By Brian O'Connor, Contributing Writer

The adage “Hope for the best, but prepare for the worst” is especially relevant to healthcare facilities, where emergencies bring unique challenges and heightened risks. For instance, healthcare facilities are unique in that a portion of their occupants are often more vulnerable than the general population, since these facilities service those in need of medical care. 

This situation can impact the ability of these occupants to evacuate independently or recognize and respond to alerts. Emergencies also can disrupt critical systems that patients rely on, such as medical gas, electrical and communication systems. Unlike other buildings, many healthcare facilities need to stay operational during emergencies, such as power outages, natural disasters and public health crises. 

Given the unique nature of healthcare environments, generic emergency preparedness plans are insufficient. NFPA 99, Health Care Facilities Code, plays a vital role in helping organizations develop more protective, customized plans. It establishes a minimum level of safety, specifically addressing emergency preparedness through requirements for risk analysis, hazard assessment and emergency operations planning. These requirements help managers prepare effectively, focusing on the unique risks posed by high patient vulnerability and critical equipment dependency. 

When developing emergency plans, managers can bring the insights and guidance from NFPA 99 and other essential resources to their fingertips using digital tools. By replacing or augmenting physical codebooks with digital versions, they can gain instant access to codes and standards across devices and work smarter, faster and more collaboratively. 

NFPA 99 is critical for managing safety risks in healthcare settings. It provides requirements for essential systems and equipment, as well as emergency and security management. Essential systems, including electrical, medical gas, medical vacuum and communication systems, need to function reliably during emergencies. NFPA 99’s risk-based approach helps managers assess and mitigate potential hazards to protect patients, staff and visitors. 

While most NFPA 99 requirements are enforced by the Centers for Medicare & Medicaid Services (CMS), they maintain a separate emergency preparedness rule. But NFPA 99 remains foundational for creating robust emergency management frameworks. 

As such, training designed around this code is highly beneficial for anyone responsible for applying life safety and fire protection requirements in healthcare settings. Time is valuable to these busy professionals, so digital tools like live and on-demand online training offer flexible and convenient formats to learn how to properly put this code into action. 

Among the key emergency preparedness requirements in NFPA 99 are these: 

Risk-based approach. NFPA 99’s risk-based approach allows healthcare facilities managers to create emergency plans based on their specific needs and patient population. After all, not all healthcare facilities need to remain fully operational during an emergency. Some can temporarily close or alter operations without severe consequences. 

Related: CMMS, Data and the Path to Compliance

Emergency planners must consider the facility’s role during a crisis — whether it will manage an influx of patients, serve as a shelter or operate at full or limited capacity — and tailor their emergency preparedness goals accordingly. Managers can use many tools to conduct a risk assessment, several of which are outlined in NFPA 551, Guide for the Evaluation of Fire Risk Assessments. 

Hazard analysis. Once operational requirements are identified, managers need to conduct a hazard vulnerability analysis (HVA) to understand potential risks. The main goal of a HVA is to identify, assess and prioritize potential hazards that could impact a facility's operations, safety and ability to care for patients during emergencies. All potential hazards are listed and grouped into three categories: human-caused events, natural events and technological events. 

To prioritize these events, a manager must consider the hazard’s probability and impact. When assessing the impact of an event, it’s important to have representation from all departments in the facility to avoid overlooking potential impacts. Managers should base the probability of events on historical data, as well as on projections and information from dependable resources. Finally, prioritizing hazards will help determine where to focus mitigation efforts since healthcare facilities do not have limitless resources. 

Emergency operations plan. An effective emergency operations plan (EOP) is crucial for managing emergencies should establish a command structure and outline protocols for critical functions, addressing areas such as communication, resource allocation, safety, security, clinical support and essential utilities. For facilities expected to operate through emergencies, an EOP should include a crisis standard of care and surge capacity strategies. The plan should be regularly practiced, with staff training and periodic updates to reflect changes in operations and potential hazards. 

During each stage of emergency planning, digital tools can save managers’ time by helping them access pertinent information faster. For example, digital codebooks offer features such as situational navigation, which allow managers to walk through specific scenarios based on occupancy, systems, space and equipment relevant to their facilities and view catered content, such as expert commentary or visual aids. 

Emergency planning in healthcare facilities involves many moving pieces. Managers need to understand and apply the detailed requirements laid out in key codes such as NFPA 99, and they need to keep track of data such as cross-departmental feedback or how often emergency procedures have been practiced or updated. 

Digital tools provide faster, on-the-go access to the codes and standards that emergency planners reference most, and they enable functions such as searching, bookmarking and sharing that make it easier to manage the disparate elements involved in emergency preparedness. Managers also can easily see changes from previous editions and leave notes in digital codebooks for their successors, minimizing safety gaps during leadership transitions and preserving institutional knowledge. 

NFPA 99’s emergency preparedness requirements are essential to safeguarding healthcare facilities and ensuring they remain resilient and operational in emergencies. By maintaining compliance, conducting ongoing risk assessments and regularly training staff, managers can protect patients and staff effectively, reinforcing their role as reliable sources of care during crises. Prioritizing these emergency preparedness measures today builds resilience for the challenges of tomorrow. 

Brian O’Connor, P.E., is a senior engineer at the National Fire Protection Association.