code brown: external emergency procedure - wa …...code brown – external emergency procedure –...

Effective: 10 January 2017

WACHS KIMBERLEY Fitzroy Crossing Hospital

Code Brown: External Emergency Procedure

Table of Contents 1.1 Principles ................................................................................................................... 2 1.2 Stages of Activiation ................................................................................................. 3 1.3 Chain of Command ................................................................................................... 4 1.4 Lines of Communication ........................................................................................... 5 1.5 Activation Flow Chart................................................................................................ 6 1.6 Incident Notification .................................................................................................. 7 1.7 Incident Site ............................................................................................................... 8

1.7.1 Site Plan ........................................................................................................... 8 1.7.2 Triage (Refer to MIMMS Card) ......................................................................... 9 1.7.3 Recommended Emergency Site Set Up ......................................................... 10

1.8 Emergency Control Centre (ECC) .......................................................................... 11 1.9 Emergency Department ........................................................................................... 11

1.9.1 Patient Flow .................................................................................................... 11 1.9.2 Emergency Department Coordinator .............................................................. 12

1.9.3 Triage Nurse ...................................................................................................12 1.9.4 Emergency Department Patient Tracking ......................................................12 1.10 Disaster Documentation – Patient Notes .............................................................. 13 1.11 Walking Wounded – Coordinated by a Community Health Nurse ...................... 13 1.12 Distressed Relatives Area ...................................................................................... 13 1.13 Media Management ................................................................................................. 14 1.14 External Roles and Responsibilities ...................................................................... 14

FORMS .............................................................................................................................. 16 Notification of Major Incident Form ............................................................................ 17 Fitzroy Hospital Emergency Telephone Numbers ..................................................... 19 Supplies for Walking Wounded Clinic ........................................................................ 20 Phone Communication Log ....................................................................................... 21 Fitzroy Crossing Hospital - Bed State Sheet ............................................................. 23

ACTION CARDS ............................................................................................................... 34 ACTION CARD 1: Hospital Emergency Controller (DoN/Delgate) ............................ 35 ACTION CARD 2: ED Coordinator ............................................................................ 36 ACTION CARD 3: Senior Medical Officer .................................................................. 37 ACTION CARD 4: Medical Officers ........................................................................... 38 ACTION CARD 5: Disaster Medical Assistance Team (DMAT) ................................ 39 ACTION CARD 6: Site Communications Coordinator (SSM) .................................... 40 ACTION CARD 7: Ambulance Driver Orderly ............................................................ 41 ACTION CARD 8: Triage Nurse ................................................................................ 42 ACTION CARD 9: Administration Coordinator .......................................................... 43 ACTION CARD 10: ED Clerical Assistant .................................................................. 44 ACTION CARD 11: Switch Board Operation ............................................................. 45 ACTION CARD 12: Catering ..................................................................................... 46 ACTION CARD 13: Orderlies .................................................................................... 47 ACTION CARD 14: Distressed Relatives Coordinator .............................................. 48

Date of Last Review: January 2017 of 48 Date Next Review: January 2022

Code Brown – External Emergency Procedure – Fitzroy Crossing Hospital

1.1 PRINCIPLES

1. The provision of emergency health services is to be based on the principle of a graduated response commencing at a local level (Fitzroy Crossing) with a gradual escalation to a district response (WA Country Health Service - Kimberley WACHS-K) and state level (Western Australian) as required with time.

2. An external emergency is defined as any “event outside the hospital that requiresemergency response that exceeds the normal day to day capacity of thehospital.”

These procedures describe the Local Health Emergency Response for FitzroyCrossing Hospital and would be activated:

· With the impending arrival of two or more seriously ill or injured patients, (or lessif the hospitals internal situation meant that they were less able to compensatefor the external emergency incident).

OR · If there is an event outside the Fitzroy region that requires assistance from a

Health Commander or Hospital Response Team/s. This will be activated byBroome Hospital and Fitzroy MIMMS qualified staff may be requested to attend



1.2 STAGES OF ACTIVIATION

While an emergency response would normally be activated in stages, in an impact event these stages may be condensed with stages being activated concurrently.

Stage 1 Standby (preparing to provide initial response)

Standby is activated when information received is sufficient to warrant preparatory activities in readiness for a response .

Emergency Response is likely:

Local Hospital Emergency Controller alerts own personnel, placing on Code Brown standby, hospital begins to prepare resources and receive patients.

Preparations may include: · Medical and nursing staff availability· Fitzroy bed availability· Mobile medical team members availability· Mobile medical team preparation of disaster kits

Stage 2 Response

Response is activated when a health emergency management response is required and resources deployed accordingly

Actions may include: · Patients are received; and / or· There is deployment of mobile medical team to the emergency site.

Stage 3 Stand Down

The stand down stage is activated when Fitzroy response is no longer required and when the hospital can resume normal business.

Actions may include: · Fitzroy Director of Nursing or Operations Manager inform site of “stand-down”· Staff deployed to the Emergency Site return to the hospital· Extra staff are sent home.

Stage 4

Debriefing and Review occurs: · Debriefing occurs· Resources are restocked· Reports are written and tabled for review· Alterations to plans, procedures and processes made as necessary.



1.3 CHAIN OF COMMAND

DEPARTMENT OF HEALTH RESPONSE

Hospital Response Local Health Disaster Coordinator (Senior Nurse on Duty) activates

Code Brown emergency response, manages the local emergency

response and contacts Regional Health Disaster Coordinator when

local capacity to manage is exceeded or a Hospital Response

Team is required

Regional Response The RHDC activates the WACHS response, Regional Emergency

Operations Centre and notifies the Regional Director, the Chief

Operating Officer (Area Health Disaster Coordinator) and the DoH

On Call Duty Officer.

Area Response The Area Health Disaster

Coordinator (AHDC) maintains communications with the Regional Health Disaster Coordinator and

the State Health Coordinator. The AHDC represent WACHS at State

Health Emergency Operation Centre.

State Response State Response coordinated

through the On Call Duty Officer and State Health Coordinator at

State Health Emergency Operation Centre

Emergency Department

Coordinated by the ED Coordinator

Activation of a Hospital Response Team is a Regional

Response that occurs through the

hospital

INCIDENT SITE Health

Commander, if deployed,

commands Hospital response teams

State Health Emergency

Operation Centre activated by State Health Coordinator

WACHS LOCAL

RESPONSE

WACHS

REGIONAL RESPONSE

WACHS AREA

RESPONSE

STATE

RESPONSE



1.4 LINES OF COMMUNICATION

(WACHS – KIMBERLEY EXECUTIVE)

HOSPITAL EMERGENCY CONTROLLER

CLINICAL NURSE SITE COMMUNICATIONS

COORDINATOR HOSPITAL STAFF INCIDENT SITE MEDICAL STAFF TEAM LEADER COMMUNITY HEALTH STAFF VOLUNTEERS PASTORAL CARE MENTAL HEALTH DISASTER MEDICAL ASSISTANCE TEAM



1.5 Activation Flow Chart

INCIDENT CALL RECEIVED

DON NOTIFIED

DON ASCERTAINS NUMBER/SEVERITY OF CASUALTIES

≤ 3 CASUALTIES > 3 CASUALTIES

ARE INITIAL REPORTS OF SEVERE INJURIES?

DISPATCH AMBULANCE WITH ON CALL ED DR AND ONE

NURSEINFORM DON OF ACTIONS

DON ASSESSES CURRENT HOSPITAL

SITUATION WITH RESPECT TO:

* NUMBER OF IN-PATIENTS

* EMERGENCY DEPARTMENT ACUITY

* NUMBER/SKILL OF STAFF ON DUTY

ON ARRIVAL AT SCENE -FIND 3 SERIOUSLY INJURED

CASUALTIES

INFORM DON

YES

NO

IS HOSPITAL AT OR NEAR CAPACITY?IS THERE A HIGH LEVEL

OF ACUITY IN ED?

NO

ACTIVATE CODE BROWN

YES

DOES CURRENT STAFFING/SKILL MIX ALLOW FOR

IMMEDIATE DISPATCH OF 2ND AMBULANCE WITH A NURSE

AND IF REQUIRED – A 2ND DMO?

DISPATCH AMBULANCE

NO

NOYES

CALL IN EXTRA STAFF AS REQUIRED

PREPARE ED FOR RECEPTION OF CASUALTIES

YES



1.6 INCIDENT NOTIFICATION The person receiving the call immediately notifies the Director of Nursing (Hospital Emergency Coordinator) and Senior Medical Officer for any external emergency. The Director of Nursing is responsible for activation of the External Emergency Response Plan. If non contactable the responsibility for activation then falls to the most senior nurse on duty in consultation with the Senior Medical Officer. The decision to activate is based on whether the required response is beyond the normal operational capacity of the hospital as per section 1.6 – Activation Flow Chart. The call can be received: · Through the Emergency Department · Through the switchboard during operating hours – the call is transferred immediately to

the Emergency Department phone · If the caller is extremely distressed and transfer of the call is inappropriate, complete

the M.E.T.H.A.N.E details as per Code Brown Emergency Cardex · Through the Emergency department after hours – the call is answered by Nursing

Staff, M.E.T.H.A.N.E details are taken as per Code Brown Emergency Cardex and the Director of Nursing is notified:

M Method of notification - caller details and phone number: E Exact Location of the incident: T Type of incident: H Hazards Present A Access to Site: N Number and Type of Casualties: E Emergency Services Present and Required:

Notification will usually come from the general public, Police, St. John Ambulance, FESA, or another Kimberley Health Service provider requiring assistance. Four phone calls are then made to:

· Clinical Nurse · The Senior Medical Officer and on call Medical Officer. · The Operations Manager (If the call has not come from the Police, confirm the actuality of the event and/or notify them of the emergency),

The Triage Nurse readies the disaster equipment for dispatch to the disaster scene or muster point. The Disaster Medical Assistance Team (DMAT) is not dispatched until ordered to do so by the Director of Nursing



Personnel to be dispatched to the disaster scene shall include:

· The Triage Nurse and one other Nurse (must be a nurse with Emergency and triage experience and another nurse, preferably with Emergency experience)

· The Medical Officer as delegated by the SMO

· The Support Services Manager who acts as the Site Communications Coordinator

If available and deemed necessary (e.g.: prolonged response required away from the hospital) a Clerk will be dispatched with the first medical team to assist with establishment and maintenance of health team communications, casualty identification and medical record keeping. 1.7 INCIDENT SITE All personnel are under the direction of the Disaster Site Controller through the chain of command. This is usually the Police. 1.7.1 Site Plan

· Fitzroy Hospital personnel (DMAT) are not to enter the site until given the all clear from the Disaster Site Controller.

· The DMAT follows direction from the Disaster Site Controller in setting up the medical area.

· The FESA personnel are responsible for extracting victims from any wreckage.

· The hospital DMAT staff does not enter or go near any wreckage or known dangerous area unless deemed safe and asked to do so by the Disaster Site Controller.

· Medical personnel at the site assume the following roles.

· The Triage Nurse becomes the Site Casualty Access Team Coordinator. · He/she is responsible for the initial triage sieve at the site and is responsible for

prompt communication of numbers of Immediate, Urgent and Delayed casualties at the scene, as well as other health needs to the Site Medical Officer and to the Site Communications Coordinator Skills needed are:

(1) Experienced clinical background / knowledge with coordination skills (2) Communication skills including use of mobile phone and satellite phone and ideally two-way radio (3) Senior person who is able to and has the authority and ability to make decisions. Has ideally completed a MIMMS Commander Course

Medical Team Medical Officer – is the Doctor allocated to the DMAT by the Senior Medical Officer to go to the scene. The DMAT Medical Officer has the final say for clinical management of casualties.



· DMAT– are made up of one of the following combinations

o DMAT Medical Officer - Senior Nurse (MIMMS Commander), other nurse (MIMMS Team member), Clerk

o DMAT Emergency nurse / General Nurse (Clerk if not already sent and deemed necessary as per 2.6)

o DMAT Communications Coordinator – Support Services Manager or senior orderly in their absence

o Additional roles – Clerk sets up and maintains communication for the medical team and prepares medical records as per disaster clerical box located in the Director of Nursing’s Office. They can be asked to assist in other duties through the DMAT chain of command and control.

· Site Set-up – The medical area at the site is set up to enable free flow of victims to the appropriate area. See example on next page.

1.7.2 Triage (Refer to MIMMS Card) · Triage is a continuous process. The categories on site are:

o Priority 1 – Immediate, RED Casualties requiring immediate lifesaving procedures o Priority 2 –Urgent, ORANGE Second priority patients who are seriously injured but not life threatening o Priority 3 – Delayed, GREEN Less serious cases not requiring immediate treatment o Dead, BLACK And if considered necessary by the Medical Commander, for casualties whose injuries are so severe that they cannot survive in the circumstances: o Expectant, A line through ORANGE marked “Expectant” The following may need to be triage to the expectant category:

a. Any person in cardio-respiratory arrest. b. Any person with Glasgow coma scale score of 3 (no eye opening, no

verbal response, no motor response). c. Major burns where age is > 60 years and body surface area burned

>50 percent. As a general rule, if score is (age + % BSA burned) > 100, mortality approaches 1.0.

d. Elderly persons with shock and multiple, severe injuries (especially CNS. & Thoracic).

NB: The expectant category should be avoided unless requested through the

Hospital Emergency Controller and authorisation is given from the State Health Emergency Operations Centre (SHEOC).



1.7.3 Recommended Emergency Site Set Up

TRIAGE SIEVE

INCIDENT

SITE

1 - IMMEDIATE

2 - URGENT

3 - DELAYED

4 - EXPECTANT

DEAD

CASUALTYCLEARING

POST

TRIAGE SORT

BODY HOLDING AREA

TEMPORARY MORTUARY

1 - IMMEDIATE

2 - URGENT

4 - EXPECTANT

AMBULANCELOADING

POINT

3 – DELAYED

HOSPITAL

HOSPITAL



1.8 EMERGENCY CONTROL CENTRE (ECC)

The Emergency Control Centre at Derby Hospital is located at

Medical Records Phone: 9166 1701

Fax: 9166 1774 Satellite Phone Number: 0147 141 329

1.9 EMERGENCY DEPARTMENT The emergency department (ED) will be the primary area dealing with the reception, triage, initial treatment, and disposal of major incident victims. The key objective of the ED response is to “do the most for the most” 1.9.1 Patient Flow

· If accurate information from the scene is available and it appears the numbers may be small, or transport to hospital will mean a spaced out or pulsed arrival, then a strategy of keeping victims in the ED for further observation and surgical decisions may be possible. However, if a true mass causality incident occurs then flow through the department must occur and the following should be the default strategy.

· Process for patient flow through the department: · Triage nurse at the ambulance entrance for all causalities · If there are an overwhelming number of causalities the 2nd triage point is the

main entrance for walking wounded / self-presenters. · Triage Red treated in 2 bays in ED and 1 in resus = total 3 · Triage Orange treated in X-Ray Room and Room 1 = total 2 · Triage Green are treated in Community Health · Designate each patient to an appropriate bay with appropriate medical and

nursing staff; · The Hospital Emergency Controller will liaise with Broome RRC, Derby Hospital,

RFDS, hospital initiated transport (e.g. volunteer drivers), ward staff and other hospitals for the transfer of patients from the emergency department.

· A log of the transfers/discharges will be maintained by the Hospital Controller.



1.9.2 Emergency Department Coordinator

· Resources will be allocated to allow the timely treatment of all patients. Including those who are not victims of the major incident (the usual workload)

· Above all, the ED coordinator will refrain from patient contact will maintain records; communicate with their staff in the ED and the Hospital Emergency Controller.

· Allocation of nursing staff and coordination of medical staff skill mix · Maintain Decisions and Events Log (Appendix 7) · Maintain Patient Log (Appendix 6) · Monitor and acquire physical resources · Monitor staff fatigue and rest periods · Consider implementing “Expectant” Category and if activated use. · Update the Hospital Emergency Controller every 30 minutes.

1.9.3 Triage Nurse

· Registered Nurse designated by the Director of Nursing or delegate who will triage providing minimal care under the direction of the ED Coordinator

· Confirm the METHANE report and any updates from the Hospital Emergency Controller

· Perform Triage at the nominated areas following the standard NTS procedure · Use prepared disaster record packs (in disaster box in ED) and tag all patients

before they enter the Emergency Department. · Direct Green (walking wounded) to the Walking Wounded Area (Community

Health) using the orderlies. · Commence the Decision / Events log, collect and record numbers and types of

injured utilising a portable white board (Appendix 7) · Treatment of injured will be organised in teams of doctors and nurses as

resources allow. Treatment may be initially limited to first aid and resuscitation only.

· Above all, the Triage Nurse will refrain from patient treatment, will maintain records, and communicate with the ED coordinator to meet the key objective.

1.9.4 Emergency Department Patient Tracking

· A whiteboard or log located in the ED area maintained by the Triage Nurse with clerical assistance.

· The boards will have the following fields: § Patient name/number § Time seen § Present patient location § Doctor § Injuries § Planned destination

· The log will be utilised by the medical and nursing staff to track patient movement, provide information for reporting to the ECC and assist planning.



1.10 DISASTER DOCUMENTATION – PATIENT NOTES · Yellow files provided, marked in consecutive numbers female DV1, DV2 etc. or

male DV1, DV2 etc. · Content of file will include the following items labelled with the appropriate

allocated number: · Identification stickers x1 · Name band x 1 · MR1 form x 1 · Additional continuation sheets x 2 · The files will only be used for the disaster victims and allocated as they are

triaged. · Name bands will be attached at the point of triage. · The file will remain with the patient, hung on the end of the bed during the ED

episode and transferred with the patient as required. 1.11 WALKING WOUNDED – COORDINATED BY A COMMUNITY HEALTH NURSE

· The Walking Wounded Clinic (Green Tag) will be set up in Community Health. · The Director of Nursing or delegate will assign a Nurse(s) to this area and

arrange for a doctor. · The Registered Nurse manning the Walking Wounded Clinic will obtain supplies

as per (Appendix 3) · Patients presenting will be triaged as per the NTS using the MR1 for

documentation · Maintain a Decisions/Events Log · Maintain contact with the Hospital Emergency Controller to arrange admission or

transfer of patients and for additional resources as required. 1.12 DISTRESSED RELATIVES AREA An area (to be advised on the day depending on availability) will be set up as a distressed relative’s area and staffed by a chaplain / DCP staff member / mental health staff member who is to:

· Ensure the setting up of tables, chairs and a coffee / tea dispenser

· Maintain a register with the details of relatives which includes: full name, address, contact telephone number (including mobiles) and details of the person they are waiting for (Appendix 8)

· Call in other staff as needed. Keep list of names, time in/out for Hospital Emergency Controller.



· Liaise with Department for Community Development for shelter, personal needs, crisis counselling.

· Maintain Decisions and Events Log (appendix 7)

· Liaise with the Emergency Controller within 24 hours after disaster to arrange hospital staff Critical Incident Stress Debriefing. Work in conjunction with Employee Assistance Program (EAP).

1.13 MEDIA MANAGEMENT

· The Administration conference room is to be provided as a secure media area established for the Regional Director or delegate to provide media information as required.

· Entry for media personnel is via the front door.

· The Regional Director or delegate is responsible for: o the release of all information to the media o liaison between media and other hospital staff o responding to enquiries of a non-official nature from the Health Service,

community and general public. 1.14 EXTERNAL ROLES AND RESPONSIBILITIES Each Agency has specific responsibilities and takes a lead role at various stages of dealing with an emergency event. The following lists some of these responsibilities (these lists are not exhaustive).

Police

· Hazard Management Agency (Control at scene)

· Traffic and crowd control;

· Removal of damaged vehicles; · Removal of bodies;

· Security of property such as luggage, vehicles;

· Care of the dead;

Fire Brigade

· Rescue co-ordination (RAR); · Fuel spills;

· Chemical spills;

State Emergency Service

· Communications network

· Provision of additional resources and equipment as directed through the command and control structure

· Provision of personnel for first aid assistance, stretcher-bearer, rescue tasks as directed through the command and control structure



Hospital

· Ambulance Service and co-ordination of patient retrieval

· Transport of casualties

· Provide Medical Team(s) and major trauma retrieval equipment to the scene

· Liaison with RFDS

· Co-ordination of clinical care at hospital · Assistance with care of the dead

· Registration of casualties upon arrival at hospital

Royal Flying Doctor Service

· Call out of aircraft - including Charter flights

· Transport of casualties

· Liaison with respect to location of nearest landing strip

· Liaison with Hospital

· Transport of medical/nursing staff to accident site

Department for Child Protection

· Physical and emotional welfare of uninjured passengers

· Provision of food and drink to incident victims at the welfare centre

· Welfare of casualties as they are discharged by hospital

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

Contact: Operations Manager (M.Faulkner) Directorate: Nursing and Midwifery Services TRIM Record # ED-CO-13-33559

Version: 2.00 Date Published: 11 January 2017 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.



FORMS



CODE BROWN – EXTERNAL EMERGENCY - APPENDIX 1

For use when a call with details received from an external community member or 000 call.

NOTIFICATION OF MAJOR INCIDENT FORM

Your Name: Date: Time:

Designation: Contact Number: Signature: Incident reported by: Name: Designation: Service: Contact Number:

Exact location of the incident:

Type of Incident (e.g. road, rail, air incident)

Hazards that are present and anticipated

Access road for emergency vehicles to use

Number and severity of casualties (may be rough estimate)

Emergency services that are already present, and those that are required.



ACTION/S: Tick (a) o when task complete

1. Call verified 1 Time: ____________

2. Operations Manager (OM) notified 1 Time: ____________ Name: ___________________________ 3. Assessment of incident by Duty Nurse Manager

/ Director of Nursing 1

· Hospital able to manage (Local response) · Regional Director Notified

1 1

Time: _____________Name:___________________________

· District Response required · Regional Nurse Director and Regional Medical Director Notified

11

Time: _____________Name:___________________________ “Please phone and forward form via fax to Emergency Department Coordinator upon completion.

Date and Time Key Decisions and Actions



CODE BROWN: EXTERNAL EMERGENCY – APPENDIX 2 Fitzroy Hospital Emergency Telephone Numbers

Title / Location Phone Number Operations Manager 0419 043 610 or 9193 3337

Emergency Department 9166 1781

Director of Nursing (D.O.N.) 0408 921 165 or 9166 1704

Support Services Manager 0427 443 659 or 9166 1703

Senior Medical Officer See Doctor’s Roster

Community Health Nurse Manager 9166 1734

Maintenance Manager (Derby) 0429 109 010

Regional Director 0407 988 161

Regional Medical Director 0407 779 200

Business Manager (Derby) 0428 884 550 or 9193 3345

Nindilingarri CEO 0428 472 452

RFDS 1800 625 800

Broome Hospital C.O.N 0408 913 638

Broome Hospital After Hours Manager 9194 2630

Emergency Department Sat Phone 0147 141 329

Ambulance Sat Phone (Main) 0147 155 244

Ambulance Sat Phone (Back-up) 0147 155 295

FESA Vol. Emergency Service Unit 0407 915 066

SES Derby 9191 1501 or 0418 900 112

SES Broome 9193 5999 or 0417 937 073

SES Port Hedland 9173 1720 or 0419 909 744

Fitzroy Police 9191 5000

Shire Derby / West Kimberley 9191 0999

Health Department of WA Duty Officer 9222 4222 or 9480 4960 (AH)



CODE BROWN: EXTERNAL EMERGENCY - APPENDIX 3

Supplies for Walking Wounded Clinic

· Intravenous trolley

· Trolley containing Suture sets MR1 forms

Suture packs Prescription pads Suture material Tissues Dressing packs Slings Alcohol wipes Dressing materials Syringes Needles Bandages and tape Fixamol Slings Crepe Bandages

· Pharmacy supplies Lignocaine 1% x 20 ADT vaccine x 10 Adrenaline 1mg x 5 Atropine 600mcg x 5 Diazepam 10mg x 5 Paracetamol x 1 box Paracetamol Elixir Paracetamol/codeine x 1 box Tramadol x 1 box Indocid 100mg supps x 1 box Naprosyn 250mg tabs NaCl irrigation solution sachets Povidine iodine 100ml sol’n Chlorhexidine 0.05% 30ml

§ Extra Equipment to include Valuables envelope Biro’s and felt pens Brown rubbish bags Thermometers Aquium hand gel Stickers stating “SB Dr” &”Visitor /Relative” Plastic bag for clothing ID wrist bands Allergy Stickers Plain writing paper

· Auroscope, opthalmoscope, BP machine and tendon hammer from the Nurses' Station.

· Plaster trolley from the emergency department § Relevant documents including MR1



TITLE: CODE BROWN – EXTERNAL EMERGENCY - APPENDIX 4

For use by Clerical / Switch Board Staff and provided to the Hospital Emergency Controller

Phone Communication Log

Date Time In Purpose in Calling Actions Arising Contact Number Sent To Time

Out Sign



Date Time In Purpose in Calling Actions Arising Contact Number Sent To Time

Out Sign



CODE BROWN: BED STATE SHEET – APPENDIX 5

Fitzroy Crossing Hospital - Bed State Sheet Date:

When a code brown and/or the cyclone response plan has been initiated either locally or at

another site within the region, the Director of Nursing or their delegate is to complete this bed state tool immediately and update hourly during the incident.

Mark the relevant box with an X indicating the type of patient or whether the bed is available or closed and tally the total amounts at the end of each column. The Director of Nursing should

liaise with the Senior Medical Officer regarding potential discharges.

Bed Number Inpatient Boarder Available Closed For D/C Potential D/C

1

2A

2B

3

4A

4B

5A

5B

6A

6B

7A

7B

8A

8B

Total X



CODE BROWN – PATIENT LOG - APPENDIX 6

Used in conjunction with the triage board in ED by the triage nurse (and used to update the Hospital Emergency Controller)

NAME TIME IN AREA CATEGORY PRESENTING COMPLAINT TREATMENT TIME

OUT DESTINATION



NAME TIME IN AREA CATEGORY PRESENTING COMPLAINT TREATMENT TIME

OUT DESTINATION



CODE BROWN – DECISIONS / EVENT LOG - APPENDIX 7

NAME: ............................................................................................ ROLE: ......................................................................................

NOTE: Once completed, this is a legal document.

DATE / TIME EVENT / ISSUE KEY DECISIONS AND ACTIONS OUTCOME SIGN



DATE / TIME EVENT / ISSUE KEY DECISIONS AND ACTIONS OUTCOME SIGN



CODE BROWN: RELATIVES REGISTER – APPENDIX 8

Name

Contact Address Contact

Number/s Person waiting for



CODE BROWN: STAFF CALL-IN LOG – APPENDIX 9

NAME ROLE TIME IN TIME OUT SIGN



STAFF CALL-IN LOG

NAME ROLE TIME IN TIME OUT SIGN



CODE BROWN: MAJOR INCIDENT LOG (RUNNING SHEET) - APPENDIX 10 Once completed this is a Legal Document.

Date and Time Key Decisions and Actions



CODE BROWN: EXTERNAL EMERGENCY - APPENDIX 11

CODE BROWN EXTERNAL EMERGENCY ETHANE QUE CARD

Exact location of disaster

……………………………………………………………………………

Type of incident

……………………………………………………………………………

Hazards present

……………………………………………………………………………

Access to the site

……………………………………………………………………………

Number of casualties

……………………………………………………………………………

Emergency Services (present and required)

……………………………………………………………………………



ACTION CARDS



ACTION CARD 1: HOSPITAL EMERGENCY CONTROLLER (DIRECTOR OF NURSING/DELGATE)

This person coordinates the Hospital’s response to CODE BROWN.

· DON/Delegate obtains ETHANE from nursing staff upon arrival.

· Awaits information from first Ambulance Team with regard to confirmation of casualty numbers and resource requirements

· Determines level of response required and whether the hospitals resources can meet demand

· Activates and equips the Emergency Control Centre (ECC)

· Ensures Tabards, Action Cards and relevant forms are available and provided

· Commence and maintain a Major Incident Log

· Commence a Decisions / Events Log (as necessary)

· Establishes communication with ED Coordinator and SMO

· Determine required update from staff every 30 minutes

· Establishes communications with the Operations Manager to keep them informed

· Activate Fitzroy Emergency Control Centre and equip with: o White board o Computer, Phone, Fax, commercial radio and if possible 2-way radios o Stationary (see Appendices – Forms at the end of Code Brown in EPM) o Pens, pencils, white board markers and white board dusters o Refreshments, water etc. as required

Ongoing Role to include:

· Establish communication link with Site Communications Coordinator at incident site with predetermined half hourly updates or as necessary

· Determine level of response required and if hospital resources can meet the ongoing demand by considering the following:

o Workforce availability (medical, clinical and non-clinical and volunteer) Forms · Notification of Major Incident Form (Appendix 1) · Phone Communication Log (Appendix 4) · Decisions / Events Log (Appendix 7) · Major Incident Log (Appendix 10)

Date of Last Review: XXX XXX of 48 Date Next Review: XXX XXX


ACTION CARD 2: ED COORDINATOR

· Receives ETHANE from the Hospital Emergency Coordinator

· On Direction of DON, dispatch the first DMAT when all is prepared.

· Notify nursing staff as necessary placing them on standby

· Ensure the ward provides a current patient status list for switchboard and that the list is reviewed at the end of each shift.

· Allocates relief nursing staff

· In conjunction with Base Medical Officer clear the Emergency Department of all non-urgent patients and commences preparation for the receiving of casualties, i.e.: supplies and staffing

· Sets up different areas to receive victims o Emergency Department – Red o Theatre Recovery – Orange o Physiotherapy department – Green

· Clarifies roles with nursing staff

· Liaises with nursing staff ward team leaders.

· Remains in the Emergency Department and assists with receipt of casualties as necessary

· Assists Director of Nursing as directed.

· Co-ordinate onward transfer of patients

· At the conclusion of the disaster inform staff and return to normal duties.

· Attends operational and LEMC debriefing sessions as required Forms · Notification of Major Incident Form (Appendix 1) · Phone Communication Log (Appendix 4) · Decisions / Events Log (Appendix 7)



ACTION CARD 3: SENIOR MEDICAL OFFICER

· Contacts all medical officers and allocates staff to go to emergency site or to stay at

the Hospital base as required.

· Liaise with nursing staff re transfer or discharge of non-disaster patients.

· Liaise with RFDS regarding additional medical assistance.

· Liaise with RFDS and other hospitals regarding referral and transfer of disaster patients.

· Assist in triage and treatment of casualties at the Hospital.

· Updates the Hospital Emergency Controller at 30 minute intervals or as necessary

· At conclusion of disaster informs medical staff that the procedure is discontinued and to return to normal duties.

· Attends operational debriefing sessions as required. FORMS · Phone Communications Log (Appendix 4)

· Decisions / Events Log (Appendix 7)



ACTION CARD 4: MEDICAL OFFICERS

· Present to Emergency Department in preparation for allocation of duties, i.e. treat casualties in ED, go to emergency site etc.

· Receive and treat casualties.

· Liaise with Director of Nursing regarding human and physical resource availability (including equipment, drugs, dressings and medical gases).

· At conclusion of the disaster, attend operational debriefing sessions as required FORMS · Phone Communications Log (Appendix 4)


· Major Incident / Medical Log (Appendix 10)



ACTION CARD 5: DISASTER MEDICAL ASSISTANCE TEAM (DMAT)

· Reports to ECC and receives ETHANE report if not received already · Collect disaster kits from the ED and don PPE · Collect and sign for drugs · Travel to the disaster site in an ambulance · Wait for clearance from the Disaster Site Controller (usually the Police or FESA) · Roles at disaster site are as follows:

o Triage Nurse is the DMAT Coordinator and is in charge of the team o Medical Officer assumes command of the triage site with the second nurse and

has overall responsibility for treatment of casualties. o If a clerk is deemed necessary and dispatched, the ward clerk will prepare and

maintain medical records and assist in casualty identification · No member of the team attempts to salvage casualties from any wreckage

unless safe and requested to do so by the Disaster Site Controller · Initial activity includes set up at site: prepare IV lines, set up area and prepare

equipment · Triage Sieve conducted as per MIMMS card at incident site area (see recommended site

set up in section 1.6.3)

· Triage tags must be secured to all victims triaged

· Communicate casualty load to Site Communications Coordinator

· Triage Sort conducted as per MIMMS card conducted at casualty clearing post

· Prepare to implement the expectant category described in section 1.6.2

· Emphasis is on speed and resuscitation with priorities on life saving measures e.g. clearing airways and maintaining cardio-respiratory function. Other priorities include stopping haemorrhage, treating shock, splinting limbs and protection of the cervical spine

· Where possible leave the dead untouched for examination by investigation authorities

· Notes made on the patient label include drug administration and changes in condition. This forms part of the medical record. Black labels act as an interim death certificate

· First priority for evacuation is patients with red labels.

· Forms - Field documentation located in disaster box in ED



ACTION CARD 6: SITE COMMUNICATIONS COORDINATOR (SSM)

· Collect equipment, PPE, satellite phone, hand held radio and phone number lists

· Attends the scene in ambulance or government vehicle

· Report to the Incident Control Point specifically the Incident Controller

· Set up of CCP if not established

· Communicates with DMAT Medical Officer and the Site Controller to confirm casualty numbers and then relays this information to the Hospital Emergency Controller.

· Liaises with the Site Controller regarding needs of the medical team for shade / shelter; lighting; water; food; shelter for victims in the green section

· Conduit between Hospital Emergency Controller and site medical team

· Establish radio channel and call signs

· Report / request additional resources to / from Fitzroy ECC

· Maintain a log utilising Phone Communication Log and the Decision and Events Log

· Report / update Hospital Emergency Controller every 15 minutes or as necessary

· When all casualties cleared from site return to the hospital and report to the ECC On return: · Calls in additional orderlies, administrative staff and catering staff as necessary

· Takes calls from non-clinical staff members in conjunction with Hospital Emergency Controller

· Arrange delivery of extra stores and equipment as requested by Senior Nursing Staff

· Arrange / prepare extra beds and equipment as required Forms · Phone Communication Log (Appendix 4)

· Fitzroy Hospital Emergency Telephone List (Appendix 2)

· Decisions and Events Log (Appendix 7)



ACTION CARD 7: AMBULANCE DRIVER ORDERLY

· Reports to ECC with the DMAT and receives ETHANE report if not received already · Assists DMAT in the collection of disaster kits from the ED · Transports DMAT to the disaster site in an ambulance · Wait for clearance from the Disaster Site Controller (usually the Police or FESA) · May be approached by the Site Controller (SES or Police) to assist in transferring

victims from any wreckage to the medical area · Assists the DMAT in setting up equipment · Manages the loading of patients onto the stretcher and into the ambulance · Works under the delegation of the Triage Nurse with respect to assistance with first

aid provision.



ACTION CARD 8: TRIAGE NURSE

· Receive and ETHANE to the Hospital Emergency Controller · DON the tabard “Triage” · Do not get involved in patient care except for minimal intervention · Triage at ambulance entrance · Assemble equipment and documentation at triage point · Ensure all patients are logged and have identi-band applied at triage point · Ensure updates are provided to the ECC via the ED coordinator every 30 minutes or

agreed time basis PT PLACEMENT · Triage Red x 6 in ED

· Triage Orange x 5 in Recovery

· Triage Green in physiotherapy FORMS · Major Incident Log (Appendix 10)

· Patient Log (Appendix 6)



ACTION CARD 9: ADMINISTRATION COORDINATOR

· Attends ECC and receives ETHANE, instructions from Hospital Emergency Controller · Oversees overall coordination of clerical and administration assistant activity · Re-directs PATS clerk to take on the role of ED Clerical Assistant · Provides 30 minute update (or predetermined time) update to the Hospital Emergency

Controller · Liaises with Director of Nursing and ED Coordinator as necessary · Calls in administration staff as necessary · Monitor and assist

o Switchboard operator o ED Clerical Assistant

Ensures Maintenance of · A log of decision / events and notifies Hospital Emergency Controller as necessary · Clerical workforce Forms · Decisions / Events Log (Appendix 7) · Fitzroy Crossing Hospital Emergency Telephone List (Appendix 2)



ACTION CARD 10: ED CLERICAL ASSISTANT

· Obtain briefing from the ED Coordinator

· Work under the direction of the Triage Nurse

· Set up all documentation an equipment required in the ambulance bay foyer

· Gather yellow disaster files

· Ensure extra MR1’s, pens and stationary equipment are available

· Assist the triage nurse with patient URN logging

· Provide MR1 for Walking Wounded Patients

· Ensure ALL disaster patients have an identi-tag applied on arrival at the ED

· Assist in the transcribing of the patient tracking whiteboard onto hard copy data as patients are moved

· Ensure documented details are available for the 30 minute reporting to the Hospital Emergency Controller.

Forms · Yellow Disaster Files

· MR1s

· Stationary and ID Tags


· Patient Log (Appendix 6)



ACTION CARD 11: SWITCH BOARD OPERATION

· Report to Hospital Emergency Controller for briefing · “CODE BROWN EXTERNAL EMERGENCY – Alert, Standby, Response or Stand

Down” via PA when instructed by Hospital Emergency Controller · It is essential that ALL stages are notified in a timely manner · Clear all calls as quickly as possible · Direct all phone enquiries and maintain a Phone Log for unanswered calls · Screen calls to the best of your ability, provide screened information · Do NOT answer ANY media questions refer to the Hospital Emergency Controller · Call in Coordinating staff and other staff at direction of Hospital Emergency Controller · Update the Hospital Emergency Controller every 30 minutes or as necessary Forms · Phone Communication Log (Appendix 4) · Decisions / Events Log (Appendix 7)



ACTION CARD 12: CATERING

· Reports to Hospital Emergency Controller as necessary. · Calls in other staff as needed and keeps list of names, time in/out for the Emergency

Controller · Ensure water and other beverages are constantly available to all staff. · Provides sandwiches and drinks to the Emergency Department Staff Room,

Emergency Control Centre, Distressed Relatives Area, Walking Wounded Area and other ward areas as directed.

· Keep a log of all catering orders.



ACTION CARD 13: ORDERLIES

· Three personnel are required in any disaster situation. · Proceed to Emergency Control Centre and receive briefing on incident. · All ambulances go to the ED. · All patients to be directed to triage. · Gather extra IV poles and pumps available and delivers same to the ED. · Provides stocked linen trolleys and wheelchairs to the ED. · Ensure there are enough oxygen supplies available for transferring of patients. · Ensure all doors other than the ambulance and front door are locked. · Assist the triage nurse to maintain security

· Escort patients from Triage to the Walking Wounded Area as directed by the Triage Nurse.

· Monitors people to prevent movement into essential areas.

· Re-stock ED and the ambulances as required.



ACTION CARD 14: DISTRESSED RELATIVES COORDINATOR

· Receive ETHANE from the Hospital Emergency Controller · Set up the Social Support Area form distressed relatives with tea, coffee etc. · Maintain register of relatives · Liaise with Regional Mental Health Team as required · Liaise with Department of Child Protection (DCP) re: shelter, etc. · Update Hospital Emergency Controller every hour or agreed time · Monitor media presence as necessary Forms

· Register of relatives (Appendix 8)

· Decisions and Events Log (Appendix 7)


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