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What Is a Code Blue?

Reviewed by Dan Brennan, MD on April 19, 2021

The term "code blue" is a hospital emergency code used to describe the critical status of a patient. Hospital staff may call a code blue if a patient goes into cardiac arrest, has respiratory issues, or experiences any other medical emergency. Hospitals typically have rapid response teams ready to go when they get notified about a code blue.

What Is a Hospital Emergency Code?

Most hospitals rely on a standardized coding system to communicate an emergency. These codes are not limited to medical events. There is currently no national standard set for emergency codes, so you may see some variance among those used in hospitals. Using hospital codes allows staff to quickly communicate the status of a situation with minimal words.

Code blue typically lets hospital staff know a patient requires resuscitation because of a medical emergency. Some places may break the code blue call down into sub-categories like:

  • Code Blue — Adult medical emergency that doesn’t allow movement of the patient.
  • Code Blue Pediatric — Medical emergency in a child that doesn’t allow movement of the patient.
  • Code Blue Neonate — Medical emergency in an infant that doesn’t allow movement of the patient.

These are a few ways that hospitals use code blue codes. A code blue sub-category could also alert staff to render aid to a patient who's having a stroke without specifying the patient's age. 

When Is a Code Blue Called?

A doctor or nurse typically calls code blue, alerting the hospital staff team that's assigned to responding to this specific, life-or-death emergency. Members of a code blue team may have experience with advanced cardiac life support or in resuscitating patients. The team may also include specialists like an anesthesiologist or internal medicine doctor.

A code blue may be called in situations where the patient is experiencing:

  • Cardiopulmonary arrest
  • Mental status changes
  • Chest Pain
  • Presyncope
  • Chest Pain
  • General worries about a patient’s status

Doctors and nurses are the ones who typically confirm a patient's status by checking for vitals like a pulse or signs of breathing. They might call code blue if the patient isn’t getting enough oxygenated blood pumping through their body due to respiratory distress or a cardiac arrest.  They might also call code blue if the patient is breathing but their condition is critical.

If a patient has a Do Not Resuscitate (DNR) order on file, the hospital staff must respect its legal boundaries. That usually precludes issuing a code blue. Patients with a DNR typically do not receive any cardiopulmonary resuscitation (CPR) efforts or any form of advanced cardiac life support (ACLS).

What Happens During a Code Blue?

A hospital’s response to a code blue call varies depending on the patient’s condition. Medical doctors typically take charge of a code blue situation. If a doctor or nurse issued the call because the patient’s heart stopped or they couldn’t find signs of breathing, they start performing CPR.

Other efforts may include intubating the patient. That involves inserting an endotracheal tube (ET) through a patient’s mouth or nose and into their trachea. Because the tube must pass through the vocal cords, patients won’t be able to speak until the ET is removed by staff. Intubation aids in resuscitation efforts during a code blue by opening the patient’s airway and helping them breathe.

If a patient’s heartbeat is irregular, staff may decide to employ an automated external defibrillator (AED) to reestablish a stable heart rhythm. If that doesn’t help, doctors may administer medications like epinephrine to start the patient’s heart or naloxone to get them breathing. Hospitals often have rules established about what drugs to use during medical emergencies.

What Are Some Other Common Hospital Emergency Codes?

There are various other color codes used to identify specific emergency incidents. Below are situations for which a hospital might employ an emergency code, even though the color indicator may vary.

Fire or Smoke. A hospital may identify situations where there is smoke, the smell of smoke, or a fire sighting as a code red. The code can also be used to indicate the sound of a fire or smoke alarm.

Missing Child. Hospitals may call a code white or orange to let staff know that there is a missing infant or child. It’s typically used to prompt staff into monitoring all exits and doors.

Bomb Threat. If someone calls in a bomb threat or issues one in person, staff may call for a code yellow or other color code indicator. It puts everyone in the hospital on alert to look for suspicious items that may have appeared over the past few hours.

WebMD Medical Reference

Sources

SOURCES:

Franciscan Health System: “Emergency Codes & Staff Response.”

Gillette Children’s Specialty Healthcare: “When a Patient is Intubated.”

Scrubs Mag: “Code Blue! Everything You Need To Know.”

WMC Health: “Standardized Emergency Color Codes.”

World Journal of Emergency Medicine: “Blue code. Is it a real emergency?”

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