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October • 19 • 2023

Use of Plain Language Codes Can Save Lives


Susie Weeks, RN, CPHRM, CPHQ



The implementation and use of plain language codes reduces code confusion and effectively communicates emergency situations quickly and clearly to mobilize assistance and resources immediately.

Active shooter incidents in healthcare settings are becoming more prevalent. These terrifying events are unpredictable, evolve quickly, and present unique challenges in various healthcare settings nationwide. The Joint Commission (TJC) reports that 39 accredited organizations experienced shootings that resulted in 39 deaths from the time frame of 2010-2020. Because active shooter situations typically do not last long and may end before law enforcement arrives, it is beneficial for healthcare organizations to prepare for the active shooter situation.1
The implementation and use of plain language codes reduces code confusion and effectively communicates emergency situations quickly and clearly to mobilize assistance and resources immediately. The concept of plain language codes in the healthcare setting is based on United States Department of Homeland Security recommendations and is founded on Incident Command System principles. Nationally, TJC urges standardizing emergency codes and adopting plain language, a recommendation supported by numerous private and governmental agencies such as the U.S. Department of Health And Human Services,  American Hospital Association, Missouri Hospital Association, and numerous other state hospital associations.
Plain language is communication that everyone can understand the first time they see or hear it. When applied to the healthcare setting, plain language communicates important information in a manner that all listeners easily understand. Uniformity in emergency alerts enables the healthcare team to mobilize and respond appropriately to an emergency, which enhances the safety of patients, visitors, and employees. In crises, seconds count!
Plain language alerts provide transparency to help those hearing or seeing the alert know immediately what actions are required. The use of plain language increases the efficiency of responses by eliminating the need for further interpretation.
Consider the following when developing a plain language emergency alert system:

Develop three types of alerts:
  • Facility Alert – Provides for the safety and security of patients, employees, and visitors, including the management of essential utilities and the impact of weather events.
  • Security Alert – Protects patients, employees, and visitors from any situation or person posing a threat to the safety of any individual within the facility.
  • Medical Alert – Provides medical care and support to patients and incident victims while maintaining care and safety of patients, employees, and visitors within a healthcare facility during an incident.
Define the following key sections for each type of alert identified above:
  • Event – Identifies the type of emergency or situation such as fire, active shooter, or missing person.
  • Location – Identifies the area responders should report to or where others should stay away from.
  • Directions – May be added when indicated and at the discretion of your organization. For instance, in an active shooter alert notification, you may want to add the direction to evacuate a specific floor or location, or say to shelter in place.
Facility Alert Examples
Fire Facility Alert + Fire Alarm + Location + Directions
Weather Facility Alert + Weather Event (tornado) + Location +
Utility/Technology Interruption Facility Alert + Utility/Technology Interruption + Location + Directions
Security Alert Examples
Active Shooter Security Alert + Active Shooter + Location + Directions
(shelter in place, evacuate, etc.)
Bomb Threat Security Alert + Suspicious Item + Location + Directions
Missing Person Security Alert + Missing Person (infant, adult) + Location + Directions
Medical Alert Examples
Mass Casualty/Trauma Medical Alert + Mass Casualty + Location + Directions
Medical Alert Medical Alert + (define the type, i.e., cardiac, stroke, fall) + Location + Directions



Include these key elements in emergency response planning, communication, and simulation training.
  • Require active participation by your healthcare organization’s senior leaders and emergency response team.
  • Involve local law enforcement and/or fire/rescue department in your planning to familiarize them with your facility design, policy, procedures, and communication strategies.
  • Assess and prepare your building as needed should there be the need to secure a location, limit access to a location, or do a facilitywide lockdown.
  • Conduct simulation trainings for each type of alert. Include local law enforcement/fire rescue when appropriate.
With violence in healthcare settings on the rise, implementing a plain language alert system is one way to promote safety and reduce harm.


1. The Joint Commission. Quick Safety Issue 4: Preparing for active shooter situations (updated June 2021).
2. Selecting an Approach to Overhead Emergency Communications; ECRI; 1/20/2021.

Copyrighted. No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances. 


  • Risk Management & Patient Safety