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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.

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

Color Code Standardization[]

• United States of America:
  • In 2000, the Hospital Association of Southern California (HASC)^[1] 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.»^[2] 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.
• Canada:
  • The various emergency preparedness services of the health regions in Alberta have also begun to discuss standardization of their colour code systems.
• Australia:
  • Australian hospitals and other buildings are covered by Australian Standard 4083 (1997) and many are in the process of changing to those standards.^[3]

Codes by Color[]

Note: Different codes are used in different hospitals.

Code Amber[]

• 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. 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 US Military hospitals and some civilian hospitals, Code Black indicates mass casualty or other public health threat.
• 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.^[4]
• May refer to an infant or child abduction. (Heartland Regional Medical Center)
• Bomb Threat (Ontario)

Code Blue[]

• Generally 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.
• Adult medical emergency (in contrast to Code White for pediatric medical emergency) per Healthcare Emergency Codes (New Jersey Hospital Association).
• Tornado warning — patients moved to interior corridors, staff and visitors seek shelter immediately (William Beaumont Hospitals, Royal Oak and Troy, MI)

Code White[]

• a pediatric medical emergency per Heathcare 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).
• a power or utility outage (Tampa Genera Hospital in Tampa, FL)

Code Brown[]

• Severe weather (Texas Tech University Health Sciences Center)
• External Emergency (Australian Standard) ^[5]
• Missing Adult (University of Toledo Medical Center)
• Medical Gas Emergency (Carolinas HealthCare System)
• Chemical Spill (Ontario Hospital Association)
• When an adult soils themeselves

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).

Code Green[]

• 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 (Ontario Hospital Emergency Codes)
• All Clear — resume normal duties (William Beaumont Hospitals, Royal Oak and Troy, MI).

Code Orange[]

• Australian Standard for Evacuation. ^[6]
• Also used for an emergency medical team for patients whose health is rapidly declining (UMASS MEDICAL)
• Hazardous material incident (New Jersey Hospital Association; William Beaumont Hospitals, Royal Oak and Troy, MI), especially radiation-related incidents (Charity Hospital, New Orleans, LA).
• Disaster, usually external, involving mass casualties (Canada).
• Out of control patient (Swedish First Hill Hospital, Seattle, WA).

Code Pink[]

• 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. ^[7]
• 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)

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.^[8]
• Hostage situation or patient abduction (Ontario Hospital Association)

Code Red[]

• Australian Standard for Fire.^[9]
• HASC recommendation for fire in the hospital. ^[10]
• 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).

Code Silver[]

• Combative person with a weapon (HASC recommendations).

Code Yellow[]

• Missing patient (Ontario Hospital Emergency Codes).

Other Codes[]

Code 10[]

• Mass casualty, not exceeding 10 people (Heartland Regional Medical Center).

Code 20[]

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

Code 99[]

• Medical emergency, resuscitation required (Fletcher Allen Health Care, Burlington and Winooski, VT).
• 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).

Code Adam[]

• Usually denotes missing person, especially a missing child; often used in department stores or other large public facilities; named for Adam Walsh, a child abducted from a Hollywood, Florida Sears store in 1981 who was later found decapitated.[2]

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»).

«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. 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).

Doctor Strong[]

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

Clear[]

• All clear code per Heathcare Emergency Codes (NJ Hospital Association).

Bomb Threat[]

• Code Yellow: HASC
• Code 10: Stanford University Medical Center (old system)
• 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

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

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.^[11]
  • California Standard. ^[12]
• Sometimes Dr Red, Dr Pyro or Dr Firestone.

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 Hospitals, used to indicate when the hospital is limiting access to the facilities. Volunteers, Families and Students may be denied access. (Was used 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

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 ^[13]
  • Californian Standard ^[14]

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
• 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}, «Total Divert», «triage situation», «Saturation Alert».
• 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»
• An episode of the 1970s series Emergency! had a fire break out in the hospital and the code name «Doctor Evac» was paged to alert staff to evacuate patients without causing panic. “Evac” is short for “evacuate”.

External links[]

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

References[]