ASTM F1651-95(2002)

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Designation:F1651–95 (Reapproved2002)
Standard Guide for
Training the Emergency Medical Technician (Paramedic)
This standard is issued under the fixed designation F 1651; 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 3.1.1 auscultation—examination by listening with a stetho-
scope.
1.1 This guide covers the training standard for the emer-
3.1.2 EMSS communications subsystem—comprises those
gency medical technician (paramedic) to deal with emergen-
resource arrangements for notifying the EMS system of an
cies. Primary care and wilderness/delayed/prolonged context
emergency, for mobilizing and dispatching resources, for
training for the emergency medical technician (paramedic) is
exchanging information, for remote monitoring of vital indi-
not within the scope of this guide, but may be dealt with in
cators, and for transmission of treatment procedures and
other ASTM standards.
directions (see Guide F 1220).
1.2 This guide identifies the knowledge and skills that all
3.1.3 human anatomy—the branch of science dealing with
programs that train the emergency medical technician (para-
the structure of the human organisms.
medic) should include in their training program.
3.1.4 human physiology—the science dealing with the func-
1.3 This standard does not purport to address all of the
tions of the human living organism.
safety concerns, if any, associated with its use. It is the
3.1.5 incident command system—the combination of facili-
responsibility of the user of this standard to establish appro-
ties, equipment, personnel, procedures, and communications
priate safety and health practices and determine the applica-
operating within a common organizational structure with
bility of regulatory limitations prior to use.
responsibility for the management of assigned resources to
2. Referenced Documents
effectively accomplish stated objectives pertaining to an inci-
dent.
2.1 ASTM Standards:
3.1.6 inspection—examination by careful visualization of
F 1149 Practice for Qualifications, Responsibilities, and
the body or a part of the body.
Authority of Individuals and Institutions Providing Medi-
3.1.7 management—actions taken by the emergency medi-
cal Direction of Emergency Medical Services
cal technician (paramedic) for a patient in need of assistance
F 1220 Guide for Emergency Medical Services Systems
due to a real or perceived traumatic or medical condition.
(EMSS) Telecommunications
3.1.8 palpation—examination by touching with the hand(s).
F 1254 Practice for Performance of Prehospital Manual
3.1.9 stress—nonspecific response of the body to any de-
Defibrillation
mand made upon it.
F 1255 Practice for Performance of Prehospital Automated
3.1.10 topographic anatomy—a study of all the structures
Defibrillation
and their relationships in a given region.
F 1258 Practice for Emergency Medical Dispatch
3.1.11 triage—the process of sorting and making priorities
F 1288 Guide for Planning for and Response to a Multiple
for emergency medical care of the sick and injured on the basis
Casualty Incident
of urgency and type of condition present, number of patients,
F 1489 Guide for Performance of PatientAssessment by the
and resources available.
Emergency Medical Technician (Paramedic)
F 1517 Guide for Scope of Performance of Emergency
4. Significance and Use
Medical Services Ambulance Operations
4.1 This guide establishes the national standard for training
3. Terminology the emergency medical technician (paramedic).
4.2 This guide shall be used by those who develop the
3.1 Definitions of Terms Specific to This Standard:
training curriculum to be used to train the emergency medical
technician (paramedic).
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
4.3 Every person who is identified as an emergency medical
Medical Services and is the direct responsibility of Subcommittee F30.02 on
technician (paramedic) shall have been trained to this guide.
Personnel, Training, and Education.
Current edition approved Oct. 10, 1995. Published December 1995.
Annual Book of ASTM Standards, Vol 13.02.
Discontinued; See 2001 Annual Book of ASTM Standards, Vol 13.01.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.
F1651–95 (2002)
4.4 It is understood that the scope of the medical practice is 9.1.12 Assess motor function,
constantly evolving. Therefore, this guide does not contain 9.1.13 Assess airway patency,
recommendations for the management of illnesses and injuries. 9.1.14 Assess electrical activity of the heart,
Furthermore, it is not intended to supersede the protocols and 9.1.15 Assess blood glucose level,
standing orders of the system medical director or the on-line 9.1.16 Assess temperature,
medical physician (see Practice F 1149). 9.1.17 Assess oxygen saturation level,
4.5 This guide does not standardize the scope of practice of 9.1.18 Assess the skin and mucous membranes for color,
the emergency medical technician (paramedic). temperature, turgor, and dampness,
9.1.19 Assess the skin for basic primary skin rashes:
5. Anatomy and Physiology
9.1.19.1 Macules and patches,
5.1 The emergency medical technician (paramedic) shall 9.1.19.2 Papules and nodules,
describe the anatomy and physiology of the major body 9.1.19.3 Wheals (hives),
systems and the differences that exist because of age and 9.1.19.4 Bullae (blisters), vesicles, and pustules, and
gender to the extent needed to assess and manage patients with 9.1.19.5 Petechiae and purpura.
the illnesses and injuries in the following sections, using the 9.1.20 Assess the fontanelle in infants, and
9.1.21 Assess vision.
techniques listed in this guide.
6. Communications and Medical Terminology
10. Examination Devices
6.1 The emergency medical technician (paramedic) shall be
10.1 The emergency medical technician (paramedic) shall
able to communicate effectively, using standard medical termi-
be trained to use the following:
nology, about the illnesses and injuries, and the techniques,
10.1.1 Blood glucose measurement devices,
listed in this guide.
10.1.2 Pulse oximeters,
10.1.3 Blood collection devices,
7. Pharmacology
10.1.4 Sphygmomanometer,
7.1 The emergency medical technician (paramedic) shall be
10.1.5 Stethoscope,
able to apply theory and principles of pharmacological inter-
10.1.6 Penlight,
vention to manage patients with the illnesses and injuries in the
10.1.7 Thermometer,
following sections, using the techniques listed in this guide.
10.1.8 Cardiac rhythm monitor,
10.1.9 Twelve-lead ECG monitor,
8. Universal Blood and Body Fluid Precautions
10.1.10 Laryngoscope,
8.1 The emergency medical technician (paramedic) shall be
10.1.11 Amplified listening device, and
taught the current local, state, Occupational Safety and Health
10.1.12 Exhaled CO detection devices.
Administration (OSHA), and Center for Disease Control
(CDC) recommendations for preventing the transmission of
11. Patient Assessment
communicable diseases. (See Refs (1, 2, and 3).)
11.1 The emergency medical technician (paramedic) shall
be educated to perform patient assessment in accordance with
9. Examination Techniques
Guide F 1489.
9.1 The emergency medical technician (paramedic) shall be
trained to perform the following examination techniques and
12. Illnesses and Injuries
use appropriate modifications to accommodate the differences
12.1 The emergency medical technician (paramedic) shall
that exist because of age and sex:
demonstrate understanding of both the pathophysiology nec-
9.1.1 Assess respirations for rate, rhythm, symmetry, and
essary to recognize the clinical presentation and the manage-
quality,
ment of the following in the prehospital context, including the
9.1.2 Auscultate for breath sounds,
differences that exist because of age and sex:
9.1.3 Assess presence, rate, regularity, and quality of the
12.1.1 Airway obstruction or compromise,
following pulses: carotid, brachial, radial, femoral, temporal,
12.1.2 Shock:
dorsalis pedis, and posterior tibial,
12.1.2.1 Hypovolemic,
9.1.4 Palpate blood pressure,
12.1.2.2 Cardiogenic,
9.1.5 Auscultate blood pressure,
12.1.2.3 Distributive, and
9.1.6 Assess capillary refill,
12.1.2.4 Obstructive.
9.1.7 Assess mental status and level of consciousness,
12.1.3 Wounds and impaled objects,
9.1.8 Assess pupils,
12.1.4 Contusions,
9.1.9 Inspect the body,
12.1.5 Orthopedic Injuries:
9.1.10 Palpate the body,
12.1.5.1 Extremity fractures, closed and open,
9.1.11 Assess sensory perception,
12.1.5.2 Extremity dislocations and subluxations, and
12.1.5.3 Extremity sprains and strains.
12.1.6 Head injuries,
The boldface numbers given in parentheses refer to a list of references at the
end of the text. 12.1.7 Face fractures,
F1651–95 (2002)
12.1.8 Eye injuries, 12.1.17.6 Pneumonia, bronchitis, and active pulmonary tu-
12.1.9 Spinal injuries: berculosis,
12.1.9.1 Strains, sprains, and fractures, and 12.1.17.7 Hyperventilation,
12.1.9.2 Back pain and herniated disks. 12.1.17.8 Spontaneous pneumothorax,
12.1.10 Chest injuries, including: 12.1.17.9 Bronchiolitis, and
12.1.10.1 Pericardial tamponade, 12.1.17.10 Apnea of infancy.
12.1.10.2 Flail chest, 12.1.18 Abdominal pain,
12.1.10.3 Sucking chest wound, 12.1.19 Cardiovascular illness:
12.1.10.4 Rib fractures, 12.1.19.1 Non-traumatic cardiac arrest,
12.1.10.5 Hemothorax, pneumothorax, and tension pneu- 12.1.19.2 Hypertension,
mothorax, 12.1.19.3 Angina and myocardial infarction,
12.1.10.6 Lung and heart contusions, and 12.1.19.4 Abdominal aortic aneurysm,
12.1.10.7 Great vessel injury.
12.1.19.5 Aortic dissection,
12.1.11 Pelvic fractures, 12.1.19.6 Congestive heart failure and pulmonary edema,
12.1.12 Blunt or penetrating abdominal trauma, 12.1.19.7 Pre-excitationsyndromes,forexample,WolffPar-
12.1.13 Poisonings, drug overdoses, and substance abuse, kinson White,
12.1.14 Environmental illness and injury: 12.1.19.8 Cardiac rhythms:
12.1.14.1 Hypothermia and frostbite, (1) Normal sinus rhythm,
12.1.14.2 Heat-related illness, (2) Sinus tachycardia,
12.1.14.3 Burns: (3) Sinus arrhythmia,
(1) Thermal, (4) Sinus bradycardia,
(2) Electrical, (5) Atrial fibrillation,
(3) Chemical, (6) Atrial flutter,
12.1.14.4 Radiation exposure, (7) Atrial tachycardia,
12.1.14.5 Electrical and lightning injuries, (8) Premature supraventricular complexes,
12.1.14.6 Exposure to plant and animal toxins, both land (9) Supraventricular escape complexes,
and marine, (10) Wandering pacemaker,
12.1.14.7 Near-drowning and cold-water submersion,
(11) Paroxyxsmal supraventricular tachycardia (PSVT),
12.1.14.8 Altitude illness (acute mountain sickness, higha- (12) Ventricular escape complexes,
ltitude pulmonary edema, high-altitude cerebral edema), and
(13) Premature ventricular complexes,
12.1.14.9 Barotrauma and decompression sickness.
(14) Ventricular tachycardia/toursades de pointes,
12.1.15 Obstetric and gynecological illness and injury: (15) Ventricular fibrillation,
12.1.15.1 Newborn infant,
(16) Asystole,
12.1.15.2 Active labor,
(17) Supraventricular tachycardia,
12.1.15.3 Imminent delivery, (18) First-degree AV block,
12.1.15.4 Uterine atony, (19) Second-degree AV block (Wenkebach/Mobitz Type
12.1.15.5 Vaginal bleeding, I),
12.1.15.6 Spontaneous abortion (miscarriage), (20) Second-degree AV block (classical Mobitz Type II),
12.1.15.7 Pre-eclampsia and eclampsia, (21) Third-degree AV block,
12.1.15.8 Trauma in pregnancy, (22) Bundle branch block/aberrant ventricular conduc-
12.1.15.9 Abnormal presentations, tion,
12.1.15.10 Ectopic pregnancy, (23) Junctional rhythms,
12.1.15.11 Pelvic inflammatory disease (PID), (24) Pacemaker rhythms,
12.1.15.12 Abruptio placenta, (25) Electromechanical dissociation, and
12.1.15.13 Placenta previa, and (26) Arterial occlusion and deep venous thrombosis.
12.1.15.14 Rape and sexual assault. 12.1.20 Neurological:
12.1.16 Endocrine disorders: 12.1.20.1 Headache, including subarachnoid hemorrhage,
12.1.16.1 Diabetes mellitus, 12.1.20.2 Transient ischemic attack and cerebro-vascular
12.1.16.2 Hyperthyroidism and hypothyroidism, accident (stroke),
12.1.16.3 Adrenal insufficiency, and 12.1.20.3 Seizures,
12.1.20.4 Syncope and near sycnope,
12.1.16.4 Hypocalcemic tetany.
12.1.17 Respiratory disorders: 12.1.20.5 Coma,
12.1.17.1 Respiratory failure and nonspecific respiratory 12.1.20.6 Meningitis,
distress, 12.1.20.7 Vertigo, and
12.1.17.2 Asthma, 12.1.20.8 Impaired level of consciousness.
12.1.17.3 Chronic obstructive pulmonary disease, 12.1.21 Genitourinary illness:
12.1.17.4 Pulmonary embolism, 12.1.21.1 Kidney stones,
12.1.17.5 Toxic inhalations, 12.1.21.2 Pyelonephritis,
F1651–95 (2002)
12.1.21.3 End-stage renal disease, 13.1.1.21 Mouth-to-mouth,
12.1.21.4 Testicular torsion, and 13.1.1.22 Mouth-to-nose,
12.1.21.5 Urinary retention. 13.1.1.23 Mouth-to-mouth and nose,
12.1.22 Ear/nose/throat emergencies: 13.1.1.24 Mouth-to-stoma,
13.1.1.25 Mouth-to-mask , and
12.1.22.1 Epistaxis (nosebleed),
12.1.22.2 Dental fractures, 13.1.1.26 Positive pressure ventilatory devices,
13.1.1.27 Oxygen delivery devices:
12.1.22.3 Epiglottitis and croup,
12.1.22.4 Peritonsillar abscess, 13.1.1.28 Low-concentration oxygen delivery devices, and
13.1.1.29 High-concentration oxygen delivery devices,
12.1.22.5 Jaw dislocation,
13.1.1.30 Needle thoracostomy,
12.1.22.6 Jaw fracture, and
13.1.2 Techniques for management of the compromised
12.1.22.7 Laryngeal injury.
circulatory system:
12.1.23 Chest pain,
13.1.2.1 Direct pressure to the source of bleeding,
12.1.24 Gastrointestinal illness:
13.1.2.2 Pressure dressings,
12.1.24.1 GI bleeding, and
13.1.2.3 Patient positioning,
12.1.24.2 Vomiting and diarrhea.
13.1.2.4 The pneumatic antishock garment, and
12.1.25 Allergic reactions:
13.1.2.5 Intraverenous (IV) fluid replacement therapy.
12.1.25.1 Localized,
13.1.3 Useofspinalimmobilizationtechniquesanddevices:
12.1.25.2 Generalized, and
13.1.3.1 Manual immobilization,
12.1.25.3 Anaphylaxis.
13.1.3.2 Cervical spine immobilization devices,
12.1.26 Infectious disease,
13.1.3.3 Short-spine immobilization devices,
12.1.27 Oncological illness (cancer):
13.1.3.4 Long-spine immobilization devices, and
12.1.27.1 Spinal cord compression, and
13.1.3.5 Helmet removal,
12.1.27.2 Airway compromise.
13.1.4 Techniques and devices for the management of
12.1.28 Terminal illness,
musculoskeletal injuries (non-spine):
12.1.29 Psychiatric and behavioral illness (situational, or-
13.1.4.1 Manua
...