4.2 Fire Safety, Emergency Response & Choking
Key Takeaways
- The acronym RACE dictates the priority sequence in a fire emergency: Rescue/Remove residents, Alarm/Activate, Contain/Confine fire by closing doors, Extinguish/Evacuate.
- The PASS acronym guides correct fire extinguisher operation: Pull the pin, Aim at the base of the fire, Squeeze the handle, and Sweep side to side.
- For conscious adults with severe airway obstruction (unable to speak, cough, or breathe), abdominal thrusts (Heimlich maneuver) are performed until the object is dislodged or the resident loses consciousness.
- In facility evacuations, residents closest to danger are evacuated horizontally past fire doors first, prioritizing ambulatory residents before non-ambulatory residents.
4.2 Fire Safety, Emergency Response & Choking
Clinical Core Concept: Healthcare facilities present unique fire and medical emergency challenges due to resident vulnerability, presence of medical oxygen, and complex physical layouts. CNAs must master emergency action protocols—specifically RACE and PASS—and deliver rapid life-saving intervention for acute airway obstructions.
1. Fire Safety Fundamentals & Oxygen Precautions
Fire safety in long-term care facilities relies on prevention, early detection, and disciplined emergency response. Healthcare fires spread rapidly due to combustible linens and high-concentration medical oxygen systems.
Medical Oxygen Safety Rules
Oxygen supports combustion, meaning fires burn far more intensely in an oxygen-enriched environment. When caring for residents receiving supplemental oxygen (via nasal cannula or mask):
- Post "OXYGEN IN USE - NO SMOKING" signs prominently on the resident's door and over the bed.
- Prohibit all open flames, matches, candles, or lighters in oxygen storage or delivery areas.
- Avoid spark-generating electrical equipment, including wool blankets, synthetic friction-causing fabrics, electric razors, or ungrounded appliances.
- Ensure oxygen cylinders are secured upright in designated carts or racks to prevent tipping and valve damage.
2. The RACE Protocol for Fire Emergencies
When smoke or fire is detected, every facility staff member must immediately execute the standardized RACE protocol in exact sequence:
- R - RESCUE / REMOVE: Immediately move any resident in direct danger to a safe area past fire doors.
- A - ALARM / ACTIVATE: Pull the nearest fire alarm station and call out the code word (e.g., "Code Red") with the exact location.
- C - CONTAIN / CONFINE: Close all doors and windows to isolate smoke and flame. Turn off oxygen equipment if trained.
- E - EXTINGUISH / EVACUATE: Extinguish small fires using an appropriate extinguisher, or evacuate the building if the fire cannot be controlled.
| Step | Action | Specific CNA Duties |
|---|---|---|
| R - Rescue | Move endangered residents | Evacuate residents from the fire room into the corridor past smoke-barrier doors. |
| A - Alarm | Trigger emergency response | Pull the nearest wall alarm station and report location: "Code Red, Room 214". |
| C - Contain | Isolate fire and smoke | Close all resident room doors, fire barrier doors, and turn off oxygen valves if trained. |
| E - Extinguish/Evacuate | Put out fire or move building | Use fire extinguisher for small fires; otherwise execute horizontal evacuation. |
3. Operating Fire Extinguishers: The PASS Method
CNAs must know how to operate Portable Fire Extinguishers safely using the PASS acronym. Fire extinguishers should only be used on small, contained fires (such as a burning trash can) after residents are rescued and the alarm is activated.
Types of Fire Extinguishers
- Class A: Wood, paper, cloth, trash, and rubber.
- Class B: Flammable liquids (grease, gasoline, oil, paint).
- Class C: Energized electrical equipment (appliances, wiring, outlets).
- Class ABC (Multi-Purpose): Safe for trash, liquids, and electrical fires commonly found in healthcare settings.
The PASS Sequence
- P - PULL: Pull the safety pin located at the top of the extinguisher handle to break the tamper seal.
- A - AIM: Aim the extinguisher nozzle low, pointing directly at the base of the fire (not at the flames).
- S - SQUEEZE: Squeeze the handle lever steadily to discharge the extinguishing agent.
- S - SWEEP: Sweep the nozzle side-to-side across the base of the fire until all flames are completely extinguished.
4. Facility Evacuation Procedures
During a major fire emergency, evacuation follows a strict hierarchy to protect the greatest number of lives:
Evacuation Priority Order
- Residents in Immediate Danger: Move residents in the room where the fire originated.
- Ambulatory Residents: Guide residents who can walk independently or with minor assistance past fire doors.
- Wheelchair-Bound Residents: Transport residents requiring wheelchairs.
- Bedridden Residents: Move bedridden residents using evacuation chairs, blanket drags, or rolling their entire beds through wide double doors.
Evacuation Direction: Always perform horizontal evacuation first—moving residents on the same floor past heavy, rated fire-barrier doors into an adjacent fire compartment—before attempting vertical evacuation down stairwells. Never use elevators during a fire emergency.
5. Airway Obstruction & Choking Emergencies
Choking occurs when a foreign body (usually food or vomitus) obstructs the airway. Elderly residents with dysphagia (swallowing difficulty), stroke, or dementia are at high risk.
Recognizing Airway Obstruction
- Partial Obstruction (Mild): Resident can cough forcefully, speak, or breathe. CNA Action: Encourage natural coughing. Do NOT interfere or perform abdominal thrusts. Stay with the resident and monitor closely.
- Severe/Complete Obstruction: Resident cannot speak, cough, or breathe. The resident may clutch their neck with both hands (Universal Sign of Choking), display cyanosis (blue lips/skin), or exhibit silent panic.
Performing Abdominal Thrusts (Heimlich Maneuver) on a Conscious Resident
- Stand behind the resident and wrap your arms around their waist.
- Make a fist with one hand, placing the thumb side against the resident's abdomen, slightly above the navel and well below the xiphoid process (breastbone).
- Grasp your fist with your other hand.
- Deliver quick, hard, inward and upward thrusts into the abdomen.
- Repeat thrusts until the object is expelled or the resident becomes unconscious.
Special Modification: For pregnant or markedly obese residents, perform CHEST THRUSTS over the center of the sternum instead of abdominal thrusts.
Unconscious Choking Resident Protocol
If the resident loses consciousness, carefully lower them to the floor, call for emergency medical assistance (Code Blue), and initiate Cardiopulmonary Resuscitation (CPR), inspecting the mouth for visible objects before delivering breaths.
6. Clinical Scenario: Response to Room Fire & Evacuation
Scenario: CNA Sarah enters Room 108 and discovers a wastebasket fire next to an oxygen-dependent resident's bed. Flames are spreading to the privacy curtain.
Correct CNA Intervention: Sarah executes RACE immediately:
- Rescue: She instantly unplugs the oxygen, assists the resident out of Room 108, and guides them into the hallway behind the smoke compartment doors.
- Alarm: Sarah pulls the hallway fire alarm pull station and calls out "Code Red Room 108!".
- Contain: She closes the door to Room 108 to smother the oxygen supply and seal the flames.
- Extinguish/Evacuate: Sarah retrieves a Class ABC extinguisher, pulls the pin, aims low at the base of the trash can, squeezes the trigger, and sweeps side to side until extinguished.
During a fire emergency in a resident's room, what is the Nursing Assistant's very first action according to the RACE protocol?
Which maneuver should a CNA perform on a conscious resident who exhibits the universal sign of choking and cannot speak or cough?
When using a fire extinguisher, what does the 'S' in the PASS acronym represent?
In a multi-story facility evacuation due to fire, which group of residents should be moved first to safety?