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Question: ESI (Emergency Severity Index) seems to say that I have to make every drunk, unconscious patient a Level 1 – is that true?

Answer: Yes, it is true. According to the Emergency Severity Index, Version 4: Implementation Handbook, "Any patient who is unresponsive, including the intoxicated patient who is unresponsive to painful stimuli, meets the Level 1 criteria and should receive immediate evaluation." ESI further defines unresponsiveness as a patient that either: "(1) is nonverbal and not following commands (acutely) or (2) requires noxious stimulus (P or U on AVPU scale)."

It is important to note that the Canadian Triage Acuity Scale (CTAS) would also assign this patient a Level 1 - Resuscitation category. CTAS defines Level 1 as: "conditions that are threats to life or limb (or imminent risk of deterioration) requiring immediate aggressive interventions." Any unresponsive patient that is not already intubated is at risk for airway compromise regardless of the cause of the unresponsiveness.

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