Standard Guide for Scope of Performance of Triage in a Prehospital Environment

SIGNIFICANCE AND USE
4.1 This guide is not intended to be used by itself, but as a component of Guide F1288. Merely conforming to the guidelines described herein will not ensure that adequate triage is carried out in a multiple casualty incident.  
4.2 The purpose of this guide is to establish a methodology for performing triage.  
4.3 Individuals responsible for performing triage must be proficient in triage methods and related life-saving techniques.  
4.4 A basic concept of triage is to do the greatest good for the greatest number of casualties.  
4.5 The assessment process must be focused so as to identify those most at risk of early death who are likely to be salvaged by rapid medical intervention.  
4.6 Triage allows the most efficient use of available resources.  
4.7 This guide acknowledges many types of individuals with varying levels of emergency medical training. It also establishes a minimum scope of performance and encourages the addition of optional knowledge, skills, and attitudinal objectives.  
4.8 A vital role in the development of and operational application of triage is that of medical control. This guide should be used by medical directors in the determination of operational and medical protocols for use during MCIs.  
4.9 This guide is intended to assist those who are responsible for defining the scope of performance of individuals who perform triage.  
4.10 For the purpose of this guide the word “injured” includes both sick or injured patients, or both.
SCOPE
1.1 This guide covers minimum requirements for the scope of performance for individuals who perform triage at an emergency medical incident involving multiple casualties in a pre-hospital environment.  
1.2 This guide acknowledges objectives based on an individual's required knowledge of signs and symptoms, patient assessment, and basic life support.  
1.3 Operating within the framework of this guide may expose personnel to hazardous materials, procedures, and equipment. For additional information see Practice F1031 and Guides F1219, F1253, F1285, F1287, F1288, F1489 and F1651.  
1.4 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety, health, and environmental practices and determine the applicability of regulatory limitations prior to use. For specific precautionary statements, see Footnote 2.2  
1.5 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

General Information

Status
Published
Publication Date
31-Oct-2020

Relations

Effective Date
01-Jul-2012
Effective Date
01-Mar-2009
Effective Date
01-Mar-2009
Effective Date
01-Mar-2009
Effective Date
01-Feb-2008
Effective Date
01-Mar-2006
Effective Date
10-Sep-2003
Effective Date
10-Sep-2003
Effective Date
10-Sep-2002
Effective Date
10-Oct-2000
Effective Date
10-Oct-2000
Effective Date
10-Nov-1998
Effective Date
10-Jun-1998
Effective Date
01-Jan-1996
Effective Date
10-Oct-1995

Overview

ASTM F1653-95(2020), Standard Guide for Scope of Performance of Triage in a Prehospital Environment, establishes essential guidelines clarifying the minimum performance requirements for individuals conducting triage at emergency medical incidents involving multiple casualties. Developed by ASTM International, this guide is recognized internationally and is intended for use as a component of ASTM Guide F1288. It helps define critical triage procedures in prehospital settings, such as accidents, disasters, or mass casualty incidents (MCIs), supporting effective emergency response and resource management.

Key Topics

  • Foundational Triage Principles

    • Performing triage is based on prioritizing care to maximize survival, using the principle of “the greatest good for the greatest number.”
    • Triage is both an initial (primary) and ongoing (secondary/tertiary) process, requiring continual reassessment and adjustment of priorities.
  • Minimum Requirements and Objectives

    • Individuals must be skilled in recognizing signs and symptoms, patient assessment, and applying basic life support.
    • Key triage tasks include:
      • Rapid patient assessment
      • Assigning priority categories (Immediate/Red, Delayed/Yellow, Minor/Green, Dead/Black)
      • Initiating life-saving interventions (such as airway management and bleeding control)
      • Documenting and communicating triage decisions
    • Recognize incidents needing triage, request additional resources, and activate command systems as necessary.
  • Dynamic and Efficient Resource Use

    • Triage supports the most efficient use of available emergency medical resources.
    • Individuals from diverse training backgrounds are acknowledged, with a minimum scope established and encouragement for additional competencies.
  • Medical Control and Protocols

    • Medical directors play a vital role in defining operational and medical triage protocols tailored to local conditions and available resources.

Applications

The ASTM F1653-95(2020) standard is practically applied across various prehospital emergency environments, particularly for:

  • Emergency Medical Services (EMS)

    • Guiding paramedics, EMTs, and first responders in systematically performing triage at scenes with multiple victims.
    • Supporting rapid assessment, patient prioritization, and efficient use of life-saving interventions even under resource constraints.
  • Disaster and Mass Casualty Response

    • Standardizing triage methods at disaster scenes to ensure thorough identification of those most likely to benefit from immediate care.
    • Assisting incident command teams in organizing, documenting, and optimizing patient flow and tracking.
  • Training and Protocol Development

    • Assisting medical directors and training coordinators in defining mandatory and optional skills for triage performers.
    • Encouraging inclusion of incident command system (ICS) principles and awareness of responder stress management.
  • Integration with Safety Practices

    • Emphasizing awareness of hazardous conditions and safe operational practices during triage events, in compliance with local regulations and best practices.

Related Standards

The effectiveness of the ASTM F1653-95(2020) guide is enhanced when used alongside other key EMS and triage-related ASTM standards, including:

  • ASTM F1288: Guide for Planning for and Response to a Multiple Casualty Incident (referenced as the primary framework)
  • ASTM F1031: Practice for Training the Emergency Medical Technician (Basic)
  • ASTM F1219, F1253, F1285, F1287, F1489, F1651: Guides for training, assessment, and performance of first responders and EMTs

For comprehensive triage implementation, referencing these standards helps organizations ensure up-to-date protocols, consistent responder training, and enhanced prehospital care during mass casualty incidents.

Keywords: triage, prehospital care, emergency medical service (EMS), mass casualty incidents (MCI), incident command system (ICS), ASTM standard, resource allocation, patient prioritization, disaster response, protocols.

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Frequently Asked Questions

ASTM F1653-95(2020) is a guide published by ASTM International. Its full title is "Standard Guide for Scope of Performance of Triage in a Prehospital Environment". This standard covers: SIGNIFICANCE AND USE 4.1 This guide is not intended to be used by itself, but as a component of Guide F1288. Merely conforming to the guidelines described herein will not ensure that adequate triage is carried out in a multiple casualty incident. 4.2 The purpose of this guide is to establish a methodology for performing triage. 4.3 Individuals responsible for performing triage must be proficient in triage methods and related life-saving techniques. 4.4 A basic concept of triage is to do the greatest good for the greatest number of casualties. 4.5 The assessment process must be focused so as to identify those most at risk of early death who are likely to be salvaged by rapid medical intervention. 4.6 Triage allows the most efficient use of available resources. 4.7 This guide acknowledges many types of individuals with varying levels of emergency medical training. It also establishes a minimum scope of performance and encourages the addition of optional knowledge, skills, and attitudinal objectives. 4.8 A vital role in the development of and operational application of triage is that of medical control. This guide should be used by medical directors in the determination of operational and medical protocols for use during MCIs. 4.9 This guide is intended to assist those who are responsible for defining the scope of performance of individuals who perform triage. 4.10 For the purpose of this guide the word “injured” includes both sick or injured patients, or both. SCOPE 1.1 This guide covers minimum requirements for the scope of performance for individuals who perform triage at an emergency medical incident involving multiple casualties in a pre-hospital environment. 1.2 This guide acknowledges objectives based on an individual's required knowledge of signs and symptoms, patient assessment, and basic life support. 1.3 Operating within the framework of this guide may expose personnel to hazardous materials, procedures, and equipment. For additional information see Practice F1031 and Guides F1219, F1253, F1285, F1287, F1288, F1489 and F1651. 1.4 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety, health, and environmental practices and determine the applicability of regulatory limitations prior to use. For specific precautionary statements, see Footnote 2.2 1.5 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

SIGNIFICANCE AND USE 4.1 This guide is not intended to be used by itself, but as a component of Guide F1288. Merely conforming to the guidelines described herein will not ensure that adequate triage is carried out in a multiple casualty incident. 4.2 The purpose of this guide is to establish a methodology for performing triage. 4.3 Individuals responsible for performing triage must be proficient in triage methods and related life-saving techniques. 4.4 A basic concept of triage is to do the greatest good for the greatest number of casualties. 4.5 The assessment process must be focused so as to identify those most at risk of early death who are likely to be salvaged by rapid medical intervention. 4.6 Triage allows the most efficient use of available resources. 4.7 This guide acknowledges many types of individuals with varying levels of emergency medical training. It also establishes a minimum scope of performance and encourages the addition of optional knowledge, skills, and attitudinal objectives. 4.8 A vital role in the development of and operational application of triage is that of medical control. This guide should be used by medical directors in the determination of operational and medical protocols for use during MCIs. 4.9 This guide is intended to assist those who are responsible for defining the scope of performance of individuals who perform triage. 4.10 For the purpose of this guide the word “injured” includes both sick or injured patients, or both. SCOPE 1.1 This guide covers minimum requirements for the scope of performance for individuals who perform triage at an emergency medical incident involving multiple casualties in a pre-hospital environment. 1.2 This guide acknowledges objectives based on an individual's required knowledge of signs and symptoms, patient assessment, and basic life support. 1.3 Operating within the framework of this guide may expose personnel to hazardous materials, procedures, and equipment. For additional information see Practice F1031 and Guides F1219, F1253, F1285, F1287, F1288, F1489 and F1651. 1.4 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety, health, and environmental practices and determine the applicability of regulatory limitations prior to use. For specific precautionary statements, see Footnote 2.2 1.5 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

ASTM F1653-95(2020) is classified under the following ICS (International Classification for Standards) categories: 11.160 - First aid. The ICS classification helps identify the subject area and facilitates finding related standards.

ASTM F1653-95(2020) has the following relationships with other standards: It is inter standard links to ASTM F1031-00(2012), ASTM F1288-90(2009), ASTM F1651-95(2009), ASTM F1177-02(2009), ASTM F1285-90(2008), ASTM F1031-00(2006), ASTM F1285-90(2003), ASTM F1288-90(2003), ASTM F1177-02, ASTM F1031-00, ASTM F1219-00, ASTM F1288-90(1998), ASTM F1285-90(1998), ASTM F1177-96a, ASTM F1651-95. Understanding these relationships helps ensure you are using the most current and applicable version of the standard.

ASTM F1653-95(2020) is available in PDF format for immediate download after purchase. The document can be added to your cart and obtained through the secure checkout process. Digital delivery ensures instant access to the complete standard document.

Standards Content (Sample)


This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the
Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.
Designation: F1653 − 95 (Reapproved 2020)
Standard Guide for
Scope of Performance of Triage in a Prehospital
Environment
This standard is issued under the fixed designation F1653; 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 (´) indicates an editorial change since the last revision or reapproval.
INTRODUCTION
Triage is a word taken from the French verb trier, that means “to sort.” During the time of the
Napoleonic wars, a technique for assigning priorities to the treatment of battlefield casualties was
established in order to maximize the use of limited resources. The basic principle of triage is to do the
greatestgoodforthegreatestnumberofcasualties.Careisprovidedfirsttothosewiththemostserious
emergencies and to those who are most salvageable. This technique is identified as essential for good
disaster medical care.
1. Scope mendations issued by the World Trade Organization Technical
Barriers to Trade (TBT) Committee.
1.1 This guide covers minimum requirements for the scope
of performance for individuals who perform triage at an
2. Referenced Documents
emergency medical incident involving multiple casualties in a
pre-hospital environment.
2.1 ASTM Standards:
F1031 Practice for Training the Emergency Medical Tech-
1.2 This guide acknowledges objectives based on an indi-
nician (Basic)
vidual’s required knowledge of signs and symptoms, patient
F1177 Terminology Relating to Emergency Medical Ser-
assessment, and basic life support.
vices (Withdrawn 2018)
1.3 Operating within the framework of this guide may
F1219 Guide for Training the Emergency Medical Techni-
expose personnel to hazardous materials, procedures, and
cian (Basic) to Perform Patient Initial and Detailed As-
equipment. For additional information see Practice F1031 and
sessment (Withdrawn 2006)
Guides F1219, F1253, F1285, F1287, F1288, F1489 and
F1253 Guide for Training the Emergency Medical Techni-
F1651.
cian (Basic) to Perform Patient Secondary Assessment
1.4 This standard does not purport to address all of the 4
(Withdrawn 1999)
safety concerns, if any, associated with its use. It is the
F1285 Guide for Training the Emergency Medical Techni-
responsibility of the user of this standard to establish appro-
cian to Perform Patient Examination Techniques
priate safety, health, and environmental practices and deter-
F1287 Guide for Scope of Performance of First Responders
mine the applicability of regulatory limitations prior to use.
Who Provide Emergency Medical Care
For specific precautionary statements, see Footnote 2.
F1288 Guide for Planning for and Response to a Multiple
1.5 This international standard was developed in accor- 4
Casualty Incident (Withdrawn 2018)
dance with internationally recognized principles on standard-
F1489 Guide for Performance of Patient Assessment by the
ization established in the Decision on Principles for the
Emergency Medical Technician (Paramedic) (Withdrawn
Development of International Standards, Guides and Recom- 4
2003)
F1651 Guide for Training the Emergency Medical Techni-
cian (Paramedic) (Withdrawn 2018)
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.02 on
Personnel, Training and Education.
Current edition approved Nov. 1, 2020. Published November 2020. Originally
approved in 1995. Last previous edition approved in 2012 as F1653 – 95 (2012). For referenced ASTM standards, visit the ASTM website, www.astm.org, or
DOI: 10.1520/F1653-95R20. contact ASTM Customer Service at service@astm.org. For Annual Book of ASTM
Most recent “Guidelines for Cardiopulmonary Resuscitation and Emergency Standards volume information, refer to the standard’s Document Summary page on
Cardiac Care,” as reprinted from the Journal of the American Medical Association, the ASTM website.
available from American Heart Association, 7272 Greenville Ave., Dallas, TX The last approved version of this historical standard is referenced on
75231. www.astm.org.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959. United States
F1653 − 95 (2020)
3. Terminology require performance of all objectives. Individuals who perform
triage shall be able to:
3.1 Definitions of Terms Specific to This Standard:
5.1.1 Identify health and safety hazards and initiate appro-
3.1.1 ongoing triage, n—the continuing process of patient
priate actions.
assessment and prioritization in a multiple casualty incident.
5.1.2 Recognize an incident that may require triage.
(Also known as secondary and tertiary.)
5.1.3 Determine the need for and request additional re-
3.1.2 primary triage, n—the initial process of rapid
sources.
assessment, provision of life-saving interventions, and assign-
5.1.4 Initiate incident command Guide F1288.
ment of visual priority identification to each patient in a
5.1.5 Identify conditions which may dictate a decision to
multiple casualty incident.
treat patients at the scene or transfer them to a designated
3.1.3 triage, n—the process of sorting and prioritizing care
treatment area.
of the sick and injured on the basis of urgency and type of
5.1.6 Initiate Primary Triage.
condition present, as well as the number of patients and
5.1.6.1 Identify victims who appear to be uninjured or
resources avai
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