Adult Prehospital CTAS
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Conduct
“Quick Look”
CTAS 1
PRESENTING COMPLAINTS
CARDIAC
Cardiac arrest
Pre-arrest
ROSC
STEMI
Chest pain w/ cardiac features ❶
w/ signs of shock
Severe end organ dysfunction ❶
to pre-arrest
Chest pain w/cardiac features ❷
borderline perfusion
Chest pain, non-cardiac
features ripping/tearing
Syncope new dysrhythmia
Chest pain, non-cardiac
features acute onset
RESPIRATORY
Respiratory arrest
Severe SOB – lethargic or ❶ Major trauma – severe
confused, cyanosis, 1–2 word
speech, unable to speak
Complete FBAO
Moderate SOB – increased
work of breathing, clipped
sentences, significant stridor
but A/W protected
FBAO with drooling or stridor, ❷
hoarseness or dysphagia
Mild/Moderate tachypnea, ❸ ≥ 30 km/hr
SOB on exertion, no obvious
increased SOB, full sentences,
mild stridor
FBAO with no distress
and difficulty swallowing
Sore throat/urti – no
respiratory symptoms
Disclaimer: This infographic can be utilized to assist in assigning levels of CTAS but is not all encompassing, or a replacement of the original document. All material has been referenced from the
“Prehospital CTAS Paramedic Guide Version 2.0: Adult”, http://www.health.gov.on.ca/en/pro/programs/emergency_health/edu/practice_documents.aspx
Determine Presenting Complaints
Cardiac • Environmental • Mental Health
Neurological • OB/GYN • Respiratory
Trauma • Other • Gastrointestinal
ENVIRONMENTAL
❶ Burn ≥ 25% BSA
❶ Chemical burn ≥ 25% BSA
❶ Hypothermia with severe
symptoms
❶ – uncontrolled
Frostbite/cold injury
– cold pulseless limb
Chemical exposure to eye(s)
Major chemical burns to
hand(s), feet, groin or face
Allergic reaction – previous
severe reaction
❷ or resolved
Burn 5–25% BSA
❷ Hypothermia with moderate ❸
symptoms
❸ Anxiety moderate
Frostbite/cold injury with
blanching of skin
Burn < 5% BSA
Hypothermia – mild with
normal vital signs
Laceration/puncture
(sutures required)
Upper extremity injury
Minor bites (+/- mild pain < 4) ⑤
TRAUMA
❶ Amputation of extremity
hemodynamic compromise
Neurovascular compromise
❶ of an extremity
❷ General trauma – MVC
ejection, rollover, extrication
time ≥ 20 min, significant
intrusion, passenger fatality,
impact ≥ 40 km/h unrestrained
or impact ≥ 60 km/h restrained
Motorcycle collision impact
Fall ≥ 6 meters or 2 stories
Penetrating injury proximal
to elbow and knee
❸
Head/Neck trauma: ❷
• MVC ejection (partial or
⑤ complete), unrestrained
striking head on windshield
• Motorcycle collision
• Pedestrian struck
• Fall ≥ 1 meter or 5 stairs
• Assault – blunt object other
than fist/feet
• Axial load to head
Minor contusions, abrasions
or lacerations (not requiring
closure by any means)
p.
Apply First Order Modifiers Apply Second Order Modifiers Assign
02 • Hemodynamic Stability Pain • Bleeding Disorder Highest
GCS (level of consciousness) BGL • Blood Pressure CTAS Level
Temperature Dehydration
MENTAL HEALTH NEUROLOGIC OBSTETRICS /
GYNECOLOGY
❶ Violent/Homicidal behaviour ❶ Active seizure ❶
– imminent harm to self or Pregnancy ≥ 20 weeks ❶
❶ others, or specific plans Unconscious GCS 3–9 ❶ – presenting fetal parts,
❷ CVA onset < 6 hrs ❷ prolapsed cord
Bizarre behaviour ❶
Vaginal bleeding ❶
Headache – sudden, severe, ❷
❷ in the 3rd trimester
Depression/Suicidal/Violent ❷ worst ever, visual acuity
bahaviour with attempted disturbances Pregnancy ≥ 20 weeks ❷
❷ suicide, clear plan or flight risk – active labour (contractions
Post-ictal – altered LOA ❷ < 2 min), complex
❷ Hallucinations with acute ❷ Seizure – resolved, normal ❸ hypertension +/- headache,
psychosis level of alertness edema or abdo pain
❷ Severe anxiety/agitation ❷ CVA onset > 6 hrs ❸ Post delivery ❷
Mother and infant
Safety/Flight risk ❷
❸ Chronic confusion – no change ❹
Vaginal bleeding – ❷
Depression/Suicidal/Violent ❸ heavy +/- pregnancy
from usual state
behaviour – no plan Pregnancy ≥ 20 week – ❸
❸
active labour (contractions
❸ ≥ 2 min), leaking amniotic
Depression – no suicidal ❹ fluid +24 hrs
❹ ideation Menorrhagia ❸
❹ Anxiety mild ❹ Non-pregnant vaginal ❹
bleeding – minor/spotting
❹
❹
OTHER GASTROINTESTINAL
❶ Dental avulsion ❷ Vomiting blood/rectal bleed ❷
– active or large amount
❶ Epistaxis – uncontrolled ❷
Vomiting blood – “coffee ❸
Eye injury/acute vision loss ❷ ground” emesis, small amount
❶
Neck pain – neck stiffness/ ❷ Rectal bleed – melena, small ❸
meningismus amount
❷
Sexual assault < 2 hrs ❷ Rectal bleed – small amount ❹
Sore throat – drooling/stridor, ❷ Constipation ❹
obvious edema/swelling of
(mild pain < 4/10)
oropharynx
Diarrhea – mild, ⑤
❷ UTI symptoms (mild dysuria) ❹ no dehydration
Dressing change (plus normal ⑤
❷
vital signs +/- mild pain < 4)
❷
⑤
 Adult Prehospital CTAS p. 2/2

FIRST ORDER MODIFIERS

2
OXYGEN SATURATION
< 90% with severe ❶ Unconscious – unable to
respiratory distress
< 92% with moderate ❷ marked pallor, cool skin,
respiratory distress
92–94% with mild-moderate ❸
respiratory distress
≥ 94% with no ❹ ineffective ventilation or
respiratory distress
⑤ – response inappropriate
HEMODYNAMIC
STABILITY
Shock Evidence of severe
end-organ hypoperfusion:
diaphoresis, weak or
thready pulse, hypotension,
postural syncope, significant
tachycardia or bradycardia,
oxygenation, decreased level
of consciousness. Could appear
flushed, febrile, toxic, as in
septic shock.
Hemodynamic Compromise ❷
Borderline Perfusion: pale,
hx diaphoresis, unexplained
tachycardia, hx postural
hypotension, feeling faint,
suspected hypotension.
Vital signs at the upper and ❸
lower ends of normal as
they relate to the presenting
complaint, especially if they
differ from the usual values
for the specific patient.
Normal vital signs
Deceased patient
GLASGOW COMA SCALE TEMPERATURE PAIN
36˚C or ≥ 38.5˚C
❶ Severe (8–10/10); Location: ❶
❶ protect airway, response to Immuno-compromised: ❷ abdomen; Duration: acute;
pain or loud noise only and neutropenia, chemotherapy, Cause: trauma
immune-suppressive drugs
without purpose, continuous
(including steroids) Severe (8–10/10); Location: ❷
seizure or progressive central; Duration: acute
deterioration in level of
Appears septic: evidence ❷
consciousness. GCS 3–9 of infection, SIRS positive Moderate (4–7/10); Location: ❸
(HR ≥ 90, RR ≥ 20 bpm), central; Duration: acute
Altered level of consciousness ❷
or evidence of hemodynamic ❸
Severe (8–10/10); Location:
compromise, respiratory peripheral; Duration: acute
to verbal stimuli, loss of
distress, decreased level
orientation to person, place
of consciousness Severe (8–10/10); Location: ❸
or time, new impairment central; Duration: chronic
of recent memory, altered Appears unwell: < 3 SIRS ❸
behaviour. GCS 10–13 positive criteria but looks ill Mild (0–3/10); Location: ❹
(flushed, lethargic, anxious central; Duration: acute
Normal – other modifiers are ❸ or agitated)
used to define. GCS 14–15 ❹ Moderate (4–7/10); Location: ❹
Appears well: comfortable ❹ peripheral; Duration: acute
⑤ and in no distress
Moderate (4–7/10); Location: ❹
peripheral; Duration: chronic
Severe (8–10/10); Location: ❹
central; Duration: chronic
Mild (0–3/10); Location: ⑤
peripheral; Duration: acute
❹ or chronic
⑤
Mild (0–3/10); Location: ⑤
⓿ central; Duration: chronic

FIRST ORDER SECOND ORDER MODIFIERS

MODIFIERS

110
80

BLEEDING BLOOD PRESSURE BLOOD GLUCOSE DEHYDRATION MENTAL HEALTH

Congenital bleeding disorders, ❷
severe liver failure, or
anticoagulant therapy, and
bleeding:
• Head (intracranial) and neck
• Chest, abdomen, pelvis,
spine
• Massive vaginal hemorrhage
• Iliopsoas muscle and hip
• Extremity muscle
compartments
• Fractures or dislocations
• Deep lacerations
• Any uncontrolled bleeding
Congenital bleeding disorders, ⑤
severe liver failure, or
anticoagulant therapy, and
bleeding:
• Moderate, minor bleeds
• Nose (epistaxis)
• Mouth (including gums)
• Joints (hemathroses)
• Menorrhagia
• Abrasions and superficial
lacerations
Systolic BP ≥ 220 or diastolic ❷
≥ 130 w/ any other symptoms
(ex. headache, CP, SOB, nausea)
Systolic ≥ 220 or diastolic ❸
≥ 130 w/ no symptoms
Systolic BP 200–220 or ❸ weakness, polyuria
diastolic 110–130 w/ any other
symptoms (ex. headache, CP,
SOB, nausea)
Systolic BP 200–220 or diastolic ❹
110–130 w/ no symptoms
< 3 mmol/L with confusion, ❷ Severe – marked volume
seizure, diaphoresis,
behavioural change, acute
focal deficits
≥ 18 mmol/L with dyspnea, ❷
tachypnea, dehydration, thirst,
< 3 mmol/L with no symptoms ❸
≥ 18 mmol/L with no symptoms ❸
⑤
❶ Abuse – physical, mental, ❸
loss with classic signs of high emotional stress
dehydration and signs and
symptoms of shock
Insomnia – acute ❹
Moderate – dry mucous ❷ Insomnia – chronic ⑤
membranes, tachycardia, plus Bizarre behaviour – chronic, ⑤
or minus decreased skin turgor non-urgent
and decreased urine output
Mild – stable vital signs with ❸
complaints of increasing thirst
and concentrated urine and
a history of decreased fluid
intake or increased fluid loss
or both
Potential – no symptoms of ❹
dehydration, presenting with
fluid loss ongoing or difficulty
tolerating oral fluids

Threats to life or limb or

Level 1 Resuscitation imminent risk of deterioration
Level 2 Emergency Potential threat to life, limb or function
Level 3 Urgent Potentially progress to a serious problem
Relates to patient age, distress, potential
Level 4 Less Urgent for deterioration or complications
Minor complaints with risk or potential Disclaimer: This infographic can be utilized to assist in assigning levels of CTAS but is
Level 5 Non-Urgent for deterioration not all encompassing, or a replacement of the original document. All material has been
referenced from the “Prehospital CTAS Paramedic Guide Version 2.0: Adult”, http://www.
Level 0 Obviously Dead Used for Termination of Resuscitation or Code 5 health.gov.on.ca/en/pro/programs/emergency_health/edu/practice_documents.aspx