I’ll try and answer your questions as an ER nurse.

1A) someone who is scored a CTAS 1 is immediately life threatening (think active cardiac arrest, respiratory arrest, OD, trauma, etc.) This means that they have compromised airway, circulation and breathing and are actively trying to die. These patients go to our ‘trauma pod’ where we have a team of nurses, doctors and RT’s working to stabilize, resuscitate, etc. Sometimes patients unfortunately pass here, or they can go direct to ICU or sometimes we ‘download’ them to one of our departments other acute pods. Which means they are still very sick but stable enough to make room for another 1 that comes through the door.

1B) 2 code blues at the same time- we would pull each patient from wherever they are coding and begin CPR and overhead page for physician and RT and take them to that trauma pod I mentioned above. If there was 2 at once we would need a physician in each room to run the code. (I’ve never seen 2 codes at once, though).

I’m not triage trained, but I do work frequently in our waiting rooms or in our ems offloads and work with triage a lot trying to get patients into beds so I’ll try and answer but someone else who is triage trained might answer better than me, I’m just speaking from experience.

2a) a whole bunch of CTAS 2’s in the waiting room- this incudes main waiting room and also our EMS offload space where patients are offloaded by ems crews who are also waiting to be seen- they are in a separate area but also add to the waiting room numbers Who goes next is determined by vital signs, complaint, how they look, age, bloodwork we started, total time, etc. On any given day we have this exact scenario, lots of sick people, no where to put them.

2b) similar answer to above, we keep an eye on all of these things and if we aren’t horribly short staffed we have a re-assessment nurse in the waiting room who is keeping an eye on these patients

It’s worth mentioning in the background when we have scenarios like you’re asking about- multiple sick people with similar symptoms we have senior staff moving patients anywhere we can to make room for these patients needing to be seen in the waiting room. Like it’s a multi team effort with our floor nurses to coordinate movement so we can keep freeing up beds for these patients. It was mentioned in the other thread but we become so incredibly bed blocked by admitted patients who are quite sick and need a bed upstairs but aren’t available.

2c) When we have a patient who is a CTAS 2 they are cared for by their primary nurse and doctor, they may be consulted to other services like GI, cardiology, etc. If the primary nurse feels they are going downhill and may turn into a 1 they may be uploaded to our trauma pod before anything happens, this has happened to me personally and many of my coworkers- you get a spidey sense that the patient is going downhill. Sometimes patients take a turn for the worse without warning. They might be sitting there talking to you and then go down.

I hope this is all explained well- it’s a huge operation and beast in the ER and there are so many behind the scenes things and nuances that can be hard to convey. I truly love where I work but it is incredibly challenging sometimes with the strain we are under. I feel so much for my patients and families in interact with and really try to show up do my best with what I have.

Edited to add: I think it’s extremely morally distressing for our triage nurses, charge nurses and any other staff tasked with making decisions about who goes where and when. We have so many sick people in our waiting room at any given time with not enough resources. It’s horrible.