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Sheetal Singh, 2 DK Sharma, 3 Sanjeev Bhoi, 4 Sapna Ramani Sardana, 5 Sonia Chauhan Code Blue Policy for a Tertiary Care Trauma Hospital in India International Journal of Research Foundation of Hospital & Healthcare Administration, July-December 2015;3(2):114-122 115 JRFHHA • Reassurance and continued observation of the collapsed patient. Each member of the multidisciplinary team is to know and understand the skills and roles of each person involved in the Code Blue response. During a Code Blue response, the multidisciplinary team recognizes the resuscitation team leader for possessing broad skills of organization and performance related to the Code Blue response. All active members should be performing as a wellconstructed team, polished by practice and experience. This will assist in preventing a disorganized and frantic code scene (Flow Chart 1).3 The incidence of out-ofhospital cardiac arrest is estimated between 36 and 128 per 100,000 subjects per year. In these victims, cardiopulmonary resuscitation efforts are made in as many as 86%, and return of spontaneous circulation (ROSC) can be achieved in 17 to 49%.4 Cardiac arrest is a medical emergency that, in certain situations, is potentially reversible if treated early. Unexpected cardiac arrest can lead to death within minutes: this is called sudden cardiac death (SCD). The treat­ment for cardiac arrest is immediate defibrillation if a “shockable” rhythm is present, while cardiopulmonary resuscitation (CPR) is used to provide circulatory support and/or to induce a “shockable” rhythm. A number of heart conditions and non-heart-related events can cause cardiac arrest; the most common cause is coronary artery disease.5 Cardiopulmonary resuscitation is an important part of the management of cardiac arrest. It is recommended that it be started as soon as possible and interrupted as little as possible. The component of CPR that seems to make the greatest difference in most cases is the chest compressions. Correctly performed bystander CPR has been shown to increase survival; however, it is performed in less than 30% of out of hospital arrests as of 2007. If high-quality CPR has not resulted in ROSC and the person’s heart rhythm is in asystole, discontinuing CPR and pronouncing the person’s death is reasonable after 20 minutes.5 For decades, conventional wisdom in treating patients with cardiac arrest was that if the heart stopped beating for longer than 6 to 10 minutes, the brain would be dead. Now a new treatment being embraced by a growing number of US hospitals suggests that patients can be brought back to a healthy life even if their heart is stopped for 20 minutes, perhaps longer. In recent months around the US, doctors and nurses say, cardiac-arrest patients who would previously have been given up for dead have been revived and discharged to return to their families and jobs with all or nearly all of their cognitive abilities intact.6 Each year in the US, 400,000–460,000 persons die of unexpected SCD in an emergency department (ED) or before reaching a hospital.7 The proportion of SCD that occur out-of-hospital has increased since 1989. Death and disability from a heart attack can be reduced if persons having a heart attack can immediately recognize its symptoms and call for emergency care. Prehospital emergency medical service systems can assist in reducing SCD rates by dispatching appropriately trained and properly equipped response personnel as rapidly as possible in the event of cardiac emergencies. However, national efforts are needed to increase the proportion of the public that can recognize and respond to symptoms and can intervene when someone is having a heart attack, including calling the designated number, attempting cardiac resuscitation, and using automated external defibrillators until emergency personnel arrive.7 Survival rates for cardiac arrests that occur in hospitals and outside them continue to be low (17 and 6%, respectively), and fewer than one-third of patients who have an out-of-hospital cardiac arrest receive CPR. Consequently, a number of changes were made to the 2005 American Heart Association Guidelines for CPR and emergency cardiovascular care. The changes were intended to simplify CPR in order to increase its use and effectiveness by both clinicians and nonprofessionals.8 In one of the study by Stundek et al, it was found that there were 1,142 cardiac arrests which were included in the analytic data set. Prehospital ROSC occurred in 299 individuals (26.2%). When controlling for initial arrest rhythm and other confounding variables, individuals with no endotracheal intubation (ETI) attempted were 2.33 (95% confidence interval [CI] = 1.63–3.33) times more likely to have ROSC compared to those with one successful ETI attempt. Of the 299 individuals with prehospital ROSC, 118 (39.5%) were subsequently discharged alive from the hospital. Individuals having no ETI were 5.46 (95% CI= 3.36–8.90) times more likely to be discharged from the hospital alive compared to individuals with one successful ETI attempt.9 A study was conducted in the year 1996, by Cobbe et al to determine the short and long-term outcome of patients admitted to hospital after initially successful resuscitation from cardiac arrest out of hospital. From the study, it was found that about 40% of initial survivors of 

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