JRFHHA

Sheetal Singh et al 10.5005/jp-journals-10035-1047

ORIGINAL ARTICLE

Code Blue Policy for a Tertiary Care Trauma

Hospital in India
1
Sheetal Singh, 2DK Sharma, 3Sanjeev Bhoi, 4Sapna Ramani Sardana, 5Sonia Chauhan

ABSTRACT Keywords: Cardiac arrest, Code Blue, Crash cart.

“Code Blue” is generally used to indicate a patient requiring How to cite this article: Singh S, Sharma DK, Bhoi S, Sardana SR,
resuscitation or in need of immediate medical attention, most
Chauhan S. Code Blue Policy for a Tertiary Care Trauma Hospital
often as the result of a respiratory arrest or cardiac arrest.
When called overhead, the page takes the form of “Code in India. Int J Res Foundation Hosp Healthc Adm 2015;3(2):114-122.
Blue, (floor), (room)” to alert the resuscitation team where to
Source of support: Nil
respond. Every hospital, as a part of its disaster plans, sets
a policy to determine which units provide personnel for code Conflict of interest: None
coverage. In theory, any emergency medical professional may
respond to a code, but in practice the team makeup is limited
to those with advanced cardiac life support or other equivalent REVIEW OF LITERATURE
resuscitation training. Frequently, these teams are staffed by
Hospital emergency codes are used worldwide to alert
physicians (from anesthesia and internal medicine in larger
medical centers or the emergency physician in smaller ones), staff for various emergency situations in hospitals. The
respiratory therapists, pharmacists, and nurses. A code team use of codes is intended to convey essential information
leader will be a physician in attendance on any code team; quickly with a minimum of misunderstanding to the
this individual is responsible for directing the resuscitation
hospital staff, while preventing stress or panic among
effort and is said to “run the code”. This phrase was coined
at Bethany Medical Center in Kansas City, Kansas. The term visitors of the hospital.
“code” by itself is commonly used by medical professionals as “Code Blue” is generally used to indicate a patient
a slang term for this type of emergency, as in “calling a code” requiring resuscitation or otherwise in need of immediate
or describing a patient in arrest as “coding”.1
The purpose of this study is to make available policy with
medical attention, most often as the result of a respiratory
regard to Code Blue which can be followed in a tertiary care or cardiac arrest. Each hospital, as a part of a disaster plan,
hospitals. It was a descriptive cross-sectional study carried sets a policy to determine which units provide personnel
out between January and June 2015. The study population for code coverage. In theory, any medical professional
included doctors, nursing personnel, paramedical staff and
quality managers of tertiary care hospital from public and may respond to a code, but in practice the team makeup
private hospitals. Checklist was made after an exhaustive is limited to those who had advanced cardiac life support
review of literature which was then improvised. The checklist or other equivalent resuscitation training. Frequently,
was discussed in focused group discussion held on 1 June physicians from anesthesia, emergency medicine and
2015, and suggestions were incorporated. Validation of the
checklist was also done by experts in various private and internal medicine are charged in the team. A rapid
public hospitals. Subsequently, interaction was done with study response team leader or a physician is responsible for
population against the backdrop of the checklist and Code Blue directing the resuscitation effort and is said to “run the
policy was formulated.
code”.2

General Principles of Code Blue3

1,4
Resident, 2Medical Superintendent, 3Additional Professor
and Medical Superintendent, 5Nurse Coordinator After ensuring the safety of the patient, staff and
1,2,4
Department of Hospital Administration, All India Institute bystanders, the management of the collapsed patient
of Medical Sciences, New Delhi, India involves as follows:
3
Department of Emergency Medicine, Jai Prakash Narayan • Prevention of further injury
Apex Trauma Centre, All India Institute of Medical Sciences • Checking response to verbal and tactile stimuli
New Delhi, India • Care of airway, breathing and circulation
5
Department of Nursing, Jai Prakash Narayan Apex Trauma • Calling for help
Centre, All India Institute of Medical Sciences, New Delhi, India • Control of bleeding
Corresponding Author: Sheetal Singh, Resident, Department • Protection from the environment
of Hospital Administration, All India Institute of Medical • Maintenance of normal body temperature
Sciences, New Delhi, India, Phone: 01126593308, e-mail:
• Protection of skin and nerves by protection of bony
[email protected]
prominences from hard objects

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 JRFHHA

Code Blue Policy for a Tertiary Care Trauma Hospital in India

• Reassu­r ance and continued observation of the and jobs with all or nearly all of their cognitive abilities
collapsed patient. intact.6 Each year in the US, 400,000–460,000 persons die
Each member of the multidisciplinary team is to of unexpected SCD in an emergency department (ED) or
know and understand the skills and roles of each person before reaching a hospital.7
involved in the Code Blue response. During a Code Blue The proportion of SCD that occur out-of-hospital has
response, the multidisciplinary team recognizes the increased since 1989. Death and disability from a heart
resuscitation team leader for possessing broad skills of attack can be reduced if persons having a heart attack
organization and performance related to the Code Blue can immediately recognize its symptoms and call for
response. emergency care. Prehospital emergency medical service
All active members should be performing as a well- systems can assist in reducing SCD rates by dispatching
constructed team, polished by practice and experience. appropriately trained and properly equipped response
This will assist in preventing a disorganized and frantic personnel as rapidly as possible in the event of cardiac
code scene (Flow Chart 1).3 The incidence of out-of- emergencies. However, national efforts are needed to
hospital cardiac arrest is estimated between 36 and 128 increase the proportion of the public that can recognize
per 100,000 subjects per year. In these victims, cardio­ and respond to symptoms and can intervene when
pulmonary resus­citation efforts are made in as many as someone is having a heart attack, including calling the
86%, and return of spontaneous circulation (ROSC) can designated number, attempting cardiac resuscitation, and
be achieved in 17 to 49%.4 using automated external defibrillators until emergency
Cardiac arrest is a medical emergency that, in certain personnel arrive.7
situations, is potentially reversible if treated early. Survival rates for cardiac arrests that occur in hos­
Unexpected cardiac arrest can lead to death within pitals and outside them continue to be low (17 and 6%,
minutes: this is called sudden cardiac death (SCD). The respectively), and fewer than one-third of patients
treat­ment for cardiac arrest is immediate defibrillation if who have an out-of-hospital cardiac arrest receive
a “shockable” rhythm is present, while cardiopulmonary CPR. Consequently, a number of changes were made
resuscitation (CPR) is used to provide circulatory support to the 2005 American Heart Association Guidelines
and/or to induce a “shockable” rhythm. for CPR and emergency cardiovascular care. The
A number of heart conditions and non-heart-related changes were intended to simplify CPR in order to
events can cause cardiac arrest; the most common cause increase its use and effectiveness by both clinicians and
is coronary artery disease.5 non­professionals.8
Cardiopulmonary resuscitation is an impor­tant part In one of the study by Stundek et al, it was found that
of the management of cardiac arrest. It is recommended there were 1,142 cardiac arrests which were included in
that it be started as soon as possible and interrupted as the analytic data set. Prehospital ROSC occurred in 299
little as possible. The component of CPR that seems to individuals (26.2%). When controlling for initial arrest
make the greatest difference in most cases is the chest rhythm and other confounding variables, individuals
compressions. Correctly performed bystander CPR has with no endotracheal intubation (ETI) attempted were
been shown to increase survival; however, it is performed 2.33 (95% confidence interval [CI] = 1.63–3.33) times
in less than 30% of out of hospital arrests as of 2007. If more likely to have ROSC compared to those with
high-quality CPR has not resulted in ROSC and the one successful ETI attempt. Of the 299 individuals
person’s heart rhythm is in asystole, discontinuing CPR with prehospital ROSC, 118 (39.5%) were subsequently
and pronouncing the person’s death is reasonable after discharged alive from the hospital. Individuals having
20 minutes.5 no ETI were 5.46 (95% CI = 3.36–8.90) times more likely
For decades, conventional wisdom in treating patients to be discharged from the hospital alive compared to
with cardiac arrest was that if the heart stopped beating individuals with one successful ETI attempt.9
for longer than 6 to 10 minutes, the brain would be dead. A study was conducted in the year 1996, by Cobbe
Now a new treatment being embraced by a growing et al to determine the short and long-term outcome of
number of US hospitals suggests that patients can be patients admitted to hospital after initially successful
brought back to a healthy life even if their heart is stopped resuscitation from cardiac arrest out of hospital. From the
for 20 minutes, perhaps longer. In recent months around study, it was found that about 40% of initial survivors of
the US, doctors and nurses say, cardiac-arrest patients resuscitation out of hospital are discharged home without
who would previously have been given up for dead have major neurological disability. Patients at high risk of
been revived and discharged to return to their families subsequent cardiac death.10

International Journal of Research Foundation of Hospital & Healthcare Administration, July-December 2015;3(2):114-122 115
 JRFHHA

Code Blue Policy for a Tertiary Care Trauma Hospital in India

Sheetal Singh et al
Who can Activate code blue? to arrive at the scene as soon as they get the message
Flow Chart 1: Process flow during
(Code“Code
BlueBlue”
response time is expected to be < 3
Any individual may call a Code Blue and certified staff
minutes).
will initiate basic life support (BLS) and automated
• The members of the Code Blue team must ensure
external defibrillator (AED) if available, until relieved by
that the area/scene is safe before proceeding with
the Code Blue team.
their response. This requires rapid assessment of the
How to Activate code blue?11 location and circumstances associated with the Code
• The Code Blue team has to be notified by the control Blue call.
room (room designated to notify the message to the • The members of the Code Blue team will not
response team) respond to areas where unpredictable and variable
• The individual calling the Code Blue must dial the environmental conditions exist. When a Code Blue
designated number to call a Code Blue is called, all members of the Code team will respond
• Identify yourself to the call centre staff who responds immediately.
to the call • Refer to appendices for site-specific information regarding
• Give the exact location (i.e. unit, floor, wing, building) members of the Code Blue team (Annexure 1).
• Tell him/her that there is a adult/pediatric Code Blue • Code team members function collaboratively during
• Code Blue team will be notified using public address the code with one person identified as the code team
system. leader.
• The Code Blue will follow the advanced cardiovascular
What Happens when code blue is Announced?12
life support (ACLS) guidelines. It is recommended
• When Code Blue is announced the message is sent to all members have current ACLS training and
the Code Blue team (Annexure 1), who are expected certification.

Annexure 1: Responsibilities of Code Blue team

team Leader
Doctor from department of anesthesiology will be the team leader
• Designates roles to team members and directs their actions
• Decides appropriate treatment as per ACLS guidelines and gives orders to team members
• Decides appropriate disposition of patient once stabilized
• Brief the patient’s attendant after resuscitation and will make sure that information has been passed to patient’s family members
• Ensures that one member (nursing) is designated to record events in the Code Blue flow sheet (Annexure-3) and get it verified
from the team leader
• Fill Code Blue report (Annexure 2) and submit to the Code Blue committee.

Physician or Anesthesiologist
Manages the airway and circulation.

One Nurse
• Assists doctor in managing the airway
• Assists in obtaining intravenous access and drug administration as per team leader’s instructions
• Assists in managing code as requested
• Will remain with the patient until the transfer occurs?

Other Nurse
• Automated external defibrillator (AED)/defibrillator switched on
• Monitor rhythms through AED pads /ECG leads/paddles
• Rhythm analysis and shock delivery as advised by Code Blue team leader
• Fill Code Blue flowsheet and attach to the patient’s medical record after showing the same to team leader.

security Personnel
• Directs team members toward code location
• He must ensure the area/scene is safe before proceeding with their response
• Ensures that no crowding of Code Blue site takes place.

Hospital Attendant
• Help nursing staff in pushing crash card near the patient
• Assists in various other activities.

International Journal of Research Foundation of Hospital & Healthcare Administration, July-December 2015;3(2):114-123 117
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Code Blue Policy for a Tertiary Care Trauma Hospital in India

Need of the Study of 50 doctors approached, 34 nurses responded out of 50,

20 quality managers interacted out of 50 and 16 doctors,
Cardiac arrest is a medical emergency that, in certain
expertize in handling Code Blue responded out of 25
situa­tions, is potentially reversible if treated early.
approached and 14 nurses, expertize in infection control
Unexpected cardiac arrest can lead to death within
practices out of 25 approached. Policy was framed after
minutes: this is called SCD.5
Despite advances in the prevention and treatment incorporating inputs from responses received against the
of heart disease and improvements in emergency backdrop of the checklist.
trans­port, the proportion of cardiac deaths classified
CODE BLUE POLICY FOR A TERTIARY CARE
as “sudden” remains high, probably because of the
TRAUMA HOSPITAL IN INDIA
unexpected nature of SCD and the failure to recognize
early warning symptoms and signs of heart disease. The Aim of the Policy
age-adjusted SCD rates and the state-specific variation
To make clear to all the staff about Code Blue and to
in the proportion of SCDs suggest a need for increased
inform and guidance regarding the same. This document
public awareness of heart attack symptoms and signs.7
summarizes the information to patients and the staff
Death and disability from a heart attack can be
about Code Blue policy. It put in the picture how the
reduced if persons having a heart attack can imme­ institute will meet its training requisites to ensure that
diately recognize its symptoms and call for emergency staffs receives adequate training in relation to Code Blue
care. Prehospital emergency medical service systems policy.
can assist in reducing SCD rates by dispatching appro­
priately trained and properly equipped response Goals and Purpose
personnel as rapidly as possible in the event of cardiac
The goals and purpose of this policy is to ensure that
emergencies. However, national efforts are needed to
skilled medical team response for emergency resusci­
increase the proportion of the public that can recognize
tation is provided.
and respond to symptoms and can intervene when
someone is having a heart attack, including calling a Scope
designated number, attempting cardiac resuscitation,
Provide skilled medical team response for emergency
and using automated external defibrillators until
resuscitation.
emergency personnel arrive.7
Responsibility
METHODOLOGY All employees of the hospital, Cardiac Arrest Review
It was a descriptive cross-sectional study carried out Committee for monitoring.
between January to June 2015. The study population
included doctors, nursing personnel, paramedical staff What is Code Blue?1
and quality managers of tertiary care trauma hospital Code Blue is one of the emergency procedure codes for
from public and private hospitals. Checklist was made cardiopulmonary arrests and life-threatening emer­gencies
after an exhaustive review of literature which was then in areas of the hospital. A Code Blue is the term used to
improvised. The checklist was discussed in focused alert the Code Blue team (resuscitation team) to an area
group discussion held on 1 June 2015, and suggestions where a person has had a cardiac/respiratory arrest.
were incorporated. Validation of the checklist was Any attempt at resuscitation is better than no attempt.
also done by experts from various private and public
hospitals. Subsequently, interaction was done with study Purpose
population against the backdrop of the checklist and To provide immediate life saving measures in cases of
Code Blue policy was formulated. life threatening emergencies.

ANALYSIS AND RESULTS When to Activate Code Blue?

A total of 200 people which included doctors, nurses, A Code Blue will be initiated on all patients, visitors
paramedical staff, and quality managers of tertiary and staff suffering a cardiac/respiratory arrest showing
care public and private hospitals were approached for following symptoms:
interaction against the backdrop of the checklist. Total • Not responsive
response rate was 62%. Forty-one doctors responded out • No breathing

International Journal of Research Foundation of Hospital & Healthcare Administration, July-December 2015;3(2):114-122 117
Sheetal Singh et al

• No neck pulse (to be witnessed by healthcare • The individual calling the Code Blue must dial the
provider). designated number to call a Code Blue.
• Identify yourself to the call center staff who responds
Sheetal
Who canSingh et al
Activate Code Blue? to the call.
• The individual assigned as recorder will document •
• Give the exact location
Resuscitation (i.e., unit,
equipment floor,
will be wing, building)
immediately
Any individual may call a Code Blue and certified staff
• Tell him/her that there is a adult/pediatric Code Blue
willallinitiate
treatments,
basicmedications,
life supportelectrocardiogram
(BLS) and automated data, available for all Code Blue calls.
• Code Blue team will be notified using public address
etc. on the
external Code Blue
defibrillator record
(AED) (Annexure 3). The
if available, Code
until relieved by • Following a successful resuscitation of in-patient, and
system.
Record remains in the
the Code Blue team. patient’s medical record after planned transfer to a critical care unit, a Code Blue team
designated individual show it to the team leader. nurse
What will remain
Happens withCode
when the patient
Blueuntil
is the transfer occurs.
Announced?
11
How
• The to Code
Activate
BlueCode
recordBlue?
(Annexure 2) is filled by the • Following
(Flow Chart 1) 12
successful codes on other than registered
teamCode
• The leader at the
Blue teamend of the
has Code
to be Blue by
notified andthesubmit to
control in-patients
• When Code (admitted patients)the
Blue is announced the patient
message is should
sent to
Code Blue committee completes the monthly
room (room designated to notify the message to the statistics be transferred to ED for further assessment
the Code Blue team (Annexure 1), who are expected and
for code committee.
response team). treatment. Exceptions to the above may occur.
to arrive at the scene as soon as they get the message
Affix patient label

Annexure 2: Code Blue report

This form has to be filled by the team leader of the Code Blue team who is the in-charge of the
patient after evaluating the event.
This is to be submitted to the Code Blue review committee within 24 hours of occurrence of the event.
This form is for quality assurance purpose.

Date and time of Code Blue _______________________________________________________________________

Location of the Code Blue ________________________________________________________________________

Patient’s description in brief

_____________________________________________________________________________________________
_____________________________________________________________________________________________

Conditions which led to Code Blue

____________________________________________________________________________________________
____________________________________________________________________________________________

Was the Code Blue managed appropriately?

____________________________________________________________________________________________
____________________________________________________________________________________________

Gaps in following the Code Blue protocol

____________________________________________________________________________________________
____________________________________________________________________________________________

Anything important needs to be mentioned

____________________________________________________________________________________________
____________________________________________________________________________________________

Name and sign of the doctor Date

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JRFHHA

Code
Code Blue
Blue Policy
Policy for
for a
a Tertiary
Tertiary Care
Care Trauma
Trauma Hospital
Hospital in
in India
India

Annexure 3: Code Blue flowsheet (adult and pediatric)

Name ____________________________, Age ____________ Circumstances Treatment given to the patient
Sex _____________ UHID of the Patient _________________ prior to arrest prior to code team arrival
Date __________ Time of Code Blue announcement ________,
Time of arrest _______________, Witnessed ______________, Time of starting CPR ___________
Diagnosis
Unwitnessed ______________________________________ CPR given by _______________

Cardiac arrest Respiratory a rrest

Airway/Ventilation
Breathing at onset Spontaneous: Aponic: Agonal: Assisted
Time of first assisted ventilation: Ventilation: BVM ET Tracheotomy others
Intubation: Time ___________________ Size: ___________________ By whom __________________

Defibrillation (Joules) Epinephrine Atropine Amiodranone Lidocaine Magnesium Code Blue team
members

TI B P R S R Comments:
M P R R A H
E O Y
2

Monitor strips to be pasted here Nursing notes

Monitor strips to be pasted here Outcome

Time resuscitation ended ____________________________

Status: Alive Dead

Reason of ending resuscitation______________________________________

Return of circulation_______________________________________________
Medical futility_____________________________________________________
Time deathdeclared _______________________________________________
Death declared by whom ___________________________________________
Family present at that time___________________________________________
_____________________________________________________________
Name of the family member contacted ________________________________
Recorder’s signature ______________________________________________
Sheetal Singh et al

cause

Other remarks if any

Auditor's report

Signature of the staff Signature of the team leader

International
International Journal
Journal of
of Research
Research Foundation
Foundation of
of Hospital
Hospital &
& Healthcare
Healthcare Administration,
Administration, July-December
July-December 2015;3(2):114-123
2015;3(2):114-122 119
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Sheetal Singh et al Code Blue Policy for a Tertiary Care Trauma Hospital in India

(Code Blue response time is expectedFlow Chartto1:be

Process flow during ‘Code Blue’
< 3 (ECG) data etc., on the Code Blue record (Annexure 3).
minutes). The Code record remains in the patient’s medical record
• The members of the Code Blue team must ensure after designated individual show it to the team leader.
that the area/scene is safe before proceeding with • The Code Blue report (Annexure 2) is filled by the
their response. This requires rapid assessment of the team leader at the end of the Code Blue and submit to
location and circumstances associated with the Code Code Blue Committee completes the monthly statistics
Blue call. for Code Committee.
• The members of the Code Blue team will not res­ • Resuscitation equipment will be immediately availa­
pond to areas where unpredictable and variable ble for all Code Blue calls.
environ­mental conditions exist. When a Code Blue • Following a successful resuscitation of in-patient, and
is called, all members of the Code team will respond planned transfer to a critical care unit, a Code Blue
immediately. team nurse will remain with the patient until the
• Refer to appendices for site-specific information transfer occurs.
regarding members of the Code Blue team (Annexure 1). • Following successful codes on other than registered
• Code team members function collaboratively during the in-patients (admitted patients) the patient should be
code with one person identified as the code team leader. trans­ferred to ED for further assessment and treatment.
• The Code Blue will follow the advanced cardiovascular Exceptions to the above may occur.
life support (ACLS) guidelines. It is recom­mended all Means of announcing Code Blue differs from hospital
members have current ACLS training and certification. to hospital depending on the resources available.
• The individual assigned as recorder will document Number of Code Blue teams is not fixed and vary
all treatments, medications, electrocardiogram from hospital to hospital.

Annexure 4: Code Blue mock drill audit sheet (adult and pediatric)15-19
Assessment and activating help Yes No comments
Did the first responder assessed the patient appropriately?
Did the first responder verbally summoned the help?
Did he/she instructed someone to call on the designated number?
Was there proper delegation of tasks to 2nd and 3rd responder by first responder?
The victim was moved from the site of code only if absolutely essential to perform CPR effectively or safely
Did the 1st responder performed appropriate ABC assessment and intervention?
Alerting code blue
Was there any delay in alerting Code Blue?
Was Code Blue announced thrice (loud and distinct)?
"Adult" of pediatric code announced
Exact location specified when announced
Any Pager/phone issue(s)/or any other means of communication
Any other issue related
Did Code Blue team responded in time (< 3 minutes)
role of 2nd and 3rd responders
Did the crash cart arrive/Kit Bag within 2 minutes?
Did the 2nd responder did the assigned job appropriately?
(opened the crash cart, provided ambu, attached defibrillator, attached oxygen, helped with CPR)
Did the 3rd responder did the job as assigned (ensure/secure IV access)
cPr quality
Delivered compressions × 2 minutes, per AHA guidelines, then commenced with usual CPR
methodology as follows:
Opened airway/checked breathing
Delivered two breaths
Checked pulse (location appropriate to age of victim)
Positioned proper hand position for compressions
Contd...

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International Journal of Research Foundation of Hospital & Healthcare Administration, July-December 2015;3(2):114-123 121
 JRFHHA

Sheetal Singh
Sheetal Singh et
et al
al Code Blue Policy for a Tertiary Care Trauma Hospital in India

Contd...

Performed correct depth for compressions

Used correct rate/ratio for one-man CPR
Applied and/or used ambu bag correctly
Reported events information to second responders clearly
Vascular access
Delay
Inadvertent arterial cannulation
Infiltration/disconnection
Other (specify in comments section)
Defibrillation(s):
Once AED available, turn on machine, applied pads and activated AED
Contd...
Followed directives per AED
crash cart
Located drugs and equipment easily
Located/assembled laryngoscope correctly and identified correct endotracheal (ET) tube
Prepared IV equipment
Correctly assembled suction
Universal precautions
Followed by all team members (gloves, face mask)
Documentation
Signature of Code team leader on code sheet
Incomplete record
Other
Team behavior
Was handover proper from 1st responder?
Were team members aware of their roles and responsibilities?
Was there any delay in identifying leader?
Was knowledge of equipment appropriate?
Was knowledge of medications/protocols appropriate?
Was communication among team members appropriate?
Any other issue
Any protocol deviation
With regard basic life support (BLS)
With regard to ACLS
Others
Equipment
Were equipment available
Were equipment available?
Was there any problem in the functionality of the equipment
Was there any problem in the functionality of the equipment?
Any
Any other
other issue
issue
Miscellaneous
Miscellaneous points
points
Did security personnel
Did security personnel respond
responded as per
as per role
role?
Did hospital attendants responded as per
Did hospital attendants respond as per role?role
*Code Blue mock drill assessment team will assess any deviation from the protocol and report to Code Blue committee
*Code Blue mock drill assessment team will assess any deviation from the protocol and report to Code Blue committee

Training Training would be conducted through regular classes

and Mock Drills (Annexure 4).
Continuous training is required for all the staff of the Awareness will be created by displaying poster both in
hospital (doctor, nurses, paramedics, grade IV, security) Hindi, English and a local language showing the number
for the implementation of Code Blue policy for all. clearly all around.

International
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Journal of Research Foundation of Hospital & Healthcare Administration, July-December 2015;3(2):114-122 121
Sheetal Singh et al

How Code Blue Teams may be Required for a Weekly Report 2002. p. 123-126. Available at: http://www.
Hospital? cdc.gov/mmwr/preview/mmwrhtml/mm5106a3.htm
8. Mutchner L. The ABCs of CPR—gain. [Internet]. Am J Nurs
There is no fixed number. Availability and accessibility 2007; 60–69; quiz 69-70. Available at: http://www.ncbi.nlm.
of resources (manpower, equipment), size of the hospital, nih.gov/pubmed/17200636.
9. Studnek JR, Thestrup L, Vandeventer S, Ward SR, Staley
design of the hospital and many other factors specific to
K, Garvey L, et al. The association between prehospital
the hospital should be taken into account while deciding endotracheal intubation attempts and survival to hospital
upon the number of Code Blue teams. discharge among out-of-hospital cardiac arrest patients.
Academic Emergency Medicine 2010. p. 918-925.
Limitation of the Policy 10. Cobbe SM, Dalziel K, Ford I, Marsden a K. Survival of 1476
patients initially resuscitated from out of hospital cardiac
This policy is specially designed for a trauma care arrest. BMJ [Internet]. 1996;312(7047):1633-1637. Available at:
hospital. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid
Means of announcing Code Blue differs from hospital =2351362&tool=pmcentrez&rendertype=abstract.
11. Medicine I, Management HC. Post-graduate programme
to hospital depending on the resources available.
international medicine – health crisis management, Essay
Number of Code Blue teams is not fixed and vary subject: code blue teams in general hospital. Guidelines and
from hospital to hospital. best practices post-graduate student: theoni zougou. 201.
12. Gerganoff CNOS, Csm M. Patient care services policy and
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