Hospital Emergency and Disaster Alert Codes and Response Codes A Call for Uniformity in the Philippines
Hospital Emergency and Disaster Alert Codes and Response Codes
A Call for Uniformity in the Philippines
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
January 9, 2012
Immediate Trigger for this ROJ’s TPOR (thoughts, perceptions, opinions, and recommendations): Alert code sounded for the Black Nazarene Feast in two hospitals I am affiliated with.
1. What is the difference between alert and response codes?
2. Is there a universal standardization of the codes?
Hospital emergency and disaster codes are being used in hospitals worldwide to convey essential information quickly to staff while preventing stress or panic among patients and visitors in the hospitals.
Hospital emergency and disaster codes are being used for two purposes, one, to convey need to be alert or ready and two, to convey type of emergency or disaster occurring in the hospital that needs a corresponding response.
To facilitate collaborative networking and responses during emergencies and disasters in the community, ideally, there should be uniformity of the codes being used by all hospitals.
There is currently no universal standardization of the emergency and disaster codes being used by hospitals. Some hospitals do not even have emergency and disaster codes at all but majority have. For those that have, there is no uniformity worldwide, countrywide, and metropolis wide.
In the Philippines, there is a need to standardize the emergency and disaster codes being used in government and private hospitals.
For the hospitals under the Department of Health, because of the Administrative Orders 182 s 2001 and 2008 – 0024, there is a standardized code alert system which consists of Code White, Code Blue, and Code Red. I don’t know to what extent the local government hospitals and private hospitals are using the same codes. From my experience, there are variable usages and connotations for the three codes.
For example, in Manila Doctors Hospital, currently, there is a Code Red which is a response code for fire. There is a Code Blue being activated when there are patients needing the service of the hospital’s resuscitation team. There is a Code White being activated when more services of doctors and nurses are needed in the Emergency Room because of surge of patients.
In the Department of Surgery of Ospital ng Maynila Medical Center, there are three alert codes in anticipation for sudden surge of patients. These are, namely: Code Red or Red Alert – all surgical teams must be physically present in the hospital; Code Yellow or Yellow Alert – two teams must be physically present in the hospital; and Code Green or Green Alert – all surgical teams are on call.
As mentioned above, in the Philippines, there is really a need to standardize the emergency and disaster codes being used in government and private hospitals to facilitate collaborative networking and responses during emergencies and disasters in the country and in a specific community.
This is a challenge for the health emergency managers in the government and private hospitals.
Offhand, my personal recommendations consist of the following aside from the need to have a uniform hospital emergency and disaster alert and response codes.
- Differentiate alert codes from response codes. Use the word “Alert” in color alert codes such as Code White Alert, Code Blue Alert, and Code Red Alert to differentiate them from response codes. The ones being used by the DOH can be adopted by all hospitals, local government and private hospitals, as long as the word “Alert” is incorporated in the code. Color codes without the word “Alert” shall be considered as response codes. Example, Code Red is a response code in cases of fire in the hospital. Code Blue is a response code in case of sudden cardiopulmonary arrest in the hospital. Code White is a response code in case of need for more medical personnel in a department, particularly, the Emergency Room, because of surge of patients.
- Formulate guidelines in what alert codes to activate by the hospitals, ones that will be applicable to all kinds of hospitals. The existing guidelines formulated by DOH (with the headings of “conditions for adopting”) need to be reviewed as they include indications for responses such as “hospital is structurally damaged requiring evacuation and/or transfer of patients” for Code Red Alert. As mentioned in No. 1 recommendation, there is a need to differentiate alert codes from response codes.
- Determine what will consist of alertness or readiness in the three levels of alert codes in terms of human resources, communication, hospital spaces, response procedures, medicines and supplies, and other indicated logistics. Ideally, the general requirements for each level of alert code should be uniform for all kinds of tertiary hospitals, whether government or private. However, because of differences in organizational structures, policies, and logistics among the different hospitals, particularly between government and private hospitals, uniformity will be difficult to achieve. There are already guidelines on the requirements in each alert code for DOH hospitals. The local government hospitals and the private hospitals can review these DOH guidelines for DOH hospitals and adopt what is adoptable and adjust as needed in the direction of either subtraction or addition, whatever will promote effective and cost-efficient readiness.
Note: See PH DOH – HEMS Guidelines on Early Warning and Alert Systems (For DOH Hospitals) in Guidelines for Health Emergency Management – Hospitals, Philippines, 2nd edition, 2008, DOH, HEMS.