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ASTM F1086-94(2002)

(Guide)

Standard Guide for Structures and Responsibilities of Emergency Medical Services Systems Organizations

Standard Guide for Structures and Responsibilities of Emergency Medical Services Systems Organizations

SCOPE
1.1 This guide establishes optimum guidelines for the structures and responsibilities that will facilitate development, delivery, and assessment of Emergency Medical Services (EMS) on state, regional, and local levels.
1.1.1 State Level—At the state level, this guide sets forth a basic structure for the organization and management of a state emergency medical services program and outlines the responsibilities of the state in the planning, development, coordination, and regulation of emergency medical services throughout the state.
1.1.2 Regional Level—At the regional level, this guide addresses the planning, development, and coordination of a functional and comprehensive EMS system which consists of all personnel, equipment, and facilities necessary for the response to the emergently ill or injured patient, according to national and state lead agency standards.
1.1.3 Local Level—At the local level, this guide sets forth a basic structure for the organization and management of a local EMS system and outlines the responsibilities that a local EMS should assume in the planning, development, implementation, and evaluating of its EMS system.

General Information

Status
Historical
Publication Date
14-Oct-1994
ICS
11.160 - First aid
Technical Committee
F30 - Emergency Medical Services
Drafting Committee
F30.03 - Organization/Management
Current Stage
Ref Project

Relations

Replaces
ASTM F1086-94 - Standard Guide for Structures and Responsibilities of Emergency Medical Services Systems Organizations
Effective Date
15-Oct-1994
Replaced By
ASTM F1086-94(2008) - Standard Guide for Structures and Responsibilities of Emergency Medical Services Systems Organizations
Effective Date
01-Feb-2008
Referred By
ASTM F1339-92(2016) - Standard Guide for Organization and Operation of Emergency Medical Services Systems
Effective Date
15-Oct-1994
Referred By
ASTM F1268-90(2020) - Standard Guide for Establishing and Operating a Public Information, Education, and Relations Program for Emergency Medical Service Systems
Effective Date
15-Oct-1994
Referred By
ASTM F1149-22 - Standard Practice for Qualifications, Responsibilities, and Authority of Individuals and Institutions Providing Medical Direction of Emergency Medical Services
Effective Date
15-Oct-1994

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ASTM F1086-94(2002) - Standard Guide for Structures and Responsibilities of Emergency Medical Services Systems OrganizationsASTM F1086-94(2002) - Standard Guide for Structures and Responsibilities of Emergency Medical Services Systems Organizations
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ASTM F1086-94(2002) - Standard Guide for Structures and Responsibilities of Emergency Medical Services Systems Organizations
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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:F1086–94 (Reapproved 2002)
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 3.1.1 Legislation establishing authority and responsibility
for EMS systems.
1.1 This guide establishes optimum guidelines for the struc-
3.1.2 Development and enforcement of minimum regula-
tures and responsibilities that will facilitate development,
tions and standards.
delivery, and assessment of Emergency Medical Services
3.1.3 Development and dissemination of a statewide plan
(EMS) on state, regional, and local levels.
and goals for EMS systems.
1.1.1 State Level—At the state level, this guide sets forth a
3.1.4 Provision of technical assistance.
basic structure for the organization and management of a state
3.1.5 Funds for the development, maintenance, and en-
emergency medical services program and outlines the respon-
hancement of EMS systems.
sibilities of the state in the planning, development, coordina-
3.1.6 Supportive components, including training, communi-
tion, and regulation of emergency medical services throughout
cations systems, record keeping and evaluation, public educa-
the state.
tion, and acute care center designation.
1.1.2 Regional Level—At the regional level, this guide
3.1.7 Overall coordination of EMS programs within the
addresses the planning, development, and coordination of a
state and in concert with other states or federal authorities as
functional and comprehensive EMS system which consists of
needed.
all personnel, equipment, and facilities necessary for the
3.2 Regional EMS System—A recommended method of
response to the emergently ill or injured patient, according to
structuring substate EMS systems to provide for EMS plan-
national and state lead agency standards.
ning, development, and coordination is to delineate specific
1.1.3 Local Level—At the local level, this guide sets forth a
geographic areas within which one organization is designated
basic structure for the organization and management of a local
as responsible for the arrangement of personnel, facilities, and
EMS system and outlines the responsibilities that a local EMS
equipment for the effective, coordinated, and expeditious
should assume in the planning, development, implementation,
delivery of health care services in a region (3.2.1) under
and evaluating of its EMS system.
emergency conditions occurring as a result of the patient’s
2. Significance and Use
condition or because of accidents, natural disasters, or similar
situations.
2.1 This guide is not meant to mandate a specific structure
3.2.1 Region—To implement a regional EMS system, the
or responsibility at the various levels but rather to suggest a
state lead agency will identify the geographic or demographic
means or method that will allow for the creation or further
area that is a natural catchment area for EMS provision for
development of a state, regional, or local EMS system.
most, if not all, patients in the designated area. Since this
2.2 This guide will assist state, regional, or local organiza-
cannot be a perfect definition from an EMS delivery point of
tions in establishing EMS systems or refining existing EMS
view, administrative and coordinating efficiency considerations
systems.
will have to be made in establishing boundaries. The state lead
3. Descriptions of EMS Systems
agency should determine and define the substate structure for
planning, coordination, and provision of emergency medical
3.1 State EMS System—A state EMS system includes all of
services. When a regional EMS system lies near a state border
the components of all EMS systems within the state, however,
such that appropriate and efficient care of patients will require
particular emphasis is placed upon the following:
cooperation of prehospital system in another state and medical
centers in another state, the state lead agency will develop a
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
plan with the adjoining state lead agency. This plan must
Medical Services and is the direct responsibility of Subcommittee F30.03 on
provide for the triage and transfer of patients across the state
Organization/Management.
border under supervision of the REMSO.
Current edition approved Oct. 15, 1994. Published December 1994. Originally
published as F 1086 – 87. Last previous edition F 1086 – 87.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.
F1086
3.2.2 Regional EMS Organization (REMSO)—AREMSO is 6.1.3 Dispatch.
a staffed organization responsible and accountable to the state 6.1.4 First response.
EMS lead agency for coordinating the system in a region
6.1.5 BLS/ALS ambulance.
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
societies, public safety, other governmental agencies, local
7. State EMS System Structure
EMS systems, and legislative bodies to establish standards and
7.1 Agency Organization—Each state should have a single
program policies for continued system improvement.
agency with overall responsibility for the state’s role in
3.2.2.1 The REMSO should be a substate unit of govern-
emergency medical services.
ment or a private entity that may be single or multi-
7.1.1 Organizationally, this agency should be located in the
jurisdictional. The REMSO should have the capacity and
state government structure such that it reflects the program’s
authority to receive and disburse public and private funds and
health orientation.
must be designated by the state EMS lead agency.
7.1.2 The agency should have a representative advisory
3.3 Local EMS System—The local EMS system may be
council, commission, or board to provide advice to the execu-
organized as a community EMS council and should include all
tive and legislative branches on policies, procedures, programs
provider groups, private and public, involved in EMS delivery
and funding for emergency medical services statewide. Alter-
including ambulance or rescue services, hospitals or hospital
natively, the agency may have a board with the authority to
councils, psychosocial services, local boards of health, police
adopt or approve rules and regulations. Such a body should
and fire departments, other related governmental and quasi-
also serve as a mechanism for obtaining public support and
governmental or political subdivisional bodies, and consumers.
participation in the program.
3.3.1 The local EMS system must have linkages to substate
7.2 Personnel—The agency should have adequate manage-
and state EMS systems.
rial, technical, and clerical staff to carry out its responsibilities.
3.3.2 The local EMS system should be in compliance with
7.2.1 There should be a designated director who is a
local ordinances and state and federal laws that govern EMS
full-time employee of the state.
delivery.
7.2.2 If the director is not a physician, there should be a
4. Standardization
medical director who serves at least on a part-time basis,
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
5. System Coordination
noncompliance with the established minimum standards.
5.1 System coordination is a function of the state EMS
7.3.4 There should be legislation to provide funding for the
system but may be delegated to a regional EMS organization
EMS program.
(REMSO). System coordination includes, but is not limited to:
7.4 Substate Structure:
5.1.1 Regional system planning.
7.4.1 The state EMS agency should determine and define
5.1.2 Operational coordination at a regional level.
the substate framework for the planning, coordination, and
5.1.3 Regional data collection and processing.
provision of emergency medical services. This guide suggests
5.1.4 Evaluation.
that certain responsibilities, authority, and accountability may
5.1.5 Continuing education.
be delegated to regional and local EMS systems. Although
5.1.6 Coordination of mass casualty incident response.
specific suggestions are offered in this guide, the intent is to
allow flexibility in configuring state and substate structures to
NOTE 1—Iftherearenoregionalorganizationswithinthestate,thestate
meet the functional needs of the system.
EMS will need to accomplish these tasks.
7.4.2 Thestateshoulddesignatetheregionalboundaries,the
6. Service Delivery
regional EMS organization within each region, and the re-
6.1 Service delivery is the major component of local EMS gional organization’s responsibilities, authority, accountability,
systems.RealizingthatpatientcareistheultimategoalofEMS and provisions for servicing the EMS needs of its constituent
systems, service delivery includes, but is not limited to: state political subdivisions. When a REMSO falls near the
6.1.1 Public information and education. border of another state it is essential that the state lead agency
6.1.2 Notification. develop a plan with the bordering state’s lead agency so that
F1086
the regional EMS system can triage and transfer patients across 8.3.2 Serving as a clearinghouse and referral center for
the border as required by the patient’s condition. information.
7.4.3 If local EMS systems have a “council” or similar
8.3.3 Consulting with public officials, hospital administra-
organizational structure, the state should have appropriate tors, ambulance service directors, EMS medical directors, etc.
communicationchannelstoapprisethemandtheregionalEMS
8.3.4 CentralizeEMSstatisticaldataprocessingandprovide
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
8.5.3 Programs for the evaluation of the system including
services.
the establishment of an EMS patient record keeping system
8.2.1.4 Is reviewed in accordance with the review cycle of
with, at a minimum, a standard run form or data set; the
the state health plan and with appropriate revisions made.
collection and tabulation of general statistics; and the devel-
8.2.1.5 Is coordinated with the health planning agency and
opment of programs to monitor, evaluate and outline definitive
is integrated into the overall state health plan.
action steps to ensure optimal systems integrity of substate
8.2.1.6 Is coordinated with the state emergency manage-
(regional) and local EMS systems.
ment agency and integrated where appropriate into the state
8.5.4 Programs of statewide public education (PE) includ-
emergency operations plan.
ing the development of PE materials of importance to the
8.2.2 The state EMS agency should establish standards and
citizens and EMS providers of the state.
guidelines for the development of EMS systems which:
8.5.5 Programs for application for designation as special-
8.2.2.1 Address all components of an EMS system. These
ized acute care (trauma, burns, poison, pediatrics, etc.) centers,
components include but are not limited to: transportation,
as necessary, to include evaluation of designated specialized
planning, critical care system development, evaluation, public
acute care centers and systems.
information and education, training, certification, medical con-
8.5.6 Programs for preparedness, response, and evaluation
trol, communications, mass casualty care, and others referred
of mass casu
...

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4.1 Since the quality of EMT training depends, in large measure, on the instructional abilities and competencies of the EMT instructor, it is imperative that the individual selected and used in this capacity possess the qualifications and capabilities necessary to provide effective instruction.  
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4.1 Implementation of this practice will ensure that the EMS system has the authority commensurate with the responsibility to ensure adequate medical direction of all pre-hospital providers, as well as personnel and facilities that meet minimum criteria to implement medical direction of pre-hospital services.  
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SIGNIFICANCE AND USE
4.1 Since the quality of pre-hospital AEMT training depends, in large measure, on the instructional abilities and competencies of the AEMT instructor, it is imperative that the individual selected and used in this capacity possess the qualifications and capabilities necessary to provide effective instruction.  
4.2 An AEMT instructor must possess clearly defined knowledge and skills competencies, have clearly defined responsibilities and scope of authority related to instructional programs, and meet other specific requirements pertinent to the level of instruction.  
4.3 Using this guide, EMS institutions and organizations should be able to develop requirements for selection and utilization of ALS/EMT instructors for ALS/EMT training and education programs.
SCOPE
1.1 This guide is intended to assist emergency medical services (EMS) agencies and institutions in selecting and utilizing individuals who teach in EMT (emergency medical technician) training programs that include instruction in advanced life support knowledge and skills.  
1.2 This guide identifies six categories of instructor in an AEMT (advanced emergency medical technician) training program: adjunct instructor, clinical/field preceptor, practical skills instructor, associate instructor, course instructor/coordinator (I/C), and course administrator. The guide recognizes that an individual may, depending on his/her level of practice and the training program involved, function in any or all of these categories.  
1.3 This guide includes specific guidelines for qualifications, training, education, experience, scope of authority, responsibilities, continuing education, evaluation, and maintenance of competency when applicable.  
1.4 This guide does not include specific guidelines for the course administrator or the adjunct instructor. While the guide recognizes, by offering a definition of each category, that these types of individuals function in many AEMT training programs, the limited instructional roles played by these individuals preclude the need for specific selection and utilization guidelines.  
1.5 This guide is intended to apply to any individual who teaches in an AEMT training program regardless of the individual's present level of clinical practice.  
1.6 This guide intentionally omits references to length of pre-hospital care experience, teaching experience, and continuing education requirements. This guide also omits reference to waiver or equivalency. These issues should be addressed by the appropriate agency.  
1.7 This guide applies only to instructors who teach in AEMT training courses designed to prepare an individual for certification to practice above the level of the EMT. It does not apply to instructors who teach in specialized courses that do not in themselves qualify the individual for a level of EMT certification.  
1.8 This guide does not establish certification requirements. Such requirements should be established by the certifying agency in the jurisdiction in which the AEMT instructor will function. This guide may be used to provide considerable guidance to the jurisdiction responsible for establishing certification standards.  
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.
Note 1: Also see Practice F1031.  
1.10 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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ASTM F1654-95(2020)(Guide)
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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ASTM F1268-90(2020)(Guide)
Standard Guide for Establishing and Operating a Public Information, Education, and Relations Program for Emergency Medical Service Systems

SIGNIFICANCE AND USE
4.1 It is essential to have the public's understanding and support for the EMS system to ensure its proper development and utilization.  
4.2 This guide encompasses those procedures, considerations, and resources that are necessary for a successful EMS public information, education, and relations program. Complex EMS systems may integrate or augment, or both, this guide in its entirety. Less complex systems may need to collaborate with other EMS organizations and related agencies. Responsibility for this guide will vary by level of authority, that is, state, regional, and local. (See Guide F1086.)  
4.3 The PIER tasks involve research, planning, production, distribution, and evaluation. Production requires significant resources and expertise and may be done most appropriately at the higher level, such as regional, state, and national levels.
SCOPE
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.  
1.2 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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ASTM F1653-95(2020)(Guide)
Standard Guide for Scope of Performance of Triage in a Prehospital Environment

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.  
1.4 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 Footnote 2.2  
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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