Code Orange: Be Prepared This Festival Season

Colour blocks with the letters CODE

Healthcare organizations will routinely have staff who manage emergency preparedness, with links to external partnerships (such as emergency responders, and other healthcare organizations who can accept patient transfers to free up bed space). Their role is to provide a safe environment by developing training, and testing effective emergency response procedures for all emergency codes (Ontario, British Columbia, Alberta, Nova Scotia, Newfoundland, as examples of the codes).

In recent years, hospitals have seen an increasing number of code orange calls in response to large events, and incidents like bus accidents, targeted van attacks, shootings, and COVID.

With many outdoor festivals back on the scene this summer, healthcare organizations must plan ahead for potential code orange calls – it’s the only way to be ready.

The overall goal of a code orange in a healthcare setting is to:

  • Enable the organization to receive and treat a sudden influx of casualties requiring emergent treatment
  • Establish triage and treatment areas to ensure incoming patients and staff are safe
  • Adjust hospital operations to increase availability of staff and beds to manage the number of casualties arriving at the organization
  • Establish an Emergency Operations Centre, as needed, to assist with meeting increased demands on the organization by being the central location to receive essential information (internally and externally) and disseminate information appropriately
  • Set up a Family Information Support Centre, as needed, that will provide support to family members of casualties of the external disaster

Risk management considerations (not an inclusive list):

  • Ensure a policy specific to the code, in this case code orange, covers the following:
    • It clearly articulates and guides staff in their roles and responsibilities that, in the event of a disaster situation (internally or externally generated) and in collaboration and cooperation with external agencies and partners, they can effectively and efficiently respond, manage, recover and resume normal operations and services
    • Ensures primary accountabilities of all key departments are specified (e.g., admitting, biomedical, central processing, communications, diagnostic imaging, environmental services, finance, food services, health information management, central stores, human resources, infection prevention and control, information technology, inpatient units, laboratory services, linen, occupational health and safety, operating room, outpatient clinics, pharmacy, facilities management, respiratory therapy, security services, social work, spiritual care, etc.)
    • The policy should enable the development of: 
      • Guidelines, procedures, plans, roles and responsibilities, communications, systems and facilities designed to support the efforts of the emergency response teams at the organization, and the achievement of incident action plan objectives and strategies
      • Processes associated with patient registration related to the influx of emergency department patients; documentation; continuity of patient care for already admitted patients; patient flow and location tracking
    • The policy and related documents support the overall priorities for the organization when confronted with a major emergency. The priorities include: 
      • Providing for the health and safety of people 
      • The stabilization of the emergency incident 
      • The protection of property and limiting harm to the environment 
      • The continuation of care services for patients and residents.
  • Ensure staff, volunteers, visitors, patients, and their families know how to respond with these recommended instructions:
    • Remain calm 
    • Do not enter the affected area 
    • If able to do so, stay with your family / support network 
    • Await direction from hospital staff
  • Ensure the Emergency Operations Centre is operational, with primary responsibilities of:
    • Providing direction, coordination and control of the emergency response and recovery
    • Establishing short term and long-term priorities
    • Collect, evaluate and communicate information
    • Manage resources
    • Liaise with other agencies
  • Ensure there is a process to conduct routine mock code exercises that are collaborative and inclusive, with both internal and external key members participating
    • Ensure all systems and processes are part of the code exercise / simulation (e.g., IT, blood bank, lab, spiritual care, security, patient flow, etc.)
    • Monitor and document all challenges, gaps, successes, and participant feedback
    • Conduct a post session debriefing for learnings and recommendations
      • Ask key questions, such as, “Did the code orange process work? Did the staff and others involved in their roles perform the way they were supposed to? Was the equipment and other related services ready and performing to meet the needs of the code?”
    • Be prepared to adjust processes and roles with the goal of improvement
    • Share results across all levels of the organization
  • Consider involvement of communications to ensure they are prepared to manage media inquiries and public messaging through standard responses that are ready and available.  
    • Readiness to manage social media and any potential misinformation 
    • Include internal messaging and standardized overhead announcements
    • Creation of a media centre to manage incoming calls from families, general public and media inquiries
  • Consider developing a staff deployment centre that can:
    • Maintain records of staff attendance and hours worked
    • Provide direction and allocation of staff throughout the hospital
    • Assess and respond to changing staffing needs
  • Consider developing a family support centre that can:
    • Direct family members
    • Obtain information from family member to assist in identification or admitting information
    • Ensure refreshments and general wellbeing needs are met
    • Keep log of families present
  • Consider reviewing or developing (if one not in place) the organization’s business continuity plan 

HIROC Resources

Key Learnings from our Subscribers

Over the years, we’ve profiled a few of our Subscribers and their code orange exercises. As your proactive partner in all thing safety, we're sharing these past stories to bookmark and to share the learnings at your own organization.

Thank you to HIROC's Subscriber Advisory Council for bringing this idea forward.

Do you have learnings to share with fellow Subscribers? Reach us at

We are here for our Subscribers. If you have questions for HIROC about coverage or safety practices, contact