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ASTM F1086-94(2008)

(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

SIGNIFICANCE AND USE
This guide is not meant to mandate a specific structure or responsibility at the various levels but rather to suggest a means or method that will allow for the creation or further development of a state, regional, or local EMS system.
This guide will assist state, regional, or local organizations in establishing EMS systems or refining existing EMS systems.
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
31-Jan-2008
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(2002) - Standard Guide for Structures and Responsibilities of Emergency Medical Services Systems Organizations
Effective Date
01-Feb-2008
Replaced By
ASTM F1086-94(2016) - Standard Guide for Structures and Responsibilities of Emergency Medical Services Systems Organizations
Effective Date
01-Jun-2016
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
01-Feb-2008
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
01-Feb-2008
Referred By
ASTM F1339-92(2016) - Standard Guide for Organization and Operation of Emergency Medical Services Systems
Effective Date
01-Feb-2008

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ASTM F1086-94(2008) - Standard Guide for Structures and Responsibilities of Emergency Medical Services Systems OrganizationsASTM F1086-94(2008) - Standard Guide for Structures and Responsibilities of Emergency Medical Services Systems Organizations
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ASTM F1086-94(2008) - 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 2008)
Standard Guide for
Structures and Responsibilities of Emergency Medical
Services Systems Organizations
This standard is issued under the fixed designation F1086; 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 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
(EMS) on state, regional, and local levels. 3.1.3 Development and dissemination of a statewide plan
1.1.1 State Level—At the state level, this guide sets forth a
and goals for EMS systems.
basic structure for the organization and management of a state
3.1.4 Provision of technical assistance.
emergency medical services program and outlines the respon-
3.1.5 Funds for the development, maintenance, and en-
sibilities of the state in the planning, development,
hancement of EMS systems.
coordination, and regulation of emergency medical services
3.1.6 Supportive components, including training, communi-
throughout the state.
cations systems, record keeping and evaluation, public
1.1.2 Regional Level—At the regional level, this guide
education, and acute care center designation.
addresses the planning, development, and coordination of a
3.1.7 Overall coordination of EMS programs within the
functional and comprehensive EMS system which consists of
state and in concert with other states or federal authorities as
all personnel, equipment, and facilities necessary for the
needed.
response to the emergently ill or injured patient, according to
national and state lead agency standards.
3.2 Regional EMS System—A recommended method of
1.1.3 Local Level—At the local level, this guide sets forth a
structuring substate EMS systems to provide for EMS
basic structure for the organization and management of a local
planning, development, and coordination is to delineate spe-
EMS system and outlines the responsibilities that a local EMS
cific geographic areas within which one organization is desig-
should assume in the planning, development, implementation,
nated as responsible for the arrangement of personnel,
and evaluating of its EMS system.
facilities, and equipment for the effective, coordinated, and
expeditious delivery of health care services in a region (3.2.1)
2. Significance and Use
under emergency conditions occurring as a result of the
2.1 This guide is not meant to mandate a specific structure
patient’s condition or because of accidents, natural disasters, or
or responsibility at the various levels but rather to suggest a
similar situations.
means or method that will allow for the creation or further
3.2.1 Region—To implement a regional EMS system, the
development of a state, regional, or local EMS system.
state lead agency will identify the geographic or demographic
2.2 This guide will assist state, regional, or local organiza-
area that is a natural catchment area for EMS provision for
tions in establishing EMS systems or refining existing EMS
most, if not all, patients in the designated area. Since this
systems.
cannot be a perfect definition from an EMS delivery point of
view, administrative and coordinating efficiency considerations
3. Descriptions of EMS Systems
will have to be made in establishing boundaries. The state lead
3.1 State EMS System—A state EMS system includes all of
agency should determine and define the substate structure for
the components of all EMS systems within the state, however,
planning, coordination, and provision of emergency medical
particular emphasis is placed upon the following:
services. When a regional EMS system lies near a state border
such that appropriate and efficient care of patients will require
cooperation of prehospital system in another state and medical
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.03 on
centers in another state, the state lead agency will develop a
Organization/Management.
plan with the adjoining state lead agency. This plan must
Current edition approved Feb. 1, 2008. Published March 2008. Originally
provide for the triage and transfer of patients across the state
approve in 1987. Last previous edition approved in 2002 as F1086 – 94(2002). DOI:
10.1520/F1086-94R08. border under supervision of the REMSO.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959. United States
F1086 − 94 (2008)
3.2.2 Regional EMS Organization (REMSO)—AREMSO is 6.1.2 Notification.
a staffed organization responsible and accountable to the state 6.1.3 Dispatch.
EMS lead agency for coordinating the system in a region
6.1.4 First response.
including system operations, and organization and coordina- 6.1.5 BLS/ALS ambulance.
tion of resources. A REMSO should have a medical director
6.1.6 Air transport.
and other technical expertise in order to provide the necessary
6.1.7 Medical facilities.
assistance to its EMS system. A REMSO should work on a
6.1.8 Psycho-social services.
regional or subregional basis in liaison with professional
6.1.9 Evaluation and quality assurance.
societies, public safety, other governmental agencies, local
EMS systems, and legislative bodies to establish standards and
7. State EMS System Structure
program policies for continued system improvement.
7.1 Agency Organization—Each state should have a single
3.2.2.1 The REMSO should be a substate unit of govern-
agency with overall responsibility for the state’s role in
ment or a private entity that may be single or multi-
emergency medical services.
jurisdictional. The REMSO should have the capacity and
7.1.1 Organizationally, this agency should be located in the
authority to receive and disburse public and private funds and
state government structure such that it reflects the program’s
must be designated by the state EMS lead agency.
health orientation.
3.3 Local EMS System—The local EMS system may be
7.1.2 The agency should have a representative advisory
organized as a community EMS council and should include all
council, commission, or board to provide advice to the execu-
provider groups, private and public, involved in EMS delivery
tive and legislative branches on policies, procedures, programs
including ambulance or rescue services, hospitals or hospital
and funding for emergency medical services statewide.
councils, psychosocial services, local boards of health, police
Alternatively, the agency may have a board with the authority
and fire departments, other related governmental and quasi-
to adopt or approve rules and regulations. Such a body should
governmental or political subdivisional bodies, and consumers.
also serve as a mechanism for obtaining public support and
3.3.1 The local EMS system must have linkages to substate
participation in the program.
and state EMS systems.
7.2 Personnel—The agency should have adequate
3.3.2 The local EMS system should be in compliance with
managerial, technical, and clerical staff to carry out its respon-
local ordinances and state and federal laws that govern EMS
sibilities.
delivery.
7.2.1 There should be a designated director who is a
full-time employee of the state.
4. Standardization
7.2.2 If the director is not a physician, there should be a
4.1 Standard setting is a major component of the state EMS
medical director who serves at least on a part-time basis,
system operation. This includes, but is not limited to:
depending on the needs of the program.
4.1.1 Legislation.
7.3 Legislation:
4.1.2 Regulations.
7.3.1 There should be comprehensive legislation that estab-
4.1.3 Guidelines.
lishes the EMS program, outlines its basic responsibilities, and
4.1.4 Licensure.
provides the authority necessary to effectively carry out these
4.1.5 Training.
responsibilities.
4.1.6 Certification.
7.3.2 There should be legislation authorizing the establish-
4.1.7 Data collection and evaluation.
ment of minimum standards for emergency medical services in
5. System Coordination
the state.
7.3.3 There should be legislation specifying penalties for
5.1 System coordination is a function of the state EMS
noncompliance with the established minimum standards.
system but may be delegated to a regional EMS organization
7.3.4 There should be legislation to provide funding for the
(REMSO). System coordination includes, but is not limited to:
EMS program.
5.1.1 Regional system planning.
5.1.2 Operational coordination at a regional level.
7.4 Substate Structure:
5.1.3 Regional data collection and processing.
7.4.1 The state EMS agency should determine and define
5.1.4 Evaluation.
the substate framework for the planning, coordination, and
5.1.5 Continuing education.
provision of emergency medical services. This guide suggests
5.1.6 Coordination of mass casualty incident response.
that certain responsibilities, authority, and accountability may
be delegated to regional and local EMS systems. Although
NOTE 1—If there are no regional organizations within the state, the state
EMS will need to accomplish these tasks. specific suggestions are offered in this guide, the intent is to
allow flexibility in configuring state and substate structures to
6. Service Delivery
meet the functional needs of the system.
6.1 Service delivery is the major component of local EMS 7.4.2 Thestateshoulddesignatetheregionalboundaries,the
systems.RealizingthatpatientcareistheultimategoalofEMS regional EMS organization within each region, and the re-
systems, service delivery includes, but is not limited to: gional organization’s responsibilities, authority, accountability,
6.1.1 Public information and education. and provisions for servicing the EMS needs of its constituent
F1086 − 94 (2008)
state political subdivisions. When a REMSO falls near the providers, and to the REMSOs. This should include, but not be
border of another state it is essential that the state lead agency limited to, the following:
develop a plan with the bordering state’s lead agency so that
8.3.1 Developing guidelines, model procedures, manuals,
the regional EMS system can triage and transfer patients across etc.
the border as required by the patient’s condition.
8.3.2 Serving as a clearinghouse and referral center for
7.4.3 If local EMS systems have a “council” or similar
information.
organizational structure, the state should have appropriate
8.3.3 Consulting with public officials, hospital
communicationchannelstoapprisethemandtheregionalEMS
administrators, ambulance service directors, EMS medical
systems of relevant information.
directors, etc.
8.3.4 CentralizeEMSstatisticaldataprocessingandprovide
8. State EMS System Responsibilities
activity reports to EMS providers and organizations involved
8.1 Regulatory:
in the provision and coordination of EMS.
8.1.1 The state should have the authority and responsibility
8.4 Funding—Thestategovernmentshouldprovidefundsto
for establishing minimum standards for the essential elements
support the development, maintenance, and enhancement of
of the EMS system.
emergency medical services systems including, but not limited
8.1.2 The state EMS agency should ensure that ambulance
to, the following:
services are licensed and certified, that vehicles and equipment
8.4.1 Administrative and programmatic support of the state
are inspected, and that ambulance personnel are licensed and
EMS agency.
certified.
8.4.2 Administrative and programmatic support of regional
8.1.3 The state EMS agency should have the responsibility
EMS organizations (REMSOs) in the form of direct funding or
to enforce the regulations, including the authority to take
facilitation of other funding.
appropriate action to revoke or suspend the license or certifi-
8.4.3 Grants to local EMS systems (or community EMS
cation of those not in compliance. Revocation and suspension
councils), ambulance providers, local governments, hospitals,
procedures should afford all litigants due process and provide
and other appropriate agencies for improvement of the EMS
for appeal.
system if such funds are available.
8.2 Planning and Standard Development:
8.5 Programs—The state EMS agency should establish
8.2.1 The state EMS agency should develop and dissemi-
and/or operate supportive statewide programs for the develop-
nate a state EMS plan that does the following:
ment of emergency medical services to include, but not
8.2.1.1 Describes the structure and framework for the de-
necessarily be limited to, the following:
velopment of EMS on a statewide basis.
8.5.1 Programs for the training and certification of prehos-
8.2.1.2 Describes the current status of EMS and identifies
pital EMS personnel.
statewide needs and priorities.
8.5.2 Programs for planning, developing, and coordinating
8.2.1.3 Outlines statewide goals for emergency medical
EMS communication systems. This should include citizen
services.
access, coordination, dispatch, and medical command/control.
8.2.1.4 Is reviewed in accordance with the review cycle of
8.5.3 Programs for the evaluation of the system including
the state health plan and with appropriate revisions made.
the establishment of an EMS patient record keeping system
8.2.1.5 Is coordinated with the health planning agency and
with, at a minimum, a standard run form or data set; the
is integrated into the overall state health plan.
collection and tabulation of general statistics; and the devel-
8.2.1.6 Is coordinated with the state emergency manage-
opment of programs to monitor, evaluate and outline definitive
ment agency and integrated where appropriate into the state
action steps to ensure optimal systems integrity of substate
emergency operations plan.
(regional) and local EMS systems.
8.2.2 The state EMS agency should establish standards and
8.5.4 Programs of statewide public education (PE) includ-
guidelines for the development of EMS systems which:
ing the development of PE materials of importance to the
8.2.2.1 Address all components of an EMS system. These
citizens and EMS providers of the state.
components include but are not limited to: transportation,
8.5.5 Programs for application for designation as special-
planning, critical care system development, evaluation, public
ized acute care (trauma, burns, poison, pediatrics, etc.) centers,
information and education, training, certification, medical
as necessary, to incl
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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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ASTM F1257-22(Guide)
Standard Guide for Selection and Practice of Emergency Medical Services Instructor for Advanced Emergency Medical Technician

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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