A Code Orange is the emergency designation used when the number and severity of incoming patients exceed the hospital’s immediate capacity. As Dr. Kenneth Chan, Head of the Emergency Department, explains, “Code Orange is usually in situations where the number of patients will overwhelm our resources. We need to mobilize our forces, gather all our resources and systematically prepare and triage patients appropriately so they go to the right places.”
When Is a Code Orange Called?
A small, unexpected surge of critically injured patients can often be managed by calling in additional staff. But when hospital leaders anticipate a much larger influx, they must consider whether regular operations can safely continue.
“We look at our current status and ask, ‘Can we handle this situation on top of everything else happening in the hospital right now?’” says Dr. Chan. “If the answer is no, then we would call a Code Orange.”
In mass-casualty scenarios, experience shows that approximately 20 percent of patients require immediate life-saving care. About 30 percent have serious but stable injuries, and roughly 50 percent have less urgent conditions. This mix helps teams estimate how many physicians, nurses, beds and operating rooms may be needed within minutes.
How a Hospital Transforms
A Code Orange changes the operations of the entire hospital. Dr. Chan notes, “It really is an all-hands-on-deck situation.” The Emergency Operations Centre is activated, bringing together clinical leaders, logistics experts, communications staff and others responsible for coordinating the response.
To make space for incoming patients, existing emergency patients are rapidly moved to inpatient units or other designated areas. Staff begin “decanting” beds, accelerating discharges when safe to do so and relocating stable patients out of high-acuity zones.
Outside, triage often moves to the ambulance bay or a large open area where teams can quickly assess patients and direct them to the most appropriate clinical space.
Inside, areas are reconfigured so patients with the most urgent needs can be assessed and treated promptly, while those with less severe injuries are managed in separate dedicated areas. Operating rooms, imaging departments and critical care teams shift into emergency-only mode. Elective surgeries are paused. It becomes a coordinated hospital-wide effort.
Critical Role
As a Level 1 trauma centre, Royal Columbian is uniquely positioned to care for the most complex emergency cases. “We do a lot of things here,” Dr. Chan says. “In a Code Orange we have to reprioritize our operations to take care of the sickest as urgently as possible.”
Built for Today’s Realities
The opening of the Jim Pattison Acute Care Tower will significantly strengthen Royal Columbian Hospital’s ability to respond to a Code Orange. The new Emergency Department is substantially larger than the current space, with modern layouts designed to improve patient flow and coordination during both everyday operations and large-scale emergencies.
The new Emergency Department also includes a dedicated mass casualty hallway, a wide and purpose-built space that allows for rapid assessment and movement of patients during a surge. The expanded ambulance bay provides more room for offloading and triage, helping teams work efficiently even in high-volume situations.
These modernized spaces, combined with the expertise of Royal Columbian’s emergency, surgical, imaging and critical care teams, will help ensure that if the unimaginable ever occurs, the hospital is as prepared as possible to respond.
When the Jim Pattison Acute Care Tower opens in 2026, the Emergency Department will relocate to the building’s main floor.