Unit 4-Safety and Emergency Procedures

Unit 4
Safety and Emergency

Procedures
Nurse Aide I Course
DHSR Approved Curriculum-Unit 4 1

Introduction to
SAFETY AND EMERGENCY
PROCEDURES
Personal safety and the well-being
of residents is a vital component of the
health care system.
If safety rules are ignored, the
nurse aide or another individual could
be seriously injured or die.

Introduction to
SAFETY AND EMERGENCY
PROCEDURES
This unit explores general safety
rules, safety measures that prevent
accidents, fire safety and prevention,
disaster plans, and responsibility in
emergency situations.
The nurse aide is expected to
respond immediately and effectively to
illness, injury, and life-threatening
circumstances.
4.0 Identify ways to prevent accidents
and other emergencies.
4.1 Adhere to general safety rules.
4.1.1 List 16 rules of general safety.

General Safety Rules
• Walk in halls and on stairs -
never run
• Keep to the right-hand side
of the hall
• Approach swinging doors
with caution
• Use handrails going up and
down stairs
(continued)
• Keep halls and stairs free of
obstacles
• Check labels on all
containers prior to using
contents
• Wipe up spilled liquids
immediately
(continued)
• Pick up litter and place it in the
proper container
• Follow instructions of your
supervisor for resident care
• Report injuries promptly
• Never use damaged or frayed
electrical cords
(continued)
• Ask for an explanation of things you
don’t understand
• Elevate side rails for residents at risk
of falling, per facility policy

(continued)
• Check linen for personal items
contained in folds prior to
sending to the laundry
• Never use malfunctioning
equipment
• Report unsafe conditions
immediately
4.1.2 Recognize factors that increase
the resident’s risk of injury.

Factors That Increase The
Resident’s Risk Of Injury
• Age related
– Decreased strength
– Slower movement
– Difficulty maintaining
balance
– Tremors that may
affect balance
(continued)
• Awareness of surroundings
– Some totally unaware
• unconscious
• coma
– Some suffer from
dementia
• confused
• disoriented
(continued)
• Decreased vision
– Difficulty seeing objects
– In danger of falling or
tripping
– Difficulty reading labels or
containers
(continued)
• Hearing impaired
– May not hear warning
signals or alarms
– May not hear approaching
equipment

(continued)
• Smell and touch

– Reduced smell – unaware
of smoke or gas fumes
– Decreased sensitivity to
heat and cold - easily
burned

(continued)
• Inability to move independently
– Crippling diseases
– Arthritis
– Paralysis

4.1.3 List six effects of medications
that could cause the resident to
have an accident.

(continued)
• Medications can:
– Affect balance
– Reduce awareness
– Cause confusion/disorientation
– Cause drowsiness
– Affect coordination
– Make fearful and
uncooperative
4.2 Identify safety measures that
prevent accidents to residents.

Preventing Falls
• Falls account for 70% of
accidents in health care facilities
• Answer call signals
promptly
• Keep frequently used
articles within reach of
resident

Preventing Falls
(continued)
• Lock brakes on movable equipment
– wheel chairs
– stretchers and mechanical lifts
– beds
– commodes

Preventing Falls
(continued)
• Properly position
residents in:
– bed
– wheel chair
• Report observations to supervisor
that lead you to believe a resident is
prone to falling
Preventing Falls
(continued)
• Report any facility structure hazard
immediately that could lead to falls
– frayed carpeting
– loose or broken side rails
– lights that don’t work

Preventing Falls
(continued)
• Report broken or
malfunctioning
equipment
immediately

Preventing Burns
• Second most
common hazard to
residents
• Check water
temperature in bath
or shower with bath
thermometer

Preventing Burns
(continued)
• Report areas
where water
temperature
seems too hot
• Monitor smoking
practices

Preventing Burns
(continued)
• Provide assistance at
mealtime to prevent
spilling hot liquids
• Use facility equipment
according to written
policies

Preventing Burns
(continued)
• Monitor use of
electrical
appliances used by
resident
• Avoid overexposure
to sunlight

Preventing Poisoning:
Toxic Products
• Store in locked cabinets
• Store away from resident areas
• Never leave products where they
might be ingested

Preventing Poisoning:
Toxic Products
(continued)
• Have identifying labels on all
containers
• Never use unlabeled substance

Preventing Injury When
Performing Care
• Provide care to right resident
• Use identification bracelets
• Call resident by name

Preventing Injury When
Performing Care
(continued)
• Use I.D. systems that
involve photographs
• Realize that care to
wrong resident can
threaten life

Preventing Suffocation
• Encourage residents to
use their dentures when
eating
• Assist to cut food into
small pieces
• Report difficulty in
swallowing

Preventing Suffocation
(continued)
• Never leave unattended in
bathtub
• Immediately transport from
areas where smoke or gas
fumes are noticed
• Properly apply and check
vest and safety belt
restraints
Preventing Spread of
Microorganisms
Wash hands before

and after care
Follow Standard
Precautions
Preventing Other Injuries
• Move equipment around corners with

caution
• Be careful of feet when transporting
residents in wheelchairs

(continued)
• Monitor residents who

wander away
• Follow instructions when
providing care
• Keep bed in lowest position
except when giving bedside
care
(continued)
• Use night lights in rooms

• Have residents wear
shoes/slippers with non-
skid soles
• Check crutches, canes and
walkers for non-skid tips

(continued)
• Keep call signal within

easy reach
• Report immediately any
observations indicating
resident is a danger to
himself or others.

4.3 Practice good personal body
mechanics.

Body Mechanics
• Body mechanics: the
coordination of body
alignment, balance and
movement
• Job requirements for nurse
aides include lifting,
moving and transferring
resident and lifting, moving
and carrying objects
Body Mechanics
(continued)
• Purpose of Good Body Mechanics

– Maximize strength
– Minimize fatigue
– Avoid muscle strain
and injury
– Assure personal and
resident safety
4.3.1 List 18 guidelines for good body
mechanics.

Guidelines for Good Body
Mechanics
• Never bend over from waist

to pick up object
• Lift firmly and smoothly
• Keep object close to body
• Keep back straight

Mechanics
(continued)
• Bend at hips and knees
and get close to object
prior to lifting
• Grip objects firmly with
both hands
• Lift by pushing up with
strong leg muscles
Mechanics
(continued)
• Get help if object or

resident appears too heavy
• Keep feet apart to provide
wide base of support
• Pivot or turn with feet

Mechanics
(continued)
• Use short steps to turn
• Turn entire body without
twisting back and neck
• Pull or push when
possible instead of lifting
• Use body weight to help
push or pull
Mechanics
(continued)
• When reaching for

an object, evaluate
distance
• Face in direction
you are working to
prevent twisting

Mechanics
(continued)
• Adjust beds to waist

level when giving
resident care
• Be sure body is in good
alignment at all times

4.4 Identify and discuss fire safety
activities and potential fire
hazards.

Fire Safety
Everyone is responsible for
preventing fires
If fire occurs, know what to do

Fire Safety
• Major fire hazards
– faulty electrical
equipment and wiring
– overloaded electrical
circuits
– plugs not properly
grounded
– clutter - paper/rags
Fire Safety
(continued)
• Major fire hazards (continued)

– unsafe practices when
oxygen is in use
– smoking
– spontaneous combustible
materials

Fire Safety
(continued)
• Elements necessary to
start fire
– fuel - material that
will burn
– heat - flame or spark
– oxygen

Fire Safety
(continued)
• Fire safety activities
– Locate and learn
• escape routes and fire escapes
• use of all fire control equipment
–fire doors
–sprinkler system controls
–fire extinguishers
• fire drill procedures
Fire Safety
(continued)
• Fire Safety Activities

– Be aware of all fire
hazards and report
them immediately

Fire Prevention
• Watch for frayed
electrical wires
• Never overload circuits
• Use three-prong
grounded plugs
• Never use extension
cords
• Control clutter
Fire Prevention
(continued)
• Dispose of rags properly
• Empty ashtrays in metal
containers
• Empty wastebaskets in
proper receptacles
• Report odors of smoke
or burning
• Keep fire exits clear
Fire Prevention
(continued)
• Control smoking practices:
– limit to specific areas
– never allow smoking in
bed
– have large ashtrays
available

Fire Prevention
(continued)
• Control smoking practices:
– observe use of
matches/lighters
– directly supervise
residents when
smoking, as necessary

4.4.1 Discuss the precautions that
should be taken when oxygen is
in use.

Oxygen Precautions
• Oxygen precautions
– Never have open flames
or smoking in area
– Remove flammable
liquids from area
– Do not use electrical
equipment in area

Oxygen Precautions
(continued)
• Oxygen precautions
– Post “Oxygen in Use”
sign
– Remove cigarettes and
matches from room
– Use cotton blankets
and clothing
In Event Of Fire
• In event of fire
– Keep calm
– Move residents to
safety
– Sound alarm
– Follow evacuation
plan
In Event Of Fire
(continued)
• In event of fire
– Close all windows
and doors
– Shut off air
conditioning
– Shut off oxygen
– Shut off lights
– Never use elevators
Use of Fire Extinguisher
• Carry upright
• Remove safety pin
• Push handle down FIRE
• Direct spray at base of fire

4.5 Review and follow disaster
procedures and plans for the
health care facility.

Disaster – Type Of Catastrophe
• Natural origin
– flood
– earthquake
– hurricane/tornado

Disaster – Type Of Catastrophe
(continued)
• Human disasters
– airplane/bus/train
accidents
– explosions
– nuclear waste
accident

Disaster Plans
Facilities are required to have

disaster plans
Disaster Plans
(continued)
• Responsibilities in a disaster
– Remove residents from
immediate danger
– Report to facility and follow
directions for your role
– Know your facility’s
disaster plan
– Assist with evacuation
Disaster Plans
(continued)
• Responsibilities in a disaster (continued):
– Help remove and secure equipment,
supplies, and records
– Think before you act; don’t waste
time
– Remain calm
– Carry out responsibilities in confident
manner
4.6 Discuss the emergency
treatment of a choking resident.
4.6.1 Assist with clearing an obstructed
airway.

Treating a Choking Resident
Causes of Choking
• Choking occurs when
the throat is blocked or
closed up and air cannot
get to the airway.

(continued)
• Airway may be blocked by:
– Food or liquids (meat
most common food)
– Blood or mucus
– Foreign objects including
the tongue
– Vomitus
(continued)
• Tilting head back in

unconscious person may
clear airway since this
pulls tongue forward

(continued)
• If victim is coughing, do not intervene:
– Stay near
– Encourage coughing -
most effective way to
dislodge obstructions
– Never slap coughing
resident on back: can
cause object to fall lower
into trachea
• Signals of severe foreign body airway
obstruction
– Unable to speak
– No air movement
– Grasping throat -
distress signal
• Abdominal thrusts, chest thrusts and
back slaps are effective for relieving
severe foreign body airway obstruction.
4.7 Demonstrate the procedure for
relief of choking.

4.8 Discuss and explain your
responsibilities in assisting with
resident who needs CPR.

Cardiopulmonary Resuscitation
(CPR)
• Agencies providing CPR instruction:
– American Heart Association
– American Red Cross
– EMS squads

How To Recognize Heart Attack
• Chest discomfort
– pressure, fullness, squeezing, or
pain
– in center of chest behind
breastbone or spread to either
shoulder, neck, jaw, or arm
– usually lasts longer than a few
minutes – comes and goes
How To Recognize Heart Attack
(continued)
• Fainting
• Sweating
• Nausea
• Shortness of breath

Accident Scene
• If certified in CPR, offer assistance

• Defer to those with more experience
and training

Accident Scene
(continued)
• Seek assistance
– in facility
• use emergency light
• use call signal
• send another resident
for help
• call for help
Accident Scene
(continued)
• Seek assistance
– at home or at accident scene
• dial 911 operator or emergency
number
• give location
• give phone number
• relate type of emergency
• give number of people needing help
• relate requested information
Information To Remember
About CPR
• You must be trained to administer
CPR
• Activate the emergency medical
system or your facility’s emergency
plan

Information To Remember
About CPR
(continued)
• CPR must be started immediately to

be effective
• Follow facility policy for Advanced
Care Directive

Cardiopulmonary Resuscitation
(CPR)
• Methods of administering CPR

– one-person CPR
– two-person CPR

4.9 Explain responsibilities in assisting
the resident for the following:
– convulsive disorders
– loss of consciousness
– shock
– hemorrhage
Convulsive Disorders (Seizures)
• Causes:
– infectious disease
– omitted medication
– head injury
– stroke
– seizure syndrome

(continued)
• Types
– Partial
– General
• Tonic-clonic
(grand mal)
• Absence
(petit mal)
– Unclassified
Specific Actions
• Summon help
• Stay with resident

Specific Actions
(continued)
• Protect from injury
– lower to floor if appropriate
– move objects away that might
cause injury
• Do not restrain or put any object into
mouth
Specific Actions
(continued)
• Loosen constricting clothing
(around neck)
• Place pillow under head and
turn face to one side
• Note time and type of seizure

Specific Actions
(continued)
• Provide rest for resident after seizure
– very tired
– may be confused
– often disoriented

Loss of Consciousness – Fainting
• Caused by temporary reduction of

blood to brain

(continued)
• Early signs and symptoms:
– dizziness
– decreased pulse and BP
– pallor and perspiration
– nausea
– cold skin
– numbness and tingling of extremities
Specific Actions
• Summon help
• Have resident sit or lie down
• Loosen tight clothing
• Position head lower than heart
– sitting - head between legs
– lying down - elevate legs
Specific Actions
(continued)
• Monitor pulse and respirations
• Have resident rest for 5-10
minutes before moving
• Provide blanket if cold

SHOCK
Causes
• Severe injury
• Excessive loss of body fluids
• Pain
• Respiratory and/or cardiac
arrest
• Anxiety
4.9.1 List seven symptoms of
approaching shock that you
might observe during resident
care.

SHOCK
Signs and Symptoms
• Low or falling blood

pressure
• Weak, rapid pulse
• Cold, moist, pale skin
• Rapid respirations

SHOCK
Signs and Symptoms
(continued)
• Thirst
• Restlessness
• Confusion and loss of
consciousness

SHOCK
Specific Actions
• Summon help
• Keep resident lying
down
• Control hemorrhage
• Keep resident warm
Hemorrhage
• Types
– Internal
– External

Hemorrhage
(continue)
• Signs and Symptoms
– Internal
• pain
• shock
• vomiting blood
• loss of
consciousness
– External
• can usually be seen
Hemorrhage
Specific Action
• Internal
– Summon help
– Stay with
resident
– Keep warm, flat
and quiet until
help arrives
Hemorrhage
Specific Action
(continued)
• External
– Summon help
– Stay with resident
– Identify location of bleeding
– Apply continuous, direct pressure
over bleeding
Hemorrhage
Specific Action
(continued)
• External
– If bleeding not controlled, apply
pressure over artery above bleeding
site
– If no pain or broken bones, elevate
wounded area above heart while
maintaining pressure
Hemorrhage
Specific Action
(continued)
• External
– keep resident
comfortable,
warm and quiet
until help arrives

4.9.2 Report emergencies accurately
and immediately.

Reporting Emergencies
• Never panic; remain calm

– Try few slow deep
breaths
– Observe surroundings
– Assess resources
available

(continued)
• Evaluate situation
– check victim
– determine safety of
environment
• Call or send for help immediately
• Determine treatment priorities

(continued)
• Report emergencies accurately
– If help is not available, contact:
• 911 or emergency number
• Police
• Fire department
• Telephone operator
• Local EMS
(continued)
• Report emergencies accurately by
stating:
– Name – Type of help needed
– Location – Number of people
– Description of needing help
scene
– Information
about injuries
(continued)
• Know your limitations

• Provide care and reassure victims
• Keep bystanders away from victims


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Unit 4

Safety and Emergency

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• Smell and touch

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Wash hands before

• Move equipment around corners with

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• Monitor residents who

• Use night lights in rooms

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• Keep call signal within

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• Purpose of Good Body Mechanics

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• Never bend over from waist

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• Get help if object or

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• When reaching for

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• Adjust beds to waist

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If fire occurs, know what to do

• Major fire hazards (continued)

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• Fire Safety Activities

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• Direct spray at base of fire

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Facilities are required to have

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