The Use of Plain Language Instead of Emergency Codes for Hospitals: Rationale and Implementation Guide


For many years hospitals have used emergency code terms to announce emergencies within the hospital and within the community that may affect the hospital. Currently, there are no regulatory standards for these codes so many hospitals make up their own. They are confusing, and ambiguous. The use of plain language is obvious and transparent to all. Transparency in a crisis situation is paramount for effective emergency notification and the safety of our staff, patients and visitors.

A national trend to use plain language versus color code announcements has been supported by the following organizations or reports.

  • S. Department of Health and Human Services
  • S. Department of Homeland Security
  • The National Incident Management System



Medium to large hospitals have hundreds to thousands of employees. Many of these employees are temporary employees that include medical students, student interns, travel agency nurses, and locum tenens physician and advance practicing health care workers. Some of these people work at other hospitals that have their own codes that may vary greatly from hospital to hospital. This can lead to confusion.

Many long-term employees aren’t extremely familiar with the emergency code words that have been used for years. A recent survey among hospital directors with 55 respondents revealed that 62% of the directors did not know what code word for a bomb threat. 40% were unaware of the term used for internal or external disaster.

When asked if it would be better to use plain language to announce emergency events instead of using code works, 65% of the respondents, believed it would be better to use plain language to announce these important notifications.



In 2012, the Missouri Hospital Association (MHA) conducted a survey of 134 hospitals concerning the use of emergency codes and the following information was identified.

  • There were four different codes terms to announce a fire
  • Seven different codes to announce a medical emergency
  • Six different codes to announce an abduction of an infant, child, or adult
  • Seven different codes to announce a severe weather alert
  • Nine different codes to announce a mass casualty event
  • Nine different codes to announce a hospital evacuation
  • Ten different codes to announce a security threat

A work group was formed and established the following objectives:

  • Reduce variations in codes among Missouri hospital
  • Increase awareness of public safety for staff, patients, and visitors
  • Promote transparency of safety protocols
  • Encourage hospitals to adopt standardized, plain language codes to protect patient and public safety within hospitals and health care facilities



For the safety of patients, visitors, and staff, Healthcare organizations must begin the process of transitioning from the use of code words to announce an emergency to the use of plain language. The use of plain language will lessen confusion and will give notification of a crisis. Notification may give innocent persons an opportunity to seek a more safe location.



  • The organization’s emergency management or safety representative should present the idea with evidence to support the change to plain language to the organization’s safety committee
  • With safety committee approval, this paradigm change should be presented to the organization’s administration for approval
  • After administrative approval, a communication plan must be developed. Work closely with the organization’s Marketing/ Communications/PR department to develop:
    • An organizational email detailing the change and why it is changing
    • An article on the organizations intranet home page concerning the change and why
    • Volunteering to present the changes and departmental staff meetings
  • Provide regular updates as needed
  • Continue education and training on the use of plain language throughout the organization



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 December 6, 2012, from

U.S. Department of Homeland Security (2008) National incident management system. Retrieved December 6,
2012, from

U.S. Department of Homeland Security, Office of Emergency (2010) Plain language FAQs. Retrieved December 6, 2012, from

Porth, L., (2013) MHA Standardized, Plain Language Emergency Codes: Implementation Guide. Missouri