Emergency

Code Blue: medical emergency

Code Blue is the response to any event where trained personnel are needed to respond to a medical crisis, whether or not it falls within the facility's normal routine of care. It applies to anyone on site, including patients, visitors and staff.

To respond effectively, a health care facility must have a plan of action, staff trained in cardiopulmonary resuscitation (CPR) with access to emergency advanced life support, and the appropriate drugs and equipment. The action plan covers:

• a formal method of raising the alarm and alerting the right staff;
• how to obtain equipment that isn't at hand;
• CPR protocols for one person, two people and a full team; and
• agreed protocols for when to stop resuscitation and for continuing care.

Medical and nursing staff must be trained in CPR and emergency advanced life support, with ongoing skills maintenance.

Code Purple: bomb threat

Code Purple is the response to a bomb threat, which may arrive in writing, by telephone, or through the discovery of a suspect object.

• Written threat: keep the message and any envelope or packaging, avoid further handling once it is recognised as a threat, and protect it as evidence, preferably in a plastic envelope.
• Telephone threat: stay on the line and complete a bomb threat checklist as soon as possible. Checklists should be held by switchboard staff and anyone who regularly takes incoming calls.
• Suspect object: don't touch or move it. Mark its location clearly (a paper trail to the nearest exit works well), check for other suspect objects nearby, then evacuate and isolate the area while searching continues elsewhere.

Code Yellow: internal emergency

Code Yellow is the response to an internal emergency that threatens the facility's operation or the safety of the people in it. It covers:

• Failure of essential services: electricity, medical gases and suction, water, communications and ventilation. How serious a failure is depends on how dependent patients are on the service.
• Hazardous substance incidents: leaks or spills of chemical, biological or radioactive materials.
• Structural damage: assessed case by case when it occurs.
• Illegal occupancy: intrusion by people seeking access to drugs, records or valuables, or targeting the facility for publicity or other reasons.

The emergency plan must address each of these. For example, it must record where medical gas cylinders, regulators and portable suction pumps are kept, and the fastest way to get them to patients if a reticulated system fails.

Code Black: personal threat

Code Black is the response to a person, armed or unarmed, who threatens to injure others or themselves, including a person threatening suicide.

• Unarmed confrontation: the facility must have plans for managing aggressive, agitated or violent people. These plans should be developed with medical, nursing, administrative and security staff, and with mental health specialists, to reduce the risk of injury to staff, patients and others.
• Armed confrontation: the response should be discreet and follow a plan developed with police. The facility's documentation must warn staff, patients and visitors not to place themselves in further danger.

Because an unarmed confrontation can become an armed one, the response plan should allow for escalation. After an incident, witnesses should be asked to stay until police arrive, and the media kept out of the facility.

Code Brown: external emergency

Code Brown is the response to an external emergency, such as an aircraft crash, major industrial accident or bridge collapse. The facility may need to send resources to the scene, prepare to receive a large number of casualties, or both.

On receiving notice, the emergency coordinator records the caller, the time, the type and location of the emergency, the number and type of injuries, and when casualties are expected to arrive. The coordinator verifies the information with the relevant emergency service before activating the emergency plan.

• External response: site medical teams, portable medical kits, additional communication links and fast ambulance turnaround.
• Internal response: clearing non-urgent cases from the emergency department, rapid discharge of non-urgent inpatients, casualty labelling and record keeping, controlled entry, facilities for victims' relatives, and routing information for release through police.

Code Orange: evacuation

Code Orange is the movement of patients, staff and others within or out of the health care facility, as quickly and safely as possible. It is often called alongside another code, for example when a fire (Code Red) leads to evacuation.

The senior staff member in the affected area assesses the threat, nearby hazards and the type of patients involved, and has the authority to order evacuation of that area. Overall control of the evacuation rests with the emergency coordinator. The nurse in charge or medical officer decides which patients are moved first.

Evacuation is carried out in three stages, depending on severity:

• Stage 1: removal from the immediate danger area, such as a room on fire.
• Stage 2: movement to a safer area, such as an adjoining compartment behind fire and smoke doors on the same level, or preferably a lower level.
• Stage 3: complete evacuation of the building, using all available staff, with ambulant patients and visitors moved first.

The needs of mobility impaired patients and staff must be planned for in advance.

Code Grey: unarmed threat

Not part of AS 4083. Code Grey is a local code used by many health services. AS 4083 lists seven colour codes and states that no others are to be used.

Code Grey is a call by staff for immediate help with a person who is aggressive, agitated or threatening but not armed. It brings a designated Code Grey team to the scene. The team is made up of staff who are trained to de-escalate and manage aggressive behaviour, and who are immediately available to respond.

Under AS 4083, unarmed and armed threats are both covered by Code Black. Facilities that adopt Code Grey generally use it for unarmed incidents managed by their own staff, and keep Code Black for incidents involving a weapon or a serious threat to safety, where police are called.

A facility that adopts Code Grey should define it in its emergency plan, including when an incident escalates from Code Grey to Code Black, and train staff in both.

Code Pink: paediatric emergency

Not part of AS 4083. Code Pink is an optional local code adopted by some health services. AS 4083 lists seven colour codes and states that no others are to be used.

Some facilities that treat children use Code Pink to call a response to a paediatric medical emergency. This allows a team with paediatric resuscitation skills and child-sized equipment to be sent, where a general medical emergency (Code Blue) response may not be enough.

The meaning of Code Pink is not consistent between health services. A facility that adopts it should define it in its emergency plan, train staff in its use, and make sure it cannot be confused with the codes set by AS 4083 or with how neighbouring services use the same colour.