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Hospital emergency codes are coded messages often announced over a
public address system A public address system (or PA system) is an electronic system comprising microphones, amplifiers, loudspeakers, and related equipment. It increases the apparent volume (loudness) of a human voice, musical instrument, or other acoustic sound sou ...
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 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, New Zealand and Australian hospitals, for example "code blue" indicates a patient has entered
cardiac arrest Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possi ...
, 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 consequences of some external event such as a natural disaster.


Standardised color codes


Australia

Australian hospitals and other buildings are covered by Australian Standard 4083 (1997) and many are in the process of changing to those standards.AS 4083-1997 Planning for emergencies-Health care facilities
/ref> * Code Black: Personal threat * Code Black Alpha: missing or abducted infant or child * Code Black Beta:
active shooter Active shooter or active killer describes the perpetrator of a type of mass murder marked by rapidity, scale, randomness, and often suicide. The United States Department of Homeland Security defines an ''active shooter'' as "an individual actively ...
* Code Black J: self-harm * Code Blue: medical emergency * Code Brown: external emergency (disaster, mass casualties etc.) * Code CBR: chemical, biological or radiological contamination * Code Orange: evacuation * Code Purple:
bomb threat A bomb threat or bomb scare is a threat, usually verbal or written, to detonate an explosive or incendiary device to cause property damage, death, injuries, and/or incite fear, whether or not such a device actually exists. History Bomb threats ...
* Code Red: fire * Code Yellow: internal emergency * Code Grey: combative person without a weapon


Canada


Alberta

Codes in
Alberta Alberta ( ) is one of the thirteen provinces and territories of Canada. It is part of Western Canada and is one of the three prairie provinces. Alberta is bordered by British Columbia to the west, Saskatchewan to the east, the Northwest Terri ...
are prescribed by
Alberta Health Services Alberta Health Services (AHS) which is headquartered in Edmonton, Alberta is the single health authority for the Canadian province of Alberta and the "largest integrated provincial health care system" in Canada. AHS delivers medical care on be ...
. * Code black: bomb threat/suspicious package * Code blue:
cardiac arrest Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possi ...
/medical emergency * Code brown: chemical spill/hazardous material * Code green: evacuation * Code grey: shelter in place/air exclusion * Code orange: mass casualty incident * Code purple: hostage situation * Code red: fire * Code white: violence/aggression * Code yellow: missing patient * Code 66: rapid response


British Columbia

Codes used in British Columbia, prescribed by the British Columbia Ministry of Health. * Code amber: missing or abducted infant or child * Code black: bomb threat * Code blue: cardiac and/or respiratory arrest * Code brown: hazardous spill * Code green: evacuation * Code grey: system failure * Code orange: disaster or mass casualties * Code pink: pediatric emergency and/or obstetrical emergency * Code red: fire * Code white: aggression * Code yellow: missing patient * Code Silver: Active shooter * Code 77: stroke * Code 99: incoming trauma


Manitoba

*Code Black: bomb threat *Code Blue: cardiac arrest/medical emergency *Code Brown: hazardous substance *Code Green: evacuation *Code Grey: environmental/shelter-in-place *Code Pink: infant/child abduction *Code Red: fire *Code White: violent person *Code Yellow: missing person


Nova Scotia

The following codes are in use in Nova Scotia. *Code Black: bomb threat *Code Blue: cardio/respiratory arrest, choking, or other life-threatening emergency *Code Brown: hazardous substance spill/release *Code Census: emergency department overcrowding *Code Green precautionary: evacuation (precautionary) *Code Green stat: evacuation (crisis) *Code Grey: external air exclusion/shelter in place *Code Orange: external disaster/reception of mass casualties *Code Pink: pediatric emergency and/or obstetrical emergency *Code Red: fire *Code Silver: person with a weapon *Code White: violent person(s)/situation *Code Yellow: missing patient/client


Ontario

In Ontario, a standard emergency response code set by the
Ontario Hospital Association According to the Ontario Hospital Association (OHA) website, the OHA is a member association that represents approximately 154 public hospitals in Ontario. The association regards itself as "the voice of Ontario's public hospitals". History O ...
is used, with minor variations for some hospitals. * Code amber: missing child/child abduction * Code aqua: flood * Code black: bomb threat/suspicious object * Code blue: cardiac arrest/medical emergency – adult * 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 defence (CBRN defence) are protective measures taken in situations in which chemical, biological, radiological or nuclear warfare (including terrorism) hazards may be present. CBRN defence consist ...
(chemical, biological, radiological, and nuclear) disaster * Code pink: cardiac arrest/medical emergency – infant/child * Code purple: hostage taking/gang activity * Code red: fire * Code silver: gun threat/shooter * Code white: violent/behavioural situation * Code yellow: missing person


Quebec

The following codes are in use in Quebec. *Code black: bomb threat/suspicious object *Code blue: adult cardiac or respiratory arrest, loss of consciousness *Code brown: in-facility hazardous spill *Code green: evacuation *Code orange: external disaster *Code pink: pediatric cardiac or respiratory arrest, loss of consciousness *Code purple: infant/neonatal cardiac or respiratory arrest *Code red: fire *Code white: violent patient *Code yellow: missing or lost patient


Saskatchewan

Codes used in Saskatchewan, prescribed by the
Saskatchewan Health Authority The Saskatchewan Health Authority is the single health region of the province of Saskatchewan. It is a health authority providing direct and contracted health services including primary, secondary, tertiary and quaternary care, home and communit ...
. * Code Red: Fire/Smoke * Code Orange: Incoming Casualties/Expanded services * Code Green: Evacuation/Relocation * Code Black: Bomb Threat/Suspicious Package * Code Purple: Hostage Taking * Code White: Aggressive/Hostile/Combative Person * Code Yellow: Missing Person * Code Blue: Cardiac/Respiratory Arrest * Code Brown: Hazardous Material/Chemical Spill * Code Silver: Active Assailant/Person with a Weapon


Yukon

The following codes are in use in Yukon. *Code Black: bomb threat *Code Blue: cardiac or respiratory arrest *Code Brown: hazardous material *Code Gold: earthquake (Yukon has the highest seismic activity rate in Canada) *Code Green stage 1: partial evacuation to a safe area within the building *Code Green stage 2: complete evacuation of the building *Code Grey: shelter in place/air exclusion *Code Orange: mass casualty *Code Red: fire *Code White: aggressive behaviour *Lockdown: violent situation/hostage taking *Code Yellow: missing patient


United Kingdom

In the UK, hospitals have standardised codes across individual
NHS The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
trusts (England and Wales) and health boards (Scotland), but there are not many standardised codes across the entire NHS. This allows for differences in demands on hospitals in different areas, and also for hospitals of different roles to communicate different alerts according to their needs (e.g., a major trauma centre like St. George's Hospital in South London has different priority alert needs to a rural
community hospital A community hospital can be purely a nominal designation or have a more specific meaning. When specific, it refers to a hospital that is accessible to the general public, and provides a general or specific medical care which is usually short-term, i ...
like
West Berkshire Community Hospital West Berkshire Community Hospital is a small hospital located in the Benham Hill area of Shaw-cum-Donnington, in West Berkshire, England. It is managed by Royal Berkshire NHS Foundation Trust. History The hospital, established to replace th ...
). Some more standardised codes are as follows: * Code black: hospital at capacity – no available beds for new admissions from A&E. A code black is declared by the hospital's general bed manager, who then relays this to the local ambulance service and posts updates for local healthcare services such as
GPs The Global Positioning System (GPS), originally Navstar GPS, is a satellite-based radionavigation system owned by the United States government and operated by the United States Space Force. It is one of the global navigation satellite sy ...
and
district nursing District Nurses work manage care within the community and lead teams of community nurses and support workers. The role requires registered nurses to take a NMC approved specialist practitioner course. Duties generally include visiting house-bound ...
teams. * Code red: This is the United Kingdom's rapid response code. This call gets specialist doctors and trauma teams to the location for assistance in things like major traumas and deteriorating patients in situations like choking or airway compromise. This call also can be used to activate a major hemorrhage protocol in the event of a massive bleed. This call is referred to as code red, staff assist, trauma protocol or rapid response. This is the only emergency protocol which has a code. The only other is what is announced as a mass casualty protocol not any codes. This is to show a major incident has taken place like a terrorist attack and the protocol is activated to alert specialists and begin special emergency procedures like mass casualty triage and decontamination. * Major haemorrhage protocol – activated via the code red system. A peri-arrest call is put out, but the transfusion lab is also alerted. A specified number of units of O-negative
packed red blood cells Packed red blood cells, also known as packed cells, are red blood cells that have been separated for blood transfusion. The packed cells are typically used in anemia that is either causing symptoms or when the hemoglobin is less than usually 70 ...
, and sometimes fresh frozen plasma and platelets, are immediately sent to the location of the call. The transfusion lab will
cross-match Cross-matching or crossmatching is a test performed before a blood transfusion as part of blood compatibility testing. Normally, this involves adding the recipient's blood plasma to a sample of the donor's red blood cells. If the blood is incomp ...
any saved blood samples for the patient, or await an urgent cross-match sample to be sent. Once this is done, units matching the patient's
blood type A blood type (also known as a blood group) is a classification of blood, based on the presence and absence of antibodies and inherited antigenic substances on the surface of red blood cells (RBCs). These antigens may be proteins, carbohydra ...
will be continually sent until the major haemorrhage protocol is stood down. Otherwise, non-colour codes are mostly used across the NHS: * 2222 (crash call or peri-arrest call) – dialling 2222 from any internal phone in nearly all NHS hospitals will connect the caller immediately to the switchboard. The caller can then specify the type of cardiac arrest or peri-arrest call (usually adult, paediatric (or neo-natal) or obstetric) and give a location (eg "Adult cardiac arrest, Surgical Admissions Unit, ground floor B block" or "Obstetric peri-arrest, obstetric theatres, 4th floor maternity wing") and the switchboard will bleep the members of the relevant cardiac arrest or peri-arrest team. Some UK hospitals do not have a peri-arrest team, and the cardiac arrest team can be used for urgent medical emergencies where cardiac arrest is imminent. * 3333 (security alert) * 4444 (fire alert) * 'Fast bleep' codes – a 2222 call for a specific member of staff. For example, in status epilepticus, it is not necessary to call the crash team (as is done in cardiac arrest) but a fast bleep can be made to the on-call anaesthetist to come urgently. * Trauma call – adult ( trauma centres only): usually called over a PA system across the emergency department, triggering a 'trauma call' paging request to all members of the trauma team - including a
trauma surgeon Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. Trauma surgeons generally complete residency training in general surgery and often fel ...
and senior members their surgical team, an anaesthetist and ODP, emergency medicine consultant or
registrar A registrar is an official keeper of records made in a register. The term may refer to: Education * Registrar (education), an official in an academic institution who handles student records * Registrar of the University of Oxford, one of the sen ...
and members of their team (this will be usually be an FY1 or SHO). Trauma calls are similar to ' resus codes' used in the US. ** Trauma call – paediatric ( trauma centres only): triggers a 'trauma call' paging request to all members of the paediatric trauma team - including a
trauma surgeon Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. Trauma surgeons generally complete residency training in general surgery and often fel ...
and senior members of their surgical team, often additionally a paediatric surgeon, a paediatric anaesthetist, ODP, (paediatric) emergency medicine consultant or
registrar A registrar is an official keeper of records made in a register. The term may refer to: Education * Registrar (education), an official in an academic institution who handles student records * Registrar of the University of Oxford, one of the sen ...
and members of their team (this will be usually be an FY1 or SHO).


United States

In 2000, the Hospital Association of Southern California (HASC) determined that a uniform code system was needed after three people were killed in a shooting incident at a hospital 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, the 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. 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. After both states had conducted a survey of all hospital members, the taskforce found many hospitals used the same code for fire (code red); however, there were tremendous variations for codes representing respiratory and cardiac arrest, infant and child abduction, and combative persons. After deliberations and decisions, the taskforce suggested the following as the Hospital Emergency Code: *
Amber alert An Amber Alert (alternatively styled AMBER alert) or a child abduction emergency alert ( SAME code: CAE) is a message distributed by a child abduction alert system to ask the public for help in finding abducted children. The system originated i ...
/
Code Adam Code Adam is a missing-child safety program in the United States and Canada, originally created by Walmart retail stores in 1994. This type of alert is generally regarded as having been named in memory of Adam Walsh, the 6-year-old son of John ...
: infant/child abduction * Code Black: bomb threat * Code Blue: heart or respiration stops (an adult or child’s heart has stopped or they are not breathing) * Code Brown: used to indicate severe weather * Code Clear: announced when emergency is over * Code Gray: combative person (combative or abusive behavior by patients, families, visitors, staff or physicians); if a weapon is involved code silver should be called * Code Green: emergency activation. * Code Orange: hazardous spills (a hazardous material spill or release; unsafe exposure to spill) * Code Pink: infant abduction, pediatric emergency and/or obstetrical emergency * Code Red: fire (also someone smoking in facility) (alternative: massive postpartum hemorrhage) * Code Silver: weapon or hostage situation * Code White: neonatal emergency, aggressive person or evacuation dependent on hospital. In some hospitals, an aggressive person is called as a Code Violet. * External triage: external disaster (external emergencies impacting hospital including: mass casualties; severe weather; massive power outages; and nuclear, biological, and chemical incidents) * 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.) * 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


Plain Language Emergency Alerts

In 2015, the South Carolina Hospital Association formed a work group to develop plain language standardization code recommendations. Abolishing all color codes was suggested. In 2016, the Texas Hospital Association encouraged the use of standardized plain language emergency alerts at all Texas hospitals. The only color code that was still recommended was "code blue," meaning a cardiac arrest. Plain language alerts are announced using the following format: "Alert Type + Description + Location (general to specific) + Instructions (if applicable)." For example, if a patient in ICU Bed 4 went into cardiac arrest, the alert would be "Medical Alert + Code Blue + Second Floor + Intensive Care Unit + Bed 4."


Codes

Note: Different codes are used in different hospitals.


Code blue

"Code blue” is used to indicate that a patient requires resuscitation or is in need of immediate medical attention, most often as the result of a
respiratory arrest Respiratory arrest is a sickness caused by apnea (cessation of breathing) or respiratory dysfunction severe enough it will not sustain the body (such as agonal breathing). Prolonged apnea refers to a patient who has stopped breathing for a long pe ...
or
cardiac arrest Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possi ...
. When called overhead, the page takes the form of "Code blue,
loor ''Pendragon: Journal of an Adventure through Time and Space'', commonly known as ''Pendragon'', is a series of ten young-adult science fiction and fantasy novels by American author D. J. MacHale, published from 2002 to 2009. The series chroni ...
oom 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 Advanced cardiac life support, advanced cardiovascular life support (ACLS) refers to a set of clinical guidelines for the urgent and emergent treatment of life-threatening cardiovascular conditions that will cause or have caused cardiac arrest, ...
or other equivalent resuscitation training. Frequently these teams are staffed by physicians (from
anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), a ...
and internal medicine in larger medical centers or the
emergency physician An emergency physician (often called an "ER doctor" in the United States) is a physician who works at an emergency department to care for ill patients. The emergency physician is a specialist in advanced cardiac life support (advanced life suppor ...
in smaller ones),
respiratory therapist A respiratory therapist is a specialized healthcare practitioner trained in critical care and cardio-pulmonary medicine in order to work therapeutically with people who have acute critical conditions, cardiac and pulmonary disease. Respirato ...
s, 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". Most usually, it’s used as a case of emergency and when a doctor or surgeon calls “Code Blue!” it is representing an emergency. This phrase was coined at Bethany Medical Center in
Kansas City, Kansas Kansas City, abbreviated as "KCK", is the third-largest city in the U.S. state of Kansas, and the county seat of Wyandotte County. It is an inner suburb of the older and more populous Kansas City, Missouri, after which it is named. As of t ...
. 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 * Californian standard 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 Slow code refers to the practice in a hospital or other medical centre to purposely respond slowly or incompletely to a patient in cardiac arrest, particularly in situations for which cardiopulmonary resuscitation (CPR) is thought to be of no medic ...
", or may fake the response altogether for the sake of the patient's family, a practice known as "show code". Such practices are ethically controversial, 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; "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.


"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, e.g.: "Paging Dr. Firestone, third floor," to indicate a possible fire on the floor specified.


"Resus" codes

Specific to emergency medicine, incoming patients in immediate danger of life or limb, whether presenting via
ambulance An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to medi ...
or walk-in
triage In medicine, triage () is a practice invoked when acute care cannot be provided for lack of resources. The process rations care towards those who are most in need of immediate care, and who benefit most from it. More generally it refers to pri ...
, are paged locally within the
emergency department An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of pat ...
as "resus" i:səscodes. 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 The estimated time of arrival (ETA) is the time when a ship, vehicle, aircraft, cargo, emergency service, or person is expected to arrive at a certain place. Overview One of the more common uses of the phrase is in public transportation where the ...
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.


See also

*
Inspector Sands "Inspector Sands" is a code phrase used by public transport authorities in the United Kingdom, including Network Rail and London Underground, to alert staff to a fire alarm without needing to evacuate the station. The exact wording depends on the ...
, code used over PA system in British public transport to indicate a serious situation *
Vessel emergency codes In addition to distress signals like Mayday and pan-pan, most vessels, especially passenger ships, use some emergency signals to alert the crew on board. In some cases, the signals may alert the passengers to danger, but, in others, the objective ...
codes used on cruise ships.


References


External links


Codes Listing, Texas Tech University Health Sciences Center
{{Hospital articles Emergency codes Emergency codes Emergency communication Color codes