INTRODUCTION:

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 understanding to staff while preventing stress and panic among visitors to the hospital,¹ In 1993, the OHA (Ontario Hospital Association) board of directors endorsed standardized emergency color codes to help reduce the chance of human error and eliminate confusion among hospital staff during an emergency. These codes were also adopted by the Canadian hospital association board of directors in March 1993 policy statement.²

EMERGENCY CODES:

An emergency code is a notification of an event that requires immediate action. The use of the codes is intended to convey essential information quickly and with minimal misunderstanding to staff, while preventing stress and panic among visitors to the hospital.

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 no 101).³

CODE BLUE: MEDICAL EMERGENCY (ADULT):

Code blue is the most universally recognized emergency occurring within the hospital. The purpose of the code is to provide response to a suspected or eminent cardio pulmonary arrest or a medical emergency for an adult patient. Code blue is be initiated immediately whenever and individual 8 years of age or older is found in cardiac or respiratory arrest. Health care providers can choose to active a code blue, typically by pressing an emergency alert button or dialing a specific phone number, if they feel the life of the person they are treating is in immediate danger.

Many hospitals have a code blue team who will respond to the code blue within minutes. Team will made up of – Doctors, Nurses, Respiratory therapist, A pharmacist. Indication of the blue code is cardiac arrest, respiratory arrest, signs of stroke, sudden drop in blood pressure.

CODE WHITE: MEDICAL EMERGENCY (PEDIATRICS):

Code white denotes different meaning in different hospital. It runs according to the policy of the hospital. In some hospitals white code denotes the medical emergency for pediatrics and in some hospitals it refers to an emergency response for a violent person. White code is a message announced over a hospital’s public address system warning the staff of

· A pending emergency/internal disaster

· A pediatric emergency

· A violent patient

· Severe weather in the area; curtains to be drawn

· A power utility outage.

The purpose of the code white is to identify an actual or potential violent or out of control person and activate the appropriate staff to response with a patient/person centered and therapeutic response.

When to active white code:

1. The person is verbally or physically threatening towards themselves, staff, patients and visitors.

2. Person is not responding to verbal de-escalation techniques, negotiating redirection, limit setting and problem- solving techniques by the staff.

3. The person may require restraints and is anticipated to be resistive to the restraining procedure.

CODE RED: FIRE:

Code red typically means there is a fire or smoke within the hospital. The purpose of the code red is to provide an appropriate response in the event of an actual or suspected fire in order to protect life, property and vital services.

When to active:

1. If someone seeing smoke, sparks or a fire.

2. Smelling smok

3. Observe some burn material

4. Presence of unusual heat

5. In the response of any fire alarm.

If the code will active:

If the code red is get activated to any hospital than the code team, staff and the hospital should follow the protocols for code Red. Here are some actions to be taken which gives as follows:

RACE:

· R- Remove patients, visitors, and personnel from the immediate fire area. Disconnected oxygen outlets.

· A- activate the fire alarm and notify others in the affected area to obtain assistance.

· C– contain the fire and smoke by closing all doors

· E- Extinguish the fire if it is safe to do so. Evacuate the area as directed.

In case you are using fire extinguisher use the technique of PASS

· P- pull the pin

· A-aim the nozzle of the extinguisher at the base of the fire

· S- squeeze the trigger

· S- Sweep the extinguisher’s contents from side to side.

After using fire extinguisher technique you have to stay away from the origin.

CODE BLACK: BOMB THREAT:

Code black is used when their will be a bomb threat situation. It typically means that there is a bomb threat to the facility.

If the code will active:

· The director of security and the administrator in charge that coordinate the bomb threat response procedure should take charge.

· Stay calm, and report the code black team.

· Obtain information where the bomb is, what kind of bomb is?

· Assist staff with a visual search of area.

· Do not touch anything suspicious.

· Turn off all pages, cell phones and electronic devices.

· Remain the area for further instructions.

CODE ORANGE: EXTERNAL DISASTER:

Code orange is used to respond safely and effectively to a disaster external to the hospital that is likely to increase the capacity and use of hospital resources. Code orange represents 3 specialized responses

· Mass causality incidents

· CBRNE (chemical, biological, radio-nuclear, explosive or environmental events due to natural, accidental, or intentional acts).

· Pandemics

To respond effectively to a code orange, hospital staff must quickly organize themselves to greet patients, regardless of the workload or situation in the hospital. Having rapid access to the updates. Information on physician’s availability and their contact information become vitally important for both hospital and patients.

Code orange includes 3 levels:

Level 1: the hospital is receiving less than 4 causalities.

Level 2: the hospital is receiving more than 3 major causalities and or the number of victims/severity of injuries will require additional staff and resources.

Level 3: the hospital is recovering more than 3 major causalities will require additional staff and resources and normal routines will be disrupted.

If the code will active:

· Employees should be familiar with the products they are using, know how to use the spill precautions they should take.

· Each department must develop individual protocols that support the organization’s overall code orange response.

CODE PINK: CHILD/BABY MISSING:

Code pink is an emergency code which is used to activate a set of action in case a child/ baby is missing from the ward/room. As there is a fair possibility that the missing child is abducted it is considered as an emergency situation and a predefined set of actions are taken on an urgent basis to safe guard the missing baby. Code pink must be activated when a neonate, infant or a child (up to 15 years of age) is missing and could not be tracked.

If the code will active:

· Before active the code pink staff should quickly collect basic description of the missing baby from parents/family/documentation.

· The incharge of the area from where code pink is get activated should function as a communicator and give information about the child.

· Incharge should be available at the desk to maintain communication and coordination.

· Psychological support should provided to the parents.

· Incharge of all the wards should understand the description and start a search of the missing child within and around their wards.

· All the entry/exits will be closed by the guards.

CODE YELLOW:

Code yellow is activated in hospital when there is need to alert the staff and the need to prepare for a pending emergency, an internal emergency, a missing patient, a severe weather alert, an emergency C- section. Some hospitals also use this code when they discover that a patient is missing.

If the code will active:

· The administrator in charge or security director will instruct the operator to announce “code yellow”.

· The administrator incharge will assume the role of incident commander or will delegate the responsibility to the most qualified individual.

CODE PURPLE: HOSTAGE TAKING:

Code purple is called in the event that a person is forcibly confined or held against his/her will, with the threat of a weapon or threat of violence.

If the code will active:

· Provide the location, visible sign and mention the weapon.

· Alert the security team, make a security plan for patients and staff

· Inspect if there is any unwanted move of any person, always welcome the further instructions by the security.

CODE GREEN: MANDATORY EVACUATION:

A mandatory evacuation of the hospital can be by a gas leak, or even an impending storm. Code green has 3 levels

Level 1: (Horizontal) - evacuate all affected person beyond the fire separation door to an adjacent safe area on the same floor.

Level 2: (vertical) - evacuate all effected persons to another floor, preferable 2 floors down.

Level 3: (total evacuation) - evacuate all persons from the buildings.

If the code will active

· Remain calm, and do not enter the affected area.

· Listen to the health care team, no hospital employee is allowed to give the incident news to anyone who is outside.

· Police will notify to take charge.

CODE BROWN: SUB GROUP EMERGENCIES:

Code brown represents sub groups that include response to floods, power failure and hazardous spills. It consist 3 levels

Level 1: (departmental response) - spill is small and can be cleaned up

Level 2: (code brown team response) - large spill that requires special clean-up procedures, the team brown will respond.

Level 3: (external response) - a health/fire/environment hazards that requires special clean up procedures.

CODE GREY: STUBBORN PATIENTS:

Code grey is one of the standardized hospital emergency codes and alerts all staff to potentially or actively combative persons. These range from stubborn patients, to abusive patients and relatives. The purpose of the code is to provide an appropriate response to situations involving an aggressive/hostile/combative or potentially combative person.^4,5

WHEN AND HOW TO OFF THE CODES:

· When the situation is under control and the code has been resolved, the strike team leader will call the facility operator and inform them to announce “all clear”.

· All persons will resume their duties

· Documentation of the incident should follow the facility’s policy and procedures.

· Any assaults or battery that results in an injury to staff must be reported to law enforcement within 72 hours.

· If the staff needs any help after activation of the codes then they are allowed to contact the police and to contact to emergency helpline number.⁶

Some Indian help lines numbers:

· National emergency number-112

· Police- 100

· Fire- 101

· Women helpline- 1091

· Aids helpline- 1097

· Disaster management- 1078

CONCLUSION:

Emergency can happen anywhere, anytime. So, we have to prepare for the managements by some policies and protocols. To be a medical professionalize the responsibility if the security of the patient increased, for that some codes had been formed by the hospitals. Different countries and different hospitals have different codes according to their policy and protocols of the hospital.⁷

REFRENCES:

1. “Emergency codes”. Sunnybrook health sciences center. Achieved from the original on 22 Nov 2018.

2. Consent manual 2007, 27th edition, Sacramento, CA, CH 3; the California healthcare association.

3. Violence and domestic violence in the workplace policy 6.30.004

4. Personal health information protection ACT (phipa) 2004, part v, 52. goverment of Onterio.toronto.

5. www.quora.com

6. www.emsa.ca.gov/HICS

7. Medical dictionary. The free dictionary.com.

Received on 29.02.2020 Modified on 31.03.2020

Int. J. Nur. Edu. and Research. 2020; 8(3):415-418.

DOI: 10.5958/2454-2660.2020.00092.7