Medical News Today: What do code blue and other hospital codes mean?

Hospital intercoms sometimes blare unfamiliar codes and alerts that may be confusing to patients. Each hospital code refers to a specific emergency situation.

Code blue means that there is an urgent medical emergency. This is usually a patient in cardiac or respiratory arrest. Other codes denote other emergencies, such as an active shooter or hazardous waste spill.

Hospital codes are a quick way to tell hospital workers who needs to attend to an emergency situation, what they need to bring, and what they should expect.

Hospital staff should consult their manual for details about their hospital’s codes, since practices can vary from facility to facility.

In this article, learn all about the meanings of different hospital codes and their benefits.

Code blue

some medical professionals responding to a Code blue in a hospital
A code blue is a quick way to tell staff that someone is experiencing a life threatening medical emergency.

Code blue means that someone is experiencing a life threatening medical emergency. Usually, this means cardiac arrest (when the heart stops) or respiratory arrest (when breathing stops).

All staff members near the location of the code may need to go to the patient.

In most cases, each medical provider will have a preassigned role in the event of a code blue during their shift.


Code white

In previous years, code white had the same meaning as code blue, but it specifically referred to medical emergencies in children and babies. Some hospitals may still use code white instead of code blue for pediatric medical emergencies.

For example, some hospitals may still use code white to alert staff that a child or baby is in respiratory or cardiac arrest, or to signal that they are experiencing another serious medical emergency.

Treating children sometimes requires smaller or specialized equipment, or even different medical procedures. Having a different code for a pediatric emergency alerts staff to these unique needs.

Other hospitals now use code white to indicate a mandatory evacuation. This could involve the entire hospital, or it may involve just one or two areas of the hospital.


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Code red

Code red alerts staff to a fire or probable fire. To respond to this code, staff must follow the hospital’s fire protocols, which typically require evacuation.

Patients near the fire who cannot move on their own will need assistance to escape the fire. The code will often come with information about the fire’s location.


Code purple or pink

Code purple alerts hospital staff to a missing child or child abduction. Some hospitals use a separate code, code pink, to denote an infant abduction.

The code should also include clear details about the child, what they were wearing, where they were last seen, and, if applicable, clear details of who they were last seen with.

In most cases, the hospital will go on lockdown during the search for the child. This is to ensure that nobody leaves the building with them.

Code gray

At some hospitals, code gray is a call for security personnel. It might indicate that there is a dangerous person in a public area, that a person is missing, or that there is criminal activity somewhere in the hospital.

A hospital may use code gray if someone, including a patient, is being aggressive, abusive, violent, or displaying threatening behavior.

Security personal can assist other hospital staff to resolve the situation or remove the person from the premise if necessary.

Code gray may also include a description of the dangerous person and their current location.


Code green

Paramedics taking patient on stretcher from ambulance to hospital
A code green may indicate the arrival of patients from a mass casualty event.

Hospitals tend to use code green along with other codes, as it indicates that the hospital is activating an emergency operations plan.

Some hospitals also use a code green to denote a mass casualty event, such as groups of survivors of a mass shooting arriving at the hospital for treatment.

The code may include a description of the mass casualty scenario, as well as information about which emergency operations plan that code activates.

Code orange

Code orange is a call for medical decontamination, usually due to a hazardous fluids spill. For example, a hospital may call a code orange if toxic chemicals spill in an emergency room, or if a bag of patient blood spills on the floor.

However, some hospitals use code orange to call for help with a violent or combative patient.


Code silver

Code silver alerts hospital staff to an active shooter in the hospital. The code alert will likely include information about the appearance and current location of the shooter.

Hospital personnel should follow the hospital’s active shooter protocols, which may include locking doors or evacuating to a specific location.

Some hospitals use code silver and code gray interchangeably. However, the Joint Commission — whose recommendations the United States Department of Health and Human Services and the U.S. Department of Homeland Security support — updated its standards in 2010 to recommend the use of code silver as a distinct code from code gray.

However, in 2014, the Recommendations for Hospital Overhead Emergency Codes — by the Florida Hospital Association — advised using plain language instead of a code for an active shooter situation and using code gray specifically to announce the need for security personnel.

This is because announcing the presence and location of an active shooter in the building, rather than using an emergency code, can help ensure that more people understand the situation and can take the relevant safety precautions.


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Code black

Code black indicates a bomb threat. The code tends to include relevant information, such as the specific location of the threat.

If there is a person in the hospital threatening to bomb the building, the code may also include a description of the person.

More specific threats are more credible. So, people who receive bomb threats over the phone should remain calm and gather as much information regarding the purported bomber as possible.

Each hospital will have an evacuation protocol in the event of a bomb threat.


Benefits and drawbacks

The inside of a hospital.
Hospital codes can quickly and succinctly provide key information to medical staff.

Hospital overhead codes standardize a hospital’s response to various emergencies. This allows them to quickly get the attention of staff and others.

Some other benefits of hospital codes include:

  • succinctly providing key information about an emergency without wasting time
  • the ability to devise a specific plan for each code
  • a uniform and preplanned response to various emergencies
  • in some cases, the ability to alert staff to a serious problem without triggering panic in patients

Every hospital adopts a slightly different approach to codes, however, which can be a problem when a staff member works at multiple facilities or moves from one facility to another.

Many hospitals and healthcare facilities in the same area try to standardize their codes.

Some other drawbacks of hospital codes include:

  • a reduced ability to alert patients to an emergency that requires their response
  • difficulty coordinating an emergency response across teams
  • the risk that staff may panic when they hear a code

Summary

Hospital codes are a simple way to alert staff to an actual or potential emergency. Codes help healthcare providers effectively respond to their patients’ needs.

Patients may find these codes confusing, but they should feel assured that each staff member knows what to do during each situation.

It is important to note that some hospitals use different codes than others.

Codes will likely remain a part of hospital culture because of their ease of use. Patients and hospital staff who want to better understand the codes in use at their hospital should consult a manual or ask about the hospital’s emergency management plan.

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