Fire, Emergency Response, Disaster and Security

Fire Safety, Extinguisher Operation, and Evacuation

In healthcare facilities, fire poses an immediate threat to vulnerable clients, visitors, and staff. When a fire occurs, the practical nurse must rely on prompt, organized thinking guided by the acronym RACE: Rescue, Alarm, Confine, and Extinguish or Evacuate. The nurse's first priority in any fire is to immediately rescue clients who are in direct danger. For example, if smoke is detected in a client room, the nurse moves that client out of the room before attending to any other duty. Activate the fire alarm as soon as possible; when staff are available, have another person activate it while clients in immediate danger are rescued. Next, staff confine the hazard by closing doors, fire barriers, and windows when safe to do so. This step limits the spread of smoke and toxic flames throughout the unit without delaying rescue or evacuation efforts.

When a small fire can be managed safely, staff use a portable fire extinguisher following the acronym PASS: Pull the pin, Aim at the base of the fire, Squeeze the handle, and Sweep side to side. When using a fire extinguisher, the nurse aims the spray nozzle directly at the base of the fire rather than at the flames above it. Directing the extinguishing agent at the base of the fire targets the burning material; the way it extinguishes the fire depends on the type of extinguisher. If sheltering in a room becomes necessary during a fire, staff keep the door closed and, if readily available, place damp towels at door gaps to reduce smoke entry. Staff must never delay evacuation to prepare or place these towels.

Evacuation occurs according to a structured sequence and follows the facility evacuation plan. After rescuing anyone in immediate danger, staff evacuate ambulatory clients first when directed by the facility plan. Next, staff evacuate semi-ambulatory clients and clients who use wheelchairs with assistance. Finally, staff evacuate clients who cannot walk using approved transport aids and enough staff to move them safely; these individuals must never be left in danger simply because they are less mobile.

Facility plans prioritize horizontal evacuation before vertical evacuation is initiated. Horizontal evacuation moves clients past fire doors to a safe area on the same floor. If danger persists, vertical evacuation moves clients by stairwell to another floor, usually a lower floor, as directed by the facility fire plan. Staff must not use elevators during a fire unless fire personnel authorize the use of a designated evacuation elevator under the facility plan. Oxygen supports combustion; only personnel authorized under the facility fire plan should shut off a medical oxygen supply, while ensuring affected clients receive an alternate source as promptly as safety permits.