Interview – A Conversation with Stephanie Trowbridge (Code Silver)

Stephanie Trowbridge, Manager of Emergency Preparedness and Corporate Policy, sat down to talk about the Code Silver policy at St. Joseph’s Healthcare Hamilton.

What is your day to day?

An important component of emergency management is to identify hazards, manage risks, and deal with actual or potential emergency situations.  Responses depend on the perceived risk of the hazard and involve the four emergency management pillars: prevention & mitigation, preparedness, response, and recovery. Thinking about all four pillars provides an opportunity to understand the risks and develop strategies to minimize those risks. It’s about being proactive and not reactive. Front line staff often come forward with identified risks, and it is essential in my role to hear the voices of those that will carry out our response plans.

What are the challenges of your role?

I don’t want to say it’s a challenge, because it isn’t, but the uniqueness of Emergency Preparedness is that there is no such thing as one plan fits all. It is important to recognize that emergencies can happen at any time and the duration and potential extent of the incident is quite often unknown.

Are your policies shaped by events only within the hospital?

Not only are we looking at incidents within hospital walls, but also what’s happening in the greater community.  Several years ago, we started to notice more incidents involving weapons, like guns, occurring in the community, and thought “if it can happen out there, it can happen in here.”   This prompted us to develop a Code Silver procedure in partnership with Hamilton Police Services and in collaboration with Hamilton Health Sciences. We as a hospital can’t plan independently; we have to make sure that our emergency response plans will integrate with community agencies. It is also important to note that some Emergency Preparedness policies & procedures are driven by local, provincial and federal legislations and standards, like Fire Safety.

How has your background in clinical work affected your emergency preparedness role?

My background in Nursing and Infection Prevention and Control were very instrumental in developing this role. I think what’s given me a positive edge is my history at St. Joe’s, and the experiences I gained moving through my different roles over the years. I have had the chance to see the hospital through different lenses, allowing me the opportunity to approach a situation from both a clinical and a facility management perspective.

When people think of emergency preparedness at St. Joe’s, they think of you. Who else is involved in our response plans?

Emergency preparedness is not Stephanie Trowbridge. Emergency preparedness is everybody’s responsibility.

SJHH Emergency Preparedness would not be at the level it is now without the support of others. I work very closely with Occupational Health & Safety Services, Security Services, Building Services, Environmental Services, Telecommunications, and our Senior Leadership Team.  The clinical areas are also extremely important in our planning.  For example, the front-line staff in the Emergency Department has been very involved over the years in informing policies such as Code Orange.

Another group that’s extremely supportive of Emergency Preparedness is our Joint Health and Safety Committees. They bring in the voice of the worker.

Can you explain the new definition of Code Silver?

When the hospital created a Code Silver policy several years ago it was very specific to an active shooter situation. The definition has since expanded to include an active threat with a weapon (e.g. firearm, knife, explosive) with intention of bodily harm.  In the world of Emergency Preparedness we learn to adapt to the changing environment.

Why do we conduct drills at St. Joe’s?

A drill may be mundane in simulation, but in a real event, they provide you with skills to recall. Real situations may be chaotic, and there is going to be some panic. We try to give people very simple, short steps for memory recall, like REACT used for Code Red situations. You can’t recall what you don’t know and haven’t practiced.

Do you think that Code Silver drills could be traumatizing to staff or patients?

I think the risk is in how you do the drill. At St. Joe’s, our drills will be discussion based; it’s about starting the conversation.  We’ve heard from staff that they want to talk more about our response procedure, and we are creating an opportunity to do so. Both Canadian and American research supports using drills to maximize preparedness for Code Silver incidents.

We are going to start with two Code Silver drills this year – the first being in February – so that we can start having those conversations.  We will adjust our drill frequency based on feedback. Patients will not be involved in these drills.

What can St. Joe’s staff keep in mind while practicing Code Silver drills?

Code Silvers are rare but very serious situations. We have to balance the reality of likelihood vs. risk.  Code Silver is not like other Emergency Colour Codes and will not result in hospital response teams coming to assist, as it is designed to do the opposite and keep people away from the situation.  Hamilton Police Services will respond to the hospital.   A key message to staff is to make every reasonable effort to protect themselves, patients, visitors, and others in the immediate area by following the procedure.

An important take away is while “Code Silver” is very specific to the hospital setting, the basics are transferrable and can be used anywhere no matter where you are.

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