R.A.C.E. stands for Rescue, Alarm, Contain, and Extinguish (or Evacuate). It is the standard fire-response sequence taught to healthcare workers so that every person on a hospital unit knows exactly what to do, and in what order, during the first seconds of a fire. The acronym is embedded in Joint Commission accreditation requirements and reinforced through mandatory drills, making it one of the most universally recognized safety protocols in clinical settings.
What Each Letter Means in Practice
The value of R.A.C.E. is that it gives staff a fixed sequence of priorities rather than a list of tasks to juggle simultaneously. During a fire drill or a real event, the expected response follows the RACE plan: rescue those in immediate danger, alert others to the danger, contain the fire, and extinguish it if possible or evacuate if needed.1AORN Journal. Fire in the OR—Prevention and preparedness Each step flows into the next, and in a real scenario, multiple staff members may be working on different steps at the same time. But for any single person arriving at the scene, the order tells you what matters most.
- Rescue: Move anyone in immediate danger away from the fire. In a hospital, that usually means patients in the room where the fire started, visitors who may be frozen in place, and staff closest to the flames. Patients on ventilators, in traction, or connected to IV lines present complications that make this step harder than it sounds.
- Alarm: Activate the nearest fire alarm pull station and call the facility’s emergency number. Many hospitals use a separate internal code (often “Code Red”) that triggers overhead announcements so the entire building shifts into response mode. Pulling the alarm also notifies the local fire department automatically.
- Contain: Close doors and windows in the fire area. Hospital fire doors are specifically designed to slow the spread of smoke and flame, and simply shutting them buys significant time. This step also means shutting off oxygen supply valves in the zone if possible, because supplemental oxygen feeds fire aggressively.
- Extinguish or Evacuate: If the fire is small and you have been trained on a fire extinguisher, attempt to put it out. If the fire is beyond a small, contained size, evacuate the area. Most healthcare fire safety training pairs R.A.C.E. with the P.A.S.S. technique for using a portable extinguisher (Pull the pin, Aim at the base, Squeeze the handle, Sweep side to side). Staff are taught to never fight a fire that has grown past what a single extinguisher can handle.
Why Hospitals Need Their Own Fire Protocol
A fire in an office building is serious, but most people in an office can walk to an exit. A fire in a hospital is a fundamentally different problem. Patients in intensive care units may be sedated, intubated, or physically unable to move without assistance. Surgical patients under anesthesia cannot respond to a fire alarm at all. Psychiatric units may have locked doors that complicate evacuation. And hospital environments are full of compressed gases, alcohol-based hand sanitizers, and electrical equipment that create both ignition sources and fuel.
Analysis of hospital fire incidents shows that electrical appliances and short circuits are the leading cause of fires in healthcare facilities. Air conditioners, ventilators, warmers, generators, and electrical panels are among the most common sources of ignition.2PubMed Central. Hospital Fire Incidents: Challenges and Solutions in a Developing Nation That means the equipment keeping patients alive is often the same equipment that starts the fire, creating an immediate tension between continuing care and eliminating the hazard.
The R.A.C.E. sequence addresses this tension by making rescue the first priority, not firefighting. In a non-healthcare setting, an employee might reasonably grab an extinguisher before doing anything else. In a hospital, the protocol is clear: get the patient out of harm’s way first, then sound the alarm, then work on containment. The order exists because hospital patients often cannot save themselves.
Where R.A.C.E. Fits in the Broader Safety Framework
R.A.C.E. does not exist in isolation. It sits inside a larger web of fire safety systems that hospitals are required to maintain. Accreditation bodies like the Joint Commission require healthcare facilities to conduct fire drills, maintain fire suppression systems, keep egress routes clear, and train every staff member on the response protocol. State and local fire codes add additional layers.
Fire risk assessments of hospital buildings often reveal gaps between what the codes require and what actually exists. A study of public hospital buildings found that roughly 84% of surveyed zones failed to meet the standard requirements for safe movement of people during a fire, even though fire extinguishment systems fared better.3Emerald Insight. Fire risk assessment of Malaysia public hospital buildings In other words, hospitals may have working sprinklers and extinguishers, but the physical layout of corridors, exits, and fire doors may still make it dangerously hard to move patients out. This is the infrastructure reality that makes the “Contain” step of R.A.C.E. so critical. If you cannot move everyone out quickly, you need to slow the fire’s spread long enough for the fire department to arrive.
Beyond R.A.C.E. and P.A.S.S., many hospitals also train on compartmentalization: the idea that a fire-rated building is designed so you can move patients horizontally behind the next set of fire doors rather than down a stairwell. Horizontal evacuation is almost always preferred in a hospital because it avoids the enormous difficulty of carrying bed-bound patients down stairs.
The Special Challenge of Evacuating Critical Care Patients
The hardest real-world test of R.A.C.E. is what happens in an intensive care unit, especially a neonatal ICU (NICU). Premature infants on ventilators, IV drips, and warming beds cannot simply be picked up and carried. Losing power to a ventilator for even a short period can be life-threatening. Yet fire does not grant exceptions.
Evacuation protocols designed for NICUs use triage-based systems and job cards that assign specific roles to each staff member before a fire ever happens. The goal is to ensure that every infant has a designated rescuer and that the most medically fragile babies are prioritized without confusion.4Journal of Neonatology. Fire Safety and Evacuation Plan: Neonatal Intensive Care Unit Perspective Post-evacuation care, including stabilization and continuity of treatment for evacuated infants, is built into the protocol because getting out of the building is only the first problem. Keeping vulnerable patients alive after they have been separated from their usual equipment is the second.
One large-scale simulation exercise evacuated 34 realistically simulated NICU infants, including 12 requiring respiratory support and 3 with highly complex medical conditions. The drill involved horizontal evacuation first to limit immediate danger, followed by vertical evacuation down several flights of stairs to a temporary holding area, and then transport to other regional hospitals for ongoing care.5Pediatric Emergency Care. Hospital-Based Emergency Preparedness That sequence, from bedside to regional transfer, illustrates why fire safety in healthcare is not just about the initial response but about maintaining the chain of care under chaotic conditions.
Operating Room Fires and R.A.C.E.
Surgical suites present a unique fire risk because all three elements of the fire triangle converge in a small space. Oxygen and nitrous oxide (the oxidizer) flow directly to the patient’s airway. Alcohol-based surgical preps, drapes, and even body hair serve as fuel. Electrosurgical devices, lasers, and fiber-optic light sources provide the ignition. The combination means that an operating room fire can ignite on or inside the patient.
In the OR, the R.A.C.E. protocol is adapted to account for the fact that the “rescue” step may mean disconnecting the oxygen source and removing burning drapes from the patient rather than physically moving the patient out of the room. Operating room fire prevention guidance stresses that staff should respond using the RACE plan while simultaneously managing the surgical fire triangle: stop the flow of oxidizer, remove the fuel source from the patient, and then address containment and evacuation.1AORN Journal. Fire in the OR—Prevention and preparedness A patient under general anesthesia with an open surgical field is about as vulnerable as a person can be, and the surgical team has to manage the fire and the patient’s physiological stability at the same time.
Operating room fires are uncommon individually, but across the volume of surgeries performed in the United States each year, they add up. Most are small and extinguished quickly, but the ones that cause serious patient burns tend to involve high oxygen concentrations near the surgical site. Prevention training for OR staff often focuses on keeping inspired oxygen concentration as low as clinically safe and allowing alcohol-based preps to dry fully before draping.
How Healthcare Workers Learn R.A.C.E.
Hospitals teach fire response through a combination of classroom orientation, annual competency reviews, and unannounced fire drills. Every new employee, whether a surgeon or a custodian, is expected to learn R.A.C.E. during onboarding. The challenge is making that knowledge stick in a way that translates to action under stress, because reading about fire response on a slide is very different from performing it when a room is filling with smoke.
One approach that has gained traction is virtual reality simulation. A study comparing nursing students who received traditional fire safety education with those who trained using a VR simulation found that both groups had similar baseline knowledge, but the VR group showed a larger gain in knowledge scores after training.6PubMed Central. Acquisition of Fire Safety Knowledge and Skills with Virtual Reality Simulation The appeal of VR is that it lets learners practice the physical sequence of pulling an alarm, closing doors, and using an extinguisher without the logistical burden and safety concerns of setting an actual fire in a hospital.
Still, the gap between knowing the protocol and acting on it under pressure remains a persistent concern in healthcare safety. Research on nurses’ fire safety knowledge and evacuation decision-making found a significant correlation between how much nurses knew about fire safety and how well they performed on evacuation decisions. Nurses with higher knowledge scores made better choices about when and how to evacuate, while those with lower knowledge were more likely to make poor decisions under simulated fire conditions.7Fire Society Journal. Analysis Correlation of Nurses’ Level of Knowledge About Fire and Evacuation in Evacuation Decision Making for Fire Disasters in Inpatient Installations at Hospital X The finding is intuitive but important: people who have genuinely internalized the protocol are more likely to use it correctly when it counts.
Common Misconceptions About R.A.C.E.
One frequent misunderstanding is that R.A.C.E. is optional or situation-dependent, something to consider rather than a fixed sequence. In practice, accreditation surveys treat it as a mandatory protocol. Surveyors may ask any staff member on the floor to explain R.A.C.E. during an unannounced visit, and inability to do so can result in a finding against the facility. It applies to everyone in the building, not just nurses and doctors. Dietary workers, maintenance staff, administrative assistants, and volunteers are all expected to know and follow the sequence.
Another misconception is that the “E” in R.A.C.E. always means “Extinguish.” Some training programs teach it as “Extinguish or Evacuate,” and others teach it as “Evacuate” alone. The distinction matters because it shapes how aggressively staff feel they should fight a fire. The more common formulation in healthcare training is the combined version: attempt to extinguish only if the fire is small and you can do so safely, and evacuate if it is not. No healthcare worker is expected to be a firefighter. The protocol explicitly acknowledges that evacuation is the safer default when there is any doubt.
A subtler misunderstanding involves the “Contain” step. People sometimes interpret it as “do nothing and wait.” In reality, containment is an active step. It means closing every door you can reach, shutting off zone oxygen valves if you know where they are, and preventing the fire from spreading to adjacent spaces. In a hospital, where corridors connect to dozens of patient rooms, closing doors is one of the most effective things any staff member can do. Smoke inhalation kills far more people than flames in most building fires, and a closed door dramatically slows smoke spread.
Variations on the Acronym
If you work in healthcare long enough, you will encounter slight variations on R.A.C.E. Some facilities teach the “A” as “Activate” (the alarm) rather than “Alert.” Some teach the “C” as “Confine” instead of “Contain.” The meaning is identical in every case; the word choice varies by institution. A handful of facilities have adopted expanded acronyms or supplementary mnemonics for specific departments, such as surgical teams that add steps related to disconnecting anesthesia gas lines.
Outside of healthcare, fire safety training in schools, offices, and industrial settings typically does not use R.A.C.E. Those environments usually rely on simpler “get out and stay out” messaging because occupants are assumed to be mobile. R.A.C.E. is fundamentally a healthcare protocol because it was built around the reality that many people in a hospital cannot evacuate themselves and that the building contains life-sustaining equipment that complicates both the fire and the response.
Oxygen as a Fire Accelerant in Hospitals
One factor that makes hospital fires uniquely dangerous deserves its own attention: supplemental oxygen. Oxygen does not burn by itself, but it dramatically accelerates combustion. Materials that would smolder slowly in normal air can ignite violently in an oxygen-enriched atmosphere. Hospital rooms, especially in ICUs and respiratory care units, routinely have elevated oxygen concentrations near the patient’s face and upper body.
This is why the “Contain” step of R.A.C.E. specifically includes shutting off zone oxygen valves when possible. Most hospital units have valve shutoffs in the corridor that control the piped oxygen supply to a group of rooms. Knowing where those shutoffs are located is part of fire safety orientation, but in practice, many staff members cannot point to them. During drills, locating the oxygen shutoff is one of the tasks that frequently trips people up.
The intersection of oxygen and fire risk is also the reason that “No Smoking” policies in hospitals are not just about patient health. An open flame or even a spark near a patient receiving supplemental oxygen via nasal cannula can cause a flash fire. Incidents of this type, while rare, have resulted in severe facial and airway burns. The risk is highest in home settings where patients use portable oxygen concentrators, but it applies in hospitals as well, particularly in older facilities or during patient transport when portable oxygen tanks are in use.
Why Fire Drills Feel Pointless but Are Not
Healthcare workers sometimes treat mandatory fire drills as an interruption, and administrators sometimes treat them as a box to check. The evidence suggests they are more important than either group gives them credit for. The correlation between fire safety knowledge and evacuation decision quality found in nursing research underscores that practice matters.7Fire Society Journal. Analysis Correlation of Nurses’ Level of Knowledge About Fire and Evacuation in Evacuation Decision Making for Fire Disasters in Inpatient Installations at Hospital X Fire is rare enough in any individual hospital that most staff will go their entire career without experiencing one. That rarity is exactly what makes drills essential: without periodic rehearsal, the motor memory and decision-making habits that R.A.C.E. depends on fade.
The NICU evacuation simulation described earlier took months of planning and coordination across multiple hospitals and emergency services. Its purpose was not just to test whether staff could move infants out of a building. It was to identify bottlenecks, communication failures, and equipment gaps that only surface during an actual (or realistically simulated) event.5Pediatric Emergency Care. Hospital-Based Emergency Preparedness Every drill reveals something that looked fine on paper but falls apart in practice, whether that is a fire door propped open by a wedge, a staff member who does not know how to silence a ventilator alarm during transport, or an evacuation route that is blocked by stored equipment.
Hospitals that take drills seriously tend to run them on different shifts, including nights and weekends when staffing is thinnest and the people on duty are least likely to have senior leadership nearby. A fire at 3 a.m. on a Sunday will be managed by whoever is working that shift, and those staff members need to know R.A.C.E. just as well as the day-shift team that attended the last in-service training session.