LS.02.01.20 Obstruction of the means of Egress
Emergency access and egress are critical during an emergency situation such as a fire. During a fire, timing and quick response are essential to save lives and property. Unobstructed emergency egress ensures that building occupants can exit a building to safety. The rationale for constructing and maintaining hospital corridors at 8 feet wide has shifted from a life safety issue to one of operations and logistics. It is recognized that the day-to-day operations of a hospital require keeping some equipment near patient rooms, including life-saving crash carts. NFPA 101 now allows certain equipment to be staged in 8-foot corridors as long as 5 feet of clear width remains and hospital employees have a plan for removing the equipment during an emergency. That rule works well because the wheel base of many portable carts and pieces of equipment is less than 3 feet. While 5 feet is enough space for hospital staff to move patients through the corridor, it’s important to note that only certain equipment can be staged in the remaining 3 feet—that space cannot be cluttered with items such as fax machines, file cabinets, and other basic storage needs. The 2012 edition of the Life Safety Code® outlines specific wheeled items that can be staged in corridors to ensure that hallways don’t become storage closets. Items allowed are:
- Equipment and carts being used by hospital workers
- Medical emergency equipment not in use, such as crash carts and isolation carts
- Patient transportation devices, such as portable lifts and wheelchairs
Additionally, these types of items cannot reduce the clear unobstructed corridor width to less than 5 feet, and the facility fire safety plan and training program must address the relocation of the wheeled equipment during a fire or similar emergency. Since these allowances are contained within the 2012 edition of the Life Safety Code but most hospitals are maintained under the 2000 edition of the Life Safety Code, hospitals that want to use these allowances must use the categorical waiver offered by the Centers for Medicaid and Medicare (CMS) permitted through CMS S&C Letter 12-12-LSC. For additional information on this and other waivers see the ASHE CMS Waiver Page.
ISSUE - Terms and Concepts
- 2012 CMS Memo Allowing Waivers on Means of Egress (PDF) (Posted Oct. 1, 2015)
- ASHE Issue Brief Explaining CMS Memo on Means of Egress (Posted Oct. 1, 2015)
- Fire Code Requirements Article and Chart (Posted Oct. 1, 2015)
RISK – Defining Failure Modes
Because patients are under medical care and, in many cases, cannot move on their own to escape the danger of fire, buildings in which patients are cared for must be designed and maintained so patients can be protected in place or moved to safe places in the building (instead of evacuated to a place outside the building). Hospitals should make sure that a sufficient number of exits exist and that they are configured to provide protection from fire. Egress doors should not be locked in a way that restricts passage to safety. Means of egress include corridors, stairways, and doors that allow individuals to leave a building or to move between specific spaces in a building. They allow individuals to escape from fire and smoke and, therefore, are an integral part of a fire protection strategy.
IMPACT – Identifying Patient Outcomes
During a fire and other emergency scenarios, it may become necessary to relocate or evacuate patients, often in reduced visibility. On first appearance, corridors seem to have ample space for many items that help support patient care: equipment, supply carts, food carts, empty beds, etc. However, a bed with accompanying monitors, pumps and portable oxygen, along with medical personnel, can require significant width to accomplish an evacuation. Making sure that corridors are properly maintained according to established requirements within the Life Safety Code and facility specific safety plans is vital to reduce the impact to patients in times of emergencies.
MITIGATION – Assessment Tools and Resources
ASHE is making several rounding tools and checklists available as part of the Focus on Compliance initiative. Facility professionals can review the various forms and find one that can easily be tailored to their facility.
- Adopt-a-Floor Instructions (Posted Oct. 1, 2015)
- Adopt-a-Floor Work Order Tool (Posted Oct. 1, 2015)
- Environmental Tour Checklist (Posted Oct. 1, 2015)
- Life Safety Standards Checklist (Posted Oct. 1, 2015)