A code silver in hospital settings means someone on the property has a weapon or is threatening people with one. Most facilities use the code for an active shooter, an armed intruder, or a hostage situation. Once the announcement is made, staff are expected to put personal safety ahead of routine work until security or police say otherwise.
The exact definition depends on the hospital. Maryland is the only state that fixes the meaning in regulation. Elsewhere, a nurse who moves from one hospital to another can find the same code used for a slightly different set of threats.
| Key pointsA Code Silver alert usually signals an armed person, an active shooter, or a hostage situation inside or near the hospital.If a safe exit exists, leave the area. If it does not, lock or block a door and stay out of sight.Call 911 once you can speak without being heard, and give the location before anything else.Maryland is the only state where the meaning is written into regulation. Elsewhere each hospital sets its own definition.The FBI recorded 48 active shooter incidents in 2023, and two of them took place in health care facilities. |
What Is a Code Silver in a Hospital? (Code Silver Hospital Meaning)
The code silver hospital meaning covers a security threat that involves a weapon. Some hospitals limit it to a confirmed active shooter. Others also use it for an armed intruder, any weapon or hostage situation, or a credible report of an individual with a weapon on site.
When the code is announced, the hospital’s priorities change for the length of the event. Staff move away from the threatened area instead of toward it, even when a patient there needs care. Clinical teams return only after police or security have cleared the space.
Why the code silver meaning varies between hospitals
No federal agency sets a national hospital code system or assigns meanings to color codes. Each hospital writes its own list, so two facilities in the same city can use different words for the same threat.
A university medical center might use Code Silver only for an active shooter. A community hospital down the road might use the same code as a general lockdown signal that covers several kinds of security incident. A third hospital might drop color codes entirely and describe the threat in plain words over the paging system.
The point at which staff can call the code also differs. Some policies require a confirmed weapon before an announcement goes out. Others allow the code on a credible report. A few go further and let any employee who sees an immediate threat trigger it without waiting for a supervisor.
Maryland’s uniform emergency codes
Maryland is the one state that regulates hospital emergency codes directly. Its rule, COMAR 10.07.01.33, requires every acute general or special hospital in the state to “adopt and implement” twelve uniform codes. Code Silver is assigned to an armed assailant, which is why some planners describe it as the Code Silver active assailant response. The regulation took effect on 11 November 2002 and was last amended on 2 March 2015.
Maryland’s other hospital security codes also differ from what hospitals in other states use. The table below shows the codes that matter most for this topic.
| Code | Maryland assignment | How it compares with other states |
| Silver | Armed Assailant | The only legally binding definition of this code in the United States |
| Green | Combative Person | Many hospitals in other states use Grey for this situation |
| Gray | Elopement (a patient leaving without authorization) | California hospitals use Gray for a combative person instead |
| Purple | Security Only Response | Other systems use Purple for child abduction or bed capacity |
| Gold | Bomb Threat | Many facilities use Black or a plain-language alert for bomb threats |
| Pink | Infant or Child Abduction | One of the few codes that means roughly the same thing nationwide |
Outside Maryland, standard code lists are voluntary. A March 2015 advisory from the Pennsylvania Patient Safety Authority found that more than 25 state hospital associations had recommended a common set of codes to their members. Maryland was the only state that required one, and Pennsylvania had no statewide system of its own.
Where to find your hospital’s definition
Most hospitals print their emergency code list on a badge card or a poster near the nurses’ station. Employees can also find it in the policy library on the staff intranet. Visitors who want to know what a code means can ask at the information desk during a normal day. During an active alert, it is better to follow the announcement than to stop and ask.
Is Code Silver the Code for Active Shooter in Hospitals?
At hospitals that define the code narrowly, the written policy names Code Silver as the active shooter code in hospital announcements. In other hospitals the code covers a wider group of armed threats, with a shooter as only one possibility.
Some hospitals do not use a color for this at all. They announce the threat in plain language, for example “Armed person in the east lobby, move away from the area.” Iowa hospitals use this approach, with each announcement built from the threat, its location, and the action people should take.
Because of these differences, the code for active shooter at one hospital may not match the code at the next. Staff who work at more than one facility need to learn each list separately.
Color codes compared with plain language
Hospitals have debated this choice since at least 2002, when Maryland adopted its uniform codes. Each approach solves one problem while creating another, as the comparison below shows.
| Approach | Strength | Weakness |
| Color code | Short, easy to repeat over a paging system, familiar to trained staff | Means nothing to visitors, and definitions differ between neighboring hospitals |
| Plain language | Understood by anyone in the building the first time they hear it | Takes longer to announce, and may frighten patients who overhear it |
| Hybrid | Gives staff the code while telling everyone else what is happening | Needs a fixed script, or the two parts of the message drift apart over time |
A 2011 survey of California hospitals found that about 80% of respondents used separate codes for a combative person and for a person with a weapon. That separation is what most people are looking for when they compare Code Silver with a behavioral emergency code.
What Triggers a Code Silver Hospital Alert?
The Code Silver weapon response begins when a person is seen with a weapon or threatens people with one. The weapon may be a firearm, a knife, a machete, or any object being used to cause harm. Many policies also include a hostage crisis, an armed or violent intruder, or a person who has barricaded themselves in a room with a weapon.
Hospitals usually do not wait for confirmation. A report that is credible enough to act on is normally sufficient, since checking whether a weapon is real would mean someone has to get closer to it.
What to report
Start with the location, then describe the person, the weapon if you saw it, and anyone who appears to be hurt. Keep to what you saw or heard yourself.
A few things should be avoided while making the report. Do not walk toward the person to confirm what you saw, and do not delay the call to gather more detail. Use the reporting channel your hospital has approved rather than a unit group chat. Assume nobody else has called yet, even if other people saw the same thing.
Consider a visitor in the emergency department who shows a handgun tucked into a waistband and threatens a nurse. The nurse leaves the room, then calls the number printed on the badge card. The report covers the location, a description of the visitor, the type of weapon, and the fact that nobody has been injured so far. Who makes the overhead announcement after that depends on local policy.
Why Would a Hospital Be on Lockdown?
A hospital on lockdown is not always dealing with a shooter. Lockdown is a way of controlling who enters or leaves a building, and hospitals use it in many situations that have nothing to do with weapons.
Hospital policies commonly list infant abduction and kidnapping as reasons for a lockdown. A chemical or biological incident that requires controlled access can also lead to one, as can a protest or disturbance near the campus. Another frequent trigger is the arrival of a violent-crime victim while the suspect remains at large.
| Trigger | What the lockdown is doing |
| Armed person on site | Keeping people away from the threat and stopping anyone new from walking into it |
| Infant or child abduction | Holding the exits so the child cannot be carried out of the building |
| Violent-crime victim arriving | Keeping a suspect who is not in custody out of the treatment area |
| Contamination or quarantine | Limiting movement so an exposure does not spread through the building |
| Disturbance near the campus | Protecting entrances when the incident is outside rather than inside |
| Threat received by phone or message | Giving security time to assess the threat before deciding what to do |
So when people ask why would a hospital be on lockdown, the lockdown alone does not answer the question. The announcement and the updates that follow are the only reliable information. People inside should wait for those updates rather than walking through a secured door or around a checkpoint to see what is happening.
Hospital Code Silver Activation: How the Alert Works
Most hospitals follow a similar Code Silver procedure once a weapon is reported. Each facility writes its own version, though none of these steps should stop a person from protecting themselves first.
1. The person who sees the threat reports it to security, the switchboard, or 911, starting with the location.
2. Security leadership or the administrator on call checks the report against hospital policy. In some hospitals any staff member can trigger the alert directly.
3. The operator makes the overhead announcement, then sends a mass-notification message to staff phones and pagers. The message names the alert and gives the location if it is known.
4. Law enforcement notification comes next, with the hospital calling local police as soon as the threat is reported. Anyone in immediate danger should call 911 themselves without waiting for the hospital to do it.
5. Incident command then takes over coordination of the response. Security, clinical leaders, and communications staff manage access to the building with the responding officers.
Who can call a Code Silver
Authority over Code Silver activation differs between hospitals. A full site lockdown is usually ordered by a designated administrator or a security supervisor, while a partial lockdown often has a shorter approval path.
Some hospitals give the first step to whoever witnesses the threat. Their reasoning is that time spent finding a supervisor is more dangerous than an occasional false alarm. Staff should learn which approach their own hospital uses before an emergency happens.
Example Code Silver notification wording
A coded announcement might sound like this: “Code Silver, main lobby. Follow your emergency response procedures. Move away from the area or secure your location. Await further instructions.”
A plain-language version could say: “Armed person reported in the main lobby. Leave the area if you can do so safely. Otherwise secure yourself and wait for official instructions.”
Both versions name the threat, give the location, and tell people what to do. Neither adds unconfirmed details about the person, which is a common mistake in live alert announcements. Updates should go out through the hospital’s approved Code Silver communication system, which usually combines overhead paging with text alerts.
The Code Silver response team
The team that responds to the alert usually includes the hospital security team, switchboard operators, administrators, clinical leaders, facilities staff, and communications personnel. Police join the team once they arrive at the hospital. Larger incidents lead to Code Silver incident command under the Hospital Incident Command System, which gives each of these groups a defined role.
A command structure matters because a hospital under an armed threat has to make several decisions at once. It has to control access and move patients while it is also handling calls from worried families. Without one person in charge, those decisions can contradict each other.
What to Do During a Code Silver: Run, Hide, Fight

Run, Hide, Fight was created by the City of Houston’s Office of Public Safety and Homeland Security. The city holds the trademark, and the program was funded through a federal preparedness grant. The version most hospitals train on today is published by the Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency. Most hospitals build their Code Silver emergency protocol around it. A hospital active shooter protocol then adds unit-specific steps. The hospital’s own training takes priority over any general guidance, including this article.
The three options are not steps to follow in order. Which one applies depends on where the threat is and what routes are open to you at that moment.
Run
If there is a safe way out, take it. Find out where the threat is, then leave through an exit that does not pass the reported location. Leave bags, coats, and equipment behind.
Keep your hands visible and empty as you move, especially when police officers are coming toward you. Do not go back to your unit for belongings or try to see what is happening near the threat.
Hide
If leaving is not safe, get into a room with a door that closes. Lock the door if it has a lock, then block it with something heavy such as a desk, a bed, or a filing cabinet.
Turn off the lights and move out of view of any window in the door. Silence phones and pagers completely, since a phone vibrating on a hard surface can be heard from the corridor.
Stay in the room until police or the hospital’s official notification system confirms it is safe. A lockdown order does not tell people to move anywhere. An all-clear passed on by a colleague also does not count as the official one.
Fight
Fighting is a last resort for when the threat reaches you and there is no way to run or hide. CISA’s guidance describes it as committing to decisive action with the aim of stopping the attacker.
This option comes with two important limits. Staff should not go looking for the attacker or try to take a weapon away while an exit remains open. Federal healthcare planning guidance also states that confronting an armed person should never be part of a health worker’s job.
Calling 911
Call or text 911 as soon as you can do so without being heard. Responding officers find five pieces of information most useful:
● The location of the shooter or armed person, as precisely as possible
● How many people are involved
● What each person looks like
● How many weapons there are and what type, if you saw them
● How many people appear to be injured
Report only what you saw yourself. If the person moves to a different area, call back so the dispatcher has the current location.
When police arrive
Remain calm and put down anything you are holding. Raise your hands with your fingers spread so officers can see them, and follow their commands without asking questions.
Do not run toward officers or grab one of them for reassurance. Avoid pointing at officers or shouting, even if you are frightened. If you are evacuating, keep moving instead of stopping an officer to ask for directions.
The Code Silver law enforcement response puts finding the attacker first, so the first officers to arrive will usually walk past people who are injured. Rescue teams follow behind them to treat the wounded. Seeing officers pass by injured people is distressing, but it is the order that federal guidance sets for them.
Role-Based Response
Each role has a different job in the Code Silver emergency response. The table summarizes the usual priorities for each role.
| Role | Priority during the alert |
| Clinical staff | Follow the unit plan. Protect patients when it does not put you in greater danger, and do not enter a threatened area for routine care. |
| Non-clinical staff | Share alerts only through approved channels. Guide people away from danger when it is safe, and keep controlled doors closed. |
| Security | Pass accurate information to police and support access control. Work with officers instead of confronting an armed person alone. |
| Switchboard operators | Use the approved script to notify the designated contacts, including emergency services. Log every update while keeping the line clear. |
| Administrators | Lead the command structure. Decide on resources, family communication, and how patient care will continue. |
| Patients and visitors | Leave the area if there is a safe route. If not, follow staff into a secure room. |
Everyone in the building should stay out of corridors and elevators during the alert. That includes people who want to find a relative or a colleague in another part of the hospital.
Code Silver Patient Safety: Protecting Patients Who Cannot Move
Hospitals face a problem that offices and schools do not. A patient on a ventilator, a patient in surgery, or a newborn cannot run or hide. The plan for these patients has to be written well before any emergency.
The CISA action guide for hospitals tells facilities to secure patients by locking down critical areas, naming operating rooms, treatment units, and intensive care units. Other federal planning guidance adds that moving critical patients may require a police escort.
Planning by unit
In operating rooms, the team usually secures the doors and continues essential care until the surgeon can safely pause or close. An operation cannot stop because an announcement has been made.
Intensive care units face a similar problem. Staff usually secure the room while life support continues, then wait for police or security to confirm a safe route before moving anyone.
The emergency department has more people coming and going than any other part of the hospital, often without screening. For that reason many policies give it a separate access-control step.
Neonatal and pediatric units need a plan for children who cannot walk out on their own. That plan should say who carries each child, how many staff each cot needs, and where they should go. Behavioral health units also need a plan that keeps patients supervised in secure rooms throughout the alert.
Each unit’s Code Silver evacuation protocol should name the routes, the staff, and the equipment needed for patient evacuation. On every unit, staff should only move patients through areas that have been cleared. A unit without a lockable room needs a written plan for that gap before an alert happens.
Hospital Lockdown Procedures
Hospital lockdown procedures can apply to a single department or to an entire campus. A Code Silver hospital lockdown uses the same procedures that hospitals apply to abductions and other security threats. Federal guidance treats lockdown as one general measure and does not define separate levels for hospitals.
The levels that appear in many online guides come from individual hospital policies. They describe how Code Silver lockdown procedures and other lockdowns are often written. They give staff a common vocabulary, but the names at your facility may be different, as may the person who has authority to call each level.
| Level, as used in some policies | What it restricts |
| Total site lockdown | All perimeter doors are secured, with nobody entering or leaving. |
| Controlled lockdown, exit only | Entry is stopped, and people leaving may be screened on the way out. |
| Controlled lockdown, both directions | Entry and exit are both screened at designated points. |
| Partial lockdown | Foot traffic is directed to a small number of staffed entrances. |
| Department lockdown | One area, often the emergency department, moves to badge access with escorts for everyone else. |
Checkpoints and a secure perimeter
During a lockdown, hospital policies usually start by checking each person’s identity and reason for being there. Badges, bags, packages, and vehicles may be checked as well, depending on the incident. CISA’s guidance for hospitals recommends monitored entrances and badge checkpoints that stop people from following someone else through a door. Code Silver hospital security plans usually assign the security department to staff these checkpoints, with local law enforcement helping at driveways when needed.
The same guidance asks hospitals to share their floor plans with local police and fire services ahead of time. Officers who already know the layout can reach the threat faster.
People on foot during a lockdown should use the designated route and follow the screening instructions. Arguing with checkpoint staff or looking for another way in only slows the process for everyone.
Code Silver vs Code Blue and Other Hospital Emergency Codes
The table below shows how Code Silver usually compares with other common hospital codes. Because definitions vary between facilities, staff should check their own hospital’s list.
| Code | Common use (varies by facility) | How it differs from Silver |
| Silver | Weapon, active shooter, or hostage threat | A weapon is present or has been reported |
| Grey | Combative or violent person, often with no weapon confirmed | A behavioral emergency rather than an armed one; Maryland uses Gray for elopement instead |
| Blue | Cardiac or respiratory arrest | A medical response, so staff move toward it rather than away |
| White | Violent person or behavioral emergency in some systems | Overlaps with Grey, which some regions use interchangeably |
| Purple | Varies widely, from hostage to abduction to bed capacity | Never interchangeable with Silver |
| Pink | Infant or child abduction | Leads to a perimeter hold rather than shelter in place |
Grey shows clearly why color codes cannot be trusted across state lines. California hospitals use it for a combative person, while Maryland’s regulation assigns Gray to a patient who leaves without authorization and gives the combative person Code Green. For other codes used in hospitals, see the guides to Code White, Code Purple, Code Pink, and Code Blue.

How Often Does a Code Silver Hospital Event Happen?
Federal data on this question comes from two separate sources. The FBI tracks active shooter incidents by location, while the Bureau of Labor Statistics tracks workplace injuries by industry.
Active shooter incidents in health care
The FBI recorded 48 active shooter incidents in 2023. Two of them took place in health care facilities, which the Bureau defines as public or private facilities that provide primary or secondary health services. Open spaces accounted for 28 incidents that year, with 14 in commercial settings.
The share is similar over a longer period. Of the 277 incidents the FBI recorded between 2000 and 2018, 12 happened in health care facilities, or 4.3% of the total. Commercial settings accounted for 121 incidents over the same period, while schools and colleges accounted for 57.
Healthcare workplace violence
Everyday violence against staff is much more common. Bureau of Labor Statistics data for 2021 to 2022 shows 14.2 serious injuries from intentional violence per 10,000 full-time workers in health care and social assistance. The rate for all private industry was 2.9.
That makes the health care rate roughly five times higher than the average. Health care and social assistance accounted for 72.8% of all such cases in private industry over those two years. The figures include only injuries serious enough to cause time away from work, a job transfer, or restricted duties.
| Measure | Health care | All private industry |
| Injuries from intentional violence per 10,000 full-time workers (2021 to 2022) | 14.2 | 2.9 |
| Share of all such cases in private industry | 72.8% | 100% |
| Active shooter incidents in 2023 (FBI) | 2 of 48 | 48 |
| Active shooter incidents from 2000 to 2018 (FBI) | 12 of 277 | 277 |
These figures help explain how hospital security programs are designed. Code Silver plans exist for an event that is rare but can cause many deaths in minutes. The training, reporting, and de-escalation work around those plans is aimed at the violence that staff face on ordinary shifts.
The Code Silver Recovery Phase and After-Action Review
Recovery begins once police or the authorized incident leader declare the threat over and issue an all-clear. A quiet corridor is not a reason to leave a secure room before that announcement.
After the all-clear, the hospital accounts for every patient, staff member, and visitor. It reunites people where it can and publishes updates about which areas remain closed. Staff should stay where they are until officials tell them to return to their work areas.
What stays disrupted
Police may keep parts of the building closed as a crime scene, sometimes for several days. Scheduled procedures are often moved to another day or another site, and families arriving for appointments may be directed to unfamiliar entrances.
The Code Silver after-action review
Hospitals hold a post-incident review once the immediate response is over. A useful review asks four questions:
● Which parts of the plan worked as written, and which only worked because someone improvised
● Where communication or access control broke down
● How the incident affected patient care, including delayed procedures
● What changes should be made to training and policy
Support for staff belongs in the same plan. Anxiety and intrusive memories often appear in the weeks after an incident rather than on the day itself. For that reason, mental health services, chaplaincy, and employee assistance programs should remain available long after the all-clear.
Code Silver Hospital Policy, Training, and Drills
A hospital’s Code Silver policy is usually part of its Emergency Operations Plan rather than a separate document. Planning starts with a hazard vulnerability assessment, which looks at the hospital’s buildings, its patients, its staffing pattern, and how quickly local police can respond.
Federal requirements
Hospitals that take part in Medicare or Medicaid must meet the emergency preparedness rule at 42 CFR 482.15. Under that rule, three documents have to be reviewed at least every two years: the emergency plan, the written policies, and the emergency communication plan.
The rule also requires hospitals to test their emergency plan twice a year. One test must be a full-scale exercise run with the wider community, or a functional exercise inside the hospital if no community exercise is available. The second test can be another full-scale exercise, a mock disaster drill, or a tabletop exercise in which a facilitator walks staff through a realistic scenario.
A real emergency that activates the plan counts in place of the next full-scale exercise. Hospitals that respond to an actual Code Silver therefore do not have to stage another full-scale drill that year.
Code Silver staff training follows a separate schedule. New and existing employees receive initial training, followed by refresher training at least every two years. Before 2019 the requirement was annual, but the 2019 Burden Reduction final rule moved most providers to a two-year cycle. Long-term care facilities kept the annual requirement. Every provider must also retrain staff when the plan changes significantly.
Running a Code Silver drill without frightening patients
A drill in a working hospital can alarm patients who do not know it is an exercise. Hospitals reduce that risk by telling patients and visitors about the drill in advance. Every announcement should also include the word “drill,” and the physical part of the exercise is best run in an empty area of the building.
A good drill tests the whole security protocol, from the first report through the overhead announcement, the mass notification, and the checkpoints at each entrance. It should also time the incident command activation from the first report. Patient accountability is the safety procedure that most often fails in exercises, so it deserves the most attention.
Equipment and industry guidance
Hospitals commonly support their plans with duress buttons, badge-controlled doors, cameras, and backup alert systems. The International Association for Healthcare Security and Safety publishes Industry Guideline 08.09, Active Shooter/Hostile Event Response. Its 2026 update brings it in line with the 2024 edition of NFPA 3000. The guideline organizes the work into preparedness, mitigation, response, and recovery under unified command.
For Code Silver training, many hospitals also use the Federal Emergency Management Agency’s free online course IS-907, Active Shooter: What You Can Do.
The Department of Health and Human Services publishes further planning material for hospitals. Its On-Campus Health Care Facility Armed Assailant Planning Considerations covers armed-assailant planning directly. The Disaster Available Supplies in Hospitals (DASH) Tool helps hospitals estimate the supplies they would need during a surge of casualties. Issue 20 of its newsletter, The Exchange, covers preparing for mass casualty burn incidents.
Equipment only helps when the plan says who answers it. For a duress button, the policy needs to name the person who responds, where that person comes from, and how quickly they are expected to arrive.
Hospital Violence Prevention Rules and Standards
There is no single national Code Silver script in the United States. Instead, hospitals work under federal workplace safety law, federal preparedness rules, accreditation standards, and any extra rules their state adds.
OSHA
OSHA has no specific standard for workplace violence. It enforces the issue through the General Duty Clause in Section 5(a)(1) of the OSH Act. That clause requires employers to provide a workplace free from recognized hazards that are likely to cause death or serious harm.
OSHA’s guidance for health care employers, publication 3148, is voluntary. Ignoring it is not a violation in itself. An employer can be cited under the General Duty Clause if a recognized risk of workplace violence existed and reasonable steps to reduce it were available.
OSHA inspections in this area follow directive CPL 02-01-058, which took effect on 10 January 2017. The directive names health care and social services specifically. An inspection usually follows a complaint, a referral, or a death or hospitalization. OSHA has no National Emphasis Program for workplace violence in health care.
California
California has the most detailed state rule. Title 8 CCR Section 3342, Violence Prevention in Health Care, came out of SB 1299 and took effect on 1 April 2017.
Under this rule, a hospital must report any incident involving a firearm or other dangerous weapon to Cal/OSHA within 24 hours of learning about it. The same 24-hour deadline applies to incidents that cause injury or present an urgent threat, while other reportable incidents must be reported within 72 hours.
The rule also sets deadlines for fixing hazards. Imminent hazards must be corrected immediately, while serious hazards must be corrected within seven days. Staff who provide direct patient care, along with their supervisors, must receive refresher training at least once a year. That training must include a chance to ask questions.
Each hospital’s plan must explain how staff can get help from police on every shift without fear of retaliation. The rule also sorts workplace violence into four types based on who commits it:
● Type 1: a person with no legitimate business at the hospital
● Type 2: a patient, a visitor, or someone accompanying a patient
● Type 3: a current or former employee, supervisor, or manager
● Type 4: someone who has a personal relationship with an employee
Accreditation and CMS
New Joint Commission workplace violence prevention requirements for accredited hospitals took effect on 1 January 2022, according to the American College of Surgeons. They cover leadership oversight, worksite analysis, incident reporting with data review, post-incident support, staff training, and written policy. The CMS emergency preparedness rule described above applies separately.
States can add their own requirements on top of these. Hospital staff should confirm the current rules with their compliance team, because requirements differ from one state to the next.
Conclusion
A code silver in hospital use almost always refers to a weapon, an active shooter, or a hostage situation. Because only Maryland defines the code in law, the announcement at your own hospital is the instruction that counts.
Staff can prepare before an alert by reading their hospital’s emergency code list and learning who is allowed to trigger it. It also helps to know what the unit plan says about patients who cannot move on their own.
For administrators, federal rules require two plan exercises a year and staff training every two years. California adds a 24-hour reporting deadline for any incident involving a weapon. Each hospital’s own plan should go further than these minimums, based on its buildings, its patients, and how quickly police can reach it.
Frequently Asked Questions
The code silver meaning in most hospitals is a weapon on the property, which may involve an active shooter, an armed person, or a hostage situation. The announcement starts a security response and often a lockdown of the affected area. Each hospital sets its own definition, so follow the instructions in the announcement you hear.
It is a hospital security alert used for a threat involving a weapon and, in some hospitals, a hostage situation. Some facilities use it only for an active shooter. Others use it for any armed person, including someone with a knife, so the color does not mean exactly the same thing everywhere.
In most hospitals it means an armed person or an active shooter, since that is the most common definition. The only way to be sure is to check the facility’s emergency code list. Hospitals usually print the list on staff badge cards and wall posters. Visitors can also ask at the information desk.
Many hospitals call it an active shooter Code Silver. Others include a shooter under a broader weapon code, or announce the threat in plain language instead of using a color. No federal rule assigns a color to an active shooter, so the active shooter code can differ between hospitals in the same city.
Authority to call the code depends on each hospital’s Code Silver protocol. A designated administrator or security supervisor usually orders a full site lockdown, while some hospitals let any employee trigger the alert when they see an immediate threat. Anyone facing immediate danger should call 911 directly.
No. Maryland is the only state that sets hospital code meanings in regulation, where Code Silver means an armed assailant. In other states each hospital writes its own list, and neighboring hospitals often disagree. Some hospitals do not use color codes at all.
Code Silver usually means a weapon, an active shooter, or a hostage threat. Code Grey usually means a combative person without a confirmed weapon. Maryland is an exception, since its regulation uses Gray for a patient leaving without authorization and Green for a combative person.
A hospital on lockdown is controlling who comes in and out, which it may do for many reasons besides a shooter. Common reasons include infant abduction, a violent-crime suspect who is still at large, or a contamination incident. A lockdown can also be a precaution or apply to only one department.
If there is a safe way out of the area, leave your belongings and go. If there is not, get into a room with a door that closes, silence your phone, and wait for official instructions. Stay out of the corridors, even if you want to find a relative.
Hospitals in Medicare must test their emergency plan twice a year, with one test being a full-scale community exercise where one is available. Each hospital decides how often those tests involve an armed-assailant scenario, based on its own hazard assessment. Hospitals can add smaller safety drills on individual units between the required exercises. Staff refresher training is required every two years.
That depends on where the threat is and how far the operation has progressed. The surgical team may lock the doors while the operation continues, pause at a safe point, or move the patient once a safe route has been cleared. Hospitals plan for these patients in advance for this reason.
Shootings inside hospitals are rare compared with other places where active shooter incidents happen. The FBI counted 48 active shooter incidents in 2023, and two of those were in health care facilities. Everyday violence against hospital staff is far more common, with serious injury rates about five times higher than the average for private industry.
This article provides general information for readers in the United States. It does not replace your facility’s emergency operations plan, its policies, or instructions from law enforcement. Follow the alert issued where you are, and call 911 in an emergency.

