TRMC Centralized Annual Update Module Emergency Response Section3 September 2013

1. TRMC Centralized Annual Update Module Emergency Response Section3 September 2013

2. Section 3 Includes: • Code Red- Fire (Policy #21-2001) • Code Pink- Infant Abduction (Policy #21-2003) • Code Yellow- Bomb Threat (Policy #21-2005) • Code Gray- Combative Person (Policy #21-2006) • Code Silver- Person with a Weapon (Policy #21-2007) • Code Orange- Hazardous Material Spill/Release (Policy #21-2008) • Code Triage- Internal (Policy #21-2009) • Evacuation Policy and Procedure (Policy #21-2011) • Hazardous Materials and Waste Management Plan (Policy #22-1004) • Workplace Violence Prevention Plan (Policy #22-1021)

3. 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.

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

5. Code Red 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.

6. Code Red 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.

7. Code Pink or Code Purple • 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)

8. Code Gray • 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 assisting 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

9. Code Silver • 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”. All staff will avoid the affected area(s). • 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 affected area.

10. Code Silver - Lockdown • Key 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 affected area.

11. 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.

12. Bomb Threat -Code Yellow • Key Points: • Refer to Policy #21-2005 • The Nursing Supervisor or Administration 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.

13. Code 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.

14. MSDS • Key Points: • Refer to policy #22-1004 • Master copies of MSDS (Material 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. • Chemicals used and stored in area. • Containers of hazardous materials are labeled with their contents and appropriate warnings.

15. 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.

16. Code Triage External Disaster • Key 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.

17. Disaster • Key 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. • The Incident Command role will be assumed by the • Nursing Supervisor or Administration designee.

18. Evacuation • Key Points: • Refer to Policy #21-2011 • There are two levels of evacuation, • Partial evacuation of patients within the hospital. • Full evacuation of patients are transferred from the building to an outside are, 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.

19. Workplace Violence • Key Points: • Refer to Policy #22-1021 • TRMC Workplace Violence Prevention Plan includes: • Management and employee involvement • Worksite security analysis • Safety training • Staff education • Record keeping

20. Workplace Violence • Key Points continued: • 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. • Immediately report any acts or threats of violence occurring on hospital premises to Security, your Supervisor, Director, or Human Resources Department. • Contact PBX (77) to call a Code Gray or Code Silver as appropriate to the situation. • Participate in debriefing and/or counseling after experiencing or witnessing a violent incident.

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