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Health TechnicalMemorandum 05-02: FirecodeGuidance in support of

functional provisions(Fire safety in the design ofhealthcare premises) 2014 edition

April 2014

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Health Technical Memorandum

05-02: FirecodeGuidance in support offunctional provisions

(Fire safety in the design ofhealthcare premises)

2014 edition

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HTM 05-02: Firecode Guidance in support of functional provisions (Fire safety in the design of healthcare premises)

Crown copyright 2014

You may re-use this information (not including logos) free of charge in any format or

medium, under the terms of the Open Government Licence. To view this licence, visit www.

nationalarchives. gov.uk/doc/open-government-licence/or write to the Information Policy

Team, The National Archives, Kew, London TW9 4DU, or email: [email protected].

uk.

This document is available from our website at https://www.gov.uk/government/collections/health-technical-memorandum-disinfection-and-sterilization

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Preface

About Health Technical Memoranda

Health Technical Memoranda (HTMs) givecomprehensive advice and guidance on thedesign, installation and operation of specialisedbuilding and engineering technology used in the

delivery of healthcare.

The focus of Health Technical Memorandumguidance remains on healthcare-specificelements of standards, policies and up-to-dateestablished best practice. They are applicableto new and existing sites, and are for use atvarious stages during the whole buildinglifecycle (see diagram below).

Healthcare providers have a duty of care to

ensure that appropriate governancearrangements are in place and are managedeffectively. The Health Technical Memorandumseries provides best practice engineeringstandards and policy to enable management ofthis duty of care.

OPERATIONALMANAGEMENT

MAINTENANCE

COMMISSIONING

It is not the intention within this suite ofdocuments to unnecessarily repeat internationalor European standards, industry standards orUK Government legislation. Where appropriate,these will be referenced.

Healthcare-specific technical engineeringguidance is a vital tool in the safe and efficientoperation of healthcare facilities. Health

Technical Memorandum guidance is the mainsource of specific healthcare-related guidancefor estates and facilities professionals.

The core suite of nine subject areas providesaccess to guidance which:

is more streamlined and accessible;

encapsulates the latest standards and bestpractice in healthcare engineering,technology and sustainability;

provides a structured reference for healthcareengineering.

DESIGN&IDENTIFYOPERATIONAL

REQUIREMENTS

SPECIFICATIONSTECHNICAL&OUTPUT

PROCUREMENT

CONCEPTDISPOSAL

OngoingReview

CONSTRUCTION

INSTALLATION

RE-USE

Figure 1 Healthcare building life-cycle

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Preface

DH Estates and Facilities Division wishes toacknowledge the contribution made byprofessional bodies, engineering consultants,healthcare specialists and NHS staff who havecontributed to the production of this guidance.

Other resources in the DH Estates

and Facilities knowledge series

Health Building Notes

Health Building Notes give best practiceguidance on the design and planning of newhealthcare buildings and on the adaptation/

extension of existing facilities.

They provide information to support the briefingand design processes for individual projects inthe NHS building programme..

All Health Technical Memoranda should beread in conjunction with the relevant parts ofthe Health Buidling Note series.

Activity DataBase (ADB)

The Activity DataBase (ADB) data and softwareassists project teams with the briefing and

design of the healthcare environment. Data isbased on guidance given in the Health BuildingNotes and Health Technical Memoranda.

For ADB technical queries only, contact theADB Helpdesk. Telephone number: 01939291684; email: [email protected]

For new ADB customers and licence renewalsonly, email: [email protected]

How to obtain publications

Health Technical Memoranda are availablefrom the UK Goverments website at:https://www.gov.uk/government/collections/health-technical-memorandum-disinfectionand-sterilization

Health Building Notes are available from thesame site at:https://www.gov.uk/government/collections/

health-building-notes-core-elements

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Executive summary

This is the 2014 edition of Health TechnicalMemorandum (HTM) 05-02 Guidance insupport of functional provisions (Fire safety inthe design of healthcare premises). Thedocument has been revised to reflect changesin legislation, guidance, the structure of theNHS, and government policy and direction onhealth and social care. A summary of majorchanges since previous editions is provided atthe end of this Executive Summary.

This 2014 edition supersedes all previousversions of HTM 05-02.

Scope

HTM 05-02 and the series of which it is partprovide specific guidance on fire safety in thedesign of new healthcare premises and majornew extensions to existing healthcare premises.While not intended to cover every possiblescenario, the standards and principles it

advocates recognise that fire safety inhealthcare premises is dependent on theinteraction between physical fire precautions,the dependency of the patient, the fire hazardsand the availability of sufficient andappropriately trained staff to safely evacuatepatients in a fire emergency.

The guidance is applicable to all premisesregulated by the Care Quality Commission(CQC), irrespective of ownership, that providethe following types of service:

CQC Code Service type

ACS Acute services

HBC Hyperbaric chamber services

HPS Hospice services

LTC Long-term condition services

MLS Hospital services for people withmental health needs, and/or

learning disabilities, and/orproblems with substance misuse

RHS Rehabilitation services

RSM Residential substance misuseand treatment/rehabilitationservices

DTS Doctors treatment services

DSS Diagnostic and/or screeningservices

UCS Urgent care services

HTM 05-02 should allow the current statutoryregulations to be applied sensibly within aframework of understanding and if appliedcorrectly, will satisfy all the requirements ofPart B of Schedule 1 of the 2010 BuildingRegulations.

Dependent on the requirements, this documentshould also be read in conjunction with the

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Executive summary

relevant HTMs and Health Building Notes(HBNs).

AimThe aim of HTM 05-02 is to ensure thateveryone concerned with the management,design, procurement and use of the healthcarefacility understands the requirements of firesafety in order to ensure optimum safety for allwho are present in the building. Only by havingknowledge of these requirements can theorganisations board and senior managersunderstand their legal duties to provide safe,

efficient, effective and reliable systems whichare critical in supporting direct patient care.

By following this guidance and applying it tothe particular needs of their local healthcareorganisation, boards and individual seniormanagers should be able to demonstratecompliance with their responsibilities.

Users of the guidance

The guidance is aimed at a wide range of usersincluding:

Providers of NHS-funded healthcare andoperating facilities in England;

Design teams, including architects andengineers;

Local building control authorities andapproved inspectors; and

Fire and rescue services.

Commissioners of NHS-funded health and careexpect that the facilities to which they referpatients will provide a safe, caring environmentthat aids a patients recovery and does notexpose them to undue risk. Documentedevidence that shows compliance with thisguidance should provide supporting material tounderpin evaluation within the NHS Premises

Assurance Model (NHS PAM) and provide

confidence of standards to the board ofdirectors and the Care Quality Commission(CQC).

Structure

The guidance in HTM 05-02 has beenrestructured to reflect the requirements of

Part B of Schedule 1 of the 2010 BuildingRegulations:

Chapter 1provides an overview of theapplication of HTM 05-02.

Chapter 2describes the principles of firesafety in healthcare premises.

Chapter 3describes the requirements tomeet B1 Means of warning andescape.

Chapter 4describes the requirements tomeet B2 Internal fire spread (linings).

Chapter 5describes the requirements tomeet B3 Internal fire spread (structure).

Chapter 6describes the requirements tomeet B4 External fire spread.

Chapter 7describes the requirements tomeet B5 Access and facilities for the

fire and rescue service.

List of major changes since the

2007 edition Chapter 1recognises the role of the Care

Quality Commission in regulating NHS-funded care and limits the application ofHTM 05-02 to premises providingspecific regulated services types; the

guidance on consultation has beenexpanded and the need to preparefire safety information to comply withRegulation 38 of the Building Regulationsand the Regulatory Reform (Fire Safety)Order emphasised.

The glossary of terms has been moved toAppendix A.

Chapter 2(previously Chapter 3) nowincludes comprehensive guidance on the

designing for fire safety in premisesproviding in-patient mental health

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services and in-patient accommodationfor people with learning disabilities.

Chapter 3combines guidance on

detection and alarm, and means ofescape, and includes revised guidanceon the provision and use of escape lifts.

Chapters 4, 5, 6and 7provide guidancethat was previously in Chapter 6 of the

superseded document and include anumber of technical changes particularlyin relation to fire hazard rooms and thelocation and operation of fire dampers,and fire and smoke dampers.

The guidance on access and facilities forthe fire rescue service is essentiallyunchanged.

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Policy and regulatory overview

This section of guidance provides an overview

of the policy and regulatory framework relevantto HTM 05-02.

Assurance of estates and facilities

One of the governments key priorities isdelivering better health outcomes for patients.

The quality and fitness-for-purpose of thehealthcare estate is vital for high-quality, safe

and efficient healthcare, and this documentsets out the general principles of fire safetyused in the construction of the healthcareestate.

Quality and fitness-for-purpose of the estate areassessed against a set of legal requirementsand standards. Adherence to the guidanceoutlined in this Health Technical Memorandum(HTM) will be taken into account as evidencetowards compliance with these legal

requirements and standards.

Where the principles of the guidance are not tobe followed, organisations should documenthow expectations are being met by equal andalternative means.

Care Quality Commission: Essential

standards of quality and safety

The Care Quality Commission (CQC) regulatesall providers of regulated health and adult socialcare activities in England. The CQCs role is tomake sure health and social care services

provide people with safe, effective,

compassionate, high-quality care and toencourage care services to improve.

At the time of preparing this document forpublication, registration requirements areset out in the Care Quality Commission(Registration) Regulations 2009 (CQCRegulations) and include requirementsrelating to:

safety and suitability of premises;

safety, availability and suitability ofequipment; and

cleanliness and infection control.

Note on amendment to the CQCRegulations

New regulations are due to come into effectduring 2014 and will apply to all providers ofhealth and social care that are required toregister with the CQC.

The CQC is responsible for assessingwhether providers are meeting the registrationrequirements (see the CQCs Guidance aboutcompliance (2010)). Failure to comply with theCQC Regulations is an offence and, under theHealth and Social Care Act 2008 (Regulated

Activities) Regulations 2010, CQC has a wide

range of enforcement powers that it can useif the provider is not compliant. These includethe issue of a warning notice that requiresimprovement within a specified time,

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prosecution, and the power to cancel aproviders registration, removing its ability toprovide regulated activities.

Outcome 10 of the CQCs Guidance aboutcompliance focuses on the safety andsuitability of premises and decrees thatpeople receive care in, work in or visit safesurroundings that promote their wellbeing.HTMs are specifically referenced in the CQCsschedule of applicable publications as ameans of compliance with Outcome 10.

Building Regulations

The Building Regulations set out requirementswith which individual aspects of building designand construction must comply in the interestsof:

the health and safety of building users;

energy conservation; and

access to and use of buildings.

Part B of Schedule 1 of the BuildingRegulations details the functional requirementsto provide for fire safety. Guidance on theapplication of the regulations is provided inapproved codes of practice The ApprovedDocuments; Approved Document B FireSafety (Volume 2 Buildings other thandwelling houses) provides guidance oncompliance with fire safety requirements forsome of the more common building types.

HTM 05-02 has been prepared in order toprovide specific guidance for healthcarepremises to demonstrate compliance withPart B of Schedule 1 of the BuildingRegulations.

Regulatory Reform (Fire Safety)

Order 2005

The Regulatory Reform (Fire Safety) Order

2005 (Fire Safety Order) imposes a generalduty to take such fire precautions as may bereasonably required to ensure that premises

are safe for the occupants and those in theimmediate vicinity. Responsibility for complyingwith the Fire Safety Order rests with theresponsible person, which for the majority ofhealthcare organisations will be the employer.

A full explanation of the requirements of theFire Safety Order is contained in HTM 05-01.

NHS Constitution

The NHS Constitution sets out the rights towhich patients, public and staff are entitled.It also outlines the pledges that the NHS is

committed to achieve, together withresponsibilities that the public, patients andstaff owe to one another to ensure that theNHS operates fairly and effectively. Allhealthcare organisations will be required by lawto take account of this Constitution in theirdecisions and actions.

Healthcare organisations need to ensure thatservices are provided in a clean and safeenvironment that is fit for purpose, based on

national best practice (pledge).

In order to deliver on this pledge, it specificallyadvises NHS organisations to take account of:

national best-practice guidance for thedesign and operation of healthcarefacilities;

the NHS Premises Assurance Model(NHS PAM).

NHS Premises Assurance Model

The NHS has developed, with the support ofDH, the NHS Premises Assurance Model (NHSPAM), whose remit is to provide assurance forthe healthcare environment and to ensure thatpatients, staff and visitors are protected againstrisks associated with hazards such as unsafepremises.

Primarily aimed at providing governance andassurance to boards of organisations, it allowsorganisations that provide NHS-funded care

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Policy and regulatory overview

and services to better understand theeffectiveness, quality and safety with whichthey manage their estates and facilities servicesand how that links to patient experience andpatient safety.

Key questions are underpinned by promptquestions that require the production ofevidence. Healthcare organisations shouldprepare and access this evidence to supporttheir assessment of the NHS PAM.

The model also includes reference to evidenceand guidance as a helpful aide-memoire to

assist in deciding the level of NHS PAMassurance applicable to a particular healthcaresite or organisation.

NHS PAM is designed to be available as auniversal model to apply across a range ofestates and facilities management services.

For more information on how to use the tool,visit the NHS PAM website.

Impact from, and adapting to,climate change

Requirements under Part B of the BuildingRegulations and the guidance in this HTM aremade for the purpose of ensuring the healthand safety of people in and around buildings.

The Environment Agency publishes guidanceon the design and construction of buildingsfor the purpose of protecting the environment.

This includes Pollution Prevention Guidelines(PPG18) on Managing Fire Water and MajorSpillages, which seeks to minimise the effectsof water run-off from firefighting.

It should be noted that compliance with theBuilding Regulations does not depend uponcompliance with other such guidance.

Healthcare organisations need to be mindfulof the Climate Change Act and the resultantmeasures that need to be taken, particularlywith regard to flooding, drought, hot weatherand freezing temperatures (for further guidance,see Health Building Note (HBN) 00-07 Planning for a resilient healthcare estate).

There are two main areas of focus for actionwith respect to climate change:

Mitigation which reduces the impactof business functions on the climatethrough the lowering of carbon emissionsfrom energy use, the reduction of water

consumption, improved efficiency oftransport etc. Under the Climate Change

Act, the government has set up theCRC Energy Efficiency Scheme, whichrequires large public and private sectororganisations to achieve energy-savingtargets.

Adaptation which requires measuresbe put in place to minimise the adverseeffects of climate change (for example

flooding, storms, heatwaves and impacton air quality). With respect to buildingsand infrastructure, flooding is identified asthe main threat by the current UK ClimateChange Risk Assessment. The nextupdate to this assessment is expectedin 2017.

All public sector bodies are required bygovernment under the National AdaptationProgramme (NAP) to put plans in place toaddress both the causes and consequences ofclimate change.

The Sustainable Development Unit (SDU) haspromoted the development of a sustainabledevelopment management plan (SDMP) by allhealthcare provider organisations. Furtherdetails can be found on the SDUs website.

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Contents

Preface .......................................................................................................................................v

Executive summary .................................................................................................................viii

Policy and regulatory overview ................................................................................................ xi

Assurance of estates and facilities xi

Care Quality Commission: Essential standards of quality and safety xi

Building Regulations xii

Regulatory Reform (Fire Safety) Order 2005 xii

NHS Constitution xii

NHS Premises Assurance Model xii

Impact from, and adapting to, climate change xiii

1. Introduction ............................................................................................................................1

General application 1

Building Regulations 1

Fire safety information 2

Consultation and qualitative design review 3

Alternative solutions 4

Use by competent persons 5

Relationship with Construction (Design and Management) Regulations 2006 5

Fire safety during building operations 5

Certification schemes 5

2. Principles of fire safety in healthcare premises ...................................................................6

Introduction 6

Fire safety philosophy 6

Progressive horizontal evacuation 7

Hospital streets 7

Vertical escape 8

Specific considerations based on patient dependency 8

Healthcare premises in Purpose Group 5 Assembly and Recreation 10

Facilities providing in-patient mental health services and in-patient accommodation for people

with learning disabilities 10Separation of patient-access areas from other parts of healthcare premises 13

Staffing levels 13

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Contents

3. Means of warning and escape ............................................................................................17

Fire detection and alarm 17

Principles of means of escape 17

Progressive horizontal evacuation 18

Sub-compartmentation 21

Travel distances 22

Hospital streets 24

Width of escape routes 27

Vertical escape 27

Assisted patient evacuation 28

Final exits 31

External escape routes 31

Departments providing intensive care 31

Operating departments 32

Emergency and escape lighting 33

Plant areas 33

Security 34

4. Internal fire spread (linings) .................................................................................................35

Roof lights 35

Thermoplastic materials 36

5. Internal fire spread (structure) ............................................................................................38

Elements of structure 38

Compartmentation 40

Elements of structure and compartment walls 40

Sub-compartment walls 41

Protected shafts 41

Protected lobbies 43

Fire stopping 44

Fire hazard rooms and areas 44

Ventilation systems 45

Cavity barriers 48

Sprinklers 50

6. External fire spread .............................................................................................................53

Space separation 53

Surfaces of external walls 55

Surfaces of roofs 55

Junction of walls and low-level roofs 55

Junction of compartment and sub-compartment walls and external walls 57

Additional requirements for car parks 57

7. Access and facilities for the fire-and-rescue service .........................................................60

Site access 60

Access around the building 61

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Access and facilities for the fire service 63

Design and construction of fire-fighting shafts 64

Fire mains 64

Venting of basements 65

Appendix A: Glossary of terms ...............................................................................................67

Appendix B: Periods of fire resistance ...................................................................................71

Appendix C: Doors and doorsets ...........................................................................................73

Door closers 74

Identification 74

Doors on escape routes 74

Appendix D: Thermoplastic materials ....................................................................................76

Appendix E: Construction and fixing of cavity barriers .........................................................78

Appendix F: Fire behaviour of insulating core panels ............................................................79

Introduction 79

Fire behaviour of the core materials and fixing systems 79

Design recommendations 80

Specifying panel core materials 80

General 80

Appendix G: Fire drawings ......................................................................................................81

Provision of drawings 81Fire drawings 81

Appendix H: Care Quality Commission types of service .......................................................83

Healthcare services 83

Appendix J: Qualitative Design Review ..................................................................................87

Appendix K: References ..........................................................................................................89

Acts and Regulations 89

European legislation 89

Firecode publications 89

Health Building Notes 90

Health Technical Memoranda 90

British and European Standards 90

Other publications 92

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1. Introduction

General application

1.1This Health Technical Memorandumprovides recommendations and guidance onthe design of fire safety in healthcare premises.It supersedes HTM 05-02 Guidance in

support of functional provisions for healthcarepremises, published in January 2007.

1.2The guidance in this document is applicableto premises regulated by the Care QualityCommission (CQC), irrespective of ownership,that provide the following types of service:

CQC Code Service type

ACS Acute services

HBC Hyperbaric chamber services

HPS Hospice services

LTC Long-term condition services

MLS Hospital services for people withmental health needs, and/orlearning disabilities, and/orproblems with substance misuse

RHS Rehabilitation services

RSM Residential substance misuseand treatment/rehabilitationservices

DTS Doctors treatment services

DSS Diagnostic and/or screeningservices

UCS Urgent care services

A full definition of services is contained inAppendix H.

1.3 HTM 05-02 should be used in thedesign of:

a.

new healthcare buildings;

b. new extensions to existing healthcarebuildings;

c. those parts of existing healthcarebuildings that are used as means ofescape from a new healthcareextension;

d. alterations to existing healthcarebuildings;

e. change of use of an existing building,or parts of an existing building, tohealthcare use.

Please note: paragraphs 1.3d and 1.3e applyirrespective of whether the alterations andchange of use constitute building work asdefined by the Building Regulations 2010.

Building Regulations

1.4The purpose of this document is to provideguidance on the minimum standards of firesafety expected in healthcare premises tocomply with Part B of Schedule 1 of theBuilding Regulations 2010. It is a guidancedocument that recognises the problems specialto healthcare and allows the current statutoryregulations to be applied sensibly within aframework of understanding. To that end, thefollowing functional provisions are expected to

be met:

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B1: To ensure satisfactory provision ofmeans of giving an alarm of fire and asatisfactory standard of means of escapefor persons in the event of fire in abuilding (Chapter 3).

B2: To ensure fire spread over theinternal linings of buildings is inhibited(Chapter 4).

B3: To ensure the stability of buildings inthe event of fire; to ensure that there isa sufficient degree of fire separationwithin buildings and between adjoiningbuildings; to provide automatic fire

suppression where necessary; and toinhibit the unseen spread of fire andsmoke in concealed spaces in buildings(Chapter 5).

B4: To ensure external walls and roofshave adequate resistance to the spreadof fire over the external envelope, andthat spread of fire from one building toanother is restricted (Chapter 6).

B5: To ensure satisfactory access for fireappliances to buildings and the provisionof facilities in buildings to assist firefighters in the saving of life of people inand around buildings (Chapter 7).

1.5 Health Technical Memorandum 05-02should be used as guidance on fire safety inall parts of healthcare buildings, classed asPurpose Group 2a Residential (Institutional),1

including departments or areas providing

ancillary services which are planned as anintegral part of a healthcare building. Theguidance it contains follows the structure of therequirements set out in Part B Schedule 1 ofthe Building Regulations.

1.6 Some of the premises listed in paragraph1.2above may be classed as Purpose Group 5 Assembly and Recreation; for these premisesthe application of HTM 05-02 should be limitedto those measures necessary to provide a safe

patient environment for the time necessary toeffect an evacuation. Such measures should be

1 As defined in Approved Document B

appropriate to the needs of the relevantpersons in the building and their levels ofdependency; additional guidance is provided inparagraphs 2.332.36.

BS 5588

1.7 HTM 05-02 refers to the guidancecontained in parts of the BS 5588 series ofstandards as a means of showing compliancewith the requirements of Part B (Fire safety) ofSchedule 1 to the Building Regulations. Indoing so the Department of Health followsthe practice adopted by the Department of

Communities and Local Government (DCLG)in relation to Approved Document B andreferences to BS 5588 remain part of HTM05-02 until such time that it is next revised.

1.8 Where designers elect to follow the relevantguidance in BS 9999 they will need to satisfythemselves and the building control body thatthis guidance adequately addresses therequirements of Part B. It is stronglyrecommended that in such cases designers

discuss their proposals with the building controlbody before starting work.

1.9 Withdrawn BS standards are readilyavailable from:

The BSI Knowledge CentreBritish Standards Institution389 Chiswick High RoadLondon, W4 4ALEmail: [email protected]

Tel: +44 (0)20 8996 7004

Fire safety information

1.10 Regulation 38 of the Building Regulationsrequires that where building work is carried outthat affects fire safety, and where the buildingaffected will be covered by the Fire SafetyOrder, the person carrying out the work mustprovide sufficient information for persons tooperate and maintain the building in reasonablesafety. This information will assist the eventualowner/occupier/employer to meet theirstatutory duties under the Fire Safety Order.

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1. Introduction

The exact amount of information and level ofdetail necessary will vary depending on thenature and complexity of the buildings design.Further guidance is provided in paragraphs1.131.19below.

1.11 For all healthcare premises covered by theguidance in this document a detailed record ofthe fire safety strategy, evacuation procedures,patient dependency and staffing levels,together with information on the operation andmaintenance of any fire protection measures ofthe building, will be required.

1.12 Guidance on the application of the FireSafety Order to healthcare premises is providedin HTM 05-01.

Consultation and qualitative design

review

1.13 Health Technical Memorandum 05-02has been written on the assumption that thepremises will be properly managed. BuildingRegulations do not impose any requirementon the management of a building; however, indeveloping an appropriate fire safety design forhealthcare premises it is essential to considerthe way in which it will be managed, as firesafety in healthcare premises relies on well-trained staff to implement a pre-agreedemergency plan; this is especially importantwhere care is provided for dependent or veryhigh dependency patients.

1.14A design that relies on an unrealistic orunsustainable management regime cannot beconsidered to have met the requirements of theBuilding Regulations.

1.15 It is therefore essential that the designteam have a full understanding of the type ofcare being provided and the dependency ofthe patients, and that the client team fullyappreciate the constraints imposed by thedesign on the movement and evacuation of

patients, visitors and staff. The design team andapproving authorities should not assume that adesign which complies with the requirements in

this document will be safe: it needs to besupported by a fully developed emergencyplan. This is also a legal requirement imposedby the Fire Safety Order.

1.16The preparation of the emergencyevacuation plan commences during the designphase and should be developed through theuser consultation process. It is important tostress that in relation to the design ofappropriate fire precautions, each type ofclinical service will present its own unique set ofproblems which will only fully emerge during thedesign phase. It is therefore essential that

architects and designers, through the clientuser group consultation process, fullyunderstand and record the fire safety issuesassociated with the clinical service beingprovided and the patients being treated.

1.17The fire safety measures and theemergency evacuation strategy should bedeveloped and agreed through discussionswith:

a.

Client user group generally involvingclinicians, nurses, managers, the firesafety advisor and the local securitymanagement specialist;

b. Design team architects and engineers;

c. Fire service representative; and

d. Building control or approved inspector.

1.18 For very large and complex projects, it is

recommended that a Qualitative Design Review(QDR), as detailed in PD 7974-0:2002, becarried out by a study team involving one ormore fire safety engineers, other members ofthe design team and the client user group.It might also be appropriate to includerepresentatives of approval bodies or theinsurers to ensure that their views can beaccounted for. Further guidance on theapplication of QDR to healthcare premises iscontained inAppendix J.

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1.19The outcome of these discussions willbe all the information required to supportRegulation 38 and should include:

a.

the emergency evacuation planincluding all assumptions in relation to:

(i) the availability of adequately trainedstaff to manage an evacuation;

(ii) the design of the fire safetysystems (such as fire load);

(iii)any risk assessments or riskanalysis;

b.

all assumptions in the design of the firesafety arrangements regarding themanagement of the building;

c. escape routes (including stairs andlifts), escape strategy (for examplesimultaneous or phased) and musterpoints;

d. details of all fire safety measures,including (but not exhaustively):

(i) compartmentation, cavity barriers,fire doors, self-closing fire doorsand other doors equipped withrelevant hardware (for exampleelectronic security locks), and fireand smoke dampers;

(ii) automatic fire detection systems,emergency communicationsystems, CCTV, fire safety signage,emergency lighting, fire

extinguishers;

(iii) dry or wet risers and other fire-fighting equipment, other interiorfacilities for the fire-and-rescueservice, emergency control rooms,location of hydrants outside thebuilding, and other exterior facilitiesfor the fire-and-rescue service;

(iv) sprinkler system(s) design,

including isolating valves andcontrol equipment; and

(v) smoke-control system(s) (or HVACsystem with a smoke-controlfunction) design, including mode ofoperation and control systems;

e. any high-risk areas (for example heatingmachinery) and particular hazards;

f. as-built plans of the building showingthe locations of the above;

g. specifications of any fire safetyequipment provided, includingoperational details, operator manuals,software, system zoning, routine

inspection, and testing and maintenanceschedules, together with records of anyacceptance or commissioning tests;

h. any other details appropriate for thespecific building; and

i. for large and/or complex premises, thefindings of the QDR.

Alternative solutions

1.20The range of NHS premises providingpatient care facilities is extensive, and theguidance in this document may not beappropriate for all types of building. However,it is expected that NHS clients, designers,building control and fire authorities will exercisea degree of judgement based on a fullunderstanding of the problem, taking intoaccount the full implications of the dependencyand medical conditions of the patients being

treated.

1.21This document describes a way ofachieving an acceptable standard of fire safetywithin new and modified healthcare buildings,but it is recognised that there may be otherways of satisfying the functional requirementsby adopting a fire safety engineering approach.

A fire safety engineering approach that takesinto account the total fire safety package canprovide an alternative approach to fire safety. If

such an approach is used, the responsibility isplaced upon those promoting the alternativeapproach to demonstrate that the alternative

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1. Introduction

satisfies the functional requirements and firesafety objectives of this document.

Use by competent persons1.22The guidance in this document has beenprepared on the understanding that it will beused by competent persons. For the purposesof this document, a competent person isdefined as a person recognised as havingsufficient technical training and actualexperience, or technical knowledge and otherqualities, both to understand fully the dangersinvolved, and to undertake properly the

statutory and Firecode provisions referred to inthis Health Technical Memorandum.

Relationship with Construction

(Design and Management)

Regulations 2006

1.23The purpose of this document isto provide guidance on the fire safetyrequirements for the completed building. It

does not address the risk of fire during theconstruction work, which is covered by theConstruction (Design and Management)Regulations 2006 and the Fire Safety Order.

The Health and Safety Executive (HSE) hasissued HSG 168: Fire safety in constructionwork (ISBN: 0 71761 332 1), which providesrelevant guidance on fire safety in construction.

1.24 When the construction work is beingcarried out on an occupied building, the Fire

and Rescue Authority is responsible for theenforcement of the 2005 Regulations in thoseparts which remain occupied.

Fire safety during building

operations

1.25A significant number of fires occur as aresult of certain building activities. The site

conduct of contractors should be adequatelysupervised and controlled. Adequateprecautions against fire should be in place,and regular contact with contractors shouldbe maintained to ensure that local fire safetypolicies are being complied with.

1.26 It is also important to ensure that whennew buildings are being constructed andhanded over in phases due consideration isgiven to fire safety after handover. There mustbe no conflict in the operation of the alarm anddetection system between the healthcare-occupied part of the premises and the

construction area. Of equal importance is theneed to ensure that means of escape is readilyavailable at all times.

Certification schemes

1.27There are many UK product certificationschemes. Such schemes certify compliancewith the requirements of a recogniseddocument which is appropriate to the purposefor which the material is used. Materials that are

not certified may still conform to a relevantstandard.

1.28 Many certification bodies which approvesuch schemes are accredited by UnitedKingdom Accreditation Service (UKAS). Sincethe fire performance of a product, componentor structure is dependent upon satisfactory siteinstallation and maintenance, independentschemes of certification and accreditation ofinstallers and maintenance firms can offerconfidence in the standard of workmanshipprovided.

1.29 Schemes such as those identified abovemay be accepted by building control bodies asevidence of compliance; however, a buildingcontrol body may want to establish before workcommences that the scheme is adequate forapproval purposes.

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2. Principles of fire safety in healthcarepremises

Introduction2.1 In healthcare buildings, particularly inpatient access areas, the immediate and totalevacuation of the building in the event of firewould be a major logistics exercise and, froma patient safety perspective, not desirable.Patients with restricted mobility, patients whouse wheelchairs, and patients confined to bedcannot negotiate escape routes, particularlystairways, unaided. Patients under medicationmay require staff assistance, and patients whoare dependent on electrical/mechanicalequipment for their survival cannot always bedisconnected and moved rapidly withoutserious consequences.

2.2 HTM 05-02 assumes that there aresufficient adequately trained staff on duty inthe building to implement the emergency plan.However, while the total evacuation of smallerbuildings, or smaller healthcare premises within

other buildings, accommodating occupantsconsidered to be independent might bepractical, the evacuation of an entire hospital inthe event of fire would be an enormous exercisein which patients might be placed at risk due totrauma or their medical condition.

2.3 Should evacuation become necessary,except for those premises with independentoccupants, it should be based on the conceptof progressive horizontal evacuation, with only

those people directly at risk from the effects offire being moved. Adopting this approach

ensures that the concept of inclusive designhas been applied.

2.4 Healthcare premises accommodatingdependent and very high dependencypatients should be divided into a series ofcompartments that may be further dividedinto sub-compartments which should beconstructed to provide the appropriate level offire safety (see Chapters 3and 5).

2.5 Where the evacuation involves very highdependency patients, additional considerationmust be given to the distance of travel thatmight be necessary to reach a place of safetywhere essential treatment and care could berecommenced.

Fire safety philosophy

Fire evacuation strategy

2.6The basic strategy for fire evacuation ofdependent and very high dependency patientsshould be to move them on their bed or in awheelchair to a safer area (refuge or place ofrelative safety) on the same floor and then (ifrequired) to evacuate the patients to anotherfloor in the building or to outside.

2.7There are three main stages of evacuation:

a. Stage 1 horizontal evacuation from

the area where the fire originates toan adjoining sub-compartment orcompartment;

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2. Principles of fire safety in healthcare premises

b. Stage 2 horizontal evacuation from theentire compartment where the fireoriginates to an adjoining compartmenton the same floor. Subsequentadditional horizontal evacuation toadjacent compartments may beundertaken (thereby putting additionalfire resistance between the buildingoccupants and the threat) prior toundertaking vertical evacuation; and

c. Stage 3 vertical evacuation to a lowerfloor, or to the outside.

2.8There are three fire conditions when

evacuation is necessary or should beconsidered:

a. Extreme emergency where there is animmediate threat to safety from fire orsmoke;

b. Emergency no immediate threat, butfire or smoke likely to spread from anadjoining area;

c. Precautionary no immediate threat tolife or safety, but there is a fire on anadjoining floor or in an adjacent building.

2.9 In extreme emergency situations, thesequence of evacuation should be:

a. those in immediate danger;

b. ambulant patients;

c. the remaining patients who are notambulant.

Progressive horizontal evacuation

2.10The principle of progressive horizontalevacuation is that of moving occupants froman area affected by fire through a fire-resistingbarrier to an adjoining area on the same level,designed to protect the occupants from theimmediate dangers of fire and smoke (a refuge).

The occupants may remain there until the fire is

dealt with or await further assisted onwardevacuation by staff to another similar adjoiningarea or to the nearest stairway. This procedure

should give sufficient time for non-ambulantand partially ambulant patients to be evacuatedvertically to a place of safety, should it becomenecessary to evacuate an entire storey.

2.11Active fire protection systems such asautomatic fire detection systems, warningsystems and fire suppression systems may beincorporated into the building so that the timeavailable for escape is maximised.

2.12 Patient-access areas should be designedto allow for progressive horizontal evacuationother than in premises where patients fall into

the independent category.

2.13Areas to which patients have accessshould not be located on storeys whereevacuation in a fire emergency wouldnecessitate travelling up a stairway to afinal exit.

Hospital streets

2.14The hospital street provides an essential

link between hospital departments andstairways and lifts; it is the main circulationroute for staff, patients and visitors. Althoughmany hospitals will be provided with hospitalstreets, they are not an essential requirement.In smaller hospitals, such as communityhospitals, and other healthcare premises,hospital streets are generally not provided.

2.15A hospital street is a special type ofcompartment that connects final exits, stairway

enclosures and department entrances. It hastwo functions from a fire safety aspect:

a. if the spread of fire within a departmentcannot be brought under control, theoccupants of the department affectedmay be evacuated via the hospital streetto parts of the hospital not affected bythe fire; and

b. it will serve the fire-and-rescue service

as a fire-fighting bridgehead.

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Vertical escape

2.16Vertical escape in healthcare premisesshould only be conducted if a fire cannot be

controlled within the space of origin and there isadditional risk to occupants outside of the firecompartment of origin. This approach to firesafety is adopted due to the additional risks thatare present to both staff and patients during thevertical escape phase.

2.17 In healthcare premises, the practice ofdesignating certain stairways as escapestairways and others as accommodationstairways only is not acceptable, since inan emergency any stairway will be used ifnecessary. Therefore all stairways should bedesigned as escape stairways other than thosecontained wholly within and only serving anatrium.

2.18 It is recognised that there are manybenefits in using lifts to assist with verticalevacuation, especially when evacuatingdependent and very high dependency patients,

and appropriate guidance is provided inChapter 3.

Specific considerations based on

patient dependency

2.19 Firecode has three classifications forpatient dependency:

Independent patients are consideredto be independent if:

their mobility is not impaired in anyway and they are able to physicallyleave the premises without staffassistance; or

they experience some mobilityimpairment and rely on anotherperson to offer minimal assistance.

This would include being sufficientlyable to negotiate stairs unaided or

with minimal assistance, as well asbeing able to comprehend theemergency wayfinding signagearound the facility.

Dependent all patients except thoseclassified as independent or very highdependency.

Very high dependency those whoseclinical treatment and/or conditioncreates a high dependency on staff. Thiswill include those in intensive care areas,operating theatres, coronary care etc andthose for whom evacuation would provepotentially life-threatening.

Independent patients

2.20Areas containing independent patients or

occupants who can escape from a fire unaideddo not have such a reliance on horizontalevacuation, and therefore the need forcompartmentation both horizontally andvertically is reduced.

2.21 In most cases, the use of ApprovedDocument B will be sufficient (purpose group2a, or 5 depending on the type of premises).However, where doubt may exist about themobility of patients, advice should be soughtfrom clinicians to ensure that no part of patientcare or treatment would prevent them fromquickly responding in the event of a fire.

2.22 Based on an assessment of each typeof patient care, it may be necessary in someinstances to apply the recommendations withinthis document in addition to those of ApprovedDocument B.

Note

Although the occupancy of an area may beidentified as independent, considerationshould be given to the need for patientscategorised as dependent or very highdependency who may need to be evacuatedthrough that area. In such circumstances themeans of escape provisions should reflectthe measures necessary for the evacuationof higher dependency occupants.

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Dependent patients

2.23The guidance in this document providesadditional guidance above that of Approved

Document B, which is necessary to meet theincreased dependency of patients who fallwithin this category (and those within the veryhigh dependency category).

Very high dependency patients

2.24 In operating theatres and areas thatprovide intensive care, any movement orevacuation of patients may be life-threatening;consequently, additional precautions are

required to address the implications of:

a. fire and smoke in a compartment eitheradjacent or below;

b. fire and smoke within the departmentitself.

2.25The enclosing of departments with fire-resisting construction and the strategic planningof adjacent compartments goes some wayto mitigating the risk. The time required forevacuation is longer, as it is often necessaryto move the patient, ventilators, monitoringequipment and support staff as one unit, andthe design should seek to maximise theprotection to the occupants allowing forextended start-up times.

2.26 Some of the equipment, such asthe ventilator, are integral parts of theanaesthesiologists equipment and so are

provided with an electrical back-up supply.However, this type of equipment is often largeand unwieldy, and the evacuation must bepre-planned, as double doorsets are requiredto facilitate the efficient movement of ancillaryequipment.

2.27The aim of any design should be toprevent a fire in an adjacent compartmenteither on the same storey or on a storey aboveor below, requiring the evacuation of a intensive

care area. The compartmentation and HVAC(heating, ventilation and air-conditioning)systems should be designed so that an


adequate period of time is provided to enable afire to be detected and extinguished before itthreatens occupants.

2.28The HVAC systems provided to intensivecare areas are designed so that the pressurewithin the department is maintained at slightlyabove that of the adjacent areas. In a fireemergency, the continuing operation of thesesystems will assist in preventing smoke andother products of combustion entering theintensive care area.

2.29Although it is accepted that some

occupants, because of their condition ortreatment, should not be moved, provision muststill be made for external evacuation. The needfor a vertical movement strategy for suchoccupants must be recognised, andappropriate measures must be installed toreduce the risk associated with such an action.

2.30 Protected lobbies are provided to thoseareas of the premises that require additionalmeans to protect against the movement

of smoke. Where risk assessment hasdemonstrated a need, very high dependencytreatment areas should be provided with alobby, which should be sized appropriately tofully accommodate a bed, the associatedancillary equipment and nursing staff, andshould include sufficient additional floor spaceto allow for any manoeuvring as necessary.

2.31 Where smoke movement into an areaaccommodating very high dependency patients

has been identified as a potential risk (that is,where no hospital streets have been provided),every door opening in the compartment wallshould be provided with a protected lobby,each door of which will provide a minimumperiod of fire resistance of 30 minutes.

2.32Any future change in dependency is likelyto result in a significant change to the fireprecautions applicable. This applies equally topremises designed for independent patients.

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Healthcare premises in Purpose

Group 5 Assembly and

Recreation

2.33 It is becoming more common for healthcentres, clinics and GP surgeries to providefacilities for minor invasive investigations orprocedures that require the use of a localanaesthetic. These will be DTS and DSSservices regulated by the Care QualityCommission seeAppendix H. Generally theprocedures will be undertaken in a minorprocedure room, or treatment room possiblywith an adjacent recovery area where patients

may remain under observation until the effectsof the anaesthetic have worn off.

2.34 In many cases the use of an anaestheticwill restrict mobility so that patients will requireassistance to escape in the event of a fire.

Therefore in DTS and DSS premises the meansof escape from relevant areas should bedesigned so that it is always possible, in thefirst instance, to escape:

a. horizontally to a place of relative safetyfrom where further horizontal or verticalevacuation is possible; or

b. directly to a place of safety at groundlevel.

2.35The place of relative safety should eitherbe a separate 30 minute sub-compartment, ora refuge in an escape stairway that is enclosedin 30 minute fire-resisting construction, either of

which should be large enough to accommodatethe number of patients who at any one timecould reasonably be expected to be receivingor recovering from minor invasive investigationsor procedures.

2.36 It is also strongly recommended that thesepremises are provided with a fire detection andalarm system that complies with the relevantguidance in the HTM 05-03 series.

Facilities providing in-patient mental

health services and in-patient

accommodation for people with

learning disabilities

2.37 In this context, an in-patient service isdefined as a unit with hospital beds thatprovides 24-hour nursing care. Such a unitmay be in a hospital campus or a communitysetting, and may be provided by the NHS or byindependent sector providers.

2.38 In-patient beds should be distinguishedfrom placements registered for the provision ofcare, which are provided by local authoritiesand independent sector providers andregistered by the CQC. These provideaccommodation, usually in a room in a multipleoccupancy facility, and a care/support packagefunded by health and social services.

2.39The guidance in HTM 05-02 applies onlyto in-patient services and not placements.

2.40 In-patient mental health services cover thefollowing range of services:

Acute in-patient bed acute in-patientwards for working age adults (1865)providing intensive medical and nursingsupport for patients in periods of acutepsychiatric illness.

Psychiatric intensive care unit a type of psychiatric ward. These wardsare secure, meaning they are locked and

entry and exit of patients is controlled.Staffing levels are higher, sometimes with1:1 nursing staffing ratios. They usuallyreceive patients who cannot be managedin an acute ward due to the level of riskthe patient poses to themselves orothers. In some cases patients may alsobe referred from prisons or rehabilitationwards. Patients will usually be detainedunder the Mental Health Act.

Forensic services this covers high,medium and low secure units, of which

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only the last two are covered byHTM 05-02.

Low secure services are provided for

those patients who have long-standingand complex problems who cannot besafely or successfully cared for in anacute ward. Patients will be detainedunder the Mental Health Act.

Medium secure services arespecially designed to meet the needs ofadults with a serious mental illness, whorequire care and treatment in a securesetting to ensure they are safely

managed. In most cases patients inmedium security will have committed anoffence and present a serious risk tothemselves and others, combined with apotential to escape.

Recovery and rehabilitation services rehabilitation units are provided foradults with severe and enduring mentalhealth problems who have ongoingsymptoms and functional impairments

and cannot manage independent living,even with support.

Child and Adolescent Mental HealthServices (CAMHS) Tier 4 in-patient

services these are defined as highlyspecialised provision that may berequired for children and young people upto the age of 18, who may or may not bedetained under the Mental Health Act.

Dementia assessment the termdementia is used to describe a syndromethat may be caused by a number ofillnesses with progressive decline inmultiple areas of function, includingimpairment of memory, reasoning,communication skills and the ability tocarry out daily activities. As well asmemory impairment, dementia might alsoinclude behavioural and psychologicalsymptoms such as depression,

psychosis, aggression and wandering.


Further information on all of the aboveis provided in Defining mental healthservices, published in 2012 by the MentalHealth Network of the NHS Confederation.

In-patient facilities for people withlearning disabilities a learningdisability affects the way a personunderstands information and how theycommunicate; it is not the same as alearning difficulty or mental illness. In-patient assessment and treatment bedsare required for people with learningdisabilities with complex mental healthproblems and/or challenging behavioursthat cannot be managed in thecommunity. The number of units acrossthe NHS is small.

Specific fire safety information relating tothe above premises

2.41Although the range of services providedvaries considerably, there are common issuesthat must be considered to enable appropriate

levels of fire safety to be achieved. The ultimateaim is to provide a safe and secure environmentwhere patients can receive care and treatment;however, safety from the effects of fire andmaintaining the required levels of securityare equally important, and the design of fireprecautions and evacuation strategies shouldnot compromise security.

2.42 Highly trained specialised nursing andclinical staff are always present when the

premises are occupied and they will be trainedto take the lead role in the evacuation ofpatients.

2.43 Should a fire start, it will be necessary toevacuate the sub-compartment of fire originand the number of staff available will influencethe speed of evacuation. Such evacuation maybe progressive horizontal evacuation to othercompartments or sub-compartments asdescribed in Chapter 3.

2.44 Patients may exhibit behavioural problemsthat could impact on the fire and security

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measures installed. Acute mental patients havea history of generating unwanted fire signals.

Tampering with fire doors is commonplace, andspecial attention must be paid to final exits.

2.45The implications of this tampering are anincrease in the number of false alarms and thepotential for complacency amongst staff to theemergency signal. A security issue may also becreated with regard to the control of patientsand the possibility of unrestricted egress.

2.46The potential to configure the alarm anddetection system such that in the first instance

only staff receive the alarm, can reduce adversereactions from patients. A general alarmconfined to the compartment or zone wouldonly be activated as the evacuation strategywas implemented. Further guidance is providedin HTM 05-03 Part B.

2.47 Integration of the alarm and detectionsystem with staff and patient monitoring andlocation systems can improve response timesto alarm situations.

2.48 For security purposes, it is importantthat final exits do not release immediately onactuation of the alarm. The release mechanismshould form part of the overall strategy formanaging the evacuation. This gives controlto the staff and increases the security of thefacility. Some means of control should beprovided such that these doors can be openedby staff, on confirmation of the fire signal, whenit becomes necessary to evacuate to a

designated (secure) assembly point.

2.49 Should it become necessary to evacuatean entire facility or part thereof, adequate safeand secure external assembly points should beavailable.

2.50 Due to the intended occupancy,evacuation to an external assembly point wouldbe a last resort only.

2.51 When designing external escape routesthat are intended for use by mental healthpatients, similar considerations to those above

should be considered, with the additionalcaveat of any security measures required toensure patient safety.

Specific design requirements for the abovepremises

2.52 Sleeping accommodation should be in aseparate compartment from day facilities.

2.53Accommodation in compartmentsproviding sleeping accommodation should belimited to:

a. bedrooms;

b. bathrooms, WCs etc;

c. cleaners room;

d. a small office for staff on overnight duty(this may be an office or a recess off acirculation route);

e. linen stores.

2.54 Where sleeping accommodation is

segregated by sex, male and female bedroomsshould be in separate sub-compartments.

2.55The maximum number of beds in anysub-compartment, including swing beds,should be no more than 10.

2.56 Where swing beds are provided it shouldbe possible to include the swing beds in eithersub-compartment.

2.57 Depending on the patients it may benecessary to maintain segregation duringevacuation; where this is the case, the designof evacuation routes should ensure that this isalways possible. This will also extend to secureplaces of safety away from the effects of fire,outside the building.

2.58 Bedrooms:

a.All bedrooms should be classed as firehazard rooms.

b. It may be necessary to provide thepotential for bedroom doors to be

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locked from the inside. However, if this isrequired, they should be easy to openfrom the inside without recourse to akey. In addition, any locking deviceused should be easy to open from theoutside of the room by means of astandard key issued to all staff.

c. Where patients have restricted mobility,are elderly or are suffering fromdementia, moving the patients ontheir beds is likely to the most effectivemethod of evacuation. Where this is thecase, the design of evacuation routesshould allow for bed evacuation andshould be designed either:

(i) to comply with Figure 1below; or

(ii) the architect or designer shouldprovide evidence to the client, fireofficer and building control officer,that their design will permit bedevacuation; or

(iii) an alternative method of evacuation

should be agreed that fullyrecognises the restricted mobilityof the patients, the limitations ofthe proposed design and theavailability of trained staff to safelymanage the evacuation.

2.59 Where communal bathrooms2areprovided, these should be designed as firehazard rooms.

Separation of patient-access areasfrom other parts of healthcare

premises

2.60 In addition to the general requirement forprogressive horizontal evacuation, healthcarepremises should also be designed to minimisethe possibility of fires from the non-patient-

2 Communal bathrooms allow unsupervised access and are

distinct from bathrooms, which are normally kept locked, with

patients only having access when supervised by staff. Theformer are generally provided in older premises where patient

bedrooms are not provided with full en-suite facilities; the latter

are generally provided in premises where patient bedrooms

have full en-suite facilities (WC, washbasin and shower).

access areas affecting the patient-access areasof healthcare premises.

2.61 Non-patient-access areas, for the

purposes of this document only, are dividedinto the following:

a. Hazard departments: departments/management units that contain high fireloads and/or significant ignition sources.Hazard departments should beseparated by distance from any patient-access areas and should not adjointhem, either horizontally or vertically,unless additional precautions are

provided.

b. Non-hazard departments: departments/management units that do not containhigh fire load and/or significant ignitionsources. Non-hazard departments mayadjoin patient-access areas, eitherhorizontally or vertically, providedthey are separated from them bycompartment walls and floors.

2.62 Patient-access areas should always be indifferent compartments from non-patient-access areas.

2.63Areas and departments/managementunits should be located in accordance with

Table 1below.

Staffing levels

2.64The provision of an adequate number ofstaff who have received effective fire safetytraining is the best first line of defence againstfire. This is particularly important when levelsof activity in the building are reduced. Thepresence of trained staff who can respondquickly and effectively to any fire emergency isa vital factor in limiting the consequences of afire, particularly where dependent patients areinvolved.

2.65Article 15 of the Fire Safety Order requiresthe responsible person to:

a. produce an evacuation procedure;

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155

0ecwrequiredwithclearcorridor

wid

thsbetween2150and2400.

170

0nominaldoorsetdrawn

Zone forhandrail/wallprotection

Door

nib

Doornibmu

stallow

doorleaftoopen

substantially

beyond

90degreesif1700

nominaldoo

rsetused

(650

)

150

(2150) 150 (100)

(1700)

ecw=

1550

150 (100)

Zone forhandrail/

2450 (2350)wallprotection

Figure 1 Widths of doors and corridors to permit bed evacuation

Note: Further guidance is provided in Chapter 3and Health Building Note 00-04 Circulation andcommunication spaces.

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Separation from patient access area

Hazard area or department/

management unit

Normal dependency Very high dependency

Atrium Refer to HTM 05-03 Part M Refer to HTM 05-03 Part M

Boilerhouse (main)1 60+ auto suppression Not allowed

Car park 60+ auto suppression Not allowed

Central staff change 60 60+ auto suppression

Commercial enterprises 60+ auto suppression Not allowed

Flammable store 60+ auto suppression Not allowed

Laundry 60+ auto suppression Not allowed

Local medical gas stores2 60+ ventilation Not allowed

Main electrical switchgear3 60+ auto suppression Not allowed

Main kitchens 60+ auto suppression Not allowed

Main stores 60+ auto suppression Not allowed

Medical records 60 60+ auto suppression

Pathology 60 60+ auto suppression

Pharmaceutical (manufacturing) 60 60+ auto suppression

Refuse collection/incineration 60+ auto suppression Not allowed

Sterile services department 60 60+ auto suppression

Works 60+ auto suppression Not allowed

Key:

60 May be adjacent but should always be separated by 60-minute fire-resisting construction. 60 minutes fire resistance may be

reduced under certain circumstances (for example if sprinklers are fitted (see paragraphs 5.125.13)).

60+ auto-suppression Preferably separate; however, if adjacent, it should be separated by 60-minute imperforate construction

together with auto-suppression in the hazard department.

Not allowed should not be located adjacent to very high dependency departments.

Notes:

1 Not applicable to small boilers/switchgear in plantrooms serving part of a building.

2 Main medical gas stores should always be located in separate buildings. Health Technical Memorandum 02-01 Medical gas

pipeline systems gives guidance. Local medical gas stores should only contain sufficient quantity for daily use.

3 A medium or high voltage transformer, or switchgear room, or battery room serving a whole building or site.

Table 1 Requirements for the location and fire separation of fire hazard departments from patient-access areas

b. have sufficient staff to implement it; and

c. ensure that staff are adequately trained.

2.66The emergency plan (see paragraphs1.131.19) should detail the fire safety provisionsto each patient area and the dependency ofthe patients within the area being considered.

This information will enable the fire safetymanagement procedures to detail theappropriate staffing levels required to undertakethe evacuation of the area in the event of a fire;this information should be prepared as thedesign is being developed to ensure design

assumptions relating to patient evacuation canbe realised by the available trained staff.

2.67 It is the responsibility of management toensure that adequate numbers of staff willalways be available and to devise suitablearrangements to provide for the safe evacuationof all relevant persons in accordance with theemergency evacuation plan. When requestedthey should be able to demonstrate that staffing

levels are adequate to ensure the effectiveimplementation of the emergency plan.

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2.68 Staff should receive training in themethods of patient evacuation appropriate tothe dependency of the patients and be familiarwith the evacuation procedures at their place ofwork, and when requested, health servicemanagers should be able to demonstrate thatstaffing levels are adequate at all times toensure the safe evacuation of patients.

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3. Means of warning and escape

Requirement

Chapter 3 provides guidance to comply withthe following Requirement from Part B ofSchedule 1 of the Building Regulations 2010.

Requirement

Means of warning and escape

B1 The building shall be designed and

constructed so that there are appropriateprovisions for early warning of fire, andappropriate means of escape in case of firefrom the building to a place of safety outsidethe building capable of being safely andeffectively used at all material times.

Fire detection and alarm

3.1The design and construction of the buildingshould ensure that fires are detected at theearliest possible opportunity and that suitablewarning is then given to the occupants and theemergency services.

3.2The provision of adequate means fordetecting a fire and raising the alarm is of vitalimportance. Early detection permits time fororderly evacuation and allows the fire to betackled at an earlier stage, thus minimising thedamage caused. Detection is dependent on

both staff observation and the automaticdetection and alarm systems.

3.3 Health Technical Memorandum 05-03Part B Fire detection and alarm systemsprovides general principles and technicalguidance on the design, specification,installation, commissioning, testing, operationand maintenance of fire alarm systems inhealthcare premises. It should be read inconjunction with BS 5839-1 and the relevantparts of BS EN 54.

Principles of means of escape

3.4The design and construction of the buildingshould ensure that at all times, patients, visitorsand staff can move away from a fire to: a placeof temporary safety inside the building on thesame level, from where further escape ispossible, ultimately to a place of safety outsidethe building; or lead directly to the outside.

3.5This chapter provides guidance on meansof escape by reference to:

a. the potential for horizontal evacuation,which is achieved by dividing the storeyinto compartments and sub-compartments;

b. the height above ground of the treatmentarea;

c. travel distances and escape routes;

d. the provision of an adequate number of

stairways to facilitate vertical escape;

e. emergency and escape lighting.

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Progressive horizontal evacuation

3.6The need for progressive horizontalevacuation is discussed in Chapter 2. This

principle will be met if the requirements inparagraphs 3.73.43and Figure 2below areachieved.

3.7 In a fire emergency, each compartmentshould be capable of accommodating, aswell as its normal occupants, the designedoccupancy of the most highly occupiedadjoining compartment. This should includespace to accommodate beds and medicalequipment required to ensure continuity ofcare.

Note

For a definition of ground level, see Height ofa building in the Glossary.

Floors up to 12 m above ground level withan area of less than 1000 m2

3.8 Every level with a floor area of less than1000 m2and which contains patient-accessareas should:

a. contain no more than 30 patients; and

b. be divided into a minimum of twocompartments.

3.9 Where a compartment provides sleepingaccommodation, the maximum number of

beds in the compartment should be no morethan 20.

3.10 On floors above ground-floor level wheresprinklers are installed, the fire-resistance ofthe compartment walls may be reduced to30 minutes (integrity and insulation), seeparagraph 5.12.

Floors up to 12 m above ground level withan area of more than 1000 m2

3.11 Every level up to 12 m above ground levelthat has a floor area of more than 1000 m2and

which contains patient-access areas should bedivided into a minimum of three compartments.One of these compartments may be a hospitalstreet (see paragraphs 3.373.40).

3.12 Where sprinklers are installed, the fire-resistance of the compartment walls may bereduced to 30 minutes (integrity and insulation),see paragraph 5.12.

Floors over 12 m above ground level

3.13 Every level over 12 m above ground thatcontains patient-access areas should bedivided into a minimum of four compartments.Where no hospital street is provided, eachcompartment should have a minimum floorarea of 500 m2; where one of thecompartments is a hospital street, the area ofthe hospital street may be less than 500 m2.

3.14 Where sprinklers are installed, theminimum floor area of each compartmentrequired by paragraph 3.13 above may bereduced to 350 m2.

General

3.15 In a fire emergency each compartmentshould be capable of accommodating, inaddition to its normal occupants, the designedoccupancy (including all relevant life supportsystems) of the most highly occupied adjoiningcompartment.

Exits from compartments

3.16 Exits from compartments should be byway of a circulation space and provided inaccordance with the guidance in Figure 2.

3.17 While it is permissible to locate clinical andsome non-clinical departments adjacent toeach other, the means of escape through thenon-clinical area must be designed to safelyaccommodate the evacuation of patients (thatis, escape routes should be sufficiently wide

enough to accommodate beds/trolleys).

3.18 It is not permissible to evacuate any non-clinical area through a clinical area unless the

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1. Storeys up to 12 metres above ground witha floor area of less than 1000 m a minimumof two exits required as shown below

Compartment Compartmentone two

A A

B

Exit A by way of a circulation space to:(i) a stairway; or

(ii) a final exit.

Exit B to an adjoining compartment(see alsoparagraphs 3.163.20)

2. Storeys up to 12 metres above ground with afloor area of more than 1000 m a minimumof three exits required as shown below

Compartment Compartment

one two

B

A A

B B

CompartmentA

three


(ii) a final exit.

Exit B to an adjoining compartment(see alsoparagraphs 3.163.20)

3. Storeys over 12 metres above ground a minimum of three exits required as shownbelow


one two

B

A A

B B

A A

B


(ii) a final exit.Exit B to an adjoining compartment

(see alsoparagraphs 3.163.20)

Maximum of 30 patients oneach storey

Where compartment provides sleepingaccommodation maximum of 20 bedsin each compartment


one two

B

C C

D Hospital street D

Exit B to an adjoining compartment(see alsoparagraphs 3.163.20)Exit C by way of a circulation space tothe hospital streetExit D by way of the hospital street onlyto a stairway or final exit

Compartment Compartment Compartment

one two three

B B

C C C

D DHospital street

Exit B to an adjoining compartment(see also paragraphs 3.163.20)Exit C by way of a circulation space tothe hospital streetExit D by way of the hospital street onlyto a stairway or final exit

Figure 2 Requirements for progressive horizontal evacuation (paragraphs 3.63.15)

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route through the clinical area is via a circulationroute only.

3.19 From ward bedrooms only, it is acceptable

to directly escape to:

a. an adjacent ward bedroom in anadjoining compartment or sub-compartment; or

b. a circulation space in an adjoiningcompartment or sub-compartment (seeFigure 3).

3.20 Where a storey is divided into three ormore compartments, the exits from eachcompartment should be located so that thereare at least two alternative exits that providehorizontal escape to adjoining but separatecompartments.

Compartment 1 Compartment 2

ward bedroom ward bedroom

Notes:

i. the escape door in the

compartment wall should be available

for use at all times and should never be

locked;

ii. the bedroom door and the escape

door should be opposite each other and

the route between them kept clear;

iii. escape should be from circulation

space through one ward bedroom only,

through the compartment wall then

through one ward bedroom only to the

circulation space.

Compartment 1 Compartment 2

ward bedroom Note:

i. in this instance escape from the

circulation space in compartment 2

should not be via the ward bedroom

into compartment 1

Key

circulation space

Figure 3 Escape from ward bedrooms

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Note

It is not possible to give precise

recommendations on the location ofalternative exits; the aim should be to locatethese as far apart as practical and if possiblein opposite walls. In the event of a fire, atleast one exit should always be available.

Escape routes over flat roofs

3.21 If more than one escape route is availablefrom a storey, or part of a building, one of those

routes may be by way of a flat roof, providedthat:

a. the route is for staff only;

b. the roof should be part of the samebuilding from which escape is beingmade;

c. the route across the roof should lead toa storey exit or external escape route;

d.

the part of the roof forming the escaperoute and its supporting structure,together with any opening within 3 m ofthe escape route, should be fire-resisting(to a minimum period of 30 minutes ifthe roof is used solely as an escaperoute, or to a period provided inTable 5if the roof is also used as a floor); and

e. the route should be adequately definedand guarded by walls and/or protectivebarriers which meet the provisions in

Approved Document K.

Compartment/department relationships

3.22The provision of compartments to facilitateprogressive horizontal evacuation should not belooked upon only in terms of means of escape.

The management responsibilities, such as theextent of the area under their control, the day-to-day management, fire drills, the management

of evacuation etc, will have a significant impacton the design, integrity, size and configurationof compartments. For these reasons it isstrongly recommended that the design of acompartment should recognise and integrate


the management and operational arrangementsby making the boundaries of compartmentscoterminous with departmental boundaries.

3.23Additional requirements forcompartmentation are provided in Chapter 5.

Sub-compartmentation

3.24The maximum size of a compartmentpermitted by this document althoughappropriate for fire containment (see paragraph5.11) is nevertheless considered too large ifthe area contains patient-access areas. In the

event of a fire, a large number of patients couldbe overcome by the spread of fire, smoke andtoxic gases. Therefore, compartmentscontaining patient-access areas should bedivided into smaller sub-compartments to limitthe number of patients who may be affected bya fire. Wherever possible, there should be abalance of patients between sub-compartments.

3.25A compartment should be sub-

compartmented if:

a. it has a floor area greater than 750 m2;or

b. it contains departments to which morethan 30 patients will have access at thesame time; or

c. it contains sleeping accommodation formore than 30 patients.

Note

For out-patient departments in hospitals, thefloor area may be increased to 1000 m2

before sub-compartmentation becomesnecessary.

3.26 Sub-compartments should be enclosedby walls having a minimum period of fireresistance of 30 minutes, which should

terminate at the underside of:

a. a compartment floor; or

b. a roof.

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Exits from sub-compartments

3.27 Each sub-compartment should beprovided with a minimum of two exits to

adjoining but separate compartments orsub-compartments.

3.28 In healthcare buildings, the left-handarrangement illustrated in Figure 4 is notacceptable.

Travel distances

3.29The distance to adjacent compartments,sub-compartments, hospital streets, stairways

and final exits should be limited to ensure thatthe occupants can escape from the effects of afire within a reasonable period of time.

Single direction of escape

3.30The maximum travel distance before thereis a choice of escape routes should be no morethan:

a. 15 m for in-patient accommodation; or

b.

as specified i