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Health Care

Facilities Handbook
SEVENTH EDITION

EDITED BY

Thomas W. Gardner, P.E.

With the complete text of the 2002 edition of NFPA 99, Standard for Health Care Facilities

National Fire Protection Association


Quincy, Massachusetts

Product Manager: Pam Powell


Developmental Editor: Khela Thorne
Project Editor: Joyce Grandy
Copy Editor: Debra Koch
Text Processing: Louise Grant
Composition: Omegatype Typography, Inc.

Art Coordinator: Cheryl Langway


Illustrations: Todd K. Bowman and George Nichols
Cover Design: Groppi Design
Manufacturing Buyer: Ellen Glisker
Printer: Quebecor World/Taunton

Copyright 2002
NFPA
One Batterymarch Park
Quincy, Massachusetts 02269
All rights reserved. No part of the material protected by this copyright notice may be reproduced or
utilized in any form without acknowledgment of the copyright owner nor may it be used in any form for
resale without written permission from the copyright owner.

Notice Concerning Liability: Publication of this handbook is for the purpose of circulating
information and opinion among those concerned for fire and electrical safety and related subjects. While
every effort has been made to achieve a work of high quality, neither the NFPA nor the contributors to
this handbook guarantee the accuracy or completeness of or assume any liability in connection with the
information and opinions contained in this handbook. The NFPA and the contributors shall in no event
be liable for any personal injury, property, or other damages of any nature whatsoever, whether special,
indirect, consequential, or compensatory, directly or indirectly resulting from the publication, use of, or
reliance upon this handbook. This handbook is published with the understanding that the NFPA and the
contributors to this handbook are supplying information and opinion but are not attempting to render
engineering or other professional services. If such services are required, the assistance of an appropriate
professional should be sought.
Notice Concerning Code Interpretations: This seventh edition of the Health Care Facilities
Handbook is based on the 2002 edition of NFPA 99, Standard for Health Care Facilities. All NFPA
codes, standards, recommended practices, and guides are developed in accordance with the published
procedures of the NFPA technical committees comprised of volunteers drawn from a broad array of
relevant interests. The handbook contains the complete text of NFPA 99 and any applicable Formal
Interpretations issued by the Association. These documents are accompanied by explanatory
commentary and other supplementary materials.
The commentary and supplementary materials in this handbook are not a part of the Standard and
do not constitute Formal Interpretations of the NFPA (which can be obtained only through requests
processed by the responsible technical committees in accordance with the published procedures of the
NFPA). The commentary and supplementary materials, therefore, solely reflect the personal opinions of
the editor or other contributors and do not necessarily represent the official position of the NFPA or its
technical committees.

NFPA No.: 99HB02


ISBN: 0-87765-476-X
Library of Congress Control Number: 2002109529

Printed in the United States of America


03 04 05 06 07
5 4 3 2

Contents

Preface

6.1
6.2
6.3
6.4
6.5
6.6

PART ONE

Health Care Facilities, 2002 Edition,


with Commentary

Administration
1.1
1.2
1.3
1.4
1.5
1.6

Referenced Publications

Definitions

13

19

Applicability
62
Nature of Hazards
63
Electrical System Requirements
Essential Electrical System
RequirementsType 1
83
4.5 Essential Electrical System
RequirementsType 2
112
4.6 Essential Electrical System
RequirementsType 3
116

Gas and Vacuum Systems

277

279

Electrical Equipment

281

Applicability
282
Nature of Hazards
283
Electrical System
284
Performance Criteria and Testing
Administration
299

Gas Equipment

284

309

9.1
9.2
9.3
9.4

Applicability
310
Nature of Hazards
311
Cylinder and Container Source
311
Cylinder and Container
Storage Requirements
312
9.5 Performance Criteria and Testing 314
9.6 Administration
316

61

4.1
4.2
4.3
4.4

Materials

8.1
8.2
8.3
8.4
8.5

15
16

19

Electrical Systems

Applicability
271
Nature of Hazards
271
Source
271
Distribution 271
Performance Criteria and Testing
Administration
278

Applicability
279
Nature of Hazards
279
Source (Reserved)
280
Distribution (Reserved) 280
Performance Criteria and
Testing (Reserved) 280
7.6 Administration (Reserved)
280

15

3.1 General
19
3.2 NFPA Official Definitions
3.3 General Definitions
20

271

7.1
7.2
7.3
7.4
7.5

Scope
7
Purpose
11
Application
11
Equivalency
12
Units and Formulas
12
Code Adoption Requirements

2.1 General
15
2.2 NFPA Publications
2.3 Other Publications

Environmental Systems

64

10

10.1 Applicability
321
10.2 Patient-Care-Related
Electrical Appliances

119

5.1 Level 1 Piped Gas and Vacuum Systems


5.2 Level 2 Piped Gas and Vacuum Systems
5.3 Level 3 Piped Gas and Vacuum Systems

Manufacturer Requirements

119
233
235

11

Laboratories

321

321

347

11.1 Applicability
348
11.2 Nature of Hazards
350
iii

iv

Contents

11.3
11.4
11.5
11.6
11.7
11.8
11.9
11.10

Structure
353
Equipment
356
Fire Protection
357
Emergency Shower
360
Flammable and Combustible Liquids
Maintenance and Inspection 369
Transfer of Gases
372
Laboratory Gas Cylinder Storage
for Non-Piped Use
372
11.11 Piped Gas Systems
374

12

Health Care Emergency Management


12.1 Applicability
377
12.2 Responsibilities
378
12.3 General Requirements

13

Hospital Requirements
13.1
13.2
13.3
13.4

14

15
16
17

395

Reserved

419

Reserved

421

Nursing Home Requirements

19

2002 Health Care Facilities Handbook

361

21

Freestanding Birthing Centers


21.1 Applicability
467
21.2 Responsibilities
467
21.3 General Requirements

467

467

Annexes

A
B
C

Explanatory Material

The Safe Use of High-Frequency Electricity


in Health Care Facilities 533

E
F

Flammable Anesthetizing Locations

Nature of Hazards

469
471

Additional Explanatory Notes


to Chapters 120 489

Informational References

567

599

Supplements
423

424

427

427

Electrical and Gas Equipment for Home


Care 431
19.1 Applicability
431
19.2 Responsibilities
431
19.3 Equipment
432

433

PART TWO

Limited Care Facility Requirements


18.1 Applicability
427
18.2 Responsibilities
427
18.3 General Requirements

Hyperbaric Facilities

20.1 Applicability
433
20.2 Construction and Equipment
435
20.3 Administration and Maintenance
435

413

Applicability
413
Responsibilities
413
General Requirements
414
Specific Area Requirements
417

17.1 Applicability
423
17.2 Responsibilities
423
17.3 General Requirements

18

381

Applicability
396
Responsibilities
396
General Requirements
397
Specific Area Requirements
401

Other Health Care Facilities


14.1
14.2
14.3
14.4

377

20

605

Overview of Fire Incidents in Health


Care Facilities 607

Regulatory Issues Affecting the Safety of Clinical


Hyperbaric Medicine Facilities 615

Disaster Recovery at Texas Medical Center from Tropical


Storm Allison 621

Cross-Reference Table for NFPA 99,


Health Care Facilities, 20021999 Editions
Index

631

About the Editor

649

625

Preface
NFPA 99, Standard for Health Care Facilities, is the result of the integration of twelve documents developed over a 40-year period by the Health Care Facilities Correlating Committee
(formerly the Committee on Hospitals). However, it is not the only document applicable to
health care facilities; there are some 50 other NFPA documents either that address, in whole
or in part, health care facilities or that can be used by health care facilities to address emergency or fire safety issues.
In categorizing fire protection for health care facilities, two general divisions of fire protection can be identified.
Facility Fire Protection. Facility fire protection features, such as hydrants, types of structural protection, length of exit travel distances, and detection and extinguishing systems, are
built into or around a structure to minimize hazards. They generally do not require human intervention to provide safety.
Operational Fire Protection. Operational fire protection practices, such as safe use of inhalation anesthetics, safe use of electricity, safe practices in laboratories, use of emergency electrical power, and emergency planning, are intended to minimize fire hazards once the health
care facility is occupied. These practices definitely rely on human intervention to provide
safety.
Some items (such as portable extinguishers, manual pull stations, and performance criteria
for grounding systems) can be categorized into either of the aforementioned divisions. In general, NFPA 99 is concerned with operational fire protection for the many activities occurring in
hospitals, ambulatory health care centers, clinics, medical and dental offices, nursing homes,
and limited care facilities. NFPA 99 includes provisions for patient care areas (e.g., wards, intensive care units, operating suites, hyperbaric and hypobaric facilities), certain laboratories, several facilitywide systems, and overall emergency planning for a facility in the event of an
emergency (fire or otherwise) that interrupts the delivery of patient care.
The effort to combine these twelve health care facility documents began in late 1979 at the
suggestion of Marvin J. Fischer, then Chairman of the Health Care Facilities Correlating Committee and Vice-President for Facilities Planning and Engineering Services, Brookdale Hospital
Medical Center, Brooklyn, New York. It was Mr. Fischers firm belief that combining these individual documents into one cohesive document would benefit health care personnel and patients, as well as designers, builders, and enforcing authorities. The correlating committee
agreed, but to assure consensus among those affected by the proposed change, the committee
solicited public comments on the idea in 1981. With overwhelming support, in January 1982
the committee proceeded with the initial step of publishing a compilation of the latest editions
of each of the documents into one bound volume. This compilation was designated NFPA 99,
Health Care Facilities Code.
The 1984 edition of NFPA 99 was the next step in the process: integration of the previous
individual documents into one new document, with a format revised to follow the NFPA Manual of Style (all definitions in one chapter; requirements in the main body of the text; recommendations in the annexes). The 1987 edition of NFPA 99 completed this integration process
by restructuring text into a form that placed nonfacility-specific requirements in one section
and facility-specific requirements into another section. (See Section 1.5 in Chapter 1 for
v

vi

Preface

details.) Once the reorganization of the document began, the creation of a handbook on NFPA
99 was a natural extension of the document. With so much material in one document, assistance in the form of commentary seemed the best method to share some of the history of this
material as well as to provide additional information and guidance in applying the standard to
present conditions.
Codes and standards by themselves can be difficult to understand for those not involved
in their development. However, it is not practical to include in these documents complete information on the requirement-adoption process (e.g., the reasons behind requirements, the
pros and cons, the voting, the striving for consensus, the research, the discussion). Annex material can help the reader to better understand the codes and standards development process;
recently, rationales for the committees decisions have been stressed. Handbooks present another vehicle for helping readers to better understand the requirements and recommendations
of a document.
It is my hope that this seventh edition of the Health Care Facilities Handbook will continue
to add to the store of knowledge on health care fire safety and will prove to be a useful resource
for all those involved in protecting health care facilities from fire and associated hazards.

Acknowledgments
The seventh edition of the Health Care Facilities Handbook is the result of substantial contributions by many talented people. I am grateful to many colleagues who provided support and
assistance, particularly Richard P. Bielen, chief systems and applications engineer at NFPA,
who also serves as staff liaison to the Technical Committee on Health Care Facilities.
Rich reviewed the entire manuscript, offering valuable comments and suggestions. The
earlier work of Burton R. Klein, my predecessor as editor, is also gratefully acknowledged. I
also thank Craig Kampmier for his contributions to this project.
A number of experts from the field of health care facilities fire safety participated in preparing commentary. The valued members of this technical team include the following:
Mark Allen, Beacon Medical Products, Charlotte, NC
Saul Aronow, Waban, MA
Mike Crowley, The RJA Group, Inc., Houston, TX
Alan Lipschultz, Christiana CareHealth Services, Newark, DE
Susan McLaughlin, SBM Consulting Ltd., Barrington, IL
Hugh Nash, Nash Lipsey Burch LLC, Nashville, TN
Russ Phillips, Russell Phillips & Associates, Inc., Rochester, NY
Robert B. Sheffield, Wound Care Group, San Antonio, TX
W. T. Workman, Workman Hyperbaric Services, Inc., San Antonio, TX
I am most grateful to Khela Thorne, the developmental editor of this book, and to Debra
Koch, the books copy editor, as well as to Pam Powell, the books product manager, for their
assistance, knowledge, perseverance, and friendship that kept this project on track.
I am grateful to Rob Swift for providing his photographic expertise and equipment in order to enhance the text with graphics. Prince William Health Systemspecifically George
Siebert, the safety directorassisted by providing access to their hospital, wherein a number
of the books photographs were taken.
I am also grateful to Gage-Babcock & Associates, Inc., for the confidence and encouragement they have provided during my career and during this project.
I must mention two others who operated behind the scenes. I thank my brother, Dr. Allen
R. Gardner, who assisted me on numerous occasions in understanding more about the medical
procedures and equipment discussed in the standard, so that I could better describe the fire
protection procedures required. And, of course, I thank my wife Laura, who supported me in
this effort from the beginning.
Thomas W. Gardner, P.E.

2002 Health Care Facilities Handbook