Hospital Emergency Codes are used in hospitalsworldwide to alert staff to various 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. These codes may be posted on placards throughout the hospital, or printed on employee identification badges for ready reference.
Back of a hospital ID badge showing disaster codes.
Hospital emergency codes may denote different events at different hospitals, including nearby ones. Because many physicians work at more than one facility, this may lead to confusion in emergencies, so uniform systems have been proposed.
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 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 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".
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; the "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. This was illustrated in an episode of Trauma: Life in the ER, entitled "West Side Stories".
"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. "Paging Dr. Stork" normally indicates that a woman is in labor and needs immediate assistance.
Code Blue (Child) - Cardio-Respiratory Arrest Age >30 days to 13 years in Ontario
Code Pink - Cardio-Respiratory Arrest Neonatal Age <30 days in Ontario
Code Blue: Cardio-respiratory arrest or medical emergency for Adult (El Camino Hospital, Mountain View, CA)
Code Pink - Used as cardiac arrest in an infant at Miami Valley Hospital in Dayton.
Code White-Neonatal: Cardio-respiratory arrest or medical emergency for <28 days (El Camino Hospital, Mountain View, CA)
Code White-Pediatric: Cardio-respiratory arrest or medical emergency for >28 days (El Camino Hospital, Mountain View, CA)
Code 2-Pediatric: Pediatric cardio-respiratory arrest (Health Partners Regions Hospital)
Code 2-Adult: Adult cardio-respiratory arrest (Health Partners Regions Hospital)
Code 25: Respiratory Distress. (Houston, Texas). Number codes are used instead of color codes to prevent curious non-essential people from cluttering the halls near the emergency area and delaying care.
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 Brown - Internal Crisis / Hazardous Spill in Ontario / e.g. Sewer backup and overflow .
Lima Delta: UnityPoint Health (Formerly known as Iowa Health System)
Code Orange: Ontario Used in Ontario hospitals to indicate an external disaster with mass casualties, CBRNE and Pandemic. 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.
Code Amber: Texas Tech University Health Sciences Center; New Jersey Hospital Association
A status sometimes called "Critical Care Bypass" (Ontario), "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.