Perceptions of hospital emergency color codes among hospital employees in Korea

Highlights

• Different emergency color codes are used in different countries, regions, hospitals.

• Color images vary depending on education, lifestyle, culture, and tradition.

• Hospital employees tended to select colors denoted in their respective hospitals.

• Red, blue, pink, and white could be adopted as standardized color codes in Korea.

Abstract

Introduction

Hospital emergency codes frequently comprise of colors to prevent confusion and enhance prompt response to emergency situations. The purpose of this study was to identify perceptions of emergency color codes among hospital employees in Korea.

Methods

A 12-color spectrum and emergency situations were selected from the standardized emergency color codes used in the US and Canada. Participants were selected via convenience sampling from four general hospitals in Seoul and Gyeonggi-Do. Between October 25 and November 30, 2016, 295 questionnaires were distributed and 266 of them were analyzed.

Results

The participants showed the highest consistency in the association between emergency images related to colors and emergency code color images associated with emergency situations in the following cases: “red for fire,” “blue for adult cardiopulmonary resuscitation (CPR),” “yellow for pediatric CPR,” “orange for external disaster,” “pink for infant/child abduction,” “white for deactivation,” and “black for violent/combative person.” Meanwhile, the most confusing colors were purple, gray, and silver. Hospital employees tended to select colors that matched the emergency codes used in their respective hospitals.

Conclusions

The four colors of “red,” “blue,” “pink,” and “white,” were strongly associated with “fire,” “cardiac arrest,” “infant/child abduction,” and “emergency deactivation,” respectively. The use of four colors for hospital emergency code standardization domestically in Korea is recommended.

Introduction

A hospital emergency code refers to the sign used by hospital staff, in the hospital or community, to prevent confusion and enhance prompt response with respect to emergency patients who require cardiopulmonary resuscitation (CPR) or to address mass casualties caused by disasters [1], [2], [3]. Emergency codes are often color-coded because it is easier to quickly identify their meaning than that of characters [4]. Therefore, color codes are considered as a visual language that many people can understand without language barriers [5], [6], [7].

However, different emergency color codes are used in different countries, regions, and hospitals, which can cause confusion and secondary accidents when healthcare workers in neighboring hospitals work together, or when firefighters or police personnel work together [4], [8], [9], [10], [11]. To minimize these concerns, more than 25 hospital associations in the US have established a standardized emergency code, and the Federal Emergency Management Agency (FEMA) [12], under the US Department of Homeland Security, has recommended the standardization of emergency codes into plain language. The use of plain language codes is recommended to aid patients’ health decision making in emergency situations by ensuring hospital transparency and considering the level of health literacy of the patient [4], [12]. Missouri State, Iowa State, and others have transitioned to using Plain Language Emergency Codes [13], [14]. Meanwhile, in Scandinavian countries hospitals do not denote color codes for emergency situations, but sometimes in-hospital preparedness are color coded based on the Medical Emergency Triage and Treatment System (METTS) to improve patient flow [15]. However, despite various strategies, the application of emergency color codes only in color, or color based emergency codes including some plain language, is still a common practice worldwide [16].

Emergency Color Codes are paged in English, such as “Code Red,” rather than using colored flags or flashing lights [10], [17]. Most hospital employees around the world, irrespective of whether English is their second language, may listen to the code in English. This requires them to interpret such messages into their first language. Therefore, it is important to consider if Korean hospital employees, whose native tongue is not English, can immediately recall the color on hearing the code in English, or reflectively think of a certain emergency without linking it to color.

The images associated with color vary depending on the internal factors of the individual, as well as external factors such as education, lifestyle, culture, and tradition [6], [18]. The symbolism of color may vary depending on the age and area in which the individual lives [7], [19], [20], [21]. “Color image” refers to the visual sensation perceived by the eye as a specific object or adjective based on personal experiences or the environment [22]. “Association” is something linked in memory or imagination with a thing or person [23].

In Korea, the hospital accreditation guidelines of the Korea Institute of Healthcare Accreditation (KIHA) [24] require the use of emergency codes only for CPR. Therefore, the number and the meaning of emergency codes differ across hospitals, and often, these codes do not consider the color image and possibility of recall of hospital employees.

The purpose of this study was to identify perceptions of emergency color codes among hospital employees in Korea.