ASTM F1651-95

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Designation: F 1651 – 95
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 3.1.2 EMSS communications subsystem—comprises those
resource arrangements for notifying the EMS system of an
1.1 This guide covers the training standard for the emer-
emergency, for mobilizing and dispatching resources, for
gency medical technician (paramedic) to deal with emergen-
exchanging information, for remote monitoring of vital indi-
cies. Primary care and wilderness/delayed/prolonged context
cators, and for transmission of treatment procedures and
training for the emergency medical technician (paramedic) is
directions (see Guide F 1220).
not within the scope of this guide, but may be dealt with in
3.1.3 human anatomy—the branch of science dealing with
other ASTM standards.
the structure of the human organisms.
1.2 This guide identifies the knowledge and skills that all
3.1.4 human physiology—the science dealing with the func-
programs that train the emergency medical technician (para-
tions of the human living organism.
medic) should include in their training program.
3.1.5 incident command system—the combination of facili-
1.3 This standard does not purport to address all of the
ties, equipment, personnel, procedures, and communications
safety concerns, if any, associated with its use. It is the
operating within a common organizational structure with
responsibility of the user of this standard to establish appro-
responsibility for the management of assigned resources to
priate safety and health practices and determine the applica-
effectively accomplish stated objectives pertaining to an inci-
bility of regulatory limitations prior to use.
dent.
2. Referenced Documents 3.1.6 inspection—examination by careful visualization of
the body or a part of the body.
2.1 ASTM Standards:
3.1.7 management—actions taken by the emergency medi-
F 1149 Practice for Qualifications, Responsibilities, and
cal technician (paramedic) for a patient in need of assistance
Authority of Individuals and Institutions Providing Medi-
due to a real or perceived traumatic or medical condition.
cal Direction of Emergency Medical Services
3.1.8 palpation—examination by touching with the hand(s).
F 1220 Guide for Emergency Medical Services Systems
3.1.9 stress—nonspecific response of the body to any de-
(EMSS) Telecommunications
mand made upon it.
F 1254 Practice for Performance of Prehospital Manual
3.1.10 topographic anatomy—a study of all the structures
Defibrillation
and their relationships in a given region.
F 1255 Practice for Performance of Prehospital Automated
3.1.11 triage—the process of sorting and making priorities
Defibrillation
for emergency medical care of the sick and injured on the basis
F 1258 Practice for Emergency Medical Dispatch
of urgency and type of condition present, number of patients,
F 1288 Guide for Planning for and Response to a Multiple
and resources available.
Casualty Incident
F 1489 Guide for Performance of Patient Assessment by the
4. Significance and Use
Emergency Medical Technician (Paramedic)
4.1 This guide establishes the national standard for training
F 1517 Guide for Scope of Performance of Emergency
the emergency medical technician (paramedic).
Medical Services Ambulance Operations
4.2 This guide shall be used by those who develop the
3. Terminology
training curriculum to be used to train the emergency medical
technician (paramedic).
3.1 Definitions of Terms Specific to This Standard:
4.3 Every person who is identified as an emergency medical
3.1.1 auscultation—examination by listening with a stetho-
technician (paramedic) shall have been trained to this guide.
scope.
4.4 It is understood that the scope of the medical practice is
constantly evolving. Therefore, this guide does not contain
recommendations for the management of illnesses and injuries.
This guide is under the jurisdiction of ASTM Committee F-30 on Emergency
Furthermore, it is not intended to supersede the protocols and
Medical Services and is the direct responsibility of Subcommittee F30.02 on
Personnel, Training and Education.
standing orders of the system medical director or the on-line
Current edition approved Oct. 10, 1995. Published December 1995.
medical physician (see Practice F 1149).
Annual Book of ASTM Standards, Vol 13.01.
Copyright © ASTM, 100 Barr Harbor Drive, West Conshohocken, PA 19428-2959, United States.
F 1651
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,
9.1.19.2 Papules and nodules,
5.1 The emergency medical technician (paramedic) shall
describe the anatomy and physiology of the major body 9.1.19.3 Wheals (hives),
9.1.19.4 Bullae (blisters), vesicles, and pustules, and
systems and the differences that exist because of age and
gender to the extent needed to assess and manage patients with 9.1.19.5 Petechiae and purpura.
9.1.20 Assess the fontanelle in infants, and
the illnesses and injuries in the following sections, using the
techniques listed in this guide. 9.1.21 Assess vision.
10. Examination Devices
6. Communications and Medical Terminology
10.1 The emergency medical technician (paramedic) shall
6.1 The emergency medical technician (paramedic) shall be
be trained to use the following:
able to communicate effectively, using standard medical termi-
10.1.1 Blood glucose measurement devices,
nology, about the illnesses and injuries, and the techniques,
10.1.2 Pulse oximeters,
listed in this guide.
10.1.3 Blood collection devices,
7. Pharmacology
10.1.4 Sphygmomanometer,
10.1.5 Stethoscope,
7.1 The emergency medical technician (paramedic) shall be
10.1.6 Penlight,
able to apply theory and principles of pharmacological inter-
10.1.7 Thermometer,
vention to manage patients with the illnesses and injuries in the
10.1.8 Cardiac rhythm monitor,
following sections, using the techniques listed in this guide.
10.1.9 Twelve-lead ECG monitor,
8. Universal Blood and Body Fluid Precautions
10.1.10 Laryngoscope,
10.1.11 Amplified listening device, and
8.1 The emergency medical technician (paramedic) shall be
10.1.12 Exhaled CO detection devices.
taught the current local, state, Occupational Safety and Health 2
Administration (OSHA), and Center for Disease Control
11. Patient Assessment
(CDC) recommendations for preventing the transmission of
11.1 The emergency medical technician (paramedic) shall
communicable diseases. (See Refs (1, 2, and 3).)
be educated to perform patient assessment in accordance with
9. Examination Techniques
Guide F 1489.
9.1 The emergency medical technician (paramedic) shall be
12. Illnesses and Injuries
trained to perform the following examination techniques and
12.1 The emergency medical technician (paramedic) shall
use appropriate modifications to accommodate the differences
demonstrate understanding of both the pathophysiology nec-
that exist because of age and sex:
essary to recognize the clinical presentation and the manage-
9.1.1 Assess respirations for rate, rhythm, symmetry, and
ment of the following in the prehospital context, including the
quality,
differences that exist because of age and sex:
9.1.2 Auscultate for breath sounds,
12.1.1 Airway obstruction or compromise,
9.1.3 Assess presence, rate, regularity, and quality of the
12.1.2 Shock:
following pulses: carotid, brachial, radial, femoral, temporal,
12.1.2.1 Hypovolemic,
dorsalis pedis, and posterior tibial,
12.1.2.2 Cardiogenic,
9.1.4 Palpate blood pressure,
12.1.2.3 Distributive, and
9.1.5 Auscultate blood pressure,
12.1.2.4 Obstructive.
9.1.6 Assess capillary refill,
12.1.3 Wounds and impaled objects,
9.1.7 Assess mental status and level of consciousness,
12.1.4 Contusions,
9.1.8 Assess pupils,
12.1.5 Orthopedic Injuries:
9.1.9 Inspect the body,
12.1.5.1 Extremity fractures, closed and open,
9.1.10 Palpate the body,
12.1.5.2 Extremity dislocations and subluxations, and
9.1.11 Assess sensory perception,
12.1.5.3 Extremity sprains and strains.
9.1.12 Assess motor function,
12.1.6 Head injuries,
9.1.13 Assess airway patency,
12.1.7 Face fractures,
9.1.14 Assess electrical activity of the heart,
12.1.8 Eye injuries,
9.1.15 Assess blood glucose level,
12.1.9 Spinal injuries:
9.1.16 Assess temperature,
12.1.9.1 Strains, sprains, and fractures, and
9.1.17 Assess oxygen saturation level,
12.1.9.2 Back pain and herniated disks.
12.1.10 Chest injuries, including:
12.1.10.1 Pericardial tamponade,
The boldface numbers given in parentheses refer to a list of references at the
end of the text. 12.1.10.2 Flail chest,
F 1651
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-excitation syndromes, for example, Wolff Par-
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,
(3) Sinus arrhythmia,
12.1.14.3 Burns:
(1) Thermal, (4) Sinus bradycardia,
(2) Electrical, (5) Atrial fibrillation,
(6) Atrial flutter,
(3) Chemical,
12.1.14.4 Radiation exposure, (7) Atrial tachycardia,
12.1.14.5 Electrical and lightning injuries, (8) Premature supraventricular complexes,
(9) Supraventricular escape complexes,
12.1.14.6 Exposure to plant and animal toxins, both land
and marine, (10) Wandering pacemaker,
12.1.14.7 Near-drowning and cold-water submersion, (11) Paroxyxsmal supraventricular tachycardia (PSVT),
(12) Ventricular escape complexes,
12.1.14.8 Altitude illness (acute mountain sickness, higha-
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 I),
12.1.15.5 Vaginal bleeding, (20) Second-degree AV block (classical Mobitz Type II),
12.1.15.6 Spontaneous abortion (miscarriage), (21) Third-degree AV block,
12.1.15.7 Pre-eclampsia and eclampsia, (22) Bundle branch block/aberrant ventricular conduction,
12.1.15.8 Trauma in pregnancy, (23) Junctional rhythms,
(24) Pacemaker rhythms,
12.1.15.9 Abnormal presentations,
12.1.15.10 Ectopic pregnancy, (25) Electromechanical dissociation, and
12.1.15.11 Pelvic inflammatory disease (PID), (26) Arterial occlusion and deep venous thrombosis.
12.1.20 Neurological:
12.1.15.12 Abruptio placenta,
12.1.15.13 Placenta previa, and 12.1.20.1 Headache, including subarachnoid hemorrhage,
12.1.15.14 Rape and sexual assault. 12.1.20.2 Transient ischemic attack and cerebro-vascular
accident (stroke),
12.1.16 Endocrine disorders:
12.1.16.1 Diabetes mellitus, 12.1.20.3 Seizures,
12.1.20.4 Syncope and near sycnope,
12.1.16.2 Hyperthyroidism and hypothyroidism,
12.1.20.5 Coma,
12.1.16.3 Adrenal insufficiency, and
12.1.16.4 Hypocalcemic tetany. 12.1.20.6 Meningitis,
12.1.17 Respiratory disorders: 12.1.20.7 Vertigo, and
12.1.20.8 Impaired level of consciousness.
12.1.17.1 Respiratory failure and nonspecific respiratory
distress, 12.1.21 Genitourinary illness:
12.1.17.2 Asthma, 12.1.21.1 Kidney stones,
12.1.17.3 Chronic obstructive pulmonary disease, 12.1.21.2 Pyelonephritis,
12.1.17.4 Pulmonary embolism, 12.1.21.3 End-stage renal disease,
12.1.17.5 Toxic inhalations, 12.1.21.4 Testicular torsion, and
12.1.17.6 Pneumonia, bronchitis, and active pulmonary tu- 12.1.21.5 Urinary retention.
berculosis, 12.1.22 Ear/nose/throat emergencies:
12.1.17.7 Hyperventilation, 12.1.22.1 Epistaxis (nosebleed),
12.1.17.8 Spontaneous pneumothorax, 12.1.22.2 Dental fractures,
12.1.17.9 Bronchiolitis, and 12.1.22.3 Epiglottitis and croup,
12.1.17.10 Apnea of infancy. 12.1.22.4 Peritonsillar abscess,
12.1.18 Abdominal pain, 12.1.22.5 Jaw dislocation,
F 1651
12.1.22.6 Jaw fracture, and 13.1.1.27 Oxygen delivery devices:
12.1.22.7 Laryngeal injury. 13.1.1.28 Low-concentration oxygen delivery devices, and
12.1.23 Chest pain,
13.1.1.29 High-concentration oxygen delivery devices,
12.1.24 Gastrointestinal illness: 13.1.1.30 Needle thoracostomy,
12.1.24.1 GI bleeding, and
13.1.2 Techniques for management of the compromised
12.1.24.2 Vomiting and diarrhea.
circulatory system:
12.1.25 Allergic reactions:
13.1.2.1 Direct pressure to the source of bleeding,
12.1.25.1 Localized,
13.1.2.2 Pressure dressings,
12.1.25.2 Generalized, and
13.1.2.3 Patient positioning,
12.1.25.3 Anaphylaxis.
13.1.2.4 The pneumatic antishock garment, and
12.1.26 Infectious disease,
13.1.2.5 Intraverenous (IV) fluid replacement therapy.
12.1.27 Oncological illness (cancer):
13.1.3 Use of spinal immobilization techniques and devices:
12.1.27.1 Spinal cord compression, and
13.1.3.1 Manual immobilization,
12.1.27.2 Airway compromise.
13.1.3.2 Cervical spine immobilization devices,
12.1.28 Terminal illness,
13.1.3.3 Short-spine immobilization devices,
12.1.29 Psychiatric and behavioral illness (situational, or-
13.1.3.4 Long-spine immobilization devices, and
ganic, and primary psychiatric),
13.1.3.5 Helmet removal,
12.1.30 Sickle cell disease and crisis, and
13.1.4 Techniques and devices for the management of
12.1.31 Physical and emotional abuse in all age groups.
musculoskeletal injuries (non-spine):
13.1.4.1 Manual stabilization,
13. Patient Management Techniques
13.1.4.2 External immobilization fixation techniques and
13.1 The emergency medical technician (paramedic) shall
devices:
be trained in th
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