The recent events in Watertown, Mass., as the hunt for perpetrators of the Boston Marathon bombing ensued, the devastation in West, Texas, that impacted a long term care facility after a nearby fertilizer plant exploded, and the everyday emergencies that occur in skilled nursing and assisted living communities at any given moment reminds us that providers must be ready for anything and everything. 

  • What if your facility is in a neighborhood that is on lockdown as law enforcement hunts for terrorists or common criminals?
  • What if your facility is in close proximity to an emergency at a refinery, chemical plant, rail yard, shipping port, or other hazardous materials that can potentially impact an entire community?
  • How close is your facility located to a dam, nuclear power station, potential terror target, or other potential hazards and perils in the community or region, where it could have a direct impact on your campus should an adverse event occur?


A Textbook Response

The basics element of emergency response and recovery to crisis or disaster, big and small, requires a culture of preparedness for “All Hazards.”  This starts with being prepared for adverse events, including one of the more common emergencies that occur within a long term care facility—a fire.
A recent fire in a resident’s bathroom at a memory care unit in a nursing home exemplified the benefits of a comprehensive staff training program and the executive management’s commitment to budgeting time and resources to ensure that employees are ready for a fire emergency.
As a fire and life safety professional given the privilege of working with this particular community for the past several years, the manner in which staff addressed this dangerous situation undoubtedly saved lives and was a textbook response to a fire that presented some unique challenges.

R.A.C.E. In Action

The fire apparently started in a ceiling mounted fixture in a resident’s bathroom in a one-story, secured memory care unit.  Upon discovery of the fire, and in accordance with the facility’s emergency procedures, staff immediately initiated the R.A.C.E. (Rescue, Alarm, Confine, Extinguish) procedure and took control of the situation.
Residents in immediate proximity to the fire were evacuated to a separate smoke compartment and eventually out of the unit.
The fire alarm system was activated, initiating an appropriate response within the facility as well as a response from the fire department.
Smoke doors automatically closed throughout the building and staff manually closed other doors that were not equipped to close automatically to help limit smoke spread.  Upon completion of the first three critical steps of the R.A.C.E. procedure, a trained staff member cautiously entered the bathroom that was on fire and successfully extinguished the fire.

Fires Present Unique Challenges

The unique challenge of this fire was based on the fact that the fire presented itself both high (at ceiling level) and low (on the floor) when the burning material in the ceiling melted and dripped onto the floor causing a secondary fire. 
The responding staff member stated that she had relied on the fire and life-safety training that she had continuously received through the years working in long term care and initiated the proper procedure to utilize a fire extinguisher based on the P.A.S.S. principle: 
P- Pull the pin on the fire extinguisher
A- Aim at the base of the fire
S- Squeeze the trigger to discharge the fire extinguisher
S- Sweep the extinguishing agent back and forth over the base of the fire 
In this case, the employee first extinguished the fire at the ceiling level and then proceeded to extinguish the secondary fire on the floor. The overall response from nursing home staff was so quick and efficient that both fires were extinguished before the building’s fire sprinkler system activated.

The Right Stuff

So, what is significant about this fire, given the fact that it didn’t make front page news? The fact that it didn’t make the news at all! The nursing home’s appropriate response to this dangerous event prevented the fire from spreading from the room of origin (the bathroom) and extending into the attic space. 
Had the fire extended horizontally into the resident’s room or vertically into the attic, the facility would most likely have suffered major service disruption and would have been at risk of severe fire and smoke damage, not to mention the possibility of harm to all of the building occupants (residents, staff, and visitors).  Instead, rapid staff intervention turned this potentially deadly situation into moderate inconvenience.
As a fire and life-safety consultant providing services to a multitude of long term care providers around the country during the course of my career, I understand that continuous training on the same basic fire response concepts, protocols, and procedures can get tedious after a while. The benefits of this essential training cannot be fully realized until that fateful day when a fire emergency occurs.

Don't Stop Training

The executive director of the nursing home where this fire occurred honored all of her team members involved with the fire with a special meeting where plaques were distributed and gratitude was expressed.
Of course, being a proactive administrator, she took advantage of the opportunity and implemented another all-staff in-service on fire and life-safety procedures. Personally, it was one of the best training sessions that I have been involved with because we were able to discuss how everything went right.
Providing a comprehensive emergency training regimen to staff, conducting regular drills and exercises, and developing a culture of preparedness for adverse events of all types will ensure that your staff safely and efficiently responds to a crisis or disaster.
Stan Szpytek is president of consulting firm Fire and Life Safety, in Mesa, Ariz., and is the Life Safety/Disaster Planning Consultant for the Arizona Health Care Association and the California Association of Health Facilities. Szpytek is a former deputy fire chief and fire marshal with more than 35 years of experience in life safety compliance and emergency preparedness. For more information, visit or e-mail Szpytek at