Naval Hospital Bremerton's Emergency Procedures Manual a Color Coded Guide and more

BREMERTON, Wash. (NNS) -- When a Code Purple emergency was announced at Naval Hospital Bremerton before dawn April 23, everyone familiar with the newly-updated Emergency Procedures Manual knew there was an obstetric emergency.

According to Terry Lerma, NHB's Emergency Preparedness Coordinator, the manual provides "just in time" information to staff for Codes they may not normally hear every day such as the Code Purple, or a Code Green for a security alert or Code Gray to activate the disaster plan.

The Emergency Procedures Manual, conceived and implemented in 2010 by Lerma with assistance from NHB's Emergency Management Committee, is specifically designed to handily provide vital emergency information covering a host of concerns. The manual has been given a complete update that includes new color coding for emergency responses, revised contact information and enhanced instructions such as activating the command's disaster plan.

There are approximately 200 manuals deployed throughout the hospital. Culinary Specialist 2nd Class Robert Shewbert and Operational Specialist 2nd Class Mary Vaa have handled the task of update each manual and replacing the old with the new. Each manual features a fold-out flap design, with the front portion opening up like a restaurant menu. On one side of the inside fold-out is a brief color-coded short explanation of each hospital code.

The manuals were updated with correct numbers, corrections/updates to procedures, and formatted in a more user friendly, reader friendly format. Mass casualty information cards have been expanded, as well as the personal preparedness section to reflect the changes/updates from "Operation Prepare" to the newer "ReadyNavy.mil."

Perhaps the most noticeable modification is that almost half of the color codes are now different hues, each with updated applicable information to NHB staff members.

"We previously had 11 color codes in our original manuals. We did not have a Code White for an active shooter/armed intruder and we didn't have a Code Silver for a lost/eloped child/adult. There are 13 color codes of which NHB uses 12. We did not opt to utilize Code Brown since in the nursing world that refers to an involuntary bodily waste disposal function. Instead, we went with "Inclement Weather Policy," said Lerma.

Lerma attests that the additional color codes reflect joint base policy and real world events.

"With recent events at other hospitals that have experienced active shooter events, or missing patients, they have become a necessity. Also, with the integration and combination of Walter Reed/Bethesda Medical Center, it became necessary to use a common operating language that National Incident Management System and other incident command systems teach us. For example, previously a Code White in Navy Medicine referred to an OB emergency. In the Army, it meant an active shooter. Imagine the confusion if a Code White is called away at a joint command. Army staff would run out the door or shelter in place, and Navy staff would run toward the Labor and Delivery Ward! So as a result, the Navy Surgeon General decided to use identical color codes. That necessitated the change in half of the color codes we used, and the addition of a couple more," explained Lerma.

Opposite the color codes in the manual are emergency phone numbers, including after hours contact information for the Command Duty Officer (CDO), Officer Of the Day (OOD) and Nurse Of the Day (NOD). The inside is arranged in an overlapping flip-tab format, covering a variety of duties and responsibilities.

"There are "quick and dirty" cheat sheets on how to use our Enterprise Land Mobile Radios (ELMRs) that we use in emergency communications in the event we lose our telephone system. There is also has information on earthquake preparedness, hospital evacuation and personal preparedness," Lerma said.

Most staff initially find out about the manual during Command Orientation and as part of the annual update training. Lerma also periodically reminds everyone prior to any training exercise to look through their manuals for a refresher on what their duties are in a disaster.

"The manual provides consistency, along with a lot of preparedness information to all hands to better ready themselves prior to a disaster. Plus, in a worst case scenario, staff members can open the manual to get quick idea of what should be happening, or what they should do if they are not familiar with a specific procedure in an emergency," Lerma added, noting that due to staff turnover, consistency in training helps keep everyone up to date on emergency procedures.

The inclusion of a Personal Preparedness tab is especially meaningful to Lerma. The information contains scaled-down lists of how to prepare for possible disasters and other emergencies for family and household members, including pets. "We combined information from the American Red Cross, Kitsap County Department of Emergency Management and Commander Navy Installation Command's 'Operation Prepare' for what we all need to think about and be ready for in case of any scenario," said Lerma.

There are also specific tabs for what to do in case of a failure of medical equipment and or with the failure of the utility system.

"It's imperative to know who to contact if equipment goes down," said Lerma. "In the case of a failure of medical equipment, we have listed a basic chart that has equipment type in one column, like a defibrillator. The next column lists the indicator, which might be 'no energy output.' The next column contains who to contact; in this case, it would be Biomedical Repair and/or the OOD. The last column contains what type of backup system to use. If one defibrillator is not working, the options are to find an alternate unit and to begin CPR."

"We did the original manual over three year ago with great help from Safety, Facilities Management, Radiology Health, Quality Management, Nursing Services, to name a few. It was time for an update. We should have them all deployed by the first of May," said Lerma, adding that as was the case before, input from subject matter experts was instrumental in preparing the manual.

For more news from Naval Hospital Bremerton, visit www.navy.mil/local/nhb/.