NHREMS Safety Policy by xV5RuU


									                                                         Environment of Care Safety Manual
                New Hanover Regional
                Medical Center

Title:                                 New Hanover Regional Emergency Medical Services Safety Plan
                                       Off Sites
Origination Date:                      12/9/99            Manual        Environment of Care Safety Manual
Review Date(s):                        2/20/02, 3/1/02    Section:      8
Revision Date(s):                      12/02              Policy No.:   8.1
Effective Date:                        12/02              Contact       NHREMS, Safety Services

    J. E. Woodard, Jr., Vice President andChief                          Eveline Saltmarsh, Assistant Chief
    Emergency Medical Services                                           Flight Operations & Critical Care Transport

    Patricia Fields, Asst. Chief                                         John Forestell
    Field Operations & Communications                                    Safety Officer

    Terry Rickey, MBA HEM CHSP                                           Barbara Bisset, RN MPH MS
    Senior Safety Officer                                                Director of Emergency Response, Safety Management
                                                                         and Special Police Services
                                                                         Chair, Environment of Care Council

         I.       PURPOSE
                  A.   The department safety plan defines safety requirements specific to the individual job
                       descriptions and other safety requirements specific to the department.

         II.      POLICY
                  A.    All employees are expected to follow the policies and procedures and plans as defined in the
                        Environment of Care Safety Manual.
                  B.    The department management and Safety Services reviews the department safety plan at a
                        minimum on a triennial basis.
                  C.    A minimum of one department specific safety related inservice is given to staff per year.
                  D.    Specific department safety training records will be maintained in the individual departments.

         III.     PROCEDURE
                  A.    Safety Policies and Procedures Specific to Emergency Medical Services:
                       1.      NHREMS Department Safety Plan
                       2.      NHREMS Hurricane Plan
                       3.      EMS Scene Safety
                       4.      Infection Control
                       5.      Hazardous Materials Response
                       6.      Helicopter Safety
                       7.      Narcotics
                       8.      Use of Personal Floatation Devices
                       9.      Use of Warning Devices During The Transport Of Patients
                       10.     Vehicle Security

                  B.           Emergency Management

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         NHREMS 1202
                                                                           New Hanover Regional Medical Center
                                                                             Environment of Care Safety Manual
                                                    New Hanover Regional Emergency Medical Services Safety Plan

              1.   Off site emergency code response wall charts for emergency codes are located in
              2.   Emergency code number 7999 (on site at NHRMC), 8300 (on site at CFH), 9-911 at
                   all other campuses.
              3.   NHREMS is a part of the incident command structure, assigned to several roles.
                   a)       Field Operations Chief is responsible for EMS field operations.
                   b)       EMS Liaison- critical for communicating field events to the Planning Team.
                   c)       External Transportation Officer – key role in coordinating all external
                            transportation needs of the hospital.
              4.   The following NHREMS notations are made for emergency codes.

                    Bioterrorism                      Bioterrorism Event
                                                      NHREMS are considered frontline first
                                                      responders. Appropriate protective
                                                      measures, including required PPE will
                                                      be worn when such an event is
                                                      identified. Infection Disease Manager
                                                      will be contacted as a resource.

                    Code Aster                        Mass Casualty
                                                      Incident command protocols will be
                                                      instituted. Refer to NHREMS

                    Code Blue                         Life Threatening Medical Emergency
                                                      Refer to Respiratory and Cardiac
                                                      Arrest Protocols.

                    Code Gray                         Non-Life Threatening Medical
                                                      Not applicable unless staff are on a
                                                      hospital campus at the time.

                    Code Orange                       Hostage
                                                      Staff is to maintain scene safety as
                                                      described earlier in this plan.

                    Code Pink Alert                   Suspicious Circumstance For Infant
                                                      /Child Abduction
                                                      NHREMS will be notified of such alerts
                                                      to watch for suspicious circumstances.

                    Code Pink                         Infant/Child Abduction
                                                      If in the affected building at the time, to
                                                      secure the nearest exit/entrance. To
                                                      watch and report any suspicious

                    Code Red                          Smell of Smoke and/or Fire
                                                      Call 9-911 if fire occurs at a station.
                                                      Use RACE and PASS procedures.
                                                      Staff is to know evacuation routes of
                                                      the stations.
                                                      If a fire occurs on a vehicle, RACE and
                                                      PASS procedures are to be utilized,
                                                      with assistance from 911 if needed. An

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                                                                     New Hanover Regional Medical Center
                                                                       Environment of Care Safety Manual
                                              New Hanover Regional Emergency Medical Services Safety Plan

                                                Occurrence Report is to be completed
                                                and forwarded to Risk Management for
                                                insurance purposes.

              Code Search                       Bomb Threat
                                                Immediately call 911, then notify 343-
                                                Evacuate the affected facility.
                                                Follow the directions of law
                                                enforcement upon their arrival

              Code Spill                        Chemical Spill (internal to facility)
                                                Use RAFT procedures.
                                                Notify the Safety Officer on Call on
                                                pager 341-6786.

              Code Strong                       Threat To Individual(S) Safety
                                                If threatened when on a campus, call a
                                                Code Strong. If on an EMS scene,
                                                contact 911.

              Code Watch                        High Security Risk To Campus
                                                Notify Emergency Department of
                                                transport of violent/or potentially violent
                                                and/or high security risk situations so
                                                lockdown measures can be initiated.

              Code White                        Communication Failure
                                                Notify Logistics Officer of equipment
                                                failures. Notify Information Services of
                                                computer failures.

              Code Yellow                       Nuclear, Biological, Chemical (NBC)
                                                Notify ED as soon as possible of
                                                events that will require patient
                                                decontamination. Use appropriate

              Civil Disturbance                 Civil Disturbance
                                                Refer to Scene Safety section of this
                                                plan. Prepare for the potential of a
                                                disruption of traffic patterns and /or for
                                                mass casualty event.

              Evacuation, Emergency             Emergency Evacuation
                                                Evacuation route diagrams are posted
                                                in all stations.

              Evacuation, Planned               Planned Evacuation
                                                Implemented when there is not an
                                                imminent threat, but the buildings must
                                                be evacuated, e.g. hurricane threat.
                                                Direction will come from Emergency
                                                Operations Command Center.

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                                                         New Hanover Regional Emergency Medical Services Safety Plan

                       Inclement Weather:                  Inclement Weather
                       Hail, Ice and Snow                  Refer to department’s Hurricane Plan.
                       Hurricane                           Know identified safe areas in all
                       Tornado                             stations in event of tornado threat.
                                                           Know safety measures if in a vehicle.
                                                           Follow actions as described in Tornado
                                                           Response Plan in the Emergency
                                                           Management Section of the
                                                           Environment of Care Safety Manual.

                       Suspicious Mail/Packages            Suspicious mail and/or packages.
                                                           As per the Suspicious Mail/Package
                                                           Plan in the Security section of the
                                                           Environment of Care Manual.

       C.     General Safety
              1.     Safety Manual Locations
                     a)      Environment of Care Safety Manuals are located in the NHREMS
                             administrative offices and satellite stations.
              2.     General Safety Training
                     a)      Refer to NHREMS orientation checklist for safety components of training.
                     b)      Safety education annual requirements:
                             (1)       Annual safety education
                             (2)       Blood borne pathogens
                             (3)       Landing zone & helicopter safety
                             (4)       Drivers of vehicles are required to take an Emergency Vehicle
                                       Operations Training course.
              3.     Stretcher Related Patient Safety
                     a)      Patient’s arms and legs are not to protrude from the stretcher.
                     b)      Patients being transported by NHREMS must be secured by utilization of at
                             least two safety straps and shoulder harness provided on the stretcher. This
                             must be done prior to moving the patient to the vehicle.
                     c)      When the patient is being transferred on a backboard, the patient is to be
                             secured to the board by utilization of the straps provided. The patient and
                             the backboard are to be secured on the stretcher with at least two safety
                             straps and shoulder harness.
                     d)      When a patient is on the stretcher, side rails of the stretcher must remain up
                             at all times unless a member of the transport team is involved in direct
                             patient care and the care requires the siderails to be down.
                     e)      All beds are to be locked before attempting to transfer a patient to or from
                             another stretcher, table or pad.
                     f)      Occupied stretchers are to be in a locked position if possible unless patient
                             is being transported.
                     g)      While wheeling the stretcher on inclines and declines, be sure that the
                             stretcher does not turn sideways.
                     h)      Children are transported in a child’s car seat restraining device that is
                             appropriate for the child’s size.
              4.     Stretcher Transport in a Facility
                     a)      Go slowly.
                     b)      Use added care when approaching corridor intersections to avoid collisions.
                     c)      Keep to the right in corridors.
                     d)      Protect patients from jars and jolts at door thresholds and elevators by going

              5.      General Personnel Safety

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                                                       New Hanover Regional Emergency Medical Services Safety Plan

                     a)    General Office Safety
                           (1)       Workspaces are to be ergonomically arranged to meet his/her
                                     individual needs.
                           (2)       Personnel are to use good posture, managing physical stress,
                                     protecting their voice, decreasing eye strain, and lessen general
                                     fatigue associated with working at a computer for long periods of
                     b)    Preemployment and annual physicals requirements specific for NHREMS
                           field personnel include:
                           (1)       Psychological testing
                           (2)       Functional capacity evaluation
                           (3)       Eye examination
                           (4)       Hearing test
                     c)    Refer to Safety Management section of the Environment of Care Safety
                           Manual for Safe Lifting, Transfer and Transport Procedures.
                     d)    Use extreme caution when using ramps in wet or icy weather.
                     e)    Sharp instruments, needles and glass objects are to be discarded and
                           disposed in receptacles specifically provided for them.
                     f)    Members of the transport team will not smoke, eat or drink during operation
                           of the vehicle.
                     g)    Seatbelts in the vehicle cab will be worn at all times. Seat belts will be worn
                           in the patient care area of the unit except when direct patient care is being
                           rendered that requires the staff member to be directly at the bedside.
                     h)    Personnel will utilize appropriate PPE for scene hazards. The equipment
                           includes, but is not limited to turnout gear, ballistic vests, and traffic vests.
                     i)    All staff who enters the helipad must have completed the Helicopter Safety
                           Competency. Refer to Helicopter Safety Plan in the Safety Management
                           Section of the Environment of Care Safety Manual.
              6.     EMS Scene Safety
                     a)    Calls dispatched with known or suspected incidents of violence require the
                           responding unit to stage no closer than 400 feet from the scene prior to Law
                           Enforcement arrival. Personnel will not enter these types of scenes until
                           cleared by Law Enforcement.
                     b)    Personnel must be aware of their surroundings and all possible dangers; i.e.
                           poorly lit areas, dark homes, and alleyways.
                     c)    Vehicles will not be parked directly in front of a scene, if possible. Personnel
                           will approach the scene from an angle to allow a better view of the scene or
                           suspicious behavior.
                     d)    Personnel will avoid standing in front of doors and windows.
                     e)    If confronted with a violent situation, personnel will retreat to a safe area and
                           contact Law Enforcement. Re-entry is not to be attempted until Law
                           Enforcement has controlled the scene.
                     f)    Firefighters turn out gear [Helmet w/shield, gloves, bunker coat, and bunker
                           pants] are to be utilized on all MVA resulting in broken glass and / or torn
                           metal. This apparel is mandatory for all personnel actively participating in
                           and or around mechanical / hydraulic extrication operations.
                     g)    Ballistic vests are issued for the protection of the field personnel. There are
                           numerous call situations in which the use of this PPE is advisable. The
                           application of this device up to the user’s good sound judgement.
                     h)    Latex or approved alternative gloves are to be worn at anytime bodily fluids
                           are present or invasive procedures are attempted.
                     i)    The Hazardous Materials Standard Operating Guidelines will be followed for
                           all known or potential HAZMAT situations. (Refer to EMS SOG).

       D.     Hazardous Materials

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                                                         New Hanover Regional Emergency Medical Services Safety Plan

              1.      Hazardous materials located in department are listed in the department’s chemical
                      inventory list, located in the Safety Manual.
              2.      MSDS sheets are located in the MSDS section in the Safety Manual and are also
                      available by calling 1-800-451-8346.
              3.      Training related to hazardous materials includes:
                      a)      24 hours HAZMAT Operations initial training for Field Ops
                      b)        8 hours HAZMAT Awareness initial training for VitaLink/AirLink
                      c)        8 hours annual HAZMAT continuing education.
              4.      Personal protective equipment for hazardous materials include face shields, masks,
                      gloves, and gowns located on every EMS vehicle.
              5.      Management of regulated waste policy is a part of orientation.

       E.     Life Safety
              1.      Explosion Hazard Regulations:
                      a)      No smoking is allowed on the NHREMS units.
                      b)      No smoking is allowed while the vehicle is being fueled.
                      c)      Protective gloves must be worn when cleaning with disinfectants and
                              germicides other than alcohol.
                      d)      No general anesthesia is administered or stored on NHREMS units.
                      e)      No combustible materials are stored on NHREMS units.
                      f)      Any defect in the oxygen administration system, such as a malfunctioning
                              flow meter must be reported immediately to the Vehicle Maintenance
                              Supervisor and the situation corrected before being put back into service.
              2.       Fire Regulations:
                      a)      The Medical Center's Fire Code Red plan is kept in the department and
                              readily available to staff. The staff is to follow the life safety procedures as
                              identified in that plan.
                      b)      Evacuation routes are posted in each NHREMS facility. In the event of a fire
                              in the off site buildings, the area of refuge is to evacuate the building.
                      c)      Fire extinguishers are in all the facilities and are on all NHREMS vehicles.
                              The staff will know the location of the nearest fire extinguisher and it's proper
                      d)      When a fire occurs in the vehicle, the staff will:
                              (1)      Stop vehicle if in motion and remove patient from immediate danger.
                              (2)      Either the RN or the paramedic will remain with the patient at all
                              (3)      The assigned driver will notify emergency personnel by contacting
                                       "911" services.
                              (4)      Staff will secure fire extinguisher and extinguish fire if possible. One
                                       fire extinguisher is located in the front of the vehicle with a second
                                       extinguisher located in the patient care area.
                              (5)      Turn off all oxygen valves. Turn off electrical equipment.
                              (6)      Secure medical record, if possible.
                              (7)      Await assistance from local emergency personnel.
                      e)      In the event any construction/renovation is planned for one of the buildings,
                              Safety Services is be notified and the Safety Officer will determine if Interim
                              Life Safety Measures (ILSM) are to be initiated.

       F.     Equipment
              1.    Staff is oriented to medical equipment prior to use. Training to specific equipment
                    specific to job description is located on employee orientation checklists.
              2.    List of medical equipment is located on vehicle daily checklists.
              3.    List of safety specific equipment located on vehicle daily checklists.
              4.    List of pertinent nonmedical equipment (that requires training to use) located on
                    employee orientation checklists.
              5.    Electrical Safety

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                                                           New Hanover Regional Emergency Medical Services Safety Plan

                         a)     All new medical electrical equipment will be inspected and approved by
                                BioMedical Engineering prior to its use. It will be reinspected on a scheduled
                                basis as determined by BioMedical Engineering. Inspection documentation
                                will be maintained by BioMedical Engineering.
                                (1)       An inspection sticker will be placed on the piece of equipment.
                                (2)       Staff is to report any inspection sticker with a date greater than one
                                          year or past the documented due date to their supervisor, who in
                                          turn will report it to BioMedical Engineering.
                         b)     All electrical equipment will have the appropriately grounded (three prong or
                                double insulation) plugs.
                         c)     Cords will be inspected to ensure that plugs or insulation areas are not
                                broken. Cords will be kept away from rough, sharp, hot surfaces. Broken
                                cords will be reported to BioMedical Engineering immediately.
                         d)     All electrical devices or equipment not meeting safety standards will be
                                removed and sent to BioMedical Engineering for assessment.
                         e)     Staff will be alert for trouble signs. If a machine overheats, smokes, or
                                sparks, it will be immediately unplugged and taken to BioMedical
                         f)     Electrical equipment will not be touched when an employee is in or near wet
                                spots or has wet hands.
                         g)     Power cords will be disconnected from receptacles by pulling the body of the
                                plug, not by pulling on the cord.
                         h)     Staff is to keep liquids away from electrical equipment.
                         i)     If electrical equipment has been dropped or otherwise physically disabled or
                                if liquid has been spilled on it, it will be taken to BioMedical Engineering.
                         j)     The staff is instructed never to touch two current carrying devices
                                simultaneously or a current carrying device with one hand and the patient
                                with the other.
                         k)     The staff is not to touch electrical devices or their metal surfaces with one
                                hand while using the other hand to adjust instrument controls, check
                                electrodes, handle the patient or adjust the stretcher.
                         l)     The staff are to spot check for dangling power or patient cables, kinks in
                                wires, loose plugs in wall receptacles, loose EKG electrodes or frayed wires.
                                These problems will be taken out of service and given to BioMedical
                                Engineering for repair.
                         m)     The staff when testing defibrillators will follow operator’s manual instructions
                                and will discharge voltage into a test block only.
                         n)     The staff is to verify staff clearance from patient and the bed prior to patient
                         o)     Defibrillation devices are to be replaced and removed from service if:
                                (1)       Anyone received a shock in connection with its use.
                                (2)       There is evidence of overheating by smell or touch.
                                (3)       There is a wire, especially a power cord that has been frayed, worn,
                                          burned or cut insulation.
                                (4)       There is a plug that is broken, bent or loose.
                                (5)       Cable connectors are loosely connected to the cable, or to the
                                          instrument panel, or that do not hold securely.
                                (6)       Switches are loose or do not snap definitively form one position to
                                (7)       Control knobs are loose or do not turn smoothly.
                                (8)       Switches, knobs or other controls that do not consistently produce
                                          the expected results when they are operated.
              6.         Any event which suggests to the user that a device is not operating normally.

       G.     Security

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                                                         New Hanover Regional Emergency Medical Services Safety Plan

              1.      All EMS stations and offices are to remain locked at all times when not occupied or
                      when an employee may be alone without adequate security. Access is available
                      through keypunch access devices or key locks.
              2.      Key punch codes and keys are not to be distributed to any person not directly
                      affiliated with NHREMS.
              3.      For vehicle security see Vehicle Security Policy.

       H.     Utility Systems
              1.        NHREMS contracts with a vendor to refill the liquid oxygen tanks.
              2.        Medical gas outlets are located on the med-walls of all EMS vehicles and aircraft.
              3.        Medical gas valves is to be turned off when not in use and anytime a risk of fire
                        exists (i.e. EMS vehicle involved in accident, smell of smoke in vehicle).
              4.        All EMS personnel assigned to the unit have the authority to turn off medical gas
                        valves as appropriate.
              5.        Off site emergency response charts are located at each station.


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