Banff Mineral Springs Hospital EMERGENCY RESPONSE CODE BLUE Cardiac Arrest / Medical Emergency EMERGENCY RESPONSE CODE BLUE ALGORITHM First Person On-Scene First Person On-Scene Call for HELP Push code button or pull the call cord on the wall Initiate Frirst Responder actions if trained to do so 1. Perform point of care risk assessment a. Don PPE as required b. Is the scene safe? c. Are there multiple persons requiring assistance? First Responder 2. Assess the individual: a. If unresponsive call for HELP / pull call cord out of the wall b. Check pulse and breathing simultaneousy c. If no pulse or only gasping breaths; start CPR as per training 3. Consider and assess for other life threatening conditions a. significant bleeding b. obvious life-threatening injury c. c. C-spine precautions If known, verify any Advance Care Planning and Goals of Care Designation (ACP/GCD) to confirm resuscitation status Page 1 of 8
EMERGENCY RESPONSE CODE BLUE ALGORITHM Second Responder If not completed by the First Responder 1. Activate Site Code Blue response [e.g. pulling call bell, dial 0 for Patient Registration. a. State Code Blue / Unit location / room number b. Wait for the operator to repeat the information c. What goes here? During the night ( 21:30-07:00 hrs) d. Dial 550 to activate the overhead paging system. e. If additional resources are required, contact EMS team via dispatch f. 9-911 2. Bring backboard, airway management supplies and resuscitation cart to the patient location, if not already there. 3. Ensure paediatric equipment from Emergency trauma room is available for patients less than 18 years of age 4. Assist with BLS procedures. Continue life support measures until the Code Team arrives o Attach O2 flow meter to the wall outlet and turn to maximum flow until reservoir bag remains inflated on Bag valve mask o Start two-rescuer CPR. Continue CPR until the job is re-delegarted or you are dismissed by the Emergency Room Nurse of the Code Team o Open the patient s airway and provide ventilation breaths with the Bag valve mask or pocket mask. Unit / Area Staff Immediate Responsibilities: Assist with BLS procedures, if indicated Assign a staff member to remain at the entrance to the area to direct the Code Blue Team to the Code Blue location Assign a staff member to control pedestrian traffic in the area Provide support to family, if present Assist other persons to move away from the area Clear the route of any excess equipment or supplies for the Code Blue Team arrival Retriene the patient Medical Records Refer to APPENDIX 1 for other duties to support the Code Blue Team Page 2 of 8
If the incident location is within the site and Patient Registration is not on-site: Patient Registration / Designate* o o o Dial 550 to activate the overhead paging system. Advise all staff Code Blue / Unit Location/ Room Number (three times) If additional resources are required, contact EMS team via dispatch 9-911 If the incident location is outside of the site s defined response locations for the Code Blue Team o Direct the caller to dial 911 to activate Emergency Medical Services o Notify the Emergency Room Staff, providing the location of the incident Announce Code Blue all clear (three times) when directed EMERGENCY RESPONSE CODE BLUE ALGORITHM Code Team Members The Code Blue Team members vary depending on where the code is located in the hospital. The Emergency Room physician and all available staff should attend a Code Blue At a minimum the Emergency Room Physician, one Emergency Room nurse and one nurse respond to all codes. The Nurse is responsible for taking the resuscitation cart to all codes on Long Term Care- St. Martha s Place. A generic guide to Code Team membership, responsibilities, and expectations is attached as APPENDIX 1. Page 3 of 8
Protective Services - when on site Respond to all Code Blue calls Assist with way-finding Assist with control of pedestrian traffic and safety concerns Supervisor / Manager of Area Assist and direct staff responding to Code Blue (see APPENDIX 1) Assist with arranging transportation as needed Gather information from staff discovering the incident Confirm Code Blue has been activated Ensure physician and patient s family are made aware of the incident Ensure Site Management is notified Arrange for staff support as needed (e.g. Employee & Family Assistance Program [EFAP], etc.) Ensure incident documentation is completed by staff (see POST INCIDENT ACTIONS) In consideration of staff and physicians impacted by the incident, engage or suggest engagement of EFAP, PFSP, and other supports (see Post Incident Actions, which follows) Page 4 of 8
Site: Provincial Template Approval Level: Covenant Health E/DM Cross Reference: Document #: ERC 1a Initial Effective Date: February 2018 Revision Effective Date: February 2018 PURPOSE is the designated phrase to provide guidelines and direction on how to respond to any person experiencing acute physiologic compromise, airway threat, respiratory and / or cardiac arrest. A Code Blue is to be initiated for acute physiological disturbances that require immediate intervention and has Resuscitative Goals of Care R1, 2 or 3 or unknown Goals of Care. 1 This plan forms a general template, as a guide for each Covenant Health site to utilize. It is essential that the plan be site specific. Individual work sites may need to add (or delete) items that are specific to their operation. 2 APPLICABILITY Compliance with this Emergency Response Code is required by all Covenant Health employees, members of the medical and midwifery staffs, students, volunteers, and other persons acting on behalf of Covenant Health (including contracted service providers as necessary). This plan does not limit any legal rights to which you may otherwise be entitled. 3 ACTIVATION can be initiated by any member of staff or physician who performs the initial assessment of the patient s condition. POST INCIDENT ACTIONS In addition to the actions outlined in the algorithm, the Supervisor / Designate of the area is to: 1 AHS Policy # HCS-38 - Advance Care Planning and Goals Of Care Designation 2 OHS Code Explanation Guide, published by Alberta Queen s Printer for the Alberta Government 3 Section 35 of the Alberta OH&S Act states that: (1) No worker shall (a) carry out any work if, on reasonable and probable grounds, the worker believes that there exists an imminent danger to the health or safety of that worker, (b) carry out any work if, on reasonable and probable grounds, the worker believes that it will cause to exist an imminent danger to the health or safety of that worker or another worker present at the work site, Page 5 of 8
Implement subsequent emergency response plans as appropriate If any Staff sustained a blood and body fluid exposure (BBFE) or are reporting that they have been impacted by the incident, ensure the following are completed: o Report through Covenant Health Occupational Health and Safety o Arrange for staff support as needed (e.g. Employee & Family Assistance Program [EFAP]), in consultation with OHS and Site Leadership Physicians impacted by the incident may seek support through the Alberta Medical Association s Physician Family Support Program (PFSP) Ensure clinical documentation is completed as follows: o Documentation of events preceding the Code Blue up and until the time the Code Team arrives, including incident documentation in the Reporting & Learning System for Patient Safety (RLS) o Other site or Covenant Health-specific documentation as appropriate Ensure incident documentation is completed. This may include: o Urgent Notification to an Emerging Issue o Other site or Covenant Health-specific documentation as appropriate REFERENCE Policy I-25, Emergency/Disaster Management Response Heart and Stroke Foundation, Basic Life Support (BLS), 2015 Page 6 of 8
APPENDIX 1: CODE BLUE TEAM RESPONSIBILITIES AND EXPECTATIONS* *The composition of the Code Blue Team will vary depending on where the code is located in the hospital. This document provides a generic guide to Code Team membership, responsibilities, and expectations. IPC Considerations: Hand hygiene may not be reasonably performed prior to care, but must be performed after care PPE must be donned prior to care or as soon as practically possible. Gloves must be worn by the team. Health care workers (HCW) at or within 1 metre of the patient s airway must wear a mask and eye protection. Code Blue Team Composition: 1. Code Blue Team Lead as determined by scope of practice a) Team Lead, who has sufficient knowledge and training to lead an adult or paediatric resuscitation, will direct the Code Blue Team and be responsible for the overall management of the resuscitation b) The role of the Code Blue Team lead may be delegated to another more experienced team member at any time c) Code Blue Team lead signs the Cardio-Respiratory Arrest Record to authorize all verbal orders given, and procedures carried out during management of the Code Blue by the Code Team d) Code Blue Team lead is to arrange for transfer to appropriate area when necessary, and remains with the Code Team until the patient is transferred e) If resuscitation attempts are unsuccessful, it is the Code Blue Team leader s responsibility to terminate the resuscitation efforts (physician only) 2. Code Blue Team Members - as determined by scope of practice a) Ensures necessary equipment is available Brings the crash cart as required b) Co-ordinates / delegates roles Manages crash cart: prepares medications, mixes intravenous solutions, manages defibrillator, etc. Documentation: Signs the Cardio-Respiratory Arrest Record upon completion of the Code Blue. When documentation is delegated to another health care professional, Code Blue nurse is responsible to review documentation with recorder and to ensure that the Cardio- Respiratory Arrest Record is completed accurately and signed by appropriate personnel Patient Care: remains at the Code Blue scene, with crash cart, until resuscitation is discontinued or de-escalated and the patient is either determined to be stable to remain in the same location or needs to be transferred to a more appropriate area Page 7 of 8
c) Airway Management Assists with endotracheal intubation or, if certified, performs endotracheal intubation in the absence of, or as directed by, the Team Lead Responsible for ensuring the difficult airway management equipment is available Assists with external cardiac compressions Confirms successful intubation with a secondary device (end tidal carbon dioxide or esophageal detection device) End tidal carbon dioxide confirmation of airway is required on all patients with an endotracheal tube, even if one is in place prior to arrival of the Code Blue Team, and will be documented on the Cardio-Respiratory Arrest Record Cuts the wires for patients with jaws wired to manage airway and ventilation Ensures blood gas sampling and analysis. Remains at the Code Blue scene, with crash cart, until resuscitation is discontinued or the patient is transferred to an appropriate area Signs Cardio-Respiratory Arrest Record and ensures that the tasks they have performed are documented accurately Responsible to restock and replace any used airway management supplies 3. Unit Manager/Manager on Call a) Contact the family and attending physician if not already present b) Accompany the patient on transport to appropriate department for a higher level of car c) Document events preceding the Code Blue up and until the time the Code Blue Team arrives d) Ensure crash cart equipment / supplies are appropriately reprocessed and restocked Page 8 of 8