Week 3- CTAS

Question 1

Canadian Triage Acuity Scale

Answer 1

• Started in hospital Emergency Departments as a tool to help define a patient need for care
• Shortly after implementation in ED, Paramedic Services adopted the program

Question 2

ED vs Ambulance CTAS

Answer 2

• ED uses it so that the sickest pt’s get care 1st
• Paramedics use it as an indicator for acuity

Question 3

Standardized System Advantage

Answer 3

• Determines the most appropriate destination based on acuity (ie. closest hospital)
• Common language for paramedics, dispatch, ED staff
• Assisted ED’s in preparing internal resources for pt’s arriving by Ambulance

Question 4

When do you give your pt a CTAS number?

Answer 4

• On pt contact
• On departure
• Arrival to receiving facility

Question 5

The Rules regarding CTAS levels

Answer 5

1) A min of 2 CTAS scores will be applied to each pt
2) The CTAS level reported to the receiving institution is the level at departure from the scene or if the pt’s condition deteriorates after transport has been initiated
3) When taking into consideration the pt’s response to treatment, subsequent CTAS levels assigned must not be any greater than 2 levels below the pretreatment acuity
4) For a pt who is VSA on arrival and who is resuscitated, the CTAS must stay as a CTAS 1
5) If Paramedic receive a TOR order while managing a pt, the CTAS level assigned for the pt and documented on the ACR is based on the status of the pt on arrival and departure (if applicable) from the scene
6) In cases where it is determined on arrival that a pt is “obviously dead”, no CTAS level (Arrival or Departure) is required to be assigned and documented as a 0 on the ACR

Question 6

Destination- LEVEL 1

Answer 6

• Nearest/ closest most appropriate receiving facility

Question 7

Destination- LEVEL 2

Answer 7

• Nearest/ closest most appropriate receiving facility based on communication between Paramedics, dispatch and the receiving facility

Question 8

Destination- LEVEL 3, 4, 5

Answer 8

• Most available receiving facility based on communication between dispatch and the receiving facility. The final destination for these lower acuity levels may also take into consideration the pt’s wishes for destination

Question 9

Canadian Emergency Department Information System (CEDIS)

Answer 9

• The Canadian Emergency Department Information System (CEDIS) is a health information tool that place pt’s into 1 of 18 categories that are system based (ex. cardiovascular, orthopedic, respiratory)

Question 10

List of CEDIS categories

Answer 10

• Cardiovascular
• ENT
• Enviornmental
• Gastrointestinal
• Genitourinary
• Mental health
• Neurologic
• Obstetrics/ Gynecology (OB/GYN)
• Ophthalmology
• Orthopedic
• Pediatric
• Respiratory
• Skin
• Substance Misuse
• Trauma
• General & minor

Question 11

What is the first step of assigning an Adult CTAS level?

Answer 11

1. Quick look
   - this applies primarily to critically ill pt’s
   - Use to place pt’s in the CTAS 1 category only

Question 12

What is the second step to assigning an Adult CTAS level?

Answer 12

2. Presenting complaint
   - The second step is to determine the presenting complaint based on the CEDIS category

Question 13

What is the third and fourth step to assigning a CTAS level?

Answer 13

3/4. First and second order modifiers
- Rules that have been created to decide the pt CTAS level

Question 14

Pediatric Prehospital CTAS

Answer 14

• For the purposes of determining a CTAS level, pediatric pt is defined as a person <18 yrs
• The S/S of serious problem may be subtle or develop quickly in children. Frequent reassessment of children is especially important to ensure their safety and address the concerns of parents/ caregivers

Question 15

1. First look- Use the paediatric Assessment Triangle

Answer 15

Appearance
- Tone
- Interactiveness
- Consolability
- Look/ gaze
- Speech

Circulation
- Pallor
- Mottling
- Cyanosis

Work of breathing
- Breath sounds
- Positioning
- Retractions
- Flaring
- Apnea/ Gasping

Question 16

2. Presenting Complaint

Answer 16

• In peds, assessment of the presenting complaint is often complicated by the limited ability of children to communicate their difficulties and a paramedic’s reliance on the perceptions of caregivers

Question 17

What are the 5 most common presenting complaints in peds?

Answer 17

• Fever
• Resp difficulties
• Injuries
• Change in behavior
• Vomiting and/ or diarrhea (dehydration)

Question 18

Pediatric History: Subjective Data

Answer 18

• The ability of young children to accurately describe symptoms, feelings, and events should never be underestimated

The following observations may also be helpful:
- Does the child have age/ developmentally appropriate behaviour and social interaction?
- Are the interfamilial dynamics appropriate?
- Are there any indicators of child abuse or neglect?

Question 19

Modifiers

Answer 19

• The application of modifiers is different in children as they are divided into physiological first order modifiers that include vital signs and non-physiological first order modifiers

Question 20

Peds Modifier Considerations- Vital Signs

Answer 20

the range of normal vital signs is quite wide and very age dependant

Question 21

Peds Modifier Considerations- Fever

Answer 21

febrile illness is a common presentation but it should be noted that the degree of temperature elevation does not necessarily reflect the severity of illness

Question 22

Peds Modifier Considerations- Pain

Answer 22

pain scales are less helpful at the extremes of age they are still helpful in determining a CTAS level. -there is no distinction between central and peripheral pain