3.4 Emergency Response, Fire Safety, and Choking/First Aid

Fire Safety: RACE and PASS

RACE is the acronym nurse aides use to remember the order of actions when a fire is discovered:

• R — Rescue: move anyone in immediate danger away from the fire first.
• A — Alarm: activate the fire alarm and notify the facility switchboard or designated number per policy, giving the exact location of the fire.
• C — Contain: close doors and windows to slow the spread of fire and smoke.
• E — Extinguish: use a fire extinguisher on a small, containable fire only if trained to do so and it is safe; otherwise, evacuate the area.

PASS is the acronym for correctly operating a fire extinguisher:

• P — Pull the safety pin.
• A — Aim the nozzle at the base of the fire, not at the flames themselves.
• S — Squeeze the handle to release the extinguishing agent.
• S — Sweep the nozzle from side to side across the base of the fire.

Aiming at the base of the fire, rather than the flames, is a detail frequently tested because it's the actual point where the fuel is burning. Health care facilities typically use horizontal evacuation as a first response to fire — moving residents through fire doors into an adjoining smoke compartment on the same floor — before attempting a full vertical evacuation down stairwells, and ambulatory residents are often assisted before bedridden residents in many facility fire plans. A nurse aide always follows the specific fire and disaster plan of their own facility rather than assuming a single universal rule.

General Emergency and Disaster Response

Nurse aides need to know their facility's emergency and disaster plan for events such as fire, severe weather, power outages, or other facility emergencies, including a missing resident (sometimes called an elopement) or a sudden medical emergency. General principles include knowing the evacuation routes and exits for the unit, knowing the location of emergency equipment such as fire extinguishers and oxygen shut-off valves, staying calm and reassuring residents, many of whom may be confused or frightened during an emergency, following the facility's chain of command without acting outside one's scope of practice, and participating in regular fire and disaster drills so the response becomes automatic.

A nurse aide is not expected to diagnose or independently treat a medical emergency, but must know how to summon help immediately, whether through a call light, an emergency call system, or calling out for the nurse, and must be ready to provide basic first aid within scope, such as abdominal thrusts for choking or calling for help after a fall, while a licensed nurse or emergency responders take over clinical decision-making.

Recognizing and Responding to Choking

The universal choking sign is clutching the throat with one or both hands while unable to speak, cough forcefully, or breathe; the resident may look panicked and the lips or fingertips may begin to turn bluish (cyanotic).

Responsive Adult

If the resident can still cough forcefully or speak, the nurse aide should encourage continued coughing and not interfere, since a forceful cough may clear the airway on its own. If the cough becomes weak or silent, or the resident cannot breathe or speak at all, the nurse aide should call for help immediately and, per training and facility policy, perform abdominal thrusts: stand behind the resident, wrap both arms around the waist, make a fist positioned above the navel and below the breastbone, grasp that fist with the other hand, and pull inward and upward in quick, firm thrusts until the object is expelled or the resident becomes unresponsive.

If the Resident Becomes Unresponsive

The response changes immediately: lower the resident carefully to the floor, call for help or activate the facility's emergency response system if that hasn't already been done, and begin cardiopulmonary resuscitation (CPR), starting with chest compressions. Current first-aid guidance treats chest compressions as also helping to dislodge the obstruction. Before giving rescue breaths, look inside the mouth for a visible object and remove it only if it can be seen and easily reached; a blind finger sweep, feeling around the mouth without seeing the object, is not recommended because it risks pushing the object further down the airway.

Call for Help vs. Act Immediately

In some emergencies, a nurse aide's very first action must be to call for help — for example, discovering an unresponsive resident with no pulse means activating the emergency response system first, or sending a coworker to call while beginning CPR. In other emergencies, an immediate hands-on action like abdominal thrusts or moving a resident away from danger must happen without delay, while help is summoned at the same time by shouting for a coworker or using a call light or emergency pull cord. The general rule: if a resident is in immediate danger and the aide can act safely within the scope of training, act, but always get help coming at the same moment, and never attempt a procedure outside that scope in hopes of fixing the problem alone.