AGENDA NFPA Technical Committee on Health …...AGENDA NFPA Technical Committee on Health Care Occupancies NFPA 101 and NFPA 5000 First Draft Meeting Wednesday-Thursday, August 26-27,

AGENDA

NFPA Technical Committee on

Health Care Occupancies

NFPA 101 and NFPA 5000 First Draft Meeting Wednesday-Thursday, August 26-27, 2015

InterContinental Milwaukee

Milwaukee, WI

1. Call to order. Call meeting to order by Chair David Klein at 8:00 a.m. on August 26,

2015 at the InterContinental Milwaukee Hotel, Milwaukee, WI.

2. Introduction of committee members and guests. For a current committee roster, see

page 03.

3. Approval of June 26-27, 2013 second draft meeting minutes. See page 07.

4. The process – staff PowerPoint presentation. See page 11.

5. Correlating committee minutes with direction for 2018 editions. See page 28.

6. Core chapters, first revisions of interest – staff review.

7. FPRF egress modeling.

Smoke compartment size report. See page 35.

Journal in-compliance column. See page 64.

Additional work. See page 66.

8. FPRF AHC occupant load factor.

Report – foreign. See page 67.

Report – domestic. See page 97.

9. Australian nursing home fire report link. See page 122.

10. Corridor projections. See page 123.

11. Corridor ceilings.

Wall termination 1 of 2. See page 124.

Wall termination 2 of 2. See page 134.

12. Health care occupancy changed to ambulatory health care. See page 137.

13. Missing corridor door latch. See page 140.

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14. Monitoring exterior valves. See page 141.

15. NFPA 101 First Draft preparation. For Public Input, see page 147.

16. NFPA 5000 First Draft preparation. For Public Input, see page 280.

17. Other business.

18. Future meetings.

19. Adjournment.

Enclosures

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Address List No PhoneHealth Care Occupancies SAF-HEA

Safety to Life

Ron Coté07/14/2015

SAF-HEA

David P. Klein

ChairUS Department of Veterans Affairs810 Vermont Avenue, NW, Suite 800Mail Code: (10NA8)Washington, DC 20420Alternate: Peter A. Larrimer

U 11/2/2006SAF-HEA

Ron Coté

Secretary (Staff-Nonvoting)National Fire Protection Association1 Batterymarch ParkQuincy, MA 02169-7471

1/1/1991

SAF-HEA

Kenneth E. Bush

PrincipalMaryland State Fire Marshals Office301 Bay Street, Lower LevelEaston, MD 21601-2721International Fire Marshals AssociationAlternate: Charles J. Giblin III

E 1/1/1978SAF-HEA

Wayne G. Carson

PrincipalCarson Associates, Inc.35 Horner Street, Suite 120Warrenton, VA 20186-3415Alternate: William E. Koffel

SE 1/1/1988

SAF-HEA

Michael A. Crowley

PrincipalJENSEN HUGHES8827 West Sam Houston ParkwaySuite 150Houston, TX 77040-5399Alternate: Eric R. Rosenbaum

SE 1/1/1985SAF-HEA

Samuel S. Dannaway

PrincipalS. S. Dannaway Associates, Inc.501 Sumner Street, Suite 421Honolulu, HI 96817-5304

SE 1/16/2003

SAF-HEA

Buddy Dewar

PrincipalNational Fire Sprinkler Association, Inc.200 West College AvenueTallahassee, FL 32301Alternate: Eric Gleason

M 10/23/2003SAF-HEA

Alice L. Epstein

PrincipalCNA InsuranceTen Town Plaza, Suite 208Durango, CO 81301

I 8/5/2009

SAF-HEA

Martin J. Farraher

PrincipalSiemens Industry, Inc.5075 Houston RoadRockford, IL 61109Alternate: Peter W. Tately

M 08/09/2012SAF-HEA

John E. Fishbeck

PrincipalThe Joint CommissionOne Renaissance BoulevardOakbrook Terrace, IL 60181Alternate: Anne M. Guglielmo

E 4/1/1996

SAF-HEA

Gary Furdell

PrincipalState of FloridaAgency for Healthcare Administration4347 South Canal CircleNorth Fort Myers, FL 33903

E 8/5/2009SAF-HEA

Michael O. Gencarelli

PrincipalUS Department of the NavyNAVFAC HQ: Medical Facilities Design Office (MDFO)1322 Patterson Avenue, Suite 1000Washington, DC 20374

E 8/9/2011

1

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Safety to Life

Ron Coté07/14/2015

SAF-HEA

Robert J. Harmeyer

PrincipalMSKTD & Associates930 North Meridian StreetIndianapolis, IN 46204American Institute of ArchitectsAlternate: Bruce D. Brooks

SE 10/20/2010SAF-HEA

Donald W. Harris

PrincipalCalifornia Office of Health Planning & DevelopmentFacilities Development Division400 R Street, Room 200Sacramento, CA 95811

E 7/12/2001

SAF-HEA

David R. Hood

PrincipalRussell Phillips & Associates, LLC500 Cross Keys Office ParkFairport, NY 14550-3507NFPA Health Care SectionAlternate: A. Richard Fasano

U 4/14/2005SAF-HEA

Richard M. Horeis

PrincipalHDR Architecture, Inc.8404 Indian Hills DriveOmaha, NE 68114

SE 10/20/2010

SAF-HEA

Henry Kowalenko

PrincipalIllinois Department of Public HealthOffice of Health Care Regulation525 West Jefferson Street, 4th FloorSpringfield, IL 62761Alternate: Dennis L. Schmitt

E 3/4/2009SAF-HEA

James Merrill II

PrincipalUS Department of Health & Human ServicesCenters for Medicare & Medicaid Services (CMS)7500 Security Boulevard, M/S S2-12-25Balitmore, MD 21244-1849US Dept. of Health & Human Services/CMSCMSAlternate: Kenneth Sun

E 3/2/2010

SAF-HEA

Daniel J. O'Connor

PrincipalAon Fire Protection Engineering4 Overlook PointLincolnshire, IL 60069-4302Alternate: Dale D. Wilson

I 1/1/1991SAF-HEA

Ben Pethe

PrincipalHealth Care Consultant3224 Fountain BoulevardTampa, FL 33609

SE 10/20/2010

SAF-HEA

G. Brian Prediger

PrincipalUS Army Medical Command HeadquartersDirector, Facilities Engineering Division2748 Worth Road, Suite 22Fort Sam Houston, TX 78234Alternate: Philip J. Hoge

U 7/24/1997SAF-HEA

John A. Rickard

PrincipalP3 Consulting5838 Balcones Drive, Suite BAustin, TX 78731-4206

SE 8/2/2010

SAF-HEA

Richard Jay Roberts

PrincipalHoneywell Life Safety624 Hammer LaneNorth Aurora, IL 60542-9155Automatic Fire Alarm Association, Inc.

M 10/20/2010SAF-HEA

Terry Schultz

PrincipalCode Consultants, Inc.2043 Woodland Parkway, Suite 300St. Louis, MO 63146-4235Alternate: Michael Zakowski

SE 7/23/2008

2

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Safety to Life

Ron Coté07/14/2015

SAF-HEA

Geza Szakats

PrincipalArup North America Ltd.560 Mission Street, 7th FloorSan Francisco, CA 94105Alternate: Matthew W. Davy

SE 8/2/2010SAF-HEA

Michael D. Widdekind

PrincipalZurich Services CorporationRisk Engineering112 Andrew CourtCentreville, MD 21617

I 1/14/2005

SAF-HEA

Fred Worley

PrincipalTexas Department of Aging & Disability ServicesLong Term Care Regulatory DivisionPO Box 149030, Mail Code E-250Austin, TX 78714

E 03/05/2012SAF-HEA

Chad E. Beebe

Voting AlternateASHE - AHAPO Box 5756Lacey, WA 98509-5756American Society for Healthcare Engineering

U 03/05/2012

SAF-HEA

Bruce D. Brooks

AlternateOdell2700 East Cary StreetRichmond, VA 23223-7830American Institute of ArchitectsPrincipal: Robert J. Harmeyer


Matthew W. Davy

AlternateArup955 Massachusetts Avenue, Suite 400Cambridge, MA 02139Principal: Geza Szakats

SE 04/08/2015

SAF-HEA

A. Richard Fasano

AlternateRussell Phillips & Associates Inc.8788 Elk Grove BoulevardBldg. 3, Suite 12-HElk Grove, CA 95624NFPA Health Care SectionPrincipal: David R. Hood

U 8/5/2009SAF-HEA

Charles J. Giblin III

AlternateMaryland State Fire Marshal’s Office1201 Reisterstown RoadPikesville, MD 21208International Fire Marshals AssociationPrincipal: Kenneth E. Bush

E 03/07/2013

SAF-HEA

Eric Gleason

AlternateNational Fire Sprinkler AssociationPO Box 621573Littleton, CO 80162National Fire Sprinkler AssociationPrincipal: Buddy Dewar

M 08/11/2014SAF-HEA

Anne M. Guglielmo

AlternateThe Joint CommissionDepartment of EngineeringOne Renaissance BoulevardOakbrook Terrace, IL 60181Principal: John E. Fishbeck

E 10/23/2013

SAF-HEA

Philip J. Hoge

AlternateUS Army Corps of EngineersHumphreys Engineer CenterKingman Building, Suite 3MX7701 Telegraph RoadAlexandria, VA 22315-3813Principal: G. Brian Prediger

U 10/20/2010SAF-HEA

William E. Koffel

AlternateKoffel Associates, Inc.8815 Centre Park Drive, Suite 200Columbia, MD 21045-2107Principal: Wayne G. Carson

SE 1/1/1991

3

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Safety to Life

Ron Coté07/14/2015

SAF-HEA

Peter A. Larrimer

AlternateUS Department of Veterans Affairs1805 Constitution BlvdValencia, PA 16059Principal: David P. Klein

U 11/2/2006SAF-HEA

Eric R. Rosenbaum

AlternateJENSEN HUGHES3610 Commerce Drive, Suite 817Baltimore, MD 21227-1652Principal: Michael A. Crowley

SE 03/07/2013

SAF-HEA

Dennis L. Schmitt

AlternateIllinois Department of Public Health525 West JeffersonSpringfield, IL 62761Principal: Henry Kowalenko

E 04/08/2015SAF-HEA

Kenneth Sun

AlternateUS Public Health ServiceCenters for Medicare & Medicaid Services (CMS)1600 Broadway, Suite 700Denver, CO 80202US Dept. of Health & Human Services/CMSCMSPrincipal: James Merrill II

E 3/2/2010

SAF-HEA

Peter W. Tately

AlternateSiemens Building Technologies927 Nottingham RoadPottstown, PA 19465Principal: Martin J. Farraher

M 10/27/2009SAF-HEA

Dale D. Wilson

AlternateAon Fire Protection Engineering400 Overlook PointLincolnshire, IL 60069-4302Principal: Daniel J. O'Connor

I 08/09/2012

SAF-HEA

Michael Zakowski

AlternateCode Consultants, Inc.2043 Woodland Parkway, Suite 300St. Louis, MO 63146Principal: Terry Schultz


Pichaya Chantranuwat

Nonvoting MemberFusion Consultants Co. Ltd/Thailand81/55 Soi Phumijit, Rama 4 RoadPrakanong, KlontoeyBangkok, 10110 Thailand

SE 1/18/2001

SAF-HEA

David M. Sine

Nonvoting MemberNational Center for Patient Safety209 West SummitAnn Arbor, MI 48103-3249National Association of Psychiatric Health Systems

U 1/1/1989SAF-HEA

Ron Coté

Staff LiaisonNational Fire Protection Association1 Batterymarch ParkQuincy, MA 02169-7471

1/1/1991

4

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BLD/SAF-HEA Second Draft Meeting Minutes Page 1

Minutes NFPA Technical Committee on Health Care Occupancies

NFPA 101 and NFPA 5000 Second Draft Meeting June 26-27, 2013 DoubleTree Hotel

San Diego, California 1. Call to Order. The meeting was called to order by Chair David Klein at 8:00 a.m. on

June 26, 2013 at the DoubleTree Hotel, San Diego, California. 2. Introduction of Committee Members and Guests.

TECHNICAL COMMITTEE MEMBERS PRESENT

NAME COMPANY

David Klein, Chair US Department of Veterans Affairs Ron Coté, Nonvoting Secretary National Fire Protection Association Chad Beebe Alt. to D. Erickson

American Society for Healthcare Engineering

Kenneth Bush, Principal Maryland State Fire Marshal’s Office Rep. International Fire Marshals Association

Wayne Chip Carson, Principal Carson Associates, Inc. Michael Crowley, Principal The RJA Group, Inc. Samuel Dannaway, Principal S. S. Dannaway Associates, Inc.

Rep. American Society of Safety Engineers Buddy Dewar, Principal National Fire Sprinkler Association, Inc. Joshua Elvove Alt. to S. Dannaway

Self Rep. American Society of Safety Engineers

Alice Epstein, Principal CNA Insurance Douglas Erickson, Principal TME, Inc.

Rep. American Society for Healthcare Engineering

Martin Farraher, Principal

Siemens Industry, Inc. Rep. National Electrical Manufacturers Assn.

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A. Richard Fasano Alt. to D. Hood

Russell Phillips & Associates, Inc. Rep. NFPA Health Care Section

John Fishbeck, Principal The Joint Commission Gary Furdell, Principal State of Florida Agency for Healthcare

Administration Robert Harmeyer, Principal MSKTD & Associates Donald Harris, Principal California Office of Health Planning and

Development Philip Hoge Alt. to G. Brian Prediger

US Army Corps of Engineers

David Hood, Principal Russell Phillips & Associates, LLC Rep. NFPA Health Care Section

Richard Horeis, Principal HDR Architecture, Inc. Robert Kleinheinz Alt. to B. Dewar

National Fire Sprinkler Association

William Koffel Alt. to W. Carson

Koffel Associates, Inc.

Henry Kowalenko, Principal Illinois Department of Public Health Peter Larrimer Alt. to D. Klein

US Department of Veterans Affairs

Daniel O’Connor, Principal Aon Fire Protection Engineering G. Brian Prediger, Principal U. S. Army Medical Command

Headquarters John Rickard, Principal Katus, LLC Richard Roberts, Principal Honeywell Life Safety

Rep. Automatic Fire Alarm Association, Inc.

Eric Rosenbaum, Principal Hughes Associates, Inc. Rep. American Health Care Association

Terry Schultz, Principal Code Consultants, Inc. Saundra Stevens, Principal Adams County Regional Medical Center Geza Szakats, Principal Arup North America Ltd. Dale Wilson Alt. to D. O’Connor

Aon Fire Protection Engineering

Fred Worley, Principal Texas Department of Aging & Disability Services

GUESTS

NAME COMPANY

Amy Carpenter Ledhardt Rodgers – Pioneeer Network Phil Jose P. R. Jose & Associates Tracy Vecchiarelli NFPA

Page 8 of 316


TECHNICAL COMMITTEE MEMBERS ABSENT

NAME COMPANY Michael Gencarelli, Principal US Department of the Navy James Merrill, Principal US Department of Health & Human

Services Ben Pethe, Principal Health Care Consultant Michael Widdekind, Principal Zurich Services Corporation

3. Approval of Previous Meeting Minutes. The August 15-17, 2012 meeting minutes

were approved with one correction. Alternate Josh Elvove who attended the First Draft meeting as a guest and whose company affiliation was shown as GSA asked that it be noted that he attended as an individual and not as a representative of GSA.

4. The New Process. Staff used the PowerPoint slides included in the agenda to explain the

Second Draft phase of the revision process. 5. Definitions Task Group. Mike Crowley volunteered to represent the committee on the

Correlating Committee task group that will draft the assignment of defined terms to the various technical committees. In future revision cycles each committee will have responsibility for handling changes to the defined terms assigned to it.

6. Hazardous Materials Task Group. David Klein volunteered to represent the committee

on the Correlating Committee’s task group that will address hazardous materials within NFPA 101 and NFPA 5000 before working with other NFPA committees.

7. Home Health Care Study (and Misc. Items). The task group consisting of Ken Bush –

Chair, Pete Larrimer, and Saundra Stevens did not report. Eric Rosenbaum was added to the task group replacing Tom Jaeger. The subject was retained on the agenda.

8. Making Ambulatory Health Care Chapters Self-Standing. The task group consisting

of Bill Koffel – Chair, Mike Crowley, Philip Hoge and Brian Prediger reported on the second day of the meeting. Associated Second Revisions were developed. The task group was discharged.

9. NFPA 101 Second Draft (formerly ROC) Preparation. Public Comments were

addressed and Second Revisions drafted. 10. NFPA 5000 Second Draft (formerly ROC) Preparation. Public Comments were

addressed and Second Revisions drafted. 11. Other Business.

• Core Chapter Changes. Staff advised that none of the changes made to the core chapters at the Second Draft meetings in May required any correlative actions by the Health Care Occupancies Committee.

• Correlating Committee Notes. Correlating Committee Notes prepared on the First

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Draft, and which should have been entered as official Public Comments, were addressed. A Committee response was generated on each Note. The Responses will be published as part of the Second Draft Report. Relative to the occupant load factor for ambulatory health care uses, the committee requested that the Correlating Committees process Second Correlating Revisions to revise the factor in Table 7.3.1.2 of NFPA 101 and Table 11.3.1.2 of NFPA 5000 from 100 sq ft to 150 sq ft regardless of what the BLD/SAF-MER committee does with the occupant load factor for business uses.

• Committee Input or Trail Balloons. The Committee Inputs generated at the First Draft meeting, for purposes of raising an issue so that it might be further addressed in the Second Draft meeting, were reviewed.

• Phase-in Period for Sprinklers in Existing High-Rise Buildings. A Second Revision was developed to revise NFPA 101 19.4.2 to continue the trend started with the 2012 edition so that there will be 6-, 9-, and 12-year phase-in periods.

• Reference Error. The committee was advised that there is a reference error in NFPA 101 19.2.2.5.2(3) where the reference should be to 19.3.5.7 and not to 19.3.5.1. The error might lead the user to believe that the requirement for sprinklers, as a condition for permitting locked doors for patient special needs, applies only to nursing homes. The intent is that all types of health care facilities must be sprinklered in order to use the locking provisions. By a unanimous vote of 22 to 0, the committee directed that a Tentative Interim Amendment be processed to correct the error.

• Fireplace Combustion Air. The committee confirmed that it is the intent of the provisions of NFPA 101 18/19.5.2.3(2) that the requirements of NFPA 54 be followed relative to combustion air makeup.

• Corridor Encroachments and Cane Detection. Second Revisions were drafted to add annex text explaining that locations where corridor encroachments exceed those permitted by accessibility regulations might need to be provided with cane detection.

• Ambulatory Health Care Smoke Compartment Size. A task group was formed to address the subject of ambulatory health care smoke compartment size for the next revision cycle. The task group consists of Josh Elvove – Chair, Chip Carson, Alice Epstein, John Fishbeck and Gary Furdell. The subject is retained on the agenda.

• Class I Flammable Liquids Stored Below Grade. The committee discussed that NFPA 30 is stricter than NFPA 45 on the subject of Class I flammable liquids stored below grade. It was agreed that NFPA 45 governs laboratories, but NFPA 30 governs flammable liquids storage even in a laboratory building.

• Next Revision Cycle. The committee agreed to meet in a 2 1/2-day meeting, tentatively scheduled for late 2015, to prepare its portion of the First Draft Report that will produce the 2018 editions of NFPA 101 and NFPA 5000.

12. Adjournment. On Wednesday, June 26 the meeting was recessed at 4:40 p.m. to permit task groups to meet. On Thursday, June 27 the meeting was reconvened at 8:00 a.m. The meeting was adjourned at 12:35 p.m. Minutes prepared by Ron Coté and Linda McKay

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NFPA 101 / 5000 First Draft MeetingsMilwaukee, Wisconsin

1

NFPA 101 / 5000 First Draft Meetings

InterContinental HotelMilwaukee, Wisconsin

July 27-31 and August 24-28, 2015

NFPA First Draft Meeting

nfpa.org 2

At this and all NFPA committee meetings we are concerned with your safety

If the fire alarm sounds, please egress the building

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2


• Please verify/update your contact information on roster attached to sign-in list

• Members categorized in any interest category who have been retained to represent the interests of ANOTHER interest category (with respect to issues addressed by the TC) shall declare those interests to the committee and refrain from voting on those issues throughout the process

nfpa.org 3

Members


• All guests are required to sign in and identify their affiliations

• Participation is limited to TC members or those individuals who have previously requested time to address the committee

• Participation by other guests is permitted at the Chair’s discretion

nfpa.org 4

Guests

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3


• Use of audio recorders or other means capable of reproducing verbatim transcriptions of this meeting is not permitted

nfpa.org 5

Members and Guests

Annual 2017 Revision Cycle – Key Dates

• Public Input Stage (First Draft): First Draft Meeting: July 27-31 and August 24-28, 2015 Posting of First Draft for Balloting Date: before October 26, 2015 Posting of First Draft for Public Comment: March 7, 2016

• Comment Stage (Second Draft): Public Comment Closing Date: May 16, 2016 Second Draft Meeting Period: TBD - June 1 to July 25, 2016 Posting of Second Draft for Balloting Date: September 5, 2016 Posting of Second Draft for NITMAM: January 16, 2017

• Tech Session Preparation: NITMAM Closing Date: February 20, 2017 NITMAM / CAM Posting Date: April 17, 2017 NFPA Annual Meeting: June 4-7, 2017 (Boston)

• Standards Council Issuance: Issuance of Documents with CAM: August 10, 2017

nfpa.org 6

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4


• Either Principal or Alternate can vote; not both

• All Principals are encouraged to have an Alternate

• Voting (simple majority) during meeting is used to establish a sense of agreement on First Revisions

• Voting (simple majority) during meeting is also used to establish Public Input resolution responses and to create Committee Inputs

nfpa.org 7

Voting During the First Draft Meeting


• Follow Robert’s Rules of Order

• Discussion requires a motion

nfpa.org 8

General Procedures

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5


• Not in order when another member has the floor

• Requires a second

• Not debatable and DOES NOT automatically stop debate

• 2/3 affirmative vote immediately closes debate, returns to the original motion

• Less than 2/3 allows debate to continue

nfpa.org 9

Motion to End Debate, Previous Question, or to “Call the Question”


• Member addresses the chair

• Receives recognition from the chair

• Member introduces the motion

• Another member seconds the motion

nfpa.org 10

Committee member actions:

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6


• Restates the motion

• Calls for discussion

• Ensures all issues have been heard

• Calls for a vote

• Announces the vote result

nfpa.org 11

Committee chair actions:

12nfpa.org

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7


• Resolve Public Input (PI)

• Create a First Revision (FR)

• Create a Committee Input (CI) – a placeholder used to solicit Public Comments and permit further work at Second Draft stage

nfpa.org 13

Committee Actions and Motions:


• Committee develops a Committee Statement (CS) to respond to (i.e., resolve) a Public Input

• Committee indicates in CS its reasons for not accepting the recommendation and/or points to a relevant First Revision

• PI does not get balloted

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Resolve a Public Input (PI)

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8


• FR is created to change current text or add new text

• Committee Statement (CS) is developed to substantiate the change

• Associated PIs get a committee response, often simply referring to the relevant FR

• Each FR gets balloted

nfpa.org 15

Create a First Revision (FR)


• Committee is not ready to incorporate a change into the First Draft but wants to receive Public Comment on a topic that can be revisited at Second Draft stage

• Committee Statement (CS) is developed to explain committee’s intent

• CI is not balloted

nfpa.org 16

Create a Committee Input (CI)

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9


• All Public Input must receive a Committee Statement

• Provide a valid technical reason

• Do not use vague references to “intent”

• Explain how the submitter’s substantiation is inadequate

• Reference a First Revision if it addresses the intent of the submitter’s Public Input

nfpa.org 17

Committee Statements (Substantiation):


• In-meeting votes establish a sense of agreement on the development of First Revisions (FR)

• FRs are secured by electronic balloting (≥2/3 of completed ballots affirmative, and affirmative by ≥1/2 voting members)

• Only the results of the electronic ballot determine the official position of the committee on the First Draft

nfpa.org 18

Formal Voting on First Revisions

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• Only First Revisions (FR) are balloted

Public Inputs and Committee Statements not balloted

Reference materials are available

• First Draft, PI, CI, and CS

• Voting options:

Affirmative on all FRs

Affirmative on all FRs with exceptions specifically noted

• Ballot provides option to vote affirmative with comment

• Vote to reject or abstain requires a reason

nfpa.org 19

Ballots


• Web-based balloting system

• Alternates are encouraged to return ballots

• Ballot session will time out after 90 minutes

• Use “submit” to save your work – ballots can be revised until the balloting period is closed

nfpa.org 20

Electronic Balloting

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nfpa.org 21

• Click link provided in ballot email

• Sign in with NFPA.org username and password


nfpa.org 22

• Select either ‘Affirmative All’ or ‘Affirmative with Exception(s)’

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nfpa.org 23

• Use “See FR- #” link to review all First Revisions

• Use “edit election” to change individual votes or to modify vote after submitting ballot


nfpa.org 24

• Make selection: Affirmative with Comment, Negative, or Abstain

• No selection defaults to affirmative

• Must include comment (reason) on each vote other than Affirmative

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nfpa.org 25

• To complete ballot click Participant Consent and Submit

• Return to edit any votes by ballot due date


• Initial ballot

• Circulation of negatives and comments – electronic balloting is re-opened to permit members to change votes

• Any First Revision that fails ballot becomes a Committee Input (CI)

nfpa.org 26

Balloting

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14

Legal

• Must comply with state and federal antitrust laws

• Participants are to conduct themselves in strict accordance with these laws

• Read and understand NFPA’s Antitrust Policy which can be accessed at nfpa.org/regs

nfpa.org 27

Antitrust Matters

Legal

• Participants must avoid any conduct, conversation or agreement that would constitute an unreasonable restraint of trade

• Conversation topics that are off limits include: Profit, margin, or cost data

Prices, rates, or fees

Selection, division or allocation of sales territories, markets or customers

Refusal to deal with a specific business entity

nfpa.org 28

Antitrust Matters (cont’d)

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15

Legal

• NFPA’s standards development activities are based on openness, honesty, fairness and balance

• Participants must adhere to the Regulations Governing the Development of NFPA Standards and the Guide for the Conduct of Participants in the NFPA Standards Development Process which can accessed at nfpa.org/regs

• Follow guidance and direction from your employer or other organization you may represent

nfpa.org 29


Legal

• Manner is which standards development activity is conducted can be important

• The Guide of Conduct requires standards development activity to be conducted with openness, honesty and in good faith

• Participants are not entitled to speak on behalf of NFPA

• Participants must take appropriate steps to ensure their statements whether written or oral and regardless of the setting, are portrayed as personal opinions, not the position of NFPA

• Be sure to ask questions if you have them

nfpa.org 30


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Legal

• Disclosures of essential patent claims should be made by the patent holder

• Patent disclosures should be made early in the process

• Others may also notify NFPA if they believe that a proposed or existing NFPA standard includes an essential patent claim

• NFPA has adopted and follows ANSI’s Patent Policy

• It is the obligation of each participant to read and understand NFPA’s Patent Policy which can accessed at nfpa.org/regs

nfpa.org 31

Patents

TC Struggles with an Issue

• TC needs data on a new technology or emerging issue

• Two opposing views on an issue with no real data

• Data presented is not trusted by committee

Code Fund Lends a Hand

• TC rep and/or staff liaison submits a Code Fund Request

• Requests are reviewed by a Panel and chosen based on need / feasibility

Research Project Carried Out

• Funding for project is provided by the Code Fund and/or industry sponsors

• Project is completed and data is available to TC

www.nfpa.org/codefund

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17

Document Information PagesAbout

• Document scope• Table of contents• Articles• Research and

statistical reports• Latest codes and

standards news on NFPA Today blog feed

• Free access

Current and Previous Editions

• Issued TIAs, FIs, Errata

• Archived revision information such as meeting and ballot information, First Draft Reports (previously ROPs), Second Draft Reports (previously ROCs), and Standards Council and NITMAM information

Next Edition

• Revision cycle schedule

• Posting & closing dates

• Submit public input/comments via electronic submission system.

• Meeting and ballot information

• First Draft Report and Second Draft Report

• NITMAM information• Standard Council

Decisions• Private TC info (*red

asterisk)• Ballot circulations,

informational ballots and other committee info

Technical Committee

• Committee name and staff liaison

• Committee scope and responsibility

• Committee list with private information

• Committee documents (codes & standards) in PDF format

• Committees seeking members

• Online committee membership application

Have a

productive

meeting

Page 27 of 316

MINUTES Joint Teleconference / Adobe Connect Meeting of

NFPA Correlating Committee on Building Code (BLD-AAC)

NFPA Correlating Committee on Safety to Life (SAF-AAC)

March 10, 2015

1. Call to Order. Teleconference / Adobe Connect meeting called to order by SAF-

AAC Chair Bill Koffel at 11:00 a.m. Eastern on March 10, 2015. BLD-AAC Chair

Jim Quiter was unable to attend.

2. Attendance Roll Call. Staff called the roll of BLD-AAC and SAF-AAC and recorded

the members who responded as being present.

The following members were in attendance:

NAME COMPANY BLD-AAC SAF-AAC

William Koffel Koffel Associates, Inc. Non-Voting

Member

Chair

Jerry Wooldridge Reedy Creek Improvement District Secretary

Chad Beebe ASHE – AHA

Rep.: TC on Board and Care

Facilities

Non-Voting

Member

Non-Voting

Member

Wayne Carson Carson Associates, Inc.

Rep.: TC on Fundamentals

Non-Voting

Member

Non-Voting

Member

Shane Clary Bay Alarm Company

Rep.: Signaling Systems Correlating

Committee

Principal: Wayne Moore

Alternate to

Non-Voting

Member

David Collins The Preview Group, Inc.

Rep.: TC on Means of Egress

Non-Voting

Member

Non-Voting

Member

John Devlin Aon Fire Protection Engineering

Corp.

Rep.: TC on Fire Protection Features

Non-Voting

Member

Non-Voting

Member

Salvatore DiCristina Rutgers, The State University of

New Jersey

Rep.: Bulding Code Development

Committee

Principal

Victor Dubrowski Code Consultants, Inc.

Re.: TC on Educational and Day-

Care Occupancies

Non-Voting

Member

Non-Voting

Member

Page 28 of 316

BLD-AAC/SAF-AAC PRE-FIRST DRAFT PLANNING MEETING MINUTES - MARCH 10, 2015 2


David Frable US General Services Administration Principal

Randy Gaw Rep.: TC on Detention &

Correctional Occupancies

Non-Voting

Member

Non-Voting

Member

John Harrington FM Global Principal

Howard Hopper UL LLC Principal Principal

Stephen Hrustich Gwinnett County Fire & Emergency

Services

Rep.: International Association of

Fire Chiefs

Principal

Jonathan Humble American Iron and Steel Institute Principal

Gerald Jones Rep: Building Seismic Safety

Council/Code Resource Support

Committee

Principal

J. Edmund Kalie Jr. Prince George’s County Government Principal

Gary Keith FM Global

Principal: John Harrington

Alternate

David P. Klein US Department of Veteran Affairs

Rep.: TC on Health Care

Occupancies

Non-Voting

Member

Non-Voting

Member

Amy Murdock Code Consultants, Inc.

Rep.: TC on Mercantile & Business

Occupancies

Non-Voting

Member

Non-Voting

Member

Isaac Papier Honeywell, Inc.

Rep.: National Electrical

Manufacturers Association

Principal

Henry Paszczuk Connecticut Dept. of Public Safety

Rep.: TC on Interior Finish &

Contents

Non-Voting

Member

Non-Voting

Member

Ronald Reynolds Virginia State Fire Marshal’s Office

Rep.: International Fire Marshals

Association

Principal

Eric Rosenbaum Jensen Hughes

Rep.: American Health Care

Association

Principal

Faimeen Shah Vortex Fire Engineering

Consultancy

Principal

Jeffrey Tubbs Arup

Rep.: TC on Assembly Occupancies

Non-Voting

Member

Non-Voting

Member

Robert Upson National Fire Sprinkler Association

Principal: Jeffrey Hugo

Alternate

Joseph Versteeg Versteeg Associates

Rep.: TC on Alternative Approaches

to Life Safety

Non-Voting

Member

Non-Voting

Member

Leon Vinci Health Promotion Consultants

Rep: American Public Health

Association

Principal: Jake Pauls

Alternate

Page 29 of 316


The following members were not in attendance:


James Quiter Arup Chair Principal

Sam Francis American Wood Council Principal

Raymond Hansen US Department of the Air Force Principal

John Kampmeyer, Sr. Triad Fire Protection Engineering

Corp.

Principal

Russell Leavitt Telgian Corporation

Rep.: American Fire Sprinkler

Association

Principal

Michael Newman Johnson & Johnson

Rep.: NFPA Industrial Fire

Protection Section

Principal

Daniel O’Connor Aon Fire Protection Engineering

Rep.: American Hotel & Lodging

Association

Principal

Richard Jay Roberts Honeywell Life Safety

Rep.: National Electrical

Manufacturers Association

Principal

The following guests were in attendance:

NAME COMPANY

Kristin Bigda National Fire Protection Association

Ron Coté National Fire Protection Association

Allan Fraser National Fire Protection Association

Daniel Gorham National Fire Protection Association

Gregory Harrington National Fire Protection Association

Robert Solomon National Fire Protection Association

3. Minutes Approval. Minutes of the BLD-AAC November 8, 2013 and SAF-AAC

November 7, 2013 meetings were approved as distributed.

4. Liaison Reports.

Sprinkler Project. Bill Koffel presented the sprinkler project liaison report. There

were no significant changes being made to NFPA 13, 13D and 13R (vis a vis NFPA

101/5000) in the current revision cycle (Annual 2015). NITMAMS are awaited. The

NFPA 13 revisions include re-inserting the sprinkler exemption for apartment unit

bathrooms.

Fire Alarm Project. Shane Clary presented the fire alarm project liaison report.

There were no significant changes being made to NFPA 72 (vis a vis NFPA

101/5000) in the current revision cycle (Annual 2015). NITMAMS are awaited.

Page 30 of 316


5. Supplemental Operating Procedures. SAF-AAC Chair Bill Koffel advised that he

and BLD-AAC chair Jim Quiter will appoint a task group to review the supplemental

operating procedures; compare its features to the NFPA Regulations Governing the

Development of NFPA Standards (Regs); and determine what, if anything, needs to

be retained in some form. Correlating committee members were asked to review the

procedures; identify any items that need to be retained; and communicate such to

staff.

6. Hazardous Materials – NFPA 101. The NFPA 101 Hazardous Materials Task

Group report was noted as received. Task Group Chair Jeff Tubbs was asked to

submit the proposed changes as official Public Input, on behalf of the task group, by

the July 6 closing date. Staff advised that the SAF-FUN, SAF-MEA, and SAF-FIR

technical committees would each address the portion of the recommended changes

that apply to their assigned chapters. Proposed new Annex C (a repository for

information on the NFPA documents that address hazardous materials) would be

addressed by SAF-FUN. The Correlating Committee would perform any needed

correlation among the technical committee actions.

7. NFPA 101/5000 2018-Edition Work Areas. The activity / plans updates from the

technical committee chairs and the development of subject areas for focus during the

2018 edition revision cycle were handled together. The resulting issues, for

consideration by the technical committees, follow:

SUBJECT NOTES NFPA 101 NFPA 5000

Glossary of Terms Direction needed on how to

proceed with definitions (on-

going)

All TCs based

on definition

assignments

All TCs based

on definition

assignments

Resilient design

concepts

Emerging topic but may pilot

a project for BLD/SAF-HEA

in 2015

HEA

Other TCs

might

consider

HEA

Other TCs

might

consider

Hazardous materials in

NFPA 101

How should code regulate

egress provisions related to

health hazards and not just

fire? (Jeff Tubbs Task

Group)

FUN, MEA,

FIR with AAC

review

Hazardous materials in

NFPA 5000

Review Chapter 34

provisions for things like

dead ends and common path

of travel

IND

Smoke compartment

size increase in health

care

Conditions needed to allow

larger compartment size in

hospitals/nursing homes

HEA HEA

CO detection in Only residential occupancy BCF BCF

Page 31 of 316



residential B&C without CO provisions;

Correlating Committee asked

earlier for a TIA

Security/safety/code

conflicts (re: schools,

in particular)

Should have content to

review from 12/2014 School

Security/Safety Workshop

FUN re: doc

Scope

expansion;

MEA, END;

Other TCs

might

consider re:

active shooter

FUN re: doc

Scope

expansion;

MEA, END;

Other TCs

might

consider re:

active shooter

Elevator use Incorporate the latest and

greatest information from

ASME

MEA, FUN BSY, MEA,

FUN

Home health care May consider joint NFPA

99/NFPA 101 project to

address durable medical

equipment (DME), safety

measures, and backup power

HEA, possible

co-ordination

w/ RES

Means of egress

remoteness

How is remoteness of exit

access potentially impacted

by vertical openings?

MEA, FIR MEA, FIR

Exterior wall

assemblies and NFPA

285

Review FPRF report (June

2014) and determine if

changes needed for NFPA

5000

BLC, SCM

“Life safety” sprinkler

systems

Introduce discussion on

scope, use and limitations of

NFPA 13D and NFPA 13R

for:

- Other than residential

occupancies

- 5- and 6-story buildings

integrating ‘pedestal

construction’ (13R)

BCF, RES BCF, RES,

BLC

NFPA 13R attic

protection

What is expected

performance level? Lives

saved but building lost

RES, BCF RES, BCF

Buildings under

construction

Evaluate application of

NFPA 241 to systems and

buildings

FUN FUN

Term “temporary” Expand definition to consider

use of temporary systems as

well as buildings/structures

FUN FUN

Page 32 of 316



Location, design,

hardening of egress

stairs based on wind

hazard

Avoid stair designs that utilize

glass on exterior walls.

Alternatively, look at use of

ASTM E1886, Standard Test

Method for Performance of

Exterior Windows, Curtain

Walls, Doors, and Impact

Protective Systems Impacted

by Missile(s) and Exposed to

Cyclic Pressure Differentials,

and/or ASTM E1996,

Standard Specification for

Performance of Exterior

Windows, Curtain Walls,

Doors, and Impact Protective

Systems Impacted by

Windborne Debris in

Hurricanes. See NIST NCST

report on Joplin, MO tornado.

FIR, MEA FIR, MEA,

SCM

In-building storm

shelter spaces

Add scoping and reference to

ANSI/NSSA/ICC 500 for

certain occupancies.

Various – incl

FUN (Scope);

AXM, END,

MER

Various – incl

FUN (Scope);

AXM, END,

MER, BLC,

SCM

Stair descent devices Add scoping, how many and

where

MEA,

Various

occupancies

BSY, MEA,

Various

occupancies

UMC technical review Close review for “conflicts”

with 90A, 90B, and other

NFPA documents (e.g.,

flexible air duct/connector

length)

BSF BSY

Roof egress New section on egress

requirements for roofs with

mechanical equipment

MEA MEA

Private

homes/dwellings

rented as B&Bs

Trend of private homeowners

advertising their home for

short stay rentals

(airbnb.com) but not licensed

or regulated in any way.

Might be more of a Pub Ed

issue.

RES RES

Life Safety Evaluation

for assembly

Continue the upgrading effort AXM AXM

Page 33 of 316



occupancies

Falls over guards in

arenas and stadia

FPRF report AXM AXM

Opening protectives

(door, windows)

ratings

Chair convened a task group FIR FIR

Inspection, testing,

maintenance (ITM) of

fire escape stairs

Consider National Fire

Escape Assn materials

MEA MEA

Day-care age for self-

preservation

FPRF report END END

Ambulatory health care

occupant load factor

2 FPRF reports HEA HEA

Apartments for the

elderly

Is there a special risk or is

special protection needed?

Revisit 1981 edition of

NFPA 101

RES RES

Open malls Chair convened a task group MER MER

Evacuation chairs Scoping and use of RESNA

standard

BSY

Accessibility reference

updating

2010 ADA; expected update

of ANSI A117.1

BSY

Green roofing systems FM Global has installation

data sheet and approval

standard

SCM

Tall timber buildings FPRF report BLC

Height and area FPRF compilation, but no

objective criteria developed

BLC

8. Other Business. No other business was raised.

9. Next Meeting. The BLD-AAC and SAF-AAC correlating committees will meet to

address NFPA 5000/101 First Draft correlation issues in December 2015 or early

January 2016.

10. Adjournment. The meeting was adjourned at 12:00 p.m. Eastern.

Minutes prepared by Ron Coté and Kelly Carey

Page 34 of 316

1

TE

CH

NIC

AL

NO

TE

S

Egress Modelling in Health Care Occupancies

Virginia Alonso

GIDAI Group, University of Cantabria

Fire Protection Research Foundation

© July 2014

The Fire Protection Research Foundation

One Batterymarch Park

Quincy, Massachusetts, U.S.A. 02169-7471

E-Mail: [email protected]

Web: www.nfpa.org/foundation

Page 35 of 316

mailto:[email protected]

http://www.nfpa.org/foundation

3

Acknowledgements

The Fire Protection Research Foundation expresses gratitude to those that assisted with the

development and review of the information contained in this report. The Research

Foundation appreciates the guidance provided by the Project Technical Panel:

Ken Bush, Maryland State Fire Marshal’s Office

Rita Fahy, NFPA

Bob Harmeyer, MSKTD & Associates

Rick Horeis, HDR Architecture, Inc.

Dan O’Connor, Aon Fire Protection Engineering

Enrico Ronchi, Lund University

Ron Cote, NFPA Staff Liaison

Robert Solomon, NFPA Staff Liaison

The author wants to express her gratitude to GIDAI´s Group, especially to the Director of the

Group, Dr. Daniel Alvear, and the researchers Dr. Orlando Abreu and Dr. Arturo Cuesta for

their support in this Project.

The content, opinions and conclusions contained in this report are solely those of the authors.

About the Fire Protection Research Foundation

The Fire Protection Research Foundation plans, manages, and communicates research on a

broad range of fire safety issues in collaboration with scientists and laboratories around the

world. The Foundation is an affiliate of NFPA.

About the National Fire Protection Association (NFPA)

NFPA is a worldwide leader in fire, electrical, building, and life safety. The mission of the

international nonprofit organization founded in 1896 is to reduce the worldwide burden of

fire and other hazards on the quality of life by providing and advocating consensus codes and

standards, research, training, and education. NFPA develops more than 300 codes and

standards to minimize the possibility and effects of fire and other hazards. All NFPA codes

and standards can be viewed at no cost at www.nfpa.org/freeaccess.

Keywords: egress modelling, health care occupancy, smoke compartment, means of egress

Page 36 of 316

http://www.nfpa.org/research/fire-protection-research-foundation

http://www.nfpa.org/freeaccess

4

Abstract

A proposed change for the 2015 edition of NFPA 101, Life Safety Code, would increase the

maximum allowable size of a smoke compartment in health-care occupancies from 22,500 ft2

(2,090 m2) to 40,000 ft2 (3,700 m2) – almost double the size (the maximum travel distance of

200 ft (61 m) to smoke barrier would remain the same).

This change could affect the evacuation/relocation of patients during an emergency in a health-

care facility. In this work, the computational model STEPS is used for analysing different

scenarios for sleeping areas in health care facilities. The results will provide input to the

technical committee regarding the potential impact of this change.

1. Introduction

The proposed change in the size of smoke compartments for health care facilities (from 22,500

ft2 to 40,000 ft2) will lead to an increase in the number of patients inside that smoke

compartment. It is important to understand how this may impact the relocation process in health

care occupancies.

The relocation - or evacuation - procedure in a health care facility is complex and a well-defined

strategy and an effective execution is necessary. It should be noted that most of the occupants

in these environments are patients that are being treated for some illness and they are not

capable to evacuate by themselves (self-evacuation). For this reason, the health care personnel

have to be ready and trained to assist (assisted evacuation) the patients in their relocation to a

another smoke compartment – or safe place.

It is well known that evacuation models are powerful tools to study the evacuation process in

different scenarios and applications [1-5]. We can find several reviews [1, 3] that show the

capabilities and limitations of these types of models. These reviews show that, apart from their

use in the field of transportations (ships, aircraft and trains) [6-8], most of the egress models

have been employed mainly for application to buildings. Apart from their possibilities, most of

Page 37 of 316

5

these models have been developed to consider the self-evacuation process instead of assisted

evacuation.

Unfortunately, just a few resources have been found related to assisted evacuation in these

scenarios. Golmohammadi and Shimshak performed one interesting study [9]. They showed an

analytical approximation to analyse the horizontal and vertical evacuation time, considering

three types of patients: Type 1 (ambulant patients), Type 2 (nonambulant patients who use

wheelchair) and Type 3 (nonambulant patients who are moved in their beds). Assuming a

defined strategy (the staff members know exactly who has to relocate/evacuate and in which

order) and based upon some basic evacuation principles, this analytical model permits the user

to consider the number and category of patients and the number of personnel and availability

of the elevator. Another study simulated the evacuation process in a hospital using the model

G-HES - Glasgow – Hospital Evacuation Simulator [10].

Although the modelling of this problem is scarce and limited, generally, it is agreed that it is

necessary to differentiate between ambulant and nonambulant patients. Furthermore, all the

patients have a preparation time that may depend on the type of illness or treatment. In some

cases, this preparation time includes the processes to disconnect the patients from equipment,

the movement of the patient from the bed to a wheelchair, stretcher or similar device or just

other common pre-relocation activities such as getting dressed or gathering their belongings. It

should be noted that the evacuation movement is also different in this kind of assisted

evacuation or relocation.

In this case, the health care personnel will relocate the patients and in many cases they will

transport them in wheelchairs, stretchers or other transportation devices. Currently, there is a

lack of data related to these preparation times and transportation speeds. Just a few papers

present some ranges and limited values for these parameters. For example, Hunt, Galea and

Lawrence present in [11] a study undertaken to quantify the preparation time and transportation

speed of trained hospital staff in evacuating people with reduced mobility using different

assistance devices. Other works such as [12] and [13] show possible ranges and values for

preparation times considering different types of patients for the sleeping areas.

Page 38 of 316

6

The goal of the project was to analyse the impact of an increase in smoke compartment size on

horizontal relocation of patients on a sleeping room floor in a health care facility.

Based upon preliminary input data and a dedicated calibration of the model inputs in STEPS

for the specific scope of this project, diverse scenarios were selected and modelled considering

the proposed change in the smoke compartment. Furthermore, since the number of health care

personnel can significantly vary in the same scenario, different ratios of patients to health care

personnel members were studied to show the impact of this parameter in the relocation process

of patients in this kind of environment.

2. Description of the evacuation model

The evacuation model STEPS – Simulation of Transient Evacuation and Pedestrian

movementS – version 5.1 (June 2012) from Mott MacDonald [14] has been used for this

Project. STEPS is a behavioural model [1] that has the capability to implement random input

variables for the pre-evacuation and/or preparation times and unimpeded and/or transport

speeds based on probability distribution function.

STEPS permits the simulation of occupants in a normal or emergency situation within different

types of buildings. Most current evacuation models, including STEPS, are mainly developed

for simulating a self-evacuation process and they present several limitations for modelling an

assisted evacuation process. The capabilities of STEPS in normal conditions mode permit the

user to define task and routes for each occupant (patients and health care personnel)

representing the transport of patients.

3. Occupant characteristics

For this study, we considered two types of occupants: health care personnel and patients. It

should be noted that other kind of occupants could be found in this scenarios such as visitors,

doctors, other staff, etc. For this study, we considered the worst-case scenario, the night time

for sleeping areas when only health care personnel and patients are assumed to be in the area.

Page 39 of 316

7

In any case, it would not be appropriate to model visitors and other transient occupants as part

of the emergency relocation process.

3.1 Type of occupants

Health Care Personnel

These individuals will be responsible for assisting with the removal and the relocation of

patients. The number of health care personnel may depend on the specific type of care provided

by the hospital (or hospital floor). It can change depending on the use area (sleeping room /

treatment room) or time of day. It should be noted that for this study we considered the worst-

case scenario, the night time for sleeping rooms when the staff available for evacuation is

presumed to be at the minimum.

Patients

Based on their ability to evacuate by themselves, we considered the following type of patients:

Type 1 – Ambulant patient with reduced mobility.

Type 2 - Nonambulant patients who need to be assisted using a wheelchair or similar

device.

Type 3 - Nonambulant patients who need to be assisted by using a stretcher, blanket or

similar device and that may have to be moved using a blanket drag. It is assumed that

this type of patient may include the patients connected to any medical equipment.

For the evacuation or relocation process, all the patients in the hospital were assumed to be

assisted by health care personnel.

3.2 Main parameters

Apart from the corresponding scenario and its characteristics (location of exits, dimensions,

number of personnel, travel distances to the exit, etc.), the assisted relocation process in a health

care facility can be described by several parameters that define the behaviors and movement of

each health care personnel:

Page 40 of 316

8

- Pre-relocation time(𝑡𝑝𝑟𝑒𝑆). The time elapsed until each health care personnel member

starts movement to relocate the patients. For this study, it was assumed that the

personnel are already assembled in the corresponding smoke compartment and prepared

for performing relocation processes.

- Preparation time(𝑡𝑝). The required time for preparing the patient for relocation. This

time depends on the type of preparation and the ability of the corresponding personnel

to be ready to move the patients:

o With no devices (ambulant patients)

o Move to a wheelchair

o Move to a stretcher

o Move to a blanket

- Unimpeded walking speed(𝑤𝑆). The walking speed of health care personnel moving

toward a patient or returning to the next patient.

- Transportation speed (𝑤𝑝). The walking speed of health care personnel while

transporting the patient to another safe compartment or while walking with the patients

(ambulant patients).

These parameters defined the behaviors of the personnel for performing the relocation process.

Furthermore, based on his/her physical and psychological characteristics each member of the

personnel will have his/her own pre-relocation time and unimpeded walking speed and the

model employed a preparation time and transportation speed for each patient. It is well known

that the evacuation process is a highly stochastic phenomenon [15, 16] due to the randomness

of human behavior and the development of the emergency.

The most realistic manner to represent this randomness is by considering the behavioral

parameters (Pre-relocation time, preparation time, unimpeded walking speed and transportation

speed) as a random variable. This means that the parameters will be defined by density

distribution law and statistical parameters. Currently, there is a lack of data regarding these

behavioral parameters. However, in order to accomplish this analysis, Tables 1 and 2 show

some values for the input parameters based on different available studies. (The references for

the study are shown in the table.)

Page 41 of 316

9

In general, the gathered data for preparation times for Type 1, 2 and 3 show a range of values.

In order to use these parameters as random variables, it was assumed that they are normally

distributed with a standard deviation of 3 sigma. Pre-relocation and preparation time, in

contrast, is assumed to be log-normally distributed, with the mean and standard deviation

shown in Table 1.

Category Distribution law Mean [s] Sigma [s] Range [s]

Health care personnel [9]

Log-normal 70.8 60

Type 1 [7] Normal 60 20 30-90

Type 2[7] Normal 110 36 100-120

Type 3[7] Normal 360 40 180-900

Table 1. Pre-relocation and preparation time for patients

Distribution

law Mean [m/s]

Sigma [m/s] Range [m/s]

Unimpeded speed for health care personnel members [10]

Normal 1.35 0.25 0.65- 2.05

Speed for ambulant patients with reduced mobility [10]

Uniform 1.12 0.28 0.84-1.40

Transportation speed for wheelchair [10]

Normal 0.63 0.04

Transportation Speed for stretcher [10]

Normal 0.40 0.04

Table 2. Unimpeded and transportation velocities for health care facilities

There is also a lack of data regarding the transportation speed for a blanket carry. However, it

should be noted that for transportation using blankets, two health care personnel members per

patient are needed for the relocating process; therefore, for evacuation modelling purposes these

patients were considered as Type 3.

3.3 Evacuation priority

The evacuation process in a health care facility is a defined procedure established in the

emergency plans of each hospital. In general, all areas or smoke compartments have a person

in charge that will assign the responsibilities to each of the health care personnel in an

emergency. Based on the corresponding number, types and location of patients each health care

personnel member will relocate specific patients from their initial location (room) to a defined

safe area.

Page 42 of 316

10

For this study, it was assumed that at the point the responsible persons established the necessity

of relocating the patients from the affected smoke compartment, the health care personnel were

gathered in a common meeting area within the compartment to receive specific instruction

(evacuation procedure or priority). The emergency plans of hospitals usually establish a

“triage” for getting as many patients out as possible. The default priority in these situations may

be assumed as:

- Patients in immediate danger (near the fire)

- Ambulant patients - Type 1

- Patients requiring some transport assistance (wheelchair) - Type 2

- Patients requiring transport assistance (stretcher/blanket) - Type 3

- Patients who are being treated and/or would be difficult to relocate/evacuate (i.e. ICU,

obese or psychiatric). These types of patients were not considered for this study

This default priority was used as the relocation sequence for the modelling.

3.4 The application floor plan

As explained above, the aim of this study was to show the potential impact on the

relocation/evacuation process of a health care facility of increasing the size of the smoke

compartment. It should be noted that health care facilities are complex environments that

combine different kinds of activities and areas in the same facility such as treatment areas,

sleeping areas, administration areas, etc.

This report is focused on the analysis of varying the smoke compartment size in sleeping areas

during night time, when, theoretically, the occupancy is higher and the number of health care

personnel is limited. Several examples of actual health care floor plans were made available for

this study and included different typologies of areas (treatment areas, sleeping areas,

administrative areas, waiting areas, etc.). In order to create the smoke compartments that most

closely represent the current area limit (22,500 ft2) and the proposed limit (40,000 ft2), one of

the floor plans was adapted to obtain a hypothetical floor plan for a sleeping area.

Page 43 of 316

11

The hypothetical floor plan for a sleeping area (see Figure 1) had a plus-shape with four smoke

compartments of approximately 20,000 ft2 (19,172 ft2). Furthermore, this configuration

maintained the 200 ft travel distance from the most remote point to an exit for each

compartment. As Figure 1 shows, each of the smoke compartments in the middle section

contained 18 rooms.

Figure 1. Layout of adapted sleeping area floor plan

1

2

3

4

Page 44 of 316

12

To study the impact of increasing the size of the smoke compartment, the smoke barrier

between compartments 1 and 2 was removed in order to consider these two areas as one large

smoke compartment (39,424 ft2). The following scenarios were considered.

Scenario 1

A fire situation in smoke compartment 1 leading to the relocation of patients to the adjacent

smoke compartments (see Figure 2).

Figure 2. Layout of Scenario 1

The patients from the 18 rooms were relocated to the smoke compartments 2, 3 and 4.

Furthermore, each side of the floor plan had two exits (at the same distance). It was assumed

that the relocation of the patients were divided evenly into the adjacent areas causing a

minimum impact in the other smoke compartments as follows:

Patients from room 1 to room 4 were relocated to smoke compartment 2



1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18

Nursing station

SMOKE COMPARTMENT 3

SMOKE COMPARTMENT 4

SM

OK

E C

OM

PA

RT

ME

NT

2

Page 45 of 316

13


In general, the rooms in health care facilities are single or double occupancy. For Scenario 1,

the rooms 2, 6, 14 and 16 were considered as a double occupancy. This means that there were

22 patients inside the smoke compartment 1 (Scenario 1). Furthermore, it was assumed that 3

patients were Type 1, 4 patients were Type 2 and 15 patients were Type 3. It was not possible

to know previously the distribution of patients in each room.

For this reason, the patients were randomly assigned to the room. To do this, a random generator

software created a series of 22 numbers corresponding with the numbers of the room. It should

be noted that numbers from 19 to 22 correspond with the double occupancy rooms. The

numbers output from the random generator software established where the patients were

located: the initial 3 numbers indicated the number of room for patients type 1, the following 4

corresponded with patients type 2, and the last 15 numbers corresponded with patients type 3.

The established distribution of the patients can be seen below in Figure 3. This was input

manually into STEPS. It should be noted that the location of patients will define the evacuation

procedure (the order of patient´s evacuation). To reproduce the evacuation procedure, the

defined evacuation routes should be implemented into the model manually by the user, for this

reason the location of patients should be known before performing the simulations.

Page 46 of 316

14

Type 1 Type 2 Type 3

Figure 3. Distribution of patients in scenario 1

Different ratios of health care personnel were analyzed in order to show the impact of this

parameter for assisted evacuation procedures. As it has been shown above, the type of patient

defines the number of required personnel for their relocation (one or two) and in many cases two

persons are required for preparation of patients although just one is required for his/her

relocation.

For this reason, emergency groups formed by two health care personnel members were

considered as follows (it is assumed that two staff members are required for relocating each

patients):

Scenario 1.1: 6 emergency groups (12 health care personnel).



Page 47 of 316

15

Based on the number of emergency groups (EG) and the “triage”, Table 3 shows the

relocation procedure simulated for each scenario.

Scenario 1.1

Rooms

EG 1 9 2 (T1) 5 2 (T3)

EG 2 8 7 4

EG 3 6 (T1) 6 (T3) 3 1

EG 4 18 14 (T2) 16(T31) 11

EG 5 17 15 13 10

EG 6 14 (T1) 16 (T32)

Scenario 1.2

Rooms

EG 1 9 2 (T1) 7 5 3 1

EG 2 8 6 (T1) 6 (T3) 4 2 (T3)

EG 3 18 14 (T1) 14 (T2) 16(T31) 12 10

EG 4 17 15 16(T32) 13 11

Scenario 1.3

Rooms

EG 1 9 17 2 (T1) 7 6 (T3) 4 2 (T3) 1

EG 2 18 6 (T1) 15 16(T31) 5 12 11

EG 3 8 14 (T1) 14 (T2) 16(T32) 13 3 10

EG –Emergency Group, T1 – Type 1, T2 – Type 2, T3 – Type 3, Tx1 and Tx2 – patients from

double occupancy rooms

Table 3. Relocation process for Scenario 1

Scenario 2

For Scenario 2 the smoke barrier between smoke compartments 1 and 2 was removed

considering a smoke compartment of 39,424 ft2 (see Figure 4). A total of patients in 36 rooms

had to be relocated to smoke compartments 3 and 4 through four exits.

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Figure 4. Layout of scenario 2

Considering the use of the nearest exit and that all the exits were available, the relocation

procedure was:

Room 1 to room 9 use the Exit 2 to the smoke compartment 3

Rooms 19 to room 27 use the Exit 1 to smoke compartment 3



Type 1 Type 2 Type 3

Figure 5. Distribution of patients in scenario 2

1 2

3

4

5

6

7

8

9

10 11 12 13 14 15 16 17 18

19 20 21 22 23 24 25 26 27

36 35 34 33 32 31 30 29 28

SMOKE COMPARTMENT 4

SMOKE COMPARTMENT 3

EXIT 1 EXIT 2

EXIT 3 EXIT 4

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For Scenario 2, rooms 2, 6, 14, 16, 20, 24, 32 and 34 were considered as a double occupancy.

This means that there were a total of 44 patients to relocate in the adjacent smoke

compartments. In this case, it was assumed that there are 6 patients Type 1, 8 patients Type 2

and 30 patients Type 3. The patients were randomly distributed in the rooms generating a series

of 44 number with a random number generator (see Figure 5). Similar to Scenario 1, for

Scenario 2 different ratios of patients to health care personnel were simulated (it is assumed

that two staff members are required for relocating each patient):

Scenario 2.1: 12 EG (24 health care personnel)

Scenario 2.2: 8 EG (16 health care personnel)

Scenario 2.3: 6 EG (12 heath care personnel)

Scenario 2.1

Rooms

EG 1 9 16 (T31) 11 25

EG 2 18 16 (T32) 1 34 (T3)

EG 3 17 6 (T3) 10 26

EG 4 8 14 (T31) 19 35

EG 5 31 14 (T32) 28 27

EG 6 23 5 29 36

EG 7 6 (T2) 4 21 20 (T3)

EG 8 15 13 30 24 (T3)

EG 9 20 (T2) 3 22

EG 10 24 (T2) 12 32 (T31)

EG 11 34 (T2) 2 (T31) 32 (T32)

EG 12 7 2 (T32) 33

Scenario 2.2

Rooms

EG 1 9 20 (T2) 14 (T32) 11 30 26

EG 2 18 24 (T2) 5 1 22 35

EG 3 17 34 13 10 24 (T3) 27

EG 4 8 7 4 19 32 (T31) 36

EG 5 31 16 (T31) 3 28 32 (T32)

EG 6 23 16 (T32) 12 20 (T3) 33

EG 7 6 (T2) 6 (T3) 2 (T31) 29 25

EG 8 15 14 (T31) 2 (T32) 21 34

Scenario 2.3

Rooms

EG 1 9 6 (T2) 16 (T31) 13 11 29 32 (T32) 27

EG 2 18 15 16 (T32) 4 1 21 33 36

EG 3 17 20 (T2) 6 (T3) 3 10 30 25

EG 4 8 24 (T2) 14 (T31) 12 19 22 34

EG 5 31 34 14 (T32) 2 (T31) 28 24 (T3) 26

EG 6 23 7 5 2 (T32) 20 (T3) 32 (T31) 35 EG –Emergency Group, T1 – Type 1, T2 – Type 2, T3 – Type 3, Tx1 and Tx2 – patients from double occupancy rooms

Table 4. Relocation process for Scenario 2

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Table 4 shows the relocation procedure for the different scenarios considering the number of

emergency groups and the “triage”. It is assumed that the staff members serve the whole

compartment in Scenario 2.

4. Computational modelling

4.1 Introduction

This section/chapter presents the implementation of the inputs for the computational modelling

of the defined scenarios with the STEPS model. STEPS permits the user to import CAD files

(*.DXF) in order to build the geometry of the floor plan. The model represents the geometry

by default as a fine network of 0.5 x 0.5 m (see Figure 6). Note that the size of the cell may

impact on the results, however this discussion is out of this work [17].

Figure 6. Geometry used in STEPS of a sleeping area in a health care facility

The model STEPS [14] in normal conditions mode permits the implementation of different

tasks adjusted to routes and sub-routes for each occupant. These routes are based on the

prefixed relocation procedures for each emergency group (Table 3 and 4).

It was simulated that each health care personnel member used the prefixed routes to reach the

different checkpoints - rooms and final destination or other smoke compartment. The schema

of relocation for each health care personnel member is shown in Figure 7.

As Figure 7 shows, the checkpoint 1 was the initial starting point, or the place where the health

care personnel member goes to get the instruction (relocation procedure). Furthermore, each

member has his own pre relocation time (𝑡𝑝𝑟𝑒𝑆) and unimpeded walking speed (𝑤𝑠 ) – these

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19

parameters are generated by STEPS based upon the probability distribution functions and

statistical parameters shown in tables 1 and 2.

Figure 7. Schema for evacuating patients by using STEPS model

From the initial location (checkpoint 1), the health care personnel members used the defined

routes to reach the corresponding locations/ rooms in the defined order.

The type of patient defined the random preparation time inside each room. After the preparation

time 𝑡𝑝𝑖|𝑖=1,..𝑅𝑜𝑜𝑚 𝑛, each health care personnel member transported the patient through the

defined route. This route was assigned with a coefficient that decreased the unimpeded walking

speed of the health care personnel member – the transportation walking speed could not be

directly assigned to the routes. Based on data from Table 2, the following coefficients were

obtained:

Type of patients Coefficient

Type 1 0.83

Type 2 0.47

Type 3 0.30

Table 5. Coefficient assigned to the routes employed by each type of patients

Checkpoint 1 Initial location

Checkpoint 2

Room 1

Checkpoint n

Room n

Checkpoint 3

Final location 1 (other smoke

compartment)

Checkpoint 4

Room 2

Checkpoint 5

Final location 2 (other smoke

compartment)

Checkpoint n

Final location n (other smoke

compartment)

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4.1 Results

In order to obtain a significance sample of evacuation times, 100 simulations were run for each

scenario. Furthermore, these samples were statistically treated in order to obtain the mean value

and standard deviation. Likewise, 90th and 95th percentiles were obtained to show a most

confidence values for evacuation/ relocation times.

4.1.1 Scenario 1

For Scenario 1.1, 22 patients were relocated and assisted by 6 emergency groups based on the

evacuation procedure shown in Table 3. Table 6 shows the results for the evacuation times.

Mean (min) Standard

deviation (min) Percentile 90th (min)

Percentile 95th(min)

Minimum (min)

Maximum (min)

30:13 02:25 33:24 34:32 20:10 37:16

Table 6. Results for Scenario 1.1

As Table 6 and histogram in Figure 8 shows, the mean evacuation time for Scenario 1.1 is 30:13

min. with a range between 20:10 min. and 37:16 min. Furthermore, in order to obtain results

with a defined confidence level, the percentiles 95th and 90th show evacuation times of 34:32

min. and 33:24min.

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Figure 8. Histogram for Scenario 1.1

Table 7 and the corresponding histogram (Figure 9), show the relocation times for Scenario 1.2

where the 22 patients were relocated by 4 emergency groups. The mean evacuation time was

43:08 minutes with a 90th percentile of 46:13 min. and 95th percentile of 47:01 minutes.

Mean (min) Standard



Minimum (min)

Maximum (min)

43:08 02:16 46:13 47:01 38:24 49:18



0

5

10

15

20

25

30

35

40

20-22 22-24 24-26 26-28 28-30 30-32 32-34 34-36 36-38

Fre

quency

Evacuation Times (min)

0

5

10

15

20

25

30

35

40

37-39 39-41 41-43 43-45 45-47 47-49 49-51

Fre

quency

Evacuation Time (min)

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In scenario 1.3 (table 8 and figure 10), when the number of health care personnel is the lowest

(3 emergency groups), the mean evacuation time is 59:34 with a 90th percentile of 65:04 min

and a 95th percentile of 66:23 min.

Figure 10. Histogram for scenario 1.3

Mean (min) Standard



Minimum (min)

Maximum (min)

59:34 04:09 65:04 66:23 47:02 70:37

Table 8. Results for scenario 1.3

4.1.2 Scenario 2

In Scenario 2, the size of the smoke compartment has been increased to almost 40,000 ft2 and

there are 44 patients.

For Scenario 2.1, 12 emergency groups had to relocate the 44 patients to the smoke

compartments 3 and 4. As Table 9 and the histogram in Figure 11 show, the mean evacuation

time was 37:14 min. with a range of values between 31:43 min. and 44:08 min. Furthermore,

in this case, the 90th and 95th percentiles were 40:21 min. and 40:39 min.

0

5

10

15

20

25

30

35

47-50 50-53 53-56 56-59 59-62 62-65 65-68 68-71

Fre

quency


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Mean (min) Standard



Minimum (min)

Maximum (min)

37:14 02:21 40:21 40:39 31:43 44:08



For Scenario 2.2 (Table 10 and Figure 12), the mean evacuation time for relocating the 44

patients by 8 EG was 49:31 min. Furthermore, the percentiles 90th and 95th of the evacuation

time were 53:33 min and 54:47 min.

Mean (min) Standard



Minimum (min)

Maximum (min)

49:31 02:51 53:33 54:47 43:46 57:08


0

5

10

15

20

25

30

35

40

30-32 32-34 34-36 36-38 38-40 40-42 42-44 44-46

Fre

qu

en

cy


Page 56 of 316

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For the last Scenario 2.3 (Figure 13 and Table 11), 6 EG needed a mean evacuation time of

67:42 min. to relocate 44 patients. Furthermore, the 90th and 95th percentiles of the evacuation

time are 72:39 min. and 76:59 min.

Mean (min) Standard



Minimum (min)

Maximum (min)

67:42 04:37 72:39 76:59 59:42 83:40


0

5

10

15

20

25

30

35

42-44 44-46 46-48 48-50 50-52 52-54 54-56 56-58

Fre

quency


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4.2 Discussion of results

Based on the modelling assumptions, the relocation times are summarized below in Table 12.

The assumptions made included a random distribution of patients in each smoke compartment

– distribution for Scenario 1 and 2 differed. Another assumption that was made was that the

staff served all patients throughout the compartment, which led to longer travel distances for

each staff member in Scenario 2 due to the larger compartment.

Scenario Mean evacuation

time (min) 90th percentile of the

evacuation time (min) 95th percentile of the evacuation time (min)

1.1 30:13 33:24 34:32

2.1 37:14 40:21 40:39

1.2 43:08 46:13 47:01

2.2 49:31 53:33 54:47

1.3 59:34 65:04 66:23

2.3 67:42 72:39 76:59

Table 12. Comparison of evacuation times for all the scenarios

An interesting result obtained from this study was the high impact of the number of health care

personnel in the relocation process. As Table 12 shows, for Scenario 1.1 (ratio 1:2) the mean

evacuation times (30:13 min) decreased more than 12 minutes compared to scenario 1.2 (43:08

0

5

10

15

20

25

30

59-62 62-65 68-68 68-71 71-74 74-77 77-80 80-83 83-86

Fre

quency


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26

min) with a ratio 1:3 and more than 19 minutes for Scenario 1.3 (59:34 min.) with a ratio 1:4.

These differences were similar for Scenario 2.

In this case, the mean evacuation time for Scenario 2.1 (37:14 min) decreased around 12

minutes compared to Scenario 2.2 (49:31 min) and up to 30 minutes for Scenario 2.3 (67:42

min).

As Table 12 shows, comparing the different sizes of the smoke compartments with equivalent

ratios of patient/health care personnel (Scenario 1.1 - 2.1, 1.2 - 2.2 and Scenario 1.3 – 2.3) for

sleeping areas, we can see that the mean evacuation times are up to 7 minutes longer – more

than 23 %. (06:59 min. between scenarios 1.1 and 2.1, 06:23 min. between scenarios 1.2 and

2.2 and 8:08 min. for scenarios 1.3 and 2.3).

We can see that these differences were even bigger for the percentiles of evacuation times (more

than 10 minutes between the 95th percentiles of scenario 1.3 and 2.3). While the compartment

size may play a role in this difference, the assumptions made during modelling may play a role

as well including assumptions related to patient distribution and the area that each staff member

served. Future work should consider these variables.

5. Future research

The development of this project has shown the necessity of further research regarding the

assisted evacuation/relocation process. This would improve the understanding of this

phenomenon, the effectiveness of the relocation strategies adopted to relocate patients during

an emergency in a health care facility and its impact in the increase of the size of the smoke

compartment in this kind of environment.

This work highlights the lack of actual data about the parameters that defines an assisted

evacuation in a hospital. Future works should offer more reliable data about the preparation

times and transportation speeds in this kind of scenarios. Experiments and drills would permit

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27

to collect and analyze these parameters in order to obtain the probability distribution function

that defines these random variables.

The present work is focused on sleeping areas, it would also be necessary to analyze other types

of areas within health care facilities such as treatment areas whose characteristics differ from

the sleeping areas.

Another important issue is the limitation of the current models for assisted evacuation. The

model STEPS permits the user to calibrate its inputs in order to overcome most of these

limitations. However, some restrictions should be taken into account:

1- The number and category of patients, the evacuation procedures and the location per

room have to be previously defined by user.

2- The relocation routes (from each room to the corresponding exit or smoke

compartment) have to be previously defined by user.

3- The transportation speed is represented as a reduction of the walking speeds of the staff

member not as a random variable itself.

4- STEPS does not reproduce the wheelchair / stretcher movement.

Further works should deal with these issues by including new modules to the current evacuation

models or obtaining new models that permits to model an assisted evacuation process.

Any future work should consider the impact of the location of the patients on the relocation

time as well as the impact of the staff service areas (i.e. if staff were limited to nursing station

areas rather than serving a full smoke compartment).

6. Conclusions

The aim of this project was to study the impact of increasing the size of the smoke compartment

in a health care facility and the impact of staff to patient ratios on the relocation process of

patients. The evacuation or relocation process in these kind of scenarios is a complex

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phenomenon that needs a well-defined strategy and an effective deployment, especially in case

of fire. This study was focused on the horizontal movement of the patients from the affected

smoke compartment and assembling them in adjacent compartments. Furthermore, this work

analysed the sleeping areas in a hospital during the night time, which was assumed to be worst

case, considering all the rooms occupied and low ratios of patients/health care personnel.

The analysis of the different ratios of health care personnel assistance during an emergency

showed that this is an important factor that can highly impact the evacuation procedure and the

required times for relocation.

Based on the assumptions made during the analysis, including how patients were located and

the service areas of the staff, results of evacuation modelling in a health care facility showed

that changes to the parameters studied could have the potential to increase the evacuation time

up to 8 minutes. As noted, this increase is affected by the distribution of patients in their rooms

and the selected evacuation procedures, so these issues should be included in further study. As

we can see in figure 5 and table 4, for Scenario 2 the distances traveled by the staff member

during the relocation process may increase. For example in Scenario 2.1, the Emergency Group

1 relocates patients from rooms 9, 16, 11 and 25, once the EG has relocated the patients from

room 11 to the adjacent smoke compartment, this EG has to travel a distances bigger than 200

ft. to reach the following patient located in room 25.

7. References

[1] E.D. Kuligowski, R.D. Peacock, B.L. Hoskins. A Review of Building Evacuation Models,

Technical Note 1680 (2nd edition), NIST, Gaithersburg, 2010.

[2] C.J.E. Castle. Guidelines for Assessing Pedestrian Evacuation Software Applications

Centre for Advanced Spatial Analysis University College London, London (2007) (Paper 115).

[3] G. Santos, B.E. Aguirre, A critical review of emergency evacuation simulation models, in:

Proceedings of the NIST Workshop on Building Occupant Movement during Fire Emergencies,

Gaithersburg, 2004, pp. 25–50.

Page 61 of 316

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[4] S.M.V. Gwynne, E.R. Galea, M. Owen, P.J. Lawrence, L. Filippidis, Review of modelling

methodologies used in the simulation of evacuation, J. Build. Environ., 34 (1999), pp. 441–

749.

[5] S.M.V. Gwynne, E.D. Kuligowski, Application modes of egress simulation, in: Proceedings

of the Pedestrian and Evacuation Dynamics, Wuppertal (2008).

[6] J.A. Capote, D. Alvear, O. Abreu, A. Cuesta, V. Alonso A real-time stochastic evacuation

model for road tunnels Saf. Sci., 52, 2013, pp. 73–80

[7] J.A. Capote, D. Alvear, A. Abreu, A. Cuesta, V. Alonso, A stochastic approach for

simulation human behavior during evacuation process in passenger trains, Fire Technol., 44

(4), 2012, pp. 911–925

[8] R.W. Bukowski, R.D. Peacock, W.W. Jones, Sensitivy examination of the airEXODUS

aircraft evacuation simulation model, in: Proceedings of the International Aircraft Fire Cabin

Research Conference, Atlantic City, USA, 1998, pp. 16–20.

[9] D. Golmohammadi, D. Shimshak, Estimation of the evacuation time in an emergency

situation in hospitals, Computer & Industrial Engineering, 61 (2001), 1256-1267.

[10] C. Johnson, Using Computer Simulations to Support A Risk-Based Approach for Hospital

Evacuation, Technical Report, University of Glasgow, 2005.

http://www.dcs.gla.ac.uk/~johnson/papers/G-HES.PDF

[11] A. Hunt, E. Galea, P Lawrence, An analysis of the performance of trained staff using

movement assist devices to evacuate the non-ambulant, Proceedings of Human Behavior on

Fire, Cambridge, UK, 2012.

[12] J.J. Fruin, Service Pedestrian Planning and Design, MAUDEP, Elevator World

Educational Services Division, Mobile, Alabama, 1971, reprinted 1987.

[13] MSC Circ. 1248, Interim Guidelines for Evacuation Analyses for New and Existing

Passenger Ships International Maritime Organization, 2002.

[14] STEPS Simulation of Transient and Pedestrian movementS: User Manual, unpublished,

available with egress model from Mott MacDonald. http://www.mottmac.com.

[15] J.D. Averill, Five grand challenges in pedestrian and evacuation dynamics, in: Proceedings

of the 5th Conference on Pedestrian and Evacuation Dynamics, Gaithersburg, 2010.

Page 62 of 316

http://www.dcs.gla.ac.uk/~johnson/papers/G-HES.PDF

http://www.mottmac.com/

30

[16] D. Alvear, O. Abreu, A. Cuesta, V. Alonso, A new method for assessing the application

of deterministic or stochastic approach in evacuation scenarios. Fire Safety Journal, Vol. 65,

2014, pp. 11-18.

[17] J. Lord, B. Meacham, A. Moore, R. Fahy, G. Proulx, Guide for evaluating the predictive

capabilities of computer egress models, NIST Report GCR 06-886, 2005.

Page 63 of 316

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Home January February 2015 NFPA 101

A YEAR AGO, my column in this space [“Size Issue,” January/February 2014] addressed the pros and cons of a proposed change for the 2015 edition of NFPA 101®, Life Safety Code®, to increase the allowable smoke compartment size in hospitals from 22,500 square feet (2,100 square meters) to 40,000 square feet (3,720 square meters). The proposal was rejected by NFPA members at the technical reports session of the Conference & Expo in June. The proponents for the change—including members of the Life Safety Technical Committee on Health Care Occupancies (SAF-HEA), health care facilities engineers who are members of the American Society for Healthcare Engineering, and other health care industry practitioners and regulators—plan to revisit the issue as part of the revision cycle that will produce the 2018 edition of NFPA 101.

The premise for the increase in smoke compartment size for new construction remains viable. New hospitals in the U.S. are designed to the Facility Guidelines Institute (FGI) Guidelines for Design and Construction of Health Care Facilities, which allots a greater amount of floor space to individual patients. The FGI Guidelines help ensure that a new smoke compartment of 40,000 square feet has an occupant load similar to that traditionally associated with a 22,500-square-foot smoke compartment, so that additional patients will not be placed at risk of fire within the smoke compartment.

Further, smoke compartment size will be prevented from becoming excessive, because a current code requirement limits the travel distance to reach a door to another smoke compartment to 200 feet (61 meters). In order to meet the travel limitation, any smoke compartment that approaches 40,000 square feet will need access to more than one adjacent smoke compartment. A smoke compartment of typical proportions situated at an end of a rectangular-shaped building, so that it accesses only one adjacent smoke compartment along its narrow dimension, might approach 30,000 square feet (2,790 square meters) before exceeding the 200-foot travel limitation. In other words, the 40,000-square-foot compartment size might not be realized due to the travel limitation.

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. Author(s): Ron Cote. Published on December 29, 2014. 0

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Any public input for increasing smoke compartment size, and any revisions to that input made by the SAF-HEA committee in its preparation of a first revision, will need to address the shortfalls identified by the NFPA membership when it rejected the change in 2014. Namely, existing smoke compartments in hospitals that were not designed to the FGI Guidelines, and which are currently limited to 22,500 square feet, must not be permitted to be made larger.

NFPA 101 applies both to new construction and existing building arrangements. Any provision for increased smoke compartment size should be crafted to permit the same language to be used in Chapter 18 for new facilities and Chapter 19 for existing. That would seem to rule out any mandate for compliance with the FGI Guidelines, as they are applicable only to new construction. A substitute criterion that could be applied to new and existing facilities is a maximum patient load per smoke compartment. Additionally, the SAF-HEA committee should work to codify criteria necessary to permit the increase in smoke compartment size to be offered to nursing homes.

The closing date for public input for processing the 2018 edition of NFPA 101 as part of the Annual 2017 Revision Cycle is July 6, 2015. Visit nfpa.org/101 and go to the link that reads, “The next edition of this standard is now open for Public Input.”

RON COTE, P.E., is principal life safety engineer at NFPA.

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David Landrum · North Las Vegas, NevadaIf the requirement of additional space is attached to infection control standards ...Reply · Like · 3 hours ago

David Landrum · North Las Vegas, NevadaThe issue here is not to examine NFPA 101 provisions, protections or application, it is rather to analize Facility Guidelines Institute (FGI) Guidelines for Design and Construction of Health Care Facilities, which allots a greater amount of floor space to individual patients; for what reason? Or what was the basis for this mandated increase? Equipment? Size of beds or what causes the requirement if more space?Reply · Like · 3 hours ago

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1

Cote, Ron

From: Kimball, AmandaSent: Wednesday, March 18, 2015 2:45 PMTo: Cote, Ron; Daniel O'Connor ([email protected]); Enrico Ronchi; Ken Bush; Richard

Horeis; Fahy, Rita; Robert Harmeyer; Solomon, RobertSubject: Health Care Egress Study

Panel Members, Some good news, we have set aside funding from the Code Fund for a second phase project to the earlier work done by Virginia on health care egress modeling. This will be a larger project where additional variables and situations can be considered. I will be in touch as this Phase 2 project is developed. I look forward to working with you all again. Also related to this issue, a project team at WPI is undertaking a project on egress modeling in health care (building off the Foundation’s project). The project group has been working with Professor Meacham and Fire Safe North America to assess staff‐assisted horizontal evacuation in hospital facilities for different size smoke compartments. Their goal is to use computational egress modeling to develop an parametric analysis of the evacuation of a smoke compartment. In an attempt to understand some of the gaps in the available data they have developed a survey. If you could provide your input, that would be greatly appreciated by the project team. The link to the survey is: http://goo.gl/forms/9vnmxpHyY3. The timeline for collecting responses is fairly short, maybe a week or so. Thanks, Amanda Amanda Kimball, P.E. Research Project Manager Fire Protection Research Foundation 1 Batterymarch Park, Quincy, MA USA 02169‐7471 617.984.7295 [email protected] www.nfpa.org/Foundation

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TECH

NIC

AL

NOT

ES

Evaluating Occupant Load Factors for Ambulatory Heath Care Facilities

Javier Cuesta

Daniel Alvear

GIDAI Group, University of Cantabria (Spain)

Fire Protection Research Foundation

© March 2014

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Acknowledgements

The Fire Protection Research Foundation expresses gratitude to those who assisted with the development and review of the information contained in this report. The Research Foundation appreciates the guidance provided by the Project Technical Panel:

Chad Beebe, ASHE

Phil Hoge, US Army Corps. of Engineers

David Klein, US Department of Veteran’s Affairs

Bill Koffel, Koffel Associates (MD)

Robert Salomon, NFPA

Rachel Miller, ARA

Ron Cote, NFPA Staff Liaison (MA)

Special thanks are expressed to the National Fire Protection Association (NFPA) for funding this project through the annual Code Fund.

The authors of this report would like to thank the collaboration of the Health Care Services of Cantabria and Madrid, the Marqués de Valdecilla University Hospital, the Santa Clotilde Hospital, and the University of Cantabria. They also express their gratitude to Dr. Arturo Cuesta and Dr. Orlando Abreu for their contributions and support of this project.

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Evaluating Occupant Load Factors for Ambulatory Health Care Facilities

3

Abstract The NFPA 101 Life Safety Code and NFPA 5000 Building Construction and Safety Code apply the occupant load factor for business occupancies of 9.33 m2/person (100 feet2/person) to ambulatory health care facilities. It has been questioned whether this use is appropriate. As a result, we collected and analyzed data on ambulatory health care facilities in order to provide more information to the Technical Committee on Healthcare Occupancies of NFPA.

1. Introduction Occupant load factor is essential to determining and calculating the means of egress required in a facility. NFPA Standards (NFPA 101, Life Safety Code and NFPA 5000, Building Construction and Safety Code) establish a unique value for an occupant load factor of 9.33 square meters/person (100 square feet/person) of gross floor area for ambulatory heath care use, based on business occupancies. It has been questioned whether the occupant load factor for business occupancies is appropriate for ambulatory health care facilities. Additionally, there is an interest in making the ambulatory health care occupancy chapter completely independent of the business occupancy chapter. According to NFPA Standards, ambulatory health care occupancy is that 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. It should be noted that inside an ambulatory health care facilities there are areas very similar to those found in business facilities, such as offices, administration rooms, and even consultation rooms. However, there are also other areas that are completely different, such as operating rooms, adult day care rooms, and waiting rooms. The goal of this project was to collect and process data regarding actual occupant loads specifically in outpatient health care environments. For this purpose, site surveys were conducted in two types of ambulatory health care environments (primary health and urgent /treatment) in the city of Santander, Spain.

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2. Objectives The specific objectives of the project were:

1. To develop a questionnaire to be used in any type of ambulatory health care facility. These documents should be useful for future work or new stages of this project.

2. To collect a significant amount of data through site surveys and visits to ambulatory health care facilities.

3. To statistically analyze the information. 4. To evaluate the real occupant load factor for ambulatory health care facilities.

3. Methodology

The methodology is divided into the following stages: 1. Contacts 2. Questionnaire 3. Data collection: Site surveys

3.1. Contacts We contacted three private health care institutions and three public health care institutions in the cities of Santander and Madrid (Spain). We sent a letter to their presidents or managers explaining the aim of the project to support the NFPA Technical Committee in evaluating the current occupant load factor. After the initial contact by mail, further contact was by email and telephone. In some cases, we also had meetings with the person responsible for the facility or institution to explain in detail the scope, methodology, and required information (CAD drawings, number of staff, etc.). The selected sample covered a wide range of different health care facilities. The response of these institutions was positive, as long as we did not disrupt the normal operation in the facility and we did not increase staff workload. One private and three public institutions agreed to participate. The final sample consisted of 21 health care facilities of which 18 were mainly dedicated to primary health care activities and 3 to urgent/treatment care activities. In terms of area, we obtained a sample of 53 floors and 109657.49 m2. Although this report does not include data from Madrid, we look forward to collecting data in facilities in Madrid to increase the total sample.

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3.2. Questionnaire Originally, the questionnaire was designed to obtain an occupant load factor for each area of the ambulatory health care facility, distinguishing among common areas, consulting rooms, administration areas, emergency areas and other areas. Therefore, the questionnaire identified the gross area and number of occupants in each of these areas. Occupants were classified into different categories: medical staff, patients, companions, administrative staff, and service staff. The questionnaire also took into account age, gender, and disability of the patients. There were various contacts between the members of the Project Technical Panel (PTP) and the GIDAI project team (via conference call and email). During a conference call, we presented the first draft of this questionnaire and preliminary results from a trial site survey. The definition of ambulatory health care facility was discussed, as well as the need to consider the total gross floor area. Later, panel members sent their comments by email, indicating that this first draft was very ambitious and that it could be impractical during the on-site surveys. Thus, the questionnaire was simplified and adjusted. Three drafts of the questionnaire were created by GIDAI prior to settling on the final questionnaire. Figure 1 shows this document, which was approved by the members of the PTP. It is expected that this questionnaire can be used universally. Before the site survey, the questionnaire was sent to the contact person at each health care facility to provide them with an overview of data collection. However, the questionnaire was only completed by researchers of the GIDAI Group during visits. Figure 2 shows the instructions for completing the questionnaire. As Figure 2 shows, the questionnaire includes information regarding the building and the occupants per floor:

General building information. The first part contains contact information and general data from the health care facility.

o Name. The name of the person performing the survey. o Position. The position of the person performing the survey. o City. The city where the health care facility is located. o Phone. The contact telephone number. o E-mail. The contact email. o Health Care Facility name. The name of the health care facility. o Number of Floors. The total number of floors in the building. o Floor Height. The height from the ground to the ceiling (in meters). o Internal code. GIDAI Group used an internal code for each building/office

to ensure privacy of the data.

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o Date. The date the survey was completed. o Time. The time the survey was completed.

Occupant load density. This part of the survey collected data regarding the area of each floor and its occupancy (number of persons), discriminating between staff, companions, and patients.

o Floor Number. The number of the floor being analyzed and its type (i.e., Basement, 1st floor, 2nd floor, etc.).

o Gross Floor Area (GFA). The floor area in square meters according to the NFPA definition: The floor area within the inside perimeter of the outside walls of the building under consideration with no deduction for hallways, stairs, closets, thickness of interior walls, columns, elevator and building services shafts, or other features.

o Nº of staff. Total number of people working in the area under consideration, including medical, administrative, and service staff.

o Nº of visitors (companions). Total number of people accompanying or visiting patients in the area under consideration.

o Nº of patients. Total number of patients in the area under consideration, including both capable and incapable patients.

o Nº of capable patients. This is the number of patients capable of evacuation by themselves.

o Nº of incapable patients. This is the number of patients incapable of evacuation by themselves.

o Type of disability. The most common type of impairment of incapable patients in the area under consideration. This is labelled as (1) physical, (2) sensory) or (3) cognitive.

This questionnaire allows collection of additional information about means of evacuation as well. It should be noted that this data and the type of disability of the incapable patients are not relevant for the occupant load factor and they are not included in this report; however, these could be useful for future projects.

Information regarding means of evacuation: o Nº of exits. The total number of floor exits. o Exit width (m). o Maximum evacuation distance (m).

Remarks. This space is for including other important or relevant information.

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Building General Information

Name:…………………………………………………………..…….….

Position: …………………………………………………………………

City: ………..…… Phone: ..................... E-mail: ….………………

Health Care Facility name: …………………………………………………………………….…..

Nº of Floors: ………. Floor Height (m): ……..…Internal code:

Date: …………………….. Time: ……………………..

Occupant load density

Floor Number

Gross Floor Area

Nº of Staff

Nº of Visitors (companions)

Nº of Patients

Nº of Capable Patients

Nº of Incapable Patients

Type of Disability

Nº of exits: … Exit 1 width (m): ………. Maximum travel distance (m): ………. Exit 2 width (m): ………. Maximum travel distance (m): ……….

Exit 3 width (m): ………. Maximum travel distance (m): ………. Exit 4 width (m): …..….. Maximum travel distance (m): ……….

Remarks

Fig. 1. Questionnaire for data collection.

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Fig. 2. Instructions to complete the questionnaire.

METHODOLOGY TO COMPLETE THE QUESTIONAIRE Building General Information Name: The name of the person who is performing the survey Position: Indicate which is his/her position in the company City: city in which the building is located Phone : contact phone E-mail : contact e-mail

Health Care Facility name: Indicate the name of the Health Care Facility Nº of Floors: Indicate the total number of floors in the building Floor Height (m): Indicate the floor height Internal code: An internal code that will be filled by GIDAI Date: Indicate the date when the survey has been filled Time: Indicate the time when the survey has been filled

Occupant load density

Floor Number Indicate the floor number and its type, for example basement, 1st floor, 2nd floor, etc.

Gross Floor Area.- Indicate the floor area within the inside perimeter of the outside walls of the building floor under consideration with no deductions for hallways, stairs, closets, thickness of interior walls, columns, elevator and building services shafts, or other features

Nº of Staff Indicate the number of people who works in the floor (medical, administrative and service staff)

Nº of visitors (companions) Indicate the number of people who goes with the patients

Nº of Patients Indicate the total number of patients on the floor

Nº of Capable Patients Indicate the number of patients capable for evacuation by themselves

Nº of Incapable Patients Indicate the number of patients incapable for evacuation by themselves

Type of Disability Indicate the most common type of impairment of incapable patients: 1 – physical, 2 – sensory, or 3 - cognitive

Nº of exits: Indicate the number of building exits Exit width: Indicate the width of each floor exit Maximum travel distance (m): Indicate the maximum distances to each since

Remarks: Indicates any other information about that may be considered important or relevant Indicate the Name and Surname of the person who has signed this survey

Indicate the date when the survey has been signed Signature of the person who has signed the survey

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3.3. Data collection: Site surveys Once the contact person accepted the requested collaboration, a date for the visit and data collection was arranged between November 2013 and February 2014. Before the visit, the CAD/pdf drawings were ordered to facilitate the tasks of the researcher. In some cases, access to this information involved a long administrative process due to security issues and requests for signed confidentiality agreements from GIDAI. Fortunately, GIDAI Group was able to obtain CAD/pdf drawings for all facilities included in the sample. In order to obtain detailed information about the sample, the health care facilities were asked to distinguish, identify, and define the different areas and types of medical care in the CAD/pdf drawings. The gross floor areas were analyzed according to the NFPA definition “The floor area within

the inside perimeter of the outside walls of the building under consideration with no deduction for hallways, stairs, closets, thickness of interior walls, columns, elevator and building services shafts, or other features” (see Figure 3).

Fig. 3. Analysis of gross floor areas.

During some of the site surveys, it was necessary to use a laser meter in order to measure the actual dimensions and/or to have a reference measure. GIDAI researchers completed the site surveys by observing different areas of the ambulatory health care facilities. They manually counted the number of people in the common areas. For private areas, such as consultation and restricted areas (treatment departments, theaters, etc.), the building coordinator or staff members were asked for the occupancy data. Sometimes, the GIDAI researchers were accompanied by a staff member, who guided them through the facility explaining the most relevant information (layout, uses, busiest days, peak hours, number of staff in each area, etc.).

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In the majority of the analyzed facilities there were two or more floors dedicated to health care.

1 facility with one floor

14 facilities with 2 floors

4 facilities with 3 floors

1 facility with 4 floors

1 facility with 8 floors The GIDAI researchers visited each of the selected facilities and completed the questionnaires by floor, breaking down the total occupancy in terms of staff and visitors/companions. In addition, data for each floor were collected at different times (twice or three times), when a higher number of people were forecasted to be present. These data were used later for statistical analysis, to obtain a real occupant load factor by ambulatory health care floor and time.

4. Results The main objective of the project was to collect and analyze data regarding the current occupant loads, specifically in ambulatory health care facilities. 4.1. Data collected Data for 21 health care facilities and 53 floors at different times of the morning (twice or three times for each floor) were analyzed from site surveys. Data regarding the real number of people and gross floor area were collected. Table 5 in the Appendix shows the occupant load factors and number of people for the 148 site surveys that formed the sample. During data collection, the Spanish population suffered a flu epidemic that caused eight deaths in Cantabria. It is likely that this epidemic precipitated an increase of people in the health care facilities, especially from vulnerable populations (children, older people, and people with breathing and heart problems). In the ambulatory health care facilities, the researchers also observed people who required assistance for evacuation, such as older people with canes, people with crutches or wheelchairs, pregnant women, children and babies, and blind people.

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Fig.4. Data collection in health care facilities. Furthermore, Table 5 in the Appendix includes the main activity of the facilities, distinguishing between primary care and urgent/treatment care, both on an outpatient basis. The first offers family medicine and physiotherapy (consultation) services, and therefore can offer services to patients who access the facility with an injury or illness (physical, sensory, or cognitive), although they do not receive specialty care. The second corresponds to facilities where many patients simultaneously receive medical treatment, anesthesia, or urgent care. Figure 5 represents the occupant load factors in m2/person and feet2/person of the 148 data points of the sample. The blue and red columns are the values obtained for primary and urgent/treatment health care respectively. Most of these occupant load factors are higher than the value established by NFPA Standards; only nine values are lower (6.08%). For primary health care facilities, some data points are much higher than the rest of the data, exceeding some of them by 60 m2/person (e.g., samples 74, 78, 79, 82, and 97). The rest of the values vary approximately between 10 and 40 m2/person. This dispersion is due to some of the analyzed floors containing unoccupied enclosures (machine rooms, multi-use rooms, libraries, etc.), which resulted in higher occupant load factors. In the case of ambulatory health care facilities, the values varied approximately between 10 and 90 m2/person. The highest values of the occupant load factor reached 140 to 144. These values correspond with an ambulatory health care facility where urgent care, medical treatment, and surgery are provided and they require more area per person. In contrast, the rest of the values correspond to ambulatory heath care facilities where there are also specialist consultations, making the occupancy density higher. .

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Fig. 5. Occupant load factor for ambulatory health care floors.

0

100

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1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100

103

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133

136

139

142

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148

Oc

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an

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ad

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eet2 /

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load

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]

Data Points

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4.2 Occupant Load Factor Two different analyses were conducted for the occupant load factor calculation. First, occupant load factors in primary health care and urgent/treatment health care were analyzed separately. Second, we examined whether the distributions of the two types of facilities came from the same population. If so, then they had the same probability distribution and could be combined and statistically analyzed to obtain an overall occupant load factor.

Occupant Load Factor in Primary Health Care Facilities By statistically analyzing sample numbers 1 to 132 in Table 5 of the Appendix the following Occupant Load Factor was obtained for the floors of the primary health care facilities.

OCCUPANT LOAD FACTOR (m2/person)

OCCUPANT LOAD FACTOR (feet2/person)

Mean Standard deviation Mean Standard deviation

23.93 14.45 257.58 155.54

Table 1. Occupant load factor in primary health care facilities for gross floor area.

As we can see in Table 1, the mean occupant load factor is clearly higher than the current value established by NFPA (9.33 m2/person). However, it should be noted that there is a high variability in the results (a standard deviation of 14.45 m2/person).

Occupant Load Factor in Urgent/Treatment Health Care Facilities A similar statistical analysis was carried out for data from the floors of the urgent/treatment health care facilities (sample numbers 133 to 148 in Table 5 of the Appendix), registering the following Occupant Load Factor (see Table 2).




32.28 23.80 347.46 256.18

Table 2. Occupant load factor in urgent/treatment health care facilities for gross floor area.

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A higher mean occupant load factor and standard deviation were observed than in the primary health care facilities. This is reasonable given that these facilities provide medical treatment, anesthesia, and urgent care, where access is restricted and more area is necessary per person. Overall Occupant Load Factors The Mann-Whitney and Kolmogorov-Smirnov tests were used to check whether the two samples came from the same population (hypothesis H0) or if the values of one tended to exceed the values of the other (hypothesis H1). The results of both tests confirmed hypothesis H0 with a level of statistical significance of 0.05. This meant that the empirical cumulative distribution functions of the two samples did not differ by location nor by shape with the given degree of certainty. This permitted the analysis of all values of the occupant load factors recorded in the site surveys as a single sample, to obtain the overall occupant load factor (see Table 3).




24.84 15.95 267.37 171.68

Table 3. Overall occupant load factor for gross floor area.

The results indicated that the 9.33 m2/person occupant load factor could be a conservative value compared with the mean occupant load factor of 24.84 m2/person obtained for the complete sample. Once again the standard deviation was very high (15.95 m2/person).

Fig. 6. Relative frequency for the occupant load factors.

0

0.1

0.2

0.3

0.4

0.5

[0,10) [10,20) [20,30) [30,40) [40,50) [50,60) [60,70) [70,80) [80,90) [90,100)

Rel

ativ

e F

req

uen

cy

Occupant Load Factor [m2/pers]

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Figure 6 shows the relative frequency of the occupant load factors registered. The data points are grouped in ten intervals with a wide range of 10 m2/person (107 feet2/person). We noticed that 50 percent of the data were lower than 20 m2/person (214 feet2/person), and 73 percent were lower than 30 m2/person (321 feet2/person).

5. Future Work The visits to health care facilities permitted the researchers to examine the different areas that exist in a typical health care facility. Some of these areas are always empty during site surveys, such as machine rooms and multi-use rooms. (Number 1 in Figure 7), while others hold a fairly constant number of people, such as medical consultation, day care hospitals, and theaters (Number 2 in Figure 7), others are devoted to administrative use, such as admissions, and offices (Number 3 in Figure 7), and finally there are others where the number of people can be more variable and a higher occupant density is possible, such as waiting rooms and common areas (Number 4 in Figure 7).

Fig.7. PDF drawing of a primary health care floor.

The above findings suggest we should study the occupant load factor by considering the use of each area of the floor. With the data collected, we can obtain the patient-to-consultation ratio or visitors/companions-to-patient ratio, which would allow us to estimate the occupancy in waiting rooms and common areas. On the other hand, it should be noted that the occupant load factors obtained for health care facilities in the collection data are real values. Therefore, there would be a lower occupant load factor if we considered all enclosures are occupied and all medical services are working a totally capacity.

4

3 4

2 2

2 1

1

4

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5.1 Methodology In most of the provided CAD drawings for each facility there is detailed information about dimensions and different uses. During visits, the researcher verified this information. The researcher also counted the number of people in each area, distinguishing between patients, companions and staff, and made note of the number of active care positions (see Figure 8).

Fig.8. Data collection in waiting rooms. The following formulas calculate the patients-to-consultation ratio or visitors/companions-to-patient ratio for each data point in our sample. The number of patients in waiting rooms per consultation (the patients-to-consultation ratio) corresponds with Formula 1, dividing the number of patients in waiting rooms (NPatients-Waiting) by the number of active care positions (NActive-Services).

(1)

Formula 2 provides the companions-to-patient ratio dividing the total number of companions (NTotal-Companions) by the total number of patients (NTotal-Patients) for the floor of the facility.

(2)

These parameters can be very useful to obtain an estimate of the occupancy in areas where this can change because companions can access the patient.

ServicesActive

WatingPatientsonConsultatiPatients N

NRatio

/

PatientsTotal

CompanionsTotalPatientCompanion N

NRatio

/

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5.2 Results Table 6 in the Appendix presents the total number of patients in the common areas and the waiting rooms, as well as the total number of active care positions registered for each health care facility for the site surveys at different times (59 data points). With these data, we obtained the patients-to-consultation ratio (RatioPatients/Consultation) for each item of the sample. Similarly, the relation between the total number of companions and the total number of patients (RatioCompanions/Patient) was calculated, although in this case the sample was formed using each floor of the health care facility during site surveys (see Table 7 of the Appendix). Table 4 shows the statistical analysis of these data, including the mean and standard deviation for each ratio.

RatioPatients / Consultation RatioCompanions / Patient

Mean Standard deviation

Mean Standard deviation

1.21 0.71 0.44 0.27

Table 4. Statistical results for patient- to-consultation ratio and companions-to-patient ratio.

Conclusions Data were collected using site surveys for several health care floors in order to analyze the occupant load factor for ambulatory health care facilities. Two types of outpatient activities were considered: primary care and urgent/treatment care. The first corresponds to facilities where the patients do not necessarily receive special care, although patients with an injury or illness that makes them incapable of evacuation by themselves can access these facilities. The second corresponds to facilities where the patients receive medical treatment, anesthesia, or urgent care, rendering them incapable of taking action for self-preservation under emergency conditions without the assistance of others. Data analysis showed that the samples from the two types of facilities came from the same population and therefore could be treated as a single sample. The overall occupant load factor was obtained, resulting in a mean value of 24.84 m2/person (267.37 feet2/person). This is higher than the current occupant load factor of 9.33 m2/person (100 feet2/person) required by NFPA Standards. However, the results were highly variable with a standard deviation of 15.95 m2/person (171.68 feet2/person) Furthermore, 50% of the data were lower than 20 m2/person (214 feet2/person).

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It should be noted that this data collection corresponds with real values of occupant load factors in ambulatory health care facilities by gross floor area. Each gross floor area can contain enclosures with different uses or activities, such as auxiliary services (machine rooms, multi-use rooms, cafeterias, etc.), medical services (consultations, surgeries, day care hospitals, etc.), administrative services (admissions, offices, etc.) and common areas (waiting rooms, halls, etc.), where the occupant load density is very different. This implies that there may be a lower occupant load factor for ambulatory health care facilities when all services operate, called the maximum occupant load factor. For this, the maximum number of people within different enclosures is easily obtained if the total number of medical services is known. However, the maximum number of people in common areas is not so easily obtained because of the variability in the number of companions and the number of patients waiting for assistance. We also obtained the patients-to-consultation ratio and visitors/companions-to-patient ratio. The results were a mean value of 1.21 and 0.44 respectively. These parameters can be useful to calculate the total number of people in the areas where companions can access the patient.

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Appendix

Data Points

Code of Health Care

Facility

Floor Number

Main Health Care

Activity

Time

Number of People Gross Floor

Area (m2)

Occupant Load Factor

(m2/pers)

Occupant Load Factor (feet2/pers) Total Pat. Comp. Staff

1

1

0 Primary 10.30

69 27 22 20 1435.39 20.80 223.92

2 1 Primary 74 33 12 29 1415.36 19.13 205.88

3 0 Primary 12.00

56 25 15 16 1435.39 25.63 275.90

4 1 Primary 82 37 17 28 1415.36 17.26 185.79

5

2

0 Primary 9.00

55 28 10 17 782.56 14.23 153.15

6 1 Primary 56 31 10 15 709.74 12.67 136.42

7 0 Primary 10.30

79 36 25 18 782.56 9.91 106.63

8 1 Primary 56 32 9 15 709.74 12.67 136.42

9 0 Primary 12.00

90 49 21 20 782.56 8.70 93.59

10 1 Primary 74 49 13 12 709.74 9.59 103.24

11

3

0 Primary 9.00

52 27 8 17 1345.50 25.88 278.52

12 1 Primary 68 37 8 23 1252.72 18.42 198.30

13 0 Primary 10.30

41 16 10 15 1345.50 32.82 353.24

14 1 Primary 108 61 22 25 1252.72 11.60 124.85

15 0 Primary 12.00

33 11 6 16 1345.50 40.77 438.88

16 1 Primary 85 45 17 23 1252.72 14.74 158.64

17

4

0 Primary 9.00

53 27 10 16 767.44 14.48 155.86

18 1 Primary 66 33 23 10 698.08 10.58 113.85

19 0 Primary 11.00

31 17 1 13 767.44 24.76 266.47

20 1 Primary 71 33 20 18 698.08 9.83 105.83

21 0 Primary 13.00

35 18 3 14 767.44 21.93 236.02

22 1 Primary 74 34 22 18 698.08 9.43 101.54

23

5

0 Primary 10.00

26 11 1 14 1087.27 41.82 450.13

24 1 Primary 68 37 11 20 815.16 11.99 129.03

25 0 Primary 11.00

28 13 3 12 1087.27 38.83 417.97

26 1 Primary 75 40 15 20 815.16 10.87 116.99

27

6

0 Primary 10.00 99 51 9 39 2072.00 20.93 225.28

28 0 Primary 12.00 94 46 12 36 2072.00 22.04 237.26

29 0 Primary 13.00 100 49 14 37 2072.00 20.72 223.03

30

7

0 Primary

8.45

45 27 5 13 555.14 12.34 132.79

31 1 Primary 48 24 10 14 658.08 13.71 147.57

32 2 Primary 38 20 7 11 658.08 17.32 186.41

Table 5. Data collected from 148 ambulatory health care floors.

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Data Points

Code of Health Care

Facility

Floor Number

Main Health Care

Activity

Time


Area (m2)


(m2/pers)


33

7

0 Primary

12.00

23 12 0 11 555.14 24.14 259.80

34 1 Primary 74 45 16 13 658.08 8.89 95.72

35 2 Primary 44 19 12 13 658.08 14.96 160.99

36 0 Primary

13.15

14 2 2 10 555.14 39.65 426.82

37 1 Primary 60 32 14 14 658.08 10.97 118.06

38 2 Primary 42 13 11 18 658.08 15.67 168.66

39

8

0 Primary

10.30

36 9 11 16 1106.69 30.74 330.90

40 1 Primary 37 17 3 17 1063.00 28.73 309.24

41 2 Primary 12 5 3 4 243.75 20.31 218.64

42 0 Primary

12.00

27 6 5 16 1106.69 40.99 441.20

43 1 Primary 44 22 8 14 1063.00 24.16 260.05

44 2 Primary 9 1 2 6 243.75 27.08 291.52

45

9

0 Primary 8.30

94 55 16 23 891.77 9.49 102.12

46 -1 Primary 77 40 17 20 859.65 11.16 120.17

47 0 Primary 12.45

82 35 20 27 891.77 10.88 117.06

48 -1 Primary 84 41 17 26 859.65 10.23 110.16

49 0 Primary 13.30

84 37 25 22 891.77 10.62 114.27

50 -1 Primary 49 26 7 16 859.65 17.54 188.84

51

10

0 Primary 8.45

54 25 10 19 803.62 14.88 160.19

52 1 Primary 49 27 9 13 723.64 14.77 158.96

53 0 Primary 12.30

58 21 20 17 803.62 13.86 149.14

54 1 Primary 53 30 11 12 723.64 13.65 146.97

55 0 Primary 13.00

55 20 16 19 803.62 14.61 157.27

56 1 Primary 38 18 8 12 723.64 19.04 204.98

57

11

0 Primary 9.00

25 7 4 14 1197.90 47.92 515.76

58 1 Primary 42 20 6 16 922.51 21.96 236.42

59 0 Primary 11.30

34 12 8 14 1197.90 35.23 379.24

60 1 Primary 38 18 6 14 922.51 24.28 261.31

61 0 Primary 12.00

36 13 10 13 1197.90 33.28 358.17

62 1 Primary 43 21 7 15 922.51 21.45 230.93

63

12

0 Primary

8.30

22 9 5 8 928.51 42.21 454.29

64 1 Primary 35 20 0 15 855.66 24.45 263.15

65 2 Primary 70 39 12 19 855.66 12.22 131.57

66 3 Primary 16 5 2 9 670.14 41.88 450.83

67 4 Primary 29 9 5 15 670.14 23.11 248.74

Table 5. Data collected from 148 ambulatory health care floors (cont.).

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Data Points

Code of Health Care

Facility

Floor Number

Main Health Care

Activity

Time


Area (m2)


(m2/pers)


68

12

5 Primary

8.30

24 12 5 7 670.14 27.92 300.56

69 6 Primary 16 5 4 7 411.54 25.72 276.86

70 8 Primary 8 3 3 2 411.54 51.44 553.72

71 0 Primary

11.30

27 17 4 6 928.51 34.39 370.16

72 1 Primary 37 16 7 14 855.66 23.13 248.93

73 2 Primary 55 24 14 17 855.66 15.56 167.46

74 3 Primary 8 5 0 3 670.14 83.77 901.67

75 4 Primary 41 18 8 15 670.14 16.34 175.93

76 5 Primary 20 8 5 7 670.14 33.51 360.67

77 6 Primary 13 3 3 7 411.54 31.66 340.75

78 8 Primary 6 2 2 2 411.54 68.59 738.30

79 0 Primary

13.00

13 4 1 8 928.51 71.42 768.80

80 1 Primary 52 26 12 14 855.66 16.46 177.12

81 2 Primary 36 17 5 14 855.66 23.77 255.84

82 3 Primary 9 5 0 4 670.14 74.46 801.48

83 4 Primary 35 15 7 13 670.14 19.15 206.10

84 5 Primary 13 6 2 5 670.14 51.55 554.87

85 6 Primary 11 4 2 5 411.54 37.41 402.71

86 8 Primary 9 5 2 2 411.54 45.73 492.20

87

13

0 Primary 8.00 60 37 9 14 1372.83 22.88 246.28

88 0 Primary 11.30

106 63 15 28 1372.83 12.95 139.41

89 -1 Primary 13 8 3 2 394.89 30.38 326.97

90 0 Primary 12.30

107 57 22 28 1372.83 12.83 138.10

91 -1 Primary 8 6 0 2 394.89 49.36 531.32

92 0 Primary 13.00

105 55 22 28 1372.83 13.07 140.73

93 -1 Primary 7 4 1 2 394.89 56.41 607.22

94

14

-1 Primary

9.00

17 6 4 7 731.95 43.06 463.45

95 0 Primary 37 24 5 8 596.04 16.11 173.40

96 1 Primary 52 23 7 22 717.90 13.81 148.60

97 -1 Primary

10.00

12 3 2 7 731.95 61.00 656.55

98 0 Primary 15 6 1 8 596.04 39.74 427.71

99 1 Primary 60 26 12 22 717.90 11.96 128.79

100 -1 Primary

11.00

23 10 6 7 731.95 31.82 342.55

101 0 Primary 16 5 3 8 596.04 37.25 400.98

102 1 Primary 71 33 16 22 717.90 10.11 108.84


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Data Points

Code of Health Care

Facility

Floor Number

Main Health Care Activity

Time

Number of People Gross Floor Area (m2)

Occupant Load

Factor (m2/pers)


103

14

-1 Primary

12.00

27 11 9 7 731.95 27.11 291.80

104 0 Primary 20 9 3 8 596.04 29.80 320.79

105 1 Primary 59 29 8 22 717.90 12.17 130.97

106

15

0 Primary 9.00

61 35 10 16 1271.55 20.85 224.37

107 1 Primary 43 18 6 19 1095.86 25.49 274.32

108 0 Primary 12.00

40 15 7 18 1271.55 31.79 342.17

109 1 Primary 82 23 9 50 1095.86 13.36 143.85

110 0 Primary 13.00

64 21 10 33 1271.55 19.87 213.86

111 1 Primary 82 23 9 50 1095.86 13.36 143.85

112

16

0 Primary 8.30

28 13 1 14 1022.35 36.51 393.02

113 1 Primary 62 43 6 13 970.23 15.65 168.44

114 0 Primary 11.30

40 20 4 16 1022.35 25.56 275.11

115 1 Primary 55 29 8 18 970.23 17.64 189.88

116 0 Primary 12.30

47 26 5 16 1022.35 21.75 234.14

117 1 Primary 65 35 12 18 970.23 14.93 160.67

118

17

0 Primary 9.30

56 24 11 21 943.54 16.85 181.36

119 1 Primary 58 32 11 15 920.96 15.88 170.92

120 0 Primary 11.00

64 29 13 22 943.54 14.74 158.69

121 1 Primary 47 26 6 15 920.96 19.59 210.92

122 0 Primary 12.00

47 21 6 20 943.54 20.08 216.09

123 1 Primary 59 34 9 16 920.96 15.61 168.02

124

18

0 Primary

9.00

45 25 5 15 514.89 11.44 123.16

125 1 Primary 55 28 11 16 588.58 10.70 115.19

126 2 Primary 25 15 1 9 588.58 23.54 253.42

127 0 Primary

10.00

36 15 6 15 514.89 14.30 153.95

128 1 Primary 65 34 15 16 588.58 9.06 97.47

129 2 Primary 33 17 6 10 588.58 17.84 191.98

130 0 Primary

11.00

27 11 1 15 514.89 19.07 205.27

131 1 Primary 57 28 13 16 588.58 10.33 111.15

132 2 Primary 25 11 4 10 588.58 23.54 253.42

133

19

0 Urgent/Treat.

9.30

490 242 129 119 5260.64 10.74 115.56

134 1 Urgent/Treat. 360 133 92 135 5418.60 15.05 162.01

135 2 Urgent/Treat. 506 245 117 144 5421.54 10.71 115.33

136 3 Urgent/Treat. 149 74 41 34 3866.15 25.95 279.29

137 0 Urgent/Treat. 12.30 596 310 158 128 5260.64 8.83 95.01


Page 88 of 316


23

Data Points

Code of Health Care

Facility

Floor Number


Time


Area (m2)

Occupant Load

Factor (m2/pers)


138

19

1 Urgent/Treat.

12.30

388 160 96 132 5418.60 13.97 150.32

139 2 Urgent/Treat. 491 225 126 140 5421.54 11.04 118.85

140 3 Urgent/Treat. 111 44 21 46 3866.15 34.83 374.91

141

20

0 Urgent/Treat. 9.00

519 158 178 183 29758.41 57.34 617.18

142 -1 Urgent/Treat. 208 66 48 94 19479.90 93.65 1008.08

143 0 Urgent/Treat. 11.30

600 222 216 162 29758.41 49.60 533.86

144 -1 Urgent/Treat. 276 82 63 131 19479.90 70.58 759.71

145

21


129 57 36 36 2399.21 18.60 200.19

146 1 Urgent/Treat. 18 15 0 3 649.01 36.06 388.10


97 38 29 30 2399.21 24.73 266.24

148 1 Urgent/Treat. 18 15 0 3 649.01 36.06 388.10


Page 89 of 316


24

Data Points

Code of Health Care

Facility


Time NPatients-Waiting NActive-Services RatioPatients / Consultation

1 1

Primary 10.30 25 44 0.57

2 Primary 12.00 30 39 0.77

3

2

Primary 9.00 38 26 1.46

4 Primary 10.30 43 28 1.54

5 Primary 12.00 56 22 2.55

6

3

Primary 9.00 35 33 1.06

7 Primary 10.30 36 35 1.03

8 Primary 12.00 33 33 1.00

9

4

Primary 9.00 43 27 1.59

10 Primary 11.00 30 25 1.20

11 Primary 13.00 30 26 1.15

12 5

Primary 10.00 23 28 0.82

13 Primary 11.00 29 26 1.12

14

6

Primary 10.00 28 32 0.88

15 Primary 12.00 28 29 0.97

16 Primary 13.00 24 29 0.83

17

7

Primary 8.45 47 29 1.62

18 Primary 12.00 47 30 1.57

19 Primary 13.15 29 29 1.00

20 8

Primary 10.30 15 31 0.48

21 Primary 12.00 13 30 0.43

22

9

Primary 8.30 63 37 1.70

23 Primary 12.45 41 43 0.95

24 Primary 13.30 34 33 1.03

25

10

Primary 8.45 33 25 1.32

26 Primary 12.30 29 23 1.26

27 Primary 13.00 19 24 0.79

28

11

Primary 9.00 9 25 0.36

29 Primary 11.30 17 23 0.74

30 Primary 12.00 12 23 0.52

31

12

Primary 8.30 63 67 0.94

32 Primary 11.30 47 60 0.78

33 Primary 13.00 49 51 0.96

34

13

Primary 8.00 29 6 4.83

35 Primary 11.30 45 23 1.96

36 Primary 12.30 37 22 1.68

Table 6. Patients-to-consultation ratio for each facility in the sample at different times.

Page 90 of 316


25

Data Points

Code of Health Care

Facility


Time NPatients-Waiting NActive-Services RatioPatients / Consultation

37 13 Primary 13.00 34 22 1.55

38

14

Primary 9.00 29 31 0.94

39 Primary 10.00 16 31 0.52

40 Primary 11.00 26 31 0.84

41 Primary 12.00 26 31 0.84

42

15

Primary 9.00 33 26 1.27

43 Primary 12.00 12 27 0.44

44 Primary 13.00 12 27 0.44

45

16

Primary 8.30 44 22 2.00

46 Primary 11.30 30 27 1.11

47 Primary 12.30 38 29 1.31

48

17

Primary 9.30 33 30 1.10

49 Primary 11.00 26 31 0.84

50 Primary 12.00 31 30 1.03

51

18

Primary 9.00 44 33 1.33

52 Primary 10.00 41 34 1.21

53 Primary 11.00 28 34 0.82

54 19

Urgent/Treat. 9.30 430 210 2.05

55 Urgent/Treat. 12.30 398 210 1.90

56 20

Urgent/Treat. 9.00 85 153 0.56

57 Urgent/Treat. 11.30 121 153 0.79

58 21

Urgent/Treat. 10.00 27 10 2.70

59 Urgent/Treat. 12.00 20 8 2.50

Table 6. Patients-to-consultation ratio for each facility in the sample at different times (cont.).

Page 91 of 316


26

Data Points

Code of Health Care

Facility

Floor Number


Time NTotal-Companions NTotal-Patients RatioCompanions / Patient

1

1

0 Primary 10.30

27 22 0.81

2 1 Primary 33 12 0.36

3 0 Primary 12.00

25 15 0.60

4 1 Primary 37 17 0.46

5

2

0 Primary 9.00

28 10 0.36

6 1 Primary 31 10 0.32

7 0 Primary 10.30

36 25 0.69

8 1 Primary 32 9 0.28

9 0 Primary 12.00

49 21 0.43

10 1 Primary 49 13 0.27

11

3

0 Primary 9.00

27 8 0.30

12 1 Primary 37 8 0.22

13 0 Primary 10.30

16 10 0.63

14 1 Primary 61 22 0.36

15 0 Primary 12.00

11 6 0.55

16 1 Primary 45 17 0.38

17

4

0 Primary 9.00

27 10 0.37

18 1 Primary 33 23 0.70

19 0 Primary 11.00

17 1 0.06

20 1 Primary 33 20 0.61

21 0 Primary 13.00

18 3 0.17

22 1 Primary 34 22 0.65

23

5

0 Primary 10.00

11 1 0.09

24 1 Primary 37 11 0.30

25 0 Primary 11.00

13 3 0.23

26 1 Primary 40 15 0.38

27

6

0 Primary 10.00 51 9 0.18

28 0 Primary 12.00 46 12 0.26

29 0 Primary 13.00 49 14 0.29

30

7

0 Primary

8.45

27 5 0.19

31 1 Primary 24 10 0.42

32 2 Primary 20 7 0.35

33 0 Primary

12.00

12 0 0.00

34 1 Primary 45 16 0.36

35 2 Primary 19 12 0.63

Table 7. Companions-to-patient ratio for each health care facility floor in the sample.

Page 92 of 316


27

Data Points

Code of Health Care

Facility

Floor Number



36

7

0 Primary

13.15

2 2 1.00

37 1 Primary 32 14 0.44

38 2 Primary 13 11 0.85

39

8

0 Primary

10.30

9 11 1.22

40 1 Primary 17 3 0.18

41 2 Primary 5 3 0.60

42 0 Primary

12.00

6 5 0.83

43 1 Primary 22 8 0.36

44 2 Primary 1 2 2.00

45

9

0 Primary 8.30

55 16 0.29

46 -1 Primary 40 17 0.43

47 0 Primary 12.45

35 20 0.57

48 -1 Primary 41 17 0.41

49 0 Primary 13.30

37 25 0.68

50 -1 Primary 26 7 0.27

51

10

0 Primary 8.45

25 10 0.40

52 1 Primary 27 9 0.33

53 0 Primary 12.30

21 20 0.95

54 1 Primary 30 11 0.37

55 0 Primary 13.00

20 16 0.80

56 1 Primary 18 8 0.44

57

11

0 Primary 9.00

7 4 0.57

58 1 Primary 20 6 0.30

59 0 Primary 11.30

12 8 0.67

60 1 Primary 18 6 0.33

61 0 Primary 12.00

13 10 0.77

62 1 Primary 21 7 0.33

63

12

0 Primary

8.30

9 5 0.56

64 1 Primary 20 0 0.00

65 2 Primary 39 12 0.31

66 3 Primary 5 2 0.40

67 4 Primary 9 5 0.56

68 5 Primary 12 5 0.42

69 6 Primary 5 4 0.80

70 8 Primary 3 3 1.00

Table 7. Companions-to-patient ratio for each health care facility floor in the sample (cont.).

Page 93 of 316


28

Data Points

Code of Health Care

Facility

Floor Number



71

12

0 Primary

11.30

17 4 0.24

72 1 Primary 16 7 0.44

73 2 Primary 24 14 0.58

74 3 Primary 5 0 0.00

75 4 Primary 18 8 0.44

76 5 Primary 8 5 0.63

77 6 Primary 3 3 1.00

78 8 Primary 2 2 1.00

79 0 Primary

13.00

4 1 0.25

80 1 Primary 26 12 0.46

81 2 Primary 17 5 0.29

82 3 Primary 5 0 0.00

83 4 Primary 15 7 0.47

84 5 Primary 6 2 0.33

85 6 Primary 4 2 0.50

86 8 Primary 5 2 0.40

87

13

0 Primary 8.00 37 9 0.24

88 0 Primary 11.30

63 15 0.24

89 -1 Primary 8 3 0.38

90 0 Primary 12.30

57 22 0.39

91 -1 Primary 6 0 0.00

92 0 Primary 13.00

55 22 0.40

93 -1 Primary 4 1 0.25

94

14

-1 Primary

9.00

6 4 0.67

95 0 Primary 24 5 0.21

96 1 Primary 23 7 0.30

97 -1 Primary

10.00

3 2 0.67

98 0 Primary 6 1 0.17

99 1 Primary 26 12 0.46

100 -1 Primary

11.00

10 6 0.60

101 0 Primary 5 3 0.60

102 1 Primary 33 16 0.48

103 -1 Primary

12.00

11 9 0.82

104 0 Primary 9 3 0.33

105 1 Primary 29 8 0.28


Page 94 of 316


29

Data Points

Code of Health Care

Facility

Floor Number



106

15

0 Primary 9.00

35 10 0.29

107 1 Primary 18 6 0.33

108 0 Primary 12.00

15 7 0.47

109 1 Primary 23 9 0.39

110 0 Primary 13.00

21 10 0.48

111 1 Primary 23 9 0.39

112

16

0 Primary 8.30

13 1 0.08

113 1 Primary 43 6 0.14

114 0 Primary 11.30 20 4 0.20

115

16

1 Primary 11.30 29 8 0.28

116 0 Primary 12.30

26 5 0.19

117 1 Primary 35 12 0.34

118

17

0 Primary 9.30

24 11 0.46

119 1 Primary 32 11 0.34

120 0 Primary 11.00

29 13 0.45

121 1 Primary 26 6 0.23

122 0 Primary 12.00

21 6 0.29

123 1 Primary 34 9 0.26

124

18

0 Primary

9.00

25 5 0.20

125 1 Primary 28 11 0.39

126 2 Primary 15 1 0.07

127 0 Primary

10.00

15 6 0.40

128 1 Primary 34 15 0.44

129 2 Primary 17 6 0.35

130 0 Primary

11.00

11 1 0.09

131 1 Primary 28 13 0.46

132 2 Primary 11 4 0.36

133

19

0 Urgent/Treat.

9.30

242 129 0.53

134 1 Urgent/Treat. 133 92 0.69

135 2 Urgent/Treat. 245 117 0.48

136 3 Urgent/Treat. 74 41 0.55

137 0 Urgent/Treat.

12.30

310 158 0.51

138 1 Urgent/Treat. 160 96 0.60

139 2 Urgent/Treat. 225 126 0.56

140 3 Urgent/Treat. 44 21 0.48


Page 95 of 316


30

Data Points

Code of Health Care

Facility

Floor Number



141

20


158 178 1.13

142 -1 Urgent/Treat. 66 48 0.73


222 216 0.97

144 -1 Urgent/Treat. 82 63 0.77

145

21


57 36 0.63

146 1 Urgent/Treat. 15 0 0.00


38 29 0.76

148 1 Urgent/Treat. 15 0 0.00


Page 96 of 316

TE

CH

NIC

AL

NO

TE

S


Kristin Steranka

William E. Koffel, P.E., FSFPE Koffel Associates Inc.

March 2015

© 2015 Fire Protection Research Foundation

The Fire Protection Research Foundation One Batterymarch Park Quincy, Massachusetts, U.S.A. 02169-7471 E-Mail: [email protected] Web: www.nfpa.org/foundation

Page 97 of 316

3

Acknowledgements

The Fire Protection Research Foundation expresses gratitude to those that assisted with the development and review of the information contained in this report. The Research Foundation appreciates the guidance provided by the Project Technical Panel:

Chad Beebe, ASHE

Phil Hoge, US Army Core of Engineers

David Klein, US Department of Veteran’s Affairs

William Lindeman, WEL Designs PLC

Rachel Miller, ARA

Mary Wei, AAAHC

Ron Cote, NFPA Staff Liaison

Robert Solomon, NFPA Staff

Special thanks are expressed to NFPA for funding this project through the annual Code Fund.

The authors of this report would like to thank the collaboration of the various ambulatory health care facilities in the Maryland, Pennsylvania, and Virginia areas. However, our agreement with the facilities was that they would not be identified in the report.

About the Fire Protection Research Foundation

The Fire Protection Research Foundation plans, manages, and communicates research on a broad range of fire safety issues in collaboration with scientists and laboratories around the world. The Foundation is an affiliate of NFPA.

About the National Fire Protection Association (NFPA)

NFPA is a worldwide leader in fire, electrical, building, and life safety. The mission of the international nonprofit organization founded in 1896 is to reduce the worldwide burden of fire and other hazards on the quality of life by providing and advocating consensus codes and standards, research, training, and education. NFPA develops more than 300 codes and standards to minimize the possibility and effects of fire and other hazards. All NFPA codes and standards can be viewed at no cost at www.nfpa.org/freeaccess.

Keywords: ambulatory health care, occupant load, occupant load factor, occupant density

Page 98 of 316

5

Abstract NFPA 101® Life Safety Code® acts as the main defining Code for life safety in all building occupancies. A fundamental use of this Code requires the application of occupant load factors as a way to determine the number of occupants for which a building or space, and the means of egress therefrom, should be designed. This factor is extremely important when determining the main means of egress from a building, and is crucial to creating the life safety requirements for any building. Though most uses are assigned their own factor, the 100 ft2/person (9.3 m2/person) that defines business use is also applied to ambulatory health care (AHC) facilities.1 This broad generalization is being called into question and has led to this research. The data collection and analysis in this report is meant to provide additional information on this topic to the Technical Committee on Health Care Occupancies of NFPA. Background As defined by NFPA 101, AHC occupancies provide medical treatment, anesthesia and other urgent care to four or more occupants who are incapable of self-preservation. AHC occupancy requirements use many of the business occupancy requirements from the LSC as the basis from which the AHC requirements are determined. Business occupancies and AHC occupancies share many of the same types of spaces: offices, conference rooms, waiting spaces, and consultation rooms. However, this is where the similarity ends. AHC occupancies also have areas which are outside the scope of the business occupancy provisions, such as prep areas, operating rooms, and post-anesthesia care units. Due to these differences there has been interest in determining the appropriate occupant load factor for AHC uses, rather than relying on the occupant load factor for business uses. Javier Cuesta, Daniel Alvear, and the GIDAI Group at the University of Cantabria researched this topic in Santander, Spain from November 2013 to February 2014; publishing a research document in March 2014 with NFPA to explain their findings. Their objective was to collect data through site surveys of different AHC facilities and evaluate the occupant loads within them. Overall, 21 health care facilities were surveyed: 18 devoted to primary care, 1 devoted to urgent care and treatment, and 2 devoted to consultation and treatment services, with a total area of approximately 1,180,343 ft2. Their secondary focus was to design a questionnaire for AHC facilities with the objective of providing a standard way of collecting additional information about an AHC facility’s means of evacuation. The priority, however, remained on data collection and determining occupant load factors.

1 The 2015 Edition of NFPA 101 revises this number to 150 ft2/person for AHC occupancies but remains as 100 ft2/person for business occupancies.

Page 99 of 316

6

Objectives The purpose of this research is to capture United States data in order to compare it to the data collected in Spain on this topic. Due to the differences of culture and use of facilities, the collected data from both countries must be analyzed to see if the analysis that was done previously can be universally applied. To replicate Spain’s research as much as possible, data was collected through site surveys of various AHC facilities (primary care and urgent care/treatment), the information was analyzed, and occupant load factors were calculated based upon the survey results. Methodology To begin this process, facilities that could be surveyed were identified from client facilities as well as facilities identified by the FPRF Technical Advisory Panel for the project. Facilities considered for the research included standalone facilities and acute care (hospitals) facilities that have a wing or floor devoted to AHC, but excluded those facilities where outpatients and inpatients are treated in the same areas. Ten facilities were initially contacted and responses were received from nine, one of which did not have separate AHC areas. The overall response was positive and helpful both with setting up the surveys and sending floor plans. Only one facility could not send detailed drawings so an average floor area and non-scaled schematic was used to find the occupancy load factor. The final sample consisted of eight facilities: three standalone outpatient surgery centers, two outpatient surgery floors that were part of larger facilities, and three primary care facilities. This combines to be a total of 14 floors and 115,959 ft2 evaluated. These facilities reach as far north as Pennsylvania and as far south as Virginia, and remain in the mid-Atlantic region of the USA. Appendix A shows a snap shot of the average Occupant Load Factors found at each facility with the building AHC average and an average for each area surveyed. Appendix B shows the input data and the solutions of both types of ratios that were solved for: Patients/ Staff and Patients/ Companion. Appendix C gives a condensed version of the survey data, with averages given for the AHC floor area and people surveyed per each time slot surveyed. Appendix D is the raw survey data that includes the breakdown of how many people were in each area surveyed for each time slot, the area of each area, and whether each person acted as patient, companion, or staff. Once the facilities began to be identified, the tables used in Spain were reorganized for use with the USA collection of data. The same basic information was taken, but the forms focused less on extra life safety aspects of the facility so as to keep the main focus on finding the real life occupant load factors. Occupants were split into categories of staff, companion, and patient and were counted about every half hour for the duration of the surveys (between 3 and 4 hours). For each survey the contact was asked when their highest patient loads were and the surveys were planned to correspond with those days and times. This “prime time” was often about the same for each facility, beginning around 7 am and dropping off around 12 pm, though the day of the week varied. Despite this coordination, the staff at some of the facilities advised us that the patient loads were light for the survey day.

Page 100 of 316

7

Prior to conducting the occupant load counts, a walkthrough of the facility was performed. The walk through provided a background of the facility, identified the uses of each area, and introduced the researcher to the staff. After this, the number of occupants in the common areas that were being surveyed was counted, every half hour, for 3 to 4 hours. The common areas that were surveyed in each facility are labeled in Appendix D in their respective tables. The provided building layouts were used to determine the gross floor areas for each of the spaces in which the occupants were counted. To do this the NFPA definition of gross floor area was used to include “the inside perimeter of the outside walls of the building under consideration with no deduction for hallways, stairs, closets, thickness of interior walls, columns, elevator and building service shafts, or other features”. Though the definition was followed in general, the spaces in the building that were not surveyed, and in which the occupants were not counted, were not included in the floor area. Results To begin the data analysis, each facility was given an ID number from 1-8. This number (i.e. Facility 1) is the name by which that facility is referenced for the rest of the document. General data and detailed data are shown for each individual facility in Appendices C & D respectively. The general data includes total area surveyed and average number of occupants, split into patients, staff, and companions for each time stamp surveyed. The detailed survey goes more in-depth to each time stamp with how the occupants and gross area were split up into different uses, such as patient care, waiting rooms, PACU etc. These tables only include gathered survey data i.e. number of occupants, usage and gross area of each space. For some of the facilities, it was pertinent to separate patients into two categories, capable and incapable, within their general data tables in Appendix C. These categories show the division of patients who are capable of self-evacuation and those who are not. This division was only made for urgent care facilities where the recovery and PACU areas could be surveyed; all patients within these areas were considered incapable of self-evacuation. The primary care facilities did not allow non-patient access to the areas where patients could clearly be stated either capable or incapable so they are listed solely as patients. Appendix A uses the gross area and the counted occupants within each facility to find an average occupancy load factor for each area that was surveyed. These values are averages of the half-hourly counts that were taken in the field. From all of the areas surveyed, 17% were less than 100 ft2/person and 83% were greater than 100 ft2/person. These individual areas are then averaged to find a total occupancy load factor for each facility. It is important to note that there is one significant outlier, Facility 4, which had an extremely low concentration of occupants. This facility is a standalone emergency department, where patients have to be transferred to an acute care hospital for inpatient treatment. They have a large gross area so the facility can be used as an emergency preparedness facility in the case of a disaster (i.e. they are prepared for a large influx of patients though everyday occupant loads have small concentrations of people).

Page 101 of 316

8

All of the facilities occupant load factors were averaged to obtain the overall occupant load factor. This was done two ways. Figure 1 shows the average of all of the surveyed facilities with the standard deviation (S.D.). Figure 2 excludes Facility 4 in its average and S.D. due its extremely low concentration of occupants and outlier effects on the average. Figure 3 shows the overall occupant load factors found in Spain’s research. By comparing Figure 2 to Figure 3, it can be seen that US and Spain’s values are close together, both showing less concentration of occupants than what is required in the present LSC.

Additional comparison was done to find the ratios of patients-to-staff and companions-to-patients for each facility at each time stamp. These values are shown in Appendix B. The number of patients per staff member was found using Formula 1, dividing the number of patients by the number of active staff.

RatioPatients/ Staff = NPatients

NStaff (1)

Formula 2 was used to find the companion-to-patient ratio by dividing the total number of companions by the total number of patients.

RatioCompanion/ Patient = NCompanions

NPatients (2)

The overall mean and standard deviation were found for both of the ratios and are shown in Figure 4. To the right of Figure 4 is Figure 5 showing Spain’s average ratios from their data.

Conclusion Through these surveys, a theme is starting to emerge. Though these spaces are large, the most varying factors are the companions that patients bring with them. For most of these AHC facilities, the number of patients is regulated by some kind of appointment. Facilities plan their number of patients and they plan how many people will be working for them, but they cannot plan for companions. The companions add in the unknown and are hard to predict because of the personal nature of being a companion. Finding a consistent companion-to-patient ratio may help to better predict these numbers for real AHC usage.

USA ft2/pers m2/pers

Mean 701 66.3

S.D. 1244 115.2

Figure 1: USA overall occupant load factor including all facilities.

USA ft2/pers m2/pers

Mean 264 25.9

S.D. 163 16.8

Figure 2: USA overall occupant load factor excluding outlier.

SPAIN ft2/pers m2/pers

Mean 267 24.8

S.D. 172 16.0

Figure 3: Spain overall occupant load factor.

RatioCompanion/Patient RatioPatient / Staff Mean S.D. Mean S.D. 0.98 0.73 0.78 0.52

Figure 4: USA statistical ratio results.

RatioCompanion/ Patient RatioPatient / Staff

Mean S.D. Mean S.D. 0.44 0.27 1.21 0.71

Figure 5: Spain statistical ratio results.

Page 102 of 316

9

In analyzing the surveyed facilities, 88% showed occupant load factors that were larger than 100 ft2/ person (9.3 m2/ person). This seems to support the trend Spain’s research points to: normal use of AHC facilities provides more space per person i.e. less concentration of occupants than currently required.

Page 103 of 316

10

Appendix A: Average Occupant Load Factor for all Facilities

Facility Average Occupant Load Factor

ft2/ pers m2/pers Facility 1A 145 13.5

Waiting Room 241 22.4Prep 112 10.4

PACU 207 19.3Nurse Room 20 1.9

Facility 2A 156 14.5 Waiting Room 99 9.2

Prep 159 14.8PACU 233 21.6Offices 131 12.2

Facility 3* 214 19.9 Waiting Room 296 27.5

Front Desk 313 29.1Back Desk 69 6.4

Prep 174 16.2PACU 220 20.4

Facility 4* 3756 349.0 Waiting Room 6312 586.4

Front Desk 448 41.7Back Desk 4150 385.6

Patient Rooms 4113 382.2Facility 5* 401 46.7 Facility 6P 350 33.2

Floor 1 162 15.0Floor 2 263 28.3Floor 3 527 48.9Floor 4 505 47.0Floor 5 304 28.2Floor 6 339 31.5

Facility 7P 518 48.2 Waiting Room 241 22.4

Patient Care 795 73.9Facility 8P 65 6.0

Pharmacy 40 3.7Floor 1 50 4.7Floor 2 104 9.7

*Free standing urgent/ treatment AHC Facility P Primary Care AHC Facility A Urgent/ treatment AHC floor or wing within larger acute care hospital

Page 104 of 316

11

Appendix B: Ratios for each facility at each time stamp surveyed B.1: Companion per Patient Ratio

Facility Time NTotal-Companions NTotal-Patients Ratio Companion/Patient

Facility 1

9:15 7 4 1.75 9:45 12 4 3.00 10:15 12 9 1.33 10:45 9 9 1.00 11:15 7 9 0.78 11:45 6 6 1.00 12:30 7 9 0.78 13:00 6 7 0.86

Facility 4

9:30 1 5 0.20 10:00 3 5 0.60 10:30 0 2 0.00 11:00 0 3 0.00 11:30 2 7 0.29 12:00 1 3 0.33

Facility 2

8:30 17 15 1.13 9:00 23 17 1.35 9:30 18 18 1.00 10:00 14 17 0.82 10:30 16 13 1.23 11:00 13 9 1.44 11:45 11 11 1.00

Facility 3

9:15 8 8 1.00 9:45 7 7 1.00 10:15 6 3 2.00 10:45 9 4 2.25 11:15 5 5 1.00 11:45 8 3 2.67

Facility 5

8:00 3 3 1.00 8:30 3 3 1.00 9:00 2 2 1.00 9:30 2 2 1.00 10:00 5 2 2.50 10:30 4 2 2.00 11:00 2 1 2.00 11:30 3 1 3.00 12:00 5 3 1.67

Facility 6

8:00 30 102 0.29 8:30 35 103 0.34 9:00 51 102 0.50 9:30 57 119 0.48 10:00 57 120 0.48

Page 105 of 316

12

Facility Time NTotal-Companions NTotal-Patients Ratio Companion/Patient 10:30 84 128 0.66

Facility 7

8:00 4 8 0.50 8:30 2 12 0.17 9:00 2 11 0.18 9:30 9 13 0.69 10:00 10 15 0.67 10:30 11 14 0.79 11:00 2 11 0.18

Facility 8

9:00 16 44 0.36 9:30 23 34 0.68 10:00 20 44 0.45 10:30 23 43 0.53 11:00 23 40 0.58 11:30 20 40 0.50

B.2: Patients per Staff Ratio

Facility Time NPatients-Waiting NActive-Staff Ratio Patients /Staff

Facility 1

9:15 4 19 0.2 9:45 4 14 0.3 10:15 9 26 0.4 10:45 9 21 0.4 11:15 9 23 0.4 11:45 6 16 0.2 12:30 9 20 0.3 13:00 7 18 0.2

Facility 4

9:30 5 8 0.6 10:00 5 4 1.3 10:30 2 5 0.4 11:00 3 3 1.0 11:30 7 7 1.0

12:00 3 8 0.4

Facility 2

8:30 15 23 0.7 9:00 17 21 0.8 9:30 18 24 0.8 10:00 17 25 0.7 10:30 13 20 0.6 11:00 9 23 0.4 11:45 11 23 0.5

Facility 3

9:15 8 12 0.7 9:45 7 10 0.7 10:15 3 7 0.4 10:45 4 10 0.4 11:15 5 8 0.6

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Facility Time NPatients-Waiting NActive-Staff Ratio Patients /Staff 11:45 3 11 0.3

Facility 5

8:00 3 6 0.5 8:30 3 8 0.4 9:00 2 7 0.3 9:30 2 8 0.3 10:00 2 3 0.7 10:30 2 6 0.3 11:00 1 3 0.3 11:30 1 3 0.3 12:00 3 4 0.8

Facility 6

8:00 102 50 2.0 8:30 103 52 2.0 9:00 102 50 2.0 9:30 119 69 1.7 10:00 120 63 1.9 10:30 128 61 2.1

Facility 7

8:00 8 19 0.4 8:30 12 16 0.8 9:00 11 13 0.9 9:30 13 12 1.1 10:00 15 15 1.0 10:30 14 14 1.0 11:00 11 14 0.8

Facility 8

9:00 44 31 1.4 9:30 34 39 0.9 10:00 44 42 1.1 10:30 43 37 1.1 11:00 40 38 1.1 11:30 40 34 1.2

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Appendix C: General Survey Tables C.1: Facility 1 Building General Information

Annapolis, MD

Facility Hourly Values

Time 9:15 9:45 10:15 10:45 11:15 11:45 12:30 13:00

Gross Floor Area (ft2)

5897 5897 5897 5897 5897 5897 5897 5897

Number of Staff 19 14 26 21 23 16 20 18

Number of Visitors (companions)

7 12 12 9 7 6 7 6

Number of Patients 4 4 9 9 9 6 9 7

Number of Capable Patients

0 0 1 0 0 1 0 0

Number of Incapable Patients

4 4 8 9 9 5 9 7

C.2: Facility 2 Building General Information

York, PA


Time 8:30 9:00 9:30 10:00 10:30 11:00 11:30


8134 8134 8134 8134 8134 8134 8134

Number of Staff

23 21 24 25 20 23 23


17 23 18 14 16 13 11

Number of Patients

15 17 18 17 13 9 11


1 3 3 3 1 2 1

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14 14 15 14 12 7 10


Gettysburg, PA Facility Hourly Values

Time 9:15 9:45 10:15 10:45 11:15 11:45


3557 3557 3557 3557 3557 3557

Number of Staff 12 10 7 10 8 11


8 7 6 9 5 8

Number of Patients

8 7 3 4 5 3


2 1 0 1 1 0

Number of Incapable

Patients 6 6 3 3 4 3


Gettysburg, PA


Time 9:30 10:00 10:30 11:00 11:30 12:00


36,425 36,425 36,425 36,425 36,425 36,425

Number of Staff 8 4 5 3 7 8


1 3 0 0 2 1

Number of Patients

5 5 2 3 7 3

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1 0 1 1 1 0


4 5 1 2 6 3

C.5: Facility 5


Bel Air, MD


Time 8:00 8:30 9:00 9:30 10:00 10:30 11:00 11:30 12:00


5000 5000 5000 5000 5000 5000 5000 5000 5000

Number of Staff

6 8 7 8 3 6 3 3 4


3 3 2 2 5 4 2 3 5

Number of Patients

3 3 2 2 2 2 1 1 3


Bethesda, MD


Time 8:00 8:30 9:00 9:30 10:00 10:30


32,796 32,796 32,796 32,796 32,796 32,796

Number of Staff 50 52 50 69 63 61


30 35 51 57 57 84

Number of Patients

102 103 102 119 120 128

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C.7: Facility 7


Fort Belvoire, MD


Time 8:00 8:30 9:00 9:30 10:00 10:30 11:00


17,532 17,532 17,532 17,532 17,532 17,532 17,532

Number of Staff 19 16 13 12 15 14 14


4 2 2 9 10 11 2

Number of Patients

8 12 11 13 15 14 11

C.8: Facility 8


Fort Meade, MD


Time 9:00 9:30 10:00 10:30 11:00 11:30


6618 6618 6618 6618 6618 6618

Number of Staff 31 39 42 37 38 34


16 23 20 23 23 20

Number of Patients

44 34 44 43 40 40

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18

Appendix D: Detailed Survey Data D.1: Facility 1

Main Activity

Time

Number of People Gross Floor Area (ft2)

OLF

Patients Companions Staff Total ft2/pers m2/pers

Waiting Room

9:15

0 7 3 10 2000 200 18.6

Prep 1 0 7 8 1165 146 13.5 PACU 3 0 9 12 2592 216 20.1

Nurse Room 0 0 0 0 140 0 0 Waiting Room

9:45

0 12 3 15 2000 133 12.4

Prep 1 0 5 6 1165 194 18.0

PACU 3 0 6 9 2592 288 26.8 Nurse Room 0 0 0 0 140 0 0

Waiting Room

10:15

1 8 3 12 2000 167 15.5

Prep 3 0 9 12 1165 97 9.0 PACU 5 4 14 23 2592 113 10.5


10:45

0 5 2 7 2000 286 26.5

Prep 4 0 7 11 1165 106 9.9 PACU 5 4 12 21 2592 123 11.5


11:15

0 3 2 5 2000 400 37.2

Prep 7 2 8 17 1165 69 6.4 PACU 2 2 12 16 2592 162 15.1

Nurse Room 0 0 1 1 140 140 13.0 Waiting Room

11:45

1 5 2 8 2000 250 23.2

Prep 4 0 7 11 1165 106 9.8 PACU 1 1 7 9 2592 288 26.8


12:30

0 6 2 8 2000 250 23.2

Prep 6 1 11 18 1165 65 6.0 PACU 3 0 7 10 2592 259 24.1


1:00 0 6 4 10 2000 200 18.6

Page 112 of 316

19

Main Activity

Time


OLF


Prep 4 0 3 7 1165 166 15.5 PACU 3 0 11 14 2592 185 17.2

Nurse Room 0 0 0 0 140 0 0 D.2: Facility 2

Main Activity

Time


OLF


Waiting Room

8:30

1 10 5 16 1591 99 9.2

Pre-Op 7 3 8 18 1938 108 10.0 PACU 7 4 6 17 4019 236 21.9 Offices 0 0 4 4 587 147 13.7 Waiting Room

9:00

3 17 3 23 1591 69 6.4

Pre-Op 8 1 8 17 1938 114 10.6 Recovery 6 5 7 18 4019 223 20.7 Offices 0 0 3 3 587 196 18.2 Waiting Room

9:30

2 8 5 15 1591 106 9.9


10:00

3 9 4 16 1591 99 9.2


10:30

1 9 5 15 1591 106 9.9


11:00

2 9 6 17 1591 94 8.7


11:45 1 9 3 13 1591 122 11.3

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Main Activity

Time


OLF


Pre-Op 2 0 6 8 1938 242 22.5 PACU 8 2 7 17 4019 236 21.9 Offices 0 0 7 7 587 84 7.8

D.3: Facility 3

Main Activity

Time Number of People Gross

Floor Area (ft2)

OLF


Waiting Room

9:15

2 4 0 6 862 144 13.3

Front Desk 0 0 2 2 453 226 21.0 Back Desk 0 0 4 4 178 45 4.1

Pre-Op 3 3 1 7 912 130 12.1 PACU 3 1 5 9 1152 128 11.9

Waiting Room

9:45

1 2 1 4 862 216 20.0


Pre-Op 3 3 3 9 912 101 9.4 PACU 3 2 3 8 1152 144 13.4

Waiting Room

10:15

0 3 0 3 862 287 26.7


Pre-Op 1 3 3 7 912 130 12.1 PACU 2 0 1 3 1152 384 35.7

Waiting Room

10:45

1 6 0 7 862 123 11.4


Pre-Op 2 2 2 6 912 152 14.1 PACU 1 1 2 4 1152 288 26.8

Waiting Room

11:15

1 5 0 6 862 144 13.3


Pre-Op 2 0 1 3 912 304 28.2 PACU 2 0 3 5 1152 230 21.4

Waiting Room 11:45

0 1 0 1 862 862 80.1

Front Desk 0 2 5 7 453 65 6.0

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Back Desk 0 0 2 2 178 89 8.3 Pre-Op 2 1 1 4 912 228 21.2 PACU 1 4 3 8 1152 144 13.4

D.4: Facility 4

Main Activity

Time


OFL

Patients Companions StaffTotal

ft2/pers m2/pers

Waiting Room

9:30

1 0 1 2 13367 6684 620.9


Patient Rooms

4 1 2 7 16181 2312 214.8

Waiting Room

10:00

0 0 0 0 13367 0 0


Patient Rooms

5 3 0 8 16181 2023 187.9

Waiting Room

10:30

1 0 2 3 13367 4456 414.0


Patient Rooms

1 0 1 2 16181 8091 751.6

Waiting Room

11:00

1 0 0 1 13367 13367 1241.9


Patient Rooms

2 0 0 2 16181 8091 751.6

Waiting Room

11:30

1 0 0 1 13367 13367 1241.9


Patient Rooms

6 2 3 11 16181 1471 136.7

Waiting Room

12:00

0 0 0 0 13367 0 0


Patient Rooms

3 1 2 6 16181 2697 250.5

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D.5: Facility 5

Main Activity

Time Number of People




Pre-Op

8:00

3 0 5 8

5,000 417 38.7

Recovery 0 0 0 0 Staff Break 0 0 0 0

Waiting Room

0 3 1 4

Offices 0 0 0 0 Pre-Op

8:30

2 0 3 5

5,000 357 33.2


Waiting Room

0 3 1 4


9:00

1 0 2 3

5,000 455 42.2


Waiting Room

0 2 1 3


9:30

1 0 2 3

5,000 417 38.7


Waiting Room

0 2 1 3


10:00

1 1 2 4

5,000 500 46.5


Waiting Room

1 4 1 6


10:30

2 2 1 5

5,000 417 38.7


Waiting Room

0 2 0 2


11:00

1 1 0 2

5,000 833 77.4 Recovery 0 0 1 1

Staff Break Area

0 0 1 1

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Main Activity

Time Number of People




Waiting Room

0 1 1 2


11:30

1 0 1 2

5,000 714 66.4

Recovery 0 0 0 0 Staff Break

Area 0 0 1

1

Waiting Room

0 3 1 4


12:00

2 0 2 4

5,000 417 38.7

Recovery 0 0 1 1 Staff Break

Area 0 0 0

0

Waiting Room

1 5 1 7

Offices 0 0 0 0 D.6: Facility 6

Main Activity


Floor Area (ft2)

OLF


Area A

8:00

29 2 7 38 6031 159 14.7 Area B 11 6 2 20 2525 126 11.7 Area C 15 6 8 29 3044 105 9.8 Area D 5 0 2 7 1320 189 17.5 Area E 8 2 2 12 2789 232 21.6 Area F 9 0 3 12 2789 232 21.6 Area G 1 1 2 4 943 236 21.9 Area H 1 3 3 7 2702 386 35.9 Area I 1 2 9 12 2761 230 21.4 Area J 2 1 2 5 823 164 15.3 Area K 7 2 3 12 2879 240 22.3 Area L 5 2 4 11 2894 263 24.5 Area M 8 3 3 14 1296 93 8.6 Area A

8:30 30 4 6 40 6031 151 14.0

Area B 4 4 2 10 2525 252 23.5 Area C 8 0 4 12 3044 254 23.6

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Main Activity


Floor Area (ft2)

OLF


Area D 3 0 2 6 1320 220 20.4 Area E 5 4 4 13 2789 215 19.9 Area F 5 1 5 11 2789 254 23.6 Area G 0 0 4 4 943 236 21.9 Area H 8 3 5 16 2702 169 15.7 Area I 8 11 5 24 2761 115 10.7 Area J 6 1 4 11 823 75 7.0 Area K 8 0 3 11 2879 262 24.3 Area L 12 6 3 22 2894 132 12.2 Area M 6 1 5 12 1296 108 10.0 Area A

9:00

22 5 5 32 6031 188 17.5 Area B 11 6 4 21 2525 120 11.2 Area C 5 0 6 11 3044 277 25.7 Area D 5 1 2 8 1320 165 15.3 Area E 8 8 2 18 2789 155 14.4 Area F 6 3 5 14 2789 199 18.5 Area G 1 2 1 4 943 236 21.9 Area H 6 7 3 16 2702 169 15.7 Area I 8 7 5 20 2761 138 12.8 Area J 4 0 3 7 823 118 10.9 Area K 17 3 3 23 2879 125 11.6 Area L 7 7 4 18 2894 161 14.9 Area M 2 2 7 11 1296 118 10.9 Area A

9:30

22 6 12 40 6031 151 14.0 Area B 25 11 10 46 2525 55 5.1 Area C 14 4 7 25 3044 122 11.3 Area D 7 0 2 9 1320 147 13.6 Area E 11 4 3 18 2789 155 14.4 Area F 5 6 6 17 2789 164 15.2 Area G 1 1 4 6 943 157 14.6 Area H 2 7 4 13 2702 208 19.3 Area I 6 10 2 18 2761 153 14.3 Area J 2 0 5 7 823 118 10.9 Area K 14 4 4 22 2879 131 12.2 Area L 6 3 4 13 2894 223 20.7 Area M 4 1 6 11 1296 118 10.9 Area A 10:00

23 10 7 40 6031 151 14.0

Area B 10 8 3 21 2525 120 11.2

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Main Activity


Floor Area (ft2)

OLF


Area C 11 0 5 16 3044 190 17.7 Area D 6 0 3 9 1320 147 13.6 Area E 12 6 3 21 2789 133 12.3 Area F 11 1 6 18 2789 155 14.4 Area G 2 2 4 8 943 118 11.0 Area H 12 11 4 27 2702 100 9.3 Area I 8 9 8 25 2761 110 10.3 Area J 2 0 3 5 823 165 15.3 Area K 12 4 5 21 2879 137 12.7 Area L 9 6 8 23 2894 126 11.7 Area M 2 0 4 6 1296 216 20.1 Area A

10:30

15 7 13 35 6031 172 16.0 Area B 16 10 3 29 2525 87 8.1 Area C 13 5 7 25 3044 122 11.3 Area D 5 1 2 8 1320 165 15.3 Area E 8 9 2 19 2789 147 13.6 Area F 18 8 6 32 2789 87 8.1 Area G 4 0 6 10 943 94 8.8 Area H 8 12 4 24 2702 113 10.5 Area I 19 18 6 43 2761 64 6.0 Area J 3 1 2 6 823 137 12.7 Area K 8 7 4 19 2879 152 14.1 Area L 9 6 4 19 2894 152 14.2 Area M 2 0 2 4 1296 324 30.1

Area uses and floor they are on Area A- Physical Therapy (1) Area H: Immunizations/ Allergies (4)

Area B- Orthopedics & Podiatry (2) Area I: Pediatric Primary Care (4)

Area C- Internal Medicine (2) Area J: Audiology & Speech (5)

Area D- Breast Care (3) Area K: Ear/ Nose/ Throat (5)

Area E- Surgery Oncology & Gynecological Cancer (3) Area L: DVBIC & Neurology (6)

Area F- Dermatology and Rheumatology (3) Area M: Behavioral Health (6)

Area G- Pediatrics: Hematology/ Oncology (4)

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26

D.7: Facility 7

Main Activity


Floor Area (ft2)



Patient Care*

8:00 5 2 16

23 14,870 647 60.1

Waiting Rm*

3 2 3 8

2661 333 30.9

Patient Care*

8:30 8 1 13

22 14,870 676 62.8

Waiting Rm*

4 1 3 8

2661 333 30.9

Patient Care*

9:00 6 1 10

17 14,870 875 81.3

Waiting Rm*

5 1 3 9

2661 296 27.5

Patient Care*

9:30 6 1 9

16 14,870 930 86.3

Waiting Rm*

7 8 3 18

2661 148 13.7

Patient Care*

10:00 6 1 12

19 14,870 783 72.7

Waiting Rm*

9 9 3 21

2661 127 11.8

Patient Care*

10:30 5 1 11

17 14,870 875 81.3

Waiting Rm*

9 10 3 22

2661 121 11.2

Patient Care*

11:00 7 1 11

19 14,870 783 72.7

Waiting Rm*

4 1 3 8

2661 333 30.9

*Cardiology Unit Only

D.8: Facility 8

Main Activity


Floor Area (ft2)



Pharmacy 9:00

9 1 3 13 701 54 5.0 Floor 1 21 12 13 46 2073 45 4.2

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Main Activity


Floor Area (ft2)



Floor 2 14 3 15 32 3844 120 11.2 Pharmacy

9:30 7 2 3 12 701 58 5.4

Floor 1 16 19 16 51 2073 41 3.8 Floor 2 11 2 20 33 3844 116 10.8

Pharmacy 10:00

11 4 3 18 701 39 3.6 Floor 1 19 3 21 43 2073 48 4.5 Floor 2 14 13 18 45 3844 85 7.9

Pharmacy 10:30

15 6 4 25 701 28 2.6 Floor 1 13 9 14 36 2073 58 5.4 Floor 2 15 8 19 42 3844 92 8.5

Pharmacy 11:00

14 5 4 23 701 31 2.8 Floor 1 10 9 15 34 2073 61 5.7 Floor 2 16 9 19 44 3844 87 8.1

Pharmacy 11:30

13 7 3 23 701 30 2.8 Floor 1 16 9 16 41 2073 51 4.7 Floor 2 11 4 15 30 3844 128 11.9

Pharmacy: Main pharmacy right near side entrance to Kimbrough.

Floor 1: Refill Pharmacy, Outpatient OR Waiting Room, Muscular Skeletal, & Physical Therapy

Floor 2: GI, Hand and Foot, Pain Management, and Pediatrics

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Cote, Ron

From: Woodruff, Mary ElizabethSent: Tuesday, March 10, 2015 7:49 AMTo: Duval, Bob; Cote, RonCc: Dutton, NicoleSubject: FW: Quakers Hill nursing home fire - inquest findings released

Of possible interest – the report of a 2011 Nursing Home fire has been released. Link below.

From: infire‐[email protected] [mailto:infire‐[email protected]] On Behalf Of Julie Wyner Sent: Monday, March 09, 2015 8:25 PM To: [email protected]; inFIRE Subject: [inFIRE] Quakers Hill nursing home fire ‐ inquest findings released Dear colleagues The NSW Coroner yesterday released the report of the inquiry into the 2011 nursing home fire in the Sydney suburb of Quakers Hill, full report can be accessed at http://www.coroners.justice.nsw.gov.au/agdbasev7wr/_assets/coroners/m401601l771004/finding,%20recommendation%20and%20reasons%20‐%20quakers%20hill%20fire.pdf regards

Julie Wyner Librarian FRNSW Library

E [email protected] | T (02) 9318 4843 | www.fire.nsw.gov.au Library, State Training College, 189 Wyndham St, Alexandria NSW 2015 | PO Box 559, Alexandria NSW 1435 FRNSW staff can search the library catalogue via the Library homepage at: http://intranet/training/resources/library/library-introduction This Library is a member of ALIES - Australasian Libraries in the Emergency Sector, and inFIRE - the international network for Fire Information and Reference Exchange.

Page 122 of 316

NFPA 101‐2012 Health Care Corridor Projections Relative to the 6‐in. projections into corridors that have 6 ft (1830 mm) or greater width, as permitted

by 18.2.3.4(2), 18.2.3.5(2) and 19.2.3.4(2), revise text as follows rather than strictly limiting the

projection to being not more 4 in. for compatibility with accessibility requirements:

18.2.3.4 (2)* Projections Noncontinuous projections not more than 6 in. (150 mm) from the corridor wall, positioned not less than 38 in. (965 mm) above the floor, shall be permitted by one of the following:

(a) Noncontinuous projections not more than 4 in. (100 mm) from the corridor wall, positioned not less than 38 in. (965 mm) above the floor, shall be permitted. (b) Noncontinuous projections not more than 6 in. (150 mm) from the corridor wall shall be permitted provided that both of the following are met:

i. The projecting item is positioned not less than 38 in. (965 mm) above the floor ii. A vertical extension, having the same depth as the projecting item, is provided to within 27 in. (685 mm) of the floor

18.2.3.5 (2)* Projections Noncontinuous projections not more than 6 in. (150 mm) from the corridor wall, positioned not less than 38 in. (965 mm) above the floor, shall be permitted by one of the following:

(a) Noncontinuous projections not more than 4 in. (100 mm) from the corridor wall, positioned not less than 38 in. (965 mm) above the floor, shall be permitted. (b) Noncontinuous projections not more than 6 in. (150 mm) from the corridor wall shall be permitted provided that both of the following are met:

i. The projecting item is positioned not less than 38 in. (965 mm) above the floor ii. A vertical extension, having the same depth as the projecting item, is provided to within 27 in. (685 mm) of the floor

19.2.3.4 (2)* Where corridor width is at least 6 ft (1830 mm), noncontinuous projections not more than 6 in. (150 mm) from the corridor wall, above the handrail height, shall be permitted by one of the following:

(a) Noncontinuous projections not more than 4 in. (100 mm) from the corridor wall, positioned above handrail height, shall be permitted. (b) Noncontinuous projections not more than 6 in. (150 mm) from the corridor wall shall be permitted provided that both of the following are met:

i. The projecting item is positioned above handrail height ii. A vertical extension, having the same depth as the projecting item, is provided to within 27 in. (685 mm) of the floor

Page 123 of 316

1

Cote, Ron

From: Cote, RonSent: Tuesday, April 01, 2014 8:02 AMTo: 'William Koffel'Cc: Solomon, RobertSubject: Health care ceilings

Thanks Bill. I deliberately stay away from the list serve sites. I will add this paper trail and that from your previous e-mail to the agenda folder for SAF-MEA’s next meeting. Thanks for documenting the history and suggesting the direction that the code text might take for the next revision cycle. Ron Coté, P.E. Principal Life Safety Engineer NFPA - Quincy, MA USA

From: William Koffel [mailto:[email protected]] Sent: Tuesday, April 01, 2014 12:51 AM To: Cote, Ron Subject: FW: Questionable TJC Finding Ron, If you care to read this, here is the email chain resulting from your response to Skip. Again, I think my response is consistent with your response. Bill From: William Koffel Sent: Tuesday, April 1, 2014 12:41 AM To: [email protected] Subject: RE: Questionable TJC Finding I have remained silent over the many posts that have occurred, primarily on the public list serve. However, Ron’s response actually should start to bring closure to the issue. Ron has answered both questions and the answer does not require an additional level of protection. Let’s explore four options:

1. The Code specifically states that the WALL terminates at the ceiling which is addressed in Ron’s first paragraph. This is an alternative to a wall that continues to the slab. The typical wall assembly has a hollow core and consists of two layers of gypsum wallboard, one on both sides. In this instance, the ceiling membrane on both sides of the wall serves as an alternative to the two layers on membrane that constitute the typical wall assembly. This is the scenario that was tested in the research tests that support the current code language.

2. The second scenario, which is Skip’s second question and is the more typical construction for most hospitals, is a corridor wall that extends slightly above the ceiling membrane instead of stopping at the ceiling membrane. As Ron points out, this is NOT the construction specifically permitted by the Code and technically needs to be addressed by an equivalency. I agree with Ron’s assessment but would further argue that the Code language should be revised to specifically permit this and that this construction is probably superior to what is specifically permitted by the Code.

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2

3. The third scenario is the one that is part of this discussion. The scenario involves the use of the ceiling membrane on one side of the wall and no ceiling membrane on the other side. The response that I proposed is that if there is no ceiling membrane on one side of the corridor wall, the corridor wall needs to extend to the slab above. Actually, I would argue a further detail that only one side of the corridor wall needs to extend to the deck. The membrane commonly found on the other side of the wall is the ceiling of the corridor. This is not requiring a second level of protection; but rather, constructing the wall in the same manner as described in the above two scenarios with two layers of membrane protection. The two layers further discount concerns one may have with a small hole in the ceiling tile (where this whole discussion actually started) even though ASHE has argued in other forums that holes in ceiling tiles generally are not permitted to exist in a health care facility. Again, as Ron pointed out in his response, this scenario is not covered by the text of the Code and needs to be addressed as an equivalency.

4. The fourth scenario, and the one posed in the follow-up question, is a corridor wall that extends at least to the ceiling membrane on the corridor side only and possibly slightly above; but there is no ceiling membrane on the other side. In the previous response, it was noted that if the wall terminates AT the ceiling, clearly the ceiling membrane must be continuous on the other side (see highlighted text). So, let’s focus on the scenario where the wall extends inches above the ceiling membrane and there is a ceiling membrane on one side of the wall. How does that final assembly equate to any of the above three scenarios in which there are two layers of membrane substituting for the Code requirement that the wall extend to the deck above? How does that final assembly equate to the assemblies tested that support this Code text in which a ceiling membrane was on both sides of the wall? How does that final assembly equate to the one in which the wall stops at the ceiling and the response below states that the ceiling must be on both sides of the wall even if only from a construction point of view? While one would not normally construct a hospital this way, if one supports this scenario it would also be possible to have a ceiling membrane only on the room side of the wall and the corridor side could be without a ceiling membrane and the corridor wall would not need to extend to the deck above. This would be “equivalent” to only providing a membrane on the corridor side of the wall.

Regarding the last scenario, if the corridor wall is permitted to stop at the ceiling that exists only on the corridor side, it should be noted that sprinkler protection will most likely be required above the ceiling membrane (depending on the location of the sprinklers in the rooms adjacent to the corridor). If there is not at least a single membrane separating the space above the corridor ceiling from the adjacent room, the space above the corridor ceiling is not a concealed space and sprinkler protection is required for that space (per NFPA 13). This alone may be a basis to construct the walls and ceilings as identified in the first three scenarios above. Lastly, in the final response to this issue it should probably be noted that for the most part we are only talking about existing conditions. Most hospitals in the US are required to comply with the International Building Code. The IBC has been interpreted, and the interpretation has been supported by ICC Committee and membership votes on code change proposals and comments, in a manner that lay-in acoustical tile is not considered as meeting a Code requirement for limiting the passage of smoke. While the Annex note in NFPA 101 states otherwise, when the construction needs to meet the IBC and lay-in acoustical tile is used, the corridor walls need to extend to the deck above. Yes, this interpretation is the subject of ongoing code change activity and does not apply to existing conditions but it still exists and will until at least the 2018 Edition of the IBC for new construction and rehabilitation projects. Bill From: ASHE Advocacy [mailto:[email protected]] On Behalf Of Ben Thurston Sent: Monday, March 31, 2014 11:47 PM To: [email protected] Subject: Re: Questionable TJC Finding James,

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Thanks for forwarding this. For some odd reason, the original question is completely missing from the original e-mail I received from Skip. Skip, In the case Ron cited, where the corridor wall terminates at the ceiling, it's pretty obvious that the ceiling would have to be continuous on both sides of the corridor wall, just from a construction point of view. But that's not the question here. I think your Question 2, which Ron didn't answer, is closer to what Joe's asking--where a suspended ceiling in the corridor forms part of the separation of the corridor from "all other areas", as permitted by 19.3.6.2.1 Exception No. 1, and there is not a suspended ceiling in a room adjacent to the corridor, is there a code requirement for the corridor walls to extend to the structure above? Since by definition the partial-height corridor walls and suspended ceiling form the required separation of the corridor from "all other areas", requiring the corridor walls to extend to the structure above would constitute a second level of separation from the corridor; and there's nothing in LSC requiring this second level of separation. If you can ask Ron to answer your Question 2, I'll be interested to hear the answer. Ben Thurston From: ASHE Advocacy [mailto:[email protected]] On Behalf Of Peterkin, James S. Sent: Monday, March 31, 2014 11:06 AM To: [email protected] Subject: Re: Questionable TJC Finding Ben, It was included in the original e-mail. See highlighted section below From: ASHE Advocacy [mailto:[email protected]] On Behalf Of Ben Thurston Sent: Monday, March 31, 2014 2:01 PM To: [email protected] Subject: Re: Questionable TJC Finding Skip, Would you please send the question that Ron responded to? Thanks! Ben Thurston From: ASHE Advocacy [mailto:[email protected]] On Behalf Of Skip Gregory Sent: Monday, March 31, 2014 6:26 AM To: [email protected] Subject: Re: Questionable TJC Finding

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Ben, I received the below from NFPA as a response to my questions concerning this issue.

JAMES GREGORY: No. Provision written for the smoke-resisting ceiling to be continuous to both side sides of corridor wall. Corridor wall then extends upward so as to contact the continuous ceiling. Equivalency can be used to do something other than prescribed if you can convince AHJ. Remember that this prescriptive "requirement" is actually an exemption to a rule that would otherwise require vertical continuity to continue to the deck above. If you have a follow-up question directly related to this inquiry, please reply to this email. If you have another question on either a separate topic or different document please return to the document information pages and submit your new question by clicking on the “Technical Questions” tab. Ron Coté, P.E. Principal Life Safety Engineer National Fire Protection Assn Quincy, MA USA Important Notice: This correspondence is not a Formal Interpretation issued pursuant to NFPA Regulations. Any opinion expressed is the personal opinion of the author and does not necessarily represent the official position of the NFPA or its Technical Committees. In addition, this correspondence is neither intended, nor should it be relied upon, to provide professional consultation or services. --------------------------------------------------------------------------------------------------- Create Date: 3/28/2014 Contact: JAMES GREGORY Document Number: 101 Edition: 2000 Section: Section 18/19.3.6.2 Subject: Termination of Corridor Walls Question for NFPA: Section 18/19.3.6.2 permits the corridor wall to terminate at the ceiling where the ceiling is constructed to limit the transfer of smoke. In this case the corridor wall does not extend to the floor

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or roof above. Question 1: May this ceiling be installed on only one side of the corridor wall? If so, which side, the corridor side or the room side? Question 2: May the ceiling terminate at the wall instead of the wall terminating at the ceiling. The wall would terminate just above the ceiling.

[see attached file: servlet.ImageServer] Best Regards, Skip Gregory, NCARB Health Facility Consulting, LLC 4128 Zermatt Drive Tallahassee, Florida 32303 P. 850.567.3303 F. 850.514.2495 Registration Is Now Open! AHCA SEMINAR/FHEA TRADE SHOW SEPT. 22-24, 2014 INFORMATION AT: www.ahcaseminar.com [email protected] www.healthfacilityconsulting.com www.Linkedin.com DropBox: https://dropbox.yousendit.com/Health-Facility-Consulting On Mar 28, 2014, at 2:30 PM, Ben Thurston wrote:

Skip, The intent of the illustration is clearly to show that the combination of a non-rated corridor wall and non-rated drop in ceiling in the corridor combine to resist the passage of smoke into and out of the corridor, which is what 18/19.3.6.2.1 requires. This could just as well have shown the suspended ceiling stopping at the wall, rather than the wall stopping at the suspended ceiling.

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As long as the combination of corridor walls and ceiling resist the passage of smoke into and out of the corridor, there is nothing in LSC remotely suggesting that adjacent areas are required to have suspended ceilings for the purpose of corridor protection, because as noted in the illustration the corridor wall and suspended ceiling provide the necessary protection. The question of whether or not the adjacent room is hazardous is important, because if it is hazardous, it will require either a suspended ceiling or walls continuous to the slab above. This is not for protection of the corridor, because the corridor is already protected by the corridor wall and ceiling, but for protection of all surrounding spaces from smoke that might be generated within the hazardous area. Even if a hazardous area does not open onto a corridor, it still requires this protection; that is, the requirement for a smoke-tight enclosure in a hazardous area is independent of the requirement for corridors have smoke-tight enclosures. If you and Bill are still adamant that all spaces adjacent to a corridor that uses a suspended ceiling as part of its smoke tight enclosure must also have suspended ceilings, then I'll post the question to the SIG to at least get the TJC perspective on this. However, I'd hate to bother that hard working group to respond to a question whose answer seems crystal clear to me. Ben Thurston, PE From: ASHE Advocacy [mailto:[email protected]] On Behalf Of Skip Gregory Sent: Friday, March 28, 2014 10:40 AM To: [email protected] Subject: Re: Questionable TJC Finding Ben, I think Bill was commenting on the question regarding the corridor partition terminating at the underside of a lay in ceiling and whether or not this ceiling on to be on both sides of the corridor... not whether the room is hazardous. I have always read this section of the code as requiring a ceiling on both sides of a corridor partition that terminates at a lay in ceiling. The handbook has a diagram of this condition and some commentary on section 19.3.6.2.1. Most AHJs in evaluating a lay in ceiling's ability to resist the passage of smoke will require the ceiling tile to be substantial (i.e. not constructed of that yellow fiberglass material with a thin vinyl covering that weighs something like an ounce per square foot and will tend to fly up and off the grid with any kind of draft) although this is not mentioned in the commentary. The commentary is more concerned with items penetrating the lay-in ceiling not the tile itself. From the Handbook 2008 LSC In new health care occupancies and sprinklered existing health care occupancies, corridor walls need not be fire rated but must be constructed to resist the passage of smoke. Corridor walls in such buildings are permitted to terminate at ceilings, provided that the wall and ceiling resist the passage of smoke. Where suspended ceilings are provided, partitions are permitted to terminate at the suspended ceiling without any additional special protection if the suspended ceiling will resist the passage of smoke. The ability of the ceiling to resist the passage of smoke must be

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carefully evaluated, and guidance is provided in A.18.3.6.2 and A.19.3.6.2.4 . A.19.3.6.2.4 An architectural, exposed, suspended-grid acoustical tile ceiling with penetrating items, such as sprinkler piping and sprinklers; ducted HVAC supply and returnair diffusers; speakers; and recessed lighting fixtures, is capable of limiting the transfer of smoke. [see attached file: PastedGraphic-1.tiff] Best Regards, Skip Gregory, NCARB Health Facility Consulting, LLC 4128 Zermatt Drive Tallahassee, Florida 32303 P. 850.567.3303 F. 850.514.2495 Registration Is Now Open! AHCA SEMINAR/FHEA TRADE SHOW SEPT. 22-24, 2014 INFORMATION AT: www.ahcaseminar.com [email protected] www.healthfacilityconsulting.com www.Linkedin.com DropBox: https://dropbox.yousendit.com/Health-Facility-Consulting On Mar 28, 2014, at 1:17 PM, Ben Thurston wrote: Bill, As I read LSC, in fully sprinklered buildings, which the OP stated this was, it's only in hazardous areas that there must either be a ceiling that resists the passage of smoke or walls that go to the slab (LSC-2000, 19.3.2.1). And in general, mechanical rooms are hazardous areas only if they contain boilers or fuel-fired heaters (19.3.2.1(1)). There was nothing in the original post indicating that this was a hazardous area, and unless it is, there's no requirement for an intact suspended ceiling or walls continuous to the slab in the mechanical room. If it does have boilers or fuel-fired heaters, it has to be protected as a hazardous area, and would require an intact suspended ceiling or walls continuous to the slab; and this is essentially what I said in my response on the open site (although apparently this hasn't been posted yet--I'll follow up with Ken). Would you disagree? Ben Thurston, PE

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-----Original Message----- From: ASHE Advocacy [mailto:[email protected]] On Behalf Of William Koffel Sent: Friday, March 28, 2014 8:41 AM To: [email protected] Subject: Re: Questionable TJC Finding The question, as I understood it, was not whether the wall needed a fire resistance rating (some of the responses dealt with hazardous areas); but rather whether the ceiling needed to resist the passage of smoke. My response was that the wall needed to be continuous to the underside of the slab above unless the ceiling is capable of resisting the passage of smoke. If only the corridor ceiling meets the criteria, the mechanical room wall needs to go to the slab (but need not necessarily have a fire-rating). -----Original Message----- From: ASHE Advocacy [mailto:[email protected]] On Behalf Of Ben Thurston Sent: Friday, March 28, 2014 10:52 AM To: [email protected] Subject: Re: Questionable TJC Finding I've already answered this on the open site so my opinion is on record (no, unless the mechanical room has fired equipment). What's the code basis for your opinion? Ben Thurston -----Original Message----- From: ASHE Advocacy [mailto:[email protected]] On Behalf Of William Koffel Sent: Friday, March 28, 2014 7:40 AM To: [email protected] Subject: FW: Questionable TJC Finding I know that I have an opinion on this subject but I also know that others have different opinions. This may be a good topic for Just Ask ASHE. I will start the discussion by saying yes, the ceiling on both sides of the corridor wall must meet the criteria. Bill William E. Koffel P.E., FSFPE President KOFFEL ASSOCIATES, INC. 8815 Centre Park Drive / Suite 200 / Columbia, MD 21045-2107 direct

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410-540-9008 / tel 410-750-2246/ fax 410-750-2588 [email protected] www.koffel.com Fire Protection Engineers: Expertly Engineering Safety From Fire -----Original Message----- From: American Society for Healthcare Engineering [mailto:[email protected]] On Behalf Of Gibson, Joe Sent: Friday, March 28, 2014 9:37 AM To: [email protected] Subject: Re: Questionable TJC Finding Slightly off topic, but do both sides of a corridor wall have to have a suspended ceiling in order to be compliant? For instance, where a corridor wall is adjacent to a non rated mechanical room and the mechanical room does not have a suspended ceiling. Does the suspended ceiling on the corridor side alone meet the intent of the code or would the mechanical room side need to have the corridor walls completely sealed to the deck? Joe Gibson Director, Engineering Phone: 601-288-2710 Fax: 601-288-2716 6051 U.S. Hwy. 49, Hattiesburg, MS 39401-7243 P.O. Box 16389, Hattiesburg, MS 39404-6389 Forrest General; Facebook; Twitter; Blog The information contained in this message and any files transmitted with it are property of Forrest General Hospital and may include privileged and confidential information and information otherwise protected by state and federal law. If you are not the intended recipient of this message or an employee or agent responsible for delivery of this message, or if you otherwise believe you have received this message in error, you are hereby notified that any dissemination, retention, distribution, reproduction, copying, or any other use of or any reliance on this communication is strictly prohibited. If you have received this communication in error, please immediately notify the sender and delete this e-mail and any attachments from your computer and system.

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NOTICE: This communication and any attachments ("this message") may contain confidential information for the sole use of the intended recipient(s). Any unauthorized use, disclosure, viewing, copying, alteration, dissemination or distribution of, or reliance on this message is strictly prohibited. If you have received this message in error, or you are not an authorized recipient, please notify the sender immediately by replying to this message, delete this message and all copies from your e-mail system and destroy any printed copies.



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Cote, Ron

From: William Koffel <[email protected]>Sent: Tuesday, April 01, 2014 12:46 AMTo: Cote, RonSubject: FW: Ask ASHE Question #1486 corridor walls and ceiling tiles

Ron, A response you provide to Skip Gregory on this issue was recently posted on the ASHE List Serve. I thought you might find the following response to ASHE on the same issue of interest and I believe consistent with your interpretation. In a separate email, I will also forward a response I just posted based upon some questions regarding your response to Skip. Bill From: William Koffel Sent: Sunday, March 30, 2014 4:08 PM To: 'Kenney, Lynn' Subject: RE: Ask ASHE Question #1486 corridor walls and ceiling tiles Lynn, Due to the controversial nature of this issue, as already demonstrated on the ASHE List Serve, I would recommend that the response be circulated to Chad, Jonathan, or both BEFORE it is circulated to the Just Ask ASHE team for comments. Obviously they, as well as I, can change our opinions as comments come in but this is going to be a challenging one to reach consensus. Bill To begin, we will limit the response to requirements in NFPA 101, Life Safety Code. New construction and rehabilitation projects in most hospitals are required to comply with the International Building Code (IBC). While the IBC permits corridor walls to terminate at the underside of a ceiling if the ceiling is capable of resisting the passage of smoke, the interpretation of the IBC as supported by recent ICC membership votes, does not recognize suspended ceiling systems as being capable of resisting the passage of smoke. While this may be the subject of future code change activity, the earliest such code change activity can influence the IBC is the 2018 Edition. It should be noted that the IFC-2015 Edition will allow certain existing suspended ceiling systems as being treated as capable of resisting the passage of smoke. In buildings (smoke compartments for Chapter 19) that are protected throughout by an approved, supervised automatic sprinkler system, both Chapters 18 & 19 of NFPA 101 Life Safety Code permit walls to terminate at ceilings provided the wall/ceiling are capable of limiting the transfer of smoke (18/19.3.6.2). Annex notes to both chapters say that an architectural, exposed, suspended-grid, acoustical tile ceiling with various penetrations is capable of limiting the transfer of smoke. It should be noted that this is essentially the same up to and including the 2012 Edition of the Life Safety Code. Two things should be noted right off. The Code does not say that the wall can stop at a corridor ceiling or at a room ceiling, it states that the wall can stop at the ceiling. The other item that should be noted is that the wording is really not accurate. In most cases the wall continues up a short distance above the ceiling plane and the ceiling actually affixes to the wall. Both of these observations might be considered to be “knit picking” but there have been AHJs that prohibit the better installation where the ceiling terminates at the wall verses the wall terminating at the ceiling. Also brought up through this question, there are some that profess that the ceiling only needs to exist on one side of the wall. The ceiling terminating at the wall, and the ceiling being on both sides of the wall are both supported by one of the major research documents that can be used to justify this provision (NBSIR 81-2444 Smoke Movement Through A Suspended Ceiling System). In the fire tests documented in the research report, the wall was built like in most hospitals

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where the wall goes up just above the ceiling plane and the ceilings were attached to the wall. In all tests the ceilings were on both sides of the corridor wall. Although it would take a serious dissertation to totally review all the tests, after reviewing the tests, it can be concluded that the spaces above the ceiling did NOT spread smoke from room to room and in most cases very little smoke was in the interstitial space, due in part to the presence of a ceiling in the fire room. Most of the smoke that did enter the interstitial spaces came from where the frame was attached to the wall. If the wall tile sat on top of the wall, it is clearly evident that the situation would be much worse. One of the weak points of the tests was that there were no ceiling penetrations in the rooms. No light fixtures with the vents, no sprinkler pipe, no speakers, etc. In one test some ceiling tiles were removed from the room of origin and in the high energy fires the ceiling in the room of origin failed. In both cases the ceiling in the other rooms prevented the smoke from entering the other rooms. The major safety factor that the Life Safety Code uses is that these provisions can only be used where there is a supervised, automatic sprinkler system (not part of the tests). Fire modeling sponsored by ASHE in 1987 documented that fast response sprinklers are capable of maintaining tenable conditions at the bed level in a typical patient sleeping room during most reasonably, credible fire scenarios (note: this is an ASHE Technical Document for which I can get the reference is desired). Subsequent full scale fire tests performed by NIST confirmed the results of the computer fire modeling. While some may say that this further negates the need for a ceiling in the room of origin, one could also argue that the primary benefit derived from the corridor wall will be in the fire scenarios in which the sprinkler systems fails to control the fire or those limited scenarios in which tenability is not maintained. As such, the fire tests without sprinklers may provide the basis for the continuity of the wall, the ceiling system, or both. The performance of sprinklers systems in health care occupancies is not well documented since the NFPA data actually includes health care facilities that would be classified as other than a health care occupancy. Following the test protocol that has been used to support the code requirement that corridor walls may terminate at the underside of a ceiling capable of limiting the passage of smoke, requires that ceilings be on both sides of the corridor wall. This provides two “weaker” membranes to “equate” to the better membrane (typically two membranes in a health care occupancy) provided by the corridor wall. In cases where a ceiling is either missing or actually undesirable the walls of such room must go up to the floor or roof above. However, that wall only has to resist the passage of smoke (single layer of gypsum board on one side of the studs would be satisfactory). The seals around penetrations and the head-of-wall seal would not have to be rated. However they must be non-combustible. It should also be noted that if a ceiling is not provided in the adjacent room and the wall does not extend to the underside of the floor or roof deck above, it would be reasonable to require sprinklers above and below the ceiling in the corridor. When a Code requires sprinklers to be provided throughout the building, NFPA 13 requires sprinklers everywhere unless a provision in NFPA 13 exempts sprinklers from the location. Currently the only related provision would be to omit sprinklers from certain concealed spaces and absent a wall to the deck or a ceiling in the adjacent rooms, the space above the corridor ceiling is not a concealed space. Based on this, in new construction, corridor walls should be constructed to extend above the ceiling plane with the ceiling grid attached to the wall. Ceilings should extend throughout. Rooms, such as IT walls should continue to the floor or room above. In existing situations walls can terminate at the ceiling as long as the ceiling – wall joint resists the passage of smoke, although this arrangement is not as smoke resistant, the Code clearly allows it. Where rooms might not have ceilings (such as IT rooms) it is best to extend the walls up to the floor or roof deck above. However, due to the “vagueness” of the wording in the Code an argument can be made that it would be acceptable. This would be of a much bigger concern in rooms that are either larger or have a higher fuel load. A few other items must be noted. As noted in the first paragraph, this type of construction might not be allowed by the local building code. Also, missing ceiling tiles are a problem not only due to the discussion above, but missing ceiling tiles most likely are a problem for the sprinkler system as it affects the height of the “true” ceiling above the sprinkler. They also might affect the fire resistance rating of the structure above depending on if the ceiling is part of a fire resistance rated floor/ceiling or roof/ceiling assembly. Lastly, missing ceiling tiles might be an infection control issue also.

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From: Kenney, Lynn [mailto:[email protected]] Sent: Friday, March 28, 2014 4:47 PM To: William Koffel Subject: Ask ASHE Question #1486 corridor walls and ceiling tiles Can you clarify? Corridor walls are allowed to terminate at an acoustical grid ceiling in sprinklered buildings. Do both sides of a corridor wall have to have a suspended ceiling in order to be compliant? For instance, where a corridor wall is adjacent to a non rated mechanical room and the mechanical room does not have a suspended ceiling. Does the suspended ceiling on the corridor side alone meet the intent of the code or would the mechanical room side of the corridor wall need to be sealed to the deck to be compliant? This question was discussed on the ASHE listserve and the responses went both ways. Thank you MW Lynn Kenney Sr. Analyst, Advocacy Team American Society for Healthcare Engineering (ASHE) 155 N. Wacker Drive, Suite 400. Chicago, IL 60606 Office – (312) 422-3826 Cell – (781) 706-1728 Fax - (312) 268-6366 www.ashe.org

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Cote, Ron

From: Cote, RonSent: Monday, September 16, 2013 9:51 AMTo: Cote, RonSubject: FW: NFPA Technical Question Response [ ref:_00D5077Vx._50050NSZpI:ref ]

For Agenda for SAF-HEA 2018 edition cycle. Revisit NFPA 101-2012 18.1.1.4.2 and clarify intent. Is intent just to prevent having to meet the requirements applicable to NEW? Must a new AHC meet Chapter 21 for existing AHC? Ron Coté, P.E. Principal Life Safety Engineer NFPA - Quincy, MA USA

From: NFPA Life Safety [mailto:[email protected]] Sent: Monday, September 16, 2013 9:24 AM To: [email protected] Subject: NFPA Technical Question Response [ ref:_00D5077Vx._50050NSZpI:ref ]

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My response is based on NFPA 101, Life Safety Code, 2000 edition. It is our belief that the intent of Exception No. 3 to 18.1.1.4.4 was to permit a portion of a hospital or nursing home to be converted to an ambulatory health care occupancy without having to meet the requirements for new ambulatory health care, as would otherwise be required by 4.6.11 for changes of occupancy. In accordance with the exception, the building must meet the the requirements of Chapter 21 for existing ambulatory health care and Chapter 19 for existing health care. If the ambulatory health care portion of the facility is going to be classified as anything other than health care, a 2-hour separation must be provided in accordance with 19.1.2. Please note the authority having jurisdiction determines compliance with the Code. Gregory Harrington, P.E. Principal Fire Protection Engineer NFPA - Quincy, MA USA Important Notice: This correspondence is not a Formal Interpretation issued pursuant to NFPA Regulations. Any opinion expressed is the personal opinion of the author and does not necessarily represent the official position of the NFPA or its Technical Committees. In addition, this correspondence is neither intended, nor should it be relied upon, to provide professional consultation or services. ---------------------------------------------------------------------------------------------------Create Date: 9/5/2013 Contact: Paul Acre Subject: Occupancy Separation Question for NFPA: 18.1.2 requires 2-hour Occupancy Separation, however since 18.1.1.4.4 Changes of Occupancy. Exception No. 3: provides for the change from HCO (Chapt 18/19) to AHCO (Chapt 20/21) ~“shall not be considered a change in occupancy or occupancy

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subclassification”: The question is can portions of a Hospital Health Care Occupancy (Chapt 18/19), have portions thereof in it that are only 1-hour (same as would be required for hazardous areas) separated per 20.3.7.1 and therefore follow the Egress provisions of Ambulatory Health Care Occupancies?

ref:_00D5077Vx._50050NSZpI:ref

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Can a missing door latch be permitted via an exemption for a space to be left open to a corridor? I’ll try to capture why I believe that a missing door latch should not be addressed via an exemption that allows spaces to be open to the corridor. In NFPA 101‐2000, some code exemptions are worded like the Exception to 18.1.1.1.1(2) in that they exempt the user from compliance with the base rule. The language typically takes the form of “the requirement of 18.x.x shall not apply…” Exception No. 1 to 18.3.6.1 is NOT of the above format. The technical committee specifically wrote the exception so as to permit spaces to be OPEN to the corridor. The first exemption written by the committee applied only to waiting spaces as addressed by Exception No. 2. It was done to facilitate function as some uses lend themselves to open spaces. Later, Exception No. 1 was written without limiting the use except that such space cannot be used for patient sleeping, patient treatment, or as a hazardous area (like a storage space). The committee felt the exemption would not be abused in that the facility is run primarily for patient sleeping and patient treatment, so open spaces will not be provided frivolously. Again, the exemption was written to facilitate function as some uses lend themselves to open spaces. In your case, the function does not utilize openness. In fact, the facility operator wants the space NOT to be open to the corridor and has provided walls and doors. A missing door latch does not create an OPEN area as permitted by the exemptions.

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Cote, Ron

From: Cote, RonSent: Wednesday, December 11, 2013 7:00 AMTo: Solomon, RobertSubject: FW: monitoring exterior valves serving hospital fire protection systems

Interesting subject. Maybe HITF should discuss. Ron Coté, P.E. Principal Life Safety Engineer NFPA - Quincy, MA USA

From: William Koffel [mailto:[email protected]] Sent: Tuesday, December 10, 2013 5:49 PM To: Kenney, Lynn Cc: Jim Lathrop; Klaus, Matthew; Cote, Ron; Jen Frecker; Sharon Gilyeat Subject: RE: monitoring exterior valves serving hospital fire protection systems This is an interesting question, actually several questions. First, NFPA 101 requires electrical supervision where the word “supervised” appears before “automatic sprinkler system” in the Code. The word supervised is used throughout Chapters 18 and 19 and as such applies to sprinkler systems in new and existing health care occupancies. The word “supervised” is what triggers the requirements of Paragraph 9.7.2 which are more restrictive than NFPA 13 and NFPA 24. The second question is whether Paragraph 9.7.2 applies to valves in the system outside of the building. An argument has been made that the private fire service main starts at the base of the riser and that is true. However, the definition of “sprinkler system” in NFPA 13 reads as follows. Note that the definition indicates that a system includes “a water source.” As such, the sprinkler system includes the tanks, pumps, and private fire service mains that are the water supply for the sprinkler system. 3.3.22* Sprinkler System. A system that consists of an integrated network of piping designed in accordance with fire protection engineering standards that includes a water supply source, a water control valve, a waterflow alarm, and a drain and is commonly activated by heat from a fire, discharging water over the fire area. The portion of the sprinkler system above ground is a network of specifically sized or hydraulically designed piping installed in a building, structure, or area, generally overhead, and to which sprinklers are attached in a systematic pattern. The system is commonly activated by heat from a fire and discharges water over the fire area. Further clarity is provided in A.9.7.2.1 which states that supervision includes water tank levels, temperatures, and pressures. As such, the Annex note clarifies that the supervision includes portions of the sprinkler system outside of the building. A.9.7.2.1 NFPA 72, National Fire Alarm and Signaling Code, provides details of standard practice in sprinkler supervision. Subject to the approval of the authority having jurisdiction, sprinkler supervision is also permitted to be provided by direct connection to municipal fire departments or, in the case of very large establishments, to a private headquarters providing similar functions. NFPA72 covers such matters. System components

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and parameters that are required to be monitored should include, but should not be limited to, control valves, water tank levels and temperatures, tank pressure, and air pressure on dry-pipe valves. In summary, I would conclude that all control valves from the water source (public main, tank, etc.) are included in the requirements of paragraph 9.7.2 of NFPA 101. Having said that, if the water supply includes an underground gate valve that requires a special key to operate, electrical supervision should not be required. This exception is not included in NFPA 101 but is included in some other codes (see the IBC). Recognizing that closed or partially closed control valves account for about 66% of the sprinkler system failures, it may be prudent to be “conservative” in the interpretation of this requirement. I apologize that all references are from the 2012 Edition of NFPA 101 and the 2013 Edition of NFPA 13. These are the editions that I can reference at this time. While there have been some revisions from the 2000 Edition of NFPA 101 and the 1999 Edition of NFPA 13, the intent of these provisions have not changed. In fact, I think some of the language in A.9.7.2.1 is actually in Paragraph 9.7.2.1 in the 2000 Edition of NFPA 101. There is one more issue I noted from the original email. I find it interesting that CMS is withholding reimbursement for the first citation of one or more existing control valves when the valves apparently were not identified to be in the closed position. Obviously the NFPA staff copied on this email most likely will not comment on this aspect but this in contrary to my experience with CMS surveyors. I wonder how long this has been going on as an unresolved issue or if there are other items in addition to this one K-tag. I have copied some others who may care to comment on the issue. Bill From: Kenney, Lynn [mailto:[email protected]] Sent: Tuesday, December 10, 2013 5:06 PM To: William Koffel Subject: FW: monitoring exterior valves serving hospital fire protection systems Your thoughts? Lynn Kenney Sr. Analyst, Advocacy Team American Society for Healthcare Engineering (ASHE) 155 N. Wacker Drive, Suite 400. Chicago, IL 60606 Office – (312) 422-3826 Cell – (781) 706-1728 Fax - (312) 268-6366 www.ashe.org From: Beebe, Chad Sent: Tuesday, December 10, 2013 3:14 PM To: Kenney, Lynn; Flannery, Jonathan Subject: FW: monitoring exterior valves serving hospital fire protection systems See string below I dont think it is an HITF issue but certainly worth a discussion or interpretation. Perhaps we could run this by some of the other SMEs?

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Chad E Beebe, AIA Sent from my Verizon Wireless 4G LTE Smartphone -------- Original message -------- From: Mark Jelinske <[email protected]> Date: 12/10/2013 8:01 AM (GMT-08:00) To: "Beebe, Chad" <[email protected]> Subject: FW: monitoring exterior valves serving hospital fire protection systems

Chad, see the string below. This may be an issue top bring up with the HITF. Unfortunately, the NFPA 24 verbiage appears to leave locking vs supervision up to an AHJ, so we probably can't get a black and white interpretation. However, perhaps we can at least get an interpretation that NFPA 101 only REQUIRES "Sprinkler System" valves to be supervised and not "Private Fire Service Main" valves. Mark Jelinske, P.E. Sr. Associate/Mechanical Engineer Cator, Ruma & Associates, Co. Colorado | Wyoming 896 Tabor Street, Lakewood, CO 80401 P (303) 232-6200 D (303) 462-8475 C (303) 881-4369 www.catorruma.com Π Please consider the environment before printing this email. The information contained in this electronic message should be considered confidential, and is intended solely for the use of the individual or entity to which it is addressed. Copying, dissemination, or disclosure of this information is strictly prohibited without the express permission of the sender. If you are not the intended recipient, please delete this message and notify the sender immediately. Thank you. -----Original Message----- From: American Society for Healthcare Engineering [mailto:[email protected]] On Behalf Of Ben Thurston Sent: Monday, December 09, 2013 1:58 PM To: [email protected] Subject: Re: monitoring exterior valves serving hospital fire protection systems Mark, I will readily agree that LSC requires sprinkler systems to comply with NFPA 13, and that LSC doesn't reference NFPA 24. But I will also state as a fact, subject of course to correction, that nowhere does LSC limit the requirement for supervision to those control valves installed as required by NFPA 13. NFPA 25 defines "control valve" as "[a] valve that controls the flow of water to a water-based fire protection system". It would seem to me that this definition would include PIVs, whether installed under NFPA 13 or NFPA 24. Further, LSC-2000, 9.7.2.1 requires that "a distinctive supervisory signal shall be provided to indicate a condition that would impair the satisfactory operation of the sprinkler

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system". Would a closed PIV impair the satisfactory operation of a sprinkler system? I would certainly think so. In any event, it matters little whether you and I agree on whether PIVs require supervision. What does matter is that CMS, or at least someone in CMS, appears to think so, and in at least one case has assessed Imminent Jeopardy against a facility without this feature. As such, I would think it would be prudent for facilities to consider installing tamper switches on PIVs that don't already have them. I'm certainly going to recommend this to my health care clients. In general, I would think that a day or two of lost Medicare reimbursement would pay for tamper switches on all PIVs in most facilities. Probably best for us to agree to disagree, and get back to our day jobs. As always, I enjoy the spirited debates that crop up from time to time on the ListServe--I always learn from them! Regards, Benjamin E. Thurston, PE 6141 Laport St. La Mesa, CA 91942 [email protected] (619) 463-8754 (home) (619) 995-8754 (mobile) -----Original Message----- From: American Society for Healthcare Engineering [mailto:[email protected]] On Behalf Of Mark Jelinske Sent: Monday, December 09, 2013 10:38 AM To: [email protected] Subject: Re: monitoring exterior valves serving hospital fire protection systems Throughout NFPA 101 section 9.7 the term "automatic sprinkler system" is used and the references are to NFPA 13. Nowhere does NFPA 101 9.7 use the term Private Fire Mains or reference NFPA 24. "Automatic sprinkler systems" are one thing, and "Private Fire Mains" are another thing. NFPA documents are usually pretty good about using the words they really mean, especially when the words are defined in NFPA documents. If they really meant to include "Private Fire Mains" in 9.7.2.1, they could have easily added the words "and Private Fire Mains", but they didn't. Mark Jelinske, P.E. Sr. Associate/Mechanical Engineer Cator, Ruma & Associates, Co. Colorado | Wyoming 896 Tabor Street, Lakewood, CO 80401 P (303) 232-6200 D (303) 462-8475 C (303) 881-4369 www.catorruma.com Π Please consider the environment before printing this email. The information contained in this electronic message should be considered confidential, and is intended solely for the use of the individual or entity to which it is addressed. Copying, dissemination, or disclosure of this information is strictly prohibited without the express permission of the sender. If you are not the intended recipient, please delete this message and notify the sender immediately. Thank you. -----Original Message----- From: American Society for Healthcare Engineering [mailto:[email protected]] On Behalf Of Ben Thurston Sent: Monday, December 09, 2013 9:10 AM To: [email protected] Subject: Re: monitoring exterior valves serving hospital fire protection systems Mark, I'm curious where you're seeing that "NFPA 101 is only asking for NFPA 13 valves to be supervised, not NFPA 24 valves"? LSC-2000, 9.7.2.1 simply requires electrical supervision on sprinkler control valves, without regard to what standard they're installed under. This section also references NFPA 72; but again, NFPA 72 refers to supervision on control valves, without regard to whether they're

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installed under NFPA 13 or NFPA 24. It seems to me that this is similar to the situation of NFPA 13 vs. LSC--NFPA 24 permits various combinations of electrical supervision, locking and sealing, but among those LSC only permits electrical supervision. Ben Thurston -----Original Message----- From: American Society for Healthcare Engineering [mailto:[email protected]] On Behalf Of Mark Jelinske Sent: Sunday, December 08, 2013 9:27 AM To: [email protected] Subject: Re: monitoring exterior valves serving hospital fire protection systems This is a reasonable view. Private Fire Service Mains are under NFPA 24, and the definition of a Private Fire Service Main is (2002 quoted since that is the easiest cut and paste version I have): 3.3.1* Private Fire Service Main. Private fire service main, as used in this standard, is that pipe and its appurtenances on private property (1) between a source of water and the base of the system riser for water-based fire protection systems, (2) between a source of water and inlets to foam-making systems, (3) between a source of water and the base elbow of private hydrants or monitor nozzles, and (4) used as fire pump suction and discharge piping, (5) beginning at the inlet side of the check valve on a gravity or pressure tank. [13:3.8] The illustration in the Annex notes is clear that NFPA 24 covers from the property line to the connection INSIDE the building. NFPA 24 require valves to be visual indicating type. The preferred method is a PIV, but any indicating valve is acceptable, such as rising stem gate valves. Where allowed by the AHJ, an underground valve with t-wrench operator us also acceptable. It sounds like all valves in the are indeed indicting. NFPA 101 is only asking for NFPA 13 valves to be supervised, not NFPA 24 valves. Therefore the NFPA 101 requirement does not start until inside the building. The only potential concern is that NFPA 24 allows 4 methods of "supervision": 6.6.2* Valves on connections to water supplies, sectional control and isolation valves, and other valves in supply pipes to sprinklers and other fixed water-based fire suppression systems shall be supervised by one of the following methods: (1) Central station, proprietary, or remote station signaling service (2) Local signaling service that causes the sounding of an audible signal at a constantly attended location (3) An approved procedure to ensure that valves are locked in the correct position (4) An approved procedure to ensure that valves are located within fenced enclosures under the control of the owner, sealed in the open position, and inspected weekly 6.6.3 Supervision of underground gate valves with roadway boxes shall not be required. This certainly allows valves to be locked or fenced in. But note that wonderful phrase "An approved procedure ..." regarding fenced/locked valve options. So who "approves"? I would hope CMS would defer to the local Fire Department. Can you show that the FD "approves" this locking arrangement? Mark Jelinske, P.E. Sr. Associate/Mechanical Engineer Cator, Ruma & Associates, Co. Colorado | Wyoming 896 Tabor Street, Lakewood, CO 80401 P (303) 232-6200 D (303) 462-8475 C (303) 881-4369 www.catorruma.com Π Please consider the environment before printing this email. The information contained in this electronic message should be considered confidential, and is intended solely for the use of the individual or entity to which it is addressed. Copying, dissemination, or disclosure of this information is strictly prohibited without the express permission of the sender. If you are not the intended recipient, please delete this message and notify the sender immediately.

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Thank you. -----Original Message----- From: American Society for Healthcare Engineering [mailto:[email protected]] On Behalf Of OSWALD,RICHARD J Sent: Friday, December 06, 2013 2:47 PM To: [email protected] Subject: Re: monitoring exterior valves serving hospital fire protection systems I consider the valves at our backflow preventers as part of the 'private fire service main' and do not consider them to be part of the 'sprinkler system'. The valves and backflow preventers on our campus water mains serve domestic water, fire hydrants and riser connections to standpipes and fire pump suction. We have fire alarm supervision of all valves once the pipe enters the building to connect to the fire pump, standpipes or sprinklers. The valves that are associated with the parallel backflow preventers are chained in the open position. Richard Oswald, CHFM Systems Specialist Woman's Hospital P. O. Box 95009 Baton Rouge, LA 70895-9009 (225) 231-5353 -----Original Message----- From: American Society for Healthcare Engineering [mailto:[email protected]] On Behalf Of Ed Tinsley Sent: Thursday, December 05, 2013 6:55 PM To: [email protected] Subject: monitoring exterior valves serving hospital fire protection systems I have a question regarding the monitoring of exterior valves in the service piping to a hospital fire protection system. Recently CMS issues a K tag and is withholding Medicare reimbursement to a hospital. The basis of the K tag is LSC 2000 9.7.2.1. According to CMS, this language requires all automatic sprinkler system valves to be supervised. My confusion is the 1999 edition of NFPA 13 allows these valves to be supervised by one of 4 methods. One of these is simply locking the valves open. (5-14.1.1.3). The valves in question were the valves were the double check backflow preventers in an above grade enclosure and several post indicating control valves. The valves were locked open. Is the CMS interpretation correct? Ed Tinsley ############################ To unsubscribe from the ASHEAHA-L list: write to: mailto:[email protected] or click the following link: http://ahals.aha.org/scripts/wa-AHALS.exe?SUBED1=ASHEAHA-L&A=1

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Public Input No. 206-NFPA 101-2015 [ Section No. 3.3.190.1 ]

3.3.190.1 Ambulatory Health Care Occupancy.

An occupancy used to provide services or treatment simultaneously to four or more patientsthat provides, on an outpatient basis, one or more of the following: (1) treatment for patients thatrenders the patients incapable of taking action for self-preservation under emergency conditionswithout the assistance of others; (2) anesthesia that renders the patients incapable of takingaction 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, areincapable of taking action for self-preservation under emergency conditions without theassistance of others. (SAF-HEA)

Statement of Problem and Substantiation for Public Input

Problem - Designation as 'urgent' care substantially increases facility construction costs in order to comply with the requirements for an Ambulatory Health Care Occupancy. An 'Urgent Care' Clinic is most often a good and timely substitute for a primary care clinic, depending on access to primary care. Based on the program level of care provided at Urgent Care Clinics, the need for enhanced facility features, e.g., emergency generators, is not necessary.

Solution - remove Urgent Care Clinics from New/Existing Ambulatory Health Care Occupancy requirements.

Health Care construction and maintenance costs are increasing substantially, and creating enhanced facility requirements unnecessarily, with definition or cause,

Note - There is a great deal of confusion among consumers, designers, health care policy makers, etc., regarding the differences between primary, urgent and emergency care. If a patient is truly in need of emergency care, 911 is called or they make it to an Emergency Department. All EMTs know the difference, and by routine, would deliver most any patient to a Emergency Department, contiguous to a hospital or free-standing. If a patient makes their way to a Urgent Care Clinic with chest pains, for example, the patient is triaged and stabilized and 911 is appropriately called. To increase the level of facility care for this one (1) patient is also increasing the cost of health care.

Recommend a survey or study of licensed (or, marketed...) Urgent Care Centers regarding patient cases before increasing facility requirements.

Submitter Information Verification

Submitter Full Name: BRUCE BROOKS

Organization: NOELKER AND HULL

Street Address:

City:

State:

Zip:

Submittal Date: Mon Jun 29 06:58:31 EDT 2015

National Fire Protection Association Report http://submittals.nfpa.org/TerraViewWeb/ContentFetcher?commentPara...

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Public Input No. 16-NFPA 101-2015 [ Section No. 18.2.2.2.5.2 ]

18.2.2.2.5.2*

Door-locking arrangements shall be permitted where patient special needs require specializedprotective measures for their safety, provided that all of the following criteria are met:

(1) Staff can readily unlock doors at all times in accordance with 18.2.2.2.6.

(2) A total (complete) smoke detection system is provided throughout the locked space inaccordance with 9.6.2.9, or locked doors can be remotely unlocked at an approved,constantly attended location within the locked space.

(3)

(4) The locks are electrical locks that fail safely so as to release upon loss of power to thedevice.

(5) The locks release by independent activation of each of the following:

(6) Activation of the smoke detection system required by 18.2.2.2.5.2 (2)

(7) Waterflow in the automatic sprinkler system required by 18.2.2.2.5.2 (3)

(8) Door locking devices shall be manually reset at the door or within the locked area.

Additional Proposed Changes

File Name Description Approved

101_PC36.pdf NFPA 101 Public Comment 36


NOTE: The following Public Input appeared as “Reject but Hold” in Public Comment No. 36 of the A2014 Second Draft Report for NFPA 101 and per the Regs. at 4.4.8.3.1.

This would add a requirement that locking devices (typically by electronic means) be manually reset either at the door or from a location within the locked area. This helps ensure that the doors remain unlocked until staff participates in the relocking process. Many of these locking systems reset as soon as the initiating signal is gone (from the fire alarm panel). In health care facilities the staff should initiate relocking; it should not be done through software programming or hardware configurations.


Submitter Full Name: TC ON SAF-HEA

Organization: NFPA 101 TC on Health Care Occupancies

Street Address:

City:

State:

Zip:

* The building is protected throughout by an approved, supervised automatic sprinklersystem in accordance with 18.3.5.1.


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Submittal Date: Fri Feb 06 14:45:51 EST 2015


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Public Comment No. 36-NFPA 101-2013 [ Section No. 18.2.2.2.5.2 ]

18.2.2.2.5.2 *

Door-locking arrangements shall be permitted where patient special needs require specializedprotective measures for their safety, provided that all of the following criteria are met:

(1) Staff can readily unlock doors at all times in accordance with 18.2.2.2.6 .

(2) A total (complete) smoke detection system is provided throughout the locked space inaccordance with 9.6.2.9 , or locked doors can be remotely unlocked at an approved,constantly attended location within the locked space.

(3)



(a) Activation of the smoke detection system required by 18.2.2.2.5.2 (2)

(b) Waterflow in the automatic sprinkler system required by 18.2.2.2.5.2 (3)

(6) (6) Door locking devices shall be manually reset at the door or within the locked area.

Statement of Problem and Substantiation for Public Comment

This would add a requirement that locking devices (typically by electronic means) be manually reset either at the door or from a location within the locked area. This helps ensure that the doors remain unlocked until staff participates in the relocking process. Many of these locking systems reset as soon as the initiating signal is gone (from the fire alarm panel). In health care facilities the staff should initiate relocking; it should not be done through software programming or hardware configurations.


Submitter Full Name: Doug Hohbein

Organization: Northcentral Fire Code Develop

Street Address:

City:

State:

Zip:

Submittal Date: Tue Apr 02 14:57:32 EDT 2013

Committee Statement

Committee Action: Rejected but held

Resolution: The subject was not raised in the First Revision phase and must be held.

* The building is protected throughout by an approved, supervised automatic sprinklersystem in accordance with 18.3.5.1 .

National Fire Protection Association Report http://submittalsarchive.nfpa.org/TerraViewWeb/FormLaunch?id=/Terra...

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Copyright Assignment

I, Doug Hohbein, hereby irrevocably grant and assign to the National Fire Protection Association (NFPA) all and full rights incopyright in this Public Comment (including both the Proposed Change and the Statement of Problem and Substantiation). Iunderstand and intend that I acquire no rights, including rights as a joint author, in any publication of the NFPA in which thisPublic Comment in this or another similar or derivative form is used. I hereby warrant that I am the author of this Public Commentand that I have full power and authority to enter into this copyright assignment.

By checking this box I affirm that I am Doug Hohbein, and I agree to be legally bound by the above Copyright Assignment andthe terms and conditions contained therein. I understand and intend that, by checking this box, I am creating an electronicsignature that will, upon my submission of this form, have the same legal force and effect as a handwritten signature


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Public Input No. 76-NFPA 101-2015 [ Section No. 18.2.2.2.10 ]

18.2.2.2.10

High-rise health care occupancies Stairs that serve a floor of an occupiable story that isgreater than 75 ft above the level of fire department vehicle access shall comply with there-entry provisions of 7.2.1.5.8.


A high-rise building is defined as “A building where the floor of an occupiable story is greater than 75 ft (23 m) above the lowest level of fire department vehicle access.” However, there may be stairs in a building that is classified as a high-rise building, that serve portions of the building where the top occupied floor is less than 75 ft above the access.

Presently, the code allows a non-high-rise building classified as a healthcare occupancy to lock exit stair doors against re-entry provided it is not a high-rise building. If the intent is to allow this for stairs that don’t serve the high-rise portion, then the modified language would allow a stair that serves only five floors to be locked against re-entry while still requiring any stair that serves the high-rise portions of the building to meet the re-entry provisions of Chapter 7.

As written, the stairs serving the non-high rise portion of the building must comply with the reentry provisions of Chapter 7 and that doesn’t appear to be the intent of the code based on the wording in the Life Safety Code Handbook, which states the following:

“Because the Code prohibits more than four floors between floors that provide a way out of the stairway, stair enclosures serving more than six or seven stories must have more than two unlocked re-entry points. This arrangement provides flexibility in buildings that, perhaps for security reasons, need to prevent re-entry on certain floors, while at the same time ensuring that one can re-enter the building without having to travel up or down too many flights of stairs.”


Submitter Full Name: PETER LARRIMER

Organization: US DEPARTMENT OF VETERANS AFFA

Street Address:

City:

State:

Zip:

Submittal Date: Thu Apr 23 11:25:59 EDT 2015


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18.2.2.2.11.1

Horizontal sliding doors Special-purpose horizontal sliding accordian or folding doorassemblies in accordance with 7.2.1.14, that are not automatic-closing shall be limited to asingle leaf and shall have a latch or other mechanism that ensures that the doors will notrebound into a partially open position if forcefully closed.


The last cycle, reference to 7.2.1.14 was removed from the code in 18/19.2.2.2.11.1. Presently, 18/19.2.2.2.11 allows two options for horizontal-sliding doors. However, it appears that the user of the code can use the first option and none of the restrictions in the second option would apply effectively negating the need for the second option.

I am not sure if this is the fix, but the way the code reads now, facilities can install horizontal sliding doors in the means of egress in accordance with 18/19.2.2.2.11.1 even when serving a large occupant load (>10) and there are no requirements on how the door is supposed to operate.




Street Address:

City:

State:

Zip:

Submittal Date: Tue Jun 30 08:42:46 EDT 2015


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18.2.2.3 Stairs.

Stairs complying with 7.2.2 shall be permitted.

18.2.2.3.1

Cameras for security or stairwell monitoring shall be permited where wiring is installed inmetal conduit and the penetrations are protected in accordance with 8.3.5


Cameras need to be allowed in stairwells per 11.8.8 and reference to protection requirements needs to be provided to ensure the installation of cameras to not damage the integrity of the stairwell protection.


Submitter Full Name: CHAD BEEBE

Organization: ASHE - AHA

Street Address:

City:

State:

Zip:

Submittal Date: Mon Jul 06 16:22:35 EDT 2015


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Public Input No. 338-NFPA 101-2015 [ New Section after 18.2.3.4 ]

18.2.3.4

(9) Stored egress devices or equipment may encroach on the required corridor width by 4.5inches on one side of the corridor.


Health care occupancies use these devices as part of the emergency egress plan . This new paragraph will allow the storage of these devices and equipment close to the area of use.


Submitter Full Name: MICHAEL CROWLEY

Organization: JENSEN HUGHES

Street Address:

City:

State:

Zip:

Submittal Date: Sat Jul 04 19:49:03 EDT 2015


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18.2.3.4*


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Aisles, corridors, and ramps required for exit access in a hospital or nursing home shall be notless than 8 ft (2440 mm) in clear and unobstructed width, unless otherwise permitted by one ofthe following:

(1)

(2)

(3)

(4) Projections into the required width shall be permitted for wheeled equipment andevacuation aides , provided that all of the following conditions are met:

(5) The wheeled equipment does not reduce the clear unobstructed corridor width toless than 60 in. (1525 mm).

(6) The health care occupancy fire safety plan and training program address therelocation of the wheeled equipment during a fire or similar emergency.

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

(17)

(18)

(19)

(20) Nursing home corridors shall be permitted to be not less than 6 ft (1830 mm) wide insmoke compartments housing not more than 30 patients.

* Aisles, corridors, and ramps in adjunct areas not intended for the housing, treatment, oruse of inpatients shall be not less than 44 in. (1120 mm) in clear and unobstructed width.

* Noncontinuous projections not more than 6 in. (150 mm) from the corridor wall,positioned not less than 38 in. (965 mm) above the floor, shall be permitted.

* Exit access within a room or suite of rooms complying with the requirements of 18.2.5shall be permitted.

* The wheeled equipment is limited to the following:

Equipment in use and carts in use

Medical emergency equipment not in use

Patient lift and transport equipment

* Where the corridor width is at least 8 ft (2440 mm), projections into the required widthshall be permitted for fixed furniture, provided that all of the following conditions are met:

The fixed furniture is securely attached to the floor or to the wall.

The fixed furniture does not reduce the clear unobstructed corridor width to lessthan 6 ft (1830 mm), except as permitted by 18.2.3.4 (2).

The fixed furniture is located only on one side of the corridor.

The fixed furniture is grouped such that each grouping does not exceed an area of

50 ft 2 (4.6 m 2 ).

The fixed furniture groupings addressed in 18.2.3.4 (5)(d) are separated fromeach other by a distance of at least 10 ft (3050 mm).

* The fixed furniture is located so as to not obstruct access to building serviceand fire protection equipment.

Corridors throughout the smoke compartment are protected by an electricallysupervised automatic smoke detection system in accordance with 18.3.4 , or thefixed furniture spaces are arranged and located to allow direct supervision by thefacility staff from a nurses’ station or similar space.

* Cross-corridor door openings in corridors with a required minimum width of 8 ft (2440mm) shall have a clear width of not less than 6 ft 11 in. (2110 mm) for pairs of doors or aclear width of not less than 41 1⁄2 in. (1055 mm) for a single door.


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(21) Cross-corridor door openings in corridors with a required minimum width of 6 ft (1830 mm)shall have a clear width of not less than 64 in. (1625 mm) for pairs of doors or a clear widthof not less than 41 1⁄2 in. (1055 mm) for a single door.


Currently there is no provision for evacuation equipment to be stored either in the stairway or corridor. This would permit evacuation sleds with or without wheels to be stored in the corridor which aide in the unlikely evacuation of patients. since these are used for the same primary purpose of the corridor (i.e. evacuation / relocation / movement of patients) there shouldn't be anything that prohibits them from being located in the corridor.




Street Address:

City:

State:

Zip:

Submittal Date: Fri Jun 26 00:34:03 EDT 2015


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18.2.3.4*


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Aisles, corridors, and ramps required for exit access in a hospital or nursing home shall be notless than 8 ft (2440 mm) in clear and unobstructed width, unless otherwise permitted by one ofthe following:

(1)

(2)

(3)

(4) Projections into the required width shall be permitted for wheeled equipment, providedthat all of the following conditions are met:

(5) The wheeled equipment does not reduce the clear unobstructed corridor width toless than 60 in. (1525 mm).


(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

(17)

(18)

(19)

(20) Nursing home corridors shall be permitted to be not less than 6 ft (1830 mm) wide insmoke compartments housing not more than 30 patients.

* Aisles, corridors, and ramps in adjunct areas not intended for the housing, treatment, oruse of inpatients shall be not less than 44 in. (1120 mm) in clear and unobstructed width.

* Noncontinuous projections not more than 6 4 in. (150 mm) from the corridor wall,positioned not less than 38 in. (965 mm) above the floor, shall be permitted.

* Exit access within a room or suite of rooms complying with the requirements of 18.2.5shall be permitted.










50 ft 2 (4.6 m 2 ).




* Cross-corridor door openings in corridors with a required minimum width of 8 ft (2440mm) shall have a clear width of not less than 6 ft 11 in. (2110 mm) for pairs of doors or aclear width of not less than 41 1⁄2 in. (1055 mm) for a single door.


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(21) Cross-corridor door openings in corridors with a required minimum width of 6 ft (1830 mm)shall have a clear width of not less than 64 in. (1625 mm) for pairs of doors or a clear widthof not less than 41 1⁄2 in. (1055 mm) for a single door.



ADA_projections.jpg ADA projection limits


For fire and life safety reasons there may not be a need to limit the projections to 4" but to meet ADA requirements hospitals must not exceed 4" projections. This conflict is creating a a problem in a number of situations where ADA issues are being cited after construction. we recommend that NFPA go back to the 4 inch projection limit and include reference in the annex to the ADA requirements. If possible, provide allowance for 6" in facilities or areas of facilities where ADA compliance is not necessary.




Street Address:

City:

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18.2.3.6

The minimum clear width for doors in the means of egress from sleeping rooms; diagnostic andtreatment areas, such as x-ray, surgery, or physical therapy; and nursery rooms shall be asfollows:

(1) Hospitals and nursing homes — 41 — 44 1⁄2 in. (1055 mm 1130mm )

(2) Psychiatric hospitals and limited care facilities— 32 in. (810 mm)

(3) Nursing Homes - 41 in. (1141 mm)


The current standard of 41.5 inches for hospitals and nursing homes has a couple of problems. For one thing, 41.5 inches appears to have been settled upon to allow a standard 3'-8" door. This is not the case, however. With a standard 1.75 inch door and 4.5 inch butt hinges, the clear width for a 3'-8" door is less than 41.5 inches. The intent of the standard is to allow beds to pass through the doors with a small margin of error. Nursing home beds are typically no more than 40 inches wide, so 41 inches will allow use of 3'-8" doors without compromising the intent of the standard. For hospitals, the use of bariatric beds has become much more prevalent and the ability to move the patient in the bed may be critical to the patient's survival in a fire event. The typical bariatric hospital bed can be as large as 43-44.5 inches wide and a 4'-0" door with standard butt hinges would have a clear opening of about 45 inches.This proposed change is intended to allow use of 3'-8" doors in nursing homes and 4'-0" doors in hospitals without compromising patient safety.


Submitter Full Name: JOHN RICKARD

Organization: P3 CONSULTING

Street Address:

City:

State:

Zip:



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18.2.3.7

The requirements of 18.2.3.6 shall not apply where otherwise permitted by one of the following:

(1) Doors that are located so as not to be subject to use by any health care occupant shall benot less than 32 in. (810 mm) in clear width.

(2) Doors in exit stair enclosures shall be not less than 32 in. (810 mm) in clear width.

(3) Doors serving newborn nurseries shall be not less than 32 in. (810 mm) in clear width.

(4) Where a pair of doors is provided, all of the following criteria shall be met:

(5) Not less than one of the doors shall provide not less than a 32 in. (810 mm) clearwidth opening.

(6) A rabbet, bevel, or astragal shall be provided at the meeting edge.

(7) The inactive door leaf shall have an automatic flush bolt to provide positivelatching.

(8) Where telescoping doors is provided, all the following shall be met:

(9) Not less then 32 inches clear shall be provided on the 1st telescoping opening

(10) Not less then 41 1/2 inches clear shall be provided upon the breakaway


I’m not sure if it was the intent of the code or not, but many jurisdictions require the clear width into a room via a sliding door be 41 1/2 inches clear via the slide of the 1st panel only. I recently did a project with private PACU bays where we had a 4 panel slider. It, additionally, broke away giving a full clear opening of 7 feet wide. The health agency would not allow it because the 1st of the 4 panels did not provide 41 1/2 inches clear. Even with the 3 panels that slid, we had 41 inches, it required the breakaway to achieve the additional opening width.

In order to achieve 41 1/2 inches clear on any sliding door, the opening has to be 9 feet or greater. And the way some agencies read this, he only can have a 2 panel sliding door, one sliding door and one fixed breakaway panel.

Sliding glass doors have not, until recently, been able to achieve positive latching as well as smoke tight. Therefore, I don't believe the code has been able to keep up with the advancements of some of the new door operations.

Not sure what a,b,c on item 4 is underlined. I did not edit that, I only added "5. a and b"


Submitter Full Name: MARVIN HUIE

Organization: WHR Architects

Street Address:


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City:

State:

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18.2.4.4 *

Not less than two exits shall be accessible from every part of each smoke compartment, andegress shall be permitted through an adjacent compartment(s), provided that the two requiredegress paths are arranged so that both do not pass through the same adjacent smokecompartment.



NFPA_101_18.2.4.4_Public_Input_Example.docx Example of issue.


As written, the code permits rooms to be in one smoke compartment while the only egress path from the room is through the corridor door into the adjacent smoke compartment. See the uploaded sketch showing the Social Worker Consultation Room as an example of this condition. The change will help clarify the intent of the code. See also the existing language used in 18.2.4.3.

Consideration should also be given to making this change in Chapter 19, specifically 19.2.4.4.




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Submittal Date: Mon Jun 01 16:26:06 EDT 2015


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Public Input No. 326-NFPA 101-2015 [ Section No. 18.2.5.7.2.2(A) ]

(A) *

Sleeping suites shall have exit access to a corridor complying with 18.3.6 or to a horizontal exit,directly from the suite.

18.2.5.7.2.2(A)(1) Upon exi ng the suite, an accumula on space of not less than 30 net ² (2.8 net

m²) per pa ent in a hospital or nursing home, or not less than 15 net ² (1.4 net m²) per resident in a

limited care facility, shall be provided within the aggregated area of corridors, pa ent rooms, treatment

rooms, lounge or dining areas, and other similar areas.


The provisions for accumulation space are currently required in 18.2.2.5.1 for horizontal exits, however accumulation space is not currently required after exiting a suite into an exit access corridor. Adding the accumulation space provisions for suites which exit into an exit access corridor will ensure that there is sufficient space during a horizontal relocation of patients into an adjacent smoke compartment using the “defend in place” strategy during a fire event.

Related Public Inputs for This Document

Related Input Relationship

Public Input No. 327-NFPA 101-2015 [Section No. 18.2.5.7.3.1(A)]


Submitter Full Name: LENNON PEAKE

Organization: KOFFEL ASSOCIATES INC

Street Address:

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State:

Zip:

Submittal Date: Fri Jul 03 11:55:38 EDT 2015


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(A)

Travel distance between any point in a sleeping suite and an interior exit access door toanother suite, an interior exit access corridor door, or a horizontal exit door from that suite shallnot exceed 100 ft (30 m).


Suite travel distance should be measured to an interior exit access door or horizontal exit due to the defend in place strategy used in hospitals during fire events. Relocating patients to the exterior of the building poses a serious risk during times of extreme temperature. It is also desirable to keeps patients in the building to ensure heath care delivery is not adversely affected.









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(A)

Patient care non-sleeping suites shall have exit access to a corridor complying with 18.3.6 or toa horizontal exit, directly from the suite.

18.2.5.7.3.1(A)(1) Upon exi ng the suite, an accumula on space of not less than 6 ² (0.56 net m²)

per pa ent shall be provided within the aggregated area of corridors, pa ent rooms, treatment rooms,

lounge or dining areas and other similar spaces.


The provisions for accumulation space are currently required in 18/19.2.2.5.1 for horizontal exits, however accumulation space is not currently required after exiting a suite into an exit access corridor. Adding the accumulation space provisions for suites which exit into an exit access corridor will ensure that there is sufficient space during a horizontal relocation of patients into an adjacent smoke compartment using the “defend in place” strategy during a fire event.



Public Input No. 326-NFPA 101-2015 [Section No.18.2.5.7.2.2(A)]

PIs seek to require accumulation spaceoutside suites




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(A)

Travel distance within a non-sleeping suite to an interior exit access door to another suite, aninterior exit access corridor door, or a horizontal exit door from the suite shall not exceed 100 ft(30 m).





Public Input No. 313-NFPA 101-2015[Section No. 18.2.5.7.2.4(A)]

Both PIs seek to clarify suite travel distance innew health care occupancies






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18.3.2.1.2

The following areas shall be considered hazardous areas and shall be protected by fire barriershaving a minimum 1-hour fire resistance rating in accordance with Section 8.3:

(1) Boiler and fuel-fired heater rooms with a total aggregate input rating for all equipment inthe room of greater than 200,000 Btu (211 MJ)

(2) Central/bulk laundries larger than 100 ft2 (9.3 m2)

(3) Paint shops employing hazardous substances and materials in quantities less than thosethat would be classified as a severe hazard

(4) Physical plant maintenance shops

(5) Rooms with soiled linen in volume exceeding 64 gal (242 L)

(6) Rooms with collected trash in volume exceeding 64 gal (242 L)

(7) Storage rooms larger than 100 ft2 (9.3 m2) and storing combustible material


The existing requirement is worded in a way that creates a number of concerns. Although it refers to boilers, it does not define the size of a boiler and the reference to fuel-fired heaters is sometimes applied to small, gas- or oil-fired water heaters that are clearly not boilers. Fuel-fired heaters also include residential-size gas or oil furnaces that present no more than an ordinary hazard. Furthermore, no distinction is made between between a room with a single large fuel-fired piece of equipment and a room with a large number of small fuel-fired pieces of equipment. This proposed change uses the total aggregate input rating in the room as the criteria, which is more representative of the actual degree of hazard. This is similar to the approach taken in 12.3.2.1.2(1)(a). Note that the proposed language still does not distinguish between boilers and water heaters, though the intent is to include fuel-fired water heaters in the aggregate input rating calculation. The TC may wish to make this clearer by changing the term "boiler" or adding an annex note.




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18.3.2.5.3*


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Within a smoke compartment, where residential or commercial cooking equipment is used toprepare meals for 30 or fewer persons, one cooking facility shall be permitted to be open to thecorridor, provided that all of the following conditions are met:

(1) The portion of the health care facility served by the cooking facility is limited to 30 bedsand is separated from other portions of the health care facility by a smoke barrierconstructed in accordance with 18.3.7.3, 18.3.7.6, and 18.3.7.8.

(2) The cooktop or range is equipped with a standard residential range hood of a width atleast equal to the width of the cooking surface, with grease baffles or other grease-collecting and clean-out capability .

(3)

(4) The hood systems hoods that are not ducted to the exterior additionally have a charcoalfilter to remove smoke and odor.

(5) The cooktop or range complies with all of the following:

(6) The cooktop or range is protected with a fire suppression system listed inaccordance with

ANSI/UL 300, Standard for Fire Testing of Fire Extinguishing Systems for Protection ofCommercial Cooking Equipment , or is tested and meets

(a) all requirements of UL Subject 300A, Extinguishing System Units for ResidentialRange Top Cooking Surfaces , in accordance with the applicable testing document'sscope.

(b) A manual release of the extinguishing system is provided in accordance withSection 10.5 of NFPA 96, Standard for Ventilation Control and Fire Protection ofCommercial Cooking Operations .

An interlock is

(a) A shutoff shall be provided to turn off all sources of fuel and electrical power to thecooktop or range when the suppression system is activated.

(7)

(8) Deep-fat frying is prohibited

(9) Portable fire extinguishers in accordance with NFPA 96 are located in all kitchen areas.

(10)

(11)

(12)

(13)

(14) Procedures for the use, inspection, testing, and maintenance of the cooking equipmentare in accordance with Chapter 11 of NFPA 96 and the manufacturer’s instructions arefollowed.

(15)

* The residential hood systems shall have a minimum airflow of 500 cfm (14,000L/min) capable of exhausting vapors under normal residential stove top cooking .

* The use of solid fuel for cooking is prohibited.

* A switch meeting all of the following is provided:

A locked switch, or a switch located in a restricted location, is provided within thecooking facility that deactivates the cooktop or range.

The switch is used to deactivate the cooktop or range whenever the kitchen is notunder staff supervision.

The switch is on a timer, not exceeding a 120-minute capacity, that automaticallydeactivates the cooktop or range, independent of staff action.

* Not less than two AC-powered photoelectric smoke alarms with battery backup,interconnected in accordance with 9.6.2.10.3, and equipped with a silence feature are


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(16)

(17)

(18)

(19)

(20)

(21)

(22)

(23) System smoke detectors that are required to be installed in corridors or spaces open tothe corridor by other sections of this chapter are not used to meet the requirements of18.3.2.5.3 (11) and are located not closer than 25 ft (7.6 m) to the cooktop or range.


Residential systems are tested to Subject UL 300A, which is a test outline to verify performance and operation of a system ONLY over a standard residential range or cook-top. Any system subjected to this test outline is tested for surface protection only using a standard residential range hood and the hood is not part of the Listing. If you are going to specify in the code compliance with UL 300A, then that needs to be the system accepted since it deals with a standard residential range hood and not a UL 300 system, which deals with a Type 1 hood. In addition the configuration of a residential hood with the HIGH cfm's currently required could be a different design than your normal residential hood, which could prevent all LISTED UL 300A COMPLIANCE SYSTEMS from complying with that part of the code. I believe the reason for the high cfm, that is given in the current text is considering higher amounts of cooking that would be in comparison to a Type 1 hood requirement, which would never occur on a residential stove under normal cooking conditions. Also, given the fact that UL 300A has 13 different fire tests dealing with various amount of oil and size of pans on a residential stove or cook-top, i do not see the reason for the high cfm requirement. If residential UL 300A systems are going to be allowed to protect this hazard then the requirements need to be in agreement with the specifications of what these systems can provide.


Submitter Full Name: PAUL ROUSE

Organization: GUARDIAN SFTY SOLUTIONS INTL

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Submittal Date: Tue May 12 11:45:34 EDT 2015

located not closer than 20 ft (6.1 m) and not further than 25 ft (7.6 m) from the cooktop orrange.

* The smoke alarms required by 18.3.2.5.3 (11) are permitted to be located outside thekitchen area where such placement is necessary for compliance with the 20 ft (7.6 m)minimum distance criterion.

* A single system smoke detector is permitted to be installed in lieu of the smoke alarmsrequired in 18.3.2.5.3 (11) provided the following criteria are met:

The detector is located not closer than 20 ft (6.1 m) and not further than 25 ft (7.6m) from the cooktop or range.

The detector is permitted to initiate a local audible alarm signal only.

The detector is not required to initiate a buildingwide occupant notification signal.

The detector is not required to notify emergency forces.

The local audible signal initiated by the detector is permitted to be silenced andreset by a button on the detector or by a switch installed within 10 ft (3.0 m) of thesystem smoke detector.


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18.3.4.3.3.2

The Fire alarm zone notification zones shall be permitted to coincide with the permitted areafor smoke compartments one or more smoke compartment boundaries or shall be inaccordance with the facility fire plan .


The proposed text currently exists as Paragraph 15.7.4.3.1, NFPA 99-2015. It is noted that the NFPA 101 addresses annunciation zoning (initiating devices) and the NFPA 99 text addresses notification appliances. A Public Input has also been submitted to NFPA 99 to use the NFPA 101 text. Whatever is decided, the requirements between NFPA 99 and NFPA 101 should be consistent.

If accepted, it should be noted that the same text should NOT be included in Chapter 19.



Public Input No. 166-NFPA 101-2015 [New Section after A.18.3.4.3.1(2)]


Submitter Full Name: WILLIAM KOFFEL


Affilliation: Self

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18.3.4.5.3 * Nursing Homes.

An approved automatic smoke detection system shall be installed in corridors throughoutsmoke compartments containing patient sleeping rooms and in spaces open to corridors aspermitted in nursing homes by

Detection in Patient Sleeping Rooms. Approved smoke detection shall be provided in allpatient sleeping rooms.

18.3.

6

4 .

1, unless otherwise permitted by one of the following:

(1) Corridor systems shall not be required where each patient sleeping room is protected byan approved smoke detection system.

(2) Corridor systems shall not be required where patient room doors are equipped withautomatic door-closing devices with integral smoke detectors on the room side installedin accordance with their listing, provided that the integral detectors provide occupantnotification.

5.3.1 Patient room smoke detectors shall be connected to the building fire alarm system forsupervision and notification.

18.3.4.5.3.2* Patient room smoke detectors shall be allowed to provide Prositive AlarmSequence or Presignal Feature as NFPA 72 Chapter 23.

.



NFPA_101_18_3_4_5_Patient_Rm_SD_PI_FINAL.pdfSubstantiation for 18.3.4.5 Detection with Research data


This Public Input seeks early warning smoke detection coverage in healthcare patient rooms. Within all national model building and fire codes, smoke detection is required to provide the minimum level of life safety in all sleeping areas. Healthcare is the only area in our nation today that does not provide this level of early warning and life safety. An historic review would show that patient rooms in the past were deemed to not need smoke detection because of the room configuration and direct line of sight with nurses and nursing stations. Staffing has been at a very competent level in the healthcare industry as a general rule. This Public Input addresses new construction of hospitals and our healthcare patient rooms. In most cases going forward patient rooms are single patient, with all the amenities of a home bedroom with the added risk of flammable gases and extensive electrical monitoring and medical equipment. The concept of a staffed “nurse’s station” is changing to where attendant on duty may no longer have


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direct visual and audible awareness of the early development of an electrical or other fire within the room of a patient. As a result, a staff attendant at a nurse’s station may not a capable of responding in a time critical manner to the early developments of a fire in a patient’s room.

Early warning smoke detection with the required automatic fire sprinkler protection is needed for the minimum level of life safety for our sick, medicated and those receiving medical attention in our healthcare facilities. This Public Input would delete the requirement for corridor smoke detection in Nursing Homes with smoke detection in each patient room.

Today’s system connected smoke detection is advanced and is immune to activation by deceptive phenomenon which in past caused unwanted alarms. Multi-criteria and multi-sensor detection technology has risen to provide reliable, fast responding early warning detection that also reduces the testing and maintenance costs with the level of technology that is standard.

Key areas of change within healthcare facilities• Increased prevalence of infection prevention isolation areas. {source: SFPE Fire Protection Engineering, Issue 65-2015; Healthcare and Fire Safety}o ABHR Alcohol Based Hand Rub units are in the patient rooms; these are typically flammable liquids and can contribute to smoke/fire and its spread. o Patient rooms often have anterooms that divide them from the main rooms, providing areas for smoke to collect in the patient room and not being seen from the corridor. (figure B)• Move towards residential setting. Patient rooms including those in nursing homes are moving towards a more comfortable residential setting that allows patients to hang more combustible items on their walls, and furniture from the home setting. As mentioned above the vast majority is single patient and some are apartment-like. The advancements and use of fire sprinklers has allowed this action, but the hazard for smoke/fire has increased with this movement. • Early warning detection is needed-same as in our homes.

Fire-Loss of Life Incidents:• Good news is that loss of life has been the lowest in years; this can be attributed to fire sprinklers, fire detection/alarm and the excellent staff response in our legacy healthcare facilities. As outlined throughout this report, the risk for fire occurrence, injury and death is increasing. • Fire (2012) at North Carolina hospital kills one patient, injures three. http://usnews.nbcnews.com/_news/2012/11/06/14969895-fire-at-north-carolina-hospital-kills-one-patient-injures-three?liteo Fire was apparently caused by use of an electronic defibrillator in a patient room• Between 2004 and 2006, there was an average of 6,400 fires in medical facilities each year that were respon¬sible for approximately 5 civilian fire deaths, 175 injuries, and $34 million in property loss annually.1 Medical facilities include hospitals, clinics, infirmaries, and other facilities that provide care to the sick and injured. Fires in these buildings2 can be particularly dangerous due to the presence of oxygen and other flammable substances and the challenge of evacu¬ating patients who may not be ambulatory. https://www.usfa.fema.gov/downloads/pdf/statistics/v9i4.pdf• Fires in health care facilities Report: NFPA's "Fires in Health Care Facilities"o In 2006-2010, U.S. fire departments responded to an estimated average of 6,240 structure fires in or on health care properties per year. These fires caused an average of six civilian deaths, 171 civilian injuries and $52.1 million in direct property damage annually.


Submitter Full Name: VINCE BACLAWSKI

Organization: NEMA

Street Address:

City:


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Submittal Date: Thu Jul 02 11:49:28 EDT 2015


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2018 EDITION OF NFPA 101 (SAF-HEA)

Patient Room Smoke Detection PUBLIC INPUT (PI)

SAF-HEA Proposed Text of Public Input: 18.3.4.5 Detection. 18.3.4.5.1 General. Detection systems, where required, shall be in accordance with Section 9.6. 18.3.4.5.2 Detection in Spaces Open to Corridors. See 18.3.6.1. 18.3.4.5.3* Nursing Homes. An approved automatic smoke detection system shall be installed in corridors throughout smoke compartments containing patient sleeping rooms and in spaces open to corridors as permitted in nursing homes by 18.3.6.1, unless otherwise permitted by one of the following:

(1) Corridor systems shall not be required where each patient sleeping room is protected by an approved smoke detection system. (2) Corridor systems shall not be required where patient room doors are equipped with automatic door-closing devices with integral smoke detectors on the room side installed in accordance with their listing, provided that the integral detectors provide occupant notification.

18.3.4.5.3* Detection in Patient Sleeping Rooms. Approved smoke detection shall be provided in all patient sleeping rooms. 18.3.4.5.3.1 Patient room smoke detectors shall be connected to the building fire alarm system for supervision and notification. 18.3.4.5.3.2* Patient room smoke detectors shall be allowed to provide Positive Alarm Sequence or Presignal Feature as per NFPA 72 Chapter 23. SAF-HEA Statement of Problem and Substantiation of Public Input: This Public Input seeks early warning smoke detection coverage in healthcare patient rooms. Within all national model building and fire codes, smoke detection is required to provide the minimum level of life safety in all sleeping areas. Healthcare is the only area in our nation today that does not provide this level of early warning and life safety. An historic review would show that patient rooms in the past were deemed to not need smoke detection because of the room configuration and direct line of sight with nurses and nursing stations. Staffing has been at a very competent level in the healthcare industry as a general rule. This Public Input addresses new construction of hospitals and our healthcare patient rooms. In most cases going forward patient rooms are single patient, with all the amenities of a home bedroom with the added risk of flammable gases and extensive electrical monitoring and medical equipment. The concept of a staffed “nurse’s station” is changing to where attendant on duty may no longer have direct visual and audible awareness of the early development of an electrical or other fire within the room of a patient. As a result, a staff attendant at a nurse’s station may not a capable of responding in a time critical manner to the early developments of a fire in a patient’s room. Early warning smoke detection with the required automatic fire sprinkler protection is needed for the minimum level of life safety for our sick, medicated and those receiving medical attention in our healthcare facilities. This Public Input would delete the requirement for corridor smoke detection in Nursing Homes with smoke detection in each patient room. Today’s system connected smoke detection is advanced and is immune to activation by deceptive phenomenon which in past caused unwanted alarms. Multi-criteria and multi-sensor detection technology has risen to provide reliable, fast responding early warning detection that also reduces the testing and maintenance costs with the level of technology that is standard. Key areas of change within healthcare facilities

Increased prevalence of infection prevention isolation areas. {source: SFPE Fire Protection Engineering, Issue 65-2015; Healthcare and Fire Safety}

o ABHR Alcohol Based Hand Rub units are in the patient rooms; these are typically flammable liquids and can contribute to smoke/fire and its spread.

o Patient rooms often have anterooms that divide them from the main rooms, providing areas for smoke to collect in the patient room and not being seen from the corridor. (figure B)

Move towards residential setting. Patient rooms including those in nursing homes are moving towards a more comfortable residential setting that allows patients to hang more combustible items on their walls, and furniture from the home setting. As mentioned above the vast majority is single patient and some are apartment-like. The advancements and use of fire sprinklers has allowed this action, but the hazard for smoke/fire has increased with this movement.

Early warning detection is needed-same as in our homes.

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Fire-Loss of Life Incidents:

Good news is that loss of life has been the lowest in years; this can be attributed to fire sprinklers, fire detection/alarm and the excellent staff response in our legacy healthcare facilities. As outlined throughout this report, the risk for fire occurrence, injury and death is increasing.

Fire (2012) at North Carolina hospital kills one patient, injures three. http://usnews.nbcnews.com/_news/2012/11/06/14969895-fire-at-north-carolina-hospital-kills-one-patient-injures-three?lite

o Fire was apparently caused by use of an electronic defibrillator in a patient room

Between 2004 and 2006, there was an average of 6,400 fires in medical facilities each year that were responsible for approximately 5 civilian fire deaths, 175 injuries, and $34 million in property loss annually.1 Medical facilities include hospitals, clinics, infirmaries, and other facilities that provide care to the sick and injured. Fires in these buildings2 can be particularly dangerous due to the presence of oxygen and other flammable substances and the challenge of evacuating patients who may not be ambulatory. https://www.usfa.fema.gov/downloads/pdf/statistics/v9i4.pdf

Fires in health care facilities Report: NFPA's "Fires in Health Care Facilities" o In 2006-2010, U.S. fire departments responded to an estimated average of 6,240 structure fires in or on health care

properties per year. These fires caused an average of six civilian deaths, 171 civilian injuries and $52.1 million in direct property damage annually.

Supporting Research: Performance of Smoke Detectors and Sprinklers in Residential and Health-Care Occupancies, James A. Milke, Ph.D., P.E., University of Maryland, May 14, 2010 http://www.afaa.org/pdf/Performance%20of%20Smoke%20Detectors%20and%20Sprinklers%20in%20Residential%20and%20Healthcare%20Facilities.pdf

Summary The relative role of smoke alarms and sprinklers has been demonstrated in numerous recent research investigations. The trend in all of the studies is that smoke alarms respond prior to residential or sprinklers and thus have the capability of providing the earliest warning of a fire to building occupants. While responding later, sprinklers provide the additional function of fire suppression to limit the development of hazardous conditions. From the analysis of NFIRS fire incident data in this study, the proportion of fires judged to be too small for operation of the smoke detectors was appreciably fewer those for sprinklers in all three occupancy groups analyzed. The following table summarizes the results. Proportion of Fire Incidents Judged to be Too Small for Operation

Smoke Detectors

Non-sprinklered property Sprinklered Property Sprinklers

1- and 2-family dwelling 13.1 12.8 38.9

Commercial residential 9.7 10.8 54.2

Health-care 11.4 17.8 65.4

The fact that fewer fires are judged to be too small for smoke detector operation than sprinklers, especially when both are present in sprinklered buildings, reflects the faster response capabilities of smoke detectors. While Bill’s (Bill, Robert, 1990) following quote on the benefit of smoke detectors was relative to an experimental program for hotel rooms, the comment is applicable to a wide variety of occupancies, as reflected in the variety of experimental and statistical indications: “The role of smoke detectors in life safety has also been clearly shown. Smoke detectors warn room occupants in either fast-growing or smoldering fires while the room environment is such that an occupant can easily escape. Moreover, the warning occurs when the fire is small. Thus, the fire may possibly be extinguished without intervention of sprinklers.” The need for warning while the fire is small is reflected in the casualty statistics for those fires which are judged too small for smoke detector and sprinkler activation. Even for these “small” fires, some casualties do occur. Nonetheless, where fire control is provided by sprinklers, rather than extinguishment, the environment following sprinkler operation is not pristine. This is caused by a decrease in the efficiency of the combustion process caused by the water application from sprinklers on burning fuels. In such instances, the generation of carbon monoxide increases during fire control. In addition, light obscuration becomes very significant throughout the room of origin, especially in small rooms. Such small rooms are characteristic of residences and health care facilities. As such, having both smoke alarms and sprinklers has significant advantages. With smoke alarms providing the early indication of fires, this permits people to evacuate (or be evacuated if assistance is needed) prior to the response of sprinklers. In this way, people can evacuate prior to the potential loss of visibility in the room of origin (and thus find their way most easily without encountering obstructions) and not be subjected to the increase in carbon monoxide (and other gases produced from incomplete combustion).

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http://usnews.nbcnews.com/_news/2012/11/06/14969895-fire-at-north-carolina-hospital-kills-one-patient-injures-three?lite


https://www.usfa.fema.gov/downloads/pdf/statistics/v9i4.pdf

http://www.nfpa.org/~/media/files/research/nfpa-reports/occupancies/oshealthcarefacilities.pdf?as=1&iar=1&la=en

http://www.afaa.org/pdf/Performance%20of%20Smoke%20Detectors%20and%20Sprinklers%20in%20Residential%20and%20Healthcare%20Facilities.pdf


Conclusion: Our healthcare system is changing; our patient rooms in hospitals and nursing homes are changing. They contain the same level, if not greater fire safety risks as our homes, dormitories, hotels and all sleeping areas that are protected by Early Warning Smoke Detection. It is time for our patients in our new healthcare facilities to have the level of safety. Smoke detection and Fire Sprinklers will save lives in our healthcare patient rooms. Smoke detection in our patient rooms is the right fire life safety action to take. Figure A Figure B

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18.3.6.1 Corridor Separation.

Corridors shall be separated from all other areas by partitions complying with 18.3.6.2 through18.3.6.5 (see also 18.2.5.4), unless otherwise permitted by one of the following:

(1) Spaces shall be permitted to be unlimited in area and open to the corridor, provided thatall of the following criteria are met:

(2)

(3) The corridors onto which the spaces open in the same smoke compartment areprotected by an electrically supervised automatic smoke detection system inaccordance with 18.3.4 , or the smoke compartment in which the space is located isprotected throughout by quick-response sprinklers.

(4) The open space is protected by an electrically supervised automatic smokedetection system in accordance with 18.3.4 , or the entire space is arranged andlocated to allow direct supervision by the facility staff from a normally occupiednurses’ station or similar space.

(5) The space does not obstruct access to required exits.

(6) Waiting areas shall be permitted to be open to the corridor, provided that all of thefollowing criteria are met:

(7) The aggregate waiting area in each smoke compartment does not exceed 600 ft 2

(55.7 m 2 ).

(8) Each area is protected by an electrically supervised automatic smoke detectionsystem in accordance with 18.3.4 , or each area is arranged and located to allowdirect supervision by the facility staff from a normally occupied nursing station orsimilar space.

(9) The area does not obstruct access to required exits.

(10)

(11) Gift shops not exceeding 500 ft2 (46.4 m2) shall be permitted to be open to the corridor orlobby.

(12) In a limited care facility, group meeting or multipurpose therapeutic spaces shall bepermitted to open to the corridor, provided that all of the following criteria are met:

(13) The space is not a hazardous area.

(14) The space is protected by an electrically supervised automatic smoke detectionsystem in accordance with 18.3.4 , or the space is arranged and located to allowdirect supervision by the facility staff from the normally occupied nurses’ station orsimilar location.


(16) Cooking facilities in accordance with 18.3.2.5.3 shall be permitted to be open to thecorridor.


* The spaces are not used for patient sleeping rooms, treatment rooms, orhazardous areas.

* This requirement shall not apply to spaces for nurses’ normally occupied nurses’stations.


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One of the arrangements where the Code permits areas in health care occupancies to be non-separated from exit access corridors without being provided with smoke detection is in nurses' stations or nursing stations. It is becoming more common in the design of health care occupancies to provided satellite nurses' stations which may not be occupied during specific hours. The exception for the omission of smoke detection should not pertain to satellite nurses' stations which are not normally occupied as there would not be early detection in these areas during "off" hours.




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18.3.6.3.1*

Doors, including doors or panels to nurse servers and pass-through openings, protectingcorridor openings shall be constructed to resist the passage of smoke, and the following alsoshall apply:

(1) Compliance with NFPA 80, Standard for Fire Doors and Other Opening Protectives, shallnot be required.

(2) For other than doors protecting pass-through openings, a clearance between the bottomof the door and the floor covering not exceeding 1 in. (25 mm) shall be permitted.

(3) The clearances between the top and vertical edges of the door and the frame, and themeeting edges of doors swinging in pairs, shall be 1/8 in. ± 1/16 in. (3.18 mm ± 1.59 mm)

(4) For doors protecting pass-through openings, a clearance between the bottom of the doorand the sill not exceeding 1⁄8 in. (3 mm) shall be permitted.

(5) Doors to toilet rooms, bathrooms, shower rooms, sink closets, and similar auxiliary spacesthat do not contain flammable or combustible material shall not be required to beconstructed to resist the passage of smoke.


A minimum clearance between the leaves of smoke resistive pairs of doors should be provided, such as is provided for doors in a fire barrier, to ensure that doors are capable of resisting the passage of smoke.


Submitter Full Name: SAMANTHA WHITE

Organization: Koffel Associates, Inc

Affilliation: Self

Street Address:

City:

State:

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Public Input No. 303-NFPA 101-2015 [ New Section after 18.3.6.5.2 ]

18.3.6.5.3 Shutters protecting openings shall be automatic closing upon detection of smoke byapproved smoke detectors in accordance with NFPA 72 National Fire Alarm and SignalingCode .


In order to limit the transfer of smoke an opening provided with a shutter must close upon smoke detector activation and not merely a fusible link. The new language will provide direction on how to install a shutter in a smoke partition to avoid problems during commissioning.



Public Input No. 302-NFPA101-2015 [New Section after8.4.3.5]

PI 302 is for smoke partitions and this PI is for corridorwalls to limit the transfer of smoke in health careoccupancies

Public Input No. 306-NFPA101-2015 [New Section after19.3.6.5.2]




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18.3.7.1

Buildings containing health care facilities shall be subdivided by smoke barriers (see 18.2.4.3),unless otherwise permitted by 18.3.7.2, as follows:

(1) To divide every story used by inpatients for sleeping or treatment into not less than twosmoke compartments

(2) To divide every story having an occupant load of 50 or more persons, regardless of use,into not less than two smoke compartments

To

(3) In hospital smoke compartments where any patient sleeping room is configured for two ormore patients, to limit the size of each smoke compartment required by 18.3.7.1(1) and

(2) to an area not exceeding 22,500 ft 2 (

2100 m

(4) 2100m 2 )

, unless the area is an atrium separated in

(5)

(6) In hospital smoke compartments where all patient sleeping rooms are configured for onlyone patient, to limit the size of each smoke compartment required by 18.3.7.1(1) and (2)

to an area not exceeding 40,000 sf 2 (3720 m 2 ). Sleeping suites in accordance with18.2.5.7 shall be permitted where every occupiable sleeping room within the suite isconfigured for only one patient.

(7) In hospital smoke compartments that contain no patient sleeping rooms to limit the size ofeach smoke compartment required by 18.3.7.1(1) and (2) to an area not exceeding

40,000 ft 2 (3720 m 2 )

(8) In nursing homes and limited care faciliites, to limit the size of each smoke compartment

required by 18.3.7.1(1) and (2) to an area not exceeding 22,500 ft 2 (2100 m 2 )

(9) To separate atria in accordance with 8.6.7, in which case no limitation in size is required

(10) To limit the travel distance from any point to reach a door in the required smoke barrier toa distance not exceeding 200 ft (61 m)


For several years there has been discussion over the appropriate size of a healthcare occupancy smoke compartment. During the last NFPA 101 cycle, the Second draft report contained language that would have increased the maximum size of smoke compartments to 40,000 sf for hospitals and kept the size at 22,500 sf for nursing homes and limited care facilities. This change was overturned by a Certified amending motion at the technical hearing by a narrow margin. Based on the testimony received, there appeared to be concern over this increase in size for a multitude of reasons.

There was concern over the lack of technical substantiation for the change. This was balanced with questions of the origin of the existing language and the technical basis for arriving at 22,500 sf. There was concern that the increase in smoke compartment size resulted in a reduction in passive protection that placed too much reliance on sprinkler systems. The response to this concern was that


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healthcare facilities have robust active and passive systems even with the increase. In addition, they have the benefit of well trained staff that act as immediate responders as well as frequently and rigorous inspections by state licensing, federal certification and third party accreditation agencies - all of which verify that the existing systems and practices are being appropriately maintained. There was concern relating to the fire history of healthcare occupancies: recent NFPA reports of fire data healthcare occupancies still show deaths in healthcare occupancies. The 2nd draft attempted to deal with this concept by allowing only hospitals to increase smoke compartment size. Hospitals have a much better fire history than nursing homes and limited care facilities.

There was concern that other countries do not have the infrastructure to ensure that water mains and sprinkler systems would reliably work and that hospital staff would be trained appropriately to be the immediate responders. These concerns highlight the importance of the "total concept" approach that NFPA has fostered since the early 1950's. If there is not a united approach to active system, passive systems, staff training and regulatory oversight - there is a higher risk of failure. If any adopting jurisdiction knows that one of the these components will reliably fail, that adopting jurisdiction should be able to amend the rule according to the special needs of that jurisdiction. There was the point that hospitals operational needs are driving larger, single-occupant patient rooms and which have less risk, while compartment size is not changing. The challenge to this argument was that the proposed language took a one-size-fits-all approach to compartment size and did not take into account the variables of facilities who might choose to perpetuate smaller, double occupancy rooms.

Regardless of the point, there was a counterpoint to every argument in this discussion. The major contributors to this debate committed to discussing the issue further in hopes of uncovering better data and reaching common ground. A separate egress study was procured, unfortunately the study was limited and the results were inconclusive. However, the proponents of this change were able to reach an agreement that we believe resolves the major concerns of the parties involved:

1. Focus the increase of smoke compartment size to hospitals only.2. Only allow the increase to 40,000 sf to smoke compartments that have single occupancy sleeping rooms -or- smoke compartments without patient sleeping rooms.3. Allow the use of suites (which might contain multiple sleeping rooms) in all smoke compartments. However, limit those smoke compartments that contained multiple patient sleeping rooms (whether they be inside of a suite or outside of a suite ) to 22,500 sf. Sleeping suites with only single occupancy sleeping rooms would be permitted to be in a 40,000 sf smoke compartment.4. Clarify that arrangements for single- vs. multiple-occupancy rooms is intended to be by design, rather than administrative decision. Thus we have used the term “configured for single patient occupancy”.

Note that the text regarding the allowance for smoke compartment defining atria to be unlimited in size was separated into it’s own line item to reduce the amount of text in this change. We are hopeful that the committee will look favorably at this change as we believe it represent the consensus of many of the interested parties.


Submitter Full Name: JOHN WILLIAMS

Organization: Washington State Department of Health

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Submittal Date: Wed Jul 01 16:08:41 EDT 2015


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18.3.7.1




(3) To limit the size of each smoke compartment required by 18.3.7.1(1) and (2) to an area

not exceeding 22,500 ft2 (2100 m2) gross floor area (See 3.3.21.2.1) , unless the area isan atrium separated in accordance with 8.6.7, in which case no limitation in size isrequired



The Code does not clearly state if the area of a smoke zone is net or gross area. The gross calculation as described in Chapter 3 clearly states how to measure the area.




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Submittal Date: Wed Jul 01 16:31:52 EDT 2015


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18.3.7.1




(3) To limit the size of each smoke compartment required by 18.3.7.1(1) and (2) to an area

not exceeding 22,500 ft2 (2100 m2), unless the area is an atrium separated in accordancewith 8.6.7, in which case no limitation in size is required

(4) To limit the size of each smoke compartment required by 18.3.7.1(1) and (2) andcontaining no sleeping rooms with more than one occupant in each room in hospitals to

an area not exceeding 40,000 ft 2 (3716 m 2 ), unless the area is an atrium separated inaccordance with 8.6.7, in which case no limitation in size is required.



The argument in favor of increasing the size of smoke compartments in the previous code cycle seemed to center around hospitals that, due to changes to the Facility Guidelines Institute design guidelines for hospitals, have more area per occupant and no semi-private sleeping rooms or wards. This proposed change is intended to address this issue by equating a 22,500 SF smoke compartment with semi-private rooms to a 40,000 SF smoke compartment with only private rooms, in the theory that moving patients (particularly patients who may be in hospital beds) to the adjacent smoke compartment has the greatest effect on the time it takes to evacuate patients and personnel from the smoke compartment of fire origin. The second largest effect on such an evacuation would be the travel distance to the smoke barrier, which is not altered.



Public Input No. 455-NFPA 101-2015 [Section No. 19.3.7.1]




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18.5.5* Grab Bars for Bathtubs, Bathtub-Shower Combinations and Showers18.5.5* Grab Bars for Bathtubs, Bathtub-Shower Combinations and Showers. Newbathtubs, bathtub-shower combinations and showers, for use by occupants, shall be providedwith grab bars complying with 18.5.5.1, 18.5.5.2, and 18.5.5.3 with all dimensions referring tothe centerline of the grab bar unless otherwise stipulated. If a dedicated shower does notexpose users to changes in elevation exceeding 0.5 inch (13 mm), as described in 7.1.6.2, andif it provides slip resistance for all surfaces when wet, as a foreseeable condition described in7.1.6.4, the requirements of 18.5.5.1, 18.5.5.2 and 18.5.5.3 shall apply only if grab bars areinstalled.

18.5.5.1 A vertical grab bar shall be provided either [option 1] installed on the control end wallof the bathtub, bathtub-shower combination and shower as specified in 18.5.5.1.1 or [option 2]as a free standing, external pole as specified in 18.5.5.1.2

18.5.5.1.1* [Option 1] A vertical grab bar, with a minimum length of 24 inches (610 mm), and itslower end between 36 and 39 inches (915 and 990 mm) above the finished floor, shall beinstalled on the entry/egress side of the control end wall of the bathtub, bathtub-showercombination and shower unit. The grab bar shall be located at least 6 inches (150 mm),measured horizontally, from any shower curtain rod fixing point on the wall.

18.5.5.1.2* [Option 2] A vertical pole-type grab bar fixed to the floor and either the room ceilingor an adjacent wall shall be installed outside of the bathtub, bathtub-shower combination orshower unit within 6 inches (150 mm), measured horizontally, outside of the outer edge of thebathtub, bathtub-shower combination or shower and within 30 inches (760 mm), measuredhorizontally, of the vertical plane of the control end wall if there is such a wall.

18.5.5.2 For bathtubs and bathtub-shower combinations bounded on three sides by walls, agrab bar shall be provided on the back wall either [Option 1] as a diagonal grab bar as specifiedin 18.5.5.2.1 or [Option 2] as a horizontal grab bar as specified in 18.5.5.2.2

18.5.5.2.1* [Option 1] A diagonal grab bar shall be installed on the back wall with a minimumlength of 24 inches (600 mm) with its higher end placed closer to the control end wall andlocated a maximum of 12 inches (305 mm) from the control end wall, with a height of 25 to 27inches (635 to 685 mm) above rim of the bathtub. The lower end of the diagonal grab bar shallbe located at a height of 8 to 10 inches (205 to 255 mm) above the rim of the bathtub and 28 to30 inches (710 to 760 mm) from the control end wall.

18.5.5.2.2 [Option 2] A horizontal grab bar shall be installed on the back wall at a height of 8 to10 inches (205 to 255 mm) above the bathtub rim with one end located a maximum of 12 inches(305 mm) from the control end wall and the other end located a maximum of 24 inches (610mm) from the opposite or head end of the bathtub.

18.5.5.3.1* Grab bars shall be circular in cross section with a minimum diameter of 1.25 inches(32 mm) and a maximum diameter of 2 inches (51 mm). If, attached to a wall, the grab bar shallprovide a minimum clearance, for hand grasp, of 1.5 inches (38 mm). These size and clearancedimensions shall be provided for at least the height requirements and the minimum lengthrequirements of 18.5.5.

18.5.5.3.2 Grab bars shall be designed and constructed to the structural loading conditions inSection 4.5 of ASCE/SEI 7. [In NFPA 5000 this reference is stipulated in Section 35.6.5.1.]




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Pauls-Grab_Bar_Justification_Detail.pdf

This file provides the full justification for the public input.

CPSC_NEISS_Sample_Narratives_for_Product_Code_0611_Injuries_in_2010.pdf

This provides supplementary information on the incidents occurring with baths/showers, resulting in hospital treatment in 2010, as reported by US CPSC/NEISS.


An expanded coverage of this outline justification is provided in an accompanying, supplementary document, intended for use by all in processing this public input which is going to 8 occupancy chapters each in NFPA 101 and NFPA 5000.

The addition of requirements for grab bars, for bathtubs, bathtub-shower combinations and showers is within the scope of the Code in the same way that handrails are essential to the Code in relation to stairs.

The proposal builds on the need to protect occupants encountering facilities addressed by Code requirements for Changes in Elevation and Slip Resistance.

The proposal addresses two aspects of people’s movement when accessing and egressing baths/showers.1. Utility for people remaining in a standing position and thus within easy reach of a vertically oriented, readily grasped, grab bar at an appropriate height and lateral position; 2. Moving to or from a crouching or seated position in water—hence applicable only to bathtubs—and thus within easy reach of a horizontal or diagonal, readily grasped grab bar also at an appropriate height and lateral position.

Outside the scope of the proposal are grab bars specifically intended for persons with disabilities, requiring more complex configurations and placements of grab bars, which are covered in great detail in ICC/ANSI A117.1

Grab bars for use by everyone have been mainstreamed for a long time, along with automatic sprinklers, for all hotel guest rooms of a well-known, major hotel chain.

Regarding epidemiology, of three important causes of injury in buildings, fire is by far the smallest cause of injuries. Baths/showers are the site of about 13 times more injuries than fire and stairs are the site of about 50 times more injuries than fire as a cause. (See the expanded, detailed justification for this, including a pie chart illustrating these ratios.)

From a public health perspective, the injuries are only one aspect of harm; the other is reduced use (and fear of use) of baths/showers and stairs; this affects well being, fitness, and health generally. The societal costs of the injuries alone is on the order of 100 billion dollars per year in the USA and other health implications could be comparable in order of magnitude.


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As with stairs, there is well-established, authoritative literature on testing, ergonomic analyses and recommendations on scoping and detailed technical criteria; the expanding summary reviews and cites such literature, especially as it specifically supports the scope and detail in the public input for grab bar installation.

The provision of grab bars, under requirements in codes and standards has been specifically addressed in formal public policies adopted by not only the American Public Health Association but also the Canadian Public Health Association.

Summing Up. The proposals (including their technical requirements based on certain requirements of ICC ANSI A117.1, other standards such as CSA B651, and important research) warrant very careful consideration, and acceptance, by the various NFPA Technical Committees to whom they are directed. The proposals are responsive to a major injury problem in buildings, with huge societal injury cost sand disability ramifications, in addition to general health benefits including sanitation and well being generally. They are very much within the scope of NFPA’s currently stated mission, “We help save lives and reduce loss with information, knowledge and passion,” and the full scope of its codes and standards which, while historically developed to address fire safety, are now not restricted to fire safety.


Submitter Full Name: JAKE PAULS

Organization: JAKE PAULS CONSULTING SERVICES

Affilliation: Myself and Linda Strobl, Public Health Nurse, Ontario

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Submittal Date: Sun Jul 05 18:16:53 EDT 2015


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Detailed Justification for Proposals for New Requirements for Grab Bars for New Baths and Showers

Submitted by Jake Pauls, CPE, representing himself and Linda Strobl, Public Health Nurse For NFPA 5000 (Building Construction and Safety Code) and NFPA 101 (Life Safety Code) Chapters, specifically Section —.5 Services, in:

• NFPA 5000 Ch. 18 and NFPA 101 Ch. 16 – New Day-Care Occupancies • NFPA 5000 Ch. 19 and NFPA 101 Ch. 18 – New Health Care Occupancies • NFPA 5000 Ch. 20 and NFPA 101 Ch. 20 – New Ambulatory Health Care Occupancies • NFPA 5000 Ch. 22 and NFPA 101 Ch. 24 – One- and Two-Family Dwellings • NFPA 5000 Ch. 23 and NFPA 101 Ch. 26 – Lodging or Rooming House Occupancies • NFPA 5000 Ch. 24 and NFPA 101 Ch. 28 – New Hotels and Dormitories • NFPA 5000 Ch. 25 and NFPA 101 Ch. 30 – New Apartment Buildings • NFPA 5000 Ch. 26 and NFPA 101 Ch. 32 – New Residential Board and Care

Goals and Objectives of the Codes: NFPA 5000 4.1.3.3.2.1 “Buildings shall be designed and constructed to reduce the probability of death or injury to occupants from falls during normal use.” NFPA 101 does not have comparable language, regarding “falls,” however it has the same requirements and leads to the same efficacy of such requirements—that help prevent and mitigate falls, e.g., with required handrail provisions, as does NFPA 5000. Generally, NFPA 101’s broad “Goals” requirement in Section 4.1.1, is intended to “provide an environment for the occupants that is reasonably safe from fire by the following means: (1)*Protection of occupants not intimate with the initial fire development (2) . . . .” Section 4.2. deals with parallel, but more detailed requirements dealing with objectives, e.g., 4.2.1 Occupant Protection. “A structure shall be designed, constructed and maintained to protect occupants who are not intimate with the initial fire development for the time needed to evacuate, relocate, or defend in place.” Notably, a leading emergency situation is the undesired activation of a smoke alarm when exposed to high humidity from operation of a shower in the vicinity. A prudent person in the shower, or even a person just anxious to have the alarm stop, will typically exit a shower facility in a hurry, thus exposing her/himself to increased danger of a misstep and fall due to dangerous underfoot conditions that should be mitigated according to longstanding requirements in the Code to prevent and mitigate missteps and falls generally. Application: Triggering the proposed new requirement for grab bars is NFPA 5000 Section 11.1.6.2 [and NFPA 101 Section 7.1.6.2]:

“Changes in Elevation. Abrupt changes in elevation of walking surfaces shall not exceed 1⁄4 in. (6.3 mm). Changes in elevation exceeding 1⁄4 in. (6.3 mm), but not exceeding 1⁄2 in. (13 mm), shall be beveled 1 to 2. Changes in elevation exceeding 1⁄2 in. (13 mm) shall be considered a change in level and shall be subject to the requirements of 11.1.7” [7.1.7 in NFPA 101].

Such criteria are well established and appear, with the exact same criteria, in many standards such as, prominently, ICC/ANSI A117.1, and ASTM F1637. Note should be taken of the requirement in both codes (NFPA 5000 11.1.6.4 and NFPA 101 7.1.6.4) for walking surfaces that are: “slip resistant under foreseeable conditions.” The pertinent Annex notes clearly identify areas that are expected to be wet as subject to this requirement.

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Thus the proposed new requirements for NFPA 5000 and NFPA 101, requiring grab bars for new baths and showers, are triggered by: • ambulation (stepping behavior) traversing elevation changes exceeding ½ inch (13 mm), and • high risk of slippery surfaces. Thus, exempt from the requirement—unless grab bars are installed voluntarily, are certain showers, designed without a raised sill in excess of ½-inch (13 mm) height, but otherwise designed for water containment within the shower facility and for slip resistant underfoot surfaces when wet. Features of the Specified Grab Bars. The grab bars included in the proposed rule are ones used by ambulatory persons transferring into or out of a bathing facility, whether it is designed solely for use as a shower, solely for the use of bathing or combines options of showering and bathing. Proposed grab bar requirements, all in each code’s Section 5 (Services) of the seven relevant occupancy chapters (with Chapter numbers indicated here with an “X”), are partly based on two kinds of use:

X.5.5.1. Utility for people remaining in a standing position and thus within easy reach of a vertically oriented, readily grasped, grab bar at an appropriate height and lateral position; X.5.5.2 Moving to or from a crouching or seated position in water—hence applicable only to bathtubs—and thus within easy reach of a horizontal or diagonal, readily grasped grab bar also at an appropriate height and lateral position.

For each of these there are two design options, either of which will meet the requirements. Grab bars specifically intended for persons with disabilities, requiring other configurations and placement of grab bars, are beyond the scope of the proposed requirement. ICC/ANSI A117.1 provides for the full spectrum of needs of people with disabilities that prevent independent standing while cleansing with water. In other words, the new requirement is for fully ambulatory, typically independent, transfers into or from a showering or bathing facility, a scenario causing more serious injuries than does fire in buildings and facilities (see pie chart below) and a scenario that is increasing in frequency—and severity—with demographic changes in the population generally (see data below). The proposal is being submitted for health care occupancies as covered in NFPA 5000 Chapter 19 and NFPA 101 Chapter 18. The Health Care Occupancies Technical Committee has a better sense of what aspects of such occupancies should be scoped for the proposed requirements for grab bars. Falls by patients, and related injuries by staff (in attempting to assist patients with bathing), are a leading problem of safety in health care facilities of almost all types. It is assumed, by the proponents, that fall dangers are already being mitigated with provision of grab bars in some areas of hospitals and nursing homes for example. However, it is not clear to what extent those are already covered by requirements, other than those in NFPA 101 and NFPA 5000; hence the proposal might need focusing on specific areas. This is left for scoping decisions by the Technical Committee who, it is hoped, see the value of consistent grab bar requirements throughout the Code. Two Details of Design and Installation.

(1) Unlike many grab bar requirements specifying an absolute clearance between the grab bar and adjacent wall surfaces, the proposed requirement specifies only a minimum clearance, an approach similar to that for handrails specified by NFPA 5000 and NFPA 101; this is addressed in a proposed new Annex note. Moreover such newly required vertical grab bars can be wall mounted or mounted between a floor and ceiling or a combination of attachment to a floor, a ceiling or a wall. Commercially available grab bar systems exist for

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all of these combinations with the best ones being the result of extensive biomechanics and other testing. (2) The loading requirement for grab bars is already covered by existing language in NFPA 5000 and, if needed for NFPA 101, should be based on the same standard. The NFPA 5000 requirement is: “35.6.5.1 All required handrails, guardrails, grab bars, vehicle barrier systems, and fixed ladders shall be designed and constructed to the structural loading conditions in Section 4.5 of ASCE/SEI 7.”

Current Exemplars. Considering the real world of many examples of bathing facilities, one of the proponents wishes to note that one well-known, progressive major hotel chain is recognized for leading the way in having automatic sprinkler protection for guest rooms of all of its properties worldwide. Less well recognized is its longstanding policy to provide grab bars serving its guests stepping into and out of guest room bathtubs and dedicated showers. As the young adult victim of an injurious fall while attempting to step out of a bathtub in a hotel guest room, one of the proponents has had a longstanding personal policy of staying at the progressive hotel chain, in preference to others, and utilizing the grab bars as a matter of normal course—well before, as well as well after, achieving his 65th birthday. In other words, the provision of grab bars must not be thought of merely as an essential aid for people over 65 years of age, a common limitation in too many fall prevention programs focused on who suffers the most-severe injuries, rather than the ergonomics applicable to the entire population. Comparisons of Three Prominent Dangers. Grab bars are just as important—for everyone—as are handrails on stairs. Even with their slightly different objectives, both NFPA 5000 and NFPA 101 do not permit new stairs without handrails. New bathing facilities are similarly in need of Code requirements for grab bar installation as a mainstreamed measure for safety in all conditions of use—by all users. Indeed, from a risk-per-use perspective, each step into and out of a bathing facility is, currently—without grab bars—more dangerous than is taking a step up or down on a stair. See the pie chart below that clearly shows the high number of injuries associated with baths and showers in the USA in 2010.

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Injury Epidemiology. The following are some insights from the US Consumer Product Safety Commission National Electronic Injury Surveillance System (CPSC-NEISS) product code 611 for bathtubs or showers, excluding enclosures, faucets, spigots and towel racks. For the year 2010, CPSC-NEISS estimated 262,745 visits to US hospital emergency rooms based on a sample count (from about 100 US hospitals) of 6,946 visits for which short naratives can be downloaded from its Web site. Such visits, with or without treatment, occurred to people of all ages. Those that resulted in hospital admission—23,107 estimated cases in the US in 2010—occurred prominently (roughly 77%) among people 60 years and older, i.e., persons more vulnerable to serious injury in falls and having more complications in health status generally. Not only are the numbers large absolutely and large relative to fire-related injuries to civilians, they are also growing rapidly as fire-related injuries drop in number, indeed by about half in recent decades. Bath and shower-related injuries in the US grew in the two decades between 1991 and 2010 by a factor of two for those resulting in an Emergency Room (ER) visit and by a factor of three for those resulting in hospital admission after first going to the ER. These increases exceed, by a factor of two or three even the troubling increases in stair-related injuries in the US with number of stair-related cases doubling for some ages (especially the 45-60 age group), even in the shorter period, 1997-2010. Generally for all ages, stair-related injuries grew by about 65 percent over all ages for hospitalized cases between 1991 and 2010. The pie chart (above) is merely a snapshot in time; it reveals relative magnitude of the problems but not their respective growth. NFPA has responded relatively well with stair-related requirements in the last decade or so; now it should address—perhaps only for the first time—the second leading category of predictable and preventable injuries in buildings. Unlike fire, the fear of which does not greatly affect healthful human activity, concern about both the dangers of stairs and the dangers of baths and showers affects other health-sustaining activities. Thus, from a public health perspective, there are dual sets of consequences from dangerous stairs and dangerous baths and showers. (See sections on cost of injuries and on public health policies below.) Ergonomic Perspectives on the Special Dangers of Baths and Showers. What all people faced, and continue to face, in the use of bathtubs or showers are wet surfaces that (being chosen for their ease of cleaning) are generally hard and smooth. Moreover, unlike other ambulation challenges, they might require stepping over tub walls typically about 15 inches above the floor—even higher with some large, showpiece tubs increasingly found in homes. Furthermore some surfaces may be degraded with slippery soap and shampoo chemicals that drastically affect slip resistance. Further exacerbating the problems, those people dependent on corrective glasses for clear vision, would encounter these conditions without them. There are other conditions, common in bathing, that exacerbate injury dangers even more. There are virtually no countermeasures commonly installed to mitigate some of these dangers; the only solid “points of control” (something to hold onto securely—a concept in occupational ergonomics) might be the edges of a vanity countertop but these, like other features of the bathroom, are not designed to be grasped with sufficient security to avert or mitigate a fall. These other features might include towel racks or flimsy storage shelving for toiletries, etc. They might take small loads but are not designed to mitigate a fall nor are they biomechanically designed to be in the right place, configuration and size. Societal Injury Costs. The societal costs, in the USA in 2010, of the bath and shower-related

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injuries were estimated at about 20 billion dollars (with, as noted above, about 263,000 injuries leading to a hospital ER visit). For comparison, in 2010, stair-related injuries were responsible for about 92 billion dollars and led to about 1,232,000 visits to US hospital ERs. Societal cost per injury is about the same for each injury type. The information source here (which used CPSC/NEISS data) is: Lawrence, B., Spicer, R., Miller, T. A fresh look at the costs of non-fatal consumer product injuries. Injury Prevention, digital publication, August 2014, paper journal publication, 2015:21:23-29. Fire-related injuries to civilians occurred to fewer than 20,000 people in the USA (according to recent NFPA-published estimates); injuries from hot water resulted in about 37,000 ER visits in 2010 (according to CPSC NEISS data) and about a sixth of the societal injury cost from baths and showers. For a better picture of what kinds of injury events occur in baths and showers, the proposal justification is also accompanied by four pages of small samples (160 cases), derived from US CPSC NEISS Web information (not subject to copyright), from the over 7,5000 one-line narratives for ER visits, in 2010, in relation to baths and showers plus the hospital admissions for the same category in the NEISS sample from about 100 US hospitals. (The four pages provided are simply the first 112 and 48 cases, respectively; they are not selected otherwise in any way from the NEISS narratives. They are intended to be indicative of the records. Literature Resources. There is extensive literature on ergonomic and public health aspects of important features such as handrails and grab bars. Rather than get into that literature base here, we should note that the general problem of differing orientations of public health and building-related professionals has been thoughtfully addressed by a well-known researcher, and proponent of bath grab bars in the Canadian code-development system, Dr. Nancy Edwards. Her paper, calling for a bridging between the differing perspectives of these groups of professionals also appeared in the same journal as noted above: Edwards, N. (2008). Performance-based Building Codes: A call for injury prevention indicators that bridge health and building sectors. Injury Prevention, 2008, 14: 329-332. That paper cites specific research on grab bars including Sveistrup H, Lockett D, Edwards N, et al. “Evaluation of bath grab bar placement for older adults.” Technology and Disability 2006;13:1–11. The leading recommendation from that study has strongly influenced what is being proposed for NFPA 5000 and NFPA 101, i.e.:

“A minimum of two grab bars should be installed in all bathtubs used by seniors, one on the faucet wall (vertical) for entering and exiting the tub, and one on the back wall (horizontal or on an angle) to help with sitting down and standing up.”

In addition, another paper, “Use of different bath grab bar configurations following a balance perturbation,” by Guitard, Sveistrup, Edwards, and Lockett, 2011, reinforces the case for two sets of grab bars when in a bathing situation-a vertical grab bar at bath entry and a diagonal or horizontal grab bar on the back wall for lowering into and rising out of the bath. Collaborative Efforts Employed. In the case of the grab bar proposals, described here, they specifically result from a collaboration of individuals coming from the building field and the public health field, with the former having extensive credentials in ergonomics (Board Certified in the field) and the latter working in public health but also serving on a task group focused on grab bar requirements for codes and on the equivalent of an NFPA Technical Committee responsible for a significant part of the National Building Code of Canada, Part 9, dealing with houses and small buildings. The latter, Linda Strobl, is also the first recipient of the award, conferred by the Canadian Public Health Association in 2015, named after a prominent professional in Canadian model code history—R. Stirling Ferguson—who, among other important duties on model codes, served on NFPA 101’s main committee, “The Committee on Safety to Life,” during the 1960s. The R. Stirling

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Ferguson Award recognizes special achievement by an individual or organization in improving the evidence base for standards and codes for the built environment. Thus, the proposals for grab bars are the result of a great deal of consideration based on ergonomics (in the case of the test-based insights and recommendations referenced above) and epidemiology as well as etiology (i.e., pertaining to the causes of falls) among other types of justification. Public Policies. Moreover, the proposed addition of grab bar-related, safety codes/standards requirements for baths and showers has been addressed in the formal policy statement adopted in 2009 by the American Public Health Association (APHA), the world’s oldest and largest organization of public health professionals. Jake Pauls has been the lead representative of the APHA on several NFPA committees since 2001 (as well as the ICC Industry Advisory Committee since the mid 1990s). The Canadian Public Health Association also has formally adopted policy positions related to grab bars. Other notable names from public health, urging such new requirements, could also be mentioned here but the broadly based impetus behind this set of proposals should be very clear to NFPA committees. The relevant recommendation from APHA Policy 200913 follows:

4. ICC and NFPA, in developing model codes and standards, should use generally a “universal design” or inclusive design philosophy, which maximizes safety and usability for the largest range of people, including elderly people or those of any age with disabilities. This includes scoping—for all new homes (subject to some very limited exemptions)—of ICC/ANSI A117.1-2009 requirements for “visitable dwelling units” as well as installation of grab bars, on the basis of ICC/ANSI A117, for all bathtubs and bathtub shower combinations of new dwelling units as well as hotel rooms.

Notably, the proposls for grab bar provision go beyond dwelling units and hotel rooms. This reflects the growing sophistication and specialization of funtions that, tradtionally, occurred within dwelling units for example. These include functions now being addressed also in long-term care (such as in nursing homes) and other supportive care (such as adult day care centers plus board and care facilities). Moreover, dwelling units are found not only in detached houses but, increasingly, in apartments (both for rental and for purchase). Medical care is provided in smaller, less-institutional settings such as ambulatory health care facilities. All of these are likely to have showering or bathing facilities. Even major airport terminals, serving long-haul flights, have shower facilities for pasengers and perhaps others as well (the one occupancy not yet mentioned in this background to our proposals, but one that NFPA might want to consider for standards and codes beyond NFPA 101 and 5000). Summing Up. The proposals (including their technical requirements based on certain requirements of ICC ANSI A117.1, other standards such as CSA B651, and important research) warrant very careful consideration, and acceptance, by the various NFPA Technical Committees to whom they are directed. The proposals are responsive to a major injury problem in buildings, with huge societal injury costs and disability ramifications, in addition to general health benefits including sanitation and wellbeing generally. They are very much within the scope of NFPA’s currently stated mission, “We help save lives and reduce loss with information, knowledge and passion,” and the full scope of its codes and standards which, while historically developed to address fire safety, are now not restricted to fire safety.

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US CPSC NEISS: First 112 Sample Narratives (of 6,946 cases) for Product Code 0611 Injuries in 2010 – ER released w/wo treatment (Product Code 611 covers bathtubs or showers including fixtures or accessories; excluding enclosures, faucets, spigots and towel racks) 41 YOM FRACTURED A RIB BY SLIPPING IN THE BATHTUB & FALLING AGAINST THE TOILET AT HOME. 53 YOF SUSTAINED A CONTUSION OF A SHIN BY BUMPING IT WHILE SHOWERING AT HOME. 18 YOF SPRAINED HER LOWER BACK BY FALLING IN THE SHOWER AT SCHOOL. 02 YOF SUSTAINED A LACERATION OF THE CHIN BY FALLING IN THE BATHTUB AT HOME. 18 YOF SUSTAINED A HEAD INJURY BY FALLING IN A SHOWER AT HOME. 80 YOM DISLOCATED A HIP BY LIFTING LEG IN SHOWER. 86 YOF SUSTAINED A LACERATION OF THE SCALP BY TRIPPING ON A RUG IN THE SHOWER AT HOME. 71 YOF SUSTAINED A HEAD INJURY BY FALLING FROM TOILET AGAINST THE BATHTUB AT HOME. 68 YOF SPRAINED AN ANKLE BY FALLING IN A SHOWER. 47 YOF FRACTURED A KNEE BY FALLING IN THE SHOWER AT HOME. 02 YOF SUSTAINED A LACERATION OF THE CHIN BY FALLING IN THE BATHTUB. 22 YOM SPRAINED A FOOT WHILE STEPPING OUT OF A SHOWER AT JAIL. 23 YOF SUSTAINED A CONTUSION OF A FOOT BY TRIPPING ON A RUG & STRIKING AGAINST A TUB AT HOME. 40 YOM SUSTAINED A LACERATION OF THE NOSE FROM BEING STRUCK BY THE SHOWER HEAD IN THE SHOWER AT HOME. 21 MOM RUPTURED AN EAR DRUM WITH A COTTON-‐TIPPED SWAB WHILE BATHING IN TUB AT HOME. 48 YOF SUSTAINED A CONTUSION OF THE NECK BY FALLING IN THE BATHTUB AT HOME. 04 YOF SLIPPED IN BATHTUB FELL AND INJURED FACE DX/ FACIAL LAC L KNEE STR 10 YOF FELL OUT OF SHOWER AND INJURED L KNEE. HAS ABRASION TO KNEE ALSO 80 YOF FELL IN SHOWER AT HOME HIT HEAD DX/ HEAD INJURY 94 YOM SLIPPED AND FELL IN SHOWER AND HIT FACE ON FLOOR DX/ FACIAL FX 55 YOM SLL LEG HEMATOMA 72 YOF CAUGHT FOOT IN TUB, INJURING LOWER LEG. NOW HAS HEMATOMA AND INCREASING PAIN. 22 YOF AT HOME FAINTED WHILE IN SHOWER AND FELL CUTTING FOREHEAD. 26 YOF SLIPPED AND FELL IN TUB DX: KNEE STRAIN 90 YOF GETTING OUT OF SHOWER WITH WALKER SLIPPED ON THE FLOOR AND HIT HEAD DX/ SCALP ABRASION 30 YOM SLIPPED AND FELL INTO TUB DX: CONTUSION TO BACK 51 YOF SLIPPED IN TUB AND HIT HEAD DX/ SCALP LAC 60 YOF SLIPPED AND FELL IN TUB DX: CONTUSION TO COCCYX 44 YOM FELL AND HIT ABDOMEN ON BATHTUB AT HOME DX/ ABDOMINAL CONTUSION 04 YOM WITH CUT TO FACE FELL IN TUB DX: LACERATION TO FACE 51 YOF AT HOME FELL AT 5PM WHEN LOST BALANCE AND HIT L SIDE OF RIBS ON BATHTUB. 33 YOF SLIPPED AND FELL IN TUB DX: HEAD LACERATION 23 MOM FELL IN BATHTUB AT HOME AND HIT CHIN CAUSING LACERATION. 62 YOM WITH BACK PAIN FELL INTO TUB DX; CONTUSION TO LOWER BACK 63 YOF FELL INTO BATHTUB / NO INJURIES OR COMPLAINTS 54 YOM SLIPPED AND FELL IN TUB DX: RIB FRACTURE

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02 YOM SLIPPED IN TUB AT HOME AND INJURED FACE DX/ CHIN LAC 25 YOF WITH CHEST PAIN AFTER FALL INTO TUB DX: CONTUSION TO CHEST 84 YOM FELL OUT OF SHOWER ON TO THE FLOOR AT HOME HIT HEAD DX/ HEAD INJURY 85 YOF SLIPPED AND FELL IN TUB AND HIT HEAD AT HOME DX/ HEAD INJURY 06 YOM AT HM WAS TAKING A BATH & SWIMMING IN TUB WHEN HE STRUCK HIS HEAD AGAINST FAUCET CAUSING HEAD LACERATION. 28 YOM AT HOME FELL IN SHOWER. WAS RESPONSIVE PER EMS. 26 YOF SLIPPED / FELL IN THE SHOWER DX: R EAR LAC. / HEAD & R SHOULDER CONTUSION 36 YOF THIS AM SLIPPED WHILE TRYING TO GET OUT OF BATHTUB AND LANDED ON BUTTOCKS. 28 YOF RIPPED FINGER NAIL OFF WHEN SLIPPED IN THE SHOWER AND THE NAIL BENT BACKWARDS. 26 YOF INJURED KNEE STEPPING OUT OF SHOWER DX/ RIGHT KNEE SPRAIN 50 YOM FELL IN BATHTUB AND HIT CHEST DX/ RIB FX 83 YOM CUT SCROTUM FELL IN TUB DX: LACERATION TO SCROTUM 71 YOF FELL OUT OF BATHTUB AT HOME AND HIT HEAD ON THE FLOOR DX/ HEAD INJURY 89 YOF FELL IN TUB HITTING HEAD DX: CLOSED HEAD INJURY 69 YOF WAS IN SHOWER AND FELL BACKWARDS STRIKING HER BACK. 08 YOF AT HOME LACERATED FACE ABOVE R ORBITAL. HIT HER HEAD ON SOAP DISH WHILE SHOWERING. NO LOC. 40 YOM SLIPPED AND FELL IN SHOWER AND INJURED CHEST DX/ RIB FX 17 YOF FELL IN TUB HURT NECK DX: NECK STRAIN 23 YOM INJURED LOWER BACK BENDING OVER IN SHOWER AT HOME DX/ LUMBAR STRAIN 83 YOF FELL IN THE TUB AT ASSISTED LIVING AND INJURED SHOULDER DX/ RT SHOULDER CONTUSION 02 YOM HIT FACE ON BATHTUB AT HOME DX/ FACIAL LAC 74 YOM FELL AND HIT HEAD IN TUB DX: CONTUSION TO HEAD 85 YOF SLIPPED AND FELL GETTING OUT OF TUB DX: CONTUSION TO HIP 58 YOF SLIPPED AND FELL INTO TUB HIT HEAD DX: CLOSED HEAD INJURY 13 MOM AT HOME FELL IN BATHTUB AND HIT FOREHEAD AND MOU TH. 06 YOM SLIPPED IN BATHTUB AND HIT HEAD DX/ HEAD CONTUSION 78 YOM SLIPPED AND FELL IN TUB DX: LACERATION TO HEAD 08 YOM SLIPPED IN TUB TWISTED ANKLE DX: ANKLE STRAIN 51 YOF HIT HEAD ON SOAP DISH IN SHOWER 2 TIMES THIS WEEK HAS HEADACHE DX/ CONCUSSION 51 YOF SLIPPED IN SHOWER AND INJURED KNEE AT HOME DX/ RIGHT KNEE CONTUSION 83 YOM SLIPPED AND FELL IN THE SHOWER LAST NIGHT AND INJURED BACK DX/ BACK PAIN 31 YOM HIT EYE WITH TOWEL WHILE GETTING OUT OF THE SHOWER AT HOME DX/ RIGHT EYE CORNEAL ABRASION 24 YOF FELL GETTING OUT OF SHOWER HIT HEAD DX/ SCALP LAC 48 YOF SLIPPED IN SHOWER HIT HEAD + LOC DX/ HEAD INJURY 11 YOM SLIPPED IN SHOWER AND INJURED LEG DX/ LEFT LEG CONTUSION 30 YOF SLIPPED AND FELL INTO TUB DX: CONTUSION TO HIP 18 MOM FELL IN TUB DX: LACERATION TO FACE 46 YOF SLIPPED AND FELL IN TUB DX: CONTUSION TO LOWER BACK

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30 YOM CUT HAND ON BROKEN SOAP DISH AT HOME DX// RIGHT HAND LAC 70 YOF SLIPPED AND FELL IN TUB DX: CONTUSION TO CHEST 31 YOM CUT THUMB ON SHOWER DRAIN THIS AM. 62 YOF SLIPPED IN THE SHOWER AND FELL ON THE FLOOR AT HOME DX/ LEFT WRIST SPRAIN 67 YOM FELL GETTING OUT OF SHOWER HIT HEAD ON TUB AT HOME DX/ SCALP CONTUSION 45 YOF PASSED OUT IN SHOWER AT GROUP HOME HIT HEAD DX/ HEAD INJURY 04 YOF FELL IN BATHTUB AND HIT MOUTH DX/ LIP LAC 43 YOM SLIPPED IN BATHTUB AND INJURED KNEE DX/ LEFT KNEE CONTUSION 15 YOM TAKING SHOWER AND SHOWER DOOR SHATTERED AND PT FEET WERE CUT WITH THE GLASS AT HOME DX/ BILAT FOOT LAC 73 YOF AT 9AM TODAY WAS GETTING OUT OF TUB AND SLIPPED AND BUM PED L RIBS ON THE TUB. C/O RIB PAIN. 87 YOF BENT DOWN TO PUT SCALE AWAY FELL AND HIT INTO TUB AT HOME DX/ LEFT HIP CONTUSION 22 YOM FELL IN TUB AT HOME AND INJURED CHEST DX/ RIB FX 40 YOF SLIPPED GETTING OUT OF BATHTUB AND INJURED LOWER BACK DX/ LOW BACK PAIN 34 YOM FELL AND HIT TUB DX: SHOULDER STRAIN 70 YOF SLIPPPED FELL HIT CHEST ON SIDE OF TUB DX: CONTUSION TO CHEST 89 YOF SLIPPED AND FELL IN THE SHOWER LAST NIGHT AT NURSING HOME INJURED CHEST DX/ CHEST CONTUSION 44 YOM FELL IN TUB AND HIT CHEST DX.CHEST CONTUSION 36 YOF SLIPPED AND FELL IN TUB DX: LACERATION TO FACE 56 YOM CUT WRIST ON BROKEN SHOWER KNOB AT HOME DX/ LEFT WRIST LAC 88 YOF FELL AT HOME IN SHOWER AND HIT HEAD ON TUB DX/ SCALP CONTUSION 51 YOM SLIPPED AND FELL IN TUB DX: NECK STRAIN 23 YOM FELL IN BATH TUB AND INJURED CHEST DX/ CHEST CONTUSION 59 YOM FELL IN SHOWER AND INJURED SHOULDER DX/ LEFT SHOULDER FX 46 YOM HAD FALL HIT TUB DX: CONTUSION TO FACE 78 YOF FELL AT HOME AND HIT FACE ON BATHTUB DX/ FACIAL CONTUSION 29YOF WITH BACK PAIN AFTER FALL IN TUB DX: LOW BACK STRAIN 31 YOF FELL GETTING OUT OF TUB AT HOME INJURED FLANK DX/ FLANK CONTUSION 72 YOF AT HOME FELL WHEN SLIPPED ON URINE IN BATHROOM AND HIT HEAD ON SIDE OF BATH TUB. 19 YOF SLIPPED AND FELL INTO TUB DX: CONTUSION TO LOWER BACK 08 YOM FELL IN THE SHOWER AT HOME AND HIT EAR DX/ LEFT EAR LAC 62 YOM SLIPPED / FELL IN THE SHOWER DX: RIB CONTUSION 09 YOF FELL IN TUB AND HIT LIP DX/ LIP LAC 56 YOF WITH SHOULDER PAIN AFTER USING BATHBRUSH IN SHOWER DX: SHOULDER STRAIN 75 YOF AT HOME FELL OFF HASSOCK APPROX 30 MIN AGO HITTING HEAD AND L ARM ON BATHTUB. DENIES LOC. 62 YOF SLIPPED IN TUB HITTING FOOT DX: CONTUSION TO FOOT 04 YOM SLIPPED IN THE BATHTUB AND HIT CHIN DX/ CHIN LAC 34 YOM FELL IN THE SHOWER AT HOME INJURED BACK DX/ BACK SPRAIN 25 YOF + ETOH BAL 313 FELL IN SHOWER AND HIT HEAD DX/ HEAD CONTUSION

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US CPSC NEISS: First 48 Sample Narratives (of 630 cases) for Product Code 0611 Injuries in 2010 – ER treated & Admitted to Hospital (Product Code 611 covers bathtubs or showers including fixtures or accessories; excluding enclosures, faucets, spigots and towel racks) 89 YOF GETTING OUT OF THE SHOWER THE NEXT THING SHE KNEW SHE WAS ON THE FLOOR WITH HEAD AND SHOULDER INJURY; SHOULDER AND HEAD CONTUSION 69 YOM WAS WASHING HIMSELF IN SHOWER, FELL ONTO BLUNT PART OF BATHTUB, IMMEDIATELY HAD PAIN & TROUBLE BREATHING. DX -‐ MULTIPLE RIB FXS 56 YOF SLIPPED IN THE SHOWER AND FELL FORWARD HITTING HER FACE & INJURiNG HER RT ARM-‐ DX-‐ MECHANICAL FALL W/ FRACTURE RT SHOULDER 78 YOF FAMILY FOUND HER ON THE FLOOR BETWEEN TOILET AND BATHTUB, SHE STATED SHE PASSED OUT WHEN SHE WAS IN SHOWER;SHOULDER INJURY 47 YOM HAD A WET SHEETROCK FALL ON HEAD WHILE IN SHOWER, +LOC, WAS CONFUSED. DX -‐ BLUNT HEAD TRAUMA W/BRIEF LOC 62 YOM HAD A SYNCOPAL TODAY AT HOME IN THE SHOWER INJURING EYE AREA-‐ DX-‐ LACERATION TO FACE( EYE) 78 YOF PRESENT TO ER FROM HOME WHEN SHE WAS TAKING A BATH AND COLLAPSED -‐ DX-‐ CARDIAC ARREST, RESUSCITAED 43 YOM PRESENT TO ER AFTER HE WAS IN THE BATHTUB AND SLIP AND FELL GETTING OUT HITTING HEAD ON FLOOR-‐ DX-‐ BLUNT HEAD TRAUMA 81 YOM PRESENT TO ER AFTER A FALL IN THE SHOWER AT HOME TODAY INJURING THE HEAD AREA-‐ DX-‐ BLUNT HEAD TRAUMA 41 YOM FELL OUT OF SHOWER AT ASSISTED LIVING HOME YESTERDAY ONTO RT SIDE C/O RT HIP & RT LEG PAIN. DX -‐ RT HIP FRACTURE 80 YOF TRYING TO GET OUT OF BATHTUB ACCIDENTLY FELL INJURED LOWER BACK; BACK CONTUSION AND AMBULATORY DYSFUNCTION 92 YOM PRESENT TO ER AFTER A FALL IN BATHTUB THIS MORNING INJURING RT HIP-‐DX-‐ FRACTURE RT LOWER TRUNK (HIP) 88 YOF PRESENT TO ER AFTER A FAL IN BATH TUB AT SNF INJURING LT HIP-‐ DX -‐ FRACTURE LT LOWER TRUNK (HIP) 88 YOF WAS GETTING OUT OF SHOWER, FELT DIZZY & FELL STRIKING BACK OF HEAD ON FLOOR INJURING LT ARM. DX -‐ SKIN TEAR LACERATION 88 YOF GETTING OUT OF BATHTUB THIS MORNING FELL TRIED TO BRACE HERSELF INJURED SHOULDER; SHOULDER FRACTURE 71 YOF WAS FOUND DOWN BY SON IN BATHTUB AT HOME, HAS INJURY TO LT EYE & FOREHEAD, IS REPETITIVE. DX -‐ BLUNT HEAD TRAUMA, +ETOH 86 YOF LOST BALANCE WHEN SHE TURNED AROUND & FELL INTO BATHTUB C/O LOW BACK PAIN. DX -‐ LOW BACK PAIN, POSS FX VS CONTUSION 80 YOF HUSBAND DID NOT WANT HER SMOKING IN THE HOUSE, WENT TO BATHROOM STOOD ON THE TOILET, OPENED WIN***, SLIPPED BETWEEN TOILET/TUB;PELVIC FX 44 YOF FELL IN SHOWER TODAY SUSTAINING HEAD INJURY. DX -‐ SCALP LACERATION 37 YOF SUSTAINED A MECHANICAL FALL IN SHOWER ONTO RT UPPER EXTREMITY, C/O RT SHOULDER PAIN. DX -‐ RT DISTAL CLAVICLE FX 37 YOM HAD A GROUND LEVEL FALL IN BATHROOM STRIKING LOWER BACK ON BATHTUB. DX -‐ SPINAL CONTUSION 84 YOF HAD SYNCOPAL EPISODE IN SHOWER AND FELL. DX: L 10TH RIB FX, INABILITY TO AMBULATE. 87 YOF FELL IN SHOWER. DX: RHABDOMYOLYSIS. 93 YOF FELL IN SHOWER AT ASSISTED LIVING. DX: L DISTAL HUMERUS FX. 79 YOM FELL IN SHOWER. DX: A FIB W/RAPID VENTRICULAR RESP, SYNCOPE, SDH, SAH, ELEVATED INR. 84 YOF FELL WHILE GETTING OUT OF BATHTUB SUSTAINING A FRACTURE TO HER LUMBAR SPINE 90 YOF SLIPPED IN BATHTUB AND GRAZED HEAD ON SHELF AT ASSISTED LIVING. DX: R KNEE STRAIN W/POSS INTERNAL DERANGEMENT, CLOSED HEAD INJURY. 82 YOF WITH NO INJ FROM FALL IN TUB 85 YOM WITH NO IN, FELL IN BATHTUB, ADMITTED FOR OTHER REASONS 52 YOM W/ALS FELL AND BECAME STUCK BETWEEN TOILET AND TUB. DX: RHABDOMYOLYSIS STATUS POST FALL, NASAL FX. 95 YOF FELL IN SHOWER SUSTAINING CHEST CONTUSION 71 YOF SLIPPED AND FELL IN SHOWER. DX: SYNCOPE, LARGE HEAD LAC, COAGULOPATHY, HYPOKALEMIA, LONT QT, ALCO 79 YOF FELL IN SHOWER SUSTAINING A FRACTURED KNEE 87 YOF WITH RIB FRACTURE FROM FALL IN TUB 79 YOM WITH LOWER BACK STRAIN FROM FALL IN SHOWER 81 YOF TURNED IN SHOWER AND FELL SUSTAINING A FRACTURED HIP 97 YOF FELL IN THE SHOWER AT NURSING HOME. DX: TRAUMATIC SDH, AGGITATION. 70 YOF FELL IN SHOWER AT HOME AND WAS UNABLE TO GET UP, SUSTAINED CHI, BACK CONTUSIONS 88 YOF FELL AGAINST BATHTUB AND WALL AT ASSISTED LIVING. DX: BACK/SHOUL PX, SYNCOPE, STAGE I THORACIC DECUBITUS ULCER, MULT OLD THORACIC FX'S. 88 YOF SLIPPED ON WET FLOOR GETTING OUT OF SHOWER AT NURSING HOME. DX: BACK CONT, PNEUMONIA, HYPOXEMIA, PLEURAL EFFUSION. 41YOF WITH NO INJURIES FROM FALL IN SHOWER, WAS ADMITTED 83 YOM FELL IN THE SHOWER. DX: TRAUMATIC ICH, FACIAL LAC, CONCUSSION W/O LOC, RENAL FAILURE. 94 YOM FELL GETTING OUT OF THE SHOWER AND HIT HEAD SUSTAINING A LACERATION 79 YOM FELL ON SIDE OF BATHTUB. DX: SYNCOPE, CHEST WALL CONT. 55 YOM SLIPPED AND FELL IN BATHTUB. DX: R HEMOTHORAX/PNEUMOTHORAX, MULT R RIB FX'S. 86 YOF FELL BACKWARDS INTO BATHTUB & HIT HEAD AT HOME DX: LACERATION TO SCALP/ ACUTE DEHYDRATED 95 YOF TRIPPED OVER THROW RUG WHILE GETTING INTO SHOWER AT HOME DX; AVULSION TO FACE/ MALIGNANT HYPERTENSION 53 YOF SLIPPED IN SHOWER AND FELL HITTING HIP ON TOILET AT HOME DX: STRAINED RIGHT HIP/ UNCONTROLABLE DIABETES

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18.7.1.6

Drills shall be conducted quarterly on each shift to familiarize facility personnel (nurses, interns,maintenance engineers, and administrative staff) with the signals and emergency actionrequired under varied conditions. Drills shall be conducted monthly so a fire drill is held at leastonce between 6 am to 2 pm (dayshift), once between 2 pm to 10 pm (evening) and oncebetween 10 pm to 6 am (overnight) each quarter.



101_PC38.pdf NFPA 101 Public Comment No. 38



Health care facilities no longer have the tradition 7:00 am – 3:00 pm, 3:00 pm -11:00 pm and 11:00 pm – 7:00 am shifts. A “shift” in a modern health care facility covers many different time frames; some employees are part time and work 4 hour shifts while others might be on 10 hour shifts. This will insure drills are spread out.



Organization: NFPA 101 on Health Care Occupancies

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Public Comment No. 38-NFPA 101-2013 [ Section No. 18.7.1.6 ]

18.7.1.6

Drills shall be conducted quarterly on each shift to conducted to familiarize facility personnel(nurses, interns, maintenance engineers, and administrative staff) with the signals and emergencyaction required under varied conditions. Drills shall be conducted monthly so a fire drill is held atleast once between 6 am to 2 pm (dayshift), once between 2 pm to 10 pm (evening) and oncebetween 10 pm to 6 am (overnight) each quarter. .






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Committee Statement

CommitteeAction:

Rejected but held

Resolution: The subject is new material that was not raised during the First Draft and must beheld.





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18.7.3.3 *

Where required by the authority having jurisdiction, a floor plan shall be provided to indicate thelocation of all required means of egress corridors in smoke compartments having spaces notseparated from the corridor by partitions.

18.7.3.4 Fire-rated door assemblies shall be inspected and tested in accordance with 8.3.3.13.


The proposed language provides a direct reference to the Chapter 8 for fire door assembly inspection and testing requirements. The PI will help ensure health care occupancies are aware of the fire door inspection and testing requirement.



Public Input No. 325-NFPA 101-2015 [New Section after 19.7.3.3]




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19.1.6.2 *

Any building of Type I(442), Type I(332), Type II(222), or Type II(111) construction shall bepermitted to include roofing systems involving combustible or non-fire-rated steel supports,decking, or roofing, provided that all of the following criteria are met:

(1) The roof covering shall meet Class C requirements in accordance with ASTM E 108,Standard Test Methods for Fire Tests of Roof Coverings, or ANSI/UL 790, Test Methodsfor Fire Tests of Roof Coverings.

(2) The roof shall be separated from all occupied portions of the building by a noncombustiblefloor assembly that includes not less than 2 1⁄2 in. (63 mm) of concrete or gypsum fill.

(3) The attic or other space shall be either unoccupied or protected throughout by anapproved automatic sprinkler system.

(4) The attic or other space shall be protected throughout by an approved automaticsprinkler system where non-fire-rated steel supports are used.


There are existing facilities with roofing systems that have a combination of combustible as well as non-fire-rated steel supports used in the construction. Facilities have been cited for non-fire-rated steel and have been given the option of replacing the steel with wood or providing fire proofing on the steel. Accepting this proposal would allow the existing non-fire-rated steel to remain in place provided that the attic space is sprinkler protected. It is expected that non-fire-rated steel protected by sprinklers will provide an equivalent or greater level of safety than wood (combustible construction) without sprinkler protection, which is presently permitted by 19.1.6.2.


Submitter Full Name: Peter Larrimer

Organization: US Department of Veterans Affa

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Submittal Date: Mon Jan 26 08:41:34 EST 2015


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Public Input No. 426-NFPA 101-2015 [ New Section after 19.2.2.2.5.2 ]

TITLE OF NEW CONTENT

(6) Hardware for new electric lock installations is listed in accordance with ANSI/UL 294,Standard for Access Control System Units .


Recommend adding the requirement for hardware for electrical locking systems to listed to UL 294, as is currently required per 7.2.1.5.6 for electrically controlled egress door assemblies.



Public Input No. 425-NFPA 101-2015 [New Section after 18.2.2.2.5.2]


Submitter Full Name: JOHN WOESTMAN

Organization: KELLEN

Affilliation: Builders Hardware Manufacturers Association (BHMA)

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19.2.2.2.5.2*

Door-locking arrangements shall be permitted where patient special needs require specializedprotective measures for their safety, provided that all of the following are met:

(1) Staff can readily unlock doors at all times in accordance with 19.2.2.2.6.

(2) A total (complete) smoke detection system is provided throughout the locked space inaccordance with 9.6.2.9, or locked doors can be remotely unlocked at an approved,constantly attended location within the locked space.

(3)



(6) Activation of the smoke detection system required by 19.2.2.2.5.2(2)

(7) Waterflow in the automatic sprinkler system required by 19.2.2.2.5.2(3)

(8) Door locking devices shall be manually reset at the door or within the locked area.



101_PC37.pdf NFPA 101 Public Comment 37.



This proposal would add a requirement that locking devices (typically by electronic means) be manually reset either at the door or from a location within the locked area. This helps ensure that the doors remain unlocked until staff participates in the relocking process. Many of these locking systems reset as soon as the initiating signal is gone (from the fire alarm panel). In health care facilities the staff should initiate relocking; it should not be done through software programming or hardware configurations.




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* The building is protected throughout by an approved, supervised automatic sprinklersystem in accordance with 19.3.5.7.


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Public Comment No. 37-NFPA 101-2013 [ Section No. 19.2.2.2.5.2 ]

19.2.2.2.5.2 *

Door-locking arrangements shall be permitted where patient special needs require specializedprotective measures for their safety, provided that all of the following are met:

(1) Staff can readily unlock doors at all times in accordance with 19.2.2.2.6 .

(2) A total (complete) smoke detection system is provided throughout the locked space inaccordance with 9.6.2.9 , or locked doors can be remotely unlocked at an approved,constantly attended location within the locked space.

(3)



(a) Activation of the smoke detection system required by 19.2.2.2.5.2 (2)

(b) Waterflow in the automatic sprinkler system required by 19.2.2.2.5.2 (3)

(6) (6) Door locking devices shall be manually reset at the door or within the locked area.


This proposal would add a requirement that locking devices (typically by electronic means) be manually reset either at the door or from a location within the locked area. This helps ensure that the doors remain unlocked until staff participates in the relocking process. Many of these locking systems reset as soon as the initiating signal is gone (from the fire alarm panel). In health care facilities the staff should initiate relocking; it should not be done through software programming or hardware configurations.




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Committee Statement

Committee Action: Rejected but held

Resolution: The subject was not raised during the First Revision phase and must be held.

* The building is protected throughout by an approved, supervised automatic sprinklersystem in accordance with 19.3.5.1 .


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19.2.3.4

(6) Stored egress devices or equipment may encroach on the required corridor width by 4.5inches on one side of the corridor.


Health care occupancies use these devices as part of the emergency egress plan . This new paragraph will allow the storage of these devices and equipment close to the area of use.




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19.2.3.4*

Any required aisle, corridor, or ramp shall be not less than 48 in. (1220 mm) in clear widthwhere serving as means of egress from patient sleeping rooms, unless otherwise permitted byone of the following:

(1) Aisles, corridors, and ramps in adjunct areas not intended for the housing, treatment, oruse of inpatients shall be not less than 44 in. (1120 mm) in clear and unobstructed width.

(2)

(3) Exit access within a room or suite of rooms complying with the requirements of 19.2.5shall be permitted.

(4) Projections into the required width shall be permitted for wheeled equipment andevacuation aides , provided that all of the following conditions are met:

(5) The wheeled equipment does not reduce the clear unobstructed corridor width toless than 60 in.(1525 mm).


(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

(17)

(18)

(19)


* Where corridor width is at least 6 ft (1830 mm), noncontinuous projections not morethan 6 in. (150 mm) from the corridor wall, above the handrail height, shall be permitted.










50 ft 2 (4.6 m 2 ).




The smoke compartment is protected throughout by an approved, supervisedautomatic sprinkler system in accordance with 19.3.5.8 .


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currently there is no provision to allow evacuation aides to be stored in the stairwell or corridor. since these are used for the same primary purpose of the corridor (i.e. evacuation / relocation / movement of patients) there shouldn't be anything that prohibits them from being located in the corridor.




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Submittal Date: Fri Jun 26 00:39:23 EDT 2015


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(A)

Travel distance between any point in a sleeping suite and an interior exit access door toanother suite, an interior exit access corridor door, or a horizontal exit door from that suite shallnot exceed 100 ft (30 m).






PIs clarify suite travel distancerequirements







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(A)

Travel distance within a non-sleeping suite to an interior exit access door to another suite, aninterior exit access corridor door, or a horizontal exit door from the suite shall not exceed 100 ft(30 m).














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19.3.2.5.3*


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Within a smoke compartment, where residential or commercial cooking equipment is used toprepare meals for 30 or fewer persons, one cooking facility shall be permitted to be open to thecorridor, provided that all of the following conditions are met:

(1) The portion of the health care facility served by the cooking facility is limited to 30 bedsand is separated from other portions of the health care facility by a smoke barrierconstructed in accordance with 19.3.7.3, 19.3.7.6, and 19.3.7.8.

(2) The cooktop or range is equipped with a standard residential range hood of a width atleast equal to the width of the cooking surface, with grease baffles or other grease-collecting and clean-out capability .

(3)

(4) The hood systems hoods that are not ducted to the exterior additionally have a charcoalfilter to remove smoke and odor.

(5) The cooktop or range complies with all of the following:

(6) The cooktop or range is protected with a fire suppression system listed inaccordance with

ANSI/UL 300, Standard for Fire Testing of Fire Extinguishing Systems for Protection ofCommercial Cooking Equipment , or is tested and meets

(a) all requirements of UL 300A, Extinguishing System Units for Residential Range TopCooking Surfaces , in accordance with the applicable testing document's scope.

(b) A manual release of the extinguishing system is provided in accordance withSection 10.5 of NFPA 96, Standard for Ventilation Control and Fire Protection ofCommercial Cooking Operations .

An interlock is

(a) A shutoff shall be provided to turn off all sources of fuel and electrical power to thecooktop or range when the suppression system is activated.

(7)

(8) Deep-fat frying is prohibited.

(9) Portable fire extinguishers in accordance with NFPA 96 are located in all kitchen areas.

(10)

(11)

(12)

(13)

(14) Procedures for the use, inspection, testing, and maintenance of the cooking equipmentare in accordance with Chapter 11 of NFPA 96 and the manufacturer’s instructions arefollowed.

(15)

* The residential hood systems shall have a minimum airflow of 500 cfm (14,000L/min) capable of exhausting vapors under normal residential stove top cooking .

* The use of solid fuel for cooking is prohibited.

* A switch meeting all of the following is provided:

A locked switch, or a switch located in a restricted location, is provided within thecooking facility that deactivates the cooktop or range.

The switch is used to deactivate the cooktop or range whenever the kitchen is notunder staff supervision.

The switch is on a timer, not exceeding a 120-minute capacity, that automaticallydeactivates the cooktop or range, independent of staff action.

* Not less than two AC-powered photoelectric smoke alarms with battery backup,interconnected in accordance with 9.6.2.10.3, and equipped with a silence feature arelocated not closer than 20 ft (6.1 m) and not further than 25 ft (7.6 m) from the cooktop or


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(16)

(17)

(18)

(19)

(20)

(21)

(22)

(23) System smoke detectors that are required to be installed in corridors or spaces open tothe corridor by other sections of this chapter are not used to meet the requirements of19.3.2.5.3 (11) and are located not closer than 25 ft (7.6 m) to the cooktop or range.

(24) The smoke compartment is protected throughout by an approved, supervised automaticsprinkler system in accordance with Section 9.7.


Please see the statement from PI 87


Submitter Full Name: PAUL ROUSE

Organization: GUARDIAN SFTY SOLUTIONS INTL

Street Address:

City:

State:

Zip:

Submittal Date: Tue May 12 12:19:28 EDT 2015

range.

* The smoke alarms required by 19.3.2.5.3 (11) are permitted to be located outside thekitchen area where such placement is necessary for compliance with the 20 ft (7.6 m)minimum distance criterion.

* A single system smoke detector is permitted to be installed in lieu of the smoke alarmsrequired in 19.3.2.5.3 (11) provided the following criteria are met:

The detector is located not closer than 20 ft (6.1 m) and not further than 25 ft (7.6m) from the cooktop or range.

The detector is permitted to initiate a local audible alarm signal only.

The detector is not required to initiate a building-wide occupant notification signal.

The detector is not required to notify the emergency forces.

The local audible signal initiated by the detector is permitted to be silenced andreset by a button on the detector or by a switch installed within 10 ft (3.0 m) of thesystem smoke detector.


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19.3.6.1 Corridor Separation.


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Corridors shall be separated from all other areas by partitions complying with 19.3.6.2 through19.3.6.5 (see also 19.2.5.4), unless otherwise permitted by one of the following:

(1) Smoke compartments protected throughout by an approved supervised automaticsprinkler system in accordance with 19.3.5.8 shall be permitted to have spaces that areunlimited in size and open to the corridor, provided that all of the following criteria are met:

(2)

(3) The corridors onto which the spaces open in the same smoke compartment areprotected by an electrically supervised automatic smoke detection system inaccordance with 19.3.4 , or the smoke compartment in which the space is located isprotected throughout by quick-response sprinklers.

(4) The open space is protected by an electrically supervised automatic smokedetection system in accordance with 19.3.4 , or the entire space is arranged andlocated to allow direct supervision by the facility staff from a normally occupiednurses’ station or similar space.


(6) In smoke compartments protected throughout by an approved, supervised automaticsprinkler system in accordance with 19.3.5.8, waiting areas shall be permitted to be opento the corridor, provided that all of the following criteria are met:

(7) The aggregate waiting area in each smoke compartment does not exceed 600 ft 2

(55.7 m 2 ).

(8) Each area is protected by an electrically supervised automatic smoke detectionsystem in accordance with 19.3.4 , or each area is arranged and located to allowdirect supervision by the facility staff from a normally occupied nursing station orsimilar space.


(10)

(11) Gift shops not exceeding 500 ft2 (46.4 m2) shall be permitted to be open to the corridor orlobby, provided that one of the following criteria is met:

(12) The building is protected throughout by an approved automatic sprinkler system inaccordance with Section 9.7 .

(13) The gift shop is protected throughout by an approved automatic sprinkler system inaccordance with Section 9.7 , and storage is separately protected.

(14) Limited care facilities in smoke compartments protected throughout by an approved,supervised automatic sprinkler system in accordance with 19.3.5.8 shall be permitted tohave group meeting or multipurpose therapeutic spaces open to the corridor, provided thatall of the following criteria are met:

(15) The space is not a hazardous area.

(16) The space is protected by an electrically supervised automatic smoke detectionsystem in accordance with 19.3.4 , or the space is arranged and located to allowdirect supervision by the facility staff from the normally occupied nurses’ station or

* The spaces are not used for patient sleeping rooms, treatment rooms, orhazardous areas.

* This requirement shall not apply to spaces for nurses’ normally occupied nurses’stations.


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similar location.


(18) Cooking facilities in accordance with 19.3.2.5.3 shall be permitted to be open to thecorridor.

(19) Spaces, other than patient sleeping rooms, treatment rooms, and hazardous areas, shallbe permitted to be open to the corridor and unlimited in area, provided that all of thefollowing criteria are met:

(20) The space and the corridors onto which it opens, where located in the same smokecompartment, are protected by an electrically supervised automatic smoke detectionsystem in accordance with 19.3.4 .

(21)


(23)

(24)

(25)

(26)

(27) Group meeting or multipurpose therapeutic spaces, other than hazardous areas, that areunder continuous supervision by facility staff shall be permitted to be open to the corridor,provided that all of the following criteria are met:

(28) Each area does not exceed 1500 ft 2 (139 m 2 ).

(29) Not more than one such space is permitted per smoke compartment.

(30) The area is equipped with an electrically supervised automatic smoke detectionsystem in accordance with 19.3.4 .



One of the arrangements where the Code permits areas in health care occupancies to be non-separated from exit access corridors without being provided with smoke detection is in nurses' stations or nursing stations. It is becoming more common in the design of health care occupancies to provided satellite nurses' stations which may not be occupied during specific hours. The exception for the omission of smoke detection should not pertain to satellite nurses' stations which are not normally occupied as there would not be early detection in these areas during "off" hours. This PI should apply to existing satellite nurses' stations since early detection is not provided in an area not separated from the corridor.

* Each space is protected by automatic sprinklers, or the furnishings andfurniture, in combination with all other combustibles within the area, are of suchminimum quantity and arrangement that a fully developed fire is unlikely to occur.

* Waiting areas shall be permitted to be open to the corridor, provided that all of thefollowing criteria are met:

Each area does not exceed 600 ft 2 (55.7 m 2 ).

The area is equipped with an electrically supervised automatic smoke detectionsystem in accordance with 19.3.4 .

The area does not obstruct any access to required exits.


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The clearance between the meeting edges of doors swinging in pairs shall not exceed 3/16 in.(4.77 mm) if meeting edge protection is not provided.


A minimum clearance between the leaves of smoke resistive pairs of doors should be provided, such as is provided for doors in fire barriers, to ensure that doors are capable of resisting the passage of smoke.



Organization: Koffel Associates, Inc

Affilliation: Self

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Public Input No. 284-NFPA 101-2015 [ Sections 19.3.6.3.5, 19.3.6.3.6, 19.3.6.3.7

]

Sections 19.3.6.3.5, 19.3.6.3.6, 19.3.6.3.7

19.3.6.3.5*

Doors shall be provided with a means for keeping the door closed that is acceptable to theauthority having jurisdiction, and the following requirements also shall apply:

(1) The device used shall be capable of keeping the door fully closed if a force of 5 lbf (22 N)is applied at the latch leading edge of the door.

(2) Roller latches shall be prohibited on corridor doors in buildings not fully protected by anapproved automatic sprinkler system in accordance with 19.3.5.7.

19.3.6.3.6

The requirements of 19.3.6.3.5 shall not apply where otherwise permitted by either of thefollowing:

(1) Doors to toilet rooms, bathrooms, shower rooms, sink closets, and similar auxiliary spacesthat do not contain flammable or combustible materials shall not be required to complywith 19.3.6.3.5.

(2) Existing roller latches demonstrated to keep the door closed against a force of 5 lbf (22 N)shall be permitted to be kept in service.

19.3.6.3.7

Powered doors that comply with the requirements of 7.2.1.9 shall be considered as complyingwith the requirements of 19.3.6.3.5, provided that both of the following criteria are met:

(1) The door is equipped with a means for keeping the door closed that is acceptable to theauthority having jurisdiction.

(2) The device used is capable of keeping the door fully closed if a force of 5 lbf (22 N) isapplied at the latch leading edge of a swinging door and applied in any direction to asliding or folding door, whether or not power is applied.


The current requirement states that a force must be provided at the "latch" edge of the door, while the requirement is providing an alternative to having a latch on the door. Change it to say leading edge, rather than latch edge, further clarifies that these doors are not required to latch if they can be kept closed with a force of 5 lbf.



Organization: Koffel Associates

Affilliation: Self

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19.3.6.5.3 Shutters protecting openings shall be automatic closing upon detection of smoke byapproved smoke detectors in accordance with NFPA 72 National Fire Alarm and SignalingCode .


In order to limit the transfer of smoke an opening provided with a shutter must close upon smoke detector activation and not merely a fusible link. The new language will provide direction on how to install a shutter in a smoke partition to avoid problems during commissioning.



Public Input No. 302-NFPA101-2015 [New Section after8.4.3.5]

PI 302 is related to smoke partitions and this PI is forcorridors which limit the transfer of smoke in health careoccupancies

Public Input No. 303-NFPA101-2015 [New Section after18.3.6.5.2]

PI 303 is for new health care occupanies and this PI is forexisting health care occupancies




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19.3.7.1

Smoke barriers shall be provided to divide every story used for sleeping rooms for more than 30patients into not less than two smoke compartments (see 19.2.4.4), and the following also shallapply:

(1) The size of any such smoke compartment shall not exceed 22,500 ft2 (2100 m2) grossfloor area (See 3.3.21.2.1) , and the travel distance from any point to reach a door in therequired smoke barrier shall not exceed 200 ft (61 m).

(2) Where neither the length nor width of the smoke compartment exceeds 150 ft (46 m), thetravel distance to reach the smoke barrier door shall not be limited.

(3) The area of an atrium separated in accordance with 8.6.7 shall not be limited in size.


The Code does not clearly state if the area of a smoke zone is net or gross area. The gross calculation as described in Chapter 3 clearly states how to measure the area.




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19.3.7.1


(1) The size of any such smoke compartment shall comply with one of the following:

(2) Smoke compartments shall not exceed 22,500 ft 2 (2100 m 2 )

, and the travel

(a) or

(b) Where permitted by 18.3.7.1, smoke compartments without patient sleeping roomsor smoke compartments where all sleeping rooms are configured for only one patient

shall not exceed 40,000 ft 2 (3720 m 2 ).

(3) The travel distance from any point to reach a door in the required smoke barrier shall notexceed 200 ft (61 m).




For several years there has been discussion over the appropriate size of a healthcare occupancy smoke compartment. During the last NFPA 101 cycle, the Second draft report contained language that would have increased the maximum size of smoke compartments to 40,000 sf for hospitals and kept the size at 22,500 sf for nursing homes and limited care facilities. This change was overturned by a Certified amending motion at the technical hearing by a narrow margin. Based on the testimony received, there appeared to be concern over this increase in size for a multitude of reasons.

There was concern over the lack of technical substantiation for the change. This was balanced with questions of the origin of the existing language and the technical basis for arriving at 22,500 sf. There was concern that the increase in smoke compartment size resulted in a reduction in passive protection that placed too much reliance on sprinkler systems. The response to this concern was that healthcare facilities have robust active and passive systems even with the increase. In addition, they have the benefit of well trained staff that act as immediate responders as well as frequently and rigorous inspections by state licensing, federal certification and third party accreditation agencies - all of which verify that the existing systems and practices are being appropriately maintained. There was concern relating to the fire history of healthcare occupancies: recent NFPA reports of fire data healthcare occupancies still show deaths in healthcare occupancies. The 2nd draft attempted to deal with this concept by allowing only hospitals to increase smoke compartment size. Hospitals have a much better fire history than nursing homes and limited care facilities.

There was concern that other countries do not have the infrastructure to ensure that water mains and sprinkler systems would reliably work and that hospital staff would be trained appropriately to be the immediate responders. These concerns highlight the importance of the "total concept" approach that


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NFPA has fostered since the early 1950's. If there is not a united approach to active system, passive systems, staff training and regulatory oversight - there is a higher risk of failure. If any adopting jurisdiction knows that one of the these components will reliably fail, that adopting jurisdiction should be able to amend the rule according to the special needs of that jurisdiction. There was the point that hospitals operational needs are driving larger, single-occupant patient rooms and which have less risk, while compartment size is not changing. The challenge to this argument was that the proposed language took a one-size-fits-all approach to compartment size and did not take into account the variables of facilities who might choose to perpetuate smaller, double occupancy rooms.

Regardless of the point, there was a counterpoint to every argument in this discussion. The major contributors to this debate committed to discussing the issue further in hopes of uncovering better data and reaching common ground. A separate egress study was procured, unfortunately the study was limited and the results were inconclusive. However, the proponents of this change were able to reach an agreement that we believe resolves the major concerns of the parties involved:

1. Focus the increase of smoke compartment size to hospitals only.2. Only allow the increase to 40,000 sf to smoke compartments that have single occupancy sleeping rooms -or- smoke compartments without patient sleeping rooms.3. Allow the use of suites (which might contain multiple sleeping rooms) in all smoke compartments. However, limit those smoke compartments that contained multiple patient sleeping rooms (whether they be inside of a suite or outside of a suite ) to 22,500 sf. Sleeping suites with only single occupancy sleeping rooms would be permitted to be in a 40,000 sf smoke compartment.4. Clarify that arrangements for single- vs. multiple-occupancy rooms is intended to be by design, rather than administrative decision. Thus we have used the term “configured for single patient occupancy”.

Note that the text regarding the travel distance requirement was separated into it’s own line item to reduce the amount of text in this change. No technical change to the travel distance requirement was intended. Also, we wanted to clarify that existing smoke compartments that want to take advantage of the larger size must comply with the requirements of chapter 18.3.7.1. We are hopeful that the committee will look favorably at this change as we believe it represent the consensus of many of the interested parties.


Submitter Full Name: JOHN WILLIAMS

Organization: Washington State Department of Health

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19.3.7.1


(1) The size of any such smoke compartment shall not exceed 22,500 ft2 (2100 m2), and thetravel distance from any point to reach a door in the required smoke barrier shall notexceed 200 ft (61 m).

(2) The size of any such smoke compartment shall not exceed 40,000 ft 2 (3716 m 2 ), andthe travel distance from any point to reach a door in the required smoke barrier shall notexceed 200 ft (61 m), in smoke compartments that contain no sleeping rooms with morethan one patient in each room in hospitals.




This proposed change is linked to a similar change in 18.3.7.1. The effect of this change would be both to allow hospitals constructed with smoke compartments of up to 40,000 SF to remain and to allow existing hospitals to be altered to have larger smoke compartments if the smoke compartment has no semi-private sleeping rooms or wards. Note that this wording also allows larger smoke compartments where the smoke compartment has no sleeping rooms, in the theory that evacuating such a smoke compartment is relatively easy compared to a smoke compartment with sleeping rooms. In either case, the travel distance to a smoke barrier has not changed from 200 feet.



Public Input No. 453-NFPA101-2015 [Section No. 18.3.7.1]

Ensures new construction does not becomenon-complying after construction is complete.




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19.7.1.6

Drills shall be conducted quarterly on each shift to familiarize facility personnel (nurses, interns,maintenance engineers, and administrative staff) with the signals and emergency actionrequired under varied conditions. Drills shall be conducted monthly so a fire drill is held at leastonce between 6 am to 2 pm (dayshift), once between 2 pm to 10 pm (evening) and oncebetween 10 pm to 6 am (overnight) each quarter.



101_PC39.pdf NFPA 101 Public Comment 39.



Health care facilities no longer have the tradition 7:00 am – 3:00 pm, 3:00 pm -11:00 pm and 11:00 pm –7:00 am shifts. A “shift” in a modern health care facility covers many different time frames; some employees are part time and work 4 hour shifts while others might be on 10 hour shifts. This will insure drills are spread out.




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Public Comment No. 39-NFPA 101-2013 [ Section No. 19.7.1.6 ]

19.7.1.6

Drills shall be conducted quarterly on each shift to conducted to familiarize facility personnel(nurses, interns, maintenance engineers, and administrative staff) with the signals and emergencyaction required under varied conditions. Drills shall be conducted monthly so a fire drill is held atleast once between 6 am to 2 pm (dayshift), once between 2 pm to 10 pm (evening) and oncebetween 10 pm to 6 am (overnight) each quarter.






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Committee Statement

CommitteeAction:

Rejected but held

Resolution: The subject is new material that was not raised during the First Draft and must beheld.





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19.7.3.4 Fire-rated door assemblies shall be inspected and tested in accordance with 8.3.3.13.


The proposed language provides a direct reference to the Chapter 8 for fire door assembly inspection and testing requirements. The PI will help ensure health care occupancies are aware of the fire door inspection and testing requirement.



Public Input No. 324-NFPA101-2015 [Section No. 18.7.3.3]

Both PIs are for health care occupancy fire door assemblyinspection and testing reference to chapter 8 requirements




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19.7.5.7.1

Soiled linen or trash collection receptacles shall not exceed 32 gal (121 L) in capacity and shallmeet all of the following requirements:

(1) The average density of container capacity in a room or space shall not exceed 0.5 gal/ft2

(20.4 L/m2).

(2) A capacity of 32 gal (121 L) shall not be exceeded within any 64 ft2 (6 m2) area innon-sprinklered buildings .

(3)

(4) Container size and density shall not be limited in hazardous areas.


AHJ are currently requiring the separation of containers by 8'. Some areas in the Hospital like the lab benefit from having different types of disposal bins in the same area. These bins are under 32 gallons but are within 64 square feet of each other. By making this a requirement in non- sprinkler buildings, it will allow for better spatial planning (especially in older structures) and provide associates with the correct options to properly dispose of items.


Submitter Full Name: TONY ECHAZABAL

Organization: MARTIN MEMORIAL MED CTR

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Submittal Date: Tue Mar 31 15:51:46 EDT 2015

* Mobile soiled linen or trash collection receptacles with capacities greater than 32 gal(121 L) shall be located in a room protected as a hazardous area when not attended.


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20.1.3.3

Sections of ambulatory health care facilities shall be permitted to be classified as otheroccupancies, provided that they meet both of the following conditions:

(1) They are not intended to serve ambulatory health care occupants for purposes oftreatment or customary access by patients incapable of self-preservation.

(2) They are separated from areas of ambulatory health care occupancies by constructionhaving a minimum 1-hour fire resistance rating.

(3) The requirement of 20.1.3.3(2) shall not apply to ambulatory health careoccupancies located with a health care occupancy.


Ambulatory health care occupancies and health care occupancies are often intermingled within hospitals. Currently the Code does not specifically allow ambulatory health care occupancies to be located within a health care occupancy without providing a 1-hour fire resistance rated occupancy separation. The safeguards required by health care occupancies are sufficient to permit ambulatory health care occupancies to be located within health care occupancies.



Public Input No. 318-NFPA 101-2015 [Section No. 21.1.3.3]




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Type your content here ..

20.2.2.2.5.2 * Door-locking arrangements shall be permitted where patient special needsrequire specialized protective measures for their safety, provided that all of the following criteriaare met:

(1)

Staff can readily unlock doors at all times in accordance with 20 .2.2.2.6 .

(2)

A total (complete) smoke detection system is provided throughout the locked space inaccordance with 9.6.2.9 , or locked doors can be remotely unlocked at an approved,constantly attended location within the locked space.

(3) *

The building is protected throughout by an approved, supervised automatic sprinklersystem in accordance with 9.7 .

(4)

The locks are electrical locks that fail safely so as to release upon loss of power to thedevice.

(5)

The locks release by independent activation of each of the following:

(a)

Activation of the smoke detection system required by 20 .2.2.2.5.2 (2)

(b)

Waterflow in the automatic sprinkler system required by 20 .2.2.2.5.2 (3)

20.2.2.2.6 Doors that are located in the means of egress and are permitted to be lockedunder other provisions of 20 .2.2.2.5 shall comply with both of the following:

(1)

Provisions shall be made for the rapid removal of occupants by means of one of thefollowing:

(a)

Remote control of locks from within the locked smoke compartment

(b)


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Keying of all locks to keys carried by staff at all times

(c)

Other such reliable means available to the staff at all times

(2)

Only one locking device shall be permitted on each door.


Infant abduction and emergency department security area a concern in ambulatory health care occupancies as well as in health care occupancies. The locking provisions proposed offer safeguards for life safety during a fire event or similar emergency. Staff in ambulatory health care occupancies are also highly trained and capable of responding during a fire event. An infant should be afforded the same security whether born in a hospital or an ambulatory health care facility.



Public Input No. 289-NFPA 101-2015 [New Section after A.20.2.2.2.4]




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20.3.4.3.3

Where facilities are required to be subdivided into smoke compartments, fire alarm notificationzones shall coincide with one or more smoke compartment boundaries or shall be inaccordance with the facility fire plan.


The proposed text currently exists as a requirement as Paragraph 15.7.4.3.1 in NFPA 99-2015. The primary reason for submitting the Public Input is to correlate with NFPA 99. It should be noted that a similar Public Input has been submitted to NFPA 99 to delete the requirement for ambulatory health care occupancies.



Public Input No. 168-NFPA 101-2015 [New Section after A.20.3.2.3]




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Public Input No. 342-NFPA 101-2015 [ New Section after 20.5.4 ]









20.5.5.3.2 Grab bars shall be designed and constructed to the structural loading conditions inSection 4.5 of ASCE/SEI 7. [In NFPA 5000 this reference is stipulated in Section 35.6.5.1.]




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21.1.3.3 *

Sections of ambulatory health care facilities shall be permitted to be classified as otheroccupancies, provided that they meet both of the following conditions:

(1) They are not intended to serve ambulatory health care occupants for purposes oftreatment or customary access by patients incapable of self-preservation.

(2) They are separated from areas of ambulatory health care occupancies by constructionhaving a minimum 1-hour fire resistance rating.

(3) The requirement of 21.1.3.3(2) shall not apply to ambulatory health careoccupancies located with health care occupancies.


Ambulatory health care occupancies and health care occupancies are often intermingled within hospitals. Currently the Code does not specifically allow ambulatory health care occupancies to be located within a health care occupancy without providing a 1-hour fire resistance rated occupancy separation. The safeguards required by health care occupancies are sufficient to permit ambulatory health care occupancies to be located within health care occupancies.



Public Input No. 317-NFPA101-2015 [Section No.20.1.3.3]

PI 317 applies to new ambulatory health care occupanciesand this PI applies to existing ambulatory health careoccupancies




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Type your content here ...

21.2.2.2.5.2 * Door-locking arrangements shall be permitted where patient special needsrequire specialized protective measures for their safety, provided that all of the following aremet:

(1)

Staff can readily unlock doors at all times in accordance with 21 .2.2.2.6 .

(2)

A total (complete) smoke detection system is provided throughout the locked space inaccordance with 9.6.2.9 , or locked doors can be remotely unlocked at an approved,constantly attended location within the locked space.

(3) *

The building is protected throughout by an approved, supervised automatic sprinklersystem in accordance with 9.7

(4)

The locks are electrical locks that fail safely so as to release upon loss of power to thedevice.

(5)

The locks release by independent activation of each of the following:

(a)

Activation of the smoke detection system required by 21 .2.2.2.5.2 (2)

(b)

Waterflow in the automatic sprinkler system required by 21 .2.2.2.5.2 (3)

21.2.2.2.6 Doors that are located in the means of egress and are permitted to be lockedunder other provisions of 21 .2.2.2.5 shall comply with all of the following:

(1)

Provisions shall be made for the rapid removal of occupants by means of one of thefollowing:

(a)

Remote control of locks

(b)


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Keying of all locks to keys carried by staff at all times

(c)

Other such reliable means available to the staff at all times

(2)

Only one locking device shall be permitted on each door.

(3)

More than one lock shall be permitted on each door, subject to approval of theauthority having jurisdiction.


Infant abduction and emergency department security are a concern in ambulatory health care occupancies as well as in health care occupancies. The locking provisions proposed offer safeguards for life safety during a fire event or similar emergency. Staff in ambulatory health care occupancies are also highly trained and capable of responding during a fire event. An infant should be afforded the same security whether born in a hospital or an ambulatory health care occupancy. Existing text in Chapter 21 will be required to be renumbered and relocated.



Public Input No. 291-NFPA 101-2015 [New Section after A.21.2.2.2.4]




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Public Input No. 166-NFPA 101-2015 [ New Section after A.18.3.4.3.1(2) ]

A.18.3.4.3.3.2

It is not the intent of this paragraph to require fire alarm system zones to coincide with smokecompartment boundaries, provided that the facility fire plan addresses the differences betweenfire alarm system zones and building smoke compartments.


If the Public Input revising 18.3.4.3.3.2 to be consistent with NFPA 99-2015, then the Annex note should be added as well.



Public Input No. 169-NFPA 101-2015 [Section No.18.3.4.3.3.2]

This is an Annex not to the revisedparagraph.




Affilliation: Self

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Public Input No. 358-NFPA 101-2015 [ New Section after A.18.5.2.3(2)(e) ]

A.18.5.5 The grab bars required in this section are designed to improve safety of showeringand bathing by ambulatory users, typically entering and exiting a bath, bathtub-showercombination or shower facility for showering while standing or for other forms of bathing whichcan entail transition to/from a crouching or sitting position. The second sentence of thisrequirement is intended to make sure that grab bars, if provided voluntarily—i.e., asnon-required —for dedicated showers, must meet the requirements of the section—so thatsomething appearing to be a grab bar can effectively perform as one. However such grab barswould only be considered non-required in the case of dedicated showers not involving misstepand fall dangers addressed by 7.1.6.2 and 7.1.6.4. This means that walking surfaces must be atleast as safe, in terms of underfoot conditions, as any other portion of the means of egress(where, for example, handrails are not required) for users not having mobility disabilities. Thiswould require exceptionally careful choice, and maintenance, of underfoot materials as well asvery effective control of water within and adjacent to the dedicated shower facility.

For grab bar requirements appropriate for other uses and users, especially users withdisabilities, refer to requirements in ICC ANSI A117.1, Standard for Accessible and UsableBuildings and Facilities. Generally, the grab bars specified for this Code will not interfere withother grab bars installed in accordance with requirements of ICC ANSI A117.1 and they cancontribute to meeting the requirements of ICC ANSI A117.1 and vice versa. For example,combination vertical and horizontal grab bars (in an L configuration), as addressed by ICC ANSIA117.1, can meet the requirements of this Code for a vertical grab bar. Similarly requirementsfor a horizontal grab bar on the back wall are compatible.

Dimensions for height of grab bars are based on typical, mass-produced bathtubs with a wallheight, above the finished floor of about 15 inches (380 mm) and the bottom of the bathtubwithin an inch or two of the finished floor elevation. Adjustments to stipulated grab bar heightlimits and ranges, referenced to the bath tub rim, should be considered for bath tubs havinghigher walls, and thus rim heights, above the bottom of the tub and, possibly, also the wallheight above the finished floor. ICC ANSI A117.1 references grab bar height dimensions to thebathtub rim and, for consistency with this widely used ANSI standard, that convention ismaintained in this Code.

A.18.5.5.1.1 Grab bars located where they interfere with sealing, with a shower curtain, againstescape of water—especially to the floor surface outside the shower facility—might introducesafety problems in the form of greatly reduced slip resistance of the walking surface (whichcould violate this Code). This is avoided with a 6-inch, horizontal separation between the showercurtain rod and the grab bar. It is assumed that other forms of water control, such as an installedenclosure, will not interfere with the use of grab bars.

A.18.5.5.2 A free-standing pole, satisfying requirements for a grab bar, can offer much flexibilityin placement, for example, within the close quarters of a small bathroom where there is a watercloset adjacent to the bathing facility and a single grab bar can serve both facilities. Where thebathing facility is free standing, without walls, especially with large soaking tubs, including thoseon pedestals, the vertical pole-type grab bar is especially useful. The pole also can solve fixingproblems with walls that are nonexistent or difficult to use for installing conventional,wall-mounted grab bars.

A.18.5.5.2.1 Using the mid points of the distance ranges and the minimum distance from thecontrol end wall results in a 45-degree angle for the diagonal grab bar. Such a diagonal grab bar(or alternatively, a horizontal grab bar fairly similar to the option provided by 18.5.5.2.1 whichmeets requirements of ICC ANSI A117.1) was found suitable in tests performed of several grabbar options with 103 independent-living seniors with average age of 70. (“Evaluation of OptimalBath Grab Bar Placement for Seniors,” by H. Sveistrup, D. Lockett, N. Edwards and F.


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Aminzadeh, University of Ottawa with funding by Canada Mortgage and Housing Corporation,2003.)

A . 18.5.5.3.1 The best performing grab bars are in the middle third of the permitted range forcircular diameter. For some grab bar designs, with undulations and other surface geometryfeatures to improve slip resistance for users’ hands, these dimensions will be nominal with smallvariations depending on where measurements are taken. Children and others with smallerhands will be able to use best the diameters within the lower part of the permitted range. Whenusing a free-standing pole for a grab bar, structural considerations, especially for stiffness, mightdictate using diameters in the upper part of the permitted range.

Note that a maximum clearance between the grab bar and an adjacent surface is specified. Withgrab bars, especially horizontal ones, on which large, downward loads are imposed by the armsof users, there is some concern about people’s hands slipping into the clear space; however thiscan occur even with an absolute 1.5 inch (38 mm) clearance, as some standards specify andmost grab bar designs provide. Thus the main difference in the end result is where, along itslength, the arm gets wedged behind the grab bar, not the complete prevention of this happeningat all.


The Annex notes provide clarification and helpful information generally about the requirements some of which could entail some judgment (for example, with different bath tub lengths and heights). Further justification is provided in the outline justification and supplementary justification information provided with the base text to which these notes relate. Clarification is also provided about the closest ANSI standard addressing some of the same issues, ANSI A117.1 for which an effort was made to avoid conflicting requirements.





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Public Input No. 320-NFPA 101-2015 [ New Section after A.18.7.5.7.1(3) ]

A.18.7.5.7.1(2) Figure A.18.7.5.7.1(2) indicates the 64 ft² area that should be measured.



LSC_64_ft.pdf


The existing requirement of “within any 64 ft² area” causes confusion. Any 64 ft² area could be an area 1 ft wide and 64 ft in length. It is often interpreted that the existing requirement is intended to be enforced in an 8 ft by 8 ft area and the figure provides guidance for compliance.



Public Input No. 321-NFPA 101-2015 [New Section after A.19.7.5.6(5)]






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Public Input No. 321-NFPA 101-2015 [ New Section after A.19.7.5.6(5) ]




LSC_64_ft.pdf





Public Input No. 320-NFPA 101-2015 [New Section afterA.18.7.5.7.1(3)]

PIs seek to clarify 64 ft²area

Public Input No. 322-NFPA 101-2015 [New Section afterA.20.7.5.4(4)]





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Public Input No. 289-NFPA 101-2015 [ New Section after A.20.2.2.2.4 ]



A.20.2.2.2.5.2 Pediatric units, maternity units, and emergency departments are examples ofareas where patients might have special needs that justify door locking. Door lockingarrangements should be permitted to reduce the risk of abduction of infants and children whoare patients.


This annex note is provided for guidance for which type of units the security provisions should apply.



Public Input No. 288-NFPA 101-2015 [New Section after 20.2.2.2.5]




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Public Input No. 168-NFPA 101-2015 [ New Section after A.20.3.2.3 ]

A.20.3.4.3.3

It is not the intent of this paragraph to require fire alarm system zones to coincide with smokecompartment boundaries, provided that the facility fire plan addresses the differences betweenfire alarm zones and building smoke compartment boundaries.


Correlation with NFPA 99-2015 if the related Public Input is approved.







Affilliation: Self

Street Address:

City:

State:

Zip:



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Public Input No. 359-NFPA 101-2015 [ New Section after A.20.4.3 ]

A.20.5.5 The grab bars required in this section are designed to improve safety of showeringand bathing by ambulatory users, typically entering and exiting a bath, bathtub-showercombination or shower facility for showering while standing or for other forms of bathing whichcan entail transition to/from a crouching or sitting position. The second sentence of thisrequirement is intended to make sure that grab bars, if provided voluntarily—i.e., asnon-required —for dedicated showers, must meet the requirements of the section—so thatsomething appearing to be a grab bar can effectively perform as one. However such grab barswould only be considered non-required in the case of dedicated showers not involving misstepand fall dangers addressed by 7.1.6.2 and 7.1.6.4. This means that walking surfaces must be atleast as safe, in terms of underfoot conditions, as any other portion of the means of egress(where, for example, handrails are not required) for users not having mobility disabilities. Thiswould require exceptionally careful choice, and maintenance, of underfoot materials as well asvery effective control of water within and adjacent to the dedicated shower facility.



A.20.5.5.1.1 Grab bars located where they interfere with sealing, with a shower curtai n,against escape of water—especially to the floor surface outside the shower facility—mightintroduce safety problems in the form of greatly reduced slip resistance of the walking surface(which could violate this Code). This is avoided with a 6-inch, horizontal separation between theshower curtain rod and the grab bar. It is assumed that other forms of water control, such as aninstalled enclosure, will not interfere with the use of grab bars.


A.20.5.5.2.1* Using the mid points of the distance ranges and the minimum distance from thecontrol end wall results in a 45-degree angle for the diagonal grab bar. Such a diagonal grab bar(or alternatively, a horizontal grab bar fairly similar to the option provided by 20.5.5.2.1 whichmeets requirements of ICC ANSI A117.1) was found suitable in tests performed of several grabbar options with 103 independent-living seniors with average age of 70. (“Evaluation of OptimalBath Grab Bar Placement for Seniors,” by H. Sveistrup, D. Lockett, N. Edwards and F.


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Aminzadeh, University of Ottawa with funding by Canada Mortgage and Housing Corporation,2003.)

A . 20.5.5.3.1* The best performing grab bars are in the middle third of the permitted range forcircular diameter. For some grab bar designs, with undulations and other surface geometryfeatures to improve slip resistance for users’ hands, these dimensions will be nominal with smallvariations depending on where measurements are taken. Children and others with smallerhands will be able to use best the diameters within the lower part of the permitted range. Whenusing a free-standing pole for a grab bar, structural considerations, especially for stiffness, mightdictate using diameters in the upper part of the permitted range.








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Public Input No. 291-NFPA 101-2015 [ New Section after A.21.2.2.2.4 ]



A.21.2.2.2.5.2 Pediatric units, maternity units, and emergency departments are examples ofareas where patients might have special needs that justify door locking. Door lockingarrangements should be permitted to reduce the risk of abduction of infants and children whoare patients.


Annex note details the units that the security provisions pertain.







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19.3.4.5.3 * Nursing Homes.

An approved automatic smoke detection system shall be installed in corridors throughoutsmoke compartments containing patient sleeping rooms and in spaces open to corridors aspermitted in nursing homes by

Detecton in Patient Sleeping Rooms. Approved smoke detection shall be provided in allpatient sleeping rooms

19.3.

6.1, unless otherwise permitted by one of the following:

Corridor systems shall not be required where each patient sleeping room is protected by anapproved smoke detection system.

Corridor systems shall not be required where patient room doors are equipped with automaticdoor-closing devices with integral smoke detectors on the room side installed in accordancewith their listing, provided that the integral detectors provide occupant notification

4.5.3.1 Patient room smoke detectors shall be connected to the building fire alarm system forsupervision and notification

19.3.4.5.3.2* Patient room smoke detectors shall be allowed to provide Positive AlarmSequence or Presignal Feature as per NFPA 72 Chapter 23 .



NFPA_5000_19_3_4_5_Patient_Rm_SD_PI_FINAL.pdfSubstantiation of 5000 19.3.4.5 and background information


This Public Input seeks early warning smoke detection coverage in healthcare patient rooms. Within all national model building and fire codes, smoke detection is required to provide the minimum level of life safety in all sleeping areas. Healthcare is the only area in our nation today that does not provide this level of early warning and life safety. An historic review would show that patient rooms in the past were deemed to not need smoke detection because of the room configuration and direct line of sight with nurses and nursing stations. Staffing has been at a very competent level in the healthcare industry as a general rule.

This Public Input addresses new construction of hospitals and our healthcare patient rooms. In most cases going forward patient rooms are single patient, with all the amenities of a home bedroom with the added risk of flammable gases and extensive electrical monitoring and medical equipment. The concept of a staffed “nurse’s station” is changing to where attendant on duty may no longer have direct visual and audible awareness of the early development of an electrical or other fire within the room of a patient. As a result, a staff attendant at a nurse’s station may not a capable of responding in a time critical manner to the early developments of a fire in a patient’s room.Early warning smoke detection with the required automatic fire sprinkler protection is needed for the minimum level of life safety for our sick, medicated and those receiving medical attention in our healthcare facilities.

This Public Input would delete the requirement for corridor smoke detection in Nursing Homes with


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smoke detection in each patient room.

Today’s system connected smoke detection is advanced and is immune to activation by deceptive phenomenon which in past caused unwanted alarms. Multi-criteria and multi-sensor detection technology has risen to provide reliable, fast responding early warning detection that also reduces the testing and maintenance costs with the level of technology that is standard.

Key areas of change within healthcare facilities• Increased prevalence of infection prevention isolation areas. {source: SFPE Fire Protection Engineering, Issue 65-2015; Healthcare and Fire Safety}o ABHR Alcohol Based Hand Rub units are in the patient rooms; these are typically flammable liquids and can contribute to smoke/fire and its spread. o Patient rooms often have anterooms that divide them from the main rooms, providing areas for smoke to collect in the patient room and not being seen from the corridor. (figure B)• Move towards residential setting. Patient rooms including those in nursing homes are moving towards a more comfortable residential setting that allows patients to hang more combustible items on their walls, and furniture from the home setting. As mentioned above the vast majority is single patient and some are apartment-like. The advancements and use of fire sprinklers has allowed this action, but the hazard for smoke/fire has increased with this movement. • Early warning detection is needed-same as in our homes.Fire-Loss of Life Incidents:• Good news is that loss of life has been the lowest in years; this can be attributed to fire sprinklers, fire detection/alarm and the excellent staff response in our legacy healthcare facilities. As outlined throughout this report, the risk for fire occurrence, injury and death is increasing. • Fire (2012) at North Carolina hospital kills one patient, injures three. http://usnews.nbcnews.com/_news/2012/11/06/14969895-fire-at-north-carolina-hospital-kills-one-patient-injures-three?liteo Fire was apparently caused by use of an electronic defibrillator in a patient room• Between 2004 and 2006, there was an average of 6,400 fires in medical facilities each year that were respon¬sible for approximately 5 civilian fire deaths, 175 injuries, and $34 million in property loss annually.1 Medical facilities include hospitals, clinics, infirmaries, and other facilities that provide care to the sick and injured. Fires in these buildings2 can be particularly dangerous due to the presence of oxygen and other flammable substances and the challenge of evacu¬ating patients who may not be ambulatory. https://www.usfa.fema.gov/downloads/pdf/statistics/v9i4.pdf• Fires in health care facilities Report: NFPA's "Fires in Health Care Facilities"o In 2006-2010, U.S. fire departments responded to an estimated average of 6,240 structure fires in or on health care properties per year. These fires caused an average of six civilian deaths, 171 civilian injuries and $52.1 million in direct property damage annually.


Submitter Full Name: VINCE BACLAWSKI

Organization: NEMA

Street Address:

City:

State:

Zip:



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2018 EDITION OF NFPA 5000 (BLD-HEA)

Patient Room Smoke Detection PUBLIC INPUT (PI)

BLD-HEA Proposed Text of Public Input: 19.3.4.5 Detection. 19.3.4.5.1 General. Detection systems, where required, shall be in accordance with Section 9.6. 19.3.4.5.2 Detection in Spaces Open to Corridors. See 18.3.6.1. 19.3.4.5.3* Nursing Homes. An approved automatic smoke detection system shall be installed in corridors throughout smoke compartments containing patient sleeping rooms and in spaces open to corridors as permitted in nursing homes by 18.3.6.1, unless otherwise permitted by one of the following:

(1) Corridor systems shall not be required where each patient sleeping room is protected by an approved smoke detection system. (2) Corridor systems shall not be required where patient room doors are equipped with automatic door-closing devices with integral smoke detectors on the room side installed in accordance with their listing, provided that the integral detectors provide occupant notification.

19.3.4.5.3* Detection in Patient Sleeping Rooms. Approved smoke detection shall be provided in all patient sleeping rooms. 19.3.4.5.3.1 Patient room smoke detectors shall be connected to the building fire alarm system for supervision and notification. 19.3.4.5.3.2* Patient room smoke detectors shall be allowed to provide Positive Alarm Sequence or Presignal Feature as per NFPA 72 Chapter 23.

BLD-HEA Statement of Problem and Substantiation of Public Input:

This Public Input seeks early warning smoke detection coverage in healthcare patient rooms. Within all national model building and fire codes, smoke detection is required to provide the minimum level of life safety in all sleeping areas. Healthcare is the only area in our nation today that does not provide this level of early warning and life safety. An historic review would show that patient rooms in the past were deemed to not need smoke detection because of the room configuration and direct line of sight with nurses and nursing stations. Staffing has been at a very competent level in the healthcare industry as a general rule. This Public Input addresses new construction of hospitals and our healthcare patient rooms. In most cases going forward patient rooms are single patient, with all the amenities of a home bedroom with the added risk of flammable gases and extensive electrical monitoring and medical equipment. The concept of a staffed “nurse’s station” is changing to where attendant on duty may no longer have direct visual and audible awareness of the early development of an electrical or other fire within the room of a patient. As a result, a staff attendant at a nurse’s station may not a capable of responding in a time critical manner to the early developments of a fire in a patient’s room.

Page 282 of 316

Early warning smoke detection with the required automatic fire sprinkler protection is needed for the minimum level of life safety for our sick, medicated and those receiving medical attention in our healthcare facilities. This Public Input would delete the requirement for corridor smoke detection in Nursing Homes with smoke detection in each patient room. Today’s system connected smoke detection is advanced and is immune to activation by deceptive phenomenon which in past caused unwanted alarms. Multi-criteria and multi-sensor detection technology has risen to provide reliable, fast responding early warning detection that also reduces the testing and maintenance costs with the level of technology that is standard.

Key areas of change within healthcare facilities

Increased prevalence of infection prevention isolation areas. {source: SFPE Fire Protection

Engineering, Issue 65-2015; Healthcare and Fire Safety}

o ABHR Alcohol Based Hand Rub units are in the patient rooms; these are typically

flammable liquids and can contribute to smoke/fire and its spread.

o Patient rooms often have anterooms that divide them from the main rooms, providing

areas for smoke to collect in the patient room and not being seen from the corridor.

(figure B)

Move towards residential setting. Patient rooms including those in nursing homes are moving

towards a more comfortable residential setting that allows patients to hang more combustible

items on their walls, and furniture from the home setting. As mentioned above the vast majority

is single patient and some are apartment-like. The advancements and use of fire sprinklers has

allowed this action, but the hazard for smoke/fire has increased with this movement.

Early warning detection is needed-same as in our homes.

Fire-Loss of Life Incidents:

Good news is that loss of life has been the lowest in years; this can be attributed to fire

sprinklers, fire detection/alarm and the excellent staff response in our legacy healthcare

facilities. As outlined throughout this report, the risk for fire occurrence, injury and death is

increasing.

Fire (2012) at North Carolina hospital kills one patient, injures three.

http://usnews.nbcnews.com/_news/2012/11/06/14969895-fire-at-north-carolina-hospital-kills-

one-patient-injures-three?lite

o Fire was apparently caused by use of an electronic defibrillator in a patient room

Page 283 of 316



Between 2004 and 2006, there was an average of 6,400 fires in medical facilities each year that

were responsible for approximately 5 civilian fire deaths, 175 injuries, and $34 million in

property loss annually.1 Medical facilities include hospitals, clinics, infirmaries, and other

facilities that provide care to the sick and injured. Fires in these buildings2 can be particularly

dangerous due to the presence of oxygen and other flammable substances and the challenge of

evacuating patients who may not be ambulatory.


Fires in health care facilities Report: NFPA's "Fires in Health Care Facilities"

o In 2006-2010, U.S. fire departments responded to an estimated average of 6,240

structure fires in or on health care properties per year. These fires caused an average of

six civilian deaths, 171 civilian injuries and $52.1 million in direct property damage

annually.

Supporting Research: Performance of Smoke Detectors and Sprinklers in Residential and Health-Care

Occupancies, James A. Milke, Ph.D., P.E., University of Maryland, May 14, 2010

http://www.afaa.org/pdf/Performance%20of%20Smoke%20Detectors%20and%20Sprinklers%20in%20R

esidential%20and%20Healthcare%20Facilities.pdf

Summary

The relative role of smoke alarms and sprinklers has been demonstrated in numerous recent research investigations. The trend in all of the studies is that smoke alarms respond prior to residential or sprinklers and thus have the capability of providing the earliest warning of a fire to building occupants. While responding later, sprinklers provide the additional function of fire suppression to limit the development of hazardous conditions.

From the analysis of NFIRS fire incident data in this study, the proportion of fires judged to be too small for operation of the smoke detectors was appreciably fewer those for sprinklers in all three occupancy groups analyzed. The following table summarizes the results.

Proportion of Fire Incidents Judged to be Too Small for Operation

Smoke Detectors

Non-sprinklered

property

Sprinklered

Property

Sprinklers

1- and 2-family

dwelling

13.1 12.8 38.9

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http://www.nfpa.org/~/media/files/research/nfpa-reports/occupancies/oshealthcarefacilities.pdf?as=1&iar=1&la=en



Commercial

residential

9.7 10.8 54.2

Health-care 11.4 17.8 65.4

The fact that fewer fires are judged to be too small for smoke detector operation than sprinklers, especially when both are present in sprinklered buildings, reflects the faster response capabilities of smoke detectors.

While Bill’s (Bill, Robert, 1990) following quote on the benefit of smoke detectors was relative to an experimental program for hotel rooms, the comment is applicable to a wide variety of occupancies, as reflected in the variety of experimental and statistical indications:

“The role of smoke detectors in life safety has also been clearly shown. Smoke detectors warn room occupants in either fast-growing or smoldering fires while the room environment is such that an occupant can easily escape. Moreover, the warning occurs when the fire is small. Thus, the fire may possibly be extinguished without intervention of sprinklers.”

The need for warning while the fire is small is reflected in the casualty statistics for those fires which are judged too small for smoke detector and sprinkler activation. Even for these “small” fires, some casualties do occur.

Nonetheless, where fire control is provided by sprinklers, rather than extinguishment, the environment following sprinkler operation is not pristine. This is caused by a decrease in the efficiency of the combustion process caused by the water application from sprinklers on burning fuels. In such instances, the generation of carbon monoxide increases during fire control. In addition, light obscuration becomes very significant throughout the room of origin, especially in small rooms. Such small rooms are characteristic of residences and health care facilities.

As such, having both smoke alarms and sprinklers has significant advantages. With smoke alarms providing the early indication of fires, this permits people to evacuate (or be evacuated if assistance is needed) prior to the response of sprinklers. In this way, people can evacuate prior to the potential loss of visibility in the room of origin (and thus find their way most easily without encountering obstructions) and not be subjected to the increase in carbon monoxide (and other gases produced from incomplete combustion).

Conclusion:

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Our healthcare system is changing; our patient rooms in hospitals and nursing homes are changing.

They contain the same level, if not greater fire safety risks as our homes, dormitories, hotels and all

sleeping areas that are protected by Early Warning Smoke Detection. It is time for our patients in our

new healthcare facilities to have the level of safety. Smoke detection and Fire Sprinklers will save lives in

our healthcare patient rooms. Smoke detection in our patient rooms is the right fire life safety action to

take.

Figure A Figure B

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19.5.5.3.2 Grab bars shall be designed and constructed to the structural loading conditions inSection 4.5 of ASCE/SEI 7 as stipulated in Section 35.6.5.1.



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From a public health perspective, the injuries are only one aspect of harm; the other is reduced use (and fear of use) of baths/showers and stairs; this affects well being, fitness, and health generally. The societal costs of the injuries alone is on the order of 100 billion dollars per year in the USA and other


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health implications could be comparable in order of magnitude.







Affilliation: Myself and Linda Strobl, Public Health Nurse, Ontario.

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Public Input No. 155-NFPA 5000-2015 [ New Section after 20.5.4 ]









20.5.5.3.2 Grab bars shall be designed and constructed to the structural loading conditions inSection 4.5 of ASCE/SEI 7 as stipulated in Section 35.6.5.1.




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Affilliation: Myself and Linda Strobl, Public Health Nurse, Ontario.

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Public Input No. 162-NFPA 5000-2015 [ New Section after A.19.5.2.3(2)(e) ]


A.19.5.5 The grab bars required in this section are designed to improve safety of showeringand bathing by ambulatory users, typically entering and exiting a bath, bathtub-showercombination or shower facility for showering while standing or for other forms of bathing whichcan entail transition to/from a crouching or sitting position. The second sentence of thisrequirement is intended to make sure that grab bars, if provided voluntarily—i.e., asnon-required —for dedicated showers, must meet the requirements of the section—so thatsomething appearing to be a grab bar can effectively perform as one. However such grab barswould only be considered non-required in the case of dedicated showers not involving misstepand fall dangers addressed by 11.1.6.2 and 11.1.6.4. This means that walking surfaces must beat least as safe, in terms of underfoot conditions, as any other portion of the means of egress(where, for example, handrails are not required) for users not having mobility disabilities. Thiswould require exceptionally careful choice, and maintenance, of underfoot materials as well asvery effective control of water within and adjacent to the dedicated shower facility.





A.19.5.5.2.1 Using the mid points of the distance ranges and the minimum distance from thecontrol end wall results in a 45-degree angle for the diagonal grab bar. Such a diagonal grab bar(or alternatively, a horizontal grab bar fairly similar to the option provided by 19.5.5.2.1 whichmeets requirements of ICC ANSI A117.1) was found suitable in tests performed of several grab


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bar options with 103 independent-living seniors with average age of 70. (“Evaluation of OptimalBath Grab Bar Placement for Seniors,” by H. Sveistrup, D. Lockett, N. Edwards and F.Aminzadeh, University of Ottawa with funding by Canada Mortgage and Housing Corporation,2003.)









Street Address:

City:

State:

Zip:



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Public Input No. 163-NFPA 5000-2015 [ New Section after A.20.4.3 ]


A.20.5.5 The grab bars required in this section are designed to improve safety of showeringand bathing by ambulatory users, typically entering and exiting a bath, bathtub-showercombination or shower facility for showering while standing or for other forms of bathing whichcan entail transition to/from a crouching or sitting position. The second sentence of thisrequirement is intended to make sure that grab bars, if provided voluntarily—i.e., asnon-required —for dedicated showers, must meet the requirements of the section—so thatsomething appearing to be a grab bar can effectively perform as one. However such grab barswould only be considered non-required in the case of dedicated showers not involving misstepand fall dangers addressed by 11.1.6.2 and 11.1.6.4. This means that walking surfaces must beat least as safe, in terms of underfoot conditions, as any other portion of the means of egress(where, for example, handrails are not required) for users not having mobility disabilities. Thiswould require exceptionally careful choice, and maintenance, of underfoot materials as well asvery effective control of water within and adjacent to the dedicated shower facility.





A.20.5.5.2.1 Using the mid points of the distance ranges and the minimum distance from thecontrol end wall results in a 45-degree angle for the diagonal grab bar. Such a diagonal grab bar(or alternatively, a horizontal grab bar fairly similar to the option provided by 20.5.5.2.1 whichmeets requirements of ICC ANSI A117.1) was found suitable in tests performed of several grab


431 of 479 7/7/2015 12:51 PMPage 315 of 316

bar options with 103 independent-living seniors with average age of 70. (“Evaluation of OptimalBath Grab Bar Placement for Seniors,” by H. Sveistrup, D. Lockett, N. Edwards and F.Aminzadeh, University of Ottawa with funding by Canada Mortgage and Housing Corporation,2003.)









Street Address:

City:

State:

Zip:



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