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Buildings, or sections of buildings, that primarily house patients who, in the opinion of the governing body of the facility and the governmental agency having jurisdiction, are capable of exercising judgment and appropriate physical action for self-preservation under emergency conditions shall be permitted to comply with chapters of this Code other than Chapter 20.
It shall be recognized that, in buildings providing treatment for certain types of patients or having detention rooms or a security section, it might be necessary to lock doors and bar windows to confine and protect building inhabitants. In such instances, the authority having jurisdiction shall make appropriate modifications to those sections of this Code that would otherwise require means of egress to be kept unlocked.
The goals and objectives of Sections 4.1 and 4.2 shall be met with due consideration for functional requirements, which are accomplished by limiting the development and spread of a fire emergency to the room of fire origin and reducing the need for occupant evacuation, except from the room of fire origin.
Because the safety of ambulatory health care occupants cannot be ensured adequately by dependence on evacuation of the building, their protection from fire shall be provided by appropriate arrangement of facilities; adequate, trained staff; and development of operating and maintenance procedures composed of the following:
Atrium walls in accordance with 126.96.36.199.6 shall be permitted to serve as part of the separation required by 188.8.131.52.1 for creating separated occupancies on a story-by-story basis, provided both of the following are met:
Sections of ambulatory health care facilities shall be permitted to be classified as other occupancies, provided that they meet both of the following conditions:
Exit through a horizontal exit into other contiguous occupancies that do not conform to ambulatory health care egress provisions but that do comply with requirements set forth in the appropriate occupancy chapter of this Code shall be permitted, provided that the occupancy does not contain high hazard contents.
Egress provisions for areas of ambulatory health care facilities that correspond to other occupancies shall meet the corresponding requirements of this Code for such occupancies, and, where the clinical needs of the occupant necessitate the locking of means of egress, staff shall be present for the supervised release of occupants during all times of use.
The following is a list of special definitions used in this chapter:
The classification of hazard of contents shall be as defined in Section 6.2.
Ambulatory health care occupancies shall be limited to the building construction types specified in Table 184.108.40.206, unless otherwise permitted by 220.127.116.11. (See 8.2.1.)
Table 18.104.22.168 Construction Type Limitations
|Stories in Height‡|
|X: Permitted. NP: Not permitted.|
|†Sprinklered throughout by an approved, supervised automatic sprinkler system in accordance with Section 9.7. (See 20.3.5.)|
Any level below the level of exit discharge shall be separated from the level of exit discharge by not less than Type II (111), Type III (211), or Type V (111) construction (see 8.2.1), unless both of the following criteria are met:
Where new ambulatory health care occupancies are located in existing buildings, the authority having jurisdiction shall be permitted to accept construction systems of lesser fire resistance than those required by 22.214.171.124 through 126.96.36.199, provided that it can be demonstrated to the authority's satisfaction that prompt evacuation of the facility can be achieved in case of fire or that the exposing occupancies and materials of construction present no threat of fire penetration from such occupancy to the ambulatory health care facility or to the collapse of the structure.
The occupant load, in number of persons for whom means of egress and other provisions are required, shall be determined on the basis of the occupant load factors of Table 188.8.131.52 that are characteristic of the use of the space, or shall be determined as the maximum probable population of the space under consideration, whichever is greater.
Any door required to be self-closing shall be permitted to be held open only by an automatic release device that complies with 184.108.40.206.2. The required manual fire alarm system and the systems required by 220.127.116.11.2 shall be arranged to initiate the closing action of all such doors throughout the smoke compartment or throughout the entire facility.
Door-locking arrangements shall be permitted where patient special needs require specialized protective measures for their safety, provided that all of the following criteria are met:
- Staff can readily unlock doors at all times in accordance with 18.104.22.168.7.
- A total (complete) smoke detection system is provided throughout the locked space in accordance with 22.214.171.124, or locked doors can be remotely unlocked at an approved, constantly attended location within the locked space.
- The building is protected throughout by an approved, supervised automatic sprinkler system in accordance with Section 9.7.
- The locks are electrical locks that fail safely so as to release upon loss of power to the device.
- The locks release by independent activation of each of the following:
Doors that are located in the means of egress and are permitted to be locked under other provisions of 126.96.36.199.6 shall comply with both of the following:
- Provisions shall be made for the rapid removal of occupants by means of one of the following:
- Only one locking device shall be permitted on each door.
The clear width of any corridor or passageway required for exit access shall be not less than 44 in. (1120 mm).
In buildings other than those complying with 188.8.131.52.1, dead-end corridors shall not exceed 20 ft (6100 mm).
The travel distance between any point in a room and an exit shall not exceed 150 ft (46 m).
Where general anesthesia or life-support equipment is used, each ambulatory health care facility shall be provided with an essential electrical system in accordance with NFPA 99 unless otherwise permitted by any of the following:
High hazard contents areas, as classified in Section 6.2, shall meet all of the following criteria:
- The area shall be separated from other parts of the building by fire barriers having a minimum 1-hour fire resistance rating, with all openings therein protected by self-closing fire door assemblies having a minimum 3/4-hour fire protection rating.
- The area shall be protected by an automatic extinguishing system in accordance with 184.108.40.206(1) or 220.127.116.11.
Laboratories in which chemicals are handled or stored shall comply with NFPA 45.
Areas where medical gas is stored or administered, and the operation, management, and maintenance of medical gases shall be in accordance with NFPA 99.
Where domestic cooking equipment is used for food warming or limited cooking, protection or separation of food preparation facilities shall not be required.
Where more than two sprinklers are installed in a single area for protection in accordance with 18.104.22.168, water-flow detection shall be provided to sound the building fire alarm or to notify, by a signal, any constantly attended location, such as PBX, security, or emergency room, at which the necessary corrective action shall be taken.
Where access to exits is provided by corridors, such corridors shall be separated from use areas by fire barriers in accordance with Section 8.3 having a minimum 1-hour fire resistance rating, unless one of the following conditions exists:
Miscellaneous openings, such as mail slots, pharmacy pass-through windows, laboratory pass-through windows, and cashier pass-through windows, shall be permitted to be installed in vision panels or doors without special protection, provided that both of the following criteria are met:
- The aggregate area of openings per room does not exceed 20 in.2 (0.015 m2).
- The openings are installed at or below half the distance from the floor to the room ceiling.
Ambulatory health care occupancies shall be separated from other tenants and occupancies and shall meet all of the following requirements:
- Walls shall have not less than a 1-hour fire resistance rating and shall extend from the floor slab below to the floor or roof slab above.
- Doors shall be constructed of not less than 13/4 in. (44 mm) thick, solid-bonded wood core or the equivalent and shall be equipped with positive latches.
- Doors shall be self-closing and shall be kept in the closed position, except when in use.
- Any windows in the barriers shall be of fixed fire window assemblies in accordance with Section 8.3.
Every story of an ambulatory health care occupancy shall be divided into not less than two smoke compartments, unless otherwise permitted by one of the following:
- This requirement shall not apply where the area of the ambulatory health care occupancy is less than 5000 ft2 (465 m2) per story and that area is protected by an approved automatic smoke detection system.
- This requirement shall not apply where the area of the ambulatory health care occupancy is less than 10,000 ft2 (929 m2) per story and the building is protected throughout by an approved, supervised automatic sprinkler system installed in accordance with Section 9.7.
- An area in an adjoining occupancy shall be permitted to serve as a smoke compartment for an ambulatory health care occupancy if all of the following criteria are met:
- The separating wall and both compartments meet the requirements of 20.3.7.
- The ambulatory health care occupancy does not exceed one of the following:
- Access from the ambulatory health care occupancy to the other occupancy is unrestricted.
Not less than 15 net ft2 (1.4 net m2) per ambulatory health care facility occupant shall be provided within the aggregate area of corridors, patient rooms, treatment rooms, lounges, and other low hazard areas on each side of the smoke compartment for the total number of occupants in adjoining compartments.
Alcohol-based hand-rub dispensers shall be protected in accordance with 22.214.171.124, unless all of the following conditions are met:
- Where dispensers are installed in a corridor, the corridor shall have a minimum width of 6 ft (1830 mm).
- The maximum individual dispenser fluid capacity shall be as follows:
- 0.32 gal (1.2 L) for dispensers in rooms, corridors, and areas open to corridors
- 0.53 gal (2.0 L) for dispensers in suites of rooms
- Where aerosol containers are used, the maximum capacity of the aerosol dispenser shall be 18 oz (0.51 kg) and shall be limited to Level 1 aerosols as defined in NFPA 30B.
- Dispensers shall be separated from each other by horizontal spacing of not less than 48 in. (1220 mm).
- Not more than an aggregate 10 gal (37.8 L) of alcohol-based hand-rub solution or 1135 oz (32.2 kg) of Level 1 aerosols, or a combination of liquids and Level 1 aerosols not to exceed, in total, the equivalent of 10 gal (37.8 L) or 1135 oz (32.2 kg), shall be in use outside of a storage cabinet in a single smoke compartment, except as otherwise provided in 20.4.3(6).
- One dispenser per room complying with 20.4.3(2) or (3), and located in the room, shall not be required to be included in the aggregated quantity specified in 20.4.3(5).
- Storage of quantities greater than 5 gal (18.9 L) in a single smoke compartment shall meet the requirements of NFPA 30.
- Dispensers shall not be installed in the following locations:
- Above an ignition source within a 1 in. (25 mm) horizontal distance from each side of the ignition source
- To the side of an ignition source within a 1 in. (25 mm) horizontal distance from the ignition source
- Beneath an ignition source within a 1 in. (25 mm) vertical distance from the ignition source
- Dispensers installed directly over carpeted floors shall be permitted only in sprinklered smoke compartments.
- The alcohol-based hand-rub solution shall not exceed 95 percent alcohol content by volume.
- Operation of the dispenser shall comply with the following criteria:
- The dispenser shall not release its contents except when the dispenser is activated, either manually or automatically by touch-free activation.
- Any activation of the dispenser shall occur only when an object is placed within 4 in. (100 mm) of the sensing device.
- An object placed within the activation zone and left in place shall not cause more than one activation.
- The dispenser shall not dispense more solution than the amount required for hand hygiene consistent with label instructions.
- The dispenser shall be designed, constructed, and operated in a manner that ensures that accidental or malicious activation of the dispensing device is minimized.
- The dispenser shall be tested in accordance with the manufacturer's care and use instructions each time a new refill is installed.
If fuel-fired, heating devices shall comply with all of the following:
Any heating device shall have safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperature or ignition failure.
Approved, suspended unit heaters shall be permitted in locations other than means of egress and patient treatment areas, provided that both of the following criteria are met:
- Such heaters are located high enough to be out of the reach of persons using the area.
- Such heaters are equipped with the safety features required by 126.96.36.199.1.
Elevators, escalators, and conveyors shall comply with the provisions of Section 9.4.
Waste chutes, incinerators, and laundry chutes shall comply with the provisions of Section 9.5.
The administration of every ambulatory health care facility shall have, in effect and available to all supervisory personnel, written copies of a plan for the protection of all persons in the event of fire, for their evacuation to areas of refuge, and for their evacuation from the building when necessary.
All employees shall be periodically instructed and kept informed with respect to their duties under the plan required by 188.8.131.52.
Fire drills in ambulatory health care facilities shall include the simulation of emergency fire conditions.
Patients shall not be required to be moved during drills to safe areas or to the exterior of the building.
For ambulatory health care facilities, the proper protection of patients shall require the prompt and effective response of ambulatory health care personnel.
The basic response required of staff shall include the following:
- Removal of all occupants directly involved with the fire emergency
- Transmission of an appropriate fire alarm signal to warn other building occupants and summon staff
- Confinement of the effects of the fire by closing doors to isolate the fire area
- Relocation of patients as detailed in the facility's fire safety plan
Proper maintenance shall be provided to ensure the dependability of the method of evacuation selected.
Smoking regulations shall be adopted and shall include not less than the following provisions:
- Smoking shall be prohibited in any room, ward, or compartment where flammable liquids, combustible gases, or oxygen is used or stored and in any other hazardous location, and such areas shall be posted with signs that read NO SMOKING or shall be posted with the international symbol for no smoking.
- In ambulatory health care facilities where smoking is prohibited and signs are placed at all major entrances, secondary signs with language that prohibits smoking shall not be required.
- Smoking by patients classified as not responsible shall be prohibited.
- The requirement of 20.7.4(3) shall not apply where the patient is under direct supervision.
- Ashtrays of noncombustible material and safe design shall be provided in all areas where smoking is permitted.
- Metal containers with self-closing cover devices into which ashtrays can be emptied shall be readily available to all areas where smoking is permitted.
Draperies, curtains, and other loosely hanging fabrics and films serving as furnishings or decorations in ambulatory health care occupancies shall be in accordance with the provisions of 10.3.1, and the following also shall apply:
- Such curtains shall include cubicle curtains.
- Such curtains shall not include curtains at showers.
Newly introduced upholstered furniture shall comply with 10.3.2.1 and one of the following provisions:
Combustible decorations shall be prohibited, unless one of the following criteria is met:
- They are flame-retardant.
- The decorations meet the flame propagation performance criteria contained in Test Method 1 or Test Method 2, as appropriate, of NFPA 701.
- The decorations exhibit a heat release rate not exceeding 100 kW when tested in accordance with NFPA 289 using the 20 kW ignition source.
- *The decorations, such as photographs, paintings, and other art, are attached directly to the walls, ceiling, and non-fire-rated doors in accordance with the following:
- Decorations on non-fire-rated doors do not interfere with the operation or any required latching of the door and do not exceed the area limitations of 184.108.40.206(4)(b) or (c).
- Decorations do not exceed 20 percent of the wall, ceiling, and door areas inside any room or space of a smoke compartment that is not protected throughout by an approved automatic sprinkler system in accordance with Section 9.7.
- Decorations do not exceed 30 percent of the wall, ceiling, and door areas inside any room or space of a smoke compartment that is protected throughout by an approved supervised automatic sprinkler system in accordance with Section 9.7.
Soiled linen or trash collection receptacles shall not exceed 32 gal (121 L) in capacity, and all of the following also shall apply:
- The average density of container capacity in a room or space shall not exceed 0.5 gal/ft2 (20.4 L/m2).
- Mobile soiled linen or trash collection receptacles with capacities greater than 32 gal (121 L) shall be located in a room protected as a hazardous area when not attended.
- Container size and density shall not be limited in hazardous areas.
Containers used solely for recycling clean waste or for patient records awaiting destruction shall be permitted to be excluded from the requirements of 220.127.116.11.1 where all the following conditions are met:
- Each container shall be limited to a maximum capacity of 96 gal (363 L), except as permitted by 18.104.22.168.2(2) or (3).
- *Containers with capacities greater than 96 gal (363 L) shall be located in a room protected as a hazardous area when not attended.
- Container size shall not be limited in hazardous areas.
- Containers for combustibles shall be labeled and listed as meeting the requirements of FM Approval 6921, Approval Standard for Containers for Combustible Waste; however, such testing, listing, and labeling shall not be limited to FM Approvals.
New engineered smoke control systems shall be tested in accordance with established engineering principles and shall meet the performance requirements of such testing prior to acceptance.
Following acceptance, all engineered smoke control systems shall be tested periodically in accordance with recognized engineering principles.
Test documentation shall be maintained on the premises at all times.