In the United States, building codes and fire codes work together to ensure that a structure meets a minimum level of safety. These regulations contain rules for things like what materials a building should be made of and where the stairs should be.
Many codes are local and can be different from one city to another. But in the 1960s, Congress mandated that all health care facilities receiving federal funds conform to the National Fire Protection Association Life Safety Code, NFPA 101.
When the new law passed, most, if not all, facilities were not in compliance. It can be extremely difficult to retrofit a building to meet a new code. Anything from the floor plan to the electrical system might need to be changed. Many building owners could not adapt their facilities to meet NFPA 101 and had to close. Lawmakers faced a dilemma. They wanted to make sure hospitals were safe, but they didn’t want the new Life Safety Code to force those hospitals into bankruptcy. They needed a more flexible code.
In 1975, the Department of Health, Education, and Welfare (now named the Department of Health and Human Services) began a joint effort with NIST to create an alternative solution. NIST came up with the Fire Safety Evaluation System for Health Care Facilities (FSES-HCF). The idea is to consider the building’s safety as a whole, rather than looking at each element individually. This system offers more flexibility so operators can make their buildings as safe as NFPA 101 while minimizing expense.
It’s essentially a point system. Experts examine a proposal for a building and award points in three fire safety categories: risk to occupants, ability to provide safety commensurate with the risk, and redundancy of multiple fire safety measures. Some of the factors they look at include type of construction, partitioning, interior finishes, hazardous activities, evacuation, fire alarms, and fire suppression systems.
Then the points are added together into a final score which is compared to the final score for a hypothetical building that meets the rigorous fire safety requirements of NFPA 101.
The FSES-HCF was formally adopted into the 1981 edition of NFPA 101 and has saved health care facilities a lot of money. From 1983 to 1989, hospitals and nursing homes nationwide saved more than $2 billion in today’s money by using the FSES. One hospital seeking to increase capacity used the FSES to reduce the cost of code compliance from around $40 million to less than $2 million. This brought its expansion plan from prohibitively expensive to reasonably affordable.
NIST continued to develop FSESs for other facilities, including board-and-care homes, multifamily housing, prisons and jails, and office buildings.
The idea caught on. The FSES was one of the first examples of “performance-based fire safety design,” a whole new approach to quantifying fire safety in building regulations.
In the United States and an increasing number of other countries, the major building and fire codes now include a performance-based option. Through this new code philosophy, NIST’s foundational research has enabled the flexible and cost-efficient design of new and repurposed buildings that meet today’s and tomorrow’s requirements for fire safety.
NIST report: The Performance Concept: A Study of Its Application to Housing, 1968.
NIST report: System for Fire Safety Evaluation of Health Care Facilities, 1980.
NIST report: A Cost-Conscious Guide to Fire Safety in Health Care Facilities, 1982.
NIST report: Benefits and Costs of Research: A Case Study of the Fire Safety Evaluation System, 1996.
ICC code: 2024 ICC Performance Code for Buildings and Facilities, 2024.
NFPA standard: NFPA 101A, Guide on Alternative Approaches to Life Safety, 2025.