Section 5.1: Fire Safety & Emergency Response (RACE/PASS Protocols)

Section 5.1: Fire Safety & Emergency Response (RACE/PASS Protocols)

Introduction to Emergency Preparedness in Iowa Facilities

In long-term care facilities, the safety of residents is the paramount responsibility of the healthcare team, with the Certified Nursing Assistant (CNA) serving as the first line of defense. Because many residents suffer from cognitive impairments, physical disabilities, or sensory deficits, they cannot independently recognize danger, hear alarms, or evacuate during an emergency. Under Iowa Administrative Code (IAC) 481-58.28, all licensed nursing facilities must maintain a comprehensive, written emergency preparedness plan that addresses disasters such as fires, tornadoes, severe blizzards, floods, and power outages. CNAs must be thoroughly familiar with this plan, participating in monthly fire drills and quarterly tornado drills to ensure an immediate, coordinated response.

The RACE Protocol: Immediate Fire Response

When a fire is suspected or detected, the CNA must immediately initiate the RACE protocol. This is a standardized, sequential acronym that guides actions. Crucially, the steps must be executed in order, though some actions may occur simultaneously if multiple staff members are present.

R - Rescue (Remove)

The absolute first priority is to Rescue or Remove any resident in immediate danger from the source of smoke or fire.

• Clinical Prioritization: If a fire occurs in a resident’s room, the CNA must remove that resident first. When evacuating a larger unit, ambulatory residents (those who can walk independently) are guided out first to clear the corridors. Next, residents requiring wheelchairs are moved, followed by bedridden residents who may need to be moved in their beds or via emergency transfer sheets (such as evacuation slides or blankets).
• Evacuation Techniques: In a fire, never use elevators. Evacuation is horizontal (moving residents past fire doors to a safe wing on the same floor) or vertical (moving down stairs to a lower level or exit). If smoke is present, the CNA should instruct residents to crawl or stay low to the floor where the air is cleaner.

A - Alarm (Activate)

Once residents in immediate danger are safe, the CNA must Alarm or Activate the fire alarm system.

• Execution: Pull the nearest fire alarm pull station. In addition to pulling the physical alarm, the CNA or another staff member must notify the nurse in charge and call 911, clearly stating the facility name, address, and the exact location of the fire (e.g., "North Wing, Room 214").
• Exam Trap: Do not attempt to extinguish the fire before activating the alarm. Even if the fire seems small, it can spread within seconds. Activating the alarm ensures that the fire department is en route and the rest of the facility is alerted.

C - Contain (Confine)

The third step is to Contain or Confine the fire and smoke to prevent it from spreading throughout the facility.

• Action Steps: Close all resident room doors and fire doors. Close windows to eliminate drafts that could feed the flames.
• Oxygen Safety: In long-term care, many residents use supplemental oxygen. Oxygen supports combustion and makes fires burn hotter and faster. The CNA must ensure that oxygen concentrators are turned off and valves on oxygen cylinders are shut, if trained and authorized to do so, once the residents are out of the room.
• Corridor Clearance: Ensure that hallways are completely clear of equipment (e.g., meal carts, linen carts, wheelchairs) so that evacuation routes remain unobstructed.

E - Extinguish (or Evacuate)

The final step is to Extinguish the fire if it is small and manageable, or Evacuate if the fire is spreading or uncontrollable.

• Extinguishing: If the fire is small (such as a trash can fire) and does not pose an immediate threat, the CNA may use a fire extinguisher.
• Evacuating: If the fire is large, spreading, or producing heavy smoke, the CNA must abandon attempts to extinguish it and focus entirely on evacuating all residents from the area, following the nurse's direction to the designated assembly point.

The PASS Protocol: Operating a Fire Extinguisher

To operate a portable fire extinguisher safely and effectively, the CNA must use the PASS protocol. This acronym outlines the physical steps required:

1. P - Pull: Pull the safety pin located at the top of the extinguisher. This breaks the plastic seal and unlocks the squeeze handle.
2. A - Aim: Aim the nozzle or hose at the base of the fire, not at the flames. Aiming at the top of the flames will not extinguish the source of the fire.
3. S - Squeeze: Squeeze the handle or lever slowly and evenly to discharge the extinguishing agent.
4. S - Sweep: Sweep the nozzle from side to side at the base of the fire until the fire is completely out.

Classes of Fire Extinguishers

CNAs must understand which type of extinguisher is appropriate for different fires:

• Class A: Used for ordinary combustibles like paper, wood, cloth, and cardboard.
• Class B: Used for flammable liquids such as grease, oil, gasoline, and paint.
• Class C: Used for electrical fires involving appliances, wiring, and energized electrical equipment.
• Class ABC (Multi-Purpose): Found in most healthcare facilities, safe for use on all three types of fires.

Severe Weather and Disaster Protocols in Iowa

Because Iowa is located in a high-risk region for severe weather, including tornadoes and windstorms, the CNA must understand state-specific disaster protocols.

• Tornado Watch vs. Tornado Warning:
  • Tornado Watch: Conditions are favorable for a tornado to form. The CNA should prepare by closing drapes and blinds (to prevent flying glass), ensuring hallways are clear, and monitoring communications.
  • Tornado Warning: A tornado has been spotted or indicated by radar. The CNA must take immediate action. Move residents away from windows and exterior walls. Evacuate residents to interior corridors, basement shelters, or windowless rooms.
• Caring for Bedbound Residents: For residents who cannot be moved from their beds, the CNA must pull the bed away from windows, place the bed in its lowest position, and cover the resident with heavy blankets and pillows to protect their face and body from falling debris and shattered glass.

Choking and Medical Emergencies

If a resident is choking, the CNA must act immediately. Under Iowa standards, the CNA must first assess for airway obstruction.

• Signs of Complete Obstruction: The resident cannot speak, cough, or breathe, and may clutch their throat (the universal choking sign).
• Abdominal Thrusts (Heimlich Maneuver):
  1. Stand behind the resident and wrap your arms around their waist.
  2. Make a fist with one hand and place the thumb side against the resident's abdomen, slightly above the navel and well below the breastbone.
  3. Grasp your fist with your other hand and press into the abdomen with a quick, upward thrust.
  4. Repeat thrusts until the object is expelled or the resident becomes unresponsive.
  5. If the resident becomes unresponsive, carefully lower them to the floor, call for help, and initiate Cardiopulmonary Resuscitation (CPR) if trained.
• Other Emergencies:
  • Seizures: Clear the area of sharp objects, place a soft pillow under the head, do not restrict movements, and never place anything in the resident’s mouth. Turn the resident on their side after the seizure stops to maintain an open airway.
  • Hemorrhage: Apply direct, firm pressure to the wound using a clean barrier cloth. Elevate the extremity if possible and call for nurse assistance.

Common Exam Traps

• Trap 1: Extinguishing before rescuing. Always RESCUE first.
• Trap 2: Aiming at the top of the flames instead of the base.
• Trap 3: Opening doors during a fire to "let smoke out." This feeds oxygen to the fire.
• Trap 4: Attempting to move a bedridden resident down stairs first. Clear ambulatory residents from the immediate danger zone first to keep paths clear, or move horizontally behind fire doors.