Ringing the Alarm: Rapid Response or Code Blue

April 11, 2017
Damion Jenkins

 Learn how to tell the difference between rapid response and code blue.

Does your patient warrant a rapid response or code blue alarm? Here’s how to tell.

Sometimes making the split decision to call a rapid response or a code blue for patients in distress can be difficult. Understanding the criteria for each helps nurses differentiate between which alarm to initiate.  

To help you better understand the differences between calling a rapid response or a code blue, let’s review the criteria for each.

Rapid response

Goal: The goal of a rapid response is to intervene before the onset of injury, respiratory arrest, or cardiac arrest.

Initiated by: A rapid response can be initiated by anyone, including family, hospital staff, nursing staff, physicians, and visitors.


Examples of when to call a rapid response

  • Heart rate over 140/min or less than 40/min
  • Respiratory rate over 28/min or less than 8/min
  • Systolic blood pressure greater than 180 mmHg or less than 90 mmHg
  • Oxygen saturation less than 90% despite O2 supplementation, deep breathing and coughing efforts, etc.
  • Acute change in mental status
  • Urine output less than 50 cc over 4 hours
  • Staff, family, or visitor has significant concern about the patient’s condition

The members of a rapid response team may include:

  • Critical Care Nurse
  • Respiratory Therapist
  • Primary RN
  • Critical Care Physician
  • Nursing Supervisor

Rapid response process

  • Detection
  • Activation
  • Response, Assessment, Intervention and Stabilization
  • Disposition
  • Evaluation


Code blue

Goal: The goal of a code blue is to perform resuscitation efforts after a person has stopped breathing, or after a person’s heart has stopped beating.

Initiated by: A code blue should be initiated by anyone with CPR certification or someone that can verify if a person has stopped breathing, or has no pulse.


Examples of when to call a code blue:

  • Person has stopped breathing
  • Person has no pulse
  • Unable to determine if the person has a pulse or if they are breathing, and is unresponsive
  • Unsure of what to do, and are very concerned for the life of the person

The members of a code blue team may include:

  • Code Team Leader
  • Critical Care RN
  • Respiratory Therapist
  • Primary RN
  • Critical Care Physician
  • Critical Care Resident
  • Recorder
  • Patient Care Tech or Nursing Assistant
  • Runner
  • Security
  • Nursing Supervisor

Code blue process

  • Detection
  • Activation
  • Response, Assessment, Intervention and Stabilization
  • Disposition
  • Evaluation

Similarities and differences

As you can see, a rapid response and a code blue are similar in that they alert a team of highly trained clinicians to respond to a medical emergency. The clear difference is that a rapid response is for the prevention of serious injury, cardiac arrest, and respiratory arrest, and a code blue is called for a person who has stopped breathing, or who does not have a heart beat, with the goal of resuscitation.

Now that you know the clear difference between calling a rapid response and a code blue, we are confident that you will do what’s best for your patients in distress.

Get more experience differentiating between different nursing concepts with free NCLEX practice questions and review.

Damion Jenkins Damion Jenkins is a nurse education consultant and adjunct nursing professor in Baltimore, Maryland. He enjoys teaching a variety of healthcare courses, including: Nursing, Certified Nursing Assistant, Geriatric Nursing Assistant, Certified Patient Care Technician, IV Therapy, Phlebotomy, Certified Medicine Aide, and Nurse Refresher. His passion for enhancing the nursing profession has led him to become an active nurse blogger, author for nursing continuing education, and a private tutor. Damion graduated from the Community College of Baltimore County in 2010, and then earned a master's degree in nursing education from Walden University in 2014. In Damion’s free time, he enjoys writing, gardening, cooking, traveling, and spending time with family and friends.

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