Goodbye color codes. Washington hospitals asked to switch to plain language
This story appears in the February 2025 issue of the WSNA Newsletter.
In collaboration with member hospitals, the Washington State Hospital Association (WSHA) has recommended standardized overhead paging codes across Washington state hospitals to improve clarity and emergency response times.
The recommended codes use plain language instead of color codes to ensure that staff, patients, and visitors can easily understand the announcements.
Instead of Code Red, for example, the code will say what kind of alert, the event, the location, and instructions on what to do. Ex: Facility alert, Fire alarm, 2nd Floor East, Follow evacuation plan.
The recommendations went into effect Oct. 1, 2024, according to best practices by the Federal Emergency Management Agency and National Incident Management System. While facilities are not required to implement the plain language calls, WSHA is strongly recommending it.
Under the recommendations, legacy color codes that will remain in use are "code blue" for cardiac or respiratory arrest and the "AMBER alert" for a missing youth. The proposed recommendations to legacy codes are as follows:
| Eliminate | Retain |
|---|---|
| Code Gray | Code Blue |
| Code Green | Amber Alert |
| Code Orange | |
| Code Red |
Plain language codes are designated into three categories: Facility, Medical, and Security.
The Washington State Hospital Associations Hospital Emergency Code Events Plain Language Implementation Guidance offers the following examples for plain language codes:
| Category | Type | Plain Language Example |
|---|---|---|
| Facility | Fire Alarm | Facility Alert + Fire Alarm + 2nd Floor East + Follow Evacuation Plan |
| Facility | External/Internal Triage | Facility Alert + External (or Internal) Triage + Establish Incident Command |
| Medical | Acute Heart Attack | Medical Alert + Acute Heart Attack + Emergency Room 5 |
| Medical | Code Blue Medical | Alert + Code Blue + Critical Care East |
| Medical | Stroke | Medical Alert + Stroke + Emergency Room 2 |
| Security | Active Shooter | Security Alert + Active Shooter + West Entrance |
| Security | Missing Person Adult | Security Alert + Missing Person Adult + 4th Floor Medical + Secure egress points |
Key benefits of plain language announcements include the following:
- Uses plain language to promote clarity and reduce confusion.
- Minimizes overhead paging noise and promotes a quieter hospital environment.
- Activates overhead paging when situations require a majority of building occupants to hear the notice for immediate staff response.
- Promotes use of alternative communication methods, i.e., call notifications, mass texting for situations that only require specific staff to be informed.
- Addresses security issues using overhead announcements for confirmed or likely threats.
For more information, see the following resources:
- Washington State Hospital Association Hospital Emergency Code Events Plain Language Implementation Guidance, WSHA, Sept. 2024.
- AMBER Alert. U.S. Department of Justice.
- WSHA standardizing emergency codes, go-live date scheduled for Oct. 1, WSHA, April 2, 2024.
- WSHA leads statewide campaign to standardize plain language hospital emergency code calls, WSHA, Oct. 8, 2024.
- Washington hospital group leads charge to ditch emergency code calls for plain language, Beckers Hospital Review, Oct. 9, 2024.
- U.S. Department of Homeland Security Plain Language Guide Frequently Asked Questions.
Jo K. Quetsch is quality/safety program manager for WSNA.