In the last 100 years, there have been many progressions in the field of fire protection.  Unfortunately, many of today’s codes were written in response to horrific fire tragedies, several of which could have been prevented.  There is one particular fire that stands out as a turning point for health care occupancies. The St. Anthony’s Hospital fire of 1949 claimed the lives of 77 people.  There are many reports outlining this fire, and none indicate a negative perspective of the hospital from a fire and safety standpoint. For the time and era, the hospital was safe and the staff “took every step to prevent fires,” and yet tragedy still struck. 

From this fire, many of the codes we know today, such as enclosed vertical openings, two paths of egress from each floor, non-combustible studs and fire-resistant drywall, requirements for sprinklers in chutes and separation of floors into at least two smoke compartments were established.  It was recognized that health care occupancies are defend-in-place structures and changes had to be made in how hospitals were designed and constructed in order to accommodate this compartmentalization.

One other key finding came from the fire marshal’s investigation of this tragedy: the need for “regular evacuation training by hospital staff.” 

NFPA 101, Life Safety Code (2012) 18.7.1 and 19.7.1 require that fire drills are performed for health care occupancies, and 18.7.2/19.7.2 discusses the foundational procedures that should occur in the event of a fire. In the annex, it is even stated in A. that, “each facility has specific characteristics that vary sufficiently from other facilities to prevent the specification of a universal emergency procedure.” 

The reason behind fire drills is clearly stated in the Annex in A. “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.” 

All of the requirements that are implemented, such as every three months, plus or minus 10 days, per shift, and must vary greater than an hour, etc., are intentional and methodical to help ensure that the drills remain planned and purposeful.  Drills should never be a “check the box” mentality. In any fire, seconds matter. In a hospital fire where patients are incapable of self-preservation and staff is directly responsible for the patient’s safety and care, the seconds matter even more.

In addition to the requirements outlined by code, facility teams need to evaluate their current systems to ensure that there is truly a plan in place for fire drills and ensure that all hospital staff know their roles and responsibilities if a fire were to occur. This includes transient and temporary staff.

Recently a hospital was cited because it had four separate towers monitored by two separate fire alarm systems. The systems were tied together, but due to the building separation were not required to nor did they activate in-tandem. The hospital was performing alternating drills based on where the fire alarm systems served, ultimately resulting in half of the necessary number of drills being performed as recommended by code. This citation was a great finding and helped the hospital staff learn and adapt by either increasing the number of drills being performed or assuring that the fire alarm systems reported in tandem across the entire building.

The citation raises the point of newer fire alarm systems and notification zones.  New high-rise hospitals are required to have voice evacuation systems. These systems are more complex and have additional requirements in NFPA 72, National Fire Alarm and Signaling Code. 

One of the most common elements of these systems is notification zones, which are defined in NFPA 72 (2010) 3.3.300.2 as, “An area covered by notification appliances that are activated simultaneously.”  These zones mean that normally when a fire is detected the entire building fire alarm system does not activate, but rather the notification zone activates. 

A good example of this is activating the fire alarm notification appliances on the floor of the fire, the floor above the fire and the floor below the fire. Further NFPA 99, Health Care Facilities Code states “Where buildings are required to be subdivided into smoke compartments, fire alarm notification zones shall coincide with one or more smoke compartment boundaries or shall be in accordance with the facility fire plan.” 

What does this mean? If a facility team has a system with notification zones and is only performing drills within one zone, they will need to coordinate drills once per shift per quarter per notification zone in order to meet the intent of the code. The intent being that the entire staff must go through education and training quarterly.

The purpose behind this is in the event of a fire emergency staff must remain calm and react instinctively. Drilling has proven time and again to reduce anxiety and increase response time during emergency events. This might take executing additional drills, changing the process for how drills are performed, or even programming a drill feature into the fire alarm system. In the end, best practices should be reviewed with the intent to train for awareness.

As technology continues to change and provide new options we must never forget the past and the reason why drills and training are so critical. This might seem like a burden to some, but being prepared through drills and training clearly improves response. And remember, seconds matter.

Josh Brackett, PE, SASHE, CHFM, is facilities operations regulatory director at Banner Health; and Derek Watson is senior director of facilities operations, Tucson market facilities, development, and construction at Banner Health.