Hospital emergency codes

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

File:WBH-Troy disaster codes.jpg

Back of a hospital ID badge showing disaster codes.

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

The fact that different hospitals, even those in close proximity to one another, do not utilize a consistent coding system leaves room for confusion in the event of an emergency or disaster. Many physicians have privileges at more than one facility, and the expectation is that he or she would be well versed in the emergency doctrines of each. However, it seems that without due diligence in regular review of the codes for each hospital, it would be very possible for confusion to ensue in the event of a code announcement. The standardization of codes, however, would diminish the secretive "code" aspect of these announcements, thereby defeating the purpose of using the codes.

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.

• 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) 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 color

Note: Different codes are used in different hospitals.

Code Blue

Cardiac arrest

• 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.
• 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 as "coding".
• In some hospitals, Code Blue has been changed to Code 99. For children is Code 45.

Other meanings

• 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)

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

Dr. Allcome

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

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, University of Chicago Medical Center
• 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

Code Pink: is used in North Carolina, CMC Medical

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: Stanford 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; Seton Medical Center, Daly City, California.
• Code 1000: Fletcher Allen Medical Center; Burlington, VT

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),[1] "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.

• "Code Pink" is used in the episode "My House" of "Scrubs" when character Turk mistakes another baby for his own and goes to his wife only to find she has his actual daughter.

External links

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