ASTM F1651-95(2009)

NOTICE: This standard has either been superseded and replaced by a new version or withdrawn.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: F1651 − 95 (Reapproved 2009)
Standard Guide for
Training the Emergency Medical Technician (Paramedic)
This standard is issued under the fixed designation F1651; 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.
1. Scope Emergency Medical Technician (Paramedic) (Withdrawn
2003)
1.1 This guide covers the training standard for the emer-
F1517 GuideforScopeofPerformanceofEmergencyMedi-
gency medical technician (paramedic) to deal with emergen-
cal Services Ambulance Operations
cies. Primary care and wilderness/delayed/prolonged context
training for the emergency medical technician (paramedic) is
3. Terminology
not within the scope of this guide, but may be dealt with in
other ASTM standards.
3.1 Definitions of Terms Specific to This Standard:
1.2 This guide identifies the knowledge and skills that all 3.1.1 auscultation—examination by listening with a stetho-
programs that train the emergency medical technician (para- scope.
medic) should include in their training program.
3.1.2 EMSS communications subsystem—comprises those
1.3 This standard does not purport to address all of the
resource arrangements for notifying the EMS system of an
safety concerns, if any, associated with its use. It is the
emergency, for mobilizing and dispatching resources, for
responsibility of the user of this standard to establish appro-
exchanging information, for remote monitoring of vital
priate safety and health practices and determine the applica-
indicators, and for transmission of treatment procedures and
bility of regulatory limitations prior to use.
directions (see Guide F1220).
3.1.3 human anatomy—the branch of science dealing with
2. Referenced Documents
the structure of the human organisms.
2.1 ASTM Standards:
3.1.4 human physiology—the science dealing with the func-
F1149 Practice for Qualifications, Responsibilities, and Au-
tions of the human living organism.
thority of Individuals and Institutions Providing Medical
Direction of Emergency Medical Services
3.1.5 incident command system—the combination of
F1220 Guide for Emergency Medical Services System
facilities, equipment, personnel, procedures, and communica-
(EMSS) Telecommunications
tions operating within a common organizational structure with
F1254 Practice for Performance of Prehospital Manual De-
responsibility for the management of assigned resources to
fibrillation (Withdrawn 2007)
effectively accomplish stated objectives pertaining to an inci-
F1255 Practice for Performance of Prehospital Automated
dent.
Defibrillation
3.1.6 inspection—examination by careful visualization of
F1258 Practice for Emergency Medical Dispatch
the body or a part of the body.
F1288 Guide for Planning for and Response to a Multiple
Casualty Incident
3.1.7 management—actions taken by the emergency medi-
F1489 Guide for Performance of Patient Assessment by the
cal technician (paramedic) for a patient in need of assistance
due to a real or perceived traumatic or medical condition.
3.1.8 palpation—examination by touching with the hand(s).
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
3.1.9 stress—nonspecific response of the body to any de-
Medical Services and is the direct responsibility of Subcommittee F30.02 on
Personnel, Training and Education.
mand made upon it.
Current edition approved March 1, 2009. Published March 2009. Originally
approved in 1995. Last previous edition approved in 2002 as F1651 – 95(2002). 3.1.10 topographic anatomy—a study of all the structures
DOI: 10.1520/F1651-95R09.
and their relationships in a given region.
For referenced ASTM standards, visit the ASTM website, www.astm.org, or
contact ASTM Customer Service at service@astm.org. For Annual Book of ASTM
3.1.11 triage—the process of sorting and making priorities
Standards volume information, refer to the standard’s Document Summary page on
for emergency medical care of the sick and injured on the basis
the ASTM website.
of urgency and type of condition present, number of patients,
The last approved version of this historical standard is referenced on
www.astm.org. and resources available.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959. United States
F1651 − 95 (2009)
4. Significance and Use 9.1.3 Assess presence, rate, regularity, and quality of the
following pulses: carotid, brachial, radial, femoral, temporal,
4.1 This guide establishes the national standard for training
dorsalis pedis, and posterior tibial,
the emergency medical technician (paramedic).
9.1.4 Palpate blood pressure,
4.2 This guide shall be used by those who develop the
9.1.5 Auscultate blood pressure,
training curriculum to be used to train the emergency medical
9.1.6 Assess capillary refill,
technician (paramedic).
9.1.7 Assess mental status and level of consciousness,
4.3 Every person who is identified as an emergency medical 9.1.8 Assess pupils,
9.1.9 Inspect the body,
technician (paramedic) shall have been trained to this guide.
9.1.10 Palpate the body,
4.4 It is understood that the scope of the medical practice is
9.1.11 Assess sensory perception,
constantly evolving. Therefore, this guide does not contain
9.1.12 Assess motor function,
recommendations for the management of illnesses and injuries.
9.1.13 Assess airway patency,
Furthermore, it is not intended to supersede the protocols and
9.1.14 Assess electrical activity of the heart,
standing orders of the system medical director or the on-line
9.1.15 Assess blood glucose level,
medical physician (see Practice F1149).
9.1.16 Assess temperature,
4.5 This guide does not standardize the scope of practice of
9.1.17 Assess oxygen saturation level,
the emergency medical technician (paramedic).
9.1.18 Assess the skin and mucous membranes for color,
temperature, turgor, and dampness,
5. Anatomy and Physiology
9.1.19 Assess the skin for basic primary skin rashes:
5.1 The emergency medical technician (paramedic) shall 9.1.19.1 Macules and patches,
describe the anatomy and physiology of the major body 9.1.19.2 Papules and nodules,
systems and the differences that exist because of age and 9.1.19.3 Wheals (hives),
gender to the extent needed to assess and manage patients with 9.1.19.4 Bullae (blisters), vesicles, and pustules, and
the illnesses and injuries in the following sections, using the 9.1.19.5 Petechiae and purpura.
techniques listed in this guide. 9.1.20 Assess the fontanelle in infants, and
9.1.21 Assess vision.
6. Communications and Medical Terminology
10. Examination Devices
6.1 The emergency medical technician (paramedic) shall be
able to communicate effectively, using standard medical 10.1 The emergency medical technician (paramedic) shall
terminology, about the illnesses and injuries, and the be trained to use the following:
techniques, listed in this guide. 10.1.1 Blood glucose measurement devices,
10.1.2 Pulse oximeters,
7. Pharmacology
10.1.3 Blood collection devices,
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,
ventiontomanagepatientswiththeillnessesandinjuriesinthe
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 F1489.
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:
12.1.1 Airway obstruction or compromise,
12.1.2 Shock:
The boldface numbers given in parentheses refer to a list of references at the
end of the text. 12.1.2.1 Hypovolemic,
F1651 − 95 (2009)
12.1.2.2 Cardiogenic, 12.1.16.1 Diabetes mellitus,
12.1.2.3 Distributive, and 12.1.16.2 Hyperthyroidism and hypothyroidism,
12.1.2.4 Obstructive.
12.1.16.3 Adrenal insufficiency, and
12.1.3 Wounds and impaled objects,
12.1.16.4 Hypocalcemic tetany.
12.1.4 Contusions, 12.1.17 Respiratory disorders:
12.1.5 Orthopedic Injuries:
12.1.17.1 Respiratory failure and nonspecific respiratory
12.1.5.1 Extremity fractures, closed and open,
distress,
12.1.5.2 Extremity dislocations and subluxations, and 12.1.17.2 Asthma,
12.1.5.3 Extremity sprains and strains.
12.1.17.3 Chronic obstructive pulmonary disease,
12.1.6 Head injuries,
12.1.17.4 Pulmonary embolism,
12.1.7 Face fractures,
12.1.17.5 Toxic inhalations,
12.1.8 Eye injuries,
12.1.17.6 Pneumonia, bronchitis, and active pulmonary
12.1.9 Spinal injuries:
tuberculosis,
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
12.1.19.2 Hypertension,
pneumothorax,
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
12.1.15.9 Abnormal presentations, conduction,
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
(26) Arterial occlusion and deep venous thrombosis.
12.1.15.13 Placenta previa, and
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,
F1651 − 95 (2009)
12.1.20.2 Transient ischemic attack and cerebro-vascular 13.1.1.12 Orotracheal/nasotracheal intubation, and
accident (stroke), 13.1.1.13 Suction devices:
12.1.20.3 Seizures, 13.1.1.14 Mechanical suction,
12.1.20.4 Syncope and near sycnope, 13.1.1.15 Filtered small-bore trap suction (for example,
modified DeLee),
12.1.20.5 Coma,
12.1.20.6 Meningitis, 13.1.1.16 Bulb syringe,
13.1.1.17 Suction catheters:
12.1.20.7 Vertigo, and
12.1.20.8 Impaired level of consciousness. 13.1.1.18 Rigid tonsillar suction catheter, and
13.1.1.19 Flexible suction catheter,
12.1.21 Genitourinary illness:
12.1.21.1 Kidney stones, 13.1.1.20 Techniques and devices to provide ventilatory
assistance:
12.1.21.2 Pyelonephritis,
13.1.1.21 Mouth-to-mouth,
12.1.21.3 End-stage renal disease,
13.1.1.22 Mouth-to-nose,
12.1.21.4 Testicular torsion, and
13.1.1.23 Mouth-to-mouth and nose,
12.1.21.5 Urinary retention.
13.1.1.24 Mouth-to-stoma,
12.1.22 Ear/nose/throat emergencies:
13.1.1.25 Mouth-to-mask , and
12.1.22.1 Epistaxis (nosebleed),
13.1.1.26 Positive pressure ventilatory devices,
12.1.22.2 Dental fractures,
13.1.1.27 Oxygen delivery devices:
12.1.22.3 Epiglottitis and croup,
13.1.1.28 Low-concentration oxygen delivery devices, and
12.1.22.4 Peritonsillar abscess,
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 Alle
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