10 Most Common Hospital Emergency Codes and Their Meanings
As of May 2018, 10 states have recommended the use of plain language for hospital emergencies as there are inconsistencies in code denotations.
Hospitals often use color codes to alert staff to an emergency or another significant event. These emergency codes allow trained hospital personnel to respond quickly and appropriately to various incidents.
Hospital emergency codes have often varied widely by location — even within hospitals in the exact same community. This potential for confusion has led many states to adopt standardized codes for all hospitals.
In 2000, the Hospital Association of Southern California (HASC) released a handbook, “Healthcare Emergency Codes: A Guide for Code Standardization,” strongly urging a uniform code system after three people were killed in a shooting incident after the wrong emergency code was called. Code Gray, which typically means a combative person, was announced, drawing staff members toward the shooter. At the time if this incident, in California hospitals, 47 different codes were used for infant abduction and 61 were used for a combative person.
Three years later, Maryland mandated that all acute hospitals in the state have uniform codes. According to a 2018 report by the American Society for Health Care Risk Management (ASHRM), other states that recommend color code standardization include Arizona, Kansas, Kentucky, Louisiana, New Hampshire, New Jersey, Oregon, Rhode Island, Washington and West Virginia (Figure 1).
As of May 2018, at least 12 different state hospital associations, patient safety organizations and healthcare worker organizations have recommended the use of plain language for hospital emergencies, including the Emergency Nurses Association (ENA), the Federal Emergency Management Agency (FEMA), the US Department of Homeland Security (DHS), Colorado, Florida, Iowa, Minnesota, Missouri, North Carolina, Pennsylvania, South Carolina, Texas and Wisconsin (Figure 1).
It is important to note that while there is significant agreement among the 10 color code systems we’ll address in this article, there is no national standard for emergency color codes, leading to inconsistencies among standard systems that are used by each state.
Additionally, according to ASHRM’s report, neither the 2018 Hospital Accreditation Standards from The Joint Commission nor the Centers for Medicare & Medicaid Services emergency preparedness requirements that became effective November 15, 2016, explicitly call for hospitals to use plain language in place of color codes.
Code Blue means someone is experiencing a life-threatening medical emergency, typically an adult. It often means cardiac arrest or respiratory failure. All staff members near the location of the code may be need to go to the patient. Most of the time, each employee has a preassigned role in the event of a Code Blue.
Code White indicates a baby or child is experiencing a life-threatening medical emergency. Having a different code for a pediatric emergency is important since treating children often requires specialized equipment.
Code Red alerts hospital staff to a fire or probable fire. A Code Red may also be activated if someone smells or sees smoke. This code will often come with information about the fire’s location and will typically require evacuation.
Code Purple means a missing child or child abduction. In most cases, the hospital will go on lockdown during the search for the child to ensure no one leaves the building with them. The code is often accompanied by additional information, including what they were wearing, where they were last seen, who they were last seen with, etc.
Code Pink is similar to Code Purple but denotes an infant abduction.
Code Gray indicates a combative or aggressive person, requiring security personnel. It is also typically accompanied by a description of the dangerous person(s) and their location.
Code Orange can vary. While it also denotes a combative or aggressive person at some hospitals, at most, it means a call for medical decontamination, typically due to a hazardous fluids spill, like chemicals or patient blood.
Code Green seems to be the most wavering code, but overall, it indicates the hospital is activating an emergency operations plan. Some hospitals use it to alert the arrival of patients from a mass casualty event while others use it to denote a missing high-risk patient. Typically, the code announcement also includes which emergency operations plan should be activated.
Code Silver alerts hospital staff to a person with a weapon and/or active shooter and/or hostage situation. Be sure not to confuse this with a Silver Alert, which some cities, including New York, use when there are missing seniors in imminent danger due to severe cognitive impairments or urgent need of medical care.
Code Black indicates a bomb threat. Each hospital should have an evacuation protocol in the event of a bomb threat.
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