Section 4.2: Fire Safety, RACE, & PASS Protocols

Fire Safety, RACE, & PASS Protocols

Fires in healthcare facilities present an extreme hazard due to the high concentration of vulnerable, non-ambulatory residents. To protect lives, Certified Nursing Assistants must be thoroughly trained in immediate fire response procedures, fire extinguisher operation, and safety regulations. Knowing how to act rapidly, systematically, and within your scope of practice during a fire emergency is a core competency tested on the Utah CNA exam.

The RACE Protocol: Immediate Fire Response

When a fire is discovered inside a facility, the RACE protocol must be implemented immediately, in sequence. Each letter of the acronym represents a critical action:

1. R – Rescue (or Remove/Relocate): Your first priority is the safety of any resident in immediate danger. If a fire starts in a resident's room, immediately move that resident to a safe area, such as behind the facility's fire-rated doors. Never leave a resident in a burning room to go find help.
2. A – Alarm (or Activate): Once residents in immediate danger are safe, activate the nearest fire alarm pull box. Call the facility's emergency number or use the intercom to notify other staff. Clearly state the location of the fire.
3. C – Confine (or Contain): Prevent the fire and smoke from spreading by closing all doors and windows. In a facility, fire-rated doors are designed to isolate smoke and heat, but they only work if closed. Shut off electrical equipment and turn off oxygen valves if designated in your facility policy.
4. E – Extinguish (or Evacuate): If the fire is small (no larger than a small wastebasket) and you have been trained, attempt to put it out using a fire extinguisher. If the fire is large, spreading, or producing heavy smoke, immediately abandon extinguishing efforts and coordinate the evacuation of the unit.

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The PASS Protocol: Operating a Fire Extinguisher

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

• P – Pull: Pull the safety pin located at the top of the extinguisher handle. This breaks the plastic seal and unlocks the triggering mechanism.
• A – Aim: Aim the nozzle or hose at the base of the fire (the source of the fuel), not at the flames. Spraying the flames will not extinguish the fire and will waste the extinguishing agent.
• S – Squeeze: Squeeze the handle or lever to discharge the extinguishing agent.
• S – Sweep: Sweep the nozzle or hose from side to side at the base of the fire until the fire is completely extinguished.

Classes of Fires and Extinguishers

Using the wrong type of extinguisher can make a fire worse. Most healthcare facilities are equipped with multipurpose Class ABC dry chemical extinguishers.

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Oxygen Safety Guidelines and CNA Scope

Oxygen therapy is widely used in long-term care, but oxygen is a powerful supporter of combustion (burning). While oxygen itself is not flammable, it causes fires to ignite more easily and burn much hotter and faster.

Strict Oxygen Safety Rules for CNAs

• No Open Flames: Ensure there are no open flames, candles, matches, or smoking within 15 feet of an oxygen source. Utah facilities must post "No Smoking - Oxygen in Use" signs on the resident's door.
• Eliminate Static Electricity: Do not use wool, nylon, or synthetic blankets or gowns, as they can generate sparks of static electricity. Use only 100% cotton blankets and clothing for residents receiving oxygen.
• Avoid Flammable Products: Never use petroleum-based products (such as Vaseline, baby oil, or petroleum-based lip balms) on a resident using oxygen. Under high-oxygen concentrations, petroleum can ignite spontaneously. Use water-soluble lubricants to treat dry nostrils or lips instead.
• Secure Cylinders: Ensure oxygen tanks/cylinders are secured upright in approved stands or carts to prevent them from tipping over and damaging the valve.

CNA Scope of Practice Regarding Oxygen

Administering oxygen is classified as a medication administration under Utah regulations. Therefore, the CNA cannot turn oxygen on or off, or adjust the flow rate (liters per minute).

• CNA Role: You must monitor the equipment. Ensure the nasal cannula (nasal prongs) or mask is positioned correctly, check the skin behind the resident's ears and under the nose for irritation or breakdown, and check that the flow rate on the flowmeter matches the rate specified in the resident's care plan. Report any discrepancy or breathing difficulty immediately to the nurse.

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Evacuation Priorities and Techniques

If a fire cannot be contained and an evacuation is ordered, residents must be evacuated in a strict, prioritized order:

1. Ambulatory Residents First: Residents who can walk independently or with minor assistance are evacuated first. Guide them to a designated safe zone. Evacuating them quickly clears the hallways and allows staff to focus on non-ambulatory residents.
2. Semi-Ambulatory Residents Second: Residents who require wheelchairs, walkers, or crutches.
3. Non-Ambulatory Residents Last: Bedridden residents who require physical transfer. Use draw sheets, evacuation chairs, slide boards, or slide mats. Never use elevators during a fire evacuation; always use stairwells and ramps.

Clinical Scenario: Fire Response

While performing evening rounds, you smell smoke and discover a fire in Mrs. Taylor's room. Mrs. Taylor is in bed and is receiving oxygen. You immediately execute the RACE protocol:

1. Rescue: You pull Mrs. Taylor out of the bed and drag her to the safety of the corridor, closing her room door behind you to confine the fire.
2. Alarm: You pull the fire alarm in the hallway and yell "Code Red, Room 214!"
3. Confine: You ensure all other resident doors in the hallway are closed.
4. Extinguish/Evacuate: Since the fire is spreading rapidly due to the oxygen supply, you do not attempt to use an extinguisher. You begin assisting other residents to evacuate the unit via the stairs.