DISASTER AND EMERGENCY CODES EMERGENCY CODES MCHS has

DISASTER AND EMERGENCY CODES

EMERGENCY CODES MCHS has a commitment to provide safety to its patients, residents and employees in the event of an emergency. We have standardized codes and drills for Emergency situations. • • Code Blue: Cardiac Arrest • Code Red: Fire • Code Yellow: Security • Code Disaster: Activate the Disaster Plan • Code Orange: Hazardous Material Release • Code Black: Tornado/ Severe Weather • Code Green: Missing Patient/ Resident • Code White: Winter Storms • Code Purple: Evacuation • Code Doctor Strong: Combative Behavior • Code Magenta: Workplace Violence • Code Silver: Active Shooter • Each facility will have an individualized plan for departure in the event of an emergency. Each facility will have a map or floor plan posted for the public they are serving. There is a flip chart located in each department to be used as a guide for employees to use in the event of an emergency. The drills established have a policy for details in case of questions and further explanation is needed. Please refer to your policy for explanation then refer to your supervisor.

EMERGENCY CODE QUICK GUIDE –FLIP CHART

CODE BLUE POLICY: • It is our intent for all patients & residents of MCHS to be informed about CPR. This will allow for the proper decision making in an event of a crisis. All professional nurses are certified in CPR in accordance to the American Heart Association or the American Red Cross Association standards for CPR. Also, it is important that our Ambulatory Clients and customers and safe in event of an emergency and that our staff can quickly respond in case of an emergency. PROCEDURE: • In an event of a crisis, full emergency treatment, including CPR will be rendered to any resident or patient of MCHS unless the staff is instructed to do otherwise. CPR is a process by which trained staff will artificially breathe and do chest compression when a resident or patient has stopped breathing and perhaps heart has stopped.

CODE BLUE • There are four choices available for the patient or resident at the time of admit to our facilities. – CODE LEVEL 1: Total Support- All reasonable and appropriate measures will be initiated in the event of a cardiac and/or respiratory arrest. – CODE LEVEL 2: Total Support excluding CPR: The patient is to be treated as medically indicated, including all efforts to prevent cardiac or respiratory arrest. Aggressive intervention for evolving medical problems is indicated; however, if sudden cardiopulmonary arrest occurs, no cardiac resuscitative effort will be undertaken, nor will mechanical ventilation be initiated for sudden deterioration of respiratory function.

CODE BLUE – CODE LEVEL 3: Limited Support, excluding CPR: Therapy already initiated should be continued as medically indicated by the patient’s condition. In general, no additional treatment will be initiated unless it is likely to benefit the patient’s condition and/or for the purpose of comfort. Adequate nutrition and hydration will be provided unless refused by a competent adult or a decision is made by a surrogate or the attending provider to discontinue such support. If cardiac or pulmonary arrest occurs, no resuscitative efforts will be made. – CODE LEVEL 4: Comfort Measures Only; Treatment is to be limited to nursing and medical therapy appropriate for hygiene and comfort. Treatment which is necessary for comfort may be used even if it contributes to cardiac or respiratory depression. Life-sustaining therapy already initiated may be discontinued by written order. Artificial feeding and hydration will be decided upon a case by case basis. – NOTE: A patient’s code status may be changed at any time as patient’s condition changes or patient/family wishes change. Any exception to a specific level must be specified by the attending provider in writing.

CODE BLUE • Nursing home - Information regarding CPR in an emergency situation may be obtained by looking in their chart or a label on the binder of the resident’s chart. Hospital- may be in the MAR or on the wristband of the hospitalized patient. • For the Ambulatory Services, Clinic: Ask the person who brought the patient in or check the patient’s health record. Wellness Center: go ahead with CPR unless otherwise instructed by an authorized person. • It is important to note that a Code Level Document is located in the chart for Swing Bed Unit Residents and Nursing Home Residents. The provider and the resident’s family sign this document.

CODE RED DISCOVERING A FIRE: • • Activate the fire alarm. The FIRE department is automatically notified when the fire alarms are activated. Announce CODE RED twice over the intercom. The fire department will phone the facility. Tell them where the fire is. Example: Room # or the basement or what wing. This way they have an idea where to enter the building. Also, tell them if evacuation is in progress and any other pertinent information. REMAIN CALM AND DON’T PANIC. KEEP COMMUNICATIONS OPEN. If the fire is small, use an available fire extinguisher to put out the fire. After you have put the fire out do not pick up the area until the Fire Department has announced it is safe to do so. Close all doors and windows in the fire area. After leaving the area place a wet blanket at the entrance of the room or hallway. If evacuation is needed, take your resident or patients to another area of the facility that is safe. If total evacuation is needed: Use the Epiphany Catholic church, (across the street to the north of the hospital): 112 6 th Ave. NE; or the Seventh Day Adventist church: 305 6 th St. NW, also the Nursing home or clinic maybe used.

CODE RED When Total evacuation is needed: – Evacuate all residents, patients and personnel nearest the danger area first – Make sure all patients, residents and staff are accounted for when you arrive at your pre-assigned destination – Always have a staff member with your patient and or residents. – Close all doors and windows as the patients or residents are evacuated and turn on the lights. – Report any missing patients or residents to the charge person. – Do not return to the area of danger, Fire department will resume responsibility to check the area.

CODE YELLOW HOSPITAL AND CLINIC PROCEDURE: The Mc. Kenzie County Emergency manager or administration will notify the hospital & clinic of the need for Code Security/Code Yellow Alert due to a potential disaster or immediate danger. • • • CLINIC will close and lock-down. They will put a recording over their phone to have the public phone the hospital if they need a physician. Hospital Phone # 842 -3000. All doors will be locked within 5 minutes of notification. During Daytime Hours: example 8 am to 5 pm. CODE YELLOW will be announced over the intercom twice. MAINTENANCE: Southeast basement door; West basement door and the Main entrance. HOUSEKEEPING: Front Door, main entrance; southeast main Entrance. NURSING: Ambulance bay, Entrance door. CLINIC MANAGER: Clinic front & back entrance. After hours Nursing will be responsible for locking all doors. All employees coming or going will use one main entrance. Maintenance will be responsible in securing the main point of entering the facility. The Incident Command Personnel or administration will determine re-opening of the MCHS.

CODE YELLOW NURSING HOME/WELLNESS CENTER/HORIZON PROCEDURE: • Instructions for LOCKDOWN will come from Administration or the Mc. Kenzie County Emergency Manager. • Doors will be locked in the nursing home and Horizons within 15 minutes of the announcement. Wellness Center will be instructed to close and send members home or to the nearest shelter. Employees at the Wellness Center will be asked to go to the Nursing home if needed. • Doors will be locked at the Nursing home and Horizons. • Maintenance will lock: Garage and Manor • Dietary will lock: Entrances for the kitchen and dining area • Housekeeping will lock: Patio doors • Laundry will lock: Basement entrances

CODE YELLOW NURSING HOME/WELLNESS CENTER/HORIZON • Nursing will lock: South and East Doors • PT will lock: West door • Front office receptionists will lock: Front doors and the outside entrance to the DON’s office • After hours Nursing will be responsible for locking all entrances. • Horizon will lock: Front door and end doors and announce to residents that we are in LOCK-DOWN and not to leave the building for any reason. • CODE YELLOW will be paged over the intercom TWICE. • Maintenance will determine the single entrance that staff will leave or enter by. • The nursing home and Horizon will reopen to the public when the ALL CLEAR has been announced by Administration or the Mc. Kenzie County Emergency Director.

CODE DISASTER PROCEDURE: • PERSONS INVOLVED IN THE DISASTER HAVE SPECIFIC DUTIES IN ORDER TO PREVENT PANIC. IT IS IMPORTANT TO REFER TO YOUR POLICY MANUAL FOR SPECIFIC DUTIES IF NOT STATED HERE. • ADMINISTRATION: Establish a Command Center, and will receive information about patients /residents. Will provide information to the news media. Will provide cool, calm instructions about the incident. • TRIAGE COORDINATOR: Assess the # of wounded. Monitor the supplies used for the emergency and sends reports to the command center. Will call in the DECON TEAM. • NURSING: Responsible to initiate the Call-Schedule. They are responsible to announce CODE DISASTER TWICE over the intercom. Start the LOCKDOWN. Assemble the supplies that are needed to care for potential wounded or sick patients. /residents.

CODE DISASTER • MAINTENANCE: These workers are responsible for the security of the 4 facilities. They will man the single point of entry and remove unauthorized persons from a restricted area. They will provide traffic control and check hazardous waste bins for proper disposal of contaminates. • NUTRITIONAL SERVICES; These workers are responsible for food and water for the employees, patients/residents, and visitors at the shelter in place. They stay in touch with the command center. • LAB & XRAY: Inventory available blood products, . Be on hand in event lab and/or x-ray are needed to treat the wounded and sick. • OFFICE PERSONNEL: Answer the telephone; assist with organizing the paperwork as it comes in. Be available for the command center and nursing as an assistant and to send information back and forth. • PATIENT TRACKING: This is accomplished with the ID Disaster Tags. Each victim will have a triage Disaster tag.

CODE ORANGE PURPOSE: Provide decontamination & treatment for patients and residents who have been exposed to hazardous material. Establish and maintain hot, warm and cold zones to maintain safety of our employees and patients. PROCEDURE: • Contact the ambulance or EMS if there is a suspicion that contaminates are in the area. • Contact the decontamination coordinators. • Hospital must be ready to receive contaminated patients and ambulatory helpers, Re-direct other patients to come into the hospital by an alternate route. • Phone outside sources if needed: [CHEMTREC: 1 -800 -424 -9300] • ALTERNATE OUTSIDE SOURCE: [CHEM-TEL: 1 -800 -255 -3924]

CODE ORANGE • When you call these companies have pertinent information about the contaminate coming in, if possible. NAME OF CONTAMINATE AND WHERE THE CONTAMINATE WAS LOCATED. INJURIES AND EXPOSURES; AND WEATHER CONDITIONS. • The decon team will prepare the decontamination area. • Setup for HOT, WARM AND COLD ZONES. • Ambulance or Nursing Representative will perform triage. • Check the policy manual for the difference in doing decon for ambulatory versus non-ambulatory patients / residents. • Secure and contain decontamination HOT zone. • Follow proper clean-up instructions as directed by Chem-tel or Chemtec. . • Ambulance must use an alternate unloading site until the area is free of contaminates.

CODE BLACK PROCEDURE: • “WEATHER WATCH”: There is a potential for severe weather or tornado. • “WEATHER WARNING”: Severe weather or tornado has been spotted in the area. • When a weather warning has been announced on the TV or radio, announce Code Black Twice over the intercom. Get your supplies in order. • Draw all shades and or drapes. • Lower the patient or resident beds, and move as many of your patients or residents to the center hallway as possible. • Distribute blankets or pillows for people to cover up with in case of flying debris. • During normal hours (8 am to 5 pm) the office personnel will assist with starting the call-in list if directed by nursing. However, after hours, the charge nurse will be in charge and will choose to start the call-in list when there is no danger to staff coming into town. (After the bad weather is gone) • When the warning is lifted, Announce “CODE BLACK CLEAR” TWICE OVER THE INTERCOM, then the patients and residents may return to normal routine or it may be time to start Code Purple.

CODE BLACK • THINGS TO REMEMBER: – Remain calm! – HOSP. / NURSING HOME/HORIZONS: get your patients or residents to the inner hallway quickly. – CLINIC: Go to the fallout shelter at the hosp. Take your patients to the inner hallway / public restrooms for shelter. – WELLNESS CENTER: Instruct your members to go home or to the nearest shelter. If no time, go to an inside protected area away from the outside walls and windows, provide mats for members and staff to cover up with. •

CODE GREEN • Hospital: Each patient will be identified with an arm bracelet. Also, each patient leaving the facility will have in hand, instructions from the nurse on duty. This way the patient is accounted upon arrival and discharge. • • Nursing Home: A picture of each resident will be taken on admission to assure proper identification of the residents. The picture will be part of the resident’s record. • • Clinic: Each patient will check in upon arrival and check out prior to leaving the premises. • • Wellness Center: Each member signs in and out on a member roster. •

CODE GREEN • Procedure: Nursing Home and Hospital: • Announce “CODE GREEN” and the Resident or Patient’s first name twice to alert the staff. • Employees will review the Resident or Patient’s normal wandering patterns in the facility. • Notify the Charge Nurse’s; who will again search the premises. • Notify the Administrator and the DON’S that the resident or patient has not been located inside the facility. An Outside search will need to be completed. Begin the outside search.

CODE GREEN • The Charge Nurse will notify the family. • Upon return to the facility: – The charge nurse will examine the patient or resident for injuries. – Designated personnel will announce “CODE GREEN CLEAR” TWICE ON THE INTERCOM. • (This allows the people to stop looking) – An Incident report will be completed and submitted to Quality Assurance. • Appropriate notation will be charted in the resident’s or Patient’s Medical Record. • All Incidents of Missing Resident or Patients will be investigated to attempt to prevent further occurrence. •

CODE WHITE • PRECAUTIONS: If Code white conditions exist, please announce code white over the intercom system twice to alert the staff. • • Be aware of all weather bulletins. • Make sure that your cell phone is charged up before you leave. • Alert your staff that they may be asked to stay if the oncoming staff members are not able to come in to replace you. • Check food supplies and check emergency generators. • Check your furnace, and check your flashlights in case of a power failure. • Check the closets for extra blankets. • Check staffing for the next two days, have we enough staff to cover, or should staff from out in the country be prepared to come early and stay until the storm is lifted?

CODE WHITE • Check the North Dakota Road Report or phone the sheriff’s office for an update on road conditions. Travel only during daylight hours. • Avoid overexertion, cold causes extra strain on the heart, do only what is needed. • Be properly dressed: remember boots, scarves, gloves and hats along with a heavy coat for extreme cold temperatures.

CODE WHITE Always travel with a winter survival equipment. Winter survival Kit for MCHS includes: Candles or flashlight Granola bars Extra water Blanket Shovel First Aid Kit. Coveralls or ski pants Book, something to read to past the time Do not attempt to travel at night unless it is really necessary. • REMAIN CALM & DON’T PANIC!!! • •

CODE PURPLE PROCEDURE: • EVACUATION ROUTES have been established in all four facilities of the MCHS. Refer to your floor plan that is posted in the hall way. • Evaluate: is it necessary to evacuate to the other side of the building or is it necessary to relocate a facility within the System or go to the a) Catholic Church, 112 6 th Avenue NE or go to the Seventh Day Adventist church at 305 6 th Street NW. or the GSH or Clinic. • Phone numbers: Epiphany Catholic Church (across from the hospital) 842 -3791 • Seventh Day Adventist Church (behind the Senior Citizens) 842 -2638 • Start Call-in Procedure for more available staff. The charge nurse will be in charge until administration is on the scene.

CODE PURPLE • Prepare an up-to-date patient / resident roster for moving patients and residents. • Families and guardians of patients and residents will be contacted after the move is complete. • Rules to Remember when an evacuation is necessary: – When an order to evacuate is declared, only use the main exit identified by the person n charge. – Always evacuate patients and residents nearest the danger area first. – Work away from the danger area, move your patients/residents to the central assembly area first. – Keep a staff member with the patients /residents at all times. – Count all patients/residents upon arrival to the safe area. Count them when transferred to an alternate site. – REPORT ANY PATIENTS/RESIDENTS OR STAFF IMMEDIATELY. – NEVER RETURN TO AN AREA OF DANGER, LET FIRE OR EMS TAKE OVER.

CODE MAGENTA • PROCEDURE: • Stay Calm, try not to panic. Maintain a secure composure, don’t stare this person down, however, give the impression that you genuinely want to assist this person. • AVOID BEING DEFENSIVE. • Try to keep the situation under control while a co -worker summons help in another room. Phone 911. or call the Sheriff’s office; 444 -3654. Use the panic button at the Nurses station at the Hospital.

CODE MAGENTA • If the building is locked and it’s after office hours • Check to see who the people are outside the building, if you do not feel comfortable. Don’t let them in; phone the police. • At Night; If a person comes by an alternate route, call for back-up from the police on duty. • In the daytime, visitors may come in by any number of routes, so ask why they are their and observe their behavior. If you continue to feel insecure, call for back-up by the police on duty. •

CODE MAGENTA • • • What to do if someone comes to the Hospital or Nursing Home and asks for medical Supplies. Find out as much information as possible for the person when they ask such questions. If you are at the Nursing Home- Inform the person where the hospital is and they can get treatment there. Explain to the person that the hospital has an open-door policy and its important to be seen by a provider for proper treatment. If a person comes to either facility and demands drugs, narcotics, or Medical supplies. Don’t try to bargain with the intruder, just do what the intruder asks and seek a safe place. Fill out the incident report later after the person has left. If you should have a dangerous individual in the facility, the patients, residents and staff are the most important; DON’T PROVOKE THE SITUATION, for the safety of the patients, residents and staff. Someone calls 911. At the Hospital – the panic button is located under the desk at the Nurses Station.

CODE DOCTOR STRONG • PROCEDURE: • This code can be used in the event of a violent/ combative patient/visitor when no other means of controlling the patient works. • First- call the police department as soon as possible and/or use the panic button at the hospital nurses station. • When a Doctor Strong is paged-all available personnel are expected to respond to help deal with the situation until law enforcement arrives. Once law enforcement arrives – personnel can return to their areas of work.

CODE SILVER PROCEDURE: • Affected areas (shooter is present) • • RUN- evacuate affected area (remain calm) • Call 911 when safe to do so- give location and description of person with weapon. • Evacuate patients/residents, visitors, volunteers, and staff is safe to do so. • Overhead page (if available) CODE Silver and the location three times. Notify administration if possible. • Remain calm and attempt to maintain patient/resident care. • Attempt to keep patients/residents/visitors who can’t be evacuated hidden out of sight. • Prevent others from entering the area where the active shooter is. • Do not attempt to move wounded people or non-ambulatory patients/residents.

CODE SILVER HIDE • a. Close doors to all patient/resident rooms. • b. Staff should remain in patient/resident rooms with them and out of the corridors. • c. Doors may be blocked with furniture. • d. Keep out of sight and take adequate cover/protection (ex. Concrete walls, thick desks, filing cabinets) • e. Silence all communication devices and alarms. • f. Keep very quiet. • Turn out all lights.

CODE SILVER FIGHT- use only as a last resort effort when your life is in danger • a. Attempt to incapacitate the shooter by rushing him/her. b. Throw objects at shooter; use objects that will inflict harm. c. Yell for distraction d. Commit to your actions.

CODE SILVER Non affected area: At a location distant from the active shooter, such as on a different floor or you are not able to leave the area safely. – Remain calm. – Evacuate people if able to do so safely. – Have one person call 911 and state your exact location and what is happening –“active shooter in building – shots fired”. – Warn other staff, visitors etc. to take immediate shelter. – go to a room that can be locked and barricade the doors and windows with furniture or equipment.

CODE SILVER NON-AFFECTED AREA-CONT. • Turn off lights, close blinds • Turn off all devices that make noise- such as radios, cell phones, etc. • Keep yourself out of sight. WHEN LAW ENFORCEMENT ARRIVES- LISTEN TO THEIR INSTRUCTIONS AND FOLLOW THEM.

POLICIES THE FULL POLICIES FOR THE EMERGENCY CODES ARE FOUND IN THE SAFETY/EMERGENCY MANUALS AVAILABLE IN ALL DEPARTMENTS. THE DISASTER (ALL HAZARDS) PLAN AND THE EVACUATION PLAN ARE LOCATED IN THE SAME MANUAL AND ARE ALSO POSTED ON THE FACILITY WEB SITE.

DISASTER CALL LIST

DISASTER CALL LIST