Implementing NFPA 101 in hospitals

NFPA 101: Life Safety Code is a reference used for strategies to protect people based on building construction, protection, and occupancy features that minimize the effects of fire and related hazards. It is the only document that covers life safety in both new and existing structures.


  • This article has been peer-reviewed.Understand NFPA 101: Life Safety Code and its impact on new and existing buildings. 
  • Learn about NFPA 101 in reference to hospitals and health care facilities.
  • Know what changes to expect in the 2018 edition of NFPA 101.

NFPA 101: Life Safety Code is a reference document often adopted as part of a state or local fire code. Regardless of adoption, many design professionals use NFPA 101 for strategies to protect people based on building construction, protection, and occupancy features that minimize the effects of fire and related hazards.

NFPA 101 provides a minimum set of requirements intended to provide a reasonable level of life safety from fire and similar emergencies. The scope of the 2018 edition has been expanded to include hazardous materials, injuries from falls, and emergency communications. NFPA 101 is also unique in that it covers life safety for both new and existing structures more comprehensively than many other codes. For most occupancy classifications, there are separate chapters for new and existing buildings and the code is intended to be applied to existing buildings in a retrospective manner.

Figure 1: In hospitals, like this one, it is frequently difficult to evacuate the occupants due to the evacuation capability of the occupants. NFPA 101 addresses these situations. Courtesy: Koffel AssociatesMission critical facilities

Life safety is critical for all occupancies. With respect to mission critical facilities, this will focus on facilities in which it is difficult to evacuate the occupants due to the evacuation capability of the occupants, such as hospitals. Other facilities addressed include those that need to continue to operate during a fire emergency (health care, detention and correctional facilities, etc.). With respect to such facilities, the engineer often finds increased requirements for building construction, compartmentation, and fire protection systems.

NFPA 101 does not include minimum requirements for the height and area of a building based upon construction type for all occupancies, but rather tends to limit such requirements to those occupancies in which evacuation times are expected to be longer (i.e., assembly occupancies, like a theater) or those occupancies in which the emergency procedures are likely to involve the relocation of the occupants instead of evacuation of the building (i.e., health care occupancies).

For example, the construction of a new multistory hospital is limited to noncombustible building construction types (referred to as Type I and Type II as defined in NFPA 220: Standard on Types of Building Construction), and the structural frame is required to have a fire-resistance rating of 1 hour or more (see NFPA 101 Table Health care occupancies use a “defend-in-place” strategy and as such, from the perspective of life safety of the occupants, the integrity of the structural system is more critical than it might be for other occupancies. Because the code anticipates that other regulatory requirements, such as a building code, will address structural-integrity issues associated with property protection and the safety of first responders, building construction need not be restricted for all occupancies.

The construction requirements also may extend beyond the structural frame. In health care occupancies, both new and existing, NFPA 101 requires that non-load-bearing partitions in buildings of Type I and Type II construction be of noncombustible or limited-combustible materials. Whereas fire-retardant-treated wood does not meet the definition of noncombustible or limited combustible, the code specifically permits fire-retardant-treated wood having a required fire-resistance rating of 2 hours or less and only when not part of a shaft enclosure.

With respect to compartmentation, one is likely to find increased requirements for the separation of mission critical occupancies from other occupancies in the same building and increased requirements for smoke compartmentation. For buildings containing multiple occupancies, NFPA 101 contains two options: separated uses or mixed occupancies. The typical separation requirement for mission critical facilities, when the separated-occupancy option is chosen, is a 2-hour fire barrier.

Alternatively, the design professional may choose to provide no separation, in which case the more restrictive requirements of the occupancies involved apply. This is broader than what might be found in some other codes that require the more restrictive requirements for building construction types and fire protection systems, but do not include egress requirements.

Smoke compartmentationFigure 2: Most mission critical facilities are required to have a fire alarm system and a sprinkler system regardless of the number of occupants or the size of the building. Courtesy: Koffel Associates

Smoke compartmentation occurs when a building is separated into two or more smoke compartments for the purpose of facilitating the horizontal relocation of the occupants to an area separated from the fire area by smoke barriers. In many cases, such separation may be adequate and no further relocation is required once the occupants are relocated to another smoke compartment. If smoke does migrate into adjacent smoke compartments, the smoke barrier provides additional time for further relocation either horizontally or vertically.

One occupancy in which smoke barriers are commonly used is health care occupancies. The 2018 edition of NFPA 101 has increased the maximum area of a smoke compartment from 22,500 sq ft to 40,000 sq ft for new hospitals and some existing hospitals. However, one limiting factor that was not revised is the travel distance to the smoke barrier door from any point in a smoke compartment, which is still restricted to 200 ft. This travel distance is measured to the doors in the smoke compartment regardless of whether there are doors to the outside or exit stairs within the smoke compartment.

The philosophy for not recognizing exits as a means to meet this requirement is that staff may be more reluctant to move the patients outside or vertically (such as via elevator); therefore, such features do not provide the same benefit as provided by a smoke compartment. The reluctance may be due to the need to continue to provide medical care, due to a weather event, or because of the physical challenges in moving patients vertically.

The increase in the maximum area of smoke compartments for hospitals is based on the fact that design requirements for new hospitals result in increased use of single-patient sleeping rooms and larger treatment areas. In fact, the NFPA 101 Technical Committee was provided with some space-planning studies illustrating the increase in area required to provide patient care in hospitals. When the area for various functions is increased, a larger smoke compartment size does not necessarily translate into more patients being exposed to a fire in the compartment of origin. To limit the application of the increased area to such facilities, the code requires that the larger smoke compartments be limited to those involving single-patient sleeping rooms and suites.

While fire alarm and sprinkler system requirements are found in all occupancy chapters, the threshold as to when such systems are required in mission critical facilities is much lower than in other building types, such as offices. In fact, most mission critical facilities will be required to have a fire alarm system and a sprinkler system regardless of the number of occupants or the size of the building.

When designing a fire protection system for such occupancies, the design professional needs to recognize that the code contains requirements that may be more specific for mission critical facilities than is required by the applicable reference standard. For example, the zoning of a fire alarm system may need to be consistent with the smoke compartmentation or emergency plan for the mission critical facility. Even if not explicitly required by the code, such zoning may be essential for the proper operation of the facility during a fire emergency.

Another example of a more restrictive requirement is the operation of automatic closing doors. Although NFPA 72: National Fire Alarm and Signaling Code allows this function to be on a door-by-door basis, NFPA 101 requires that all automatic closing doors in a health care occupancy that are within a smoke compartment will automatically close upon detection of smoke within that smoke compartment.

Alternatively, the system may be designed to close all automatic closing doors throughout the facility. There also may be some unique considerations in life safety mission critical facilities that need to be addressed regarding occupant notification. One option may be to use the private operating-mode option contained in NFPA 72, which is designed to notify the staff necessary to implement the emergency plan and not necessarily all occupants. The code also may allow for alternative occupant-notification concepts.

For example, NFPA 101 permits the omission of audible alarm-notification appliances in critical care areas of health care occupancies due to the need to hear patient monitor alarms. The 2018 edition of NFPA 99: Health Care Facilities Code expands this provision by allowing the occupant notification to be based on the results of a risk assessment. There are areas of a hospital, such as a neonatal intensive care unit (NICU), in which traditional alarm-notification appliances requirements (audible and visual) may present a risk to the patients that needs to be addressed using an alternative compliance strategy.

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