Fire and Rescue created by Sue Peterson

You are a nursing assistant working alone with 4 cognitively impaired residents. Three have physical issues as well and need varying degrees of mobility assistance. You have 30-45 seconds to rescue the residents from a burning building. Once out of the building the residents will be contained in a safe, fenced area. Due to cognitive impairment they can’t help each other out of the room under any circumstances. What additional information do you need before planning your rescue? How will you rescue the residents?

Driving Question

How will you rescue patients from a burning building in a home health care setting?

This challenge happens at the beginning of a unit on safety in our Health Professions course (Career & Technical Education department). The course is a full year, and requires students to learn and practice a variety of skills in the classroom and complete an internship during second semester. At the end of the course, students take the exam to become a certified nursing assistant (CNA).

For Students:

11th-12th grade

Unit Title:

Safety in Health Professions

Length:

1-2 block periods (90 minutes each)

Course:

Health Professions

Unit Launch

Students are introduced to the RACE framework for responding to an emergency (Rescue persons in immediate danger, sound the nearest fire Alarm, Confine/contain the fire, use the fire Extinguisher on a small fire). They are then presented with the challenge using the PowerPoint and handout below.

Fire Scenario Teacher Presentation

Fire Scenario Assessment – Handout

Midpoint Check

Culminating Experience

Students role play their solutions using the classroom as their “home health care” setting. They are timed on how quickly and whether they can successfully carry out their plans. The course instructor is a registered nurse and a Red Cross certified CPR and First Aid instructor.

Differentiation (e.g. Special Education, English Language Learners)

Fire Scenario Assessment – Handout

How does this assessment fit in with your system of assessment?

Students take regular unit assessments throughout the course, and take the state exam at the end of the course for Certified Nursing Assistants.

Teacher Reflection

Here’s what I really enjoy about this unit:

The ideas in this unit are applicable to a wide range of emergency situations – chemical lab safety, student medical emergency in PE, how to assess drowning behaviors, earthquake response, school/mall shooting, etc. The more I discussed this scenario with my students and applied it to real patients, we realized that there is no one right answer. An ambulatory patient with severe cognitive disability could be much more difficult to evacuate from the building than a small, easily lifted bed-bound patient. Knowing the overall goals (RACE framework, save as many patients as possible) is the most important for making the best decisions in the moment.

Here’s what I’m still working on making better about this unit:

Student Reflection

Here’s what I really enjoy about this unit:

Here’s how this unit could help me learn more effectively:

Outside Expert Reflection

Here’s how this unit connects really well to my work:

Here’s where I think there are opportunities for growth:

Authentic Problem

Emergency evacuations are practiced in health care facilities on a regular basis so staff will know what to do in a real emergency

Authentic Assessment

This challenge came from a test question in a practice state exam for nursing assistant certification. The question read:

In the case of a fire which resident should you rescue first?

A) Wheelchair Bound
B) Blind
C) Ambulatory
D) Bedbound

Ambulatory would be correct because they would be the quickest to move out and would maximize the # of lives the NA could save. Choices beyond that weren’t addressed in the question.

Student Voice

Students identify problems within the challenge and attempt to come up with their own solution.

Expertise

Later in the year when we go to our main internship site, we could ask the new employee orientation staff person (who teaches us about evacuation and emergency procedures there) for his input on the scenario.

Culturally Responsive Instruction

Students will probably grapple with the moral issues of what is best for individuals vs what is the best way to maximize lives saved.

Collaboration

Teams of 5+ will work on the problem. In a group of 5 all will need to be actors in the scenario.

Academic Discourse

Through textbook readings and a Safety Unit powerpoint students learn basic information about fire emergencies in health care. Discuss R-A-C-E (Rescue, Activate Alarm, Contain, Extinguish). Students use professional behavior in skill practice with “patients.”

Washington State standards of practice and competencies for nursing assistants WAC 246-841-400

Competencies and standards of practice are statements of skills and knowledge, and are written as descriptions of observable, measurable behaviors. All competencies are performed under the direction and supervision of a licensed registered nurse or licensed practical nurse as required by RCW 18.88A.030. The following competencies are considered standards of practice for both nursing assistant-certified and nursing assistant-registered:

(9) Safety and emergency procedures. A nursing assistant demonstrates the ability to identify and implement safety and emergency procedures. A nursing assistant:

(d) Demonstrates principles of good body mechanics for self and client or resident, using the safest and most efficient methods to lift and move clients, residents, or heavy items.

(f) Demonstrates knowledge and follows fire and disaster procedures.

About the Authors

Sue Peterson

I have been a registered nurse since 1980 and have been teaching Health Science Careers (including nurse assistant training) since 1986. I have been an American Red Cross CPR and First Aid instructor since the 1980s.