Hospital emergency codes are used to alert staff members to an urgent medical situation that requires immediate attention. While there are a few "universal" codes that are used in most hospitals across the country, some facilities have their own localized versions as well. Localized emergency codes can help ensure that everyone in the facility is aware of the specifics of the emergency and can respond quickly and appropriately. In this article, we'll discuss the different types of localized hospital emergency codes and how they can help streamline communication in a healthcare setting.
Other localized codes which can vary depending on the hospital or healthcare organization:
- Code Red: This code indicates a fire or smoke emergency.
- Code Pink: This code indicates an infant or child abduction.
- Code Orange: This code is called when there is a mass casualty or disaster situation, such as a natural disaster or terrorist attack.
- Code Brown: This code is used in hospitals to indicate a situation in which there is a hazardous spill
Code Red generally refers to a fire emergency. It is a specific emergency code that is used to alert hospital staff to the presence of a fire in the facility. The code is typically announced over the hospital's public address system, and all hospital personnel are trained to respond to it quickly and appropriately.
When a Code Red is called, hospital staff will follow established procedures to ensure the safety of patients, staff, and visitors. It is important for hospital staff to be well-trained and prepared for emergency situations like Code Red, in order to protect the lives and health of everyone in the facility.
What is the protocol for responding to a fire or smoke in a hospital?
The specific procedures and actions taken during a Code Red may vary depending on the hospital's policies and procedures but generally include the following steps:
- Alerting staff and patients: When a Code Red is called, hospital staff will use the hospital's communication system to alert all staff and patients in the affected area.
- Closing doors: In order to contain the fire or smoke, staff will close all doors in the affected area and prevent anyone from entering or exiting.
- Evacuating patients: If necessary, hospital staff will evacuate patients from the affected area to a safe location.
- Controlling the fire: Hospital staff who are trained in fire safety and extinguishing fires will work to control and extinguish the fire.
- Assessing damage: After the fire has been controlled, staff will assess the damage to the hospital and determine if any repairs or cleanup is necessary.
It's important for hospital staff to be trained in fire safety procedures and for hospitals to have emergency protocols in place to ensure that everyone in the hospital remains safe in the event of a fire emergency. Hospitals may also conduct regular fire drills to ensure that staff are prepared to respond quickly and effectively to a Code Red emergency.
How do you evacuate patients safely?
When evacuating patients in an emergency situation, it is important to do so in an organized and efficient manner. Hospital staff should have a plan for evacuating patients and be aware of any special considerations that may need to be considered when moving certain patients.
During the evacuation, staff should check each patient's medical records to ensure they take the correct medication and provide them with the necessary medical devices. They should also help secure the patient and provide necessary physical support during the evacuation.
Finally, each patient's vital signs should be monitored throughout the evacuation to ensure stability.
How do you prevent the spread of smoke and fire?
Preventing the spread of smoke and fire in the hospital is critical to protecting patients, staff, and visitors from harm. Here are some ways to prevent the spread of smoke and fire in the hospital:
- Ensure proper storage and handling of flammable materials: Flammable materials, such as cleaning supplies and medical gases, should be stored properly and handled carefully to prevent accidental fires.
- Maintain fire safety equipment: The hospital should have fire safety equipment, such as fire extinguishers, sprinkler systems, and smoke detectors, that are properly maintained and inspected regularly.
- Conduct fire safety training: All hospital staff should receive regular fire safety training to ensure they know how to prevent fires and respond quickly in an emergency.
- Follow proper smoking policies: Smoking should be prohibited in and around the hospital to prevent fires from smoking materials.
- Ensure proper electrical wiring: Electrical wiring should be installed and maintained by qualified professionals to prevent electrical fires.
- Maintain clear exit routes: All exit routes should be clearly marked and kept clear of clutter to ensure that people can safely evacuate the building in the event of a fire.
- Conduct regular fire drills: Regular fire drills should be conducted to ensure that hospital staff knows how to respond quickly and effectively in the event of a fire emergency.
By following these steps, hospitals can help prevent the spread of smoke and fire and keep patients, staff, and visitors safe.
What is a fire alarm?
A fire alarm is a device that is used to detect smoke, heat, or flames and alert people of the potential danger of a fire. It consists of a control panel, detectors, and an alarm notification system. When a detector senses a fire, it sends a signal to the control panel, which activates the alarm notification system. The system includes audible and visual alerts designed to be loud and attention-grabbing to ensure that everyone in the building can hear and respond to the alarm.
Fire alarms are required by law in most public buildings, including hospitals, schools, offices, and apartment buildings, and are an essential component of fire safety.
What is a fire extinguisher?
A fire extinguisher is a portable device that can be used to control or extinguish small fires. It typically consists of a hand-held cylindrical pressure vessel containing an agent which can be discharged to extinguish a fire. Fire extinguishers, usually found in public areas such as hospitals, schools, offices, and other buildings, are designed to suppress or contain fires before they become too large and dangerous.
Fire extinguishers are generally classified according to the type of fire they can be used on, such as:
- Class A: Trash and paper
- Class B: Flammable liquids
- Class C: Electrical
What is a fire door?
Fire doors are an essential component of any building’s fire safety system, as they can help to save lives and protect property in the event of a fire. It is a special type of door that is designed to prevent the spread of fire and smoke within a building.
Fire doors are typically made from metal or wood, and are designed to be highly resistant to heat and flames. They usually have intumescent seals which expand when exposed to high temperatures, creating an airtight seal that prevents smoke from entering the room. In addition, fire doors are usually equipped with a self-closing mechanism that automatically closes the door when it is heated by fire.
Training required for proficiency: Fire safety training and regular fire drills, including training on the use of fire extinguishers and evacuation procedures.
Code Red Process Mnemonics
The acronym R-A-C-E is used to remember the steps for responding to a fire emergency. The steps are:
- Rescue anyone in immediate danger
- Activate the fire alarm system
- Contain the fire by closing doors and windows if possible
- Extinguish the fire if it can be done safely, or Evacuate the building.
Following these steps can help minimize the risk of injury or loss of life in the event of a fire.
P-A-S-S: Pull, Aim, Squeeze, Sweep (for using a fire extinguisher)
The acronym P-A-S-S is used to remember the steps for using a fire extinguisher in the event of a fire. The steps are:
- Pull the pin on the extinguisher
- Aim the nozzle at the base of the fire
- Squeeze the handle to release the extinguishing agent
- Sweep the nozzle from side to side, covering the entire area of the fire until it is extinguished.
It's important to remember that fire extinguishers are only effective for small fires and that individuals using a fire extinguisher should be trained on its proper use and limitations.
Code Brown is a term used in hospitals to indicate a situation in which there is a hazardous spill, such as a chemical spill, in the facility.
When a Code Brown is announced, it triggers a hospital's hazardous materials emergency response plan, which includes immediate notification of the appropriate personnel, such as the environmental services department, and the implementation of safety measures to prevent the spread of the hazardous material. The staff will also work to contain the spill and clean it up as quickly as possible, using specialized equipment and following established protocols to ensure the safety of patients, staff, and visitors.
What is a hazardous material?
A hazardous material is any substance that has the potential to cause harm to humans, animals, or the environment. Hazardous materials can include chemicals, biological agents, radioactive substances, and other materials that are considered dangerous. It's important for hospitals to be aware of the hazardous materials in their facility and take steps to protect staff and patients from exposure. A color-coded system is often used to help identify hazardous materials, with blue representing biological hazards, yellow representing chemical hazards, and red representing radioactive materials.
What is the protocol for responding to a hazardous spill or exposure in a hospital?
The protocol for responding to a hazardous spill or exposure in a hospital may vary slightly depending on the specific facility and the type of hazardous material involved. However, in general, the following steps are typically followed:
- Notify appropriate personnel: The first step is to immediately notify the hospital's emergency response team, such as the environmental services department or the hospital's safety officer.
- Secure the area: The area where the spill or exposure occurred should be secured to prevent the spread of the hazardous material. This may involve closing doors, posting signs to warn people of the danger, and evacuating the immediate area.
- Assess the situation: Once the area is secured, the response team will assess the situation to determine the severity of the hazard and the appropriate course of action.
- Don protective equipment: Hospital staff will don personal protective equipment (PPE) to prevent exposure to hazardous material. PPE may include gloves, gowns, masks, and eye protection.
- Contain and clean up the spill: The response team will work to contain the spill and clean it up using specialized equipment and following established protocols. This may include using absorbent materials to contain and clean up the spill or using neutralizing agents to neutralize the hazardous material.
- Decontaminate the affected area and equipment: Once the spill has been contained and cleaned up, the affected area and equipment should be thoroughly decontaminated to remove any residual hazardous material.
- Follow up: The hospital will conduct follow-up monitoring to ensure that the area is safe and that any exposed staff or patients receive appropriate medical attention.
It's important to note that hospital staff are trained in hazardous material response and follow strict protocols to prevent exposure and ensure the safety of patients, staff, and visitors.
What is PPE?
Personal Protective Equipment (PPE) is any type of clothing, accessory, or device designed to protect an individual from potential hazards in the workplace. Common types of PPE include items such as gloves, goggles, face shields, and respirators. It is important for hospital staff to be properly trained in using PPE and always to wear it when necessary. PPE should be inspected regularly for signs of wear and tear and should be replaced when necessary.
What personal protective equipment (PPE) is necessary?
The specific personal protective equipment (PPE) necessary for responding to a hazardous spill or exposure in a hospital may vary depending on the type of hazardous material involved. However, in general, the following PPE may be necessary:
- Eye protection, such as goggles or a face shield
- Protective footwear, such as shoe covers
Hospital staff should be trained on the appropriate use of PPE and follow established protocols to prevent exposure and ensure their safety. Additionally, the PPE used should be appropriate for the specific hazard and should be inspected before use to ensure that it is in good condition and free of defects.
What is decontamination?
Decontamination is the process of removing or neutralizing hazardous materials in a given area. It is commonly used in medical and industrial settings to reduce the risk of exposure and contamination. Decontamination protocols will vary depending on the type of hazardous material present but typically involve some form of physical removal and/or chemical treatment. Decontamination should be performed as quickly as possible to reduce personnel's time, and patients are exposed to the hazardous materials.
What are the steps for decontamination?
Decontamination should be performed quickly to reduce the risk of further exposure or contamination. Hospital staff should be trained in decontamination procedures and follow established protocols to ensure their safety
- Remove contaminated clothing: Any contaminated clothing or PPE should be removed and placed in a biohazard bag for proper disposal.
- Rinse or shower: The affected person should rinse off any visible contamination with water or take a shower to remove any remaining hazardous material from the skin or hair.
- Flush eyes and nose: If the eyes or nose were exposed to hazardous material, they should be flushed with water to remove any remaining contaminants.
- Collect information: Any information about hazardous material exposure, such as the type and amount of exposure, should be collected for medical evaluation and follow-up.
- Medical evaluation: The affected person should receive a medical evaluation, including monitoring for any symptoms of exposure and treatment as necessary.
- Clean up the area: The area where the exposure occurred should be cleaned up and decontaminated to remove any residual hazardous material.
Training required for proficiency: Hazardous materials training, including using PPE and decontamination procedures.
Code Brown Process Mnemonics
S-T-O-P is a simple safety measure that should be followed in order in case of a hazardous spill, particularly of chemicals or gases. The steps involve
- Stopping the source of the spill
- Turning off ventilation systems
- Opening windows for ventilation
- Protecting oneself and others by wearing appropriate personal protective equipment (PPE).
Following these steps is important only if you are trained in hazardous material handling and familiar with the materials involved.
D-E-C-O-N is an acronym that stands for:
It is a set of steps that should be followed in order to decontaminate oneself after exposure to hazardous materials. The steps involve removing contaminated clothing or equipment, flushing eyes with water or saline, cleaning exposed skin thoroughly with soap and water, putting on clean overalls or protective clothing, and washing hair and scalp with soap and water. D-E-C-O-N should only be performed by trained personnel who are familiar with the specific hazardous materials involved and the appropriate safety protocols.
"Code Orange" is a term used in hospitals to indicate a mass casualty incident or disaster that may overwhelm the hospital's resources and require additional assistance. A Code Orange may be initiated due to a variety of events, such as a natural disaster, a terrorist attack, or a major transportation accident.
When a Code Orange is announced, it triggers the hospital's emergency response plan, which includes notifying staff and coordinating with other healthcare facilities and emergency services. The hospital may also activate its disaster response team to coordinate the response and manage resources.
What is a mass casualty?
A mass casualty is an event in which many people are injured or killed due to a single incident. This could be anything from a natural disaster, to an act of terrorism, to an industrial accident. Mass casualty incidents require special planning and preparation by healthcare facilities due to the large number of patients who may need medical attention. To prepare for such an event, hospitals should create a surge plan outlining how to manage the increased demand for medical services.
What is the protocol for responding to a mass casualty or disaster situation?
The specific actions taken during a Code Orange may vary depending on the type and severity of the incident, but some common steps include:
- Mobilizing resources: Hospital staff will work to mobilize additional resources, such as staff, supplies, and equipment, to handle the increased demand.
- Coordinating with other healthcare facilities: The hospital may coordinate with other healthcare facilities in the area to share resources and coordinate patient care.
- Triage: Hospital staff will triage patients to determine the severity of their injuries or illnesses and prioritize care based on the severity of the condition.
- Communication: Hospital staff will communicate with patients and their families and other healthcare facilities and emergency services to keep them informed of the situation and any updates.
What is triage?
Triage is a medical process used to prioritize patients according to their level of need. When faced with a surge of patients, healthcare providers must determine which ones require immediate attention and which can wait. This process is usually done using an algorithm that assesses the patient’s condition and assigns them a score based on their illness or injury severity. Patients with higher scores are treated first, while those with lower scores may wait until resources become available.
How do you triage patients?
Triage is a dynamic process; patients may be reassessed and their triage category may change based on their condition and the availability of resources. Additionally, the specific triage process may vary depending on the healthcare facility and the type of incident being triaged.
The following are the steps involved in triaging patients:
- Rapid assessment: The first step in triage is to perform a rapid assessment of each patient to determine their level of urgency. This includes a quick evaluation of their vital signs, level of consciousness, and any obvious injuries or symptoms.
- Categorization: Once the initial assessment is complete, patients are categorized into priority groups based on the severity of their condition. The most commonly used triage categories are:
- Immediate (red): Patients with life-threatening injuries or illnesses that require immediate attention and treatment.
- Delayed (yellow): Patients with injuries or illnesses that are not life-threatening but require medical attention within a few hours.
- Minimal (green): Patients with minor injuries or illnesses that can wait for treatment.
- Expectant (black): Patients who are either dead or have injuries or illnesses that are so severe that they are unlikely to survive.
- Treatment and transport: Patients are then treated and transported to appropriate care areas based on their triage category. Immediate and delayed patients are typically taken to the emergency department or other acute care areas, while minimal patients may be taken to urgent care or other non-acute care areas.
What is surge capacity?
Surge capacity is the ability of a healthcare facility to increase its capacity quickly in times of emergency or unexpected surges in patient volume. This includes increasing staffing levels, expanding care areas, and managing patient flow efficiently to ensure that patients with the most urgent needs receive care first. Surge capacity also involves ensuring enough resources are available to meet the increased demand for care and communicating regularly with staff, patients, and families about the status of the surge.
What are the steps for managing a surge of patients?
Managing a surge of patients can be a challenging task for healthcare facilities. It requires careful planning, preparation, and execution to ensure that patients receive appropriate care and that resources are utilized efficiently. Here are the general steps for managing a surge of patients:
- Activate the surge plan: Healthcare facilities should have a plan that outlines specific steps to be taken when patient volume exceeds normal levels. The surge plan should be activated when the facility anticipates a surge of patients or is experiencing one.
- Assess available resources: The facility should assess available resources, such as staff, equipment, and supplies, to determine if additional resources are needed to manage the surge.
- Increase staffing: If additional staff is needed, the facility can call in extra staff, use volunteers or reassign staff from other departments to areas where they are needed the most.
- Expand the capacity of care areas: The facility can expand the capacity of care areas by opening additional rooms or wards, converting non-patient areas into care areas, or using portable facilities.
- Manage patient flow: Patients should be triaged and managed efficiently to reduce wait times and ensure that patients with the most urgent needs receive care first.
- Communication: Effective communication between staff, patients, and families is important during a surge. Regular updates about the status of the surge and the availability of resources should be communicated to all stakeholders.
- Prioritize care: Prioritizing patient care based on the severity of their condition is critical during a surge. Patients with life-threatening conditions should be treated first.
- Monitor the situation: The facility should monitor the situation closely to ensure that patients receive appropriate care and that resources are being utilized efficiently.
- Debrief and review: After the surge, the facility should conduct a debriefing to review the response and identify areas for improvement in the surge plan.
Training required for proficiency: Emergency preparedness training, including mass casualty management, triage, and surge capacity planning.
Code Orange Process Mnemonics
S-A-V-E-D is an acronym that stands for
It is a set of steps that should be followed in order to respond to a hazardous materials incident or release. The steps involve establishing a safe perimeter, assessing the situation, improving ventilation, monitoring the environment, and decontaminating affected individuals, equipment, and surfaces. These steps should only be performed by trained personnel familiar with the specific hazardous materials and the appropriate safety protocols. If unsure, it's best to seek assistance from trained emergency responders or professionals.
M-A-S-S is an acronym used in triage for a mass casualty incident. It stands for:
The steps involve quickly assessing the situation, evaluating each casualty's condition, sorting casualties by priority, and sending them to the appropriate treatment areas. Triage should only be performed by trained personnel who are familiar with the specific triage protocols and procedures. Establishing clear communication and coordination between different responders and organizations is important to ensure an effective and efficient response.
Code Pink is a term used in hospitals to indicate a situation where an infant or child is missing or abducted from the hospital. This code alerts hospital staff to the situation and initiates a rapid and coordinated response to locate the missing child and prevent their removal from the premises.
What is an abduction?
Abduction refers to the act of taking someone away against their will, often using force or coercion. It can involve kidnapping, where someone is taken and held captive, or it can involve taking someone away from their home or place of safety without their consent.
Abduction is a serious crime and can have significant physical and emotional consequences for the victim and their loved ones. It is important to report any suspected abductions to the authorities immediately to ensure the victim's safety and help bring the perpetrators to justice.
What is the protocol for responding to an infant or child abduction?
Responding to an infant or child abduction requires a quick and coordinated effort from hospital staff, law enforcement, and the community to ensure the child's safety and well-being. The protocol for responding to an infant or child abduction may vary slightly depending on the hospital, but it generally includes the following steps:
- Call a "Code Pink" or "Code Adam": These are the common codes used in hospitals to indicate a missing or abducted child. The code will trigger a coordinated response from hospital staff and security personnel.
- Lock down the hospital: All hospital entrances and exits will be secured to prevent the abductor from leaving the premises with the child.
- Search the hospital: Hospital staff will conduct a thorough search of all areas of the hospital, including patient rooms, restrooms, stairwells, and other potential hiding places.
- Notify law enforcement: Hospital security will notify the local police department and provide them with a description of the child, the abductor (if known), and any other relevant information.
- Alert the media: Hospital administrators may choose to contact the media to ask for their assistance in broadcasting information about the abduction and the missing child.
- Support the family: Hospital staff will provide emotional support to the child's family and keep them updated on the situation as it unfolds.
- Conduct a debriefing: After the child is found, hospital staff and law enforcement will conduct a debriefing to review the response and identify any areas for improvement in future abduction scenarios.
What is a security lockdown?
A security lockdown is an emergency procedure that is implemented in hospitals to protect the safety of patients, visitors, and staff. During a security lockdown, all entrances and exits to the hospital are secured, with access only granted to individuals with proper authorization. In addition to restricting access to the premises, security personnel will be on alert for suspicious activity or persons. The purpose of a security lockdown is to limit the potential for a dangerous situation from occurring or escalating.
How do you secure the hospital and prevent the abductor from leaving?
Securing the hospital and preventing the abductor from leaving is critical in responding to an infant or child abduction. Here are some of the steps that hospitals may take to secure the facility:
- Lockdown: The hospital may initiate a lockdown procedure, which involves locking all entrances and exits to prevent the abductor from leaving the premises with the child.
- Security personnel: Hospital security personnel may be stationed at all entrances and exits to monitor who enters and leaves the hospital.
- Identification checks: All individuals attempting to enter or exit the hospital may be required to show identification and verify their credentials before being allowed.
- Video surveillance: Hospital security may monitor all areas of the hospital using video surveillance cameras to detect any suspicious activity.
- Alarms and alerts: Alarms and alerts may be installed at all hospital entrances and exits, which can be triggered if an unauthorized individual attempts to leave the hospital with the child.
- Cooperation with law enforcement: Hospital security may work closely with local law enforcement to coordinate the response and ensure that all possible exit points are covered.
What is a missing person report?
A missing person report is a formal document that is filed with law enforcement in order to report the disappearance of an individual. This document includes information such as the name, age, address, physical description of the missing person, and any other relevant details that may help locate them. It also includes contact information for family members and friends who should be notified if the missing person is located. Once a missing person report is filed, law enforcement will investigate the case and attempt to locate the individual.
What is the process for notifying law enforcement?
Time is of the essence in responding to an infant or child abduction, and it's critical to notify law enforcement as soon as possible to increase the chances of a safe recovery. The process for notifying law enforcement of an infant or child abduction may vary depending on the hospital's policies and the circumstances of the situation, but generally, the following steps may be taken:
- Call 911: The hospital's security team or staff member who discovers the abduction should immediately call 911 to report the incident and provide information about the child, the abductor (if known), and the hospital's location.
- Provide a description: Hospital staff should provide law enforcement with a detailed description of the child, including any identifying characteristics such as age, height, weight, hair color, and clothing. They should also provide a description of the abductor, if known, and any information about the vehicle or mode of transportation used in the abduction.
- Coordinate with law enforcement: Hospital security may work closely with law enforcement to provide updates and information about the abduction as it unfolds, including any sightings of the child or the abductor. They should also provide any additional information requested by law enforcement to assist in the investigation.
- Provide support: Hospital staff should provide emotional support to the child's family and keep them informed of the situation as it unfolds. They should also cooperate with law enforcement in providing any additional support or resources that may be necessary.
Training required for proficiency: Infant/child abduction prevention and response training, including security procedures and communication with law enforcement.
Code Pink Process Mnemonics
I-N-F-A-N-T can also be used as an acronym for Code Pink, which is a term used in hospitals to indicate an infant abduction or security threat. It stands for:
The steps of I-N-F-A-N-T for Code Pink are to identify that an infant is missing or that there is a security threat, notify hospital security and the appropriate authorities, quickly search the hospital and surrounding areas to locate the missing infant or identify any potential threats, restrict access to and from the hospital's maternity ward and other areas where infants are kept, take note of any important information about the situation, and provide support to the infant's family and work with the appropriate authorities to investigate the incident and recover the missing infant. It's important to follow each hospital's specific procedures and protocols in the event of a Code Pink situation.
A-B-D-U-C-T is an acronym used to respond to an abduction emergency. It includes the following steps:
- Block Exits
- Unite Staff
- Call Police
- Take Action
The first step is to sound the alarm and notify authorities, followed by blocking all possible exits, providing a detailed description of the abductor, uniting staff members and coordinating a plan of action, calling the police, and providing them with information to assist in locating the abductor and victim, and taking action by following the pre-determined plan to ensure the safety of everyone involved. It's important to have regular training and drills to ensure that staff members are prepared to respond quickly and appropriately in case of an emergency.
Disclaimer: It is important to note that the meaning of code colors may vary between hospitals or healthcare organizations, and some may not use the same codes. Hospitals may have unique codes and emergency procedures, so it's always a good idea to familiarize yourself with the codes used in your specific healthcare facility.
In conclusion, hospital emergency codes are essential to providing a safe and secure environment for patients and staff. It is important to understand the various codes that may be used in a healthcare setting and for responding to an emergency. Hospitals should train staff members on responding to emergencies and ensure that they are familiar with the codes used in their facility.
In order to ensure that staff members are properly trained and prepared to respond to emergencies, hospitals should provide regular drills and practice sessions. By doing so, staff members can become familiar with the codes in use and understand how to implement them properly. Additionally, it is important for all healthcare facilities to update their emergency procedures regularly and keep staff informed of any changes. This can help ensure that everyone is prepared to respond quickly and appropriately in an emergency.
1. Ohio Emergency Codes (https://www.ohca.org/uploads/news/Ohio_Emergency_Codes.pdf)
2. Centers for Disease Control and Prevention (CDC). (2020). Active threat response: Strategies and techniques for healthcare workers during a crisis situation.
3. Campus Magazine Hospital Emergency Code (https://www.campussafetymagazine.com/hospital/hospital-emergency-codes-meanings/)
4. National Center for Biotechnology Information. (2021). Code Gray: Crisis intervention and violence in Healthcare Settings.
5. The Joint Commission (2019). Code Gray: A Guide for Responding to a Potential Violent Patient or Visitor.