Code Amber External Disaster Plan at KFSH Riyadh: Activation and Response Strategy

1. Code Amber2012 King Faisal Specialist Hospital and Research Centre- Riyadh

2. Definition • KFSH External Disaster Plan • Disaster that does not involve the facilities of KFSH • Situation that results in the sudden influx of casualties to the Hospital that may overwhelm resources and disrupt normal operations • Examples: Explosions, major accidents and fires and other situations resulting in mass casualties

3. Decision to Activate • Chairman of DEM and MCA Executive on Call communicate and jointly confirm Code Amber Activation

4. Phase I: Activation • Chairman DEM • Activates DEM Code Amber sub-plan • Notifies Security Shift Supervisor • MCA Executive On-Call • Notifies CEO,COO and EDMCA • Notifies PBX shift supervisor • Activates MCA sub-plan

5. Activation Department of Emergency (DEM): • Deploys a DEM RN to the Protocol/Emergency Gate (Gate#9) to assist in traffic screening and patient diversion • Notifies Paramedic Supervisor • Deploys Primary Triage Team to Outpatient Lobby • Notifies Executive on Duty (EOD)

6. Activation • Communications: • Activate CODE AMBER Call Back system (Command center and Essential Staff) through pager and cell phone messages • Hook up/install all required communications equipment in the Command Centre • Security Supervisor: • Activates Security Sub-Plan • Unlock doors of the Command Centre and PGC • Manage traffic flow within the hospital • Open entrance of Outpatient Lobby • Open Conference Gate (Gate#7) • Restrict Entrance from Outpatient Gate (Gate#8) • All other Departments shall activate their respective CODE AMBER Sub-Plans in case of code amber

7. Victims & Traffic Flow • Entry through gate 8 to be closed • Gate 9 • Protocol, Category 1 & 2 to Emergency room • Disaster Victims to outpatient entrance • All others (category 3,4,&5) and visitors to be to be sent away • Cars in parking lot and disaster victims exit through Gate 8 • Physicians enter through main entrance and multistory parking will be opened after hours

8. Screening Triage in OPD Entrance Protocol DEM

9. Triage Color Coding • Takes place at outpatient lobby • Green (walking wounded) to ortho clinic • Yellow and red to be transported to emergency room (Strechers/whealchairs) • Black to dental clinic

10. Command Center Setup • Security to unlock doors of the Command Center and connect CCTV • Communications to hook-up phones and Bring Radios • ITA to Hookup Internet, bring printer, fax and extra laptop • Audiovisual to hookup TV and operate screens

11. Members of the Command Center • Chief Executive Officer • Chief Operating Officer • Deputy Chief Executive Officer • Chief Administrative Officer • Executive Director, Medical & Clinical Affairs • Deputy Executive Director, Medical & Clinical Affairs • Executive Director Nursing Affairs • Deputy Executive Director Nursing Affairs • Chairman Hospital Safety Committee • Director, Safety & Security • Director, Quality Management • Director, Patient Services • Director, Clinical Services • Head, Case Management • Coordinator , Hospital Safety Committee • Lead Secretary, Medical & Clinical Affairs

12. Roles and Responsibilities of Command Center • Assesses the Hospital’s capacity • Address clinical areas requirements for additional resources • Authorize • Cancellation of Ambulatory clinics • Cancellation of booked inpatient surgical cases • Discharge inpatients to make room for disaster victims • Manpower Pool to deploy personnel • Public appeal for blood donors • Deployment of Hospital personnel to respond to an external site • roles that would be outside normal operating policies • Re-opening of Outpatient Gate (Gate#8) for general/limited entrance • Deactivation • Fax the disaster victim details, to the Patient Information Center • Delegates senior Hospital officials to meet/ accompany the press • Liaises directly with outside agencies • Un-hold patient admissions

13. Availing Resources • Resources to be made available automatically • Operating Rooms (Level II and Level IV) • Day Surgery Unit • Outpatient Lobby (Triage Area) • Orthopedic Clinic • Dental Clinic • Resources to be made available if needed (Per Command Center) • General Outpatient Clinics in other areas of the hospital • Oncology Clinic • Cardiology Clinic • Dialysis Clinic

14. Reporting to Command Center • every (30 min) • Inpatient Bed Inventory (Case Management and/or Nursing) Online Bed Board • Number of Available Operating Rooms (Nursing) • Number of Units of Blood (Pathology & Laboratory Medicine) • Manpower Pool – Available Staff • Disaster Victim Count (Extension 31012 or 31013) from DEM

15. Roles of Staff-Medical Department Chairmen • Ensure that their Departmental Code Amber Sub-Plan is being implemented • Ensure that inpatients suitable for discharge have the necessary discharge orders prepared Physicians • If on duty stay in clinical areas to facilitate the discharge of patients and to implement their departmental sub-plan. Report to Medical Staff Manpower Pool after the inpatient have been attended • All other physicians recalled to the hospital (except DEM) are to report directly to the Medical Staff Manpower Pool

16. Roles of Staff-Nursing Head Nurse/Charge Nurses • Implement their Departmental Code Amber Sub-Plan • Know the bed status of the unit at all times and update the online Bed Board and/or the Patient Resource Status Reports Other Nurses • All Nurses on duty stay in their clinical areas • Extra nurses will report to Nursing Staff Manpower Pool • All other Nurses recalled to the hospital (those designated in their departmental plans recalled to the hospital) are to report directly to the Nursing Staff Manpower Pool

17. Roles of Staff Department Heads • Ensure that their Departmental Code Amber Sub-Plan is being implemented • Do not report to the Command Center unless otherwise directed to do so Individuals on duty • Report to their usual station to maintain hospital operations • Clinical Services staff recalled to the hospital are to report to their respective departments. If needed they are to report directly to the Clinical Services Manpower Pool • All other staff recalled to the hospital are to report to General Staff Manpower Pool

18. Manpower Pools • Medical Staff Manpower Pool (PGC – Classroom # 4) • Nursing Staff Manpower Pool ED of Nursing Office • Clinical Services Manpower Pool  Clinical Services Director’s Office • General Staff Manpower Pool, Administration and Financial Services (PGC – Auditorium)

19. North Tower Patient Discharge and Holding Center Family and Visitor Information Center North Tower, to be staffed by: • Public Relations • Social Services • Patient Relations • Food Services • Nursing Affairs • Case Management & Admission (Registration) • Safety, Security

20. Reminder Each department should have a sub-plan which is implemented during the code • Review the department sub-plan • Ensure that your telephone and mobile numbers are correct on the departmental recall list • Know how to use the recall list • Carry Hospital Identification badge at all times • If you are on duty, remain in your clinical area unless otherwise instructed • If you are called in, then report directly to your department or the appropriate manpower pool and sign in Manpower Pool Location