Hospital emergency codes

Back of a hospital ID badge showing disaster codes.

Hospital emergency codes are coded messages often announced over a public address system of a hospital to alert staff to various classes of on-site emergencies. The use of codes is intended to convey essential information quickly and with minimal misunderstanding to staff while preventing stress and panic among visitors to the hospital. Such codes are sometimes posted on placards throughout the hospital or are printed on employee identification badges for ready reference.

Hospital emergency codes have often varied widely by location, even between hospitals in the same community. Confusion over these codes has led to the proposal for and sometimes adoption of standardized codes. In many American, Canadian, and Australian hospitals, for example "code blue" indicates a patient has entered cardiac arrest, while "code red" indicates that a fire has broken out somewhere in the hospital facility.

In order for a code call to be useful in activating the response of specific hospital personnel to a given situation, it is usually accompanied by a specific location description (e.g., "Code red, Second floor, corridor three, room two-twelve"). Other codes, however, only signal hospital staff generally to prepare for the fallout of some external event such as a natural disaster.

Color code standardization

• Australia:
  • Australian hospitals and other buildings are covered by Australian Standard 4083 (1997) and many are in the process of changing to those standards.^[1]
• Canada:
  • Codes used in British Columbia, prescribed by the British Columbia Ministry of Health:^[2]
    • Code Red: Fire
    • Code Blue: Medical lockdown
    • Code Orange: Disaster or Mass Casualties
    • Code Green: Evacuation
    • Code Yellow: Missing Patient
    • Code Amber: Missing or Abducted Infant or Child
    • Code Black: Bomb Threat
    • Code White: Aggression
    • Code Brown: Hazardous Spill
    • Code Grey: System Failure
    • Code Pink: Pediatric Emergency and/or Obstetrical Emergency
  • In Ontario, a standard emergency response code set by the Ontario Hospital Association is used, with minor variations for some hospitals:^[3][4][5]
    • Code Black: Bomb Threat/Suspicious Object
    • Code Blue: Cardiac Arrest/Medical Emergency – Adult
    • Code Aqua: Flood
    • Code Brown: In-facility Hazardous Spill
    • Code Green: Evacuation (Precautionary)
      • Code Green STAT: Evacuation (Crisis)
    • Code Grey: Infrastructure Loss or Failure
      • Code Grey Button-down: External Air Exclusion
    • Code Orange: Disaster
      • Code Orange CBRN: CBRN (Chemical, Biological, Radiological, and Nuclear) Disaster
    • Code Pink: Cardiac Arrest/Medical Emergency – Infant/Child
    • Code Purple: Hostage Taking/Gang Activity
    • Code Red: Fire
    • Code White: Violent/Behavioural Situation
    • Code Yellow: Missing Person
      • Code Amber (code purple): Missing Child/Child Abduction
  • The various emergency preparedness services of the health regions in Alberta have also begun to discuss standardization of their color code systems.
• United States:
  • In 2000, the Hospital Association of Southern California (HASC)^[6][7] determined that a uniform code system is needed after "three persons were killed in a shooting incident at an area medical center after the wrong emergency code was called." While codes for fire (red) and medical emergency (blue) were similar in 90% of California hospitals queried, 47 different codes were used for infant abduction and 61 for combative person. In light of this, HASC published a handbook titled "Healthcare Facility Emergency Codes: A Guide for Code Standardization" listing various codes and has strongly urged hospitals to voluntarily implement the revised codes.
  • In 2003, Maryland mandated that all acute hospitals in the state have uniform codes.^[8]
  • In 2008, the Oregon Association of Hospitals & Health Systems, Oregon Patient Safety Commission, and Washington State Hospital Association formed a taskforce to standardize emergency code calls under the leadership of the Dr. Lawrence Schecter, Chief Medical Officer, Providence Regional Medical Center Everett.^[9] After both states had conducted a survey from all hospital members, the taskforce found many hospitals used the same code for fire (code Red); however, there were tremendous variations existed for codes representing respiratory and cardiac arrest, infant and child abduction, and combative person. After deliberations and decisions, the taskforce suggested the following as the Hospital Emergency Code:^[10]
    • Code Blue: Heart or Respiration Stops (An adult, child, or infant’s heart has stopped or they are not breathing.)
    • Code Red: Fire
    • Code Orange: Hazardous Spills (A hazardous material spill or release; Unsafe exposure to spill.)
    • Code Silver: Weapon or Hostage Situation
    • Code Grey: Combative Person (Combative or abusive behavior by patients, families, visitors, staff or physicians) If a weapon is involved “CODE SILVER” should be called.
    • Amber Alert: Infant/ Child Abduction
    • Internal Triage: Internal Emergency (Internal emergency in multiple departments including: Bomb or bomb threat; Computer network down; Major plumbing problems; and Power or telephone outage.)
    • External Triage: External Disaster (External emergencies impacting hospital including: Mass casualties; Severe weather; Massive power outages; and Nuclear, biological, and chemical accidents)
    • Rapid Response Team: Medical Team Needed at Bedside (A patient’s medical condition is declining and needs an emergency medical team at the bedside) Prior to heart or respiration stopping
    • Code Clear: Announced when emergency is over
  • In 2015, the South Carolina Hospital Association formed a work group to develop plain language standardization code recommendations. Abolishing all color codes was suggested.^[11]

Codes

Note:Different codes are used in different hospitals.

Code Blue

Medical lockdown

"Code Blue" is generally used to indicate a patient requiring resuscitation or in need of immediate medical attention, most often as the result of a respiratory arrest or cardiac arrest (by cardiac arrest is nowadays considered to not just mean asystole, the most severe example, but also pulseless electrical activity [PEA], coarse or fine ventricular fibrillation [VF or V-fib], or unstable irregular ventricular tachycardia [VT or V-tach]- some of these lethal, non-circulating arrhythmias are shockable by a defibrillator, some are not and are primarily treated by epinephrine and similar drugs). When called overhead, the page takes the form of "Code Blue, (floor), (room)" to alert the resuscitation team where to respond. Every hospital, as a part of its disaster plans, sets a policy to determine which units provide personnel for code coverage. In theory any medical professional may respond to a code, but in practice the team makeup is limited to those with advanced cardiac life support or other equivalent resuscitation training. Frequently these teams are staffed by physicians (from anesthesia and internal medicine in larger medical centers or the Emergency physician in smaller ones), respiratory therapists, pharmacists, and nurses. A code team leader will be a physician in attendance on any code team; this individual is responsible for directing the resuscitation effort and is said to "run the code". This phrase was coined at Bethany Medical Center in Kansas City, Kansas.^[12] The term "code" by itself is commonly used by medical professionals as a slang term for this type of emergency, as in "calling a code" or describing a patient in arrest as "coding" or "coded".

• Australian Standard^[1]
• Californian Standard^[6]

In some hospitals or other medical facilities, the resuscitation team may purposely respond slowly to a patient in cardiac arrest, a practice known as "slow code", or may fake the response altogether for the sake of the patient's family, a practice known as "show code".^[13] Such practices are ethically controversial,^[14] and are banned in some jurisdictions.

Variations

• "Plan Blue" was used at St. Vincent's Hospital in New York City to indicate arrival of a trauma patient so critically injured that even the short delay of a stop in the ER for evaluation could be fatal; the "Plan Blue" was called out to alert the surgeon on call to go immediately to the ER entrance and take the patient for immediate surgery. This was illustrated in an episode of Trauma: Life in the ER, entitled "West Side Stories".

"Doctor" Codes

"Doctor" codes are often used in hospital settings for announcements over a general loudspeaker or paging system that might cause panic or endanger a patient's privacy. Most often, "Doctor" codes take the form of "Paging Dr. Sinclair", where the doctor's "name" is a code word for a dangerous situation or a patient in crisis. In Johnny Mnemonic It was explained by Spider (Henry Rollins) that the doctor's name was "Dr. Allcome". e.g.: "Paging Doctor Firestone, third floor," to indicate a possible fire in the location specified. "Paging Dr. Stork" normally indicates that a woman is in labor and needs immediate assistance.

"Resus" Codes

Specific to emergency medicine, incoming patients in immediate danger of life or limb, whether presenting via ambulance or walk-in triage, are paged locally within the emergency department as "Resus" [ri:səs] codes. These codes indicate the type of emergency (general medical, trauma, cardiopulmonary or neurological) and type of patient (adult or pediatric). An estimated time of arrival may be included, or "now" if the patient is already in the department. The patient is transported to the nearest open trauma bay or evaluation room, and is immediately attended by a designated team of physicians and nurses for purposes of immediate stabilization and treatment.

Codes by emergency

Active assailant

• Code Silver: Providence Medical Center, Dominion Hospital ^[15]

Bomb threat

• Code Black: UnityPoint Health (Formerly known as Iowa Health System)
• Code Yellow: HASC^[16]
• Code Yellow: Reported Bomb Threat (El Camino Hospital, Mountain View, CA)^[17]
• Code 10: Stanford University Medical Center (old system), Scripps Healthcare San Diego
• Code Black: Standard government reporting code. Markham Stouffville Hospital, University of Chicago Medicine, Ohio State University Medical Center, Alberta, Quebec and Ontario hospitals, Cheyenne Regional Medical Center Cheyenne, Wyoming and HealthPartners Regions Hospital St. Paul, MN
• Code Blue: Some schools in Western New York and in schools in Volusia County, Florida
• Code 100: Heartland Regional Medical Center
• Code Purple: by Telephone, Mail, Person on Site. Australian Standard
• Code Orange: Oakwood Healthcare
• Code B: Superstition Mountain Mental Health Center (SMMHC, Inc.)
• Code Grey: Bronson Methodist Hospital
• Code White: Mercy Hospital, Oklahoma City, OK
• Operation 005: Baptist Health Floyd, New Albany, IN

Cardio-respiratory arrest

• Code Blue (Child) – Cardio-Respiratory Arrest Age >30 days to 13 years in Ontario^[5]
• Code Pink – Cardio-Respiratory Arrest Neonatal Age <30 days in Ontario^[5]
• Code Blue: Cardio-respiratory arrest or medical emergency for Adult (El Camino Hospital, Mountain View, CA)^[17]
• Code Pink – Used as cardiac arrest in an infant at Miami Valley Hospital in Dayton.
• Code White-Neonatal: Cardio-respiratory arrest or medical emergency for <28 days (El Camino Hospital, Mountain View, CA)^[17]
• Code White-Pediatric: Cardio-respiratory arrest or medical emergency for >28 days (El Camino Hospital, Mountain View, CA)^[17]
• Code Blue-Pediatric: Pediatric cardio-respiratory arrest HealthPartners Regions Hospital
• Code Blue-Adult: Adult cardio-respiratory arrest HealthPartners Regions Hospital
• Medical Team/Pediatric Medical Team – Cardio-Respiratory arrest in an adult/child (South Nassau Communities Hospital, Oceanside, NY)
• Code 10: cardio pulmonary arrest
• Cardiac Alert: cardio pulmonary arrest (Hartford Hospital, Connecticut)
• Dr Quick: cardio pulmonary arrest (New Britain General, Connecticut)
• "99": Cardiopulmonary Arrest (Health Sciences Centre, Winnipeg, Manitoba, CANADA)
• CPR Team: cardiopulmonary arrest (Beaumont Health, Detroit, MI)

Child abduction/missing person

• Amber Alert and Code Adam, both well-known public announcements to denote missing or abducted children, have gained traction in hospital usage since 2000. Used at Miami Valley Hospital.
• Code Pink can denote child or infant abduction. Used at Northside Hospital in Atlanta, Cedars-Sinai Medical Center in Los Angeles, Carolinas Healthcare System in North Carolina, University of Texas Medical Branch in Galveston, Massachusetts General Hospital in Boston, Winchester Hospital in Winchester, Massachusetts, Marin General Hospital in Greenbrae, CA, Park Nicollet Methodist Hospital, Regions Hospital, Cheyenne Regional Medical Center, Oregon Health and Science University in Portland, Oregon, and Seattle Children's. Included in HASC recommendation for Infant Abduction.
• Code Purple was sometimes also used for Child Abduction when Code Pink is specifically for infant abduction. Included in HASC recommendation for Child Abduction.
• Code Gold: Calgary Health Region
• Code Amber: Alberta health regions and Ontario
• Code Nap: Used at some rural Iowa hospitals.
• Code Rainbow: University of California at Davis Medical Center
• Code Stork: Health Partners Regions Hospital
• Code Black: Heartland Regional Medical Center
• Code Purple: UnityPoint Health (Formerly known as Iowa Health System)
• Code Walker (Oregon Health and Science University in Portland, Oregon) for a cognitively impaired individual who has wandered away from a clinical area.
• Code Yellow – Missing Patient/Infant Abduction in Ontario
• Code Alert: Infant Abduction Baptist Health Floyd, New Albany, IN

Combative person/assault

• Code Green: UnityPoint Health (Formerly known as Iowa Health System)
• Code North: Stanford University Medical Center
• Code Gray: Angry/Violent patient or visitor (El Camino Hospital, Mountain View, CA)^[17]
• Code Grey: Combative Person with no weapon (HASC)
• Code Silver: Combative Person with a weapon (HASC)
• Code Black: Personal Attack (Australian Standard Code)
• Code White: Violent Patient (Markham Stouffville Hospital), Quebec and Ontario
• Code Atlas: Virginia Healthcare System
• Security Stat: Heartland Regional Medical Center
• "Mr. or Dr. Strong" to (location), at other hospitals (Montefiore Medical Center, Bronx, NY – Also Code 5)
• "Dr. Heavy" to (location), at other hospitals (Nassau University Medical Center, Nassau, NY, Mather Hospital, Suffolk, NY)
• "Dr. Armstrong" to (location), at other hospitals
• Code Yellow: Cheyenne Regional Medical Center
• Yellow Alert: Health Partners Regions Hospital
• Code 21: University of Minnesota Medical Center, Fairview, UofM Amplatz Children's
• Code Violet: Nationwide Children's Hospital, Miami Valley Hospital
• Code Purple: Seattle Children's
• Code Secure: Security needed to deal with a combative patient or family member.
• BERT/BERT Strong: Behavioral emergency response team / Behavioral emergency response team when person becomes violent (Dominion Hospital, Falls Church, VA)

Evacuation

• Code White: Texas Tech University Health Sciences Center in U.S
• Code Orange: Australian Standard.
• Code Green: Mercy Hospital, Oklahoma City, OK
• Code Green: Quebec and Ontario
• Under the HASC Emergency Code System, evacuation would be included in an Emergency Alert, Code Triage.

Fire

• Usually Code Red.
  • Australian Standard.^[1]
  • California Standard.^[6]
  • Joint Commission standard.
  • Ontario Hospital Association color code standard^[5]
  • Park Nicollet Methodist Hospital
  • Dr. Red Cheyenne Regional Medical Center
  • El Camino Hospital, Mountain View, CA^[17]
  • Oregon Health and Science University in Portland, Oregon
  • Long Grass Health Partners Regions Hospital
• Sometimes Dr. Red, Dr. Pyro, or Dr. Firestone.
• Sometimes "Evacuation Bell"
• Code F (University of Michigan Hospitals)
• Red Alert (Beaumont Health, Detroit, MI)

Hazardous materials spill/release/decontamination

• Code Orange: Nationwide Children's Hospital, El Camino Hospital (Mountain View, CA), Seattle Children's
• Code Brown: Ontario

Hostage situation

• Code Silver – Person with a weapon / hostage situation (El Camino Hospital, Mountain View, CA)^[17]
• Code Purple – Hostage in Ontario^[5]
• Code Siege – Carilion Clinic Hospitals

Internal disaster

• Code Green: Texas Tech University Health Sciences Center.
• Code Grey: University Health Network, Toronto
• Code Yellow: Stanford University Medical Center (old system), Australian Standard, Mercy Hospital (Oklahoma City, OK)
• Code Triage – Internal: HASC, El Camino Hospital,Mountain View, CA^[17]
• Code Orange: Hazardous Materials spill (El Camino Hospital, Mountain View, CA)^[17]
• Code 4: Montefiore Medical Center, Bronx, NY
• Code Alert sometimes denotes disaster.
• Code Brown – Internal Crisis / Hazardous Spill in Ontario / e.g. Sewer backup and overflow .
• Dr. Whitestone: Internal Disaster Baptist Health Floyd, New Albany, IN

Lockdown/limited access

• Lima Delta: UnityPoint Health (Formerly known as Iowa Health System)
• Code Orange: Ontario Used in Ontario hospitals to indicate an external disaster with mass casualties, CBRNE and Pandemic. Lockdown or controlled facility access is often used as part of the response. Volunteers, Families and Students were denied access during SARS Outbreak of 2003.
• Code Red: Most commonly used by schools to indicate that a dangerous and/or harmful person is on campus.
• Code Silver:Carilion Clinic Hospitals
• Code Yellow (Fort Pierce, Florida)

Mass-casualty incident / external disaster

• Code Brown

An Australian standard code used to describe any outside of the hospital incident such as loss of power, communications, a natural disaster (such as flood or bushfire) that threatens to overwhelm or disrupt a hospital or health service capability with large numbers of casualties.^[18]

• Code Yellow: Texas Tech University Health Sciences Center, Nationwide Children's Hospital
• "MASCAL" may also be used
• Code 10, Code 20, or Code 99: Heartland Regional Medical Center, Brookdale Hospital
• Code Orange: Calgary Health Region, Quebec and Ontario
• Code Triage: Scripps Healthcare San Diego; Hoag Hospital Newport Beach; Seton Medical Center, Daly City, California; El Camino Hospital, Mountain View, CA.^[17]
• Code 1000: Fletcher Allen Medical Center; Burlington, VT
• Code Orange: Park Nicollet Methodist Hospital
• Code Orange: Cheyenne Regional Medical Center
• Orange Alert: Health Partners Regions Hospital
• Code 7: Montefiore Medical Center, Bronx, NY (aka External Disaster)
• Mr. Victor Charlie: MVC-Multiple Vehicle Collision, Ottawa Emergency Services and First Responders (prepare for Code Orange)
• Dr. Redstone: External Disaster Baptist Health Floyd, New Albany, IN

Other patient emergencies

• Code Brain: Possible stroke or CVA patient: Used by many facilities with stroke center certification to indicate for critical care nurses and doctors to respond as well as for CT scan techs and radiologists to be ready to scan and read.
• Code Heart: Used to indicate a patient who is experiencing an acute cardiac event such as an MI. Code Heart is generally used to assemble a team of critical care nurses and doctors to stabilize the patient as well as mobilizing a cath lab team if necessary.
• Code Rapid Response: Used in many facilities with a rapid response system in place to call for response by a rapid response team: generally made up of nurses, respiratory therapists, lab techs and sometimes doctors who respond to a patients bedside and intervene to prevent a patient from escalating to Code Blue. Code Rapid Response is generally called when there is a change in the patients mental status or vital signs as well as when a patient begins seizing. In most facilities with a rapid response team in place, the code can be called by anyone such as concerned staff member or family member.
• Code Sepsis: This code is called whenever there is a patient who is in or is in danger of entering septic shock.

Severe weather

• Code Brown: Texas Tech University Health Sciences Center
• Code Black: Mercy Health Center (Oklahoma City); Norman Regional Hospital (Norman); Denton Regional Medical Center; Iowa Health System (Severe Warning); Parkland Hospital (Dallas)^[19]
• Code Gray: Cook Children's Medical Center, Fort Worth, TX; Iowa Health System (Severe Watch); St. John's Regional Medical Center, Joplin, MO; Miami Valley Hospital (Tornado Warning)
• Code Yellow: Heartland Regional Medical Center
• Code Green: Schools in Volusia County, Florida
• Code White: schools in Morgan County, West Virginia
• Code Purple: Schools in Berkeley County, West Virginia

Theft/armed robbery

• Code Amber: Texas Tech University Health Sciences Center; New Jersey Hospital Association

Total divert

• A status sometimes called "Critical Care Bypass" (Ontario),^[20] "Total Divert", "triage situation", "Saturation Alert" or "High Occupancy" (University of Michigan Health System).
• Generally used by hospitals as a status indicator for EMS/ambulance services denoting that the issuing ER/trauma facility has reached maximum patient capacity and should not receive any more new patients if at all possible.
• A variation on "Total Divert", called "Bypass", is used at many U.S. hospitals to indicate emergency facilities at or over maximum capacity; this variation was featured in the "Road Warriors" episode of Trauma: Life in the E.R.. As explained by a trauma nurse in the episode, the status change does not always keep new patients from arriving.
• Can be denoted as Code Purple or Code Yellow in some hospitals.
• The Joint Commission status is called "on diversion" (for a class of patients) and "total diversion" (not receiving any patient), referring to diversionary contracts required by EMTALA.

Other codes

• Code Black – An influx of patients so great that a hospital doesn't have the resources to handle them (mostly caused by major disasters such as a fire injuring many victims).
• Code Omega – Life-Threatening Blood Loss. Used in Ontario^[5]
• Code Omega – (Obstetrics) Life Threatening Blood Loss in a Peri-Partum Woman. Used in Ontario^[5]
• Gold Alert – Unstable Patient(s) with Multiple System Trauma en route. Kentucky.^[21]
• Code 33 – Obstetrical Crisis in Ontario^[5]
• Code 99 – Stroke Patient (Park Nicollet Methodist Hospital)
• Incoming Code 99 – Stroke patient arriving by ambulance or helicopter (Park Nicollet Methodist Hospital)
• Trauma Alert (Level 1 or 2, or Full or Partial) – Trauma Patient(s) en route.^[21]
• Code Roscoe – Active Shooter/Armed Intruder (Mercy Hospital, Oklahoma City, OK)
• Code Yellow: Standby status means the hospital has been contacted about a "possible" incident in the community. Alert status means that the incident "has" occurred. Used at: Miami Valley Hospital.
• Dr Gottaway: Dr Jane Gottaway/Dr Joe Gottaway – pt elopement (male vs female)
• "(service (respiratory, surgery, etc.) 25": Medical Emergency (Health Sciences Centre, Winnipeg, Manitoba, Canada)

See also

• Inspector Sands, code used over PA system in British public transport to indicate a serious situation

References

External links

• Codes Listing, Texas Tech University Health Sciences Center
• Stanford Medical Codes (HASC based scheme)