Trending Topics

How to Respond to Fires in Senior Care Facilities


AP Photo/Nick Wass
Stretchers and fire trucks stand by outside a nursing home in Chevy Chase, Md., following a fire in 2005. Many of the 140 residents needed assistance out of the building and four people were hospitalized with injuries from the fire.

By Michael Lee

The “graying of America” is covered widely in the mainstream media — but what about its effects on our responses? People aged 65 and older made up 12.4 percent — or 35 million — of the population in 2000. It’s predicted they will form 16.3 percent of the population by 2020, while in 2030 nearly one in five Americans will be 65 and older.

Coupled with the new life expectancy standard of 77.7 years of age, we are facing what will soon be a critical residential impact for seniors and the ability to care for them based on their self-care abilities. This means that if you have not already noticed an increase in the construction of senior care facilities, you soon will. It will in turn increase the number of facilities we will be responding to — and therefore we should be evaluating our standard approaches to the strategy and tactics of fighting fires in senior care facilities.

Based on the level of an assistance a resident requires and their life skill abilities/intervention, the question of self-preservation prompts the following question: In the possibility of a fire, are the individuals in this facility able to rescue themselves? If fire department intervention is required, how many resources will be required and how involved with the rescue mission will command commit resources before locating, confining and extinguishing the fire?

A large number of senior care residents may be incapable of self-evacuating, or self-recognizing a threat and unable to choose the most appropriate self-rescue option. This limited or absent ability to self-evacuate may require a shift in thinking and tactics compared to the standard firefighting tactics of RECEO.

Facilities You Will Encounter

Currently the NFPA’s Fire Protection Handbook defines senior care facilities as those that are responsible for the treatment of persons with physical, mental illness, disease or infirmity of aged persons. These may consist of sleeping accommodations for individuals who may be incapable of self-preservation due to physical or mental disabilities/limitations. Some may have security measures that limit freedom of movement. According to the Life Safety Code, these senior care facilities are generally sub-divided into:

Independent-living facilities
These may consist of condos, apartments or townhouses where seniors live with limited or no supervision. The seniors can still drive and live active lifestyles. Residents are generally checked on every 24 hours to confirm they are doing well.

Assisted-living facilities
These cater to the group of seniors that is ambulatory and able to complete self-hygiene care processes. Facilities generally have on-site dining and the staff can assist residences with limited intervention such as medication administration and are checked on more frequently.

Limited-care facilities
These can be a complete building or a portion of a building used for housing four or more persons who are incapable of self-preservation because of age, physical limitations due to accident or illness, or limitations such as mental retardation/developmental disability, mental illness or chemical dependency.

Long-term care facilities
Also called nursing homes, dependent living or skilled nursing facilities. In these facilities, seniors may be fully lucid, but still be a victim of deteriorating physical health. These facilities host individuals who have physical challenges from ambulatory difficulties to ventilator-dependent patients. These seniors are generally unable to care for themselves, their needs and safety without assistance from another person. These facilities utilize oxygen through cylinders or plumbed in piping.

Hybrid facilities
This is the fastest growing of the senior care facilities. They are large facilities that can handle all four groups. This seems to be common for Alzheimer’s patients. They also allow for the possibility of moving a patient from one area to another should their ability to deliver self-care deteriorates and increased levels of assistance are required.

The significant amount of resources required for rescue may prevent the successful ability to extinguish the fire and successfully rescue all occupants if the standard RECEO acronym of rescue, exposures, confinement, extinguish and overhaul is not modified.

A better option may be to protect residents in place while a locate/confine/extinguish tactic would remove the source of the problem and minimize the number of occupants that may have to be removed. This may also reduce the total amount of resources required to manage this incident from multiple alarm assignments to hopefully 2 alarms.

The definition of a “defend-in-place” tactic is when a fire can be quickly controlled. This tactic requires leaving people in a burning building and is a calculated risk. Such a decision must be made based on the available resources, size of the fire, extent of danger to the victim and the ability of a victim to take advantage of areas of refuge that were hopefully part of the construction design.

For a defend-in-place tactic to be a successful option, existing building construction features that utilize the NFPA Standard 1 – Life Safety Code should have been required in the design phase of construction.

Requirements of the Life Safety Code for construction of a senior care facility that has areas of refuge require a significant amount of pre-planning in the design phase of construction. From a fire department perspective, it is also critical that the elements built during construction are kept functional and operational by on-site, regular fire safety inspections. The features that should be designed into the creation of a safe senior care facility include:

Fire-resistive construction
Facilities of more than three stories should be of a two-hour fire-resistive construction. Those less than three stories may be built with combustible materials, but should have proper fire sprinkler support.

  • Compartmentation
    Sleeping areas (other than the room of origin) must be able to serve as a temporary area of refuge and should be isolated from all other areas of the building spaces by fire rated construction.
  • Protection of vertical openings
    All shafts and/or stairwells should be enclosed in a fire rated material. For vertical openings that connect more than three floors, a two-hour rating is required. For less than three floors, it must have a one-hour rating.
  • Adequate means of egress
    Due to the limited movement of occupants, design is primarily created to enhance horizontal rescue versus vertical movement. Movement corridors must be wide enough to allow for occupant movement and movement of patient beds.
  • Exit marking/illumination/back-up battery power
  • Limiting the incorporation of interior finish materials
  • Fire alarms
  • Smoke movement control
    Designed into the air handling systems.
  • Adequate protection of building service equipment
    Those areas where mechanical equipment is contained within the footprint of the structure should have a minimum two-hour rating.
  • Control of fuel loads
  • Ensure that combustible items added after completion of construction does not surpass the ability of the extinguishing ability for sprinkler suppression systems in any area.
  • Fire sprinklers.

Correct design of senior care facilities can greatly assist with the defend-in-place strategy if they follow the above recommendations outlined in the NFPA Fire Protection Handbook. All of the features bring another layer of protection to the fire protection design. The design allows for occupants to move horizontally to areas of refuge instead of trying to exit down vertical stairwells when they may be mobility challenged. Barriers subdivide each floor to create further areas of refuge without having to use stairs. Automatic sprinklers assist with enhancing the defend-in-place strategy. In addition, the compartmentation decreases the ability of a fire to move easily from one area to another.

Fires at senior care facilities are challenging and will generate more operational tasks than standard first alarm companies can handle. If the incident commander is unable to assign sufficient resources early on, they will be placed in a position where they are constantly trying to catch up. Any reported fire in a senior care facility should be automatically upgraded to a second alarm assignment.

It is critical that the initial companies have preplanned this facility and are very familiar with it. Interior hose stretch lengths should have already been measured and companies should know the required lengths based on the floor plan.

The defend-in-place strategy is a choice the incident commander may consider when initial on scene or responding resources may not be able to match the requirements for the standard RECEO process. The amount of assistance required to assist all occupants off of the fire floor may prohibit the effective fire suppression efforts.

The defend-in-place concept is to find/confine/extinguish the fire and thereby decrease the source of the smoke/heat problems. Chief Tom Brennan put it this way: “If you put the fire out, your problems tend to go away.” To do this, it requires that the initial crews be familiar with on-site suppression equipment:

  • Does the facility have standpipes or are you responsible for creating your own interior water supply?
  • Are the standpipes accessible from the interior of the stairwell or must it be accessed from the hallway?
  • Is the initial hose selection able to extinguish the volume of fire to be put out? Can the extinguishment process be completed quickly?
  • Is evacuating residents impacting the interior fire attack team?
  • How critical is the smoke layer on the fire floor?
  • How soon will ventilation be required for interior occupant survival?

The decision to utilize the defend-in-place strategy should never be chosen lightly. This is one tactic where ventilation must be initiated early but coordinated with interior attack crews. If ventilation tactics will draw the fire into the main evacuation hallway, wait until the attack team is ready for their push to extinguish. What is the possibility this may become a wind-driven fire once the unit of origin is found and entry is gained?

These tactics increase the possibility of exposing occupants to fire in areas where they may be rescued easily. Crews must be very deliberate to try to prevent smoke from the fire floor from traveling to unaffected areas. Positive pressure ventilation in stairwells and the fire floor can be very effective in controlling smoke migration.

Initial tactics once the defend-in-place strategy is selected dictate that the initial attack team will be very busy for a short amount of time. Its primary assignment is to find the seat of the fire and stretch an initial attack line as close to the fire as possible. This may require hoisting a 2 ½" gated wye as the supply line through a window a unit or two away.

The fire must be knocked down as quickly as possible and then ventilation initiated if it has not been started. Secondary teams must begin a unit to unit search for victims to evacuate. If the units are tenable, wait until the environment in the evacuation hallway is safe before moving the occupants down dark, smoky hallways.

Have an on-site manager meet with the IC to confirm the accountability of all occupants. It might be a good idea to get a coach bus or two to respond to the scene to allow for a comfortable environment for your occupants. Remember that although we may be warm, the seniors may not be. Anticipate the need for additional transport units should the occupants develop issues secondary to the stressful event they are being exposed to.


Fire Protection Handbook. (18th Ed) Section 9. Chapter 8. Senior Care Facilities, Nursing Homes and Assisted Living Centers. National Fire Protection Association, Quincy, MA.

Kennedy, M. and Alexander, A. Fire Engineering Magazine. Volume # 161. Issue #1. Fire Operations in Senior Living Facilities. Downloaded from: on November 8, 2009 at 1230.

Klaene, B. and Sanders, R. Structural Firefighting – Strategy and Tactics. (2nd Ed). Chapter 11. Pages 271 – 272. Jones and Bartlett Publishers. Sudbury, MA.

Michael Lee teaches firefighters the ‘Street Smarts’ they need to survive in some of the most dangerous situations they encounter: ice rescues, basement fires, and structural collapses. Read Lee’s advice in his FireRescue1 exclusive column.