Fire safety

Fire items are sequence memory under stress: rescue who is burning now, pull the alarm, shut the door, then decide extinguish versus get out. Oxygen makes everything more flammable. Large-scale casualty sorting lives in Emergency and disaster triage.

RACE: the response sequence

When fire or smoke is in a client environment, the tested order protects life before property. Rescue anyone in immediate danger if you can do it without becoming the next victim - that often means removing the client from the flaming room into the corridor. Activate the alarm and facility fire response next so the whole building’s plan starts. Contain by closing doors (and windows when relevant) to limit oxygen feed and smoke travel. Then extinguish only a small, contained fire with a proper extinguisher, or evacuate along the unit plan.

Closing a door is not abandonment theater - it is smoke control. A closed door can buy minutes for the people on the other side. If you are unsure whether to fight or flee, evacuate. Heroes who re-enter toxic smoke fail the exam and the shift.

PASS, extinguisher class, and oxygen

Extinguishers work only on small fires and only if you aim at the fuel base, not the pretty top of the flames. Pull the pin to break the tamper seal, aim low, squeeze, and sweep. Know PASS; also know when the fire is already too big - then RACE becomes evacuate. Using the wrong extinguisher wastes seconds and can spread the fire (water on a grease or energized electrical fire is the classic mistake).

1. Pull the pin.
2. Aim at the base of the fire.
3. Squeeze the handle.
4. Sweep side to side until out - or abandon if it grows.

Oxygen is not flammable by itself, but it dramatically accelerates burning. In a fire involving an oxygen-enriched area, shut off the O2 source if you can reach it safely. Day-to-day teaching: no smoking, no open flames, no sparking toys or equipment near oxygen; secure cylinders upright; keep tanks away from heat; avoid petroleum products on oxygen equipment as commonly taught. Static-prone fabrics appear on some stems - prefer cotton. Home O2 teaching is the same physics: oxygen-enriched clothing and bedding catch more easily.

Electrical safety and other unit hazards

Faulty equipment next to a wet floor is how nurses and clients get shocked. If a client is in contact with a sparking or buzzing device, do not become the next conductor - disconnect power at the plug or breaker if you can do it without grabbing the live chassis with wet hands, then assess the client. Report damaged cords; keep fluids off pump and monitor bases; use grounded outlets as intended. Microwave or space-heater improvisation on clinical units is an exam “stop that” cue.

Radiation safety (diagnostic or implant sources) uses three levers: minimize time near the source, maximize distance, and use shielding (lead apron, lead container for seeds as ordered). Cluster care so you are not lingering unnecessarily. That cluster is a different hazard than fire, but Saunders parks it in the same safety chapter - on stems, pick the lever that matches the named hazard.

Evacuation order and elevators

Unit fires often use horizontal evacuation first: move clients past smoke doors into an adjacent compartment on the same floor, not necessarily straight outdoors. Smoke compartments buy time because fire doors and barriers slow spread. Vertical evacuation (down stairs to another floor or out) comes when the whole floor is unsafe. Many NCLEX patterns evacuate ambulatory clients first so they do not clog corridors while staff move those who need stretchers or wheelchairs. Bedbound clients need equipment and teamwork - assign help rather than leaving walkers stranded behind a jam.

• Never use elevators during a fire - stairs only.
• Feel doors with the back of your hand; do not open a hot door into a fire.
• Stay low under smoke; cover faces with damp cloth if that cue appears.
• Account for clients after moving zones - missing persons search is coordinated, not freelance re-entry.
• Close doors behind you as you clear rooms - containment continues during evacuation.

Know your exits on day one of orientation. In a stem, the nurse who pauses to grab personal belongings or to fight a hallway fully involved in flame is the wrong answer. Life, then containment, then property. If your clothing catches, stop-drop-roll beats running with flames.

Priority map