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Code Orange Mass Casualty

Specific Work Area Action

Department

Surgical Suites

Building

3rd Floor C Wing

Campus:

Civic

Flow Chart

 

 

 

 

Staffing and Staging

Department:

Surgical Suites

Director:

Suzanne Madore

Manager:

Joanna Schubert

613-107-0222

Clinical Care Leader:

(if applicable)

Katie Tsang

613-327-1373

Staffing: Complement Required:

 

Minor:

 

Monday- Friday 07:30-15:30 No additional resources required. Bring booking office clerk to front desk as needed.

Evening/Nights/Weekends/Holidays/Spill over: For every OR suite the following is required; 2 RNs and 1 RPN, 1 OR Attendant per 2 rooms. Additional clerk and transport worker’s (TW) when required.

Major:

 

 

As above

Staging Location:

 

Phone #

 

Areas of Responsibility

Location

 

Minimum Staff Required

 

MOR Control Desk

MOR Clinical Manager

Clinical Care Leader  Anesthesia Coordinator

CCF or Float CF

ACC Clerk/Booking Clerk

MDRD

PACU

 

Job Action Role Index

Clinical Manager (CM)/ Clinical Care Leader (CCL)

Coordinating Care Facilitator (CCF)/ Float CF

Administrative Control Centre (ACC) Clerk/ Booking Clerk

Anesthesia Coordinator


Job Action Sheets

 

Role:

CLINICAL MANAGER / CLINCAL CARE LEADER

Unit Command Post Location:

Telephone: 18800

MOR Nursing Station

 

Start Date & Time

End Date & Time

 

 

Name/Position of person assuming role:

Joanna Schubert/Katie Tsang

Responsible to: Clinical Director/ In patient Unit Leader (Upon activation of EOC) (Emergency Operations Center)

Activation Phase

 

       Assist with initiating setup of MOR Unit Command Post

       Put on position identification vest (located at Nursing Station/Command Post)

       Read entire job action sheet

       Obtain briefing from CCF on Emergency Department (ED) status

       Determine and coordinate the following roles, and distribute Job Action Sheets for each role:

       MOR Clerk and Booking Clerk

       MOR Float CF

       MOR Anesthesia Coordinator

       Acquire updated Census of MOR from CCF/Float CF and continue or maintain CATEGORIZATION of patients:

                 Category A – No intervention; able to send back to sending unit and discharge with minimal risk

                 Category B – Anesthesia induced, no surgical intervention; reverse and send to PACU

                 Category C – Anesthesia induced, surgical procedure commenced; determine timeframe of procedure or to 

                                         safely abort procedure

       Send updated CATEGORIZATION Census to Emergency Operations Centre (EOC) as required

       Begin populating white board with OR status

 

CODE ORANGE OPERATIONAL PHASE

 

       When code orange called, hold sending for all remaining elective patients with the possibility of cancellation

       Obtain direction from EOC regarding number of OR’s required to accommodate incoming patients

       Coordinate the relocation of patients who have not had anesthesia and are ambulatory.

       Assign TW’s to escort back to the sending unit

       Obtain direction from Emergency Operations Centre regarding decanting of unit to PACU and ICU

       Ensure ongoing communication with Anesthesia Coordinator, MOR CCF and Float CF

       Participate in briefings with EOC as required

       Be prepared to provide EOC with frequent updates regarding OR status, number of rooms ready to accept patients, and number of patients arriving on unit, staff numbers; surplus/needs

       Initiate Fan Out and callback of staff as directed by the EOC and dependent on unit needs

       Designate second Ward Clerk to initiate staff fan out based on information received from EOC and unit requirements

       Disseminate information from EOC with appropriate personnel re: status of disaster

       Communicate with decanting unit in preparation for receiving casualties and surgical patients

       Consider the event impact from the long-term perspective

• Ensure your staff are taking rest breaks

• Observe your staff for signs of stress or fatigue and report concerns to Occupational Health group. Reinforce EAP support

• Brief your relief, ensuring that ongoing activities are identified and follow-up requirements are known

• Ensure designates have been identified to fill your role in your absence

 

CODE ORANGE DEMOBILIZATION PHASE

       Respond to demobilization orders and brief team

       Complete all required forms, reports and other documentation.

       Provide input to the after-action report

       Identify need to activate Employee Assistance Program

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Job Action Sheets

 

Role:

COORDINATING CARE FACILITATOR (CCF)

Unit Command Post Location:

Telephone: 19553

MOR Nursing Station

 

Start Date & Time

End Date & Time

 

 

Name/Position of person assuming role:

Julia Budiansky

Responsible to: Clinical Manager/Clinical Care Leader

CODE ORANGE ACTIVATION PHASE

 

       Report to MOR desk and assist in initiation of unit Command Post

       Read entire job action sheet

       Identify and call Float CF to MOR Command Post

       Complete primary assessment of Operating Rooms and availability of emergency and elective case carts, identify potential need for OR

       Place a hold on further advancement of procedures for elective cases

       Acquire updated Census of MOR and begin CATEGORIZATION of patients:

  Category A – No intervention; able to send back to sending unit and discharge with minimal risk

                Category B – Anesthesia induced, no surgical intervention; reverse and send to PACU

                 Category C – Anesthesia induced, surgical procedure commenced; determine timeframe of procedure or to 

                                        safely abort procedure

       Brief MOR CM/CCL and Float CF of OR status

       Give report to CM and Float CF

       Leave unit for ED Resus Post

       Keep completed OR schedule and staff assignment/flow sheet with her at all times

       Update and direct the Float CF to maintain surgical suites code orange status and provide OR status report to CM every 15 minutes or as requested

 

CODE ORANGE OPERATIONAL PHASE

       Continue to communicate with MOR CM/CCL regarding ED status and Code Orange Status

       Provide Float CF with information regarding number of patients requiring OR, report of injuries

       Request rooms with 3 rd staff member have extra staff report to OR Command Post and await further direction/instruction, reassign nurses as needed

       Assign emergency case carts to specific patient and rooms available

 

CODE ORANGE DEMOBILIZATION PHASE

       Return to Main OR Command Post

       Discuss with Anesthesia, post op designation of patients

       Respond to demobilization orders and brief team

       Complete all required forms, reports and other documentation.

       Provide input to the after-action report

       Identify need to activate Employee Assistance Program

 

Job Action Sheets

 

Role:

Float CF

Unit Command Post Location:

Telephone: 19855

MOR Nursing Station

 

Start Date & Time

End Date & Time

 

 

Name/Position of person assuming role:

 

Responsible to: Clinical Manager/Clinical Care Leader

CODE ORANGE ACTIVATION PHASE

 

       Report to MOR desk and assist in initiation of Unit Command Post upon hearing Code Orange overhead page or receiving notification from CCF.

       Put on position identification vest (located at Nursing Station)

       With CCF, complete primary assessment of Operating Rooms and availability of emergency and elective case carts, inform staff of Code Orange

       Keep completed OR schedule and staff assignment/flow sheet with her/him at all times

       Assist CM to begin populating Emergency White Board with OR Status and Activity

       Remain in Surgical Suites area reporting frequently to Command Centre

       Assign and delegate tasks as required

 

CODE ORANGE OPERATIONAL PHASE

 

       Acquire updated Census of MOR and begin CATEGORIZATION of patients with Anesthesia Coordinator (if not already done by CCF):

  Category A – No intervention; able to send back to sending unit and discharge with minimal risk

                Category B – Anesthesia induced, no surgical intervention; reverse and send to PACU

                Category C – Anesthesia induced, surgical procedure commenced; determine timeframe of procedure or to 

                                        safely abort procedure

       Continue to monitor unit and decant for incoming admitted patients as required

       Assess room status, and case cart availability and report information to OR Command Post every 15 minutes, or as requested

       Assist with updating white board as reports are given

       Coordinate with MDRD re: case cart requirements

       Notify MDRD if there is any missing equipment needed and which OR it should go to, provide updates of incoming injuries and needed instrumentation and supplies

       Continue to communicate with MOR CM/CCL/CCF, which OR’s are available and set up to receive patients from ED

       Advise staff to changeover room and prepare to receive a patient

       When notified by the CCF a patient is ready for the OR, ensure the room has received the correct case cart from MDRD and ensure the staff are aware the patient is en route

       Provide OR with Charting Packages (paper charting) if unable to book patient in SIMS

       Request incoming staff to report to OR Command Post and Float CF assign staff to needed areas

       Report staffing needs or surplus to CM/CCL

       Disseminates info to all staff re: status of CODE ORANGE

       Ensure staff nutritional and break needs met

       Consider the event impact from the long-term perspective, begin planning staff for the following shift

• Ensure your staff are taking rest breaks

• Observe your staff for signs of stress or fatigue and report concerns to Occupational Health group.  Reinforce EAP support

• Brief your relief, ensuring that ongoing activities are identified and follow-up requirements are known

 

CODE ORANGE DEMOBILIZATION PHASE

       Respond to demobilization orders and brief team

       Complete all required forms, reports and other documentation.

       Provide input to the after-action report

       Identify need to activate Employee Assistance Program

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Job Action Sheets

 

Role:

Anesthesia Coordinator

Unit Command Post Location:

Telephone: 18800

MOR Nursing Station

 

Start Date & Time

End Date & Time

 

 

Name/Position of person assuming role:

 

Responsible to:

CODE ORANGE ACTIVATION PHASE

 

       Free self from clinical duties and report to MOR desk and assist in initiation of Unit Command Post
(Anesthesia Coordinator Monday to Friday 0730-1600, 2 nd call staff 1600-1800, 1 st call staff 1800-0730)

       Put on position identification vest (located at Nursing Station)

       Read Entire job action sheet

       Acquire updated Census of MOR and begin CATEGORIZATION of patients with CCF or Float CF

Category A – No intervention; able to send back to sending unit and discharge with minimal risk

                Category B – Anesthesia induced, no surgical intervention; reverse and send to PACU

                Category C – Anesthesia induced, surgical procedure commenced; determine timeframe of procedure or to 

                                        safely abort procedure

       Receive report from CCF or Anesthesia in ED department regarding casualties and incoming OR patients

       Assess availability of anesthesia staff, residents, A. A’s. Instructions given to report to Anesthesia Coordinator with readiness/progress

       Update white board with deployment and availability of anesthesia personnel

 

CODE ORANGE OPERATIONAL PHASE

       Continue to monitor unit, decant for incoming admitted patients

       Direct PAU Anesthesia or senior resident to PACU to assist in decanting process and medically clear patients for transfer to other units

       Assist the PACU CF with the triage of OR patients and help facilitate decanting of OR patient’s to designated areas and availability of beds

       Utilize NCT (Non Clinical Time) staff during daytime hours if required

       Consider pulling residents back from off-service locations if required

       Initiate Fan Out and callback of staff as directed by the Emergency Operations Centre, and unit requirements (Specify number of staff required, and delegate Anesthesia Admin Assistant, to instruct staff to report in scrubs to Anesthesia Lounge and await further instruction)

       Continue to communicate with MOR CM/CCL/CCF

       Collaborate with PACU/ICU re: casualty count

       Ensure staff nutritional and break needs met

       Consider the event impact from the long-term perspective

• Ensure your staff are taking rest breaks

• Observe your staff for signs of stress or fatigue and report concerns to Occupational Health group.  Reinforce EAP support

• Brief your relief, ensuring that ongoing activities are identified and follow-up requirements are known

 

CODE ORANGE DEMOBILIZATION PHASE

       Respond to demobilization orders and brief team

       Complete all required forms, reports and other documentation.

       Provide input to the after-action report

       Identify need to activate Employee Assistance Program

Anesthesia Staff Carrying Trauma Pager:

·         Free self from clinical duties in OR and proceed to ED Resus Post

·         Assist Chief TTL and OR CCF to coordinate flow of patients from ED to OR

·         Provide summary of status in ED and personnel requirements to the Anesthesia Coordinator in MOR Command Post

·         Assist emergency triage nurse with assessment and triage of patients

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                            Job Action Sheets

 

Role:

ADMINISTRATIVE CONTROL CENTRE (ACC) CLERK

Unit Command Post Location:

Telephone:18800

MOR Nursing Station

 

Start Date & Time

End Date & Time

 

 

Name/Position of person assuming role:

Linda Bennett and Glen Chauvin

Responsible to: Clinical Manager/ Clinical Care Leader

CODE ORANGE ACTIVATION PHASE

       Upon activation of Code Orange, announce overhead “Code Orange: All staff please return to your room and await further instructions” into all rooms.

       Booking Clerk to relocate to the ACC to assist with phone calls and booking of patients

       Hold sending for all remaining OR Elective procedures

       Maintain order at the OR Command Post by answering the telephone and maintaining a clear line for access to and from EOC and other essential areas

       Maintain OR Schedule/Emergency Board, update patient locations and classifications as directed by CCF/Float CF

       Call Logistics (# 1-8056) for # of stretchers, # of wheelchairs to be delivered to Main OR STAT and # of porters required

 

CODE ORANGE OPERATIONAL PHASE

 

       Provide staff with charting packages if unable to book patients in SIMS

       Assist with ongoing documentation of event and MOR activities

       Keep telephone lines to essential/emergency calls only

       When instructed initiate OR Fan Out, and record information of available staff

       Inform Float CF/CM/CCL of staff available to return

 

CODE ORANGE DEMOBILIZATION PHASE

 

       Respond to demobilization orders from SDCU Charge RN/Clinical Manager/CCL

       Complete all required forms, reports and other documentation.

 

 

 

 

 

 

 

                            Job Action Sheets On Shift/After Hours

 

Role:

Charge Nurse

Unit Command Post Location:

Telephone:19553

MOR Nursing Station

 

Start Date & Time

End Date & Time

 

 

Name/Position of person assuming role:

 

Responsible to: On Call Anesthesia

CODE ORANGE ACTIVATION PHASE

       Upon activation of Code Orange call (or have clerk call) CM, CCL, and CCF to notify of hospital status

       Complete primary assessment with Anesthesia (if possible) of Operating Rooms and availability of emergency and priority case carts, inform staff of Code Orange

       Hold sending for any further emergency patients, and hold further advancement of procedures

       Requests clerk (if applicable) to notify “call” team, 2 nd clerk, and 2 Anesthesia Aids

       Request clerk (if applicable) call for extra TW’s to report to Main OR Command Post

       Identify emergency rooms to use in order, Rooms 8, 7, 9, 10, 2, 3, 4

       Keep completed OR flow sheet with her at all times

       Assign Float CF if possible to await further instruction from Charge Nurse

       Leave unit for ED Resus Post

 

CODE ORANGE OPERATIONAL PHASE

       OR Float CF to start white board and update until CM/CCL/delegate arrives

       Coordinate with MDRD re: case cart requirements

       Notify MDRD if there is any missing equipment needed and which OR it should go to, provide updates of incoming injuries and needed instrumentation and supplies

       Continue to communicate with Charge RN in ED which OR’s are available and set up to receive patients from ED

       Advise staff to changeover room and prepare to receive a patient

       When notified by the Charge RN in ED a patient is ready for the OR, ensure the room has received the correct case cart from MDRD and ensure the staff are aware the patient is en route

       Provide OR with Charting Packages (paper charting) if unable to book patient in SIMS

       Collaborate with PACU/ICU re: casualty count

       Incoming staff to report to OR Command Post and Float CF to begin assigning staff to needed areas

       When instructed, have clerk initiate OR Fan Out, and record information of available staff

       Track staff names in each room

 

CODE ORANGE DEMOBILIZATION PHASE

       Complete all required forms, reports and other documentation.

 

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