Hospital emergency codes

For the computer virus, see Code Red (computer worm). For the Portall Album, see Code Black (album). For the Iceahouse Album, see Code Blue (album). For the practice of corruption among U.S. law enforcement, see Blue Code of Silence.

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 may denote different events at different hospitals, even nearby ones. Since many physicians have privileges at more than one facility, this may lead to confusion in emergencies, so uniform systems have been proposed.

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

• United States of America:
  • In 2000, the Hospital Association of Southern California (HASC)^[2][3] 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.^[4]

Codes by color

Note: Different codes are used in different hospitals.

Code Blue

Cardiac arrest

"Code Blue" is generally used to indicate a patient requiring resuscitation or otherwise 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 emergency department and intensive care unit physicians, respiratory therapists, and nurses. At least one attending physician must be 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.^[5] 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".

• • Australian Standard^[1]
  • Californian Standard^[2]

Variations

• "Plan Blue" is 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" is called out to alert the surgeon on call to immediately proceed to the ER entrance and take the patient upstairs for immediate surgery. This was illustrated in an episode of Trauma: Life in the ER entitled "West Side Stories".

Other codes

"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 code word for a dangerous situation or a patient in crisis. e.g.: "Paging Doctor Firestone, third floor," to indicate a possible fire in the location specified.

Codes by emergency

Bomb threat

• Code Yellow: HASC^{[citation needed]}
• Code 10: Stanford University Medical Center (old system), Scripps Healthcare San Diego^{[citation needed]}
• Code Black: Markham Stouffville Hospital, University of Chicago Medical Center,^{[citation needed]} Ohio State University Medical Center,^{[original research?]} Alberta, Quebec and Ontario hospitals.
• Code Blue: Some schools in Western New York and in schools in Volusia County, Florida^{[citation needed]}
• Code 100: Heartland Regional Medical Center^{[citation needed]}
• Code Purple: Australian Standard^{[citation needed]}
• Code Orange: Oakwood Healthcare^{[citation needed]}
• Code B: Superstition Mountain Mental Health Center (SMMHC, Inc.)^{[citation needed]}
• Code Grey: Bronson Methodist Hospital
• Code Black: Park Nicollet Methodist Hospital
• Alert Blue: Health Partners Regions Hospital
• Code Black: Cheyenne Regional Medical Center

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.
• Code Pink can denote child abduction. Used at Carolinas Healthcare System in North Carolina, University of Texas Medical Branch in Galveston, and Massachusetts General Hospital in Boston.
• Code Purple was sometimes also used for Child Abduction
• Code Gold: Calgary Health Region
• Code Amber: Alberta health regions
• Code Rainbow: University of California at Davis Medical Center
• Code Stork: Health Partners Regions Hospital
• Code Pink: Park Nicollet Methodist Hospital
• Code Pink: Cheyenne Regional Medical Center
• Code Black: Heartland Regional Medical Center
• Code Silver: Iowa Health Systems

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), Quebec and Ontario
• Code Atlas: Virginia Healthcare System
• Security Stat: Heartland Regional Medical Center
• "Mr. Strong" to (location), at other hospitals
• "Dr. Armstrong" to (location), at other hospitals
• Code Yellow: Park Nicollet Methodist Hospital
• Code Yellow: Cheyenne Regional Medical Center
• Yellow Alert: Health Partners Regions Hospital

Evacuation

• Code White: Texas Tech University Health Sciences Center.
• Code Orange: Australian Standard.
• Code Green: Quebec and Ontario

Fire

• Usually Code Red.
  • Australian Standard.^[1]
  • California Standard.^[2]
• Sometimes Dr. Red, Dr. Pyro, or Dr. Firestone.
• Sometimes "Evacuation Bell"

Code Red. Park Nicollet Methodist Hospital

• Dr. Red Cheyenne Regional Medical Center
  • Long Grass Health Partners Regions Hospital

Code F

• University of Michigan 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
• Code Triage - Internal: HACS
• Code Alert sometimes denotes disaster.

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.
• Code Red: Most commonly used by schools to indicate that a dangerous and/or harmful person is on campus.

Mass casualty incident

• Code Yellow: Texas Tech University Health Sciences Center
• "MASCAL" may also be used
• Code 10, Code 20, or Code 99: Heartland Regional Medical Center
• Code Orange: Calgary Health Region, Quebec and Ontario
• Code Triage: Scripps Healthcare San Diego; Hoag Hospital Newport Beach; Seton Medical Center, Daly City, California.
• 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

Severe weather

• Code Brown: Texas Tech University Health Sciences Center
• Code Black: Mercy Health Center (Oklahoma City)
• Code Gray: Cook Children's Medical Center, Fort Worth, TX; St. John's Regional Medical Center, Joplin, MO
• Code Yellow: Heartland Regional Medical Center
• Code Green: Schools in Volusia County, Florida

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),^[6] "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.

External links

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

References

1. ^ ^{a b c} AS 4083-1997 Planning for emergencies-Health care facilities
2. ^ ^{a b c} LISTSERV 15.5 – MEDLIB-L Archives
3. ^ California Healthcare Association News Briefs July 12, 2002Vol. 35 No. 27
4. ^ DSD.state.md.us
5. ^ Unplugged: Reclaiming Our Right to Die in America, Wiliam H. Colby, page 63
6. ^ CMAJ.ca