TRMC Centralized Annual Update Module

Emergency Response

Section3

September 2014

Section 3Section 3Includes: Includes: 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 RedCode Red Key Points: RACEKey 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 ExtinguisherFire ExtinguisherKey Points: PASS Key Points: PASS

PullPull the pin.

AimAim the nozzle at the base of the fire.

Squeeze Squeeze the operating handle to release the

extinguishing agent.

SweepSweep from side to side at the base of the fire until the

fire appears to be out.

Code RedCode RedKey Points:Key Points:

Refer to Policy # 21-2001 Do not use elevator during a Code Red unless directed to

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 RedCode Red

Key Points continued:Key Points continued:

The Code Red response team consists of: Engineering Nursing Supervisor (when in house) Security Respiratory Therapy (only in patient care areas) Radiation Safety Officer, Laser Safety Officer, Lab

Safety Officer (if alarm is in their respective area). Staff from various departments.

Code Pink or Code PurpleCode Pink or Code PurpleKey Points:Key Points: Refer to Policy #21-2003 & 21-2004 Stop all non-critical work. Send a designee to cover all interior stairwell

doors, elevator areas, hallways and doors that exit anywhere near your work area.

No one is allowed to exit the hospital until security examines the premises.

Do not attempt to bodily apprehend the abductor.

Report all suspicious persons to security (77)

Key Points: Refer to Policy #21-2006 Any staff member confronted with or witnessing a combative

situation should call a Code Gray, dial 77. Security responds to STAT calls and assists staff with

combative and unruly patients, visitors or staff.

Recognize early warning signs! Verbal Abuse Verbal threats of harm. Intimidation by words. Physical Battery

Create a barrier Call for assistance

Code GrayCode Gray

Code SilverCode SilverKey Points:Key Points: Refer to Policy # 21-2007

Any employee who perceives a situation to be life threatening may call PBX by dialing 77 and describe the situation and the specific location.

PBX will notify Security who will respond “stat”. Security will assess the situation and decide what action to take.

If a ‘Code Silver’ is required PBX will announce 3 times “Code Silver- location” 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 SilverCode SilverKey Points:Key Points:Only the Administrator (designee), Nursing Supervisor (designee), Security and/or Law Enforcement has the authority to order a Code Silver Lockdown.

PBX will announce “Code Silver” and location or “Code Silver Facility Lockdown” for limited access lockdown.

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 - LockdownCode Silver - LockdownKey Points:Only the Administrator (designee), Nursing Supervisor (designee), Security and/or local Law Enforcement has the authority to order a facility lockdown.

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.

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 SilverCode 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.

Code BlackCode BlackKey Points:Key Points: Refer to Policy # 21-1000

First employee to identify an Active Shooter situation will call PBX by dialing 77 and “Code Black” with the specific location.

PBX will notify Administrator, Nursing Supervisor/Designee and/or Security. 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.

PBX will announce 3 times “Code Black- (location) and Facility Lockdown”. All staff will avoid the affected area(s).

PBX will dial 911 and inform Tulare Police Department.

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 YellowBomb Threat -Code Yellow

Key Points: Key Points: Refer to Policy #21-2005 The Nursing Supervisor or Administration designee

directs when a “Code Yellow” is announced.

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 OrangeCode Orange

Key Points: Refer to Policy #21-2008

A code orange is called for a Chemical or Biohazardous spill likely to cause unknown effects, injury, illness, or harm to the environment.

Employees using hazardous materials must know the hazards of these materials, the possible routes of exposure, and how to clean small spills safely.

EIEIO stands for Evacuate personnel, Identify chemical, Eliminate spread, Inform Switchboard (Director/Supervisor/Safety Officer/Engineering), and Organize clean up.

MSDS Changing to SDSMSDS Changing to SDSKey Points: Refer to policy #22-1004

Master copies of MSDS (Material Safety Data Sheets) or SDS (Safety Data Sheets) are available in the Emergency Department and Engineering.

MSDS information is accessible through the hospital intranet “MSDS Online”.

Departments have MSDS for hazardous products.

Available for chemicals used and stored in area.

Containers of hazardous materials are labeled with their contents and appropriate warnings.

Transitioning to the standardized SDS format completely by June 1, 2016.

Code Triage Internal Disaster Code Triage Internal Disaster

Key Points: Refer to Policy # 21-2009

Part of the Hospital Incident Command System (HICS) Disaster Plan.

Departments affected should carry out the responsibilities delineated in their departmental disaster plan following appropriate departmental responsibilities.

Immediately upon hearing Code Triage Internal, departments not effected should take an inventory of their supplies and departmental status.Relay information to Planning Chief and/or Logistics Chief.

Plans should include two evacuation routes.

Code Triage External DisasterCode Triage External DisasterKey Points: Refer to Policy #21-2010

Part of Hospital Incident Command System (HICS) Disaster Plan.

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.

Employees should accept transfer of station or duties within their capabilities without question.

If staffing becomes a problem, employees may be requested to remain on duty.

DisasterDisasterKey Points:Refer to the Emergency Preparedness Procedures Flip Chart (yellow) and departmental policies and procedures for disaster.

The disaster command center is located in the Medical Staff Conference Room unless announced elsewhere.

The disaster Labor Pool is located in the Cafeteria unless announced elsewhere.Off duty personnel call the Hospital Disaster Hotline 559-684-4525 (number on name badge).

The Incident Command role will be assumed by the Nursing Supervisor or Administration designee.

EvacuationEvacuationKey Points: Refer to Policy #21-2011

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.

Evacuation is initiated by the Incident Commander (HICS Plan).

Evacuate using a designated safe exit after determining the location of patients to be evacuated.

Evacuate patients in immediate danger first, then ambulatory patients, then semi-ambulatory, non-ambulatory patients are last.

Workplace ViolenceWorkplace ViolenceKey Points:

Refer to Policy #22-1021

TRMC Workplace Violence Prevention Plan includes:1. Management and employee involvement2. Worksite security analysis3. Safety training4. Staff education5. Record keeping

Workplace ViolenceWorkplace ViolenceKey Points continued: 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.

Commit to an environment of zero tolerance for workplace violence.

Report risk factors that may contribute to assaults.

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 ViolenceWorkplace ViolenceKey Points continued:Immediately report any acts or threats of violence occurring on hospital premises to Security, your Supervisor, Director, or Human Resources Department.

Report any kind of threat or gut feeling that a person may act out.

Contact PBX (77) to call a Code Gray, Code Silver or Code Black as appropriate to the situation.

Participate in debriefing and/or counseling after experiencing or witnessing a violent incident.

Thank you for Viewing Section 3Thank you for Viewing Section 3

You may now return to take the Section 3 test, then move on to Section 4.

Good Luck!Good Luck!