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ASTM F1653-95(2007)

(Guide)

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

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

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 F 1031, Guides F 1219, F 1253, F 1285, F 1287, F 1288, F 1489 and F 1651.
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 and health practices and determine the applicability of regulatory limitations prior to use. For specific precautionary statements, see Footnote 3.

General Information

Status
Historical
Publication Date
31-Jan-2007
ICS
11.160 - First aid
Technical Committee
F30 - Emergency Medical Services
Drafting Committee
F30.02 - Personnel, Training and Education
Current Stage
Ref Project

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ASTM F1653-95(2007) - Standard Guide for Scope of Performance of Triage in a Prehospital Environment
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NOTICE: This standard has either been superseded and replaced by a new version or withdrawn.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:F1653–95 (Reapproved 2007)
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 2. Referenced Documents
1.1 This guide covers minimum requirements for the scope 2.1 ASTM Standards:
of performance for individuals who perform triage at an F1031 Practice for Training the Emergency Medical Tech-
emergency medical incident involving multiple casualties in a nician (Basic)
pre-hospital environment. F1177 Terminology Relating to Emergency Medical Ser-
1.2 This guide acknowledges objectives based on an indi- vices
vidual’s required knowledge of signs and symptoms, patient F1219 Guide for Training the Emergency Medical Techni-
assessment and basic life support. cian (Basic) to Perform Patient Initial and DetailedAssess-
1.3 Operating within the framework of this guide may ment
expose personnel to hazardous materials, procedures, and F1253 Guide for Training the Emergency Medical Techni-
equipment. For additional information see Practice F1031, cian (Basic) to Perform Patient Secondary Assessment
Guides F1219, F1253, F1285, F1287, F1288, F1489 and F1285 Guide for Training the Emergency Medical Techni-
F1651. cian (Basic) to Perform Patient Examination Techniques
1.4 This standard does not purport to address all of the F1287 Guide for Scope of Performance of First Responders
safety concerns, if any, associated with its use. It is the Who Provide Emergency Medical Care
responsibility of the user of this standard to establish appro- F1288 Guide for Planning for and Response to a Multiple
priate safety and health practices and determine the applica- Casualty Incident
bility of regulatory limitations prior to use. For specific F1489 Guide for Performance of PatientAssessment by the
2 4
precautionary statements, see Footnote 3. Emergency Medical Technician (Paramedic)
F1651 Guide for Training the Emergency Medical Techni-
cian (Paramedic)
3. Terminology
3.1 Definitions of Terms Specific to This Standard:
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 Feb. 1, 2007. Published February 2007. Originally
approved in 1995. Last previous edition approved in 2002 as F1653 – 95(2002). For referenced ASTM standards, visit the ASTM website, www.astm.org, or
DOI: 10.1520/F1653-95R07. 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 Withdrawn. The last approved version of this historical standard is referenced
75231. on www.astm.org.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.
F1653–95 (2007)
3.1.1 ongoing triage, n—the continuing process of patient 5.1.4 Initiate incident command Guide F1288.
assessment and prioritization in a multiple casualty incident.
5.1.5 Identify conditions which may dictate a decision to
(Also known as secondary and tertiary).
treat patients at the scene or transfer them to a designated
3.1.2 primary triage, n—the initial process of rapid assess-
treatment area.
ment, provision of life saving interventions and assignment of
5.1.6 Initiate Primary Triage.
visual priority identification to each patient in a multiple
5.1.6.1 Identify victims who appear to be uninjured or
casualty incident.
minimally injured and able to help themselves, and direct them
3.1.3 triage, n—the process of sorting and prioritizing care
to a designated area of safety.
of the sick and injured on the basis of urgency and type of
5.1.6.2 Perform a rapid assessment of the remaining vic-
condition present, as well as the number of patients and
tims. Check respiratory status, circulatory status and level of
resources available. The objective is to properly treat and
consciousness.
transport patients to medical facilities appropriately situated
5.1.6.3 Immediate medical interventions should be limited
and equipped for their care.
to opening the airway and controlling gross hemorrhage.These
...

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5.1 The emergency medical dispatcher should be a specially trained telecommunicator with specific emergency medical knowledge. Many of these personnel still perform in this role without the benefits of dispatch specific medical training and medically sound protocols. The majority perform their duties without appropriate medical management provided through a structured quality assurance/improvement environment. Training only prepares a new EMD for correct use of the EMDPRS. It cannot ensure that the EMDPRS is used as intended. Since the EMD is clearly defined as a prehospital medical professional, it is necessary to establish sound medical management processes through a multi-component QA/QI program administered by the EMD's agency in conjunction with the physician medical director. Prompt, correct, and appropriate patient care can be enhanced through the use of a standardized approach to quality assurance, especially the component of EMD performance assessment. This practice is intended for use by agencies, organizations, and jurisdictions having the responsibility for providing such services and assurances to the public through the correct management of the nation's emergency medical dispatchers.
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1.9 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.
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Standard Guide for Training and Evaluation of Individuals Who Are Responsible for or Perform Triage in a Prehospital Environment

SIGNIFICANCE AND USE
4.1 This guide is intended for use by those responsible for the development and implementation of training programs, that include competency evaluation, for triage in the prehospital environment.  
4.2 This guide is not intended to be used by itself, but as a component of Guide F1288.  
4.3 This guide acknowledges many types of individuals with varying levels of emergency medical training. It also establishes a minimum training standard and encourages the addition of optional knowledge, skill, and attitudinal objectives.  
4.4 A vital role in the development 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 and coordinated with those who are responsible for training.  
4.5 At the beginning of the program, students shall be informed of the course objectives and requirements for successful completion.
SCOPE
1.1 This guide covers minimum requirements for the training and evaluation of individuals who perform triage at an emergency medical incident involving multiple casualties in a prehospital environment.  
1.2 All training will be in accordance with Guide F1653.  
1.3 Included in this guide is a standard for knowledge and skill evaluation.  
1.4 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, F1288, F1453, and F1489.  
1.5 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 the document cited in Footnote 3.  
1.6 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.

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4.1 It is essential to have the public's understanding and support for the EMS system to ensure its proper development and utilization.  
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1.1 The purpose of this guide is to provide national voluntary standards and recommendations to effectively provide emergency medical service system information and education to the public.  
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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.  
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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.

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