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Hospital emergency codes are coded messages often announced over apublic address system of ahospital to alert staff to various classes of on-site emergencies. The use of codes is intended to convey essential information quickly and with minimal misunderstanding to staff while preventing stress and panic among visitors to the hospital. Such codes are sometimes posted on placards throughout the hospital or are printed on employee identification badges for ready reference.
Hospital emergency codes have varied widely by location, even between hospitals in the same community. Confusion over these codes has led to the proposal for and sometimes adoption of standardised codes. In many American, Canadian, New Zealand and Australian hospitals, for example "code blue" indicates a patient has enteredcardiac arrest, while "code red" indicates that a fire has broken out somewhere in the hospital facility.
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 two-twelve"). Other codes, however, only signal hospital staff generally to prepare for the consequences of some external event such as anatural disaster.
This table is a simplified summary of the emergency codes documented in this article. Note that there may be additional nuances to meaning and cause in individual regions, and some uncommon codes or callouts are omitted for brevity. More information is given in other sections.
 Australia |  Canada |  United States |  United Kingdom | ||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| rest of Australia |  Victoria |  Alberta |  British Columbia |  Manitoba |  Nova Scotia |  Ontario |  Quebec |  Saskatchewan |  Yukon |  Arizona |  California |  Colorado |  Florida |  Kansas |  Kentucky |  Hawaii |  Louisiana |  Maryland |  North Carolina |  New Hampshire |  Ohio |  Oregon |  Rhode Island |  Washington |  West Virginia | ||
| Code red | Fire | Rapid response (External disaster or mass casualty event) | |||||||||||||||||||||||||
| Code pink | Pediatric or obstetrical emergency | (unused) | (unused) | Pediatric or obstetrical emergency | Child abduction | Pediatric or obstetrical emergency | (unused) | (unused) | Child abduction | (unused) | Child abduction | (unused) | Pediatric or obstetrical emergency | (unused) | (unused) | (unused) | (unused) | (unused) | |||||||||
| Code orange | Evacuation | External disaster or mass casualty event | Hazardous material | Hazardous material | (unused) | ||||||||||||||||||||||
| Code amber | (unused) | (unused) | (unused) | Child abduction | (unused) | (unused) | Child abduction | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | Missing patient | Child abduction | (unused) | ||||
| Code yellow | Internal emergency | Missing patient | Bomb threat | (unused) | (unused) | (unused) | External disaster or mass casualty event | (unused) | External disaster or mass casualty event | (unused) | (unused) | External disaster or mass casualty event | (unused) | Trauma | (unused) | (unused) | (unused) | ||||||||||
| Code green | (unused) | Pediatric or obstetrical emergency | Evacuation | (unused) | Missing patient | (unused) | Internal emergency | (unused) | (unused) | Bomb threat | (unused) | Unarmed violence | (unused) | (unused) | (unused) | (unused) | Bomb threat | (unused) | (unused) | (unused) | |||||||
| Code blue | Cardiac, respiratory, or other life-threatening medical emergency | (unused) | |||||||||||||||||||||||||
| Code purple | Bomb threat | Hostage situation | (unused) | (unused) | (unused) | Hostage situation | Pediatric or obstetrical emergency | Hostage situation | (unused) | Child abduction | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | External disaster or mass casualty event | (unused) | (unused) | External disaster or mass casualty event | (unused) | (unused) | (unused) | |
| Code brown | External disaster or mass casualty event | Hazardous material | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | ||||||||
| Code white | (unused) | (unused) | Unarmed violence | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | |||||||
| Code grey | Unarmed violence | Shelter in place | System failure | Shelter in place | System failure / Shelter in place | (unused) | (unused) | Shelter in place | Unarmed violence | (unused) | (unused) | Unarmed violence | Severe weather | Missing patient | (unused) | Unarmed violence | Severe weather | Unarmed violence | (unused) | ||||||||
| Code silver | (unused) | (unused) | (unused) | Armed violence | (unused) | Armed violence | (unused) | Armed violence | (unused) | Armed violence | (unused) | Armed violence | (unused) | Armed violence | (unused) | Armed violence | (unused) | (unused) | (unused) | ||||||||
| Code black | Armed violence | Bomb threat | (unused) | (unused) | Bomb threat | Severe weather | Bomb threat | (unused) | (unused) | Bomb threat | (unused) | (unused) | (unused) | (unused) | At capacity | ||||||||||||
| MET call | Non-life-threatening medical emergency | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | (unused) | |
Australian hospitals and other buildings are covered by Australian Standard 4083 (1997)[1]
Emergencies (public hospital services)
Codes inAlberta are prescribed byAlberta Health Services.[2]
Codes used inBritish Columbia, prescribed by theBritish Columbia Ministry of Health.[3]
Codes used in Manitoba as defined in WRHA policy,"Codes: Standardised Emergency"; policy No. 50.00.010[4]
The following codes are in use in Nova Scotia.[5][6]
InOntario, a standard emergency colour code system set by theOntario Hospital Association (OHA) is used, with minor variations for some hospitals. Additional clinical codes, such as code transfusion, code trauma, code 99,[8] etc. are not set by the OHA.[9][10][11]
The following codes are in use in Quebec.[12]
Codes used inSaskatchewan, prescribed by theSaskatchewan Health Authority.[13]
The following codes are in use in Yukon.[14]
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In the UK, hospitals have standardised codes across individualNHS trusts (England and Wales) and health boards (Scotland), but there are not many standardised codes across the entire NHS. This allows for differences in demands on hospitals in different areas, and also for hospitals of different roles to communicate different alerts according to their needs (e.g., amajor trauma centre likeSt. George's Hospital in South London has different priority alert needs to a ruralcommunity hospital likeWest Berkshire Community Hospital).Some more standardised codes are as follows:
Otherwise, non-colour codes are mostly used across the NHS:
In 2000, the Hospital Association of Southern California (HASC)[17][18][19] determined that a uniform code system was needed after three people were killed in a shooting incident at a hospital after the wrong emergency code was called. While codes for fire (red) and medical emergency (blue) were similar in 90% of California hospitals queried, 47 different codes were used for infant abduction and 61 for combative person. In light of this, the HASC published a handbook titledHealthcare Facility Emergency Codes: A Guide for Code Standardization listing various codes and has strongly urged hospitals to voluntarily implement the revised codes.
In 2003,Maryland mandated that all acute hospitals in the state have uniform codes.[20]
In 2008, the Oregon Association of Hospitals & Health Systems, Oregon Patient Safety Commission, and Washington State Hospital Association formed a taskforce to standardise emergency code calls.[21] After both states had conducted a survey of all hospital members, the task force found many hospitals used the same code for fire (code red); however, there were tremendous variations for codes representing respiratory and cardiac arrest, infant and child abduction, and combative persons.[21]
Consistent across the thirteen states with uniform codes as of 2020 were code red (fire), code blue (cardiac arrest and/or medical emergency), and code orange (hazardous material spill/release). Some other colour codes used in multiple states are listed in the table below. Of these, only Maryland's code is mandatory as of 2020.
| State | Yellow | Grey | Silver | Pink | Black | Purple | Green | Adam/Amber |
|---|---|---|---|---|---|---|---|---|
| Arizona | Bomb threat | Combative Person | Weapon/hostage | Infant abduction | ||||
| California | Bomb threat | Combative Person | Weapon/hostage | Infant abduction | Child abduction | Patientelopement | ||
| Colorado | Combative Person | Weapon | Infant/child abduction | Bomb threat | ||||
| Florida | Security response | Infant/child abduction | Bomb threat | EOP activation | ||||
| Kansas | Armed intruder | Infant abduction | Bomb threat | |||||
| Kentucky | Disaster Plan Activation | Weapon/hostage | Bomb threat | |||||
| Hawaii | Security assistance | Infant abduction | Severe weather | Bomb threat | ||||
| Louisiana | Disaster/mass Casualty | Severe weather | Active shooter/ weapon | Infant/child abduction | Bomb threat | |||
| Maryland | Emergency/ Disaster | Elopement | Armed assailant | Infant/child abduction | Combative person | |||
| North Carolina | Missing infant/child | |||||||
| New Hampshire | Combative Person | Active shooter | Bomb threat | Surge | Missing person | |||
| Ohio | Disaster | Severe weather | Weapon/hostage | Child medical emergency | Bomb threat | Infant/child abduction | ||
| Oregon | Combative Person | Infant/child abduction | ||||||
| Rhode Island | Trauma patient/team | Security response | Hostile situation/weapon | Infectious event | Bomb threat | Infant/child abduction | ||
| Washington | Combative Person | Infant/child abduction | ||||||
| West Virginia | Security/Combative Person/ Weapon/Hostage | Infant/child abduction |
Additional codes (not including plain-language codes) include, but are not limited to:[21]
In 2015, the South Carolina Hospital Association formed a work group to develop plain language standardisation code recommendations. Abolishing all colour codes was suggested.[22] In 2016, the Texas Hospital Association encouraged the use of standardised plain language emergency alerts at all Texas hospitals.[23] The only colour code that was still recommended was "code blue," meaning a cardiac arrest.
Plain language alerts are announced using the following format: Alert type + description + location (general to specific) + instructions (if applicable).[23][24] For example, if a patient in ICU Bed 4 went into cardiac arrest, the alert would be "Medical alert + code blue + second floor + intensive care unit + bed 4."
In January 2025, the Washington State Hospital Association (WSHA) recommended plain-language codes, although it advised keeping the legacy colour codes of "Code Blue" and "Amber Alert." The new system, which is "strongly recommend[ed]" but not required, classifies alerts into "Facility," "Medical," and "Security" alerts.[25]
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Note: Different codes are used in different hospitals.
"Code blue” is used to indicate that a patient requires resuscitation or is in need of immediate medical attention, most often as the result of arespiratory arrest orcardiac arrest. When called overhead, the page takes the form of "Code blue, [floor], [room]" to alert the resuscitation team where to respond. Every hospital, as a part of its disaster plans, sets a policy to determine which units provide personnel for code coverage. In theory any medical professional may respond to a code, but in practice, the team makeup is limited to those withadvanced cardiac life support or other equivalent resuscitation training. Frequently these teams are staffed by physicians fromanaesthesia,internal medicine oremergency medicine,respiratory therapists, pharmacists, and nurses. A code team leader will be a physician in attendance on any code team; this individual is responsible for directing the resuscitation effort and is said to "run the code".
This phrase was coined at Bethany Medical Centre inKansas City, Kansas.[26] The term "code" by itself is commonly used by medical professionals as a slang term for this type of emergency, as in "calling a code" or describing a patient in arrest as "coding" or "coded".
In some hospitals or other medical facilities, the resuscitation team may purposely respond slowly to a patient in cardiac arrest, a practice known as "slow code", or may fake the response altogether for the sake of the patient's family, a practice known as "show code".[27] Such practices are ethically controversial,[28] and are banned in some jurisdictions.[citation needed]
"Plan blue" was used atSt. Vincent's Hospital in New York City to indicate arrival of a trauma patient so critically injured that even the short delay of a stop in the A&E for evaluation could be fatal; "plan blue" was called out to alert the surgeon on call to go immediately to the A&E entrance and take the patient for immediate surgery.[citation needed]
"Doctor" codes are often used in hospital settings for announcements over a general loudspeaker or paging system that might cause panic or endanger a patient's privacy. Most often, "doctor" codes take the form of "Paging Dr. Sinclair", where the doctor's "name" is a code word for a dangerous situation or a patient in crisis, e.g.: "Paging Dr. Firestone, third floor," to indicate a possible fire on the floor specified.[citation needed]
Specific toemergency medicine, incoming patients in immediate danger of life or limb, whether presenting viaambulance or walk-intriage, are paged locally within theemergency department as "roesus" [ri:səs] codes. These codes indicate the type of emergency (general medical, trauma, cardiopulmonary or neurological) and type of patient (adult or paediatric). Anestimated time of arrival may be included, or "now" if the patient is already in the department. The patient is transported to the nearest open trauma bay or evaluation room, and is immediately attended by a designated team of physicians and nurses for purposes of immediate stabilisation and treatment.[citation needed]