17. Emergency Codes

A list of emergency codes that may be announced via the paging system is given in the following table. You will also have this list written on the back of your identification badge:

CODE RED – FIRE

A “Code Red” is a case in which the fire alarm system is triggered. This could be triggered by a number of circumstances, including:

A person triggering the pull station

• Smoke or heat triggering a detector
• Sprinkler activation

A “Code Red – All clear” will be determined in consultation with the fire department when the home is safe and may resume normal operations.

How to react if you discover a fire and/or hear the fire alarm:

R – Remove people from immediate danger if possible.
E – Ensure doors and windows are closed to confine the fire and smoke.
A – Activate the fire alarm system using the nearest pull station to the fire.
C – Call 9-1-1 and notify the RN to advise the exact location of the fire.
T – Try to confine or extinguish the fire without undue risk. Evacuate if necessary.

NOTE: Place wet towels, sheets, blankets, pillows or other confining materials at the bottom of the closed door to the room with the fire, to restrict the rapid transfer of smoke to the rest of the area.

Upon hearing the fire alarm, an assigned staff member will proceed to announce “Code Red (Location of fire)” and repeat 3 times.

What to do once the alarm and code have been announced:

1. All personnel must proceed to the assigned area immediately. Depending on the responsibilities of the specific job role and regular assignment, the fire scene, work place, or emergency operations center
2. Shut down some equipment properly in the area (e.g., ovens, laundry equipment).
3. Workers at the fire scene are under the direction of the manager of the incident and must remain at the fire site, performing the tasks assigned
4. Workers proceeding to the fire scene or their work area should travel rapidly but carefully in pairs.
   • With due care and caution, approach the stairwells and smoke barrier doors.
   • Check all doors before opening.
   • Look through the windows for signs of fire.
   •. If the door now has a window, gently put your hand flat on the door and feel wet.
   • Check for smoke at the base of the door.
   • Proceed only if the path is free of fire and smoke. If there are signs of smoke and/or fire, proceed to another stairwell/corridor and repeat the checks for safety.
5. Report to the emergency operations center for assignment of duties if it is dangerous to return to your work place.
6. Follow the specific duties of your job position.
7. Do not resume normal duties until “Code Red, All Clear” announcement has been made over the paging system.

Incident Manager or Designate

In general, the authority and responsibility for the evacuation decision lies with the manager of the incident or the fire department if present.

Evacuation begins with the evacuation of occupants from individual rooms beyond a collection of doors for fire separation. The initial response to an emergency situation is a partial evacuation. This includes excluding residents in this order from the room/area affected by the fire emergency:

1. The room of emergency site
2. The room adjacent to the emergency site
3. The room directly across from the emergency site

Evacuate these residents beyond a fire separation door to a safe area by utilizing the team and chain evacuation procedure. DO NOT use elevators unless approved by the fire department.

When the decision is made to evacuate an entire area or building, this will be communicated by an assigned staff member making an announcement over the paging system. “Code Green (Location)” and repeat 3 times while speaking slowly and calmly. Conversion of the fire alarm system to the second phase will create a continuous ringing of the bells. Refer to the “Code Green” policy.

Establish an emergency operations center to facilitate a coordinated response to the emergency. The emergency operations center is ideally set up in a safe location with several exit routes available. The most senior person on site who is not at the fire scene should take charge of the emergency operations center. Primary and secondary evacuation routes are to be pre-determined and staff must move residents along these pre-assigned routes to safety. If necessary, the incident manager will determine the appropriate exits at the time of the emergency.

CODE GREEN – EVACUATION

The emergency exits should be clearly marked with exit signs and all doorways should be free of any obstruction. Some doorways lead to other corridors, some lead outside. Make yourself familiar with the locations of all emergency exits during your orientation shift.

A “Code Green” will be announced over a paging system and repeated 3 times. There are four types of evacuation procedures and they are as follows:

Horizontal Evacuation:
Horizontal evacuation refers to the moving of residents from a fire affected area to a safer area on the same floor. The boundary between the fire affected area and the safer area, in this case, is a fire separation across the floor which has a fire resistance rating and which includes a self-closing door(s), across the corridor.

Vertical Evacuation
Vertical evacuation refers to the moving of residents from a fire affected area to a safer area on another floor below the fire floor. In this case, the boundary between the fire affected area and the safer area is the fire separation between the floors. Vertical evacuation may be used where the fire emergency prevents a horizontal evacuation.

Partial Evacuation

If the building you are working in is compartmented by fire separations or fire-resistant doors, partial evacuation should take place when a disaster or fire compromises the residents’ safety. If residents are in imminent danger in one area of the facility, that area may be evacuated while the other sections of the building are not, or they may be moved to a safe area that exists in another area of the building. This movement can be either horizontal or vertical.

Total Evacuation
In a total evacuation, every occupant in the building is to be cleared from the building. Total evacuation should occur when a disaster is such that the health and safety of the residents are placed in imminent danger throughout the whole facility. A total evacuation will be at the discretion of the incident manager or fire department.

Sequence of Evacuation

1. Room of fire origin
2. The room next to and opposite of the room of fire origin
3. Rooms on a diagonal from the room of fire origin
4. All other rooms, beginning with the closest to the fire area (a, b)
5. Evacuate fire area beyond the nearest fire-resistant doors, close doors behind you and continue evacuating as necessary. We recommend you familiarize yourself with the placement of all fire-resistant doors during your orientation.

CODE YELLOW – MISSING PERSON

A resident is considered missing when they are not in a location where staff would expect to find them. Residents are encouraged to move freely in the residential care home except in areas which are considered to be hazardous. However, it is recognized that certain resident must be restricted to designated areas for their own health and safety unless accompanied by a designated person. Occasionally, and in spite of close supervision, a resident may find an opportunity to wander away and go missing.

1.0 Risk Level: Any code yellow emergency situation is a progressive incident. This means that the longer the resident is missing, the more the level of risk to the resident and the home is increased.

2.1 Wanderer’s Registry: The Alzheimer’s Society has a national wanderer’s registry and local police services have a local wanderer’s registry. All residents at risk of wandering are encouraged to be registered with both.

When a resident is determined to be missing, the time must be recorded on a daily planner or other document and a preliminary search of the unit is to be conducted, involving available staff. This will include checking the leave of absence book, visitors log and asking other staff and residents if they have seen the resident. If the resident has not been located after 5 minutes notify the incident manager or supervisor on duty.

Incident Manager / Supervisor

When notified by an employee that a resident has not been located after the initial 5 minutes search the incident manager will:

• Assume responsibility for the incident.
• Utilize the Incident Manager Check List – Code Yellow to track actions and log the times of the response.
• Obtain a description of the resident together with the resident identification photo which should be in the resident’s profile or care plan.
• Re-check the leave of absence book and visitor log.
• Follow up with persons that may have visited the resident that day.
• If it is suspected that the resident has left the building with a family member, designate a staff member to call the family to confirm.
• Announce or designate an employee to announce over the PA system for the resident including their name (generally, this is repeated 3 times).
• Call the unit nurses and program supervisors in the other units/program areas to determine if the resident is on other floors.
• Check external sitting areas.
• This stage will last no longer than 10 minutes, for a total of 15 minutes after the first indication the resident was missing.

NOTE: If a resident is reported as being seen leaving the home through an exit door, begin searching the exterior grounds and neighborhood immediately.

If the resident has not been located within 10 minutes of being notified, regardless of the completeness of the current search for the resident, ensure the following tasks are completed.

1. Announce or designate an employee to announce “Code Yellow (Residents Name and Unit) and repeat 3 times. Repeat the announcement after 5 minutes.
2. Notify the police providing a description.
3. Complete a Missing Person Report.
4. When the police arrive, provide them with a photo of the resident and copy of the Missing Person Report along with a summary of the actions taken prior to the police action.
5. Ensure the staff search continues in a supplement to the police action.
6. Notify the Administrator or designate. The Administrator will notify the Regional Director.
7. Outside of peak staffing hours, initiate the Staff Call Back List.
8. Establish a command post in the Emergency Operations Centre where all responding staff will report for instruction.
9. Print out copies of the photograph of the resident for distribution to staff and responders.
10. Provide a description of the resident (physical description and clothing) including a photo and a search floor plan or area map for staff to initiate the search for the resident.
11. Where possible, assign staff to search areas they are the most familiar with for the initial search.
    a. If it is a suspected that the resident may have left the building, direct specific staff to start an external search at the same time the internal search is being performed. Provide maps for all the designated search areas beyond the ground of the residential care home.
    b. Ensure all external searches are done in parts.
    c. Instruct staff to report back at a minimum of every 10 minutes.

Staff:

1. When a Code Yellow is paged, respond to the unit/area where the Code was paged. A minimum of one staff member will remain in each resident home area and program to maintain the safety and security of the other residents.
2. Check your assigned area by looking in resident rooms, under beds, in closets, bathrooms, lounges, stairwells, utility rooms, etc. As rooms are searched, identify them with the “searched” signs and mark them on the search map.
3. Ensure you perform all external searches in pairs. When conducting an external search check the neighborhood within a four-block radius from the home. This search will not replace the police search of the area but provide additional support.
4. Report back to the Incident Manager/Supervisor every 10 minutes to provide an update and to be given further instruction. The reporting can be done either by physically reporting in, by cell phone or by another device.

NOTE: Search of the neighborhood must be done by vehicle. Trained search teams from the emergency services will do a more thorough ground search.

If a Resident Can Not be Located:

The duties and responsibilities of each individual designation are as follows:

Staff:

1. Report to the incident manager for additional tasks that may include a re-check of all designated areas previously searched.
2. Report all search results to the Emergency Operations Centre. The number of searches carried out in each designated area will be determined by the incident manager.

Incident Manager or Designate:

1. Notify and maintain contact with the following parties:
   • Resident’s family or SDM
   • Local Police
   • Regional Director
   • Respective Health Authority in your province or region
2. Ensure all necessary documentation is completed in a timely manner.

When a resident is found, the following designations and their duties are:

Registered Staff:

1. Assess the resident’s condition by taking the necessary steps to ensure their health, safety, and comfort.
   a. Contact EMS if the resident has been injured or is ill.
   b. Notify the treating medical practitioner if necessary.
2. Document the incident on the resident’s progress notes.

Incident Manager:

1. Announce or designate an employee to announce the all clear: “Code Yellow (Residents name) All Clear” and repeat 3 times.
2. Advise all searches and authorities that have been contacted that the resident has been located. This could include the following parties:
   • Administrator
   • Residents family
   • Police
   • Regional Director
   • Respective Health Authority in your province or region
3. Maintain an accurate record of the search by completing the Missing Resident Report and Checklist. The report must be made available to the Administrator, Director of Care and Regional Director within 24 hours of the incident.
4. Hold a short de-briefing in the Emergency Operations Center to obtain timely feedback from the searchers on the handling of the event.

CODE WHITE – VIOLENT SITUATION

A staff member assessing a violent situation as posing an immediate danger to themselves and/or others can call a “Code White” at any time. These situations may include aggressive residents, visitors or other persons. In a situation where assistance in de-escalation and/or control of the disruption/violence is necessary responding staff will use non-violent interventions. The primary aim is to remove all persons from the situation to minimize the risk of injury.

1. If you identify a crisis situation, remove yourself from the confrontation and immediately notify the police by calling 9-1-1. Provide as much information as possible about the situation.
2. Advise other staff of a “Code White” identifying the location of the incident and if a weapon is involved.
3. Call police with an update on the situation every 5 minutes.
4. Designate a staff member to meet the police at the main entrance and provide directions to the scene as well as optional access (e.g., stairways, elevators).
5. If any injuries are incurred, ensure first aid is provided in a safe location and EMS is notified (9-1-1). Designate a staff member to call the Administrator as soon as possible.
6. At the conclusion of the incident, complete the Incident Report and forward it to the administrator.

All Staff:

• Staff in the immediate area and staff responding to the Code will assist by removing any others from harm’s way and the immediate confrontation to a safe location.
• All staff, including supervisors and maintenance staff, from the unit or area of emergency, will assist in evacuating residents from the area of threat. The incident manager or supervisor may send staff back to their duties depending on the situation and if the situation is under control.
• Use tactical verbal communication and non-violent interventions to de-escalate the situation if it is safe to do so.
• If the aggressor has a weapon, no attempt will be made to remove the weapon or subdue the person. The goal is to remove others from the situation.
• All staff involved will complete a written report of the details of the incident and submit it to the Administrator before leaving the residential care home.

External Incidents:

• A school “lockdown” that occurs at a nearby school or other situation of violence that occurs externally that may have an impact on the home, staff will be advised of a “Code White External”.
• “Code White External” will have available staff immediately respond to the external sitting areas to usher resident back into the building and to lock the entrances or switch the doors to manual so they are controlled from the inside only.
• Persons will not be permitted to leave the building until the all-clear has been given.