Understanding Hospital Emergency Codes
Hospitals use a system of color-coded emergency alerts to quickly communicate specific types of emergencies to staff without causing panic among patients and visitors. These codes allow trained personnel to initiate appropriate response protocols immediately upon hearing the announcement, while minimizing confusion and anxiety in an already stressful healthcare environment. Among these codes, Code Red is one of the most critical and universally recognized, signifying a fire or smoke emergency within the hospital facility.
While the specific codes used can vary between hospitals and healthcare systems, Code Red for fire is one of the most standardized emergency codes across the healthcare industry. The Association of Healthcare Organizations and other regulatory bodies have worked to standardize these codes to improve consistency, especially as healthcare workers move between institutions. When a Code Red is announced over a hospital's public address system, it triggers a well-rehearsed chain of responses designed to protect patients, visitors, and staff while containing and extinguishing the fire.
What Triggers a Code Red
A Code Red can be triggered by several situations within a hospital. The most obvious trigger is the detection of an actual fire, whether it's a small wastebasket fire, an electrical fire in equipment, a kitchen fire, or any other combustion event within the facility. Smoke detection systems throughout the hospital can automatically trigger a Code Red when they detect smoke particles in the air, even before visible flames appear. Manual pull stations located throughout the hospital can also be activated by any person who observes fire or smoke, immediately initiating the Code Red response.
It's important to note that not every Code Red involves a large, visible fire. In many cases, the code is activated for situations that have the potential to develop into dangerous fires if not addressed quickly. A burning smell from overheated electrical equipment, smoke coming from a piece of medical machinery, or even an activated sprinkler system can trigger a Code Red response. The philosophy behind this sensitive trigger threshold is that in a hospital setting—where many patients are immobile, on life support, or otherwise vulnerable—early detection and response can mean the difference between a minor incident and a catastrophic event.
The RACE Protocol
When a Code Red is announced, hospital staff follow the RACE protocol, a systematic response framework that prioritizes patient safety. RACE is an acronym that stands for Rescue, Alarm, Contain, and Extinguish/Evacuate. This protocol provides a clear, memorable sequence of actions that staff can follow even under the stress and confusion of a fire emergency. Every hospital employee, from physicians and nurses to housekeeping and administrative staff, is trained in the RACE protocol as part of their mandatory fire safety education.
The first step, Rescue, involves immediately removing anyone who is in direct danger from the fire. This means moving patients, visitors, and staff away from the area where fire or smoke has been detected. For patients who are ambulatory, this may be as simple as guiding them away from the danger zone. For patients who are bedridden, on ventilators, or otherwise immobile, rescue may require coordinated effort from multiple staff members using specialized evacuation equipment such as evacuation sleds, drag sheets, or wheelchairs.
Alarm, the second step, involves activating the nearest fire alarm pull station if it hasn't already been activated, and calling the hospital's emergency number to report the specific location and nature of the fire. Providing accurate information about the fire's location, size, and any hazards (such as oxygen tanks in the area) helps the response team and fire department prepare appropriately. The hospital switchboard or command center then broadcasts the Code Red announcement over the PA system, specifying the location of the emergency.
Contain and Extinguish
The third step of the RACE protocol, Contain, focuses on preventing the fire from spreading. Hospital staff are trained to close all doors in the area, as fire-rated doors can contain a fire within a single room or compartment for a significant period, buying time for evacuation and firefighting efforts. Closing doors also prevents smoke from spreading through the facility, which is critical because smoke inhalation is the leading cause of death in building fires. Staff also shut down oxygen and other gas supplies in the affected area if it can be done safely, as these gases can dramatically accelerate fire spread.
The fourth step is Extinguish or Evacuate, depending on the situation. If the fire is small and staff have been trained in fire extinguisher use, they may attempt to extinguish the fire using portable fire extinguishers located throughout the hospital. However, if the fire is too large to safely extinguish, or if it's spreading rapidly, the priority shifts to evacuation. Hospital evacuation plans are carefully designed to move patients horizontally to adjacent fire compartments first, as horizontal movement is faster and easier than vertical evacuation, especially for patients with mobility limitations.
The PASS Technique for Fire Extinguishers
When hospital staff use portable fire extinguishers during a Code Red, they follow the PASS technique, another acronym designed to make the correct procedure easy to remember under pressure. PASS stands for Pull the pin, Aim at the base of the fire, Squeeze the handle, and Sweep from side to side. This technique ensures that the extinguishing agent is directed at the fuel source of the fire rather than at the flames themselves, which is a common mistake that can reduce the effectiveness of fire extinguisher use.
Hospital fire extinguishers are strategically placed throughout the facility and are inspected regularly to ensure they are charged and functional. Most hospitals use ABC-type fire extinguishers, which are effective against ordinary combustible materials (Class A), flammable liquids (Class B), and electrical fires (Class C). Staff are trained to only attempt extinguishing a fire if the fire is small enough to be contained, they have a clear exit path behind them, and the fire extinguisher is appropriate for the type of fire. If any of these conditions are not met, the correct action is to evacuate and wait for the professional fire response.
Special Considerations in Hospital Fires
Hospital fires present unique challenges that don't exist in other building types. The presence of compressed oxygen, flammable anesthetic gases, and other medical gases creates potential fuel sources that can dramatically accelerate fire spread and intensity. Electrical medical equipment, from ventilators and monitors to surgical lasers and electrocautery devices, represents both potential ignition sources and critical life-support systems that cannot simply be shut off without risking patient lives. These factors make hospital fire safety an exceptionally complex field that requires specialized training and protocols.
Patient vulnerability is another factor that distinguishes hospital fires from fires in other settings. Many hospital patients are sedated, anesthetized, paralyzed, or otherwise unable to self-evacuate. Patients in intensive care units may be connected to multiple life-support systems that cannot be simply disconnected. Neonatal intensive care units present the challenge of evacuating extremely vulnerable infants who require specialized transport equipment. Surgical patients may be mid-procedure when a Code Red is called, creating agonizing decisions about whether to continue or abort the surgery. These complexities are why hospitals conduct regular fire drills and have detailed, unit-specific evacuation plans.
What Patients and Visitors Should Know
If you're a patient or visitor in a hospital and you hear a Code Red announcement, the most important thing you can do is remain calm and follow the instructions of hospital staff. Do not attempt to use elevators, as they are typically recalled to the ground floor during a fire emergency and may become inoperable. If you are ambulatory and instructed to evacuate, move quickly but calmly to the nearest stairwell or the location directed by staff. If you are a patient who cannot move independently, rest assured that staff are trained to assist you and will prioritize your safety.
Visitors should be aware of the exit routes posted on the backs of room doors and at regular intervals throughout hospital corridors. If you notice fire or smoke before a Code Red is called, immediately alert hospital staff and activate the nearest fire alarm pull station if you know how to do so. Do not attempt to fight the fire yourself unless you are trained in fire extinguisher use and the fire is small enough to safely manage. Above all, do not open any closed doors that feel hot to the touch, as this may indicate fire on the other side.
Prevention and Training
The best Code Red response is one that never has to happen, which is why hospitals invest heavily in fire prevention. This includes regular inspection and maintenance of electrical systems, proper storage of flammable materials, compliance with building fire codes, and ongoing education for staff about fire hazards specific to the healthcare environment. Many hospitals employ dedicated fire safety officers who oversee prevention programs, conduct risk assessments, and coordinate with local fire departments.
Hospital accreditation organizations, such as The Joint Commission, require healthcare facilities to conduct fire drills at regular intervals and to document staff participation in fire safety training. These drills simulate Code Red scenarios and allow staff to practice the RACE and PASS protocols in realistic conditions. After each drill, debriefing sessions identify areas for improvement and reinforce correct procedures. This commitment to ongoing training ensures that when a real Code Red occurs, hospital staff can respond swiftly, confidently, and effectively to protect everyone in the facility.
