Hospital emergency codes

For the Icehouse Album, see Code Blue (Icehouse album).

For the computer virus, see Code Red (computer worm).

For the Portall Album, see Code Black (album).

For the Caroline Cooney novel, see Code Orange (book).

Hospital Emergency Codes are used in hospitals worldwide to alert staff to various emergency situations. The use of codes is intended to convey essential information quickly and with a minimum of misunderstanding to staff, while preventing stress or panic among visitors to the hospital. These codes may be posted on placards throughout the hospital, or printed on employee/staff identification badges for ready reference.

Back of a hospital ID badge showing disaster codes.

Hospital emergency codes are frequently coded by colour, and the colour codes denote different events at different hospitals and are not universal.

Colour code standardisation

• Australia:
  • Australian hospitals and other buildings are covered by Australian Standard 4083 (1997) and many are in the process of changing to those standards.

• Canada:
  • The various emergency preparedness services of the health regions in Alberta have also begun to discuss standardisation of their colour code systems.

• United States of America:
  • In 2000, the Hospital Association of Southern California (HASC)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, there were 47 different codes 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.

Codes by colour

Note: Different codes are used in different hospitals.

Code Amber

• Infant/Child Abduction (Phoenix Indian Medical Center)
• Generally used in the U.S. to denote suspected child/infant abduction from a hospital setting (New Jersey Hospital Association); named for Amber Hagerman, an abducted and murdered child whose death inspired the AMBER Alert nationwide alert system. Amber Alerts are announced in many jurisdictions via the Emergency Alert System, (successor to the Emergency Broadcast System) over broadcast radio and TV. Many U.S. hospitals specially tag pediatric patients' hospital wrist bands with a device designed to trigger an alarm if the wrist band passes a sensor at exit points; however, this occasionally triggers false alarms (such as a parent taking their child home and keeping the wrist band as a souvenir).
• A theft or armed robbery in progress within the facility (Texas Tech University Health Sciences Center).

Code Black

• In only the states of Alaska and Georgia a Code Black indicates that a patient was pronounced dead.
• In US Military hospitals and some civilian hospitals, Code Black indicates mass casualty or other public health threat. In this case, all doctors are ordered to return to the hospitals.
• In Australia code black is a personal threat. This incorporates a diverse range of situations including assaults, confrontations, hostage situations and threats of personal injury or attack.
• May refer to an infant or child abduction. (Heartland Regional Medical Center)
• Bomb Threat (Ontario, Manitoba, Quebec)
• In the military code black is bomb threat or discovery of suspicious package.
• Evacuation/Isolation due to a threat of Explosive
• Severe Weather Alert

Bomb Threat (Tampa General Hospital)

Code Blue

• This phrase was coined at Bethany Medical Center in Kansas City, Kansas.
• Used at St John River District Hospital in East China, MI as a "ADULT EMERGENCY" All available staff must respond to this code.

• Generally is used to indicate a patient requiring immediate resuscitation, most often as the result of a cardiac arrest. May also be used as a radio call to indicate that a patient en route to the hospital requires resuscitation. "Code Blue - Adult" or " - Pediatric" are sometimes used to provide additional information about the patient. HASC have suggested these codes be replaced by "Code Blue" and "Code White", respectively.
• 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 as "coding".
• Adult medical emergency (in contrast to Code White for pediatric medical emergency) per Healthcare Emergency Codes (New Jersey Hospital Association).
• Adult medical emergency in Australia (for instance, VT/VF, fall is GCS ≥ 3, bradycardia, accelerated HTN).
• Tornado warning - patients moved to interior corridors, staff and visitors seek shelter immediately (William Beaumont Hospitals, Royal Oak and Troy, MI)

Code Brown

• Severe weather (Texas Tech University Health Sciences Center)
• External Emergency (Australian Standard)
• Missing Adult (Ohio Hospital Association) (University of Toledo Medical Center) (University of Cincinnati Medical Center)
• Medical Gas Emergency (Carolinas HealthCare System)
• Chemical Spill (Ontario Hospital Association)
• Any incident of someone defecating (slang among nurses regarding defecation) (LLUMC)
• Autopsy (Tampa General Hospital)

Code Gray/Grey

• A combative person with no weapon under HASC suggestions.
• A security emergency (New Jersey Hospital Association).
• In the Calgary Health Region a Code Grey denotes an air quality issue, or need to enact an air exclusion plan (i.e. shutting off external air circulation, closing windows and doors).
• Severe Weather (Cook Children's Medical Center, Fort Worth, TX)
• Emergency team response for inpatient stroke.
• Air Exclusion (Ontario)
• Unruly Patient/Visitor (Tampa General Hospital)
• Patient in violent (psychotic) episode needing restraint/sedative medication

Code Green

• Internal/External Disaster. (Phoenix Indian Medical Center)
• A combative person using physical force, especially weapons. (some American hospitals)
• Internal disaster. (Texas Tech University Health Sciences Center)
• Code Green is used to indicate an evacuation situation, and can refer to the evacuation of a ward/floor/wing (Code Green) or the entire hospital (Code Green - Stat) depending on the call (Ontario Hospital Emergency Codes, Winnipeg Regional Health Authority)
• All Clear - resume normal duties (William Beaumont Hospitals, Royal Oak and Troy, MI).
• Fire Drill - Implement RACE and PASS procedures. (Cook Children's Medical Center, Fort Worth, TX)
• Difficult delivery in Obstetrics, requiring immediate assistance (Heartland Regional Medical Center)

Code Pink

• Infant/child abduction (Beth Israel Deaconess Medical Center, Boston, MA)(Tampa General Hospital).

• In units where electronic patient wristbands are used, Code Pinks are frequently triggered by accident, either by care providers transporting a patient past an alarmed exit or a discharged patient/patient's parent requesting the wristband as a souvenir.

• Code Pink may also denote a call by, or on behalf of, a nurse when she is being harassed, berated or otherwise abused by a physician. The arrival of other nursing staff is usually enough to stop the physician's behaviour.
• Biohazardous contamination of a patient or staff. (Heartland Regional Medical Center)
• A birth is imminent and no physician is present. (Bloomington Hospital, Bloomington Indiana)
• A pediatric cardiac arrest (MUHC, Canada; Kingston General Hospital; Ohio Hospital Association)
• Patient is under influence of illegal substances (UK First Aid organisations)

Code Purple

• Emergency department can no longer accept patients; divert incoming cases to other hospitals if at all possible (Canada, also Wellstar Health Group)
• Australian Standard for Bomb or Substance alert.
• Hostage situation or patient abduction (Ontario Hospital Association)
• Psychiatric emergency - patient is a threat to self or others (Beth Israel Deaconess Medical Center, Boston, MA).
• Lost or disoriented elderly patient (Swedish First Hill Hospital, Seattle, WA).
• Patient, Staff, Visitor Injury (Tampa General Hospital)

Code Red

• Fire. (Australian Standard,, California Standard, Ontario, Quebec)
• HASC recommendation for fire in the hospital.
• Sometimes used to denote patients arriving with burn injuries (Charity Hospital, New Orleans, LA).
• A disaster has occurred and casualties are inbound; hospital disaster plan in effect (William Beaumont Hospitals, Royal Oak and Troy, MI).
• Smoke or Fire Detected. (Cook Children's Medical Center, Fort Worth, TX)
• Incoming life-threatening trauma (Mercy Medical Center, Sioux City, IA)

Code Silver

• Combative person with a Lethal Weapon (HASC recommendations).
• Violent Situation - Lockdown (Cook Children's Medical Center, Fort Worth, TX)

Code Yellow

• Missing patient (Ontario Hospital Emergency Codes)(Tampa General Hospital)
• Internal / External Disaster - More ER patients expected. (Cook Children's Medical Center, Fort Worth, TX)
• Severe weather alert (Heartland Regional Medical Center)
• Emergency C-section (Naval Hospital Guam)
• Under influence of alcohol, suspected dangerous (UK First Aid organisations)
• Combative Person/Behavioral Problem requiring assistance from other staff (Metropolitan St. Louis Psychiatric Center)
• Internal Disaster (Australian Standard)
• a bomb threat (Tacoma General Hospital in Tacoma, WA)

Code White

• a pediatric medical emergency per Healthcare Emergency Codes (New Jersey Hospital Association).
• a combative or violent patient (in Canada)[1]
• Severe weather in the area - draw drapes in patient areas, staff and visitors advised to remain in the building (William Beaumont Hospitals, Royal Oak and Troy, MI).
• Natural disaster or other mass event requiring evacuation, hospital disaster plan in effect (Coler-Goldwater Specialty Hospital, New York, NY)
• a power or utility outage (Tampa Genera Hospital in Tampa, FL)

• Used at st John River District Hospital in east china, MI 48054

Code Orange

• A Code Orange alert indicates a "show of force"
• Emergency/Disaster Response for an external disaster (Ontario)

Code Rainbow

• used when a riot has broken out or similar large-scale disaster has occurred, and indicates that employees who would not normally respond to an emergency page (such as financial department staff, cafeteria and maintenance staff, clinicians who are currently with a patient or a group, etc.) should drop everything and respond, leaving only very minimal staff in place on units (North Shore Health Care Center Traumatic Brain Injury Rehabilitation Program in Lynn, MA)

Other codes

Code 8

• Violent situation (Fletcher Allen Health Care, Burlington, VT).

Code 10

• Mass casualty, not exceeding 10 people (Heartland Regional Medical Center).
• Bomb Threat (University of California San Diego)
• Calls are made when merchants are suspicious about accepting a credit card. The phrase "Code 10 authorization" is used to avoid alerting the customer to the fact that the merchant is suspicious of their card.

Code 20

• Mass casualty, not exceeding 20 people (Heartland Regional Medical Center).

Code 50

• Non-Life Threatening Medical Emergency (Alberta Children's Hospital, Calgary, Alberta, Canada)

Code 66

ICU outreach, i.e. patient deteriorating, worried about patient, etc. (Foothills Medical Centre, Peter Lougheed Centre, Rockyview General Hospital, Calgary, Alberta, Canada).

Code 99

• Medical emergency, resuscitation required (Fletcher Allen Health Care, Burlington and Winooski, VT; St. John's Mercy Medical Center, St. Louis, MO; St. John's Mercy Hospital, Washington, MO).
• Mass casualty of more than 20 people is expected to arrive in the Emergency Department. (Heartland Regional Medical Center)

Code 100

• Bomb threat, whether by phone or other means (Heartland Regional Medical Center).
• Mass casualty of more than 20 people is expected to arrive in the Emergency Department (KSB Hospital)

Code Adam

• Usually denotes missing person, especially a missing child; often used in department stores or other large public facilities; named for Adam Walsh, an abducted child.

Code Atlas

• Staff cannot manage the situation (e.g. combative patient). Used in several Richmond, VA hospitals.

Code Elope

• Denotes the code called overhead for a patient who leaves the hospital unannounced. Patient is normally a threat to themselves or others, usually because they are medicated and are unable to conduct normal activities that a non-medicated person could.

Code Trauma

• Assemble the trauma team in anticipation of arrival of a Level 1 trauma patient (Scripps-Mercy Hospital, San Diego, CA). Often issued in conjunction with a timeframe for when the patient is due to arrive and what kind of transport is delivering them (e.g. "Code Trauma, Lifeflight, 5 minutes out" means "Assemble trauma team for anticipated arrival within the next 5 minutes of one or more Level 1 patients via helicopter").

Code Zebra

• Bioterrorism alert (Santa Clara County Health Department). A code zebra may also in some cases denote harassment.

Mail Call

• Indicates that a very strong child is being restrained and staff who can do so without injuring themselves are to report to the area. Originally referred to a staff member needing a male to help with a restraint, but was revised to reflect that many female staff are also physically able to help in such a situation. (Lowell Youth Treatment Center in Lowell, MA)

"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. _____", where the doctor's "name" is a codeword for a dangerous situation or a patient in crisis.

Dr. Allcome

• Serious emergency. "Doctor Allcome to Ward 5." would indicate that all medical staff not presently occupied are needed. (The Med, Memphis Tennessee)

Dr. Firestone

• Fire in the hospital. If a fire's location can be isolated, the location of the fire is included in the page, e.g. "Paging Dr. Firestone to 3 West" indicates "Fire in or near west stairwell/wing on third floor" (William Beaumont Hospitals, Royal Oak and Troy, MI).

Dr. Pyro

• Fire in the hospital/healthcare facility. "Paging Dr. Pyro on ____" indicates a fire and its origin or current location, e.g. "Paging Dr. Pyro on 3" means "Fire on third floor" (Kaiser Permanente, system-wide).

Dr. Strong

• Patient needing either physical assistance or physical restraint. "Paging Dr. Strong ..." indicates that any physically capable personnel (orderlies, police or security officers, EMTs or firemen, etc.) in the proximity should report and be prepared either to move a patient who "fell down" and cannot get back up or to "capture and restrain" an uncooperative patient.

Dr. Stone

• Security situation (ER in Lewisville, TX)

Paging [Director of Nursing's name] to the reception desk

• Used at the now-defunct Mediplex of the North Shore (Traumatic brain injury rehabilitation program in Lynn, MA, which was sold several times and was eventually shut down by the state due to numerous violations) to indicate that state overseers were in the building and program staff were to cease all practices that were illegal or unethical. (The facility did not normally use the overhead page system to ask a specific person to come to a location).

Codes by emergency

Bomb threat

• Code Yellow: HASC
• Code 10: Stanford University Medical Center (old system), Scripps Healthcare San Diego
• Code Black: Markham Stouffville Hospital
• Code Blue: Some schools in Western New York
• Code 100: Heartland Regional Medical Center
• Code Purple: Australian Standard
• Code Orange: Oakwood Healthcare
• Code B: Superstition Mountain Mental Health Center (SMMHC, Inc.)

Child abduction/missing person

• Code Adam is sometimes used for missing person.
• Code White is used in the IWK Health Centre for a missing person.
• Code Yellow: Markham Stouffville Hospital
• Code Black: Heartland Regional Medical Center
• Code Silver: Iowa Health Systems

Child Abduction

• Code Pink can denote child abduction
• Code Purple was sometimes also used for Child Abduction
• Code Kinder: William Beaumont Hospitals
• Code Gold: Calgary Health Region
• Code Amber: Alberta health regions

Combative person/assault

• Code North: Stanford University Medical Center
• 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)
• Security Stat: Heartland Regional Medical Center

Evacuation

• Code White: Texas Tech University Health Sciences Center.
• Code Orange: Australian Standard.
• Code Green: Calgary Health Region

Fire

• Usually Code Red.
  • Australian Standard.
  • California Standard.
• Sometimes Dr. Red, Dr. Pyro, or Dr. Firestone.
• Sometimes "Evacuation Bell"

Internal disaster

• Code Green: Texas Tech University Health Sciences Center.
• Code Yellow: Standford University Medical Center (old system), Australian Standard
• Code Triage - Internal: HACS

Lockdown/limited access

• Code Orange: Ontario Used in Ontario hospitals to indicate an external disaster with mass casualties. 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.

Mass casualty incident

• Code Yellow: Texas Tech University Health Sciences Center
• Code Black: Military Hospitals
• MASCAL may also be used
• Code 10, Code 20, or Code 99: Heartland Regional Medical Center
• Code Orange: Calgary Health Region
• Code Triage: Scripps Healthcare San Diego; Hoag Hospital Newport Beach

Medical emergency - resuscitation team/imminent death

• Usually Code Blue, sometimes Code 99. Because this is the most frequent code, a patient undergoing cardiac arrest is often referred to as "Coding."
  • Australian Standard
  • Californian Standard

Severe weather

• Code Brown: Texas Tech University Health Sciences Center
• Code Black: La Rabida Children's Hospital (Chicago)
• Code Gray: Cook Children's Medical Center, Fort Worth, TX
• Code Yellow: Heartland Regional Medical Center

Theft/armed robbery

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

Total divert

• A status sometimes called "Critical Care Bypass" (Ontario),[2] "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.
• This status was featured in the episode "Total Divert" of Trauma: Life in the E.R., set at San Francisco General Hospital in San Francisco, CA; however, as explained by a trauma nurse in the episode, the status change does not always keep new patients from arriving.
• 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..
• Can be denoted as Code Purple or Code Yellow in some hospitals.

Pop culture references

• Code black is a medical term used in the ABC series Grey's Anatomy, in the episode "It's the End of the World". In this instance, the term refers to the presence or the threat of a bomb within the hospital.

• In the film Johnny Mnemonic a character uses the name Dr. Allcome, claiming it is a hospital code for "Doctors All Come..."

• The hardcore punk band TSOL has a song called "code blue" which is about necrophilia.

• Trauma: Life in the E.R., shot at trauma centers throughout the U.S., features different hospitals usage of the various codes.
• A 2004 book based on a teenager finding smallpox scabs is called "Code Orange"
• Code Blue, a documentary series about a hospital emergency room, is named for the commonly-used code blue to indicate a patient in distress

• "Code Brown" is a colloquialism used to indicate that a patient has defecated on themselves and requires cleanup. In addition to being a commonly-used term by rank-and-file healthcare workers, it is referenced many times in earlier seasons of "E.R.", as well as in a webisode of "Scrubs".

• In the TV series The West Wing episode In the Shadow of Two Gunmen, the President is shot and is diverted to a designated hospital. The staff nurse announces "Blue, blue!" indicating the ER should be evacuated for security reasons.

External links

• Codes Listing, Texas Tech University Health Sciences Center (pdf)
• Stanford Medical Codes (HASC based scheme)
• Theda Care.org code listing