The new era of National Health Insurance in 2000 has had a significant impacted on the management and operation of smallscale hospitals. In response to social needs, and in order to survive under the new insurance system, some small-scale hospitals have transformed or established new Respiratory Care Wards by using existing hospital space. According to the 2009 statistics released by Department of Health, Executive Yuan, there are a total of 307 small-scale medical institutes which provide servicesunder 99 beds. Compared with other large-scale medical centers and general hospitals, small-scale hospitals cannot properly deal with safety management and response to emergency evacuation due to lack of facilities, equipment and human resources. Therefore, small-scale hospitals face a major challenge in emergency response once a fire has occurred. As a result of such a situation, this study has focused mainly on Respiratory Care Wards (RCW) where patients are unable to evacuate. It hopes to analyse the safety management, and emergency response in small-scale hospitals by means of understanding the space characteristics and fire risk. Through on-site surveys, we can understand the fire risk, space features, patient characteristics, facilities and equipment. With reference to the related regulations of hospital emergency management and response, we will propose some fire safety engineering approaches, such as refuge areas in horizontal evacuation and so-called “besieged zones” for “defense-in-place”, etc., to provide some alternative measures to improve fire safety for those small-scale hospitals.