Color Codes in Healthcare: Keep Us Safe or Keep Us Laughing?

July, 2012:  “Code red, Tanner 7, Code red, Tanner 7,” an electronic voice calmly announces on the overhead. All the elevators return to the ground floor. All automatic doors immediately close. Everything stops. No surgery can begin. No one can be transferred from the operating room to the recovery room.  Everyone freezes. 

“Hmmm, what does that code red mean?” you might think. Is some orthopedic surgeon up to his knees in blood and needs help? Has one of the women physicians lost her temper again and is on a rampage like a raging bull? No, it means that a smoke alarm has gone off. Probably someone is smoking in a bathroom. Makes sense—red, fire.

July, 1979:  “Code blue, 6 North, code blue, 6 North.” A real voice 30 years ago at the Bronx Municipal Hospital urgently shouts, sending every doctor running up or down several flights of steps to get to the bedside of a patient who is literally turning blue. That was the way it was before code call teams and much more sophisticated communication systems were in place. (In some places this is now relegated to a number, e.g. code 10.)Consider how helpful the other colors might be:

• Code brown for loss of power. Wait for the back-up generator and then what? Turn off the lights? Start using sutures and not cautery to control bleeding? Use your hands to “mechanically” breathe for the patient?
• Code green for a natural disaster. An earthquake, tornado or a tsunami—how helpful? Stuff happens for which there is no time to react. And for those other disasters, like a blizzard, just look out the window.
• Code pink—an imminent delivery. I hope it is a delivery of 3 dozen giant white peonies for me.
• Code silver—security is needed. That silver badge to quiet an out of control patient or family member. I hope they have other silver things to help them, like a good cell phone to call for real help.
• Code purple—this one is the best of all. A bomb threat. And for that, there is a purple colored data card one might find at random phones.

At top: “Place this card under your telephone. Questions to ask:”

When is the bomb going to explode? Hmmm, depending on the answer, I think the call would be over as most of us as we high tail it out of there.

Where is it right now? I hope not near me, if I am still on that phone.

What does it look like? Might be hard to figure out how it looks different from the machinery in every corner of every square foot of the hospital.

What kind of bomb is it?  Oh, I must have missed that course in medical school.

What will cause it to explode? Do I really want to know?

Did you place the bomb?  Who cares?

Why?  During the diatribe of some slight real or perceived, that’s your chance to turn over the card (see below) and really get helpful information.

What is your address? Anyone smart enough to make a bomb would be smart enough not to answer this question.

What is your name? Ditto.

And then there is generous space for the exact wording of the threat. And after that a space for the sex, race and age of the caller. How one gets those pieces of information is not stated. Don’t forget to date, time and write the extension of the phone where the call was received.

Then turn over the card. Characterize the caller’s voice: Calm, angry, excited, slow, rapid, soft, loud, laughter, crying, normal, distinct, slurred, whispered, nasal, stutter, lisp, raspy, deep, ragged, clearing throat, deep breathing, cracking voice, disguised, accent, familiar (like who?). Yes, a place to check off for each. (How about high pitched, low pitched, hoarse, etc.? Clearly a voice expert did not help with this card.)

Then listen for the background noises: street, crockery, voices, PA system, music, house noise, motor, office machinery, factory machinery, animal noises, clear, static, local, long distance (who can tell anymore?), booth.

And finally the use of threat language. (Isn’t the whole call threat language?) Well spoken (educated), foul, irrational, incoherent, taped, message read by threat maker.

And then in case you might not think of this: “Report call immediately.” But it doesn’t say to whom to report it. No phone number. Nothing. Nada.  Am I missing something? Yes, directions to the nearest exit.

This is no joke.  I promise to be more serious next week. Don’t be alarmed. This is no threat.