We'll start out with what you have in the hospital.
Staged Evacuation / Defend in Place
When there's an alarm, I believe that most of the hospital employees act as if the fire evacuation system is a "Defend-In-Place" system. For a hospital, rather than getting everyone out of the building if there's a fire, the patients are told to get behind a closed fire door.
The alarm sounds off, though, as a "Staged Evacuation" system. With staged evacuation, when there's a fire, rather that totally evacuate the entire building, the alarms sound off around the building in stages.
Technically, for Staged Evacuation, the first stage of evacuation sounds off in the zone of incidence (fire zone) and also the adjacent zones. For a grid of fire zones in squares, that's a total of nine fire zones on each of three floors.
Later, the fire department decides on the next stages of evacuation.
When it's a high-rise building, with only one fire zone per floor, the "Staged Evacuation" is usually interpreted as the fire floor, the floor above, and the floor below. However, when there are many zones per floor, the adjacent zones also have to be taken into account; the real staged evacuation system is the Zone of Incidence, and All Adjacent Fire Zones
Think of it this way - If there's a fire at the edge of a fire zone, the fire could break through to an adjacent zone at any time. Wouldn't it be a good idea to notify the people in the adjacent zone so they also take appropriate action?
Whole Floor Sounding Off with an Alarm
I've done a lot of work with a large downtown hospital complex. When I first started there, it was a Total Evacuation-Sound System; all 10 floors, of three hospitals that are connected together, sounded off with any fire alarm. This was acceptable to the hospital(s) at that time.
That was changed a few years later to a Staged Evacuation System. With that staged evacuation system, each floor, covering about 2 city blocks and across all three hospitals were considered an evacuation-sound zone (as opposed to fire-zone, which is limited in size). There were many fire walls, with some floors having more than 10 fire-zones. However, for evacuation or Defend-In-Place, the whole floor was considered to be a single evacuation zone. (OK, all hospitals everywhere are really Defend-In-Place. To make the entire floor to be Defend-In-Place, the chimes and strobes turned on for the entire floor.)
With the hospital(s), even the emergency department was included in the alarms for the floor; The ED Department's chimes and strobes went off when there was an alarm going off in any of the three hospitals, on that floor, the floor above, and the floor below.
The Code refers to the zone of incidence, and the adjacent zones, for the evacuation. However, in these three hospitals, which cover almost two blocks, all the chimes and strobes on a floor sounded off at the same time. This was far more than what is required in the NFPA Code.
Actually, though, the City Fire Marshal, the State Fire Marshal, Joint Commission, and CMS (the Medicare People) were all fine with exceeding the minimum requirements shown in the NFPA Code. As long as the fire zone of incidence, and all adjoining fire zones went into alarm, the minimum requirements shown in the Code were satisfied. Also sounding off the chimes and strobes for the rest of the zones on the floor is acceptable.
Keep in mind that the guidelines shown in the NFPA Code don't show the best way to make a fire alarm system; the guidelines shown in the NFPA Codes show the absolute minimum requirements to have an adequate fire alarm system. What's more, the National Fire Protection Association (NFPA) also says that the fire alarm system can be done better.
Read the article at:
https://www.douglaskrantz.com/SCWhoIsAHJ.html -- Just Who Is the Authority Having Jurisdiction (AHJ)?
At the hospital I worked with, one of the big reasons that the whole floor, across all three hospitals, sound off is because of the sound. One of your concerns is that when someone on the floor hears the chimes outside of the fire zone, they don't know what to do.
If I Were There
If I were there to make some recommendations. I'd recommend using training during Fire Drills to address the issues you brought up. Possibly the zones that sound off need to expanded so that intuitively, everyone that hears the chimes will know what to do.
Yes, I know, you perform regular fire drills. The hospital I worked with used these drills for improvements. During all of the fire drills, they had a team of about 10 people with clip boards going around the building. Each member of the team would cover a different area of the hospital during the fire drill, and look for problems that need to be corrected. Things like:
- All patients should be taken care of
- Someone from engineering should show up with fire extinguishers
- Someone in engineering should stay with the fire alarm system
- Someone from security should show up at the fire site, up ready to handle the situation
- Someone from security should stand by where the fire department would arrive, to make sure the firefighters know where to go
- Make sure that no one has propped open any fire doors
- Make sure that all chimes and strobes sound off where they were supposed to
- Any other problem that needs to be addressed
Basically, the fire drill team would note issues on the clipboards, and discuss how the system could work better. The follow-up would include better training for the hospital employees, or correction of any technical issues.
If some people didn't know what should be done, the team could then discuss the root cause of the confusion and take care of the root cause.
Fire Alarm Evacuation-Sound Pattern
You mention that some healthcare workers don't know what to do when they hear the alarms in another fire-zone. The fire drill team, described above, will be able to pinpoint the confusion, and look for ways to change the pattern of the chimes and strobes. Maybe, to solve the problem, the whole floor, including the Emergency Department, could be included in the same fire alarm evacuation-sound zone. Then the hospital personnel on the whole floor would hear the same fire alarm, and everyone would take action.
Then again, the fire drill team could recommend that the personnel in the areas of the evacuation-sound confusion be better trained to take appropriate actions, or continue normal work, when they hear distant chimes.
Authority Having Jurisdiction (AHJ)
Remember, the NFPA Code (highlighted in the article above) shows the property owner as one of the AHJs, at least under some circumstances. The property owners, according to the NFPA Code, can make some of the decisions. You still will want to have the local fire marshal, and possibly the State Fire Marshal involved in on some of the changes, especially the changes to the fire alarm evacuation-sound zones.
Bottom line, the hospital doesn't have to stand by and accept a fire alarm system that has problems with confusion; if there's a problem with confusion during a fire alarm, the hospital, working with fire marshals, can initiate improvements to the system. This is because, even according to the NFPA, the hospital has some authority.