•• The following presentation will cover The following presentation will cover information on:information on:

•• Emergency CodesEmergency Codes•• Fire SafetyFire Safety•• SecuritySecurity

Kingston Hospitals’ Sites:KGH – Kingston General HospitalHDH – Hotel Dieu HospitalProvidence Care Sites:

MHS – Mental Health ServicesSMOL – St. Mary’s of the Lake HospitalPM – Providence Manor

In the Event of Any Emergency:Call Switchboard @ 4444 to report the emergency.

Give specific information; your name, location and the nature of the emergency.*Important Note* After Hours:

At some sites, Switchboard may go off duty. During these times, the 4444 number is forwarded to the Kingston Hospitals’ Security Control Centre. The process for reporting the emergency remains the same.

For Day-to-day Security Requests:Call the Security Control Centre at KGH (613-549-6666) ext. 4142

In the Event of Any Emergency:Call Switchboard @ 4444 to report the emergency.

Give specific information; your name, location and the nature of the emergency.*Important Note* After Hours:

At some sites, Switchboard may go off duty. During these times, the 4444 number is forwarded to the Kingston Hospitals’ Security Control Centre. The process for reporting the emergency remains the same.

For Day-to-day Security Requests:Call the Security Control Centre at KGH (613-549-6666) ext. 4142

EMERGENCY CODES: DIAL 4444Code “RED” FireCode “GREEN” EvacuationCode “ORANGE” External DisasterCode “YELLOW” Missing PersonCode “AMBER” Infant/Child AbductionCode “11” Inmate EscapeCode “BLACK” Bomb ThreatCode “BROWN” Hazardous SpillCode “GREY” External Air ExclusionCode “99” Medical EmergencyCode “BLUE” Cardiac ArrestCode “PINK” Paediatric Cardiac ArrestCode “WHITE” Violent EpisodeCode “PURPLE” Hostage Situation

Emergency procedures manuals have been circulated throughout the hospitals and offsite buildings.

These manuals contain the response and recovery procedures for all of the emergency codes.

Many of the codes have been revised into a new format.

At the beginning of the codes that have recently been revised there is an overview page that can be used as a quick reference to identify the immediate responses to the emergency from all staff.

This includes responses from Switchboard, Security and/or other departments that will be responding.

Inside each code there are job action sheets that contain specific information regarding the response and recovery efforts.

These sheets are designed to be removed from the manual by staff, and job actions can be checked off as they are completed right on the sheet.

(FIRE)UPON DISCOVERY OF SMOKE OR FIRE

REMOVERemove patient

(If in patient’s room)Call out CODE RED & Location

SITE REMOVALRemove person(s)

from room(s) adjacent to and across from

affected area.

ENSUREEnsure doors and windows are

closed. Turn off fans and air conditioners if possible

IMMEDIATELY SEARCH THE AREA YOU ARE IN FOR SIGNS

OF SMOKE OR FIRE

CALL SWITCHBOARDDial 4444 & Advise of Situation

UPON HEARING A FIRE ALARM

TRY TO EXTINGUISHIf within your capability, if not await

further instructions up to and including evacuation

Note: Upon hearing the location of the alarm staff from areas above, below or adjacent to the Code Red Site should return to their units.

SWITCHBOARDAnnounce Code Red

Notify Fire Services 911

R

E

C

T

A ALARMCall out CODE RED & Location

Activate Pull Station

The primary code related to fire safety is Code Red which is to be used upon discovery of smoke or fire.When you discover smoke or fire, initiate the R.E.A.C.T. acronym. The process is detailed in upcoming slides.

(EVACUATION)

HAZARD(i.e. fire)

LIMITED EVACUATIONMove personnel from affected area

(i.e. Code Red)

ACTIVATE APPROPRIATE EMERGENCY(i.e. Code Red)

APPROPRIATE AUTHORITY ASSESS

Executive Director, delegate will assess the emergency and determine the need

for further evacuationNotify Switchboard 4444

SWITCHBOARDAnnounce Overhead three times

Code Green (location)Notify Security Control Centre

EXTENDED EVACUATIONHorizontal evacuation of a floor or wing,

to another area within the Hospital

TOTAL EVACUATIONVertical evacuation of a wing or the entire

Hospital, to the exterior of the building

Note: Code Green will be announced in one of two ways, either “Code Green Cautionary” (where you prepare for evacuation), or

“Code Green Stat” (where your start evacuating right away).

The other code related to fire safety is Code Green – Evacuation.

However, Code Green is not limited to use only during fires. It may be used for any emergency requiring evacuation of one or more areas of the hospital/facility.There are two levels of Code Green that may be implemented during an Emergency:

“Code Green – Cautionary” will be used to inform staff to start preparing for evacuation. This would be followed by overhead announcements with specific instructions for the affected area.“Code Green – Stat” will be used for emergencies requiring immediate evacuation.

The type of tones or bells you may hear during a fire alarm may also indicate the need to evacuate. Information on alarms is covered in the R.E.A.C.T. section of this presentation.

We use the R.E.A.C.T. acronym to describe the response to discovering smoke or fire.The R.E.A.C.T. acronym is not a linear formula. You do not have to do one step at a time. In fact, it is better to be doing more than one step at a time. The best way to accomplish this is by delegating the steps to other people in the area.

The R.E.A.C.T. acronym is in place at Providence Care, and K.G.H. sites. H.D.H. will be changing their fire response acronyms to R.E.A.C.T.. Consequently, at that site, you may see references to the old acronym (R.A.C.E.). However, the responses are essentially the same.

The R in R.E.A.C.T. stands for Remove. You want to remove anyone that is in immediate danger, for example, anyone in the same room as the fire, if you can do so safely.

The “Remove” step of R.E.A.C.T. can be referred to as ‘site removal’ as illustrated above. The rooms are labeled in the order of evacuation. The first room to be evacuated is the room of fire origin. Then the rooms next to and opposite that room are evacuated, as they are the rooms the fire is going to spread to next.

Move people beyond the fire barrier doors in the middle of the hallway and then return to evacuate others, if it is safe to do so.

1Elevator

3 2

2 2

3

Smoke during fires is often more of a hazard than the actual flames. Smoke spreads quickly and contains carbon monoxide and other toxic gases that displace oxygen, making it difficult to breathe.

Smoke tends to leave people disoriented, impaired, blinded and confused. This in turn, can affect rescue and fire fighting efforts.

The evacuation sequence is shown in the following diagrams. Site removal incorporates horizontal movement across a fire separation barrier. Horizontal movement is

always the first direction of travel.

The buildings are subdivided into compartments known as ‘safe areas’. The walls and doors are designed to withstand heat and flame for a long period of time. Once you move beyond a fire separation you will be in a safe area.

If a horizontal evacuation is not available, a vertical evacuation can be done using the exit stairwells.

VERTICAL EVACUATIONSGo down a story below the fire floor.You do not want to go above the fire, as heat and smoke rise.If you are on the ground floor, go to the exterior of the building. Never go below grade (into the basement) during a vertical evacuation.Never use the elevators during an evacuation, unless instructed to do so by the Fire Department.Never take patients down stairs in wheelchairs.

PATIENT EVACUATIONAlways evacuate the easiest people first:

Ambulatory patients (those that can walk on their own) are easiest. Semi-ambulatory patients are harder to evacuate, and non-ambulatory patients will likely require more than one person to evacuate them. Resistive patients should be left until last. You can move several people who want to leave in the same amount of time spent struggling with someone who doesn’t.

ONE PERSON CARRY TECHNIQUESONE PERSON CARRY TECHNIQUES(SEMI(SEMI--AMBULATORY)AMBULATORY)

SIDE BY SIDESIDE BY SIDE

BEAR HUGBEAR HUG

TWO PERSON CARRY TECHNIQUESTWO PERSON CARRY TECHNIQUES(NON(NON--AMBULATORY)AMBULATORY)

SWING CARRYSWING CARRY

EXTREMITY CARRYEXTREMITY CARRY

Evacuchek and REMAR devices are in place at Providence Care sites. When evacuating, activate the device so that it indicates the room has been vacated. The device will close if the door is opened, signaling that someone has entered.

Evacuchek

REMAR

Inactivated Activated

The Evacusled is an emergency evacuation device in place at Providence Care sites:

• It is designed for use with non- ambulatory patients.

• It is ergonomically designed. As there is no lifting involved.

• Monthly in-services are provided at St. Mary’s of the Lake Hospital.

The sled is normally stored beneath the patient’s mattress so it is easily accessible.

Head and foot ends are deployed and connected.

The patient, mattress and Evacusled all come off the bed deck together.

Patients can be evacuated horizontally down hallways…

… Or vertically down stairs.

Continuing on with the R.E.A.C.T. acronym, the E stands for ENSURE CONTAINMENT.

Close the door to the affected room and close all doors in the area. This will limit the spread of smoke and fire and also limit the amount of oxygen available to the fire.

The A in R.E.A.C.T. stands for ALARM.

If you discover a fire, it’s important that you don’t shout “Fire!”.... people will often react with panic. Instead, shout “CODE RED” and the location of the fire (e.g. kitchen, bathroom, John’s office, etc.).This implies an organized response and cues your colleagues to respond using the R.E.A.C.T. formula.Remember to delegate the R.E.A.C.T. steps to people in the area.

The next part of the Alarm step is activating an alarm station.These are usually located near an exit, stairwell, or on either side of fire separation doors. At MHS these stations require a key to activate, which all staff are provided with. Insert the key and turn it to the right.

Activating an alarm station initiates the building’s alarm system. This system looks after automatic features such as closing fire doors, shutting off ventilation systems and recalling elevators to the first floor.

The alarm systems are two stage. The first stage is an “alert” stage, used to get your attention and notify you of the Code Red emergency.

You’ll hear tones or bells overhead followed by an announcement from Switchboard indicating the location of the Code Red.If additional evacuation is required a Code Green may be activated at the alarm station by Security, or the Fire Department, which will sound an alternate tone/bell. Either faster tones or a steady ring. This will be followed by further announcements for the affected area(s).

If you hear the Code Red announced:

Look for signs of smoke or fire, check closed doors in the corridor for heat, and if you find anything respond using the steps in R.E.A.C.T.

If you’re working at an offsite location, the alarm system may be one stage, which will require you to evacuate as soon as the alarm sounds. For more information speak with your supervisor and read your department’s fire safety plan.

The C in R.E.A.C.T. stands for CALL 4444 (Switchboard).

Give specific information about the location, size, and type of fire. Provide the door number of the room the fire is in if you know it. For example:

“Code Red Johnson 1. The room is J1-012-3. It’s a small garbage fire and

there’s lots of smoke”.

The T in R.E.A.C.T. stands for TRY TO EXTINGUISH the fire. If it is within your capability, or concentrate on further evacuation.

There are three things that need to be present in order to produce fire:

Fuel, heat and oxygen.Together they combine to create the chemical reaction that is fire. By removing one of these three sources, the fire will be extinguished.

That is how fire extinguishers work. They typically take the oxygen and/or heat out of the equation.

There are several types of fuel that you should be aware of, as well.

Class A fuels are solid, combustible materials, such as wood, paper, trash and plastics.

Class B fuels are flammable liquids, such as oil, grease, acetone and gasoline.

Class C fuels are energized electrical equipment. Basically, anything that is plugged in to an electrical socket or has a battery.

Within the hospital are several different types of fire extinguishers. All extinguishers will have a pictograph label telling you which type of fire they are designed to fight.

A.P.W. or air pressurized water extinguishers can be used on Class “A” type fires.

Typically, they are silver with a rubber hose and gauge attached.

CO2 or carbon dioxide extinguishers are designed for class “B” and “C” fires only.

Typically they are red with a plastic horn attached.

“ABC” or dry chemical extinguishers are designed for class A, B & C fires.

Typically, they are red, with a rubber hose and gauge attached.

There are rules for fighting fires. Staff are not fire firefighters, nor are they expected to be.

You should not put yourself in any danger. But you can act within your capability. For example, a small garbage fire could be extinguished without putting yourself in harm’s way.

There is another fire safety acronym that you can use to remember how to operate a fire extinguisher.

It is: P.A.S.S.

The P in P.A.S.S. stands for “Pull the pin”. There is usually a plastic tab holding the pin in place. Just break the tab as you pull out the pin.

The A stands for “Aim at the base”. Frequently, the temptation is to aim at the flames. However, if you do that, the extinguishing agent will fly right through the fire and do no good. You want to hit the base of the fire where the fuel is.

The first S stands for “Squeeze the handle or trigger”. This releases the extinguishing agent from the extinguisher.

The second S stands for “Sweep from side to side”. Sweep the extinguisher back and forth over the base of the fire. Start at a safe distance away and work your way forward. Once the fire is out, keep an eye on the area in case it re-ignites.

If you empty the extinguisher just lay it on the floor on its side, so people know that it is empty. You don’t want someone to come around the corner and try to put out the fire with an empty extinguisher.

• The next series of slides depict fire hazards and violations to the fire code and/or the fire protection and prevention act.

• Take a look at each picture to see if you can determine what is wrong.

Can you see the problem?

Can you see the problem?

ANSWER:

The tree is blocking the pull station.

All life safety equipment must be free of obstructions.

Can you see the problem?

Can you see the problem?

ANSWER:

There is a garbage bin and cardboard box in front of the fire hose cabinet.

Can you see the problem?

Can you see the problem?

ANSWER:

The fire exit is completely blocked.

Can you see the problem?

Can you see the problem?

ANSWER:

Storage in the corridor. Public corridors need to remain clear of combustibles and storage.

Can you see the problem?

Can you see the problem?

ANSWER:

The most common violation – a door propped open. All doors are to remain closed when the room is unoccupied.

• If you hear the Code Red alarm, check your area for any signs of smoke or fire

• If at any time you discover smoke or fire initiate R.E.A.C.T.• If it is within your capability, extinguish the fire using the

P.A.S.S. process• Always evacuate horizontally first• Get beyond a fire barrier (separation) door and into a safe

area• Read the Code Red Fire Safety Plan• Know your responsibilities

• The following slides will provide a brief overview of other Emergency Codes in place at the Kingston Hospitals sites.

• The information provided is very general, so it is highly recommended that you consult the Emergency Procedures Manual for the site that you are working at for more detailed instructions.

• Emergency Codes at all sites are in various phases of revision, as a result you may find some codes that are not in the newer format, or that have not been introduced to your site yet.

The hospital(s) would be notified by the Province and/or the municipality (e.g. emergency services) of a potential disaster.

All sites would be receiving a large influx of patients beyond which they could normally handle. At Providence Care sites, these would be decanted patients from KGH & HDH.

Staging areas for staff, volunteers and decanted patients would be assembled throughout the sites (Clinic areas, Cafeterias, Staff Lounges, etc.).

Reception areas would be prepared outside of the sites to accept incoming patients.

If the disaster was a C.B.R.N. (chemical, biological, radiological or nuclear) event, the decontamination tents would be set up outside of the KGH Emergency Room and the HDH Urgent Care Centre.

Extra staff would be called in through the site fan out procedure.

Clinic patients would be rapidly discharged.

Clinics would be cancelled.

Access to the facility would be limited by locking down all electronically controlled exterior doors.

The St. Lawrence Seaway:

There are many ships carrying hazardous cargo that pass through our area on a frequent basis.

Industry:

There are some chemical plants in our area. E.g. the Invista Nylon Plant, which is less than 3 km from Mental Health Services.

The railway system utilized by industry is also a potential source of hazards.

Airport:

Kingston has a small municipal airport, which presents a potential area of risk.

Highway 401:

One of the busiest highways in North America.

Many trucks carrying hazardous chemicals /cargo drive through the Kingston area.

This procedure refers to patients, but can be used for any person considered missing (E.g. staff members, visitors, contractors, etc.).Code Yellow is to be used for adults.Upon discovery that a patient is missing:

Search the immediate area first, including any locked areas (check closets, and under beds and desks).Under the direction of the area Manager/Charge Nurse have the patient paged overhead to return to the floor. Call nearby areas to inform them of the missing patient.Request Security assistance in locating the patient.If the patient does not return, or is not found, or there is a more urgent need to located them call Switchboard (4444) and request them to announce Code Yellow.

It will the be responsibility of Nursing staff to decide to involved the Police if they believe it is necessary (E.g. there is an imminent threat to the patient).Security will conduct a preliminary search of the facility and grounds.If the patient is not located, it is normally the responsibility of the attending physician to discharge the patient or to request a comprehensive search of the facility.

A child is anyone under 18 years of age.An infant is a child under 1 year of age.If you are aware of an infant or child is missing, search the immediate area first, including locked areas.If he or she is not found, notify Switchboard at 4444 to declare the Code Amber.If you witness an abduction, notify Switchboard at 4444 immediately (they will request the child’s, age, sex and hair colour to be announced overhead).Switchboard will notify the Police who will command the situation when they arrive.Isolate and contain the area to preserve evidence. If you find any potential evidence do not touch it, notify the Police

If you are aware of an inmate escaping notify Switchboard at 4444 immediately.The Police and Correctional Services are responsible for searching for escaped inmates.Hospital staff are not to interfere with escaping inmates. If you spot an escaping inmate notify the Incident Command Centre through the Switchboard and report the location.Hospital staff will only be asked to look for an escaped inmate under the guidance/control of Correctional Services or the Police through coordination with Emergency Management and Security (E.g. reporting anyone suspicious in your area).

Look around your immediate area for anyone that may be lost, confused, or just shouldn’t be there and notify the Incident Command Centre through the Switchboard if you see someone.

If you receive a bomb threat, try to stay calm.There is a bomb threat questionnaire, located on the back of thefirst Code Black page of the Emergency Procedures Manual.Do your best to write down the caller’s threat verbatim.

Try to get an answer for each question on the questionnaire.

Do not hang up the phone. Security or the Police will hang it up for you. The call can most often be traced as long as the line remains open.

If you have call display, write down whatever numbers come up regardless of if it looks like a phone number or not.

Notify Switchboard @ 4444 from another phone or have a coworker call for you.

4444

If you hear a Code Black announced look around your immediate are for anything suspicious (a diagram of possible signs of a suspicious package is located in an appendix to the Code Black procedure).If you find something, evacuate the area and notify the IncidentCommand Centre through the Switchboard.Do not pull the fire alarm. The vibrations of the tones/bells could detonate the device.Do not use a phone, radio, or pager around suspicious items as the transmissions from these devices could detonate the device.

A comprehensive search is a search of the facility where all areas (locked and unlocked) are checked by search teams.In the event of a comprehensive search for Code Yellow, Code Amber, Code 11, or Code Black, any staff member may be called upon to assist in searching the facility.Teams (with a minimum of two staff members) will be formed with available staff to conduct the comprehensive search.Each team will be assigned an area to search and report Their findings to the Incident Command Centre.Teams are provided with maps, checklists, master keys, & a flashlight.

This Code refers to chemical, biological, radioactive & hazardous drug (cytotoxic) spills.Other than for radioactive substances, if the spill is small and manageable, initiate a clean up on your own in accordance with the substance’s material safety data sheet.If the spill is large or unknown, evacuate & isolate the immediate area and notify Switchboard @ 4444For major chemical spills or unknown substances, pull the fire alarm.For radioactive spills, regardless of how much, always evacuate the immediate area.

(EXTERNAL AIR EXCLUSION)

UPON NOTIFICATION OF EXTERNAL AIR EMERGENCY

PRESIDENT & CEO / DELEGATE

Dial 4444 – Notify Switchboard to Announce

Code GreyDetermine the need for

further response

SWITCHBOARDAnnounce “Code Grey – Please remain in your work area until

advised further. Do not operate external doors or elevators. Do

not leave the hospital.” TwiceNotify Security via radio

Notify Maintenance pager 108

RESPONSEAll staff return to their area of workReturn all patients to their rooms

Clear the corridors of obstructionsAwait further instructions

SECURITYActivate & silence the fire

alarm system to shut down the fan system

Post “DO NOT ENTER” notices on the external doors

MAINTENANCESeal all mechanical

rooms that cannot be closed to the outside airPost “DO NOT ENTER”

notices on the doors

UPON HEARING A CODE GREY

A Code Grey may be utilized when the air outside of the facility is hazardous to the occupants. (E.g. a truck carrying a chemical overturns on the road nearby and a hazardous vapour cloud is in the air).It may also be called for utility emergencies, (loss of water, power, communications, etc.) or even severe weather emergencies (thunderstorms or tornados).The type of emergency should be announced along with the Code Grey.

Code 99 – Medical Emergency

This code is to be used for any medical emergency other than cardiac arrest (if the person is talking call Code 99).

Code Blue – Cardiac Arrest (Adult)

This code is to be used for an adult suffering from cardiac arrest (lack of respirations or pulse)

Code Pink – Cardiac Arrest (Pediatric)

This Code is to be used for an infant or child suffering from cardiac arrest

When calling a medical code tell Switchboard specific information (E.g. your name, location and the type of required code).

For a Code 99, state the nature of the emergency (E.g. collapse, fall, injury or bleeding, etc.).

A medical team will respond to the area.

Members of the medical team will vary depending on the, day, time, and location of the emergency

RESPONSE

(VIOLENT EPISODE)

ANYTIME THERE IS VIOLENCE OR A THREAT OF VIOLENCE

STEP #1DIAL 4444 – Provide details to

Switchboard

SWITCHBOARDAnnounce Code

White Notify Security via radio

SECURITY SERVICESSecurity will contain and control the area upon arrival or isolate the area and notify the Police

STEP #2Isolate the area to prevent injury to

bystanders

This code may refer to “acting out” individuals at some sites, if the person is aggressive or threatening, this code applies.Anytime there is violence or even a threat of violence notify Switchboard @ 4444 immediately.You do not need to wait for someone to be physically assaulted before calling for help.If the aggressor is loud, belligerent, or threatening in any way, call for help.Maintain a safe distance from the aggressor.Never try and deal with the situation alone.Do not allow the aggressor to block your escape route.Security will be notified and respond immediately.A Code White can also be used if you are witness to a criminal act (theft, robbery, etc.).

If you are aware of a hostage situation, evacuate and isolate the immediate area.Notify Switchboard @ 4444.Do not attempt any action, leave it for the Police.Switchboard will notify the Police who will command the situation when they arrive.Code Purple will not be announced overhead unless directed by Police or Senior Administration.

Do not show or attempt physical resistance once captured.Cooperate and follow instructions.Avoid sudden or threatening movement or gestures of any kind.Do not make threats of retaliation, deals or promise rewards.Try to maintain a low profile and not draw attention from the hostage taker.Trust the Police, they may minimize your importance to the hostage taker so you will be freed.Take note of the hostage taker(s) description and anything he/she/they say.

Even though you may want the situation to resolve as soon as possible, be patient and let the Police do their job. It has been shown that the longer a hostage situation goes on the more likely it will result in a positive outcome for the hostages.In the event of a Police assault, fall to the floor to get out of the line of fire and to distinguish yourself from the hostage taker(s).If you do decide to physically resist the hostage taker, do so without hesitation and fight for your life using whatever means you can (attacking the body’s weak points, e.g. eyes, throat, groin, etc.)