1. Access the “Standardization of Emergency Code Calls” computer-based learning (CBL) in the Learning Management System on the MHSnet. Available mid-August 2009 Standardization of Emergency Code Calls in Washington and Oregon Hospitals Effective: October 1, 2009

2. We are committed to safe, quality healthcare for our patients and the community. One way to promote safety and reduce harm is to standardize emergency code calls in hospitals throughout the state. Washington, Oregon and California (in addition to other states) have recommended that all hospitals standardize emergency codes. This includes a change in the emergency number we dial….  New Emergency # 5555 Replaces ‘811’ at the Tacoma Campus and ‘7777’ in Puyallup Outpatient and Ambulatory Areas – continue to dial 9-911 When will this happen? October 1, 2009 Why change?

3. Code Red = Fire This Emergency Code stays the same.  Activate nearest fire alarm pull station and... Code Red should be immediately called (Dial: 5555 ) if a fire is suspected. This may include: Seeing smoke or fire Smelling smoke or other burning material Feeling unusual heat on a wall, door or other surface Notification by a patient, visitor, staff, etc. of a fire Code Red may also be initiated automatically by electronic fire detection equipment in the facility. Other MHS buildings, not part of the hospital itself, will continue to activate fire alarm pull station (if available) and dial 9-911 for fire response. New Emergency Codes:

4. Code Blue = Cardiac Arrest Heart or Respiration Stopping (Adult, Child and Infant) Replaces ‘Code 4’ on the Tacoma Campus and ‘Code 99’ in Puyallup Code Blue should be immediately called. (Dial: 5555 ) if a cardiac or respiratory arrest is suspected. This may include: When an adult, child or infant is not breathing or heart has stopped Medical emergency that cannot be moved Code Blue may also be initiated by pressing the code button (where available). Indicate whether an “adult” or “pediatric” Code Blue response is needed. Other MHS buildings, not part of the hospital itself, will continue to dial 9-911 for Emergency EMS response. New Emergency Codes:

5. Code Orange = Hazardous Material Spill/Release This is a new Emergency Code. Code Orange should be immediately called (Dial: 5555 ) in the event of a hazardous material spill or release. This may include: When there is a hazardous material spill/release that is likely to cause injury or illness May result in exposure that exceeds exposure limits or may harm the environment. Consult hospital policy, Material Safety Data Sheets (MSDS) and container labels before attempting to clean up the spill. Note: Code Orange will be called overhead and appropriate staff will be notified and respond to the hazmat event. Other MHS buildings, not part of the hospital itself, will dial 253-403-1013 (MHS Security Dispatch) for assistance with hazmat events. New Emergency Codes:

6. Code Gray = Combative Person Replaces ‘Code Orange’ on all MHS Hospital campuses Code Gray should be immediately called (Dial: 5555 ) to protect patients, staff, visitors and property in the event of a combative person. Combative or abusive behavior can be displayed by anyone. A single sign alone may not require action, but a combination of any of the following may be cause for concern and action: Direct or verbal threats of harm Destruction of property Intimidation of others by words or action Code Gray will be called when staff is concerned about their own safety and the safety of others, due to abusive or assaultive behavior. Other MHS buildings, not part of the hospital itself, will dial 9-911 for police response. New Emergency Codes:

7. Code Silver Code Silver = Weapon or Hostage Situation Code Silver Code Silver should be immediately called (Dial: 5555 ) to activate a response to manage and/or de-escalate a potentially threatening situation involving a person with a weapon or who has taken a hostage(s). Code Silver Code Silver will be called when staff are concerned about their own safety and the safety of others and suspect that someone has a weapon or has taken a hostage. The definition of a weapon is any firearm, knife or instrument that can cause bodily harm. Code Silver Code Silver will NOT be announced overhead – a response team from internal security and (potentially) external law enforcement will be called. Staff should NOT attempt to intervene or negotiate, but wait for the emergency team to arrive. Other MHS buildings, not part of the hospital itself, will dial 9-911 for police response. New Emergency Codes:

8. Amber Alert = Infant or Child Abduction Replaces ‘Code Pink’ on all MHS Hospital campuses Amber Alert should be immediately called (Dial: 5555 ) when an infant or child is missing or abducted. Follow procedures outlined in the Emergency Response Plan (ERP) Infant/Child Abduction – Amber Alert Policy including: Control entry into your department by unknown persons and monitor common areas. Post available personnel in hallways, at intersections, elevators and stairwells. These personnel will remain in place until the ‘All Clear’ is announced. Be aware that the abductor can be a stranger to the child, a family member (such as a non-custodial parent) or family acquaintance. Other MHS buildings, not part of the hospital itself, will dial 9-911 for police response. New Emergency Codes:

9. Code External Triage = External Disaster Replaces ‘Code 99’ on the Tacoma Campuses and ‘Code D’ in Puyallup Code External Triage should be called (Dial: 5555 ) to provide a mechanism that will allow the facility to respond to a variety of external emergency situations. Follow procedures outlined in the Comprehensive Emergency Management Plan - Emergency Response Plan (ERP) policy. Examples of External Triage include: Any event where there are mass casualties Natural disaster – flood, tornado, earthquake Massive power outage Bioterrorism Nuclear, biological and chemical incidents Other MHS buildings, not part of the hospital itself, please check with your supervisor for specific disaster preparedness protocols. New Emergency Codes:

10. Code Internal Triage = Internal Disaster Replaces ‘Code 10’ on the Tacoma Campuses and ‘Code D’ in Puyallup Code Internal Triage should be called (Dial: 5555 ) to provide a mechanism that will allow the facility to respond to a variety of internal emergency situations and ensure continued operations of the facility under emergency conditions. Follow procedures outlined in the Comprehensive Emergency Management Plan - Emergency Response Plan (ERP) policy. Examples of Internal Triage include: Total power outage, utility disruption Plumbing outage and/or problems Telephones not working Computer network down Flooding Explosion without fire Bomb/bomb threat Other MHS buildings, not part of the hospital itself, please check with your supervisor for specific disaster preparedness protocols. New Emergency Codes:

11. Some Emergency Codes are staying the same on the Tacoma campus and changing (standardizing) at Good Samaritan Hospital: Code STEMI (Dial 5555 ) Replaces ‘Code 4’ at Good Samaritan Hospital Hospital-only Standardized team response to assure rapid care for the patient having an acute Myocardial Infarction (heart attack) If you suspect your patient is having a heart attack – call the Rapid Response Team) If the patient’s heart or breathing stops - a CODE BLUE should be called Code Neuro (Dial 5555 ) Replaces ‘Code 5’ at Good Samaritan Hospital Hospital-only Standardized team response to assure rapid care for the patient having a stroke. If you suspect your patient is having a stroke – call the Rapid Response Team If the patient’s heart or breathing stops - a CODE BLUE should be called. What Else is Changing?

12. The following Emergency Codes will NOT change… Rapid Response (Dial 5555 ) Hospital-only – for in-patients only Provides an early response and additional support to the health care professional to slow or prevent patient clinical deterioration. If the patient’s heart or breathing stops - a CODE BLUE should be called. What Else is Staying the Same?

13. Do Not add any variances, changes or exceptions to the bands (ie: “Patient is a DNR except for……”). For patients with selected variances/advanced directives/allergies etc., staff are to check the chart for the most current information. Wristband colors will also be standardized across MHS Note: Not all wristbands may be used in all MHS Facilities. Please check your department’s protocols. Allergy Band – Red (no change) Parent of Hospitalized Child - Blue Falls Precaution – Yellow Do Not Resuscitate (DNR) – Purple  BP, IV, Blood Draws Limb Precaution – Pink Wrist Band Updates

14.  New Emergency Code number to dial is: 5555 Starting October 1, 2009 this number will replace ‘811’ on the Tacoma Campus Hospitals and ‘7777’ at Good Samaritan. Facilities currently dialing 9-911 to access emergency assistance will continue to do so… Reminder... Dial 5555 for Emergency Assistance starting Oct 1, 2009!

15. Next Steps... Assure that all pertinent signs, paperwork, posters, booklets, wristbands, etc. in your work area have been updated with the versions containing the newest Emergency Codes All hospital policies and publications will be updated to reflect the new Emergency Codes. You may access MHS policies through the MHSnet. Make sure all hospital telephones have been stickered with the new ‘ 5555 ’ number Obtain additional stickers from Printing Services Replace all Emergency Management Flip Charts in your area with updated versions Obtain Emergency Management Flip Charts from Printing Services. Obtain new ‘Cue-Cards’ (extra badge containing emergency numbers and other information) Obtain ‘Cue-Cards’ from Printing Services.

16. Codes and Staff Response For further response details and information please refer to policy Code/ConditionResponse Code Red: Fire, smoke or smell of smoke If you find a fire, follow RACE R – Rescue anyone in immediate danger A – Activate alarm and dial 5555 (hospitals) or call 9-911 C – Control ventilation - close doors E – Extinguish fire or Evacuate Code Blue: Cardiac or respiratory arrest Code Blue – Pediatric Cardiac or respiratory arrest 1.Initiate Basic Life Support (start CPR) 2.Hospitals: Call 5555 or press code button where available 3.Other facilities: call 9-911 4.Initiate Basic Life Support (start CPR) 5.Hospitals: Call 5555 or press code button where available 6.Other facilities: call 9-911 Code Orange Hazardous Material Spill or Release 1.Hospitals – call 5555 2.Other Facilities – call 253-403-1013 (MHS Security Dispatch) 3.Appropriate personnel will be dispatched to area 4.Consult hospital policy, Material Safety Data Sheets (MSDS) and container labels before attempting to clean up any spill. Code Gray: Combative or Violent Patient 1.Hospitals: call 5555 2.Other Facilities: call 9-911 3.Designated persons only report to area 4.Limit people in the immediate area to designated staff Code Silver: Person with Weapon or Hostage Situation 1.Hospitals: call 5555 2.Other Facilities: call 9-911 3.Will NOT be paged overhead – appropriate personnel will be privately paged 4.Designated persons only report to area – limit responders Amber Alert Infant or child missing or abducted 1.Hospitals: call 5555 2.Other Facilities: call 9-911 3.Look around your work area 4.Report to nearest unmanned exit/stairwell/elevator and request people to wait 5.Notify security or police of anything suspicious Code External Triage External Disaster Code Internal Triage Internal Disaster  Phase 1 – Alert/Planning  Phase 2 – Activate  All Clear – resume normal activities 1.Return to your department and locate disaster supplies 2.Implement disaster plan – HICS Activation 3.Department leader assigns staff for labor pool 4.Complete department assessment 5.Contact Command Center Rapid Response Team (Hospitals only) Rapidly deteriorating patient 1.Call 5555 2.Rapid Response Team reports to area Code STEMI (Hospitals only) Patient having a heart attack 1.Call 5555 2.Activate Rapid Response Team for deteriorating patient 3.If patient becomes pulseless or stops breathing – call a Code Blue Code Neuro (Hospitals only) Patient having a stroke 1.Call 5555 2.Activate Rapid Response Team for deteriorating patient 3.If patient becomes pulseless or stops breathing – call a Code Blue

17. For more information: Emergency Management Flip Chart (Available through Printing Services) Emergency Management Office: 253-403-8181 MHS Security 253-403-1013 (Security Dispatch – Tacoma) 253-697-1735 (Security – Puyallup) MHS Safety Office 253-403-2084 (Tacoma) 253-697-2269 (Puyallup) 253-403-9168 (Ambulatory) Institute for Learning and Development 253-403-1280 Questions?