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Emergency Codes Ni
Emergency Codes Ni
Emergency Codes Ni
1. Take shelter.
2. If a landline phone is available, dial
Code Designations the facility’s active shooter code. For
example, Florida health care
Code Silver – Active Shooter facilities can activate this code by
An active shooter is defined as dialing “20” from a landline phone.
an event in which an individual 3. Give the call center or emergency
or group Breakdown of Active team on the other end of the line
Shooter Prevalence. with information about the shooter’s
Depending on facility preference, Code appearance, hostages, location and
Silver or Code Grey may be used communications. ONLY DO THIS IF
interchangeably. However, Joint IT IS SAFE FOR YOU TO SPEAK
Commission standards were updated in WITHOUT THE SHOOTER
2010, which advise facility managers to HEARING OR SEEING YOU.
use Code Silver to denote active 4. LEAVE THE PHONE “OFF THE
shooter incidents. HOOK” TO ALLOW RECORDING
During this emergency preparedness OF ALL EVENTS TAKING PLACE.
5. If sheltering, stay in place until Code Orange – Assistance Needed or
Hazardous Spill
instructed to leave by law
enforcement or if the
Code Orange is another code that may
situation permits.
have facility-specific meanings. Joint
6. If the situation is located in
Commission standards define Code
another part of the facility, activate
Orange as an exposure to a hazardous
all security doors to your unit.
material or substance within a facility.
7. If security doors are unavailable,
However, it may be used to denote
barricade the unit with whatever
“attention needed” for violent patient
items are available to prevent entry
situations or other emergencies. The
into your unit.
key lies in understanding a Code
8. When hiding and evacuating are not
Orange’s differentiation from Code
possible, and If your life is in
Silver. A Code Orange may be called if a
imminent danger, try to disrupt and/
patient is being violent during a medical
or incapacitate the shooter by acting
procedure, attempts to leave the facility
aggressive, throwing things at him,
while under an order of protective
yelling or by taking other extreme
custody or another event.
measures.
9. It is important to remember your
Upon activation, an announcement may
duties to protect the lives of those
be made.
you serve during this incident.
10. When leaving the facility or upon For example, “Code Orange, Medical
being located by law enforcement, Spill and Location.” Alternatively, “Code
make sure your hands are up and Orange, Violent Patient, and Location.”
away from your pockets and clearly
visible. Depending on your facility’s emergency
preparedness plans, the first example
Following a Code Silver, asserts may follow decontamination protocols,
the Department of Homeland Security including mobile showers, hazmat suits
(DHS), your supervisor may require all or evacuations if necessary.
staff members to complete an incident
report. This may be required even for The second example may have
floors or units where sheltering in place specific guidelines, such as the
was used and no loss of life occurred. following:
Such reports can help managerial staff
learn from the incident and prepare for 1. Upon activation, all proper, trained
the possibility of a future attack. personnel may be called to the
location of the violent patient.
Depending on the facility, proper
personnel may include those with Some facilities may also provide
training in handling aggressive additional evacuation codes when
patients, like Satori Alternatives to calling the code. “Code Red, Medical
Managing Aggression. ICU. Code White Medical ICU.” (Code
2. Discuss the specific needs and White will be discussed in further detail
issues occurring during the event. later in this article.)
3. Use communication-based
aggression-management techniques There are four steps to responding to
to resolve the situation. a Code Red in a healthcare facility,
4. If a court order exists, nursing given the acronym, RACE, which
personnel may be required to include the following:
forcibly administer intravenous
medications, apply restraints or take 1. Rescue – Rescue all individuals,
other specific actions. including staff, patients or visitors,
5. Complete an incident report upon nearest the fire. Do not get
the event’s end. belongings, and only bring items that
6. Follow up with your supervisor are essential. For example, a person
regarding your actions during the on life-sustaining IVs or machinery
event, including reviewing proper may be moved with patients. Do not
protocols and best practices for worry about non-life-sustaining items
responding to such events in the or equipment.
future. 2. Alarm – Activate the fire alarm if a
code has not yet been called. Upon
Code Red – Fire activation, some announcements
A Code Red denotes the may be automatic. If an
presence or reasonable announcement is not made, have a
presumption a fire is occurring staff member dial the overhead
in a facility. For instance, a operator or make the
staff member who sees or smells smoke announcement, depending on your
may activate fire codes. In most facility’s protocols. Smaller facilities
facilities, automatic fire detection may allow any staff member to make
systems may alert staff members first. overhead announcements.
An overhead code may be called as 3. Confine – Attempt to confine the fire
well. by closing doors between you and
For example, “Code Red, Medical ICU.” the fire. This will also help prevent
the fire from growing. Additionally,
The code may also provide additional avoid moving between fire-barrier
directions when appropriate, like doors and areas unless absolutely
“Evacuations underway in Medical ICU.” necessary. Touch the door prior to
entering the facility to ensure you arriving at the location of the fire.
are not walking into an inferno. Another factor to consider is the type of
4. Extinguish – Using an appropriate fire extinguisher. Some fire
fire extinguisher, attempt to extinguishers may be classified as
extinguish the fire. a Type A, B or C. Many modern
extinguishers may have a Type ABC,
Fire extinguishers also have an acronym allowing for use on any type of fire.
for remembering how to use the device
and effectively put out the fire, explains
the Occupational Safety and Health
Administration, PASS:
There are a few other ways to help Incidents involving child abduction may
prevent a Code Pink, which include the worsen in hostage situations or
following: incidents involving an active shooter.
Follow your facility’s policies and
Make sure you know who is on procedures for addressing each code in
the floor. When parents or family tandem.
members visit children or infants,
request photo identification to Code Black – Bomb Threat
prevent unauthorized entry to the
unit.
A Code Black denotes a bomb
Check all children and parents for
threat to the facility. This may
proper documentation and safety
include the identification of an
equipment, like patient-parent
actual bomb within the facility. To
matching armbands or electronic
prevent confusion, always consider any
monitors, to prevent an abductor
Code Black to be a verified threat to the
from taking a child.
facility.
Report any malfunction of child-
If a threat is phoned to the facility, try to
safety equipment, especially
get as much information about the caller
problems with abduction locks and
as possible. If the phone has a record
monitors, at once.
function, activate it without notifying the
Report any suspicious behavior
other party on the line. Ask questions
to security or appropriate
about the threat, and signal the issue to
personnel. This tip may be most
other employees to activate the Code.
used when parents have
Try to keep the caller on the line for as
disagreements or court orders
long as possible. Ask these questions:
limiting contact with children. In
some cases, a child’s own parents
Where is the bomb located?
may attempt an abduction if a court
How soon will it detonate?
order has removed custody from the
Why has a bomb been placed in the
parents.
facility?
How do you know a bomb is there? Wording that indicates the
When was it placed? perpetrator has a possible plan for
What do you want in exchange? the bomb or threat.
What is your name? Indications of a time and place for
Do you have a contact number to the bomb to detonate.
call you back on? A lack of strong indicators that the
Can you tell me anything else about person has taken preparation steps
the bomb? for completing the treat.
It is important that you remain calm and Indications of the bomb’s
not get angry at the individual phoning in composition.
a threat. Upon the arrival of security or The increased emotional state of the
law enforcement, turn the call over to perpetrator, like saying, “I’m
them. serious,” or “I’m going to do this.”
Depending on your facility, an overhead High-risk threats are very specific and
announcement will be made. realistic. The perpetrator may give
“Code Black, Phoned Threat, South 8.” names, reasons for why he or she is
Alternatively, “Security Alert, Phoned doing this, information about plans to
Threat, South 8.” detonate the bomb, including actions
taken to ensure its completion, like
For additional guidance, the DHS Office taking a hostage or using weapons to
for Bombing Prevention and the FBI protect the bomb. In addition, the
have created a checklist for determining perpetrator may provide his or her own
the credibility of a bomb threat. identity.
Some medium-risk threats and all high-
A low-risk threat has the following risk situations require immediate
characteristics: intervention. If law enforcement and
security professionals have arrived,
The threat is vague.
follow their commands. Otherwise, you
Information is inconsistent, lackluster
need to activate the code denoting an
in detail or implausible.
evacuation due to a bomb threat. In this
The caller is easily identified and has
case, the overhead announcement may
made multiple calls.
include a double-code for both a bomb
The threat was discovered, like
threat and evacuation (Code White),
finding a package, not receiving an
depending on your facility’s protocols.
actual threat.
Furthermore, the areas being evacuated
Medium-risk threats may have the
should be listed.
following characteristics:
“Code Black, Code White, All Personnel
in the South Tower.”
A direct threat is feasible.
Follow these steps in the interim:
1. Remove yourself and any individuals codes will be called to indicate the
in imminent danger from a reason for the evacuation, assuming an
suspected bomb or package. This existing code has not yet been
includes evacuating the floor or unit activated.
if the bomb is located in your unit. “Code White, Code Red Medical
2. Contact authorities as soon as ICU.” If a previous code has been
possible, and active the Code Black. called, like a Code Silver, the overhead
3. Depending on your facility and the announcement will not likely contain a
care-level required of your patients, repeat of the Code Silver. The key to
you may need to begin evacuation understanding how to respond to an
procedures. evacuation lies in listening carefully to
4. Unlike Code Silver, do not shelter in the announcements.
place. Begin evacuating the facility,
starting with a reverse-triage When an evacuation code is activated,
protocol. (More on reverse-triage you will need to remove as many
protocols will be discussed under patients as possible, including their
“Code White.”) family members, from the affected
5. If the threat not found to be credible areas. While you may want to save as
by law enforcement, an evacuation many lives as possible, it is important to
order may be rescinded. consider your own safety too. Do not put
6. Law enforcement personnel or yourself in a life-threatening situation
administration are usually the unless absolutely necessary.
individuals ordering an evacuation.
To evacuate patients, follow a “Reverse-
Code White – Hospital Evacuation Triage Protocol.” This protocol is named
because unlike triage, you want to move
Code White denotes a the least-intensive patients first. A
mandatory hospital standard Reverse-Triage Protocol is
evacuation. However, it may as follows:
not necessarily require a hospital-wide
evacuation. In other words, specific 1. Evacuate ambulatory patients.
floors and areas may be evacuated to 2. Remove wheelchair-bound patients.
improve safety and address the 3. Remove bed-bound patients. If
emergency. The announcement may be elevators are not function, like during
as follows: a “Code Red,” drag the patient’s bed
with the patient still in bed down the
“Code White, Medical ICU.” Since a stairs. However, be as careful as
Code White typically involves another possible for patients that have
emergency in the facility, additional
recently undergone surgery or major As a nurse or other immediate
medical procedures. caregiver, your facility will provide
4. Patients in the middle of medical additional direction on what you need to
procedures should be moved as accomplish and complete with respect
soon as it is reasonably safe to do to training for new changes in plan
so. If the procedure is wound activation. Due to the intensive,
dressing or other minor procedure, administrative-driven protocols that must
stop, cover the wound and begin be reviewed and managed in creating
respective evacuation protocols. an Emergency Operations Plan, the
5. If patient family members are next journal will focus on an in-depth
present, ask them to please help discussion of Code Green and
with getting their loved ones out of Emergency Preparedness and
the facility. Operations Planning.