In a 2007 report to the U.S. Congress, the Office of Mine Safety and Health Research of the U.S. National Institute for Occupational Safety and Health (NIOSH OMSHR) stated that built-in-place refuge alternatives (BIP RAs) provide significant advantages over mobile refuge alternatives. At present, the requirement to locate refuge alternatives within 305 m (1,000 ft) of working faces makes BIP RAs impractical in most coal mines. BIP RAs would be practical if three issues are addressed: (1) allowing BIP RAs to be located at greater distances from the working face, (2) developing a reliable process for the design and approval of BIP RA stoppings that meet the 0.1-MPa (15-psi) design criteria, and (3) developing systems that reliably deliver breathable air to the refuge alternative. In 2015, NIOSH OMSHR conducted a study of these three issues and issued a report. In the report, justification was provided for allowing the placement of BIP RAs at greater distances from the working face than the currently mandated 305 m (1,000 ft), guidelines were developed that could be used by industry when submitting BIP RA stopping design applications for approval which are patterned after the Mine Safety and Health Administration guidelines for coal mine seal design applications, and insights were provided into options for providing a reliable supply of clean, breathable air to BIP RAs. This paper presents a summary of the study's findings and also addresses issues discovered during the building and designing of a BIP RA that OMSHR researchers constructed in NIOSH's Experimental Coal Mine in Pittsburgh to research the testing and improving of BIP RAs. These issues include several issues related to the delivery, distribution and exhaust of ventilation air to the BIP RA and some general construction issues that require further investigation.