Understanding Hospital Defend-In-Place Egress Strategy

The evacuation of patients in a hospital is complex.

By Steven Dannaway, PE, DBIA – Patients may be found in varying conditions at any given time that makes them “incapable of their own self-preservation”, including:

• On life support equipment
• Undergoing a medical procedure
• Experiencing injuries or health issues that prevent typical mobility
• Asleep and slow to respond to emergency events

A Defend-In-Place Egress Strategy is the solution recognized by the building and fire codes to mitigate the hazard that fire and emergency events pose to patients in a hospital.

Defend-In-Place Overview

Under a Defend-In-Place Egress Strategy, hospital staff will relocate patients from the smoke compartment where the fire originates and across smoke barriers into an adjoining compartment. The adjoining compartment serves as a temporary refuge staging area for relocated patients while emergency conditions are assessed and determined if further evacuation is necessary. Visitors, ambulatory patients, and staff not involved in patient relocation can use the provided exit facilities. Patients remote from the compartment of fire origin will not evacuate and will defend-in-place.

Total Concept

The fundamental aspects of a building that support a Defend-In-Place egress strategy are described by NFPA 101, the Life Safety Code, under a “Total Concept.”

The Total Concept involves:

1. Fire compartmentation: Establish of fire/smoke compartments that will limit the spread of fire/smoke out of the room of fire origin, within the compartment of origin, and from spreading beyond the compartment of origin.
2. Evacuation Routes and Refuge Area: Design egress facilities, corridor systems, redundant paths of travel, and refuge areas that will facilitate the relocation of patients and allow for temporary refuge areas within the building while emergency conditions are continuously evaluated.
3. Fire Protection Systems: Coordination of fire protection systems with the compartmentation and evacuation strategy. Important considerations are fire suppression, fire detection, and notification. It is essential to detect the location of the fire and, once detected, to be able to notify the appropriate staff on the location of the fire allowing staff to implement appropriate emergency procedures corresponding to the area of fire origin.
4. Emergency Response Procedures: Healthcare staff are the key to a successful Defend-In-Place egress strategy. Critical functions of trained staff include sounding and relaying alarms and directions, evacuating the patient(s) from the room of fire origin, closing doors to the room of fire origin, and moving patients out of the zone of fire origin, and monitoring directions for future actions during an emergency.

Holistic Fire Protection Approach

The Defend-In-Place egress strategy depends heavily on a fundamental principle of fire protection engineering. This multi-faceted approach includes multiple safeguards against fire to create a safe environment for patients, staff, and visitors. Successful fire prevention and life safety strategy within a hospital facility is noted by NFPA 101, Annex 18.1.1.2 to include the following key elements:

1. Prevention of ignition
2. Detection of fire
3. Control of fire development
4. Confinement of the effects of fire
5. Extinguishment of fire
6. Provision of refuge areas and/or evacuation facilities
7. Staff reaction

An important item to consider as an addition to this list is the proper notification of staff on the occurrence and location of a fire event.

Fire Safety & Evacuation Plans

The International Fire Code (2021 edition, Section 403.7.2.1) and NFPA 101 (2021 edition, Section 18.7.2) require a written fire safety and evacuation plan for hospital facilities. Ultimately, it is the Owner’s responsibility to maintain such a plan and keep staff periodically instructed of their duties and responsibilities under the plan. These codes detail the minimum information that a fire safety and evacuation plan should contain.