THE 2012 EDITION OF THE LIFE SAFETY CODE HOSPITAL EDITION SESSION #5 AGENDA: Ambulatory Health Care & Business Occupancies Definitions / Examples Mixed & Contiguous Occupancies Ambulatory Health Care & Business Occupancies: General Requirements Means of Egress Requirements Protection Requirements Building Services / Operating Features 1
DEFINITIONS / EXAMPLES 12 42: Occupancy Chapters Assembly Educational Day-Care Health Care 20 / 21 Ambulatory Health Care Detention & Correction One- and Two- Family Dwelling Lodging or Rooming Hotels & Dormitory Apartments Residential Board & Care Mercantile 38 / 39 Business Industrial Storage DEFINITIONS / EXAMPLES HEALTHCARE AMBULATORY BUSINESS HEALTHCARE MOST STRINGENT BLEND OF LEAST STRINGENT BUSINESS & HEALTHCARE 2
DEFINITION NFPA & CMS 3.3.188.7 Health Care Provide medical or other treatment or care simultaneously to four or more persons on an inpatient basis. Where such occupants are mostly incapable of self-preservation due to age, physical or mental disability, or because of security measures not under the occupant s control. EXAMPLES 3.3.188.7 Health Care In-Patient Hospital Areas Nursing Homes Skilled Nursing Facilities (SNFs) Inpatient Hospice Limited Care Facilities Psychiatric Facilities Certain Board and Care Facilities 3
DEFINITION NFPA 3.3.188.1 Ambulatory Health Care 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 (New Text) DEFINITION CMS FINAL RULE 3.3.188.1 Ambulatory Health Care Provide services or treatment simultaneously to four or more patients that provides, on an outpatient basis, one or more of the following: PER CMS FINAL RULE: For ambulatory surgery centers (ASC) seeking Medicare reimbursement, CMS considers all ASC providers to be classified as ambulatory care occupancy regardless of the number of patients. 4
EXAMPLES 3.3.188.1 Ambulatory Health Care Ambulatory Surgery Centers Urgent Care Centers Endoscopy Centers Certain End Stage Renal Disease Centers ESRD facilities that are located adjacent to high hazardous occupancies and those facilities that do not exit to the outside at grade level from the patient treatment area. Hospital Outpatient Surgical Departments * Certain Emergency Departments * * = Must be properly separated & not serving certain inpatients DEFINITION NFPA & CMS / EXAMPLES 3.3.188.3 Business An occupancy used for account and record keeping or the transaction of business other than mercantile. Outpatient Clinics (ambulatory) General Offices (finance, HR, etc.) Doctor s Offices Dentist Offices 5
GENERAL REQUIREMENTS (Chapter 18/19 HEALTH CARE) MULTIPLE OCCUPANCIES: Sections of health care occupancies shall be permitted to be classified as other occupancies, provided: They are not intended to provide services simultaneously for four or more inpatients for housing, treatment, or customary access by inpatients incapable of self-preservation. They are separated by a minimum 2hr FRR barrier. For other than previously approved separations, the entire building is sprinklered. Section 19.1.3.3 (1) (Revised Text) GENERAL REQUIREMENTS (Chapter 18/19 HEALTH CARE) CONTIGUOUS OCCUPANCIES: Ambulatory care facilities, medical clinics, & similar facilities that are contiguous to Health Care Occupancies can be classified as Ambulatory Health Care or Business Occupancies provided they are not intended to provide services to four or more health care patients inpatients who are litter borne. Section 19.1.3.4.1 (Revised Text) Ambulatory care facilities, medical clinics, & similar facilities that are contiguous to health care occupancies shall be permitted to be used for diagnostic & treatment services of inpatients who are capable of self-preservation. Section 19.1.3.4.2 (New Text) 6
GENERAL REQUIREMENTS (Chapter 18/19 HEALTH CARE) HEALTH CARE OCCUPANCY EXITING THROUGH OTHER OCCUPANCIES: If the means of egress from health care occupancy traverses non-health care spaces, these spaces (the means of egress) shall conform to the requirements of this Code for health care occupancies. Unless exit is through a compliant horizontal exit (19.2.2.5) Sections 19.1.3.6 & 19.1.3.7 GENERAL REQUIREMENTS (Chapter 18/19 HEALTH CARE) 7
GENERAL REQUIREMENTS (Chapter 18/19 HEALTH CARE) GENERAL REQUIREMENTS (Chapter 18/19 HEALTH CARE) 8
EMERGENCY DEPARTMENTS?? DEFINITIONS / EXAMPLES 12 42: Occupancy Chapters If construction completed before JULY 5, 2016. If construction started (substantial permits approved) after JULY 5, 2016. 9
GENERAL REQUIREMENTS TOTAL CONCEPT. JUST LIKE HEALTH CARE Design, Construction, Compartmentation Detection, Alarm and Extinguishment Prevention, Planning and Training 10
GENERAL REQUIREMENTS AMBULATORY HEALTH CARE MULTIPLE OCCUPANCIES: Sections of ambulatory health care occupancies shall be permitted to be classified as other occupancies, provided: They are not intended to serve ambulatory health care occupants for purposes of treatment or customary access by patients incapable of self-preservation. They are separated by a minimum 1 hr FRR barrier. Section 21.1.3.2 GENERAL REQUIREMENTS AMBULATORY HEALTH CARE AMBULATORY HEALTH CARE OCCUPANCY EXITING THROUGH OTHER OCCUPANCIES: If the means of egress from health care occupancy traverses non-ambulatory health care spaces, these spaces (the means of egress) shall conform to the requirements of this Code for ambulatory health care occupancies. Unless exit is through a compliant horizontal exit (19.2.2.5) Section 21.1.3.3 11
CONSTRUCTION REQUIREMENTS AMBULATORY HEALTH CARE Not permitted in combustible buildings unless fully sprinklered. BUSINESS No requirements. Section 21.1.6 Section 39.1.6 MEANS OF EGRESS REQUIREMENTS AMBULATORY HEALTH CARE Delayed Egress (more than one) and Access Control allowed on any door. Travel Distance from any point in a room to an exit: 150 ft not sprinklered 200 ft sprinklered Normal & Emergency lighting for means of egress Emergency task lighting for anesthesia locations Section 21.2 BUSINESS Delayed Egress (more than one) and Access Control Allowed Travel Distance from any point in a room to an exit: 200 ft not sprinklered 300 ft sprinklered Normal lighting for egress Emergency lighting if: 3 or more stories > 50 occupants or LED > 300 occupants total Section 39.2 12
PROTECTION OF VERTICAL OPENINGS AMBULATORY HEALTH CARE See 39.3.1 BUSINESS In accordance with Section 8.6 30 min minimum FRR for existing enclosures Few Exceptions: 8.6.9.1 Convenience Openings 39.2.4.6/7 Single tenant exit 39.3.1.1 Unprotected Vertical Openings Section 21.3.1 Section 39.3.1 PROTECTION OF HAZARADOUS AREAS AMBULATORY HEALTH CARE See 39.3.2 Doors to hazardous areas shall be self closing or automatic closing (New Text) BUSINESS Hazardous area including, but not limited to, areas for general storage, boiler or furnace rooms, and maintenance shops that including woodworking and painting see Sec. 8.7 Enclose with 1 hr FRR Barrier OR Protect with sprinkler system Section 21.3.2 Section 39.3.2 13
PROTECTION OF HAZARDS AMBULATORY HEALTH CARE Laboratories Anesthetizing Locations Medical Gas PROTECTION OF HAZARDS AMBULATORY HEALTH CARE Cooking Facilities HINT: BUSINESS OCCUPANCY HAS SIMILAR PROVISIONS 21.3.2.4 Cooking facilities shall be protected in accordance with 9.2.3 21.3.2.5 Where domestic cooking equipment is used for food warming or limited cooking, protection or separation of food preparation facilities shall not be required. (New Text) 14
PROTECTION REQUIREMENTS AMBULATORY HEALTH CARE Alcohol- Based Hand-Rub Dispensers 21.3.2.6 Alcohol-based hand-rub dispensers shall be protected. All same rules as Health Care Occupancies applies (New Text) HINT: BUSINESS OCCUPANCY IS SILENT ON THIS ISSUE INTERIOR FINISH AMBULATORY HEALTH CARE See 39.3.3 BUSINESS Interior wall & ceiling finishes shall be: Class A or B in exit & exit access corridors Class A, B or C in other areas Interior floor finish: No requirements Section 21.3.3 Section 39.3.3 15
DETECTION, ALARM AND COMMUNICATION SYSTEMS AMBULATORY HEALTH CARE Fire Alarm systems required Initiation by manual means & any detection required Occupant & Emergency forces notifications required Positive Alarm sequence permitted (New Text) Section 21.3.4 BUSINESS Fire Alarm System if: 3 or more stories > 50 occupants or LED > 300 occupants total Initiation by either: Manual Means Complete Detection System Auto-sprinkler System Occupant Notification required Occupant notification Emergency Forces only for new or replaced systems Positive Alarm sequence permitted Section 39.3.4 EXTINGUISHMENT REQUIREMENTS AMBULATORY HEALTH CARE Sprinklers not required Portable fire extinguishers required BUSINESS Sprinklers not required Portable fire extinguishers required HINT: ALTHOUGH NOT REQUIRED, 5 LB CO2 FIRE EXTINGUISHERS ARE RECOMMENDED IN EACH OPERATING ROOM Section 21.3.5 Section 39.3.5 16
CORRIDOR REQUIREMENTS AMBULATORY HEALTH CARE No Requirements BUSINESS No Requirements HINT: SINCE NO CORRIDOR REQUIREMENTS, NO SUITES, CORRIDOR CLUTTER, ETC. BUT MEANS OF EGRESS STILL NEEDS TO BE KEPT CLEAR!! Section 21.3.6 Section 39.3.6 SUBDIVISION OF BUILDING SPACES AMBULATORY HEALTH CARE Separation from other tenants and occupancies BUSINESS No requirements AND Smoke compartments Section 21.3.7 Section 39.3.7 17
SUBDIVISION OF BUILDING SPACES AMBULATORY HEALTH CARE SEPARATION FROM OTHER TENANTS: 1-hr FRR walls (minimum) slab to slab Doors such as 1 ¾ thick solid-bonded wood-core doors and equipped with positive latch Doors shall be self-closing, and shall be kept in the closed position, except when not in use Any windows shall be of fixed fire window assemblies HINT: UNIQUE DOOR REQUIREMENTS COMPARED TO SMOKE BARRIERS OR TYPICAL 1HR FRR BARRIERS Section 21.3.7.1 SUBDIVISION OF BUILDING SPACES AMBULATORY HEALTH CARE 18
SUBDIVISION OF BUILDING SPACES AMBULATORY HEALTH CARE SMOKE BARRIERS: Every story shall be divided into not less than two smoke compartments, unless: Facility is < 5,000 sq ft & smoke detection system Facility is < 10,000 sq ft & automatic sprinklers An area in an adjoining occupancy shall be permitted to serve as a smoke compartment if all the following criteria is met: The separating wall and both compartments are 1hr FRR The ambulatory health care facility is < 22,500 sq ft Access from the facility to the other occupancy is unrestricted Section 21.3.7.1 38 19
SUBDIVISION OF BUILDING SPACES AMBULATORY HEALTH CARE SMOKE BARRIERS: 30 min FRR minimum Smoke dampers not required in fully sprinklered facility Doors such as 1 ¾ thick solid-bonded wood-core doors, must be self or automatic-closing Cross corridor smoke barrier doors need not positive latch FIRE DRILLS AMBULATORY HEALTH CARE Need to have a plan and available to all staff Requires periodic instruction (aka annually by most AHJs) Fire Drill must include transmission of fire alarm Patients not required to be moved Quarterly each shift 9:00 pm 6:00 am a coded announcement is permitted instead of audible alarms Section 21.7.1 BUSINESS Instructed in the fire plan In buildings occupied by more than 500 persons, or by more than 100 persons or the LED- employees shall be periodically instructed and old drills periodically where practical. Section 39.7.2 20
PROCEDURE IN CASE OF FIRE AMBULATORY HEALTH CARE Must have a written fire safety plan that includes: Removal of all occupants directly involved in fire Evacuation of smoke compartments & possible floor evacuation Transmission of fire alarm Emergency phone call to Fire Department Confine the fire (doors, etc.) Fire extinguishment Section 21.7.2 BUSINESS Must have a fire plan Designated employees shall be periodically instructed in the use of portable fire extinguishers HINT: THE JOINT COMMISSION AND OTHER AHJS EXPECT ANNUAL DRILLS IN FREE STANDING BUSINESS OCCUPANCIES Section 39.7.2 / 3 COMBUSTIBLE DECORATIONS AMBULATORY HEALTH CARE COMBUSTIBLE DECORATIONS Combustible decorations shall be prohibited unless one of the following is met: They are flame-retardant Decorations meet NFPA 701, Standard Methods of Fire Tests for Flame Propagation of Textiles & Films Decorations exhibit a heat release rate not exceeding 100 kw when tested per NFPA 289 They are decorations, such as photographs and paintings and in such limited quantities that a hazard of fire development or spread is not present. Section 21.7.5.4 21
BUILDING SERVICES / OPERATING FEATURES AMBULATORY HEALTH CARE / BUSINESS SOILED LINEN / TRASH RECEPTACLES Containers used solely for recycling clean waste or for patient records awaiting destruction shall be permitted to be excluded from the 32 gallon rule if: Container does not exceed 96 gal Containers exceeding 96 gal are placed in haz areas Container size shall not be limited in haz areas Containers are labeled/listed as meeting FM Approval Standard 6921, Containers for Combustible Waste; however, the testing/labeling/listing is not limited to FM Approvals (any lab can perform the tests) ANNUAL INSPECTION OF FIRE AND SMOKE DOOR ASSEMBLIES ANNUAL INSPECTION OF DOOR OPENINGS Complying with 7.2.1.15.2 (New Text) Applies to ALL Occupancy Chapters AMBULATORY HEALTH CARE / BUSINESS Fire rated doors shall be inspected per NFPA 80 Smoke doors shall be inspected per NFPA 105 Annual requirement, but allows a performance-based program 22
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