A code gray is an emergency code used in hospitals and other healthcare facilities to indicate a potentially violent or behavioral emergency. It alerts staff to a potential threat posed by an aggressive or combative patient, visitor, or other individual on the premises.
Purpose of a Code Gray
The purpose of calling a code gray is to notify staff throughout the facility of a dangerous or threatening situation quickly so they can take appropriate security and response measures. It indicates there is an immediate risk of physical harm to healthcare workers, patients, or others from a disruptive, aggressive, or violent person on the premises.
It mobilizes specially trained staff such as security personnel to respond rapidly and de-escalate or contain the situation. It also allows healthcare workers and others to get out of harm’s way by providing an early warning before the situation escalates to violence.
When is a Code Gray Called?
A code gray may be called for incidents such as:
- A threatening, disruptive, or violent patient
- A threatening or disruptive visitor
- An active shooter situation
- A bomb threat or other security threat
- Domestic violence situations
- Gang violence within the facility
- A person wielding a weapon
- Any other potentially dangerous or violent situation
The code alerts all hospital staff to a clear and present danger that requires an emergency response. It is only used for immediate or rapidly escalating threats of violence, not just a mildly agitated patient.
How a Code Gray is Initiated
A code gray can be initiated by any staff member in a healthcare facility who witnesses threatening behavior. They will call the emergency dispatch operator at the hospital and report a “Code Gray” along with the location.
Emergency operators are trained to collect essential details about the code gray, such as:
- Where is the event located?
- How many perpetrators are involved?
- Are weapons involved?
- Is anyone injured or being threatened?
Staff are also trained to activate the nearest emergency call box and provide details if the situation is life-threatening. The emergency dispatch operator will immediately relay the “Code Gray” alert through the facility’s alert system.
Code Gray Alert and Announcement
When a code gray is called, an announcement will be broadcast through the healthcare facility via the PA system, mass notification system, and other communication channels to alert staff. An example code gray announcement would state:
“Code Gray, [Location]. Code Gray, [Location].”
The location identifies where the event is taking place so staff know to avoid that area. No other details are broadcast over the PA to avoid tipping off or further agitating the perpetrator.
In addition to a PA announcement, healthcare facilities have other methods to rapidly communicate the alert, including:
- Text alerts to staff mobile devices
- Email alerts
- Digital signage with warning messages
- Strobe lights
- Desktop computer pop-up alerts
- Badge vibration alerts for some staff
These redundant systems allow rapid notification to all staff throughout the building, both clinical and non-clinical.
Staff Response to a Code Gray
When they hear a code gray announcement, all staff are trained to take immediate precautions to protect themselves, patients, and others. The main responses include:
- Security staff: Will immediately report to the scene to contain the perpetrator and neutralize the threat.
- Clinical staff: Secure patients in a safe location, away from the threat. Remove objects that could be used as weapons.
- Non-clinical staff: Shelter in place in a secure room.
- Leadership: Establish incident command center to direct response.
If staff hear or witness a code gray but no alert has been called yet, they are trained to immediately call it in. Timely alerting is critical for staff safety in a rapidly escalating situation.
Code Gray Response Team
Healthcare facilities train specialized teams to respond to threats and de-escalate or contain violent situations. This typically includes:
- Security staff: Guard personnel and campus police who are trained in defensive tactics, nonviolent containment, appropriate use of force, and de-escalation techniques.
- Emergency response leadership: Emergency operations managers, emergency preparedness directors, emergency department leaders, and other key personnel trained in emergency response.
- Clinical staff: Designated clinical staff volunteers are trained as code gray responders to assist security personnel during an event.
The code gray response team takes a tiered approach to responding rapidly to contain the incident and protect healthcare workers and patients from harm.
Code Gray Precautions During Response
When responding to a code gray event, trained responders are advised to take tactical precautions including:
- Donning protective equipment like stab-proof vests
- Working in pairs or teams and using the buddy system
- Approaching in a careful, non-confrontational manner
- Trying verbal de-escalation first before using restraints
- Having emergency medication orders in place if needed for sedation
- Clearing hallways, entrances, exits to allow responders access
Healthcare facilities provide code gray response kits that include protective gear, specialized equipment like bite guards, restraints, and emergency medication orders that can be quickly accessed.
Code Gray Termination
Once the perpetrator is contained and the threat has been neutralized, the code gray response team commander will terminate the alert and announce an “All Clear” message. This lets all staff know the emergency situation has been resolved and normal operations can resume.
The code gray response team conducts an after-action analysis to identify opportunities for improvement in policies, training, resources, and communications to enhance response in the future.
Importance of Code Gray Training
Hospitals provide regular and mandatory education to ensure all staff know how to recognize threatening situations and respond appropriately to code grays. This includes:
- Annual education on code gray policies
- Role-specific education for security, clinical, and leadership staff
- Code gray drills and exercises
- De-escalation training
- Self-defense and physical containment techniques
Proper code gray training is vital for the safety of healthcare workers as well as patients. Education aims to prevent code grays by learning to recognize early warning signs of violence and intervene before situations escalate.
Code Gray Compared to Other Hospital Codes
Code grays differ from other emergency alert codes used in hospitals:
| Code Type | Purpose |
|---|---|
| Code Gray | Violent/combative behavior |
| Code Red | Fire |
| Code Blue | Medical emergency |
| Code Silver | Active shooter |
| Code Black | Bomb threat |
While codes like code blue and code red are purely for medical and fire emergencies respectively, code gray addresses security threats of violence unique to healthcare settings. It indicates a threat to health worker safety that requires a security-focused response.
Legal Considerations for Code Grays
When responding to code gray events, healthcare facilities must act within appropriate legal guidelines. This includes:
- Only using restraints and sedation when absolutely required for safety
- Avoiding excessive use of force
- Honoring advanced directives
- Involving law enforcement for criminal threats
- Following mandatory reporting requirements for violent crimes
- Conducting risk assessments before discharge if threats were made
- Documenting all code gray response actions, including any use of restraints or medications
Hospitals have a duty to provide a safe, non-violent environment for patients, visitors, and staff members. However, they must also follow laws and regulations governing emergency response, healthcare, and patient rights when addressing code gray scenarios.
The Impact of Code Grays on Healthcare Workers
Experiencing or responding to violent emergencies can have significant psychological impacts for healthcare workers. Code grays and other threats of workplace violence contribute to:
- Increased stress, anxiety, and burnout
- Fear, anger, and feeling unsafe at work
- Post-traumatic stress injury and trauma
- Increased risk of depression, substance abuse, and suicide
Hospitals aim to provide mental health resources to support staff resilience and recovery from traumatic events. Having clear code gray policies, training, and resources also empowers healthcare workers to feel capable of responding to threats safely and effectively.
Conclusion
Code grays are a vital way for hospitals to alert their staff to threatening behavior or violence occurring on the premises. They indicate a clear risk to the safety of healthcare workers and patients from disruptive, aggressive, or armed individuals. Code grays mobilize specially trained security and clinical teams to quickly contain the threat using de-escalation, protective actions, and other emergency response protocols. Hospitals continue to enhance code gray policies and training to provide healthcare staff with the knowledge, resources, and support systems they need to respond safely and effectively to violence in the workplace.
