5.5 Emergency Response, Fire Safety, Choking, and Incident Reporting

Fire Safety Protocols: RACE and PASS

Fires in long-term care facilities present immediate, catastrophic threats to residents who may be confused, bedridden, or non-ambulatory. CNAs must memorize and execute standardized emergency protocols without hesitation.

The RACE Fire Emergency Protocol

When a fire or smoke is detected, nursing assistants must execute actions in accordance with the RACE acronym:

• R = Rescue / Remove: Immediately rescue and move any resident in direct, immediate danger to a safe area past fire barrier doors.
• A = Alarm / Activate: Pull the nearest manual fire alarm station and call the facility emergency operator or 911 to announce the fire location.
• C = Contain / Confine: Close all resident room doors, fire doors, and windows to block smoke and flame spread; shut off oxygen valves if designated.
• E = Extinguish / Evacuate: Extinguish small, manageable fires using a fire extinguisher, or evacuate residents according to the facility evacuation plan.

The PASS Extinguisher Technique

When operating a portable fire extinguisher on a small fire, follow the PASS sequence:

Extinguisher Types: Facilities use Class ABC multi-purpose dry chemical extinguishers, effective on trash/wood (A), liquid/grease (B), and electrical (C) fires.

Management of Airway Obstruction (Choking)

Choking occurs when a foreign body (usually food) obstructs the airway. CNAs must recognize choked signs immediately to prevent cardiac arrest and brain damage.

Recognizing Airway Obstruction

• Partial Obstruction: Resident can cough forcefully and speak. CNA Action: Do not interfere! Encourage the resident to keep coughing forcefully to dislodge the object.
• Complete Obstruction: Resident cannot speak, cough, or breathe; clutches throat with hands (universal sign of choking); skin turns blue/cyanotic. CNA Action: Intervene immediately with emergency thrusts!

Interventions for Conscious Adult Choking

• Abdominal Thrusts (Heimlich Maneuver):
  1. Stand behind the resident and wrap your arms around their waist.
  2. Make a fist with one hand; place the thumb side of the fist against the resident's abdomen, slightly above the navel and well below the xiphoid process.
  3. Grasp your fist with your other hand and press into the abdomen with quick, inward and upward thrusts.
  4. Repeat thrusts until the object is dislodged or the resident loses consciousness.
• Chest Thrusts (Obese or Pregnant Residents): Wrap arms around resident's chest under armpits; place fist thumb-side on the center of the sternum; pull straight back with quick chest thrusts.

Interventions for Unconscious Choking Victim

1. Call for help / activate emergency medical services (911).
2. Carefully lower resident to the floor onto a firm, flat surface.
3. Begin CPR starting with 30 chest compressions.
4. Before delivering rescue breaths, open airway and look in the mouth. If a dislodged object is visible, remove it. NEVER perform a blind finger sweep!

Basic Life Support (CPR) and AED Awareness

When a resident experiences cardiac arrest, high-quality Cardiopulmonary Resuscitation (CPR) maintains blood flow to vital organs until advanced medical help arrives.

CPR Standards for Adult Victims

• Assessment: Check for responsiveness and simultaneously check for normal breathing and a carotid pulse for 5 to 10 seconds.
• Compression-to-Ventilation Ratio: 30 chest compressions to 2 rescue breaths for adult cardiac arrest.
• Compression Rate: 100 to 120 compressions per minute (to the rhythm of the song "Stayin' Alive").
• Compression Depth: 2 to 2.4 inches (5 to 6 cm) into the chest, allowing full chest recoil after each push.
• Minimize Interruptions: Keep compression pauses under 10 seconds.

Automated External Defibrillator (AED) Use

An AED analyzes heart rhythms and delivers an electrical shock if a shockable rhythm (ventricular fibrillation) is present. CNAs should turn on the AED, apply pads to the bare chest (upper right chest, lower left ribs), clear the victim during analysis and shock delivery, and immediately resume chest compressions.

Objective Incident Reporting Procedures

An incident (or occurrence) is any unexpected event that results in—or has potential to cause—injury or harm to a resident, staff member, or visitor. Examples include falls (even if uninjured), skin tears, medication errors, equipment failures, needle sticks, or elopement (resident wandering off).

Role of the Nursing Assistant

1. Provide immediate care and safety to the resident; notify the charge nurse instantly.
2. Complete the facility incident report as soon as possible after the resident is safe.

Objective Documentation Guidelines

• State Facts Only: Document strictly what was seen, heard, or directly observed (e.g., date, exact time, location, physical findings).
• Avoid Assumptions or Opinions: Do not guess how an event occurred. Write: "Found resident lying on bathroom floor beside wheelchair," NOT "Resident fell out of wheelchair while reaching for soap."
• No Statements of Fault: Never assign blame to staff, residents, or equipment.
• Chart Documentation Rule: The incident report is an internal administrative quality control document. DO NOT write "incident report filed" in the resident's medical record. Chart physical observations and care given, but keep the incident report separate per facility policy.