This blog post was originally shared as an article by former team member, Maria Gonzalez, in ASIS NYC Chapter's Security Director magazine.

The path of egress in a healthcare facility can be described as the means by which patients, staff, and visitors can navigate and exit the facility safely during an emergency. It encompasses exit access and exit discharge, ensuring a smooth and safe transition from any point in the facility to the safe areas outside the  exterior of the building. Given the critical nature of healthcare services and the vulnerable populations they cater to, ensuring a clear and secure path of egress is crucial for facility design. Landing on the correct design early in the process, minimizes redesign, and ensures long term functionality of the facility. 

Security directors in healthcare facilities have the challenging task of ensuring that patients, staff, and visitors are protected, while also facilitating efficient operations. They need to be informed of the nuanced challenges and potential solutions for the path of egress from very early on during the design process of a new facility. This article highlights some of the key security challenges and offers potential solutions as to how a security consultant can make a difference in improving them.

When working on any healthcare project, it’s important to remember that the overarching goal is to improve the quality of care and experience for patients, staff and visitors. Here are three vital points of interest and considerations for security professionals when designing optimal paths of egress:

1. Consultants and Early Involvement

Challenges: Often, the initial space programming, location of stairs, and other egress points are determined without adequate expert input from the client and consultant security teams. When this occurs, clients will find themselves using noisy delayed egress door hardware and incurring additional costs in order to maintain the shortcut solution. 

Solutions: Engage consultants and security stakeholders in the early stages of the project, especially during the Programming and Schematic Design (SD) phases, to ensure optimized and safe egress paths. When a design team is armed with information on how the security systems need to operate, they can incorporate designs into a space that will optimize security with fewer devices and ultimately guarantee years of optimal operation. 

‍2. Strategic Space Placement

Challenges: Placing sensitive or high-occupancy spaces without strategic input can pose security risks as well as costly and complicated physical security solutions.

Solutions: Healthcare facilities such as behavioral health hospitals and labor and delivery units, should be compartmentalized due to their sensitive nature. Proper configuration aids these efforts by adding enhanced protection without the need for complex security access control. It is important that when designing these spaces, both owners and designers consider the unique code requirements that will create situations of evacuation, lockdown, or shelter-in-place, and verify that paths of egress are not placed through departments that need to be secured from public access.

3. Dual Egress Doors

Challenges: Modern healthcare settings are divided into smoke compartments in order to aid in the relocation of non-ambulatory patients in the event of an emergency. Smoke compartments frequently lead to the prevalence of dual egress doors, which can be challenging to coordinate. Dual egress doors  are often the most complex doors in a facility because they may require delayed egress hardware, local power supplies, fire alarm interface relays, local electrical power, auto-operators, ADA push plates, key switches, alarm contacts, and request-to-exit devices.  When misused, or overused, delayed egress doors can result in code compliance issues, frequent false alarms, high noise levels, and additionally cause undue disturbance and anxiety to the staff and patients. 

Solutions: Proper department layout planning, design considerations, and thorough door hardware coordination can reduce the need for the complex physical security solutions that are needed to remain code compliant. Minimizing the use of these noisy and complex doors, will simplify ongoing operations for staff, visitors and patients. If and when the physical security system needs to be implemented, it is crucial to ensure that the architect, door hardware consultant, security consultant, stakeholders from the owner side, and fire alarm engineer are coordinating their scope. Lack of input from any of these groups can turn into extremely costly change orders, affect the project schedule, and oftentimes difficult to change later in the project without a complete reprogramming of the spaces.

The path of egress in healthcare facilities is more than just a code-required emergency exit route - it's a crucial element in the overall safety and security of the establishment and its patrons. Ensuring a secure path of egress in healthcare facilities requires a multifaceted approach that considers the unique challenges posed by these dynamic environments. Through strategic design, technology adoption, proper departmental layout, and coordination of the numerous trades involved, healthcare institutions can create a safe, secure, and efficient environment for all.

Finally, to close the loop on the staircase story at the top, after thorough review of the department layouts, the code requirements, and the challenges of the physical security system – a new additional staircase turned out to be indeed the path of least resistance to maintain a safe path of egress for this hospital.