Hospital Emergency Codes and Procedures

Emergency Codes Rev Date: Sept 2016

What are Hospital Emergency Codes? Hospital Emergency Codes are used in hospitals worldwide to denote to staff various kinds of emergency situations. Using codes provides essential information quickly and is understood by staff, while preventing stress or panic among visitors to the hospital. Hospital Emergency Codes are coded by colour most Ontario hospitals use the same colour coding system Detailed resource information relating to SMGH Emergency Code process and procedures can be found in the following locations: 1. The Pulse (Intranet) SMGH Policy & Procedure Manual- Emergency Codes 2. Yellow contingency binders in your departments Emergency Preparedness Station

RED FIRE close all doors; proceed to gathering place BLUE CARDIAC ARREST Cardiac/Respiratory emergency; code team will respond GREEN EVACUATION follow evacuation protocols for patients, staff YELLOW MISSING PATIENT follow search protocol ORANGE EXTERNAL DISASTER receipt of mass casualties incoming WHITE VIOLENT/AGGRESSIVE PERSON team responds BLACK BOMB THREAT search using maps; report suspicious packages BROWN HAZARDOUS SPILL report spill, team responds AQUA FLOOD team responds GREY LOSS OF ESSENTIAL SERVICES follow departmental procedures AIR EXCLUSION close all windows; lock down PURPLE HOSTAGE TAKING or abduction or armed intruder; call 911 and work with police SILVER ACTIVE KILLER Evacuate, hide, survive

Overview Dial 888 to notify switchboard of emergency codes Reference to all codes can be found on your hospital ID badge Fire drills are held monthly on a rotating basis Other mock exercises held throughout the year Workplace Safety, in conjunction with the Joint Occupational Health and Safety Committee, develop exercises and review policies.

Code Red - Fire The purpose of the Code RED is to define the process for staff, visitors, and patients to respond appropriately in case of a fire, fire alarm or smell of smoke. If you hear a Code RED called: Discontinue regular work Close all doors Make sure patients and visitors are in their rooms Turn off all non-essential equipment and gases Know your gathering location. Assemble in your designated areas and wait for further instruction Do not use elevators or telephones (unless absolutely necessary)

The mock fire When you see this strobe and flag in your path, you must treat it like a real fire and follow the Code Red procedures.

If you are the first to notice a fire . Pull the closest fire alarm Provide assistance to patients or those in danger Notify Switchboard (ext. 888) Provide your name, location and extent of fire Close all doors Extinguish fire if possible (use acronym PASS) Wait for further instructions

How to use a fire extinguisher Use the acronym PASS P pull the safety pin A aim nozzle at the base of the fire S squeeze the handles together S sweep from side to side

2 stage Alarm System 1st Stage: Bells at 60 strokes/minute, indicates fire 2nd Stage: Bells at 120 strokes/minutes, indicates entire hospital is to be evacuated Fire department will arrive on-site and proceed to the area affected by fire. The Fire department and/or Emergency personnel, will use the center stairwell; staff needing to use the stairs will use the stairwells at the end of the hallways, respectively. * During a Code Red, staff may be required to stay beyond their shift.

Code Green-Evacuation The purpose of the Code GREEN policy is to outline the procedures required to safely evacuate all patients, visitors, staff, and volunteers in a controlled manner. Types of evacuation can vary from a partial to a total evacuation of the hospital. Remember, the fire alarm ringing faster means evacuation is required. This alarm will only be engaged at that time.

4 Stages of Evacuation STAGE 1: LOCAL OR PARTIAL EVACUATION The fire occurs in a patient-occupied room, office etc. Will be carried out by the first person or persons to discover the fire All staff in the fire-affected area working together to move patients Supplement with other staff responding to the alarm or from the staff labour pools on request. STAGE 2: HORIZONTAL EVACUATION The fire occurs in a specific area of the hospital Will be carried out by all staff in the fire-affected area working together with the fire responders (fire department, engineering staff, security staff), Supplemented with other staff responding to the alarm or from the staff labour pools on request. STAGE 3: VERTICAL EVACUATION ALL patients on a fire-affected floor are compromised or may be compromised because of smoke or fire or the fact that a fire-affected zone cannot be horizontally evacuated Evacuation will be carried out by all staff in the fire-affected area working together with the fire responders (fire department, engineering staff, security staff), Supplemented by other staff responding to the alarm or from the staff labour pools on request. STAGE 4: TOTAL OR COMPLETE EVACUATION ALL patients on ALL floors are compromised or may be compromised Will be carried out by as many staff as necessary working together.

Evacuation of patients Elevators are under the command of the fire department and will be held at the 1st floor during an alarm and can not be used during an alarm. Patients are to be evacuated using the nearest exit or the East and West stairwells. Center stairwells (B and E) are needed for Emergency Personnel (Fire, Police) only. Patient evacuation: Remove all patients from the affected floor or zone Ambulatory patients are to be escorted quickly by 1 or 2 staff and exit using the nearest safe exit. Active treatment and non-ambulatory patients will be evacuated using a blanket technique or available evacuation device using standard transfer techniques. Using the stairwell slider boards: Going backwards with your left hand on the rail, hold the blanket with the right hand and slowly descend the stairs. Staff on the affected floor give the care of the patients over to the other staff on the first landing down, then return to affected floor (bucket brigade style) Keep to the right in corridors and stairwells Take flashlights, patient records and medication administration records to the evacuation center.

Code Orange Pre-Alert Code Orange Pre-Alert & Preparation Use when event details are unclear The purpose of the Code ORANGE is to coordinate a safe and effective response to an external disaster or any external pressure that may impact surge capacity or capability on the hospital, in particular the Emergency Department. Code Orange Level 1 An event which will overwhelm the ED department but not require a full hospital wide response The nature of the incident and disaster may vary; therefore, the Code ORANGE policy and procedure is flexible to meet the needs of the incident. Incidents that may precede a Code ORANGE can range from a major disaster such as an air crash with multiple casualties to an epidemic. Code Orange Level 2 A large event requiring full hospital wide response

Disaster Fan Out List The purpose of the disaster fan out list is to bring in additional staff in the event of a disaster. Up to date lists should be kept at home: 1. If you receive a call, go down the list calling names below yours until you reach a person (do not leave messages) 2. Report to SMGH with your badge and enter through the door by the One Voice One Vision monument

Code Yellow-Missing Patient The purpose of a Code YELLOW is to alert staff that the whereabouts of an individual patient is currently unknown to the staff in a specific patient/client care area. Code YELLOW provides all staff with direction for assisting in determining the patient s location and safe return. What do you do if you notice a patient missing? Inform nurse/team leader Check patient s room/washroom for street clothes and belongings Use search map to search unit Contact Switchboard (ext. 888) and provide a brief description of the missing patient All other departments are to search units & bring signed map to unit of missing patient Security searches exterior grounds Nurse responsible for the patient is to document in the electronic documentation system

Code White- Violent Person WHITE A Code is called to respond to episodes where individuals become violent and/or display behaviour which threatens staff, patient/client and building occupant safety. A Code WHITE is called immediately when staff safety is compromised. The main objectives of initiating a Code WHITE are: To provide a standard staff response to obtain assistance in managing episodes involving violent person To preserve the safety of staff, clients and other building occupants. To communicate an episode of violence to other staff members working in the building. To assist persons displaying violence to regain control over their behaviour.

Code White- Violent Person This is not an automatic call for Police If you are directly involved with the acting out individual, you will act as the Team Lead Call on your co-workers to assist/someone call for security (x5555) Attempt to de-escalate the situation Continue to engage with the acting out individual until assistance arrive Code White Response Team includes: Security Central Porters & Emergency Attendants One staff (RN/RPN) from 500/600/ED and ICU Clinical Aide from the unit where code occurs

Code Brown-Hazardous Spill The purpose of the Code BROWN is to define procedures required for the safe containment and management of chemical spills or release. The policy and procedure also ensures a timely, effective and safe response and resolution to the spill. A Code BROWN will be called if there is an internal spill/contamination, leak, suspicious unusual smell, gas, or vapor, or discovery of an unknown substance, liquid or powder.

Code Brown Criteria The criteria that classify a spill as a Code BROWN: Exposure requires medical attention Uncontrollable volatility (not stable) Requires protection from vapours/fumes Causes damages that will require repair Can t be properly handled due to lack of training or safety equipment Requires extended clean up Is an unknown substance Involves unknown substance

How to call a Code Brown Call Switchboard at ext 888 Information required: Specify location of spill Type of substance and approximate volume of spill What medical assistance is needed, if any Your name and extension Secure the area Wait for the Spill team, have a copy of the SDS available

Code Grey Air exclusion, Loss of Essential Services A Code GREY is a hospital emergency code that may be called for reasons as below: 1. To control contaminated air from entering the building. This may result from an external chemical spill or fire. Should such an event occur, Engineering Services will initiate procedures to limit external air intake. 2. Disruption or loss of essential services such as hydro, water, heating, cooling, ventilation, telecommunications or medical gas supply.

Code Grey Loss of Essential services Can be both planned (e.g. for maintenance) or unplanned (e.g. unexpected power outage) Listen for overhead announcement Can include loss of oxygen, water, hydro, medical air, heating/cooling, etc., even telecommunications such as the internet Follow department procedures, downtime procedures as required

Code Aqua - Flood To ensure a quick response to internal, uncontrollable flooding Call 888 and provide your location Triggers a response from teams such as Engineering, Housekeeping and Infection Control

Code Black Bomb Threat The purpose of the Code BLACK is to define the course of action required in response to a written or verbal bomb threat or upon discovery of a suspicious package or object. Staff are to report all bomb threats or suspicious packages or objects discovered anywhere in the facility immediately. Staff members are not to handle suspicious packages or objects. In the event that you receive a bomb threat: Be calm and courteous Do not interrupt the caller Keep the caller on the line as long as possible Obtain as much information as you can (listen for background noise) Call and report to Switchboard @ ext. 888

What to do if you hear a Code Black called Form search teams (aim to complete search within 10 minutes) Follow search map for your area (department contingency binder) One member searches, other records areas on completed map Place Room Checked tags on doorframe of searched rooms Notify Charge person when search is completed Bring search map to Switchboard DO NOT TOUCH suspicious packages notify Switchboard (ext. 888) if any are found

Code Purple- Hostage Taking/ Abduction The purpose of the Code Purple is to define the course of action required in response to actual or potential incidents involving hostage taking scenarios, including abduction Hostages are taken to be used as currency. It is usually more physically contained in nature than a Code Silver and may not require the same scope of Police response.

Code Purple Hostage taking/ Abduction Ifyou are taken as a hostage: Do not panic, try remaining calm and maintain perspective. Establish eye contact but don t stare Speak when spoken to, avoid strong opinion or making suggestions Attempt an escape only if you are positive that you will succeed Do not accept food/drink from the hostage taker or negotiators Position yourself away from doors and windows

Code Purple observing a hostage taking/abduction If you are observing a hostage taking or abduction situation: Get away from the immediate area Call 888 and provide your location, # of victims and injuries, # of intruders and description Do not approach the intruder, stay in the location you told switchboard so police can access you for an interview Keep yourself safe. Police will handle the situation when they arrive.

Code Silver Active Assailant Threat or Use of a Weapon with Intent to Harm Planned response to ensure the safety of all healthcare workers, patients and visitors at the hospital when an individual is in the possession of a weapon. Enhanced police response is required. Call if there is a threat, attempt or active use of a weapon to cause harm. Make every effort to protect yourself, patients, visitors and others in the immediate area.

Code Silver- Active Assailant Evacuate. Hide. Fight to survive Remain CALM and evacuate to a safe place Do not confront a person with a weapon Do not attempt to remove wounded persons from the scene If possible, assist others to leave the area and redirect those trying to enter Evacuate to a safer area, or outside of the building, if able and is safe to do so.

Code Silver If unable to evacuate, HIDE Use rooms with doors that lock Barricade the door with heavy furniture Silence your cell phone and turn off any sources of noise (e.g. radios, TV s etc.) Hide behind large objects (e.g. cabinets, desks, walls, etc.) Remain quiet and low to the ground SURVIVE Fight only if your life is in imminent danger. Attempt to disrupt/incapacitate the assailant commit to your actions. If others are available, work together to distract and attack the assailant as fiercely as possible.

Severe Weather Advisory (Watch) vs Warning Tornado Advisory: conditions pose potential for an event Assess patient for moving into hallway or lower level Clear hallways of non-essential items Warning: an event is occurring, imminent or likely Move patients to hallways if possible or away from window Close blinds/drapes Gather flashlights and make sure the batteries work. All solariums, waiting rooms and the 10th floor must be evacuated (windows). Earthquake Remain in place. If tremors begin to create falling debris, DROP, COVER and HOLD until the shaking stops. Avoid or Exit the elevator immediately. Close blinds/drapes- stay away from windows Stay close to inside walls

Questions? Contact your Workplace Safety Coordinator at safety@smgh.ca