The Correct Order of Actions Using the RACE Acronym
The correct order of actions in the RACE acronym for emergency situations is: Rescue, Alarm, Contain, Extinguish or Evacuate. 1
Detailed Breakdown of RACE Protocol
R - Rescue
- First priority is to rescue people in immediate danger from the emergency situation 1
- Staff safety must be the priority when dealing with a fire or other potentially life-threatening emergency 1
- Rescuers should make an emergency "dynamic risk assessment" weighing responsibilities to patients against risk to their own life 1
- Focus on moving those in immediate danger to safety before proceeding to other steps 1
A - Alarm
- Activate the fire alarm to alert others in the building 1
- Call for help immediately after ensuring immediate rescue efforts have begun 1
- Ensure fire alarms are audible throughout the department (unless specifically turned off by clinicians) 1
- Delegate one staff member to update all teams about the emergency situation 1
C - Contain
- Contain the fire or emergency by closing doors and windows 1
- Consider operating oxygen shut-off valves (area valve service units) for the affected area if appropriate 1
- Remove all drapes and burning material in case of non-airway fire 1
- Flood fire with saline or saline-soaked gauze to contain spread 1
E - Extinguish or Evacuate
- Attempt to extinguish small fires using appropriate fire extinguishers (carbon dioxide extinguishers are recommended for electrical fires and those in operating theaters) 1
- If fire cannot be contained or extinguished, proceed with evacuation 1
- Follow evacuation routes and procedures established for the specific clinical area 1
- Aim to complete evacuation within 30 minutes when necessary 1
Implementation Considerations
Training Requirements
- Clinical staff should receive multidisciplinary training in fire management and evacuation procedures as part of annual mandatory training 1
- Practical "walk-through" training and simulated evacuations should be practiced every 2 years 1
- Nominated clinical staff should be trained to select and safely use fire extinguishers 1
- Laminated action cards specific to each clinical area should be placed next to all manual fire call points 1
Equipment Preparation
- Each clinical area should have appropriate evacuation equipment stored in easily accessible locations 1
- Ensure sufficient numbers of appropriately trained staff are working on each shift to enable emergency evacuation at any time 1
- Maintain proper ventilation (>10 air changes per hour) in areas using high-flow oxygen to prevent oxygen enrichment of ambient air 2
- Have carbon dioxide fire extinguishers available in areas where lasers are used 1
Common Pitfalls to Avoid
- Failing to maintain protective formations during evacuation (reported in 49% of simulated scenarios) 3
- Inappropriate single patient evacuation (observed in 20% of simulated scenarios) 3
- Failure to communicate with law enforcement to ensure safe treatment areas (problematic in 30% of simulations) 3
- Wrapping tubes in metal foil to reduce fire risk is a historical practice that is actively discouraged 1
Post-Emergency Actions
- All staff involved in a fire or similar emergency should be supported following the event 1
- Attend a short operational debrief and be assessed by occupational health before returning to work 1
- Conduct a full investigation of any critical incident looking at all relevant contributory factors 1
- Implement peer-support tools such as trauma risk management to support affected staff 1