9

CHAPTE R

Responding to
Emergencies

Goals
After reading this chapter, you will have the information needed to:

• Recognize and respond to common medical • Keep people safe in the event of a fire emergency.
emergencies, including stroke, myocardial infarction,
choking, bleeding, shock, seizure, fainting, burns and • Keep people safe during weather emergencies
and other events that disrupt the facility’s ability to
delirium. function normally.
• Prevent a fire emergency from occurring.

After practicing the corresponding skills, you will have the information needed to:

• Care for an adult who is choking.

 You have been caring for Mrs. Schulman,
one of your home health clients, for
Medical Emergencies
3 years. For as long as you have known
Mrs. Schulman, part of your duties have been to
Recognizing and Responding
help her get ready for her bridge club visit every to Medical Emergencies
Friday evening. But this Friday afternoon, when you The following steps guide your actions in an emergency
arrive at Mrs. Schulman’s house, she tells you she and ensure your safety and the safety of others.
doesn’t feel like company. The only other time you
can remember Mrs. Schulman missing her Friday 1. Recognize the emergency. Sometimes it
evening bridge game was last winter, when she was will be obvious that a person is in distress and/
hospitalized for pneumonia. Mrs. Schulman asks you or an emergency exists. Other times, however,
to please call her friends and tell them not to come. a medical emergency may only be signaled by a
She says, “I just feel really strange, not like myself slight change in the person’s normal behavior or
at all. My left leg feels numb…like I might fall if I try appearance. As a nurse assistant, you will have
to put weight on it. And my left arm feels weak and in-depth knowledge of what is normal for each
strange too. If you could just make me a cup of tea person in your care. A change from normal could
and help me get ready for bed, I think that might be signal an emergency and should be reported
best. I’m sure I’ll feel better in the morning.” You tell immediately (Figure 9-1).
Mrs. Schulman that you are worried about her, and 2. Take action. Taking action could make the
that you’d like to talk to someone else about her difference between life and death for the person
symptoms and find out what you should do. who needs help.
3. Check the scene and the person. Before
An emergency is a situation that arises suddenly
rushing to help an injured or ill person, conduct a
and requires immediate action to keep a person safe.
scene size-up and get an initial impression. Try to
Emergencies can be medical in nature, involving an
answer these questions about the scene:
acute illness or injury that requires immediate attention
to prevent the person from dying or experiencing
permanent long-term effects. Emergencies can also
• Is the scene safe to enter? Check for
hazards, such as fire, downed electrical wires,
be environmental, involving changes to a person’s spilled chemicals, an unstable building or
environment that affect the person’s health and safety.
Examples of environmental emergencies include fires,
weather emergencies (such as snowstorms, tornadoes
and hurricanes) and disasters (severe events that
cause widespread damage and destruction, affecting
many people and disrupting normal functioning of the
community). As a nurse assistant, you may work in
many different settings. However, regardless of the
setting, you must know how to respond in the event
of an emergency to keep the people in your care safe.
Know your employer’s procedures for what to do and
follow them always.

Figure 9-1 Your knowledge of what is normal for each person in your
care can help you detect when something is wrong. Sometimes the
only sign of a medical emergency is a slight change in the person’s
appearance or behavior.
K EY TE R M S

• automated external • delirium • first aid • shock

defibrillator (AED)
• disaster • myocardial infarction • syncope
• cardiopulmonary
resuscitation (CPR) • emergency • presyncope

• cerebrovascular • epilepsy • seizure

accident

112 | | Nurse Assistant Training

 traffic that could put your safety or the safety occurred or who knows the injured or ill person
of bystanders at risk. Do not enter bodies of may be able to provide valuable information
water unless you are specifically trained to about the situation or the person. Bystanders
perform in-water rescues. Avoid entering can also assist in other ways, such as by calling
confined areas with poor ventilation and places 9-1-1 or the designated emergency number,
where natural gas, propane or other substances waiting for EMS personnel and leading them to
could explode. Do not enter the scene if there the site of the emergency, getting needed items
is evidence of criminal activity or the person is (such as an AED and first aid kit), controlling
hostile or threatening suicide. If these or other crowds and reassuring the injured or ill person.
dangers are present, stay at a safe distance Check the person. When you reach the person,
and call for help, or call 9-1-1 or the designated you can conduct a more thorough check to
emergency number immediately. Once determine what is wrong and what care is needed.
professional responders make the scene safe,
you can offer your assistance as appropriate. • If the person is awake and responsive, obtain
permission to continue (consent) and then begin
• What happened? Take note of anything that
might tell you the cause of the emergency. If
to gather additional information about the nature
of the person’s illness or injury.
the person is unresponsive and there are no
witnesses, your check of the scene may offer the • If the person appears to be unresponsive, shout,
using the person’s name if you know it. If there
only clues about what happened. Use your senses
is no response, tap the person’s shoulder (if
to detect anything out of the ordinary, such as
the person is an adult or child) or the bottom
broken glass, a spilled bottle of medication or an
of the person’s foot (if the person is an infant)
unusual smell or sound. Keep in mind that the
and shout again while checking for normal
injured or ill person may not be exactly where
breathing. Check for responsiveness and
they were when the injury or illness occurred—
breathing for no more than 5 to 10 seconds.
someone may have moved the person, or the
If the person does not respond to you in any way
person may have moved in an attempt to get help.
(such as by moving, opening his or her eyes,
• How many people are involved? Look
carefully for more than one injured or ill person. A
or moaning) and the person is not breathing
or is only gasping, the person is unresponsive.
person who is moving or making noise or who has If the person responds and is breathing normally,
very visible injuries will likely attract your attention the person is responsive, but may not be fully
right away, but there may be a person who is awake. Give care according to the conditions
silent and not moving or a person blocked out by that you find and your level of knowledge and
debris or wreckage that you do not notice at first. training.
It also is easy to overlook a small child or an infant.
In an emergency with more than one injured or ill • Unresponsiveness, trouble breathing and severe
bleeding are all signs of a life-threatening
person, you may need to prioritize care (in other
emergency. If your initial check of the person
words, decide who needs help first).
reveals these or any other life-threatening
• What is your initial impression about the
nature of the person’s illness or injury?
conditions, make sure that you call for help or
get someone to call for help or 9-1-1 or the
Before you reach the person, try to form an initial designated emergency number right away. Also
impression about the person’s condition and what have someone bring an AED and a first aid kit, if
is wrong. For example, does the person seem these items are available.
alert, or confused or sleepy? Look at the person’s
4. Call. If you call for help in a hospital, there is usually a
skin—does it appear to be its normal color, or
code you can dial to get help from within the facility.
does it seem pale, ashen (gray) or flushed? Is the
In other healthcare settings, you may be required to
person moving, or motionless? Does the person
dial 9-1-1 or another designated emergency number.
have any immediately identifiable injuries? Look
Know your employer’s policies and procedures
for signs of a life-threatening illness or injury, such
related to calling for help in an emergency.
as loss of consciousness, trouble breathing or
severe bleeding. If you see severe, life-threatening 5. Care. Provide appropriate care (according to the
bleeding, use the resources available to you to situation and your level of training) until help arrives.
control the bleeding as soon as possible. Help the person rest comfortably, and provide

• Is anyone else available to help? Take

note of bystanders who can be of assistance.
reassurance because the person is likely to be
frightened and upset. In the sections that follow, we
will review initial basic first aid steps for some
A bystander who was there when the emergency

Chapter 9 | Responding to Emergencies | 113

 common medical emergencies. First aid is care that Common Medical Emergencies
is provided to an injured or ill person while waiting
for more advanced help to arrive. To expand your Stroke
knowledge of how to respond to emergencies, A stroke, or cerebrovascular accident, occurs
especially in a setting other than a healthcare facility, when blood flow to a part of the brain is interrupted
it is strongly recommended that you take formal by a blood clot, resulting in the death of brain cells. A
American Red Cross First Aid/CPR/AED training in stroke can also be caused by bleeding into the brain
addition to the nurse assistant training course. tissue. Strokes can cause permanent brain damage,
6. Report and record. Your observations about what but with quick action, sometimes the damage can be
happened before, during and after the emergency stopped or reversed.
are important to share with other members of the The signs and symptoms of a stroke can vary from
healthcare team. These observations should be person to person. A person who is having a stroke may
reported to the nurse and documented on the show any of the following signs and symptoms:
appropriate forms, per your employer’s policy. Note
whether the person complained of any symptoms
before the event, the time the symptoms started
• Trouble with speech and language, including
slurring of words, being unable to form words or
and how long the symptoms lasted. Be specific. being unable to understand what others are saying
For example, “Mrs. Roberts was breathing at a • Drooling or difficulty swallowing
rate of 25 breaths per minute” is more specific
than “She was having trouble breathing.” If you
• Drooping of the features on one side of the face (for
example, the eyelid and the corner of the mouth)
arrived on the scene to find the person in distress
• Trouble seeing in one or both eyes
and unconscious or otherwise unable to tell you
what happened, note anything unusual that you • Weakness
observed while you were checking the scene and
the person. Also report and record exactly what
• Paralysis or numbness of the face, arms or legs,
especially on one side of the body
you did to help the person (for example, “I helped
• A sudden, severe headache
her to sit up and held her there”).
• Dizziness or loss of balance
• Confusion
• Loss of consciousness
Observe and Report • A generally ill appearance or abnormal behavior
The “FAST” check (Figure 9-2) is a quick way of
In older people, the signs and symptoms checking for signs of a stroke:
of an emergency may be very general and
nonspecific, and they may be barely noticeable Face. Ask the person to smile. Is there weakness or
to someone who does not know the person drooping on one side of the face?
well. Because you will spend a lot of time with Arm. Ask the person to raise both arms. Does one arm
the people in your care and you will get to drift downward or appear to be weak?
know what is normal for each of them, you will
be in a good position to notice subtle changes Speech. Ask the person to repeat a simple sentence,
that could be a sign of a medical emergency. such as “The sky is blue.” Does the person have
General signs and symptoms that could signal trouble speaking or is speech slurred?
a medical emergency in an older person
Time. If the person has trouble performing any of
include the following and should be reported
these actions or shows other signs and symptoms
to the supervising nurse right away:
of a stroke, call for help immediately. Prompt medical
●● Headache attention may reduce the amount of disability the
●● A change in the person’s usual level of person experiences as a result of the stroke.
activity
If you think that a person is having a stroke, follow
●● A change in mental status (such as your employer’s procedure for calling for help. Stay
agitation, the new onset of confusion, or with the person and provide reassurance until help
increased confusion in a person who is arrives. If the person is responsive but not fully
already confused) awake, or if the person is drooling or has trouble
●● Lethargy (extreme drowsiness or swallowing, place the person on one side in the
sleepiness) recovery position and monitor the person’s
●● Difficulty sleeping condition until EMS or other help arrives.

114 | | Nurse Assistant Training

Figure 9-2 The FAST check for stroke.

Signs and symptoms of a heart attack vary from

person to person and can be different in women
Observe and Report than they are in men. A person who is having a
heart attack may show any of the following signs
Note when the person’s signs and symptoms and symptoms:
started (or, if you do not know when the signs
and symptoms started, note the last time • Chest pain, which can range from mild to
unbearable. The person may complain of pressure,
the person was known to be well). This is
squeezing, tightness, aching or heaviness in the
important information to report because some
chest. The pain or discomfort is persistent, lasting
of the medications used to treat stroke are
longer than 3 to 5 minutes, or going away and
only effective within a certain time frame after
then coming back. It is not relieved by resting,
the onset of signs and symptoms.
changing position or taking medication. It may be
Myocardial Infarction difficult to distinguish the pain of a heart attack
from the pain of indigestion, heartburn or a muscle
A myocardial infarction, or heart attack, occurs
spasm.
when blood flow to part of the heart muscle (the
myocardium) is blocked. Because the cells in the
affected area of the heart muscle are not receiving
• Discomfort or pain that spreads to one or both
arms, the back, the shoulder, the neck, the jaw or
the oxygen and nutrients they need, they die, the upper part of the stomach
causing permanent damage to the heart muscle. • Dizziness or lightheadedness

Chapter 9 | Responding to Emergencies | 115

 • Trouble breathing, including noisy breathing,
shortness of breath and breathing that is faster than
person. Anxiety increases the person’s discomfort.
Closely monitor the person’s condition until EMS
normal or other help arrives and takes over. Notice any
• Nausea or vomiting changes in the person’s appearance or behavior.

• Pale, ashen (gray) or slightly bluish skin, especially

around the face and fingers
You can learn about other steps, including when to
give aspirin, in an American Red Cross First Aid/
CPR course.
• Sweating
• A feeling of anxiety or doom Cardiac Arrest
• Extreme fatigue (tiredness) If the person becomes unresponsive, stops breathing
• Unresponsiveness normally, and the heart stops beating, the person is
in cardiac arrest and will require cardiopulmonary
Although men most often have the “classic” signs of resuscitation (CPR) and possibly defibrillation
a heart attack, such as chest pain that radiates down (delivery of an electric shock to the heart muscle to
one arm, women often have more subtle signs and help restore a normal rhythm).
symptoms or experience them differently than men
do (Figure 9-3). For example, in women, the “classic” Cardiac arrest is not the same as a heart attack.
signs and symptoms may be milder or accompanied by While a heart attack can cause a cardiac arrest,
more general signs and symptoms such as shortness many other things can as well, including trauma,
of breath, nausea or vomiting, extreme fatigue, and poisoning, and an environmental emergency such as
dizziness or lightheadedness. Because these signs heat stroke. Cardiac arrest occurs when the heart
and symptoms are so general and nonspecific, women stops beating or beats too ineffectively to circulate
may experience them for hours, days or even weeks blood to the brain and other vital organs. When
leading up to the heart attack but dismiss them as the heart stops beating properly, the body cannot
nothing out of the ordinary. survive for long. CPR is a skill used to sustain
respiration and circulation for a person who has
If you think a person in your care is having a gone into cardiac arrest. An automated external
heart attack, stay with the person and follow your defibrillator (AED) is a portable electronic device
employer’s procedure for calling for help. Have that delivers a defibrillation shock with a push of a
the person stop what they are doing and rest in a button to help the heart restore an effective pumping
comfortable position to reduce the heart’s need for rhythm (Figure 9-4). High quality CPR and the
oxygen. Many people experiencing a heart attack proper use of an AED have been shown to improve
find it easier to breathe while sitting. Loosen any survival rates among people experiencing cardiac
tight or uncomfortable clothing. Reassure the arrest. You should know the location of AEDs in your

MEN... WOMEN...
often, but not always, experience the “classic” may experience the “classic” signs
signs and symptoms of a heart attack: and symptoms but they are often milder
and may be accompanied by more
Chest pain, pressure, squeezing, general signs and symptoms such as:
tightness, aching or heaviness that HEART
lasts longer than 3-5 minutes or ATTACK
goes away and comes back Shortness of breath
Nausea, vomiting or diarrhea
Radiating pain to arm(s), shoulder Fatigue
or neck Dizziness
Sweating
Secondary signs and symptoms may Back or jaw pain
include dizziness, loss of consciousness,
sweating, nausea or shortness of breath

Figure 9-3 Men and women often experience heart attacks differently.

116 | | Nurse Assistant Training

 Figure 9-4 An automated external defibrillator (AED) is often used along with cardiopulmonary resuscitation (CPR) when a person is in cardiac
arrest. Know the location of the AED in your facility in case you need to retrieve it quickly.

facility, because you may be asked to retrieve the Dental problems or poorly fitting dentures can affect
AED in an emergency while a co-worker administers a person’s ability to chew food properly, putting the
CPR. You should also know where CPR breathing person at risk for choking. Eating while talking or
barrier devices (used to protect both the person laughing, or eating too fast, can also lead to choking.
being resuscitated and the rescuer from the spread
If you are with a person who starts to choke, you will
of microbes in saliva, blood and other body fluids)
need to take quick action. First, ask the person, “Can
are kept so you can access them in a hurry. The skills
you speak?”
for administering CPR and using an AED are not
taught as part of this course, but you are strongly
encouraged to take the American Red Cross First
• If the person can speak and is coughing forcefully,
encourage the person to keep coughing. Stay with
Aid/CPR/AED course to learn these skills. the person and have the person sit up. If the person
is not able to expel the object and clear the airway
As a nurse assistant, you need to know what your
quickly, call for help.
role is if a person in your care has a cardiac arrest.
In some situations, a person may have a “do not
resuscitate” (DNR) order. In this case, cardiopulmonary
• If the person cannot speak and is coughing weakly
or making a high-pitched sound while breathing, the
resuscitation would not be done. Also, be aware if the airway is blocked and the person will soon become
person has an advance directive such as a living will or unresponsive unless the airway is cleared. You must
durable power of attorney for healthcare; or a Physician call for help immediately while you begin to care for
Orders for Life-Sustaining Treatment (POLST). These choking (Skill 9-1).
documents specify what life-sustaining measures
the person wants. State and local laws about these
• If the person becomes unresponsive, you must
administer CPR, which is not taught as part of this
situations vary. Always follow your employer’s course. This skill is taught as part of the American
procedure for do not resuscitate orders and advance Red Cross First Aid/CPR/AED course, which you
directives and what to do if a cardiac arrest occurs. are strongly encouraged to take in addition to your
nurse assistant training course.
Choking
Choking occurs when the airway becomes either Bleeding
partially or completely blocked by a foreign object. Bleeding can be internal or external. Internal bleeding
Many of the people in your care will have risk factors is often difficult to recognize, but external bleeding is
for choking. For example, neurological conditions, such not. Uncontrolled bleeding (also called hemorrhage),
as a stroke or multiple sclerosis, can affect a person’s whether it is internal or external, is life threatening.
ability to swallow or clear the airway through coughing. To provide care for a person who is bleeding

Chapter 9 | Responding to Emergencies | 117

 externally, first take standard precautions by putting than normal, changes in skin color and restlessness.
on disposable latex-free gloves. If you think the blood Provide reassurance, and keep the person calm.
might spray or splatter, you may need eye and face Remember to wash your hands immediately after
protection as well. Control the bleeding by covering removing your gloves. Some instances of severe
the wound with a sterile gauze pad or other clean bleeding may require application of a tourniquet, which
dressing and apply direct pressure with your gloved is a skill taught in many first aid courses. Always make
hand until the bleeding stops (Figure 9-5, A). This may sure you seek help as indicated in your employer’s
take as long as 15 minutes. If blood soaks through policies if you believe a tourniquet should be applied
the first dressing, place another dressing on top of or if you believe life-threatening bleeding is occurring.
the first and apply additional direct pressure (press
harder than you did before, if possible). When the Shock
bleeding stops, check for circulation (feeling, warmth Shock is a progressive, life-threatening condition in
and color) beyond the injury. Then apply a bandage which the circulatory system fails to deliver enough
over the dressing to maintain pressure on the wound oxygen-rich blood to the body’s tissues and organs.
and to hold the dressing in place (Figure 9-5, B). As a result, organs and body systems begin to fail.
If the bleeding does not stop, you must call for help. Common causes of shock include severe bleeding,
Stay with person, and observe the person closely for severe allergic reactions (anaphylaxis) and severe
signs that may indicate that the person’s condition is infections that overwhelm the body, but shock can
worsening, such as breathing that is faster or slower develop quickly after any serious injury or illness.
A person who is showing signs and symptoms of
shock needs immediate medical attention.
A person who is going into shock may show any of the
following signs or symptoms:

• Restlessness or irritability
• Altered level of consciousness
• Nausea or vomiting
• Pale, ashen (grayish), cool, moist skin
• Rapid breathing
• Rapid, weak heartbeat
• Excessive thirst
The treatment for shock depends on the underlying
cause. For example, if the shock is caused by severe
blood loss, the bleeding must be stopped. Shock that
A is caused by a severe allergic reaction is treated by
administering epinephrine. People who know they are
severely allergic to something may carry epinephrine
with them in the form of an auto-injector (Figure 9-6).
You can learn how to assist someone with using an

Figure 9-6 A person who is at risk for anaphylactic shock as a

B result of a severe allergy may carry an auto-injector like this one. The
Figure 9-5 First aid for external bleeding. (A) Cover the wound with auto-injector contains epinephrine, a medication used to treat life-
a sterile dressing and apply direct pressure. (B) Apply a pressure threatening allergic reactions. EpiPen® is a registered trademark
bandage to secure the dressing. owned by the Mylan companies.

118 | | Nurse Assistant Training

auto-injector in the American Red Cross First Aid/ very quiet and have a blank stare. A person with epilepsy
CPR/AED course. may experience something called an aura (an unusual
sensation or feeling) before the onset of a seizure.
To provide first aid for a person who is in shock, first
call for help immediately. While you are waiting for help Most seizures last only a few minutes, and the person
to arrive: usually recovers fully without any complications.

• Have the person lie flat on their back (Figure 9-7). Your main goal is to protect the person from injury
• Control any external bleeding. during the seizure. Move nearby furniture or other

• Cover the person with a blanket to prevent loss of

body heat.
objects out of the way that the person could
accidentally hit while convulsing. Do not try to hold

• Do not give the person anything to eat or drink,

even though the person may complain of thirst.
or restrain the person, and do not put anything in the
person’s mouth or between the teeth to prevent the
person from biting their tongue. Place the person on
Eating or drinking increases the person’s risk
their side in a recovery position as soon as it is feasible
for vomiting and aspiration (inhalation of foreign
so that fluids (saliva, blood, vomit) can drain from
matter into the lungs). Aspiration can cause serious
the mouth (Figure 9-8). Typically, once the muscular
complications, such as pneumonia.
convulsion stage passes, the person will remain
• Provide reassurance and help the person rest
comfortably. Anxiety and pain can intensify the
unresponsive for a period of time and then gradually
return to a normal level of responsiveness. Maintain the
body’s stress and speed up the progression of person in the recovery position until the person is once
shock. again awake and alert.
• Continue to monitor the person’s condition and
watch for changes in level of consciousness. The person may be drowsy and disoriented for a
period of time. The person may be very tired and want
Seizure to rest. Check to see if the person was injured during
the seizure. Offer comfort and reassurance, especially
A seizure is the result of abnormal electrical activity
if the seizure occurred in public, as the person may
in the brain, leading to temporary and involuntary
feel embarrassed and self-conscious. Stay with the
changes in body movement, function, sensation,
person until the person is fully recovered from the
awareness or behavior. Seizures can have many
seizure and aware of their surroundings.
different causes. Some people may have epilepsy, a
chronic seizure disorder that can often be controlled Fainting
with medication. Other causes of seizure include
fever, infection, diabetic emergencies, heat stroke and Fainting, also known as syncope, is a temporary loss of
injuries to the brain tissue. consciousness caused by a sudden decrease in blood
flow to the brain. When the brain is suddenly deprived
Although usually we think of a seizure as involving of its normal blood flow, it momentarily shuts down.
convulsions (uncontrolled body movements caused by
contraction of the muscles) and loss of consciousness, Fainting can be triggered by an emotional shock,
sometimes a person having a seizure will just become such as the sight of blood. It may be caused by pain,

Figure 9-8 Place the person in the recovery position as soon as

feasible. Turning the person onto the side helps to prevent the
Figure 9-7 Help a person who is in shock to lie down on their back, person from choking on fluids (such as saliva or vomit) that may pool
and keep the person from becoming too chilled or too hot. in the mouth.

Chapter 9 | Responding to Emergencies | 119

 specific medical conditions like heart disease, standing attention. Follow your employer’s procedures for
for a long time or overexertion. Some people, such as calling for help if the person with burns:
pregnant women or older adults, are more likely to faint
when suddenly changing positions, for example when • Has trouble breathing.
moving from lying down to standing up. Whenever
changes inside the body momentarily reduce the blood
• Has burns covering more than one body part or a
large area of the body.
flow to the brain, fainting may occur. • Has burns to the head, neck, hands, feet or genitals.

A person may faint with or without warning. Often, • Has signs of burns around the mouth and nose.
the person may first feel lightheaded or dizzy
(presyncope). There may be signs of shock, such
• Has burns involving underlying structures (for
example, muscles or bone) and the person is
as pale or ashen, cool, moist skin. The person may younger than 5 years or older than 60 years.
have blurry vision, feel nauseated and complain of
numbness or tingling in the fingers and toes. The
• Has a burn caused by exposure to chemicals, an
explosion, lightning or electricity.
person’s breathing and pulse may become faster. To
While waiting for help to arrive, first stop the burning
prevent a fainting episode, help the person lie down
by removing the source of the injury, if it is safe for
(Figure 9-9). While the person is lying down, you
you to do so. For a burn caused by heat, cool the
should monitor breathing and level of consciousness.
burn with large amounts of cool or cold running
There are some additional techniques you can learn
water for at least 10 minutes. For a liquid chemical
in first aid to help prevent someone with presyncope
burn, remove the chemical from the skin by flushing
from actually fainting. If the person does begin to
the area with large amounts of cool water for at
collapse, lower the person to the floor using good
least 15 minutes. For a dry chemical burn, brush the
body mechanics, and position the person flat on their
chemical off using gloved hands and then flush the
back. Loosen tight clothing, such as a tie, collar or
area with cool water for at least 15 minutes. Be careful
scarf. Check that the person is breathing normally.
not to get the chemical on yourself or on another area
Do not give the person anything to eat or drink. If the
of the person’s body. If the burn was caused by an
person vomits, roll the person onto one side to prevent
electrical shock, turn off the power at its source before
choking. The person will usually recover quickly with
attempting to assist the person. If you cannot turn the
no lasting effects; however, the person should receive
power off at the source, do not touch the electrical
a medical evaluation after the episode.
wire or the person.
Burns Finally, cover the burned area loosely using a sterile,
Burns are traumatic injuries to the skin and sometimes dry dressing. Provide reassurance, and monitor the
the underlying structures (for example, bone and person for the development of shock.
muscle) caused by contact with extreme heat,
chemicals, electricity or radiation. Burns can range Delirium
in severity from minor (for example, a sunburn) to Delirium is a change in cognition that leads to
critical. Critical burns are life threatening, disfiguring sudden severe confusion. It has a rapid onset and
and disabling, and they require immediate medical is related to chemical changes in the body. Quick
identification and treatment of the underlying cause
of the delirium is necessary to reduce the person’s
risk for experiencing long-term effects. Delirium is
sometimes mistaken for dementia in older adults.
You will learn more about delirium and dementia in
Chapter 20.
Signs and symptoms of delirium include:

• Seeing, feeling or hearing something that is not

there (hallucinations).
• Not being able to recognize a familiar person.
• Being extremely restless, especially at night.
• Failing to remember things that happened quite
recently.
Figure 9-9 A person who feels faint may be able to prevent syncope
by lying down.
• Wandering, even though the person knows the way
to get around.

120 | | Nurse Assistant Training

• Not being able to concentrate or follow instructions. • Keep materials such as matches and lighters in a
• Becoming lethargic and displaying little movement
or activity.
secure place, out of reach from children and people
who are confused.

Call for help immediately. An older adult experiencing • Never permit smoking around a person who is using
oxygen.
delirium needs medical attention to identify and treat
the underlying cause. Remain calm as you focus on
keeping the older adult safe.
• Report any electrical equipment that is not working
properly or is not well maintained to your supervisor.

Responding to Fire Emergencies

Fire Emergencies If a fire does break out, you must know how to
A fire in a healthcare facility can be devastating. Many respond. Your facility will have a fire emergency plan,
people who are receiving healthcare have limitations in which will specify the method used to alert others
mobility, hearing, vision or understanding—all of which to fire (for example, a phone number to call or the
interfere with their ability to successfully react to a fire. location of fire alarm pull boxes). The fire emergency
As a nurse assistant, you must know how to prevent a plan will also specify when and how to evacuate the
fire from occurring, and what to do if a fire does occur. people in the building, as well as any special measures
to take to prevent a fire from spreading. Be familiar
Preventing Fire Emergencies with your facility’s fire emergency plan and participate
For a fire to occur, the following must be present: fuel in the periodic drills that are held to practice putting
(something that burns), heat (something to ignite the the plan into action (Figure 9-11).
fuel) and oxygen (Figure 9-10). Removing any one of The word “RACE” can help you to remember how to
these elements will stop a fire from increasing. react to a fire emergency:
Remember that many people who receive healthcare
require oxygen therapy, which increases the risk for fire. • Rescue. Stop what you are doing and remove
anyone in immediate danger from the fire to a safe
Take the following precautions to help prevent fires: area. Get out as safely and quickly as possible. The
• Supervise the people in your care whenever they
smoke.
less time you and others are exposed to poisonous
gases, heat or flames, the safer everyone will be.

• Follow your employer’s rules about smoking. If you

provide care for people who smoke, make sure
Box 9-1 describes how to move people to safety in
the event of a fire emergency.
they smoke only in appropriate places and safely
extinguish their smoking materials. Make sure the
• Alarm. Activate the nearest fire alarm pull station (if
applicable). Call 9-1-1 (or another number, per your
person uses any protective equipment (such as a employer’s policy) to report the location and current
smoking apron) per your employer’s policy. extent of the fire.

Figure 9-10 Three elements must be present for a fire to start: fuel Figure 9-11 Knowing what to do in the event of a fire can save your
(something to burn), heat (something to ignite the fuel) and oxygen. life and the lives of others.

Chapter 9 | Responding to Emergencies | 121

 • Contain. Close all doors and windows that you can
safely reach to contain the fire. As you leave an
area, close the door behind you.
• Extinguish. Only attempt to extinguish the fire if it is
safe for you to do so. If the fire is relatively small and
contained, you may be able to put it out using a fire
extinguisher.
Generally, to use a fire extinguisher, pull the safety
pin out, aim the hose at the base of the fire, squeeze
the handle, and spray using a side-to-side sweeping
motion (Figure 9-12). There are three major types of
fires, classified as type A, B or C (Table 9-1). Most fire
extinguishers are ABC fire extinguishers, which means
they are effective against all types of fires. In the event
that an ABC fire extinguisher is not available, you must
use an extinguisher specific to the type of fire or take
other measures as summarized in Table 9-1. Figure 9-12 If you need to use a fire extinguisher, remember the
word “PASS”: Pull the pin out, Aim the hose at the base of the fire,
Squeeze the handle, Spray in a side-to-side motion.

Table 9-1 Types of Fires and Fire Extinguishers

Type Description How to Put the Fire Out

A fire that uses ordinary dry materials Type ABC fire extinguisher, or Type A fire extinguisher, or water.
A as fuel, such as wood, paper or leaves

A grease fire (kitchen fires are often Type ABC fire extinguisher, or Type B fire extinguisher, or smother the
grease fires) fire by sprinkling baking soda over it or putting the lid on the pan and
B removing the pan from the heat source.

NEVER USE WATER!

An electrical fire, such as one caused Type ABC fire extinguisher, or Type C fire extinguisher.
C by frayed wiring
NEVER USE WATER!

Box 9-1 Removing People to Safety in a Fire Emergency

• Touch doors with the back of your hand before

you open them. If the door is hot, do not open it.
• Move people who cannot walk in their beds or in
wheelchairs.
Leave the area another way. If the door is cool,
stand to one side and open it slowly. If you see • Remember that people may be frightened and
confused. Help to reassure them by remaining
heavy smoke on the other side, close the door. calm and explaining what is happening. Reassure
• Stay low. Smoke rises, and it is easier to breathe
when you are closer to the floor.
people that you will help move them to a safe
area. After people are moved to a safe place,
• Use stairs, not an elevator. make sure a staff member remains with them to

• If your clothing or that of another person catches

fire, stop, drop (to the ground), and roll over and
keep them from wandering into dangerous areas.
The presence of a staff member is especially
important for people who have vision or hearing
over (to extinguish the flames).
disabilities or who are confused.

122 | | Nurse Assistant Training

Weather Emergencies, occurs suddenly, there is no time to evacuate, and the
normal functioning of the facility will be affected for an
Disasters and Other Events extended period of time.
with Widespread Impact In the event of a disaster, you will play a very important
Environmental events can occur that put people in role in helping to reassure and calm the people in
immediate danger and affect the ability of the facility to your care. Many of the people in your care will have
function normally, resulting in an emergency situation. characteristics that make them more vulnerable
For example, weather emergencies such as ice or during times of crisis. For example, a person who has
snowstorms can result in power outages, an inability recently experienced an upsetting event (such as
to receive supplies for an extended period of time, separation from or loss of a loved one) might be less
and staffing shortages. When this occurs, the facility’s able to cope with the emotional impact of the disaster.
ability to follow normal routines to provide care may A person who is dependent on others for care will
be disrupted, and an emergency exists. When an understandably be very frightened during an event that
event affects many people and causes widespread disrupts the normal routine of the facility. A person
damage and destruction in the community, it is called with dementia will not be able to understand what is
a disaster. Disasters can be caused by natural events happening and will become very upset by the change
(such as tornadoes, hurricanes or floods), or they may in the normal routine. People who speak a language
be caused by man (such as bombings, chemical leaks other than English may fear that they will not be able
and nuclear accidents). to communicate their needs. By staying calm, knowing
what to do and offering reassurance, you can help the
As a nurse assistant, you must be prepared in the people in your care to feel safe.
event of a weather emergency or disaster. Know
what types of weather emergencies are common In a disaster situation, staff members who are on duty
in the area where you live, and familiarize yourself may be required to stay at the facility for longer than
with actions you should take to keep yourself and one shift because conditions outside may make it
others safe should such an emergency arise. Box 9-2 unsafe or impossible for people to travel to and from
summarizes actions you take in the event of some the facility. If you are on duty and a disaster occurs,
common weather emergencies. You can learn more your primary responsibility is assisting the people in
about other weather emergencies that may be your care. However, naturally, you will be concerned
more common in your area by visiting the American about the health and safety of your own family
Red Cross website or your local American Red while you cannot be with them. Developing a home
Cross chapter. disaster preparedness plan that describes what family
members should do if they are away from home or
Your employer will have a disaster preparedness plan apart from each other when a disaster occurs can give
that specifies the actions the staff should take in the you peace of mind. Review the plan frequently with
event of a disaster. Make sure you know your role and family members so that you are confident everyone
responsibilities. Often, when a major event such as a knows what to do. Also, make sure you are prepared in
hurricane is predicted and there is time to prepare, the the event that you must remain in the facility for longer
disaster preparedness plan will specify that patients or than one shift. For example, if you require medication
residents are to be evacuated to another facility. The to manage a chronic condition, make sure you have
disaster preparedness plan will also specify measures enough on hand to see you through the emergency.
that should be taken to cope with the event if it

Chapter 9 | Responding to Emergencies | 123

 Box 9-2 Weather Emergencies

General Precautions • Be alert to weather conditions (for example,

• Listen for weather reports on the radio or television.

In a hospital or nursing home, know which staff
dark or greenish clouds, funnel clouds), blowing
debris and the sound of an approaching tornado.
A tornado often sounds like a freight train. Inform
members are assigned to listen to the reports.
other staff members if you see or hear anything.
• Have a flashlight, a battery-operated radio and
fresh batteries available. • Move people to the basement of the building.
If the building has no basement, a windowless
• Make sure you have access to a supply of fresh
water.
room on the lowest level of the building is the
next best option.
Hurricanes. A hurricane occurs when the winds of
• Close the doors to rooms and close fire doors.
a large tropical storm (that is, a storm that begins
over warm ocean water) increase to 74 miles per • Make sure doorways to halls, fire doors and exits
are not blocked.
hour or more.
A hurricane watch means a hurricane is possible
• Follow evacuation procedures if necessary.
A tornado warning means a tornado has been
in your area within the next 48 hours. If a hurricane
sighted or indicated on weather radar in the area.
watch is issued in your area:
If a tornado warning is issued in your area:
• Prepare for a possible evacuation, per your
employer’s disaster preparedness plan. • Immediately move yourself and others to the
basement of the building or a windowless room
• Check outdoor areas: remove or secure loose
objects and prepare to board up windows.
on the lowest level of the building.
Earthquakes. An earthquake occurs when the
A hurricane warning means hurricane conditions are plates that make up the Earth’s surface move against
expected within 36 hours. If a hurricane warning is each other, causing the Earth to shake. This activity
issued in your area: in the Earth may cause buildings to shake, windows
• Follow your employer’s disaster preparedness
plan for evacuating patients or residents to
to shatter and objects to shift or fall. It also can
cause fires to start and can generate large ocean
another facility (if an evacuation order is issued). waves. Earthquakes can occur in most states, and

• If you are not told to evacuate, move people into

interior rooms or hallways. Keep people away
they may occur at any time without warning. If you
are inside when an earthquake occurs, stay inside
and protect yourself and others from falling or
from windows. If a person cannot easily get of
shifting objects by taking cover under a large, heavy
bed, move the person in the bed into a hallway,
object (such as a desk or table) and holding on.
or push the bed against the wall. Assign a staff
If you are outside when an earthquake occurs, stay
member to stay with people who have been
outside but move away from buildings, trees and
moved to safety.
overhead wires.
• Cover people with blankets or bedspreads to
protect them from flying glass in case windows After the earthquake:

•
break.
Close the doors to rooms and close fire doors.
• Be prepared for aftershocks (smaller quakes that
occur after the first tremor).
• Make sure doorways to halls, fire doors and exits
are not blocked.
• Check yourself and others for injuries. Never try
to move seriously injured people unless they are
• Monitor weather conditions carefully. in danger of further injury.
Tornadoes. A tornado is a spinning, funnel-shaped
windstorm that moves along the ground. Tornadoes
• Do not use equipment or services requiring
electricity, gas, water or sewage disposal
can arise very suddenly. because these systems may be damaged. If you
smell gas or see a broken line, shut off the main
A tornado watch means that weather conditions valve or inform the person responsible. Do not try
are favorable for a tornado in your area. If a tornado to turn utilities back on.
watch is issued in your area:

(Continued )

124 | | Nurse Assistant Training

 Box 9-2 Weather Emergencies (Continued)

• Never smoke or light candles. Earthquakes can

create gas leaks, and an open flame from a match
• Listen to a battery-operated radio for updated
information about the emergency.

•
or cigarette lighter can cause an explosion.
Use the telephone only in a life-threatening
• Clean up spilled medicines, drugs, flammable
liquids and other materials.

•
emergency.
Watch for fallen power lines.
• Open cabinets and closet doors cautiously. The
items inside may have shifted and could fall on
you when you open the door.

Check Your Understanding 5. You are with a group of residents in the

day room when suddenly one of the female
Questions for Review residents loses consciousness and slumps
over in her chair. What should you do after
1. What should you do if a fire alarm sounds checking the scene?
while you are at work?
a. Call for help immediately.
a. Leave the building and go home. b. Splash water on the resident’s face to
b. Ask another nurse assistant what to do. revive her.
c. Follow your employer’s policies for responding c. Move furniture out of the way to protect her
to a fire alarm. from further injury.
d. Ignore the fire alarm, because it is probably d. Administer cardiopulmonary resuscitation
only a fire drill. (CPR).
2. If your clothing catches fire, you should: 6. As soon as it is safe to do so, how should you
a. Run, cover and cool. position a person who is having a seizure?
b. Stop, drop and roll. a. Flat on the person’s back
c. Call the fire department. b. On the person’s side
d. Blanket, bathe and bandage. c. Seated, with the person’s head between the
knees
3. Which of the following could be a sign of a
d. On the person’s stomach
stroke?
a. Profuse sweating 7. One of your co-workers has cut herself with
b. Convulsions a knife while cutting up fruit for a smoothie-
making activity with the residents, and she is
c. Fainting
bleeding severely. What is the first thing you
d. Drooping on one side of the face
should do?
4. You are helping Mr. Cooperstone to eat when a. Call 9-1-1 and monitor her for shock.
he begins to choke. He is making a high- b. Put on a pair of gloves and then go to her aid.
pitched wheezing sound, and it is difficult for c. Put a dressing over the cut and apply pressure
him to answer you when you ask if he needs to stop the bleeding.
help. What should you do?
d. Rinse the cut with water.
a. Perform cardiopulmonary resuscitation (CPR).
b. Call for help immediately, and then begin 8. You are a home health aide on duty and a
administering back blows and abdominal tornado watch has been issued for your area.
thrusts. Which area in the client’s home would be the
best place to move the client to safety?
c. Watch him carefully for a minute to see if he is
able to cough up the object on his own. a. The dining room, which has large windows
d. Call for help immediately, and then provide b. A windowless bathroom on the ground floor
reassurance until help arrives. c. The client’s room
d. The front hall

Chapter 9 | Responding to Emergencies | 125

 9. Which of the following could be a sign or 5. You wake Mrs. George and notice that the left
symptom of a myocardial infarction? side of her mouth is drooping. What should
a. Blurred vision you do?
b. Nausea 6. Mrs. Lopez is wandering around the nursing
c. Aura home, which is unusual for her. She is confused
d. Shock about who you are and where she is. What
should you do?
10. Fainting, also known as _________, is a
temporary loss of consciousness caused
by a sudden decrease in the blood supply
to the brain. What Would You Do?
Recall Mrs. Schulman from the beginning of the
Questions to Ask Yourself chapter. You are concerned about the numbness
1. You enter Mr. Lee’s room and see flames shooting and weakness Mrs. Schulman is reporting on her
out of the trash can. What should you do? left side. You do the “FAST” test with Mrs. Schulman
and see that she is not able to raise her left arm. You
2. You are alone at Mrs. Jones’s house and she suspect that Mrs. Schulman has had a stroke and
begins to choke on a piece of hot dog. What decide to call 9-1-1, per your employer’s policy. Then
should you do? you call Mrs. Schulman’s daughter.
3. You are with Mr. Smith in the bathroom and you 1. What information should you be ready to give the
emergency services dispatcher?
notice that he is sweating profusely, clutching
2. What care will you provide to Mrs. Schulman while
his chest and gasping for air. What should
you are waiting for the ambulance to arrive?
you do?
4. You are caring for Mr. White in his home and he
begins to have a seizure. What should you do?

126 | | Nurse Assistant Training

 SKILLS

Skill 9-1
Caring for an Adult Who Is Choking
1. Verify that the person is choking by asking the 3. Give 5 abdominal thrusts.
person to speak to you.
• If the person is able to speak to you or is
• Have the person stand up straight. Stand
behind the person with one foot in front of the
coughing forcefully: Encourage the person to other for balance and wrap your arms around
keep coughing, but be prepared to give first aid the person’s waist.

•
for choking if the person’s condition changes.
If the person is unable to speak to you or
• Using two fingers of one hand, find the person’s
navel. With your other hand, make a fist and
is coughing weakly: Send someone to call place the thumb side against the person’s
9-1-1 or the designated emergency number and stomach, right above your fingers.
to obtain an AED and first aid kit. Continue to
• Cover the fist with your other hand.
step 2 after obtaining consent.
2. Give 5 back blows.
• Pull inward and upward to give an abdominal
thrust (Figure 2).
• Position yourself to the side and slightly behind
the person. Place one arm diagonally across
the person’s chest (to provide support) and
bend the person forward at the waist so that the
person’s upper body is as close to parallel to the
ground as possible.
• Firmly strike the person firmly between the
shoulder blades with the heel of your hand
(Figure 1).

Figure 2

Figure 1
(CONTINUED)

Chapter 9 | Responding to Emergencies | 127

 SKILLS

Skill 9-1
Caring for an Adult Who Is Choking CONTINUED
Note: If the person is pregnant or too big for 4. Continue giving sets of 5 back blows and
you to wrap your arms around, you will need to 5 abdominal thrusts until:
give chest thrusts instead of abdominal thrusts.
To give chest thrusts, position yourself behind • The person can cough forcefully, speak, cry
or breathe.
the person as you would for abdominal thrusts.
Place the thumb side of your fist against the • The person becomes unresponsive.
Note: If the person becomes unresponsive,
center of the person’s breastbone. Then cover
your fist with your other hand and pull straight gently lower the person to the floor and
back, giving a quick, inward thrust into the begin CPR if you are trained, starting with
person’s chest (Figure 3). compressions. After each set of compressions
and before attempting rescue breaths, open the
person’s mouth, look for the object and remove
it if seen. Never put your finger in the person’s
mouth unless you actually see the object.
5. Document your observations and actions per your
employer’s policy. Be aware that the person will
need to receive a medical evaluation after the
emergency has passed.

Figure 3

128 | | Nurse Assistant Training