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What is code purple in hospital?

What is code purple in hospital?

In hospitals, color codes are often used to alert staff to various emergency situations or events. One of the most widely used color codes is a “code purple”, which indicates that a violent or behavioral emergency is taking place and assistance is needed immediately. A code purple signals hospital staff that urgent help is required to restrain a violent or aggressive patient, visitor, or other individual who is posing an immediate safety risk. This article will provide an overview of what exactly a code purple entails, when it is called, and how hospital staff respond during these tense and potentially dangerous situations.

What Does “Code Purple” Mean?

A code purple is an emergency alert used in hospitals to signal that immediate assistance is needed due to violent, aggressive, or hostile behavior taking place. It indicates that a combative person is putting patients, hospital staff, visitors, or themselves in immediate danger, and extra help is required to restrain the individual and regain control of the situation.

Some key things to know about code purple alerts:

  • Used for any type of violent, aggressive, or uncontrolled behavior
  • Alerts security teams and other personnel to respond urgently
  • Immediate action needed to protect safety
  • Extra assistance required for restraint and containment
  • Can be initiated by any hospital staff member

The term “code purple” can refer to a violent patient, visitor, staff member, or anyone else on hospital premises. It does not specify who is being violent, just that urgent assistance is needed.

When is a Code Purple Initiated?

A code purple can be called for a wide range of emergencies involving aggressive behavior in a healthcare facility, including:

  • A patient acting violently toward hospital staff
  • A visitor threatening or attacking nurses, doctors, or other providers
  • A patient attempting self-harm through combative actions
  • Family members fighting with each other or hospital security
  • An angry individual causing a disturbance and refusing to calm down
  • A person under the influence of drugs or alcohol becoming violent
  • Any type of physical violence taking place on hospital grounds

Essentially any immediate safety risk posed by someone’s uncontrolled violent actions can warrant a code purple alert. The key factor is that the aggressive behavior is happening right now and quick response is needed to contain the situation.

How Staff Respond to a Code Purple

When a code purple is announced, the response from hospital staff is swift and coordinated:

  • Security teams converge on the area immediately
  • Other personnel rush to the scene to assist
  • Staff work together to safely restrain the violent individual
  • Security guards may handcuff or physically hold the person down
  • If needed, the personnel may administer sedation medication
  • The aggressive individual is contained until the situation is resolved
  • Staff protects and reassures frightened patients and visitors
  • The code purple is called off when the risk has been mitigated

The focus is on safely diffusing the situation as quickly as possible with manpower and restraints. Protecting innocent bystanders in the surrounding area is also a priority. Security teams are central to responding, given their training in physical containment methods. Other staff provide backup support as needed depending on the circumstances.

Code Purple Response Team

While codes can be initiated by any staff member who witnesses an emergent situation, special code purple response teams are trained to handle these incidents. Key members of code purple response teams include:

  • Security officers
  • Emergency department nurses and technicians
  • Mental health professionals
  • Direct care staff from affected units
  • Police officers, if situation requires

Security teams take the lead in restraining violent individuals, using holds, handcuffs, and restraint equipment as needed. ED staff assist with medical assessment and sedation medication administration. Mental health professionals help de-escalate situations through verbal intervention if possible. Police provide backup for high-risk scenarios.

Use of Sedating Medications

If a disturbed patient continues acting in a threatening manner despite security intervention, the code purple team may administer emergency sedation medications. Common medications used in these scenarios include:

Medication Effects
Haloperidol Rapid tranquilization
Lorazepam Sedation, amnesia
Ziprasidone Rapid control of agitation
Promethazine Sedation, anti-nausea

These are given intramuscularly or intravenously, taking effect within minutes to quickly control the situation. Dosages given are higher than standard doses in order to rapidly sedate the aggressive individual.

Protective Gear Used

Code purple response team members wear protective gear when responding to alerts, both to defend themselves and restrain combative individuals.protective gear worn includes:

Protective Gear Purpose
Face shields Prevent bites or bodily fluid exposure
Protective gloves Reduce risk of disease transmission
Scrubs Prevent clothing from being grabbed
Closed toe shoes Protect feet from kicks or stomps

The gear provides a barrier to protect staff from injuries during struggles with unstable patients. Security personnel also don their standard protective vests when responding to codes.

Use of Restraints

Security officers have a variety of restraints available for controlling violent patients and visitors during code purples. Types of restraints used include:

  • Handcuffs – applied to wrists to restrict movement
  • Ambulatory restraints – soft cuffs or straps to restrain the ankles and wrists together
  • Full bed restraints – restraints that strap down all limbs to a bed
  • Arm or leg splints – immobilize violent limbs
  • Papoose boards – immobilize entire body in children

Ideally, the minimum amount of restraint is used for the minimum time necessary to control agitation and prevent harm. Restraints are adjusted as the situation improves and removed as soon as safely possible.

Code Purple Location Identification

Hospitals have visual indicators to help staff quickly identify the location where a code purple emergency is occurring, such as:

  • Code purple flags
  • Code purple LED ceiling lights
  • Glowing purple hologram projectors
  • Digital signage outside area showing “Code Purple”
  • Intercom announcements identifying code location

These visual and audible beacons allow responding personnel to rapidly pinpoint where their assistance is needed. This saves critical time compared to relying solely on verbal descriptions of the area.

Communication via Walkie-Talkies

Communication during code purple response is extremely important for coordination between security, medical personnel, and other staff. Two-way radios or walkie-talkies are essential tools to relay real-time updates. Key communications include:

  • Location and details of emergency situation
  • Requesting backup personnel respond
  • Announcing sedation given and effects
  • Warning staff of dangers like weapons or escapes
  • Confirming the aggressive patient is restrained
  • Calling off the code purple when risk is contained

Short, concise statements help teams work together for rapid, well-coordinated responses. This improves safety for staff and patients during volatile situations.

Debriefing After Code Purple Incidents

After any code purple emergency, a debrief process occurs to assess what transpired and identify any areas for improvement. Key aspects of the debriefing include:

  • Accounting for any injuries or trauma to patients, visitors or staff
  • Assessing the response time and effectiveness of interventions
  • Reviewing proper security procedures were followed
  • Examining whether restraint/sedation use was warranted and safest methods were employed
  • Soliciting staff feedback on what worked well or could be improved
  • Providing support resources for any staff experiencing distress

Debriefs improve preparedness and protocols for managing future episodes. Adjustments to code purple protocols are made as needed based on debrief learnings.

Code Purple Training Exercises

To ensure effective responses to violent incidents, hospitals conduct code purple training drills. Practice exercises help ingrain logical responses and coordination between teams. Code purple drills include:

  • Acting out sample scenarios with role play
  • Practicing safe restraint holds
  • Rehearsing use of protective gear and restraint devices
  • Walking through step-by-step response protocols
  • Timing mock responses and communication
  • Providing simulated code purple experience for new staff

Drills solidify proper techniques so that when real codes occur, teams respond appropriately under pressure. Practice makes these emergency responses become instinctual.


Code purple alerts are an essential tool to summon urgent assistance for managing violent situations in hospitals. Given the unpredictable and hazardous nature of aggressive behavior, clear codes and protocols are invaluable for protecting healthcare staff, patients, and visitors. While such incidents are challenging, proper training, response coordination, protective gear, and containment measures allow code teams to effectively resolve these emergencies. Code purples enable hospitals to swiftly neutralize threats and restore safety for all.