Designing health care facilities and medical campuses: Fire and life safety

Hospitals, clinics, and similar facilities are among the most demanding an engineer can tackle—technology is evolving rapidly, hospital managers are increasingly budget-conscious, and assist in saving lives. Fire and life safety is also a very important aspect designing these facilities.

By Consulting-Specifying Engineer November 21, 2018


  • Andrew Flanagan, PE, GPD, LEED AP, Associate, Senior Plumbing Engineer, Interface Engineering, Portland, Ore.
  • Mikhail Fuks, PE, HFDP, Engineering Group Leader, P2S Inc., Long Beach, Calif.
  • Gary Hamilton, PE, LEED AP, CxA, EDAC, SASHE, Senior Vice President, WSP, Arlington, Va.
  • Alex Harwell, Client Manager/Project Manager, Dewberry, Raleigh, N.C.
  • Ted Hood, Senior Project Manager, TLC Engineering for Architecture, Brentwood, Tenn.
  • George P. Isherwood, PE, Vice President, Peter Basso Associates Inc., Troy, Mich.
  • Jeremy Jones, PE, LEED AP, EDAC, Healthcare Market Leader, Affiliated Engineers Inc., Chapel Hill, N.C.
  • Brian Kannady, PE, Principal, ME Engineers, Golden, Colo.

CSE: What are some of the unique challenges regarding fire/life safety system design that you’ve encountered for such projects? How have you overcome these challenges?

Jones: We have a hospital expansion project currently in the design phase in Raleigh, N.C., where our local jurisdiction’s fire code language comes from the 2006 International Fire Code. The fact that our building is both a high-rise and a Seismic Category C triggers a requirement for 30 minutes of onsite water storage for fire protection. This equates to almost 60,000 gal. We have very little site area for an aboveground tank, so we have designed an underground cistern under the fire pump room, coupled with a vertical-turbine fire pump. It is a unique arrangement and has required significant coordination with the architect, structural engineer, contractor, and local fire marshal.

CSE: Describe unique security and access-control systems you have specified in such facilities.

Jones: Our major challenges in security and access control are often a result of the competing interests of patient safety and patient security. Two examples that come to mind are behavioral health and infant protection.

  1. In a behavioral health facility, patients are often confined behind locked doors both for their protection and the protection of the staff caring for them. Thoughtful design must be given to the function of that physical security during an emergency, such as a fire. If the code requires a pull station in an area in which behavioral health patients have regular access, can you responsibly install it? Do all doors immediately open if the fire alarm system is activated for any reason? There are significant dangers either way. The appropriate compromise almost always involves some type of delayed egress, but this takes significant understanding and buy-in by both the owner and the AHJ.
  2. Unfortunately, anywhere infants are present, infant abduction is a concern. Multiple levels of infant tracking and additional security are required to prevent this atrocity. If all security doors immediately open when a fire alarm pull station is pulled, a potential criminal could exploit that fact. At the same time, easy exit is required during a legitimate emergency. Similar to behavioral health, delayed egress is almost always the solution, but this adds risk of both types of negative outcomes.

CSE: Mass shootings are an increasing concern. Has that been reflected in your designs for such projects-and if so, how? How has NFPA 3000: Standard for an Active Shooter/Hostile Event Response (ASHER) Program been incorporated into recent designs?

Isherwood: Hospitals that we work on have been designed with some infectious disease isolation rooms that require special ventilation isolation. Hospitals are also discussing and planning for mass tragic events that may have effects on a mass population and how to handle a large volume of human exposure.

CSE: Describe a project that had unique medical gas needs. How did you ensure the NFPA codes/standards were met and that the project met the owner’s project requirements and budget goals?

Jones: We have a hospital expansion project in Raleigh, N.C., where the expansion displaces the existing oxygen farm. This farm serves all the traditional oxygen needs of the facility as well as a set of hyperbaric chambers. Clearly, a hospital’s oxygen system is critical to patient safety and has zero tolerance for downtime. The result on our project was the carefully sequenced installation of a brand-new oxygen farm, remote from the expansion zone. Underground oxygen lines were installed to feed both the existing hospital and the expansion, but these lines had to completely avoid the expansion’s construction zone to eliminate the risk of any damage being done. All of this needed to be permitted, installed, and proven prior to removal of the existing tanks and any construction of the expansion.