Standardized Comparison of Triage in EMS (SCORE) Study

1. What is this study?

CTAS stands for the Canadian Triage Acuity Scale. CTAS defines 5 levels of triage according to the perceived need for physician assessment.

2. What is this study trying to accomplish?

The SCORE study is a comprehensive program to evaluate the reliability and validity of CTAS level assignment by paramedics and EMS service implementation is proposed.

3. Who is eligible for this study?

The study involves primary and advance care paramedics from 8 regional EMS services (Peterborough, Toronto, Hamilton, Simcoe, Muskoka, Durham,peel and Hamilton).A random sample of Advanced Care Paramedic crews and an equal number of randomly selected Basic Care Paramedic crews from five EMS systems(rural and urban) are the participants of this study. A paramedic observer(advanced and basic) with advanced CTAS and decision rule training will observe each crew, record the critical elements of each Prehospital encounter on a data collection sheet and assign a CTAS level to the patient on departure from scene and on arrival at hospital.

At the hospital, the observer will ensure that the triage nurse assigns the CTAS level without prior knowledge of the paramedic assignment.  The observer will record the CTAS level assigned by the triage nurse as well as the CTAS level at departure from the scene and on arrival at the receiving hospital, case severity code, return priority code and status change code recorded by the treating paramedic on the ambulance call report. The patient’s health insurance number (HIN) will be collected for the purposes of linkage to outcome data. In addition, the observer will record the times of departure from scene and arrival at hospital to estimate the transport interval.

4. Why bother doing this study?

At present there are no consistently utilized measures of patient acuity among paramedics in Ontario.  CTAS is being implemented over the next several months.  Information on the interface between paramedics and emergency departments would inform decision-making on the Emergency Health Care system.  The Emergency Health Services Branch of the Ontario Ministry of Health has recently mandated the use of CTAS by paramedics in the province to improve communication between prehospital care providers and emergency departments. The introduction of CTAS among paramedics provides a superb opportunity to evaluate its utility in providing prehospital information in an accurate and consistent manner.

5. Who is involved?

Participating regions for this study are: Peterborough, Toronto, Hamilton, Simcoe, Muskoka, Durham, Peel, Hamilton.


6.  What are the timelines?

Designed and launched in 2003, this is an ongoing trial hoping to complete in 2008.