1. Standardized Emergency Codes: Tools and Resources

2. Standardized Emergency Codes Background In 2007, the Kansas Hospital Association’s Quality Technical Advisory Group developed a survey to ascertain data related to color coding associated with wristbands and emergency/overhead codes. Over half of Kansas hospitals responded to the survey. The emergency codes survey showed a wide variety of emergency codes utilized by Kansas hospitals. However, more than 85 percent of hospitals had similar codes related to the Code Red-Fire and Code Blue-Medical Emergency. In addition, all Kansas hospitals answered “yes” or “partially consider” to the question of would they consider a standardized set of emergency codes.

3. Standardized Emergency Codes Background cont…. Lessons learned from recent disasters show that the resources and talent of our health care system must be shared and potentially sent to other communities, regions or the nation. On a more local basis, some facilities are already sharing staff from nursing agencies and physician groups. As these people move from facility to facility it appears logical that the codes which trigger emergency protective and response steps should be standardized to help insure quick action.

4. Standardized Emergency Codes Nationwide Trend States with statewide standardized emergency codes (yellow) States with partial standardized emergency codes (blue)

5. Standardized Emergency Codes Kansas Standardized Emergency Codes **Note: Plain text can be substituted for any color code

6. Standardized Emergency Codes Frequently Asked Questions Question – Can our facility add local codes specific to our organization? Answer – Yes. The intent of this standardization is to set a statewide base-level standard. The KHA Emergency Preparedness Technical Advisory Group recognized that there may need to be facility, community or region specific codes

7. Standardized Emergency Codes FAQs cont… Question – How do Kansas codes compare to neighboring states? Answer – Colorado appeared in the committee's research to be the only neighboring state with an adopted system by their hospital association as a recommendation for their facilities. The five color codes adopted by Kansas are all the same as the codes used by Colorado. Most of the codes were based off of recommendations by the American Hospital Association and the previous Hospital Emergency Incident Command System.

8. Standardized Emergency Codes FAQs cont… Question – Do I have to use the color codes as written? Answer – Yes or you may use plain text. If you are going to use any kind of code for fire, cardiac arrest/medical emergency, bomb threat, infant abduction or hazardous material spill/release, you should use the color codes established. You must use plain text on inclement weather alerts.

9. Standardized Emergency Codes FAQs cont… Question – When will hospitals across the state be implementing standardized emergency codes? Answer – Although this is a voluntary effort, all hospitals in Kansas are encouraged to adopt these standardized emergency codes by Jan. 1, 2010.

10. Standardized Emergency Codes FAQs cont… Question – Can other organizations or agencies utilize the standardized overhead emergency codes, like nursing homes or EMS? Answer – Absolutely. The intent is standardization, the more health care facilities that adopt the codes the better.

11. Standardized Emergency Codes FAQs cont… Question – Will my facility be provided with any educational materials? Answer – This toolkit, with the KHA recommended Emergency Codes, will be placed on the KHA Web site in the Emergency Preparedness section, along with these FAQs. Included with the FAQs are a set of guidance statements that the organization's emergency preparedness team can consider when looking at possible modification of internal policies, procedures and/or guidelines. These are suggestions put forth to stimulate discussion and planning.

12. Standardized Emergency Codes FAQs cont… Question – Will my facility have to absorb the costs of implementing standardized overhead emergency codes? Answer – Hospitals participating in the emergency preparedness grant can use funding to support this initiative. Since the code recommendations helps supports one of National Incident Management Systems requirements for hospitals and health care systems, funding is eligible.

13. Standardized Emergency Codes FAQs cont… Question – Do emergency codes have to solely be announced by an overhead speaker? Answer – No, some hospitals send text message alerts through various communication systems that send information to key staff before notifying the public. Depending on the situation, it may be necessary to send information to key staff before announcing it via an overhead speaker.

14. Standardized Emergency Codes Code Red: Fire PURPOSE –To provide the procedures to be followed to protect patients, visitors, staff and property in the event of a real or suspected fire.

15. Standardized Emergency Codes Code Blue: Cardiac Arrest / Medical Emergency PURPOSE –To facilitate the arrival of equipment (crash/code cart) and specialized personnel to the location of an individual in cardiopulmonary or respiratory arrest. If there is any doubt about the existence of a valid DNR order or an advanced health care directive, then the response should be towards an immediate decision to call a CODE BLUE and initiate Cardiopulmonary Resuscitation (CPR) at the level appropriate to the training of the responder.

16. Standardized Emergency Codes Code Black: Bomb Threat PURPOSE –To establish a method for coordinating an appropriate facility response to ensure immediate protection of life, property and the continuation of vital patient care services in the event of a bomb threat or discovery of a bomb or suspicious package.

17. Standardized Emergency Codes Code Pink: Infant Abduction PURPOSE –To protect infants from removal by unauthorized persons and to identify the typical physical description and actions demonstrated by someone attempting to kidnap an infant from a health care facility, in addition, to define the health care facility’s response to an infant abduction.

18. Standardized Emergency Codes Code Orange: Hazardous Material Spill/Release PURPOSE –To identify unsafe exposure conditions, safely evacuate an area, and/or protect others from exposure within the health care facility or on its grounds, due to hazardous materials spill/release. A hazardous material spill/release is an unexpected release into the environment (internal or external to the facility), either accidental or deliberate, that has the potential to cause injury or illness, may result in further risks such as an explosion, and may result in exposure to a potentially toxic substance which exceeds state or federal exposure limits, or may harm the environment. Some substances and situations can create potentially dangerous or deadly circumstances very quickly, and may require immediate activation of Incident Response Plans. –To ensure hazardous materials and waste used within the health care facility are handled and managed according to applicable regulations, minimizing their impact on the environment.

19. Standardized Emergency Codes Inclement Weather Alerts: Plain Text/Language Purpose – To provide consistent terminology for weather-related events using plain text messaging or clear language. Weather-related events will be stated based on National Oceanic and Atmospheric Administration’s (NOAA) warning and watch definitions. Tornado WatchTornado Warning Severe Thunderstorm WarningSevere Thunderstorm Watch Flash Flood WarningFlash Flood Watch Winter Weather AlertHeat Alert Wind Chill AlertWind Advisories Dense Fog Advisories

20. Standardized Emergency Codes Color Code Coordination In the wake of any disaster or emergency it’s important to recognize codes utilized by other first responders or disciplines. National Emergency Medical Services Triage Color Codes: The basic sections of a triage tag include the four colors of triage: Black (Deceased): no care needed Red (Immediate): life threatening injuries Yellow (Delayed): non-life threatening injuries Green (Minor): minor injuries

21. Standardized Emergency Codes Code Coordination, cont. Department of Homeland Security Threat Alerts The scale consists of five color-coded threat levels, that are intended to reflect the probability of a terrorist attack and its potential gravity. Severe (Red): severe risk High (Orange): high risk Elevated (Yellow): significant risk Guarded (Blue): general risk Low (Green): low risk

22. Standardized Emergency Codes Code Coordination, cont. Kansas Hospital Association’s Wristband Recommendations The colors below were chosen based on a nationwide initiative to standardize patient wrist bands (inpatient) and include the use of: Yellow: fall risk Red: allergy Purple: "Do Not Resuscitate" Pink: limited extremity (optional) Green: latex allergy (optional)

23. Standardized Emergency Codes Keys to Successful Implementation Nurses, physicians and health unit clerks are the people that usually make emergency code calls; however, it is imperative that other hospital employees be included in the education process. Take a few minutes to observe the activities of the day at one of the nursing stations. In just a 30-minute observation, you will probably see and hear things that help identify other stakeholders. Include medical staff early in the process; identify and rely on a physician champion to discuss the initiative and its importance. All active and courtesy physicians, including attending physicians, hospitalists, intensivists, residents and interns need to be familiar with emergency codes and be prepared to respond appropriately. Communication is important for the emergency code standardization process. In order for the desired goals to be effective, the hospital staff should communicate the adopted codes with fire department personnel, EMS, police and other external emergency responders.

24. Standardized Emergency Codes Keys to Successful Implementation Put together a strong implementation team; make assignments for the various steps (e.g. training, communication planning and resource development) so you can keep focused on the overall implementation and coordination. Keep the organization’s leadership informed of progress and enlist their aid, as needed, if you encounter serious obstacles. People have more confidence and approach a change more positively if the communication is clear and implementation runs smoothly. Develop your implementation work plan very early and use it as a guide and checklist to make certain nothing is omitted inadvertently. Few projects proceed as planned. Develop a realistic timeline before beginning ─ one that allows for unexpected delays or problems.