Fire and Emergency Response

Fire Response: RACE and PASS

Every healthcare worker must respond to fire the same way, because seconds matter and residents cannot always save themselves. The two acronyms you must know exactly are RACE and PASS.

RACE — What to Do When You Discover a Fire

The order matters: residents come before the alarm, and the alarm comes before any attempt to fight the fire. Smoke and toxic gases kill more people than flames, which is why containing the fire by closing doors is a rescue measure in itself.

PASS — Using a Fire Extinguisher

• P — Pull the pin on the extinguisher
• A — Aim at the base of the fire, not the flames
• S — Squeeze the handle to release the agent
• S — Sweep from side to side across the base

Only attempt to extinguish a small fire, keep your exit behind you, and never let the fire get between you and the door.

Oxygen Safety

Oxygen does not burn, but it supports combustion — it makes other materials ignite faster and burn hotter. When oxygen is in use:

• No smoking anywhere in the area; post "Oxygen in Use" signs
• No open flames, candles, lighters, or matches
• Avoid sparks — use only facility-approved electrical equipment, avoid wool blankets and synthetic fabrics that create static electricity
• Keep oxygen cylinders secured upright in a holder or cart so they cannot fall and become a projectile
• Keep grease and oil away from oxygen connections

Evacuation and Disaster Preparedness

Follow the facility’s emergency plan and the incident leader’s directions. Some healthcare fire plans use defend-in-place and staged evacuation because moving residents also carries risk. The following are common fire-response concepts; the actual hazard, resident care needs and approved plan determine the route and order:

1. Horizontal evacuation first — move residents through smoke or fire doors to a safe area on the same floor
2. Vertical evacuation: use approved safe routes and trained assistance when the emergency plan or incident leader requires relocation to another floor; ordinary elevators are not used during a fire.
3. Resident movement: rescue people in immediate danger first. The plan may organize ambulatory, wheelchair and bed-bound groups differently; use the assigned staff and approved transfer or evacuation equipment. A mobility-based sequence never overrides immediate danger.

Before any emergency, know your facility's fire exits, alarm locations, extinguisher locations, and the disaster plan. Facilities hold regular fire drills — take them seriously and know your assigned role. For disasters such as Montana's winter storms, wildfires, or power outages, the facility's emergency plan covers backup power for oxygen and refrigeration, resident identification, and evacuation destinations.

During a fire evacuation, do not use ordinary elevators; follow the approved route and responder directions, keep doors closed behind you, stay low if smoke is present, and check doors for heat with the back of your hand before opening them. For bed-bound residents, use approved evacuation equipment and the assistance taught for the emergency; a blanket drag or carry is used only when trained and directed. Speed does not justify an unsafe transfer. Account for every resident at the assembly area using the census list. Facilities also announce emergencies with codes (for example, a fire code); learn your facility's code words and what each one requires of you. Report anything that smells like smoke or looks like faulty electrical equipment — frayed cords and overloaded outlets are common ignition sources, and reporting them is part of the CNA's safety role.

Choking, Cardiac Arrest, and Poisoning

Choking (Foreign-Body Airway Obstruction): 2025 AHA Adult BLS

This sequence follows the 2025 American Heart Association adult BLS guideline. Montana’s currently linked curriculum lists choking care but is not proof that every training provider or facility has adopted this edition. Use current hands-on training and the facility’s emergency-response procedures.

• Mild obstruction with an effective cough: encourage coughing and closely observe for worsening. Do not give water or perform a blind finger sweep.
• Responsive adult with severe obstruction (weak or absent cough, inability to speak, or worsening breathing): activate emergency help. Use repeated cycles of 5 back blows followed by 5 abdominal thrusts until the object is expelled or the person becomes unresponsive.
• Late pregnancy or inability to encircle the abdomen: use 5 back blows followed by 5 chest thrusts, rather than abdominal thrusts.
• Becomes unresponsive: lower the person safely, start CPR with chest compressions, and ensure emergency response is activated. When opening the airway for breaths, remove an object only if it is visible; never sweep blindly.

Cardiac Arrest

Activate emergency response promptly and send someone for the automated external defibrillator (AED). Provide CPR and use the AED according to your training, the facility’s emergency procedure, related physician orders and the resident’s valid advance directives. Know the resident’s resuscitation status through the care plan before an emergency; a valid do-not-resuscitate order must be respected. If the status is unclear, alert the nurse or response team and follow the emergency procedure rather than delaying the call for help while searching for paperwork. A DNR order is not a direction to withhold all other indicated care.

Poisoning and Chemical Hazards

Under OSHA’s Hazard Communication Standard, staff need ready access to Safety Data Sheets (SDS) for covered hazardous chemicals, such as hazardous cleaning products and covered hazardous medications. Do not assume that every medicine or every nonhazardous product has the same SDS requirement. The SDS explains the hazards, safe handling, required protective equipment, and first-aid measures. For skin or eye exposure, start the first aid specified by the product label, SDS and your training, and immediately alert the nurse; prompt water irrigation is often required. Obtain substance-specific poison advice rather than improvising a neutralizer. For suspected poisoning, alert the nurse and call Poison Control at 1-800-222-1222 for substance-specific instructions. If the person collapses, cannot be awakened, has a seizure or has trouble breathing, activate emergency medical services immediately. Do not induce vomiting or give a treatment on your own; some substances cause further injury if vomited or aspirated. Store all chemicals in their original labeled containers, never in food or drink containers.

Source boundaries: 42 CFR 483.73 requires a facility-specific emergency plan, safe evacuation and resident tracking. 42 CFR 483.24(a)(3) addresses BLS subject to related orders and advance directives. OSHA’s healthcare hazard-communication guidance and Poison Control first aid support chemical precautions; they do not replace the facility’s trained response.