CTAS Levels – Common Prehospital Presentations

 

The following are lists of the CEDIS categories and typical presenting complaints by CTAS level.  The three ENT categories have been folded into one category thus there are sixteen (16) categories for each CTAS level compared to the eighteen used by triage nurses.  In addition, some first order modifiers have been added to help clarify some of the presenting complaints.

 

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CTAS Level 1 – Resuscitation

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Cardiovascular • Cardiac arrest - traumatic and non-traumatic • Pre-arrest - severe end-organ hypoperfusion (e.g. tachycardia, hypotension) • Patients with a return of spontaneous circulation (ROSC) following a cardiac arrest • Chest pain with cardiac features - severe end-organ hypoperfusion • Severe dehydration

 

Environmental • Chemical burn - ≥25% body surface area

 

Mental Health • Violent/homicidal behaviour - imminent harm to self or others or specific plans • Bizarre behaviour - uncontrolled

 

Neurological • Unconscious - GCS 3-9 • Seizures - actively seizing

 

Obstetrics/Gynecology • Pregnancy ≥20 weeks - presenting fetal parts, prolapsed cord • Pregnancy ≥20 weeks - vaginal bleeding in 3rd trimester

 

Respiratory • Respiratory arrest • Shortness of breath - severe respiratory distress

 

Trauma • Major trauma - severe hemodynamic compromise (shock) • Traumatic amputation of an extremity

 

CTAS Level 2 – Emergent

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Cardiovascular • Chest pain with cardiac features - borderline perfusion (e.g. tachycardia with low blood pressure) • Hypertension - SBP ≥220 or DBP ≥130 with symptoms • Syncope - history of new onset dysrhythmia/irregular pulse and/or known/suspected change in rate • Moderate dehydration

 

Ears, Nose, Throat • Dental avulsion • Sore throat - drooling or stridor, obvious edema/swelling of lips, tongue or oropharynx • Neck pain - neck stiffness/meningismus +/-fever • Epistaxis - uncontrolled despite appropriate pressure

 

Environmental • Frostbite/cold injury - cold pulseless limb • Hypothermia with severe symptoms  • Chemical exposure - eye(s) • Chemical exposure - major burns to hand(s), feet, groin or face • Allergic reaction - previous severe reaction

 

Gastrointestinal • Vomiting blood - active or significant hematemesis • Rectal bleed - large amount of melena or rectal bleeding • Abdominal pain (severe pain)

 

Mental Health • Attempted suicide or clear suicide plan • Severe anxiety/agitation

 

Neurologic • Altered level of consciousness - GCS 10-13 • Headache - sudden, severe, worst ever • Headache - visual acuity disturbance +/- eye pain • Seizure - post-ictal • CVA - time of symptom onset <3.5 hours

 

Obstetrics/Gynecology • Vaginal bleeding - heavy +/- pregnancy • Pregnancy ≥20 weeks - active labour (contractions <2 minutes apart) • Pregnancy ≥20 weeks - complex hypertension +/- headache +/-edema +/-abdominal pain 

 

 

Ophthalmology • Acute vision loss

 

Respiratory • Shortness of breath - moderate respiratory distress • Foreign body obstruction - drooling or stridor, hoarseness or dysphagia

 

Trauma • Significant Mechanism of Injury - all patients with injuries, symptoms and complaints related to trauma • Penetrating head, chest or abdomen • Neurovascular compromise of an extremity • Burns -  ≥25% body surface area • Abdominal pain (severe central pain)

 

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CTAS Level 3 - Urgent

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Cardiovascular • Chest pain, non cardiac features - acute onset, ongoing • Hypertension - SBP ≥220 or DBP ≥130 with no symptoms • Hypertension -  SBP 200-220 or DBP 110-130 with symptoms • Mild dehydration

 

Environmental • Frostbite/cold injury - blanching of skin • Hypothermia - moderate symptoms 

 

Gastrointestinal • Vomiting blood - “coffee-ground” emesis, small amount • Rectal bleed - melena, small amount

 

Mental Health • Depression/suicidal (suicidal ideation, no plan) • Moderate anxiety/agitation

 

Neurologic • Seizures - resolved, normal level of alertness • CVA - onset of symptoms ≥3.5 hours or resolved

 

Obstetrics/Gynecology • Menorrhagia • Pregnancy ≥20 weeks (active labour, contractions ≥2 minutes apart) • Pregnancy ≥20 weeks - possible leaking amniotic fluid (≥24 hours)

 

Respiratory • Shortness of breath - mild/moderate respiratory distress • Foreign body obstruction - no distress but with difficulty swallowing

 

Trauma • Burns - 5-25% body surface area

 

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CTAS Level 4 – Less Urgent

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Cardiovascular • Hypertension - SBP 200-220 or DBP 110-130 with no symptoms • Potential for dehydration

 

Environmental • Hypothermia - mild with normal vital signs

 

Gastrointestinal • Rectal Bleeding - small amount • Constipation (mild pain < 4/10)

 

Genitourinary • Urinary tract infection complaints/symptoms (mild dysuria)

 

Mental Health • Mild anxiety/agitation

 

Neurologic • Confusion - chronic, no change from usual state

 

Obstetrics/Gynecology • Non pregnant vaginal bleeding - minor/spotting

 

Trauma • Burns - <5% body surface area • Laceration/puncture (sutures required) • Upper extremity injury 

 

 

 

CTAS Level 5 – Non-Urgent

 

 Environmental • Minor bites (+/- mild pain <4)

 

Gastrointestinal • Diarrhea (mild, no dehydration)

 

General and Minor • Dressing change (plus normal vital signs +/- mild pain <4)

 

Respiratory • Sore throat/upper respiratory illness - no respiratory symptoms/compromise

 

Trauma • Minor contusions, abrasions or lacerations (not requiring closure by any means)