Emergency Response Guide

When discovering smoke or fire your role is to:

• Remember & Practice RACE
  • R – Rescue persons in immediate danger
  • A – Alarm/Alert by pulling the closest fire alarm and calling 57-5555
  • C – Contain fire by closing door.
  • E – Extinguish fire (attempt) with closest fire extinguisher or evacuate area. Do not put yourself at risk.
• Remember & Practice PASS (Use of fire extinguisher)
  • P – Pull the safety pin
  • A – Aim at the base of the fire
  • S – Squeeze the handle
  • S – Sweep from side to side until fire is out or extinguisher is empty

Staff Response to Fire Alarm:

• Practice R-A-C-E
  • R - Rescue persons in immediate danger
  • A - Alarm/Alert by pulling the closest fire alarm and call Command Center by dialing 57-5555. If your site is located on the NCH campus call 57-5555. If your site is located off the NCH campus, then call 911 or your building's fire emergency number.
  • C - Contain fire by closing door.
  • E - Extinguish fire (attempt) with closest fire extinguisher or evacuate area. Do not put yourself at risk.
• Practice P-A-S-S
  • P - Pull the safety pin
  • A - Aim at the base of the fire
  • S - Squeeze the handle
  • S - Sweep from side to side until fire is out or extinguisher is empty
• Security will respond to all fire alarms on NCH Campus
• Take count of patients and visitors in your area. (Print or obtain census)
• Check rooms for patients or visitors (Including bathrooms) and close door once room has been assessed.
• Check door before opening it. Do not open a hot door.
• In the event of a fire that cannot be contained without causing harm:
  • Immediately begin moving patients, visitors and staff beyond closed smoke/fire doors. Unless otherwise directed, move patients that are in the area of fire, away from fire through two (2) sets of smoke doors on the same floor.
  • Supply oxygen masks via portable tanks to those in need.
  • Move portable oxygen tanks (cylinders) away from fire area.
  • Charge nurse or respiratory therapy may direct that the zone emergency medical gas control valves can be shut off.
    • Special exception for Preoperative Services or any other anesthetizing locations: A registered nurse under the direction of the anesthesia provider, surgeon/proceduralist or charge nurse may authorize shutting off medical gas supply valves
  • Await further instructions

Horizontal or Vertical Evacuation may be ordered. Begin evacuation of all patients only under the direction of the Fire Marshall

Code Delta Level 3 may be initiated

OC EM Approval Letter

Threat by Telephone or other Verbal Communication Device

• Remain calm. Keep caller on the line as long as possible.
• Listen carefully. Be polite and show interest.
• If possible, write a note or motion to an Associate to call Security.
• Note the number and/or letters on your phone display.
• Ask the following questions:
  • When will the bomb explode? ________________
  • Where is the bomb? __________________
  • What kind of bomb is it? ____________________
  • What does it look like? ______________________
  • What is your name? _______________________
  • Why are you doing this? __________________
  • Would you like to speak to a manager? ________________
• Note caller details:
  • Male/Female/Age
  • Accent/Speech Impediments
  • Write exact words of threat.
• Once the caller hangs up, immediately report bomb threat by calling 57-5555 using a landline phone
• Do not discuss threat with or alarm patients, visitors or families.
• Do not use two way radios or cell phones
• Contact your manager:
  • DO NOT use two-way radios or cell phones to transmit: radio signals may detonate a bomb.
  • DO NOT discuss threat with patients, visitors, or families.
  • DO NOT touch or go near suspicious packages, objects, etc.
  • DO NOT start or repeat rumors.
  • Report suspicious items to the Logistics Center (TLC) at 57-5555.

Threat by Telephone or other Verbal Communication Device

Report suspicious package, letter or email immediately by calling 57-5555 using a landline phone

• Recognition of Suspicious Packages and Letters:
  • Unidentified package with an uneven weight distribution
  • Unusual odor, excessive wrapping, grease marks
  • Visible wiring or tinfoil
  • Unusually heavy for size
  • Rigid contents in a flexible envelope
  • Poor handwriting, spelling, or too many stamps affixed to package/envelope
  • Hand delivered by an unknown source
• Place package or letter in an isolated area. Do not tamper with the package.
• Immediately call 57-5555 to report possible threat
• Do not use two-way radios or cell phones
• Threat must be cleared before resuming use of these items
• The Logistics Center will notify 911
• They will coordinate search of the building
• Do not evacuate unless ordered to do so

Code “Active Shooter/Assailant” – Requested when an incident in the clinic or on the clinic grounds involves an individual or group that is using a weapon, brandishing a weapon, or is suspected of having a weapon.

Call The Logistics Center at 57-5555 and provide the following information:

• Location of the active shooter; be specific (floor & department)
• Number of shooters (if more than one);
• Descriptive information about the shooter: race, age, gender, weight, height, clothing, etc.
• Number and type of weapons held by the shooter(s);
• Number of potential victims at the location;
• If off campus or an internal phone is not available, immediately call 911

1. RUN - if there is an accessible escape path, attempt to escape the premises.

• Have an escape route and plan in mind, use stairs, not elevators. Avoid location of ACTIVE SHOOTER.
• Evacuate regardless of whether others agree to follow.
• Leave your belongings behind. Do not carry anything with you so you can move faster and not be mistaken for the shooter.
• Help others escape, if possible.
• Prevent individuals from entering an area where the active shooter may be.
• Do not attempt to move wounded people, leave them and report their location to authorities.
• Do not re-enter building until directed by law enforcement.

2. HIDE - If escape is not possible, find a place where the shooter is less likely to find you. Your hiding place should:

• Be out of the active shooter's view
• Provide protection if shots are fired in your direction.
• If on an inpatient unit:
  • Do not open locked access doors
  • Clear corridors
  • Keep patients and visitors in their rooms
  • Hide under desks
• If in patient room:
  • Close and barricade door
  • Turn off lights
  • Silence electronic devices

  To prevent an active shooter from entering your hiding place:

• Lock the door if possible
• Blockade the door with heavy furniture
• If the active shooter is nearby:
  • Lock the door
  • Silence your cell phone, pager, and other communication devices.
  • Turn off any source of noise, such as a radio, television, etc.
  • Hide behind large items, such as a cabinet, desk, etc.
  • Remain quiet

3. FIGHT – If the first two options are not available fight as a last resort and only when your life is in imminent danger

• Attempt to incapacitate the shooter
• Act with as much physical aggression as possible
• Improvise weapons or throw items at the active shooter
• Commit to your actions . . . your life depends on it

  If an active shooter is outside the building:

  • Find a location with a room that can be locked. If one cannot be found readily, try to determine if there is a nearby room that can be locked which you can reach safely.
  • Once you are in a secure room, close and lock all doors and windows. Turn off lights and get everyone down on the floor so nobody is visible from the outside.
  • Have someone in the room call 911 and tell the dispatcher quietly what you know, where you are, how many people are with you, and what you are wearing. Also, inform the dispatcher if there are any injuries and any other information the dispatcher requests.
  • Remain in place until police gives you instruction.
  • An unknown voice may be the shooter trying to lure you from safety. Do not respond to any voice commands unless you can verify it is a police officer.

  When Law Enforcement Arrives:

  • The first officers to arrive will not stop to aid injured persons. Rescue Teams of other officers and medical personnel will follow the first officers into secured areas to treat and remove injured persons.
  • Remain calm and follow officers’ instructions
  • Put down any items in your hands (bags, jackets, purses, etc.)
  • Immediately raise hands and spread fingers
  • Keep hands visible at all times
  • Avoid making quick movements toward officers
  • Do not stop to ask officers for help or directions when evacuating. Just proceed in the direction from which officers are entering the premises.
  • Continue to follow instructions by police until you are released.

SECURE YOURSELF

SECURE YOUR PATIENTS

Definitions:

• Code Green Delta Level 1 - An emergency/event has occurred in the community or region with the anticipation of 25 or more patients arriving at our facility.
• Code Green Delta Level 2 - A local or regional emergency/event with the anticipation of 24 or less patients arriving at our facility.
• Code Green Delta Level 3 – Infrastructure/operations failure impacting delivery of safe patient care (i.e., power, electricity, water, telephone, computers, etc.)

Emergency Operations Plan

The Emergency Operations Plan is designed to ensure appropriate, effective response to a variety of emergency situations that could affect the safety of patients, associates and visitors or the environment, or adversely impact our ability to provide healthcare services to the community based on the Hazard Vulnerability Analysis. The organization’s Emergency Operations Plan is organized around the National Incident Management System/Hospital Incident Command System (NIMS/HICS). When the need for a Code Green Delta is identified:

• The ED Medical Physician along with the Patient Flow Supervisor notifies the Administrator On-Call and the decision to active a Code Green Delta is made.
• Incident Commander is established (initial default is Patient Flow Supervisor until Administrator on Call or Incident Commander arrives)
• NCH’s Logistics Center established (Administration Conference Room, 1st floor) and activates Code Green Delta page to all pre-determined Code Green Delta grouping.
• Hospital Incident Command activated
• Overhead page repeated 3 times “Code Green Delta (1 or 2) in ED. Approximate ETA …”

Initial associate’s response when you hear the Code Green Delta announcement:

• Unless associates are designated to report to the Labor Pool, remain in your dept, continue with work tasks, limit telephone use and await further instructions.
• Emergency Department activates departmental MCI Plan
• Immediate Physician Response to Code Green Delta 1 or 2 (during normal hours of operation):
  • All Physicians will await direction from the Incident Command Chief Medical Officer in the following areas:
    • PICU, Critical Care Attending report to PICU
    • NICU Attending report to NICU
    • Anesthesiologist and Surgeons report to PACU
    • Pediatricians report to 4th floor conference room
    • Medical Imagining Physicians report to Medical Imaging
    • All other Specialist will remain in their department
    • Hospitalist begin inpatient unit rounding identifying potential patient discharges
  • Nursing Department:
    • If staffing allows, 1 Nurse from PICU and 1 Nurse from the 4th Floor will report immediately to ED
  • Other departments reporting immediately to ED:
    • 1 Respiratory Therapist
    • 1 Radiology Technician
    • 1 Social Worker
  • Supplies/equipment to ED:
    • Environmental Services delivers 10 stretchers, 10 wheelchairs and linen cart to outside the ED
    • Pharmacy delivers 3 medication drawers
    • Equipment technician delivers 3 crash carts
  • Labor Pool, ground floor, Medical Imaging/ Lab Waiting Area (Room A – 0501)
  • All inpatient and outpatient units send completed Disaster Information Form to Labor Pool
  • Code Green Delta storage container will be stored in the Incident Command

Code Green Delta Room Assignments:

• Incident Command Center: Executive Conference Room, 1st floor
• Labor Pool: Medical Imaging/ Lab Waiting Area - Ground Floor
• Discharge Holding Unit: 5th Floor Clinic
• Family Gathering/Waiting Area: Occupational Therapy Rehab Gym, 5th floor
• Family Support and Information Center: Auditorium
• Pediatric Safe Area—“Maternal Fetal Commons” on 1st Floor
• Media Relations Room: Data Center Building
• Associate Sleeping Area: Clinic areas

Hospital Administrator, Administrator On-Call, Risk Management On-Call Leader, Public Relations On-Call Leader shall be notified after resolution occurs or if the event is prolonged (over 30 minutes)

All associates are responsible for helping ensure the safety of patients, families and visitors.

• Preventing Patient Elopement or Abduction:
  • Associates must ensure each inpatient is banded with a security band.
  • When an inpatient approaches an exit, the alarm is automatically activated.
  • Upon activation of a security band sensor, an overhead Code Pink announcement with location is made and surveillance cameras zoom in to the specific exit to aid in identification.
  • Security responds to location of each Code Pink.
  • Inpatient units must immediately check if all their patients are accounted for.
  • Associates should report any suspicious activity.
  • If the child is found with a person that is not the child’s parents/guardians, try to keep the person in the area only if the child, yourself, visitors and other associates are not in danger. Do not use force to stop the person from leaving.
• If Tot Guard has not activated and you realize that patient is missing:
  • Dial the Logistics Center at 57-5555 or push the Code Pink button on the nurse call associates panel if you witness or are notified of child abduction
  • Provide description of missing patient such as:
    • Actual gender (abductor may have tried to change gender look i.e. cut hair, put on baseball cap)
    • Age
    • Hair and eye color
    • Approximate weight and height
    • What child was wearing (color and type of clothing including shoes)
  • Code Pink is announced 3 times (Sample): Attention - Code Pink. We have a lost 5 year old boy wearing a red shirt, blue jeans and black sneakers. He has blonde hair and weighs about 40 pounds. If you find him call 57-5555.
  • Associates Response To Missing Person:
    • Security deploys immediately to main gate, back gate, Main Lobby and reporting department
    • Associates should monitor their department/work area and report any suspicious activity to 57-5555
  • If the child is found with a person that is not the child’s parent/guardian, try to keep the person in the facility only if the child, yourself & others are not in danger. Do not use force to stop a person from leaving
• Refer to the Code Pink Policy for additional guidance
  • The organization’s Code Pink Policy is located on-line at the Nemours intranet Policy Tech.

Severe weather is defined as any meteorological condition that may cause damage to human life or property. This may include but is not limited to: Severe thunderstorm, Tornado, High wind advisory, Hail, Lightening, or Flooding

• Implementation of “Severe Weather Alert”:
  • When a decision is made to implement the Severe Weather Plan or the facility is informed of an imminent tornado or hurricane strike:
    • PFS sends notification to patient care team to begin preparations to secure/move patients page “Severe Weather Alert” (2) times every five (15) minutes until further directed
    • An “all-page” overhead and radio announcement shall be sent indicating “Severe Weather Alert.”
    • Close all shades, drapes, vertical blinds, doors
    • Patients should be positioned in the safest possible place in accordance with their condition and unit
    • Ambulatory patients and patients in wheelchairs should be moved to interior locations as determined by unit leadership.
    • Non-ambulatory patients:
      • Place in flat position, as tolerated
      • Cover with blankets
      • Turn bed so headboard is between patient and any window
    • Terminate all non-emergency treatment.
    • Turn off or unplug unnecessary electrical equipment.
    • All associates shall stay in their assigned areas unless directed otherwise by their supervisors/leaders.
    • All department supervisors/leaderships shall plan for adequate staffing during the disaster.
    • Visitors shall be instructed to stay with patients.
    • All patients and associates shall be relocated to the inner hallways or away from windows until the Severe Weather Alert All Clear” is given.
  • Any relocation activities should be directed by supervisory associates under the director of the Hospital Incident Command. Any storm damage shall be reported to the Hospital Incident Command.
  • Activate other Emergency Operation Plans as needed (i.e., Electrical Power Failure Plan, Hurricane Response Plan, etc.).
• Termination of “Severe Weather Alert”:
  • Once the danger has passed, the Severe Weather Plan shall be terminated by the Hospital Incident Commander.
  • The Hospital Incident Commander shall advise the TLC to page “Severe Weather All Clear” (2) times and repeat every 15 minutes for one (1) hour.
  • An “all-page” shall be sent indicating “Severe Weather Alert All Clear.”
  • Department supervisors/leaders shall complete a Severe Weather Critique and submit the document to the hospital EOC Safety Manager

Chemical Spill Response:

If there is a chemical spill, you have a responsibility to know proper procedures:

• Direct associates and visitors away from the chemical spill.
• Cover the spill and close doors leading to the spill area.
• Contact TLC at 57-5555 and ask for an emergency chemical spill clean-up. Give specific location of spill.
• Clean Utility rooms throughout the hospital have universal spill kits to aid in the clean up process.
• Dispose of materials properly and sanitize/store equipment used in clean up.
• Submit a Nemours Incident Report to Risk Management.

Many Associates work with or come into contact with chemical products in order to do our jobs. You have a right to know the hazards involved with these products and how to protect yourself. The best source of information is the Safety Data Sheet SDS. The SDS contain product, safety, hazard, first aid and other information. You can access SDS information three ways:

• 1) 3E’s online database accessible through the Nemours Intranet site
• 2) By phone at (800)451-8346

Workplace Violence is defined as: Any behaviors, including overt acts of violence, threats of violence, physical and verbal intimidation, and verbal abuse, which cause a person to feel a reasonable concern for his or her safety while at NCH, should call 57-5555 and ask for a “Security Alert” to the specific location where the incident is occurring.

Examples of workplace violence may include, but are not limited to:

• Physical violence
• Intentionally destroying property
• Threats of violence and harm, acts of aggression or intimidation, whether direct, indirect or veiled

In a violence/security alert incident:

• You witness loud, abusive language on the NCH campus.
• You witness increased, escalating violent behavior on the NCH campus.
• An NCH Associate has a perception of a potential/or real violent threat to either themselves, an Associate, patient, or visitor.

To initiate a Security Alertstrong>, call The Logistics Center (TLC) at 57-5555 or activate panic button if department is equipped with one. Then:

• 1. Provide your name and location.
• 2. Give a description of the incident.
  • Who is involved?
  • Age/Gender/Race of the involved
  • Relay to security personnel the specified threat if weapons or explosives were mentioned
• 3. Remain calm. Security is on its way.
• 4. Evacuate patients and staff away from the area.