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RESPONSE

Emergency Response Team Activation”

Objective: This procedure defines the general provisions for the notification of the ERT members to initiate a response to an incident.

6.0 Activation Procedure:
6.1 The activation of the Medical Center Hospital Emergency Response Team is initiated as specified by the following:

     Code Orange 1 - A Code Orange 1 is defined as the accidental or unplanned release of a material or materials within Medical Center Hospital that is considered a hazardous material and such release by requirement or procedure requires a response by specially trained and/or equipped ERT members to mitigate the incident.

     Code Orange 2 - A Code Orange 2 is defined as an external event that has the potential or will require receiving victims for medical treatment that are or are potentially contaminated by materials that are considered to be hazardous either by definition or action.

6.2 Activation Procedure for Code Orange 1:
     6.2.1 Any hospital employee, upon determination of the accidental release of a hazardous material shall immediately notify the hospital operator by calling extension 2000 and providing the following information:
          6.2.1.1 The location of the incident;
          6.2.1.2 If known, what the material(s) are that have been released;
          6.2.1.3 Their name and/or the appropriate contact person.
     6.2.2 Upon receiving the above information the hospital switchboard shall immediately:
          6.2.2.1 Page Code Orange 1 (3) times on the hospital-wide paging; and give the location;
          6.2.2.2 Notify Hospital Security and Engineering by Radio of the Code Orange and give the location;
          6.2.2.3 Activate the hospital beepers indicating Code Orange 1 and the area.
     6.2.3 Upon being notified of a Code Orange 1, available members of the Emergency Response Team shall immediately respond and shall activate the Emergency Response Team Emergency Notification beeper system to assure notification of all team members.

6.3 Activation Procedure for Code Orange 2:
     6.3.1 Upon receiving notification of a Code Orange 2, (External Hazardous Material Incident), the hospital operator shall:
          6.3.1.1 Page Code Orange 2 (3) times on the hospital-wide paging; and give the location;
          6.3.1.4 Notify Hospital Security and Engineering by Radio of the Code Orange and give the location;
          6.3.1.5 Activate the hospital Code Orange beepers indicating Code Orange 2 and the area.

6.4 Back-up Activation Procedure:
     6.4.1 In the event the overhead paging system fails, the hospital operator shall announce on the Hospital Radio, Security/Engineering Channels that either a Code Orange 1 or 2 has been activated. After hours and holidays, the Hospital Operator shall contact the Engineering staff person on duty either by radio or by any means necessary to notify them of the Code Orange 1 or 2.
     6.4.2 Upon being notified, either available Emergency Response Team members of the Engineering staff shall activate the ERT Emergency Call Beepers.

7.0 Team Member Duties upon Activation:
ERT members will take the following actions upon activation:

7.1 Shall respond to the location as directed from information provided through the Emergency Beeper system.  In the event that there is no specific information, or their response was initiated by the overhead paging system, members shall report to the Engineering Department.
     7.1.1 No team member on sick or injury leave from his or her department shall respond to any Code Orange.  Any member that is OFF DUTY and due to the consumption of any substance that may affect your mental or physical being is not FIT FOR DUTY shall not respond.

7.2 Special Situations:
     7.2.1 Activation of the ERT Emergency Beeper System, when necessary can be at response levels as follows:
          7.2.1.1 For Your Information: This message is used to advise ERT members of situations that have the potential to effect the operations of the ERT. Activation might be necessary but not at this time.
          7.2.1.2 Stand By: This message is used to advise the ERT that a condition(s) exists that makes it likely that a response of the ERT will be necessary.  ERT members should make the necessary preparations to respond upon notification.
          7.2.1.3 Report Status and Time to Hospital: This message is used when a RESPONSE is HIGHLY LIKELY, and the availability of ERT members is needed. Members should respond with their travel time to return to the facility.
          7.2.1.4 First Call Group Respond: This message is transmitted to indicate that a response is necessary. When this message is received, FIRST CALL GROUP needs to respond to manage the incident and/or determine if the full resources of the ERT are required.
          7.2.1.5 All Call: This message is transmitted to indicate that an incident has taken place that requires the full resources of the ERT.  This will be determined by the FIRST CALL GROUP or by the nature of the incident.
          7.2.1.6 TEST- This is a Test: This is a routine message used to test the operation of the ERT Emergency Beeper System.  This message can be sent by it or is commonly followed by information important for the operation of the ERT.
          7.2.1.7 Please be advised: This message is used to notify the ERT as a whole of information necessary for the operation of the ERT.  This message can also be sent to individual ERT members to provide information necessary to the function of the ERT.

8.0 Response Groups:
8.1 The ERT is divided into two (2) functional response groups.  The delineation of the response groups is modified with personnel changes within the ERT.  The delineation of the ERT members to either group is done to balance experience, qualifications and other elements to assure the safe operations and regulatory compliance of each group during a limited response.

8.2 The ERT is divided into two (2) response groups.  The purpose in this division is to limit the first response call in to small incidents were the full resources of the entire ERT are not required.  Each of the two response groups are on a rotating call basis to the ERT Emergency Beeper activation's on a weekly basis.  The scheduled week shall begin at 07:00 hours Monday mornings and rotate the following Monday at 07:00 hours.
8.3In the event an incident requires the full resources of the ERT, the Incident Commander or designated individual may cause the “ALL CALL” beeper message to be broadcast.  All ERT members either on the first call response group or the stand-by call group are required to be beeper available, except as covered by the other portions of this SOP.

9.0 First Arriving Team Members:
9.1The objective of this section is to outline actions to be taken until the arrival of sufficient qualified personnel to fill required positions for any given incident.

9.2 RESPONSIBILITIES:  The first arriving ERT Member shall be responsible for:
     9.2.1Begin size-up and establishing a recognized command structure in preparation for the arrival of the other ERT members.
     9.2.2Within their ability, take what action possible to assure that the following are undertaken;
          9.2.2.1Obtain a briefing and/or available information about the incident from available sources.  Initiate a Site Plan and Briefing checklist.  The site plan shall be integrated into the ICS System and the Briefing Chief shall be assigned to the Resource Officer when established.
          9.2.2.2Begin implementation of the ICS System, including a command post operation.
          9.2.2.3Assure affected areas are evacuated; a safe zone is established or any additional first actions necessary to prevent or reduce possible injury to any individual(s).
          9.2.2.4To take any action possible to reduce the negative impact to the environment.
          9.2.2.5To reduce the impact to physical property, structures or any other object of value.
          9.2.2.6Allocate resources, as they become available to meet the objectives of the Site Plan or proposed concept for the incident.

10.0 Incident Command System:
10.1 An Incident Command System shall be established for all activation's of the incident by an (*), and may be expanded to include any or all-additional positions as required by the incident.  These positions are as follows:

10.2 *Incident Commander: An Incident Commander shall be established for all activation's of the ERT.  The Incident Commander shall be at least a “Hazardous Materials Technician” and shall be responsible for all operations undertaken by the ERT.  This individual within the Incident Command System is responsible for all actions taken by the ERT and is responsible for coordination with other groups or individuals from both within and outside the hospital for all aspects dealing with the hazardous material incident.  During the course of the incident, the individual assigned as Incident Commander may change.  These changes might be due to duration of the incident, the arrival of a more senior (experience level) ERT member or due to the need for other special skills.  In all cases, while the ERT is activated, an individual shall assume the role of Incident Command and any change of that position will be formal and documented.

10.3 *Safety Officer: A Safety Officer shall be established for any activation of the ERT in which any personnel assets of the team are deployed.
     10.3.1 The Safety Officer shall be at least a “Hazardous Materials Technician” and shall be responsible for all safety during operations undertaken by the ERT.  This individual within the Incident Command System maintains the responsibility for personnel safety during all operations undertaken by the ERT.
     10.3.2 Shall be responsible to develop a site safety plan and to assure it is communicated to all required parties.
     10.3.3 Follow and complete the Safety Sector Officer checklist.
     10.3.4 In conjunction with the Incident Commander, develop and implement a plan to restrict entry into the site to other personnel or responding agencies.
     10.3.5 Remain in contact with the Incident Commander and all Sectors, and maintain an awareness of the overall operations.
     10.3.6 Monitor to ensure acceptable practices are adhered to throughout the course of the emergency.
     10.3.7 Anticipate safety and health hazards and prepare a plan to manage the risks.
     10.3.8 Has the authority to, at any time, stop or intervene in any ERT operation where in their professional opinion a danger exists that has not been previously identified or places individuals at a point of jeopardy that is unacceptable.
     10.3.9 If the Safety Officer finds it necessary to stop or intervene during any ERT operation, they shall immediately advise the Incident Commander of such an action and assist in the determination of any appropriate further action(s).
     10.3.10 Shall be responsible for establishing a Safety Sector under
the Incident Command System during any incident that because of it's size or location requires additional Safety Monitors to assure the safest possible operation during the incident.
     10.3.11 Shall immediately advise the Incident Commander of any unsafe condition and shall assist the Incident Commander to correct any such conditions.
     10.3.12 Prepare reports for termination of the incident and note any exceptions during the post-incident briefing.

10.4 *Medical Officer: A Medical Officer shall be established for any activation of the ERT in which any personnel assets of the team are deployed. (Must be at least an Emergency Room Physician with prior HazMat Training).
     10.4.1 The Medical Officer shall be responsible for monitoring for all ERT members designated to donning any protective apparel.  This individual within the Incident Command System maintains responsibility for personnel medical issues during all operations undertaken by the ERT.
     10.4.2 In consultation with the Incident Commander and the Safety Officer, they shall select a site appropriate to conduct medical screenings.
     10.4.3 If necessary or desirable utilize other medically trained individuals to supplement the ability to provide medical screenings.
     10.4.4 Assign and supervise personnel performing pre and post medical screenings.
     10.4.5 Shall complete the Medical Sector Officer checklist.
     10.4.6 Has the authority to remove any ERT member from duty if he/she believes, for medical reasons, the member is unfit for entry or other operations.
     10.4.7 Has the authority to have any ERT member be evaluated or treated if they deem such action to be necessary.
     10.4.8 Shall assure that all required records for each ERT member taking part in any operation are completed and maintained.  Where exposure to any chemical has occurred or the response has required the mitigation of any chemical, completed exposure records shall be filed for each ERT member having potential for exposure.
     10.4.9 PRE-ENTRY MEDICAL SCREENING PROCEDURE:
          10.4.9.1 Medical screenings are performed during all incidents and training where donning of personal protective equipment in order to:
          10.4.9.1.1 Establish baseline vital signs.
          10.4.9.1.2 Identify individuals with a potential risk.
          10.4.9.2 Medical assessments shall conform to the current Medical Evaluation Checklist.
          10.4.9.3 Exclusion Criteria
          10.4.9.3.1 Exclusion criteria shall conform to current established issues.  In addition to these issues, the Medical Officer or any designated medical staff may exclude a ERT member, when in their opinion such exclusion is based on sound medical reasoning.
          10.4.9.3.2 New prescription medication within (2) weeks or OTC medication within (24) hours must be cleared with the Medical Officer.  The consumption of alcohol within the last (24) hours shall be evaluated for possible need for exclusion.
          10.4.9.4 Post Entry Medical Screening
          10.4.9.4.1 All ERT personnel upon being decontaminated (unless making immediate return, such as after receiving a fresh air cylinder), shall report to the Medical Sector for post-entry screening.
          10.4.9.4.2 All ERT members shall receive a post-entry assessment in accordance with the current post-entry medical evaluation guidelines, maintained as a separate document.
     10.4.10 Rehabilitation:
          10.4.10.1 Upon release from the Post-Medical Entry Medical Screening, ERT members, when required, shall undergo rehabilitation meeting guidelines as adopted by the ERT.
          10.4.10.2 All ERT members shall remain in Rehabilitation until achieved parameters are met. Upon release, the ERT member shall report to the Safety Officer.  He/she shall return to the Entry Team Officer for reassignment.

11.0 Mitigation Officer:
A Mitigation Officer shall be established for any activation of the ERT in which any personnel assets of the team are deployed.

11.1 The Mitigation Officer shall have at least 40 hours of WMD training and shall be responsible for all mitigation operations undertaken by the ERT.  This individual within the Incident Command System is responsible for organizing the ERT personnel who will be committed to an incident in PPE for either defensive or offensive operations.  They shall be responsible for assuring ERT personnel are properly equipped with PPE for assignment to any position, including, but not limited to, victim management, recon, rescue and/or mitigation tasks.

11.2 In consultation with the Incident Commander, he/she shall select appropriate staging site for entry team personnel.

11.3 Follow and complete the Mitigation Officer Checklist.

11.4 Assign support personnel to necessary Mitigation Team functions to assure task completion, including but not limited to personnel to assist the entry personnel in donning PPE.

11.5 Report and receive information from the Incident Commander, Safety Officer, Resource Officer, Decontamination Officer or other functions as required.

11.6 Report any issue concerning status or operation to the Incident Commander.

12.0 Decon Officer:
A Decon Officer shall be established for any activation of the ERT in which personnel assets of the team are deployed.

12.1 The Decon Officer shall have at least 40 hours of WMD Training and shall be assigned by the Incident Commander on all incidents when personnel may be exposed to any hazardous materials at the incident sight.

12.2 The Decon Officer shall assume the responsibility for safe and acceptable methods of decontamination for any incident.  IN NO SITUATION WILL ANY ENTRY PERSONNEL BE COMMITTED TO ANYACTION WITHOUT FIRST HAVING ESTABLISHED A DECONTAMINATION SYSTEM FOR THEIR RECOVERY.

12.3 Shall be responsible to assure the completion of the Decon Team Checklist.

12.4 Shall receive from the Resource Officer information concerning the material involved and appropriate decontamination method.

13.0 Decontamination Line Setup:
13.1 The Decon Officer will establish the Decon Corridor.

13.2 The corridor will be clearly marked with traffic cones and/or barrier tape and be secured against entry by unauthorized personnel.

13.3 The Incident Commander, Safety Officer and Resource Officer will make selection of PPE. It shall be the responsibility of the Safety Officer to assure that this information is provided to the Entry and Decon Officers.  Upon selection of the appropriate PPE, it shall be the responsibility of the Decon Officer to assure adequate supplies of PPE are obtained.

13.4 The Decon Officer shall be responsible for selecting appropriate decontamination solution(s) and methods to be employed for the decontamination of victims, PPE and equipment, consulting information provided by the Resource Officer.

13.5 The Decon corridor shall be complete and all personnel in place prior to any work commencing in the Hot Zone. A final radio check and/or review of emergency hand signals shall be made with all entry and decontamination staff prior to entry into the Hot Zone.

Response Continued

US Patent Numbers 7,720,998 B2, 7,836,207