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DIAL 5555

SELECT COLOR FOR MORE/LESS INFORMATION

BLUE

Medical Emergency

Any medical emergency that has escalated beyond your ability to deal with, either personally or within your group.

Call Code Blue by dialing 5555 and identify the location.

Remain calm and initiate basic life support – the ABC’s (airway, breathing, circulation) – if trained.
When the response team arrives, inform them of the situation and any isolation precautions.
A Code Blue can be called anywhere inside the hospital extending outside to the walkway surrounding the hospital.
Beyond the walkways call 911.

PINK

Pediatric Emergency

Any neonatal (baby) emergency that has escalated beyond your ability to deal with, either personally or within your group.

Call Code Pink by dialing 5555 and identify the location.

Remain calm and initiate basic life support – the ABC’s (airway, breathing, circulation) – if trained.

When the response team arrives, inform them of the situation and any isolation precautions.

RED

Fire

On discovery of a fire or visible smoke.

Call Code Red by dialing 5555 and identify the location.

Initiate S-C-A-T-E

Save – remove people from the immediate danger
Contain the fire by closing all windows and doors
Alarm – activate the fire alarm
Tell – telephone the call centre at 5555 and give details

Evacuate those at risk from the surrounding area and extinguishing the fire, if trained and safe to do so.

Obtain and put on the “Fire Warden” vest found next to this booklet in your department, and act as the lead until relieved by a repsonse team member

When you hear Code Red announced:

Remain where you are and await location notification.
Restrict all unnecessary staff, patient, visitor movement within the hospital
Where appropriate, close all window and doors.
Clear all corridors.
Do not attempt to use elevators.
Upon hearing notification, return to your unit.
Wait for further instructions.

GREEN

Evacuation

Removal of Persons from all or part of the hospital’s area of harm behind designated fire barrier doors. There are two types of Code Green: Code Green – Evacuation Precaution and Code Green STAT – Evacuation Crisis.

Code Green is called by QCH Incident Commander /Admin-On-Call

 

Await further instructions which will include the type of Code Green based on severity:

  • Code Green (Evacuation Precaution): evacuate a specific location of occupants until the situation is contained. Usually horizontally.
  • Code Green STAT (Evacuation Crisis): Immediately remove all occupants from an area on a large scale for possibly a prolonged period of time horizontally or vertically.
  • If evacuating outside the hospital, gather staff and patients to these areas
  1. Front Entrance area.
  2. Emergency Department area.
  3. Cancer Centre Entrance area.
  4. West Entrance area.
  5. Shipping Receiving Entrance area.

HORIZONTAL

  • Remove patient from room into corridor and close door.
  • Clear Rooms on either side of the room involved. Move patients towards the exit.
  • When moving patients, always place them on the other side of the fire doors in an area well clear of the door opening.
  • Depending on where the incident is, you may have to do a partial vertical evacuation to the floors below.
  • Ensure Admin On-Call/Unit Manager/After Hours Clinical Manager are informed of the incident and: where patients are relocated to, number of patients evacuated and to which rooms they have been evacuated.
  • Use wheel chairs, gurneys, etc., to assist in the horizontal evacuation. Remember Patient Charts must be moved also.
    A partial vertical evacuation can be done in conjunction with the horizontal evacuation without requiring special permission.
  • But remember, once in the stairwell, wheelchairs, gurneys, crutches etc., are not permitted.
  • Refer to the Fire or Emergency Procedures manual, Evacuation Section, for more information.

TOTAL HOSPITAL EVACUATION

  • Authorized only when ordered by: CEO, Campus Operating Officer, Administrator on Call, Ottawa Fire Chief.
  • Announcement and rapid evacuation bells will occur.
    Instructions will be given on PA system.
  • Use only safe exit stairways when moving patients downwards to outside of Hospital.
  • Move ambulatory patients first. Gather patients together and have a staff member lead them to an area of safety.
  • Semi-ambulatory – move these patients next. When in stairwell, do not use wheelchairs, canes, crutches, etc.
  • Provide necessary assistance as required. Usually one staff member in front and one staff member behind the patients to lead them to safety.
  • Non-ambulatory or resistive – move these patients last.
  • Use the lifting procedures as outlined in the Evacuation Section of the Fire or Emergency Procedures Manual.
  • All patient charts are to follow patients to the triage site.
  • Bell High School in Bells Corners is our designated destination following a total evacuation.

BROWN

Internal Spill

An internal hazardous material spill that cannot be safely contained or cleaned by trained departmental resources. Dial 5555 and communicate situation.

Code Brown is called by the manager of Environmental or Plant Services, and/or Protection Services and/or Admin-On-Call.

  • Contain the spill and barricade area from traffic
  • Identify the hazard and stop leak if possible
  • Turn off any ignition sources in the area
  • Await the QCH trained response team

YELLOW

Missing Patient

A comprehensive search by staff to locate a missing patient before that patient’s safety and well-being is compromised.

Code Yellow is called by the department head/Admin-On-Call in the following manner:

  • Preliminary Search -A search of the unit and surrounding area and common QCH gather places (where food, coffee and gifts are sold) by unit personnel and Protection Services.
  • Stage 1 -Using the “All QCH” email send the patient description out. In addition announce Code Yellow Stage1 Search.
  • Stage 2 -A comprehensive search of all areas including locked rooms/areas using departmental/unit floor plans.
  • If you locate the patient:
    • Dial 5555 and inform the Call Centre staff
    • Monitor from a distance the movement of the patient until Protection Services responds.

Attention all staff, Code Yellow in effect.

Below are the identification, description, and circumstances/risk of the missing person:

Identification
FULL NAME:
DATE OF BIRTH:
AGE:
COMPLEXION:
GENDER:

Description
HEIGHT:
WEIGHT/BUILD:
HAIR (colour/length):
CLOTHING:
DISTINGUISHING FEATURE (scars, tattoos, beard, etc.):

Circumstances/Risk:
ELOPEMENT FROM:
TIME:
INITIATED BY:
Patient is at risk for self harm: Yes No
Patient is at risk for harming others: Yes No

 

Required action:
Notify protection services immediately by dialing 5555 and inform the Call Centre of the patient’s location.

Tips to staff:

  1. Be mindful of your surroundings especially if the elopement occurred close to your department.
  2. If you are a staff member working at a higher visual advantage such as C4, A4 etc. head to the nearest window and perform a visual scan of the area.
  3. Do not approach if patient is prone to violence, keep a visual line of site and notify security immediately.

AMBER

Missing Infant

A comprehensive search by designated staff to locate a missing/Abducted infant/child before that patient’s safety and well-being is compromised.

Code Amber is called by the department head/Admin-On-Call

  • Upon receiving the infant/child’s description, all staff will immediately initiate a comprehensive departmental and hospital search.
  • Stop/question anyone carrying packages, bags, knapsacks etc that could contain the missing infant.
  • If you locate the patient:
    • Dial 5555 and inform the Call Centre staff.
    • Monitor from a distance the movement of the Infant/Child until Protection Services responds.

ORANGE CBRNE

External CBRNE

A response to an external disaster whereby the increase of patients demands additional resources to manage the event and decontamination from Chemical, Biological, Radiation, Nuclear (CBRN) hazardous material exposure.

Code Orange is called by the Emergency Department medical/clinical lead and Admin-On-Call.

  • Report to your supervisor and assess staffing
  • Start to plan resources required to support incident
  • Await further instructions

ORANGE

External Disaster

A response to an external disaster whereby the arrival of patients demands additional resources to manage the event.

Code Orange is called by the Emergency Department Medical/Clinical lead and Admin-On-Call

  • Report to your supervisor and assess staffing
  • Start to plan resources required to support incident
  • Await further instructions

BLACK

Bomb Threat / Suspicious Package

To address a bomb threat, or the discovery of, or the search for a suspicious object.

Call a Code Black by dialing 5555 and identify your location.

Bomb Threat: If you receive a bomb threat call:Remain calm, courteous and gather as much information from the caller as possible.

For example:

Ask: Where is the Bomb located

Ask: When will it go off

Dial 5555 and inform the Call Centre staff

The area identified by the caller will be searched thoroughly by protection services and the staff on that unit.

Code Black will NOT be announced overhead.

If no area was identified a search through All QCH must take place with all units and departmental staff participating.

Code Black will be announced overhead to start this procedure.

Suspicious Object: If you hear a Code Black being called overhead, initiate a search in your work area for suspicious objects If you find a suspicious object, remain calm, do not touch the package, dial 5555 and inform the Call Centre staff

GREY

Infrastructure Failure

An infrastructure or hospital systems failure that will result in a significant interruption of hospital services – such as loss of power, water, heating, ventilation, medical gases, communications and IS/IT systems. An infrastructure or hospital systems failure that will result in a significant interruption of hospital services – such as loss of power, water, heating, ventilation, medical gases, communications and IS/IT systems.

 

A Code Grey will be called after impact discussions between the Manager/Director responsible for the failed equipment and Admin-On-Call.
Senior Admin, Admin-on-call and the After Hours Clinical Managers may be consulted on the impact to determine calling the Code Grey.

  • Assess your area and your patient’s immediate needs and start to activate your downtime procedures where applicable
  • Keep staff and patients regularly informed
  • Await further instruction
  • An initial overhead announcement will be called followed by an “All QCH” email
  • Minimum hourly updates by email will follow until the Code Grey is cleared.

GREY BUTTON DOWN

External Air Hazard

An external event that contains hazardous gases that are deemed harmful and must be kept excluded from the hospitals air supply.

Shelter in Place: A response to a threat or hazard external to a building (typically atmospheric or environmental in nature) whereby building administrators ensure exterior doors remain closed to restrict access to and discourage exit from the building. i.e. chemical spill with plume

 

A Code Grey Button-Down will be called after impact discussions between Senior Admin, After Hours Clinical manager, Admin Supervisor, Director/Manager of Plant Services and Admin-On-Call.

  • Turn off all external air intake systems
  • Assess your area and close all external windows and doors.
  • Restrict staff and patient from leaving the hospital until safe to do so.
  • Keep staff and patients regularly informed
  • Await further instruction
  • An initial overhead announcement will be called followed by an “All QCH” email
  • Minimum hourly updates by email will follow until the Code Grey is cleared.

WHITE

Violent Patient

A cautious and prescribed response to a person who is displaying undue anxiety, yelling or otherwise represents a threat of aggression or violence to themselves or others.

Call a Code White by dialing 5555 and identify the location.

  • Remove yourself from harm if possible.
  • Apply Gentle Persuasive Approach techniques and Non-Violent Crisis Intervention techniques
  • Wait for trained Protection Services and Code White Response Team to arrive.

PURPLE

Hostage Taking

An incident where a person(s) is being held against their will by another individual(s).

You may hear the term “Lockdown” announced overhead with this code.

Lockdown: A response to an immediate threat inside the building whereby persons within the building are to move away from the area to a safe location, lock and barricade their door and remain silent.

 

Call a Code Purple by dialing 5555 and identify the location.

 

  • Call Centre Staff will call 911 for Police assistance
  • Protective Measure Lockdown should be initiated
  • Remain calm and evacuate all people from the area
  • If you witness the event, record as much detail as possible
  • Protection Services will respond to the situation and act as the lead until the Police arrive.
  • Await and Police Response Team

SILVER

Person with a Weapon

An event where a person has a weapon and there is potential for imminent danger.

You may hear the term “Lockdown” announced overhead with this code.

Lockdown: A response to an immediate threat inside the building whereby persons within the building are to move away from the area to a safe location, lock and barricade their door and remain silent.

 

Call a Code Silver by dialing 5555 and identify the location.

 

RUN-HIDE-SURVIVE

  • Remain calm and if close to an exit and safe to do so, evacuate immediately the area
  • If not safe to evacuate, take cover and hide in a safe area, lock the doors, shut off the lights
  • Lay flat on the floor and stay quiet
  • Await response team and Police

PROTECTIVE MEASURES

 

Code Protective Measures

1. Shelter in Place:

A response to a threat or hazard external to a building (typically atmospheric or environmental in nature) whereby building administrators ensure exterior doors remain closed to restrict access to and discourage exit from the building. i.e. chemical spill with plume

2. Secure Facility:

A response to an imminent or immediate threat or hazard external to a building whereby building administrators lock all exterior doors to prohibit access to and discourage exit from the building. Persons within the building may carry on with their normal activities. i.e. gunshot injury transported to ED and risk of retaliatory violence.

3. Lockdown:

A response to an immediate threat or hazard inside a building whereby persons
within the building are to move to a safe location, lock and barricade their door (hide) and remain silent. i.e. active shooter