The heat from wildfires is increasingly disrupting the electrical grid and causing rolling blackouts.

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Health care is one of the most regulated fields in the United States and one of the largest contributors of greenhouse gas emissions and carbon to the planet. 

The current push for sustainability is at the forefront of many discussions for necessary reasons, but how often does it occur without a corresponding discussion of the fire and life safety ramifications of adopting the processes and technology necessary to achieve it? 

As environmental sustainability gains momentum, it has the potential to reverse many of the life safety improvements adopted over time. The question then becomes: How can health facilities professionals consider life safety as they pursue sustainability? This article looks at some of the trade-offs between sustainability and life safety as they present themselves over four areas of health care facilities management.

1. Electrification

The need for increased electrification comes with an equal need to ensure the safety of electrical systems. Some of the issues from the viewpoints of sustainability and life safety include:

Sustainability perspective. Building electrification is the process of replacing technologies utilizing fossil fuels as a source of energy with technologies that use electricity. This has a significant impact on reducing operational emissions for the building sector.

According to the International Energy Agency, the best way to reduce energy demand is to move away from fossil fuels due to the efficiency of electric technologies. To accomplish full electrification of the building sector, the electrical grid will need to support the increased electrical load. Simultaneously, the electrical grid will need to reduce its reliance on fossil fuels. The Energy Information Administration (EIA) reported that 4,243 billion kilowatt-hours (kWh) were generated by utilities in 2022, which derived from 60% fossil fuels (i.e., coal, natural gas, petroleum and other gases), and about 20% each from nuclear and renewables.

Today, most of the grid relies on fossil fuels, but the trend toward renewable energy sources is growing. In March 2023, the EIA announced that electricity generated from renewables surpassed coal in the U.S.

As the electrical grid improves worldwide, building owners and operators are grappling with electrifying and decarbonizing existing and new buildings. Prohibition of natural gas in existing buildings is materializing in some state and local jurisdictions. In May 2023, New York became the first state to ban natural gas and fossil fuels in most new buildings. In California, nearly 50 jurisdictions have taken the same approach.

The Lawrence Berkeley National Laboratory reports that all major energy end users have electric alternatives. For example, heat pumps are an economically viable substitute, particularly in buildings that previously used an air conditioning unit paired with a space-heating unit to manage indoor temperatures.

Life safety perspective. The increase in electrification has led to many conversations and changes to codes and standards, service and maintenance of electrical equipment, firefighting strategies and more. It is important to understand what works and what does not work. In many cases, the technology is changing so fast that the data lags significantly, which creates gaps in safeguards.

The first edition of the National Fire Protection Association’s NFPA 855, Standard for the Installation of Stationary Energy Storage Systems, was released three years ago. It provides the minimum requirements for mitigating the hazards associated with stationary, temporary and mobile energy storage systems as well as the storage of lithium metal or lithium-ion batteries. 

However, the standard only focuses on stationary and mobile energy storage systems; it does not include language about how items connect to the electrical grid. It is silent regarding where interconnections are permitted, how many are permitted, the distance they must be separated and other issues for technologies like bidirectional vehicle chargers.

As the economy presses forward with sustainability, the lives of electricians and emergency responders are at risk. Without safeguards, the electricity from these devices could back-feed to a presumed safe location, thereby creating the potential for injury and death. The proactive and reactive protection for each aspect of electrification can be radically different depending on the application.

 Increased electrification also adds new variances in electrical safety. As more buildings convert from fossil fuel to electrification, the need for incoming power from the electrical grid is increased. If a large hospital that normally provides heating via multiple natural gas-fired boilers converts to a fully electric heating configuration, significantly more power from the local electric utility is required. This might require an increase in the size of the incoming electric service and associated electrical gear. And as voltage and amperage increase, so does the potential of injury and fire risk.

Finally, the sustainability movement is creating challenges in firefighting methods. For a fire in an automobile that utilizes fossil fuels, the tactics are straightforward. The team simply extinguishes the fire using water or foam. Now, consider extinguishing an electric vehicle fire. Lithium, used in many of today’s hybrid and electric vehicles, burns extremely hot and creates a self-sustaining fire. Depending on the surroundings, some fire departments simply let the vehicle burn, while other departments douse the fire with copious amounts of water or foam, which concerns environmentalists.

The location of the fire also increases the life safety risk potential. For instance, an electric vehicle fire in an underground parking garage with multiple electric vehicles makes the situation even worse. There would be no way to put this intense fire out. Even if the garage contains a robust fire protection system and the fire department responds rapidly, the risk of significant structural damage is likely because the water will intensify the fire and the responders may not have the appropriate extinguishing agents.

2. Smart buildings

The growth of smart buildings can help enhance sustainability if facilities recognize the limitations of these technologies. Some considerations include:

Sustainability perspective. Enhanced data-driven technology is key to controlling building efficiency. The premise of smart buildings is to integrate building systems such as heating, ventilation and air conditioning (HVAC); lighting; security; and other systems using automated controls.

Many building automation systems incorporate automatic fault-detection algorithms to limit diagnostic time and expedite repairs. The increase in building automation and control, coupled with fault detection, significantly reduces energy consumption.

To cut emissions, the Biden administration announced the Climate Smart Buildings Initiative in August 2022. The goal is to reduce emissions from federal buildings by 50% by 2032 and achieve net-zero emissions by 2045. Actions like these are necessary to reduce emissions and consequently improve the climate.

Life safety perspective. The migration to smart buildings increases the complexity of integrated systems. For example, development of NFPA 4, Standard for Integrated Fire Protection and Life Safety System Testing, is to confirm end-to-end functionality of integrated active and passive life safety systems. 

Thus, a smoke detector activating is only one component of a building’s life safety ecosystem. If that smoke detector connects to an emergency control function, like the shutdown of an air-handling unit, initiation of the smoke evacuation system or activation of occupant notification, the life safety management plan expects the emergency control function to operate appropriately.

With an increased focus on smart buildings that leverage elaborate technologies like fan arrays, air-handler sequencing and ramp-down schedules, multivendor communication and coordination is significantly more time-consuming and complex. This complexity leads to additional points of failure, especially throughout the life cycle of the building, which disturbs life safety. Furthermore, several equipment manufacturers have introduced self-testing fire alarm devices. 

While good in theory, there will always be a human element that must be considered. For example, a temporary construction smoke detector inadvertently concealed by a new ceiling may pass a self-test but lacks effectiveness and purpose of the asset. The above-ceiling installation of a smoke detector, unless considered interstitial space, is not its location or purpose. The detector will continually report that it is operating properly when it is not, and the only way to identify the error is if somebody physically discovers it in the inappropriate location.

While smart buildings are great for the environment, complexity can invite error that derails safety. Smart building operators must increase the scrutiny of these systems to ensure they are functioning as intended.

3. Sustainable construction

While the relationship between sustainable construction and sustainable performance is obvious, the connection between sustainable construction and life safety is less clear. Major considerations for both include:

Sustainability perspective. The Pacific Northwest National Laboratory states that green buildings are environmentally friendly and resource-efficient for the life of the building. The intent is to minimize the adverse impact on the natural environment while having an affirmative influence on surroundings and occupants. Green building materials include bamboo, cork, recycled plastic, reclaimed wood, plant-based polyurethane rigid foam and “hempcrete.”

Over the past several decades, the reduction and bans of chlorofluorocarbons and hydrochlorofluorocarbons in HVAC systems significantly decreased ozone depletion. More recently, mass timber construction is increasing market share due to its ability to sequester carbon emissions. A typical steel and concrete building might emit 2,000 metric tons of carbon dioxide, whereas a mass timber building can invert and sequester 2,000 tons instead.

Other positive attributes include conservation of nonrenewable resources and improved design flexibility. Additionally, green building materials reduce maintenance and replacement costs over the life of a building and improve occupant health. Finally, these materials do not expose occupants to asbestos, lead, mercury, volatile organic compounds or phthalates.

Life safety perspective. Sustainable construction has been around since people built structures out of locally sourced wood, straw, mud and similar materials. However, as towns and cities began to grow, so did death and destruction from fire. Even today, flammable building materials, such as cladding systems, still plague civilization.

In health care, patients deemed incapable of self-preservation require a defend-in-place protocol to ensure that building evacuation is the last resort. In these occupancies, noncombustible construction allows additional time to extinguish or escape a fire. The additional time is critical when staff and responders must save those who cannot save themselves.

Outside of fire protection, one must consider other life safety risks. Controlling infections through the introduction of bacteria is a primary concern in health care. When leveraging wood and mass timber construction, it amplifies the risk of infection because wood is not a smooth, cleanable surface. Even if the wood is sealed, the cleaning and disinfection required in health care eventually breaks down the sealant, thus harboring bacteria.

While the premise of sustainable construction is necessary, careful application is paramount because the rewards do not always outweigh the risks.

4. Wildfire activity

By their very nature, wildfires have an influence on and are influenced by sustainability and life safety issues. Some of the issues include:

Sustainability perspective. The Environmental Defense Fund performed a study and determined that the average wildfire season in the western U.S. is over three months longer than it was a few decades ago. 

The leading cause is rising average temperatures, which lead to premature snowmelt, unseasonable droughts and accelerated low humidity. Less moisture in the air and on the ground leads to an increase in combustibility, which advances larger and more intense wildfires.

Whether intentionally or not, humans start 85% of all wildfires. Couple that with the climate-related factors that contribute to the growth and intensity of wildfires, and it creates disasters. 

Moreover, a study funded by the Department of Agriculture’s Forest Service’s Wildland Fire Chemical Systems program found that fire retardants used to help smother wildfires are toxic. This toxicity has significant adverse effects on aquatic wildlife in the immediate drop zone and the surrounding dilution areas.

Increasingly, the heat from wildfires is disrupting the electrical grid and causing rolling blackouts. When buildings experience utility loss, the carbon-emitting generators come on and the global warming problem perpetuates.

Life safety perspective. Fires are necessary to rejuvenate the land, control invasive plants and temper future wildfires, but there has been a dramatic decrease in the number of prescribed, or “controlled,” burns over the years.

As defined by the Forest Service, teams of fire experts perform prescribed fires during specific weather conditions to restore the environment that naturally depends on fire. Data shows that prescribed burns are the best method of reducing wildfires. However, environmental activists have expressed concerns about the long-term health and environmental impacts of the smoke and the impact to the wildlife habitat, which led states to reduce the number of controlled fires. 

This is counterproductive. If data shows that controlled burns reduce long-lasting, devastating wildfires, the comparatively smaller problems associated with the burns must be accommodated. When a raging fire is burning uncontrollably, the safety of the fire service, residents, buildings and wildlife are all at risk.

Sustainable solutions

According to the Environmental Protection Agency, the Earth’s climate has changed dramatically since the Industrial Revolution through the release of large amounts of carbon dioxide and other ozone-depleting gases into the atmosphere. 

The building sector alone is responsible for about one-third of global greenhouse gas emissions.

Scientists agree that as greenhouse gases cover the planet, they trap the sun’s heat and lead to global warming and climate change. While the building sector has a tremendous responsibility to reduce global emissions, reducing emissions does not mean sacrificing safety.

More than a century ago, people understood the risks and benefits of fires and implemented codes and policies to solve problems that fires created. As sustainability and decarbonization continue to emerge as global issues, the development of codes and policies to solve the problems that technology creates is imperative. 

Joshua Brackett, PE, CHFM, SASHE, system regulatory director for facilities at Banner Health in Phoenix; Kara Brooks, MS, LEED AP BD+C, is senior associate director of sustainability at the American Society for Health Care Engineering; and Richie Stever, MHA, SASHE, is vice president of real estate and construction at the University of Maryland Medical System in Linthicum, Md. They can be reached at, and