Chapter 6: Emergencies and Occupational Health and Safety

 

[YOUR CLINIC NAME] complies with requirements established by WorkSafeBC as well as the College of Physicians and Surgeons of BC mandatory assessment standards for emergencies and occupational health and safety.

6.1 Critical Incident Reporting

[YOUR CLINIC NAME] documents all critical incidents, include emergencies and work place incidents. A critical incident log can be found [location].  

All occupational health and safety concerns and incidents are reported to Work Safe BC. View critical incident reporting information.

6.2 Emergency Kits

There are two emergency kits located in the clinic.

[Person or role] is responsible for maintaining the two emergency supply kits in accordance with the College of Physicians and Surgeons of BC Safety Assessment Standards for emergency kits.

  1. For more minor staff medical emergencies a level one emergency kit emergency kit is available, located in [location].
  2. For patient and more serious medical emergencies, there is an emergency kit is located in [location].

       This kit includes:

Emergency Medication:

  • Epinephrine (1 mg of 1/1000 solution or prefilled syringe)
  • Diphenhydramine (50 mg of oral/parenteral preparations)
  • Salbutamol metered dose inhaler
  • Nitroglycerin spray (0.4 mg)
  • Acetylsalicylic acid (80 mg)
  • Lorazepam (1 mg sublingual preparation)
  • Oral and parenteral benztropine (if haloperidol is given in office)
  • Glucose gel
  • Naloxone (for risk-appropriate clinical settings)

Emergency Equipment

  • Bag valve mask ventilator
  • Blood pressure cuff (pediatric, small adult, large adult)
  • Glucose meter
  • Oral airways (pediatric, small adult (size 3–4), medium adult (size 4–5), large adult (size 5–6)
  • Nebulizer or metered dose inhaler spacer and face masks
  • Personal protective equipment (latex-free disposable gloves, fluid-resistant mask, eye protection)
  • Oxygen source, oxygen mask (pediatric, adult) and tubing
  • Portable suction device and catheters, or bulb syringe
  • Intravenous extension tubing and T-connectors
  • Pulse oximeter for child and adult usage
  • Resuscitation tape (color-coded) for pediatric dosage determination
  • Automated external defibrillator
  • ECG machine

 

6.3 Emergency Exits

[YOUR CLINIC NAME] has [#] of emergency exits. They are located [insert location].

Ambulance Exits

[Include details about ambulances entering and/or leaving the clinic property].

 

6.4 Medical Emergencies 

[YOUR CLINIC NAME] Medical emergency protocol is activated for all situations where a patient or staff member is noted to be unstable.  These include patient in distress, vital signs abnormal, breathing laboured, reduced level of consciousness. Steps are indicated below.

  1. Follow CPR guidelines:
    1. If witnessed unconsciousness, position patient safely to the floor, obtain AED, start CPR 30:2 compressions to breaths or continuous 100/minute.
  2. Call for help early: 
    1. Most responsible physician (MRP) (the clinician involved with the patient) will call for available help from all staff clinicians.
    2. Inform reception of the type of medical emergency
    3. Reception duties:
      1. Immediately call 911 and provide details of medical emergency, location and need for ambulance assistance.
      2. Provide MRP cell phone for direct discussion with ER doctors
    4. MRP to send for the Emergency Kit while helping to position patient in safest manner (likely on floor if CPR is to be done).
  3. Designate leadership: 
    1. MRP is the clinician involved with patient
    2. Establish role clarity and distribute workload (e.g. designate someone to document situation)
    3. Communicate effectively
  4. Monitor and Follow –up
    1. Monitor ABC’s, vital signs, and pulse oximetry.
    2. Arrange for patient transfer to Acute Care Facility.
    3. Arrange for complete documentation to accompany patient.
    4. Notify family members and other appropriate caregivers.

Patient Transfer

The following protocol has been instituted in order to provide a safe and expedient transfer of a patient to hospital following an unanticipated event:

  • Decision to transfer the patient will be made by the MRP
  • The patient will continue to be monitored until EHS arrives, while the MRP calls the hospital to arrange admission.  MRP may consider keeping in close communication with the hospital

Procedure:

  1. Do not move the patient unless environment is unsafe or EHS cannot reach them.
  2. Ensure clinic space is free of obstruction to ensure access by EHS.
  3. Receptionist will call the ambulance indicating the acuity and the level of care and direct them to the appropriate exit.
  4. A photocopy of the completed chart note will accompany the patient to hospital.  The documentation will include all pertinent chart documentation available
  5. Administrative follow up (MRP responsible for ensuring complete)
    1. Ensure documentation complete.
    2. Arrange for staff de-briefing as necessary.

 

6.5 Fire and Earthquake

6.5.1 Fire

Fire alarm pull stations and extinguishers are located [Insert location]. All staff will learn this information during their orientation period at [YOUR CLINIC NAME]   

In the event of a fire in the building, take the following steps:

  1. Immediately sound the fire alarm by activating one of the fire alarm pull stations.
  2. At your discretion, attempt to control the fire with available extinguishers.
  3. If you are not able to control the fire, leave the building by the nearest exit and IF POSSIBLE, ISOLATE THE FIRE BY CLOSING ALL DOORS.  
  4. Dial 911 (ask for Fire) if necessary. Confirm that help is on the way.
    • State your name.
    • Give address where fire is: [insert address]
    • Give information about fire: (e.g.: computer – front lobby).
  5. Meet the fire department at [location] to give updated information and assistance.
  6. STAY CALM. DO NOT PANIC.

In the event of a fire alarm sounding in the building, take the following steps:

  1. Take count of arrived patients in [EMR] if possible, to allow for a headcount later.
  2. Advise everyone in the clinic exit via the emergency exits and proceed to the muster point. The muster point is located [location].
  3. Ensure any non-ambulatory patients are taken to safe areas for fire department rescue.
  4. Clinicians should end any consultations or procedures underway and instruct patients to leave by the nearest Emergency Exit or safe area.  Staff should assist patients in exiting when needed.
  5. Close all doors behind you as you leave and proceed in a quiet, orderly manner. When you leave the building, move away from the door to allow others behind you to emerge from the exit.
  6. Do not use elevator.
  7. Walk. Do not run.
  8. Do not re-enter the building for any reason.
  9. Only return to the building when you are advised by the fire department when it is safe to do so.

 

6.5.2 Earthquake

The following policies and preventative measures have been instituted in order to prepare and protect our staff and patients in the event of an earthquake:

  • The patient beds must always be in the locked position when in use.
  • Stretchers must always be in the locked position, with the side rails up.
  • Flashlights and batteries are kept in every room in the clinic.
  • An emergency supply of water and dry, imperishable foods are kept on site.

In the event of an earthquake, take the following steps:

  1. At the first sign of any shaking or swaying, everyone should take cover under a desk, table, or doorway and instruct any patients or other clinic visitors to do the same.
  2. If there are any non-ambulatory patients in mid-procedure and not immediately movable, the clinician should first cover the patient with a drape or blanket, then proceed to take cover.
  3. Once the shaking has subsided, we will follow our fire protocol for ending the procedures, and evacuating the premises.

 

6.6 Risks of Violence in Health Care

According to WorkSafe BC, patient violence is a leading cause of injury in the health system. Additionally, upon examination of the incidents, many of the patients were found to have a history or risk of violent behaviour that was not properly communicated in the patient chart. Privacy laws do not prohibit the labeling of patients with a “risk of violence” tag, and consent is not required when information is being disclosed for worker safety. Additionally, it is not a violation of patient privacy for one organization to disclose information to another, if that information is immediately necessary for the safety of employees. It is important that all employees who are in contact with patients are aware of risks of violence in patients, and any known triggers that may set off a violent event.

If an employee feels that a situation is becoming unsafe, they should leave the area and report to a supervisor. He or she will determine how to control the situation.

 

6.7 Procedures for Sharps Injuries

Used needles and other sharp instruments (sharps) should be appropriately handled to avoid injury, including minimizing contact with used sharps. Sharps should be disposed of in approved puncture-proof containers, located in the same area where the sharp was used.

Sharps disposal containers are located [location]

As recommended by WorkSafe BC, if you are stuck by a used needle follow these steps immediately:

  • Let the wound bleed freely
  • Inform a doctor at the clinic
  • Go to a hospital within 2 hours, and inform them you are a health care worker with a sharps injury.

CPSBC assessment standards for sharps safety.

 

6.8 Workplace Safety 

[YOUR CLINIC NAME] is committed to providing a safe and healthy workplace for all staff. A combination of measures will be used to achieve this objective, including the most effective control technologies available. Our work procedures will protect not only our workers, but also anyone who enters our workplace.

All employees must follow the procedures described to prevent or reduce risk of illness or injury. All new employees will be provided with safety training as a part of their initial job training. Policy and procedure reviews will be given annually, or with any updates to the policy.

[YOUR CLINIC NAME] safety procedures are based on guidelines developed by WorkSafe BC and the BC Centre for Disease Control. Every clinic employee is expected to follow these policies and procedures, as an important part of their position at the clinic. These policies and procedures are updated regularly and their use is mandatory.

Each employee is expected to obey safety rules and exercise caution and common sense in all work activities.

6.8.1 Routine Practices to Prevent the Spread of Infectious Disease

The following practices should always be performed to prevent the spread of infection diseases:

  • Hand-washing should occur before and after every patient contact. Wash hands with soap and warm water for 15-30 seconds. Waterless, alcohol-based hand-sanitizers are also effective, unless hands are visibly soiled.   See CPSBC assessment standards for Hand Hygiene for further details
  • Wear disposable, waterproof gloves when touching blood and body fluids, or when handling contaminated items. Gloves should be used in addition to hand-washing, not as a substitute.
  • Wear other personal protective equipment (for example, face shields, eye protection, and gowns) if there is a risk of splashes or sprays of blood and body fluids.
  • Handle contaminated equipment and linens according to safe work procedures to prevent the transfer of infectious organisms.
  • Handle and dispose of sharps according to safe work procedures.
  • Use mouthpieces or other ventilation devices instead of mouth-to-mouth resuscitation, whenever possible.
  • Appropriate sterilization and disinfection of reusable equipment and office surfaces (counters and furniture) on a routine basis.

6.8.2 Preventing ​Transmission ​Respiratory ​Infection by of ​Airborne or ​Droplet Routes

The following practices should always be performed to prevent the spread of infection by airborne or droplet routes:

  • Screen patients when scheduling appointments. Whenever possible, patients suspected of carrying a transmittable respiratory infection should be booked at the end of the day
  • Quickly triage patients suspected of carrying a transmittable respiratory infection out of common waiting room areas.
  • Make waterless alcohol-based hand antiseptics and disposable surgical masks available to all patients. Ask patients suspected of carrying transmittable respiratory infections to don a mask and use the hand-sanitizer immediately upon entering the clinic, and again before seeing a doctor or nurse.
  • Close the door of examining rooms, limiting access to the patient by visitors and staff members.
  • Patients known to be carriers of antibiotic resistant organisms should have this indicated in their medical record, and special care should be taken to prevent the spread of these organisms, including disinfecting all surfaces that have been in direct contact with the patient, immediately after a visit.
  • Routine infection control practices (hand-washing, sanitizing surfaces, and using personal protective equipment) are to be used with all patients, regardless of presumed infection or diagnosis.

Links to the College of Physician and Surgeons of BC assessment standards for infection prevention and control.

Detailed descriptions of policies and procedures for infection prevention and control, recommended by WorkSafe BC and the BC Centre for Disease Control.

6.8.3 Waste Disposal

Biomedical Waste:

Municipal and provincial laws regulate the disposal of biomedical waste. There are two categories of biomedical waste:

  1. Anatomical – including tissues, organs, and body parts (not including hair, nails, and teeth)
  2. Non-anatomical
  • Human blood and blood products
  • Items contaminated with blood that would release liquid if compressed
  • Body fluids contaminated with blood, excluding urine and feces
  • Sharps
  • Broken glass or other sharp objects that would have come into contact with blood or body fluids

[Describe clinic procedures for biomedical waste disposal]

Pharmaceutical Waste:

Pharmaceutical waste (returned medications) is returned to pharmacies or drug company representatives.

[Describe clinic procedures for pharmaceutical waste disposal]

Confidential Paper Waste:

Confidential paper waste is shredded with a two-way shredder and recycled.

WHMIS:

The Workplace Hazardous Materials Information System (WHMIS) is a national hazard communication standard. It includes cautionary labeling of containers of hazardous substances, material safety data sheets (MSDS), which provide specific information about hazardous substances, and worker education programs. Employers are expected to uphold WHMIS standards in the workplace, and employees are expected to be familiar with the system prior to beginning employment.

View WHMIS information.

If staff have not completed WHMIS training, or feel that they would benefit from repeating the course, [YOUR CLINIC NAME] will support this training.

Handling of cytotoxic drugs:

Cytotoxic drugs are therapeutic agents intended for, but not limited to, the treatment of cancer. They are highly toxic to cells, mainly through their action on cell reproduction.

Based on guidelines from the BC Cancer Society, employees are to be educated on safe handling and exposure documentation of cytotoxic agents within their first three months of employment.

Access to cytotoxic agent storage areas, cytotoxic waste removal, and any handling of cytotoxic agents will be limited to authorized personnel only. These agents are stored separately from other drugs kept onsite, and they will be labeled appropriately. If you feel there is a potential risk in handling of any substance in the office, contact your supervisor immediately, who will assist in a risk assessment.

Do not handle any unauthorized or unknown substances without confirming with a supervisor.