3.4 Emergencies and First Aid
Key Takeaways
- RACE is the order of actions in a fire: Rescue, Alarm, Confine, Extinguish; PASS is how to use an extinguisher: Pull, Aim (at the base), Squeeze, Sweep
- For a conscious choking adult who cannot speak, cough, or breathe, give abdominal thrusts (Heimlich); if the person becomes unresponsive, lower them safely and call for help/begin CPR per training
- During a seizure, protect the resident (clear the area, cushion the head, turn to the side if possible) - NEVER restrain them or put anything in the mouth
- Signs of shock include pale, cool, clammy skin, rapid weak pulse, rapid breathing, low BP, and confusion; keep the resident lying down, warm, and call the nurse at once
- For fainting (syncope), lower the resident to prevent a fall and keep them lying flat; for bleeding, apply direct pressure with gloves; always call the nurse - aides assist, the nurse and team direct
The Nurse Aide's Role in an Emergency
In any emergency the aide's job is to stay calm, keep the resident safe, call for help, and act only within their training - typically basic life support, first aid, and the steps below. The aide does not diagnose or treat; the nurse and emergency team direct care. A useful priority check is the ABCs - Airway, Breathing, Circulation: make sure the airway is open, the resident is breathing, and there is a pulse, in that order, then get help.
Fire Safety: RACE and PASS
Fires are a tested emergency because facilities drill them often. Two mnemonics carry almost every fire question.
RACE - what to do, in order, when a fire starts:
- R - Rescue anyone in immediate danger.
- A - Alarm: pull the fire alarm and call for help.
- C - Confine the fire by closing doors and windows.
- E - Extinguish the fire only if it is small and it is safe to do so.
PASS - how to operate a fire extinguisher:
- P - Pull the safety pin.
- A - Aim the nozzle at the base of the flames (not the top).
- S - Squeeze the handle.
- S - Sweep from side to side.
With oxygen in use, post "No Smoking / Oxygen in Use" signs and keep all flames, sparks, cigarettes, and electric razors away - oxygen makes fire spread explosively. This oxygen-safety point shows up often.
Choking and the Heimlich Maneuver
Choking is a true airway emergency. First decide whether the airway is partly or fully blocked.
- Partial blockage / forceful coughing - the resident can still cough, speak, or wheeze. Encourage them to keep coughing and do not interfere; coughing is the best way to clear it. Stay with them.
- Complete blockage - the resident cannot speak, cough, or breathe, may clutch the throat (the universal choking sign), and may turn blue. Act immediately.
Conscious adult with a complete obstruction - abdominal thrusts (Heimlich): Stand behind the resident, wrap your arms around the waist, make a fist with the thumb side just above the navel and below the ribs, grasp it with your other hand, and give quick inward and upward thrusts until the object comes out or the resident becomes unresponsive. Call for the nurse.
If the resident becomes unresponsive: Lower them safely to the floor, call for help/activate the emergency response, and begin CPR if you are trained and certified, checking the mouth for the object before each set of breaths per your training. For a pregnant or very large resident, use chest thrusts instead of abdominal thrusts.
Falls, Fainting, Seizures, Shock, Bleeding, and Burns
| Emergency | First Response (within aide scope) |
|---|---|
| Fall | Do not move the resident; stay with them, check for injury, call the nurse, complete an incident report |
| Fainting (syncope) | Help the resident lie down (or lower them to prevent a fall); keep them flat, loosen tight clothing, call the nurse |
| Seizure | Protect from injury - clear the area, cushion/lower the head, turn to the side if possible; do NOT restrain or put anything in the mouth; time it; call the nurse |
| Shock | Keep the resident lying down and warm; do not give food or drink; call for help immediately |
| Bleeding | Put on gloves; apply firm direct pressure with a clean cloth; do not remove soaked cloths (add more); call the nurse |
| Burn (minor) | Cool with cool (not ice-cold) running water; do not apply ointments, butter, or ice; cover loosely; report |
Seizures - what NOT to do
During a seizure, the resident's muscles jerk uncontrollably. Never try to hold them down (restrain) and never force anything between the teeth - both cause injury. Just protect the head, move furniture away, turn them on their side if you can to let saliva drain, note how long the seizure lasts, and provide privacy. Stay until the nurse arrives.
Recognizing shock
Shock means the body's organs are not getting enough blood and oxygen. Early signs: pale, cool, clammy (moist) skin; a rapid, weak pulse; rapid shallow breathing; low blood pressure; restlessness or confusion; and thirst. Shock is life-threatening - keep the resident lying down, keep them warm, do not give anything by mouth, and get the nurse at once.
When to Call for Help
The rule of thumb: when in doubt, call the nurse. Use the call light or facility emergency system for chest pain, trouble breathing, sudden weakness or slurred speech (possible stroke), uncontrolled bleeding, unresponsiveness, a fall with injury, or any sudden change in condition. Acting fast and getting trained help saves lives - hesitating does not.
Worked Example: During lunch, Ms. Bell suddenly clutches her throat, cannot speak or cough, and her face begins to turn blue. You recognize the universal choking sign and a complete airway obstruction. You do not offer water (which would worsen it) and do not wait. You stand behind her, place a fist just above her navel, and give quick inward-and-upward abdominal thrusts while calling out for the nurse. The food dislodges after several thrusts and she gasps a breath. You stay with her, report the event, and document it. Recognizing complete vs. partial obstruction - and acting immediately - is what the exam rewards.
A fire breaks out in a resident's room. Using the RACE protocol, what is the FIRST action the nurse aide takes?
A resident has a seizure and falls to the floor, with arms and legs jerking. What is the correct nurse aide response?
A resident is sitting in the dining room, suddenly grabs their throat, cannot speak or cough, and is turning blue. What should the nurse aide do?
A nurse aide notices a resident is suddenly pale, with cool clammy skin, a rapid weak pulse, and is confused. These are signs of: