Code Orange 1 CODE ORANGE MASS CASUALTY INCIDENT (MCI) RESPONSE PLAN Covenant Health Edmonton Acute Care Hospitals This document contains information specific to Grey Nuns Hospital (page 14) and information specific to the Misericordia Hospital (page 15) 1
MASS CASUALTY INCIDENT This document outlines the Grey Nuns Hospital and Misericordia Hospital contingency plans in preparation to receive multiple casualties from an event or multiple events occurring simultaneously, which may take place within Alberta Health Services Edmonton Zone or in another Alberta Health Services zone in the province. Awareness of a multi-casualty incident may occur as a result of notification from: Alberta Health Services Emergency Disaster Management Office Edmonton Zone EMS (comes through the Critical Care Line) or other sources. Victims can arrive at the emergency department with no notice. If the number or type of casualties has the potential to overwhelm the hospital, a Code Orange may be declared. In circumstances where patients start arriving without advance notification, the Emergency Department should immediately notify the Site Administration or if after hours; the Manager on call. The Manager on call will call the Covenant Health Senior Executive on call and Covenant Health Emergency Disaster Management on-call (780.735.9000 and ask operator for E/DM on-call) and, if necessary, the Alberta Health Services Zone Executive on call via RAAPID North @ 1.800.282.9911. Code Orange may be activated in one of three levels: Standby Partial or Full The decision to activate a Code Orange response and the appropriate level will be the responsibility of the Senior Executive or designate. What do I do when I hear CODE ORANGE paged on the overhead PA system? a) If you are not in your assigned work area, return immediately to your work area. b) The unit/department manager/delegate shall report to Administration for briefing. c) As appropriate, the unit/department manager/delegate will implement the unit/department Code Orange process. d) Depending on the situation, staff may be required to stay at work until extra relief workers are available or until the Code Orange has been discontinued. All areas shall develop a unit-specific plan for Code Orange response congruent with this plan. 2
Activating Code Orange CODE ORANGE STAND BY Definition: An incident has not yet occurred, but has the potential to cause a large number of casualties which will overwhelm ambulances and the Emergency Departments throughout the Alberta Health Services Edmonton Zone. OR An incident has occurred in Edmonton zone, or from outside the zone, and the number and status of casualties are not confirmed. 1. Action Instruct Switchboard to page overhead Code Orange Stand By three (3) times. All Staff are requested not to leave work until further notice. CODE ORANGE PARTIAL ACTIVATION Definition An incident has occurred, which will impact the Hospital. The number of casualties is limited and/or the time frame for activation is limited. 1. Action Notify the Site Administrator/designate and Bed Manager unless the information about the casualties has come from either source. Instruct Switchboard to page Code Orange Partial Activation three (3) times. Site Administrator or designate will notify Covenant Health Emergency Disaster Management on-call at 780.735.9000 and RAAPID North @ 1.800.282.9911 All Staff are requested not to leave work until further notice. Incident Command will be established using the response guide on page 5. 3
CODE ORANGE FULL ACTIVATION Definition An incident has occurred which has already produced a large number of casualties. OR Code Orange Partial Activation has already been activated, and other specific functions must now be activated to support the site response. 1. Action Instruct Switchboard to page Code Orange Full Activation three (3) times and repeat after ten (10) minutes or as required. Incident Command will be established in the Emergency Department using the response guide on page 6. All Staff are requested not to leave work until further notice. The Site Administrator or Designate will determine the need for an on site Incident Command Post. All of the Incident Command System functions will be established in the Site Incident Command post (ICP) if activated with the exception of casualty care and decontamination units. The Site Administrator or Designate will contact Covenant Health Emergency Disaster Management on-call: 780.735.9000 and ask operator for E/DM on-call. All Staff are requested not to leave work until further notice. A Mass Casualty situation may primarily affect one site, or many sites may receive casualties. Each site within the Edmonton zone may declare different levels of Code Orange response, depending on their proximity to the incident, and their current level of site activity. Alberta Health Services Edmonton zone may activate the Edmonton Zone Emergency Operations Centre depending on the magnitude of the incident and the anticipated impact on one or all sites. When communication is received that the number of casualties is subsiding, on site Administration will determine if the Hospital can plan for a return to normal operations and activities or ALL CLEAR. CODE ORANGE ALL CLEAR Definition: The initial impact to the Hospital has been received, and departments should plan accordingly. Departments and emergency functions stand down at different times 1. Actions Department managers determine their area s current and anticipated work load. Staffing and supplies are evaluated for next 24 to 48 hours. Staff is sent home at discretion of department supervisors. Assess the need for Critical Incident Stress Management. 4
Response Guide Mission: To safely manage the influx of patients into the Emergency Department. The incident may be accidental or intentional and can include casualties from a natural, physical, chemical, biological, radiological, nuclear or explosive event. Directions Read this response guide and review incident management team chart Use this response guide as a checklist to ensure all tasks are addressed and completed OBJECTIVES Prepare for the influx/surge of trauma, burn, contaminated and/or infected victims Ensure facility security Patient triage and medical management Collect forensic evidence for law enforcement, as per ED policy and procedure if appropriate Communicate situation status and information to senior executive, staff, patients, media and the public Immediate (Operational Period 0-2 Hours) COMMAND Incident Commander: Activate the Command Staff and s Receive notification about the incident from Regional Transport Office/local officials (EMS) Notify the emergency department staff of possible incoming trauma, blast, infectious or contaminated casualties Assess the need for, and activate the decontamination plan Activate the Code Orange Plan and the Incident Command Post (ICP) Establish operational periods Establish operational objectives Information : Monitor media outlets for updates on the incident and possible impacts on the hospital Establish a patient information center; coordinate with the Liaison Establish a media staging/briefing area and initiate media/communications plan 5
Liaison: Establish communication with the field providers and the local ICP to ascertain incident information Communicate with other healthcare sites to determine: Situation status Surge capacity including trauma and/or burn beds Patient transfer/bed availability Capability to loan needed equipment, supplies, medications, personnel, etc. Safety : Monitor safety practices related to staff, patients, and facility, and implement corrective actions to address or correct the problems Medical/Technical Specialist: Assist Operations in identifying specific medical care management needs of injured patients by the incident. If the incident is a suspected communicable disease outbreak or chemical/biological incident: Verify from the Emergency Department attending physician and other affected clinics, in collaboration with Public Health officials, and report the following information to the Incident Commander: Number and condition of patients affected, including the worried well Type of biological/infectious disease involved (case definition) Medical problems present besides biological/infectious disease involved Measures taken (e.g., cultures, supportive treatment) Potential for and scope of communicability Implement appropriate Personal Protective Equipment (PPE) and isolation precautions Coordinate with the Operations to verify from the Emergency Department attending physician and other affected physicians offices, in collaboration with regional officials, and report the following information to the Incident Commander and s: Number and condition of patients affected, including the asymptomatic Medical problems present besides infectious disease involved Measures taken (e.g., cultures, supportive treatment) Potential for and scope of communicability 6
OPERATIONS Activate Medical Care, Infrastructure, HazMat, and Security s as required Consider the possibility of contaminated victims. Check for radiation and chemical/biological contamination of incoming casualties. If necessary, activate appropriate Medical/Technical Specialist Conduct hospital and/or clinic census to determine early discharges Provide facility security, traffic and crowd control Security to activate facility lock-down plan if necessary. Activate surge capacity plan Discharge patients early; establish discharge holding area. Cancel elective surgeries and outpatient clinics/testing, if required Convert outpatient procedure beds into inpatient beds. Use hallways or create alternate treatment areas (e.g., cafeteria). Consider the need to partner with external agencies such as the local municipality, non-government agency (i.e. Red Cross), to create emergency treatment capacity outside the hospital. Initiate mutual agreements with other health care facilities. Include acute, long-term care, and rehabilitation facilities. Consider other local facilities such as schools, community centers. Use automated surveillance and tracking systems. Link information from physicians, clinics, and hospitals to the public health system and the first-responder community. Implement communication systems to allow rapid dissemination of information to key players and planners in a mass-casualty event. If this is a suspected infectious disease outbreak or chemical/biological incident: Ensure proper implementation of infectious patients surge plan, including: Location for off-site triage, as appropriate Set up decontamination area and implement decontamination plan and procedures for adults, pediatrics, and patients with special needs if required Proper rapid triage of people presenting requesting evaluation. Coordinate with Security, if necessary Staff implementation of infection precautions, and higher level precautions for high risk procedures (e.g., suctioning, bronchoscopy, etc.), as per current CDC guidelines Proper monitoring of isolation rooms and isolation procedures Limit patient transportation within facility for essential purposes only Restrict number of clinicians and ancillary staff providing care to infectious patients Activate disaster patient registration procedures Prepare for fatalities in conjunction with local law enforcement, coroner/medical examiner and local Incident Command Post (ICP) Rapidly triage and prioritize patient care and resources Arrange for transfer of critical trauma and burn patients to specialty care facilities, as appropriate Implement evidence collection procedures if appropriate 7
PLANNING Prepare and implement patient, bed, materiel and personnel tracking Establish operational periods and develop Incident Action Plan, in collaboration with the Incident Commander LOGISTICS: Initiate staff call-back procedures to obtain additional staffing for impacted areas Anticipate an increased need for medical supplies, antivirals, IV fluids and pharmaceuticals, oxygen, ventilators, suction equipment, respiratory protection/ppe, and respiratory therapists, transporters and other personnel Ensure functionality of communications and IT/IS systems Intermediate (Operational Period 2-12 Hours) COMMAND Incident Commander: Review incident objectives and Incident Action Plan, modify as needed Activate and implement emergency management plans, as indicated, including mass fatality plan Continue regular briefing of Command staff/s Information : Continue the patient information center, in collaboration with Liaison Manage media relations, public information, risk communication and integrate public relations activities with the Regional Emergency Coordination Centre (RECC) if activated Liaison : Continue regular communication with the local ICP and other officials to ascertain situation status and communicate hospital status and needs if any Keep public health advised of any health problems/trends identified, in cooperation with infection control Facilitate law enforcement requests for patient/staff interviewing Safety : Continue to monitor safety practices of staff and patient safety and use of personal protective equipment Medical/Technical Specialist: Assist Operations in meeting specific medical care management needs of those injured by the incident 8
OPERATIONS Implement procedures for patient valuables management, evidence collection and security Continue patient care and management activities Implement family notification procedures in conjunction with family assistance center operations Ensure rapid patient registration. Ensure proper waste water and expendable materials disposal Continue facility security, traffic and crowd control Implement forensic/evidence collection policies and procedures if appropriate If suspected infectious disease outbreak or chemical/biological incident: Conduct disease surveillance, including number of affected patients/personnel Continue isolation activities as needed Consult with infection control for disinfection requirements for equipment and facility Continue patient management activities, including patient cohort, patient/staff/visitor medical care issues Coordinate with Logistics implementation of mass vaccination/mass prophylaxis plan Implement local mass fatality plan (including temporary morgue sites) in cooperation with local/state public health, emergency management, and medical examiners. Assess capacity for refrigeration/security of deceased patients PLANNING Continue patient, bed, materiel and personnel tracking Update and revise the Incident Action Plan Ensure documentation of patient care and hospital response Revise security plan and family visitation policy, as needed Plan for termination of incident LOGISTICS Provide mental health support services for staff (Critical Incident Stress Management) Facilitate procurement of supplies, equipment and medications for response and patient care Continue to provide supplemental staffing to impacted areas to maintain operations Ensure communications systems and IT/IS functionality If this is a suspected infectious disease outbreak or chemical/biological incident: Implement distribution plans for mass prophylaxis/immunizations for employees, their families, and others. Coordinate activation of staff vaccination/prophylaxis plan with Operations Monitor the health status of staff who are exposed to infectious patients Establish Family Care Unit under Support to address family/dependent care issues to maximize employee numbers at work. 9
FINANCE/ADMINISTRATION Establish the tracking of response costs and claims and report to the Incident Commander Track and follow up with employee illnesses and absenteeism issues, if necessary Extended (Operational Period Beyond 12 Hours) COMMAND Incident Commander: Continue regular briefing of Command staff/s. Address issues identified Information : Continue patient information center, as necessary Coordinate efforts with public health resources/zone Emergency Operations Centre Liaison : Continue to ensure integrated response with local ICP Facilitate law enforcement requests for patient/staff interviewing Continue to update public health of any health problems/trends identified Safety Office: Continue to monitor safety practices and take appropriate corrective actions Medical/Technical Specialist: Continue to assist Operations in meeting specific medical care management needs of injured by the incident OPERATIONS Continue patient management and facility monitoring activities. Communicate personnel/equipment/supply needs to Zone Emergency Operations Centre, if activated Maintain infrastructure support and services Continue security measures Plan for demobilization and system recovery 10
PLANNING Review and update the Incident Action Plan and plan for demobilization and system recovery Ensure documentation is being completed by all Sections Continue patient, personnel, materiel and bed tracking LOGISTICS Provide for staff food and water Ensure adequate supplies, equipment, personnel and facilities to support extended response operations Continue to communicate personnel/equipment/supply needs to Zone Emergency Operations Centre, if activated FINANCE/ADMINISTRATION Continue to track response expenses and employee injury/illness and absenteeism Provide a report for the Zone Emergency Operations Centre, if activated/required. 11
ALL CLEAR (Incident Recovery) COMMAND Incident Commander: Oversee and direct demobilization and system recovery operations Information : Provide final briefings as needed to patients/visitors/staff/media, in cooperation with Zone Emergency Operation Centre Liaison : Prepare a summary of the status of the hospital and disseminate to Command staff/s and to public health/ems as appropriate Safety : Oversee safe restoration to normal operations OPERATIONS Return patient care and services to normal operations Ensure evidence and appropriate documentation are provided to law enforcement officials PLANNING Finalize the Incident Action Plan and demobilization plan Compile a final report of the incident and hospital response and recovery operations Ensure appropriate archiving of incident documentation Write after-action report and corrective action plan to include the following: Summary of actions taken Summary of the incident Actions that went well Area for improvement Recommendations for future response actions Recommendations for correction actions 12
LOGISTICS Provide for mental health (acute and long term) services for staff and patients, in collaboration with Operations Section Restock supplies, equipment, medications and blood products to normal levels FINANCE/ ADMINISTRATION Submit final response expenses to the Incident Commander for approval and to appropriate external authorities for reimbursement or other assistance Please Note: There are two sources that staff can access to get information about disaster response and status: In the event of a major disaster, messages will be posted on Alberta radio and television stations. Please note if you have satellite TV (not Alberta provider) you will not receive the warnings. 13
F. PHONE NUMBER / KEY AREAS Grey Nuns Hospital AREA LOCATION PERSON RESPONSIBLE Grey Nuns Site Command Incident Commander Emergency Post: (Site Administrator Operations Room 0647 /delegate) Centre Zone Emergency Operation Centre Staff Assembly Edmonton Zone Emergency Operations Centre Coronation Plaza Auditorium Incident Commander AHS Emergency Disaster Management Human Resource Services Manager PHONE # Incident Command 735-9859 (Backup 496-3395) 735-7785, 9970, 9858, 9694 FAX: 735-7202 located in Library Rm0634 Zone Emergency Operation Centre 780-408-6656 1-877-253-7093 Fax 780-408-6649 Email zeoc.edmonton@albertahealthservices.ca Projection Room #14678 HR 780-735-7252 Media Centre Discharge Centre Casualty Information Centre Oxygen Supply Centre Health Sciences Library RM 0634 Rehab Medicine, Outpatient Treatment, Rm. 1109 & 1114 Rehab Gymnasium Unit 42 Communications / Media Relations Coordinator Manager of Rehab Medicine Program Manager, Mental Health Supervisor, Respiratory Services 780-394-7027 780-735-7161 780-735-7691 780-735-7043 Child Care Centre 4 th Floor St. Marguerite Building INITIAL TREATMENT AREAS Emergency Critical Emergent / Urgent Casualties Endo Outpatient Department Non-critical Urgent Casualties Non-urgent Walking Casualties Manager, Volunteer Services Program Manager / Charge Nurse Program Manager / Charge Nurse Program Manager / Charge Nurse 780-735-7800 780-940-3141 780-735-9967 780-735-7120 780-735-7116 780-735-7399 14
G. PHONE NUMBER / KEY AREAS Misericordia Hospital AREA Misericordia Hospital Incident Command Post (ICP) Zone Emergency Operation Centre Staff Assembly LOCATION Board Room (1N-106) Edmonton Zone Emergency Operations Centre Coronation Plaza Auditorium (1N-110) PERSON RESPONSIBLE Incident Commander (Site SOO / Delegate) Incident Commander - AHS Emergency Disaster Management Planning Section Chief will assign person(s) to man this area PHONE # 780-735-2783 780-735-2711 780-735-2710 780-735-2453 780-735-2831 780-408-6656 1-877-253-7093 Fax: 780-408-6649 email: zeoc.edmonton@albertahealthser vices.ca Internal number only 13124 Media Centre Discharge Centre Casualty Information Centre Oxygen Supply Centre INITIAL TREATMENT AREAS Emergency Critical / Emergent / Urgent Casualties Day Medical / Endo Non-critical Urgent Casualties Outpatient Department Nonurgent Walking Casualties Garden Cafeteria Garden Cafeteria DMU 4W-33 Endo - 1SW103/104 Operation Section Chief to assign lead for this area Manager or designate for the area as noted in Discharge Centre Program Manager / Charge Nurse Program Manager / Charge Nurse Program Manager / Charge Nurse 780-735-2166 780-735-2166 ED Triage Desk - 780-735-2627 Day Medical Unit - 780-735-2692 General Clinics - 780-735-2958 15
INCIDENT MANAGEMENT TEAM CHART IMMEDIATE Incident Commander Public Information Safety Liaison Medical/ Technical Specialist Operations Planning Logistics Finance/ Administration Staging Manager Personnel Vehicle Equipment/Supply Medication Resources Personnel Tracking Materiel Tracking Service Communications Unit IT/IS Unit Staff Food & Water Unit Time Medical Care Inpatient Unit Outpatient Unit Casualty Care Unit Mental Health Unit Clinical Support Services Unit Patient Registration Unit Situation Patient Tracking Bed Tracking Support Branch Director Employee Health & Well-Being Unit Family Care Unit Supply Unit Facilities Unit Transportation Unit Labor Pool & Credentialing Unit Procurement Infrastructure Power/Lighting Unit Water/Sewer Unit HVAC Unit Building/Grounds Damage Unit Medical Gases Unit Medical Devices Unit Environmental Services Unit Food Services Unit Documentation Compensation/ Claims HazMat Detection and Monitoring Unit Spill Response Unit Victim Decontamination Unit Facility/Equipment Decontamination Unit Demobilization Cost Security Access Control Unit Crowd Control Unit Traffic Control Unit Search Unit Law Enforcement Interface Unit Business Continuity Information Technology Unit Service Continuity Unit Records Preservation Unit Business Function Relocation Unit Legend Activated Position 16
INCIDENT MANAGEMENT TEAM CHART -- INTERMEDIATE Incident Commander Public Information Safety Liaison Medical/ Technical Specialist Operations Planning Logistics Finance/ Administration Staging Manager Personnel Vehicle Equipment/Supply Medication Resources Personnel Tracking Materiel Tracking Service Communications Unit IT/IS Unit Staff Food & Water Unit Time Medical Care Inpatient Unit Outpatient Unit Casualty Care Unit Mental Health Unit Clinical Support Services Unit Patient Registration Unit Situation Patient Tracking Bed Tracking Support Branch Director Employee Health & Well-Being Unit Family Care Unit Supply Unit Facilities Unit Transportation Unit Labor Pool & Credentialing Unit Procurement Infrastructure Power/Lighting Unit Water/Sewer Unit HVAC Unit Building/Grounds Damage Unit Medical Gases Unit Medical Devices Unit Environmental Services Unit Food Services Unit Documentation Compensation/ Claims HazMat Detection and Monitoring Unit Spill Response Unit Victim Decontamination Unit Facility/Equipment Decontamination Unit Demobilization Cost Security Access Control Unit Crowd Control Unit Traffic Control Unit Search Unit Law Enforcement Interface Unit Business Continuity Information Technology Unit Service Continuity Unit Records Preservation Unit Business Function Relocation Unit Legend Activated Position 17
INCIDENT MANAGEMENT TEAM CHART EXTENDED Incident Commander Public Information Safety Liaison Medical/ Technical Specialist Operations Planning Logistics Finance/ Administration Staging Manager Personnel Vehicle Equipment/Supply Medication Resources Personnel Tracking Materiel Tracking Service Communications Unit IT/IS Unit Staff Food & Water Unit Time Medical Care Inpatient Unit Outpatient Unit Casualty Care Unit Mental Health Unit Clinical Support Services Unit Patient Registration Unit Situation Patient Tracking Bed Tracking Support Branch Director Employee Health & Well-Being Unit Family Care Unit Supply Unit Facilities Unit Transportation Unit Labor Pool & Credentialing Unit Procurement Infrastructure Power/Lighting Unit Water/Sewer Unit HVAC Unit Building/Grounds Damage Unit Medical Gases Unit Medical Devices Unit Environmental Services Unit Food Services Unit Documentation Compensation/ Claims HazMat Detection and Monitoring Unit Spill Response Unit Victim Decontamination Unit Facility/Equipment Decontamination Unit Demobilization Cost Security Access Control Unit Crowd Control Unit Traffic Control Unit Search Unit Law Enforcement Interface Unit Business Continuity Information Technology Unit Service Continuity Unit Records Preservation Unit Business Function Relocation Unit Legend Activated Position 18
INCIDENT MANAGEMENT TEAM CHART RECOVERY Incident Commander Public Information Safety Liaison Medical/ Technical Specialist Operations Planning Logistics Finance/ Administration Staging Manager Personnel Vehicle Equipment/Supply Medication Resources Personnel Tracking Materiel Tracking Service Communications Unit IT/IS Unit Staff Food & Water Unit Time Medical Care Inpatient Unit Outpatient Unit Casualty Care Unit Mental Health Unit Clinical Support Services Unit Patient Registration Unit Situation Patient Tracking Bed Tracking Support Branch Director Employee Health & Well-Being Unit Family Care Unit Supply Unit Facilities Unit Transportation Unit Labor Pool & Credentialing Unit Procurement Infrastructure Power/Lighting Unit Water/Sewer Unit HVAC Unit Building/Grounds Damage Unit Medical Gases Unit Medical Devices Unit Environmental Services Unit Food Services Unit Documentation Compensation/ Claims HazMat Detection and Monitoring Unit Spill Response Unit Victim Decontamination Unit Facility/Equipment Decontamination Unit Demobilization Cost Security Access Control Unit Crowd Control Unit Traffic Control Unit Search Unit Law Enforcement Interface Unit Business Continuity Information Technology Unit Service Continuity Unit Records Preservation Unit Business Function Relocation Unit 19 Legend Activated Position