The Johns Hopkins Hospital and The Johns Hopkins University Health, Safety and Environment Manual Fire Safety:

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1 Page 1 of 10 Keywords: Emergency Room, Evacuation, Evacuation Plans, Fire, Fire Incident Responsibilities, Fire Safety, Gas Shutoff, Inpatient Area, Intensive Care, JHH Fire Incident Responsibilities, Laboratory Personnel, Medical Gas Shutoff, Nursing Staff, Operating Room Staff, Physicians, Security, Visitors, Windows Table of Contents Page Number I. PREFACE 1 II. NURSING STAFF INPATIENT AREAS 1 III. PHYSICIANS 2 IV. OTHER PERSONNEL ON INPATIENT UNITS 3 V. EMERGENCY ROOM, DIAGNOSTIC AND THERAPEUTIC SERVICE PERSONNEL 3 VI. INTENSIVE CARE, SPECIAL CARE AND RECOVERY ROOM PERSONNEL 4 VII. OPERATING ROOM AND DELIVERY ROOM PERSONNEL 5 VIII. ALL PERSONNEL IN A BUSINESS OCCUPANCY 6 IX. LABORATORY PERSONNEL 7 X. SECURITY 8 XI. HELIPAD PERSONNEL 8 XII. MRI Personnel 10 XIII. REVIEW CYCLE 10 I. PREFACE This section outlines employee responsibilities and proper responses to a fire emergency in The Johns Hopkins Hospital. Review the fire incident responsibilities appropriate for your position. It is important for these procedures to be committed to memory before a fire incident. Preplanning is essential. Proper and timely response to a fire emergency requires knowledge of responsibilities, procedures, evacuation routes and refuge areas. The fire incident responsibilities are established in categories as follows: Nursing Staff - Inpatient Areas Physicians Other Personnel On Inpatient Units Emergency Room, Diagnostic and Therapeutic Service Personnel Intensive Care, Special Care and Recovery Room Personnel Operating Room and Delivery Room Personnel All Personnel In a Business Occupancy Laboratory Personnel Security Helipad personnel MRI personnel II. NURSING STAFF INPATIENT AREAS A. If you discover a fire or smoke, react immediately: 1. Remove patient(s) and other individual(s) from immediate danger. 3. Pull the nearest fire alarm in the building.

2 Page 2 of Call Tell the operator where the fire is, the kind of fire, your name and extension number. 5. Alert the charge nurse. B. Other Concerns 1. Medical Gases a. Provide an alternate and portable oxygen/medical gas source for those patients requiring it. Each unit with an oxygen system is supplied with a backup cylinder (s) for emergency use. Oxygen Therapy and Respiratory Therapy are important resources for supporting patients on medical gases. b. Disconnect all medical gas equipment at the wall outlet. c. The Emergency Zone Shut-off Valve for Oxygen should not be utilized unless a) the room or compartment is fully engaged by fire or is inaccessible; b) the equipment cannot be disconnected or turned off at the source; or c) you are directed to do so by the Baltimore City Fire Department. d. Only the charge nurse (or another nurse at the direction of the charge nurse) is authorized to shut off the zone valve after an assessment of patients requiring oxygen/medical gas in the affected zone is conducted. 2. Visitors a. Direct visitors of inpatients to remain in the rooms of patients they are visiting. b. Direct other unit visitors to the exits 3. Windows a. Do not open windows unless directed by the Baltimore City Fire Department. b. Provide window key, if applicable. C. When the fire alarm sounds, DO NOT LEAVE THE UNIT - Defend in Place: 1. Account for all patients. 2. Assure patients and visitors that the "Emergency Plan" is in operation. 3. Close all room and corridor doors. 4. Direct visitors in patient rooms to remain with patients. 5. Clear volunteers and visitors from corridors. Direct to area of refuge or out of building. 6. Clear corridors of mobile equipment. D. Evacuation preparation 1. Identify patients requiring continuous life support or monitoring. 2. Identify patients requiring assistance such as portable medical gas sources or transport devices for evacuation. 3. Give priority to horizontal (same floor) evacuation routes. 4. Do not evacuate in mass unless directed by the proper authority at the scene, i.e. Fire Department, Health, Safety and Environment or Security Shift Supervisor. 5. If assistance is needed to evacuate patient(s), dial Ask the operator to page Emergency, all available doctors and nurses please report to (building), (floor). 6. When necessary, seal corridor or room doors with wet linen to block the spread of smoke. III. PHYSICIANS If you discover a fire, remain calm. 1. Remove patient(s) and other individuals from immediate danger. 3. Report the fire immediately regardless of size. PULL THE NEAREST FIRE ALARM BOX 5. Alert the charge nurse. 6. DO NOT LEAVE THE UNIT. Assess patients' needs and provide medical support as necessary. If you are on a patient unit, when the alarm sounds:

3 Page 3 of Do not leave the unit defend in place. 2. Report to nursing station. Prepare to assist in emergency procedures. Evacuation Preparation 1. Assure patients and visitors emergency plan is in effect. 2. Identify patients requiring life support or continuous monitoring. 3. Identify patients requiring assistance in evacuation. 4. Establish patient evacuation priorities. 5. Provide for continued life support, monitoring, and therapies during evacuation. 6. Assist in patient evacuation when necessary. 7. Do not evacuate unless in a room with smoke/fire or directed by the proper authority at the scene, i.e. fire department, health, safety and environment or security shift supervisor. For all hospital emergencies 1. Respond to calls for assistance to evacuate patients. Calls for assistance will be announced over the paging system as "EMERGENCY, ALL AVAILABLE DOCTORS AND NURSES PLEASE REPORT TO (building), (floor). 2. Approach floor requiring assistance through a building not involved in fire, if possible. 3. Residents and interns report to your assigned area if identified in Code Red page message. IV. OTHER PERSONNEL ON INPATIENT UNITS 1. Remove patients and other individuals from immediate danger. 2. Close door to confine smoke or fire. 3. Report the fire immediately regardless of size. PULL THE NEAREST FIRE ALARM BOX. 5. Alert the charge nurse and nursing staff. 6. DO NOT LEAVE THE UNIT. Report to nursing station; assist in emergency procedures as directed. If you are on a patient unit when alarm sounds: 1. Do not leave the unit defend in place. 2. Remove your equipment from the corridor. Place equipment in storeroom, pantry, empty patient room or designated room. Close the door. 3. Report to nursing station. 4. Be prepared to follow directions of Nursing Staff and a. Assist in emergency procedures as directed by charge nurse or nursing staff. b. Assist in clearing corridors (evacuation routes). c. Assist in directing visitors to designated areas of refuge. d. Assist in securing area. e. Assist in evacuation of patients when necessary. V. EMERGENCY ROOM, DIAGNOSTIC AND THERAPEUTIC SERVICE PERSONNEL 1. Remove patient(s) and other individuals from immediate danger.

4 Page 4 of Report the fire immediately (regardless of size). PULL THE NEAREST FIRE ALARM BOX. 5. Alert the charge nurse. 6. Direct emergency responders to location of fire. Response to fire or smoke in immediate area 1. Alert all physicians, nurses and technicians in the threatened area. a. Discontinue examinations, therapy and surgical procedures as fast as possible. b. Move patients in danger to an area of refuge. 2. Close all doors. 3. Seal corridor or room doors with wet linen to block spread of smoke. 4. Move patients requiring assistance, i.e. wheelchairs, stretchers, to an area of refuge. 5. Assign personnel to check all waiting areas. Direct ambulatory patients and visitors to an area of refuge. 6. Assign responsible individual to remain with patients. 7. Account for all patients. 8. Prepare for possible evacuation. Response to building alarm or Code Red: 1. Notify all physicians, nurses and technicians. a. The decision to discontinue procedures is discretionary. b. The decision to initiate an examination or procedure should be made only after acquiring knowledge of the status of the emergency. 2. Close all doors. 3. Move patients requiring assistance to an area of refuge. 4. Assign responsible individual to remain with patients. 5. Direct ambulatory patients and visitors to an area of refuge. 6. Account for all patients. 7. Prepare for possible evacuation. Clear corridor of mobile equipment. Evacuation Preparation 1. Give priority to horizontal (same floor) evacuation routes. 2. If the fire is not in your immediate area, do not evacuate unless directed by the proper authority at the scene, i.e. fire department, health, safety and environment or security shift supervisor. 3. If assistance is needed to evacuate patient(s), dial ask the operator to page "emergency, all available doctors and nurses report to (building), (floor). VI. INTENSIVE CARE, SPECIAL CARE AND RECOVERY ROOM PERSONNEL 1. Remove patient(s) and other individuals from immediate danger. 3. Report the fire immediately (regardless of size). PULL THE NEAREST FIRE ALARM BOX. 5. Alert the charge nurse.

5 Page 5 of Direct Emergency responders to location of fire. Response to fire or smoke in immediate area 1. Alert all physicians, nurses and technicians in the threatened area. 2. Close all corridor and room doors. 3. Seal corridor and room doors with wet linen, when necessary, to block spread of smoke. 4. Prepare to move patients from danger. a. Plan movement of patients and essential equipment. b. Prepare patients for movement to an area of refuge where life support, therapies or monitoring can be resumed. Response to building alarm or Code Red: 1. DO NOT LEAVE THE UNIT defend in place; assist with emergency procedures. 2. Alert all physicians, nurses and technicians. 3. Close all corridor and room doors. 4. Prepare for possible evacuation. 5. Clear corridor and egress routes of mobile equipment. Evacuation Preparation 1. Give priority to horizontal (same floor) evacuation routes. 2. Prepare patient(s) for evacuation - Substitute portable life support equipment where possible, i.e. oxygen tanks, battery powered equipment, etc. 3. If the fire is not in your immediate area, do not evacuate unless directed by the proper authority at the scene, i.e. fire department, health, safety and environment or security shift supervisor. 4. If assistance is needed for evacuation, dial ask the operator to page "emergency, all available doctors and nurses please report to (building), (floor). VII. OPERATING ROOM AND DELIVERY ROOM PERSONNEL 1. Remove patient(s) and other individuals from immediate danger. 3. Report the fire immediately (regardless of size). PULL THE NEAREST FIRE ALARM BOX. 5. Alert the charge nurse. 6. Direct Emergency responders to location of fire. 7. Use fire extinguisher if properly trained to do so and fire is in incipient stage. Response to fire or smoke in immediate area 1. Operating rooms and delivery rooms: a. Alert all physicians, nurses and technicians in the threatened area to prepare patients for immediate removal. b. Close all corridor and room doors. c. Seal corridor and room doors with wet linens, when necessary, to block spread of smoke. d. Surgical/Delivery team move patients in danger to an area of refuge. e. Use fire extinguisher if properly trained to do so and fire is in incipient stage.

6 Page 6 of Prep rooms, labor rooms, support areas: a. Move patients in danger to an area of refuge. b. Close all room and corridor doors. c. Assign responsible individual to remain with patient(s). d. Seal corridor or room doors with wet linen, when necessary, to prevent spread of smoke. e. Prepare for possible evacuation. f. Use fire extinguisher if properly trained to do so and fire is in incipient stage. Response to fire in or on the patient 1. If the fire is small enough (the fire has just started, is entirely visible, has not spread much beyond the ignition point and have no underlying components) pat it out with a gloved hand or towel. 2. For large fires: a. Stop the flow of the oxidizer. b. Remove the burning materials from the patient and smother. c. Squirt saline or sterile water down ET tube if necessary and remove tube. d. If the above methods do not work, use a fire extinguisher if properly trained to do so. e. Care for the patient. Response to building alarm or Code Red: 1. Notify all physicians, nurses and technicians that a fire alarm has been sounded. a. The decision to discontinue surgical procedure is discretionary. b. The decision to initiate a surgical procedure should be made only after acquiring knowledge of the status of the emergency. 2. Account for all patients. Assure patients that "Emergency Plan" is in operation. 3. Assign responsible individual to remain with patient(s). 4. Close all room and corridor doors. 5. Prepare for possible evacuation. 6. Clear corridor and egress routes. Evacuation Preparation 1. Give priority to horizontal (same floor) evacuation routes. 2. Prepare patient(s) for evacuation. Substitute portable life support equipment where possible, i.e. oxygen tanks, battery powered equipment, etc. 3. If the fire is not in your immediate area, do not evacuate unless directed by the proper authority at the scene, i.e. fire department, health, safety and environment or security shift supervisor. 4. If assistance is needed to evacuate patient(s), dial ask the operator to page "emergency, all available doctors and nurses please report to (building), (floor). VIII. ALL PERSONNEL IN A BUSINESS OCCUPANCY 1. Remove all individuals in immediate danger. 2. CLOSE THE DOOR.

7 Page 7 of Report the fire immediately regardless of size. PULL THE NEAREST FIRE ALARM BOX. 5. Evacuate. Leave the building by the nearest accessible fire exit. Use stairs or exit through a fire door to an adjacent building. Response to fire alarm Evacuate. Leave the building by the nearest accessible fire exit. Use stairs or exit through a fire door to an adjacent building. IX. LABORATORY PERSONNEL 1. Remove all individuals in immediate danger. 2. Close doors. 3. REPORT THE FIRE IMMEDIATELY REGARDLESS OF SIZE. PULL THE NEAREST FIRE ALARM BOX. 4. Dial Tell the operator the building involved, the floor, the kind of fire, your name and extension number. 5. Clear area of non-laboratory personnel. Take patients to a designated refuge area. Direct others to evacuate the building. 6. If possible, turn off gas and oxygen valves. 7. If possible, return flammable materials to approved storage cabinets. 8. Leave the building by the nearest accessible fire exit. Use stairs or exit through a fire door to an adjacent building. If there is a fire inside a Chemical Fume Hood: 1. Shut the sash 2. Evacuate 3. Pull the alarm 4. Call If there is a fire inside a Biological Safety Cabinet: 1. If the laboratory occupant is able to safely turn off the power to the biological safety cabinet this should be done in order to reduce the flow of air 2. Evacuate 3. Pull the alarm 4. Call Response to fire alarm 1. Clear area of patients and non-laboratory personnel. Take patients to a designated refuge area. Direct others to evacuate the building. 2. Evacuate. Leave the building by the nearest accessible fire exit. Use stairs or exit through a fire door to an adjacent building. 3. Typical steps taken before evacuating the area include: a. Turn off all gas cocks. b. Close valves on gas cylinders, especially oxygen. c. Return flammable materials to the approved cabinet. d. Place radioactive materials in labeled hoods or refrigerators. e. Close all windows and doors.

8 Page 8 of 10 X. SECURITY 1. Remove all individuals from immediate danger. 2. Close doors to confine smoke/fire. 3. Report the fire immediately regardless of size. PULL THE NEAREST FIRE ALARM BOX. 5. Alert the charge nurse, or area supervisor. 6. Do not leave the unit. Report to nursing station; assist in emergency procedures as directed. 7. If the fire is not in your immediate area, do not evacuate unless directed by the proper authority at the scene, i.e. fire department, health, safety and environment or security shift supervisor. 8. Secure the emergency area. Keep unnecessary personnel out of area; Re-route personnel, visitors, etc. 9. Supply communications assistance at the scene of the fire. 10. If fire is manageable and you are trained to use fire extinguisher, attempt to extinguish fire. 11. Assist in evacuation procedures, if necessary. Responsibilities when building alarm sounds 1. Report to assigned locations. 2. Meet Fire Department at staging areas: a. Rutland Avenue entrance. b. Wolfe Street (Harvey/Nelson) entrance. c. Weinberg: Jefferson entrance 3. Direct Fire Department to the scene of the fire. 4. Detain elevators at the first floor of the building in which the alarm is sounded for use by Emergency Personnel. XI. HELIPAD PERSONNEL 1. Upon verification of a fire on the helipad, the security officer or staff member will contact the Security Communications Center. 2. Security Communications Officer will notify and advise of situation Facilities, Lifeline HopComm, dispatch a supervisor, call 911 and activate security leadership call tree 3. Lifeline HopComm will advise area flight programs and activate the alternative LZ plan for JHH 4. Lifeline HopComm will contact flight program involved (if known) and advise of situation 5. Lifeline HopComm will also notify Emergency Medicine Administration (EMA) to report the incident. In turn, EMA will report, as required, to external agencies and also receive approval, when indicated, to return helipad to normal operations 6. Facilities Engineers will serve as the clearing house to receive reports from staff, et al for falling materials or debris from the crash, fire and/or fire department operations 7. Upon the completion of the on scene investigation and removal of debris, structural integrity of pad and buildings should be investigated by Facilities Engineering to ensure helipad is usable. Assessment should then be provided to EMA so they can evaluate and share with appropriate external agencies 8. DCA/HICS will consider evacuation potential for its occupants in Zayed Tower 9. Ongoing assessment of helipad and structural ability to continue operations by EMA, designated external agencies and DCA/HICS until the return to normal operations 10. Return to normal operations plan after recovery phase and structural recertification, if indicated

9 Page 9 of 10 Security 1. Report to helipad to receive landing crew for every helicopter landing 2. Clear entry to helipad for helicopter landing and take off 3. Prevent reception team from entering helipad until helicopter has fully landed 4. Depress designed yellow button to activate foam suppression system in the event of a crash involving fire. Button can be pressed on the heliport or in the security office adjacent to the ED waiting room. This room is not staffed so a delay in activation will occur. If the crash does not initially affect the bunker, the officer in the bunker should be the one to activate the fire suppression system. If the bunker is affected activation will come from the secondary location. 5. Inform Security Communications Officer that helicopter has crashed 6. Security Communications Officer call 911 to report to crash 7. Security Communications Officer alert Security leaders, et al 8. Send out alert notification through Rave (or tell DCA to send it out) Clear Zayed circle and prevent exits from building at this site until all clear is received Facilities Engineering 1. Activate and implement the fire/foam suppression system in which the nozzles oscillate back and forth to suppress the fire on the helipad 2. Ensure preventative maintenance (PM) program for the fire/foam suppression system is in compliance with established standards 3. Ventilation system automatically shuts down to prevent/minimize smoke and fumes to enter building through installed smoked detectors 4. Respond to potential HVAC outage, other outages and structural damage to building and front entrance of ZBB 5. Contact Facilities Manager if there are any issues related to the fire suppression system. 6. Contact the Engineering Operations and Planning Manager in Facilities if there are any issues related to the mechanical systems on the helipad (i.e. snow melt system, etc.) First Responder [Baltimore City Fire Dept - BCFD] 1. Respond to JHH incident 2. Work with internal first responders (e.g. fire brigade, facilities, security) in response and recovery phases Reception Team (Lifeline/AED/PED/) 1. Do not respond to patient and flight crew if helicopter crashes 2. Rapidly seek shelter in stairwell if helicopter crashes on helipad Disaster Control Administrator 1. Send out alert notification if security has not sent it out 2. Send out other alert notification message 3. Activate command system, if indicated 4. Liaison with the Fire Department and/or Police Incident Commander 5. If off campus evacuation has to occur, determine alternate locations for staging areas away from Zayed building Emergency Departments

10 Page 10 of Go on mini-disaster through EMRC 2. Shut down ambulance ramp and prevent any access or exit to ambulance ramp until all clear is received when necessary by Security since not all helicopter crashes will have catastrophic consequences that would lead to shutting down access to ambo ramp. 3. Prepare to receive patients 4. Activate Code Yellow ED or Hospital if needed and/or Administrative Alert develop an internal Disaster Plan on how to respond to disasters or critical events on the East Baltimore Campus XII. MRI Personnel MRI Personnel 1. Remove patient(s) and other individuals from immediate danger. 3. Report the fire immediately (regardless of size). PULL THE NEAREST FIRE ALARM BOX. 4. Quench the magnet. A quench will extinguish the static field within a matter of minutes. Quenching the magnet will allow the MRI area to be safe to enter for first responders and the fire department. 5. Dial Tell the operator where the fire is, the kind of fire, your name and extension number. 6. Alert the charge nurse. 7. Direct emergency responders to location of fire. 8. Use a fire extinguisher if you have been trained to do so. XIII. REVIEW CYCLE Annually

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