Code GREEN DELTA Level 1

• If staffing allows, immediately send 1 (one) to the Emergency Department. his nurse should immediately seek out Labor Pool coordinators and state s/he is from the PICU
• Complete and drop off Disaster Information Form to the Labor Pool located in the Medical Imaging/ Lab Waiting Area (Room A – 0501)
• Work with Charge Nurse and Attending Physician to assess potential discharges or transfers
• Prepare for potentially large volume of admissions
• Assess that essential equipment is available
• Assess stock of supplies
• Reassure families only if prompted
• Be prepared to initiate call trees if instructed by Incident Command

Code GREEN DELTA Level 1

• Maintain regular patient care unless otherwise instructed by Incident Command
• Complete and drop off Disaster Information Form to the Labor Pool located in the Medical Imaging/ Lab Waiting Area (Room A – 0501)
• Work with Charge Nurse and Attending Physician to assess potential discharges or transfers
• Prepare for potentially large volume of admissions
• Assess that essential equipment is available
• Assess stock of supplies
• Reassure families only if prompted
• Be prepared to initiate call trees if instructed by Incident Command

Code GREEN DELTA Level 1

• All Surgical Department procedures in progress should be completed without delay
• No surgical procedures should to be started unless the patient is classified as high-risk. Notify Incident Command if a high risk procedure is indicated
• Review surgical and procedural schedule. Prioritize any high risk surgeries or procedures and notify Incident Command
• Await approval from Incident Command to cancel elective and non-high risk surgeries and procedures
• Notify patient and family of cancellations related to the activation of a mass causality response
• If and when appropriate, reschedule procedures and surgeries
• Complete and drop off Disaster Information Form to the Labor Pool located in the Medical Imaging/ Lab Waiting Area (Room A – 0501)
• Assess that essential equipment is available
• Assess stock of supplies
• Reassure families only if prompted
• Be prepared to initiate call trees if instructed by Incident Command

Code GREEN DELTA Level 1

• Emergency Department activates departmental MCI Plan
• Charge Nurse should validate one nurse from each of the following units has reported directly to the Emergency Department: PICU, 4th floor
• Ten (10) stretchers, (10) wheelchairs, and one (1) linen cart will be parked outside the ED
• Three (3) crash carts will arrive from Equipment Technician
• Three (3) medication drawers will arrive from the pharmacy
• Flow Supervisor and Attending Physician will identify potential discharges or transfers
• Prepare for potentially large volume of admissions
• Be prepared to initiate call trees if instructed by Incident Command

Emergency Department Supervisor

The Charge Nurse will assume the role and responsibility of Emergency Department Supervisor until the ED Manager arrives. The Charge Nurse will delegate any current patient care responsibilities to staff.
Emergency Department Supervisor will work with the Patient Flow Coordinator to obtain additional staff for the ED from other inpatient units (RNs, Respiratory Therapists, Unit Coordinators, etc) A Labor Pool Disaster Staffing form, stating the number of Emergency Department physicians, nurses, technicians currently working on that specific shift, will be completed and sent to the Labor Pool located outside of Medical Imaging, ground floor.

• An RN or paramedic will be assigned Triage Unit Leader and will go to the ambulance bay to prioritize and direct incoming patients.
• A paramedic will be assigned Hazmat Branch Leader (as needed) to supervise the decontamination area
• Members of the Decon Team will be assigned to assist patients and families with the decontamination process.
• The Pivot RN will remain at the reception desk to care for walk in patients. The Pivot RN will remain in constant contact with the Emergency Department Supervisor with an update
• Zone Leaders (Red, Yellow, Green) will be assigned as needed based on the volume and acuity of patients.
• At least one RN will be assigned to each of the Treatment Rooms (ED/PICU RN)
• An RN/Paramedic team (based on availability) will be assigned to each zone.
• An associate (unit coordinator, support services technician) will remain at the nurse’s station to answer phones and assist families with questions and/or concerns.

Emergency Department Supervisor will remain in constant communication with the Emergency Treatment Director, Hazmat Branch Leader, and Pivot Nurse.

Emergency Treatment Director

The Attending physician will assume the role of Emergency Treatment Director. The Emergency Treatment Director will coordinate appropriate distribution of physicians amongst ED treatment areas, will call for additional physician support for the rapid influx of patients, and direct the physicians to their zones.

• A physician will be assigned to the ED Treatment Rooms
• Physicians will be distributed to the red, yellow and green zones.
• One physician/practitioner will be assigned to the ED Commons Area for management of low acuity patients
• The Emergency Treatment Director will communicate with the Emergency Department Supervisor.
• The Emergency Treatment Director will immediately assess current ED patients for clinical status and disposition.
• The Emergency Treatment Director will determine if any ED patients can be discharged immediately to provide bed space for the anticipated disaster patients and will facilitate their discharge.

Patient Movement

• Low acuity patients awaiting results or treatments to finalize their care and disposition will be moved to the ED Commons Area until disposition is possible.
• Higher acuity patients that cannot be dispositioned will remain in an exam room until disposition can be determined.
• Current ED patients that have not been placed in a treatment bed will remain in the ED Commons Area, with the exception of emergency or critical patients who will be brought back to the appropriate care location.
• The Emergency physician will work with the Patient Flow Coordinator, Hospitalist, and Intensivist to facilitate admission of patients and their movement to the appropriate floor for continued treatment.

Staff

Once staff have received their assignments, they will prepare for patient arrival:

• IV start kits, One Liter Normal Saline bags, and necessary supplies will be placed in each room
• Ensure that adequate linen is readily accessible (call for more linen if needed)
• Fill blanket warmers
• Set up all cardiac monitors:
• Ensure all connections for complete physiologic monitoring (pulse oximetry probe, EKG leads, blood pressure cuff) are in all rooms.
• Place all monitors on stand-by.

As ED staff report, the Emergency Department Supervisor will direct them to an area of need.
As other patient care unit staff report, the Emergency Department Supervisor will direct them, as appropriate, to the “Labor Pool” to be reassigned by Incident Command.
The Charge Nurse will update Incident Command on staffing needs and those released back to the “Labor Pool.”

Code GREEN DELTA Level 1

• If staffing allows, immediately send 1 (one) to the Emergency Department. his nurse should immediately seek out Labor Pool coordinators and state s/he is from 4S
• Complete and drop off Disaster Information Form to the Labor Pool located in the Medical Imaging/ Lab Waiting Area (Room A – 0501)
• Work with Charge Nurse and Attending Physician to assess potential discharges or transfers
• Prepare for potentially large volume of admissions
• Assess that essential equipment is available
• Assess stock of supplies
• Reassure families only if prompted
• Be prepared to initiate call trees if instructed by Incident Command

Code GREEN DELTA Level 1

• Maintain regular patient care unless otherwise instructed by Incident Command
• Complete and drop off Disaster Information Form to the Labor Pool located in the Medical Imaging/ Lab Waiting Area (Room A – 0501)
• Work with Charge Nurse and Attending Physician to assess potential discharges or transfers
• Prepare for potentially large volume of admissions
• Assess that essential equipment is available
• Assess stock of supplies
• Reassure families only if prompted
• Be prepared to initiate call trees if instructed by Incident Command

Code GREEN DELTA Level 1

• Maintain regular patient care unless otherwise instructed by Incident Command
• Complete and drop off Disaster Information Form to the Labor Pool located in the Medical Imaging/ Lab Waiting Area (Room A – 0501)
• Work with Charge Nurse and Attending Physician to assess potential discharges or transfers
• Prepare for potentially large volume of admissions
• Assess that essential equipment is available
• Assess stock of supplies
• Reassure families only if prompted
• Be prepared to initiate call trees if instructed by Incident Command

Code GREEN DELTA Level 1

• Complete and drop off Disaster Information Form to the Labor Pool located in the Medical Imaging/ Lab Waiting Area (Room A – 0501)
• Review clinic schedule and assess for critical patient visits and patients traveling long distances for appointments
• Await Incident Command decision for appointment cancellation. Notify families of cancelled appointments.
• If appropriate, reschedule or resume patient appointments
• Assess that essential equipment is available
• Assess stock of supplies
• Reassure families only if prompted
• Be prepared to initiate call trees if instructed by Incident Command
• Prepare for possible reassignment of nursing staff

Code GREEN DELTA Level 1

During 8 am to 5PM:

• Code GREEN DELTA 1 or 2 situation: Upon notification from Emergency Department of an influx of patients, the supervisor would do the following:
  • During regular business hours, call Incident Commander, and brief the situation, asking for activation of either Code GREEN DELTA 1 or 2 If s/he is off campus, unavailable, immediately notify Administrator on Call for activation order.
  • Call Security Command Center to activate Code GREEN DELTA notification
  • Notify Administrator on Call
  • Ensure Labor Pool is activated and manned appropriately
  • Report to Incident Command
  • Set up Incident Command display Emergency Operations Plan binder and Incident Command Vests and portfolios
  • Be prepared to brief Incident Command Chiefs and Commander:
    • Pertinent, available information on the situation
    • Status of current patient population, census, and staffing
    • Specific number of patients in the following areas:
      • PICU, number of vented patients, CRRT
      • NICU, number of vented patients
    • Emergency Department
      • Currently being treated
      • Observation cases
      • Number of waiting patients
    • Dialysis patients being treated
    • PeriOp:
      • Scheduled cases
      • Cases in progress
      • Number of critical cases versus elective cases on schedule
      • Ask surgical leadership to review potential cases for cancellation
    • Clinics
      • Status of current patients

After hours, 5PM to 7AM:

• In the absence of an onsite Administrator on Call, the Patient Flow Supervisor assumes the Incident Commander responsibilities until the Incident Commander arrives
• Follow day time supervisor responsibilities
• Refer to Incident Command Checklist
• Be prepared to brief Incident Command upon arrival of team

Code GREEN DELTA Level 1

Specialty Nursing Includes But Is Not Limited To: Clinical Nurse Educators, Advanced Practice Nurses, Nursing Advancement, IV Therapy Nurses, Nursing Informatics

• Complete and drop off Disaster Information Form to the Labor Pool located in the Medical Imaging/ Lab Waiting Area (Room A – 0501)
• Work with Charge Nurse and Attending Physician to assess potential discharges or transfers as applicable in your assigned area
• Assess that essential equipment is available
• Assess stock of supplies
• Reassure families only if prompted
• Prepare for potentially large volume of admissions
• Be prepared to initiate call trees if instructed by Incident Command

Code GREEN DELTA Level 1

• Complete and drop off Disaster Information Form to the Labor Pool located in the Medical Imaging/ Lab Waiting Area (Room A – 0501)
• Assess that essential equipment is available
• Assess stock of supplies
• Be prepared to initiate call trees if instructed by Incident Command
• Prepare for possible reallocation of staff if required by Incident Command

Code GREEN DELTA Level 1

Specialty Nursing Includes But Is Not Limited To: Clinical Nurse Educators, Advanced Practice Nurses, Nursing Advancement, IV Therapy Nurses, Nursing Informatics

• One pre-designated Respiratory Therapist will report to the Emergency Department
• Additional therapists may be requested by Incident Command through the Therapist In Charge
• Assess that essential equipment is available
• Assess stock of supplies

Code GREEN DELTA Level 1

• One pre-designated Respiratory Therapist will report to the Emergency Department
• Additional therapists may be requested by Incident Command through the Therapist In Charge
• Assess that essential equipment is available
• Assess stock of supplies

Code GREEN DELTA Level 1

• One pre-designated Respiratory Therapist will report to the Emergency Department
• Additional therapists may be requested by Incident Command through the Therapist In Charge
• Assess that essential equipment is available
• Assess stock of supplies

Code GREEN DELTA Level 1

• One pre-designated Respiratory Therapist will report to the Emergency Department
• Maintain communication with Therapist In Charge if more therapists are needed
• Additional therapists may be requested by Incident Command through the Therapist In Charge
• Assess that essential equipment is available
• Assess stock of supplies

Code GREEN DELTA Level 1

• One pre-designated Respiratory Therapist will report to the Emergency Department
• Additional therapists may be requested by Incident Command through the Therapist In Charge
• Assess that essential equipment is available
• Assess stock of supplies

Code GREEN DELTA Level 1

• One pre-designated Respiratory Therapist will report to the Emergency Department
• Additional therapists may be requested by Incident Command through the Therapist In Charge
• Assess that essential equipment is available
• Assess stock of supplies

Code GREEN DELTA Level 1

• One pre-designated Respiratory Therapist will report to the Emergency Department
• Additional therapists may be requested by Incident Command through the Therapist In Charge
• Assess that essential equipment is available
• Assess stock of supplies

Code GREEN DELTA Level 1

• One pre-designated Respiratory Therapist will report to the Emergency Department
• Additional therapists may be requested by Incident Command through the Therapist In Charge
• Assess that essential equipment is available
• Assess stock of supplies

Code GREEN DELTA Level 1

• One pre-designated Respiratory Therapist will report to the Emergency Department
• Additional therapists may be requested by Incident Command through the Therapist In Charge
• Assess that essential equipment is available
• Assess stock of supplies

Code GREEN DELTA Level 1

• PICU, Critical Care Attending report to PICU
• Administrator or designee send current list of departmental physicians in house at the time of the Code Green Delta announcement to the Labor Pool
• Assess for potential transfers and discharges
• Prepare for possible large volume of admissions
• Prepare to activate call tree
• Await specific instructions from Incident Command

All other physicians can be found or contacted at the locations listed below

• PICU, Critical Care Attending report to PICU
• NICU Attending report to NICU
• Anesthesiologist and Surgeons report to PACU
• Pediatricians report to 4th floor conference room
• Medical Imagining Physicians report to Medical Imaging
• All other Specialist will remain in their department
• Hospitalist begin inpatient unit rounding identifying potential patient discharges

Code GREEN DELTA Level 1

• NICU Attending report to NICU
• Administrator or designee send current list of departmental physicians in house at the time of the Code Green Delta announcement to the Labor Pool
• Assess for potential transfers and discharges
• Prepare for possible large volume of admissions
• Prepare to activate call tree
• Await specific instructions from Incident Command

All other physicians can be found or contacted at the locations listed below

• PICU, Critical Care Attending report to PICU
• NICU Attending report to NICU
• Anesthesiologist and Surgeons report to PACU
• Pediatricians report to 4th floor conference room
• Medical Imagining Physicians report to Medical Imaging
• All other Specialist will remain in their department
• Hospitalist begin inpatient unit rounding identifying potential patient discharges

Code GREEN DELTA Level 1

• Emergency Department lead physician identifies need for increased support/resources due to present patient requirements or impending patient arrival: Administrator on Call notified, situation reviewed, and decision made to activate code delta process.
• If an immediate need exists to activate a Code Green Delta the ED Lead Physician and Patient Flow Supervisor are empowered to call a Code Delta and notify the Administrator On Call (e.g. No estimated time of arrival of mass causality or patients already present)

Emergency Department Physician response to active Code Delta:

• Administrator or designee send current list of departmental physicians in house at the time of the Code Delta announcement to the Labor Pool
• The ED attending assumes the role of Emergency Treatment Director. Their role is to organize patient care, assign physician assignments, assess medical needs (decontamination) and communicate with the Incident Command the number of patients, acuity and disposition.
• The Charge Nurse assumes the role of Emergency Department Supervisor. Their role is to assign zone leaders, help the Emergency Treatment Director in the organization of patient care, and communicate essential needs from each zone leader to the Emergency Treatment Director. They need to maintain a total census of every patient in the department and their disposition.
• The Zone leaders (Red - Yellow - Green and Staging) are RNs (the Green leader can be an ED tech to help with RN staffing) - their role is assure the rooms are labeled, identify immediate and ongoing staffing and equipment needs, communicate the needs to the ED Supervisor (Charge RN), make staffing assignments and maintain a census for the zone. Their role is not patient care, but a "charge RN" for that zone.
• The zones can represent acuity - highest (red) assigned the closer rooms, to low (green) assigned to the outpatient area for future evaluation.
• The zones can be used to divide the volume of patients with similar acuity levels.
• Zones can be ignored and "code teams" assigned for each acute patient (best done with a small number of patients - i.e., 4 critical patients from a house fire.)
• In Flu Pandemic, the zones can be assigned to the outpatient modules and teams of staff assigned to quickly decompress volume of non-acuity patients.
• The Staging area is meant for patients awaiting discharge or admission and is generally in 1A. If this need does not exist that area should be utilized as an additional treatment area for disaster patients.
• The proposed room assignments can be altered, but should be properly labeled to minimize confusion
• These decisions are decided by the ED Treatment Director with the help of the ED Supervisor. Communication of the plan is key

All other physicians can be found or contacted at the locations listed below

• PICU, Critical Care Attending report to PICU
• NICU Attending report to NICU
• Anesthesiologist and Surgeons report to PACU
• Pediatricians report to 4th floor conference room
• Medical Imagining Physicians report to Medical Imaging
• All other Specialist will remain in their department
• Hospitalist begin inpatient unit rounding identifying potential patient discharges

Code GREEN DELTA Level 1

• Pediatricians report to 4th floor video conference room
• Administrator or designee send current list of departmental physicians in house at the time of the Code Green Delta announcement to the Labor Pool
• Assess for potential transfers and discharges
• Prepare for possible large volume of admissions
• Prepare to activate call tree
• Await specific instructions from Incident Command

All other physicians can be found or contacted at the locations listed below

• PICU, Critical Care Attending report to PICU
• NICU Attending report to NICU
• Anesthesiologist and Surgeons report to PACU
• Pediatricians report to 4th floor conference room
• Medical Imagining Physicians report to Medical Imaging
• All other Specialist will remain in their department
• Hospitalist begin inpatient unit rounding identifying potential patient discharges

Code GREEN DELTA Level 1

• Hospitalist begin inpatient unit rounding identifying potential patient discharges
• Administrator or designee send current list of departmental physicians in house at the time of the Code Green Delta announcement to the Labor Pool
• Assess for potential transfers and discharges
• Prepare for possible large volume of admissions
• Prepare to activate call tree
• Await specific instructions from Incident Command

All other physicians can be found or contacted at the locations listed below

• PICU, Critical Care Attending report to PICU
• NICU Attending report to NICU
• Anesthesiologist and Surgeons report to PACU
• Pediatricians report to 4th floor conference room
• Medical Imagining Physicians report to Medical Imaging
• All other Specialist will remain in their department
• Hospitalist begin inpatient unit rounding identifying potential patient discharges

Code GREEN DELTA Level 1

• Anesthesiologist and Surgeons report to PACU
• All other Specialist will remain in their department
• Administrator or designee send current list of departmental physicians in house at the time of the Code Green Delta announcement to the Labor Pool
• Assess for potential transfers and discharges
• Prepare for possible large volume of admissions
• Prepare to activate call tree
• Await specific instructions from Incident Command

All other physicians can be found or contacted at the locations listed below

• PICU, Critical Care Attending report to PICU
• NICU Attending report to NICU
• Anesthesiologist and Surgeons report to PACU
• Pediatricians report to 4th floor conference room
• Medical Imagining Physicians report to Medical Imaging
• All other Specialist will remain in their department
• Hospitalist begin inpatient unit rounding identifying potential patient discharges

Code GREEN DELTA Level 1

• Anesthesiologist and Surgeons report to PACU
• All other Specialist will remain in their department
• Administrator or designee send current list of departmental physicians in house at the time of the Code Green Delta announcement to the Labor Pool
• Assess for potential transfers and discharges
• Prepare for possible large volume of admissions
• Prepare to activate call tree
• Await specific instructions from Incident Command

All other physicians can be found or contacted at the locations listed below

• PICU, Critical Care Attending report to PICU
• NICU Attending report to NICU
• Anesthesiologist and Surgeons report to PACU
• Pediatricians report to 4th floor conference room
• Medical Imagining Physicians report to Medical Imaging
• All other Specialist will remain in their department
• Hospitalist begin inpatient unit rounding identifying potential patient discharges

Code GREEN DELTA Level 1

• All Specialists will remain in their department
• Administrator or designee send current list of departmental physicians in house at the time of the Code Green Delta announcement to the Labor Pool
• Assess for potential transfers and discharges
• Prepare for possible large volume of admissions
• Prepare to activate call tree
• Await specific instructions from Incident Command

All other physicians can be found or contacted at the locations listed below

• PICU, Critical Care Attending report to PICU
• NICU Attending report to NICU
• Anesthesiologist and Surgeons report to PACU
• Pediatricians report to 4th floor conference room
• Medical Imagining Physicians report to Medical Imaging
• All other Specialist will remain in their department
• Hospitalist begin inpatient unit rounding identifying potential patient discharges

Code GREEN DELTA Level 1

All Other Physicians Including But Not Limited To: Orthopedics, Diagnostic Referral, Pathology, Primary Care, Developmental Medicine, Genetics, Immunology, Behavioral Health, Endocrinology, Hematology/Oncology, Neurology, Nephrology, Pulmonology, Rheumatology, Weight Management, Rehabilitation, Otolaryngology, Transition Team, Dentistry, Ophthalmology, Urology

• All Specialists will remain in their department
• Administrator or designee send current list of departmental physicians in house at the time of the Code Green Delta announcement to the Labor Pool
• Assess for potential transfers and discharges
• Prepare for possible large volume of admissions
• Prepare to activate call tree
• Await specific instructions from Incident Command

All other physicians can be found or contacted at the locations listed below

• PICU, Critical Care Attending report to PICU
• NICU Attending report to NICU
• Anesthesiologist and Surgeons report to PACU
• Pediatricians report to 4th floor conference room
• Medical Imagining Physicians report to Medical Imaging
• All other Specialist will remain in their department
• Hospitalist begin inpatient unit rounding identifying potential patient discharges

Code GREEN DELTA Level 1

• If a Code GREEN DELTA 1 or 2 is required based on an MCI alert from EMResource conference the ED Charge Nurse and PFS. Provide the following information:
  • Location of the incident
  • Description of incident (traffic accident, fire, etc)
  • Total Number of victims
  • Acuity of victims
  • Decontamination needed (yes/no)
• Hospital Incident Command activated

Code Green Delta Room Assignments:

• Incident Command Center: Executive Conference Room, 1st floor
• Labor Pool: Medical Imaging/ Lab Waiting Area (Room A – 0501), Ground Floor
• Discharge Holding Unit: 5th Floor Clinic
• Family Gathering/Waiting Area: Occupational Therapy Rehab Gym, 4th floor
• Family Support and Information Center: Auditorium
• Pediatric Safe Area—“Kids Track” on Main Floor
• Media Relations Room: Off the NCH campus across the street
• Associate Sleeping Area: Clinic areas
• Associate Child Care Area: 1st floor computer rooms 1721 (12 beds) & 1722 (12 beds)
• Associate Elder Care Area: 1st floor computer room 1723 A (10 beds) & 1723B (10 beds)
• Emergency Shelter location for associates pets: enclosed area by back loading dock

Code GREEN DELTA Level 1

• If a Code GREEN DELTA is requested, take down the following information
  • Name of caller
  • Location of the incident
  • Description of incident (traffic accident, fire, etc)
  • Number of victims coming to NCH
  • Acuity of victims
  • Gender, ages, and race of the victims
  • Decontamination needed
  • ETA to NCH
• Immediately contact the PFS (57-2364), who will contact the administrator on call.
• The acting incident Commander will direct Security when to announce the Code Delta Green
• Announce twice that there is a Code Green Delta 1 on the Fire Alarm System “Attention Please Code Green Delta Level 1.” If decontamination is needed, announce “Attention Please Code Green Delta 1 Decon.”
• Incident Commander is established (initial default is Patient Flow Supervisor until Administrator on Call or Incident Commander arrives)
• NCH’s Logistics Center established (Administration Conference Room, 1st floor) and activates Code Green Delta page to all pre-determined Code Green Delta grouping.
• Hospital Incident Command activated
• The Security Officer Recall Roster will be in effect. It will be the Emergency Department Security Officer’s responsibility
• If the situation warrants, the main Lobby entrance will be closed off using cones or barriers and placed in a lock-down status.
• Security Officers Unit 34 will be stationed at the main entrance and will assist with access control and package
• Security officer Unit 36 will assist with building sweeps.

Code Green Delta Room Assignments:

• Incident Command Center: Administration Conference Room, 1st floor
• Labor Pool: Medical Imaging/ Lab Waiting Area (Room A – 0501), Ground Floor
• Discharge Holding Unit: 5th Floor Clinic
• Family Gathering/Waiting Area: Occupational Therapy Rehab Gym, 4th floor
• Family Support and Information Center: Auditorium
• Pediatric Safe Area—“Kids Track” on Main Floor
• Media Relations Room: Off the NCH campus across the street
• Associate Sleeping Area: Clinic areas
• Associate Child Care Area: 1st floor computer rooms 1721 (12 beds) & 1722 (12 beds)
• Associate Elder Care Area: 1st floor computer room 1723 A (10 beds) & 1723B (10 beds)
• Emergency Shelter location for associates pets: enclosed area by back loading dock

Mobilize, assign, and pre-position emergency response personnel

• Security Patrol Unit 35 will initiate and operate an ID check post at the main vehicle entrance at Nemours Parkway and Lake Nona Blvd. All vehicles and pedestrians are to be stopped at this location and Employee badges verified. A Nemours vehicle and traffic cones will be utilized to block lanes and divert traffic in this effort. Unit 35 will be tasked with boarding all delivery trucks and performing a vehicle inspection prior to granting access. A phone call should be made to all receiving parties to verify delivery (this includes Materials Management deliveries). The security patrol will escort any responding police/ fire department personnel to the loading dock area. An interior security unit or manager will respond to the loading dock and provide escort for the emergency personnel to the incident scene.
• Notify Engineering Managers and request assistance with access control, building sweeps, and package inspections by staff.
• Contact the Incident Command Center to notify of severe threat status. Ask that each department conduct area sweeps. They will be tasked with conducting a department sweep once per shift and calling into the Command Center with results.

Close high risk and/or vulnerable facilities, if applicable

• The Nemours vehicle is to be parked at the main entrance creating a physical barrier. It will remain until the severe threat level is lifted
• Loading dock will not be accessed without a Materials Management representative present to verify delivery personnel and perform vehicle inspection.
• All site construction projects will be reviewed by Facilities and Security Management to determine whether the project will be suspended until the severe threat level is lifted.
• All special events will be cancelled during the severe threat event.
• Exterior door inspections and exterior sweeps to all properties are to be performed once per shift.
• Look for unattended packages, suspicious person(s) or unauthorized vehicles. Be sure to take down the vehicle tag number immediately upon identifying suspicious activity. Increased visibility of our patrols is the goal during such an event.
• Patrol should report all exterior light and access failures immediately.
• Do not allow vehicles to park alongside any of the buildings. Approach all illegally parked Vehicles and direct the driver to move immediately.
• All exterior property fencing must be inspected every 12-hours.

Immediate protocol alterations

• The Incident Command Center will be the central contact for all appointments by contractors, Vendors and/or visitorsrequiring escort. Department contacts and/or escorts will be required to give 24 hours notice for scheduled visits. A daily list will be generated by the Incident Command Center and distributed to all posts including patrol. Only those visitors and vendors on the list will be admitted onto the site.
• No personal deliveries will be permitted on site. This includes but is not limited to food and floral deliveries, etc.
• Package inspections will be performed on all packages entering the buildings.
• Badge spot inspections should be conducted on a continuous basis. Ensure all associates are wearing their identification badge in the building and advise those who are not that it is mandatory to do so.
• Building exterior sweeps will be conducted each shift.

Guidelines

In the event of a severe threat, and as directed by NCH Executive Management, the following protective measures shall be implemented only at those facilities that may be at risk during a period of heightened alert.

Initiate notification procedures and communicate as required

1. Notification to the following people and/or designee should take place during the first phase after Severe threat status is declared.
   1. Director of Facilities
   2. Administrator On Call
2. The Incident Command Center will be responsible for notifying the following entities.
   1. Emergency Response Group
   2. Security Administrator
   3. Safety Administrator
3. The Healthcare Emergency Incident Command System (HEICS) will be implemented and the Code Delta Command Center (Facilities Conference Room) will be staffed 24/7 during a severe threat affecting any NCH Facility. All satellite status updates will be communicated through The Command Center.

Level 1 - Criteria

Mass Casualty Incident with the anticipation of 25 or more patients.

• Notification as per Emergency Management Plan
• Staff pre-designated for Emergency Room report as directed.
• Follow Emergency Management Plan
• Establish Command Post and open Incident Command Center
• Commence with documentation.

Level 2 - Criteria

Local or Regional Emergency with the anticipation of fewer than 25 patients.

• Notification of Emergency Department Physician in Charge and Administrator on-call.
• Request for additional personnel made by the Emergency Department Staff.
• Follow Emergency Management Plan.
• Establish Command Post and open Incident Command Center.
• Commence with documentation.

Level 3 - Criteria

Operations Systems Failure

• Notification to all personnel by email, pager, and overhead announcement.
• Request for needed personnel, management and labor pool.
• Establish Command Post and open Incident Command Center.
• Commence with documentation.

Code GREEN DELTA Level 1

• Incident Commander is established (initial default is Patient Flow Coordinator until Administrator on Call or Incident Commander arrives)
• NCH’s Logistics Center established (Administration Conference Room, 1st floor) and activates Code Green Delta page to all pre-determined Code Green Delta grouping.
• Hospital Incident Command activated
• Incident Commander is established (initial default is Patient Flow Coordinator until Administrator on Call or Incident Commander arrives)
• NCH’s Logistics Center established (Administration Conference Room, 1st floor) and activates Code Green Delta page to all pre-determined Code Green Delta grouping.
• Hospital Incident Command activated
• The Security Officer Recall Roster will be in effect. It will be the Emergency Department Security Officer’s responsibility for notifying all Security personnel of the threat status and advising them when/where to report for duty.
• If the situation warrants, the main Lobby entrance will be closed off using cones or barriers and placed in a lock-down status.
• Security Officers Unit 34 will be stationed at the main entrance and will assist with access control and package inspections
• Security officer Unit 36 will assist with building sweeps.

Code Green Delta Room Assignments:

• Incident Command Center: Administration Conference Room, 1st floor
• Labor Pool: Medical Imaging/ Lab Waiting Area (Room A – 0501), Ground Floor
• Discharge Holding Unit: 5th Floor Clinic
• Family Gathering/Waiting Area: Occupational Therapy Rehab Gym, 4th floor
• Family Support and Information Center: Auditorium
• Pediatric Safe Area—“Kids Track” on Main Floor
• Media Relations Room: Off the NCH campus across the street
• Associate Sleeping Area: Clinic areas
• Associate Child Care Area: 1st floor computer rooms 1721 (12 beds) & 1722 (12 beds)
• Associate Elder Care Area: 1st floor computer room 1723 A (10 beds) & 1723B (10 beds)
• Emergency Shelter location for associates pets: enclosed area by back loading dock

Mobilize, assign, and pre-position emergency response personnel

• Security Patrol Unit 35 will initiate and operate an ID check post at the main vehicle entrance at Nemours Parkway and Lake Nona Blvd. All vehicles and pedestrians are to be stopped at this location and Employee badges verified. A Nemours vehicle and traffic cones will be utilized to block lanes and divert traffic in this effort. Unit 35 will be tasked with boarding all delivery trucks and performing a vehicle inspection prior to granting access. A phone call should be made to all receiving parties to verify delivery (this includes Materials Management deliveries). The security patrol will escort any responding police/ fire department personnel to the loading dock area. An interior security unit or manager will respond to the loading dock and provide escort for the emergency personnel to the incident scene.
• Notify Engineering Managers and request assistance with access control, building sweeps, and package inspections by staff.
• Contact the Incident Command Center to notify of severe threat status. Ask that each department conduct area sweeps. They will be tasked with conducting a department sweep once per shift and calling into the Command Center with results.

Close high risk and/or vulnerable facilities, if applicable

• The Nemours vehicle is to be parked at the main entrance creating a physical barrier. It will remain until the severe threat level is lifted
• Loading dock will not be accessed without a Materials Management representative present to verify delivery personnel and perform vehicle inspection.
• All site construction projects will be reviewed by Facilities and Security Management to determine whether the project will be suspended until the severe threat level is lifted.
• All special events will be cancelled during the severe threat event.
• Exterior door inspections and exterior sweeps to all properties are to be performed once per shift.
• Look for unattended packages, suspicious person(s) or unauthorized vehicles. Be sure to take down the vehicle tag number immediately upon identifying suspicious activity. Increased visibility of our patrols is the goal during such an event.
• Patrol should report all exterior light and access failures immediately.
• Do not allow vehicles to park alongside any of the buildings. Approach all illegally parked Vehicles and direct the driver to move immediately.
• All exterior property fencing must be inspected every 12-hours.

Immediate protocol alterations

• The Incident Command Center will be the central contact for all appointments by contractors, Vendors and/or visitorsrequiring escort. Department contacts and/or escorts will be required to give 24 hours notice for scheduled visits. A daily list will be generated by the Incident Command Center and distributed to all posts including patrol. Only those visitors and vendors on the list will be admitted onto the site.
• No personal deliveries will be permitted on site. This includes but is not limited to food and floral deliveries, etc.
• Package inspections will be performed on all packages entering the buildings.
• Badge spot inspections should be conducted on a continuous basis. Ensure all associates are wearing their identification badge in the building and advise those who are not that it is mandatory to do so.
• Building exterior sweeps will be conducted each shift.

Guidelines

In the event of a severe threat, and as directed by NCH Executive Management, the following protective measures shall be implemented only at those facilities that may be at risk during a period of heightened alert.

Initiate notification procedures and communicate as required

1. Notification to the following people and/or designee should take place during the first phase after Severe threat status is declared.
   1. Director of Facilities
   2. Administrator On Call
2. The Incident Command Center will be responsible for notifying the following entities.
   1. Emergency Response Group
   2. Security Administrator
   3. Safety Administrator
3. The Healthcare Emergency Incident Command System (HEICS) will be implemented and the Code Delta Command Center (Facilities Conference Room) will be staffed 24/7 during a severe threat affecting any NCH Facility. All satellite status updates will be communicated through The Command Center.

Level 1 - Criteria

Mass Casualty Incident with the anticipation of 25 or more patients.

• Notification as per Emergency Management Plan
• Staff pre-designated for Emergency Room report as directed.
• Follow Emergency Management Plan
• Establish Command Post and open Incident Command Center
• Commence with documentation.

Level 2 - Criteria

Local or Regional Emergency with the anticipation of fewer than 25 patients.

• Notification of Emergency Department Physician in Charge and Administrator on-call.
• Request for additional personnel made by the Emergency Department Staff.
• Follow Emergency Management Plan.
• Establish Command Post and open Incident Command Center.
• Commence with documentation.

Level 3 - Criteria

Operations Systems Failure

• Notification to all personnel by email, pager, and overhead announcement.
• Request for needed personnel, management and labor pool.
• Establish Command Post and open Incident Command Center.
• Commence with documentation.

Code GREEN DELTA Level 1

Administrator on Call for Code Delta 1, 2, 3 or special "Disaster Code"

• Activation of a Code Delta 1, 2 or 3 occurs when the Nursing Supervisor contacts the Administrator on Call and reports a detailed scenario of what is occurring:
  • Estimated arrival of 25 or more patients to the Emergency Department (Code Green Delta 1)
  • Estimated arrival of 24 or less patients to the Emergency Department (Code Green Delta 2)
  • An infrastructure/operations failure directly impacting the delivery safe patient care i.e., power loss, fire. (Code Green Delta 3)

Note: Emergency Physician, in collaboration with the Patient Flow Coordinator, is empowered to make Code Green Delta activation if ETA of incoming patient influx is imminent and then notify the Administrator On Call

• If this notification occurs during routine business hours, the Administrator on Call confers with the Incident Commander, COO, as to the activation of a Code Green Delta.
• If this notification occurs after hours, the Administrator On Call is empowered to activate a Code Delta
• After hours, the Administrator on Call assumes the responsibility as acting Incident Commander in the Incident Command Center

"Disaster Alert"

• Some disaster situations may not require the immediate, full manpower response resulting from activating a Code Delta 1, 2, or 3. Yet, key stakeholders should be alerted to the actual or potential disaster situation and further discussion occurs whether to activate an actual Code Delta.
• The Administrator on Call would then ask the Command Center to notify the following Leaderships personnel for further discussion:
  • Incident Commander
  • Safety Officer
  • Operations Chief
  • Planning Chief
  • Logistics Chief
  • Chief Medical Officer
  • Chief Nursing Executive
  • Any specific departmental/division leader directly impacted by that specific situation. i.e. , loss of HVAC, loss of computers

CLICK TO ACCESS INCIDENT COMMAND CHECK LIST

Code GREEN DELTA Level 1

Administrator on Call for Code Delta 1, 2, 3 or special "Disaster Code"

• Activation of a Code Delta 1, 2 or 3 occurs when the Nursing Supervisor contacts the Administrator on Call and reports a detailed scenario of what is occurring:
  • Estimated arrival of 25 or more patients to the Emergency Department (Code Green Delta 1)
  • Estimated arrival of 24 or less patients to the Emergency Department (Code Green Delta 2)
  • An infrastructure/operations failure directly impacting the delivery safe patient care i.e., power loss, fire. (Code Green Delta 3)

Note: Emergency Physician, in collaboration with the Patient Flow Coordinator, is empowered to make Code Green Delta activation if ETA of incoming patient influx is imminent and then notify the Administrator On Call

• If this notification occurs during routine business hours, the Administrator on Call confers with the Incident Commander, COO, as to the activation of a Code Green Delta.
• If this notification occurs after hours, the Administrator On Call is empowered to activate a Code Delta
• After hours, the Administrator on Call assumes the responsibility as acting Incident Commander in the Incident Command Center

"Disaster Alert"

• Some disaster situations may not require the immediate, full manpower response resulting from activating a Code Delta 1, 2, or 3. Yet, key stakeholders should be alerted to the actual or potential disaster situation and further discussion occurs whether to activate an actual Code Delta.
• The Administrator on Call would then ask the Command Center to notify the following Leaderships personnel for further discussion:
  • Incident Commander
  • Safety Officer
  • Operations Chief
  • Planning Chief
  • Logistics Chief
  • Chief Medical Officer
  • Chief Nursing Executive
  • Any specific departmental/division leader directly impacted by that specific situation. i.e. , loss of HVAC, loss of computers

CLICK TO ACCESS INCIDENT COMMAND CHECK LIST

Code GREEN DELTA Level 1

• Administrator or designee send current list of departmental physicians in house at the time of the Code Green Delta announcement to the Labor Pool
• Deliver three (3) medication drawers directly to the Emergency Department
• Be available for support as requested by patient units and Incident Command
• Prepare for potentially large amount of medication orders
• Prepare to initiate call tree

Code GREEN DELTA Level 1

• Unless designated by Patient Flow Supervisor or Incident Command, remain in department and continue with tasks
• Assist with assessing and/or calling to obtain additional supplies

Code GREEN DELTA Level 1

• A pre-designated Social Worker will report immediately to the Emergency Department
• All other Social Workers should check in with the Labor Pool

Code GREEN DELTA Level 1

• No specific required duties
• Be available as requested by Incident Command

Code GREEN DELTA Level 1

• No specific required duties
• Be available as requested by Incident Command

Code GREEN DELTA Level 1

• Be available for support related to building systems management
• Be available as requested by Incident Command

Code GREEN DELTA Level 1

• No specific required duties. Please be available if contacted by Incident Command
• Be aware of incorrectly routed Blood Type and Screen. Please direct to Blood Bank
• Please be aware of STAT lab orders

Code GREEN DELTA Level 1

• Be aware of STAT orders and STAT type and screens
• Prepare for potentially large request of blood products
• Be aware of STAT and priority orders for blood products
• Prioritize blood product orders (I.E. RBCs for trauma patient vs. routine FFP for stable transplant patient)

Code GREEN DELTA Level 1

• No specific required duties. Please be available if contacted by Incident Command

Code GREEN DELTA Level 1

• No specific required duties. Please be available if contacted by Incident Command

Code GREEN DELTA Level 1

• Medical Imagining Physicians report to Medical Imaging
• 1 (one) Radiology Technician will report immediately to the Emergency Department
• Please be aware of STAT or priority orders

Code GREEN DELTA Level 1

• Medical Imagining Physicians report to Medical Imaging
• 1 (one) Radiology Technician will report immediately to the Emergency Department
• Please be aware of STAT or priority orders

Code GREEN DELTA Level 1

• Medical Imagining Physicians report to Medical Imaging
• 1 (one) Radiology Technician will report immediately to the Emergency Department
• Please be aware of STAT or priority orders

Code GREEN DELTA Level 1

• Medical Imagining Physicians report to Medical Imaging
• 1 (one) Radiology Technician will report immediately to the Emergency Department
• Please be aware of STAT or priority orders

Code GREEN DELTA Level 1

• Medical Imagining Physicians report to Medical Imaging
• 1 (one) Radiology Technician will report immediately to the Emergency Department
• Please be aware of STAT or priority orders

Code GREEN DELTA Level 1

• No specific required duties. Please be available if contacted by Incident Command

Code GREEN DELTA Level 1

• No specific required duties. Please be available if contacted by Incident Command

Code GREEN DELTA Level 1

• Immediately deliver 10 (ten) stretchers, 10 (ten) wheelchairs, and linen cart outside the Emergency Department
• Be aware of STAT cleaning orders for potential admissions
• Be available for additional support related to Environmental Services as requested by Incident Command

Code GREEN DELTA Level 1

• Emergency Department Equipment Technician delivers 3 crash carts
• Be available to assist with unit or Incident Command needs as instructed by Incident Command
• Be aware of STAT supply requests

Code GREEN DELTA Level 1

• Volunteers should immediately report to the Labor Pool located in the Medical Imaging/ Lab Waiting Area (Room A – 0501) and await instructions
• Volunteers may be utilized as "runners"

Code GREEN DELTA Level 1

• Complete and drop off Disaster Information Form to the Labor Pool located in the Medical Imaging/ Lab Waiting Area (Room A – 0501)
• Assess that essential equipment is available
• Assess stock of supplies
• Be prepared to initiate call trees if instructed by Incident Command
• Prepare for possible reallocation of staff if required by Incident Command

Code GREEN DELTA Level 1

• Provide support for patients, siblings, and parents if safe to do so. If available space is considered high traffic or being utilized by clinical staff, step outside of the room or to an area which would not disrupt the immediate view or contact of any patients from a clinical provider.

Code GREEN DELTA Level 1

• The Public Relations Spokespersons will handle all questions from the public and media

Code GREEN DELTA Level 1

• Provide Support as requested by Incident Command