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How NFPA 99 Risk Categories Impact Facility Design

NFPA 99, the Health Care Facilities Code, plays a crucial role in ensuring the safety of patients, staff, and visitors in ambulatory healthcare facilities through its risk-based approach. Here's how the four NFPA 99 Risk Categories are applied in design:

1. Identifying Risk Categories:

The first step is for the governing body of the facility to conduct a thorough risk assessment, considering various factors like:

  • Patient population and acuity levels: Are they mostly healthy outpatients or critically ill patients requiring life support?
  • Procedures performed: Are they low-risk procedures like vaccinations or high-risk surgeries?
  • Levels of Anesthesia: Will anesthesia or sedation render a patient incapable of self-preservation?
  • Equipment and systems used: Is equipment required for patient life support or for administrative purposes?
  • Fire hazards and vulnerabilities: Are there flammable materials present? How easy is it to evacuate?

Based on this assessment, each system and piece of equipment in the facility can be assigned a risk category:

  • Category 1: Failure likely causes major injury or death to patients or caregivers.
  • Category 2: Failure likely causes minor injury to patients or caregivers.
  • Category 3: Failure may cause discomfort but not injury to patients or caregivers.
  • Category 4: Failure has no impact on patients or caregivers.

2. Design Implications for Each Category:

The assigned risk category dictates the level of safety measures required for each system or equipment. For example, Category 1 requires the most stringent measures, like redundant systems, fire-resistant enclosures, and automatic backup power; whereas, Category 4 will likely have minimal safety requirements. The safety features in Categories 2 and 3 will be somewhere in between and are spelled out in the individual chapters of NFPA 99.

By applying these risk-based principles to design, ambulatory healthcare facilities can:

  • Prioritize safety for critical systems and patients: Resources are allocated where they are most needed, ensuring the well-being of vulnerable individuals.
  • Optimize costs: Unnecessary safety measures are avoided for low-risk areas, making construction and maintenance more efficient.
  • Promote flexibility: The governing body of the facility is able to determine the specific risk levels and safety needs to be assigned to their facility based on the unique details of their operation. 

Additional Points:

  • The specific requirements for each risk category are detailed in NFPA 99, and additional guidance may be available from local authorities.
  • The risk assessment process is an ongoing one, and changes to the facility or its operations may necessitate reassessing risk categories and adjusting safety measures accordingly.
  • Consulting with experienced fire protection and life safety professionals, such as experienced architects and engineers, is highly recommended for ensuring compliance and optimal design in ambulatory healthcare facilities.

To assist in determining the risk category of a facility, ASHE, The American Society for Health Care Engineering, provides a Risk Assessment Tool that can be found at this link:

I hope this overview helps you understand how NFPA 99 Risk Categories may applied to ambulatory healthcare facility design. If you have questions, or we can help you in assessing your facility design needs, contact us using the form below or at