Every Hospital Emergency Code Explained

0:01 Code Blue. The most famous code in medicine, and it means a patient has stopped breathing or their heart has stopped. The overhead page sends a team running to the room: Physicians, nurses, a respiratory therapist, often a pharmacist, and the crash cart with the defibrillator and emergency drugs. The name is commonly traced to the blue tinge of skin starved of oxygen. The outcomes are worse than television suggests. Among American adults who arrest in hospital, roughly one in four survives to go home. One thing to know before the rest of this video: There is no national standard for hospital codes. The colors here follow the list most American hospitals copy, and where hospitals disagree, this video says so. Rapid Response.

0:47 The code that exists so that fewer Code Blues are needed. Research that began in Australia in the early 1990s found that most patients who arrest on a hospital ward show warning signs for hours beforehand: A falling blood pressure, a racing heart, rising confusion. The rapid response team is called on those signs, before the arrest, by any nurse who is worried. It usually brings a critical care nurse, a respiratory therapist and a physician to the bedside within minutes. The idea took years to spread because it asks hospitals to act on a nurse's judgment that something is wrong rather than on proof that it already is. Condition H. The same rapid response team, but one that patients and their families can call themselves. It exists because of an eighteen month old named Josie King,

1:34 who died at Johns Hopkins Hospital in 2001 after staff missed signs of severe dehydration that her mother had repeatedly pointed out. Her family took the story public, and in 2005 a Pittsburgh hospital created Condition H, where the H stands for help. A family member who believes a patient is getting worse and cannot get anyone's attention dials a number, and the team comes. It is the only code on this list that anyone in the building is allowed to call. Code White. Code Blue for a child. In the most common system it means a pediatric medical emergency, and it is separate from the adult code for practical reasons. Children need different drug doses, calculated by weight, and different sized equipment, from breathing tubes to defibrillator pads.

2:24 Many hospitals keep a dedicated pediatric cart organized by color bands that match a child's measured length, so a team can find the right size in seconds without doing arithmetic under pressure. It is also a good early example of how unstandardized this subject is. In some hospitals, Code White means something else entirely, including a violent person. Code Stroke. A code built entirely around time. When a patient arrives with the signs of a stroke, the page mobilizes a neurologist, the scanner and the pharmacy at once, because the most common kind of stroke is a clot and the drugs that dissolve it only work within a limited window. The phrase used in stroke medicine is time is brain, and it has been quantified. One widely cited estimate puts the loss at around one point nine million neurons

3:12 for every minute a major stroke goes untreated. The code exists to compress a sequence of handoffs that would normally take hours into a single simultaneous response. Code STEMI. The heart attack equivalent, named for the most dangerous type, where an artery supplying the heart is completely blocked. The treatment is to open it, usually by threading a balloon through the blood vessels, and the standard is to do it within ninety minutes of the patient arriving. The code lets an emergency physician activate the catheterization lab directly from the patient's first heart tracing instead of waiting for a cardiologist to review it. In one published study, activating the lab this way cut the median time to treatment overnight and at weekends from over two hours to around eighty minutes.

3:58 Code Red. Fire, and almost universally so. Hospitals handle fire differently from any other building, because many of the people inside cannot walk out. Staff are trained in an acronym, RACE: Rescue anyone in immediate danger, raise the alarm, contain the fire by closing doors, then extinguish or evacuate. Hospitals are built for a strategy called defend in place. Fire doors and walls divide each floor into compartments, so patients can be moved sideways into the next compartment, away from the fire, rather than carried down stairwells. Full evacuation of a hospital is the last resort, because moving critically ill patients can kill them too. Code Orange. A hazardous material spill or release. It covers a chemical spill in a laboratory, a leak in the building,

4:46 or contaminated patients arriving from outside after an industrial accident or an attack. The last case is the one hospitals worry about most, because a contaminated patient who walks into an emergency department can contaminate the department and take it out of action. Code Orange sets up decontamination, often in a tent or a dedicated area outside the entrance, where patients are washed before they come in. Staff wear protective suits and respirators, and nobody enters until they have been cleaned. Code Pink. An infant abduction. When it is called, staff move to cover every exit, stairwell and elevator, and anyone carrying a baby or a bag large enough to hold one can be stopped. Abductions of newborns from hospitals rose through the 1980s and have fallen

5:35 sharply since, largely because of what Code Pink now sits on top of. Most maternity units put electronic tags on newborns that sound an alarm or lock the doors if the baby is carried past a sensor, and they issue matching bands to the mother. Nurses are trained on the typical profile of an abductor, which is usually someone who has visited the unit before. Code Purple. The same response for an older child, in the most common system. It is separate from Code Pink because the search is different. An infant has to be carried, which narrows the search to adults with bags. An older child can walk, hide, or be led out by the hand, so the response widens to every corner of the building and the grounds.

6:20 Purple is also one of the least consistent codes in the country. In some hospitals it means a bomb threat, in others a combative person, and in others a hostage situation. Someone who moves between hospitals can hear the same color and have to stop to remember which building they are in. Code Adam. A missing child code that did not come from medicine at all. It was created by Walmart in 1994 and named after Adam Walsh, a six year old abducted from a department store in Florida in 1981. Staff take a description of the child, one employee watches each exit, and if the child is not found within minutes, police are called. In 2003 Congress required every federal office building to adopt it.

7:06 Many hospitals use it alongside or instead of Code Purple, which means a child missing in a hospital can be announced under two different names depending on where you are. Code Green. In the most common system, a patient who has left without authorization and may be at risk, usually someone confused, sedated, or held for their own safety. Hospitals call this elopement. The response resembles the abduction codes but runs in reverse: The concern is someone getting out rather than someone being taken. Green was added to the standard list after it was first published, which shows how the list grows. It is also one of the colors hospitals disagree about most. Elsewhere, Code Green has meant an evacuation, and in some places it has meant an all clear.

7:52 Code Gray. A combative person: A patient, relative or visitor who has become violent or threatening, without a weapon. Staff and security respond to calm the situation or restrain the person. It is one of the most frequently called codes in many hospitals, and the reason is uncomfortable. American healthcare workers account for about seventy three percent of all nonfatal workplace injuries caused by violence, according to federal labor statistics, while making up a small fraction of the workforce. Most of those assaults come from patients, often confused, intoxicated or in crisis, which is why Code Gray training emphasizes de-escalation before force. Code Silver. A person with a weapon, an active shooter,

8:38 or a hostage situation, and the reason the standard list exists. In September 1999 a gunman entered West Anaheim Medical Center in California. The hospital had no code for a shooter, so staff announced Code Gray. Their Code Gray procedure told male staff to go to the location and help control a combative person. It sent people toward the gunman. Three hospital workers were killed. The hospital association for the region surveyed its members, found codes meaning different things from one building to the next, and in 2000 published the standard list this video has been following, with Code Silver added. Code Yellow. A bomb threat, in the standard list. The response is unusual because staff are asked to search their own areas instead of evacuating.

9:29 They know what belongs in their unit and a stranger does not, so they are best placed to notice an unfamiliar bag. Radios and phones may be restricted near a suspected device. Evacuating a hospital on every phoned threat would endanger patients far more than most threats do, so the code is built around searching first. Outside the standard list, yellow has been used for a disaster, a missing patient, or an internal emergency, which brings us to the problem. Code Black. Also a bomb threat, in many hospitals that do not follow the standard list, and the clearest example of why these codes cause trouble. A nurse who trained where Yellow means bomb and now works where Black means bomb has to translate in her head during an emergency.

10:16 One review in Pennsylvania found that between 2004 and 2013, hospitals in that single state used eighty different emergency codes for thirty seven kinds of events. Code Black has also meant severe weather, a mass casualty event, and a deceased patient, depending on the building. Staff who work shifts at more than one hospital carry that confusion with them. Code Triage. A disaster. Triage Internal means something has gone wrong inside the hospital, such as a power failure, a flood or a loss of water. Triage External means something has happened outside that is about to send the hospital more patients than it can normally handle, such as a mass shooting, a building collapse or a major crash.

11:04 The standard list later added a Triage Alert for the stage before, when an event has happened and casualties may be coming. The response is a surge: Elective surgeries postponed, stable patients discharged or moved to free beds, off duty staff called in, and a command center opened. Code Lavender. The only code on this list for the staff. It is usually credited to the Cleveland Clinic, which launched it in 2008, and it is called after something traumatic: A death, a failed resuscitation, a violent incident, or an especially hard shift. A small team arrives with emotional support, often a chaplain or a counselor, sometimes just a quiet room and something to eat. The Cleveland Clinic expected it to be used for patients and families

11:50 and found that most calls came from employees. It is named after the plant, for its reputation as calming, and it is a code that did not exist a generation ago. All Clear. The announcement that ends every other code on this list, and the place the whole system is heading. For decades hospitals have used colors partly to avoid alarming patients and visitors. But the colors mean different things in different buildings, and one of them sent staff toward a gunman. As of 2020, at least twenty five state hospital associations were recommending that hospitals drop the colors and say plainly what is happening and where, in a format along the lines of security alert, active shooter, second floor, east wing, avoid the area.

12:36 Washington State recommended the switch for its hospitals in 2024, and emergency nursing's professional body has endorsed it. The most famous codes in medicine are slowly being replaced by plain English. Thanks for watching. Should hospitals drop colors for plain English? Drop it in the comments. Also, please remember to like and subscribe if you enjoyed this video.