Preparedness

Please take the time to familiarize yourself with this manual and keep it somewhere accessible. It is here to inform you of [Insert Clinic Name]’s plan for handling emergencies and to help you to protect yourself and your staff. 

Emergency preparedness is a shared responsibility for the clinic and an effective emergency response depends on the prompt action of individuals. Being well prepared can help limit damage and reduce the risk of harm to staff and property.

No matter what the emergency is, stop and think before you act, and then act decisively. In an emergency, if you are first on the scene, you must be prepared to:

• Take charge.
• Call 9-1-1 for police, fire, or ambulance. 
• Remain at the scene until relieved of responsibility by emergency services.

In an emergency, these are response priorities:

• Protect the health and safety of all people.
• Protect public health, property, and environment.
• Reduce economic and social loss.

Remain informed

In the event of a sustained disruption to [Insert Clinic Name]’s services due to an emergency, weather conditions, or other circumstance, notices and information updates will be communicated by local government and emergency services.

Be prepared

Being prepared, whether it’s at home or at work, can make a difference in an emergency. Visit PreparedBC for more information on how you can be better prepared for an emergency situation.

Evacuation

Be prepared: Familiarize yourself with the evacuation procedure posted at the clinic’s main entry and exits.

Clinic evacuation area:
Ensure all staff know the muster point and evacuation details for your clinic. If your clinic is in a professional building or mall, other businesses could be meeting at the same muster point.

All-clear can only be determined and announced after emergency services respond.

Evacuation procedure:

• Follow Fire Marshal or designate instructions. 
• Do not search for your belongings if they are not in the immediate area.
• Shut all doors and proceed calmly to the muster point.
• Proceed to the nearest stairwell and exit the building.
• Emergency lighting in the exits and stairwells will be active if a power failure is experienced.
• In the absence of lighting, use the wall to guide you to the nearest exit.
• Do not use the elevator.
• Do not go back into the building for any reason until the “all-clear” is announced by a Fire Marshal or by emergency services.

Evacuation of Persons with Disabilities

The most important factor in emergency safety for people with disabilities is advanced planning. Each member of [Insert Clinic Name] is encouraged to assist in the safe evacuation of persons with disabilities.

All emergencies

• In a full evacuation, do not use elevators, unless authorized to do so by police or fire personnel.
• If the situation is life threatening, call 9-1-1, state the type of emergency, and request assistance.
• Always ask someone with a disability how you can help before assisting.
• If the person cannot travel down a stairway on their own, help them to an Area of Refuge on that floor. Notify the Fire Marshal, emergency services personnel, or designate where the person is located.

Hearing impaired 

• Get the attention of a person with a hearing disability by touch or eye contact.
• Clearly communicate the problem.
• Gestures and pointing are helpful but writing a note may help.
• Offer visual instructions regarding the safest route or direction by pointing toward exits or the evacuation map.

Mobility impaired

• Clear exit route (if possible) so the person can move away from the hazard to a safer area such as a stairwell or office with closing doors. 
• Immediately notify the Fire Marshal or emergency personnel about any people remaining in the building and their location.
• Emergency services will evacuate them as necessary.

Visually impaired

• Offer to lead individuals out of the building to safety, providing instructions (e.g., elevator not to be used).
• Give verbal instructions about the safest route and estimated distances (i.e., number of steps) and directional to walk.
• Do not grasp a visually impaired person’s arm. Ask if they would like to hold onto your arm as you exit.

Power outage

• If an outage occurs during the day and an individual with disability chooses to wait in the building for electricity to be restored, assist them to a window.
• Inform the Fire Marshal or designate if an individual chooses to remain in a building.

Shelter-in-Place

The Fire Marshal or designate will notify occupants of the emergency and the decision to Shelter-in-Place, if applicable. Some examples include an earthquake, an armed assailant, or if a chemical, biological, or radiological contaminant has been released.

• Follow instructions issued by the Fire Marshal or designate.
• Move out of the hallways and into offices.
• Close all doors and windows.
• Cover any glass doors if possible.
• Turn off lights and electronic equipment.
• Crouch down in areas that are out of sight from doors and windows.
• Remain quiet.
• Do not hide in washrooms.

Should the fire alarm sound, evacuate the building unless:

• You are instructed NOT to do so by a Fire Marshal or designate.
• You have been advised by emergency services to NOT evacuate the building. 
• You are in imminent danger if you leave the sheltering place.

Fire

Be prepared. Familiarize yourself with fire extinguisher locations, fire or smoke alarms, and evacuation routes by viewing the clinic map located at each exit.

If you discover a fire:

• Manually activate the fire alarm. 
• Determine if it is safe for you to attempt to extinguish the fire (see fire extinguisher instructions below).
• Immediately exit the building using the stairs, with the last person closing the door. 
• Do NOT use elevators.
• Call 9-1-1, state the type of emergency and provide details about the fire.

Fire extinguishers

If it is safe to do so, you may fight a small, contained fire with a fire extinguisher. If you choose to try to put out a fire with an extinguisher never turn your back on the fire and ensure you have a clear exit behind you.

Fire extinguisher instructions

Pull the safety pin from the handle.
Aim the hose at the base of the fire.
Stand three to six feet away from the fire.
Squeeze the handle and sweep the hose from side to side.

If a fire alarm sounds:

• Follow instructions of the Fire Marshal or designate.
• Walk to the nearest exit closing doors and assist people who have special needs.
• Inform the Fire Marshal or emergency personnel if you suspect someone is trapped inside. 
• Gather at the designated muster area. 
• Do not attempt to re-enter the building until instructed to do so by emergency personnel or Fire Marshal.

If trapped in a room (fire in a hallway):

• Drop to hands and knees and crawl towards exit.
• Stay low, as smoke rises.
• Hold your breath as much as possible, breathe shallowly through your nose, covering your face with a shirt or towel.

If forced to advance through flames:

• Move quickly.
• Hold your breath, cover your head, close your eyes as much as possible.

Spill Response

Major spill
In the event of a spill which involves the release of a type or quantity of a chemical that poses an immediate risk to health or an uncontrolled fire or explosion:

• Notify staff and nearby businesses of the incident.
• Evacuate the building by activating the fire alarm. 
• Call 9-1-1, state the type of emergency and give details of the incident: location, types of hazardous materials, and if there are any people injured. 

When calling 9-1-1 state:

• The nature of the emergency.
• The location/address [Insert Clinic Name and address here].
• The nearest entrance, room number, or other wayfinding details.
• Your name and phone number.
• If the incident involves personal injury or chemical contamination:
  • Move the injured away from immediate hazards if this can be done without further injury. 
  • Locate the nearest emergency eyewash facility. Remove any contaminated clothing from the injured and flush all areas of the body contacted by chemicals with copious amounts of cool water for 15 minutes. 
  • Administer first aid as appropriate and seek medical attention.

Minor spill
In the event of a spill involving the release of a chemical which does not pose an immediate risk to health and does not involve chemical contamination to the body:

• Notify staff nearby of the incident.
• Call 9-1-1 if required.
• Isolate the area. Close doors and evacuate the immediate area if necessary.
• Unplug nearby electrical equipment.
• Open windows and turn on exhaust fans if available.
• Locate spill kit.
• Choose appropriate personal protective equipment (e.g., goggles, gloves, gown).
• Confine and contain spill. Cover with appropriate absorbent material. Acid and base spills should be neutralized prior to cleanup. Sweep solid material into a plastic dustpan and place in a sealed bag or container.
• Wet mop spill area. Be sure to decontaminate the broom, dustpan, etc. Put all contaminated items (gloves, clothing, etc.) into a sealed container or plastic bag.

Power Outage

Building power outage:

• Remain calm and follow directions from the supervisor, if present.
• If evacuation is required, assist people with special needs.
• Turn off all electrical equipment including computers and lights.
• Do not use the elevator.
• Proceed to the muster point if required and consider weather conditions.

People trapped in an elevator (if applicable):

• Use the elevator’s phone to contact help if available.
• If you are outside the elevator, call 9-1-1 for assistance.
• Communicate to those inside that you are getting help.
• Wait at the elevator until emergency services arrive, if it is safe to do so.

Severe Weather

Severe weather conditions can occur suddenly or be predicted ahead of time. In British Columbia, severe weather likely to occur includes accumulations of snow and ice, heavy rains and resultant flooding, and high winds.

Personal Safety

Snow and ice
To the greatest extent possible, walk only on paths that have been cleared or sanded. Wear appropriate footwear. Stay clear of the sagging or downed power lines. Heavy snow and ice may cause tree limbs to fall. Avoid areas with the heaviest concentration of trees. Exercise extreme caution when driving.

Heavy rains and flooding
In the case of extensive roof or window leaks or imminent flooding of ground areas: unplug electrical devices and secure all equipment by moving if off the floor or covering it.

High winds
If possible, remain inside the building, away from windows. When outside, avoid areas with the heaviest concentration of trees. Stay clear of sagging or downed power lines.

Flooding

Major flooding:

• Call 9-1-1, state:
  • The nature of the emergency.
  • The location/address
    • [Insert Clinic Name]
    • [Clinic Address].
  • Information about the situation.
• Secure vital equipment, records, and chemicals. 
• Shut off all electrical equipment.

Evacuation:

• If advised to evacuate, do so immediately. Help anyone who needs assistance.
• Follow instructions from emergency personnel or Fire Marshal if available.
• Follow recommended evacuations routes, climb to higher ground.

After a flood:

• Flood dangers do not end when the water begins to recede.
• Do not return to the area until authorities indicate it is safe to re-enter.
• Stay out of the building if flood waters remain around the building.
• Water may be contaminated by sewage or other chemicals.

Earthquake

The biggest dangers during an earthquake stem from:

• Falling objects such as pictures, items on shelves or cupboards, ceiling titles, furniture, cabinets, and bookshelves.
• Swinging doors and broken windows.
• Fires from broken natural gas lines or electrical short circuits.

If you are inside a building during an earthquake:

• Stay inside, taking cover underneath a desk.
• Stay away from windows and do not use the elevator.

After the shaking stops:

• If instructed to evacuate, follow [Insert Clinic Name] evacuation procedures.
• Only use phones to report serious injuries.
• Help injured or trapped people if it is safe to do so. If you are able, provide first aid, where appropriate.
• Do not move anyone seriously injured unless they are in immediate danger of further injury.

Threatening and Violent Behaviour

Threats may be indirect expressions of frustration or anger directed toward a doctor, employee, clinic, or direct statements of intent to harm. These situations are complex, and clinic staff are not expected to assess whether the threat is serious and might lead to actual harm. Take any behaviour or words implying a threat seriously and inform the employer as soon as possible.

Steps to follow
If the threat is immediate, leave the interaction if possible and call 9-1-1, state the type of emergency and request assistance. 

Angry or hostile individuals:

• Stay calm and maintain eye contact.
• Be courteous, patient, and respectful.
• Keep a minimum of an arm’s length from the aggressive individual.

Verbal threats: 

• Signal to a coworker, you need help (have a prearranged saying or system).
• The co-worker calls 9-1-1.

Threats with a weapon:

• Signal to a co-worker, you need help (have a prearranged saying or system).
• The co-worker calls 9-1-1.
• Stay calm and maintain eye contact. 
• Keep talking and cooperate with the person holding the weapon.
• Do not attempt to get the weapon. If possible, move towards an escape. 

Post-incident documentation
As soon as possible after the incident:

• Record what occurred with as many details as possible. The sequence of events and what was said, including statements and the context.
• Provide documentation to your employer.