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1 HealthStream Regulatory Script Fire Safety Version: May 2007 Lesson 1: Introduction Lesson 2: Fire and Fire Safety Lesson 3: Fire Prevention and Facility Safety Lesson 4: Fire Response

2 Lesson 1: Introduction 1001 Introduction Welcome to the introductory lesson on fire safety. This introductory lesson gives the course rationale, goals, and outline. IMAGE: 1001.JPG As your partner, HealthStream strives to provide its customers with excellence in regulatory learning solutions. As new guidelines are continually issued by regulatory agencies, we work to update courses, as needed, in a timely manner. Since responsibility for complying with new guidelines remains with your organization, HealthStream encourages you to routinely check all relevant regulatory agencies directly for the latest updates for clinical/organizational guidelines. If you have concerns about any aspect of the safety or quality of patient care in your organization, be aware that you may report these concerns directly to The Joint Commission. Page 1 of 4 2

3 1002 Course Rationale Patients are often too sick to protect themselves from harm. This means that fires in healthcare facilities can be especially dangerous. IMAGE: 1002.JPG Healthcare workers must be able to identify fire risks to prevent fires. They must also know what to do if a fire does occur. This course will teach you: How to identify fire risks and prevent fires How to respond to a fire emergency How The Joint Commission and CMS expect accredidated facilities to handle fire safety Page 2 of 4

4 1003 Course Goals After completing this course, you should be able to: Identify the three sides of the fire triangle List sources of fuel, oxygen, and heat in the healthcare setting Discuss the importance of fire safety List the primary goals of the Life Safety Code List common causes of fire in the healthcare setting List methods of preventing fires Identify high-risk areas for fires List the steps of RACE Identify methods of carrying patients to safety Identify how to contain a fire Recognize when it is safe to use a portable extinguisher to fight a fire List guidelines for patient evacuation IMAGE: 1003.JPG Page 3 of 4

5 1004 Course Outline Lesson 1 provided the course rationale and goals. FLASH ANIMATION: 1004.SWF/FLA Lesson 2 will introduce fire and fire safety. Lesson 3 will describe fire prevention and facility safety. Lesson 4 will explain how to respond to a fire. Page 4 of 4

6 Lesson 2: Fires and Fire Safety Introduction 2001 Introduction & Objectives Welcome to the lesson on fire and fire safety. FLASH ANIMATION: 2001.SWF/FLA After completing this lesson, you should be able to: Identify the three sides of the fire triangle List sources of fuel, oxygen, and heat in the healthcare setting Discuss the importance of fire safety List the primary goals of the Life Safety Code Point 1 of 8

7 2002 Fire Fires need: Fuel Oxygen Heat FLASH ANIMATION: 2002.SWF/FLA These three items make up the fire triangle. A fire will break out whenever these items come together in the right amounts. Point 2 of 8

8 2003 Healthcare Facilities and the Fire Triangle Can you think of sources of fuel, oxygen, and heat in your healthcare facility? Take a moment to come up with some ideas. Then, click the links below to check your ideas: Fuel Oxygen Heat Clearly, the three sides of the fire triangle are present throughout the healthcare setting. Therefore, there is always a risk of fire. CLICK TO REVEAL Fuel There are many sources of fuel in a hospital. For example, all of the following burn easily: linens, dressings, ointments, alcohol-based solutions, catheters, and tubing. Oxygen Oxygen is present all around us, in the air we breathe. In the healthcare setting, oxygen is often present at unusually high levels. This occurs because of the use of high-oxygen medical gases. When extra oxygen is available, fire is even more likely to break out. Heat Lasers and other types of medical equipment produce heat. Damaged electrical devices can spark to start a fire. Cigarette-smoking is another source of heat that can complete the fire triangle. Point 3 of 8

9 2004 Fire Safety: Prevention When you know what to do to help prevent fires from starting, you can reduce the risk of fire in your facility. IMAGE: 2004.GIF This can help keep patients and staff safe. Always remember that prevention is the best defense against fire. Point 4 of 8

10 2005 Fire Safety: Standards Even with the best efforts at prevention, fires sometimes occur. IMAGE: 2005.JPG Therefore, healthcare facilities must have fire safety programs in place and up-to-date. These programs keep the facility, patients, and staff as safe as possible in the event of fire. Both The Joint Commission and CMS [glossary] set standards for fire safety programs in healthcare facilities. Both groups base their standards on the National Fire Protection Association (NFPA) Life Safety Code. Point 5 of 8

11 2006 Life Safety Code The Life Safety Code provides guidelines to keep hospitals safe in the event of fire. IMAGE: 2006.JPG For example, according to the Life Safety Code, hospitals must: Have clearly marked exits and exit paths, including back-up exits Keep exit paths clear and well lit Use fire-alarm systems Use doors and windows that can contain fire In the next lesson, we will take a closer look at strategies for preventing fires and following the guidelines of the Life Safety Code. Point 6 of 8

12 2007 Review FLASH INTERACTION: 2007.SWF/FLA Complete the table with sources of fuel, oxygen, and heat/ignition in the healthcare setting. Fuel Oxygen Heat/Ignition Alcohol.bmp Ointment2.bmp Air.bmp O2.bmp ESU2.bmp Laser.bmp Point 7 of 8

13 2008 Summary You have completed the lesson on fire and fire safety. NO IMAGE Remember: The three sides of the fire triangle are fuel, oxygen, and heat. A fire will break out whenever these three items come together in the right amounts. Removing any one item will prevent a fire. Hospitals have many sources of fuel, oxygen, and heat. This means there is always a risk of fire. Prevention is the best defense against fire. Even the best efforts at prevention sometimes fail. Therefore, healthcare facilities must have fire-safety programs. Drills should be conducted to identify any weaknesses in the plan. These programs keep the facility, patients, and staff as safe as possible during a fire. The Joint Commission and CMS set fire safety standards for healthcare facilities. These standards are based on the NFPA Life Safety Code. The Life Safety Code provides guidelines to help keep people safe during a fire. Point 8 of 8

14 Lesson 3: Fire Prevention and Facility Safety 3001 Introduction & Objectives Welcome to the lesson on fire prevention and facility safety. FLASH ANIMATION: 3001.SWF/FLA After completing this lesson, you should be able to: List common causes of fire in the healthcare setting List methods for preventing fires Identify high-risk areas for fires Point 1 of 19

15 3002 Fire Prevention and the Facility You can help prevent fires in your facility. IMAGE: 3002.JPG However, even the best efforts at prevention sometimes fail. If this happens, your facility has safety measures in place to help keep the facility, patients, and staff as safe as possible during a fire. Point 2 of 19

16 3003 Common Causes of Fires Thousands of fires occur in healthcare facilities each year. IMAGE: 3003.JPG Common causes include: Cigarette smoking Electrical malfunction Equipment misuse Point 3 of 19

17 3004 Common Causes of Fires: Prevention To help prevent fires caused by smoking: Follow your facility s rules about smoking. Smoke only in areas where smoking is permitted. Instruct visitors and patients to smoke only in designated areas. IMAGE: 3004.JPG To help prevent fires caused by electrical malfunction: Remove damaged equipment from service. Report faulty equipment for repair. Inspect all equipment prior to use. For more information on electrical hazards, see the course Electrical Safety. To help prevent fires caused by equipment misuse: Receive training BEFORE using any piece of equipment. For more information on equipment hazards, see the course Medical Equipment Safety. Point 4 of 19

18 3005 Common Fire Locations Fires are most likely to occur in areas that have a lot of fuel, oxygen, or heat. These areas include: Laundries Laboratories Boiler rooms Storage rooms Surgical suites FLASH ANIMATION: 3005.SWF/FLA Note: Surgical fires are rare. However, devastating fires can and do occur in the surgical setting. Point 5 of 19

19 3006 Fires and Alcohol-Based Hand Rubs (1) In October 2002, the CDC [glossary] released updated guidelines for hand hygiene. These guidelines recommend alcohol-based rubs for routine use in the clinical setting. IMAGE: 3006.JPG Alcohol-based hand-rub dispensers are usually placed in: Patient rooms Treatment rooms Suites Corridors Alcohol is a good fuel. Alcohol-based rubs can burn readily and easily. Point 6 of 19

20 3007 Fires and Alcohol-Based Hand Rubs (2) Precautions must be taken to make sure that alcohol rubs do not become a source of fuel in a hospital fire. IMAGE: 3007.JPG Alcohol dispensers should not be located above, near, or on: Heat or ignition sources Electrical outlets Light switches Alcohol dispensers can only be placed in carpeted areas if the area is in a sprinklered smoke compartment. Large supplies of alcohol-based rubs should be stored in cabinets or other areas approved for materials that burn readily. Finally, when using an alcohol rub, be certain to rub your hands until they are dry. This is especially important in areas of the hospital where there are high levels of oxygen, such as operating rooms. Point 7 of 19

21 3008 Safety Features If prevention efforts fail and a fire breaks out, your organization must be prepared to respond. FLASH ANIMATION: 3008.SWF/FLA Your facility has safety features to ensure an effective response. These safety features include: Fire alarm systems Fire extinguishers Emergency exit routes and doors Smoke and fire doors and partitions Fire plan Let s take a closer look at each safeguard. As you review each safeguard, pay attention to YOUR related role. Point 8 of 19

22 3009 Safety: Fire Alarm Systems Fire alarm systems include both automatic and manual devices. FLASH ANIMATION: 3009.SWF/FLA Automatic devices include smoke detectors and sprinkler systems. Smoke detectors give early warning of fires. Sprinkler systems respond to help extinguish fires automatically. Manual alarm devices include manual pull stations. YOUR ROLE: Know the location of manual pull stations on your unit. Point 9 of 19

23 3010 Safety: Fire Extinguishers Fire extinguishers fight fires by removing sides of the fire triangle. FLASH ANIMATION: 3010.SWF/FLA They do this by releasing materials that: Cool the burning fuel Remove oxygen from the fire These materials include: Water Carbon dioxide Dry chemical powder Point 10 of 19

24 3011 Fire Extinguishers: Materials Different types of fire-extinguisher materials fight different types of fires. This is shown in the table to the right. IMAGE: 3011.GIF Each fire extinguisher has a label to show which types of fires it can fight. Types of fires include: Class A: wood, cloth, paper, and plastic fires Class B: gasoline, kerosene, and oil fires Class C: electrical fires Point 11 of 19

25 3012 Fire Extinguishers: You and Your Facility Your facility must: Place fire extinguishers in appropriate locations Provide appropriate types of fire extinguishers Train staff on how to select and use fire extinguishers IMAGE: 3012.GIF YOU must: Know where to find the nearest fire extinguisher Know which types of fire extinguisher are available in your facility Follow guidelines for choosing a fire extinguisher for a particular type of fire Know how to use a fire extinguisher Point 12 of 19

26 3013 Fire Extinguishers: How to Use All workers in your healthcare facility should know how to use a fire extinguisher. IMAGE: 3013.GIF Use the acronym PASS to help you remember: P: Pull the pin. A: Aim the nozzle at the base of the fire. You should be standing six to ten feet away from the fire. S: Squeeze the handle in five-second bursts. Do not move toward the fire too soon. If you do, the fire might be pushed backward, where it can flare up again. S: Sweep the nozzle from side to side across the base of the fire. Point 13 of 19

27 3014 Safety: Emergency Exit Routes and Doors Emergency exit routes and doors are another important safety feature. IMAGE: 3014.GIF Your facility must: Inform you of exit and evacuation routes Place exit lights over emergency exit doors YOU must: Know exit and evacuation routes Keep exit routes and exits clear Know where to find equipment for evacuating patients during a fire Know how to use this equipment Point 14 of 19

28 3015 Safety: Fire and Smoke Doors and Partitions Hospital facilities have: Automatic fire doors Fire and smoke partitions IMAGE: 3015.JPG These safety features separate the building into many zones. Fire and smoke in one zone should not spread easily to other zones. Therefore, fires can be contained. This means that fewer patients need to be evacuated during a fire. In many cases: Only patients within a single zone must be evacuated. These patients are moved to a safe zone of the hospital. They do not have to leave the building. YOUR ROLE: Make sure that automatic fire doors are not blocked. Make sure that these doors are not propped or wedged open for any reason. Fire doors must be able to close automatically in the event of a fire. Point 15 of 19

29 3016 Safeguards: Fire Plan Your facility must have a fire plan in place. The fire plan describes what to do during a fire. IMAGE: 3016.JPG Some of the safety features previously described may be included in the fire plan. For example, the fire plan should give exit and evacuation routes. Your facility must: Train you on your duties and responsibilities under the plan Conduct routine fire drills on each shift. YOU must: Know your duties and responsibilities under the fire plan Attend all training classes related to fire safety Participate in all fire drills, as required Point 16 of 19

30 3017 Review FLASH INTERACTION: 3017.SWF/FLA Common causes of fires in the healthcare setting are smoking, electrical malfunction, and equipment misuse. How may fires related to these causes be prevented? Type your thoughts in the box below, then click Submit to compare your answer to ours. Did you recall all of the following? To help prevent fires caused by smoking: Follow your facility s smoking policy Smoke only in designated areas Instruct visitors and authorized patients to smoke only in designated areas To help prevent fires caused by electrical malfunction: Remove damaged or faulty equipment from service Report malfunctioning equipment so that it may be repaired To help prevent fires caused by equipment misuse: Receive training BEFORE using any piece of equipment Point 17 of 19

31 3018 Review PASS stands for: a. Pop, Approach, Stand, Spray b. Pull, Approach, Squeeze, Sweep c. Pull, Aim, Squeeze, Sweep d. Pop, Aim, Stand, Spray MULTIPLE CHOICE INTERACTION [CORRECT ANSWER: C] [FEEDBACK FOR A: Incorrect. The correct answer is C. When using a fire extinguisher, Pull the pin, Aim the nozzle, Squeeze the handle, and Sweep from side to side.] [FEEDBACK FOR B: Incorrect. The correct answer is C. When using a fire extinguisher, Pull the pin, Aim the nozzle, Squeeze the handle, and Sweep from side to side.] [FEEDBACK FOR C: Correct. When using a fire extinguisher, Pull the pin, Aim the nozzle, Squeeze the handle, and Sweep from side to side.] [FEEDBACK FOR D: Incorrect. The correct answer is C. When using a fire extinguisher, Pull the pin, Aim the nozzle, Squeeze the handle, and Sweep from side to side.] Point 18 of 19

32 3019 Summary You have completed the lesson on fire prevention and facility safeguards. NO IMAGE Remember: Common causes of fire in the healthcare setting are smoking, electrical malfunction, and equipment misuse. To prevent fires related to these causes, smoke in designated areas only. Use and maintain equipment properly. Fires occur most commonly in laundries, laboratories, boiler rooms, and storage rooms. Alcohol-based hand rubs should be stored in areas approved for materials that burn readily. Dispensers should be placed only in safe locations. After applying an alcohol-based rub, rub your hands until they are dry. Know where to find fire alarm pull stations on your unit and how to operate them. Know where to find the nearest fire extinguisher on your unit. Know the different types of extinguishers available and which type to use in a given situation. To use an extinguisher, PASS. Know exit and evacuation routes. Keep exit routes clear. Never block or prop open automatic fire doors. Know your duties and responsibilities under the fire plan. Participate in all required training and drills. Point 19 of 19

33 Lesson 4: Fire Response 4001 Introduction & Objectives Welcome to the lesson on the fire response. FLASH ANIMATION: 4001.SWF/FLA After completing this lesson, you should be able to: List the steps of RACE Identify methods for carrying patients to safety Recognize ways of alerting others to a fire Identify how to contain a fire Recognize when it is safe to use a portable extinguisher to fight a fire List guidelines for patient evacuation Point 1 of 16

34 4002 RACE (1) When you hear the fire alarm in your facility, you may not know if it is a drill or a true fire emergency. IMAGE: 4002.GIF Treat each alarm as if it is a true emergency. Respond accordingly. The RACE acronym can help you remember what to do. Point 2 of 16

35 4003 RACE (2) Respond to a fire emergency using the RACE protocol: R: Remove or Rescue A: Alarm or Alert C: Confine or Contain E: Extinguish or Evacuate Click on each of the steps in the list above to learn more. Note: The steps of RACE are presented in a specific order. In practice, they often overlap. For example, if you discover a fire in a patient s room, you may rescue the patient (R) and call out for help (A) at the same time. CLICK TO REVEAL [Remove/Rescue] 4003a.GIF [Alarm/Alert] 4003b.GIF [Confine/Contain] 4003c.GIF [Extinguish/Evacuate] 4003d.GIF Nevertheless, RACE is a useful framework. Let s keep the RACE acronym in mind as we take a closer look at what to do in the event of a fire. Point 3 of 16

36 4004 Rescue/Remove and Alarm/Alert If you discover a fire in a patient s room, you should immediately call for help. Use your hospital s fire code. For example, some hospitals use Dr. Red and the room number. IMAGES: 4004.JPG This addresses the first two steps in the RACE protocol: (R): You have called for help to Remove the patient from danger. Once help arrives, it is time to remove the patient to safety. (A): You have given the Alarm. Point 4 of 16

37 4005 Rescue/Remove Techniques In an emergency situation, you may have to carry patients to safety. Carrying techniques include: Side-by-side assist Chair lift Swing carry Cradle drop Extremity carry Click on each of the methods in the list above to learn more. Be sure to check with a supervisor for a list of transfer techniques approved for use in your facility. CLICK TO REVEAL [Side-by-side assist] 4005a.GIF [Chair lift] 4005b.GIF [Swing Carry] 4005c.GIF [Cradle Drop] 4005d.GIF [Extremity Carry] 4005e.GIF Important note: Patients in critical condition should be moved in their beds. Point 5 of 16

38 4006 Confine/Contain and Alarm/Alert As soon as patients in the room of fire origin [link to glossary] have been removed to safety: Confine (C) the fire. Close the door to the room. Then, place a wet towel along the bottom. Back up your previous call for help (A) by: Activating a manual pull station Phoning the fire department IMAGE: 4006.GIF When you call the fire department, give: Your name The phone number from which you are calling Your exact location A description of the fire, including what you see and smell At this point, continue to confine the fire by closing all nearby doors. You also may need to shut off all medical gases to decrease the supply of oxygen to the fire. Follow your facility s fire safety policies. Point 6 of 16

39 4007 Extinguish So far: Patients in immediate danger have been removed to safety (R). The fire alert or alarm has been given (A). All doors and windows in the immediate area have been closed (C). IMAGE: 4007.GIF Now, it is time to think about extinguishing the fire (E). Only use a fire extinguisher if: The fire is small enough to put out with a single portable extinguisher. You are certain you know how to use a fire extinguisher (see lesson two). You are certain that you can extinguish the fire without allowing your escape route to become blocked. Point 7 of 16

40 4008 Extinguish: Fire Size The fire may have looked small when you discovered it. IMAGE: 4008.JPG Fires can spread rapidly. Before re-entering the room with an extinguisher, touch the closed door with the back of your forearm. If the door is warm, do NOT open it. The fire behind the door is probably too large to fight. Point 8 of 16

41 4009 Evacuate You may decide that the fire is too large to fight with an extinguisher. Or, you may try to put out the fire, but find that a single extinguisher will not do the job. IMAGE: 4009.JPG In either case, the next step is evacuation (E). Designated personnel within your facility are responsible for ordering the evacuation of patients. Once the fire department arrives, they will coordinate with your facility to continue the evacuation. Point 9 of 16

42 4010 Evacuate: Defend-in-Place Defend-in-place is a strategy of defending against the danger of a fire, while remaining inside the building. NO IMAGE Patients are evacuated from the danger zone to a safe zone. Patients closest to the fire are moved first. Full evacuation of sick patients can be difficult and dangerous. Therefore, defend-in-place is an important strategy for healthcare facilities. Point 10 of 16

43 4011 Evacuate: Order of Evacuation Any patients in the room of fire origin should be moved to a protected location immediately (R), as described earlier in the lesson. IMAGE: 4011.GIF Remaining patients should be removed from the danger zone in this order: 1. Patients in rooms next to the room of fire origin, regardless of their mobility 2. Patients in rooms directly across the hallway from the room of fire origin, regardless of their mobility 3. Other patients in the danger zone, in this order: a. Walking patients b. Wheelchair patients c. Bed or litter-borne patients The graphic on the right shows an example of how to evacuate patients. Notice that the patients able to walk are evacuated before the patient in a bed (see point 3 above). Point 11 of 16

44 4012 Evacuate: Horizontal Horizontal evacuation is the first strategy used to defend-inplace. IMAGE: 4012.GIF Patients are moved down the hall, out of the danger zone, through at least one set of fire or smoke doors. Point 12 of 16

45 4013 Evacuate: Vertical Vertical evacuation involves moving patients down the stairs to a lower floor or safe area of the facility. IMAGE: 4013.GIF In general, the fire department orders vertical evacuations. Point 13 of 16

46 4014 Evacuate: Important Points When evacuating patients: Do not evacuate any patient past the room of fire origin. Patients who cannot reach a fire or smoke door without passing the room of fire origin may need to be evacuated to the outside of the building. These patients then may enter a safe zone of the building from the outside. After removing all patients from a room, close the room door. Mark the room as empty, according to facility guidelines. For example, some facilities place a pillow on the floor outside the room. Move charts with patients. During vertical evacuations, use stairwells. Avoid elevators. NO IMAGE Point 14 of 16

47 4015 Review FLASH INTERACTION: 4015.SWF/FLA The RACE acronym can help you remember what to do in the event of a fire. What are the steps of the RACE protocol? Type your thoughts in the box below, then click Submit to compare your answer to ours. Did you recall the following? R: Rescue all patients from the immediate area of the fire. If the fire originates in a patient s room, immediately remove the patient. A: Initiate the alarm. Alarm initiation may include any or all of the following: Calling out for help Activating a manual pull station Phoning the fire department C: Confine the fire by closing the door to the room of fire origin. E: If the fire is small enough to be extinguished with ONE portable extinguisher, attempt to extinguish. Otherwise, prepare to evacuate. Point 15 of 16

48 4016 Summary You have completed the lesson on fire response. NO IMAGE Remember: Respond to a fire using the RACE protocol: Rescue/Remove, Alarm/Alert, Confine/Contain, Extinguish/Evacuate. If you discover a fire in a patient s room, immediately call for help. Do not yell FIRE. This might panic the patients. Remove the patient from the room. Be sure to use an approved carrying technique. After removing all patients from the room, close the door to confine the fire. Activate a manual pull station and/or call the fire department. Consider using a fire extinguisher only if the fire is small and you are certain you know how to use an extinguisher (PASS). If it is not possible to put out the fire using a single extinguisher, evacuate all patients in the danger zone. Defend-in-place by relocating patients from the smoke zone to a safe zone. Evacuate patients in this order: 1) patients closest to the fire, regardless of mobility, 2) other patients in the smoke zone. Other patients in the smoke zone should be evacuated in this order: 1) walking patients, 2) wheelchair patients, and 3) bedor litter- borne patients. Do not evacuate any patient past the room of fire origin. Mark all evacuated rooms. Point 16 of 16

49 [Fire Safety] Course Glossary # Term Definition 1. room of fire origin the room in which a fire starts 2. CMS Centers for Medicare and Medicaid Services 3. CDC Centers for Disease Control and Prevention

50 [Fire Safety] Pre assessment 1. Which of the following statements is true? a. High levels of oxygen are rare in the healthcare setting. b. Although high levels of oxygen are likely in the surgical setting, there are no sources of fuel in this setting. c. A faulty ECG machine could start a fire. d. Together, alcohol, surgical drapes, and ointment will start a fire. Correct answer: C Rationale: Medical equipment and electrical devices of all kinds can start a fire if faulty or damaged. 2. The Life Safety Code (LSC) requires that: a. Hospitals keep exit routes clear. b. Hospitals provide lighted signs for exit doors and exit routes. c. Hospitals provide backup exit routes. d. All of these are requirements of the LSC. e. None of these is a requirement of the LSC. Correct answer: D Rationale: All of these are included in the LSC. 3. All of the following statements are true EXCEPT: a. Thousands of fires occur in healthcare facilities each year. b. Equipment use is a common cause of fires in the healthcare setting. c. Hospital fires often originate in storage rooms. d. Surgical fires account for most fires in the healthcare setting. Correct answer: D Feedback: Devastating fires can and do occur in the surgical setting. Overall, however, surgical fires are rare. Fires are more frequent in hospital laundries, laboratories, boiler rooms, and storage rooms.

51 4. All staff members are responsible for knowing all of the following EXCEPT: a. The location of manual fire alarm pull stations b. How to use a fire extinguisher c. How to coordinate both horizontal and vertical evacuations d. The location of exit and evacuation routes Correct answer: C Rationale: You should know how to evacuate patients. Designated personnel within your facility order and coordinate horizontal evacuations. The fire department coordinates vertical evacuations. 5. Automatic fire doors in healthcare facilities: a. May be propped or wedged open during day-to-day hospital operations. b. Open automatically when there is a fire, for more rapid evacuation of patients. c. Decrease the need for patient relocation in the event of fire. d. All of these are true. e. None of these is true. Correct answer: C Rationale: Fire doors must always remain free to close automatically. They must never be blocked, wedged, or propped open. When fire doors close properly, fire and smoke do not spread easily from one zone of the hospital to another. This minimizes the need for patient evacuation. 6. You enter a patient s room and discover a small fire burning on the bed. The patient appears to have fallen asleep while smoking. You should immediately: a. Awaken the patient and scold him for smoking in an unauthorized area. b. Call out for help to remove the patient from the room as quickly and safely as possible. c. Try to smother the fire with a blanket from the patient s bed. d. Leave the room to find the nearest manual fire alarm pull station. Correct answer: B Rationale: As soon as you discover the fire, call out for help so that you can remove the patient from the room quickly and safely.

52 7. Choose the answer that is FALSE. In an emergency situation: a. The side-by-side assist is best for carrying patients who require minimal assistance. b. Both the swing carry and the extremity carry require two caregivers. c. The chair lift involves dragging a patient across the floor in a tilted chair. d. The cradle drop is the safest transfer technique for the patient. Correct answer: D Rationale: The cradle drop involves wrapping the patient in a blanket and dragging the patient across the floor. This may be dangerous for the patient. It should be used only in extreme circumstances. 8. You discover a fire in a patient room. You remove all patients from the room. You then close the room door and place a wet towel along the bottom of the closed door. Why? a. To help confine the fire b. To help prevent smoke from spreading to the rest of the facility c. To help minimize the flow of oxygen to the fire d. All of these e. None of these Correct answer: D Rationale: Closing the door on a fire can help confine the fire. 9. You discover a small fire in a patient room. You remove all patients and close the door to the room. You then hurry to the nearest manual pull station to activate the fire alarm system. You return to the room with a portable extinguisher. You touch the closed door with the back of your forearm. The door feels warm. You should: a. Pull the pin on the extinguisher prior to entering the room, so that you are ready to use the extinguisher as soon as you enter. b. Get a second extinguisher before entering the room, as the fire has probably grown too large to fight with a single extinguisher. c. Notify your supervisor that the fire has grown too large too fight with an extinguisher, and stand by for instructions regarding patient evacuation. d. Immediately begin to evacuate all patients on the unit. Correct answer: C Rationale: If a door feels warm to the touch, it is too large to fight with a single extinguisher. If a fire is too large for a single extinguisher, prepare to evacuate, and allow the fire department to fight the fire.

53 10. A fire has broken out. You have been given orders to begin evacuation of your unit. Which of the following patients should you evacuate FIRST? a. A bedridden patient in a room right next to the room of fire origin. b. A wheelchair-bound patient in a room directly across the hallway from the room of fire origin c. An ambulatory patient two rooms down from the room of fire origin d. A bedridden patient several rooms away from the room of fire origin, but right next to the emergency exit Correct answer: A Rationale: Patients in rooms next to the room of fire origin should be evacuated FIRST, regardless of their mobility. 11. Whenever possible, vertical evacuation of patients is preferable to horizontal evacuation. a. True b. False Correct answer: B Rationale: Horizontal evacuation is preferable. Vertical evacuation should be used only when safe horizontal evacuation is not possible.

54 [Fire Safety] Final Exam 1. Common locations for fires in the healthcare setting include all of the following EXCEPT: a. Laundries b. Waiting rooms c. Storage rooms d. Laboratories Correct Answer: Waiting rooms Answer Rationale: Fires are most likely to occur in areas with a lot of oxygen, fuel, or heat. Such areas include laundries, storage rooms, laboratories, boiler rooms, and operating rooms, but not waiting rooms. 2. Alcohol-based rubs should be applied to the hands, then allowed to air-dry. a. True b. False Correct Answer: False Answer Rationale: When using alcohol-based hand rubs, be sure to rub your hands until they are dry. This can help decrease the risk of fire. 3. A water extinguisher is always the best choice for fires involving wood, cloth, paper, or plastic. a. True b. False Correct Answer: False Answer Rationale: Both water and dry-chemical extinguishers are rated for this type of fire. The best choice of extinguisher in this situation depends upon other factors.

55 4. Fire doors and partitions help contain fires and decrease the need for patient evacuation. a. True b. False Correct Answer: True Answer Rationale: Fire doors and partitions divide a facility into separate zones. This helps to contain fires and decreases the need for patient evacuation. 5. You discover a fire in a patient s room. True or False: You should try to put out the fire before removing the patient. a. True b. False Correct Answer: False Answer Rationale: Always call for help and remove the patient FIRST. 6. Which of the following can help prevent the spread of smoke and fire from a room? a. Closing the door of the room b. Placing a wet towel at the bottom of the closed door of the room c. Closing the doors to rooms next to and across the hall from the room d. All of these answers Correct Answer: All of these answers Answer Rationale: All of these methods can help prevent the spread of smoke and fire. 7. If you are unable to put out a fire with a single portable extinguisher, you should: a. Go get another extinguisher. b. Call for someone to bring you another extinguisher. c. Attempt to smother the fire with a blanket. d. Confine the fire and prepare to evacuate. Correct Answer: Confine the fire and prepare to evacuate. Answer Rationale: If a fire cannot be put out with a single extinguisher, confine the fire and evacuate.

56 8. Which of the following statements is TRUE? a. After evacuating a room, leave the door open to indicate that it is empty. b. Use elevators for vertical evacuation. c. If a patient is located on the far side of a smoke zone, that patient must be evacuated past the room of fire origin. d. Move charts with patients. Correct Answer: Move charts with patients. Answer Rationale: Move charts with patients to help ensure continuity of care. 9. You should respond to a fire emergency using the protocol. a. Life Emergency Code b. PASS c. RACE d. HELP Correct Answer: RACE Answer Rationale: When responding to a fire emergency, Rescue, Alarm, Confine, and Extinguish or Evacuate. PASS helps you to remember how to use a fire extinguisher. 10. A fire has broken out. You have been given orders to begin evacuation of your unit. Which of the following patients should you evacuate FIRST? a. A bedridden patient in a room right next to the room of fire origin. b. A wheelchair-bound patient in a room directly across the hallway from the room of fire origin c. An ambulatory patient two rooms down from the room of fire origin d. A bedridden patient several rooms away from the room of fire origin, but right next to the emergency exit Correct answer: A Rationale: Patients in rooms next to the room of fire origin should be evacuated FIRST, regardless of their mobility.

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