What is a code blue?

A code blue is part of an emergency code system. Different colors or terms mean different things.

In Ohio, code blue in a hospital means there’s a medical emergency involving an adult. You may hear an announcement if you’re in the hospital at the time of an emergency.

The code blue announcement may include warning sounds. It will include a location. The place may be a floor number or a department description like the intensive care unit (ICU). An emergency involving a child is called “code pink.”

Usually, code blue means that someone has gone into cardiac or respiratory arrest. The code indicates that the sick person can’t be moved.

What happens during a code blue?

Every hospital has its own policy for code blue events. Some places assign duties for a code blue to clinical employees at the beginning of each shift. Other places may have a policy that calls for everyone who is near the emergency to report to the code blue. Still, others may have a dedicated code blue or resuscitation team.

Having these different codes allows hospitals to be prepared for emergencies. Each member of the staff should know their role. If you’re a healthcare provider, you should know how to do cardiopulmonary resuscitation (CPR) and how to use a defibrillator even if you’re not part of a code blue team. It might take three to five minutes for a code team to arrive at the location, according to one estimate. This means it’s important that everyone keeps their skills current.

Code blue teams may use more than one method to revive someone. These methods include CPR, intubation, a defibrillator and medications. There may be people assigned to each of these activities, with the process coordinated by one person. The “crash cart” holds all the supplies needed in code blue situations.

CPR

The major part of CPR involves chest compressions, which keep blood moving to your organs until your regular heartbeat starts up again. The person doing CPR puts both hands, with interlocked fingers, on the chest of the person who’s in cardiac arrest. The giver of CPR pushes down with controlled firm pressure at a regular rhythm on the other’s chest. Getting CPR can double or even triple your chance of survival.

Intubation

Healthcare providers use intubation to help someone who isn’t breathing. A provider inserts a tube through your mouth, or sometimes nose, and down into your trachea (airway/windpipe). The tube keeps your airway open so that air can get through. The tube can connect to a bag that is deflated by hand to breathe for you or a machine that delivers the oxygen.

Before and during intubation, another healthcare provider may give you air through a bag and mask ventilation or oxygen through a mask.

Defibrillator

The code blue team may use an automated external defibrillator (AED). Anyone can use this device. It delivers a life-saving shock to a person in cardiac arrest. When used in the right way, the shock may be able to restore a normal heart rhythm.

Many public places have added AEDs because anyone can use them. Most AEDs have easy-to-use instructions on them — and the machines read the instructions out loud to you, but a 911 dispatcher can also help you use the AED.

Medications

In some cases, your code blue team will use medications, most commonly epinephrine and amiodarone. Epinephrine affects muscle contractions and airway widening. Amiodarone is an antiarrhythmic, so it works to put your heart back into a safe heart rhythm. Other medications that may be used include vasopressin and lidocaine. A code blue team may use other drugs in certain situations.

Do hospital code blue announcements refer only to patients?

No. When you hear code blue in a hospital announcement, it can refer to anyone. It can mean that a patient or a visitor or even someone who works there is experiencing a medical emergency. An estimated 1% of cardiac arrest cases will happen to people who aren’t patients — they are visiting or working in the hospital, including parking areas and other spaces.

Does code blue mean that someone has died?

The code blue announcement doesn’t mean that someone has died. However, it does mean that someone is in danger of dying.

Are there other emergency codes?

Yes. The goal of using codes is to inform everyone who needs to be aware of a problem or concern without scaring people who are not at any risk. Healthcare staff in your area will let you know if there are any issues you need to be aware of.

While there’s no standard set of codes, many hospitals in the following countries generally use the same colors to mean the same thing:

  • The U.S.
  • Canada.
  • Australia.
  • New Zealand.

Here are some of the codes used in Ohio, according to the Ohio Health Care Association:

Emergency CodeEmergency (Event)
Code AdamAbduction of an infant or a child.
Code BlueMedical Emergency involving an adult.
Code PinkMedical Emergency involving a child.
Code BrownMissing adult patient.

A note from Cleveland Clinic

Hearing a code blue announcement at a hospital or other healthcare facility can be a bit alarming. It may help to know that there’s a skilled team of healthcare providers who are moving quickly to help.

Last reviewed by a Cleveland Clinic medical professional on 07/25/2022.

References

  • Dauksewicz, B.W. (2019), Hospitals should replace emergency codes with plain language. (https://doi.org/10.1002/jhrm.21346) J of Healthcare Risk Mgmt, 38: 32-41. Accessed 7/25/2022.
  • Institute for Healthcare Improvement. Code Blue. Where To? (AHRQ). (http://www.ihi.org/education/IHIOpenSchool/resources/Pages/Activities/AHRQCaseStudyCodeBlue.aspx) Accessed 7/25/2022.
  • Jackson JE, Grugan AS. Code blue: Do you know what to do? (https://journals.lww.com/nursing/FullText/2015/05000/Code_blue__Do_you_know_what_to_do_.10.aspx) Nursing. 2015;45(5):34-39. Accessed 7/25/2022.
  • McMahon MM. The many codes for a disaster: a plea for standardization. (https://www.intljourtranur.com/article/S1540-2487(06%2900103-9/fulltext) Disaster Manag Response. 2007;5(1):1-2. Accessed 7/25/2022.
  • Merck Manuals. Cardiopulmonary Resuscitation (CPR) in Adults. (https://www.merckmanuals.com/professional/critical-care-medicine/cardiac-arrest-and-cpr/cardiopulmonary-resuscitation-cpr-in-adults) Accessed 7/25/2022.
  • Ohio Health Care Association. Ohio Emergency Codes. (https://www.ohca.org/uploads/news/Ohio_Emergency_Codes.pdf) Accessed 7/25/2022.

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