Healthcare facilities typically have many nonambulatory patients. Which tactic and location should be noted in the preincident plan?

• A. Defend in place
• B. Evacuate
• C. Rescue operations only
• D. Fire suppression first

Answer: (A)

When many patients are nonambulatory, the safest plan is to defend in place. This means keeping patients where they are and using the building’s protection to prevent the fire or smoke from reaching them, rather than trying to move them quickly through doors and corridors that can be crowded or obstructed. In practice, this approach relies on directing staff to shelter patients in areas that are protected by fire-rated barriers, with doors closed and smoke control measures in place, until the incident is controlled or it’s safe to evacuate.

The preincident plan should clearly note where these safe areas are—areas of refuge or protected zones within the patient care units on the same floor (or where appropriate, a designated safe area that's protected by construction and barriers). This allows responders to know exactly where patients are being defended and where staff should concentrate care and monitoring during a fire event, reducing the risk of delays or injury from hurried evacuations.

Defend in place is favored here because attempting evacuation for nonambulatory patients can be dangerous, time-consuming, and may overwhelm staff, whereas keeping patients secure in protected spaces minimizes exposure to heat, smoke, and travel hazards. Other options—evacuation, rescue operations only, or prioritizing fire suppression first—either pose greater risk to nonambulatory patients or interrupt essential patient care.