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Defend in Place--The Redundancy and Interconnectivity of Life Safety in Health Care

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Defend in Place--The Redundancy and Interconnectivity of Life Safety in Health Care
Creator:
ASHBY, JOHN H.
Copyright Date:
2008

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Architectural design ( jstor )
Building codes ( jstor )
Buildings ( jstor )
Emergency evacuations ( jstor )
Fire protection ( jstor )
Handbooks ( jstor )
Health care facilities ( jstor )
Health care industry ( jstor )
Hospitals ( jstor )
Smoke ( jstor )
City of Quincy ( local )

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University of Florida
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University of Florida
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Copyright John H. Ashby. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
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4/30/2009
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656216289 ( OCLC )

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DEFEND IN PLACE— THE REDUNDANCY AND INTERCONNECTIVITY OF LIFE SAFETY IN HEALTH CARE By JOHN H. ASHBY A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARCHITECTURE UNIVERSITY OF FLORIDA 2004

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Copyright 2004 by John H. Ashby

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iii ACKNOWLEDGMENTS I would like to thank my wife Rebecca, for her support and encouragement in the completion of this document. I would also like to thank my employer, Harvard Jolly, Inc. for their continued support with this project.

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iv TABLE OF CONTENTS Page ACKNOWLEDGMENTS.................................................................................................iii LIST OF FIGURES...........................................................................................................vi ABSTRACT....................................................................................................................... ix CHAPTER 1 INTRODUCTION........................................................................................................1 2 HISTORY OF THE NATIONAL FIRE PROTECTION ASSOCIATION AND THEIR LIFE SAFETY CODE.....................................................................................3 3 HOSPITALS AS A BUILDING TYPE.......................................................................8 Patients....................................................................................................................... .10 Outpatient Population..........................................................................................10 In-patient Population...........................................................................................11 Staff.......................................................................................................................... ...12 Public......................................................................................................................... .12 4 EXITING....................................................................................................................14 Egress Components....................................................................................................16 Compartmentation Theory for Exits (Non-Hospital-Specific)...................................17 5 DEFEND IN PLACE..................................................................................................19 Mandatory Adoption of NFPA 101............................................................................19 Hospitals, Sanitariums and Correctional Institutions.................................................21 Compartmentation......................................................................................................22 Isolation of Hazardous Spaces.............................................................................23 Isolation of Exit Access Corridor Systems..........................................................24 Smoke Compartmentation...................................................................................24 Horizontal Exits...................................................................................................29 Fire Suppression Systems...........................................................................................30 Staff Training..............................................................................................................33 Character of Construction...........................................................................................33 Notification of Event..................................................................................................34

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v Smoke Control............................................................................................................35 Currency of Codes......................................................................................................35 Interconnectivity and Redundancy.............................................................................36 6 EBB AND FLOW OF A HOSPITAL AND HOW DEFEND IN PLACE STRATEGIES CAN IMPROVE FUNCTIONAL FLOW DURING SEVERAL TYPES OF EMERGENT EVENTS...........................................................................39 7 CONCLUSION...........................................................................................................44 APPENDIX A SMOKE COMPARTMENT REQUIREMENTS AND CALCULATIONS FOR THE CASE STUDY...................................................................................................46 B EXIT REQUIREMENTS AND CALCULATIONS FOR THE CASE STUDY.......56 C CHARACTER OF CONSTRUCTION......................................................................66 D CURRENCY OF CODE EXAMPLES......................................................................68 LIST OF REFERENCES...................................................................................................75 BIOGRAPHICAL SKETCH.............................................................................................78

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vi LIST OF FIGURES Figure page 2-1. Timeline of the Development of the National Fire Protection Association................4 2-2. Adoption of NFPA 101. Statewide adoption of NFPAÂ’s 101 Life Safety Code as of March 2004 is shown as shaded.............................................................................7 3-1. A Special Procedure Room...........................................................................................8 3-2. An Outpatient Surgery Room.......................................................................................9 3-3. An Operating Room at Moffitt Cancer Center, Tampa, Florida..................................9 4-1. Exiting or Evacuation from a Building.......................................................................15 4-2. Compartmentation......................................................................................................17 4-3. Fire Compartment.......................................................................................................18 5-1. A Ship at Sea Also Must Adhere to Defend in Place.................................................20 5-2. Hospital Compartmentation........................................................................................24 5-3. Three Levels of Compartmentation............................................................................25 5-4. Horizontal Exit........................................................................................................... 29 5-5. Sprinkler Type and Use..............................................................................................32 5-6. Diagrammatic Interconnectivity Relationship............................................................37 5-7. Diagrammatic Redundancy Relationship...................................................................38 6-1. Circulation............................................................................................................... ...39 6-2. The Flow of Defend in Place During an Internal Emergent Event............................41 6-3. The Ebb of Defend in Place During External Emergent Events................................42 6-4. Life Safety Flow for Case Study................................................................................42

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vii 6-5. Life Safety Ebb for Case Study..................................................................................43 A-1. Smoke Compartment 1 Calculations.........................................................................48 A-2. Smoke Compartment 2 Calculations.........................................................................49 A-3. Smoke Compartment 3 Calculations.........................................................................50 A-4. Smoke Compartment 4 Calculations.........................................................................51 A-5. Smoke Compartment 5 Calculations.........................................................................52 A-6. Smoke Compartment 6 Calculations.........................................................................53 A-7. Smoke Compartment 7 Calculations.........................................................................54 A-8. Smoke Compartment 8 Calculations.........................................................................55 B-1. Smoke Compartment 1 Exit Calculations..................................................................58 B-2. Smoke Compartment 2 Exit Calculations..................................................................59 B-3. Smoke Compartment 3 Exit Calculations..................................................................60 B-4. Smoke Compartment 4 Exit Calculations..................................................................61 B-5. Smoke Compartment 5 Exit Calculations..................................................................62 B-6. Smoke Compartment 6 Exit Calculations..................................................................63 B-7. Smoke Compartment 7 Exit Calculations..................................................................64 B-8. Smoke Compartment 8 Exit Calculations..................................................................65 C-1. Junction of One-hour Smoke Wall with a Subservient Intersecting Partition...........66 C-2. Rated Smoke Partition Terminating at Exterior Wall Constructed of Metal Studs...67 C-3. Rated Smoke Partition Terminating at Exterior Wall Constructed of Concrete Masonry Units..........................................................................................................67 D-1. Wall Stenciling Indicating Partition Rating of Two-hour Fire/Smoke Construction68 D-2. Rated Compartment Partition Deficiency..................................................................69 D-3. Penetration of Compartment Wall.............................................................................70 D-4. Door to Hazardous Space “Held Open” by Door Stop, Preventing the Door Closer From Operating Properly..............................................................................71

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viii D-5. Open Conduit Allowing the Passage of Smoke Between Compartment Walls........72 D-6. Rated and Tested Door Frame Label Painted Over, Obscuring the Stated Rating....73 D-7. Rated Door and Frame Painted Over, Obscuring the Stated Rating..........................74

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ix Abstract of Thesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Architecture DEFEND IN PLACE—THE REDUNDANCY AND INTERCONNECTIVITY OF LIFE SAFETY IN HEALTH CARE By John H. Ashby May 2004 Chair: Professor Gary W Siebein Major Department: Architecture The purpose of this thesis is to uncover the underlying principles of life safety in hospital design such that the basic tenet, termed “Defend in Place,” can be readily grasped and implemented in the design of a hospital through a case study method. This thesis investigates the development of life safety concepts, the functioning of the hospital and its occupants, and basic code principles in order to facilitate an understanding of life safety in health care. A case study analysis of a design for a proposed 122-bed, 200,000 square foot hospital was conducted to develop building systems to meet the requirements of the Life Safety Code and uncover architectural design principles that can be used to organize and prioritize the multitude of individual requirements. This research finds that while the code contains many specific requirements, general architectural design concepts for organizing responses to the code are not presented. The Defend in Place concept was distilled into seven key elements: compartmentation, fire suppression, character of construction, smoke control,

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x notification, staff training and currency of codes. These redundant systems can be interconnected through architectural design to enhance life safety of hospital patients. Clarification of the Defend in Place concept allows for proper implementation of life safety requirements in the design of hospitals. It also can improve the functional design of a hospital by enhancing the ebb and flow of the facility during a crisis, either internal or external in origin. Therefore, understanding the architectural implications of the Defend in Place concept can ensure the required level of safety for the occupants of a hospital, or with creative implementation, it can enhance the day-to-day functions for the occupants.

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1 CHAPTER 1 INTRODUCTION An architect is required to pore over thousands of pages of building code information, Life Safety Code information and many other documents just to meet the minimum legal requirements for the protection of a buildingÂ’s structure and its occupants. The process of code research typically starts by determining the buildingÂ’s occupancy type; with this decision made there is a seemingly endless stream of decisions to follow. Construction type is limited in part by use or occupancy of the building; site restraints will dictate other limits placed on the building design. To the young or inexperienced architect, it may seem that with every decision made, there are three more to make, when those three are made, nine more await, and so on. All occupancy types have their special and unique requirements. Most occupancy types depend on the ability of the occupants to be able to defend themselves during emergent situations. To be able to defend themselves, they must be cognizant of their environment and surroundings, non-reliant on artificial means of life support, ambulatory, and finally, they must not be restrained. The Life Safety Code presumes that for most occupancy types, evacuation or exiting the building is the primary means to preserve the lives of the occupants. When the majority of the buildingÂ’s occupants do not fall into the category of being able to defend themselves during an emergent event, other provisions must be implemented in the design of the building to provide for their safety. The tenet is referred to as Defend in Place; it adds yet another layer of complexity to the process of designing a building.

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2 How can this tenet, simple in wording, yet complex in successful execution, be broken down to a level that allows the architect to understand the reasons for the specific and specialized life safety features found in an institution that would require the implementation of the Defend In Place concept, such as in a hospital? This can be achieved by developing a historical overview of the events that have affected the Life Safety CodeÂ’s development, and providing an understanding of how these solutions are developed, then how are they implemented into a design of a hospital? Simplified graphic examples that demonstrate the various concepts and components of Defend in Place provide quick access to the information. Using a case study project illustrates the implementation of these concepts and theories within a realistic scenario. The case study that will be used for this research is a proposed 122bed replacement hospital in New Port Richey, Florida. The case study hospital will contain all the components typically found in a hospital. The facility will have an emergency department planned for 30,000 annual visits, six operating rooms, a fully equipped medical imaging department, and representative support spaces found in a facility of this size to serve a community that is located in the fastest growing county in the state of Florida.

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3 CHAPTER 2 HISTORY OF THE NATIONAL FIRE PROTECTION ASSOCIATION AND THEIR LIFE SAFETY CODE The National Fire Protection Association’s current objective is to reduce the worldwide burden of fire and other hazards on the quality of life by developing and advocating scientifically based consensus codes and standards, research, training and education.1 The National Fire Protection Association is the author of the 101 Life Safety Code, which deals specifically with the protection of the occupants in the built environment. A fundamental assumption of the Life Safety Code is that there is only one fire in one location, at any time.2 The National Fire Protection Association (NFPA) has its roots in the Industrial Revolution era with the development of sprinkler systems and electrical power systems and their use in the built environment. Specifically, the beginning of the National Fire Protection Association can be traced to Thomas Alvin Edison’s birth in the village of Milan, Ohio, on February 11, 1847. Edison is credited as being the father of electricity. Edison’s life while a teenager during this period of history was somewhat analogous to the life of young techies and the birth of computers in Silicon Valley, California in the 1970s and 1980s. He refined his invention of the incandescent lamp to such a point that in 1882 he built the first electric light power station on Palace Street in New York, New York. The power produced by this plant was direct current, referred to as DC. Edison 1 NFPA ONLINE, “About NFPA,” 2003, http://www.nfpa.org/catalog/home/AboutNFPA/index.asp (accessed February 2004). 2 Ron Cote, ed., Life Safety Code Handbook , 8th ed. (Quincy, MA: National Fire Protection Association, Inc., 2000), 37.

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4 felt that alternating current, or AC power, at this time in its maturity was much too dangerous for use in a setting that was susceptible to fire. Figure 2-1. Timeline of the Development of the National Fire Protection Association

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5 The development of electricity continued with the first public exhibit of the light bulb at the “Palace of Electricity” at the 1893 world fair in Chicago, Illinois. The form of electricity that powered this exhibit’s lights was alternating current. The display was wired by George Westinghouse. Edison along with many other people felt that AC was still much too unsafe for use at that time. In fact, no insurance company would underwrite the world fair until William Henry Merrill, an electrician from Boston, Massachusetts, was hired by the Capital Stock Fire Insurance People in Chicago to test the untried wiring of the display. The event was approved for use and insured. Merrill went on to become the founder of what turned into the Underwriters Laboratory in 1894. On a parallel path, sprinklers were being developed. In 1852 James Bichens Francis developed a sprinkler system made of perforated pipes to protect the Plant of the Proprietors of the Locks and Canals, on the Merrimack River in Lowell, Massachusetts. Activating this system would flood the entire building, possibly causing as much water damage to the property as a fire could. In 1874 an American named Henry S. Parmalee patented the first automatic sprinkler head, which he had designed to protect his piano factory from fire. Only the head or heads in the area of the fire would automatically activate the sprinkler system once a certain temperature was reached at the head. This basic concept is still in use today, although it has been refined considerably. The newly invented device also avoided ancillary water damage to the property. During the time from which the automatic sprinkler head was patented and 1896, the installation of sprinklers was becoming very popular. Each installation was unique, and often unreliable, so insurance companies sought to develop a standard for the installation and maintenance of automatic sprinklers. A board of eight people was formed to study the

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6 problem and draft regulations for the proper installation of the sprinklers. In 1896 the board developed twelve articles as a result of several meetings; the first article named the organization the National Fire Protection Association, and the other eleven described the proper design and installation of sprinklers. In 1897 the same organization, understanding the potential of electricity, both good and bad, unified the five separate electrical codes that then existed in the United States and drafted the first National Electric Code.3 After the Triangle Shirt Waist Fire on March 25th, 1911, which resulted in one hundred and forty-six deaths, the National Fire Protection Association drafted a pamphlet titled “Outside Stairs for Fire Exits” in response to the failure of external fire escapes during the fire. In 1918 the National Fire Protection Association published a second pamphlet titled “Safeguarding Factory Workers from Fire”; this publication was aimed at protecting factory workers from fire. The NFPA also understood that different types of occupancies had different requirements for safe egress, so it published the Building Exit Codes in 1927. The objective of the National Fire Protection Association at that time was to establish the proper safeguard against the loss of life and property by fire.4 3 Charles Grant, “Birth of the NFPA,” NFPA Journal 96, no. 4 (July/August 2002): 3. 4 Building Exits Code , 8th ed. (Quincy, MA: National Fire Protection Association, Inc., 1946), 7.

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7 Figure 2-2. Adoption of NFPA 101. Statewide adoption of NFPA’s 101 Life Safety Code as of March 2004 is shown as shaded. (Source: NFPA, “Comprehensive Consensus Codes,” 2003)

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8 CHAPTER 3 HOSPITALS AS A BUILDING TYPE Hospitals, or the health care industry, in general are the second most regulated industry in the United States, behind only the nuclear power industry.1 Hospitals have three main categories of occupants within their special occupancy type: the patients, the staff and the public. Each main category of occupants can be broken down further and presents its own unique requirements with regard to life safety for an emergent fire event. Figure 3-1. A Special Procedure Room 1 Marvin Fischer and others, Fire and Safety in Health Care Facilities (Quincy, MA: National Fire Protection Association, Inc., 2000), 3-17.

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9 Figure 3-2. An Outpatient Surgery Room Figure 3-3. An Operating Room at Moffitt Cancer Center, Tampa, Florida

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10 Patients Patients fit into either of the two following population subsets: the in-patient classification, or the outpatient classification. The first group, the in-patient population, is technically defined by various regulatory agencies as persons admitted to the hospital for a stay of 24 hours or more. Outpatients consist of patients in the Emergency Department, outpatient surgery patients, or any other group that is going to have a stay at the hospital of less than 24 hours.2 Outpatient Population The outpatient population is considered ambulatory by federal and state regulatory agencies, but in reality, they can be unconscious for more than half of their short stay. Emergency patients may be brought to the hospital by ambulance and be unable to move on their own for a plethora of medical reasons. Outpatient surgery patients are under some form of anesthesia during at least part of their stay, and they also need time to recover from the medical procedure that brought them to the hospital in the first place. Many other treatments are performed in a hospital on an outpatient basis. A great number of the outpatient procedures render the patient at a reduced capacity as far as mental and physical activities go for at least some part of the time they spend at the facility. Outpatients must be considered to be non-ambulatory when designing for life safety in a hospital. 3 2 Fischer, Fire and Safety in Health Care Facilities , 18-21. 3 Thomas W. Gardner, ed., Health Care Facilities Handbook , 7th ed. (Quincy, MA: National Fire Protection Association, Inc., 2002), 23.

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11 In-patient Population In-patients are considered non-ambulatory by regulatory agencies. With current insurance requirements, an early discharge from a hospital is the norm4. A large portion of their recovery happens at home, or at other building types. Almost every admitted patient in a hospital is of reduced capacity as far as mental and physical capabilities go, with very few exceptions.5 These patients who are at a reduced capacity depend on the building, the buildingÂ’s medical systems, as well as the staff for their survival. A large portion of the non-ambulatory in-patient population who are dependent on the building could not survive being outside the structure for even a very short period of time. The stress of being moved could also contribute to a negative outcome in their survival rate6. The designer of hospitals must understand that the worst environmental conditions could exist during an evacuation because of an emergent fire event. A hurricane, thunderstorm, flood, snow storm, or any other number of natural inclement weather conditions could exist during an emergent fire event making evacuation from the building as dangerous to these occupants as the fire. The portion of in-patient occupants who are dependent on the building systems for survival include those patients who require the use of piped medical gases, electricity to power medical devices, as well as the control of the forced air systems to regulate relative pressure relationships between their space and various other spaces and to monitor and control temperature and humidity within a hospital to either reduce the chances of infections from developing or being transferred from one patient to another. As with the 4 Gardner, Health Care Facilities Handbook , 34. 5 Fischer, Fire and Safety in Health Care Facilities , 137. 6 Fischer, Fire and Safety in Health Care Facilities , 142-144.

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12 population of in-patients described above, these people would either perish or develop life-threatening infections from the evacuation of the building.7 The last group of in-patients to consider is those who are dependent on the medical staff for their care. Patients within an Intensive Care Unit often require one on one care; seldom is the ratio of patient to caregiver greater than 2 to 1 at this level of care.8 The patient in the midst of a cardio catheterization procedure or an organ transplant is dependent on a team of people to keep him alive. He is also reliant on the buildingÂ’s medical systems as well as the building itself evacuation will assure his demise. Staff The staff of a hospital can be divided into three sub-groups: caregivers, noncaregivers and facility maintenance staff.9 Caregivers provide direct medical support to the patients. Doctors, nurses and technical staff as well as medical administration are included in this group of caregivers. Caregivers are an essential component to provide support for the patient population during an emergent fire event. Non-caregivers include non-medical administration, information technology groups and volunteers. A majority of this population is also essential during an emergent event to provide support to the patients and medical caregivers. Volunteers are the one group that should be evacuated during an emergent fire event. Public The public will serve no support role during an emergent fire event and should be evacuated early and with little supervision or resources from the hospital and the staff. 7 Fischer, Fire and Safety in Health Care Facilities , 146. 8 Fischer, Fire and Safety in Health Care Facilities , 147. 9 American Institute of Architects, Guidelines for Design and Construction of Hospital and Health Care Facilities, 2001 ed. (Washington, DC: American Institute of Architects, 2001), 19 and 103.

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13 The public can interfere with the operations of the essential staff and the caregivers of the patients. Separate code requirements should be in place for this segment of the occupant group. Evacuation should happen at the very first signs of an event anywhere within the facility to reduce the publicÂ’s risk of harm from the conflagration or other emergent event and to relieve the building and staff resources from assisting the public and focus the staffÂ’s efforts on providing for the patients.

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14 CHAPTER 4 EXITING The requirement for exits to be designed to provide protection for the lives of the occupants while evacuating an emergent fire event history is rich. The single most important event that built the momentum to develop the Life Safety Code was the Triangle Shirt Waist Fire in 1927 in New York City.1 Refinements to the exiting requirements of the Code came from several events including those that happened at the Beverly Hills Supper Club Fire, Cocoanut Grove Night Club Fire, Iroquois Theater Fire and many other fires that had a large number of people perish due to a fire and unsuccessful exiting.2 Exiting can cause as much harm, if not more, to the patients of a hospital than staying in place and facing the emergent fire event; but exiting is an important concept to understand and is a legitimate requirement of the Life Safety Code for all building types including hospitals.3 While exiting is used in hospitals only as a last resort and after all attempts to defend the occupants in place have failed, the public should in all cases, be required to exit the building. This will provide for additional area within the hospital for refuge to be used by the remaining occupants for protection from the event. The public evacuating would remove the source of external strain from the staff, which would allow them to focus solely on assisting the patients. Exiting by the public will also assure their 1 Cote, Life Safety Code Handbook , 94. 2 Cote, Life Safety Code Handbook , 95. 3 Cote, Life Safety Code Handbook , 95.

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15 own safety during the event without introducing any additional sources of danger to them. Figure 4-1. Exiting or Evacuation from a Building Exiting relies on the occupants of a building to be able to leave the building on their own accord and the building must provide enough protection and separation from the fire’s location to allow additional time for those that need assistance to be helped during the egress of the structure.4 The concept of exiting requires timely notification of the emergent fire event, and includes the need for a quick response by the occupant to move towards and through the exits of the building to a public way.5 Multiple layers of protection are provided by the Life Safety Code to allow for the safe egress of the occupants for most building types. This protection allows for some level of protection from the source of the fire as multiple users move toward and converge on the exits and negotiate them successfully under an increasing level of stress brought on from the event. The theory of exiting is comprised of many facets and specific requirements; the elements that will be discussed here are egress components and compartmentation theory 4 Stephen Murphy, “The Human Factor,” NFPA Journal 96, no. 5 (September/October 2002): 54-60. 5 Murphy, “The Human Factor,” 54-60.

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16 for exits. Exit width, direction of movement, number of required exits, and travel distance should not be interpreted as having a lower level of importance in the design of a hospital because they are omitted from this discussion. Egress Components The three components of egress are exit access, exit and exit discharge.6 The reader is directed to the current adopted version of the Life Safety Code for exact physical requirements of each component. The three components are listed here in the order an occupant would utilize and traverse them. Exit access is usually defined as habitable space and the building components a user negotiates to reach an exit. These components include doors, corridors, unprotected stairs, and unprotected ramps.7 Exits are the portion of egress separated by appropriately rated construction. Examples of exits can include doors to the exterior, enclosed and protected stairs and ramps, horizontal exits and exit passageways.8 Exit discharge is often one and the same as the exit when the exit is an exterior door. The exit discharge is the point of discharge from the building and the path of travel leading from the exit to a public way, which is technically defined as a 10-foot wide and 10-foot high unobstructed passage leading to the property line.9 6 Cote, Life Safety Code Handbook , 104. 7 Cote, Life Safety Code Handbook , 106. 8 Cote, Life Safety Code Handbook , 108. 9 Cote, Life Safety Code Handbook , 108.

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17 Compartmentation Theory for Exits (Non-Hospital-Specific) This theory simply stated is the separation by construction of the user from the event to allow time for safe egress during an emergent event. Methods for implementation of this theory are less simplistic. Figure 4-2. Compartmentation The first layer of exit compartmentation is the separation of hazardous areas from the balance of the spaces.10 Hazardous areas can include storage rooms, boiler rooms and tenant demising walls among other areas. The second layer of compartmentation is achieved by protecting the common exit access corridor system from all other occupiable spaces of the building by rated construction of the corridor walls. The next layer of compartmentation is the separation by rated construction of the common exit access corridor system from the exits.11 10 Cote, Life Safety Code Handbook , 109. 11 Cote, Life Safety Code Handbook , 110.

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18 The final layer of compartmentation is the fire compartment itself. Fire compartments divide the floor plate into two or more areas with complete horizontal and vertical separation from outside wall to outside wall and from floor to underside of structure above.12 Doors are allowed through the fire compartment walls but the fire compartment walls are not required to include a door. The Life Safety Code states that fire compartments provide “serious” protection from fire and some protection from smoke.13 The purpose of these walls is to provide for protection and the preservation of property and life in the event that a fire catastrophically overcomes the adjacent compartment. Figure 4-3. Fire Compartment 12 Cote, Life Safety Code Handbook , 153. 13 Cote, Life Safety Code Handbook , 154.

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19 CHAPTER 5 DEFEND IN PLACE Exiting or evacuation of a hospital during an emergent fire event is not possible for the majority of its patient and staff population because of their unique needs, requirements, and the support roles played by the staff. The concept of Defend in Place is used for life safety in hospitals because of the fact that most occupants cannot safely evacuate the building. Because of this unique factor regarding the life safety of occupants in hospitals, the hospital is treated as “a ship at sea” as far as life safety is concerned.1 Emergent egress from a hospital kills patients. Stress from evacuation during an emergent fire event results in a twenty-five percent morality rate attributed solely to the stress of the evacuation.2 Mandatory Adoption of NFPA 101 On December 8, 1961 a fire broke out in a 13-story hospital located in Hartford, Connecticut, after a burning cigarette was tossed into a trash chute. The fire smoldered for about an hour due to a lack of oxygen, until the chute door was reopened, then flames shot up to reach the top floor of the hospital. Seven patients, five visitors and four staff members died that night. Significant changes to the Life Safety Code as a result of that fire included reducing the dead-end travel distance allowed in hospitals, additional smoke door requirements and the requirement for closers on fire rated doors. The National Fire 1 Fischer, Fire and Safety in Health Care Facilities , 354. 2 James Gregory, Bureau Chief, Agency for Health Care Administration, 19th AHCA Seminar, November, 2002.

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20 Protection Association met with senators and staffers to explain that enforcement of NFPA’s 101 Life Safety Code would have resulted in fewer fatalities. In 1967, under an amendment to the Social Security Act, the federal government made conformance to the Life Safety Code a condition for Medicare and Medicaid reimbursement for all hospitals and nursing homes in the United States.3 Figure 5-1. A Ship at Sea Also Must Adhere to Defend in Place. 3 John Nicholson, “Sprinklers in Hospitals,” NFPA Journal 96, no. 4 (July/August 2002): 78.

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21 Hospitals, Sanitariums and Correctional Institutions The Life Safety Code provided for the concept of Defend in Place since the first edition, stating that: The purpose of this section of the code is to promote life safety from fire in hospitals, sanitariums & correctional institutions. Exits or characters of construction alone are not sufficient to provide proper safety for occupants physically or mentally disabled or under restraint. For this reason, this section is treated differently from other sections of the code and more emphasis is placed upon construction of buildings, fire prevention and fire protection.4 The first edition of the Life Safety Code (then titled Building Exits Code) also recognizes the special and unique requirements of individual occupancies. The eighth edition of the Building Exits Code published in 1946 had six specialized occupancy categories, and had distinctive requirements for each. These chapters addressed the following special occupancy types: ! Hospitals, Sanitariums and Correctional Institutions ! Schools ! Department Stores ! Places of Public Assembly ! Hotel and Apartment Houses ! Office Buildings5 The version of the Life Safety Code that is currently adopted by the state of Florida is the 2000 edition, and has eleven separate categories, each divided into 2 sections, addressing the requirements for new construction and the minimum standards that existing buildings must maintain.6 Important considerations are given to staff training in the first eight editions of the Building Exits Code. Fire suppression systems allowed for greater latitude in design and 4 Building Exits Code , 77. 5 Building Exits Code , 79. 6 Cote, Life Safety Code Handbook , 314.

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22 planning of hospitals. Hospital beds were required to be on casters in these first eight editions of the Code. Special emphasis was given to horizontal exits, fire compartments and ramps over that of stairs.7 Defend in Place is comprised of seven unique components: compartmentation, fire suppression, staff training, character of construction, notification of event, smoke control and currency of codes. Each separate and individual component is a redundancy of the others; if one fails the other six will provide the needed protection for the occupants and allow them to remain within the structure. The seven components are at the same time interconnected in their implementation, in that omitting one would reduce the success of the concept to a point being unacceptable as a minimum of design, while allowing for some reduction in their application is still effective. That is, the whole is greater than the sum of the parts. Compartmentation Compartmentation in hospitals provides for life safety by keeping the danger separate from the occupants, and providing a tenable space outside the area or compartment of the emergent fire event. General compartmentation is provided on three levels: separation or isolation of hazardous spaces from non-hazardous and habitable spaces, isolation of exit access corridor systems from rooms and suites, and smoke compartmentation.8 7 Building Exits Code , 83. 8 Cote, Life Safety Code Handbook , 326.

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23 Isolation of Hazardous Spaces The National Fire Protection AssociationÂ’s Life Safety Code defines a hazardous space as an area that poses a greater degree of danger than the balance of the building.9 Hazardous spaces include storage rooms, boiler rooms, and separate occupancies to name just a few. Separations of these areas are provided by character of construction. Typically, rated construction isolates the hazardous room or area from the rest of the building. The character of construction is often supplemented with increased fire suppression system requirements, additional smoke control systems, and an increased level of notification systems requirements. The theory of separation and isolation of these hazardous areas provides containment of the fire to the areas that present the most risk from reaching the other portions of the building. The containment of the event will either eliminate the spread of fire and smoke, or delay the spread of the fire and smoke to the rest of the building, providing necessary time to react to the emergent fire event. These hazardous areas are often unoccupied, which would allow for the emergent fire event to rapidly accelerate before a reaction could be implemented.10 Greater damage and risk to the occupants would exist if the emergent fire event was not isolated from the rest of the spaces or exit access system by character of construction allowing additional protection for the occupants. 9 Cote, Life Safety Code Handbook , 327. 10Fischer, Fire and Safety in Health Care Facilities , 417.

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24 Figure 5-2. Hospital Compartmentation Isolation of Exit Access Corridor Systems Isolation and separation of the exit access corridor system from rooms and suites is critical in hospitals to provide the possibility of egress from the building by the public, egress from the building by non-essential staff occupants, and provide protection to ensure the safe movement within the building from the area of the fire event to other areas that will provide internal safe refuge for the occupant. This is a fundamental and important component of the Defend in Place theory. Smoke Compartmentation Smoke compartmentation is the single most important architectural component of Defend in Place. Smoke kills more people during an event than fire.11 Any fire will 11 Anthony O’Neill, “Prescription for Health-Care Facility Safety,” NFPA Journal 96, no. 4 (July/August 2002): 32.

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25 produce smoke, and the controlled movement (evacuation or venting) or isolation of the smoke is important. There are three levels of smoke compartmentation: containment at the source, containment within the room of origin and containment within the smoke compartment of origin.12 Figure 5-3. Three Levels of Compartmentation Containment at the source is accomplished by several methods. The first method, and usually the most successful system, is the use of sprinklers. This topic will be discussed in more depth under fire suppression systems later in this chapter. Other components of Defend in Place that contribute to containment are character of construction, staff training, and notification of the event. Character of construction includes the use of fire resistant materials to construct the space, and the use of materials 12 Cote, Life Safety Code Handbook , 114.

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26 with the correct flame spread ratings for interior finishes. By using fire resistant materials for construction meeting the Underwriters Laboratories minimum requirements for tested assembly U422 having a fire rating of 1 hour, fire will not spread internally within the walls or other cavities, and proper flame spread ratings of finishes will retard the spread of fire internally to the room or space. Staff training educates the staff about fire dangers and proper methods for the storage of materials. Rooms that are typically unoccupied or rooms and spaces that are designed for the public to wait (these spaces are often open to the corridor system and do not provide for the isolation of the corridor system) but are not supervised by staff when in use by the public (when waiting rooms are supervised by staff members, the staff can prevent the fire or react quickly and not compromise the exit access system) must include smoke detectors or in some cases fire detectors. This notification system will alert both the staff and the fire department of the event starting as well as defining the general location of origin so both can work quickly to extinguish the fire and protect the occupants before the fire spreads. Containment within the room is very important. Once the event involves the entire room of origin, a great amount of heat is being generated and the flames are also generating a great deal of smoke. When this amount of heat, smoke and flames has developed, it can easily consume the adjacent spaces and rooms at a rate that progresses geometrically, quickly making the entire building, but most importantly the exit access system, untenable. This phenomenon is known as flash over. Containment within the room of origin is accomplished by compartmentation and all the other six methods of Defend in Place, which are fire suppression systems, character of construction, smoke control, staff training, notification of event, and currency of codes.

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27 To control an event at the room of origin, the fire suppression system, as stated above, is the single most important component to accomplish the containment by separation. It acts to extinguish the event, not allowing the fire to grow or produce any more heat or smoke. Smoke control reacts to the event and isolates and controls the movement of smoke. Character of construction limits the spread of the fire by separating the space from the exit access system.13 This is important to ensure safe passage and movement of the occupants in the case that the area of the fire becomes untenable. Because all hospitals are required to be fully sprinklered, the minimum hourly rating of the separation at the corridor walls is reduced. The National Fire Protection Association has researched this fact by performing full scale testing of mock construction scenarios, and by studying actual fire events, finding that reducing the rating of the exit access system walls from a one hour fire rating to a smoke tight rating (defined as 30-minute fire) does not have negative effects on this level of compartmentation.14 Staff training has proven to be key at this level as concluded in the investigations of actual emergent fire events by the National Fire Protection Association in the seven years leading up to the reduction of this requirement.15 The staff is trained to react to the early warnings that the event has started, and if required, to evacuate the occupants who were in the room of origin to an area of safe refuge. This area may be the patient’s own room, another patient’s room or another smoke compartment. The staff is also trained to make rounds and verify that all other room occupants are safe, then separate them from the original event further by manually closing the doors to the patient rooms. It would be 13 Fischer, Fire and Safety in Health Care Facilities , 147. 14 Alisa Wolf, “Behind Closed Doors,” NFPA Journal 96, no. 3 (May/June 2002): 52. 15 Wolf, “Behind Closed Doors,” 52.

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28 understandable to think that door closers should be required on all doors that open to the corridor system, especially patient room doors, but again research has found that door closers will cause six times more injuries, even with magnetic releases, than they will prevent during an emergent fire event.16 Currency of code* is also crucial to this level of protection. Hospitals are required to maintain all the life safety systems mentioned in this paper, and many other systems not mentioned here. The final level of compartmentation is containment of the emergent fire event within the smoke compartment of origin. If there is a breach in the previous level of containment, containment within the room of origin, the fire and smoke will quickly spread from the room of origin through the exit access corridor system. The Life Safety Code requires that all rooms open directly onto the exit access corridor system, which is required to ensure safe exiting, but in the case of Defend in Place, rooms opening onto the corridor can provide a death trap and the corridor system can allow the fire to spread and trap the patients in their rooms. To prevent this entrapment from happening, each floor of a hospital that contains patients is of a certain size, and is required to be completely subdivided from exterior wall to exterior wall horizontally, and from floor to underside of structure above into at least two separate spaces. This separation will make sure that patients in compartments other than that of the one of origin are safe. There is also a requirement that adjacent smoke compartments must have 30 square feet of free area for each patient from the adjacent compartment to seek safe refuge in the adjoining compartment. The square footage requirement was derived by assuming that litter borne 16 Wolf, “Behind Closed Doors,” 53. *Currency of Code is defined as the maintenance, upkeep and exercising and testing of, as appropriate, and dictated by the various Authorities Having Jurisdiction, the building systems and components that provide life safety features for the protection and safeguarding of the occupants.

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29 patients will be transferred to the adjacent compartment. The typical size of the litter (stretcher) or hospital bed is approximately three feet in width by seven feet in length, plus there is an allowance for miscellaneous equipment such as respirators. See the Appendix for a case study. Horizontal Exits Horizontal exits provide another form of compartmentation, serving a hospital both as a Defend in Place component and extending the travel distance to an exit proper. Horizontal exits in a hospital often serve dual purposes for two of reasons. Since serious rated character of construction is being used by the designer to conceptually extend the travel distance to an exit, the horizontal exit partition often serves a redundant function by increasing the rating to two-hour fire/smoke. As shown in the Appendix, the travel distance to both an exit and a smoke compartment door must be met from anywhere in the facility. This wall provides both at the same time. Figure 5-4. Horizontal Exit

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30 A fundamental flaw with this requirement of the Code is that it makes no allowance for two realistic scenarios. The first scenario is that if a compartment contains only public or staff and not patients of any type, these occupants should evacuate the building immediately. Only essential staff will be needed in the patient care areas to assist with patient support. A smoke compartment that houses public and staff will be evacuated and thus should not be counted on to provide an occupant load on any adjacent smoke compartments containing patients, or a compartment containing other staff and public. The second flaw in the code is that some compartments are not conducive to accepting other patients in emergent fire situations. Examples of these types of compartment adjacencies are compartments that house operating suites, because of infectious concerns, emergency departments, because most are already overcrowded, and psychiatric and similar wards which might endanger both the patient housed in that compartment and the patient moved into that compartment. Refer to Appendix A for a case study used as a basis to form this theory. Fire Suppression Systems The single most important component of any life safety system is an automatic sprinkler system.17 Having a fully sprinklered building is like having a fireman with a hose on duty 24 hours a day, 7 days a week, and the fireman is everywhere at once. In 1973, the federal government required, under the Social Security Act, that all hospitals must be fully sprinklered in order to receive Medicare reimbursement. This requirement came after several fires killed a total of 27 people in the previous four years, and many of the deaths were believed to be preventable if the facilities involved were fully sprinklered. The two most significant fires took place at a hospital in Winston-Salem, 17 Fischer, Fire and Safety in Health Care Facilities , 256.

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31 North Carolina in 1969, killing 11 occupants, and at a hospital in Pittsburgh, Pennsylvania, killing 10 people in 1971. Both fires started in an unoccupied area of the hospital. The fire in North Carolina started in a storeroom containing pallets of toilet paper, and was caused by careless smoking by an employee. The fire spread quickly once it fully ignited the pallet of toilet paper and spread down the corridor system unchecked, until the local fire department responded and extinguished the event.18 Careless smoking also caused the fire in the Pittsburgh hospital, but this time a patient was smoking in bed, igniting the mattress. The fire spread quickly down the corridor until a one-hour fire smoke wall contained the blaze until the fire department responded.19 The Life Safety Code requires not only that hospitals be fully sprinklered, but that any smoke compartments containing a sleeping room to be covered entirely by quick response heads, or QRS heads.20 Quick response heads should not be confused with low temperature heads. Automatic sprinkler heads are rated by what temperature they are activated at, and there are low temperature heads, normal temperature heads, and high temperature heads. Quick response heads react at the same temperature as standard heads, but the fusible link that triggers water flow reacts sooner once it reaches the design temperature, working to contain the event faster than standard heads. 18 Nicholson, “Sprinklers in Hospitals,” 78. 19 Fischer, Fire and Safety in Health Care Facilities , 257. 20 Fischer, Fire and Safety in Health Care Facilities , 257.

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32 Figure 5-5. Sprinkler Type and Use Other types of life safety systems that are part of the fire suppression category are fire extinguishers, stand pipes and fire pumps. Fire extinguishers must be located within the facility so that anyone is never farther than 75 feet from an extinguisher. The extinguisher is required to allow the staff a chance to snuff the fire immediately upon it being noticed. A fire extinguisher is rated by both capacity and the type of agent it contains. A hospital must have a 4-A:60-B:C extinguisher which is of a capacity to allow sufficient agent discharge to allow a non-firefighter to extinguish the blaze, and is capable of fighting all types of common fires; that is, type ABC because of the wide range of potential types of fires that could be faced. Type A extinguishers contain agents to control wood, cloth, paper, etc., Type B extinguishers contain agents to fight fires of flammable liquids in origin and Type C extinguishers work on fires of electrical origin. Fire pumps and stand pipe systems are in place to assist the fire department once they have responded to the notification, and are not typically used by the staff or anyone else.

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33 Staff Training Staff training is not an architectural provision for life safety, but because of the level of training the staff receives, they are treated as a first responder to the emergent fire event. The fire department is also required to respond to the event in case of a fire alarm notification. Because the staff is highly trained, many other components of life safety are at a somewhat reduced capacity. The staff is trained to be able to move the patients to another area if required by how the emergent fire event has developed. They are also trained to close all doors within their area of charge, and to clear the exit access system of all people, carts and unnecessary items. Finally, they are trained in the proper use of fire extinguishers, as well as fire prevention.21 Character of Construction Character of construction includes the requirement that all concealed components of construction be non-combustible.22 If wood is used inside a wall, shaft or similar area it must be treated to prevent the spread of fire and smoke by application of a chemical, usually a salt compound, during the processing of the raw material into dimensional lumber. This fire treated wood must also pass a testing agencyÂ’s requirements in order to receive a label. Character of construction also addresses other components of construction and methods for fireproofing. For the most part, hospitals are constructed to meet Type II construction or the more stringent Type I. Both of these types of construction are considered to be non-combustible; Type I is defined by the National Fire Protection Association as a type of construction that all structural members are non21 Fischer, Fire and Safety in Health Care Facilities , 214. 22 Cote, Life Safety Code Handbook , 378.

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34 combustible and having a fire resistance rating not less than three hours or as allowed by NFPA 220. Type II construction is defined as any type not meeting the requirements of Type I and having a fire resistance rating for its structural members of two hours, or as allowed by NFPA 220.23 Construction must also be detailed to meet rigorous Underwriters Laboratory standards and testing. Rated partitions are a fundamental requirement to separate hazardous areas from non-hazardous areas.24 They are also required to protect areas of greater importance from areas of lesser importance such as protecting the exit and exit access ways from areas of standard hazard. Interior finish requirements, specifically flame spread ratings, work to reduce the fuel for the fire. Corridors are required to have a flame spread rating of Class A, which is the most restricted. Rooms off the corridor system can have finishes with a flame spread rating of Class B.25 UL listed assemblies are required for all rated construction. The Underwriters Laboratory test construction methods for their resistance to fire and smoke and rate the assemblies in terms of time before a failure of the assembly occurs. Notification of Event Fire alarm pull stations are required near exits and smoke compartment doors to allow someone to activate the fire alarm system on their way out of the dangerous zone. Annunciator panels are required at the building entry for use by the fire department so they can immediately know where to proceed once they arrive at the building. But 23 Cote, Life Safety Code Handbook , 381. 24 Cote, Life Safety Code Handbook , 367. 25 Cote, Life Safety Code Handbook , 345.

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35 because staff is also considered a form of first responder, annunciator panels are also required in a 24-hour supervised area, usually the emergency department or a nurse station, so early action can be taken by the staff. The staff and other occupants are notified of the event by a horn and strobe device that gives both audible and visual clues to the event. A public address of the event is also required to be made by the staff receiving the signal at the annuciator panel. The fire department is also notified of the alarm event, typically by automated telephone message. Smoke Control Dampers are use to prevent the passage of smoke through the forced air system and its return air system. Smoke alarms are required in non-occupied areas and waiting areas that are not supervised 24 hours a day because of the increased hazard due to lack of supervision by the staff. Smoke evacuation systems are not a typical component of the life safety system of hospitals unless there is an atrium within the occupancy. No return air plenums are allowed because such a system without dampers would allow the uncontrolled passage of smoke from its point of origin to almost any other area in the hospital, most critically, from the room of origin out, or from the compromised smoke compartment to the safe compartment. Currency of Codes Many authorities having jurisdiction exist to enforce the requirements of hospitals to maintain the required life safety systems after they are installed. JHCAO, which stands for Joint Health Care Accreditation Organization, reviews on a three-year basis all hospitals that seek Medicare reimbursement; the authority to do this is given to them by Congress under the Social Security Act. The Veterans Administration also requires their facilities to be JHCAO certified and graded.

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36 Many states have their own authority to license a healthcare facility. The state of Florida has AHCA, which stands for the Agency for Health Care Administration. This agency, by authority of state statutes, reviews any new hospitals during planning, design and construction.26 AHCA also requires that any changes made to the physical building or its services, such as electrical changes, be reviewed and approved for construction by the agency.27 AHCA also performs annual life safety visits to each hospital to act as another set of eyes, to ensure that life safety systems are maintained and remain operational for the life of the facility. Interconnectivity and Redundancy The seven components of Defend In Place are interconnected; some reduction is allowed because the others exist, for example, the reduction in ratings of corridor walls from a 1-hour fire rating to a 30-minute fire rating. Also, omitting the requirement of closers on patient rooms doors is allowed because of the hospital being fully sprinklered. The seven components of Defend in Place are also redundant to each other. If any one component should fail, the other six will work together to provide the level of protection required by the Defend in Place concept. 26 Florida State Statutes, Chapter 59-A3, 2000. 27 Florida State Statutes, Chapter 59-A3, 2000.

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37 Figure 5-6. Diagrammatic Interconnectivity Relationship

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38 Figure 5-7. Diagrammatic Redundancy Relationship

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39 CHAPTER 6 EBB AND FLOW OF A HOSPITAL AND HOW DEFEND IN PLACE STRATEGIES CAN IMPROVE FUNCTIONAL FLOW DURING SEVERAL TYPES OF EMERGENT EVENTS Basic functional design principles for hospital design dictate that the three main circulation and occupancy functions be separated. The three functional and circulatory areas to be separated are public, patient and service functions. Figure 6-1. Circulation The public, via methods of design, are typically restricted in their movement through the hospital. The front door of the hospital and its associated functions, along with certain spaces such as waiting rooms, are usually for the publicÂ’s exclusive use. Associated functions include the cafeteria, gift shop, meeting rooms, and admitting spaces. The design methods usually implemented to restrict the publicÂ’s movement freely through the hospital can be as simple as doors; separation from less critical areas is

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40 often provided by closed, unlocked doors. Separation of the public from other increasingly sensitive areas can be provided by signage or locked doors. The patient areas are typically found in an internal zone, used exclusively for patient care. The public area often has a connection via waiting rooms, but good design practices as well as safety issues prohibit the mixing of these two zones. Patients need to be able to move freely and safely, often under the control of the staff, from their rooms to specialized procedure spaces such as medical imaging, operation suites and intensive care areas, then to a recovery space and finally, back to their rooms. Patient safety, infection control and patient privacy necessitate a separate zone for their circulation. Service zones are often found in the rear of the hospital. This location will separate deliveries and waste removal from visitors entering the front of the hospital. The service area also has a connection to the patient area for the delivery of supplies and removal of waste products such as soiled linens. The connection between these two functions is usually limited. Service personnel will typically fill a supply room from one side in bulk, while the medical staff obtains the portion needed by each patient from the other side, limiting the contact between the two groups. Soiled or waste products are often treated the same way, with two doors, one for the service staff to remove the waste in bulk, such as the complete removal of large soiled linen carts taken in bulk to the laundry, and the other door for the medical staff to place patientsÂ’ soiled linens in a cart as needed. During an emergent fire event, the two outer zones, the public zone and the service zone, should be evacuated. This will provide extra square footage into which patients can be moved in accordance with the Defend in Place concept of life safety, which is characterized by a flow of movement.

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41 Figure 6-2. The Flow of Defend in Place During an Internal Emergent Event During other types of external emergent events such as a hurricane or a mass casualty event, the building and service areas should again be evacuated. This will allow those in need to be able to enter the building for treatment. The evacuated areas in the front of the hospital originally intended for the publicÂ’s use can be converted into a triage space or overflow treatment area. The service area in the back can be set up for command and control for use by hospital administrators as well as civil defense personnel.

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42 Figure 6-3. The Ebb of Defend in Place During External Emergent Events Figure 6-4. Life Safety Flow for Case Study

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43 Figure 6-5. Life Safety Ebb for Case Study

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44 CHAPTER 7 CONCLUSION After conducting and analyzing the research for this thesis, the following conclusions can be made. First, the evolution of the Life Safety Code is reactionary; it stems from historical fire events that demonstrated deficiencies in providing life safety at the time of the fire. Next, different occupancies have unique requirements. Almost all of the different occupancy types protect the occupants from the emergent fire event by allowing enough time to receive notification of the event, react, move towards and through the exit, and finally discharge from the building. Hospitals are unique in that successful evacuation is arduous because of the non-ambulatory nature of the occupants, and the evacuation for some occupants will assure their demise because of their dependence on medical building systems. So, from the first edition of the building code, a concept of Defend in Place has been implemented, although this concept has never been referred to in those exact terms. Defend in Place allows the occupants protection from the emergent event by maintaining tenable conditions inside the hospital. Defend in Place can be distilled to seven main components: compartmentation, fire suppression, character of construction, smoke control, notification, staff training and currency of codes. These seven components of Defend in Place are implemented in such a fashion, that if one or two of the components should fail to provide protection for some reason, the remaining components will provide the minimum level of required protection for the occupants of the building. In this way, they are redundant to each other. At the same time, character of construction, smoke control and notifications requirements can be

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45 reduced because the effectiveness of fire suppression systems is so dominant in providing protection. Therefore, these interconnections are an important aspect of the code. With this understanding of Defend in Place and its components, life safety in hospital design can then be enhanced to allow for a better flow of occupants within the building, but away from an internal emergent fire event, and to allow for the ebb of patient movement within the hospital during an external emergent event such as a mass casualty incident, while still providing for the strategy of Defend in Place. The concept of Defend in Place works, and has been refined to such a point by the National Fire Protection Association that in the last five years there has been only one death per year due to fire and smoke in a hospital1. However, further refinement of the code is warranted, because the occupant load from a smoke compartment containing only the public or staff should not be counted in the adjacent patient occupied smoke compartments as currently required. The public should exit the building, allowing the patients to move to the public and staff occupied smoke compartments rather than moving into an undesirable adjacent compartment such as one containing operating rooms, deemed so because of the increased risk to the patients already in that compartment. Further research and study on this refinement should be performed to verify that no reduction in the protection of the life safety for the patients would result. 1 Gregory, 19th AHCA Seminar.

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46 APPENDIX A SMOKE COMPARTMENT REQUIREMENTS AND CALCULATIONS FOR THE CASE STUDY The 2000 Edition of the Life Safety Code requires a hospital to be divided into at least two separate spaces or compartments. This is a fundamental component of Defend in Place. The Life Safety Code states that: 18.3.7* Subdivision of Building Spaces. 2000edition 18.3.7.1 Buildings containing health care facilities shall be subdivided by smoke barriers, unless otherwise permitted by 18.3.7.2, as follows: (1) To divide every story used by inpatients for sleeping or treatment into not less than two smoke compartments (2) To divide every story having an occupant load of 50 or more persons, regardless of use, into not less than two smoke compartments (3) To limit the size of each smoke compartment required by (1) and (2) to an area not exceeding 2100 m2 (22,500 ft2), unless the area is an atrium separated in accordance with 8.6.7, in which case no limitation in size is required (4) To limit the travel distance from any point to reach a door in the required smoke barrier to a distance not exceeding 61 m (200 ft) 18.3.7.2 The smoke barrier subdivision requirement of 18.3.7.1 shall not apply to the following: (1) Stories that do not contain a health care occupancy, located totally above the health care occupancy (2) Areas that do not contain a health care occupancy and that are separated from the health care occupancy by a fire barrier complying with 7.2.4.3 (3) Stories that do not contain a health care occupancy and that are more than one story below the health care occupancy (4) Open-air parking structures protected throughout by an approved, supervised automatic sprinkler system in accordance with Section 9.7 18.3.7.3 Smoke barriers shall be provided on stories that are usable but unoccupied.

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47 18.3.7.4 Any required smoke barrier shall be constructed in accordance with Section 8.5 and shall have a fire resistance rating of not less than 1 hour, unless otherwise permitted by the following: (1) This requirement shall not apply where an atrium is used, provided that both of the following criteria are met: (a) Smoke barriers shall be permitted to terminate at an atrium wall constructed in accordance with 8.6.7(1)(c). (b) Not less than two separate smoke compartments shall be provided on each floor. (2)* Smoke dampers shall not be required in duct penetrations of smoke barriers in fully ducted heating, ventilating, and air conditioning systems. Further, the Life Safety Code requires each smoke compartment to be able to absorb the occupant load of each individual and adjacent smoke compartment. The Life Safety Code states: 18.3.7.6.1 Not less than 2.8 net m2 (30 net ft2) per patient in a hospital or nursing home, or not less than 1.4 net m2 (15 net ft2) per resident in a limited care facility, shall be provided within the aggregate area of corridors, patient rooms, treatment rooms, lounge or dining areas, and other low hazard areas on each side of the smoke barrier. 18.3.7.6.2 On stories not housing bed or litterborne patients, not less than 0.56 net m2 (6 net ft2) per occupant shall be provided on each side of the smoke barrier for the total number of occupants in adjoining compartments.

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48 Smoke Compartment SC 1.1 Occupants in Compartment 81 Area required in each adjacent compartment (81*30) = 2,430 sf Area provided SC 1.2 11,513 sf Figure A-1. Smoke Compartment 1 Calculations

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49 Smoke Compartment SC 1.2 Occupants in Compartment 84 Area required in each adjacent compartment (84*30) = 2,520 sf Area provided SC 1.1 5,713 sf SC 1.3 8,253 sf SC 1.4 11,109 sf Figure A-2. Smoke Compartment 2 Calculations

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50 Smoke Compartment SC 1.3 Occupants in Compartment 74 Area required in each adjacent compartment (74*30) = 2,220 sf Area provided SC 1.2 11,513 sf SC 1.4 11,109 sf SC 1.5 9,107 sf Figure A-3. Smoke Compartment 3 Calculations

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51 Smoke Compartment SC 1.4 Occupants in Compartment 90 Area required in each adjacent compartment (90*30) = 2,700 sf Area provided SC 1.2 11,513 sf SC 1.3 8,253 sf SC 1.5 11,121 sf SC 1.7 6,299 sf Figure A-4. Smoke Compartment 4 Calculations

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52 Smoke Compartment SC 1.5 Occupants in Compartment 50 Area required in each adjacent compartment (50*30) = 1,500 sf Area provided SC 1.3 8,253 sf SC 1.4 11,109 sf SC 1.6 11,121 sf Figure A-5. Smoke Compartment 5 Calculations

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53 Smoke Compartment SC 1.6 Occupants in Compartment 62 Area required in each adjacent compartment (62*30) = 1,860 sf Area provided SC 1.5 11,121 sf Figure A-6. Smoke Compartment 6 Calculations

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54 Smoke Compartment SC 1.7 Occupants in Compartment 54 Area required in each adjacent compartment (54*30) = 1,620 sf Area provided SC 1.4 9,107 sf SC 1.8 6,875 sf Figure A-7. Smoke Compartment 7 Calculations

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55 Smoke Compartment SC 1.8 Occupants in Compartment 75 Area required in each adjacent compartment (75*30) = 2,250 sf Area provided SC 1.7 6,299 sf Figure A-8. Smoke Compartment 8 Calculations

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56 APPENDIX B EXIT REQUIREMENTS AND CALCULATIONS FOR THE CASE STUDY The following is an example of exit calculation. For reasons of simplicity, the floor plate is divided into areas along the smoke compartment walls; this method of calculation serves as a check for the size limit of each smoke compartment in the previous appendix. The Life Safety Code dictates that: 7.3.1.2* Occupant Load Factor. The occupant load in any building or portion thereof shall be not less than the number of persons determined by dividing the floor area assigned to that use by the occupant load factor for that use as specified in Table 7.3.1.2, Figure 7.3.1.2(a), and Figure 7.3.1.2(b). Where both gross and net area figures are given for the same occupancy, calculations shall be made by applying the gross area figure to the gross area of the portion of the building devoted to the use for which the gross area figure is specified and by applying the net area figure to the net area of the portion of the building devoted to the use for which the net area figure is specified. Occupant load is determined by dividing the square footage of the smoke compartment by the square footage per person as required by the Life Safety Code. Level exits provide 0.2” of exit width per person using the exit, while stairs provide only 0.37” of capacity per person. The occupant load is then divided by the exit width provided, yielding occupant exiting capacity as shown on the tables provided.

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57 Table B-1. Life Safety Code Occupant Load Factor Table 7.3.1.2 Occupant Load Factor Use m2 (per person)1 ft2 (per person)1 Assembly Use Concentrated use, without fixed seating 0.65 net 7 net Less concentrated use, without fixed seating 1.4 net 15 net Bench-type seating 1 person/455 linear mm 1 person/18 linear in. Fixed seating Number of fixed seats Number of fixed seats Waiting spaces See 12.1.7.2 and 13.1.7.2 See 12.1.7.2 and 13.1.7.2 Kitchens 9.3 100 Library stack areas 9.3 100 Library reading rooms 4.6 net 50 net Swimming pools 4.6 (water surface) 50 (water surface) Swimming pool decks 2.8 30 Exercise rooms with equipment 4.6 50 Exercise rooms without equipment 1.4 15 Stages 1.4 net 15 net Lighting and access catwalks, galleries, gridirons 9.3 net 100 net Casinos and similar gaming areas 1 11 Skating rinks 4.6 50 Educational Use Classrooms 1.9 net 20 net Shops, laboratories, vocational rooms 4.6 net 50 net Day-Care Use 3.3 net 35 net Health Care Use Inpatient treatment departments 22.3 240 Sleeping departments 11.1 120 Source: NFPA 101 Life Safety Code Handbook, Ron Cote, Editor, Eighth Edition

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58 Figure B-1. Smoke Compartment 1 Exit Calculations

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59 Figure B-2. Smoke Compartment 2 Exit Calculations

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60 Figure B-3. Smoke Compartment 3 Exit Calculations

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61 Figure B-4. Smoke Compartment 4 Exit Calculations

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62 Figure B-5. Smoke Compartment 5 Exit Calculations

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63 Figure B-6. Smoke Compartment 6 Exit Calculations

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64 Figure B-7. Smoke Compartment 7 Exit Calculations

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65 Figure B-8. Smoke Compartment 8 Exit Calculations

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66 APPENDIX C CHARACTER OF CONSTRUCTION As stated in the body of the document, Compartmentation, either smoke compartment walls or fire compartment walls are required to divide the floor plate into two or more completely separate compartments with complete horizontal separation from outside wall to outside wall. Below are construction details demonstrating this requirement. Figure C-1. Junction of One-hour Smoke Wall with a Subservient Intersecting Partition

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67 Figure C-2. Rated Smoke Partition Terminating at Exterior Wall Constructed of Metal Studs. A detail similar to this one provides the continuous horizontal separation from outside wall to outside wall. Figure C-3. Rated Smoke Partition Terminating at Exterior Wall Constructed of Concrete Masonry Units. A detail similar to this one provides the continuous horizontal separation from outside wall to outside wall.

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68 APPENDIX D CURRENCY OF CODE EXAMPLES Below are actual examples taken from a life safety survey on a hospital. This survey was performed in order to maintain the Defend in Place components to provide for the life safety of the occupants. Figure D-1. Wall Stenciling Indicating Partition Rating of Two-hour Fire/Smoke Construction

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69 Figure D-2. Rated Compartment Partition Deficiency. Rated compartment partitions are required to divide the floor plate into separate compartments, horizontally from outside wall to outside wall, and from floor to underside of structure above. This photographs shows the partition is not sealed tight against the bottom of the structure above.

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70 Figure D-3. Penetration of Compartment Wall

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71 Figure D-4. Door to Hazardous Space “Held Open” by Door Stop, Preventing the Door Closer from Operating Properly.

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72 Figure D-5. Open Conduit Allowing the Passage of Smoke Between Compartment Walls

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73 Figure D-6. Rated and Tested Door Frame Label Painted Over, Obscuring the Stated Rating.

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74 Figure D-7. Rated Door and Frame Painted Over, Obscuring the Stated Rating.

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75 LIST OF REFERENCES American Health Care Association. Full-Scale Fire Tests in a Nursing Home Patient Room . Washington: American Health Care Association, 1975. American Hospital Association. Safety Guide for Health Care Institutions . Chicago: American Hospital Association, 1972. American Institute of Architects. 2001 ed. Guidelines for Design and Construction of Hospital and Health Care Facilities . Washington, DC: American Institute of Architects, 2001. Barham, Ronald. Fire Engineering and Emergency Planning: Research and Applications . London: E & FN Spon, an imprint of Chapman & Hall, 1996. Billington, M. J. Means of Escape from Fire . Oxford: Blackwell Science Ltd., 2002. Brannigan, Francis L. Building Construction for the Fire Service . 3rd ed. Quincy MA: National Fire Protection Association, 1992. Butcher, E. G. Smoke Control in Fire Safety Design . London: E & FN Spon, 1979. Cantor, David. Fires and Human Behavior . New York: John Wiley & Sons, 1980. Chaff, Linda. Health & Safety Management for Medical Practices: Evaluating Risk and Implementing Safety for Physician Offices . Washington: American Medical Association Press, 2002. Chertkoff, Jerome M. DonÂ’t Panic: The Psychology of Emergency Egress and Ingress . Westport, CT: Praeger Publishers, 1999. Cook, John L. Jr. Standard Operating Procedures and Guidelines . Saddle Brook, NJ: Fire Engineering Books & Videos, 1998. Cote, Ron, ed. Life Safety Code Handbook . 6th ed. Quincy, MA: National Fire Protection Association, 1994. Cote, Ron, ed. Life Safety Code Handbook . 7th ed. Quincy, MA: National Fire Protection Association, 1997. Cote, Ron, ed. Life Safety Code Handbook . 8th ed. Quincy, MA: National Fire Protection Association, 2000.

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76 Cote, Arthur, and Percy Bugbee. Principles of Fire Protection . Quincy, MA: National Fire Protection Association, 1988. DeHorn, John D. Kirk’s Fire Investigation . 5th ed. Upper Saddle River, NJ: Prentice Hall, 2002. Egan, M. David. Concepts in Building Firesafety . New York: John Wiley & Sons, 1978. Fischer, Marvin J., Thomas W. Gardner, Burton R. Klein, and James K. Lathrop. Fire and Safety in Health Care Facilities . Quincy, MA: National Fire Protection Association, 2000. Gardner, Thomas W., ed. Health Care Facilities Handbook. 7th ed. Quincy, MA: National Fire Protection Association, 2002. Grant, Cecile E., and Patrick J. Pagni, eds. Fire Safety Science: Proceedings of the First International Symposium . Washington: Hemisphere Publishing Corporation, 1986. Grant, Charles. “Birth of the NFPA.” NFPA Journal 96, no. 4 (July/August 2002): 4354. International Conference on Performance-Based Codes and Fire Safety Design Methods. Proceedings: 3rd International Conference on Performance-Based Codes and Fire Safety Design Methods. Bethesda, MD: Society of Fire Protection Engineers, 2000. Kashiwagi, Takashi, ed. Fire Safety Science: Proceedings of the Fourth International Symposium . Boston: International Association for Fire Safety Science, 1994. Keyes, Edward. Cocoanut Grove . Fairfield, PA: Fairfield Graphics, 1942. Lathrop, James K., ed. Life Safety Code Handbook . 3rd ed. Quincy, MA: National Fire Protection Association, Inc., 1985. Leibrock, Cynthia. Design Details for Health: Making the Most of Interior Design’s Healing Potential . New York: John Wiley & Sons, 2000. Malkin, Jain. Hospital Interior Architecture: Creating Healing Environments for Special Patient Populations . New York: John Wiley & Sons, 1992. Miller, Richard L. Hospital and Healthcare Facility Design . New York: WW Norton & Company, 2002. Murphy, Stephen. “The Human Factor.” NFPA Journal 96, no. 5 (September/October 2002): 54-60. National Fire Protection Association. Building Exits Code . 8th ed. Boston, MA: National Fire Protection Association, 1946.

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77 National Fire Protection Association. “About NFPA.” 2003. http://www.nfpa.org/ catalog/home/AboutNFPA/index.asp, accessed February 2004. National Fire Protection Association. “Comprehensive Consensus Codes.” 2003. http://www.nfpa.org/BuildingCode/AboutC3/NFPA101/nfpa101.asp, accessed March 2004. National Fire Protection Association. NFPA Ready Reference: Fire Safety in Health Care Facilities . Quincy, MA: National Fire Protection Association, 2003. National Fire Protection Association. NFPA Ready Reference: Human Behavior in Fire Emergencies . Quincy, MA: National Fire Protection Association, 2003. Nicholson, John. “Sprinklers in Hospitals.” NFPA Journal 96, no. 4 (July/August 2002): 41-46. O’Neill, Anthony. “Prescription for Health-Care Facility Safety.” NFPA Journal 96, no. 4 (July/August 2002): 32-34. Ramachandran, Ganapathy. The Economics of Fire Protection . London: E & FN Spon, an imprint of Routledge, 1998. Sharry, John A., ed. Life Safety Code Handbook . 1st ed. Quincy, MA: National Fire Protection Association, 1978. Turner, George E. A Simulation Model of Pedestrian Movement in Building Circulation System Components . Washington: The Catholic University of America, 1985. Wolf, Alisa. “Behind Closed Doors.” NFPA Journal 96, no. 3 (May/June 2002): 80-84.

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78 BIOGRAPHICAL SKETCH John H. Ashby graduated from Southern Illinois University at Carbondale, Illinois with a Bachelor of Science degree in 1985. After 10 years of professional architectural experience, he returned to school at the University of Florida to seek a Master of Architecture degree.