Question: I was on a call recently where I was instructed that all patients from a scene, where there has been a fatality, are CTAS 2. I had never heard of this so I asked our Quality Assurance and they said that all patients from the vehicle which had the fatality in it are CTAS 2. They also told me that Victoria Hospital (LHSC) is thinking about making them all CTAS 1. I asked around and not many people had heard about this. I looked through the original CTAS course module and could not find anything on this. I thought we were supposed to CTAS according to presenting condition. Some of these people are out walking around at the scene with no complaints.

 Great question!! The new CTAS Program and Training Bulletin for paramedics coming from MOHLTC address this exact question. I am sure this is where the confusion stems from since the Training Bulletin has not been released yet however some paramedics may have been part of focus groups in preparing the package and as such have advanced knowledge of the content.

Mechanism of Injury (MOI) is a First Order Modifier. MOI may place a patient in a more acute CTAS level in patients who may have otherwise been considered stable. All trauma patients meeting the MOI criteria below are to be considered CTAS level 2. Remember however, to apply all applicable modifiers as other first order modifiers may classify the patient as CTAS Level 1.

The adult MOI-based modifier recommendations are shown below:

Table 7- Mechanism of Injury Mechanism of Injury CTAS Level 2

General Trauma - Motor Vehicle Collisions: Ejection from vehicle, rollover, extrication time >20 minutes, significant intrusion into passenger's space, death in the same passenger compartment, impact >40 km/h (unrestrained) or impact >60 km/h (restrained) - Motorcycle Collision: Impact with a vehicle >30 km/h, especially if rider is separated from motorcycle - Fall: From >6 metres (>18 feet) - Penetrating Injury: To head, neck, torso or extremities proximal to elbow and knee

Head Trauma - Motor Vehicle Collision: Ejection from vehicle, unrestrained passenger striking head on windshield - Pedestrian struck by vehicle - Fall from >1 metre (>3 feet) or 5 stairs - Assault with blunt object other than fist or feet

Neck Trauma - Motor Vehicle Collision: Ejection from vehicle, rollover, high speed (especially if driver unrestrained) - Motorcycle Collision - Fall from >1 metre (>3 feet) or 5 stairs - Axial Load to the Head

As an aside, the CTAS guidelines are extremely important however unfortunately quite complex. The Training Bulletin is 93 pages long! SWORBHP has repeatedly requested the MOHLTC to implement mandatory paid in-class training on CTAS for all paramedics since we feel that the compliance rate among paramedics reviewing 93 pages of material while on shift will be low.

As this is not an Advanced Life Support Patient Care Standard, this is not a topic that forms the domain of the BH program nor can it be reviewed in the limited time available during annual BH recerts. It is the hope of SWORBHP that individual EMS services use available CE hours to review this important material. CTAS scores are a standardized set of rules that paramedics, triage nurses, and physicians use every day. Individual health care centres are not empowered to unilaterally or arbitrarily modify these rules so it would be impossible for LHSC to "make" these clinical situations all a CTAS 1.

CTAS,Miscellaneous

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