Describe the specific steps you would take in the event of a fire in a healthcare facility, including how to protect patients and follow facility evacuation plans.
In the event of a fire in a healthcare facility, a Certified Nursing Assistant (CNA) must act quickly, calmly, and decisively, following established protocols to protect patients and ensure a safe evacuation. The immediate actions taken during a fire can significantly impact the safety of all individuals present, so it is essential that all staff are familiar with the specific steps that should be taken in the event of a fire. The key is to follow the acronym RACE and then PASS, while being mindful of all safety procedures and the need to prioritize patient safety.
The first step is to activate the fire alarm immediately. If you discover a fire, activate the nearest fire alarm system by pulling the fire alarm pull station, if available. This action notifies the facility's fire response team and initiates the facility's emergency procedures. Never assume someone else has already activated the alarm. If there is no pull station available, notify the staff immediately and provide as much information about the fire as possible, including the location, size of the fire, and any injuries. It is essential to activate the alarm as quickly as possible so that other individuals are aware of the situation and can take appropriate actions. For example, if you see smoke coming from a room, activate the nearest pull station to alert the facility, and start the evacuation process.
Next, use the acronym RACE to guide your actions. RACE stands for Rescue, Alarm, Contain, Extinguish/Evacuate. R stands for Rescue: Immediately rescue any patients who are in immediate danger from the fire. This might mean moving them from their rooms or assisting them away from the immediate area of the fire. Prioritize patients in immediate danger or those who are unable to move themselves. This should be done with caution to avoid any injury to both the patient and the CNA. For example, if a fire starts in a patient’s room, first assist the patient out of the room to a safe location.
A stands for Alarm, which should have been completed in the first step, so verify that the fire alarm has been activated. C stands for Contain: Attempt to contain the fire if it is small and contained, such as in a waste basket. Do this by closing the doors and windows in the immediate area of the fire to prevent the spread of smoke and fire, if you can do so safely. Do not attempt to fight the fire if it is too large or out of control. For example, if a small fire breaks out in a patient’s room, close the door to contain the fire, and prevent it from spreading further.
E stands for Extinguish or Evacuate. If the fire is small and you are trained in using fire extinguishers and you are able to do so without causing yourself danger, you can attempt to extinguish it, or if it is too large, assist patients to evacuate safely. Do not attempt to fight a fire that is too large or out of control. If you are not trained on using a fire extinguisher, evacuate the patients safely, and close all the doors behind you. For example, if the fire is small and you are trained, use a fire extinguisher to extinguish the fire, but if it is too large and you are not trained, assist patients away from the area.
If evacuation is necessary, follow your facility's evacuation plan, which will be unique to each facility. The evacuation plan will outline the evacuation routes and assembly points, which should be communicated to all staff members on a routine basis. Know your role in the evacuation process, such as which patients to evacuate, and the route you need to take. Prioritize patients who are closest to the fire, or those who are at the highest risk, or those who are non-ambulatory. Use the evacuation route posted at your facility, and do not use the elevators. If a patient is bedridden, use assistive devices such as a slide board, or a stretcher. For example, if you are assigned to assist patients from a specific wing of the facility, familiarize yourself with the best route, and the safest place to take those patients.
When assisting patients during an evacuation, assess their abilities and assist them based on their needs. If they can ambulate, support them, and guide them to the safe location. If they are not able to ambulate, use wheelchairs or stretchers, and always ensure you are using safe body mechanics. Be sure to keep them calm by offering reassurance, and clear, simple, instructions. Do not rush the patients and be sure to assess them throughout the process. For example, do not attempt to carry a patient if they are not able to walk, as you could cause injury to yourself and the patient. Instead use appropriate assistive equipment such as a wheelchair.
If a patient has special needs such as being on a ventilator, or oxygen therapy, ensure they have the equipment they need during the evacuation. Be mindful of any patient who is on oxygen therapy, and do not let them walk in the area near the fire with their oxygen, as this can lead to an explosion. If a patient is receiving IV therapy, ensure you carefully remove them from the IV pump and ensure they still have access to intravenous fluids. Be sure to take necessary equipment such as oxygen tanks, or wheelchairs. For example, if the patient is on oxygen therapy, make sure they have a portable oxygen tank to take with them during the evacuation, if possible. If the patient is on IV therapy, ensure the IV line is secured.
Once all patients have been evacuated, account for everyone by doing a headcount. Be sure to let other staff members know if there is anyone missing, so that they can search for anyone who has not been accounted for. Ensure that all staff members are safe and accounted for. For example, report to the designated staff member when all of your assigned patients have been moved to safety, and if any patients are unaccounted for.
If you are trained to use a fire extinguisher, remember the acronym PASS, to help you use a fire extinguisher effectively. PASS stands for Pull, Aim, Squeeze, and Sweep. Pull the pin, aim the nozzle at the base of the fire, squeeze the handle to release the extinguishing agent, and sweep the nozzle from side to side across the base of the fire. However, remember that your primary role is to ensure patient safety, and to only attempt to extinguish a small fire if you are able to do so safely, without putting yourself at risk. For example, if you are using a fire extinguisher, be sure to aim at the base of the fire and use a sweeping motion to cover the entire fire. If the fire is too large, you should leave the area immediately and focus on evacuation.
Always follow any additional directives from the facility's fire response team or other authority. After all patients and staff are safe, cooperate with the investigation, and ensure you are always following policies and procedures to maintain a safe work environment. For example, if the fire response team requires you to provide details regarding what you observed, you should provide them as much information as you can recall accurately and truthfully.
In summary, in the event of a fire, a CNA should immediately activate the fire alarm, follow the RACE protocol (Rescue, Alarm, Contain, Extinguish/Evacuate), use the acronym PASS if using a fire extinguisher, adhere to the facility’s evacuation plan, prioritize patient safety, provide assistance to those who require it, and follow any additional instructions from the facility's fire response team. By following all of these steps, a CNA can ensure that all individuals, patients and staff, are as safe as possible during a fire.