A code black in surgery refers to a bomb threat or other security emergency occurring in the operating room (OR) or elsewhere in the hospital. It signals that immediate evacuation is required to protect patients and staff from potential harm.
What triggers a code black?
A code black may be triggered by:
- A phone call or other warning of a bomb threat targeting the OR or hospital
- The discovery of a suspicious package or device in or near the OR
- A violent incident unfolding near the OR, like an active shooter situation
- A non-medical emergency requiring rapid evacuation, like a fire or gas leak
The goal is to alert all available staff to the potential danger so that safety protocols can be swiftly implemented.
How is a code black communicated?
Clear and urgent communication is essential when initiating a code black. There are a few main ways it may be announced:
- The hospital operator will call the OR charge nurse and announce “Code black for the operating room.”
- Overhead paging systems will declare “Code black” followed by the location.
- Security officers will communicate the code black in person when evacuating the area.
This immediately tells all staff in the vicinity to stop what they are doing and evacuate. No explanation is provided initially in order to avoid panic and confusion.
What is the response to a code black?
Hospitals have detailed emergency protocols in place to respond swiftly and safely to a code black event. Here are typical next steps:
- The operating surgeon will stop the procedure and close the surgical opening as quickly as possible.
- Any non-essential staff will immediately leave the OR.
- Anesthesia providers will prepare the patient for urgent transport.
- Security will arrive to escort staff and patients out of the area.
- Patients will be moved either laterally to an adjacent OR or out of the department completely.
- OR staff will remain with patients throughout the evacuation.
The response priorities are to stabilize any open surgical patients, evacuate personnel, and relocate to a safe place while awaiting an all-clear notice.
How is the code black resolved?
Once the OR has been fully evacuated, security personnel and the bomb squad may sweep the area to assess the threat and declare the situation safe. An overhead announcement will then communicate “Code black all clear.”
At this time, patients and staff may re-enter the OR and resume surgical procedures as quickly as possible. Hospital leadership will ensure proper documentation describing:
- How the code black was communicated
- Personnel and patient response
- Details provided on the nature of the threat
- How the emergency was resolved
They will then debrief all teams to identify any gaps or improvements needed in the code black protocol.
Why is a swift code black response important?
Timely action is critical when evacuating the OR, where very vulnerable patients face life-threatening risk if procedures are disrupted. Delays could endanger both patients and staff.
Benefits of a swift code black response include:
- Preventing harm to patients, whose open bodies would be exposed if evacuation is not immediate.
- Allowing anesthesiologists to safely prepare patients for urgent transport.
- Quickly mobilizing security teams to secure the evacuation area.
- Protecting OR staff from potential physical threats.
- Localizing the emergency area to keep the rest of the hospital safe.
With an effective code black plan, hospitals can rapidly remove those in the impacted zone until the threat is addressed.
What emergency protocols help enable rapid response?
Hospitals institute various emergency management protocols to help OR teams act quickly and decisively in the event of a code black. These may include:
- Code black drills – Practice evacuations to assess and improve response.
- Coordination with security – Define security’s role in evacuations.
- One-touch phone calling – Pre-programmed numbers speed communication.
- Code carts – Carts stocked with emergency equipment for transport.
- Designated safe rooms – Nearby rooms to temporarily relocate patients.
With protocols like these in place, OR personnel can follow established steps to safely and quickly respond, protecting patient lives.
How are patients monitored after a code black?
Meticulous patient monitoring is critical in the minutes, hours and days after a code black, since the interrupted surgical procedure can create risks like:
- Hemorrhage from open vessels
- Air embolism due to open vessels
- Contamination of the sterile surgical site
- Adverse anesthesia effects
- Patient confusion or anxiety
To mitigate these risks, OR teams will:
- Perform frequent neurologic checks on anesthetized patients
- Monitor vital signs for any instability
- Watch incision sites for bleeding or contamination
- Assess pain levels and treat any discomfort
- Evaluate mental status when patients awaken
The OR charge nurse will oversee ongoing patient monitoring and document all assessments until the patient is safely recovered from anesthesia and any surgical complications.
What special risks do code blacks create for surgical patients?
Code blacks introduce a number of perioperative risks, both during and after the evacuation:
- Hemorrhage: Open blood vessels may begin bleeding when surgery stops suddenly.
- Infection: Open incisions are at risk for microbial contamination.
- Air embolism: Air bubbles can enter the bloodstream through open veins.
- Anesthesia complications: Interrupting anesthesia can lead to problems like awareness or lid lag.
- Blood clots: Lack of mobility increases DVT risk.
- Surgical objects left inside: Surgical sponges or instruments may be accidentally retained.
Care teams must balance these risks against the need for immediate evacuation during the code black event.
How are OR team members impacted psychologically?
The tremendous stress of a code black can have psychological effects on surgical personnel as well:
- Acute stress reaction – Anxiety, racing heart, etc. during the event.
- Post-traumatic stress – Distressing memories, dreams or flashbacks.
- Extended anxiety – Fears of another emergency occurring.
- Distrust – Doubting hospital safety protocols.
Hospitals have behavioral health specialists available to support staff members experiencing operational stress or trauma reactions. Counseling aims to promote coping skills and resilience when processing these emergencies.
Conclusion
A code black creates an intensely stressful situation in the OR, but prepared teams can respond quickly and safely when these rare events occur. Strict security protocols, coupled with rapid evacuation and patient monitoring, help mitigate the many risks associated with interrupting urgent surgeries. With the safety of both patients and personnel as top priorities, hospitals institute thorough emergency plans to manage code blacks while also supporting staff through any resulting psychological impacts.