Fundamentals - Principles, part 13: Disaster Response - Fires, Equipment Malfunctions, Chemical Exposure, Tornadoes, and Bomb Threats
by Meris Shuwarger BSN, RN, CEN, TCRN July 19, 2021 Updated: June 16, 2022 8 min read
What should you do if there's a fire at the hospital? If equipment breaks? If you spill chemicals on yourself? What do you do with patients during a tornado? What should you do if someone calls in a bomb threat? We'll explore all of this in this article on disaster response in nursing.
The Fundamentals of Nursing video series follows along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Fire safety is an important part of inpatient safety knowledge you will need as a nurse. You will likely be tested on fire safety on the NCLEX and take training modules on this at your hospital.
The key fire safety methods we will discuss here are RACE, which cover the order of your duties in a fire, and PASS, which are the steps to operate a fire extinguisher.
The RACE sequence covers your duties as a nurse if a fire happens. RACE stands for Rescue, Activate the alarm, Contain the fire, and Extinguish/Evacuate.
If a fire happens, the first thing you should do is rescue anyone in immediate danger. For example, if a person is on fire, or directly in the path of a fire without the ability to move, you would rescue them.
Activate the alarm
After rescuing anyone in immediate danger, pull the fire alarm. This requires that you know where the fire alarms are located, so make sure to be aware of this at your facility.
Contain the fire
After the alarm is activated, contain the fire by closing doors (especially fire doors), once everyone has been rescued from the other side of them.
Extinguish and Evacuate
Extinguish the fire by using the fire extinguisher—we'll cover the PASS sequence next, which explains how to operate an extinguisher. Evacuate patients from the area if instructed to do so by fire officials or facility leadership.
The pass sequence describes how to operate a fire extinguisher.
- Pull the pin.
- Aim at the base of the fire (NOT THE TOP).
- Squeeze the lever.
- Sweep side-to-side.
Sometimes in a hospital or your facility, you will encounter faulty equipment. Things don't work sometimes. It's important for you to take it out of use immediately.
Tag the item, per your facility policy, to alert others that it does not work so that they don't try to use it after you. It's your responsibility to make sure that you don't just set it down and allow someone else to pick it up later, incorrectly assuming that it works—this could be very dangerous for a patient.
Your facility will likely have a policy on whom to report it to. There might be a special room or closet where faulty equipment goes. Make sure you follow those procedures.
Following correct procedures during equipment malfunction helps nurses avoid the unintentional tort of negligence.
Sometimes in a hospital setting, you might be exposed to chemicals. The procedures you will follow depend on your facility policy and what type of chemicals you might be encountering.
If it is a dry chemical, brush it off of yourself immediately.
Remove clothing, because clothing can hold onto the chemical, and flush your skin with water. Typically, a hospital has a hazmat decontamination shower.
Materials Safety Data Sheets
The Occupational Safety and Health Administration (OSHA) regulates workplace safety in the US. OSHA came out with Hazard Communication Standards in the 1980s to ensure that employers disclose toxic and hazardous substances in the workplace to employees. As part of this, OSHA requires that materials safety data sheets be easily available to any employee in a standardized format.
If you are exposed to a chemical, check the materials safety data sheets to know any extra steps that should be taken for exposure to that specific chemical.
For example, if your eyes are exposed to hydrochloric acid, you should immediately flush them with water for at least 15 minutes, but it's at least 30 minutes for exposure to mercury. You learn these differences through the MSDS.
What do you do if you're at the hospital and there's a tornado outside? Maybe you've never considered this before, but it's likely to be on your nursing exams.
One of the first things you should do in a tornado is avoid windows, because they are likely to be blown out and shower broken glass everywhere. This means you'll move to the center of the building, maybe in a hallway, or in a windowless room like a bathroom.
If your patient cannot be moved (if they are unstable or in very critical condition), then place a blanket over them for protection, so that if the windows shatter, at least they are covered and won't be cut or injured by the glass.
Regionally, you may also be trained on disaster response plans for earthquakes, hurricanes, or tsunamis.
Bomb threats are something we hope we never encounter, but if we do, it is very important to know how to respond.
If you are on the phone and somebody calls and makes a bomb threat, it is important to keep them on the line for as long as possible. Keep them talking. And even if they hang up, you don't hang up. When they are talking, you should be writing down everything you can think of:
- What do they sound like?
- Is their voice high pitched or low pitched?
- Do they have a speech impediment?
- Do they have an accent?
- Do they sound nervous?
- What are their exact words?
In any situation where a crime is happening, it can be hard to remember to make observations when we are focused on the situation at hand, our safety, or if we fear for our lives. But remember how helpful these observations can be later. It may help to periodically remind yourself that if you witness a crime or something scary, you will remember to observe the perpetrator, because that information could help others later.
Level Up RN's teaching on disaster response is intended to help prepare you for Fundamentals nursing exams. The Fundamentals of Nursing video series is intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI and NCLEX.
Hi. I'm Meris, and in this video, we're going to be talking about inpatient safety. We're going to talk about a lot of things: fires, equipment malfunctions, chemical exposure, tornados, and bomb threats. Definitely a lot of information to know. I will be following along with our Fundamentals of Nursing flashcards which are available on our website, levelupRN.com. And if you are following along with me, I am starting on card number 37.
So let's get started.
So first up, we're talking about fire safety. I guarantee you this is stuff you have to know for your nursing exams, for NCLEX, and even when you start working in the hospital.
I 100% guarantee you you're going to take training modules on this in your hospital. So it's good idea to get a good head start.
You'll see that on the card we have two acronyms. The first is RACE, and the second is PASS.
So RACE stands for-- the R is Rescue.
Rescue anyone who is in immediate danger.
A is going to be Activate the Alarm. So you're going to pull the fire alarm.
C is going to be for Contain the Fire. So this is usually going to be done by closing doors, especially fire doors, once everyone has been rescued from the other side of them.
And E is going to be for Extinguish. So that's where you're actually going to put out the fire.
So those are the steps of what to do in which order when you see a fire or find out about a fire.
Now you'll also see the PASS sequence. The PASS sequence is, what do we do with the fire extinguisher?
Now working in fire and EMS for a long time, this is second nature to me, but when I was learning, PASS is what I kept in my brain.
So Pull the pin, Aim at the base of the fire, Squeeze the lever, and Sweep side to side.
That tells you how to use a fire extinguisher to put out a fire. Make sure that you are aiming at the base of the fire and not at the top of the flames.
Very, very, very important to know.
Moving on to some other really important patient and patient safety things for you to know. If you ever have faulty equipment-- which it happens. Things don't work sometimes. It's very, very, very important for you to take it out of use immediately, right?
So I'm not going to keep using the fault IV pump, for instance. I'm going to take it out of use. And the most important thing I want you to think of is putting a tag on it. I'm going to tag that item per facility policy to say, "Hey, this doesn't work," so that nobody else tries to use it.
Then you're going to follow your facility policy on who to report it to. Maybe there's a special room to put it in.
But we really want to make sure that no other medical providers or professionals are using that equipment not knowing that it's malfunctioning.
Up next, we have chemical exposure. This again is going to be based on the type of chemical, so you're going to want to be familiar with what you might be encountering.
But dry chemicals you should brush them off of yourself immediately.
Then we are going to have you strip completely. Take off all of your clothes because the clothes can hold onto that chemical.
Then you're going to flush the skin with water. Typically, a hospital has a place to go, a hazmat decontamination shower.
And you're also going to want to look at the MSDS, materials safety data sheets, to tell you what to do about this particular chemical.
What I should do if I'm exposed to hydrochloric acid may be very different than what I should do if I am exposed to acetic acid. Right? So you're going to want to look at the MSDS sheets.
Alright. Let's talk about tornadoes. This one I think is so interesting because I'd never considered it before I was in nursing school, but what do you do if you're at the hospital and there's a tornado outside?
So one of the first things that you should do is avoid windows. So this means we're going to move in towards the center of the building. This might be in a hallway, or this might be in a windowless room, maybe a bathroom.
And if your patients cannot be moved - maybe they're very unstable, critical patients - we're going to place a blanket over them for protection so that, should the windows shatter, at least they are covered and won't be cut or injured in that way.
And then lastly, let's talk about bomb threats. Bomb threats are something we hope we never encounter, but if we do, very important to know what to do about them.
If somebody calls and makes a bomb threat, it is very important to keep them on the line for as long as possible.
You want to keep them talking. And even if they hang up, you don't hang up.
When they are talking, you should also be writing down everything you can think of. What do they sound like? Is their voice high pitched or low pitched?
Do they have a speech impediment?
Do they have an accent?
Do they sound nervous? All of those sorts of things. And you want to write it down because you're going to forget.
And you may want to write down also exact wording of what was said.
So those are some things that are very important to know when it comes to inpatient safety for you and your patients. I hope that was a helpful review.
If it was, please like this video and leave me a comment below. If there's something that you use to help you remember this information, I would love to hear it.
In the next video, we're going to be talking about more inpatient safety, but we're going to be talking about sharps injuries, body mechanics, and internal radiation or brachytherapy.
You will not want to miss this video. It is very important for your nursing exams. So be sure to subscribe to the channel so that you can be the first to know when it's up. Thanks so much, and happy studying!
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