5.3 Emergency Procedures: Fire (RACE/PASS), Choking & Medical Emergencies
Key Takeaways
In a healthcare facility fire, staff must execute the RACE protocol using the facility emergency plan, with simultaneous help where possible: Rescue residents in immediate danger, Activate the fire alarm, Confine the fire by closing doors and windows, and Extinguish or Evacuate.
Portable fire extinguishers are discharged using the PASS technique: Pull the pin, Aim at the base of the flames, Squeeze the operating handle, and Sweep side-to-side across the base of the fire.
Conscious severe choking is managed with cycles of five back blows followed by five abdominal thrusts (chest thrusts for late pregnancy or when the abdomen cannot be encircled); if the resident becomes unresponsive, the CNA must ease them to the floor, call for emergency help, and begin CPR starting with 30 chest compressions.
Blind finger sweeps are strictly prohibited during airway obstruction management because probing blindly can push a foreign object deeper into the pharynx and convert a partial or high obstruction into a fatal tracheal occlusion.
During an active seizure, the CNA must protect the resident from trauma by clearing the environment, cradling the head, timing the seizure, never placing any object in the mouth, and positioning the resident on their side in the recovery position post-ictally.
5.3 Emergency Procedures: Fire (RACE/PASS), Choking & Medical Emergencies
Certified nursing assistants are frontline responders. In acute disasters and emergencies—such as fires, choking, seizures, syncope, or cardiac arrest—rapid execution of standardized protocols is vital to saving resident lives.
Facility Fire Response: The Sequential RACE Framework
In a fire, healthcare staff must execute the RACE protocol using the facility emergency plan; staff can act simultaneously:
- R - Rescue / Remove: The immediate priority is rescuing any resident in immediate danger from the fire zone. Move the resident past fire barrier doors. If bedbound, roll the bed out or use an emergency blanket drag. Never stop for personal belongings.
- A - Alarm / Alert: Summon help as soon as possible while rescuing safely; activate the nearest pull station and announce the facility fire code (e.g., "Code Red" and location) to summon staff and dispatch 911.
- C - Confine / Contain: Prevent smoke and flame spread by closing all room doors, corridor smoke doors, and windows. Shut off localized oxygen valves only if authorized by the nurse.
- E - Extinguish or Evacuate: Attempt a small incipient fire only if trained, equipped with the correct extinguisher, the alarm has been raised, and a safe escape path remains. Do not enter dense smoke or delay evacuation to fight a fire. If flames spread, evacuate immediately. Evacuation follows a horizontal model: move residents past fire doors into an adjacent smoke compartment on the same floor first. Vertical stairwell evacuation occurs only if containment fails.
Operating Fire Extinguishers: PASS and Fire Classifications
Corridor fire extinguishers are operated using the PASS sequence:
- Fire Classifications: Class A (ordinary combustibles: wood, paper, cloth); Class B (flammable liquids/gases); Class C (electrical equipment); Class K (kitchen cooking oils). Corridors are equipped with multi-purpose Class ABC dry chemical extinguishers.
- The PASS Technique:
- P - Pull: Pull the safety pin at the handle top, breaking the tamper seal.
- A - Aim: Aim the nozzle low, pointing directly at the base of the fire where fuel burns, rather than into rising flames.
- S - Squeeze: Squeeze the operating handle smoothly to release the extinguishing agent.
- S - Sweep: Sweep the nozzle side-to-side across the base of the fire until flames are extinguished. Use the extinguisher's specified effective distance and keep an exit behind you.
Airway Obstruction: Recognizing Choking and Conscious Interventions
Foreign body airway obstruction is common in long-term care due to dysphagia, dentures, and neurological deficits:
- Partial vs. Complete Obstruction:
- Partial Airway Obstruction: The resident coughs forcefully and can speak. CNA Intervention: Do NOT deliver back blows or thrusts; physical intervention can lodge the object deeper into the trachea. Stay with the resident, encourage coughing, and monitor closely.
- Complete Airway Obstruction: The resident displays the universal choking sign (clutching throat), cannot speak, cough, or breathe, and rapidly develops cyanosis.
- Severe Conscious Obstruction (2025 AHA): Activate emergency response. Alternate five back blows followed by five abdominal thrusts until the object is expelled or the resident becomes unresponsive. Lean the person forward and give back blows between the shoulder blades with the heel of the hand. For abdominal thrusts, stand behind the resident with feet spread for balance; wrap arms around the waist. Make a fist; place the thumb side against the midline abdomen, slightly above the navel and well below the xiphoid process. Grasp the fist with your other hand and deliver quick, upward and inward thrusts into the abdomen.
- Chest Thrust Modifications: For late pregnancy or when you cannot encircle the abdomen, use five back blows followed by five chest thrusts instead of abdominal thrusts. Stand behind, encircle arms under axillae, place the thumb side of the fist on the center of the sternum, and pull straight back with rapid chest thrusts.
Management of the Unresponsive Choking Victim
If a choking resident loses consciousness, modify the rescue sequence immediately:
- Ease to Floor: Lower resident gently to the floor in a supine position, protecting head and spine.
- Call for Help / Code: Shout for emergency help, call 911, and activate the medical emergency code.
- Initiate CPR Compressions: Begin basic life support immediately with 30 chest compressions (100–120 compressions/minute, at least 2 inches deep while avoiding depths over 2.4 inches, allowing full recoil) to generate intrathoracic pressure.
- Airway Inspection Before Breaths: Open the airway with the head-tilt/chin-lift maneuver and look inside the mouth. If a foreign object is clearly visible, remove it with a finger sweep.
- NEVER Perform a Blind Finger Sweep: Probing blindly into the pharynx risks wedging the object deeper into the larynx, converting a treatable blockage into fatal tracheal occlusion.
- Ventilations: Attempt 2 rescue breaths. If the first breath does not raise the chest, reposition and attempt the second without prolonged interruption. Continue 30:2 compression-to-ventilation cycles until advanced life support arrives.
CNA Responsibilities During Acute Medical Emergencies
Nursing assistants must respond swiftly during acute medical crises:
- Seizure Management: During a generalized tonic-clonic seizure, the resident loses consciousness with muscle rigidity and rhythmic convulsions.
- Primary CNA Goal: Protect the resident from trauma.
- Guide resident to the floor, clear away furniture and sharp objects, and place a soft folded towel under the head. Loosen tight neckwear.
- NEVER place any object in the mouth (no tongue depressors, spoons, or fingers). This causes dental fractures, oral bleeding, and airway obstruction.
- NEVER restrain convulsive movements; restraint can cause bone fractures and muscle tears.
- Time the event. Gently turn the person to the side when safely possible to allow drainage; do not force movement against convulsions. Summon the nurse immediately and emergency help for a seizure lasting over five minutes, repeated seizures without recovery, a first seizure, injury, or trouble breathing/waking. Give nothing by mouth until fully alert.
- Syncope (Fainting): Temporary cerebral hypoperfusion causing transient unconsciousness, preceded by pallor and dizziness. Assist the person to a safe supported position, call the nurse, and assess responsiveness and breathing within training. Use supine positioning if tolerated and no injury or breathing contraindication is suspected; follow nurse/emergency direction. Do not force elevation of legs or wait a fixed period before calling for help.
- Myocardial Infarction (AMI) and Cardiac Arrest:
- Heart Attack (AMI): Signs include chest pressure radiating to the arm/jaw, dyspnea, diaphoresis, and nausea. Geriatric, female, and diabetic residents frequently exhibit atypical symptoms (sudden fatigue, shortness of breath, epigastric discomfort). CNA action: summon nurse/code immediately, position in Semi-Fowler's (head elevated 30–45 degrees) to reduce cardiac workload, loosen clothing, and stay present.
- Cardiac Arrest: For an unresponsive resident without normal breathing, activate emergency response and obtain an AED. A trained healthcare rescuer checks breathing and pulse for no more than ten seconds; if there is no definite pulse, start CPR and use the AED promptly. Follow current BLS training and verified resuscitation orders; a CNA does not infer a DNR from age, hospice status, or appearance.
| Emergency Event | Diagnostic Clinical Signs | Immediate Priority CNA Action |
|---|---|---|
| Facility Fire | Active flames, smoke detection, alarm | Execute RACE: Rescue first, Alarm, Confine, Extinguish/Evacuate |
| Complete Choking | Universal sign; inability to speak or cough | Activate help; alternate 5 back blows and 5 abdominal thrusts, with indicated chest-thrust substitution |
| Unresponsive Choking | Choking victim collapses and loses consciousness | Ease to floor; call code; start CPR (30 compressions); inspect mouth |
| Tonic-Clonic Seizure | Unresponsive, violent rhythmic jerking | Clear hazards; cushion head; do NOT restrain; nothing in mouth |
| Syncope (Fainting) | Sudden transient loss of consciousness, pallor | Support safely, summon nurse, check responsiveness/breathing and follow emergency directions |
| Myocardial Infarction | Chest pressure, dyspnea, diaphoresis, nausea | Call code/nurse; place in Semi-Fowler's; provide calm presence |
Sources checked October 16, 2026
FDA patient lift safety; 2025 AHA adult BLS; MedlinePlus crutch use.
A CNA finds a small wastebasket fire beside a resident. The resident can be removed safely without entering dense smoke. What is the immediate priority?
Run to the nearest fire station to pull the wall alarm and shout the emergency code
Rescue the resident from the room and move them to a safe area behind fire barrier doors
Locate the nearest Class ABC fire extinguisher and attempt to extinguish the flames
Close the resident's door immediately to confine the smoke before entering the room
A resident who was actively choking and receiving abdominal thrusts suddenly goes limp and becomes completely unresponsive. What sequence of interventions must the certified nursing assistant initiate immediately?
Perform a deep blind finger sweep into the pharynx, deliver 5 abdominal thrusts on the floor, and check for a carotid pulse
Place the resident in a lateral recovery position, run to fetch an oxygen tank, and await the arrival of the paramedics
Ease the resident gently to the floor, call for emergency help, and begin CPR starting with 30 chest compressions
Prop the resident upright in a chair, administer 2 rescue breaths with a bag-valve-mask, and shake the resident to assess consciousness
A resident sitting in the dayroom suddenly exhibits generalized muscular rigidity followed by rhythmic jerking convulsions and falls from the chair. Which intervention is the certified nursing assistant's primary responsibility during the active convulsive phase?
Hold the resident's arms and legs tightly against the floor to suppress violent tremors and prevent muscle strains
Clear away surrounding tables and chairs, place a soft folded towel under the head, and never insert anything into the mouth
Insert a padded wooden tongue depressor between the teeth to maintain airway patency and prevent tongue biting
Force the resident into a seated upright position and administer oral sips of water to prevent dehydration
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