Hospital emergency 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, New Zealand 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.
Standardised color codes
- Code black: personal threat
- Code black alpha: missing or abducted infant or child
- Code black beta: active shooter
- 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
- Code red: fire
- Code yellow: internal emergency
- 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 black: bomb threat/suspicious package
- Code blue: cardiac arrest/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 amber (code purple): 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) 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
In the UK, hospitals have standardised codes across individual NHS trusts, 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 (eg a major trauma centre like St. George's Hospital in South London has different priority alert needs to a rural community hospital like West Berkshire Community Hospital). 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 and district nursing teams.
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 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 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.
- Major haemorrhage protocol - activated via the 2222 call system. A peri-arrest or cardiac arrest call is put out, but the transfusion lab is also alerted. A specified number of units of O-negative packed red blood cells and (sometimes FFP and platelets) are immediately sent to the location of the call. The transfusion lab will crossmatch 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 will be continually sent until the major haemorrhage protocol is stood down.
- 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 and senior members their surgical team, an anaesthetist and ODP, emergency medicine consultant or registrar 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 and senior members of their surgical team, often additionally a paediatric surgeon, a paediatric anaesthetist, ODP, (paediatric) emergency medicine consultant or registrar and members of their team (this will be usually be an FY1 or SHO).
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, 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 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. 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:
- Amber alert: infant/child abduction
- Code blue: heart or respiration stops (an adult or child’s heart has stopped or they are not breathing)
- Code clear: announced when emergency is over
- 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
- Code orange: hazardous spills (a hazardous material spill or release; unsafe exposure to spill.)
- Code pink: infant abduction
- Code red: fire (alternative: massive postpartum hemorrhage)
- Code silver: weapon or hostage situation
- External triage: external disaster (external emergencies impacting hospital including: mass casualties; severe weather; massive power outages; and nuclear, biological, and chemical accidents)
- 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
Note: Different codes are used in different hospitals.
"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. 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. 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".
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". Such practices are ethically controversial, and are banned in some jurisdictions.
"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 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.
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.
"MET" or "RRT" Codes
Hospital based healthcare in the United States often use a Medical Emergency Team ("MET") or Rapid Response Team ("RRT"), although the terminology of the specific team names may vary by hospital. The goal of the MET or RRT Code is to identify, respond, and stabilize a deteriorating patient before they require resuscitation. Many hospital systems empower anyone, including patients and family members, to initiate a MET or RRT Code since early detection of patient deterioration usually leads to better patient outcomes. The MET or RRT Code will trigger a response from a specialized team including members from other areas of the hospital including critical care or emergency medicine physicians, nursing, respiratory therapy, and pharmacy. The nurse and physicians that are responsible for the patient's care are often required to respond as well as they are the most familiar with the patient's history and care plan.
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