How do emergency rooms work?

The emergency room (ER) is the only hospital department that operates 24/7, 365 days a year and accepts any patient without a referral or prior appointment. Although the structure of ERs in Canada is generally standardized, there are regional differences. Below is a detailed description of how the ER works, the triage system, waiting times, payment, and alternatives.

1. Stages of patient care

Stage What happens Approximate duration*
Registration The patient shows their insurance card or passport and receives an identification bracelet. 2–5 min
Triage A nurse assesses the symptoms and vital signs and assigns a CTAS category from 1 to 5. 3–10 min
Waiting CTAS 1–2 patients are admitted immediately, CTAS 3–5 patients wait in the waiting room depending on priority and ER workload 0 min–10+ hours
Examination and diagnosis The doctor conducts an examination, orders tests, X-rays/CT scans, and consults with specialists 15–30 min + time for tests
Decision Discharge home with instructions / emergency procedure / hospitalization (boarding in the ER and waiting for a bed) 1–12 hours+
* Actual times depend on the season, staffing, and workload.

2. CTAS triage system

The Canadian Triage & Acuity Scale (CTAS) standardizes patient prioritization in all ER departments.

CTAS Level Time to Assessment Examples of Situations
1. Resuscitation Immediate Cardiac arrest, massive bleeding
2. Emergent ≤ 15 min stroke, acute shortness of breath
3. Urgent ≤ 30 min fracture without shock symptoms, severe asthma
4. Less Urgent ≤ 60 min moderate sore throat with fever
5. Non-Urgent ≤ 120 min chronic rash, uncomplicated cold
Patients may be re-evaluated if their condition worsens.

3. Reasons for long wait times

  1. ER overload — visits have increased by 30–50% since the pandemic.
  2. Bordering — a shortage of available hospital beds forces patients to remain in the ER for long periods of time.
  3. Staff shortages — a shortage of nurses and paramedics, especially in underfunded regions.
  4. Seasonal peaks — flu, RSV, and COVID-19 outbreaks in the spring and fall.

4. Payment and insurance

  • For holders of provincial cards (AHCIP, OHIP, etc.), doctor services, tests, and hospitalization are free.
  • Tourists and temporary residents receive emergency care but are responsible for the bill (ED visit ≈ $875 CAD; hospital stay from $2,000 CAD).
  • Ambulance calls in Alberta are free for those with insurance; patients without an AHCIP card pay for transportation at the EMS rate.

5. What to bring to the ER

  1. AHCIP card or passport.
  2. List of current medications and known allergies.
  3. ICE (In Case of Emergency) contact in your phone.
  4. Phone charger.

6. Alternatives to the ER for non-emergencies

Option When to choose Examples of conditions
Health Link 811 Nurse advice for non-urgent symptoms mild cough, skin redness
Urgent Care Centre Injuries/symptoms requiring immediate attention broken arm, deep cut
Walk-in clinic Minor infections, repeat prescriptions, mild pain cystitis, ear infection, bronchitis without shortness of breath
Prescribing pharmacist Minor ailments, continuation of stable therapy cold sores, conjunctivitis

7. Upcoming reforms

  • eCTAS — introduction of AI algorithms to optimize triage.
  • Treat-and-release — programs for paramedics for on-site treatment.
  • Door-to-doctor targets — target ≤ 60 min for CTAS 3.
  • Foreign nurses — simplified licenses for foreign professionals to reduce ER closures.

8. Practical advice for patients

  1. In a critical situation, call 9-1-1 and follow the dispatcher's instructions.
  2. Inform staff of any deterioration in your condition while waiting.
  3. For travel, have travel insurance if you do not have provincial coverage.
  4. Remember: CTAS, not arrival time, determines the priority of care.

Canada's emergency departments guarantee free care for insured individuals, but they face overcrowding and staff shortages. Knowing the algorithm and using alternatives helps you get medical care faster.