Hospital emergency codes are coded messages often announced over a public address system of a hospital to alert staff to various classes of on-site 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. Such codes are sometimes posted on placards throughout the hospital or are printed on employee identification badges for ready reference.

Hospital emergency codes have varied widely by location, even between hospitals in the same community. Confusion over these codes has led to the proposal for and sometimes adoption of standardized codes. In many American, Canadian, New Zealand and Australian hospitals, for example "code blue" indicates a patient has entered cardiac arrest, while "code red" indicates that a fire has broken out somewhere in the hospital facility.

In order for a code call to be useful in activating the response of specific hospital personnel to a given situation, it is usually accompanied by a specific location description (e.g., "Code red, second floor, corridor three, room two-twelve"). Other codes, however, only signal hospital staff generally to prepare for the consequences of some external event such as a natural disaster.

Standardised color codes

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

Alberta

Codes in Alberta are prescribed by Alberta Health Services.[2]

British Columbia

Codes used in British Columbia, prescribed by the British Columbia Ministry of Health.[3]

Manitoba

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Nova Scotia

The following codes are in use in Nova Scotia.[4][5]

Ontario

In Ontario, a standard emergency response code set by the Ontario Hospital Association is used, with minor variations for some hospitals.[7][8][9]

Quebec

The following codes are in use in Quebec.[10]

Saskatchewan

Codes used in Saskatchewan, prescribed by the Saskatchewan Health Authority.[11]

Yukon

The following codes are in use in Yukon.[12]

United Kingdom

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In the UK, hospitals have standardised codes across individual NHS trusts (England and Wales) and health boards (Scotland), but there are not many standardised codes across the entire NHS. This allows for differences in demands on hospitals in different areas, and also for hospitals of different roles to communicate different alerts according to their needs (e.g., a major trauma centre like St. George's Hospital in South London has different priority alert needs to a rural community hospital like West Berkshire Community Hospital). Some more standardised codes are as follows:

Otherwise, non-colour codes are mostly used across the NHS:

United States

In 2000, the Hospital Association of Southern California (HASC)[15][16][17] determined that a uniform code system was needed after three people were killed in a shooting incident at a hospital 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, the 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.[18]

In 2008, the Oregon Association of Hospitals & Health Systems, Oregon Patient Safety Commission, and Washington State Hospital Association formed a taskforce to standardize emergency code calls.[19] After both states had conducted a survey of all hospital members, the taskforce found many hospitals used the same code for fire (code red); however, there were tremendous variations for codes representing respiratory and cardiac arrest, infant and child abduction, and combative persons. After deliberations and decisions, the taskforce suggested the following as the Hospital Emergency Code:[20]

Plain Language Emergency Alerts

In 2015, the South Carolina Hospital Association formed a work group to develop plain language standardization code recommendations. Abolishing all color codes was suggested.[21] In 2016, the Texas Hospital Association encouraged the use of standardized plain language emergency alerts at all Texas hospitals.[22] The only color code that was still recommended was "code blue," meaning a cardiac arrest.

Plain language alerts are announced using the following format: "Alert Type + Description + Location (general to specific) + Instructions (if applicable)."[22] [23] For example, if a patient in ICU Bed 4 went into cardiac arrest, the alert would be "Medical Alert + Code Blue + Second Floor + Intensive Care Unit + Bed 4."

Codes

Note: Different codes are used in different hospitals.

Code blue

"Code blue" redirects here. For other uses, see Code Blue.

"Code blue” is used to indicate that a patient requires resuscitation or is 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". Most usually, it’s used as a case of emergency and when a doctor or surgeon calls “Code Blue!” it is representing an emergency.

This phrase was coined at Bethany Medical Center in Kansas City, Kansas.[24] 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" or "coded".

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".[25] Such practices are ethically controversial,[26] and are banned in some jurisdictions.[citation needed]

Variations

"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; "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.[citation needed]

"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. Sinclair", where the doctor's "name" is a code word for a dangerous situation or a patient in crisis, e.g.: "Paging Dr. Firestone, third floor," to indicate a possible fire on the floor specified.[citation needed]

"Resus" codes

Specific to emergency medicine, incoming patients in immediate danger of life or limb, whether presenting via ambulance or walk-in triage, are paged locally within the emergency department as "resus" [ri:səs] codes. These codes indicate the type of emergency (general medical, trauma, cardiopulmonary or neurological) and type of patient (adult or pediatric). An estimated time of arrival may be included, or "now" if the patient is already in the department. The patient is transported to the nearest open trauma bay or evaluation room, and is immediately attended by a designated team of physicians and nurses for purposes of immediate stabilization and treatment.[citation needed]

See also

References

  1. ^ a b AS 4083-1997 Planning for emergencies-Health care facilities
  2. ^ "AHS Emergency / Disaster Management" (PDF). Edmonton, AB: Alberta Health Services. Archived (PDF) from the original on 23 April 2019. Retrieved 25 September 2018.
  3. ^ "BC Standardized Hospital Colour Codes" (PDF). Victoria, BC: British Columbia Ministry of Health. 21 January 2011. Archived (PDF) from the original on 10 January 2019. Retrieved 5 October 2017.
  4. ^ "Emergency Voice Codes Poster" (PDF). Nova Scotia Health Authority - Corporate. Retrieved 2022-09-07.
  5. ^ "Policy Template". Nova Scotia Health Authority. Retrieved 2022-09-07.
  6. ^ "Health Authorities Act (amended)". Nova Scotia Legislature. 27 November 2017. Retrieved 2022-09-07.
  7. ^ "OHA Emergency Management Toolkit" (PDF). Toronto, ON: Ontario Hospital Association. 31 March 2013. Archived (PDF) from the original on 21 November 2018. Retrieved 5 October 2017.
  8. ^ "Emergency Codes". North York General Hospital. Archived from the original on 4 July 2019.
  9. ^ "Emergency Codes". Sunnybrook Health Sciences Centre. Archived from the original on 22 November 2018.
  10. ^ "Codes d'alerte en mesure d'urgence". Santé Montréal. Retrieved 2022-08-13.
  11. ^ "DIRECTOR & EXECUTIVE DIRECTOR On-call Reference Manual & Resources" (PDF). Saskatchewan Health Authority. Retrieved 6 September 2022.
  12. ^ "Code Orange, Code Black: Deciphering 'secret' hospital emergency messages". Healthing.ca. Retrieved 2022-09-05.
  13. ^ Government of Canada, Natural Resources Canada. "Simplified seismic hazard map for Canada, the provinces and territories". seismescanada.rncan.gc.ca. Retrieved 2022-09-05.
  14. ^ "NHS Warns Code Black Status Pressure Services Mount". Herald of Scotland. July 16, 2021.
  15. ^ a b "Hospital Emergency Codes".
  16. ^ California Healthcare Association News Briefs July 12, 2002Vol. 35 No. 27 Archived December 2, 2008, at the Wayback Machine
  17. ^ "2014 Emergency Codes". Archived from the original on 2018-02-05. Retrieved 2018-03-19.
  18. ^ ".33 Uniform Emergency Codes". Maryland Division of State Documents. Archived from the original on 15 March 2019.
  19. ^ "Standardization Emergency Codes Executive Summary" (PDF). Washington State Hospital Association. October 2008. Retrieved July 11, 2016.
  20. ^ "Standardization Poster Emergency Code Call" (PDF). Washington State Hospital Association. January 2009.
  21. ^ "Plain Language Emergency Codes Implementation Tool Kit" (PDF). South Carolina Hospital Association. Archived from the original (PDF) on 25 February 2017. Retrieved 24 February 2017.
  22. ^ a b "Plain-Language Emergency Alerts | Texas Hospital Association". www.tha.org. Retrieved 2022-09-19.
  23. ^ Dauksewicz, Benjamin W. (2019-01-01). "Hospitals should replace emergency codes with plain language". Journal of Healthcare Risk Management. 38 (3): 32–41. doi:10.1002/jhrm.21346. PMID 30156353. S2CID 52110164.
  24. ^ Colby, William H. (2007). "The Ascent of Medical Technology". Unplugged: Reclaiming Our Right to Die in America. AMACOM Books. p. 63. ISBN 978-0814401606.
  25. ^ "Slow Codes, Show Codes and Death". The New York Times. 22 August 1987. Archived from the original on 23 April 2019. Retrieved 6 April 2013.
  26. ^ DePalma, Judith A.; Miller, Scott; Ozanich, Evelyn; Yancich, Lynne M. (November 1999). "'Slow' Code: Perspectives of a Physician and Critical Care Nurse". Critical Care Nursing Quarterly. Lippincott Williams and Wilkins. 22 (3): 89–99. doi:10.1097/00002727-199911000-00014. ISSN 1550-5111. PMID 10646457. Archived from the original on 2013-03-28. Retrieved 2013-04-07.