including the door must have either self-closing or automatic-closing devices; functioning hardware, including positive latching devices; and the gaps between the meeting edges of door pairs are no more than ? inch wide with the undercut being <  ¾ inch (See LS.02.01.10 EP 5).

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In a similar manner the walls that hold the doors must be built to maintain their rating. For the 2-hour fire barrier, the wall construction must also pass the testing agency test. All components that affect the fire barrier must be tested to ensure the fire barrier as a system can perform as required.

If a fire rated door or other fire barrier component were modified, the rating is no longer maintained. For example, if a person applied white surgical tape over the door latch to cause the door to no longer latch, the door would be ineffective in containing fire in a fire condition, allowing the fire to spread. In a similar manner, if a contractor were installing cables above the ceiling and penetrated a rated fire barrier and did not install an acceptable remedy, the entire fire barrier could be compromised.

Suggested Solution to Managing Fire Barriers:

Many organizations use a Barrier Management Program, restricting the access above ceilings to prevent unknown breaches in the fire barriers. This program is discussed in greater detail in June Perspectives (pages 3 – 5). However, clinical staff can be an important part of the solution as well. Supporting facilities by endorsing the Barrier Management Program is an important first step. But also, supporting facilities by insisting staff do not block fire doors open, do not compromise latching or closing devices and providing support during construction activities.

Building Compartmentation: Defend in Place

Units of Defense: Building Compartmentation

Healthcare occupancies are designed to protect occupants by defending in place, rather than evacuation (as in business occupancy). To accomplish this, healthcare occupancies are designed with certain features that protect the occupants. For this to occur, all features of fire safety, including the building construction and fire suppression/alarm systems, need to be fully operable.

In the Joint Commission released an LSC model called the Unit Concept. This model was mainly developed to educate the surveyors about the LSC, but when it caught on, the Joint Commission published the concept and used it to teach health care professionals about code compliance. In a health care occupancy, because of the building type and staff-to-patient ratios, the reaction to a fire is to "defend in place."

The Unit Concept includes the following:

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