Richmond Agitation-Sedation Score (RASS)
What It Measures
The RASS puts a single number on how awake or agitated a person is, on a scale running from +4 to -5. It is the most widely used sedation scale in intensive care, where the question is not whether someone is conscious but whether they are at the right level.
Four positive levels describe agitation: restless at +1, agitated at +2, very agitated at +3, and combative at +4. Zero means alert and calm. Five negative levels describe sedation, from drowsy at -1 through to unarousable at -5. Scoring follows three steps: observe the person, then speak to them, then apply physical stimulation if there is no response to voice. What separates the sedation levels is how long the person sustains eye contact once roused.
Further Reading
Additional Notes
Licensing Notes: The scale is reproduced without a posted fee across hospital protocols, clinical trial documents, and professional society materials.
Learn More: The RASS is the gateway to delirium assessment. A score of -4 or -5 means stop — the person is too deeply sedated to be assessed for delirium. At -3 or above, proceed to the CAM-ICU or another delirium tool. That sequencing is why the RASS appears at the top of nearly every ICU delirium protocol.