How are hospital fire and life safety systems being designed differently?

Hospitals and health care facilities are changing and their fire and life safety systems must transform with them

By Consulting-Specifying Engineer December 9, 2021
Courtesy: Christopher Barrett, Henderson


  • Mark Chrisman, PE, PhD, Healthcare Practice Director, Principal, Henderson Engineers, Lenexa, Kansas 
  • Mike Fialkowski, PE, RCDD, LEED AP, Technology Services Market Leader, Affiliated Engineers Inc, Madison, Wisconsin 
  • Zach Frasier, PE, Mechanical Engineer, Moses Engineering, Gainesville, Florida 
  • Steve Lutz, PE, LEED AP, Associate Director, Harris, St. Paul, Minnesota 

Mark Chrisman, PE, PhD, Healthcare Practice Director, Principal, Henderson Engineers, Lenexa, Kansas
Mike Fialkowski, PE, RCDD, LEED AP, Technology Services Market Leader, Affiliated Engineers Inc, Madison, Wisconsin
Zach Frasier, PE, Mechanical Engineer, Moses Engineering, Gainesville, Florida
Steve Lutz, PE, LEED AP, Associate Director, Harris, St. Paul, Minnesota

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? 

Mark Chrisman: Particularly when working on existing health care facilities, we encounter unique challenges that include construction types that are no longer permitted, lack of fire sprinkler protection or fire alarm systems, shafts that aren’t properly fire rated or protected and situations that require a waiver or an equivalency. Since each facility is distinct due to its features or staff, the end result of our work may be different. However, the approach we take to resolve issues may be similar across various facilities. It’s why it’s important to have a collaborative team in place as well as field experience in code or life safety in existing facilities. 

How have the trends in fire/life safety changed in hospitals? 

Mark Chrisman: Since American health care facilities are some of the most inspected and regulated buildings in the world, the general level of life safety and staff response remains at a high level. Some past trends in health care facilities have included fire stopping, damper testing, means of egress, as well as challenges with inspection, testing and maintenance documents. As we continue to experience technological changes and focus more on flexibility, more code and standard provisions are being used than in the past.  

For example, fire alarm private mode notification (only requiring visible notification in public areas and audible notification where staff is) has been allowed for a while. But with the recent focus on HCAHPS (including sound levels or annoyances during the patient stay) scores, more and more facilities are asking about using this provision. Most patients are not going anywhere during an evacuation without being assisted by staff, so why notify them or risk a false alarm going off and causing undue stress (we have all heard stories of fire alarm notifications being accidentally activated in the middle of the night). 

The $70 million, 77,000-square-foot University Health 2 (UH2) facility is the newest addition to the University Health hospital system in Kansas City, Missouri. Henderson Engineers provided electrical, fire and life safety, mechanical, plumbing, security and telecom building systems design services on the project. Courtesy: Christopher Barrett, Henderson

What fire, smoke control and security features might you incorporate in these facilities that you wouldn’t see on other projects? 

Mark Chrisman: Due to most patients being incapable of self-preservation (not being able to evacuate without assistance from staff), there are many passive and active life safety features that are provided in health care facilities but do not exist in other building types. These features include additional fire-rated walls, floors and ceilings and more robust fire alarm systems and fire sprinkler systems. Health care facilities also undergo more fire drills and staff training on response plans. All these measures help protect both staff and patients from fire or smoke spreading beyond the room or space of origin. 

Mike Fialkowski: Facility and access control design for health care buildings require many additional considerations during design. These facilities need to consider how doors operate during different times of the day and different operational modes. As an example, access control needs to be flexible to enable a pandemic-mode-capable patient care unit. During normal operation, doors around the unit would be controlled simply to only allow approved access. In pandemic mode, the access control will need to support additional triage at the unit entrance, track who has accessed the area for contact tracing, enable flows from clean spaces to anterooms to treatment to dirty spaces and enforce additional operations specific access layers.  

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

Mark Chrisman: With specific departments dedicated to infants, pediatrics or behavioral health patients, safety for patients and staff is critical. Blending facility-specific safety concerns with fire and life safety (means of egress) requirements can be very tricky, especially when dealing with all the applicable codes, standards and guidelines for health care facilities. When accounting for differences in staff response, facility type and whether fire sprinklers and fire alarm systems are present, there are a number of methods to address the respective needs of a facility and still meet all fire and life safety requirements.  

Once we have an approach approved by staff and the authority having jurisdiction, it’s important to talk through how to we’ll accomplish this delicate balance with hardware, software and all other applicable systems. This is often best approached by involving the appropriate contractors, vendors and manufacturers to make sure an integration will work. 

Mike Fialkowski: It seems elementary, but comprehensive discussions about how automated doors operate need to happen during the design phase. The complexity of the door systems, trade partner responsibilities, operation options, security options and door usage all contribute to acceptable usability and maintainability. “Swipe card to open door” is no longer an acceptable way to specify how the door, door hardware and access control work together. We lead discussions with the design team to document how automated doors work and perform during different operational modes and emergency situations (fire alarm and code blue as an example). These discussions are key to a successful installation.