ASTM F1086-94(2016)

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.
Designation: F1086 − 94 (Reapproved 2016)
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 June 1, 2016. Published June 2016. Originally approve
provide for the triage and transfer of patients across the state
in 1987. Last previous edition approved in 2008 as F1086 – 94(2008). DOI:
10.1520/F1086-94R16. 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 (2016)
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 (2016)
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 include evaluation of designated specialized
control, communications, mass casualty care, and others re-
acute care centers and systems.
ferred to within this guide.
8.5.6 Programs for preparedness, response, and evaluation
8.2.2.2 Address the needs of patients in the following
of mass casualty incidents.
clinical target groups: behavior, burns, cardiac emergencies,
obstetrical/perinatal emergencies, neonatal/pediatric
8.6 Coordination:
emergencies, poisoning, head and spinal cord injuries, trauma,
8.6.1 The state agency should have the primary responsibil-
and other medical emergencies.
ity for coordinating EMS activities with other state and federal
8.2.2.3 Identify the responsibilities of the various entities
agencies and with other states.
and levels of government involved in the system.
8.6.2 The state EMS agency should establish and maintain a
8.3 Technical Assistance—The state EMS agency should liaison with other state and national EMS and EMS related
provide technical assistance to local units of government, EMS organizations.
F1086 − 94 (2016)
8.6.3 The state EMS agency should have a role in coordi- sumer participants of the EMS system in the region. The
nating the EMS aspects of the state’s disaster response. The council(s) advise(s) the REMSO on EMS matters.
state EMS agency should coordinate disaster programs affect-
9.1.3 REMSO should be represented individually or collec-
ing hospitals through state health planning agencies, profes-
tively on the state lead agency adv
...