5.2 Safety & Emergency Response
Key Takeaways
- Fall prevention is proactive: call light in reach, non-skid footwear, clear pathways, locked wheels, low bed, and answering call lights promptly
- Restraints are a last resort requiring a provider order; try alternatives first and check a restrained resident at least every 15-30 minutes for circulation and skin
- Fire response follows RACE (Rescue, Alarm, Confine, Extinguish/Evacuate); extinguisher use follows PASS (Pull, Aim, Squeeze, Sweep) — never use elevators
- For a conscious choking adult who cannot speak or cough, give abdominal thrusts (Heimlich); for seizures, protect the head, never restrain, and never put anything in the mouth
- Report and document every incident factually and immediately; oxygen is a fire hazard, so post No Smoking signs and keep flames and grease away
Safety questions appear throughout the New Jersey CNA written exam and underpin the indirect-care points scored in the skills evaluation. The CNA's first job in any emergency is to stay calm, stay with the resident, call for the nurse, and provide only the care within your scope.
Fall Prevention
Falls are the leading cause of injury in long-term care. Prevention is proactive, not reactive.
- Keep the call light within reach and answer it promptly
- Lock wheels on beds and wheelchairs before transfers
- Keep the bed in the lowest position with brakes locked
- Provide non-skid footwear; clear clutter, cords, and spills
- Ensure adequate lighting and offer regular toileting
- Use a gait belt for ambulation and stand on the resident's weak side
If a resident starts to fall, do not try to catch them. Ease them to the floor while protecting the head, then call for help and stay with them.
Restraint Alternatives and Safe Use
A restraint is any device or method that limits free movement. Federal OBRA law and New Jersey policy require restraints to be a last resort, used only with a provider's order, for the shortest time, and the least restrictive option.
| Try First (Alternatives) | If a Restraint Is Ordered |
|---|---|
| Frequent toileting and rounds | Use a quick-release knot, never a square knot |
| Activities, companionship | Tie to the movable bed frame, not the side rail |
| Bed/chair alarms, low beds | Check at least every 15-30 minutes |
| Address pain, hunger, anxiety | Release every 2 hours for movement, skin, toileting |
Restraint risks include strangulation, impaired circulation, pressure injuries, and emotional harm.
Fire Response: RACE and PASS
| RACE | PASS (Extinguisher) |
|---|---|
| Rescue anyone in immediate danger | Pull the pin |
| Alarm — pull the alarm, call for help | Aim at the base of the fire |
| Confine — close doors and windows | Squeeze the handle |
| Extinguish small fire or Evacuate | Sweep side to side |
Never use elevators during a fire. In oxygen-enriched rooms, fire spreads fast — keep oxygen away from flames, grease, and electrical sparks, and post No Smoking signs.
Basic First Aid Within Scope
| Emergency | CNA Action |
|---|---|
| Choking (can't speak/cough) | Abdominal thrusts (Heimlich) until object clears or resident is unresponsive, then call for help and start CPR if trained |
| Seizure | Lower to floor, protect head, turn on side, time it, never restrain or put anything in the mouth |
| Syncope (fainting) | Lower to a safe position, elevate legs if no injury, loosen tight clothing, monitor breathing |
| Severe bleeding | Apply firm direct pressure with a clean barrier; do not remove soaked dressings — add more |
| Shock | Keep resident lying down and warm, do not give food or water, call for help immediately |
Incident Reporting and Emergency Codes
Report every fall, error, or unusual event to the nurse immediately and complete an incident report with objective facts — what you saw, said, and did — never opinions or blame. Many facilities use color codes (commonly Code Red for fire, Code Blue for cardiac/respiratory arrest); learn your specific facility's codes during orientation.
You are walking with a New Jersey resident who suddenly becomes weak and begins to slide toward the floor. What is the safest action?
A resident receiving oxygen by nasal cannula in a New Jersey long-term care facility tells you they want to light a candle for a religious observance in their room. What is the BEST response?