St. Elizabeths Hospital strived for self-sufficiency. Leaders of the hospital wanted it to be able to provide for itself and made it their mission to develop a range of services on-campus to address those needs. The Fire House was constructed in 1883 to support that initiative. The small, brick structure was designed in the Italianate style and housed the hospital’s firefighting engines. There was also a living space for the chief engineer. The defining characteristic of the Fire House is its clock tower. It told campus residents the time, but was also used to signal emergencies.
During the earlier decades of its operation, St. Elizabeths was plagued by a series of fatal fires. Its design made fires in the Center Building especially dangerous. Buildings designed in the cottage plan were more easily contained; however, as the campus grew, the hospital's officials realized that they needed a better firefighting system. Having a fire house on the campus was also important because St. Elizabeths was in a remote location and the closest fire department was more than two miles away.
By the 1930s, a lot of the maintenance taking place on the West Campus focused in upgrading and maintaining the older buildings. New development and construction continued to take place on the East Campus. The older buildings were more susceptible to fires and the those earlier decades of the 20th century, the hospital faces destructive fires. By the 1960s, the Department of Health, Education, and Welfare stepped in to provide the hospital with more funding to improve fire suppression plans on the campus, This included an upgrade in the hospital's plumbing facilities, heating unites, and electrical systems. Some of the funding was also used to upgrade the Fire House's equipment.