International Journal of Healthcare Education & Medical Informatics

Volume 8, Issue 1 - 2021, Pg. No. 12-18

Peer Reviewed & Open Access Journal
Original Article

Knowledge and Awareness regarding Emergency

Colour Codes among Resident Doctors and
Nursing Staffs of Tertiary Care Facility of District
Etawah
Saxena D1, Devi T Nilima2, Agarwal Tanya3, Bharti Rakesh Kumar4, Singh NP5, Jain PK6
MD Post Graduate, 5Professor, 6Professor and Head of Department, Department of Community Medicine, UPUMS, Saifai,
1,2,3,4

Etawah, Uttar Pradesh, India.

DOI: https://doi.org/10.24321/2455.9199.202109

I N F O A B S T R A C T

Corresponding Author: Background: Emergency codes are comprehensive, nationwide,

Saxena D, Department of Community Medicine, systematic approach to incident management, includes the command
UPUMS, Saifai, Etawah, Uttar Pradesh, India. and coordination of incidents, resource management, and information
E-mail Id: management. Therefore, it is important for all residents, doctors and
[email protected] staff to be aware and have knowledge about it.
Orcid Id:
Aims: 1) To assess the knowledge and awareness about emergency
https://orcid.org/0000-0001-8519-2694
colour codes among resident doctors and nursing staffs of tertiary care
How to cite this article:
health centre. 2) To find out the training status of Advanced Cardiac Life
Saxena D, Devi TN, Agarwal T, Kumar BR, Singh
Support and Basic Life Support among resident doctors and nursing staffs
NP, Jain PK. Knowledge and Awareness regarding
Emergency Colour Codes among Resident Methods and Material: A cross sectional study was conducted on all
Doctors and Nursing Staffs of Tertiary Care Facility the resident doctors and the nursing staffs in UPUMS Saifai, Etawah.
of District Etawah. Int J HealthCare Edu & Med A pre-designed and pre-tested semi-structured questionnaire was
Inform. 2021;8(1):12-18. used to get the desired information. The questions were pertaining to
knowledge and awareness of emergency codes, ACLS, BLS and training
Date of Submission: 2021-02-02
regarding to it.
Date of Acceptance: 2021-03-20
Data were entered in excel sheet and were analysed by using IBM SPSS
version 25. Descriptive statistics was calculated for quantitative variables.
Chi-square and Fischer-exact test was used for analysis of categorical
variables. P value less than 0.05 was taken statistically significant.
Results: Out of 120 participants, 60% (72/ 120) were resident doctors
and 40% (48/ 120) were nursing staffs. Most of the resident doctors
(47/ 72) were trained in Basic Life Support as compared to Advanced
Cardiac Life Support.
Conclusions: Knowledge and awareness regarding emergency colour
codes was very poor among resident doctors and nursing staffs and
also training was not done in BLS and ACLS.
Keywords: Emergency Color Codes, National Incident Management
System, ACLS, BLS

International Journal of Healthcare Education & Medical Informatics (ISSN: 2455-9199)

Copyright (c) 2021: Author(s). Published by Advanced Research Publications
 Saxena D et al.
13 Int. J. HealthCare Edu. & Med. Inform. 2021; 8(1)

Introduction Study Duration

Life threatening situations can strike at any moment in any The study was conducted for three months duration i.e.,
place, and to anyone. The doctor is ultimately responsible July to September 2019.
for effectively managing the emergency scenario. The Study Participants
inability to react with medical emergencies due to lack of
training can have disastrous results and possibly the legal The study participants were the Post Graduate resident
ramifications.1,2 Therefore, the healthcare providers must be doctors and nursing staff of all departments of our university.
well prepared to handle medical emergencies. The hospitals Sampling Plan
must be prepared with full list of drugs and equipment to The study planned to include all the Post Graduate resident
deal efficiently and effectively with different emergencies. doctors and nursing staff of all departments purposively.
To accomplish this several countries have standardised Study Tool
their hospital emergency codes to improve their ability.
The emergency codes were created to alert medical staff The questionnaire was designed in a way that it could assess
to a dangerous situation while avoiding upsetting patients the theoretical and practical knowledge of the participant
and visitors.1,4 When a code is called a pre-determined to the emergency codes and training status of BLS/CPR, and
group of physicians, nurses and other medical staff react ACLS and their previous experience and exposure to it. The
quickly and effectively due to their training in the same. pilot study was conducted and the necessary corrections
To facilitate code uniformity the committee developed made accordingly.
a standardized set of uniform codes and guidelines that The questionnaire consisted of four sections. First section
can be adopted by all healthcare facilities.3-5 To mention was on sociodemographic profile, second of awareness
a few standardized code names are Red for fire, Blue for regarding emergency color codes and its management,
Cardiac arrest, Black for Bomb, Pink for infant abduction, third of Basic Life Support and fourth section consisted
Gray for Security personnel needed, Orange for a hazardous of questions related to Advanced Cardiac Life Support. In
material spill/ release and Green for Mass casuality/ Natural second section, questions were of awareness, the meaning
disaster. These are core of the principles of National Incident of color codes, team members dedicated to particular
Management System.6-9 code, mock drill, emergency responding protocols and the
Along with this, the Basic Life Support and Advanced training status. The questions regarding Basic Life Support
Cardiac Life Support are the medical procedures and the consisted of the Cardiopulmonary Resuscitation (CPR) steps,
skills which are there to save the victim from the life- ever performed the resuscitation, reasons for unwillingness
threatening emergencies until the medical care is provided in performing CPR, the ratio of chest compression and the
at the hospital.10-13 Creating awareness and educating training status. The questions of fourth section consisted of
nursing staff along with resident doctors is very essential usage of Automatic External Defibrillator, emergency drugs,
to prevent the delay in providing the emergency care. their dosage, routes of administration and the training status.
Owing to the fact that nursing staff frequently become first Methodology and Data Collection
responders in the hospital to cardiac arrest. Thus, successful The data was collected during the first two months of study
resuscitation is a reflection of their skill and knowledge. period. Informed consent of those who were willing to
BLS procedure includes cardiopulmonary resuscitation participate in the study was taken. Those who were willing
in (CPR), bleeding control, artificial ventilation and basic to participate and gave their consent were included in the
airway management.15-17 study. Those who were not on duty due to any reason (sick
BLS and ACLS training has been routinely recommended leave, casual leaves, maternity leave and absentees) were
training procedure for all healthcare professionals. However, not included. Those who participated in pilot study were
these trainings are not routinely practice in developing also excluded. The authors visited all the departments and
countries like India. Hence, the present study was conducted interviewed the residents and nursing staffs during three
with the aim of assessing the knowledge and awareness shifts i.e., morning, evening and night. In the third month
regarding emergency colour codes, BLS and ACLS among of study duration the collected data in the questionnaire
resident doctors and nursing staff and the prospective of was entered in the excel sheet after coding for analysis.
introducing these skills into regular curriculum. Ethical Approval
Subjects and Methods The study proposal was approved by the Institutional Ethical
Study Design and Setting Committee. Before the start of the study, the permission to
This cross-sectional study was conducted at Uttar Pradesh carry out the study was obtained from the Dean (Medical)
University of Medical Sciences, Saifai, Uttar Pradesh, India. and Nursing Superintendent.

ISSN: 2455-9199
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Saxena D et al.
Int. J. HealthCare Edu. & Med. Inform. 2021; 8(1) 14

Statistical Analysis Overall Scores of Knowledge and Awareness

After evaluating the individual answer sheets, the scores were The mean score of all participants was 11.71 ± 2.72 SD with
segregated and compared between the resident doctors and a score range of 3-16. The participants (12, 9.9%) below
nursing staffs. A mean score of knowledge and awareness mean score were considered having poor knowledge. Those
was taken as ‘average’ and below that was considered as (91, 75.2%) having mean as score were considered having
‘poor’ and above that as ‘good’. Data were analysed by average knowledge. The participants (18, 14.9%) having
using IBM SPSS version 25.0. Descriptive statistics was scores greater than mean were considered as having good
calculated for quantitative variables. Chi-square and Fischer- knowledge (Figure 1).
exact test was used for analysis of categorical variables. P Knowledge regarding Emergency Color Code
value less than 0.05 at 95% Confidence interval was taken
statistically significant. The conclusions were drawn based In the section of knowledge (Table 2) regarding emergency
on the results of the analysis. color code, maximum (53,75.7%) resident doctors and
nursing staff (30, 62.5%) were not having correct knowledge
Results regarding the meaning of codes (p=0.865 at 95% CI). Most of
Socio-Demographic Characteristics of the Study the resident doctors (49, 70 %) and nursing staff (33, 68.7%)
Subjects were having knowledge of the initial fire incident objective.
There was no significant difference in knowledge of resident
A total of 120 resident doctors and nursing staff participated
doctors and nursing staff for both above mentioned question
in the study. Of 120 responders, 72(60%) were resident
(p=0.865 and p=0.936 at 95% CI). Most of (resident doctors
doctor and 48(40%) Nursing Staff. The proportion of males
55 ,78.5% and nursing staff 38,79.1%) the study participants
78(65%) was higher than females 42(35%). The age of the
have knowledge of extinguishing techniques using a fire
participants (n=120) ranged from 25 to 42 years (Table 1).
extinguisher. Most of (resident doctors 65, 92.8% and
Table 1.Sociodemographic Profile nursing staff 87.5, 42%) them were having knowledge about
(n= 120) potential hazardous material in the hospital.
S. No. Variables Categories Frequency (%)
Awareness regarding Emergency Color Code
Male 78(65)
1. Gender In the section of awareness (Table 3) regarding the
Female 42(35) emergency color code, most of the resident doctors
25-30 88(73.9) (49,70%) and nursing staff (45, 93.7%) were aware about
Age (in team members dedicated to resuscitation team and the
2. 31-35 22(18.5)
years) difference between them was not found to be statistically
>35 10(7.6)
significant (p=0.936 at 95% CI). The resident doctors (49,
Resident 70 %) were aware more than nursing staff (45, 93.7%)
72(60)
3. Occupation Doctor about team members dedicated to resuscitation team and
Nursing Staff 48(40) the difference between them was found to be statistically
significant (p=0.001 at 95% CI). Majority of the resident
doctors (46,65.7%) were aware more than nursing staff
(18,37.5%) about the guidelines being followed for the
training of resuscitation team and the difference between
them was found to be statistically significant (p=0.05 at 95%
CI). Regarding the awareness about various exit routes of
department/ hospital and emergency, the resident doctors
were aware more than nursing staff and the difference
between them was found to be statistically significant
(p=0.018 at 95% CI). Most of (resident doctors 65, 92.8%
and nursing staff 42, 87.5%) them were aware of hazardous
material spill/ release protocols.
Knowledge and Awareness regarding Basic Life
Support and Advanced Cardiac Life Support
Figure 1.Pie Chart Depicting Proportion of Study A total of 87, 72.5% participants responded correctly
Participants for Knowledge and awareness Score regarding the number of chest compressions in 1 minute
Categorisation regarding Emergency Colour Codes whereas 78, 65% participants could answer the ratio of chest
among Study Participants (n=120) compressions to breaths in an adult. And 67, 55.8% study

ISSN: 2455-9199
DOI: https://doi.org/10.24321/2455.9199.202109
 Saxena D et al.
15 Int. J. HealthCare Edu. & Med. Inform. 2021; 8(1)

participants answered correctly about the location of the Support 47 (65.2%) resident doctors and 34 (70.8%) nursing
chest compression and only 59, 49.1% participants could staff answered positively. For the training status of the
arrange the correct sequence of resuscitation. 82, 68.3% participants in Advanced Cardiac Life Support 25 (34.7%)
out of 120 respondents were aware that defibrillation is the resident doctors and 26 (54.1%) nursing staff were found
most important intervention in lifesaving in CPR situations trained.
which is a good awareness prevalence percentage. The overall training status and the comparison of the study
Training Status of Basic Life Support and Advanced participants is shown in Figure 2 and Table 4. This study
Cardiac Life Support found no association between the scores and the training
For the training status of the participants in Basic Life status of the participants (Table 5).
Table 2.Comparison of Responses regarding Knowledge of Emergency
Colour Codes among Study Participants
(n= 120)
Study Subjects
S. Knowledge regarding Emergency Colour P value at 95%
Responses Resident Nursing
No. Codes confidence interval
Doctors Staff
Yes 52 18
1. Knowledge about emergency colour codes p< 0.05
No 20 30
Knowledge about correct meaning of each Yes 19 12
2. p= 0.865
code No 53 36
Knowledge of any recommended fire Yes 11 9
3. disaster management plan in your hospital p=0.617
set up No 61 39

Knowledge of the initial fire incident Yes 49 33

4. p=0.936
objective No 23 15
Knowledge of extinguishing techniques Yes 55 38
5. p=0.721
using a fire extinguisher No 17 10
Knowledge about potential hazardous Yes 65 42
6. p=0.631
material in your hospital No 7 6
*Chi Square test applied
Table 3.Comparison of Responses regarding Awareness related to Emergency
Colour Codes among Study Participants
(n= 120)
Study Subjects p Value at 95%
S. Awareness Status about Emergency Color
Responses Resident Nursing Confidence
No. Codes
Doctors Staff Interval

Awareness about team members dedicated to Yes 49 45

1. p= 0.001
resuscitation team No 23 3
Awareness about the guidelines being Yes 46 18
2. p= 0.05
followed for the training of resuscitation team No 26 30
Yes 19 10
3. Aware of acronym R.A.C.E. p=0.486
No 53 38
Awareness about emergency operation plan Yes 12 8
4. p=1.0
activation No 60 40
Awareness about various exit routes of your Yes 61 47
5. p=0.018
department/ hospital and emergency numbers No 11 1

ISSN: 2455-9199
DOI: https://doi.org/10.24321/2455.9199.202109
Saxena D et al.
Int. J. HealthCare Edu. & Med. Inform. 2021; 8(1) 16

Aware of hazardous material spill/ release Yes 58 35

6. p=0.326
protocols No 14 13
*Chi Square test applied
Table 4.Comparison of Training Status of the Study Participants of Basic Life Support
(BLS) and Advanced Cardiac Life Support (ACLS)
Study Participants
S. P value at 95%
Training Status Resident
No. Responses Nursing Staff Confidence Interval*
Doctors
Yes 47 34
1. Basic Life Support (BLS) P=0.524
No 25 14
Yes 25 26
2. Advanced Cardiac Life Support (ACLS) p=0.035
No 47 22
*Chi Square test applied
Table 5.Association between Training Status and Knowledge and
Awareness Score of Study Participants
Knowledge and awareness score of study participants
Training Status (p=0.98 at 95% CI)
Poor Average Good
Trained 7 (10.1%) 52 (75.4%) 10 (14.5%)
Not Trained 5 (9.6%) 39 (75%) 8 (15.4%)

care, hence the need of training and retraining. The reasons

attributed for lack of knowledge and awareness regarding
emergency codes, BLS and ACLS in this study included lack
of available professional training, busy curriculum, and
lack of interest. Although no association between training
status and scores was found in this study, which is contrary
to the study conducted by Kumar et al.8 This may be due
to difference in theoretical knowledge and practical skills.
A large number 85% (102) of study participants were of
the opinion that training of emergency codes, BLS and
ACLS should be a part of undergraduate curriculum of
both medical and nursing. As the skills deteriorated over
Figure 2. Bar Chart Illustrating the Training Status
a period of time, the students did not have confidence or
of Study Participants (Overall) regarding Basic Life
have a favourable perception about CPR/ BLS. Although
Support and Advanced Life Support (n=120)
training improves the knowledge, the loss of skills with time
Discussion highlights the need to have repeated training over a period
Health professionals should have sound knowledge and of time. This is possible only if the training is introduced
awareness regarding emergency codes, BLS and ACLS. at the beginning of the curriculum rather than in the final
This study revealed that 9.9% (12) study participants were year, which is the current practice.
having poor, 75.2% (91) having average, 14.9% (18) having Because the updating of the guidelines every 5 years,
good knowledge and awareness regarding emergency codes repetitive training is needed to ensure the changes.
regarding (Figure 1). The results of the present study were The Medical Council of India has already incorporated
consistent with those of the study conducted by Roshana emergency medicine as a separate speciality. The awareness
et al.11 A total of 75.2% (91) of the study participants and basics of ACLS of the medical and paramedical team
had average knowledge. Similar results were reported and BLS as the first aid will be the prime responsibility of
by Somaraj et al.18 The overall mean score regarding the this new emergency specialty. Educational institutions
knowledge and awareness was found to be 11.71 ± 2.72 should be involved in the training of health professionals for
SD. This indicates the lack of requisite skills in emergency CPR and other emergencies that can occur. CPR should be

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 Saxena D et al.
17 Int. J. HealthCare Edu. & Med. Inform. 2021; 8(1)

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DOI: https://doi.org/10.24321/2455.9199.202109