5.5 Fire, Disaster, and Body Mechanics
Key Takeaways
- RACE = Rescue residents in immediate danger, Activate the alarm, Confine the fire by closing doors and windows, then Extinguish OR Evacuate based on size and training.
- PASS = Pull the pin, Aim at the BASE of the fire, Squeeze the handle, Sweep side-to-side until the fire is out or the extinguisher is empty.
- Fire extinguisher classes: A (ordinary combustibles like wood/paper/cloth), B (flammable liquids/gases), C (energized electrical equipment), D (combustible metals like magnesium), K (kitchen oils and animal fats).
- Proper body mechanics: feet shoulder-width apart for a wide base of support, bend at the hips and KNEES (not the back), keep the load close, push instead of pull, pivot the feet instead of twisting the spine.
- Back injury is the most common occupational injury for CNAs - OSHA and the NC NNAAP rate it the #1 cause of CNA work-related disability, which is why a gait belt and mechanical lift must be used whenever a resident cannot bear weight reliably.
Fire, Disaster, and Body Mechanics
Quick Answer: In a fire, follow RACE (Rescue, Alarm, Confine, Extinguish/Evacuate). To use an extinguisher, follow PASS (Pull, Aim, Squeeze, Sweep). For your back, use a wide base of support, bend at the knees, keep the load close, push don't pull, and pivot don't twist.
RACE: Fire Response Order
Every NC facility drills RACE quarterly. The order matters - a CNA who calls 911 before moving a resident out of an actively burning room can be cited.
| Letter | Stands for | What the CNA does |
|---|---|---|
| R | Rescue | Move residents in immediate danger to a safe area first - directly behind a closed fire door is acceptable if the corridor is full of smoke |
| A | Alarm / Activate | Pull the nearest fire alarm pull station and call the facility code (or 911) |
| C | Confine / Contain | Close doors and windows behind you - even one closed door can buy 20 minutes of survivable time |
| E | Extinguish / Evacuate | If the fire is small (trash-can size) and you are trained, use PASS. Otherwise evacuate horizontally to the next smoke compartment, never down a stairwell into smoke |
PASS: Using a Fire Extinguisher
- Pull the pin (this breaks the tamper seal).
- Aim at the base of the fire (aiming at the flames wastes agent on something that cannot burn).
- Squeeze the handle to discharge.
- Sweep from side to side until the fire is out OR until the extinguisher is empty.
Stand 6-8 feet back, keep an exit at your back, and never turn your back on a fire that is not fully out.
Fire Extinguisher Classes
| Class | Fire type | Examples |
|---|---|---|
| A | Ordinary combustibles | Wood, paper, cloth, plastic, trash |
| B | Flammable liquids and gases | Gasoline, oil, propane, alcohol, acetone |
| C | Energized electrical equipment | Wiring, motors, appliances - water would conduct electricity |
| D | Combustible metals | Magnesium, sodium, titanium (rare in long-term care) |
| K | Kitchen oils and animal fats | Deep fryers, grease fires - found in facility kitchens |
Most long-term care areas use multi-purpose ABC dry-chemical extinguishers; kitchens have a separate K extinguisher next to the cooking line. Never use a water (A) extinguisher on a grease (K) or electrical (C) fire - it spreads grease and conducts electricity.
The Fire Triangle
Three elements are required for a fire: heat + fuel + oxygen. Removing any one stops the fire - which is why "Confine" (closing doors and windows) helps starve the fire of oxygen. Common ignition sources in long-term care are oxygen + open flame (smoking near O2 is banned), faulty electrical equipment, kitchen grease, and unattended heating pads.
Oxygen Safety
Oxygen does not burn by itself, but it supports combustion and turns small fires into large ones.
- No smoking, candles, electric razors, or open flames in any room with oxygen in use.
- Keep cylinders 6 feet from heat sources.
- Store cylinders upright in a stand so they cannot fall and become a missile if the valve breaks.
- Post 'Oxygen in Use' signs on the door.
- Use cotton blankets and gowns, not synthetic or wool, with oxygen residents.
Other Disasters in North Carolina
NC facilities drill for the disasters most likely to affect the state:
- Hurricane / tropical storm (June-November Atlantic season): pre-position supplies, secure outdoor equipment, follow facility evacuation plan, account for residents.
- Tornado (peak April-June): move residents to interior rooms, hallways, or basements on the lowest floor away from windows and exterior walls. Do not stand near windows or skylights.
- Severe winter weather (Piedmont and mountains): power outage protocols, backup generators for oxygen concentrators, blankets, no candles.
- Active shooter / workplace violence: Run, Hide, Fight (DHS protocol).
- Power outage: use battery-powered flashlights only - never candles in a healthcare setting due to oxygen and combustibles. Bring oxygen-dependent residents to a generator-supplied area.
- Hazardous chemical spill: do not attempt cleanup unless trained and PPE is available; notify the nurse and follow the SDS (Safety Data Sheet) and the facility hazard communication plan (OSHA 29 CFR 1910.1200).
Body Mechanics: Protecting Your Back
OSHA, the Bureau of Labor Statistics, and the National Institute for Occupational Safety and Health (NIOSH) all rank nursing assistants among the highest rates of work-related musculoskeletal disorders in the U.S. Back injury is the #1 work-related disability among CNAs.
The Six Rules of Safe Body Mechanics
- Wide base of support. Feet shoulder-width apart, one foot slightly forward. A narrow stance is easy to tip.
- Bend at the hips and knees - NEVER at the waist. Use the strong leg muscles, not the small muscles of the lower back.
- Keep the load close to the body. Holding a 30-pound resident 10 inches from your chest puts more strain on the spine than holding 100 pounds against your chest.
- Push, pull, or roll before you lift. Mass at rest is easier to slide than to lift.
- Pivot the feet - do not twist the spine. Twisting under load is the most common cause of acute back injury.
- Use mechanical lifts and gait belts whenever a resident cannot bear weight reliably. Two-person assist with a gait belt for partial weight bearers; a Hoyer / mechanical lift for non-weight bearers.
Gait Belt Technique
- Apply the belt over clothing, around the waist, tight enough to fit only the flat of your hand under it.
- Grasp the belt underhand (palms up) at the sides and back - never grab clothing or skin.
- Stand close, knees bent, on the resident's strong side.
- On a count of three, shift your weight to your back leg to bring the resident up.
- Never use a gait belt on a resident with rib fractures, recent abdominal surgery, an ostomy, or a feeding tube near the waist.
A CNA in a North Carolina nursing facility discovers a small fire in a resident's wastebasket. The resident is in the bed near the fire. In what order should the CNA act?
A grease fire breaks out on the stove in the long-term care facility kitchen. Which type of fire extinguisher is REQUIRED for this fire?