1. ONLINE SELF-STUDY Joint Commission and Emergency Preparedness Refresher for the Clinic Environment

2. Clinical Environmental Management Program The University and UNC Hospitals have a comprehensive Safety Management Program (SMP) to insure the safety of all of its patients, visitors, faculty, and staff. The program is designed primarily as a safety promotion and accident prevention activity. Safety program responsibilities include consultation services, facility inspections, safety training, employee incident/injury investigations, emergency response, hazardous materials waste programs, safety committee activities, and environmental management. The University SMP is overseen by the Safety and Security Committee and UNC-CH Department of Environment, Health and Safety. Any questions you have regarding health and safety issues can be referred to the Department of Environment, Health and Safety at 919-962-5507.

3. Joint Commission Environment of Care Under the Joint Commission Standards there are six areas of concentration in the Environment of Care.  Safety  Medical Equipment  Hazardous Materials  Fire/Life Safety  Utilities Management  Security Each of these elements will be presented in more detail during this course.

4. Safety All University healthcare workers are expected to conduct their daily activities in such a way that they do not expose themselves or others to potential injury, including: needlestick or sharp injuries, infectious diseases, slips and falls, back injuries, and/or chemical exposures. Exposures can be reduced by using appropriate engineering controls, using proper personal protective equipment (PPE), using proper lifting techniques, and following the appropriate procedures to avoid exposures to chemicals and other hazardous substances. UNC-CH Department of Environment, Health and Safety, UNC Hospitals Environmental Health and Safety, as well as each department, are responsible for monitoring and trending employee incidents to develop and implement loss prevention activities to reduce the numbers and types of incidents occurring.

5. Suggestions/Concerns About Care and Safety in the Organization If you have a suggestion or concern related to care and/or safety of patients or staff within your organization and feel that it has not been addressed by in- house administration, you have the right and are encouraged to report these issues to the Joint Commission’s Office of Quality Monitoring by either calling 1-800-994-6610 or emailing complaint@jointcommission.org.

6. Workplace Safety All employees can assist in ensuring their work areas are free of hazards by:  keeping passageways clear of trip hazards  ensuring floors are kept free of any debris or moisture  reporting unsafe conditions or equipment to the department manager, and/or UNC-CH Department of Environment, Health and Safety  storing all equipment and supplies properly  keeping file drawers and cabinet doors closed when not in use  preventing trash or clutter from accumulating  refraining from using space heating devices (i.e. electric space heaters) which are prohibited  cleaning up or reporting spills as soon as possible

7. Latex Allergy For some individuals, exposure to latex products, such as powdered latex exam gloves, can cause a mild to severe allergic reaction. If you believe that you may have a latex allergy, you should notify your supervisor and contact the University Employee Occupational Health Service (UEOHC) for evaluation at 919-966-9119. Additional information regarding potential hazards associated with latex exposure is also available at the UEOHC.

8. Ergonomics Ergonomics hazards may exist in the workplace, including poor workstation layout, improper work methods, improper tools, excessive tool vibration, inappropriate workflow or work/rest regimens, and task repetition rates. If you suspect that there may be an ergonomic hazard in your workplace, you should notify your supervisor and complete an online ergonomic self- evaluation. If you believe that you may be suffering from an ergonomic- related injury, you should complete an incident report, notify your supervisor, and call the University Employee Occupational Health Clinic (UEOHC) at 919- 966-9119 to make an appointment with an occupational healthcare provider.online ergonomic self- evaluation

9. Hazard Recording Requirements  Patient Incident Reporting: Any incident involving a patient at UNC Hospitals should be reported to Risk Management through the Patient Occurrence Reporting System as soon as possible after the patient has been provided appropriate care. Incidents can be reported by calling 919-966-3041 or by completing a patient incident report and forwarding it to the Legal Department.  Visitor Incident Reporting: Incidents occurring at ambulatory care locations should be reported to Ambulatory Care Administration at 919-966-7400. Incidents occurring on UNC Hospitals property should be reported to Hospital Police (919-966- 3686). If a visitor needs immediate emergency medical attention call 911 or 919-966-4111.  Property Damage: Any state or personal property which is damaged as a result of an incident should be reported to UNC Campus Police (911) or Hospital Police (919-966-3686).

10. Employee Incident Reporting If an employee incident occurs (i.e. any accident, incident or near miss situation) the employee is to notify his/her supervisor, complete an Employee Incident Report, and report to the University Employee Occupational Health Clinic (UEOHC) at 145 N. Medical Drive, NC AHEC Building (919-966-9119, open 8:30-4:30, Monday-Friday).Employee Incident Report If the injury is serious or life-threatening or for any other after-hour work-related injury that requires immediate medical care, University employees should go directly to the UNC Emergency Department or closes emergency medical facility. If immediate medical care is not needed, then the employee should report to the UEOHC the following business day.

11. Bloodborne Pathogen Exposures University Employees  University employees with an occupational exposure to blood or OPIM are to call the University Employee Occupational Health Clinic at 919-966-9119 (8:30am- 4:30pm, Monday-Friday). After hours, holidays, and weekends, the Needle Stick Hotline is covered by UNC Healthlink at 919-966-7890. Students (including Visiting Medical Students)  In the fall and spring semesters, when Campus Health Services is open, students should call 919-966-6561 (Clinic 2). When CHS is closed, students should call the main CHS phone number at 919-966-2281 and they will be connected to the Healthlink nurse who will page the on-call CHS physician.

12. Electrical Safety Electrical Safety is everyone's responsibility in a healthcare setting. Precautions that you can take include the following:  obtaining proper instructions before using any electrical equipment  not using any electrical equipment or wall receptacle that appears to be damaged or in poor repair  reporting all unsafe conditions immediately to the supervisor in charge of the area in question  tagging and removing from service immediately any electrical equipment found to present an electrical hazard  reporting all shocks immediately pulling the plug, not the cord, to remove the plug from an outlet  never using a three-prong grounded plug in a two-slot outlet  not overloading adapters or circuits  extension cords are not permitted  not using a portable electric heater

13. Electrical Safety An approved surge protection device may be used to: 1. perform some specific non-permanent (temporary) task 2. provide power to critical areas when the normal electrical supply is out of service 3. energize small office equipment, such as computers and its related equipment

14. Equipment Inspections All electrical patient care equipment, including equipment used in Ambulatory Care, Campus Health Service, and Family Medicine, must be inspected by Medical Engineering. Prior to using any patient care equipment, the user should ensure that the equipment has been inspected and displays a current Medical Engineering sticker. Before using any equipment, the user should be trained in the capabilities, limitations, and applications of the equipment. Patient owned electrical equipment such as radios, hair dryers, electric razors, etc. are the responsibility of the patient, visitor, or staff to ensure the equipment is safe and in good working order.

15. Safe Medical Device Act Any equipment or device found to be defective or in disrepair should be immediately removed from service and secured to prevent use. If a patient or employee incident occurs, including near miss situations, because of an equipment or product (medical device) malfunction or defect, immediately report the incident to Risk Management (919-966-3041) or UNC Hospitals Environmental Health and Safety (919-966-0749) to facilitate reporting under the Safe Medical Devices Act.

16. Electromagnetic Interference with Patient Care Equipment The use of wireless cellular devices (WCDs) in occupied patient rooms shall be limited as much as practical. In areas where patients are dependent on life-support equipment, including all Critical Care and Step-Down units, the Emergency Department, the Operating Rooms and Procedure areas, PACU, Labor and Delivery, Dialysis, McLendon Laboratories, all Radiology areas including Imaging Suites, MRI, CT, Nuclear Medicine and Linear Accelerators, Cardiac Catheterization, EKG, EEG, and the CNP Sleep Laboratories, the use of WCDs are to be restricted as much as possible.

17. Electromagnetic Interference with Patient Care Equipment The following guidelines (in order of preferred compliance), shall be adhered to if at all possible in patient sensitive areas: 1. Individuals are to leave the patient sensitive area prior to using the WCD. 2. WCDs shall be at least 3 feet from any energized medical equipment in areas designated above. Patients and visitors will respect the work that needs to be performed by the staff. In the event that the use of WCDs interferes with care being rendered to the patient, users may be instructed to turn off the device. If asked, users must comply with the request immediately. Non-compliance may result in loss of user privileges.

18. Equipment Hazard Reporting If there is an incident involving any type of equipment at UNC Hospitals, you need to report the incident as soon as possible to Risk Management at 919-966- 3041. If there is an equipment incident involving a patient, visitor, or staff remember to follow the procedures outlined in the Hazard Reporting Requirements under the General Safety section.

19. Hazardous Materials, Waste, and the Environmental Management Program The Environmental Management Program is managed by the Department of Environment, Health and Safety (EHS) and pertains to the disposal of hazardous waste. If you are responsible for the disposal of hazardous waste, you will receive more in- depth training through your department. Any questions concerning environmental management issues should be reviewed with your departmental safety coordinator, supervisor, or EHS. Hazardous materials are those substances that are potentially hazardous to your safety and health. Employees may encounter many hazardous materials that are classified as health and/or physical hazards. A health hazard is anything that causes acute or chronic health effects. A physical hazard is any chemical that is flammable, an oxidizer, or corrosive. Examples of Hazardous Materials in the Clinic Environment include infectious waste, flammable liquids and gases, toxic chemical, radioactive materials, chemicals, drugs, and compressed gas cylinders. All departments using hazardous chemicals are responsible for determining if a less hazardous chemical may be substituted. Appropriate precautions should always be used in handling hazardous materials.

20. Hazard Communication Background What is OSHA’s Hazard Communication Standard? OSHA’s Hazard Communication standard (29 CFR 1910.1200), promulgated 1994, requires that employees be informed of the hazards of chemical(s) that they work with or are present in their work area.

21. OSHA Hazard Communication Standard (continued) The four elements of the program include:  Ensuring chemicals are labeled  Maintaining departmental/work unit/laboratory chemical inventories  Maintaining Safety Data Sheets (SDS)  Training of personnel by Supervisor on the chemicals that are used or in the workplace

22. OSHA collaborates with United Nation To view details of this report, double click picture. Understanding the need for consistent classifications of hazardous chemicals, OSHA decided to better align with the United Nations’ Globally Harmonized System by adopting a common classification and labeling of chemicals.

23. HazCom 2012 HazCom 2012 will use a “specification” approach rather than a “performance-oriented” approach. Hazards will be classified thus providing a specific criteria for classification of health and physical hazards, as well as classification of mixtures. Specifically:  Appendix A defines health and physical hazards  Appendix B includes additional parameters to evaluate health hazard data  Appendix F pertains to Carcinogens

24. Labels HazCom 2012 requires chemical manufacturers and importers to provide a label that includes a harmonized product identifier, pictogram, signal word, and hazard statement for each hazard class and category. Precautionary statements must also be provided.

25. Labels - Pictograms Pictograms are required on labels to alert users of the chemical hazards to which they may be exposed. Each pictogram consists of a symbol on a white background framed within a red border and represents a distinct hazard(s), such as health, physical, and environmental. The pictogram on the label is determined by the chemical hazard classification. There are nine pictograms with only the environmental pictogram being optional.

26. Labels – Distinct Hazards As previously stated, “Distinct hazards” are chemicals in which there is scientific evidence that a health, physical, and/or environmental hazards may occur.  Health Hazard - acute or chronic health affects may occur if exposed.  Physical Hazard - a combustible liquid, a compressed gas, explosive, flammable, an organic peroxide, an oxidizer, pyrophoric, unstable (reactive) or water-reactive  Environmental Hazard – pose risk or danger to the environment

27. Labels – Pictograms (Health)  Acute Toxicity (fatal and toxic)  Fatal in contact with skin  Fatal if inhaled  Fatal if swallowed  Toxic if swallowed  Toxic in contact with skin Examples: Chloroform, Acrylonitrile, Arsenic Skull and Cross Bones will appear on the most severely toxic chemicals. Depending on the toxicity of the chemical, the skull and crossbones indicates that the chemical may be toxic or fatal. Specifically it can mean:

28. Labels – Pictograms (Health)  May be corrosive to metals  Causes severe skin burns  Causes serious eye damage Examples: Sodium Hydroxide (lye) and Sulfuric Acid Corrosive will appear on chemicals that have corrosive properties. Depending on the properties of the chemical(s) in the product, the corrosion pictogram can mean:

29. Labels – Pictograms (Health)  Harmful if swallowed  Acute Toxicity (harmful)  Harmful in contact with skin  Skin Sensitizer  Harmful if inhaled  Respiratory Tract Irritant  Causes skin irritation  Irritant (skin and eye)  Causes serious eye irritation  May cause allergic skin reaction  Hazardous to Ozone Layer Examples: Isopropyl Alcohol, Acetic Acid, Ammonia Exclamation Mark will appear on chemicals with less severe toxicity. This symbol will never be used with “skull and crossbones” symbol. Depending on the health hazard, it can mean:

30. Labels – Pictograms (Health)  Carcinogen  Mutagenicity  Reproductive Toxicity  Respiratory Sensitizer  Target Organ Toxicity  Aspiration Toxicity Examples: Ethyl Alcohol, Carbon Monoxide, Sodium Nitrite, and Hydrogen Sulfide Health Hazard will appear on chemicals with less severe toxicity. This symbol will never be used with “skull and crossbones” symbol. Depending on the health hazard, it can mean:

31. Labels – Pictograms (Health/Physical) Gas Cylinder can cause fires, explosions, oxygen deficient atmospheres, toxic gas exposures as well as the innate physical hazard associated with cylinders under high pressure  Gases under pressure  Compressed gases  Liquefied gases  Refrigerated liquefied gases  Dissolved gases Examples: Methane and Propane

32. Labels – Pictograms (Physical) Exploding Bomb symbol will appear on chemicals that have explosive properties.  Unstable Explosives  Self-reactive substances and mixtures  Organic peroxides Examples: Nitroglycerine and TNT, Gunpowder, Rocket propellants, and Pyrotechnic mixtures (fireworks).

33. Labels – Pictograms (Physical)  Extremely flammable gas  Extremely flammable aerosol  Self-Heating  Flammable aerosol  Extremely flammable liquid and vapor  Highly flammable liquid and vapor  Flammable liquid and vapor  Flammable solid Examples: Methane and Butane, Pyrophorics, Organic Peroxides Flame symbol will appear on chemicals that are flammable. Depending on the properties of the chemical(s) and the product, the flame can mean:

34. Labels – Pictograms (Physical) Flame over circle symbol will appear on chemicals that are:  Oxidizers  Oxidizing gases, liquids, and solids Examples: Hydrogen Peroxide and Nitrous Oxide

35. Labels – Pictograms (Environment) Environment symbol will appear on chemicals which are acutely hazardous to fish, crustacean, or aquatic plants. This is the only symbol that is not mandatory.  Aquatic Toxicity  Acute hazards to the aquatic environment  Chronic hazards to the aquatic environment

36. Label – Signal Word A Signal Word is used to indicate the relative level of severity of hazard and alert the reader to a potential hazard on the label. The signal words used are:  "Danger" - used for the more severe hazards  “Warning" - used for less severe hazards.

37. Labels- Hazard Statement A Hazard Statement describes the nature of the hazard(s) of a chemical, including where appropriate the degree of hazard. All of the applicable hazard statements must appear on the label.

38. Labels – Precautionary Statement A Precautionary Statement is a statement that describes recommended measures that should be taken to minimize or prevent adverse effects.

39. Label – What do UNC Employees need to do? Effective June 1 2015, all chemicals received at the University should have the required label. Any material transferred to another container must also have the same label versus just chemical/product name.

40. Safety Data Sheets (SDS) HazCom 2012 requires Safety Data Sheets - SDS (formerly known as Material Safety Data Sheets – MSDS) to use a specified 16-section standardized format. Under the new format, employees wanting information regarding Exposure Controls/Personal Protection will always refer to Section 8 of the Safety Data Sheets.

41. Safety Data Sheets (SDS) To improve employee understanding, information listed on the label, like Precautionary Statement, will be same information the employee will find on the Safety Data Sheet. The standardize 16 sections is broken down as follows:

42. Safety Data Sheet – 16 Sections 1. Identification of the substance or mixture and of the supplier 2. Hazards identification 3. Composition/information on ingredients Substance/Mixture 4. First aid measures 5. Firefighting measures 6. Accidental release measures 7. Handling and storage 8. Exposure controls/personal protection 9. Physical and chemical properties 10. Stability and reactivity 11. Toxicological 12. Ecological information (non mandatory) 13. Disposal considerations (non mandatory) 14. Transport information (non mandatory) 15. Regulatory information (non mandatory) 16. Other information including information on preparation and revision of the SDS

43. Resources - Guidance & Outreach OSHA has developed an extensive web page to provide additional resources for employees at: http://www.osha.gov/dsg/hazcom/index.html Supervisors can find printable guidance material that can be utilized when training employees, including OSHA Briefs, Fact Sheet, and Quick Cards.

44. Major Chemical Spill Plan The Major Chemical Spill Plan is activated by the Director On-call when notified that a spill has occurred that poses an immediate threat of fire, explosion, personnel exposure or pollution of the general environment. A major spill will necessitate the response of Chapel Hill Fire Department and the Regional Hazardous Material Emergency Response Team. The immediate evacuation of personnel from the spill area should occur if the spill poses a clear and present danger and is not readily confinable. Individuals should call 911 and explain the scenario to the best of their ability to the operator. The operator will immediately notify UNC-CH Department of Environment, Health and Safety (919-962-5507) or UNC Healthcare Environmental Health and Safety (919-966-0749).

45. Fire/Life Safety Fire Safety education is essential for the protection of everyone should a fire occur. In the event of a fire, the following steps should be taken: R - Remove or rescue individuals in immediate danger A - Activate the alarm by pulling the fire pull station located in the corridors and calling 911. C - Confine the fire by closing windows, vents and doors E - Evacuate to safe area - Know the evacuation routes for your areas. Extinguish the fire with the proper extinguisher located in all hallways, if you can do so safely.

46. Fire Signal System at UNC Hospitals Fire strobe lights, tone signals, and overhead paging are located in corridors throughout all hospital buildings. Activation of one of the alarm systems at UNC Hospitals will result in the following announcements or alarms/signals.  Overhead Tones and Lights Only (No announcement is made) - Fire detection device other than a fire pull station has been activated by zone. Immediately following activation of a smoke detector, the telephone operators will notify all persons responsible for checking fire alarms. Employees are to stand by for further instruction.  Attention Please: Location - Smoke or fire has been reported by either a pull station or a 911 call  Attention Please: All Clear - Emergency has been corrected. Resume normal activities.  Attention Please: This is a Hospital wide Fire Drill. Location - A hospital wide fire drill is being held and all employees, faculty and staff are expected to participate.

47. Fire Signal System at UNC Hospitals Ambulatory Care Center, WakeBrook, and UNC Hospitals Surgical Center at Connor Drive: Fire strobe lights and audible alarms are used in these locations. For additional information on fire response at these locations, review the respective fire prevention policies. Hedrick, Facility Support Buildings, Family Practice Center, Timberlyne, Meadowmont B, UNC Imaging and Spine Center, Hillsborough Medical Office Building and the UNC Wellness Centers: Fire strobe lights are used throughout these buildings. No overhead announcements are made. When the system is activated, employees should follow the RACE response and evacuate the building. Each department should designate an area outside to meet individuals to verify that all persons are present. Other UNC Health Care Locations: Other buildings/locations not specifically noted above will have different fire alert systems in place. Each individual working in those locations must know the exact response in the event of a fire/drill for their location.

48. Fire Signal System at UNC Hospitals Specific information about fire evacuation procedures by UNC Hospital location is available in the Fire Prevention Control and Evacuation policy located in UNC Hospitals Health and Safety manual. http://intranet.unchealthcare.org/intranet/hospitalde partments/safetynet/policies For fire prevention in surgical/procedural areas, please refer to the UNC Hospitals Fire Prevention in Surgical Areas policy.

49. Fire Signal System at Campus Health Service Fire strobe lights and audible alarms are located throughout the building. The Fire Marshal will announce the following message over the intercom system: “The fire alarm is sounding. All ambulatory patients and staff please evacuate the building immediately. Emergency Coordinators should assume duties.” Only after the fire alarm is reset by the Chapel Hill Fire Department or the University’s Department of Environment, Health and Safety, the Nursing Services Fire Marshal announces “ALL CLEAR”. Repeat this three times! Specific fire response and evacuation procedures are located in the Campus Health intranet: https://share.unc.edu/sites/dsa/chs/SitePages/Home.aspx https://share.unc.edu/sites/dsa/chs/SitePages/Home.aspx

50. Fire Signal System at School of Dentistry UNC School of Dentistry Be attentive to any messages being broadcast through the alarm system. An alarm sounding without a message indicates an immediate evacuation is required. Annunciators may instruct occupants to “STAND-BY”. This indicates the situation is occurring in another building and evacuation is not yet required. If the condition becomes more urgent, the message will indicate a full evacuation is required. Stay calm and exit the building. Do not use elevators when the fire alarm or strobe lights are activated. Dental School employees will direct visitors and patients to the closes designated staging area. More information about evacuation procedures is available in the UNC School of Dentistry Emergency Evacuation Policy and Procedure Manual.

51. Evacuation Procedures It is important to be familiar with the fire safety characteristics in the building within which you work. Each building is divided into compartments to limit the spread of fire and restrict the movement of smoke. Fire walls, doors, and vertical openings, such as stairwells are designed to prevent the spread of smoke and fire. Doors are instrumental in the containment of smoke or fire. All doors must be closed and any equipment in the corridors must be cleared. These structures, including ceiling tiles, cannot be removed or interrupted. Holes in the walls and ceilings must be patched with the proper fire chalking. Exits are marked by an approved sign that is readily visible from any direction of exit access. In such buildings, individuals can be moved horizontally or downward (vertically) to an area clear of heat and smoke and kept there until the danger is over.

52. Evacuation Procedures If evacuation is needed, evacuate horizontally (on the same floor) if possible. If horizontal evacuation is no possible, use stairs that go down, away from the fire. Never use the elevator for evacuation unless the Chapel Hill Fire Department directs you to do so. After you have evacuated a patient from their room and closed the door, place a pillow outside the door (or other identified item for your area) to signal that the room has been checked.

53. Evacuation Procedures Ambulatory persons: Form a group of ambulatory patients/individuals and appoint a helper to lead them to safety and to remain with them until the all-clear announcement is made. Wheelchair persons: Move these patients to safety on the same floor level if possible. Take chairs back for additional patients. Others may help by taking this category of patients downward later, if necessary. Stretcher or helpless persons: If the patient cannot walk with support or sit upright in a wheelchair, then they should be transported using a stretcher, rolled in their beds, dragged on the floor on mattresses or blankets, or carried. These persons should also be moved to safety on the same floor level, if possible. Others may help by taking these patients downward later, if necessary. Wheelchairs, stretchers and bottled oxygen may be necessary in order to transport patients and certain phone numbers should be readily available. For additional information specific to your department, refer to your site-specific fire/emergency plan information sheet.

54. Fire Detection Systems Fire strobe lights and audible alarms are located throughout the ACC. Activation of the alarm system at the Ambulatory Care Center will result in the following announcements:  Smoke Detector- A device that senses visible or invisible particles of combustion (smoke)  Heat Detector- A device that senses a change in temperature above a fixed setting.  Manual Pull Station- A device that personnel use to activate the fire alarm system typically located in corridors near exits and stairwell doors.  Water Flow Alarm- A device used to detect any flow of water from a sprinkler system.  Smoke Damper- An automatically closing device used to stop the movement of smoke through an air duct penetration of a required smoke wall.  Duct detector- A smoke detector located in air ducts for the purpose of fan shutdown in the presence of smoke.

55. Fire Extinguishers Fire Extinguishers - To effectively fight a fire, you must understand what causes a fire to burn. There are three basic elements of fire: fuel, heat, and oxygen. Removing any one of these elements will cause the fire to cease to burn. The first step of extinguishing a fire is to identify the type of fire and choose the right extinguisher to use. There are three major classes of fire and three types of extinguishers:

56. Fire Extinguishers, con’t. Class A: Contains only water and should be used on class A fires only (ordinary combustible products such as paper, cloth or wood). NEVER use this type of fire extinguisher on an electrical fire. Class BC: Contains carbon dioxide and should be used on class B fires (flammable liquid fires) or Class C fires (electrical fires). Class ABC: Contains a white powder and can be used on class C fires (electrical fires) or class A or B fires.

57. Using the Fire Extinguisher In the event a fire occurs in your area, you should assist in securing persons to a safe area as needed. In the event a fire occurs in another area, you should remain available and provide assistance as needed. To properly use a fire extinguisher, you only have to remember to PASS. P – Pull the pin between the handles A – Aim the nozzle at the base of the fire S – Squeeze the handles together S – Sweep the extinguisher from side to side

58. Using the Fire Extinguisher, con’t. Discharge the fire extinguisher as you approach the fire to ensure its operation. The extinguishing agent should be applied even after the flames are extinguished. Never leave an extinguished fire unattended. Always, extinguish the fire with your back to an exit door, in case you have to leave the area. If safe, you should remain in the area until the fire department arrives on the scene.

59. Fire Safety Prior to opening any door during a fire emergency, feel the door and the doorknob. If either are hot, do not open the door. If the door and knob are cool, stand to the side of the door and open the door slowly. If you must enter a fire scene, stay low. Remember that smoke and heat rise to the ceiling and you must crawl beneath them.

60. Fire Safety Reminders DO’s  Keep hallways clear of furniture, surplus, and equipment  Know the location of all fire alarm pull stations, fire extinguishers, and fire exits in your work area  Know evacuation routes for your work area and what to do in case of a fire  Smoke only in designated outdoor smoking areas  Keep your work area clean and free of clutter  Learn patient transportation and evacuation techniques DO NOT’s  Leave equipment standing in traffic lanes or hallways since this could obstruct the evacuation of patients and personnel  Obstruct fire equipment or fire doors so they do not open/close properly  Place anything within 18” of a sprinkler head  Smoke in stairwells  Prop open emergency exit or stairwell doors for any reason  Tamper with electrical wiring, equipment, or fuses.

61. Medical Gasses Shut-off/UNC Hospitals Medical gas shut-off valves are specific to particular locations and may control medical gas flow to extended areas. Remember that not only the patients in the area of the fire but all patients in the area controlled by the valve will be deprived of medical gases if the valve is shut off. In anesthetizing locations, the anesthesiologist in charge of the case will be responsible for handling medical gas shut-off procedures. The controlling valve for medical gases in the area will be shut off by Plant Engineering/Facility Services personnel, Hospital Police, the nurse in charge of the area, or in clinics, the senior clinician.

62. Emergency Preparedness The Alert Carolina System (ACS) communicates in multiple ways with students, faculty and staff, as well as visitors, local residents, parents and the news media in the event of an emergency or dangerous situation. Under Alert Carolina System Protocols adopted in August 2011 and revised in Fall 2013, the University informs the campus community using four different types of notifications – Emergency Warning, Timely Warning and Informational and Adverse Weather. Faculty and staff are encouraged to register their cell phones with Alert Carolina in order to receive timely notifications. More information can be found at the Alert Carolina website (www.alertcarolina.unc.edu).www.alertcarolina.unc.edu

63. Emergency Preparedness What is a catastrophic emergency? An event that overwhelms UNC Health Care’s ability top provide patient care services. External Emergency Occurs outside the Hospitals  Plane crash  Tornado  Building collapse Internal Emergency Occurs inside the Hospitals  Fire  Power outage  Chemical Spill The Emergency Preparedness Procedures Quick Reference Guide includes checklists of all code responses. It is available in each department and on the hospital intranet at: http://intranet.unchealthcare.org/hospitaldepartments/disaster Code response information is in the right navigation bar.

64. If There is an Emergency…. An overhead announcement with the Emergency Response Code will be made. For example, “Code Triage – Standby” Before an Emergency  Be familiar with the site-specific fire/emergency response plan  Know the response codes on the back of your ID badge During an Emergency  Follow your Supervisor’s instructions  Keep incident leaders informed  Review online emergency response guides as needed  Report situation updates or needs to the Command Center at 919-966- 2393.

65. Emergency Preparedness Disaster events are those events that stress the medical system by exceeding its capacity to deliver services in the usual manner. Disaster events could include natural disasters as well as internal events. Regardless of whether a disaster is internal or external, the key to effective management is an orderly mobilization of personnel and supplies. If an event occurs, the following announcements will be heard over the public address system:

66. Code Pink: Abducted Child or Infant All Staff Take Extra Precautions (A-STEP)  Monitor your areas and report suspicious behavior to Hospital Police immediately.  Approach and verify the identify of all people carrying infants or with children of the appropriate age and inspect containers that could conceal infants (if appropriate).  Designated personnel report to ground floor exits for egress control. Staff All Floor Exits (SAFE) Nursing, physicians and support staff work together to physically man all exits from inpatient areas.

67. Code Silver: Hostage Situation Call 911  Use the Code Silver Checklist in the Quick Reference Guide.  Keep patients, visitors, and other staff away from the hostage location. If possible keep visitors in the waiting rooms while keeping patients in their rooms.  Establish a perimeter to keep out all patients, staff, and visitors to reduce the chances of further injuries and additional hostages.  Stay alert for bombs or similar devices and report any suspicions immediately.

68. Code Blue/Code Stork Code Blue - Cardiac Arrest or Respiratory Arrest or Unresponsive Person Code Stork - Birthing Emergency

69. Code Yellow: Bomb Threat Call 911  If you receive a bomb threat, complete the Bomb Threat Checklist located in the Quick Reference Guide.  Everyone should checked their areas for unusual or suspicious packages or articles. Report any found to 919-966-3686. DO NOT TOUCH OR MOVE THEM.  DO NOT allow others into the area until Hospital Police have arrived and taken over.

70. Code Orange: Chemical Spill A major chemical spill is defined as a release or spill of a large quantity of a chemical agent (solid, liquid, gas) in an uncontrolled state posing an immediate threat of fire, explosion, personnel exposure, or pollution of the general environment. An immediate threat spill is a spill that poses a clear and present danger to personnel in the general area. Spills that occur in the:  Hospitals should be reported to 919-966-3686  Spills on Campus should be reported to 911.

71. Code White: Radiation Exposure High-level exposure to ionizing radiation or exposure to radioactive materials. Radiation Spills – Report immediately to UNC Department of Environment Health and Safety 919- 962-5507. Patient Exposure - Refer to the Emergency Operation Plan for information on the treatment of patients suspected of a radiation exposure.

72. Code Gray: Security Threat (Suspicious Person or Package) There are three kinds of Code Gray alerts:  General Alert – Security alert situation, such as a fight or person making threats.  Suspicious Person Alert – Person acting in a suspicious manner (asking about bed capacity, security contingent)  Suspicious Package Alert – Discovery of a package that seems to be out of place in your work area. Call 911  Do NOT act alone  Use the appropriate form to record your observations  Keep the area as safe as possible until help arrives.

73. Code Black: Utility Failure Water, Medical Gases, Electrical A Utility Management Grid is located in each department in the Emergency Preparedness Quick Reference Guide. In case of utility failure at:  UNC Hospitals, call Plant Engineering at 919-966-4484  ACC, Family Practice, etc call UNC-CH Facilities Service at 919-962-3456 Suspected terrorism should be immediately reported to Hospital Police at 919-966-3686.

74. Code Green: Biological Exposure (including Bioterrorism) If you suspect an act of bioterrorism or a highly communicable disease OR you notice a trend in signs and symptoms, contact Hospital Epidemiology at 919- 966-1638 or page: 123-7427 Always wear appropriate personal protective equipment to protect yourself from exposure.

75. Code Triage: Mass Casualty Event Code Triage is an internal or external event by which large numbers of patients are expected in a short time period. Follow your departmental Site Specific Fire/Emergency Response Plan that incorporates a system for mobilizing personnel and resources. Emergency Staffing – If emergency staffing is needed during an event, the Hospital Incident Command System may deploy personnel from one part of the organization another.  Clinical Staff – Remain on your until called  Non-Clinical Staff – Remain in your positon until called.

76. Code Weather: North Carolina has 3 common weather emergencies: Hurricanes, Tornados, and floods. Tornado Alert  Move ambulatory patients to interior hallways or similar areas of the unit away from windows (see your Site-specific fire & Emergency Plan).  Non-ambulatory patients that cannot be readily moved should be protected in place by:  Covering patients with sheets or blankets  Securing any loose items over the patient  Rotating beds away from windows  Close all patient room doors  Immediately seek shelter in the nearest safe zone.  Following a direct hit, immediately report any injuries to 911.

77. Active Shooter  If possible, close and barricade the doors to the unit  Close all patient room doors  Try to move all ambulatory patients and visitors to a secured area off the unit or clinic  Keep as quiet as possible  Notify UNC Hospital Police via 911 and provide the following information:  Your name  Your location (be as specific as possible)  Number of shooters  Description of shooters  Description of weapons involved  Number of persons with you and any injuries  If you are escorting or transporting a patient for treatment, the following action should be taken:  Immediately evacuate the patient to the nearest in-patient area, preferably an ICU  If no in-patient area is nearby, evacuate the patient to a safe area, and immediately call Hospital Police Dispatch to notify them of your location and the condition of your patient. Do not leave your location until an “All Clear” announcement has been made.

78. Utilities Management Program Healthcare Systems and UNC Hospitals have a comprehensive utility management program to ensure the appropriate utilities are available to support patients and personnel. A grid has been developed to assist in what to expect, whom to contact, and responsibility of the user, when a system fails. Most instances should be reported to Facilities Services Division (919-962- 3456) in University buildings and Plant Engineering (919-966-4484) in Hospital buildings.

79. Utilities Management Program Utility Failure  Ensure all patient care equipment is plugged into red outlets.  Discuss the potential fore evacuation with the charge nurse should utilities remain offline for an extended period of time.  Prepare for downtime procedures should the network become inaccessible.  Consider the use of runners.

80. Security Management All faculty, staff, students and other persons acting on behalf of the Hospitals, are required to obtain and maintain a single current UNC Health System Identification Card. The UNC Health System Identification Card must be worn with the photo side visible whenever practical while on UNC Hospitals property. Each Staff member or affiliate must maintain the ID card while their affiliation continues with the health system. Identification Cards remain the property of the health system and must be returned when the cardholder is no longer affiliated, or upon request of the employee’s supervisor or Hospital Police personnel. Access to University buildings is managed by the UNC Public Safety and the OneCard Office. UNC School of Medicine maintains a separate ID system for access to SOM buildings in addition to UNC Hospitals buildings. More information can be found at http://www.med.unc.edu/planning/id-badges- building-access.http://www.med.unc.edu/planning/id-badges- building-access

81. Security Management Academic healthcare centers are not immune to serous crime and it is everyone’s responsibility to take precautions to protect our community. There is a delicate balance between providing open public access and reasonable safety and security. All criminal incidents or suspicious activities within University Facilities should be reported to UNC Campus Police at 911. This includes the Ambulatory Care Center, Family Practice, Campus Health Service, University buildings, and the employee parking areas. All incidents that occur within the Hospital and on hospital property should be reported to the Hospital Police Department at 919-966-3686.

82. Consultation If you have any questions regarding any of the above information, please contact the UNC Department of Environment, Health and Safety at 919-962-5507. Additional information is also available in several reference manuals including the UNC-CH Health and Safety Manual, UNC Hospitals Safety Policy Manual, the Infection Control Manual, and the Emergency Operations Plan.

83. Completion and Post Test You have completed this self-study unit. Please call Environment, Health and Safety if you have any questions or want further discussion. In order to receive credit for this course, please complete the short multiple choice test. To take this test, you may click on the highlighted Post-test now.Post-test REMINDER: University employees with duties in Health Care Facility or UNC Hospitals are required to complete annual Tuberculosis and Infection Control training. In addition, if duties involve exposure to blood or other potentially infectious materials. University employees are required to complete annual Bloodborne Pathogen training. Both courses are available on-line. For more details, return to the training page at ehs.unc.edu/training/self.shtml. ehs.unc.edu/training/self.shtml