7.3 Emergencies: Fire, Choking & Medical Crisis

Emergency Mindset for the Wisconsin CNA

Safety (~8 of 75 Headmaster knowledge questions) includes not only preventing falls but also responding when something goes wrong: fire, choking, unresponsiveness, chest pain, stroke signs, and severe bleeding. The exam does not expect you to act as a paramedic. It expects you to:

1. Recognize the emergency.
2. Protect the resident (and yourself) from immediate danger.
3. Call for help using the facility method (nurse, charge nurse, code button, 911 per policy).
4. Stay with the resident when safe to do so and provide aid within your training and scope.
5. Follow facility policy and the nurse’s direction — do not invent advanced life-support steps you were never taught.

Wisconsin facilities vary in code language (“Code Blue,” “rapid response,” etc.), but the CNA pattern is consistent: protect, call, stay, assist within role.

Fire Safety: Know Before You Need It

Every shift, know:

• Primary and secondary exits from your unit
• Locations of fire extinguishers and alarm pulls
• Evacuation routes and staging areas
• How oxygen shut-off and fire doors work per your orientation (do not freestyle shutting valves you were not trained to operate)
• That exits and extinguishers must never be blocked by carts, linen hampers, or chairs

RACE — Fire Response Sequence

RACE is the memory tool most nurse-aide programs and exam items use:

Order matters in spirit: life safety first. You do not hunt for an extinguisher while a resident is in a burning room. Rescue (if safe) and alarm take priority over heroics with a fire hose you do not have.

PASS — Using a Fire Extinguisher

If policy and safety allow you to fight a small, contained fire:

Then back away; watch for re-ignition; report. If the fire grows, smoke thickens, or your exit is threatened — leave. Extinguishers are limited tools, not magic.

Fire + Oxygen

If oxygen is in use near a fire emergency, follow facility training: remove residents from danger, support ordered oxygen decisions made by licensed staff, and never create sparks near flowing oxygen. Know that oxygen-enriched environments make ordinary fires more intense.

Vertical and Horizontal Evacuation Concepts

Long-term care often uses defend-in-place or horizontal evacuation (moving past fire doors to a safe smoke compartment) before full building evacuation. You will not redesign the fire plan on test day — choose answers that follow the facility fire plan, close doors, and protect residents rather than improvising elevators in a fire (elevators are generally not used during fire evacuation).

Choking

Choking occurs when the airway is blocked by food or a foreign body. Residents at higher risk include those with dysphagia, poor dentition, neurological disease, sedation, or who eat too fast. Mealtime is a high-risk period — another reason assisted feeding and aspiration precautions matter (Personal Care chapter).

Signs of Severe Airway Obstruction

• Universal choking sign (hands at the throat)
• Inability to speak, cry, or cough effectively
• Silent cough or high-pitched noise
• Cyanosis (bluish lips/face)
• Panic, then possible unresponsiveness if unresolved

A resident who is coughing forcefully may still be moving air — encourage coughing and stay ready; do not perform blind finger sweeps. When the person cannot breathe, cough, or speak, it is an emergency.

CNA Response Framework

1. Ask “Are you choking?” if the person can respond.
2. Call for help immediately / activate emergency response per facility.
3. Perform relief of foreign-body airway obstruction only as you were certified and trained (adult conscious choking: abdominal thrusts / Heimlich-type maneuvers in many BLS courses; modifications for pregnant or obese residents such as chest thrusts; special considerations for infants — follow your current BLS and facility protocol).
4. If the resident becomes unresponsive, lower them safely to a firm surface, activate emergency procedures, and begin CPR per your training if you are certified and facility policy directs CNAs to do so — licensed staff will lead advanced care.
5. Never leave a choking resident alone to “go find the nurse” without activating a call system if one is available; shout for help while you stay and act if you are the only trained person present.

Exam caution: Do not invent drug protocols, cricothyrotomy, or ALS steps. The correct CNA-level answer centers on recognition, calling for help, and trained choking relief/CPR within scope.

Prevention Links

• Follow diet texture and liquid consistency orders.
• Seat residents upright for meals; chin-tuck only if trained/care planned.
• Cut food appropriately; do not rush feeding.
• Report coughing, wet voice, or pocketing of food to the nurse.

Medical Crises: Protect, Call, Stay

Unresponsive Resident

If you find a resident who does not respond to verbal or gentle tactile stimulation:

1. Ensure scene safety.
2. Check for responsiveness; call the resident by name.
3. Call for help / activate emergency system immediately.
4. Check breathing (and pulse if trained in BLS sequence for healthcare providers) per your current certification.
5. Begin CPR if indicated and you are trained/facility-authorized; use AED if available and trained.
6. Stay until relieved by nurse or emergency responders; report what you observed (time found, what you did).

Do not drag an unresponsive resident around the facility alone. Do not delay calling for help to finish unrelated tasks.

Chest Pain

Chest pain can signal cardiac ischemia, heart attack, or other emergencies. CNA actions:

• Stay calm; keep the resident at rest (usually sitting or lying as comfort and policy allow — do not force exercise).
• Call the nurse immediately — this is not a “wait and see” observation for end of shift.
• Loosen tight clothing; monitor for sweating, nausea, shortness of breath, jaw/arm pain, anxiety.
• Do not give the resident medication from your pocket or their drawer unless a specific facility protocol under licensed direction applies — medication administration is generally not a CNA role.
• Stay with the resident; be ready to report onset time and symptoms accurately.

Stroke Signs — FAST

Stroke is time-critical. Teach yourself FAST:

Other sudden signs: one-sided weakness/numbness, severe headache, vision loss, confusion, trouble walking. Call the nurse immediately, keep the resident safe from falls, NPO (nothing by mouth) if swallowing may be unsafe until assessed, and stay with them. Do not give food, water, or oral meds while stroke is suspected.

Severe Bleeding

For external bleeding within CNA first-aid training:

1. Call for help / nurse.
2. Use standard precautions (gloves).
3. Apply direct pressure with clean gauze/cloth.
4. Elevate the extremity if appropriate and no fracture is suspected per training.
5. Do not remove soaked dressings — add more on top.
6. Do not use tourniquets unless trained and directed by current facility/BLS guidance for life-threatening limb hemorrhage.
7. Stay with the resident; keep them warm and calm; watch for shock signs (pallor, rapid weak pulse training-level observation, restlessness) and report.

For vomiting blood, rectal bleeding, or suspected internal bleeding: do not give food or drink; position for comfort/safety per nurse direction; call the nurse urgently.

Seizures (Brief Exam Note)

If a resident has a seizure: protect the head, clear sharp objects, do not force objects into the mouth, do not restrain thrashing limbs forcefully, time the seizure, call for help, and place in recovery position when the seizure ends if breathing and policy allow — then nurse assessment. Report length and residual weakness/confusion.

What CNAs Must Not Do in Emergencies

Stay inside the lines that protect residents and your license pathway:

If a question offers a dramatic advanced procedure you never practiced in NATCEP, it is almost certainly wrong for a CNA.

Skills and Knowledge Exam Tie-Ins

Emergency items often mix with other domains:

• Infection control: gloves for bleeding.
• Resident rights: dignity during evacuation and crisis; explain what you can.
• Communication: clear, calm report to the nurse with facts (who, what, when, what you did).
• Safety equipment: unlocked exits, working call system, known extinguisher locations.

Quick Recognition Table for Test Day

Emergencies feel chaotic; good aides run a short mental script: Is the scene safe? Who needs rescue? Who have I called? What am I trained to do until help arrives? That script is what the Wisconsin Safety domain rewards — and what residents need when seconds matter.