Emergency & Disaster Preparedness, Equipment Safety & Restraints

Fire Response: RACE and Fire Extinguisher Use: PASS

Every healthcare worker must know the standard fire-response sequence and how to operate a portable extinguisher, since a delayed or wrong response can cost lives.

RACE is the overall response sequence for discovering a fire; PASS is the specific technique used only during RACE's final extinguish step, and only for small, contained fires -- anything larger requires evacuation, not a fire-extinguisher attempt.

Emergency Code Colors

Hospitals use overhead color codes to alert staff to emergencies without alarming patients and visitors. Exact codes vary by facility policy, but common conventions include:

• Code Red -- fire
• Code Blue -- cardiac or respiratory arrest, requiring immediate resuscitation response
• Code Gray -- combative or violent person
• Code Silver -- weapon or hostage situation
• Code Pink -- infant or child abduction
• Code Black -- bomb threat
• Code Orange -- hazardous material spill

Because codes differ between facilities, every PCT/A should learn the specific code list during orientation at each new employer rather than assuming a code means the same thing everywhere.

Disaster Preparedness

Beyond single-patient emergencies, every facility maintains an all-hazards emergency operations plan and organizes its response using the Hospital Incident Command System (HICS), a standardized command structure that assigns clear roles (incident commander, operations, logistics) so a large-scale event -- a mass-casualty incident, severe weather, or utility failure -- is managed with the same clarity as a routine code. Facilities run fire drills and disaster drills on a regular schedule, and every staff member, including the PCT/A, is expected to know the nearest exits, the evacuation routes, and the difference between horizontal evacuation (moving patients to a safe area on the same floor, through a fire/smoke barrier) and vertical evacuation (moving patients to a different floor), which is used only when horizontal evacuation is not sufficient.

Equipment Safety

Simple equipment habits prevent a large share of patient falls and injuries:

• Lock bed and wheelchair wheels before every transfer, and before leaving a patient unattended in a wheelchair
• Raise side rails according to facility policy and the patient's individual fall-risk assessment -- appropriate rail use supports safety, but using all four rails inappropriately as a restraint requires the same order and monitoring as any other restraint
• Apply stretcher/gurney safety belts during any transport
• Keep the bed in its lowest position with brakes locked when not actively providing care, to reduce fall-related injury

Restraints: Least Restrictive First

A restraint is any method that restricts a patient's normal freedom of movement, and falls into two categories: physical restraints (a device applied to the body or limbs, such as a vest, wrist/ankle restraint, or mitts) and chemical restraints (a medication used to control behavior rather than to treat a diagnosed condition). Because restraints carry real risks -- skin breakdown, circulation compromise, psychological distress, and even strangulation -- they are always the last resort, used only after less restrictive alternatives have been tried and documented as unsuccessful. Alternatives include bed/chair alarms, moving the patient closer to the nurses' station, frequent reorientation, and involving family or a sitter.

When a restraint is genuinely necessary:

1. A physician's order is required, specifying the type of restraint, the reason, and a time limit -- restraints are never applied on a PCT/A's own initiative.
2. The restraint chosen must be the least restrictive option that keeps the patient safe (for example, mitts before wrist restraints, wrist before a full vest).
3. The patient must be monitored at least every two hours, checking circulation, skin integrity, correct application, and range of motion, with the restraint briefly released during checks when safe to do so.
4. Basic needs -- toileting, hydration, and repositioning -- must be offered at each check.
5. The restraint is discontinued as soon as the behavior that justified it resolves; it is never continued out of convenience.

Accurate documentation -- reason, alternatives tried, type applied, monitoring findings, and patient response -- protects both the patient and the facility and is required at every check. A physician's restraint order is time-limited and must be renewed rather than automatically continued, and the restraint is removed as soon as it is safely possible, since prolonged unnecessary use is itself considered a form of neglect.