Essential Hospital Codes Every Nurse Should Know

Hospital codes are shorthand alerts used in healthcare settings to communicate critical situations swiftly and discreetly. These codes help staff respond efficiently and ensure patient and staff safety.  

Variations in hospital codes across locations 

While many hospital codes are standardized across healthcare systems, there can be significant variations depending on the country, state, or even individual hospital. Nurses must familiarize themselves with their facility’s specific emergency codes to respond effectively in critical situations. 

How hospital codes differ 

1. Regional and national differences. Some countries have unique hospital codes that differ from those used in the United States. For example, in Canada, "Code Black" often refers to a bomb threat, but in some hospitals, it may indicate severe weather. Similarly, the UK uses plain language alerts rather than color codes to minimize confusion. 
2. State-specific guidelines. In the U.S., states may have differing recommendations for emergency codes. Some state hospital associations have standardized certain codes, while others leave it up to individual facilities to establish their own systems. 
3. Hospital-specific policies. Even within the same state or healthcare system, individual hospitals may use different codes. For example, one hospital may use "Code White" for a violent person, while another may use "Code Gray" for the same situation. Some facilities have begun transitioning to plain language alerts, such as "Active Shooter in the Emergency Department," rather than "Code Silver," to ensure clarity. 

Why nurses must know their facility’s codes 

• Avoid confusion in emergencies. Misinterpreting a code can lead to delays in response, putting patients and staff at risk. 
• Ensure compliance with hospital policies. Understanding the facility’s protocol ensures nurses follow the correct procedures and avoid disciplinary actions. 
• Improve teamwork and coordination. When everyone follows the same emergency response system, communication and efficiency improve, leading to better patient outcomes. 

To stay prepared, nurses should review their hospital’s emergency response manual, participate in regular drills, and clarify any code-related questions with their supervisor or emergency response team. 

1. Code blue: Medical emergency 

Meaning: 

Code blue is one of the most well-known hospital codes, indicating a medical emergency, typically cardiac or respiratory arrest. When Code blue is called, a resuscitation or response team, including nurses, physicians, and often respiratory therapists, is immediately mobilized to provide life-saving interventions. 

Nurse response 

As a nurse, your role in a code blue may vary depending on your training and the unit in which you work. Typical responsibilities include: 

• Starting CPR if needed
• Assisting in setting up and using emergency equipment, like a defibrillator
• Administering medications  

Documenting events and interventions 

2. Code red: Fire 

Meaning: 

Code red indicates a fire or that smoke is present within the hospital facility. This code is critical for patient safety, as even a small fire can require an evacuation or a plan to contain the area. 

Nurse response 

Nurses are pivotal in managing patients and ensuring their safety during a code red situation. Remember the acronym RACE during code red responses. This means: 

• Rescue: Move patients, visitors, and staff away from the danger area.
• Alarm: Pull the fire alarm and notify the emergency team.
• Contain: Close doors to prevent the spread of smoke and fire.
• Extinguish/evacuate: Use a fire extinguisher if the fire is small and manageable. If necessary, assist with evacuation. Patient safety is the top priority, so be prepared to evacuate quickly if directed. 

3. Code pink: Infant or child abduction 

Meaning: 

Code pink alerts staff that an infant or child is missing or abducted from the hospital. Pediatric units, maternity wards, and NICUs are most vulnerable to this situation. 

Nurse response 

During a code pink, nurses should do the following: 

• Secure all exits to prevent anyone from leaving the building.
• Monitor hallways, stairwells, and other potential escape routes.
• Report any suspicious activity immediately. In some facilities, all staff may be asked to assist in the search until the child or infant is found or the code is cleared. 

4. Code silver: Active shooter or weapon threat 

Meaning: 

Code silver indicates an active shooter or weapon threat within the hospital. This code is designed to protect patients, staff, and visitors from immediate harm. 

Nurse response 

Under a code silver, nurses should follow the run, hide, fight protocol, which includes: 

• Run: If possible, leave the area immediately.
• Hide: If evacuation isn’t possible, secure yourself and patients in a safe room, lock doors, and silence phones.
• Fight: As a last resort, if your life is in imminent danger, use any available items as defense. Prioritize patient safety, especially those who cannot be easily moved, by hiding with them and securing their location if possible. 

5. Code black: Bomb threat 

Meaning: 

Code black is called when a bomb threat is received, whether it’s a phone call, suspicious package, or other indications of a potential explosive device on hospital grounds. 

Nurse response 

Upon hearing code black, nurses should do the following: 

• Follow instructions from security or emergency personnel.
• Avoid handling any suspicious objects or packages.
• Stay informed on whether an evacuation is necessary and be prepared to assist in moving patients safely. Awareness and communication are key. Ensure all patients remain calm and informed about the situation to avoid panic. 

6. Code orange: Hazardous material spill 

Meaning: 

Code orange is called for any hazardous material or chemical spill that could endanger the health of patients and staff. 

Nurse response 

If you encounter a code orange situation, take the following steps: 

• Clear the area of all non-essential personnel and patients.
• Avoid contact with the substance and prevent it from spreading.
• Follow hospital procedures for containment and decontamination, including wearing proper personal protective equipment (PPE) if you are directly involved in cleanup. It’s essential to adhere to safety protocols and await further instructions from the hospital’s hazardous materials team. 

7. Code gray: Combative person 

Meaning: 

Code gray is called when a person — either a patient, visitor, or staff member — becomes physically aggressive or violent. 

Nurse response 

During a code gray, nurses should take the following actions: 

• Maintain a safe distance from the combative individual.
• Try to de-escalate the situation, if safe to do so, using calm and non-threatening language.
• Secure the safety of other patients and staff in the vicinity. In some facilities, security or designated personnel will respond to assist, allowing nurses to focus on their patients’ safety. 

8. Code yellow: Disaster or mass casualty incident 

Meaning: 

Code Yellow alerts hospital staff to an external disaster or mass casualty event, such as a natural disaster, large-scale accident, or public health crisis, which may result in a high influx of patients. 

Nurse response 

During a code yellow, nurses are vital in managing the increased patient load. They may be required to do the following: 

• Prepare additional areas for incoming patients.
• Triage patients and prioritize treatment.
• Conserve supplies and work efficiently. In such scenarios, nurses may also be asked to work extended hours or assist with duties outside of their usual scope to accommodate the surge in demand. 

9. Code green: Evacuation 

Meaning: 

Code green signifies that an evacuation is necessary due to an immediate threat, such as structural damage or another risk compromising hospital safety. 

Nurse response 

In a code green, nurses should follow these steps: 

• Prioritize high-risk patients, ensuring their safety and assisting in their safe transport.
• Familiarize themselves with evacuation routes and assembly points.
• Prepare patients by securing essential equipment and medications for transport. Nurses should remain calm and organized, ensuring each patient is accounted for and safely moved to the designated area. 

10. Code white: Medical emergency in non-hospital settings 

Code white is most often used in Canada, but also in some U.S. hospitals, to indicate a medical emergency outside the hospital, such as in an outpatient clinic or parking lot. It may also refer to incidents involving aggressive behavior toward staff. 

Nurse response 

For code white, follow procedures like those of code blue if it involves a medical emergency, bringing appropriate resuscitation or medical equipment if directed. If it refers to an aggressive individual, follow de-escalation procedures and alert security as needed. 

Familiarity with hospital codes and the protocols they initiate is essential for every nurse. These codes are designed to streamline emergency responses, protect lives, and minimize disruptions in a hospital’s operations.  

It’s important to stay updated on your facility’s specific code system, as variations may exist between regions or hospitals. By understanding each code’s significance and response, you can act quickly and confidently, ensuring the safety and well-being of patients, colleagues, and yourself.