By Jeff Wardon, Jr., Assistant Editor

In most buildings, a fire alarm signals the need to evacuate. But in hospitals and other healthcare facilities, many patients cannot simply walk outside or descend stairwells, making traditional evacuation impractical. Instead, healthcare facilities rely on a defend-in-place approach that combines fire-rated construction, compartmentation, smoke control systems and rigorous staff training to keep patients and caregivers safe.  

Healthcare Facilities Today spoke with Pamela Reno, regional practice leader at Telgian Engineering & Consulting, to understand the way healthcare organizations can support defend-in-place strategies through building design, maintenance and emergency preparedness. 

HFT: Why is the defend-in-place model central to fire and life safety in healthcare environments, and what building features must be in place for it to work as intended? 

Pamela Reno: The defend-in-place strategy is important because not everybody can get up and move around in a hospital. There are patients who are bedridden, so if there were a fire, they can’t simply get up, evacuate and leave the building. 

That’s why the defend-in-place strategy is so important. It helps protect both employees and patients by making sure everyone stays safe. One of the biggest parts of that strategy is moving patients horizontally rather than vertically because during a fire, we generally can’t rely on elevators, depending on the size and location of the fire. 

It’s about moving patients horizontally into another safe area and making sure those fire doors are functioning properly and maintained. Those measures reduce patient risk and help limit disruption. 

The other key component is staff training. We rely on staff to know exactly what to do and where to go if there’s a fire. That’s crucial because many patients are connected to medical equipment, are unconscious or otherwise don’t have the ability to walk out of the building like they would in most other facilities. 

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That’s why the defend-in-place strategy is so critical. It’s also why hospitals have sprinklers, fire alarm systems, fire walls, smoke doors and fire doors. If there’s a fire in one area of the hospital, those systems allow us to move patients safely from one compartment of the building to another while keeping them protected. 

HFT: How do compartmentation, smoke control and fire-rated assemblies support defend-in-place strategies during a fire? 

Reno: I like to think of compartmentation in terms of hospital suites, like an ICU suite. When you have a suite that’s designed within a certain square footage and built with the proper fire-rated walls, doors and assemblies, it’s intended to contain a fire for a specific period, whether that’s one hour or two hours. 

That’s important because when we move patients to another area as part of our defend-in-place strategy, those fire-rated assemblies work together with the sprinkler system to help keep the fire contained. The goal is to hold the fire in that compartment long enough for the fire department to arrive and respond. 

At the same time, the smoke control system helps manage smoke movement and airflow because obviously, we don’t want to feed the fire or allow smoke to spread into other areas. 

All those systems work together to help patients evacuate safely. You have the fire-rated assemblies, the sprinkler system and the smoke control system all supporting the defend-in-place strategy. 

Compartmentation also establishes the boundaries for that strategy. We know where one fire compartment ends and another begins, so if there’s a fire, we can move patients from one compartment to the next. Ideally, that gives us the one- to two-hour window those fire-rated assemblies are designed to provide, allowing patients to remain protected while emergency responders bring the situation under control. 

HFT: What operational planning, staff training and coordination with local fire departments are essential to ensure defend-in-place strategies are executed effectively? 

Reno: From an operational standpoint, training is really the biggest thing. That includes fire alarm training, conducting fire drills and making sure employees understand exactly what needs to happen if there’s a fire. 

In hospitals, we teach the RACE procedure: rescue, alarm, confine, extinguish and evacuate. Those are the steps we want staff to follow as part of the defend-in-place strategy. First, you rescue anyone in immediate danger. Then you sound the alarm and confine the fire by closing doors. If it’s something small like a trash can fire, you may be able to use a fire extinguisher to put it out. If not, then you evacuate patients from one area of the hospital to another safe compartment. 

Those are the kinds of scenarios we practice during fire drills. They’re also an important part of the accreditation process because hospitals are required to conduct fire drills and demonstrate that staff know how to respond appropriately. 

From an operational standpoint, regularly training and practicing those procedures is one of the best ways hospitals can prepare for and successfully implement a defend-in-place strategy. 

Jeff Wardon, Jr., is the assistant editor for the facilities market. With more than three years of experience, he covers topics including technology, wellness, sustainability and emerging industry trends.