code black – personal threat preparedness and response ... · halls creek hospital . ... guiding...

Effective: 23 September 2016

WACHS KIMBERLEY Halls Creek Hospital

Code Black – Personal Threat Preparedness and Response Procedure

Table of Contents 1. Guiding Principles ....................................................................................................... 2

2. Prevention of Code Black ........................................................................................... 2

3. Code Black Definitions ............................................................................................... 3

4. Alpha (Infant Child Abduction) ................................................................................... 3

5. Notification of Code Black Overview ......................................................................... 4

6. Duress Systems........................................................................................................... 5

7. Staff Responsibilities - Overview ............................................................................... 6

8. Code Black Procedures .............................................................................................. 6

Business Hours ............................................................................................................. 7

After Hours .................................................................................................................... 7

9. Source Documents ...................................................................................................... 9 10. Acknowledgments ..................................................................................................... 10 11. Action Cards .............................................................................................................. 10

11.1 Threatened Staff / Threat to Others ..................................................................... 13

11.2 First Responder to Duress ................................................................................... 15

11.3 Second in Charge Duress Response .................................................................. 17

11.4 District Medical Officer ......................................................................................... 18

11.5 All Purpose Orderly ............................................................................................. 20

11.6 Reception Staff .................................................................................................... 21

11.7 Hospital Emergency Coordinator ......................................................................... 23

11.8 Director of Nursing ............................................................................................... 24

11.9 Ambulance Staff .................................................................................................. 25

11.10 Regional Health Disaster Coordinator ............................................................... 26

12. Appendices ................................................................................................................ 27 APPENDIX A – Offender ID Form ............................................................................... 27

APPENDIX B – WACHS Kimberley Emergency Incident Report ................................ 29

APPENDIX C – WACHS Electronic Safety Risk Report Form ..................................... 32

APPENDIX D – WACHS Kimberley Violence and Agression Form ............................. 33

APPENDIX E – Duress Pendant and Pager Testing Sample Form ............................. 35

APPENDIX F – WACHS Kimberley Emergency Contacts and Links........................... 36

Date of Last Review: September 2016 of 35 Date Next Review: September 2018

Code Black – Personal Threat Preparedness and Response Procedure – Halls Creek

1. Guiding Principles The WA Country Health Service (WACHS) has a responsibility under the Occupational Safety and Health Act to hold the safety of all patients, visitors and staff as paramount. Aggression is an escalating problem within the health system that may result in staff, patient or visitor injury. A Code Black is a call for assistance, when any individual (staff, patient or visitor) is at personal threat of harm from an act of aggression. At all times, the first consideration is the preservation of human life with the safety of staff and patients uppermost. Under no circumstances should staff, patients or visitors place themselves at risk.

There are three types of threats within the Code Black category:

1. Code Black - Personal Threat (Unarmed or Armed or Hold Up). 2. Code Black - Alpha (Abduction). 3. Code Black – Shooter WA Health Code Black Bravo – Active Shooter 4. Code Black – J (Self Harm).

Of these categories two types of Code Black risks are identified within Halls Creek Hospital.

1. Code Black - Personal Threat (Unarmed or Armed or Hold Up). 2. Code Black - Alpha (Abduction). WA Health Code Black Alpha (Infant / Child Abduction)

2. Prevention of Code Black

The following procedures are to assist staff in preventing and resolving Code Black Personal Threat situations as quickly and as calmly as possible: · Adhere to existing simple security precautions:

- Wear an official identification badge displaying a photo of the staff member, title, name and WACHS logo.

- Maintain clear exit paths. - Ensure security doors are kept closed (e.g. swipe card access doors). - Ensure that all staff with patient and visitor contact have attended mandatory

training. - Be alert for people behaving in an unusual manner. - Identify persons who are known to be violent and report their presence. - Ensure all staff are aware of potential aggressors. - Assess the situation and be alert to the triggers of violence. - Designate safe escape routes in your workplace. - Clearly identify “staff only areas” and maintain as such.

· People who do not have a valid reason for being in the hospital should be requested to leave.

· Call Security, where available, if concerned.


http://www.health.wa.gov.au/CircularsNew/circular.cfm?Circ_ID=13202



3. Code Black Definitions A personal threat arises where there is a threat to others by an individual who is violent or threatening in manner. A personal threat may present as an unarmed or armed confrontation by an individual or group of persons. The proper management of an aggressive, agitated, violent or threatening person can decrease actual physical harm (assault).

Unarmed confrontation · Excessive noise, e.g. loud or intrusive conversation or shouting. This may include: - threatening or abusive language involving

excessive swearing or offensive remarks - derogatory racial or sexual remarks - malicious allegations relating to members of staff,

other patients or visitors - offensive sexual gestures or behaviour.

· Wilful damage to hospital property. · Threats or threatening behaviour. · Verbal or physical violence.

Armed confrontation · All of the above with a weapon which includes any article that might cause injury such as a chair, bat, IV pole, needles with/without syringes, guns and knives.

· An armed hold up is one type of armed confrontation where staff are threatened with a weapon, in order to steal property or drugs and is regarded as a significant crime.

Hold Up Any demand for money, personal belongings or drugs involving a personal threat situation either armed or unarmed.

An armed hold up is one type of armed confrontation where staff are threatened with a weapon, in order to steal property or drugs and is regarded as a significant crime.

4. Alpha (Infant Child Abduction)

Any person can be abducted. Infants and/or children are the most vulnerable to be abducted. To minimise the risk of abduction, staff are to adhere to existing simple security precautions: · Ensure all visitors to infants and/or children are identified. · Inform and orientate parents and visitors to the facility security protocols · Never leave an infant or a child unattended i.e. in their room. · Ensure infant or a child is in a secure nursery or ward when leaving the ward etc. · Parents and or visitors are required to return the infant or a child to the nursery on

leaving the ward. · Report to a staff member on leaving and/or returning to the ward.



Staff should be vigilant and report immediately unusual suspicious behaviour displayed by an individual(s) this includes but is not limited to: · Repeated visits “just to see” or “hold” the infant or a child. · Inquiries about hospital (facilities) procedures, floor lay out and staff numbers. · Curiosity about issues such as uniforms or other means of identification of staff. Abduction is the only Code Black announced over the Public Address/ EWIS system (where available) When an infant or a child is abducted, one of the best methods of recovery is to make an immediate announcement so that staff can begin searching the building. This procedure includes checkpoints at all entrances and exits, stopping all people with infants or children and asking them for identification. It is important to note that under no circumstances should staff, mother / partner, visitors place themselves or the infant at risk. Principles – Abduction (Actual or suspected event)

· Ensure a thorough search the ward and hospital perimeter is undertaken · Respond appropriately and rapidly to secure the ward and the hospital perimeter

(prior to hospital lockdown), Do this by ensuring staff are posted at exit points · Call a Code Black – Alpha as soon as staff are aware of the event. · Obtain clear description of the event from witnesses. · Provide at all times privacy and monitor the condition of the parent(s). · All relevant staff should be briefed immediately. · Secure the scene where the infant or a child was last sighted to preserve any

evidence for the Police. · Notify surrounding health care facilities and the Emergency Department of an

infant or a child missing and possible abduction. Provide a detailed current description of the missing infant or a child for accurate identification.

Principles – Communication/ Media

· ONLY the dedicated media spokesperson is to talk with the media. · Ensure all relevant current information is provided along the internal chain of

command to or from the activated Local Emergency Operation Centre. · Engage the services of WACHS Communications to affirm appropriate media

release. The Rural Media assistance contact is 08 9222 6499 staffed 24 hours 7 days a week

· Ensure all information on the abduction is cleared by the Regional Health Disaster Coordinator (Regional Director) – Kimberley or Hospital Emergency Coordinator (Operations Manager) and Police before being released.

· If necessary ensure a “hotline” for incoming calls is set up at the switchboard or other designated area.

· Ensure privacy for the parents /carer where possible.



5. Notification of Code Black Overview

To notify staff of either a Code Black or Code Black Alpha, the alarm is raised using staff duress alarm (fixed button) and if safe to do so or by dialling 9 (switchboard) or attracting the attention of another staff member to raise the alarm. When dialling 9 for switch, staff are to advise them of the Code and location and to contact the clinical nurse manager in charge. When pressing a personal duress button or fixed duress button, this will automatically send a page/SMS to the duress response team. The message will state the area of the owner of the pendant or fixed button. The only Code Black that can be announced over the Public Address EWIS system (if available) is Code Black Alpha (infant/child abduction) where the aim is to notify staff to the possible abduction and to secure entrances and exits to the hospital.

6. Duress Systems

Duress strips/buttons/pendants are installed as a means of safely notifying a personal threat situation without inciting the individual causing the disturbance or placing the staff member at risk. These denote only a general duress area and should be followed by a call to 9 SWITCHBOARD to notify the nurse manager of the exact location of the duress. Duress alarms take several forms (where fitted): · Personal Duress alarm pendant: Small plastic pendant on a lanyard with a

duress button. These are allocated to various departments and individuals within the hospital and must be worn at all times. They should not be carried in pockets as this can increase the rate of false alarms. Duress pendants vary Testing instructions and procedures will vary at each site depending on the type of pendant, please refer to the hospital’s pendant instructions.

· Fixed duress alarm: Button or strip fixed under desks or on walls activated by

pressing the alarm. This will alert to an area only, staff will need to direct the Emergency Response (Duress) Team or staff as per local protocol on their arrival.

DURESS AND PAGER TESTING PROCESS · Regular testing of duress systems is to be carried out as per local protocols,

typically annually by maintenance staff and monthly by staff in local sites. (Appendix E)

· The staff member testing the Duress Alarm should contact reception to send out a message on the paging system to the Emergency Response (Duress) Team or staff as per local procedure and to maintenance stating.

· The duress response team are to contact reception immediately and acknowledge the alarm.

· Reception staff are to notify the testing staff member following acknowledgement of the duress response team.



· Instances of no response or faults are to be reported to the Operations Manager

and Maintenance Manager immediately. · Staff member running the duress alarm testing test (usually reception staff with

nursing staff during normal hours) is responsible for maintaining a response list and submitting this monthly to the Occupational Safety and Health Committee.

· Each facility is to regularly test all alarms (strip/button) on a rotating monthly basis so all areas are tested over a four to five week cycle as per local procedures.

7. Staff Responsibilities - Overview

Staff are responsible to identify if their role consists of being part of the duress response team. If their duties that day will impact their ability to respond, they must notify their manager to identify another person responsible during the time they are unavailable. PHONES Each phone has a registered number and is tracked on the duress system. Pagers are allocated per position per shift; therefore, staff are to handover the pager at the end of each shift. Each pager must remain in the area allocated and not mixed up, otherwise this may cause risk in relation to the planned Code Black response. Phones are the property of WACHS Kimberley. Lost duress phones can cause risk to the hospital and planned code response. At the commencement of each shift, staff are responsible for collecting the phones associated with their area of work. Phones must be switched on and ready for use. STAFF TRAINING Aggression management training is provided by WACHS Kimberley and is mandatory for all clinical staff and duress response team members. This training module is the first day of MAYBO training. All clinical Mental Health staff are to attend the complete three (3) day MAYBO Training course. All clinical and non –clinical staff are to receive Code Black training during Mandatory Training. Within one (1) month of employment: All staff will receive training in the use of and testing of duress equipment and their roles and responsibilities as a general staff member and as a member of the duress response team Identified “at risk” (i.e. staff working in Emergency Department and Mental Health) will be orientated to the system immediately on commencement of employment. All staff members who have not been orientated to the duress system within one (1) month must follow up with their line manager to book in duress training. Duress response teams will practice responding (drills and skills) four (4) times per year, to maintain competency using a simulated response. The simulated training will be recorded through Learning and Development and outcomes will be tabled at the next Emergency Management Committee meeting for review and action.



8. Code Black Procedures Follow the RRRR steps when safe to do so: Raise the alarm – Remain calm – Retreat to safety – Record details The alarm should be raised by using the available duress system, (personal pendant, strip/ button under desk or on wall) if available or when safe to do so dial 9 Code Black or attract attention of another staff member to dial 9 Code Black or 000 for the police. Tell the switchboard operator/police the following information twice: · Code Black – Duress response required, Director of Nursing/Clinical Nurse

Manager/Area Manager, Clinical Nurse, and Orderly at the incident · Your location and the location of the incident · A brief summary of the situation (who what where how) · Number of people involved

All serious personal threat (duress) situations or any involving injury to staff, patients or visitors must be documented and reported to the Director of Nursing during normal hours and to the Director of Nursing/Clinical Nurse Manager on-call after hours. Verbal de-escalation and distraction may sometimes be enough to manage the situation. This technique involves: · remaining calm. · listening to the individuals concerns in an empathic, non-confronting manner, · emphasising the desire to help. · trying to make the individual more comfortable. · utilising accompanying friends and relatives, if appropriate.

A useful approach is to utilise the principles of LASSIE:

· Listen to the problem. · Acknowledge issues. · Separate them. · Seat them, Indicate options. · Encourage compliance. Duress Response Team Structure and Training The following positions for the duress response team Halls Creek Hospital

Role Business Hours After Hours Team Leader Director of Nursing (DON) /Clinical

Nurse Manager (CNM) After hours ED Nurse, On Call DON/CNM

Second in Charge ED Nurse Shift Coordinator Ward /ED Nurse Team Member District Medical Officer Team Member Hotel Services Manager All Purpose Orderly Team Member All Purpose Orderly All Purpose Orderly



Halls Creek Emergency Coordination Team

· Operations Manager (East Kimberley Emergency Coordinator). · Director of Nursing (Hospital Emergency Coordinator). · Support Services Manager · All Purpose Orderly 1 and 2 · Nurse in Charge of shift · District Medical Officer · Regional Health Disaster Coordinator

Duress Response Team Training Duress Response Team members are to have completed MAYBO Conflict Management (including Risk Assessment and De-escalation training) training, which is a one (1) day course. RESPONDING TO CODE BLACK When a duress pendant or fixed button is pressed, it will initiate an automatic SMS to all the duress response team members with the following information: · Code Black · Area allocated to the duress pendant/fixed button When a CODE Black SMS is received, the duress response team is required to proceed to the duress location point.

Duress Response Team Leader – First Responder – Role and Responsibilities The first responder arriving at the scene of a duress situation is to observe the situation: · Assess situation and under all circumstances, ensure your own safety as well as

staff safety · Notify police(and request police presence if required) in all cases where threatening

behaviour is displayed · Develop a plan in consultation with other team members to manage and resolve

the incident in the most safe and efficient manner possible · Delegate roles and responsibilities of the team and identify successors if required · Never engage directly with the offender, as staff need to be able to make decisions

and delegate response actions as the incident progresses · Liaise with the Hospital Emergency Coordinator regarding response plan and

resources required during the whole incident · Complete and collate documentation for all actual events and forward to Hospital

Emergency Coordinator · Record all false duress alarms and forward to the Maintenance Manager



ESCALATION OF DUESS RESONSE SUPPORT At any time, the first responder can request an increase in support by calling on other Maybo trained staff for assistance or by requesting support from the on call DMO, on Psychiatrist or Police and other emergency services. This is arranged by person in charge or Hospital Emergency Coordinator if the EOC is activated. A staff member may be delegated to make a public announcement or ask switch to call the requested support. REPORTING OF CODE BLACK All duress personal threat situations including any incidents involving injury to staff, patients or visitors must be documented and reported to the Hospital Emergency Coordinator (DON) during normal hours and the After-hours Director of Nursing/Clinical Nurse Manager. The following documentation is required for completion by the appropriate staff: · The Offender ID Form (Appendix A) · The WACHS Kimberley Emergency Code Activation Report Form (Appendix B),

generally completed by all staff members involved in the incident to assist with chronological recording of events.

· A WACHS electronic Safety Risk Report Form (Appendix C) DEBRIEFING All staff involved in a Code Black are offered the opportunity to attend a debriefing session if required. This is an opportunity to talk about and gain support from other involved in the incident. WACHS offers access to the WACHS Employee Assistance Program. IMPROVEMENT PROCESS All documentation completed regarding the Code Black incident is to be collated and reviewed by the Hospital Emergency Coordinator. Outcomes to be identified and reported to the Regional Health Disaster Coordinator and OSH committee as required. Staff may be requested to participate in an improvement process review of the incident, to identify strategies to reduce the likelihood of another incident and improve the Hospital’s response to Code Black.

9. Source Documents

· Australian Standard 2010, Planning for Emergencies – Health Care Facilities. AS 4083-2010. Section 5.6 For Personal Threat, Armed or Unarmed person threatening injury to others or to themselves: Response Colour Code Black Standards Australia Limited, NSW pp 21 – 22. Available from: Standards Australia Online [18 November 2012].

· Australian Standard 1997, Security for Health Care Facilities. AS 4485.1-1997. Part 1: General Requirements Standards Australia Limited, NSW. Available from: Standards Australia Online [18 November 2012].


http://wachs.hdwa.health.wa.gov.au/index.php?eID=tx_nawsecuredl&u=318&file=fileadmin/sections/kimberley/corporate_services/WACHS-K_Emergency_Procedures/WACHS-K_Emergency_Code_Activation_Report_2.0_2015-08.doc&t=1474508318&hash=a9ba0fdcd18530faff1db345dad589e9

http://trim/hptrimwebclient/download/?uri=967850

http://wachs.hdwa.health.wa.gov.au/index.php?id=10785



· Australian Standard 1997, Security for Health Care Facilities. AS 4485.2-1997. Part 2: Procedures Guide Standards Australia Limited, NSW. Available from: Standards Australia Online [18 November 2012].

· WA Health Media Communication. [25 January 2013]. · Department of Health Code Black Alpha (Infant/Child Abduction) [30 January 2013]. · Bunbury Hospital 2013 Section 8 Code Black Procedure [October 2011]. · Swan Kalamunda Health Service (Swan Health Campus) Emergency Procedures

Manual Code Black [October 2011]. · Kimberley Broome Hospital. Code Black Preparedness & Response Procedure

[May 2013] · Kimberley Derby Hospital Emergency Management. Section 8 Code Black Personal

Threat [11 April 2011]. · Kununurra Hospital Personal Threat Response Plan [Revised January 2013]. · Crilly, J., Chaboyer, W., Creedy, D. (2004). Violence towards emergency

department nurses by patients. Accident and Emergency Nursing, 12:7-73. · Fems, T. (2005). Violence in the accident and emergency department - An

international perspective. Accident and Emergency Nursing, 13:180-185. · WA Health Clinical Incident Management Policy using the Advanced Incident

Management System 2006.

10. Acknowledgments Assistance from the following organisations and individuals for their generosity of time, collaborative sharing of information, expertise and knowledge is gratefully acknowledged in the preparation of this document. In particular: · Swan Kalamunda Health Service WA. · WACHS South West - Bunbury Hospital WA. · WACHS Kimberley - Broome Hospital WA · WACHS Kimberley Derby Hospital. · WACHS Kimberley Kununurra Hospital. · Operational Managers and other members of WACHS Kimberley Regional

Executive.





11. Action Cards Action Cards define specific emergency response functional roles and tasks. Individual staff members can hold more than one action card role depending on the circumstances. Individuals can also be reassigned different action cards (or roles) as needed. Tasks on an action card can be amended to fit the situation by adding or deleting tasks. The key elements on action cards are: · Title – role to be performed. · Applicable to – Hospital(s) area where role is undertaken. · Location – The Location of where the role is be fulfilled · Person Responsible - The designated staff member (by position) assigned to that

particular role (not named individuals). · Successor in Absence - The staff member (successor in absence) who fills the role

in the absence of the designated person. · Who to report to – the supervisor who has direct authority over that role. · Resources required. Action cards have three stages for activity: · IMMEDIATE: Deal with problem. · ONGOING: Current problem and action taken to facilitate a safe resolution. · STAND DOWN: A return to normal activity. There are no names of individual staff members (position titles are used) or telephone contact numbers on action cards, as these may change from time to time. Contact lists should be held by individual Team Leaders/Departmental Managers and a central list in the Local Emergency Operations Centre. Action Cards are divided into two functional areas:

1) Halls Creek Hospital Staff 2) Executive Team Emergency Operations Centre

Action Cards with specific detail about the role (Note: Not all action cards require these roles and not all facilities will have these positions) are attached to this procedure and include: · Threatened Staff/Threat to Others. · Hospital Emergency Coordinator. · First Responder · Clinical Nurse Managers/Ward Shift Coordinator. · All Purpose Orderly. · Director/Coordinator of Nursing. · Senior Medical Officer/Director of Medical Services. · Regional Health Disaster Coordinator. The role of the Regional Health Disaster Coordinator (Regional Director) or delegated person (usually the Hospital Emergency Coordinator) is to evaluate the emergency from the information provided, to decide the level of assistance that will be required for key support services and to coordinate effective delivery.



Code Black

Action Cards



11.1 Threatened Staff / Threat to Others

Title THREATENED STAFF / THREAT TO OTHERS Applicable to HALLS CREEK HOSPITAL Location INCIDENT SITE Position Responsible STAFF MEMBER AT INCIDENT Successor in Absence N/A Reports to FIRST RESPONDER DURESS TEAM Resources DURESS PENDANT / FIXED BUTTON OR TELEPHONE Under no circumstances are staff, patients or visitors to place themselves or others in further jeopardy. Call or get assistance to call Code Black as soon as it is safe to do so. Follow the RRRR steps when safe to do so: Raise the alarm – Remain calm – Retreat to safety – Record details. · Raise alarm, using duress alarm (personal pendant, strip, bell/button under desk or on

wall) if available or when safe to do so dial 9 (Switchboard) Code Black or attract attention of another staff member to dial 9 (Switchboard) for assistance if no duress response.

· If possible wait by phone until the Emergency Response (Duress) Team or staff as per local protocol contacts your extension to request your name and exact location and type of incident.

· If you are by yourself and doors can be closed, lock them to create a barrier between you and the threat.

· If possible manoeuvre yourself to place a physical barrier between yourself and the aggressor, e.g. a desk, bench, chair.

· If you are out of danger - stay out of danger.

· If the offender is armed, do not attempt to disarm the offender

· If you can leave the area safely, do so. Do not leave a colleague alone.

· If the risk is abduction, observe the offender, abductees and route of escape.

· Comply with the aggressor’s instructions but only do what you are told. Do not volunteer anything.

· Use verbal de-escalation techniques and try to keep the aggressor engaged in conversation. Let them know what you can do for them in this situation.

· If the infant or missing child is not located conduct a rapid sweep of the immediate vicinity and report the situation to the Clinical Nurse Manager/Ward Shift Coordinator

· The person in charge will put the hospital in total shut down and staff need to man the exit doors asking people to remain in the hospital for and identification check



· Use verbal de- escalation techniques with the offender until assistance arrives and try

to keep the aggressor in conversation. Let them know what you can do for them in this situation. Try to defuse the situation, use LASSIE: - Listen to the problem. - Acknowledge issues. - Separate them. - Seat them. - Indicate options. - Encourage compliance

· If you can leave the area safely, do so and activate a response by dialling 9 Code Black

· If you are out of danger stay out of danger.

· Make a mental note of what you observe about the offender (personal description, vehicle etc.)

· Preserve the scene for evidence. Do not touch or move anything.

· Write down everything you observe when it is safe to do so prior to discussion with colleagues or other witnesses on the Offender ID Form (Appendix A) and Emergency Incident Report Form (Appendix B) when it is safe to do so.

· Report any vehicle used by the offender(s) if observed, e.g. vehicle type, colour, and registration.

· Stand down will be authorised by the Hospital Emergency Coordinator. · Complete Offender ID Form (Appendix A) commence an Emergency Incident Report

Form (Appendix B) the electronic Safety Risk Report Form (Appendix C) prior to discussion with colleagues or other witnesses and when able, complete and hand all forms to Hospital Emergency Coordinator.

· Resume normal activity.

· Attend debrief if required. MAKE NO COMMENT TO THE MEDIA – HOSPITAL EMERGENCY COORDINATOR WILL DIRECT MEDIA VIA THE WACHS COMMUNICATIONS CENTRE AND IN ABSENCE OF REGIONAL DIRECTOR WILL BE THE MEDIA LEAD.



11.2 First Responder to Duress

Title FIRST RESPONDER TO DURESS Applicable to HALLS CREEK HOSPITAL Location INCIDENT SITE Position Responsible CLINICAL NURSE MANAGER / ED SHIFT COORDINATOR Successor in Absence WARD SHIFT COORDINATOR OR

MOST SENIOR NURSE ON DUTY Reports to HOSPITAL EMERGENCY COORDINATOR Resources MOBILE PHONE AND MAYBO TRAINING SKILLS Under no circumstances are staff, patients or visitors to place themselves or others in further jeopardy. · Proceed with caution to the scene as directed by SMS/mobile phone and liaise with

the Hospital Emergency Coordinator and the Emergency Responders (Duress) as per local protocol.

· The team leader and is not to engage with the offender as you need to delegate tasks and make decisions regarding the incident

· The First responder is to engage with offender initially then to hand over to senior responder if required

· DO NOT enter incident area alone; wait for the Emergency Responders (Duress)

· Determine plan to manage incident in consultation with the duress responders and local departmental staff to identify resources required. This includes managing effective clinical service delivery for patients if required

· Liaise with Hospital Emergency coordinator if required and provide an update regarding the situation, management plan and request resources and actions as necessary. Remain in contact so you can update the situation as it changes.

· If Code Black Alpha, conduct a thorough search of the incident site and assess the need to rapidly secure the site and initiate Hospital Lockdown if not already initiated by hospital coordinator.

· If Hospital Lockdown is initiated, ensure staff are posted at exit points to prevent visitors exiting the hospital. One designated exit from the ward, ambulance bay and hospital front door will be established in a Lock down situation.

· Assess the need to involve the Police, notify switchboard to call 000 if not already done and liaise with Police on their arrival.

· If the Police were contacted, send the orderly to meet the police at front reception. Orderly to provide and update the police regarding the situation whilst escorting Police to incident site

· Liaise with Police on their arrival regarding the situation, management plans and actions to date. Assist Police with their investigations and instructions.

· Liaise with District Medical Officer or if unavailable, the EK Senior Medical Officer at Kununurra Hospital/After hrs the executive on call regarding medical management and initiate medical care if required. This may require Code Blue activation.



· Assess need to evacuate area and review evacuation procedure in Code Orange section of this Manual.

· Preserve the scene for evidence. Do not allow anyone to touch or move anything. Delegate a senior staff member and Orderly to assist with this task

· All witnesses are to remain at the incident site and not to discuss the incident with other witnesses. Delegate a senior staff member to assist with this task

· Stand down will be initiated by the response team leader and authorised by the Emergency Coordinator.

· Complete Offender ID Form (Appendix A) commence an Emergency Incident Report Form (Appendix B) the Electronic Safety Risk Report Form (Appendix C) prior to discussion with colleagues or other witnesses and when able, complete and hand all forms to Hospital Emergency Coordinator.

· Assist Police with investigation.

· Ensure involved staff (or others) attend debrief and receive support as appropriate.

· Participate in a review of this Code Black incident with the response team

· Resume normal activity. MAKE NO COMMENT TO THE MEDIA – HOSPITAL EMERGENCY COORDINATOR WILL DIRECT MEDIA VIA THE WACHS COMMUNICATIONS CENTRE AND IN ABSENCE OF REGIONAL DIRECTOR WILL BE THE MEDIA LEAD.



11.3 Second in Charge Duress Response

Title SECOND IN CHARGE DURESS RESPONSE Applicable to HALLS CREEK HOSPITAL Location INCIDENT SITE Position Responsible CLINICAL NURSE MANAGER / MOST SENIOR TEAM MEMBER Successor in Absence WARD SHIFT COORDINATOR /MOST SENIOR TEAM MEMBER

OR MOST SENIOR NURSE ON DUTY

Reports to EMERGENCY COORDINATOR (DON) Resources MOBILE PHONE AND MAYBO TRAINING SKILLS Under no circumstances are staff, patients or visitors to place themselves or others in further jeopardy. · Proceed with caution to the scene as directed by SMS and liaise with the other duress

responders present. · You are second in charge and you are to manage the engagement with the offender

using your MAYBO training skills , if it is not already under control by the person who activated the duress alarm – then stand back, assess the situation – do not rush in

· If the person is not coping give him/her an option/escape route to remove themselves, and if it is safe to do so takeover. If unable to deescalate remove yourself, staff, patients and visitors to safety until Police have arrived.

· If the person is armed, do not attempt to disarm the offender · If the risk is abduction, observe the offender, abductees’ ad route of escape. Be

prepared to assist with Hospital Lockdown · Assess need to evacuate area as advised by Police and review evacuation procedure

in Code Orange · If casualties are present, advice Emergency Department immediately post

confrontation, requesting them to await further instructions. · Assist the Police in their preliminary investigation as requested. · Initiate medical care when safe to do so if required. This may require Code Blue

activation. · Stand down will be confirmed by the duress responder team leader and authorised by

the Hospital Emergency Coordinator. · Complete Offender ID Form (Appendix A) commence an Emergency Incident Report

Form (Appendix B) the Electronic Safety Risk Report Form (Appendix C) prior to discussion with colleagues or other witnesses and when able, complete and hand all forms to Hospital Emergency Coordinator.

· Assist Police with investigation. · Ensure involved staff (or others) attend debrief and receive support as appropriate. · Participate in a review of this Code Black incident with the response team · Resume normal activity. MAKE NO COMMENT TO THE MEDIA – HOSPITAL EMERGENCY COORDINATOR WILL DIRECT MEDIA VIA THE WACHS COMMUNICATIONS CENTRE AND IN ABSENCE OF REGIONAL DIRECTOR WILL BE THE MEDIA LEAD.



11.4 District Medical Officer

Title DISTRICT MEDICAL OFFICER Applicable to HALLS CREEK HOSPITAL Location INCIDENT SITE Position Responsible AVAILABLE DOCTOR/EKSENIOR MEDICAL OFFICER Successor in Absence ON CALL DOCTOR Reports to DURESS REPONDER TEAM LEADER Resources PHONE AND MAYBO TRAINING SKILLS AND MEDICATIONS Under no circumstances are staff, patients or visitors to place themselves or others in further jeopardy. Call or get assistance to call Code Black as soon as it is safe to do so. Follow the RRRR steps when safe to do so: Raise the alarm – Remain calm – Retreat to safety – Record details · Receive notification by internal notification system.

· Proceed with caution to the scene as directed

· Consult with the Director of Nursing /most senior staff member / Response Team leader to determine a plan to manage the incident.

· Advise Hospital Emergency Coordinator and East Kimberley Medical Officer of any issues requiring executive action.

· Provide clinical status report

· Consult regularly with East Kimberley Emergency Coordinator, Regional Medical Director, Director of Nursing and Clinical Nurse Manager/Ward Shift Coordinator re any assistance required.

· Provide medical support to incident as required

· Assist staff, patients and visitors to remain safe whilst incident is occurring

· Implement instructions from the Duress Response Team Leader

· If casualties are present, advise Emergency Department immediately post confrontations, requesting them await further instructions.

· Initiate medical care when safe to do so if required. This may require Code Blue activation.

· Advise and seek assistance from external agencies if required e.g. Royal Flying Doctor Service

· Assist the police with their investigation as required

· If the offender is armed, do not attempt to disarm the offender

· Comply with the offender’s instructions but only what you are told. Do not volunteer anything



· If the risk is abduction, observe the offender, abductees’ ad route of escape. Be

prepared to assist with Hospital Lockdown

· Stand down will be confirmed by the duress responder team leader and authorised by the Hospital Emergency Coordinator.

· Complete Offender ID Form (Appendix A) commence an Emergency Incident Report Form (Appendix B) the Electronic Safety Risk Report Form (Appendix C) prior to discussion with colleagues or other witnesses and when able, complete and hand all forms to Hospital Emergency Coordinator.

· Assist Police with investigation.

· Ensure involved staff (or others) attend debrief and receive support as appropriate.





11.5 All Purpose Orderly

Title ALL PURPOSE ORDERLY Applicable to HALLS CREEK HOSPITAL Location INCIDENT SITE Position Responsible ALL PURPOSE ORDERLEY Successor in Absence DELEGATED PERSON BY DURESS RESPONSER LEAD Reports to HOSPITAL EMERGENCY COORDINATOR Resources MOBILE PHONE AND MAYBO TRAINING SKILLS Under no circumstances are staff, patients or visitors to place themselves or others in further jeopardy. · Proceed with caution to the scene as directed by SMS and liaise with the Emergency

Response (Duress) Team or staff as per local protocol. · DO NOT enter incident area alone; wait for staff as per local protocol. · Implement instructions from the Duress Senior Responder · If the police were contacted, meet police at front reception. You are to provide an

update regarding the situation whilst escorting the Police to the incident site and introduce to the person in charge

· Liaise with Duty Medical Officer regarding medical management. · Assist in the restraint of individual as requested by Senior Nurse, or Medical Officer. · If situation arose from a non-medical related incident, remain in area. · Ensure staff, patients and visitors remain safe. · Assist Police (if present) with their investigations as required. · If the offender is armed, do not attempt to disarm the offender · Comply with the offender’s instructions but only what you are told. Do not volunteer

anything · If the risk is abduction, observe the offender, abductees’ ad route of escape. Be

prepared to assist with Hospital Lockdown · Stand down will be confirmed by the duress responder team leader and authorised by

the Hospital Emergency Coordinator. · Complete Offender ID Form (Appendix A) commence an Emergency Incident Report





11.6 Reception Staff

Title RECEPTION STAFF Applicable to HALLS CREEK HOSPITAL Location INCIDENT SITE Position Responsible HOSPITAL FRONT RECEPTION STAFF Successor in Absence DELEGATE PERSON ON DUTY Reports to CLERICAL SUPERVISOR AND DURESS RESPONSE TEAM Resources SWITCHBOARD, MOBILES AND PA Under no circumstances are staff, patients or visitors to place themselves or others in further jeopardy.

· When you receive a CODE BLACK phone call, collect the following information: - Code Black (Type) - Caller's location and location of incident (if they are different) - A brief summary of the situation (who what when where how) - Number of people involved in the incident

· Send a message to the Director of Nursing/Clinical Nurse Manager with the following message:

- CODE BLACK a code type (i.e. Personal Threat or Alpha (Missing Child) - Actual location of the incident - Number of people involved in the incident

· Telephone Police or any other emergency services on 000 if requested by the duress responder or Hospital Emergency Coordinator and ask them to arrive at front reception (An orderly will meet police etc.at front reception and escort them to the incident.)

· Document all your actions on the Emergency Incident Report Form (Appendix B) include:

- Date and time - What happened (i.e. received/made phone call from/to, made PA - What you did (i.e. details of phone discussion, announcement) - Any defined actions (i.e. Police will arrive in 7 minutes etc.

· Make any announcements over the Public Address EWIS System as requested by the duress response team leader and the Hospital Emergency Coordinator NB: Do not make a PA announcement for a CODE BLACK Personal Threat

· If Code Black Alpha announce “ATTENTION ATTENTION Code Black Alpha. Initiate Hospital Lockdown, senior staff, please control all entry and exit points in your area, allow only emergency services personnel to enter or exit. Area warden, stand by for further instructions”. Repeat this twice.

· Ensure staff, patients and visitors remain safe

· Make CODE BLACK STAND DOWN announcement twice of the PA when requested by the Hospital Emergency Coordinator



· Complete Emergency Activation Incident Report Form (Appendix B) and when able,

complete and hand all forms to Hospital Emergency Coordinator.

· Assist Police with investigation. Ensure involved staff (or others) attend debrief and receive support as appropriate.





11.7 Hospital Emergency Coordinator

Title HOSPITAL EMERGENCY COORDINATOR Applicable to HALLS CREEK HOSPITAL Location EXECUTIVE OFFICE or LOCAL EOC Position Responsible OPERATIONS MANAGER /DIRECTOR OF NURSING Successor in Absence CLINICAL NURSE MANAGER/HOTEL SERVICES MANAGER Reports to REGIONAL HEALTH DISASTER COORDINATOR

(REGIONAL DIRECTOR) Resources PHONE, EMAIL AND CONTACT NUMBERS (Appendix F) Under no circumstances are staff, patients or visitors to place themselves or others in further jeopardy.

· Receive notification by internal notification system. · If contacted by the Duress Responder, request an appraisal of the situation and

determine support and resources required · Establish the Emergency Operations Centre(EOC) if necessary and notify the East

Kimberley Health Disaster Coordinator (Operations Manager or Executive on call) if the EOC is established

· Initiate Hospital Lockdown if CODE BLACK Alpha and not already done by duress responders

· Notify surrounding health care facilities and the Emergency Department about missing child and possible abduction. Provide a detailed current description of the missing infant or child for accurate identification

· Request switch to contact police or any other emergency services if not already done. · Assess need to provide medical support. If so, liaise with Senior Medical Officer and

initiate medical care if not already done by the responders. This may require Code Blue activation only if it is safe to do so.

· Assess need to evacuate incident area and discuss with response team. This may require Code Orange activation if safe to do so.

· Assess need to contact snake catcher if location of snake is known · Assist police with their enquiries/investigations as required · Consult regularly with Director of Nursing / CNM/ED Shift Coordinator, Medical Officer

re any assistance required · Determine completion of Code Black incident with Duress Response Leader and

Police make announcement “CODE BLACK STAND DOWN” twice · Complete the Emergency Incident Report Form (Appendix B) and any EOC

documentation as required · Assist Police with investigation. · Ensure involved staff (or others) attend debrief and receive support as appropriate. · Participate in a review of this Code Black incident with the response team · Coordinate and participate in review of Code Black with the Executive Team and OSH

committee · Resume normal activity. · MEDIA: Arrange media briefing and prepare statement if requested by the Regional

Health Disaster Coordinator. Access to the WACHS media communications for rural areas is 08 9222 6499 and is manned 24 hours 7 days a week.



11.8 Director of Nursing

Title DIRECTOR OF NURSING Applicable to HALLS CREEK HOSPITAL Location EXECUTIVE OFFICE or LOCAL EOC Position Responsible OPERATIONS MANAGER Successor in Absence CLINCAL NURSE MANAGER /

MOST SENIOR PERSON ON DUTY Reports to HOSPITAL EMERGENCY COORDINATOR Resources PHONE, EMAIL AND CONTACT NUMBERS (Appendix F) Under no circumstances are staff, patients or visitors to place themselves or others in further jeopardy. · Receive notification by internal notification system, report to EK Operations Manager. · If contacted by the Duress Responder, request an appraisal of the situation and

determine support and resources required · Participate in the Emergency Operations Centre(EOC) if necessary · Assess clinical activity at the site and determine if extra staffing support is needed · Assess clinical activity at site of incident and develop code blue response if there is a

large scale medical emergency identified · Assess need to provide medical support. If so, liaise with the Medical Officer and

initiate medical care if not already done by the responders. This may require Code Blue activation only if it is safe to do so.

· Request switch to contact police or any other emergency services if not already done. · Assist police with their enquiries/investigations as required · Assess need to evacuate incident area and discuss with response team. This may

require Code Orange activation if safe to do so. · Initiate Hospital Lockdown if CODE BLACK Alpha and not already done by duress

responders · Assess need to contact snake catcher if location of snake is known · Consult regularly with Clinical Nurse Manager/ED Shift Coordinator, Medical Officer re

any assistance required · Complete the Activation Incident Report Form (Appendix B) and any EOC

documentation as required · Assist Police with investigation. · Ensure involved staff (or others) attend debrief and receive support as appropriate. · Participate in a review of this Code Black incident with the response team · Coordinate and participate in review of Code Black with the Executive Team and OSH

committee. MAKE NO COMMENT TO THE MEDIA – HOSPITAL EMERGENCY COORDINATOR WILL DIRECT MEDIA VIA THE WACHS COMMUNICATIONS CENTRE AND IN ABSENCE OF REGIONAL DIRECTOR WILL BE THE MEDIA LEAD.



11.9 Ambulance Staff Title AMBULANCE STAFF Applicable to HALLS CREEK HOSPITAL Location HALLS CREEK COMMUNITY Position Responsible FIRST RESPONDER Successor in Absence SECOND RESPONDER Reports to DIRECTOR OF NURSING Resources MOBILE PHONE, SATELLITE PHONE and TWO WAY RADIO Under no circumstances are staff, patients or visitors to place themselves or others in further jeopardy.

· Proceed with caution to the scene DO NOT enter incident area alone, the first responder is to engage with offender only if able to do so.

· The first responder/senior staff to coordinate the response by: Pausing – standing back, taking a moment before approaching and assessing the situation:

Try to leave the person to calm down, try not to rush the person, act calmly be aware of body language and tone of voice used to the person, show respect and dignity at all times, explain your actions “I would like you to…..” It would help me….”

· The second responder assess the need to involve the Police, keeping calm and calling the police 000 for assistance using the mobile phone if in range or satellite phone if out of range

· If violence on the part of the aggressor appears imminent, staff and clients are to attempt to seek safe refuge while Police are on the way to assist

· The second responder to liaise with Police on their arrival gives update on the situation, management plans and actions to date. Assist Police with their investigations and instructions.

· Liaise with the Medical Officer at Halls Creek Hospital regarding medical management and initiate medical care if required. This may require Code Blue activation.

· Preserve the scene for evidence. Do not allow anyone to touch or move anything. · All witnesses are to remain at the incident site and not to discuss the incident with

other witnesses. · Stand down will be initiated by the first responder or the Police. · Complete Offender ID Form (Appendix A) commence an Emergency Incident Report





11.10 Regional Health Disaster Coordinator Title REGIONAL HEALTH DISASTER COORDINATOR Applicable to ALL HOSPITALS Location LOCAL EMERGENCY OPERATIONS CENTRE Position Responsible REGIONAL DIRECTOR Successor in Absence NOMINATED REGIONAL EXECUTIVE MEMBER Reports to CHIEF OPERATIONS OFFICER Resources PHONE, EMAIL AND CONTACT NUMBERS (Appendix F) · Liaise with the Hospital Emergency Coordinator at the hospital site to confirm alert and

receive briefing on severity and nature of the Code Black.

· Notify Chief Operating Officer and Regional Executive members of the Code Black and convene meetings as appropriate.

· If required establish the Local Emergency Operations Centre and liaise with external organisations if large scale evacuation possibly necessary.

· Send an initial report to the WA Health Department On Call Duty Officer (08) 9328 0553 [email protected]

· Continue to liaise with the Hospital Emergency Coordinator and receive information (e.g. progress of the Code Black, evacuation and details of patients who may need relocating).

· Determine any resource requirements required from State Health sources or elsewhere based on reports from Hospital Emergency coordinator.

· Arrange briefing to external agencies if involvement required delegating to other senior staff as appropriate e.g. Regional Medical Director through to Royal Flying Doctors Service to coordinate patient evacuations.

· Update WA Health Department on Call Duty Officer and Chief Operating Officer as appropriate regarding assistance required.

· Support and provide assistance as necessary.

· Receive reports on any service interruptions from Hospital Emergency Coordinator and inspect incident site(s) as appropriate.

· Notify WA Health Department on Call Duty Officer and Chief Operating Officer of Stand down Code Black status.

· Coordinate a debrief and Code Black plan review meeting as necessary with Hospital Emergency Coordinator, Regional Executive members and any other staff as appropriate.

MEDIA: Arrange media briefing and prepare statement as appropriate. Access to

WACHS media Communications for Rural areas is 08 9222 6499 and is staffed 24 hours 7 days a week.


mailto:[email protected]


12. Appendices APPENDIX A – Offender ID Form Separate form required for each person. To be completed immediately after the incident by each staff member, also visitor(s) or patient(s) if possible. Please circle or write response as applicable. Do not guess - if you are not sure about any aspect leave blank. DO NOT consult others when completing this form.

Surname: First Name:

Address: Postcode:

Home Phone No: Bus Phone: Name/Nickname used: Teeth:

Good / Spaced / Uneven / Bad / Missing / Protruding Sex: Male / Female Estimated Age:

Race: Moustache: Yes / No Colour: _________________________________ Type:___________________________________

Height: Metres: Cm: / Feet: Inches: Weight: Kg:________ Stn/Lbs:________ Build: Thin / Solid / Medium / Obese Beard: Yes / No

Colour: _________________________________ Type:___________________________________

Stature: Erect / Slouched / Stooped Voice: Soft / Clear / Slangy/ Accented / Loud / Slurred If Accented – State Type: Hair: Colour:_________________________________ Medium / Wavy / Thin / Short / Straight / Thick / Normal / Thick / Long / Curly / Bald

Eyes: (Colour) _____________________ (Size) _____________________ Squint Starry

Hands: Size: ____________ Missing Or Deformed Fingers:___________________ Hairy Soft Callused Gloves: Yes / No

Spectacles: Yes / No Frame Colour: _______________ Thick / Tinted / Bifocal

Nails: Short / Long / Medium / Bitten Walk: Normal / Limp / Pigeon Toe / Quick / Springy Complexion: Fair / Fresh / Pale / Suntan / Pimply / Freckled / Dark / Ruddy Ears: Shape:

Nose: Shape: ________ Size:

Disguise:

Mouth: Shape________ Size________ Other Distinguishing Features: Scars or Marks (Tattoos, Scars, Skin Discolouration, Location, etc.) Describe In Full: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

OFFENDER ID FORM



Jewellery (Describe) _____________________________________________________________________________________ _____________________________________________________________________________ Clothing (including Hat, Tie, Shirt, Coat, Trousers, Dress, Skirt, Sweater, Shoes, etc.): _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Weapon (type): _____________________________________________________________________________________ _____________________________________________________________________________________ Method And Direction of Escape: _____________________________________________________________________________________ _____________________________________________________________________________________ Make of Car:___________________________ Model of Car:

Registration:__________________________________ Colour:

Method of Operation (What did offender do, say, touch, etc.):

Name: ________________________________________ Signature: ______________________ Date: _____________________ Time: __________



APPENDIX B – WACHS Kimberley Emergency Incident Report

WACHS Kimberley Emergency Incident Report

WACHS Kimberley Emergency Code Activation Report To be completed in an emergency situation by the Hospital Emergency Coordinator. Please complete both sides. ¨ Broome ¨ Derby ¨ Fitzroy Crossing ¨ Halls Creek ¨ Kununurra ¨ Wyndham Date: Time alarm raised:

Location of emergency: Time code called: þ Colour Code Called RED* BLUE

(complete MRK179) PURPLE* BLACK*

(complete Safety Risk Report form for armed or unarmed incidents)

ORANGE* YELLOW* BROWN* CBRN* (Chemical, Biological, Radiological, Nuclear)

*specify type of emergency:__________________________________________________

Hospital Emergency Coordinator (HEC) Time Notified Time of arrival on site HEC Notified Emergency Services Fire & Emergency Services (FESA) Police Ambulance Other Services (please specify)

Date/Time Record of events and actions taken By Whom?


http://wachs.hdwa.health.wa.gov.au/index.php?eID=tx_nawsecuredl&u=318&file=fileadmin/sections/kimberley/corporate_services/WACHS-K_Emergency_Procedures/WACHS-K_Emergency_Code_Activation_Report_2.0_2015-08.doc&t=1474508318&hash=a9ba0fdcd18530faff1db345dad589e9


Continued…

Date/Time Record of events and actions taken By Whom? TIME CODE STOOD DOWN @ ____________HRS DEBRIEF / COMMENTS / EVALUATION: RECOMMENDATIONS: OUTCOMES: PRINT NAME: Signature of person completing report: Date:

FORWARD COMPLETED REPORT TO OPERATIONS MANAGER DERBY (Executive Sponsor Emergency & Disaster Management)



APPENDIX C – WACHS Electronic Safety Risk Report Form WACHS Safety Risk Report NOTE: · Staff member affected or injured as result of Code Black must fill out Safety Risk

Report Form as required and can also add additional information (i.e. Part E )

· All staff must be made immediately aware of employer assistance program.


http://trim/hptrimwebclient/download/?uri=967850


APPENDIX D – WACHS Kimberley Violence and Aggression Form

WACHS Kimberley Violence and Aggression Form Reporting Person: Location/Ward:

Date Time of Incident:

Type of Aggression: Aggression by: Level of Aggression:

□ Verbal Patient MRN □ Mild

□ Assault/Physical Abuse □ Relative/Visitor □ Moderate

□ Property damage □ Intruder □ Severe

□ Self-discharge/abscond □ Staff □ Critical

□ Potential for Violence & Aggression (see risk assessment)

Mild Sarcasm, derogatory comments, threatening expressions or hand gestures

Moderate Mild threats, hostility, slamming doors, breaking or throwing objects

Severe Intimidating behaviour with a perceived or real threat of physical harm

Critical USE OF AN OBJECT OR WEAPON, physical harm, behaviour out of control, police called for assistance

Brief Description of the Incident: Include activity & behaviour preceding and during event, what were the triggers.

Contributory Factors (can be multiple): Person/Patient: Staff:

Systems:

□ Anxiety/Frustration □ Inadequate knowledge/experience □ Patient search not completed □ Anger □ Failure to follow policy/procedure □ Patient notes not available □ History of Aggression □ Communication problems □ Inadequate security

□ Delayed Assessment □ Intimidation Tactics □ Environmental hazard □ Confusion/Dementia □ Insufficient staff □ Overcrowding □ Psychiatric illness □ Poor team work □ Inappropriate bed

If □ Drugs □ Other: □ Other:

□ Alcohol

□ Smoking related

□ Organic cause □ Cultural Safety

□ Other: De-escalation Technique – Please tick all appropriate boxes

If code Black Insert Team Members Names: □ Shift

Coordinator/CNM □ Discussion/Diffusion

□ Security □ Physical Restraint

□ Code Black □ Chemical Restraint

□ Police □ Security

□ RMO □ Police

□ Other:

PTO



Outcomes: Yes No

Change in treatment □ □ Surveillance □ □

Transferred to another hospital □ □ Patient on MH forms □ □

Patient injured from incident □ □ Management plan in place □ □

Medical intervention sought □ □ Discharged patient removed/escorted from hospital

□ □

Patient sedated as per WACHS guidelines

□ □

Staff injured □ □

Name:

Position:

Treatment required □ □ If a staff member was injured please see your line manager for

Workers Compensation Forms after seeking Medical Attention if required

Staff Requiring Notification:

Primary Nurse (if a patient) □ Name: Time:

Shift Co-Ordinator □ Name: Time:

NM/AHNM, DON or RCC □ Name: Time:

Medical Officer □ Name: Time:

Operations Manager/Director □ Name: Time:

REPORT COMPLETED BY: Name: Time:

Department:

Investigation completed by Supervisor - please scan to Regional OSH Coordinator Original copy can be kept by supervisor for review at local OSH meeting

Investigation Report:

Recommendation (Action statement):

CNM: Scanned □ Faxed □ Date:



APPENDIX E – Duress Pendant and Pager Testing Sample Form DURESS PENDANT and PAGER TESTING (SAMPLE ONLY)

Date:

Emergency Department Ward Reception CNM

Phone Orderly Phone

DON Phone

Hotel Services Phone

Comments

ED Touch Strip

Reception Touch Strip

Duress Pendant 1

Duress Pendant 2

Duress Pendent 3

Duress Pendent 4



APPENDIX F – WACHS Kimberley Emergency Contacts and Links WACHS Kimberley Emergency Contacts and Links

· WACHS Kimberley Emergency Coordination and Regional Contact Details

· External Emergency and Support Contact List

· WACHS Kimberley Executive On Call 1800 669 229

· WA Health On Call Duty Officer 08 9328 0553 (24-hour paging service)

· WebEOC log-in and guide (Health Service Manuals are contained within WebEOC under the Menu option)

· Disaster Preparedness Management Unit (DPMU)

· Code Blue - MER documentation

This document can be made available in alternative formats on request for a person with a disability

Contact: East Kimberley Operations Manager (D.Hindmarsh) Directorate: Operations TRIM Record # ED-CO-13-49914

Version: 2.00 Date Published: 23 September 2016 Copyright to this material is vested in the State of Western Australia unless otherwise indicated. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the provisions of the Copyright Act 1968, no part may be reproduced or re-used for any purposes whatsoever without written permission of the State of Western Australia.


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http://wachs.hdwa.health.wa.gov.au/index.php?eID=tx_nawsecuredl&u=318&file=fileadmin/sections/kimberley/corporate_services/WACHS-K_Emergency_Procedures/WACHS-K_Emergency_Coordination_and_Regional_Contact_Details_1.1_2015-09.docx&t=1474445491&hash=6c871ab222f91c761f6ebd0a211cb87a

http://wachs.hdwa.health.wa.gov.au/index.php?eID=tx_nawsecuredl&u=318&file=fileadmin/sections/kimberley/corporate_services/WACHS-K_Emergency_Procedures/External_Emergency_and_Support_Contact_List.docx&t=1474445534&hash=a3a57ef6396b0dc54bebaeb237e79fe1

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http://ww2.health.wa.gov.au/Corporate/Articles/U_Z/WebEOC

http://www.public.health.wa.gov.au/1/1194/2/disaster_management.pm
