4.4: Emergency Procedures & Fire Safety

Emergency Procedures & Fire Safety

Introduction to Emergency Preparedness

Emergencies can occur at any time in healthcare facilities. A Certified Nursing Assistant must be prepared to respond calmly, rapidly, and effectively to save lives and prevent injuries. The Oregon State Board of Nursing (OSBN) and the Oregon Health Authority (OHA) require CNA programs to train candidates in emergency response, including fire safety, choking management, seizure care, and disaster response. CNAs must be familiar with their facility's disaster plans, emergency exits, fire extinguisher locations, and communication codes.

Fire Safety and the RACE Protocol

In the event of a fire, the CNA must immediately implement the facility's fire plan. The standard national protocol for fire response is the acronym RACE, which stands for:

• R - Rescue (or Remove): The first and most critical priority is to rescue any resident in immediate danger from fire, heat, or smoke. Move them to a safe area, such as behind fire doors or outside the building, depending on the facility's evacuation plan.
• A - Alarm (or Activate): Once residents in immediate danger are safe, activate the nearest fire alarm pull station. The CNA should also call the facility's emergency number or 911 to report the exact location of the fire.
• C - Confine (or Contain): Prevent the spread of smoke and fire by closing all doors and windows in the fire area. If the fire is in a resident's room, close the door after rescuing the resident.
• E - Extinguish (or Evacuate): If the fire is small (no larger than a wastebasket) and contained, and you have a safe exit route, you may attempt to extinguish it using a fire extinguisher. If the fire is large or spreading, do not attempt to extinguish it; immediately evacuate the area according to facility directions.

During a fire emergency, elevators must never be used. CNAs must guide residents to designated emergency exits, taking special care with non-ambulatory residents who may require transport via wheelchairs, stretchers, or evacuation blankets.

Using a Fire Extinguisher and the PASS Protocol

To operate a portable fire extinguisher, remember the acronym PASS:

• P - Pull: Pull the safety pin located at the top of the extinguisher. This unlocks the handle mechanism.
• A - Aim: Aim the nozzle or hose at the base of the fire, not at the top of the flames. Aiming at the base targets the fuel source.
• S - Squeeze: Squeeze the trigger or handle to release the extinguishing agent.
• S - Sweep: Sweep the nozzle from side to side across the base of the fire until the flames are extinguished.

Fire extinguishers are classified by the types of fires they are designed to put out:

• Class A: Used for ordinary combustibles like wood, paper, cloth, and trash.
• Class B: Used for flammable liquids like grease, gasoline, oil, and paint.
• Class C: Used for electrical fires involving energized electrical equipment like appliances, wiring, and outlets.
• Class ABC (Multi-Purpose): The most common type found in healthcare facilities, which can be used on any of the above fire types.

Choking and Obstructive Airway Management

Choking occurs when a foreign object blocks the airway, preventing breathing. A CNA must recognize the signs of choking immediately.

• Mild Airway Obstruction: The resident can still exchange air, speak, cough forcefully, or breathe. The CNA's role is to encourage the resident to keep coughing to clear the object and to stay with them to monitor their condition. Do not intervene with abdominal thrusts.
• Severe Airway Obstruction: The resident cannot speak, cough, or breathe. They may make high-pitched squeaking sounds or grab their throat (the universal sign of choking). Their skin, lips, or nail beds may turn blue (cyanosis). This is a life-threatening emergency.

Abdominal Thrusts (Heimlich Maneuver)

If a resident has a severe airway obstruction and is conscious:

1. Confirm Choking: Ask, "Are you choking? Can you speak?" Under Oregon skills exam guidelines, you must ask this question before performing thrusts. If the resident nods but cannot speak, state that you are going to help.
2. Position Yourself: Stand behind the resident. Wrap your arms around their waist.
3. Position Your Hands: Make a fist with one hand. Place the thumb side of your fist against the resident's abdomen, slightly above the navel and well below the breastbone (sternum). Grasp your fist with your other hand.
4. Perform Thrusts: Press your fist into the resident's abdomen with quick, upward thrusts. Repeat these thrusts until the object is expelled or the resident loses consciousness.

If the resident becomes unconscious, carefully lower them to the floor, supporting their head. Call for emergency help (or instruct someone else to do so) and activate the emergency response system. Begin cardiopulmonary resuscitation (CPR), starting with 30 chest compressions. Each time you open the airway to give breaths, look inside the resident's mouth. If you see the object, perform a finger sweep to remove it. Never perform a blind finger sweep, as this can push the object deeper into the airway.

Seizure Care Protocols

A seizure is a sudden, uncontrolled electrical disturbance in the brain that can cause changes in behavior, movements, or levels of consciousness. The CNA's primary role during a seizure is to protect the resident from injury.

In the event of a seizure, the CNA must:

• Note the time the seizure begins.
• Call for assistance immediately, but do not leave the resident unattended.
• Protect the resident's head by placing a pillow, folded blanket, or clothing underneath it.
• Clear the area of furniture, equipment, or sharp objects that could cause injury.
• Loosen tight clothing, especially around the resident's neck.
• Do NOT attempt to restrain the resident's movements.
• Do NOT place anything in the resident's mouth (such as fingers, spoons, or tongue depressors), as this can cause airway obstruction or dental injuries.
• Turn the resident onto their side (recovery position) if possible, to keep the airway clear and allow saliva or vomit to drain.
• Remain with the resident until the seizure ends, providing comfort and reassurance as they regain consciousness.
• Note the duration of the seizure and describe the movements observed, then report these details immediately to the charge nurse.

Facility Emergency Codes and Natural Disasters

Healthcare facilities use standardized emergency codes to communicate emergencies quickly without causing panic among residents and visitors. Common codes include:

• Code Red: Fire.
• Code Blue: Cardiac or respiratory arrest.
• Code Amber or Code Pink: Missing resident or infant abduction.
• Code Silver: Active shooter or person with a weapon.
• Code Yellow: Disaster or mass casualty event.

In Oregon, disaster planning also includes preparation for regional natural disasters, such as earthquakes and wildfires. During a wildfire evacuation or earthquake emergency, the CNA must follow the facility's specific disaster manual, assist with transport, and participate in resident headcounts to ensure that every resident is accounted for.