Hospital fires are uncommon — but when they happen, they unfold fast, in an environment full of patients who cannot move themselves, pressurized oxygen lines, and staff who must act without hesitation. Two mnemonics exist specifically to give healthcare workers a clear sequence in those moments: RACE and PASS.
RACE guides your overall response to a fire — what to do and in what order. PASS tells you how to operate a fire extinguisher if you reach the point of trying to suppress a small fire. Both are taught in nursing fundamentals, tested on the NCLEX, drilled in hospital orientation programs, and referenced in Joint Commission standards. Knowing them is not optional for nursing students.
The RACE mnemonic
RACE is the primary fire response protocol used in healthcare settings throughout the United States. It gives nurses and all healthcare staff a prioritized sequence of actions when fire is discovered.
| Letter | Step | What it means |
|---|---|---|
| R | Rescue | Remove patients in immediate danger |
| A | Alert | Activate the alarm and call for help |
| C | Confine | Close doors and windows to contain the fire |
| E | Extinguish / Evacuate | Suppress a small fire — or evacuate if it cannot be controlled |
Detailed RACE breakdown
R — Rescue
The first priority is getting patients out of immediate danger. “Immediate danger” means the fire is actively threatening a patient’s location — not that there is a fire somewhere in the building.
Rescue begins with the patients who are closest to the fire and who cannot self-evacuate. In a hospital, that means anyone who is bedridden, sedated, post-surgical, on mechanical ventilation, or otherwise unable to move independently. Ambulatory patients should be directed to move themselves to the safe side of a fire door. Non-ambulatory patients require direct physical assistance — horizontal transfer in the bed, or lift-and-move techniques appropriate to the setting.
The NFPA recommends a horizontal evacuation approach first: move patients away from the fire within the same floor, rather than attempting vertical evacuation down stairwells unless the floor itself is compromised. Stairwells are difficult with beds and wheelchairs, create bottlenecks, and can introduce smoke if doors are held open too long.
Rescue also means protecting yourself. Do not enter an area that places you in immediate danger without appropriate protection — a nurse who is incapacitated cannot help anyone. If the fire is beyond what you can safely approach, alert first and wait for support.
A — Alert
Activate the fire alarm immediately. In most healthcare facilities, this means pulling the nearest pull station — the red wall-mounted activation boxes found at stairwells and along corridors. Pulling a station triggers the building’s fire alarm system, alerts the fire department through automatic monitoring, and activates sprinklers in affected zones according to facility design.
At the same time, call 911 directly if there is any doubt that fire department has been alerted. Internal alarm systems can malfunction, and direct contact ensures emergency services are dispatched.
Notify the nursing supervisor or charge nurse, and activate any internal fire response protocols your facility uses. Most hospitals operate under an overhead announcement system — a specific code (commonly “Code Red”) that alerts all staff throughout the building to a fire emergency and triggers the facility’s incident command structure.
Do not assume someone else has called. In high-stress situations, bystander effect operates even among trained professionals. If you found the fire, you alert — and confirm that the alarm has been activated.
C — Confine
Closing doors is one of the highest-impact actions in fire response, and it is the one most often skipped in panic.
A closed door dramatically slows fire spread and — critically — controls smoke movement. Smoke inhalation is the leading cause of fire-related death; most people who die in structural fires die from smoke, not flames. A solid fire-rated door can maintain a barrier for 30-90 minutes, giving emergency responders time to reach the building and staff time to complete evacuation.
In healthcare settings, confinement is built into the physical environment. Fire doors throughout hospital corridors are held open with electromagnetic hold-open devices that release automatically when the fire alarm activates, converting open corridors into compartmentalized sections. Nursing staff should verify these doors have closed and manually close any that did not release.
Confinement steps to take:
- Close the door of the room where the fire originated
- Close all patient room doors on the affected unit
- Verify corridor fire doors have released and closed
- Close windows if accessible and safe to do so
- Turn off oxygen and other medical gases in the immediate area if controls are accessible
- Place wet towels along door gaps if available — this blocks smoke infiltration
Turning off oxygen is worth emphasizing. Oxygen does not burn, but it sharply accelerates combustion in everything else. An oxygen-enriched atmosphere — any environment where oxygen concentration exceeds approximately 23% — dramatically increases the rate at which materials ignite and burn. Oxygen lines should be shut off at the wall outlet or zone valve for the affected area when doing so does not endanger patients who depend on continuous oxygen therapy.
E — Extinguish or Evacuate
The final step in RACE requires a judgment call: can this fire be suppressed, or do you need to evacuate?
Attempt extinguishment only if all of the following are true:
- The fire is small and contained (approximately wastebasket-sized or smaller)
- You have a fire extinguisher immediately available
- You have an unobstructed exit behind you
- You have already activated the alarm and rescue is underway
- You have been trained in fire extinguisher use
If the fire is spreading, if the room is filling with smoke, if you are not sure of the fire’s extent, or if the above conditions are not met — evacuate. A growing fire doubles in size every minute. There is no recoverable position once a fire is beyond a small, contained stage.
When evacuation is the decision, guide ambulatory patients through the nearest fire exit to the designated assembly area. Remain calm — staff composure directly influences patient response. Do not use elevators. Close doors behind you as you move through the corridor.
The PASS mnemonic
PASS is the step-by-step technique for operating a portable fire extinguisher. If RACE’s final E leads you to attempt extinguishment, PASS is how you do it.
| Letter | Step | What it means |
|---|---|---|
| P | Pull | Pull the safety pin from the handle |
| A | Aim | Aim the nozzle at the base of the fire |
| S | Squeeze | Squeeze the handle to discharge the agent |
| S | Sweep | Sweep from side to side at the base |
Detailed PASS breakdown
P — Pull the pin
Fire extinguishers have a plastic safety pin through the handle that prevents accidental discharge during storage. Pull it out completely before doing anything else. Most pins have a tamper seal — a thin plastic or metal strip — that will break when the pin is pulled. If the seal is already broken when you reach the extinguisher, the extinguisher may have been previously used and could be partially discharged; proceed, but be aware.
A — Aim at the base
Point the nozzle or hose at the base of the fire — the point where the fuel is burning — not at the flames themselves. This is the most commonly misunderstood step.
Flames are the visible product of combustion, but they are not the source. Directing the extinguishing agent at the flames achieves little because the fuel below continues to ignite. Aiming at the base suppresses the fuel source, which is where combustion is actually occurring.
Stand at a safe distance — typically 6 to 8 feet — before discharging. Move closer only if the fire responds and begins to shrink.
S — Squeeze the handle
With the pin removed and the nozzle aimed at the base of the fire, squeeze the handle to release the extinguishing agent. Use firm, steady pressure. Releasing the handle stops the discharge, which allows you to conserve agent if needed.
Most portable fire extinguishers used in hospitals contain 10-30 seconds of discharge time at full pressure. Use that time efficiently.
S — Sweep side to side
While squeezing, move the nozzle in a slow, sweeping motion from side to side along the base of the fire. This distributes the extinguishing agent across the burning fuel rather than concentrating it in one spot. Continue until the fire is out or the extinguisher is empty.
If the fire reignites after apparent suppression, back away and do not attempt to re-engage without a second extinguisher. Reignition indicates the fuel source has not been fully suppressed.
If the extinguisher empties without suppressing the fire, evacuate immediately. Close the door behind you.
Clinical context: fire safety in healthcare
Healthcare environments carry specific fire risks that differ from a typical office or residential setting.
Oxygen-enriched environments. Supplemental oxygen is in use throughout hospital floors, ICUs, operating rooms, and emergency departments. As noted above, elevated oxygen concentrations accelerate combustion significantly. NFPA 99 (Healthcare Facilities Code) and NFPA 101 (Life Safety Code) govern fire safety design in healthcare buildings specifically because of these risks. Anesthetic gases used in operating rooms add another dimension — several are flammable, and OR fires involving drapes, prep solutions, and electrical equipment under oxygen-rich conditions are a documented and serious risk.
Electrical equipment. Electrical malfunction accounts for the majority of healthcare facility fires. The density of powered equipment — ventilators, infusion pumps, warming blankets, imaging equipment, surgical tools — creates multiple ignition opportunities. Class C fires (energized electrical equipment) require carbon dioxide (CO2) or other non-conductive extinguishing agents. Water-based agents must not be used on live electrical fires. Hospitals stock CO2 extinguishers and water-mist extinguishers for operating room use specifically because of this requirement.
The Joint Commission requirements. Joint Commission-accredited facilities are required to conduct fire drills regularly — at least once per shift per quarter in most settings — to ensure staff respond correctly under realistic conditions. Fire extinguishers must be inspected annually and after each use, maintained according to NFPA 10, and located throughout the facility so that no staff member has to travel more than 75 feet to reach one. Nurses should know where extinguishers are located on their assigned units before a fire occurs.
NCLEX testing. RACE and PASS appear regularly in NCLEX fundamentals questions, often in scenario format. Common question types ask you to identify the correct first step in a fire response, the correct extinguisher operation technique, or which patients to prioritize for rescue. Understanding the clinical reasoning behind each step — not just the letters — is what makes these questions answerable even when the wording is unfamiliar.
Common mistakes to avoid
Not closing doors. This is the most consequential error in fire response. Closing the door of the room where a fire started can be the single action that prevents a fatal outcome. Staff who leave doors open while evacuating remove one of the most effective barriers between fire, smoke, and patients.
Trying to extinguish a fire that’s too large. If the fire is not small and contained, attempting extinguishment wastes critical time and puts the nurse in danger. When in doubt, evacuate. The decision to use an extinguisher should take seconds, not minutes of deliberation.
Aiming at the flames, not the base. Aiming high at visible flames instead of the base of the fire is the most common PASS error. It wastes extinguishing agent and fails to suppress combustion at its source.
Not knowing where fire extinguishers are located. During an actual fire, there is no time to search. Know the location of fire extinguishers on your unit during orientation and at the start of each shift.
Reversing the RACE sequence. Some students attempt to Alert before Rescue when a patient is in immediate, life-threatening danger. While alerting is critical, a patient trapped near a fire cannot wait while the alarm is pulled first. Rescue imminent danger, then alert — this is the intended sequence when both needs are simultaneous.
Related mnemonics
Fire safety is one piece of a broader framework of environmental safety competencies nursing students develop during fundamentals. Related areas of study include:
- SBAR communication — the structured communication framework used when reporting a fire or any clinical emergency to the charge nurse, rapid response team, or physician. RACE tells you what to do; SBAR tells you how to communicate it.
- MONA mnemonic — for acute coronary syndrome management. ACS is a high-acuity event where the same calm, systematic response you practice in fire drills is required. Mnemonics work in emergencies because they are practiced until automatic.
- ADPIE nursing process — the foundational nursing process framework. Fire response is an application of the assess-plan-implement-evaluate cycle compressed into seconds.
Building a working library of mnemonics across safety, clinical, and communication domains makes you faster and more reliable in the settings where patients need competent nurses most.
Summary
RACE stands for Rescue, Alert, Confine, Extinguish or Evacuate — the four-step fire response protocol used in healthcare settings across the United States. Rescue patients in immediate danger first. Activate the alarm and call 911. Close all doors to confine fire and smoke. Extinguish only if the fire is small, contained, and you have a clear exit behind you — otherwise evacuate.
PASS stands for Pull, Aim, Squeeze, Sweep — the technique for operating a portable fire extinguisher. Pull the pin, aim at the base of the fire (not the flames), squeeze the handle to discharge the agent, and sweep side to side until the fire is out.
Both mnemonics appear on the NCLEX, are required knowledge in nursing fundamentals, and reflect Joint Commission-endorsed fire response procedures. Knowing the sequence is necessary — understanding the clinical reasoning behind each step is what makes that knowledge useful when it matters.
This article is for educational purposes. Clinical practice should always follow current evidence-based guidelines, your facility’s fire response protocols, and the most current Joint Commission and NFPA standards.