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2. Objectives Identify procedures to use in the event of a Code Yellow. Recall two important procedures to follow when receiving a Code Gold bomb threat. Explain the role of staff in a Code Pink. Recall essential information for Code Purple implementation. Recall essential information for Code Orange implementation.

3. The information presentedhere meets… Occupational Safety & Health Administration (OSHA) safety mandates Center for Disease Control (CDC) infection control standards Joint Commission on Accreditation of Healthcare Organizations (JCAHO) environment of care requirements, clinical nursing concepts and skills Corporate compliance through the Office of the Inspector General Centers for Medicare & Medicaid Services (CMS) standards, quality, and customer service

4. Graphic images used in this presentation include the following sources… Clip Gallery and Clip Gallery Live, 2006 Microsoft Corporation. All rights reserved. LifeART images, copyright 2006, Lippincott, Williams & Wilkins. All rights reserved.

5. Emergency Codes The Maryland Department of Health and Mental Hygiene has adopted regulations requiring all Maryland hospitals to use a uniform set of emergency security codes. This means the emergency codes will be the same from one Maryland hospital to another. Beginning November 1, 2004 the following emergency code names will no longer be used: Code D (disaster) Code S (search) Code K (infant or child abduction) Code Silver (hostage, barricade, weapon)

6. Emergency Codes These new emergency codes will be used by all departments and units on the Hospital campus as well as Hospital owned off-sites beginning November 1, 2004.

7. Emergency Management Plan Healthcare facilities must be able to respond to a rapid influx of patients if an emergency or disaster occurs. The Health System’s Emergency Management Plan tells us how to use personnel and equipment during a Code Yellow (emergency or disaster). The Emergency Management Plan is found in the following locations: Meditech OA Library, Policy and Procedure Manuals cabinet. Disaster Plan Manual (yellow notebook with black lettering) in each hospital unit or department. With the Administrator-On-Call.

8. Internal and External Disasters Disaster - any incident, natural or man-made which causes or poses widespread danger to occupants and property to the extent that normal services are disrupted. Internal Disaster - occurs on the Hospital Campus. External Disaster - occurs at any other Health System site or elsewhere in the community.

9. Disaster Drills To prepare for an actual disaster, the Hospital Campus will conduct Code Yellow (disaster) drills on a regular basis. A drill will differ from an actual disaster in only in two areas: 1. Call Tree - Each unit or department’s call tree will be implemented, but employees will not be told to report to work. 2. Patient/Customer Care - Actual patient/customer care will not be jeopardized for participating in an drill. While other Health System sites do not participate in the Hospital Campus disaster drills, they may schedule their own disaster drills using procedures described in their unit/department-specific emergency management plans.

10. Responding to a disaster... To be ready for an actual disaster, all units or departments, including those at other Health System sites need: 1. An up-to-date Call Tree. 2. Employees prepared to respond if called. 3. Unit or department-specific emergency management (disaster) plan. Depending on the extent of a disaster, Employees from other Health System sites may be asked to participate in an “actual” disaster. Or, another Health System site may need to be used to care for disaster victims.

11. Emergency Management PlanActivation When the Hospital’s Emergency Management plan is activated, a Code Yellow will be announced over the public address system. At other Health System sites where a Code Yellow occurs, staff will be notified according to the steps outlined in their unit or department-specific Emergency Management plan. Six areas are established on the Hospital campus: Area Location 1. Command Center Board Room 1D (effective 7/1/06) 2. Nursing Manpower Nursing Staff Office 3. Disaster Triage Emergency Department 4. Family Waiting Area Outpatient Registration 5. Walking Wounded Ambulatory Services 6. Supportive Care OR Holding Room

12. The six areas established on the Hospital Campus and their specific responsibilitiesare...

19. If you are called from hometo respond to a Bring your I.D. badge so that you can be identified as a Health System employee.

20. Bomb Threat Beginning November 1, 2004 the new code name for a bomb threat is Code Gold. “Code S” will no longer be used. Bomb threats can occur at any Health System site. If you receive a bomb threat call… Be alert to every detail mentioned or noted. Keep the caller on the line. Jot down the exact time and exact wording of the message. Try to notify a co-worker that you are receiving a bomb threat so that they can call for emergency help.

21. Bomb Threat Bomb threats at the Hospital should call extension “8122” for emergency help. All other Health System sites, should call the following for emergency help as soon as a bomb threat is received: # 1 - Call 911 # 2 - Call 301-790-8122 (ext. 8122) to alert the Administrator-On-Call

22. During a bomb threat call,there are questions you should ask the caller and details you should note.

23. Bomb Threat Report

24. Bomb Threat Report

25. Bomb Threat - For bomb threats at the Hospital, staff will be notified of a Code Gold over the public address system. At other Health System sites where a bomb threat occurs, staff will be notified according to the steps outlined in their unit or department-specific emergency management plan. For a bomb threat, the Emergency Management Plan will be activated by the Administrator-On-Call. The Command Center and the other areas according to the plan will also be established.

26. Bomb Threat - When a Code Gold is called, you may be asked to participate in a search of your unit or department. This is because you and your co-workers are more familiar with items that are normal and routinely found in your unit or department. Someone from another unit or department wouldn’t know what should be there or should not be there.

27. A Special Part of the Emergency Management Plan is…

28. Announcement Code Pink means an infant or child is MISSING and presumed abducted! At the Hospital, Code Pink will be announced over the public address system. At other Health System sites where a Code Pink occurs, staff will be notified according to the steps outlined in their unit or department-specific disaster plan. When you hear a Code Pink announced you must know immediately what to do. Time is very important to make sure that the missing child does not leave the building.

29. When a Code Pink is announced... At the Hospital, the public address announcement will tell you the age and gender of the missing child. At other Health System sites, the manner in which a Code Pink is announced should be described in your unit or department-specific disaster plan. Examples… If you hear Code Pink, LDRP, 2 day old male… Then you will know to search for or stop individuals leaving the building with a 2 day old male child. If you are notified of a Code Pink, Diagnostic Imaging, 3year old female... Then you know that the missing child is from Diagnostic Imaging and is a 3 year old female child.

30. Staff have two responsibilities... 1. Monitoring all exits. 2. Searching for the missing child!

31. FIRST... Verify that the abduction has occurred and the amount of time that has elapsed.

32. THEN... Notify your unit or department supervisor.

33. Monitoring Exits Health System employees will monitor all exits to make sure no one leaves the area with a missing child. All employees monitoring exits will stay at their stations until they are notified that the Code Pink is over. At the Hospital, the “All Clear” will be announced over the public address system.

34. Be aware that small children can be concealed… Under coats and in large packages

35. For more details on handling a Including how to approach individuals who are with a child that fits the description of the missing child, Consult the Emergency Management Plan... Cabinet: Policy & Procedure Manuals # 2: Emergency Management Plan # 8: Internal Em. Management Plan # 4: Infant/Child Abduction Plan

36. More Information

37. Code Purple tells Health System staff how to respond to a hostage, barricade or weapon (armed intruder) situation. Everyone must know and understand this plan! Security Only Response

38. Responsibilities The first staff person to identify a hostage, barricade, or weapon situation must immediately call for emergency help. At the Hospital: # 1 - Call extension 8122 All other Health System sites: # 1 - Call 911 # 2 - Call 301-790-8122 (x 8122) to notify the Administrator-on-Call Do not risk your personal safety to intervene!

39. Responsibilities The first staff person to identify a Code Purple situation should observe and report details to Security/Police… Number of hostages Type of problem Type and number of hostage takers Type and number of weapons being used Threats and demands made by hostage takers

40. Responsibilities A lockdown procedure will be implemented by the Security Department... Locking all doors to the building Asking visitors to leave the building immediately Restricting access to the hostage/intruder area The Administrator-on-Call will activate the Emergency Management Plan.

41. Announcement At the Hospital, the announcement for Code Purple will be made over the public address system… “Attention please, Code Purple is in effect. Lockdown procedures are effective immediately. All visitors are asked to leave the building immediately. Access to ( area ) is now restricted.” At other Health System sites where a Code Purple occurs, staff will be notified according to the steps outlined in their unit or department-specific emergency management (disaster) plan.

42. For additional information on Code Purple, including unit/ department-specific information, please refer to the Emergency Management Plan in the Policy and Procedure Manuals cabinet of the Meditech Library. The Emergency Management Plan is also found in the following locations: Disaster Plan Manual (yellow notebook with black lettering) in each hospital unit or department. With the Administrator-On-Call Additional Information

43. Hazardous Material Spill or ReleaseWeapons of Mass Destruction Plan

44. Weapons of Mass Destruction Plan The Weapons of Mass Destruction Plan gives specific instructions for treating massive numbers of patients exposed to… Biological agents Chemical agents Radiological agents Or any other acts of terrorism

45. Weapons of Mass Destruction Plan Staff will be notified using the emergency code: Code Orange. Code Orange has three functions… Decontamination Transportation Lockdown

46. Responsibilities Hospital units/departments will respond to a Code Orange based on their priority designation… High Impact Clinical High Impact Ancillary Low Impact

47. Responsibilities Your specific responsibility in a Code Orange will be defined in your unit/department-specific emergency management plan. Depending on the extent of a Code Orange… Employees from other Health System sites may be required to participate in an “actual” Code Orange Or, other Health System sites may need to be used to care for Code Orange victims.

48. Announcement At the Hospital, Code Orange will be announced over the public address system. The announcement will tell employees to activate the … Decontamination Plan Transportation Plan Lockdown procedures And ask all visitors to leave the building immediately, exiting through the Main Lobby. At other Health System sites, staff will be notified according to the steps outlined in their unit/department-specific emergency management (disaster) plan.

49. Additional Information A copy of the Weapons of Mass Destruction Plan can be found in the following locations: Meditech OA Library, Policy and Procedure Manuals cabinet. Code Orange Manual (yellow notebook with orange lettering) in each hospital unit or department. With the Administrator-On-Call

50. For responding to all types of emergencies you should know… What is expected of you and your unit when participating in disaster drills and real disasters. Your unit/department-specific policy and procedures related to a Code Yellow emergency. What to do in the event of a… Bomb threat Code Gold Infant or child abduction Code Pink Code Purple security only - hostage, barricade or weapon (armed intruder) situation Code Orange hazardous material spill or release - weapons of mass destruction

51. Uniform Emergency Codes The Maryland Department of Health and Mental Hygiene has adopted regulations requiring all Maryland hospitals to use a uniform set of emergency security codes. This means the emergency codes will be the same from one hospital to another. Effective November 1, 2004 these codes will be used by all departments and units on the hospital campus as well as hospital owned off-sites.

52. Now, it’s time to see what you learned! Copies of the Emergency Management post test can be found on… The WCHS Intranet, WCHS Inservices page. Or, in the Meditech Library, Human Resource Development cabinet, Mandatory Inservices Info drawer. Read the questions and circle the correct answers on your paper copy. Give your completed post test to the designated person in your unit or department.

53. To Exit This Inservice… Press the escape key on your keyboard. Click on the back button in the upper left corner of your computer screen to return to WCHS Inservices page.