A code black is an emergency code used in hospitals and other medical facilities to signal a bomb threat or other security emergency requiring evacuation and lockdown. It alerts staff to a potentially dangerous threat on the premises so they can take appropriate action to protect patients, visitors, and employees. Code black indicates a life-threatening situation that necessitates an immediate response.
When a code black is called, it initiates a systematic response to secure the building and move people to safety. The priority is to get patients, staff, and visitors out of harm’s way as quickly as possible. At the same time, emergency personnel and security teams work to assess the threat, secure critical infrastructure, and contain the emergency.
Code black protocols can vary between hospitals, but they generally involve stopping all non-emergency activity, evacuating and sealing off affected areas, restricting access and movement within the building, and mobilizing police and SWAT teams if needed. The response draws on resources from hospital security, local police, emergency services, facilities management and hospital administration to manage the incident.
When is a Code Black Called?
There are a few situations that could prompt a hospital to declare a code black emergency:
– Bomb threat – Any time a credible threat about a bomb or other explosive device is received, a code black will be activated. This allows rapid evacuation and search of the building to find and disable any devices.
– Active shooter – If an active shooter or armed assailant enters a hospital, a code black mobilizes police while getting innocent people out of harm’s way as quickly as possible. Hospital security works to isolate, contain and neutralize the shooter threat.
– Infrastructure failure – A major infrastructure failure like a fire, gas leak or power outage may require a partial or total building evacuation during repairs. This necessitates a code black to prevent access and route people away from unsafe areas.
– External emergency – Any external emergency near a hospital that threatens operations could prompt a code black. This could include severe weather, a dangerous chemical spill, an aircraft crash or a major traffic accident nearby that overwhelms the hospital’s resources. A code black allows staff to prepare for and safely manage a potential influx of patients.
How Code Black Activations Work
When a code black is activated in a hospital, several things happen quickly:
– The code is announced – “Code black” alerts are broadcast over PA systems, radios, phones and other communication channels. They may be followed by specific instructions or the location. Code black may also be activated covertly in certain scenarios.
– Lockdown initiated – Access to the building is restricted and all entrances/exits secured. Internal doors are closed and locked to isolate danger zones. No one is allowed to enter or exit until the situation is cleared.
– Areas evacuated – Patients, visitors and non-essential staff are directed to exit the building or move to predetermined safe zones. Outpatient services may be canceled. Police and security teams sweep the area to ensure it is cleared of people.
– Security teams deployed – Available security and police officers are sent to critical locations like entrances, restricted areas, utilities and command centers. Their role is to contain threats, manage access and assist emergency response.
– Response teams activated – Teams trained to handle code black emergencies report to designated command locations. This can include administration leaders, emergency managers, physicians, nurses and support staff.
– Utilities secured – Resources like power, water, generators, communication systems are protected or shut down if necessary.
– Traffic rerouted – Access roads are kept clear for emergency vehicles and non-emergency traffic is directed away from the facility.
– Safe zones established – Designated assembly points are created where evacuated people can gather and be accounted for. Safe zones have access to food, water and bathrooms.
– Suspicious devices inspected – Police and bomb squad units sweep the building to locate and inspect any potential bombs, weapons or contraband.
– All-clear given – Once the threat is addressed, an all-clear ends the code black response and signals a return to normal operations.
Code Black Procedures for Hospital Staff
Hospital employees have specific duties and protocols they must follow when a code black is activated. These responsibilities aim to maintain safety, critical services and control of the situation.
– Physicians – Ensure patients are secured, stabilize critical cases, document patient needs and medications, provide additional clinical support as needed.
– Nurses – Account for patients, assist with evacuation or lockdown, gather supplies and medications for transport, manage safe zones.
– Security officers – Lock down facility, sweep key areas, guard entrances/exits, escort police, control elevators.
– Facilities staff – Shut down HVAC, utilities, generators, secure maintenance areas and hazardous materials.
– Administration – Report to emergency operations center, communicate with staff, liaise with police and authorities.
– Support staff – Guide evacuation routes, assist disabled individuals, provide water and necessities to people in lockdown.
– Ancillary staff – Cancel/divert deliveries and shipments, direct media inquiries to PIO, document events.
– Medical records – Secure and preserve patient records, provide information to care teams.
– IT staff – Protect systems integrity, restrict external access, preserve communications.
– Transport staff – Prepare emergency vehicles, establish safe patient transport routes.
All staff are expected to remain calm, evacuate if in an affected area, report suspicious activity, follow all instructions from emergency personnel and help others in need during code black events.
Communication During a Code Black
Clear communication is critical for managing any hospital emergency. For events like a code black, healthcare facilities have specialized communication plans to rapidly share information, instructions and updates.
Communication channels utilized for a code black may include:
– PA system announcements – Quickly broadcast alert hospital-wide.
– Phone trees / call cascades – Deliver targeted messages to department groups.
– Radios – Direct contact for security, facilities and transport teams.
– SMS text alerts – Send lockdown or evacuation orders to mobile phones.
– IP phones / intercoms – Connect administrators to crisis teams.
– Email alerts – Provide incident details and instructions.
– Printed memos – Post updates in gathering areas.
– Runners – Staff carry messages to distant personnel.
– Whiteboards – Display clear instructions in safe zones.
– Social media – Share public updates (in coordination with PIO).
– Website banners – Notify public of service disruptions.
Having redundant communication systems is vital so operations can continue if any one channel is compromised. Communication is managed from the hospital’s emergency operations center by the incident commander. Interpreters are utilized to ensure communication with any disabled or non-English speaking staff or patients.
Personnel Roles in a Code Black
Responding to a code black requires coordinated action from many personnel across a hospital. While exact roles vary between organizations, typical responsibilities include:
– Incident commander – Leads overall emergency response from hospital command center. Often a senior administrator.
– Emergency manager – Brings facilities, staff and systems together under incident command structure.
– Police liaison – Hospital’s primary contact with law enforcement responding to the scene.
– Facilities manager – Oversees building lockdown, utilities, restricted areas.
– Security manager – Directs hospital’s security force to contain threats, secure assets.
– Nursing supervisor – Coordinates care staff response, manages patient safe zones.
– Public information officer – Communicates with media and public stakeholders about the incident.
– Logistics lead – Sources equipment, supplies, food, transportation needed for response.
– IT manager – Maintains critical communication and data systems.
– Department heads – Execute response within their units (ED, Surgery, Pediatrics, etc.).
– Social workers – Address patient/family psychosocial needs.
– Clinical staff – Continue caring for current patients as safely possible.
Having clearly defined authority and responsibilities before an event allows rapid, coordinated action during the confusion of an actual emergency. Regular training and drills help ingrain these roles.
Code Black Training and Exercises
Given the chaos that emergency events like active shooters or bomb threats can create at a hospital, staff must be prepared well in advance through training and practice. Code black preparedness involves both awareness education and skills practice.
Training content may include:
– Threat recognition – Spotting suspicious packages or persons. Reporting policies.
– Communication protocols – Using code words, addressing language barriers.
– Equipment use – Operating duress alarms, emergency notification systems.
– Emergency procedures – Evacuation vs. defend-in-place. Handling utilities.
– Security basics – Access control, searching, evidence preservation.
– Emergency operations – Activating the Hospital Incident Command System.
– Self defense – For security staff to restrain threats.
– Stress management – Coping methods for trauma and panic.
Drills allow staff to practice code black response skills in a simulated scenario. Drills include activities like:
– Evacuation drills – Exiting areas and assembling at rally points.
– Lockdown drills – Securing rooms and sheltering-in-place.
– Search drills – Sweeping areas for suspicious items or persons.
– Skills checks – Demonstrating emergency equipment use and procedures.
– Tabletop exercises – Discussion-based practice for management teams.
– Functional drills – Activating only certain portions of the response.
– Full-scale exercises – Facility-wide scenario involving community partners.
The more realistic the training and drill scenarios, the better prepared staff will be if an actual emergency strikes. Scheduling regular refresher training ensures plans, skills and equipment remain current.
Code Black Emergency Supplies
Hospitals keep various supplies on hand to support code black and other emergency operations. Typical code black supplies include:
– Duress alarms – Worn by staff to covertly signal threats.
– Two-way radios – For communication between security and administration.
– Flashlights, headlamps – In case power is lost.
– Barrier tape, cones – To block off unsafe areas.
– Caution signs – Notify restricted or hazardous zones.
– Whistles, megaphones – Gain attention, give instructions.
– First aid kits – For any injuries sustained during an incident.
– Fire extinguishers – Critical for a facility.
– Blankets, cots – For staff/patients stuck in lockdown.
– Packaged food, water – For people unable to leave.
– Mobile phone chargers – Maintain communication channels.
– Backup generators – Provide power to critical systems.
– Emergency lighting – Illuminate escape routes and rally points.
– Printed action guides – Remind staff of procedures.
– Hotel key cards – Control access to secured areas during lockdown.
Supplies are kept in designated emergency storage areas with inventory checked and restocked routinely. Having equipment immediately on hand saves precious time during an emergency.
Code Black Precautions for Patients and Visitors
To assist hospitals in managing code black emergencies, patients and visitors should:
– Remain calm and follow all staff instructions.
– Leave belongings behind if evacuating.
– Report any suspicious activity immediately to staff.
– Silence mobile phones and avoid making phone calls.
– If evacuating, assemble at the designated rally point.
– If sheltering-in-place, stay away from windows, doors.
– Cooperate fully with security teams and law enforcement.
– Expect delays in care, meals, visitors, procedures.
– Anticipate having movement restricted during lockdowns.
– Refrain from posting incident details on social media.
– Wait for an official all-clear announcement before leaving safe zones.
– Be understanding of stressed staff managing a chaotic event.
– Seek medical help for any injuries or issues sustained during the incident.
Listening carefully and following instructions helps maintain safety in an emergency. Patience and cooperation also aids hospitals as they work to contain threats while caring for those affected.
Code Black Case Study Examples
To understand how code black responses work in real hospital emergencies, consider these case study examples:
Bomb threat at a children’s hospital
When a bomb threat was phoned into King’s Daughters Children’s Hospital in Brooklynn, New York, administrators immediately declared a code black. As police and bomb squad were dispatched, the hospital was placed into lockdown and non-critical patients were evacuated to an adjacent parking lot rally point. Teams swept the building room by room searching for any suspicious devices while families were notified and all but emergency surgeries canceled. Roads around the hospital were cordoned off by police. Thankfully the threat was a hoax. The code black lasted several hours until an all-clear was given.
Active shooter inside suburban hospital
An active shooting incident at Suburban Hospital in Bethesda, Maryland prompted a code black activation. The hospital’s security team quickly moved to confront and contain the shooter while administrators called 911 and initiated lockdown procedures. Staff shepherded patients away from the affected areas while police teams entered the building to pursue the attacker. Movement was restricted but patient care continued under tight security. After a 45-minute manhunt inside the building, the shooter was located and arrested with no casualties.
External tanker truck explosion
When a gasoline tanker truck overturned and exploded just outside Mercy West Hospital in Cincinnati, Ohio, the blast wave caused damage inside the building prompting a code black. Non-critical patients were discharged or transferred to sister hospitals to free up capacity while teams evaluated the integrity of the building and utility systems like power, water and fuel lines. Minor injuries were treated and debris cleaned up. Some sections remained closed pending repairs. Outpatient appointments were cancelled but emergency services continued with tighter security screening at entrances.
Bomb threat forces urban hospital evacuation
Staff at Community General Hospital in Chicago, Illinois implemented a code black evacuation after a bomb threat identified the basement as the target location. 1,200 patients were assisted to exit the building over 45 minutes and assembled in a parking area guarded by police. 200 patients considered critically ill or injured were kept under close watch inside protected sections of the hospital. Bomb technicians searched but found no device. After three hours, patients were moved back into the hospital once it was declared safe.
Code Black Best Practices
Examples from hospitals across the country reveal some best practices for managing code black events:
– Keep response plans updated and equipment stocked. Review policies every 6 months.
– Train all staff annually at minimum. Drill various scenarios throughout the year.
– Expand awareness training to include patients, families and community partners.
– Install duress alarms, security cameras, and access control systems. Monitor them closely.
– Make several evacuation options available depending on type of threat. Have procedures for both total and partial evacuation.
– Designate defensive safe rooms to shelter critical patients who cannot be moved. Stock with supplies.
– Back up critical communications, computer systems and patient records offsite.
– Maintain current patient rosters with care requirements to assist evacuation triage.
– Coordinate with community partners like law enforcement to align emergency plans.
– When possible, limit access points and implement screening to detect threats.
Following these steps helps hospitals fine-tune their code black protocols, train staff thoroughly and invest appropriately in emergency preparedness. Doing so builds more resilient facilities that can protect lives even in extreme events.
The Critical Role of Code Black
A code black represents a frightening yet real possibility at hospitals and medical facilities of all kinds. The number of violent acts, extremism and civil unrest make vigilant emergency preparedness more critical than ever at healthcare sites. By planning ahead, training relentlessly, and investing in safety, hospitals can minimize the damage from even the most explosive emergencies.
While no one wants to face crises like armed assailants or bomb threats, ignoring the risks is not an option. The existence of solid code black programs means that hospitals don’t have to be helpless in the face of violence. Staff have the tools needed to detect threats early, respond decisively, and shield those in their care from harm. Just as medical teams work tirelessly to save lives, code black protocols work tirelessly to sustain the safe havens needed to preserve those lives. The result – resilient hospitals where patients can heal and staff can work protected even in the darkest of times.
Conclusion
A code black signals a major security threat like a bomb or active shooter at a hospital that necessitates urgent lockdown, evacuation and an emergency response. Clear communication, comprehensive training and redundant safety systems help hospital teams respond decisively to contain dangers and protect lives until the situation is resolved and normal operations can resume. Having detailed code black procedures in place allows hospitals to maintain care during crises, train staff through drills, and invest appropriately in preparedness. While emergencies like bomb threats create an atmosphere of fear and uncertainty, proper code black protocols give hospitals the ability to combat those threats with calm action.