Code Brown - External Emergency Procedure - Harvey Hospital · 5. Activation of Code Brown Emergency Response . The Code Brown Emergency Response can be activated by several means:

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Code Brown

External Emergency Procedure Harvey Hospital

Printed or saved electronic copies of this policy document are considered uncontrolled. Always source the current version from WACHS HealthPoint Policies.

Date of Last Review: October 2019 Page 1 of 53 Date Next Review: October 2024

Effective: 22 October 2019

WACHS SOUTH WEST Harvey Hospital

Code Brown - External Emergency Procedure

Table of Contents 1. Code Brown - Introduction ......................................................................................... 3

2. Administration and Governance ................................................................................ 3

3. Distribution and Availability ....................................................................................... 4

4. Incident Notification .................................................................................................... 4

5. Activation of Code Brown Emergency Response .................................................... 5

6. Chain of Command ...................................................................................................... 7

7. Resources .................................................................................................................... 8

8. Local Emergency Operations Centre ......................................................................... 8

9. Media Enquires ............................................................................................................ 8

10. WebEOC ....................................................................................................................... 8

11. Emergency Telehealth Service in a MCI (activation of Code Brown) ...................... 8

12. Health Response Team ............................................................................................... 8

13. Call in Procedure for Staff .......................................................................................... 9

14. Decanting of Patients .................................................................................................. 9

15. Hospital Set up for Reception of Casualties ............................................................. 9 15.1 Local Emergency Operations Centre ..................................................................... 9 15.2 Emergency Department ......................................................................................... 9 15.3 Walking Wounded (ATS – 4, 5 and some 3) – Therapy Room ............................ 11 15.4 Distressed Relatives Area – Dining Room of the Permanent Care Unit (PCU) ... 11

16. Compliance ................................................................................................................ 12

17. Evaluation .................................................................................................................. 12

18. Standards ................................................................................................................... 12

19. References ................................................................................................................. 12

20. Related Forms............................................................................................................ 12

21. Related Policy Documents ....................................................................................... 12

22. Related WA Health System Policies ........................................................................ 12

23. Policy Framework ...................................................................................................... 12

24. Supplies for the Walking Wounded Clinic ............................................................... 13

25. Action Cards .............................................................................................................. 14 25.1 Action Card 1: First Responder ........................................................................... 15 25.2 Emergency Controller .......................................................................................... 16 25.2 Action Card 2: Emergency Controller .................................................................. 17 25.3 Action Card 3: Local Health Disaster Coordinator ............................................... 20 25.4 Action Card 4: Clerical Officer Emergency Department ....................................... 22

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Code Brown - Emergency Response Procedure - Harvey Hospital



25.5 Action Card 5: Emergency Department (ED) Coordinator ................................... 23 25.6 Action Card 6: Permanent Care Unit / Inpatient Coordinator ............................... 25 25.7 Action Card 7: Triage Nurse - Emergency Department (ED) ............................... 28 25.8 Action Card 8: Emergency Department Orderly / PCA ........................................ 29 25.9 Action Card 9: Relative Reception Coordinator ................................................... 30 25.10 Action Card 10: Clerical Officer Front Office ...................................................... 31 25.11 Action Card 11: Traffic Coordinator ................................................................... 32 25.12 Action Card 12: Support Service Coordinator .................................................... 33 25.13 Action Card 13: Walking Wounded Coordinator ................................................ 34

26. Appendices ................................................................................................................ 35 APPENDIX 1 - PHONETIC ALPHABET ............................................................................... 36 APPENDIX 2 - LOGGING ON TO WEBEOC ....................................................................... 37 APPENDIX 3 - ETHANE CUE CARD .............................................................................. 40 APPENDIX 4 - DECISIONS / EVENTS LOG ........................................................................ 41 APPENDIX 5 - MAJOR INCIDENT / MEDICAL LOG ............................................................. 42 APPENDIX 6 - PATIENT LOG ........................................................................................... 44 APPENDIX 7 - STAFF CALL-IN LOG................................................................................. 45 APPENDIX 8 - RELATIVES REGISTER .............................................................................. 46 APPENDIX 9 - VOLUNTEER REGISTER ............................................................................ 47 APPENDIX 10 - AVAILABLE SPECIALISTS AND GENERAL PRACTITIONERS ........................ 48 APPENDIX 11 - COMMUNICATION LOG............................................................................ 49 APPENDIX 12 - BED OCCUPANCY STATUS ..................................................................... 50 APPENDIX 13 - MIMMS SITE DISASTER PHONE NUMBERS ............................................ 51 APPENDIX 15 - NOTIFICATION OF INCIDENT .................................................................... 52 APPENDIX 15 – CONTACT NUMBERS .............................................................................. 53





1. Code Brown - Introduction

An external emergency is defined as a multi-casualty incident that stretches or overwhelms the available health resources, e.g. bus crash, aircraft crash, structural collapse, explosion. The provision of emergency health services shall be based on the principle of a graduated response. The response should start at a local level with a gradual escalation to district and state (Western Australian) level as required with time.

2. Administration and Governance

The Harvey Hospital, Code Brown Emergency Response Procedure has been developed and issued under the authority of the WACHS-SW Regional Director in accordance with applicable legal and other requirements. These Emergency Response Procedures have been formally recommended by the Wellington Health Service District Manager, endorsed by the WACHS-SW Inland Operations Manager and approved by the WACHS-SW Regional Director as the operating procedures to be followed in a Code Brown at Harvey Hospital.

Recommended Lucy Murphy A/District Manager Wellington 17 Oct 2019

Approved Jeremy Higgins Inland Operations Manager WACHS-South West 17/10/2019

Endorsed Kerry Winsor Regional Director WACHS-South West 22 October 2019





3. Distribution and Availability

The current editable version of this Code Brown Emergency Response Procedure is held by the WACHS Policy Unit. The procedures are available electronically to all staff via the WA health system wide intranet portal – HealthPoint. Hard copies of the Harvey Hospital Code Brown Emergency Procedures are held in the Emergency Response Manuals located in the areas described below.

Distribution and Availability Emergency Department - Staff station General Ward – Staff Station Clinical Nurse Managers Office Kitchen Administration Aged Care Unit

4. Incident Notification

• When a staff member receives any outside call pertaining to an external emergency, the staff member should complete the “Notification of a Major Incident” Form (Appendix 15) and ETHANE (Appendix 3) to gain necessary information:

- Caller’s name, position, location, service and telephone 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 a rough estimate) - Emergency services that are already present, and those that are required.

• If the emergency is nearby, the sudden influx of patients may be the first indication

of a mass casualty event. • Verify the call, by contacting the organisation that the caller is representing. • The information must be immediately conveyed to 000 and the Senior Nurse on Duty

who is the Emergency Controller (EC) and the District Manager who becomes the Local Health Disaster Coordinator (LHDC). The Emergency Controller is required to carry the Wi-Fi phone Ext 216 at all times and take the role of LHDC until a more senior staff member arrives.

• If notification of the external disaster comes from the Bunbury Hospital Duty Officer, the “Notification of a Major Incident” Form is to be filled in and the Senior Nurse on Duty must be notified.





• The staff member assuming the role of EC must notify the CNM, DM and South West Executive on-call 1800 744 059.

• If first notification is received at Harvey Hospital, the EC must complete the CETHANE form (Appendix 3) and phone it to Bunbury on 97221262 and fax it to the Bunbury ED at 97221019.

• Situation Report is prepared for advice to the RHDC of the incident. As per the WACHS Emergency Management: Situation Report Procedure

5. Activation of Code Brown Emergency Response

The Code Brown Emergency Response can be activated by several means: • By the EC / LHDC with any external emergency event outside the hospital that

requires emergency treatment of casualties that exceeds the normal day-to-day capacity of the hospital.

• When directed by the Director General (DG) or nominated delegate. • On receipt of credible information relating to mass casualties e.g. St John

Ambulance. • The Regional Health Disaster Coordinator (RHDC) has authority to activate a

regional wide emergency response.

5.1 Stages of Activation While an emergency response would normally be activated in stages, in an impact event’ these stages may be condensed with stages being activated concurrently. Phase 1 – Alert (There is a possible Emergency which is being confirmed) The alert phase is activated when advice of an impending or potential emergency is received or when following the occurrence of an event, it is unclear as to whether a health response is required. During this stage the situation is monitored by the EC / LHDC to determine the likelihood and nature of the health emergency response and resource requirements assessed. Actions: • The EC liaises with effected services to determine the extent of the health

response required. • The EC alerts own personnel, placing site on Code Brown – Alert. • Follow local escalation process to inform CNM, District Manager, Operations

Manager and RHDC including after hours. Where practicable the Situation Report is to be used.

• Review Medical and Nursing staff availability. • Review Harvey Hospital bed availability and identify patients for discharge or

transfer. • Preparation of the Emergency Department. • Preparation of the LHDC. • Prepare walking wounded area


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Phase 2 – Standby (the emergency is imminent, prepare for a response) Standby is activated when information received is sufficient to warrant preparatory activities in readiness for a response. Actions:

• The EC alerts own personnel, placing site on Code Brown - Standby, hospital begins to prepare resources and receive patients.

• Follow local escalation process to inform CNM, District Manager, Operations Manager and RHDC including after hours. Where practicable the Situation Report is to be used

• It should be recognised that medical and nursing resources at Harvey Hospital may be best utilised in the ED rather than deploying essential staff to the site of the incident.

• Prepare the site including medications and communication devices such as satellite phones & allocation of WiFi phones

• Deploy PCA to the Main Entrance to direct all casualties via ED entrance • Send SMS to all staff example - “Harvey Code Brown Standby has been

activated. Please prepare, in case you are required to respond”

Phase 3 - Response (the emergency exists and a response is required) Response phase is activated when a health emergency management response is required. Actions may include:

• Following local escalation process to inform CNM, District Manager, Operations Manager and RHDC. Where practicable the Situation Report is to be used.

• Patients are received and / or there is decanting of patients

Phase 4 -Stand Down (the emergency has abated and recovery activities begin)

The stand down stage is activated when the Harvey Hospital response is no longer required and when the hospital can resume normal business. Actions may include:

• EC informing the site of “stand down” • Informing CNM, District Manager, Operations Manager and RHDC. Where

practicable the Situation Report is to be used • Debriefing occurs • Resources are restocked • Reports are written and tabled at the WACHS-SW South West Executive

Emergency and Disaster Sub-Committee • Alterations to plans, procedures and processes made as necessary





6. Chain of Command

Level of response WA HEALTH RESPONSE

WACHS LOCAL

RESPONSE

STATE

RESPONSE

WACHS

REGIONAL RESPONSE

Emergency Department

Coordinated by the ED Coordinator

Hospital Response Emergency Controller (EC) (Senior

Nurse on Duty) activates Code Brown emergency response, in conjunction

with the Local Health Disaster Coordinator (LHDC) and manages the

local emergency response. The Regional Health Disaster Coordinator

(RHDC) is contacted when local capacity to manage is exceeded or a

HRT is required.

Activation of a HRT is a Regional

Response that occurs through

the hospital

INCIDENT SITE Health Commander,

if deployed, commands Health Response Team/s.

Regional Response The RHDC activates the WACHS response, Regional Emergency Operations Centre (REOC) and

notifies the Regional Director, the Chief Operating Officer - Operations (Area Health Disaster Coordinator - AHDC)

and the WA Health State Health Incident Command Centre (SHICC).

State Response State response coordinated through

the On Call Duty Officer (OCDO) and Director General’s Delegate

at (SHICC).

WACHS AREA

RESPONSE

Health Service Response The Area Health Disaster Coordinator (AHDC) maintains communications with the Regional Health Disaster Coordinator (RHDC) and the State

Health Incident Control Centre (SHICC) The AHDC represent WACHS at State Health Incident Coordination

Centre (SHICC).

State Health Incident

Coordination Centre activated by Director General’s

Delegate





7. Resources Should additional resources be required, the Nursing Coordinator /Hospital Resource Nurse and Director of Emergency Medicine at Bunbury Hospital, in collaboration with the RHDC are to activate the WACHS-SW District Emergency Response or if necessary, request activation of the State Health Emergency Response Plan (SHERP).

8. Local Emergency Operations Centre

The Harvey Hospital Local Emergency Operations Centre (LEOC) is to be located in the Meeting Room located in Main Corridor.

9. Media Enquires • Media enquiries / communication are coordinated by the WACHS-SW Inland

Operations Manager. • Media enquiries are managed by WACHS Communications, available 24hrs/

day on 61454166. • A media area should be established by the LHDC • The suggested media area location is the Silver Chain Office, at the end of

the Nurses Quarters. 10. WebEOC

• Log in at https://myeoc.health.wa.gov.au/eoc7/ • WebEOC is a web based Incident Management System that facilitates

response and recovery agencies to access relevant incident information. It allows agencies to communicate and collaborate in real time during special events and disasters.

• WebEOC should be used to capture information pertaining to the incident. This includes capturing disaster patient demographics in the Regional Casualty Tracking board, and use of the Activity Communications Log to detail actions and communications relating to the incident.

11. Emergency Telehealth Service in a MCI (activation of Code Brown)

• ETS can offer the current (usual) level of service but have no ability to scale this

up, primarily due to technological restrictions, in a Mass Casualty Incident • Principles of MCI ‘most for the most’ are upheld • Refer to the WACHS Role of Emergency Telehealth Service in a Mass Casualty

Incident policy document (Currently under development). 12. Health Response Team

• The Harvey Hospital is not a South West site that deploys a Hospital Response

Team • The Collie Health Service and Bunbury Hospital are sites with capacity to deploy

Hospital Response Teams


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13. Call in Procedure for Staff

• on confirmation of a major incident the EC can request available staff to be called in including clinical, administration and support services staff

• staff rostered for the next shift are not usually contacted in the first instance • staff call in list is available from the back of the roster file, this includes

ETA (Expected Time Arrival) • staff must remember to bring their identification (ID) and swipe card

14. Decanting of Patients

• Decanting is the discharging or transferring of patients out of the hospital in order to make beds available for casualties and to free up staff required in other areas of the hospital as part of the Emergency Response. No patients are to be discharged or transferred until authorised by the EC.

• Patients and residents are reviewed by a medical officer, where practicable and the Shift Coordinator to determine possible transfer or discharge

• Patients considered suitable for discharge, where possible will have prescriptions provided, appropriate discharge letters, instructions and arrangements made. Relatives or friends may be requested to collect patients. Where discharge is not practicable relatives may be called to the hospital to provide support to residents for the duration of the activation.

• Patients for transfer must have copies of medical records, medications and belongings made available to go with them. The LHDC and RHDC and / or SHICC will make arrangements for transfer and transport.

15. Hospital Set up for Reception of Casualties

15.1 Local Emergency Operations Centre The Local Emergency Operations Centre (LEOC) will be the primary area dealing with the managing the operational, logistical, planning needs of the major incident. The Harvey Hospital Local Emergency Operations Centre (LEOC) is to be located in the Meeting Room located in Main Corridor. The Local Emergency Operations Centre (LEOC) is set up by the xxx or delegate. A white board and satellite phone are available in the LEOC. 15.2 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”.

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 the victims in the ED for further observation and surgical decisions may be possible. However, if a true mass casualty incident





occurs then flow through the department must occur and the following should be the default strategy.

• Process for patient flow through the department: o The Triage Nurse attends to the presenting casualties:

- More triage nurses could be used initially - Patients are triaged on arrival using the Australasian Triage Score

(ATS). Score 1, 2 and some 3 are treated in in ED - Patients with ATS Score 4 or 5 and some 3 are treated in the Therapy

Room, (Walking Wounded Clinic) entry through front door of the ED, to the triage desk

- Designate patients to appropriate bay with appropriate medical and nursing staff use PCA to direct to walking wounded clinic

- Walking wounded pending discharge to be placed in the Permanent Care Sitting Room

• The EC liaises with SJA, 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 is to be maintained by the EC. • A staff member will be positioned at the main entrance to the Harvey Hospital

and provide direction. Of all casualties to ED entrance(Action Card - Traffic Controller typically PCA or Orderly)

Emergency Department Patient Tracking • A log placed in the ED area is maintained by the Triage Nurse, assisted by

administration staff. This may be paper based or whiteboard (source from Meeting Room)

• The log will have the following fields: o Patient name/number o Time seen o Present patient location o Doctor o Injuries o Planned destination

• The log will be utilised by the medical and nursing staff to track patient movement, provide information for reporting to LHDC / EC and assist planning.

Disaster Documentation, Patient Notes • Yellow files provided, marked in consecutive numbers female DV1, DV2 etc. or

male DV1, DV2 etc. located in the Code Brown Box located in the ED. storeroom.

• Content of the file is to include the following items labelled with the appropriate allocate number: o Identification stickers x1 o Name band x1 o MR1 form x1





o Pathology and Medical Imaging request forms x1 each o Additional continuation sheets x2 o Registration form o MR 176 Intravenous fluids o MR170A Medications o MR2 Emergency Department Trauma notes

• The files are only to be used only for the disaster victims and allocated as they

are triaged.

• Name bands are to be attached at point of triage.

• The file is to remain with the patient, hung on the end of the bed during the ED episode and transferred with the patient as required.

15.3 Walking Wounded (ATS – 4, 5 and some 3) – Therapy Room • The Walking Wounded Clinic will be set up in the Therapy Room with impending

discharges to go the Permanent Care Sitting Room • Any overflow will be placed in the main waiting area, near the Main Entrance to the

Hospital. • The LHDC is to arrange for a doctor and assign a clinical nurse and additional staff

as required to this area. • The Clinical Nurse managing the Walking Wounded Clinic is to obtain supplies as

per Section 24 and liaise with the EC for admissions, transfers and resources. • Note: From the incident site Walking Wounded are identified by the SMART

disaster sort and sieve as Green Tag

15.4 Distressed Relatives Area – Dining Room of the Permanent Care Unit (PCU) The Dining Room of the Permanent Care Unit (PCU) is to be set up for distressed relatives and staffed by PCA(s) and or Support Services staff (Clinical staff may also be positioned here) who are to:

• Keep list (log) of names, time in/out of staff for EC / LHDC

• 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

• Call in other support staff such as mental health staff and social workers.

• Liaise with the LHDC to inform Police and Australian Red Cross of identification of victims/injured

• Liaise with Department of Communities for shelter, personal needs, crisis counselling

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

Australian Red Cross volunteers (may be contacted by Department of Communities).





16. Compliance

Failure to comply with this policy document may constitute a breach of the WA Health system MP0031/16 Code of Conduct (Code). The Code is part of the Employment Policy Framework issued pursuant to section 26 of the Health Services Act 2016 (WA) and is binding on all WACHS staff which for this purpose includes trainees, students, volunteers, researchers, contractors for service (including all visiting health professionals and agency staff) and persons delivering training or education within WACHS. WACHS staff are reminded that compliance with all policies is mandatory.

17. Evaluation Monitoring of compliance with this document is to be carried out by Harvey Clinical Nurse Manager or delegate every 5 years.

18. Standards National Safety and Quality Healthcare Standards - 1.10f

19. References WA Health System Management Arrangements WACHS Emergency Management: Situation Report Procedure

20. Related Forms WACHS Safety Risk Report Form

21. Related Policy Documents WACHS Emergency Management: Situation Report Procedure WACHS Emergency (Disaster) Management Arrangements Policy

22. Related WA Health System Policies MP0073/17 Emergency Management Policy WA Health Pre-hospital Handbook

23. Policy Framework Public Health

This document can be made available in alternative formats

on request for a person with a disability

Contact: Nurse Educator (M. Wootton) / J. Uren (A/CNM) Directorate: Nursing and Midwifery Services TRIM Record # ED-CO-18-45000

Version: 1.00 Date Published: 23 October 2019

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.


https://ww2.health.wa.gov.au/About-us/Policy-frameworks/Employment/Mandatory-requirements/Conduct-Ethics-and-Integrity/Reporting-of-Criminal-Conduct-and-Professional-Misconduct-Policy

https://ww2.health.wa.gov.au/About-us/Policy-frameworks/Employment/Mandatory-requirements/Conduct-Ethics-and-Integrity/Reporting-of-Criminal-Conduct-and-Professional-Misconduct-Policy

https://www.legislation.wa.gov.au/legislation/statutes.nsf/main_mrtitle_13761_homepage.html

https://www.safetyandquality.gov.au/wp-content/uploads/2017/11/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf

http://ww2.health.wa.gov.au/%7E/media/Files/Corporate/general%20documents/emergency%20disaster/PDF/WA-Health-Emergency-Management-Arrangements.pdf





https://ww2.health.wa.gov.au/About-us/Policy-frameworks/Public-Health/Mandatory-requirements/Disaster-Preparedness-and-Management/Emergency-Management-Policy

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24. Supplies for the Walking Wounded Clinic

• 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 Paracetamol x 1 box Paracetamol Elixir NaCl irrigation solution sachets Povodine iodine 100ml sol’n Chlorhexidine 0.05% 30ml Ibuprofen

• Extra Equipment to include Valuables envelope Biros and felt pens Brown rubbish bags Hand gel Plastic bag for clothing ID wrist bands Allergy Stickers Plain writing paper

• Auroscope, ophthalmoscope, BP machine and tendon hammer from the Nurses' Station.





25. Action Cards 1. First responder

2. Emergency Controller (CNM or delegate)

3. Local Health Disaster Coordinator (District Manager or delegate)

4. Clerical Officer Emergency Department

5. ED Coordinator

6. Permanent Care Unit / Inpatient Coordinator

7. Triage Nurse - Emergency Department

8. Emergency Department PCA / Orderly

9. Relatives Reception Coordinator

10. Clerical Officer Front Office

11. Traffic Coordinator

12. Support Services Coordinator

13. Orderly – Hospital

14. Walking Wounded Coordinator





25.1 Action Card 1: First Responder

First Responder: A staff member who has been alerted to an external emergency.

Responsibilities : - Take measures to record relevant information. - Take measures to ensure the Emergency Controller Wi-Fi 216 is notified. - Take measures to ensure that the Clinical Nurse Manger M: 0419 838 652 is notified

ON ALERT TICK √

1.

Record CETHANE information on the Code Brown External Emergency Cue Card.

• Caller’s name, role, location and contact details. • Exact location of the incident. • Type of incident. • Hazards identified at the site. • Access routes to site. • Number of casualties. • Emergency service - present and required.

2. Verify the call by contacting the organisation the caller is representing.

3. Alert the site Emergency Controller and provide CETHANE report.

4. Wait for further instructions from the Emergency Controller.





25.2 Emergency Controller • After-hours the Emergency Controller has delegated responsibility until the DM or

CNM arrives on site. • Follow the Section 4. Incident Notification steps outlined • Once notified of the disaster, the emergency controller is to activate Code Brown

and use the nominated Wi-Fi phone - 216 • If there is power failures use the satellite phone and/or analogue disaster phone. • The analogue number for Harvey is 9729 2388

Following notification - the role Hospital Emergency Controller

• Assess the situation using the information provided (ETHANE – Appendix 3). • Bed Situation - Consider number of available beds in potential discharges and

creation of area’s to place patients. Consider decanting current inpatients to other hospitals if necessary.

• Clear the Therapy Room to setup the Walking Wounded Area. Establish Staffing:

• Provide and ETHANE (Appendix 3) to staff members and allocate roles and action cards

• Medical staff – Organise Medical Staff for ED and the Walking Wounded Clinic • Nursing staff – Ensure staff available for the walking wounded clinic, ED and normal

ward duties. Anticipate staff required for current and next shifts. • Clerical Staff – call in staff to man the front office and ED office (main switch board) • Support Services Staff – call in as necessary to provide support. • Security – arrange for orderlies/ security agency to provide security • Mental Health Nurse /Social Worker – where practicable • Radiographer – where practicable • Staff to park near nurses quarters • Any staff member called in to assist in an emergency needs to be listed on Staff

Call In sheets with details of designation, time on/off duty. Re-mind staff to wear ID at all times and bring swipe cards.

Ongoing:

• Perform location and emergency specific actions required to ensure the safety of patients, staff, visitors and property.

• Liaise with medical staff regarding potential discharges or transfers. • Communicate as per Section 4. Incident Notification. • Determine requirement for volunteers and tasks that may be allocated to them. • Monitor staff for fatigue and implement fatigue management strategies, including

tracking shift length of staff and consider that staff/volunteers may be unsafe to drive home and will require transport home and back to the site.

• Provide updated information regarding expected patient case mix and any other changes that affect resource requirements to the Emergency Controller Bunbury Hospital.

• Participate and facilitate staff defusing, prior to staff leaving for their shift and in formal debriefing post event.





25.2 Action Card 2: Emergency Controller Emergency Controller: Clinical Nurse Manager M: 0419 838 652

After hours the nominated EC is the Shift Coordinator Wi-Fi 216 NB: The nominated EC has responsibility until the Clinical Nurse Manger takes over

Reporting to: District Manager - Wellington M: 0438 104 845

Responsibilities: Alert and control the health response to an external emergency.

ON ALERT: Advice of an impending emergency. TICK √

1.

Receive and or Record CETHANE information on the Code Brown External Emergency Cue Card.

• Caller’s name, role, location and contact details. • Exact location of the incident. • Type of incident. • Hazards identified at the site. • Access routes to site. • Number of casualties. • Emergency service - present and required

2. Activate the Code Brown procedure.

3. Alert the Emergency Department Area Warden and provide CETHANE. Determine Emergency Department capacity.

4. Proceed to the LEOC (Meeting Room), don EC vest (white)

5.

Ensure all areas are notified by whatever means available of the Code Brown On Alert status. Attention Attention: This is the Emergency Controller. This is to notify of a Code Brown On Alert status. All Area Wardens to assemble in the Local Emergency Operation Centre (LEOC), in the Meeting Room. Please assemble in 10 minutes for a SITREP”. (Repeat)

6. Contact the Regional Health Disaster Coordinator (Regional Director) by dialling M: 0407 988 161, provide the first report (CETHANE) and advise On Alert.

7. Contact the Inland Operations Manager on M: 0438 062 341 provide the first report (CETHANE) and advise On Alert

8. Contact the ED Clerical by dialling 9 and provide the report (CETHANE). Ensure Communication Log established.

9. Contact Bunbury Hospital on 9722 1262 and provide the report (CETHANE) and advise On Alert.

10. Contact VMP on-call and advise of Code Brown – On Alert.

STANDBY: Commence preparatory activities in readiness for a response. TICK √

1. On confirmation of Standby Ensure all areas are notified by whatever means available of the Standby status: “Attention Attention: This is the Emergency Controller.





This is to notify of a Code Brown Standby status. Can all Area Wardens please assemble in the Meeting Room in 5 minutes for a SITREP.” (Repeat).

2. Confirm number of available beds, number of patients suitable for transfer and discharge and staffing levels.

3. Ensure RFDS and SJA are aware.

4. Delegate staff call in as required. This may include a SMS informing staff of the Code Brown activation and request standby.

5.

Provide a SITREP to managers. • Provide a brief on the required health response. • Allocate roles. • Issue Action Cards and vests. • Establish scheduled timings for briefings. • Confirm traffic management, media and security resources.

6. Log into WebEOC on https://myeoc.health.wa.gov.au/eoc7/

7. Liaise with Area Wardens to ensure that there is adequate equipment and supplies to deal with expected casualties.

8. All casualties will enter via the Emergency Department

9. Allocate appropriate staffing to ED

10. Ensure the Admin Coordinator allocates a dedicated Clerical Officer to the ED and Front Office Note: Relative Reception via Front Office

11. Ensure a PCA or Orderly is stationed at the Front Entry to direct all casualties to the ED

CONFIRMED: A health disaster management response is required. TICK √

1.

Ensure all areas are notified by whatever means available of the confirmed status: “Attention Attention: This is the Emergency Controller. This is to notify of a Code Brown Confirmed status. Can all Area Wardens please assemble in the Command Centre in 5 minutes for a SITREP.” (Repeat).

2. As required confirm contact with the State Health Incident Coordination Centre (SHICC) by dialling 08 6266 0603.

3. In conjunction with the inpatients VMPs provide instructions to clear the Hospital of all non-urgent patients.

4. Instruct the Communications Officer to direct all media enquiries to the 2/24 WACHS Media contact 08 9223 8755 or the Inland Operations Manager 0438 062 341.

5. Where notified by a relevant authority that a health response is not required, carry out Code Brown Stand Down actions.

STAND DOWN: The disaster response is no longer required. TICK √

1. Ensure all areas are notified by whatever means available of the Stand Down status.






2. Refurbish equipment where required.

3. Commence debriefing processes with all senior staff and key stakeholders. (Refer to the WACHS-SW Emergency Response Report Template).

4. Compile an emergency response report for the LHDC and RHDC. Consider need for risk report.

Forms Required

• ETHANE cue sheet (Appendix 3) • Major Incident Log – running sheet (Appendix 5) • Phone Communication Log (Appendix 11) • Staff and Community Contact List (Appendix 7)





25.3 Action Card 3: Local Health Disaster Coordinator Local Health Disaster Coordinator: District Manager M: 0428 955 818 NB: If on-site carries Wi-Fi 233, kept in the Nurse Station

Reporting to: WACHS-SW Inland Operations Manager M: 0438 062 341

Responsibilities: Control the health response to an emergency external of the facility.

ON ALERT: Advice of an impending emergency TICK √

1. Receive a CETHANE from the Emergency Controller.

2. Confirm that the Regional Health Disaster Coordinator is aware and is On Alert.

3. Establish regular communication timelines.

4. Supervises the establishment and operation of the Local Emergency Operation Centre.

5. Log into WebEOC on https://myeoc.health.wa.gov.au/eoc7/


1. Ensure that WACHS Communications are updated on 6145 4166. Identify Media point of contact – Inland Operations Manager Media centre - Silver Chain Clinic in the Nurse Quarters

2. Attend meeting in Meeting Room and confirm preparatory activities are in progress.

3. Track progression of disaster on WebEOC.

4. Confirm traffic management plans and consider site security.


1. Act as the Local Health Disaster Coordinator.

2. Liaise with the Regional Health Disaster Coordinator obtain information and provide status report on response capability. Confirm ongoing communication protocol. Executive on-call 1800 744 059

3. Manage press and media liaison and ongoing arrangements with Inland Operations Manager, RHDC and WACHS Media 08 9223 8755

4. Maintain a current list of casualties and status of casualties

5.

Draw up on-going plans if the emergency is protracted in relation to: • Relief teams • Onward referral of patients • Diversion of patients • Decanting of patients

6. Provide SITREP to Regional Health Disaster Coordinator every 30 minutes or more frequently if required.







1. Inform all relevant stakeholders that the Code Brown is discontinued and return to normal duties.

2. Participate in hospital response debrief.

3. Assist with organisation of multi-agency debriefing within one week of emergency in conjunction with LEMC, as required.

4. Prepare a written report of the emergency and response for RHDC. Table at the South West Emergency Disaster Management Committee Sub Committee.

5. Assist with recovery and equipment refurbishment post event





25.4 Action Card 4: Clerical Officer Emergency Department

ED Clerical Officer: Switchboard Operator Ext 9

Reporting to: Emergency Controller Wi-Fi 216

Responsibilities: To assist with clerical and record maintenance during an emergency response.


1. On receipt of call regarding a potential disaster transfer the call to the Shift Coordinator on Wi-Fi 216

2. Commence and maintain a Communication Log

3. Refer any Media queries to Inland Operations Manager M: 0438 062 341

4. When instructed by the Emergency Controller commence contact extra staff refer to on-call list


1. Receive SITREP from the Emergency Controller.

2. Log in to WebEOC and monitor situation.


1. Answer phone calls on the main incoming line and direct as appropriate.

2. Direct all calls from relatives to the Front Office Reception to Ext 201

3. Direct all calls offering donations and/or assistance/volunteers to the Front Reception on Ext 201

4. Maintain communications with the Emergency Controller. 5. Respond to the directions of the Emergency Controller. 6. Maintain WebEOC casualty numbers as required.

STAND DOWN: The disaster response is no longer required. TICK √ 1. Ensure that the Communication Log is given to the Emergency Controller 2. Participate in debrief 3. Refurbish equipment

Forms required:

• Communication Log (Appendix 11) • Volunteer Information (Appendix 9) • Available Specialists and G.P’s (Appendix 10) • Log of Decisions Events (Appendix 4)





25.5 Action Card 5: Emergency Department (ED) Coordinator

Area Warden : ED Shift Coordinator Wi-Fi 214


Responsibilities: Coordinates Emergency Department response in collaboration with the Emergency Controller for an external emergency.


1. Convene all key ED staff and provide a CETHANE on the type, scope and location of the external emergency. Disseminate Action Cards.

2.

Liaise with the on-call VMP about triage and resource requirements. Set up triage points:

• Ambulance presentations at the Ambulance airlock • All other presentations to ED Waiting Room via the ED Entry

3. Request the Emergency Controller to notify medical, nursing and clerical staff. Allocate ED duties.

4. Ensure resources for the required health response are adequate.eg supplies, pharmacy Escalate immediately to the Emergency Controller if there are deficits.

5. Conduct a review of Emergency Department presentations with the VMP and discharge as appropriate.

6. Communicate half hourly updates to the Emergency Controller

7. Coordinate triage, registration, resuscitation and on-going care.

8.

Respond to the needs of the situation • Specialty staff • Refreshments and meals • Medical equipment and consumable resupply

9. Ensure personal effects are receipted and valuables are protected.

10. Ensure security measures are maintained.

11. Inform the Emergency Controller of any deceased casualties.

12.

Commence and maintain patient tracking board with the following fields, use electronic, white board or paper base system to maintain log.

• Patient name/number • Time in • Triage score • Location / area • Presenting complaint / injuries • Treatment • Doctor • Planned destination • Time out






1. Participate in the Debrief.

2. Assist with recovery and equipment refurbishment

Forms required for this role: • Major Incident Log (Running Sheet) (Appendix 5) • Patient Log (Appendix 6)





25.6 Action Card 6: Permanent Care Unit / Inpatient Coordinator PCU / Inpatient Coordinator: Registered Nurse Ext 220 -

Reporting to: Emergency Controller Wi-Fi 216 Responsibilities: Coordinate nursing activity of the General Ward and PCU in response to an external emergency.

- Possible decanting - Calling in of relatives/carers of in-patients


1. Receive a CETHANE from the Emergency Controller and report to the inpatient area.

2. Disseminate information on the type, scope and location of the external emergency to the nursing team.

3. Review staffing levels, supply needs and pharmacy stock levels. Report any deficits to the Emergency Controller.


1. Receive a SITREP from the Emergency Controller and report on the inpatient area status. Obtain and distribute Action Cards as required.

2. Liaise with ward staff and receive a brief on the preparedness of the inpatient area to decant in-patients and receive causalities from ED.

3. Prepare list of patients suitable to discharge/ transfer in consultations with treating VMP’s.


1. Proceed to the Meeting Room for a SITREP.

2. Communicate current and predicted staffing levels and inpatient activity to Emergency Controller. Confirm communication plan (phone numbers) for the duration of the event.

3. Return to the Inpatient Ward and prioritise nursing care, treatment and investigation.

4. Review the inpatient numbers and care plans to ensure adequate care.

5. Facilitate discharge of appropriate patients and ensure patients suitable for transfer to other district sites are packaged for same.

6. Provide at least half hourly updates to the Emergency Controller.

7. Assign nursing staff to provide patient care.

8.

Commence and maintain patient tracking board with the following fields. • Patient identification. • Diagnosis / Injuries • Present patient location. • Admitting Doctor. • Destination • Time out

9. Monitor staff breaks and fatigue and address any issues.






1. Participate in the Debrief.


Forms required:

• Bed Occupancy Status (bed management system or census) (Appendix 12)

• Patient Log (Appendix 6)





25.7 Triage Nurse

• Clinical Nurse designated by the Emergency Controller who will triage and co-ordinate Emergency Department.

• Confirm the ETHANE report (Appendix 3) and any updates

• Perform Triage at the nominated areas following the standard ATS method

• Use prepared disaster record packs (from reception) and apply identi-tag all patients before they enter the Emergency Department.

• Allocate triage 3, 4, 5 to walking wounded if appropriate using orderlies or security to transfer casualties.

• Commence the patient tracking log, collect and record numbers and types of injured utilising the log in the Emergency Department.

• Treatment will be organised in teams of doctors and nurses as resources allow. Treatment may be initially limited to first aid and resuscitation only.

• Staff will be allocated to allow the timely treatment of patients who are not victims of the major incident (the usual daily workload).

• Update the Emergency Controller with numbers, condition reports etc. every 30 minutes.

• Above all, the Triage Nurse will refrain from patient treatment, will maintain records, communicate with their staff in the ED, the Hospital Controller, and ensure that resources are requested and distributed in a timely manner, to meet the key objective.





25.7 Action Card 7: Triage Nurse - Emergency Department (ED)

Triage Nurse 1 : Delegated Registered Nurse (Triage competent)

Reporting to: Emergency Department Coordinator Wi-Fi 214

Responsibilities: Located in ED Triage Area


1. Liaise with the Emergency Department Coordinator and receive a SITREP

2. Collect Action Card from Emergency Department Coordinator.

3. Set up the triage entry point

4. Triage patients as they present using the Australian Triage Score (ATS).

5. Maintain communications with ED Coordinator half hourly regarding presenting categories and triage resource requirements.


1. Participate in debrief.


Forms Required; • ETHANE cue sheet (Appendix 3) • Patient Log (Appendix 6) • Decisions / Events Log (Appendix 4) • MR1





25.8 Action Card 8: Emergency Department Orderly / PCA

Orderly/ PCA Emergency Department : PCA or Orderly as delegated

Reporting to: Emergency Department Coordinator Wi-Fi 214

Responsibilities: Responsible to ensure that the ED is clean and is suitable for accepting casualties. Also transports casualties as requested.


1. Liaise with the Emergency Department Coordinator and receive a brief on the type, scope and location of the external emergency.

2. Collect Action Card from Emergency Department Coordinator.

3. Respond to the directions of the ED Coordinator.

4. Be responsible for transporting casualties to Medical Imaging and to the Inpatient Ward for admission.

5. Ensure the numbers and locations of patient trolleys and dressing trolleys are known.

6. Ensure adequate supplies of portable oxygen cylinders.

7. Ensure blanket warmers are restocked.

8. Ensure linen for ambulance use is restocked.

9. Ensure areas are cleaned and ready for use.

10. Ensure clinical areas are continually resupplied.

11. Maintain communications with the ED Coordinator


1. Participate in the debrief


Forms required: • Major Incident Log (Running Sheet) (Appendix 5) • Patient Tracking Log (Appendix 6)





25.9 Action Card 9: Relative Reception Coordinator

Relative Reception Coordinator: Front Office Clerical Officer may be delegated to other staff


Responsibilities: Coordinating relatives, family and friends.


1. Liaise with the Emergency Controller and receive a brief on the type, scope and location of the external emergency.

2. Collect Action Card from EC

3. Proceed to the PCU Dining Room and arrange set up as required

• chairs and tables • refreshments

4. Maintain the relative register at the Front Office

5. Liaise with the Department of Communities for shelter, personal needs and crisis counselling.

6. Provide half hourly updates to the Emergency Controller


8. Ensure a decisions/events log is maintained.




Forms required: • Relatives Register (Appendix13) • Decision/Events Log (Appendix 11)





25.10 Action Card 10: Clerical Officer Front Office Clerical Officer Front Office: Clerical Officer as delegated Ext 201

Reporting to: Emergency Controller Wi-Fi 216 Responsibilities: Coordinating clerical and administrative assistance to support the health response. ON ALERT: Advice of an impending emergency TICK √

1. Proceed to the LEOC, Meeting Room for a CETHANE.

2. Collect Action Card from LEOC, Meeting Room.

3. Review staffing levels and supply needs


1. Proceed to the LEOC, Meeting Room for a SITREP.

2. Disseminate information on the type, scope and location of the external emergency to the admin team, as required.

3. Review staffing levels and supply needs. Report any deficits to the Emergency Controller.

4. Obtain and review the VMP on call list to disseminate to all departments



2. Refer/transfer all relative calls to the Front Office Ext 201.

3. Refer all media enquiries to Inland Operations Manager M: 0438 062 341

4. Provide an updated list of on call VMPs and specialists to relevant staff.

5. Support Emergency Controller/ LEOC with clerical needs, as required.

6. Provide half hourly updates to the Emergency Controller.






Forms required for this role: • Phone Communication Log (Appendix 11) • Patient Log (Appendix 6) • Available Specialists and GPs (Appendix 10) • Log of Decisions / Events (Appendix 4) • Volunteer Log (Appendix 9)





25.11 Action Card 11: Traffic Coordinator

Traffic Coordinator : PCA / Orderly or engineering staff as delegated


Responsibilities: Coordinating on site traffic. - Direct vehicle and pedestrian traffic at the entrance to the hospital - All ambulances to go to the ED - All casualties are to be directed to triage desk at ED



2. Collect Traffic Coordinator vest and Action Card from LEOC. Don vest. Keep Action Card on hand.

3. Provide direction for all traffic flow (ambulance, bus or private vehicle) within campus grounds using signs and bollards (as available).

4. Direct relatives to the Primary Health Main Reception.

5. Direct all media to Meeting Room (Support Services) via the delivery entrance.



8. Maintain communications with all key stakeholders.








25.12 Action Card 12: Support Service Coordinator Support Services Coordinator: Support Services Coordinator or delegate

Note: Likely to be delegated to the Orderly, PCA, Cook or PSA

Reporting to: Emergency Controller Ext 216

Responsibilities: To ensure that the hospital receives support services to maintain activities in a Code Brown situation.


1. Proceed immediately to the LEOC (Meeting Room)

2. Receive brief from the Emergency Controller on the type, scope and location of the emergency and the required health response (casualty reception).

3. Ensure all support services staff are informed

4. Liaise with the Emergency Controller to determine the allocation of resources.

5. Ensure adequate PSA/ PCA/ cleaner/ orderly support for clinical areas.

6.

Coordinate the following to support the health response, including distressed relatives room:

• Linen services (includes restocking general and blanket warmer) • Cleaning and waste management • Food services • Orderly services • Mortuary services

7. Maintain communications with support service staff and other key stakeholders.




Forms required:

• Staff Call In log (Appendix 7)





25.13 Action Card 13: Walking Wounded Coordinator

Walking Wounded Coordinator: Registered Nurse Wi-Fi 390

Reporting to: Emergency Controller Ext 216

Responsibilities: Coordinate walking wounded casualty area


1. Proceed to the Meeting Room for Sit Rep and CETHANE

2. Prepare Therapy Room for walking wounded casualties

3. Emergency Controller to arrange additional staff, medical, nursing, administration as required

4. Liaise with Support Service Coordinator for services as required


1 Liaise with Emergency Controller for expected casualty numbers

2 Collect dressing trolley from Treatment Room include additional equipment as per 24. Supply List link

3 Set-up environment for reception of casualties – include source additional chairs from Physiotherapy Gym

4 Organise documents and log


1. Coordinate walking wounded clinic

2. Maintain log of casualties. Note discharge or transfer times.

3. Provide 30 minute updates to the Emergency Controller


1. Inform area of stand down 2. Participate in debrief 3. Assist with recovery and equipment refurbishment 4. Prepare reports as required

Forms required for this role: • Supplies for Walking Wounded Clinic (Section 24) • Log of Decisions / Events (Appendix 4) • Patent Log (Appendix 6) • MR1





26. Appendices

South West Forms

Appendix 1 Phonetic Alphabet Chart Appendix 2 Logging onto WebEOC Appendix 3 ETHANE cue sheet Appendix 4 Decisions / Events Log Appendix 5 Major Incident / Medical Log Appendix 6 Patient Log Appendix 7 Staff Call in Log Appendix 8 Relative Register Appendix 9 Volunteer Register Appendix 10 Available Specialists and General Practitioners Appendix 11 Phone Communication Log Appendix 12 Bed Occupancy Status (bed management system or census) Appendix 13 MIMMS Sites Disaster Phone Numbers Appendix 15 Notification of Incident Appendix 16 Local Phone Numbers List





APPENDIX 1 - PHONETIC ALPHABET





APPENDIX 2 - LOGGING ON TO WEBEOC https://myeoc.health.wa.gov.au/eoc7/














APPENDIX 3 - ETHANE CUE CARD

CODE BROWN EXTERNAL EMERGENCY

ETHANE CUE CARD

Caller identified …………………………………………………………………………

Exact location of disaster ……………………………………………………………………………

Type of incident ……………………………………………………………………………

Hazards present ……………………………………………………………………………

Access / Egress to the site ……………………………………………………………………………

Number and type of casualties…………………………………………………………………………

Emergency Services (present and required)…………………………………………………………





APPENDIX 4 - DECISIONS / EVENTS LOG Decisions / Events Log

Date / Time Event /Issue Key Decisions and Actions Outcome Sign





APPENDIX 5 - MAJOR INCIDENT / MEDICAL LOG

Major Incident / Medical Log • Once completed this is a Legal Document. • Use of WebEOC is preferable but if no access use this document as a temporary record and then transcribe into WebEOC

Date and Time Key Decisions and Actions









APPENDIX 6 - PATIENT LOG

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

Name Time In Area Category Presenting

Complaint Treatment Time Out Destination





APPENDIX 7 - STAFF CALL-IN LOG Staff “Call In” Log

Name Role Time In Time Out Sign





APPENDIX 8 - RELATIVES REGISTER

Relatives Register Name Contact Address Contact Numbers Person waiting for





APPENDIX 9 - VOLUNTEER REGISTER

Volunteer Register

Completed by clerical staff. Credentialing completed by Warren Health Service LHDC

Name Address Contact Number

ID (D/L, Nursing

Reg) Special Skills

Date and Time

Available

Any Special Requirements E.G. Dietary,

Medical

ID Badge Issued

Copy Of Driver's License





APPENDIX 10 - AVAILABLE SPECIALISTS AND GENERAL PRACTITIONERS

Available Specialists and General Practitioners

Completed by clerical staff and used to update the Emergency Controller

Name Contact Number Specialty Time Available ID Badge Issued





APPENDIX 11 - COMMUNICATION LOG

Phone Communication Log NAME of Officer Completing Log._________________________

Date Time Phone Call FROM:

Phone Call TO: Purpose in Calling Actions Arising Sign





APPENDIX 12 - BED OCCUPANCY STATUS Bed Occupancy Status (bed management system or census)

Compiled by ward staff and provided to the Emergency Controller

Bed Number Bed Available Potential Discharge Time Bed Available Comments





APPENDIX 13 - MIMMS SITE DISASTER PHONE NUMBERS MIMMS Sites Disaster Phone Numbers – Please refer to Local Emergency Control Centre and Emergency Department for current list.


Code Brown - Emergency Response Procedure - Warren Health Service



APPENDIX 15 - NOTIFICATION OF INCIDENT Notification of Incident – Sit Rep can be found below http://wachs.hdwa.health.wa.gov.au/index.php?id=6509 Completed as per the WACHS Emergency Management: Situation Report Procedure


http://wachs.hdwa.health.wa.gov.au/index.php?id=6509


Code Brown - Emergency Response Procedure - Warren Health Service



APPENDIX 15 – CONTACT NUMBERS Phones are maintained in the Nurses Station write up room. Position Contact Number Emergency Controller 216 District Manager 233 Triage ED 214 Walking Wounded C 390 Traffic Coordinator 212 Area Warden Perm Care Unit 234 Kitchen (role) Ext 227 Admin Front Office Ext 201 ED / Switch board Ext 9


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