WRH EMERGENCY CODES

Since 1993, a series of colours have been used across Ontario health care facilities to indicate to staff the presence of an emergency situation. It is important that ALL employees, students and volunteers know these codes.

INCIDENT NAME RATIONALE FOR COLOUR

Fire Code Red Colour of fire

Cardiac Arrest Code Blue Cardiac victim is often cyanotic / blue

Internal Evacuation Code Green Green (light) means “go” Missing Patient Code Yellow

Bomb Threat or Search Code Black Colour of charred material after an explosion Violent Person Code White White is the colour of restraints

Chemical Spill Code Brown The colour of chemical spill

Neo-Natal Arrest Code Pink A resuscitated baby “pinks” up

External Disaster Code Orange Colour of ambulance bringing victims

In Case of Emergency . . . At Met, Western, and Malden Park (MPCCC), any staff member can notify switchboard of an emergency by dialing:

3333

When this happens, the appropriate Code personnel will respond. Please state the Code, Campus, and Specific Location. At all other WRH sites like Regional Children’s Centre (RCC), and off-site programs, (i.e. Withdrawal Management Service, Residential Rehabilitation) any staff member can access emergency assistance by dialing:

911 Once a Code is Called . . . Switchboard will announce the code and the location overhead. The announcement will be made three (3) times in succession. Response teams will make their way to the designated location with crash carts or other necessary equipment. Staff members in the affected areas will also be expected to assist in the response.

Emergency Codes On-Line The most up to date codes policies can be found via the Policy Library on the WRH Intranet.

Emergency Codes Kits Located on each unit, the Emergency Codes Kit contains important information and/or supplies that may be needed in the case of an emergency.

Code Red – Fire in the Hospital Upon discovery of smoke or fire, follow the acronym R.A.C.E.

R

ESCUE/REMOVE • Remove person(s) from immediate area (if necessary) • Re-assure patients / visitors in area • Remember elevators do not work at this time

A

LARM/ASSESS • Pull the nearest fire alarm • Remain calm • Call switchboard (Ext. 3333) Met / Western • Dial 911 at all other sites

C

ONFINE • Close all doors and windows, etc. • Clear hallways of any obstructions

E (i.e. stretchers, wheelchairs, equipment)

XTINGUISH/EVACUATE • Fight fire if possible using the appropriate extinguisher • Code Green is the code for internal evacuation • May involve horizontal or vertical evacuation

Using a Fire Extinguisher We use the acronym P.A.S.S. to remember the steps in using a fire extinguisher.

Reminder: If away from your unit/department (i.e. Cafeteria) and a Code Red is called in your area, use the stairway to return to the area, if safe to do so.

Code Green – Internal Evacuation

Pull the pin

Aim nozzle at base of fire Squeeze handle

Sweep from side to side

A Code Green may occur as a result of either an internal or external event. A gas leak, explosion or a rapidly spreading fire would require an immediate evacuation. A toxic spill in the community is an external event that could result in an evacuation if deemed necessary.

Level 1 – Horizontal Evacuation

Level II – Vertical Evacuation

Level III – Total / Premises Evacuation

• All persons in a zone/wing are moved beyond a corridor fire separation door to an adjacent area on the same floor

• Only affected area will move at this point

• All persons on the affected floor are moved two floors down

• First and ground floors are moved out of the building

• All persons are moved from the affected building outside or to another building

• Determined by Fire Dept, CEO, or Medical Officer of Health

Note: When clearing rooms during an evacuation, a piece of green tape is placed across the door jam to indicate that a room has been checked and is clear. You can find this tape in the Emergency Codes Kit.

Code Yellow – Missing Patient/Client/Resident

Level I – Search by Security & Unit Staff

Level II – In-Depth Search by ALL Staff

• Most Responsible Person (MRP) will assess potential risk

• MRP calls switchboard 3333 with patient info

• A full description of the individual will be distributed through the voicemail system

• Security and staff from the affected area search all general areas

• An unusual occurrence report in Risk Monitor Pro must be completed and submitted regardless if the patient is found

• All general areas will be fully searched by Security and Facilities

• All staff will conduct a thorough search of their areas using the departmental search grids (located in the Emergency Codes Kit)

• Search coordination site will be set up in the Administration Suite of the site

• Searched areas will be checked off on the grid and forwarded to the Search Coordination site

Code Yellow – Missing Infant/Child General Roles and Responsibilities

Most Responsible Person

(MRP) Security General Staff

• Provide Switchboard with a description of the alleged abductor and infant/child

• Attend to doors with Security

• Notifies the Police • Initiates search of the

entire facility • Notifies guards and

parking attendants

• Immediately search entire unit/area

• Using search grids, conduct a complete search of the working area

• Report any suspicious activity to Security

Code Blue – Medical Emergency in Adult or Child

Rescuer # 1 Duties

(First Person on the Scene) Rescuer # 2 Duties

(Second Person on the Scene) • Determine need for medical attention and/or

unresponsiveness • Confirm wishes of the victim • Call for assistance i.e. “Help, Code Blue” • Dial switchboard using 3333 • Check the time and start CPR, if necessary • Remain at the site to assist

• Respond to the call for help • Bring any emergency equipment available to

the location of the Code • Confirm that the Code has been called • Ensure that other patients/people close by,

are safe and taken care of • If necessary, assist Rescuer # 1 with CPR • Remain at site to assist

Code Blue Team: ED Physician, RNs from ICU/CCU/Cardiology, Registered Respiratory Therapists (RRT), 1st/2nd Person on scene Met/Western Campus: Code Blue Team will respond and bring crash cart. Windsor Regional Cancer Centre (WRCC): WRCC Staff bring crash cart to site of Code Blue Malden Park (MPCCC) / Regional Children’s Centre (RCC) / Off-Site: Notify EMS (911) Outside Building (but on Hospital Property): Dial 3333. Switchboard will initiate call to EMS and announcement will be made overhead. Code Blue Met Campus Only:

• To activate the Code Team Response, utilize the CODE BUTTON at the bed side. Switchboard will automatically be notified and will announce overhead. An audible alarm will sound on the nursing unit, emergency lights will illuminate outside the room and the room will be displayed on the Nursing Station monitor.

• In Paediatrics, “Code Blue Paed” will be announced. In the NICU, “Code Pink” will be announced.

• If the Code Button is activated in error (or the Code is something other than a Code Blue), it is the responsibility of staff to notify Switchboard (Dial 3333) regarding the correction/change of code.

NOTE: To improve management of pediatric crisis situations (ie. threats to airway, moderate to severe respiratory distress, change to neurological status), a Pediatric Emergency Response Team (PERT) has been created. Dial 4444 for team response. This does not replace a Code Blue Pediatric but is used as a preventative measure to hopefully avoid a Code Blue situation.

To improve the management of obstetrical crisis situations, an Obstetrical Rapid Response Team (OBRRT) has been created. Dial 4444 for team response. This does not replace a Code Blue but is used as a preventative measure to hopefully avoid one.

Code Pink – Medical Emergency in an Infant (< 1 Month)

Rescuer # 1 Rescuer # 2 Rescuer # 3

• Identify a medical emergency

• Call for assistance e.g. “Help, Code Pink”

• Check the time and begin CPR

• Remain at the site to assist

• Dial 3333 and call a Code Pink (Call a Code Blue at Western Campus)

• Bring equipment to the scene

• Assist rescuer # 1 with CPR

• Remain at the site to assist

• Confirm that Code Pink has been called (Code Blue at Western) and help is on the way

• Assist Rescuer # 1 and # 2 with resuscitation

Code Pink Team: ED Physician, Neonatologist, Registered Respiratory Therapist (RRT), 2 NICU staff, 1st/2nd Person on scene Met Campus: Code Pink Team will respond Western Campus: There is no Code Pink Team at the Western Campus – call a Code Blue Windsor Regional Cancer Centre (WRCC): Code Pink Team will respond. Directions to Code provided by WRCC Staff Malden Park (MPCCC) / Regional Children’s Centre (RCC) / Off-Site: Notify EMS (911)

Code White – Violent Person This emergency code is used to signify that the behavior of an individual is deemed to be out of control or at risk of becoming out of control. WRH is committed to providing a safe and secure work environment, free from violence, threats, intimidation and harassment. Threats, threatening behavior or acts of violence against employees, affiliates, clients, visitors, residents or other individuals on WRH properties, will not be tolerated. A Code White Policy has been developed in conjunction with the Workplace Violence Response Policy to provide an effective and efficient method of responding to many forms and degrees of workplace violence. A Code White Emergency may be initiated in any of the following situations: - De-Escalation efforts have failed, or appear to be failing - The physical safety of staff, patients, or visitors is threatened due to actions or

behaviours of a person(s) - A person displays a substantial loss of control which could result in harm to

themselves, others or the physical environment. - Aggressive or violent behaviour is imminent or has erupted

Met/Western/WRCC

Malden Park Response RCC/Off-Site

• Remove yourself and others from immediate danger if the offending party cuts off efforts at communication

• Appoint person to dial 3333

• Remove yourself and others from immediate danger if the offending party cuts off efforts at communication

• Appoint person to dial Ext. 76529 to report Code White Malden Park

• Remove yourself and others from immediate danger if the offending party cuts off efforts at communication

• Call for help or contact 911 if necessary

Call a Code White when you witness or are involved with any individual who is not responding to de-escalation intervention and is: Threatening, harassing or being verbally abusive to another individual Attempting to harm themselves or others Attempting to destroy property Displaying threatening behavior that is escalating Refusing to leave hospital property when required

Code Brown – Chemical Spill

Level 1: Department Response

Level 2: Code Brown Team Response

Level 3: External Response

• Spill is small in volume • Spill can be cleaned up

with water or disinfectant • Can be handled by

department/unit staff • Poses no threat of

irritation • Housekeeping can be

contacted for assistance, if necessary

• DO NOT CALL A CODE BROWN

• Spill is generally larger in volume

• Spill is hazardous or unidentifiable

• Spill requires special clean up procedures

• Cannot be handled by department/unit staff

• May require evacuation of the immediate spill/release area

• CALL A CODE BROWN LEVEL II

• Spill is considered a health, fire, and/or environmental hazard

• Safe clean up requires respiratory equipment to be worn

• Requires evacuation beyond the immediate spill area

• CALL A CODE BROWN LEVEL III – FIRE DEPARTMENT WILL BE CALLED

Code Brown Response Team: Most Responsible Person (MRP)/Department Manager, Housekeeping Supervisor, Facilities, Security

C

ode Black – Bomb Threat

Search Protocol

General Staff Search Team Search

• Although police are called, the hospital is responsible for the actual search

• Using the Departmental Floor Plan (located in the Emergency Codes Kit), staff search their own area for anything suspicious

• Searched areas will be checked off using a highlighter

• Public areas (i.e. washrooms, cafeteria, etc.) should be checked first

• Forward completed search grid to the site’s Administration Suite

• Security and Facilities conduct a thorough search of the premises

• Using hospital floor plans, searched areas are checked off using a highlighter

Reminder: If you see something suspicious, DO NOT: • Touch, move, or open it • Activate light switches or slam doors • Use cell phone, pager or two-way radios

Code Orange – External Disaster Code Orange signifies a disaster in the community and includes tornado, flood, fire, motor vehicle accidents, plane crash, explosion, toxic spill, acts of terrorism, etc. Influenza viruses periodically cause worldwide epidemics, or pandemics, with high rates of illness and death. A Code Orange Disaster Plan has been designed to assist staff in dealing with situations where the number of potential patients presenting to the hospital may overwhelm the available resources. The plan ensures that the arrival of casualties from a disaster or the result of a pandemic can be managed in the most efficient and effective method available.

Code Description

Code Orange Advisory • Conditions are present which increase the possibility

that a disaster could occur in the community (i.e. tornado, flood, fire, toxic spill, terrorist threat)

• Wear ID Badge Code Orange Alert • Hospital has been notified that a disaster has

occurred in the community • No casualties are arriving yet • Each unit completes Code Orange Disaster Inventory

Checklist Code Orange Confirmed Level I

• Hospital is receiving LESS than 4 major casualties • Departments immediately affected will be involved

Code Orange Confirmed Level II

• Hospital is receiving MORE than 4 major casualties

Code Orange Confirmed Level III

• Hospital is receiving MANY MORE than 4 casualties with complex injuries

• All normal hospital routines are disrupted Code Orange Downgraded – Follow up will continue

• Hospital is no longer receiving casualties • Staff continue to care for current casualties • Complete Code Orange Operations Report • Return to department as indicated by MRP in

designated area Code Orange - Decontam • Indicates a chemical, biological, or radioactive

disaster • May require lockdown and decontamination

procedures