Code Black in Hospitals: What Does It Mean? Should I Worry?

• Code black in hospitals is becoming a new emergency-level status, but what does it mean?
• Typically, this status is declared by a hospital bed manager and is only called when certain criteria are met.
• In most cases, code black in hospitals serves as a last resort to preserve resource allocation.

Editor’s note: This article was originally published on Sept. 24, 2021, and updated on Aug. 24, 2024.

As a nurse myself, I had never heard of a code black in hospitals before.  

Code red means fire, blue for cardiac or respiratory arrest, pink for stolen or missing baby, and silver for an active shooter within the facility. These were all the universal codes that I learned throughout my time in the field.  

Interested in learning what a code black entails?  

What is a Code Black Status?

Hospitals across the U.S. are beginning to shift into a ‘code black status,’ but what does that mean? 

Code black in hospitals is typically determined by the bed manager and declares that all non-emergency and outpatient procedures be deferred with few exceptions.  

When this is declared, it’s due to a lack of resources, such as bed capacities, staffing shortages, or various medications and tools used for medical interventions.

 If code black in hospitals is called, patient safety is put at risk. 

What Causes Code Black in Hospitals to be Called? How Is It Implemented?

Now, that is the ultimate question, isn’t it?  

Here in some of our local hospitals in Lexington, Kentucky, we are already seeing them canceling elective surgeries for the same reason.  

That alone causes mass chaos.  

People needing hysterectomies, back surgery, knee replacements, LASIK, and the list goes on and on. 

And then, of course, the next problem is the new backlog of procedures piling up.  

If the last year and a half has taught us anything, it is that COVID-19 is here to stay and is not going anywhere anytime soon.  

Unfortunately, I wouldn’t be surprised if code black in hospitals became more prevalent.  

But what if it becomes more than just the cancellation of elective surgeries?  

What if it is not just a precautionary measure for when hospitals are out of ventilators, but rather, we are out of ventilators?  

This is not a drill.

The Universal DNR Order

Various Idaho hospitals have a “Universal DNR Order” implemented into its Crisis Standards of Care Action Plan.   

According to an Idaho Department of Health and Welfare document on strategies for patients in “scarce resource situations,” the Universal DNR Order is defined as: 

“Adult patients who are hospitalized during a patient emergency when crisis standards of care have been declared, and hospitals are using mechanical ventilation allocation framework due to high demand of ventilators, that adult patients should receive no attempts at resuscitation in the event of cardiac arrest.”  

This may sound barbaric, however, as unfortunate as it is, it’s a possibility if facilities become so overrun without enough resources. 

For a universal DNR order to be called in a facility, there must be an insufficient number of ventilators, and the facility must be operating under the Crisis Standards of Care plan with a Universal DNR clause applied. 

Idaho hospitals last operated under the Crisis Standards of Care in February 2022.  

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