ASTM F1258-95(2001)

NOTICE: This standard has either been superseded and replaced by a new version or withdrawn.
Contact ASTM International (www.astm.org) for the latest information
Designation:F1258–95 (Reapproved 2001)
Standard Practice for
Emergency Medical Dispatch
This standard is issued under the fixed designation F 1258; the number immediately following the designation indicates the year of
original adoption or, in the case of revision, the year of last revision. A number in parentheses indicates the year of last reapproval. A
superscript epsilon (e) indicates an editorial change since the last revision or reapproval.
1. Scope agency to provide aid to medical emergencies that includes:
systematized caller interrogation questions, systematized pre-
1.1 This practice covers the definition of responsibilities,
arrival instructions, and protocols matching the dispatcher’s
knowledge, practices, and organizational support required to
evaluation of injury or illness severity with vehicle response
implement, perform, and manage effectively the emergency
mode and configuration.
medical dispatch function.
3.1.4 medical direction—the management and accountabil-
1.2 This practice is useful for planning and evaluating the
ity for the medical care aspects of an emergency medical
training, implementation, and organizational support to satisfy
dispatch (EMD) program including: the medical monitoring
the functional needs of emergency medical dispatching.
oversight of the training of the EMD personnel; approval and
1.3 This standard does not purport to address all of the
medical control of the operational emergency medical dispatch
safety concerns, if any, associated with its use. It is the
priority reference system (EMDPRS); evaluation of the medi-
responsibility of the user of this standard to establish appro-
cal care and prearrival instructions rendered by the EMD
priate safety and health practices and determine the applica-
personnel; direct participation in the EMD system evaluation,
bility of regulatory limitations prior to use.
quality, assurance, and quality improvement process and
2. Referenced Documents
mechanisms; and, responsibility for the medical decisions and
care rendered by the emergency medical dispatcher and emer-
2.1 ASTM Standards:
gency medical dispatch program.
F 1031 Practice for Training the Emergency Medical Tech-
3.1.5 public safety telecommunicator—anindividualtrained
nician (Basic)
to communicate remotely with persons seeking emergency
F 1381 Guide for Planning and Developing 9-1-1 Enhanced
assistance and with agencies and individuals providing such
Telephone Systems
assistance.
F 1552 Practice for Training Instructor Qualification and
3.1.6 telephone aid—consists of “ad-libbed” telephone in-
Certification Eligibility of Emergency Medical Dispatch-
structions provided by either trained or untrained dispatchers
ers
and differs from DLS-based prearrival instructions in that the
F 1560 Practice for Emergency Medical Dispatch Manage-
instructions provided to the caller are based on the dispatcher’s
ment
knowledge or previous training in a procedure or treatment
3. Terminology
without following a scripted prearrival instruction protocol.
They cannot be medically preapproved since they do not exist
3.1 Definitions of Terms Specific to This Standard:
in written form.
3.1.1 emergency medical dispatcher (EMD)—a trained pub-
3.1.7 telephone treatment sequence protocols—specific
lic safety telecommunicator with additional training and spe-
treatment strategies designed in a conversational script format
cific emergency medical knowledge essential for the efficient
that direct the EMD step by step in giving critical prearrival
management of emergency medical communications.
instructions such as CPR, Heimlich maneuver, mouth-to-
3.1.2 emergency medical dispatching—the reception and
mouth breathing, and childbirth instruction.
management of requests for emergency medical assistance.
3.1.8 vehicle response configuration—the specific ve-
3.1.3 emergency medical dispatch priority reference system
hicle(s) of varied types, capabilities, and numbers responding
(EMDPRS)—a medically approved system used by a dispatch
to render assistance.
3.1.9 vehicle response mode—the use of emergency driving
This practice is under the jurisdiction ofASTM Committee F30 on Emergency
techniques, such as warning lights and siren, versus a routine
Medical Services and is the direct responsibility of Subcommittee F30.04 on
driving response.
Communications.
Current edition approved Oct. 10, 1995. Published December 1995. Originally
published as F 1258 – 90. Last previous edition F 1258 – 90.
Annual Book of ASTM Standards, Vol 13.02.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.
F1258–95 (2001)
4. Summary of Practice recommendations concerning the development of a supportive
structure and program content.
4.1 An emergency medical dispatcher is a trained public
4.6 Use of this practice is not intended to protect the EMD
safety telecommunicator with additional training and specific
or dispatch organization from liability for negligent actions or
emergency medical knowledge essential for assessment of
failure to perform in accordance with established and approved
medical emergencies and limited remote treatment and appor-
medical practices and protocols.
tionment of medical priorities. The EMD functions under the
4.7 The EMD must be certified through either state govern-
medical authority of an off-line medical director to receive and
ment processes or by professional medical dispatch standard-
manage calls for emergency medical assistance through the
setting organizations.
systematic interrogation of callers, using procedures estab-
4.7.1 When certification is achieved by recognition of a
lished by the off-line medical director who remains responsible
professional medical dispatch standard-setting organization, it
for the medical quality assurance of the EMD program.
shall clearly demonstrate compliance with all criteria enumer-
4.1.1 The EMD’s role includes the ability to:
ated in this practice and within Practice F 1560 and Practice
4.1.1.1 Remotely evaluate the patient or incident,
F 1552.
4.1.1.2 Interpret the requirement and need for emergency
medical resources,
5. Significance and Use
4.1.1.3 Allocate the appropriate resources,
5.1 This practice is intended to promote the use of trained
4.1.1.4 Identify conditions requiring prearrival instructions
telecommunicators in the role of emergency medical dis-
and provide them to the caller when necessary, possible and
patcher. It defines the basic skills and medical knowledge to
appropriate,
permit understanding and resolution of the problems that
4.1.1.5 Coordinate the response of emergency medical and
constitutetheirdailyroutine.Tousetrainedtelecommunicators
other public safety resources,
fully as functioning members of the emergency medical team,
4.1.1.6 Provide information to the responding units regard-
it is deemed necessary to upgrade the telecommunicators’
ing the emergency scene and patient, and
training by the addition of the concept of emergency medical
4.1.1.7 Record and retrieve emergency medical response
dispatch priorities.
records.
5.2 All agencies or individuals who routinely accept calls
4.1.2 There must be continuity in the delivery of EMD care.
for emergency medical assistance from the public and dispatch
To provide correct medical care safely and effectively, the
emergency medical personnel shall have in effect an emer-
EMD that is medically directing, evaluating, and coding must
gency medical dispatcher program in accordance with this
maintain direct access to the calling party and must use a
practice. The program shall include medical direction and
medically approved emergency medical dispatch priority ref-
oversight and an emergency medical dispatch priority refer-
erence system.The person giving the medical instruction to the
ence system.
caller must be the same person that asks the systematic
5.3 The successful use of the EMD concept depends on the
interrogation questions.
medical community’s awareness of the “prearrival” state of
4.1.3 To accomplish the above safely and effectively, the
EMS affairs and their willingness to provide medical direction
EMD must use a medically approved EMDPRS that includes:
in dispatch.
4.1.3.1 Systematized caller interrogation questions,
5.4 This practice may assist in overcoming some of the
4.1.3.2 Systematized prearrival instructions, and
misconceptions regarding emergency medical dispatching.
4.1.3.3 Protocols that determine vehicle response mode and
These include the uncontrollable nature of the caller’s hysteria,
configuration based on the EMD’s evaluation of injury or
lack of time of the dispatcher, potential danger and liability to
illness severity.
the EMD, lack of recognition of the benefits of dispatch
4.2 This practice is intended to be used by agencies as a prearrival instructions, and misconceptions that red lights,
baseline for establishing a certifying emergency medical dis- siren, and maximal response are always necessary.
patch training program that includes the implementation of the 5.5 TheEMDisthememberoftheEMSresponseteamwith
emergency medical dispatch priority reference system, under the broadest view of the entire emergency system’s current
medical direction, and provides a means of evaluating the status and capabilities. The EMD has immediate lifesaving
EMD program. capability in converting the caller into an effective first
responder. This practice recognizes the EMD’s role as includ-
4.3 This practice will provide a common set of expectations
ing:
for training, performance, and preplanned response based on
understanding of the medical condition, thorough interroga- 5.5.1 Interrogation techniques,
tion, caller intervention, safe responses, and prearrival instruc- 5.5.2 Triage decisions,
tions.
5.5.3 Information transmission,
4.4 This practice establishes the EMD’s role and responsi- 5.5.4 Telephone medical intervention, and
bilities in receiving, managing, and dispatching calls for
5.5.5 Logistics and resource coordination during the event.
medical assistance and related agency coordination.
5.6 For the EMD, this practice supersedes any other EMSS
4.5 An organizational structure as defined in Practice standards under which an individual may be qualified, such as
F 1560 must be in place before implementing the EMD Practice F 1031. It is not the role of the EMD to generate a
program; therefore, this practice establishes some general specific diagnosis but rather to elicit accurately a finite body of
F1258–95 (2001)
information, assign the appropriate response, and to commu- 6.1.4.1 A mass casualty plan for notification and operation
nicate clearly among persons and units involved in the re- in a disaster situation,
sponse. The protocols for inquiry, response, and resource 6.1.4.2 A directory of emergency response resources and
coordination are essential and must not be modified based on information resources,
an individual’s possible experiences as a responder. 6.1.4.3 Awritten description of the communications system
5.7 As an initial contact with the EMS system, the EMD is configuration for the service area, and
6.1.4.4 A record-keeping system, including report forms or
subject to questioning of actions as they relate to medical
practice.Thispracticemaybeusedbyagenciesasarecognized a computer data management system to permit evaluation of
EMD compliance with the EMDPRS, evaluation of protocol
baseline for EMD training, practice, and organization and is
intendedtosupplantdefactostandardsthatexistinsomeareas. effectiveness, and timeliness of interrogation and dispatch.
This practice will assist in developing sound EMD programs
7. Functions of Emergency Medical Dispatch
that will reduce the need and potential for legal action and
provide a common set of expectations for performance.
7.1 Receive and Process Calls for Assistance—The EMD
5.8 It will bring more accurate information into the dispatch
mustreceiveandrecordcallsforemergencymedicalassistance
office by way of appropriate understanding of the medical
from various sources. This function includes the establishment
conditionandthereforebetterinterrogation,callerintervention,
of effective communication with the person requesting assis-
and decision-making. It allows for preplanned responses, safer
tance, using the EMDPRS to evaluate the patient or situation,
responses (fewer units responding with lights and siren), fuel
provide appropriate prearrival instructions, and select the most
and energy savings (smaller units and fewer units used when
appropriate EMS system action in response to each call.
possible),andmaysaveadvancedlifesupportresourcesfortrue
7.2 Dispatch and Coordinate Appropriate, Available Re-
advanced life-support emergencies when a tiered-level re-
sponse Resources—The EMD must select and dispatch the
sponse is available.
necessary EMS vehicles and personnel to the scene of an
emergency in an appropriate time frame. The EMD functions
6. System Components in coordinating the movements of EMS vehicles en route to the
scene, en route to the medical facility, and back to the base of
6.1 Emergency Medical Dispatch Priority Reference System
operations. This requires that the EMD have current knowl-
(EMDPRS):
edge of the status of all EMS resources in the dispatch area and
6.1.1 This system is a written, reproducible document in a
the geographic constraints that will affect the EMS response.
uniform format based on medical and administrative protocols.
ThisalsorequiresthattheEMDhavedispatch-specificmedical
The emergency medical dispatch priority reference system
training and understands the use of systematized interrogation
directs the EMD to complete a full, programmed interrogation.
and response assignment protocols.
The information from the caller is paired with preset problem
7.3 Provide Information and Prearrival Instructions:
groups to determine the appropriate response level. It shall
7.3.1 To the caller, the EMD is the contact with the
include the following:
emergency response agency and must be prepared to provide
6.1.1.1 A set of systematized caller interrogation (key)
emergency care instructions to callers waiting for an EMS
questions.Thekeyquestionsmustobtaintheminimumamount
response.These instructions should enable the caller to prevent
of information necessary to:
or reduce further injury to the victim and to do as much as
6.1.1.1.1 (a) Adequately establish the correct level of re-
possible under the circumstances to intervene in any life-
sponse,
threatening situation that exists. These instructions should also
6.1.1.1.2 (b) Establish the need for prearrival instructions,
include appropriate warnings and safety messages regarding
and
potential dangers that can be reasonably forese
...