ASTM F1086-94

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Designation: F 1086 – 94
Standard Guide for
Structures and Responsibilities of Emergency Medical
Services Systems Organizations
This standard is issued under the fixed designation F 1086; 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 Development and enforcement of minimum regula-
tions and standards.
1.1 This guide establishes optimum guidelines for the struc-
3.1.3 Development and dissemination of a statewide plan
tures and responsibilities that will facilitate development,
and goals for EMS systems.
delivery, and assessment of Emergency Medical Services
3.1.4 Provision of technical assistance.
(EMS) on state, regional, and local levels.
3.1.5 Funds for the development, maintenance, and en-
1.1.1 State Level—At the state level, this guide sets forth a
hancement of EMS systems.
basic structure for the organization and management of a state
3.1.6 Supportive components, including training, communi-
emergency medical services program and outlines the respon-
cations systems, record keeping and evaluation, public educa-
sibilities of the state in the planning, development, coordina-
tion, and acute care center designation.
tion, and regulation of emergency medical services throughout
3.1.7 Overall coordination of EMS programs within the
the state.
state and in concert with other states or federal authorities as
1.1.2 Regional Level—At the regional level, this guide
needed.
addresses the planning, development, and coordination of a
3.2 Regional EMS System—A recommended method of
functional and comprehensive EMS system which consists of
structuring substate EMS systems to provide for EMS plan-
all personnel, equipment, and facilities necessary for the
ning, development, and coordination is to delineate specific
response to the emergently ill or injured patient, according to
geographic areas within which one organization is designated
national and state lead agency standards.
as responsible for the arrangement of personnel, facilities, and
1.1.3 Local Level—At the local level, this guide sets forth a
equipment for the effective, coordinated, and expeditious
basic structure for the organization and management of a local
delivery of health care services in a region (3.2.1) under
EMS system and outlines the responsibilities that a local EMS
emergency conditions occurring as a result of the patient’s
should assume in the planning, development, implementation,
condition or because of accidents, natural disasters, or similar
and evaluating of its EMS system.
situations.
2. Significance and Use 3.2.1 Region—To implement a regional EMS system, the
state lead agency will identify the geographic or demographic
2.1 This guide is not meant to mandate a specific structure
area that is a natural catchment area for EMS provision for
or responsibility at the various levels but rather to suggest a
most, if not all, patients in the designated area. Since this
means or method that will allow for the creation or further
cannot be a perfect definition from an EMS delivery point of
development of a state, regional, or local EMS system.
view, administrative and coordinating efficiency considerations
2.2 This guide will assist state, regional, or local organiza-
will have to be made in establishing boundaries. The state lead
tions in establishing EMS systems or refining existing EMS
agency should determine and define the substate structure for
systems.
planning, coordination, and provision of emergency medical
3. Descriptions of EMS Systems
services. When a regional EMS system lies near a state border
such that appropriate and efficient care of patients will require
3.1 State EMS System—A state EMS system includes all of
cooperation of prehospital system in another state and medical
the components of all EMS systems within the state, however,
centers in another state, the state lead agency will develop a
particular emphasis is placed upon the following:
plan with the adjoining state lead agency. This plan must
3.1.1 Legislation establishing authority and responsibility
provide for the triage and transfer of patients across the state
for EMS systems.
border under supervision of the REMSO.
3.2.2 Regional EMS Organization (REMSO)—A REMSO is
This guide is under the jurisdiction of ASTM Committee F-30 on Emergency
a staffed organization responsible and accountable to the state
Medical Services and is the direct responsibility of Subcommittee F30.03 on
EMS lead agency for coordinating the system in a region
Organization/Management.
Current edition approved Oct. 15, 1994. Published December 1994. Originally
published as F 1086 – 87. Last previous edition F 1086 – 87.
Copyright © ASTM, 100 Barr Harbor Drive, West Conshohocken, PA 19428-2959, United States.
F 1086
including system operations, and organization and coordina- 6.1.6 Air transport.
tion of resources. A REMSO should have a medical director 6.1.7 Medical facilities.
and other technical expertise in order to provide the necessary 6.1.8 Psycho-social services.
assistance to its EMS system. A REMSO should work on a 6.1.9 Evaluation and quality assurance.
regional or subregional basis in liaison with professional
7. State EMS System Structure
societies, public safety, other governmental agencies, local
7.1 Agency Organization—Each state should have a single
EMS systems, and legislative bodies to establish standards and
agency with overall responsibility for the state’s role in
program policies for continued system improvement.
emergency medical services.
3.2.2.1 The REMSO should be a substate unit of govern-
7.1.1 Organizationally, this agency should be located in the
ment or a private entity that may be single or multi-
state government structure such that it reflects the program’s
jurisdictional. The REMSO should have the capacity and
health orientation.
authority to receive and disburse public and private funds and
7.1.2 The agency should have a representative advisory
must be designated by the state EMS lead agency.
council, commission, or board to provide advice to the execu-
3.3 Local EMS System—The local EMS system may be
tive and legislative branches on policies, procedures, programs
organized as a community EMS council and should include all
and funding for emergency medical services statewide. Alter-
provider groups, private and public, involved in EMS delivery
natively, the agency may have a board with the authority to
including ambulance or rescue services, hospitals or hospital
adopt or approve rules and regulations. Such a body should
councils, psychosocial services, local boards of health, police
also serve as a mechanism for obtaining public support and
and fire departments, other related governmental and quasi-
participation in the program.
governmental or political subdivisional bodies, and consumers.
7.2 Personnel—The agency should have adequate manage-
3.3.1 The local EMS system must have linkages to substate
rial, technical, and clerical staff to carry out its responsibilities.
and state EMS systems.
7.2.1 There should be a designated director who is a
3.3.2 The local EMS system should be in compliance with
full-time employee of the state.
local ordinances and state and federal laws that govern EMS
7.2.2 If the director is not a physician, there should be a
delivery.
medical director who serves at least on a part-time basis,
4. Standardization
depending on the needs of the program.
4.1 Standard setting is a major component of the state EMS
7.3 Legislation:
system operation. This includes, but is not limited to: 7.3.1 There should be comprehensive legislation that estab-
4.1.1 Legislation.
lishes the EMS program, outlines its basic responsibilities, and
4.1.2 Regulations. provides the authority necessary to effectively carry out these
4.1.3 Guidelines.
responsibilities.
4.1.4 Licensure. 7.3.2 There should be legislation authorizing the establish-
4.1.5 Training. ment of minimum standards for emergency medical services in
4.1.6 Certification. the state.
4.1.7 Data collection and evaluation. 7.3.3 There should be legislation specifying penalties for
noncompliance with the established minimum standards.
5. System Coordination
7.3.4 There should be legislation to provide funding for the
5.1 System coordination is a function of the state EMS
EMS program.
system but may be delegated to a regional EMS organization
7.4 Substate Structure:
(REMSO). System coordination includes, but is not limited to:
7.4.1 The state EMS agency should determine and define
5.1.1 Regional system planning.
the substate framework for the planning, coordination, and
5.1.2 Operational coordination at a regional level.
provision of emergency medical services. This guide suggests
5.1.3 Regional data collection and processing.
that certain responsibilities, authority, and accountability may
5.1.4 Evaluation.
be delegated to regional and local EMS systems. Although
5.1.5 Continuing education.
specific suggestions are offered in this guide, the intent is to
5.1.6 Coordination of mass casualty incident response.
allow flexibility in configuring state and substate structures to
meet the functional needs of the system.
NOTE 1—If there are no regional organizations within the state, the state
7.4.2 The state should designate the regional boundaries, the
EMS will need to accomplish these tasks.
regional EMS organization within each region, and the re-
6. Service Delivery
gional organization’s responsibilities, authority, accountability,
6.1 Service delivery is the major component of local EMS and provisions for servicing the EMS needs of its constituent
systems. Realizing that patient care is the ultimate goal of EMS state political subdivisions. When a REMSO falls near the
systems, service delivery includes, but is not limited to: border of another state it is essential that the state lead agency
6.1.1 Public information and education. develop a plan with the bordering state’s lead agency so that
6.1.2 Notification. the regional EMS system can triage and transfer patients across
6.1.3 Dispatch. the border as required by the patient’s condition.
6.1.4 First response. 7.4.3 If local EMS systems have a “council” or similar
6.1.5 BLS/ALS ambulance. organizational structure, the state should have appropriate
F 1086
communication channels to apprise them and the regional EMS 8.3.4 Centralize EMS statistical data processing and provide
systems of relevant information. activity reports to EMS providers and organizations involved
in the provision and coordination of EMS.
8. State EMS System Responsibilities
8.4 Funding—The state government should provide funds
8.1 Regulatory:
to support the development, maintenance, and enhancement of
8.1.1 The state should have the authority and responsibility
emergency medical services systems including, but not limited
for establishing minimum standards for the essential elements
to, the following:
of the EMS system.
8.4.1 Administrative and programmatic support of the state
8.1.2 The state EMS agency should ensure that ambulance
EMS agency.
services are licensed and certified, that vehicles and equipment
8.4.2 Administrative and programmatic support of regional
are inspected, and that ambulance personnel are licensed and
EMS organizations (REMSOs) in the form of direct funding or
certified.
facilitation of other funding.
8.1.3 The state EMS agency should have the responsibility
8.4.3 Grants to local EMS systems (or community EMS
to enforce the regulations, including the authority to take
councils), ambulance providers, local governments, hospitals,
appropriate action to revoke or suspend the license or certifi-
and other appropriate agencies for improvement of the EMS
cation of those not in compliance. Revocation and suspension
system if such funds are available.
procedures should afford all litigants due process and provide
8.5 Programs—The state EMS agency should establish
for appeal.
and/or operate supportive statewide programs for the develop-
8.2 Planning and Standard Development:
ment of emergency medical services to include, but not
8.2.1 The state EMS agency should develop and dissemi-
necessarily be limited to, the following:
nate a state EMS plan that does the following:
8.5.1 Programs for the training and certification of prehos-
8.2.1.1 Describes the structure and framework for the de-
pital EMS personnel.
velopment of EMS on a statewide basis.
8.5.2 Programs for planning, developing, and coordinating
8.2.1.2 Describes the current status of EMS and identifies
EMS communication systems. This should include citizen
statewide needs and priorities.
access, coordination, dispatch, and medical command/control.
8.2.1.3 Outlines statewide goals for emergency medical
services.
8.5.3 Programs for the evaluation of the system including
8.2.1.4 Is reviewed in accordance with the review cycle of the establishment of an EMS patient record keeping system
the state health plan and with appropriate revisions made.
with, at a minimum, a standard run form or data set; the
8.2.1.5 Is coordinated with the health planning agency and collection and tabulation of general statistics; and the devel-
is integrated into the overall state health plan.
opment of programs to monitor, evaluate and outline definitive
8.2.1.6 Is coordinated with the state emergency manage- action steps to ensure optimal systems integrity of substate
ment agency and integrated where appropriate into the state
(regional) and local EMS systems.
emergency operations plan.
8.5.4 Programs of statewide public education (PE) includ-
8.2.2 The state EMS agency should establish standards and
ing the development of PE materials of importance to the
guidelines for the development of EMS systems which:
citizens and EMS providers of the state.
8.2.2.1 Address all components of an EMS system. These
8.5.5 Programs for application for designation as special-
components include but are not limited to: transportation,
ized acute care (trauma, burns, poison, pediatrics, etc.) centers,
planning, critical care system development, evaluation, public
as necessary, to include evaluation of designated specialized
information and education, training, certification, medical con-
acute care centers and systems.
trol, communications, mass casualty care, and others referred
8.5.6 Programs for preparedness, response, and evaluation
to within this guide.
of mass casualty incidents.
8.2.2.2 Address the needs of patients in the following
8.6 Coordination:
clinical target groups: behavior, burns, cardiac emergencies,
8.6.1 The sta
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