5.2 Fire Safety (RACE/PASS), Disaster Plans & Workplace Emergencies

The Fire Triangle and Oxygen Therapy Safety Precautions

Fire represents an immediate, catastrophic threat in healthcare environments where many residents are non-ambulatory, cognitively impaired, or dependent on life-sustaining medical equipment. Effective fire prevention begins with understanding the Fire Triangle.

                    [ HEAT / IGNITION ]
                     (Electrical Sparks,
                      Open Flames, Heat)
                           /\     
                          /  \    
                         /    \   
                        / FIRE \  
                       /________\ 
        [ OXYGEN ]                  [ FUEL ]
     (Atmospheric Air,           (Linens, Paper, Wood,
     Supplemental O2 Tanks)       Clothing, Solvents)

A fire cannot start or continue if any one of these three interdependent elements is removed. In healthcare settings, medical oxygen therapy creates an oxygen-enriched environment where materials ignite at significantly lower temperatures and burn with extreme velocity and intensity.

Clinical Oxygen Safety Rules for the CNA

• Prominent Signage: Verify that clear, yellow "OXYGEN IN USE — NO SMOKING" signs are posted on the outside of the resident's room door and above the head of the bed.
• Absolute Ban on Open Flames & Ignition Sources: Keep smoking, matches, lighters, electronic cigarettes, candles, and other ignition sources away from oxygen according to posted facility and fire-safety separation rules.
• Prohibition of Petroleum-Based Products: Never apply petroleum jelly (e.g., Vaseline), mineral oil, or oil-based lotions to the lips, nares, or face of a resident receiving oxygen. Petroleum products can burn rapidly when an ignition source is present in an oxygen-enriched environment. Use the water-based product approved in the resident’s oxygen plan.
• Static Electricity Prevention: Ensure all bed linens, blankets, and resident gowns are made of 100% cotton. Prohibit wool, nylon, silk, or synthetic fleece blankets, which generate electrostatic sparks capable of igniting oxygen.
• Electrical Safety Inspections: Ensure all electrical medical equipment (concentrators, beds, IV pumps) is grounded with three-pronged hospital-grade plugs. Inspect power cords for fraying, exposed wiring, or cracked insulation. Never use unapproved extension cords or overload power strips.
• Oxygen Cylinder Handling: Compressed-gas cylinders can become dangerous projectiles if damaged. Secure and store them in the orientation and rack/cart required by the manufacturer and facility; never leave a cylinder loose on a bed, floor, or walkway.

The RACE Fire Emergency Response Protocol

When smoke, burning odor, or active fire is detected in a healthcare facility, staff must act instantly and without hesitation. The standardized, universally tested acronym RACE defines the mandatory sequence of clinical priorities.

+-----------------------------------------------------------------------------------------+
|                         THE RACE FIRE RESPONSE PROTOCOL                                 |
+-----------------------------------------------------------------------------------------+
|  R  |  RESCUE / REMOVE   | Immediately remove anyone in immediate danger from fire/smoke.|
|-----+--------------------+--------------------------------------------------------------|
|  A  |  ACTIVATE / ALARM  | Pull the nearest manual fire alarm pull station; call 911/PBX.|
|-----+--------------------+--------------------------------------------------------------|
|  C  |  CONTAIN / CONFINE | Close all doors and windows to isolate smoke, heat, and fire. |
|-----+--------------------+--------------------------------------------------------------|
|  E  |  EXTINGUISH /      | Extinguish if the fire is small and safe; otherwise EVACUATE |
|     |  EVACUATE          | residents horizontally past fire barrier smoke doors.        |
+-----------------------------------------------------------------------------------------+

Detailed Breakdown of RACE Steps

1. R — Rescue / Remove (First and Highest Priority):
   • The immediate priority is always resident safety. If a fire starts in a resident's room, immediately remove that resident and any roommates from the room into the corridor behind the fire barrier zone.
   • If the resident cannot walk, roll the entire bed into the hallway, use a wheelchair, or perform an emergency blanket drag across the floor.
2. A — Activate / Alarm:
   • Immediately pull the nearest wall-mounted manual fire alarm pull box.
   • Dial the facility emergency telephone extension or 911, stating the exact room number, wing, and nature of the fire to activate the internal facility fire response (e.g., "Code Red").
3. C — Contain / Confine:
   • Close the door to the room where the fire originated to starve the fire of fresh oxygen and prevent deadly smoke from entering the hallway.
   • Close all resident bedroom doors, bathroom doors, and cross-corridor smoke barrier doors along the unit.
   • Shut windows and ensure oxygen zone valves are turned off if directed by the fire marshal or charge nurse.
4. E — Extinguish or Evacuate:
   • Extinguish: If the fire is small (smaller than a standard wastebasket), contained, and does not block your exit route, use an appropriate portable fire extinguisher.
   • Evacuate: If the fire is spreading, generating heavy toxic smoke, or cannot be safely extinguished, carry out staged horizontal evacuation. Move residents horizontally through corridor fire doors into an adjacent safe smoke compartment on the same floor. Vertical evacuation down enclosed stairwells to the ground level occurs only if horizontal zones become compromised or under incident command orders.

Operating Fire Extinguishers: The PASS Technique and Fire Classes

Portable fire extinguishers are positioned along healthcare corridors at regular intervals. To operate a fire extinguisher effectively and safely, the CNA must memorize and execute the PASS procedure.

The PASS Method for Fire Extinguisher Operation

• P — PULL THE PIN: Pull the metal locking pin located at the top of the handle, breaking the plastic inspection tamper seal.
• A — AIM AT THE BASE: Hold the extinguisher upright and aim the discharge nozzle or hose at the base of the fire (the fuel source on the floor/surface), never at the leaping flames above.
• S — SQUEEZE THE HANDLE: Squeeze the top operating lever/trigger smoothly down to release the pressurized extinguishing agent.
• S — SWEEP SIDE-TO-SIDE: Sweep the nozzle smoothly from side to side across the base of the burning material until the fire is completely smothered. Maintain a safe distance of 6 to 8 feet from the fire.

+-----------------------------------------------------------------------------------------+
|                        FIRE EXTINGUISHER CLASSIFICATIONS                                |
+-------+-----------------------------+-----------------------------+---------------------+
| Class | Fuel Source Category        | Typical Material Examples   | Extinguishing Agent |
+-------+-----------------------------+-----------------------------+---------------------+
| **A** | Ordinary Combustibles       | Wood, paper, cloth, plastic | Water, Dry Chemical |
| **B** | Flammable Liquids & Gases   | Grease, oil, gasoline, paint| CO2, Dry Chemical   |
| **C** | Energized Electrical Gear   | Wiring, motors, appliances  | CO2, Dry Chemical   |
| **ABC**| Multipurpose Universal     | All common facility fires   | Ammonium Phosphate  |
| **K** | Commercial Kitchen Fats     | Deep fryer oils, animal fat | Wet Potassium Agent |
+-------+-----------------------------+-----------------------------+---------------------+

Exam Key Fact: Most healthcare facilities install multipurpose Class ABC dry chemical extinguishers throughout clinical units because they safely extinguish ordinary trash/linens (Class A), flammable liquids (Class B), and energized electrical equipment (Class C) without conducting electricity to the operator.

Disaster Preparedness: Severe Weather, Power Outages & Workplace Emergencies

Long-term care facilities must maintain comprehensive disaster plans to protect fragile resident populations during natural disasters, infrastructure failures, and security emergencies.

Severe Weather (Pennsylvania Winter Storms, Tornados & Floods)

• Tornado / Severe Storm Warnings: Move residents from exterior rooms with perimeter windows into interior hallways, central rooms, or designated shelter areas. Close all heavy window drapes, blinds, and interior doors to shield against flying glass shards. Lower beds to the lowest height and pull privacy curtains.
• Blizzards & Ice Storms: Ensure extra thermal blankets are distributed; monitor room temperatures closely (maintaining regulatory temperature between 71°F and 81°F under federal guidelines).

Power Failures and Emergency Generator Protocols

• During municipal power blackouts, backup emergency diesel generators automatically engage within 10 seconds.
• The Red Outlet Rule: Use the emergency-power outlets designated by the facility for specified critical equipment. Do not assume outlet color alone, unplug a device, or move a plug without direction; labeling and emergency circuits vary by building.
• Ensure flashlights are available; never use candles or open-flame lighting during power outages.

Power Failure Protocol:
[Utility Grid Down] -> [Emergency Generator Starts (<10 sec)] -> [RED Outlets Energized]
Rule: Plug all life-support & medical devices ONLY into RED wall receptacles.

Active Threat & Workplace Violence (Run, Hide, Fight)

• Under Department of Homeland Security and OSHA standards, healthcare workers respond to an active armed threat using three prioritized strategies:
  1. Run (Evacuate): If an accessible escape route exists, evacuate residents and staff immediately. Leave personal belongings behind.
  2. Hide (Barricade): If evacuation is impossible, move into secure rooms, lock and barricade doors with heavy furniture, turn off lights, close blinds, silence mobile devices, and remain quiet out of sight.
  3. Fight (Defend): As an absolute last resort when life is in imminent danger, act aggressively to disrupt or incapacitate the shooter using physical force and improvised weapons.

Hazardous Chemical Spills and OSHA Safety Data Sheets (SDS)

• Under the OSHA Hazard Communication Standard, every facility maintains a centralized Safety Data Sheet (SDS) binder (or digital database) detailing chemical properties, health hazards, PPE requirements, first aid measures, and spill cleanup protocols for all workplace chemicals (such as hospital disinfectants, floor strippers, and sterilizing agents).
• Emergency Eyewash Protocol: If a chemical splashes into a worker's or resident's eyes, immediately lead them to the emergency eyewash station. Flush both eyes continuously with tepid water for a minimum of 15 minutes, holding eyelids open, and notify the charge nurse immediately.