PLAIN LANGUAGE
EMERGENCY CODES
IMPLEMENTATION TOOLKIT
executive summary
Hospitals in South Carolina and the South Carolina Hospital Association are committed
to safe, quality health care. One way to promote safety and reduce harm is to
implement plain language emergency codes.
Historically, hospital emergency codes were assigned a color. The use of color codes
was intended to convey essential information quickly with minimal misunderstanding to
staff, while preventing stress and panic among visitors to the hospital.
Unfortunately, the risks of using color codes now outweigh the benefits. There is
significant variation of color codes across organizations, which leads to confusion of
health care providers and, in some instances, harm to health care providers.
Hospitals have also received feedback from consumers stating that color codes
increased their stress level. Consumers want to be informed and have asked hospitals
for transparency.
Nationally, the Joint Commission has recommended the standardization of emergency
codes. The trend to adopt plain language is supported by U.S. Department of Health
and Human Services, U.S. Department of Homeland Security, The National Incident
Management System (2008) and The Institute of Medicine’s Health Literacy report and
recommendations (2004)
Plain language is communication your audience can understand the first time they see
or hear it. People know what actions are required based on the information they receive.
Hospitals should also take this opportunity to consider when overhead paging is
appropriate versus silent notification.
This voluntary initiative is intended to improve the safety and continuity among hospitals
in South Carolina. Each hospital should convene a team to evaluate the use of plain
language. The recommendation to adopt plain language emergency codes has been
developed by experts from hospitals across South Carolina and is based on literature,
research and national guidelines.
timeline
It is recommended that all participating hospitals adopt the standardized codes by December 31, 2016.
1
FEBRUARY 2016
Provide hospitals with resources
to support implementation.
Seek hospitals’ intent to adopt
specific codes and date of adoption.
Standardized emergency codes
among participating hospitals adopted.
MARCH 2016
Conduct webinars to provide additional
education and answer questions.
4
5
DECEMBER 2016
Announce new initiative and recommendation.
2
3
APRIL 2016
JANUARY 2016
JUNE 2016
Conduct webinars to provide updates and
answer questions; share implementation
strategies among participating hospitals.
6
7
MAY 2017
Evaluate implementation status.
recommendations
Category + Alert + Location + Directions
FACILITY ALERT
EVENT
Decontamination
Evacuation/Relocation
Fire
Hazardous Material Release
Mass Casualty
Utility/Technology Interruption
Weather
RECOMMENDED PLAIN LANGUAGE
Facility Alert + Decontamination + Location + Directions
Facility Alert + Evacuation + Location + Directions
Facility Alert + Fire + Location + Directions
Facility Alert + Threat + Location + Avoid the area
Facility Alert + Mass Casualty + Location + Directions
Facility Alert + Utility/Technology Interruption + Location + Directions
Facility Alert + Weather Event + Location + Directions
SECURITY ALERT
EVENT
RECOMMENDED PLAIN LANGUAGE
Armed Subject
Bomb Threat
Civil Disturbance
Controlled Access
Missing Person
Security Assistance
Security Alert + Threat + Location + Directions
Security Alert + Threat+ Location + Directions
Security Alert + Civil Disturbance + Location + Avoid the area
Security Alert + Controlled Access + Location + Directions
Security Alert + Missing Person + Location + Directions
Security Alert + Security Assistance + Location + Directions
Suspicious Package
Security Alert + Suspicious Package + Location + Directions
MEDICAL ALERT
EVENT
Medical Alert
RECOMMENDED PLAIN LANGUAGE
Medical Alert + Medical Emergency + Location + Directions
ANNOUNCEMENT EXAMPLE
Facility Alert, Utility/Technology Interruption, West Building, Plug Critical Equipment Into Red Outlets
notes & suggestions
FACILITY ALERT
RECOMMENDED PLAIN LANGUAGE
Decontamination
Facility Alert + Decontamination + Location + Directions
Evacuation/Relocation
Facility Alert + Evacuation + Location + Directions
Fire
Facility Alert + Fire + Location + Directions
Hazardous Material Release
Facility Alert + Threat + Location + Avoid the area
Mass Casualty
Facility Alert + Mass Casualty + Location + Directions
Utility/Technology Interruption
Facility Alert + Utility/Technology Interruption + Location + Directions
Weather
Facility Alert + Weather Event + Location + Directions
SECURITY ALERT
RECOMMENDED PLAIN LANGUAGE
Armed Subject
“Security Alert + Threat + Location + Directions
Bomb Threat
“Security Alert + Threat+ Location + Directions
Civil Disturbance
“Security Alert + Civil Disturbance + Location + Avoid the area
Controlled Access
“Security Alert + Controlled Access + Location + Directions
Missing Person
“Security Alert + Missing Person + Location + Directions
Security Assistance
“Security Alert + Security Assistance + Location + Directions
Suspicious Package
“Security Alert + Suspicious Package + Location + Directions
MEDICAL ALERT
RECOMMENDED PLAIN LANGUAGE
Medical Alerts
Medical Alert + Medical Emergency + Location + Directions
DETERMINATION OF WHETHER A SILENT OR OVERHEAD NOTIFICATION WILL BE CALLED SHOULD BE DECIDED
UPON BY THE INDIVIDUAL FACILITY. RECOMMENDATIONS FOR SPECIFIC CIRCUMSTANCES ARE AS FOLLOWS.
NOTES/SUGGESTIONS
Overhead page
An evacuation facility alert will only be used when referencing the evacuation of an entire building.
A relocation facility alert will be used when horizontal or vertical evacuation is necessary.
Smoke alarm response should be the same.
Focus directions on “avoiding the area”.
Only announce if public is in jeopardy or if an outside agency is required to assist in clean-up.
Major traumatic events that do not qualify as a surge (i.e. a slow, gradual increase).
An event that is impacting the ED as well as other departments. “Surge” will be decided upon individually by hospitals.
Plant Facility System Alert would fall under this event.
Classified as all the things you need to run a facility; the facility will decide if any additional language is needed.
Tornado watches/warnings, snow, ice, severe thunderstorm, etc.
NOTES/SUGGESTIONS
Differentiate between inside vs. outside the facility;
“Escape immediate danger or shelter in place” is best overall terminology to use with giving directions.
Immediate threat; direct with staff instructions
Keep this event in this category in case it is ever needed because it does not fall into other categories.
Cannot use “lockdown” terminology.
Vulnerability; always use “missing” unless there is absolute certainty about abduction;
stay away from using abduction unless necessary because if they are abducted, they are still missing.
An out of control visitor/individual causing a disturbance. This can also include a caveat of “escalated behavior” if necessary.
“Suspicious package, avoid the area.”
NOTES/SUGGESTIONS
These will be listed on a matrix, but fall under daily operations response rather than emergency management response.
research
GOALS
REDUCE VARIATION OF
EMERGENCY CODES
AMONG SOUTH
CAROLINA HOSPITALS
INCREASE COMPETENCYBASED SKILLS OF
HOSPITAL STAFF
WORKING IN MULTIPLE
FACILITIES
ALIGN, IF POSSIBLE,
STANDARDIZED CODES
WITH NEIGHBORING
STATES
INCREASE STAFF,
PATIENT, AND
PUBLIC SAFETY
WITHIN HOSPITALS
AND CAMPUSES
Emergency code terminology used to notify
staff in a health care facility about an event that
requires immediate action varies significantly
from facility to facility. This variation may lead
to confusion for staff working in more than
one facility. The general public that frequents
hospitals often hears the current codes as
meaningless noise.
Once the idea of plain language was brought
to SCHA’s attention, research was conducted to
assess the successes and failures of the use
of these codes across the country. Through
research it was concluded that there is no
federal requirement that health care facilities use
plain language emergency alerts, and to date,
Maryland is the only state that has mandated
hospitals implement uniform code terminology
as a component of their emergency disaster
plan. However, there is clearly a national trend to
standardize emergency codes. At least 25 hospital
associations have already recommended the
use of standardized emergency codes by their
hospitals and health care facilities. Several hospital
associations have advocated using ‘plain
language’ codes based on recommendations from
government agencies such as the U.S. Department
of Homeland Security. SCHA did not conduct
an assessment of variability in codes, as the
research provided in other states was sufficient.
PROMOTE
TRANSPARENCY
OF SAFETY PROTOCOLS
BACKGROUND
PRINCIPLES
THIS IS A VOLUNTARY
INITIATIVE; IT IS NOT
A MANDATE TO ADOPT
ALL OR ANY OF THE
RECOMMENDED
EMERGENCY CODES.
THE RECOMMENDATIONS
ARE BASED ON
LITERATURE AND
NATIONAL SAFETY
RECOMMENDATIONS.
USE OF PLAIN LANGUAGE
EMERGENCY CODES IS
THE LONG-TERM GOAL
OF THIS INITIATIVE TO
ENSURE TRANSPARENCY
AND PATIENT AND
PUBLIC SAFETY.
MINIMIZING OVERHEAD
PAGES IN HOSPITALS
IS ENCOURAGED TO
PROVIDE A QUIETER
HOSPITAL ENVIRONMENT,
LEADING TO IMPROVED
SAFETY AND PATIENT
OUTCOMES.
workgroup members
Sarah Kirby, Co-Chair
Jeffrey Straub, Co-Chair
Bob Besley
Eric Brown, MD
Julie Marie Brown
Ray Brown
Tavia Buck
James Clarke
Matthew Conrad
Scott Cooper
Patti Davis
Patrick Devlin
Brian Fletcher
Jerry Flury
Ann Flynn
Jennifer Gregg
George Helmrich
Kim Jolly
Stephan Jones
Debbie Mixon
Todd O’Quinn
Pennie Peralta
Michael Platt
Michael Puckett
Greg Reed
Chris Rees
Chief Operating Officer
Corporate Emergency Manager
Director of Security & Emergency Management
Physician Executive
System Director, Regulatory Compliance
Director of Safety, Communications & Volunteer Services
Chief Nursing Officer
Corporate Director, Emergency Management
Administrative Specialist
EMS/EM Coordinator
Project Manager
Director of Safety, Security & Emergency Preparedness
Disaster Preparedness Program Manager
Director of Emergency Management
Safety Coordinator
Nurse Manager, Emergency Department
Chief Medical Officer
Chief Nursing Officer
Safety Coordinator
Administrative Director, Risk Manager
Director of Safety Operations
Vice President of Nursing
Emergency Preparedness & Safety Coordinator
Emergency Management Coordinator
Director of EOC & Emergency Management
AVP, Patient Safety, Service Excellence & Physician Services
Palmetto Health Baptist Parkridge
Spartanburg Regional Medical Center
Aiken Regional Medical Centers
Palmetto Health Richland, USCSOM
Palmetto Health
Beaufort Memorial Hospital
Roper St. Francis Mount Pleasant Hospital
Carolinas HealthCare System
Carolinas Hospital System- Florence
Trident Medical Center
Baptist Easley Hospital
Tidelands Health
MUSC Health
Roper St. Francis Hospital
Conway Medical Center
Dorn VA Medical Center
Baptist Easley Hospital
Clarendon Health System
AnMed Health
Palmetto Health Tuomey
AnMed Health
Roper St. Francis Hospital
Palmetto Health
McLeod Regional Medical Center
Greenville Memorial Hospital
Tidelands Health
SCHA STAFF
Morgan Rackley Bowne
Jimmy Walker
Graduate Student
Senior Vice President
SCHA, University of South Carolina
SCHA
frequently asked questions
WHY IS THE SOUTH CAROLINA HOSPITAL ASSOCIATION ENDORSING AND
LEADING AN INITIATIVE TO ADOPT STANDARDIZED, PLAIN LANGUAGE
EMERGENCY CODES?
SCHA and member hospitals are committed to increasing patient, employee and visitor safety during any
incident. The need to standardize emergency codes has been recognized by hospital emergency preparedness
staff, especially in communities with more than one hospital or adjacent to nearby states. The decision to adopt
plain language was proactive and based on literature, research and early trends among hospitals to promote
transparency and safety. The early trend aligns with new federal initiatives to adopt plain language standards.
HOW DID SCHA DEVELOP THESE SPECIFIC CODES FOR STANDARDIZED USE?
SCHA invited volunteers to participate in a workgroup, consisting of individuals from member hospitals of all
sizes, care capabilities, and geographic regions across the state. The group was co-chaired and SCHA staff
facilitated the process. The workgroup, which first met in November 2015, met regularly to develop the plain
language standardized code recommendations. Consensus was the primary method used for decision making.
WHY IS PLAIN LANGUAGE IMPORTANT?
The adoption of plain language promotes transparency, increases safety and aligns with national initiatives. The
Institute of Medicine considers plain language a central tenet of health literacy (2004). The National Incident
Management System also has established plain language requirements for communication and information
management among emergency managers (2008).
WHY DID THE SOUTH CAROLINA RECOMMENDATIONS ELIMINATE ALL
COLOR CODES, WITHOUT EXCEPTION?
Members of the plain language workgroup felt that including color code exceptions in this toolkit would send
mixed messages about the importance of using communication your audiences can understand the first time
they see or hear it.
DOES USE OF PLAIN LANGUAGE CREATE ADDITIONAL FEAR AMONG
PATIENTS & VISITORS?
Although this is a commonly expressed concern, research suggests that plain language does not create
additional fear among patients and visitors. In fact, it may decrease uncertainty among patients and visitors.
To address the growing concern of patient and family confusion, a recent Joint Commission report on health
literacy and patient safety recommends making plain language a “universal precaution” in all patient encounters.
DOES USE OF PLAIN LANGUAGE REDUCE PATIENT PRIVACY OR PROTECTION?
If policy implementation adheres to principles of privacy and HIPAA, use of plain language should not adversely
affect patient privacy.
HOW SHOULD A HOSPITAL DETERMINE WHICH EMERGENCY CODES TO
ANNOUNCE TO ALL PATIENTS, VISITORS AND EMPLOYEES AND WHICH
EMERGENCY CODES TO ANNOUNCE TO ONLY SPECIFIC HOSPITAL PERSONNEL?
It is important that each hospital consult its emergency management and leadership teams to determine
appropriate policies and procedures for the organization. As a general rule, the trend is to reduce the amount of
overhead paging and announce overhead only those codes that at least the majority of patients, employees and
visitors should be aware of and prepared to respond.
HOW SHOULD HOSPITALS HANDLE SECURITY ISSUES, SUCH AS AN
ARMED AND VIOLENT INTRUDER?
It is important that each hospital consult its emergency management and leadership teams to determine
appropriate policies and procedures for the organization. As a general rule, hospitals should consider overhead
announcements when there is a confirmed or likely armed violent intruder.
IS ADOPTION OF ANY OR ALL OF THESE PLAIN LANGUAGE EMERGENCY CODES
MANDATORY?
Although this initiative is strongly encouraged and endorsed by the SCHA Board of Trustees, there is currently
no federal or state regulation requiring adoption of any or all of these standardized, plain language emergency
codes.
IS THERE A TIME LINE TO IMPLEMENT PLAIN LANGUAGE?
There is a target date of December 31, 2016, for South Carolina hospitals to implement these plain language
emergency codes.
references
Florida Hospital Association. (2014). Overhead Emergency Codes: 2014 Hospital Guidelines. Retrieved September 15, 2015, from
http://www.jointcommission.org/assets/1/6/EM-2014_RECOMMENDATIONS_FOR_HOSPITAL_EMERGENCY_CODES_FINAL_(2).pdf
Healthcare Association of Southern California (2011) Health care emergency codes: a guide for code standardization, (3rd ed).
Institute of Medicine. (2001). Crossing the Quality Chasm: A new health care system for the 21st century. Retrieved September 15, 2015, from
https://iom.nationalacademies.org/~/media/Files/Report Files/2001/Crossing-the-Quality-Chasm/Quality Chasm 2001 report brief.pdf
Iowa Hospital Association. (n.d.). Plain Language Emergency Codes: Implementation Guide. Retrieved September 15, 2015, from
https://www.ihaonline.org/Portals/0/webdocs/publications/Plain Language Document.pdf
Joint Commission Resources (2012). Emergency management in health care: an all hazards approach (2nd ed). ISBN: 978-1-59940-701-2.
Minnesota Hospital Association (n.d.) Plain language emergency overhead paging: implementation toolkit.
Missouri Hospital Association. (2013). Standardized, Plain Language Emergency Codes: Implementation Guide. Retrieved September 15, 2015, from
http://web.mhanet.com/2013_Emergency_Code_Implementation_Manual.pdf
North Carolina Hospital Association. (2014). Implementation Guide: Standardized, Plain Language Emergency Alerts. Retrieved September 15, 2015, from
https://www.ncha.org/healthcare-topics/emergency-preparedness/emergency-alerts
Pennsylvania Patient Safety Authority. (2015). Standardized Emergency Codes May Minimize “Code Confusion”.
Pennsylvania Patient Safety Advisory, 12(1), 1-6. Retrieved September 15, 2015, from
http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2015/mar;12(1)/Pages/01.aspx
Redish J.C. (2000). What is information design? Technical Communication; 47(2):163-166.
Ryherd, E., Okcu, S., Ackerman, J., Zimring, C., & Persson Waye, K. (2012). Noise pollution in hospitals: Impact on staff. J. Clinical Outcomes Management, 19(11), 491-500. Retrieved September 15, 2015,
from http://turner-white.com/pdf/jcom_nov12_noise.pdf
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (n.d.). Plain Language: A Promising Strategy for
Clearly Communicating Health Information and Improving Health Literacy. Retrieved September 15, 2015, from
http://health.gov/communication/literacy/plainlanguage/PlainLanguage.htm
U.S. Department of Homeland Security (2008) National incident management system. Retrieved September 15, 2015, from
https://www.fema.gov/pdf/emergency/nims/NIMS_core.pdf
U.S. Department of Homeland Security, Office of Emergency (2010) Plain language FAQs. Retrieved September 15, 2015, from
http://www.dhs.gov/sites/default/files/publications/PlainLanguageFAQs_0.pdf
acknowledgments
THE SOUTH CAROLINA HOSPITAL ASSOCIATION WOULD LIKE TO
ACKNOWLEDGE THE FOLLOWING COMMITTEES FOR THEIR WORK AND SUPPORT
OF THE STANDARDIZED, PLAIN LANGUAGE EMERGENCY CODES INITIATIVE
SCHA Plain Language Emergency Codes Workgroup
SCHA Board of Trustees
SCHA Strategic Issues Council
SCHA Quality Council
THE SOUTH CAROLINA HOSPITAL ASSOCIATION ALSO
RECOGNIZES THE FOLLOWING STATE HOSPITAL ASSOCIATIONS FOR
THEIR WORK ON STANDARDIZED EMERGENCY CODES
Colorado Hospital Association
Florida Hospital Association
Iowa Hospital Association
Kansas Hospital Association
Minnesota Hospital Association
Missouri Hospital Association
North Carolina Hospital Association
Southern California Hospital Association
Wisconsin Hospital Association
additional resources
Along with this toolkit, we’ve included a number of supplemental resources.
To download additional copies of these pieces, please visit www.scha.org/plain-language.
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