Hospital Emergency Codes: Essential Guidance for Healthcare Professionals
An in-depth guide to understanding, responding to, and managing hospital emergency codes and critical incident procedures.
Hospital Emergency Codes: Comprehensive Guidance for Healthcare Professionals
In the high-stakes environment of hospitals, clear communication and coordinated action are crucial. Emergency codes are universal color-coded alerts used throughout healthcare settings to notify staff of specific critical situations without causing panic among patients or visitors. This guide details the most common emergency codes, procedures for code activation, team member responsibilities, and essential best practices for responding effectively to hospital emergencies.
Table of Contents
- Overview of Hospital Emergency Codes
- Code Blue: Cardiac or Respiratory Arrest
- Code Red: Fire
- Code Orange: Hazardous Material Event
- Code Pink: Infant/Child Abduction
- Code Silver: Active Shooter/Weapon Threat
- Code Gold: Bomb Threat
- Other Codes and Specialized Response Teams
- Emergency Code Activation Procedures
- Roles and Responsibilities During Emergency Codes
- Best Practices for Emergency Response
- Frequently Asked Questions (FAQs)
Overview of Hospital Emergency Codes
Hospital emergency codes facilitate rapid staff mobilization and ensure an organized response to critical events. Each code is color-coded and standardized to minimize confusion. The following table summarizes the core codes and their meanings as commonly used across major healthcare institutions, including the Johns Hopkins Health System:
| Code | Situation/Emergency | Brief Description |
|---|---|---|
| Blue | Cardiac/Respiratory Arrest | Immediate resuscitation needed for adult/pediatric patient |
| Red | Fire | Fire or visible/suspected smoke within the facility |
| Orange | Hazardous Material Spill | Release or spill of dangerous chemicals/biologicals/radiologicals |
| Pink | Infant/Child Abduction | Missing or abducted infant or child within the institution |
| Silver | Active Shooter/Weapon/Hostage | Presence or threat of weapon, armed person or hostage situation |
| Gold | Bomb Threat | Received bomb threat or suspected explosive device |
| Grey | Elopement | Missing or at-risk patient elopement from designated unit |
| Green | Combative Person | Aggressive or violent individual threatening safety |
| Purple | Security Response | Critical security incident or mass disruption |
| Yellow | Emergency/Disaster | Disaster situation, mass casualty, or significant influx of patients |
| Alpha Team | Pre-life threatening Obstetrics | Obstetric emergency team activation |
| Bravo Team | Life threatening Obstetrics | Obstetrical condition threatening mother’s or baby’s life |
| Rapid Response Team | Pre-arrest | Critical but not yet arrested patient requiring urgent evaluation |
Code Blue: Cardiac or Respiratory Arrest
Code Blue calls for immediate response when a patient experiences cardiac or respiratory arrest. Successful intervention is time-critical and depends on staff trained in Basic and Advanced Life Support (BLS/ALS).
- Activated when a patient is unresponsive, not breathing, and/or pulseless.
- Hospital operator announces “Code Blue” with precise location overhead or via pager system.
- Code Blue team (nurses, physicians, respiratory therapists, pharmacists, and others) rush to the scene equipped with crash cart and emergency drugs.
- Initiate chest compressions and airway management until advanced care arrives.
- Documentation of event, times, interventions, and outcomes is mandatory.
Code Red: Fire
A Code Red indicates fire, smoke, or a suspected ignition source within hospital premises.
- ALL staff members must implement the RACE protocol:
- Rescue anyone in immediate danger.
- Alarm: Activate fire alarm and notify the operator.
- Contain: Close all doors and windows to prevent spread.
- Extinguish/Evacuate: Use the nearest extinguisher if safe or begin evacuation.
- Staff should not use elevators during a fire incident.
- Follow detailed fire evacuation and defend-in-place protocols as per institution policy.
Code Orange: Hazardous Material Event
Code Orange covers situations involving hazardous material spills or contamination, such as chemical, biological, or radiological agents.
What others are reading
- Upon discovery, isolate the area and prevent further spread by containing spill if possible.
- Notify Environmental Health and Safety (EHS) along with security and nursing supervisors immediately.
- Evacuate and decontaminate affected individuals following institutional guidelines.
- Do NOT attempt cleanup unless specifically trained in hazardous material procedures.
- Ensure all exposures and actions are thoroughly documented.
Code Pink: Infant/Child Abduction
A Code Pink is announced when a child, infant, or newborn goes missing or is abducted from the hospital.
- Lock down all exits and secure relevant units or wings immediately.
- Security and law enforcement coordinate efforts for swift recovery and investigation.
- Staff are assigned to monitor corridors, stairwells, and parking areas.
- All personnel must adhere to identification verification procedures when transporting pediatric patients.
- Surveillance camera footage is reviewed for suspicious activity.
Code Silver: Active Shooter/Weapon Threat
Code Silver is called when there is an active shooter, an individual with a weapon, or a hostage crisis within the hospital.
- Immediately alert security and call emergency services (police).
- Hospital operator will announce “Code Silver” and location.
- Staff and visitors should follow ALICE protocols: Alert – Lockdown – Inform – Counter – Evacuate, based on situational risk.
- Evacuate or barricade in place if safe to do so.
- Remain calm and provide law enforcement with all available information when safe.
Code Gold: Bomb Threat
A Code Gold is used for receiving a credible bomb threat or discovery of a suspicious explosive device.
- Remain calm and keep the caller on the line (if via phone) to gather as much information as possible.
- Notify hospital operator, security, and local law enforcement immediately.
- Do not use mobile devices near the suspected device.
- Follow evacuation protocols if instructed by authorities.
- Complete the bomb threat checklist for all details received.
Other Codes and Specialized Response Teams
- Code Gray – Elopement: Notification of a missing patient or one who has left a secure area; staff immediately search and notify security.
- Code Green – Combative Person: Signifies an aggressive individual; de-escalation and security interventions commence.
- Code Purple – Security Response: Encompasses various large-scale or potentially violent disruptions requiring a specialized security response.
- Code Yellow – Disaster/Mass Casualty: Addresses major emergencies, mass casualty events, or overwhelming patient influx. Disaster teams mobilize, triage areas are set up, and resources are deployed as per disaster plans.
- Alpha/Bravo Teams: Highly trained teams responding to pre-life threatening and life-threatening obstetrical emergencies, respectively.
- Rapid Response Team: Triggered for acute but not yet arrested patients, to prevent further deterioration before Code Blue criteria are met.
Emergency Code Activation Procedures
Quick and accurate activation of emergency codes is critical for positive patient and staff outcomes. All team members must know:
- The correct extension or emergency number (e.g., “5151” or “x4444”) for their location.
- What information to provide: exact location, nature of the emergency, number of people involved, hazards present.
- How to use overhead paging or the hospital’s internal emergency notification systems.
- Recognition of when to trigger the emergency code.
Always remain calm, speak clearly, and stay on the line with the operator until instructed otherwise.
Roles and Responsibilities During Emergency Codes
Effective code response depends on a clear understanding of individual and collective responsibilities. Key roles typically include:
- First Responder: Identifies the emergency, initiates the code, and delivers immediate first aid within their training.
- Code Team Leader: Directs the emergency response, assigns roles, and communicates with the team.
- Nursing Staff: Provide life support, patient care, and ensure environment safety and documentation.
- Security Personnel: Manage crowd/traffic control, secure the incident scene, liaise with police or fire departments.
- Environmental Services: Assist with decontamination, spill control, and restoration of normal operations after resolution.
- Administrative/Supervisory Staff: Oversee incident management, support affected staff/patient families, and ensure external communication.
Best Practices for Emergency Response
- Participate in hospital emergency code drills and regular training to maintain readiness.
- Always keep emergency exits, alarm pull stations, and fire extinguishers accessible.
- Take all code activations seriously—even drills should simulate real response behaviors.
- Always follow up with appropriate documentation of events, interventions, and lessons learned.
- Communicate clearly with patients and visitors during emergencies to reduce anxiety.
- Understand the “defend in place” policy unless evacuation is ordered by competent authority (e.g., Fire Department or Incident Commander).
- Regularly review unit-specific emergency procedures and life safety plans.
Frequently Asked Questions (FAQs)
What should I do if I am unsure which code to activate?
If uncertain, err on the side of caution and contact your hospital’s operator, supervisor, or the security desk for immediate guidance. Do not delay response when patient or staff safety is at risk.
Are emergency codes standardized across all hospitals?
While many codes are similar, there may be variation in code meaning and activation procedures across institutions. Staff must learn the specific codes used at their facility and review code policies regularly.
How often are staff required to participate in code training?
At least annual training is mandatory, with additional drills or refreshers as determined by hospital policy, accreditation requirements, or incident reviews.
Who has authority to order a mass evacuation during emergencies?
A competent authority—such as the Incident Commander, senior administrator, nursing supervisor, or local fire department—must order any large-scale evacuation. Staff may evacuate individuals in immediate danger without waiting for approval.
What is the “defend-in-place” strategy during emergencies?
This approach involves protecting patients and staff from danger within their current locations when evacuation is not immediately possible or safe, while preparing for possible later evacuation as directed.
Conclusions and Recommendations
Familiarity with hospital emergency codes and a rapid, coordinated response saves lives. All healthcare professionals and ancillary staff are responsible for understanding institutional emergency code protocols, participating in ongoing training, and actively contributing to patient and staff safety during critical events.
References
- https://facilities.jhmi.edu/FacilitiesV4/DesignAndConstruction/HelpManual/Emergency%20Codes.pdf
- https://facilities.jhmi.edu/FacilitiesV4/DesignAndConstruction/Safety%20Manual/CLASP%20Manual%202012.pdf
- https://www.miemss.org/home/LinkClick.aspx?fileticket=OlEAgjR13kA%3D&tabid=170&portalid=0&mid=554
- https://www.hopkinsacg.org/wp-content/uploads/2022/06/Johns-Hopkins-ACG-System_ED-Classification-E-Guide-v052322.pdf
- https://www2.gov.bc.ca/assets/gov/health/conducting-health-research/data-access/johns-hopkins-acg-system-technical-reference-guide.pdf
- https://health.maryland.gov/pophealth/documents/local%20health%20department%20billing%20manual/pdf%20manual/section%20vi/jh%20family%20healthplan%20prov%20manual%20may%202020.pdf
- https://www.hopkinsacg.org/article/now-available-v12-1-the-johns-hopkins-acg-system/
Similar Articles
Read full bio of Sneha Tete
