TRMC Centralized Annual Update Module Emergency Response Section

TRMC Centralized Annual Update Module Emergency Response Section 3 September 2014

Includes: Section 3 1. Code Red- Fire (Policy #21 -2001) 2. Code Pink- Infant Abduction (Policy #21 -2003) 3. Code Yellow- Bomb Threat (Policy #21 -2005) 4. Code Gray- Combative Person (Policy #21 -2006) 5. Code Silver- Person with a Weapon (Policy #21 -2007) 6. Code Black – Active Shooter (Policy #21 -1000) 7. Code Orange- Hazardous Material Spill/Release (Policy #21 -2008) 8. Code Triage- Internal (Policy #21 -2009) 9. Evacuation Policy and Procedure (Policy #21 -2011) 10. Hazardous Materials and Waste Management Plan (Policy #22 -1004) 11. Workplace Violence Prevention Plan (Policy #22 -1021)

Code Red Key Points: RACE Remove All persons away from immediate danger. Activate Pull fire alarm at manual pull station and call 77 in hospital. Off campus dial 911 (Clinics, Family X-Ray, MKL, etc. ) Close All doors to prevent the spread of fire and smoke. Extinguish The fire if safe to do so, and evacuate if fire is out of control.

Fire Extinguisher Key Points: PASS Pull the pin. Aim the nozzle at the base of the fire. Squeeze the operating handle to release the extinguishing agent. Sweep from side to side at the base of the fire until the fire appears to be out.

Code Red Key Points: Ø Refer to Policy # 21 -2001 Ø Do not use elevator during a Code Red unless directed to Ø Ø do so by the Fire Department. Post someone (when available) at the elevator to ensure it is not being used. All areas of the facility and staff are required to participate in any drill conducted while on duty. The hospital uses a “defend-in-place” strategy for responding to fires: isolate, contain, extinguish before it becomes necessary to evacuate patients. The Allied Building, Clinics, MKL, and Family X-Ray are all classified as “ambulatory occupancy” and are required to evacuate the building. Report all fires and smoke immediately.

Code Red Key Points continued: The Code Red response team consists of: Ø Engineering Ø Nursing Supervisor (when in house) Ø Security Ø Respiratory Therapy (only in patient care areas) Ø Radiation Safety Officer, Laser Safety Officer, Lab Safety Officer (if alarm is in their respective area). Ø Staff from various departments.

Code Pink or Code Purple Key Points: Ø Refer to Policy #21 -2003 & 21 -2004 Ø Stop all non-critical work. Ø Send a designee to cover all interior stairwell doors, elevator areas, hallways and doors that exit anywhere near your work area. Ø No one is allowed to exit the hospital until security examines the premises. Ø Do not attempt to bodily apprehend the abductor. Ø Report all suspicious persons to security (77)

Key Points: Code Gray Ø Refer to Policy #21 -2006 Ø Any staff member confronted with or witnessing a combative situation should call a Code Gray, dial 77. Ø Security responds to STAT calls and assists staff with combative and unruly patients, visitors or staff. Ø Recognize early warning signs! Ø Verbal Abuse Verbal threats of harm. Intimidation by words. Ø Physical Battery Create a barrier Call for assistance

Key Points: Code Silver Ø Refer to Policy # 21 -2007 Ø Any employee who perceives a situation to be life threatening may call PBX by dialing 77 and describe the situation and the specific location. Ø PBX will notify Security who will respond “stat”. Security will assess the situation and decide what action to take. Ø If a ‘Code Silver’ is required PBX will announce 3 times “Code Silverlocation” for example: “Code Silver-external” for an outside event with victims in the Emergency Department. “Code Sliver- ED for a weapon or hostage situation within the Emergency Department. All staff will avoid the affected area(s).

Code Silver Key Points: Ø Only the Administrator (designee), Nursing Supervisor (designee), Security and/or Law Enforcement has the authority to order a Code Silver Lockdown. Ø PBX will announce “Code Silver” and location or “Code Silver Facility Lockdown” for limited access lockdown. Ø Hospital staff stay clear of Code Silver location until “All Clear” is announced by PBX. Do not pass through or near the affected area.

Code Silver - Lockdown Key Points: Ø Only the Administrator (designee), Nursing Supervisor (designee), Security and/or local Law Enforcement has the authority to order a facility lockdown. Ø PBX will announce “Code Silver Facility Lockdown” will require no individuals are allowed to enter or exit the facility; or “Code Silver (location) Lockdown” allowing selected access and egress of the facility. Caution must be taken as the facility is at risk from persons wishing to enter the facility with ulterior motives. Ø Hospital staff will lock any locking doors to establish barriers, stay clear of Code Silver location until “All Clear” is announced by PBX. Do not pass through or near the affected area.

Code Silver A Code Silver may be called if someone (other than law enforcement) brings a weapon into the facility. Weapons include: a. Firearm (gun). b. Knife. c. Any instrument that can cause bodily harm or injury.

Key Points: Code Black Ø Refer to Policy # 21 -1000 Ø First employee to identify an Active Shooter situation will call PBX by dialing 77 and “Code Black” with the specific location. Ø PBX will notify Administrator, Nursing Supervisor/Designee and/or Security will assess the situation and secure the area if safe to do so. Then report to 911 the number of shooters, number of victims, exact location of shooter, type and number of weapons possibly in the possession of the shooter. Ø PBX will announce 3 times “Code Black- (location) and Facility Lockdown”. All staff will avoid the affected area(s). Ø PBX will dial 911 and inform Tulare Police Department. Ø Hospital staff directly affected should remain calm. 1. Evacuate 2. Hide Out or 3. Take Action (see “How to Respond” poster on next slide).

Bomb Threat -Code Yellow Key Points: Ø Refer to Policy #21 -2005 Ø The Nursing Supervisor or Administration designee directs when a “Code Yellow” is announced. Ø If you receive a bomb threat what should you do? • Do not hang up. • Remain calm. • Notify PBX -Dial 77. • Do not touch the bomb. • Evacuate the area if directed.

Code Orange Key Points: Ø Refer to Policy #21 -2008 Ø A code orange is called for a Chemical or Biohazardous spill likely to cause unknown effects, injury, illness, or harm to the environment. Ø Employees using hazardous materials must know the hazards of these materials, the possible routes of exposure, and how to clean small spills safely. Ø EIEIO stands for Evacuate personnel, Identify chemical, Eliminate spread, Inform Switchboard (Director/Supervisor/Safety Officer/Engineering), and Organize clean up.

MSDS Changing to SDS Key Points: ØRefer to policy #22 -1004 Ø Master copies of MSDS (Material Safety Data Sheets) or SDS (Safety Data Sheets) are available in the Emergency Department and Engineering. Ø MSDS information is accessible through the hospital intranet “MSDS Online”. ØDepartments have MSDS for hazardous products. ØAvailable for chemicals used and stored in area. Ø Containers of hazardous materials are labeled with contents and appropriate warnings. Ø Transitioning to the standardized SDS format completely by June 1, 2016. their

Code Triage Internal Disaster Key Points: Ø Refer to Policy # 21 -2009 Ø Part of the Hospital Incident Command System (HICS) Disaster Plan. Ø Departments affected should carry out the responsibilities delineated in their departmental disaster plan following appropriate departmental responsibilities. Ø Immediately upon hearing Code Triage Internal, departments not effected should take an inventory of their supplies and departmental status. Ø Relay information to Planning Chief and/or Logistics Chief. Ø Plans should include two evacuation routes.

Code Triage External Disaster Key Points: Ø Refer to Policy #21 -2010 Ø Part of Hospital Incident Command System (HICS) Disaster Plan. Ø External Triage should be called when any emergency situation outside the facility may result in multiple victims that require the support of several departments to assist with their needs. Examples of an external disaster are: Multi-vehicle accident, earthquake, train derailment, nuclear, biological, or chemical incident, any event with mass casualties. Ø Employees should accept transfer of station or duties within their capabilities without question. Ø If staffing becomes a problem, employees may be requested to remain on duty.

Disaster Key Points: Ø Refer to the Emergency Preparedness Procedures Flip Chart (yellow) and departmental policies and procedures for disaster. Ø The disaster command center is located in the Medical Staff Conference Room unless announced elsewhere. Ø The disaster Labor Pool is located in the Cafeteria unless announced elsewhere. Ø Off duty personnel call the Hospital Disaster Hotline 559 -684 -4525 (number on name badge). Ø The Incident Command role will be assumed by the Nursing Supervisor or Administration designee.

Key Points: Evacuation Ø Refer to Policy #21 -2011 Ø There are two levels of evacuation, 1. Partial evacuation of patients are within the hospital. 2. Full evacuation of patients are transferred from the building to an outside area, other hospital, or other alternative area. Ø Evacuation is initiated by the Incident Commander (HICS Plan). Ø Evacuate using a designated safe exit after determining the location of patients to be evacuated. Ø Evacuate patients in immediate danger first, then ambulatory patients, then semi-ambulatory, nonambulatory patients are last.

Workplace Violence Key Points: Ø Refer to Policy #22 -1021 Ø TRMC Workplace Violence Prevention Plan includes: 1. Management and employee involvement 2. Worksite security analysis 3. Safety training 4. Staff education 5. Record keeping

Workplace Violence Key Points continued: Ø According to 2014 Bureau of Labor Statistics health care professionals are 16 times more likely to be attacked on the job than any other type of service professional. ØCommit to an environment of zero tolerance for workplace violence. Ø Report risk factors that may contribute to assaults. Ø Recognize warning signs of escalating behavior: pacing/restlessness, cursing, yelling, excessive insistence, clenched fists, threats [CPI (Crisis Prevention Institute) early warning signs and interventions].

Workplace Violence Key Points continued: Ø Immediately report any acts or threats of violence occurring on hospital premises to Security, your Supervisor, Director, or Human Resources Department. Ø Report any kind of threat or gut feeling that a person may act out. Ø Contact PBX (77) to call a Code Gray, Code Silver or Code Black as appropriate to the situation. Ø Participate in debriefing and/or counseling after experiencing or witnessing a violent incident.

Thank you for Viewing Section 3 You may now return to take the Section 3 test, then move on to Section 4. Good Luck!