Before We Start
Why fire safety is different in a hospital
Hospital fires present unique challenges that make them far more dangerous than fires in other settings. Hospitals contain patients who cannot evacuate themselves — they may be on ventilators, in traction, sedated, or recovering from surgery. A fire that people in an office building would simply walk away from can be catastrophic in a hospital.
Additionally, hospitals contain enormous quantities of oxygen — in tanks, in wall systems, piped throughout the building. Oxygen dramatically accelerates fire. A fire in an oxygen-enriched environment grows faster and burns hotter than in normal air.
This is why the priority order in hospital fire response (RACE) puts patient rescue FIRST — before calling the alarm, before containing the fire, and certainly before trying to extinguish it.
💡 The Fire Triangle — What Fire Needs to Exist
Fuel — something to burn (linens, paper, alcohol, patient gowns)
Heat — an ignition source (electrical equipment, static electricity, open flame)
Oxygen — to sustain combustion
Remove any one of these and the fire cannot exist. Most fire extinguishers work by removing oxygen (smothering) or heat (cooling). Understanding this helps you know what type of extinguisher to use.
RACE — Response Priority Order
What to do first when you discover a fire
RACE is the priority sequence for hospital fire response. Each step must be done in order — Rescue is always first, not after you pull the alarm, not after you grab an extinguisher. Rescue first.
R — Rescue
Remove patients from immediate danger FIRST
If patients are in immediate danger from flames or smoke — move them before doing anything else. This is the reversal of instinct (which is to call for help first) — but in a hospital, a patient who cannot move themselves will die if you wait.
How to move patients quickly:
• Ambulatory patients: assist them to walk out, guide them
• Non-ambulatory: horizontal evacuation (move to adjacent smoke compartment by pulling the bed or using a sheet to drag)
• Patients on equipment: disconnect non-essential equipment, keep life-sustaining equipment running as long as safely possible
• Vertical evacuation (using stairs) is a last resort — never use elevators in a fire
Horizontal evacuation first: Move patients to the next fire compartment (through fire doors) — most hospital fires are contained within one compartment. Full building evacuation is rarely necessary.
💊 Rescue FIRST — pull the patient out of immediate danger before pulling the alarm. Once patients are safe, then alarm. This is counterintuitive but correct for hospital settings.
A — Alarm
Activate the fire alarm system
Pull the nearest manual fire alarm pull station AND call the hospital operator (or 911 if outside a hospital). Announce "Code Red" per facility protocol.
What to report:
• Location of fire (building, floor, room number)
• What is burning (if known)
• Whether patients have been rescued
Why alarm comes after rescue: Activating the alarm before removing patients from immediate danger means precious seconds are spent on the alarm while a patient is in flames. Rescue takes priority when the danger is immediate. If patients are NOT in immediate danger — alarm first, then address patients.
💊 Announce: "Code Red, 4 North, Room 412." Clear language, specific location. Don't say "there's a fire somewhere on 4" — say exactly where.
C — Contain
Close doors to slow fire and smoke spread
Fire spreads through oxygen, heat, and combustible materials. Closing doors slows all three by limiting oxygen to the fire and creating a physical barrier against heat and smoke.
Close:
• The door to the room where the fire is
• All patient room doors in the vicinity
• Fire doors in the corridor (they will close automatically if the alarm is pulled, but verify)
Never prop fire doors open. This is unfortunately common on hospital floors (for convenience) and negates the fire containment system entirely.
Closing a door buys time: A closed door can withstand fire for 20–30 minutes — enough time for fire suppression systems and the fire department to respond.
💊 A closed door is a life-saving barrier. Studies show that people who survive fires are more often found behind closed doors than open ones — even without fire suppression.
E — Extinguish
Use a fire extinguisher — ONLY if safe to do so
Attempt to extinguish a fire ONLY if all of these conditions are met:
• The fire is small and contained
• You have the correct type of extinguisher
• You have a clear escape route behind you
• You have been trained to use a fire extinguisher
If any condition is not met — do not attempt to fight the fire. Leave the area and let the fire department handle it.
Fire extinguisher types:
• Class A: ordinary combustibles (wood, paper, cloth) — water or dry chemical
• Class B: flammable liquids (alcohol, gas) — CO₂ or dry chemical
• Class C: electrical equipment — CO₂ or dry chemical (never water on electrical)
• Class K: kitchen fires (oils, fats) — wet chemical
• ABC extinguishers: handle most hospital fires (multipurpose)
💊 Never use water on an electrical fire — it conducts electricity and can electrocute you. Use CO₂ or dry chemical on electrical equipment fires.
PASS — How to Use a Fire Extinguisher
Four steps — in order — every time
P — Pull
Pull the safety pin from the handle
The safety pin prevents accidental discharge during transport and storage. Grip the extinguisher with one hand and pull the pin straight out with the other. You'll hear or feel it release.
Once the pin is pulled, the extinguisher is armed. Squeezing the handle will discharge the agent.
A — Aim
Aim the nozzle at the BASE of the fire — not the flames
This is the most important technique point. Aiming at the flames is instinctive — and wrong. The flames are the result of combustion, not the source. The base of the fire is where the fuel is burning.
Aim at the base — where the fire meets what it is burning. This is where the extinguishing agent needs to be to cut off fuel or oxygen at the source.
💊 AIM AT THE BASE — not the flames. Every extinguisher question on NCLEX tests this. Aim at flames = ineffective. Aim at base = extinguishes the fire.
S — Squeeze
Squeeze the handle to discharge the extinguishing agent
Squeeze the handle firmly and continuously. Most extinguishers discharge for only 8–30 seconds — the entire charge will be depleted quickly. Do not squeeze in short bursts — maintain steady pressure until the fire is out or the extinguisher is empty.
Stand at a safe distance (typically 6–8 feet) — close enough to be effective, far enough to avoid flash-back.
S — Sweep
Sweep side to side at the base until the fire is out
Move the nozzle slowly from side to side, covering the full width of the fire at its base. Continue sweeping until the fire appears to be extinguished.
After apparent extinguishment: Watch the area. Fires can reignite. Back away slowly — never turn your back on a fire. If the fire reignites — leave immediately. Your escape route must always be behind you.
💊 After the fire is out: watch for 30 seconds, back away slowly, never turn your back. Report to the fire department that the fire has been extinguished so they can verify complete suppression.
Oxygen Safety
Special considerations in an oxygen-rich hospital environment
Oxygen dramatically increases fire risk
• Oxygen concentrations above 21% (room air) cause materials to ignite more easily and burn faster and hotter
• Never use open flames (candles, matches) near oxygen equipment
• No smoking within 10 feet of oxygen storage or use
• Petroleum-based products (Vaseline, oil-based lip balm) are flammable in oxygen — use water-based products near oxygen
• Keep oxygen cylinders secured upright (they can become dangerous projectiles if knocked over and the valve breaks)
• Oxygen cylinders are stored in designated areas away from heat sources and combustibles
💊 Never use Vaseline on lips or nares of a patient receiving oxygen — it is petroleum-based and flammable in an oxygen-enriched environment. Use water-based lubricants only.
🏥 Fire Response Scenario
You are working the night shift on a medical-surgical floor. At 0315, you smell smoke and see flames coming from the storage closet at the end of the hall. There are 8 patients on the floor. Two are ambulatory. Four can move with assistance. Two are on ventilators.
R
Rescue: Closest patients — rooms 401 and 402 — are adjacent to the fire. Assist the ambulatory patient in 401 out immediately. Call for help to move patient in 402. Alert all staff on the floor with "Code Red, Hallway Closet." Begin horizontal evacuation — move patients through fire doors into the adjacent smoke compartment.
A
Alarm: Pull the nearest fire alarm pull station. Call the hospital operator: "Code Red, 4 North, hallway storage closet. Patient evacuation in progress." Charge nurse activates the facility fire plan.
C
Contain: Close the storage closet door. Close all patient room doors in the hall. Verify fire doors are closed. Discontinue supplemental oxygen to patients not in immediate distress (oxygen feeds the fire). Notify respiratory therapy regarding ventilator patients.
E
Extinguish: Fire is small and in the closet. ABC extinguisher located in the hallway. One nurse maintains patient safety while another attempts extinguishment using PASS — Pull, Aim at base, Squeeze, Sweep. Fire is contained. Fire department arrives 4 minutes later and verifies complete suppression.
📌 NCLEX Application
Fire safety questions are consistent on NCLEX. Key facts to have memorized:
RACE priority order: Rescue → Alarm → Contain → Extinguish
PASS sequence: Pull → Aim (at base, NOT flames) → Squeeze → Sweep
Classic NCLEX questions:
• "What is the nurse's FIRST action when discovering a fire?" → Rescue patients in immediate danger
• "Where should the nurse aim the fire extinguisher?" → At the BASE of the fire
• "A patient has oxygen running via nasal cannula. Which type of lubricant should the nurse use for oral care?" → Water-based (never petroleum-based near oxygen)
• "Which action is the priority when a fire alarm sounds?" → Remove patients from immediate danger first
Never use elevators during a fire evacuation. Elevators can trap people and may malfunction. Use stairs or horizontal evacuation through fire doors.
⚠️ The Trap — Activating the Alarm Before Rescuing
In most non-hospital fire safety training, the first step is always to activate the alarm. In a hospital, this is modified — Rescue comes first when patients are in immediate danger.
The reasoning: a hospital patient who cannot move independently will be harmed in the 30–60 seconds it takes to pull the alarm if the fire is immediately threatening them. Move them first, then alarm.
However: if patients are NOT in immediate danger (you smell smoke but see no fire, or the fire is in an unoccupied area), alarm comes before rescue — because there may not be any immediate rescue needed yet.
NCLEX scenario: "A nurse discovers a fire in a patient's room. The patient is in the bed adjacent to the flames." → First action: RESCUE the patient. Then alarm. This is the tested answer.
✓ Final Self-Test — RACE and PASS
Answer each question:
1. What is the FIRST action in hospital fire response?
2. What does the C in RACE stand for?
3. Where do you aim a fire extinguisher?
4. Why should you never use water on an electrical fire?
5. What type of lubricant is safe near oxygen?
6. Should you use an elevator to evacuate during a fire?
Answers:
1. Rescue — remove patients from immediate danger
2. Contain — close doors to slow fire spread
3. At the BASE of the fire, not the flames
4. Water conducts electricity — risk of electrocution
5. Water-based lubricants only (never petroleum-based near oxygen)
6. Never — use stairs or horizontal evacuation through fire doors
🎉 You've completed all 34 Nursing Fundamentals lessons!
Every core concept in Nursing Fundamentals — from ADPIE and the 5 P's to SBAR and fire safety — is now covered. Head back to the Fundamentals page to review cards, test yourself with the quiz, or practice with flashcards.
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