System for Fire Safety Evaluation of Health Care Facilities

The Fire Safety Evaluation System (FSES) for Health Care Facilities [1] was the first of a series of FSES documents covering a variety of types of occupancies including apartment buildings [2], prisons and jails [3], office and laboratory buildings [4], overnight accommodations in National Parks [5], and board and care facilities [6]. These have provided means for meeting or exceeding the level of safety prescribed by the applicable code while providing the designer with a wide range of cost saving and functional options. The FSES’s have been adopted into building codes and similar regulations and have been institutionalized by the establishment of a special technical committee of the National Fire Protection Association (NFPA) charged with the responsibility for Alternative Methods for Life Safety in Buildings. This committee maintains NFPA Standard 101A [8] in support of the FSES’s, thereby ensuring that each FSES remains current and an appropriate reflection of the changing safety levels prescribed by building codes and regulations. This description, however, focuses on the FSES for Health Care Facilities, as a representative sample of the complete series. The FSES for Health Care Facilities was part of a broad fire safety effort sponsored by the Department of Health and Human Service in response to an important need to develop a means for meeting the fire safety objectives of prescribed codes without necessarily being in explicit compliance with the code. In the 1960s, with the birth of the Medicare and Medicaid programs, Congress prescribed conformance with the requirements of the Life Safety Code, National Fire Protection Association Standard 101, in all nursing homes and hospitals receiving funds under those programs. A nation-wide inspection and enforcement program was established to ensure compliance. Most, if not all, inspected facilities were found to be in some degree of non-compliance with the specific requirements of the Life Safety Code. A significant number were closed as a result. Others undertook correction programs. Many, including some of the Nation’s largest and most prestigious hospitals, were declared to fail this safety standard. The FSES for Health Care Facilities was developed to discover alternate solutions, delivering at least an equivalent level of safety as compared to that produced by exact compliance with the detailed prescriptions of the Life Safety Code. In the case of one large hospital complex, the use of the FSES reduced the cost of compliance from an estimated $30 million to $60 million to less than $2 million. Equally important, the development of alternative approaches allowed the improvements to be made without interruption of hospital services. The FSES is a grading system designed to determine the overall level of fire safety of an existing or proposed facility in comparison with a hypothetical facility that exactly matched each requirement of the Life Safety Code. The enclosed figure shows Table 4 and 5 of the FSES for Health Care Facilities. These two tables are the most critical to the evaluation. These tables describe most of the universe of common building factors that determine fire safety, such as type of construction, partitioning and finishes, hazardous activities, fire detection and suppression, and fire alarm systems. For practical considerations, however, factors relating to building utilities, furniture, and emergency procedures are handled elsewhere in the FSES. The levels of parameter values in Table 4 represent the levels of performance that exist in the real world of health care facilities. Some are those required by the code, while others have either more or less impact on safety than the code requirements. The values assigned to each level are dimensionless, developed through consensus and designed to be comparative in relative value in both the evaluation of the levels within a parameter and between parameters. The specific values for each element in a parameter were developed by iteration through three separate Delphi panels. The base scale of measurement was established by these panels with the directive that the most powerful safeguard was assigned a score of 10, and an element that neither added to or detracted from safety was score 0. Using this scale, all other elements were scored with negative numbers representing an element detrimental to life safety and positive numbers representing elements additive to life safety. Computer analysis was used to evaluate all possible permutations. The overall safety of the resulting solutions was then evaluated by the Delphi groups. The iterative process of adjusting parameter element values and appraising the resultant level of safety continued until all of the panels concurred that all solutions indicating a level of fire safety that equaled or exceeded the level provided by rigid conformance with the letter of the code did deliver that indicated level of safety.