What Do the Different Hospital Emergency Codes Mean?

Hospital emergency codes are used to efficiently convey important information to staff regarding urgent situations that require targeted, specific responses. Historically, color codes have been used to keep overhead announcements discreet. However, due to the lack of standardization between hospitals and the potential for confusion and harm, some facilities have moved away from this model in favor of plain-language announcements.

We’ll look at the history of using emergency codes in hospitals and provide an overview of common alerts, such as code blue, and explore the lack of consistency in how these codes are defined and used by facilities. This is critical to understand, especially when onboarding new clinicians used to different emergency alerts. Our explanation of some frequently used alert codes and what they might cover, along with resources for emergency response preparedness, will help you better prepare your team.

History of Emergency Codes in Hospitals

The use of emergency codes in hospitals dates back to the mid 20th century, and was likely influenced by crisis-response communication principles used by the military and first responders, including police. Terms like code blue gained popularity in hospitals in the 1990s, with the prevailing belief that such terms could allow trained staff to respond to significant situations while preventing stress and panic for patients and visitors.

The use of color-coded terms in healthcare facilities flourished, with each facility setting its own standards. This meant that there could be different emergency codes in hospitals, even within a single community — presenting confusion (for example, for staff who worked at multiple agencies).

In 1999, an incident occurred in California involving a man who entered a medical center with a gun. The incident was announced with an incorrect color code, drawing staff to the area of the gunman. The gunman opened fire, resulting in three staff deaths. Following this tragedy, the Hospital Association of Southern California (HASC) proposed that California hospitals should voluntarily implement standardized hospital emergency codes to mitigate confusion for staff.

Clarifying and Standardizing Hospital Codes to Protect Staff and Patients

HASC’s initiative to standardize hospital emergency codes was the first in a series of at least 23 hospital associations recommending similar initiatives. In addition, the use of plain-language alerts entered the conversation, with the Federal Emergency Management Agency (FEMA) recommending this approach in a 2006 alert stating: “It is important that responders and incident managers use common terminology. There simply is little or no room for misunderstanding in an emergency situation.“

By 2020, 13 states had recommended the use of standardized color-code alert systems, and Maryland mandated state-specific terminology. Many other state hospital associations advocated for plain-language alert systems.

Trend Toward Plain-Language Alerts

The trend away from color codes, and toward the use of plain language, has gained ground. Brigham and Women’s Hospital in Boston, for example, transitioned away from color-coded alerts to plain-language alerts in 2013. Hospital leadership attributed their swift response to an active shooter event in 2015 to this innovation.

Under the previous system, the announcement would have gone out as a hospital emergency code gray, an often contested code with various meanings. With their new system in place, the event was conveyed in a straightforward announcement:

“A life-threatening situation now exists at Watkins Clinic B—Shapiro 2. All persons should immediately move away from that location if it is safe to do so. If it is not safe to move away, shelter in place immediately.”

This ensured that staff, patients, and visitors were aware of the severity of the unfolding event. The hospital was cleared (people moved away from the incident or sheltered in place) within 16 minutes.

Potential Meanings of Different Emergency Hospital Codes by Color

The meaning of color codes varies from one hospital to another. While some color codes have common meanings (such as “code red” for fire), others differ widely between agencies. Many hospitals issue employee badges with hospital emergency codes printed on the back, so that staff can quickly reference a code and respond appropriately. Here are some potential meanings for the most common hospital color codes.

*There are no national or inter-agency standards for emergency codes. Meanings vary widely.

Potential Meaning of Other Hospital Emergency Codes

In addition to emergency hospital codes by color, there are also numeric codes or other coded terms. Hospitals may use these terms to indicate that a significant event is unfolding and requires a response from trained staff. Here’s a breakdown of some of the common terms used, and the meaning that may be conveyed.

*There are no national or inter-agency standards for emergency codes. Meanings vary widely.

Resources for Hospital Emergency Response Preparedness

In the event of an emergency, communication is crucial. Responsible parties must alert staff, patients, and visitors about the threat. Traditionally, this involved benign-sounding color-coded announcements, but thanks to an evolving body of research about communication best practices, this model is changing. Several state hospital associations have published plain- language implementation guides, including:

• Iowa
• New Jersey
• Texas
• Washington

In addition to checking with state-level leaders in the healthcare industry, it may also help to look at federal emergency response management materials, such as National Incident Management System’s (NIMS) tools and training resources. The Iroquois Health Association also has a helpful guide that outlines different emergency code systems in use by each state.

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