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Designation: F 1031 – 00

Standard Practice for


Training the Emergency Medical Technician (Basic)1
This standard is issued under the fixed designation F 1031; 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 means of providing Emergency Medical Technician (Basic)


1.1 This practice covers a standard course for the training of training. The practice should be used by all individuals and
the emergency medical technician (basic) which will prepare a agencies that train such persons.
person to perform those skills commonly required to render 4.2 Successful completion of this course of training neither
lifesaving aid at the scene of an emergency and during constitutes nor implies certification or licensure.
transportation to a definitive care facility. 4.3 This practice adopts the knowledge and skill objectives
1.2 It is not the intent of this practice to require that the contained in the DOT curriculum (latest version) as the
curriculum be used exactly as presented, but only that the standard practice for training those persons who provide
knowledge and skill objectives that are part of the curriculum emergency medical care at the basic life support level and are
be included in any course purporting to train the emergency known as emergency medical technicians (basic). The actual
medical technician (basic). It is not the intent of this practice to lesson plans contained in the referenced document are recom-
limit the addition of knowledge and skill objectives as required mended for use; however, each instructor may modify the order
by local conditions. of presentation according to local needs.
4.4 This practice outlines a comprehensive course that
2. Referenced Documents covers most common emergencies encountered by the emer-
2.1 U.S. Department of Transportation/National Highway gency medical technician. EMT-basic courses that do not
Traffıc Safety Administration: include all of the knowledge and skill objectives of this
DOT Emergency Medical Technician-Ambulance: National practice may not be referred to as meeting this standard.
Standard Curriculum, Course Guide , latest version2
5. Contents of Course
DOT HS Emergency Medical Technician-Ambulance: Na-
tional Standard Curriculum, Instructor’s Lesson Plans, latest 5.1 The practice for training the emergency medical techni-
version.2 cian (basic) is a course consisting of, at a minimum, the
knowledge and skill objectives contained in DOT curriculum
3. Description of Term Specific to This Standard (latest version). The knowledge and skill objectives are delin-
3.1 emergency medical technician (basic)—as outlined in eated as Objectives and are listed at the beginning of each of
this practice, a person who has successfully completed the the designated lessons contained in the document. The course
course of training, may provide emergency medical care, and shall also include the objectives listed in the In-hospital
may transport the sick and injured. Legal functioning as an Clinical Guidelines, Appendix C, of DOT curriculum (lastest
EMT (basic) will be based upon licensure/certification require- version).
ments, as established by the authority or authorities having
6. Course Implementation
jurisdiction.
6.1 The course shall be conducted in accordance with the
4. Significance and Use regulations of the governmental authority having jurisdiction.
4.1 The purpose of this practice is to provide a standard 6.2 It is highly recommended that all courses adhere to the
procedure for presentation outlined in DOT curriculum (latest
version).
1
This practice is under the jurisdiction of ASTM Committee F-30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.02 on 7. Keywords
Personnel Training and Education.
Current edition approved Oct. 10, 2000. Published January 2001. 7.1 EMS; EMT; curriculum
Originally published as F1031-86. Discontinued February 1999 and reinstated
F1031-00.
2
Available from Superintendent of Documents, US Government Printing Office,
Washington, DC 20402.

Copyright © ASTM, 100 Barr Harbor Drive, West Conshohocken, PA 19428-2959, United States.

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F 1031
The American Society for Testing and Materials takes no position respecting the validity of any patent rights asserted in connection
with any item mentioned in this standard. Users of this standard are expressly advised that determination of the validity of any such
patent rights, and the risk of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM Headquarters. Your comments will receive careful consideration at a meeting of the responsible
technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should make your
views known to the ASTM Committee on Standards, at the address shown below.

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Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above address or at
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2
Designation: F 1086 – 94 (Reapproved 2002)

Standard Guide for


Structures and Responsibilities of Emergency Medical
Services Systems Organizations1
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


1.1 This guide establishes optimum guidelines for the struc- for EMS systems.
tures and responsibilities that will facilitate development, 3.1.2 Development and enforcement of minimum regula-
delivery, and assessment of Emergency Medical Services tions and standards.
(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, coordina- hancement of EMS systems.
tion, and regulation of emergency medical services throughout 3.1.6 Supportive components, including training, communi-
the state. cations systems, record keeping and evaluation, public educa-
1.1.2 Regional Level—At the regional level, this guide tion, 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 3.2 Regional EMS System—A recommended method of
national and state lead agency standards. structuring substate EMS systems to provide for EMS plan-
1.1.3 Local Level—At the local level, this guide sets forth a ning, development, and coordination is to delineate specific
basic structure for the organization and management of a local geographic areas within which one organization is designated
EMS system and outlines the responsibilities that a local EMS as responsible for the arrangement of personnel, facilities, and
should assume in the planning, development, implementation, equipment for the effective, coordinated, and expeditious
and evaluating of its EMS system. delivery of health care services in a region (3.2.1) under
emergency conditions occurring as a result of the patient’s
2. Significance and Use condition or because of accidents, natural disasters, or similar
2.1 This guide is not meant to mandate a specific structure situations.
or responsibility at the various levels but rather to suggest a 3.2.1 Region—To implement a regional EMS system, the
means or method that will allow for the creation or further state lead agency will identify the geographic or demographic
development of a state, regional, or local EMS system. area that is a natural catchment area for EMS provision for
2.2 This guide will assist state, regional, or local organiza- most, if not all, patients in the designated area. Since this
tions in establishing EMS systems or refining existing EMS cannot be a perfect definition from an EMS delivery point of
systems. view, administrative and coordinating efficiency considerations
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
3.1 State EMS System—A state EMS system includes all of planning, coordination, and provision of emergency medical
the components of all EMS systems within the state, however, services. When a regional EMS system lies near a state border
particular emphasis is placed upon the following: such that appropriate and efficient care of patients will require
cooperation of prehospital system in another state and medical
centers in another state, the state lead agency will develop a
plan with the adjoining state lead agency. This plan must
1
This guide is under the jurisdiction of ASTM Committee F30 on Emergency provide for the triage and transfer of patients across the state
Medical Services and is the direct responsibility of Subcommittee F30.03 on border under supervision of the REMSO.
Organization/Management.
Current edition approved Oct. 15, 1994. Published December 1994. Originally
3.2.2 Regional EMS Organization (REMSO)—A REMSO is
published as F 1086 – 87. Last previous edition F 1086 – 87. a staffed organization responsible and accountable to the state

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

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F 1086
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
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
NOTE 1—If there are no regional organizations within the state, the state meet the functional needs of the system.
EMS will need to accomplish these tasks. 7.4.2 The state should designate the regional boundaries, the
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

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organizational structure, the state should have appropriate tors, ambulance service directors, EMS medical directors, etc.
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 state agency should have the primary responsibil-
obstetrical/perinatal emergencies, neonatal/pediatric emergen- ity for coordinating EMS activities with other state and federal
cies, poisoning, head and spinal cord injuries, trauma, and agencies and with other states.
other medical emergencies. 8.6.2 The state EMS agency should establish and maintain a
8.2.2.3 Identify the responsibilities of the various entities liaison with other state and national EMS and EMS related
and levels of government involved in the system. organizations.
8.3 Technical Assistance—The state EMS agency should 8.6.3 The state EMS agency should have a role in coordi-
provide technical assistance to local units of government, EMS nating the EMS aspects of the state’s disaster response. The
providers, and to the REMSOs. This should include, but not be state EMS agency should coordinate disaster programs affect-
limited to, the following: ing hospitals through state health planning agencies, profes-
8.3.1 Developing guidelines, model procedures, manuals, sional associations and other appropriate organizations to
etc. maximize cooperation and obtain implementation assistance.
8.3.2 Serving as a clearinghouse and referral center for 8.6.4 The state EMS agency should have a defined role in
information. the state’s highway safety program as established by statute or
8.3.3 Consulting with public officials, hospital administra- executive order.

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9. Regional EMS System Structure 10.2 The REMSO board sets organizational policy for the
9.1 Regional EMS organizations (REMSO) can be estab- REMSO and contracts with the state lead agency and state
lished either as units of government or as private entities. The constituent political subdivisions. It must be responsive to the
basic structures of a regional EMS system should consist of the demands of the state lead agency and of the REMSO advisory
following: council in order to hold the REMSO designation for the region.
9.1.1 When Structured as a Unit of Government: 10.3 The REMSO advisory council(s) should provide guid-
9.1.1.1 The REMSO should have a specific individual ance to the REMSO in planning its activities.
assigned as the lead person or coordinator responsible for the 10.4 The REMSO should maintain adequate staff and facili-
region’s EMS system. This person is responsible to the ties to conduct ongoing planning, implementation, technical
designating state agency and to the governmental organization assistance, and evaluation of at least the following EMS system
by which employed or from which a portion of his or her components (described as follows unless future ASTM stan-
earnings are derived, and responsive to a REMSO advisory dards substitute) in its region utilizing national standards
council. adopted as state minimum standards for each (the REMSO
9.1.1.2 A REMSO advisory council should consist of rep- itself need not be the implementing agency in each case; the
resentatives designated by constituent state political subdivi- local EMS agency may be the implementing agency as long as
sions to provide guidance to the organization through the the REMSO can demonstrate that the component is being
coordinator. All local EMS systems must be represented on the addressed adequately):
advisory council. 10.4.1 Staffıng and Training—An adequate number of hos-
9.1.2 When Structured as a Private Entity Organization: pital and prehospital health professionals should exist to
9.1.2.1 The REMSO board should consist of individuals provide EMS on a 24-h basis. Provision should be made for the
willing to accept fiduciary responsibility for the governance of initial and ongoing training of these personnel utilizing cur-
the organization designated as the REMSO, for the supervision ricula consistent with state and national criteria for each.
of the REMSO director and actions of the REMSO staff. 10.4.2 Transportation—There should exist an adequate sys-
9.1.2.2 The REMSO director, directly and through delega- tem of ground, air, and water transport with vehicles that meet
tion to any REMSO staff, should be an individual who has the appropriate standards regarding location, design, performance,
responsibility for the direction of the REMSO. equipment, personnel, and safety. Basic life support (BLS) and
9.1.2.3 The REMSO advisory council should consist of advanced life support (ALS) prehospital and interhospital
individuals designated by constituent state political subdivi- transport of critical patients should be addressed.
sions to represent their constituencies on EMS matters. All 10.4.3 Communications—There should be provision for
local EMS systems must be represented on the advisory two-way communication between personnel and facilities
council. The council should be separate from the REMSO within the coordinated communication system(s). Elements
board, although individuals may serve as members of both. within the system(s) include public access to the EMS system,
This separability is to ensure continued representation of key resource allocation, and medical control on both the BLS and
constituencies in the guidance of the REMSO operation ALS levels.
regardless of the organization (board, director, staff) designated 10.4.4 Patient Transfer—A system of identifying the most
as the REMSO for that region by the state lead agency and any appropriate facility to manage a patient’s clinical problem
future changes in that designation. should be developed. This will be under medical control and
9.1.2.4 A contract (or written agreement) between the state will utilize pre-existing transfer policies. A mechanism to
lead agency, the REMSO and constituent state political subdi- provide a continuum of care for each patient in the EMS
visions should be executed defining the responsibilities and system should be identified including protocols for selection of
objectives of both parties. the primary receiving facility and subsequent transfer to an
9.1.2.5 The contract should identify any funding arrange- appropriate facility meeting the overall needs of the patient.
ment utilizing state funds and contain provisions for monitor- 10.4.5 Medical Control—Medical control implies involve-
ing and auditing of expenditures. ment of the medical community and ensures medical account-
9.1.2.6 The REMSO board should be the policy making ability in all phases of the EMS system and consists of the
body for the designated REMSO. following elements that must be implemented:
9.1.2.7 The REMSO advisory council (or sub-regional 10.4.5.1 Designation of a medical director for the region’s
councils if practical) should also include provider and con- EMS program, who is responsible for overall supervision and
sumer participants of the EMS system in the region. The implementation of all medical requirements.
council(s) advise(s) the REMSO on EMS matters. 10.4.5.2 Effective emergency medical planning and desig-
9.1.3 REMSO should be represented individually or collec- nation of on-line medical control resources.
tively on the state lead agency advisory council. 10.4.5.3 Design and utilization of treatment protocols that
establish the standards for levels of care at both the BLS and
10. Regional EMS System Responsibilities ALS level from the scene to the appropriate level of hospital
10.1 The state lead agency should designate and contract care in case of failure or interruption of provisions for on-line
with the REMSOs in the state. The state lead agency should medical control.
provide state funding or facilitate other funding sufficient for 10.4.5.4 New EMS technology that supports the training
the operation of REMSOs. and operations of the program.

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10.4.5.5 An effective process for accountability (records, active participation on the REMSO provider/
case review, audits of day-to-day incidents and mass casualty consumer council.
incidents, etc.).
10.4.6 Public Access and Education—Provisions should be 11. Local EMS System Structure
made to provide programs of public education and information 11.1 The local EMS system may have a coordinating body
to establish an awareness of the EMS system, how to access the (or community EMS council) composed of representatives
system, and how to use the system properly. All patients should from public and private provider groups involved in the
have access to the entire EMS system regardless of their ability delivery of EMS including ambulance and rescue services,
to pay for such services. The public should have access to the medical society, emergency nurses, hospitals or hospital coun-
governing boards and advisory councils regarding EMS in their cils, psychosocial services, local boards of health, police and
area. Public CPR/First Aid training should be established. fire departments, other related governmental and quasi-
10.4.7 System Evaluation—A regional prehospital patient governmental or political subdivisional bodies and representa-
record should be established in combination with a system, for tives of the public or consumers of emergency medical
central collection and processing of such records. The record sciences.
should cover the patient’s initial entry into the prehospital 11.2 Access to the System—Public access should be through
system through to the patient’s transfer to the hospital emer- a centralized access such as a 911.
gency unit. A mechanism for tie-in to hospital patient visit and 11.3 Dispatch:
discharge information should exist. Analysis should be done on
11.3.1 There should be coordinated dispatch of resources.
a routine basis, using this data (returned to the regions by the
state if a statewide system exists) and appropriate process or 11.3.2 It is desirable to have prearrival assistance or specific
outcome indicators, to determine the effectiveness of the EMS instructions to aid caller before help arrives on the scene. The
system. instructions provided to the dispatcher should have medical
control approval prior to implementation.
10.4.8 Emergency Responder Coordination—The system
should include provisions for appropriate system response to 11.4 Personnel:
incidents beyond the day-to-day resource capacities of indi- 11.4.1 Basic Life Support (BLS):
vidual EMS provider organizations. Written mutual aid ar- 11.4.1.1 First Responder—Non-ambulance responders (po-
rangements should be established with neighboring REMSO/ lice, etc.) should have minimum of DOT First Responder
local EMS systems to ensure integration of care and should capability.
consider the role of non-EMS public safety agencies, their 11.4.1.2 EMT-Ambulance Attendants—Attendants should
roles, relationships, and responsibilities in standard operation. have a minimum of DOT EMT-Basic capability. (Defibrillation
10.4.9 Disaster/Mass Casualty Incident Coordination— and starting IVs are optional capabilities in accordance with
Provisions should be made for expanding standard operations state standards.)
to meet the needs created by mass casualty and disaster 11.4.2 Advanced Life Support (ALS)—Advanced life sup-
incidents. This will include plans for integrating state, regional, port should also include such techniques as endotracheal
and local communications systems. intubation and the use of intravenous medications and certain
10.5 The REMSO should develop a written plan addressing lifesaving procedures as defined in the state certification
all of the components in 10.4 and any additional components as process.
may be prescribed in an EMS state plan. The plan should be 11.5 Medical Direction—There should be physician control
assessed for progress made in each of the component areas and on all treatment protocols including on-line procedures and
revised as necessary to be consistent with state standards. off-line standing orders.
These assessments are to be reported to the state EMS lead 11.6 Psycho-Social Services—There should be prior ar-
agency and should be made available within the EMS region. rangements for availability, appropriate training, and utilization
10.6 The REMSO should recommend appropriate minimum of trained mental health providers.
levels of EMS for each unit of local government within the 11.7 Communications—There should be provisions made
EMS region, and include this in the plan and annual report for dispatch and communication between the field personnel
described in 10.5. Designated minimum levels should be and the receiving hospital or resource hospital.
consistent with state minimum standards and should be influ- 11.8 Transportation—A transportation network (land, air,
enced by such characteristics as population, geography, health and water) should be established to ensure an adequate
status demographics, and local economy. response time to the site as well as a minimal transit time from
10.7 The REMSO should develop regional policies, proto- the site to the receiving facility. Provisions should include
cols, and standards that meet state minimum standards. transportation to acute care centers.
10.8 The REMSO should coordinate with the state lead 11.9 Receiving Facility—A receiving facility should be in
agency to ensure that state and regional minimum standards are operation 24 hours a day, seven days a week with emergency
actively enforced. care capability. Each facility should be identified as to its level
10.9 The REMSO should coordinate with local government, of capability. Provisions should be made to identify special
EMS provider organizations, consumer groups, local EMS capabilities based on specific standards (trauma care, mental
systems, and other entities to promote fair representation and health units, poison control, cardiac care, pediatrics, etc.).

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12. Local EMS System Responsibilities 12.3 Coordination:
12.1 Planning and Development—To implement the lev- 12.3.1 The local EMS agency should assist in maintaining
el(s) of service local EMS system wants or is capable of coordination between EMS providers and their medical direc-
providing, consideration must be given to the following: tion. This may be best accomplished through regularly sched-
12.1.1 First Responder—Firefighters, police officers, and uled meetings between providers and medical administrators.
others who may respond to emergencies and provide emer- 12.3.2 Other primary roles of coordination include over-
gency care but do not transport. sight and assistance with communication problems, assisting
12.1.2 Emergency Medical Technician—Basic life support the local training agency in preparation and conduct of courses,
(BLS) ambulance attendant responders who provide initial assuring that all EMS providers have mutual aid agreements as
stabilization at the scene of the emergency and transportation necessary, and participation in the preparation and develop-
to the medical facility. ment of emergency and disaster plans.
12.1.3 If a local EMS system has elected to have advanced 12.3.3 The local EMS system is directly responsible to the
life support (ALS) capability they will have advanced life REMSO for all of its activities and the local EMS system
support responders who, because of training and medical activities must conform to REMSO policies. If there is no
control, are permitted to utilize more advanced procedures REMSO, the local EMS system is directly responsible to the
prior to transporting victims to specialized acute care centers. state lead agency.
12.2 Standards—The local EMS agency should develop 12.4 Quality Assurance—The primary responsibility is at
standards that meet state regulations. Those standards should local level and is achieved by high-quality initial training,
include, but not be limited to: continuing medical education, medical direction, monthly run
12.2.1 Level of Continuing Education—The amount of reviews by medical control group, and periodic medical audits
annual continuing education will meet that required by the of patient care.
state. 12.5 Funding—Financial support of service is a primary
12.2.2 Staff—The minimum number of qualified ambulance responsibility of local EMS and would include appropriate fee
attendants consistent with state requirements. structuring, grants, donations, and government budget pro-
12.2.3 Training—The hours of initial training must meet the cesses.
minimum specified by the state. The local EMS agency should 12.6 Safety—EMS system should ensure that standards for
establish local quality control standards and provide for audit- safety of rescuers, providers, patients, and bystanders are
ing competency. developed and enforced.

ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

6
Designation: F 1118 – 91 (Reapproved 2003)

Standard Specification for


National Air Medical Transport Units Resources Catalog1
This standard is issued under the fixed designation F 1118; 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.

INTRODUCTION

Committee F30 was established on a voluntary basis to edit, update, and create, where necessary,
voluntary standards for all facets of emergency medical services (EMS).
Task Group F30.01.02 is responsible for water and air vehicles and has prepared standards that
cover the medical transport units for the three levels of general patient care, namely basic, advanced,
and specialized.
This specification complements these standards in that it presents a unique method of cataloging
EMS resources. It consists of a format that, when completed and submitted by the air ambulance
providers, will give a complete catalog of medical air transport capabilities. The catalog will be known
as the “National Air Medical Transport Units Resources Catalog.” The short title “Resources Catalog”
may be used when the meaning is clear.
The “Resources Catalog” is designed for use by planners, particularly in the time of a major national
emergency. The format contained in this specification provides a standard method of presenting the
key data so that communications during a stressful time will be quicker and easier.
Special attention has been taken to identify that information that is needed for immediate reference.
For example, the concern during an emergency will be for the numbers of patients that can be carried,
and at what level of care, rather than the commercial details about a particular name brand.

1. Scope 1.4 Information contained in the unit’s operations manual,2


1.1 This specification provides the format and guidelines for such as the weight and balance calculations for the “Special-
producing a catalog of current resources of air medical ized Medical Resources” listed in Appendix X1, is not included
transport units, showing the patient care capability of each, in in the catalog but it will be available to the planners, on
standard form. request.
1.2 This specification applies to all the air transports in- 2. Significance and Use
volved in patient care that meet one or more applicable ASTM
medical transport unit specifications. 2.1 The intent of the “Resources Catalog” is to tabulate the
1.3 This specification incorporates only the information that national capability for medical air transportation and to enu-
is considered essential for use by the planners during an merate the level of patient care that each unit can provide. The
emergency. The intent is to provide information on what is level of care is based on the ASTM Specifications related to
available, what level of care it can provide, where it is, and the each type of medical air transport.
earliest it can respond, so that the most efficient use can be 2.2 The “Resources Catalog” will provide a resource with
made of each unit, in accordance with the emergency plans. which the emergency planners can identify the capability,
availability, and response times for those units outside their
local areas. With such up-to-date information, they can request
the air medical transport unit that most closely meets the
mission profile within the time frame required.
1
This specification is under the jurisdiction of ASTM Committee F30 on
Emergency Medical Services and is the direct responsibility of Subcommittee
2
F30.01 on EMS Equipment. See FAA Advisory Circular 135-14 for recommended content and layout of the
Current edition approved March 10, 2003. Published March 2003. Originally unit operation manual. Available from Superintendent of Documents, U.S. Govern-
approved in 1991. Last previous edition approved in 1997 as F 1118 –91 (1997)e1. ment Printing Office, Washington, DC 20402.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1118 – 91 (2003)
2.3 This catalog will increase public awareness of the cant changes occur that affect operational or patient care
availability and the high standard of emergency medical capability. (This does not include temporary changes such as
transportation. maintenance down-time.)
3.3 The completed formats will be reviewed by the state
3. Format EMS director (or equivalent official) and, with state (or
3.1 Appendix X1 is the format to be completed for each equivalent) approval, will be submitted to the F30.01.02 Task
individual unit that meets one or more of the ASTM rotary Group Chairman for consolidation into this specification.
wing or fixed wing medical transport standards. The format Annual updates will be forwarded to the Task Group Chairman
will be completed by the air ambulance provider and the unit’s prior to the Committee F30’s regular year-end meeting.
medical director and submitted to the state EMS director (or 3.4 The task group will assemble the formats, as submitted,
equivalent official). provide a comprehensive index and a map showing the
3.2 Using this same procedure, the format will be updated locations and declared areas.
by the air ambulance provider3 annually and each time signifi- 3.5 The catalog will be updated by the task group at the
regular year-end meeting and will be published annually by
ASTM.
3
Air Ambulance Provider—The individual or entity that holds the air ambulance 4. Keywords
provider certificate and is responsible for and manages the operation of the fixed
wing medical transport unit. 4.1 air-medical; national resource catalog

2
F 1118 – 91 (2003)

APPENDIX

(Nonmandatory Information)

X1. RESOURCES CATALOG FORMAT


EMERGENCY MEDICAL SERVICES
NATIONAL AIR MEDICAL TRANSPORT UNITS RESOURCES CATALOG

3
F 1118 – 91 (2003)

ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

4
Designation: F 1149 – 93 (Reapproved 2003)

Standard Practice for


Qualifications, Responsibilities, and Authority of Individuals
and Institutions Providing Medical Direction of Emergency
Medical Services1
This standard is issued under the fixed designation F 1149; 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 3.3 delegated practice—only physicians are licensed to


1.1 This practice covers the qualifications, responsibilities, practice medicine; prehospital providers must act only under
and authority of individuals and institutions providing medical the medical direction of a physician.
direction of emergency medical services. 3.4 direct medical control—when a physician or authorized
1.2 This practice addresses the qualifications, authority, and communication resource personnel, under the direction of a
responsibility of a Medical Director (off-line) and the relation- physician, provides immediate medical direction to prehospital
ship of the EMS (Emergency Medical Services) provider to providers in remote locations. (Also known as on-line medical
this individual. direction.)
1.3 This practice also addresses components of on-line 3.5 emergency medical services system (EMSS)—all com-
medical direction (direct medical control) including the quali- ponents needed to provide comprehensive prehospital and
fications and responsibilities of on-line medical physicians and hospital emergency care including, but not limited to; Medical
the relationship of the prehospital provider to on-line medical Director, transport vehicles, trained personnel, access and
direction. dispatch, communications, and receiving medical facilities.
1.4 This practice addresses the relationship of the on-line 3.6 intervener physicians—a licensed M.D. or D.O., having
medical physician to the off-line Medical Director. not previously established a doctor/patient relationship with the
1.5 The authority for control of medical services at the emergency patient and willing to accept responsibility for a
scene of a medical emergency is addressed in this practice. medical emergency scene, and can provide proof of a current
1.6 The requirements for a Communication Resource are Medical License.
also addressed within this practice. 3.7 medical direction—when a physician is identified to
develop, implement, and evaluate all medical aspects of an
2. Referenced Documents EMS system. (syn. medical accountability.)
2.1 ASTM Standards: 3.8 medical director off-line—a physician responsible for all
F 1031 Practice for Training the Emergency Medical Tech- aspects of an EMS system dealing with provision of medical
nician (Basic)2 care. (Also known as System Medical Director.)
F 1086 Guide for Structures and Responsibilities of Emer- 3.9 on-line medical physician—a physician immediately
gency Medical Services Systems Organizations2 available, when medically appropriate, for communication of
medical direction to non-physician prehospital providers in
3. Terminology remote locations.
3.1 Description of Terms Specific to This Practice 3.10 prehospital provider—all personnel providing emer-
3.2 communication resource—an entity responsible for gency medical care in a location remote from facilities capable
implementation of direct medical control. (Also known as of providing definitive medical care.
medical control resource.) 3.11 protocols—standards for EMS practice in a variety of
situations within the EMS system.
3.12 standing orders—strictly defined written orders for
1
This practice is under the jurisdiction of ASTM Committee F30 on Emergency actions, techniques, or drug administration when communica-
Medical Services and is the direct responsibility of Subcommittee F30.03 on
Organization/Management.
tion has not been established with an on-line physician.
Current edition approved Sept. 10, 2003. Published October 2003. Originally
approved in 1988. Last previous edition approved in 1998 as F 1149 – 93 (1998).
2
Annual Book of ASTM Standards, Vol 13.02.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1149 – 93 (2003)
4. Significance and Use 5.3.1 Establishing system-wide medical protocols (includ-
4.1 Implementation of this practice will ensure that the EMS ing standing orders) in consultation with appropriate special-
system has the authority, commensurate with the responsibility, ists.
to ensure adequate medical direction of all prehospital provid- 5.3.2 Recommending certification or decertification of non-
ers, as well as personnel and facilities that meet minimum physician prehospital personnel to the appropriate certifying
criteria to implement medical direction of prehospital services. agencies.
4.1.1 The state will develop, recommend, and encourage 5.3.2.1 Every system shall have an appropriate review and
use of a plan that would assure the standards outlined in this appeals mechanism, when decertification is recommended, to
document can be implemented as appropriate at the local, assure due process in accordance with law and established
regional, or state level (see Guide F 1086). local policies. The Director shall promptly refer the case to the
4.1.2 This practice is intended to describe and define re- appeals mechanism for review, if requested.
sponsibility for medical directions during transfers. It is not 5.3.3 Requiring education to the level of approved profi-
intended to determine the medical or legal, or both, appropri- ciency for personnel within the EMS system. This includes all
ateness of transfers under the Consolidated Omnibus Budget prehospital personnel, EMTs at all levels, prehospital emer-
Reconciliation Act and other similar federal and/or state laws. gency care nurses, dispatchers, educational coordinators, and
physician providers of on-line direction (see Practice F 1031).
5. Medical Director 5.3.4 Suspending a provider from medical care duties for
5.1 Position—System Medical Director (Off-line Medical due cause pending review and evaluation.
Director). 5.3.4.1 Because the prehospital provider operates under the
5.1.1 Each EMS system shall have an identifiable Medical license (delegated practice) or direction of the Medical Direc-
Director who, after consultation with others involved and tor, the director shall have ultimate authority to allow the
interested in the system, is responsible for the development, prehospital provider to provide medical care within the pre-
implementation, and evaluation of standards for provision of hospital phase of the EMS system.
medical care within the system. 5.3.4.2 Whenever a Medical Director makes a decision to
5.1.1.1 All prehospital providers (including EMT (Emer- suspend a provider from medical care duties, the process shall
gency Medical Technician) basics) shall be medically account- be prescribed by previously established criteria.
able for their actions and are responsible to the Medical 5.3.5 Establishing medical standards for dispatch proce-
Director of the EMS agency (local, regional, or state) that dures to assure that the appropriate EMS response unit(s) are
approves their continued participation. dispatched to the medical emergency scene when requested,
5.1.1.2 All prehospital providers, with levels of certification and the duty to evaluate the patient is fulfilled.
above EMT basic, shall be responsible to an identifiable 5.3.6 Establishing under what circumstances non-transport
physician who directs their medical care activity. might occur.
5.1.2 The Medical Director shall be appointed by, and 5.3.6.1 All decisions by prehospital providers regarding
accountable to, the appropriate EMS agency in accordance non-transport shall be based on defined protocol or on-line
with Guide F 1086. communications.
5.2 Requirements of a Medical Director: 5.3.6.2 Develop a procedure for record keeping when the
5.2.1 The medical aspects (see 5.3) of an emergency medi- reason for non-transport was the result of a patient’s refusal,
cal service system shall be managed by physicians who meet including the appropriate forms and review process.
the following requirements: 5.3.7 Establishing under which circumstances a patient may
5.2.1.1 Licensed physician, M.D. or D.O. be transported against his or her will; in accordance with state
5.2.1.2 Experience in, and current knowledge of, emergency law including, procedure, appropriate forms, and review pro-
care of patients who are acutely ill or traumatized. cess.
5.2.1.3 Knowledge of, and access to, local mass casualty 5.3.8 Establishing criteria for level of care and type of
plans. transportation to be used in prehospital emergency care (that is,
5.2.1.4 Familiarity with Communication Resource opera- advanced life support versus basic life support, ground, air, or
tions where applicable, including communication with, and specialty unit transportation).
direction of, prehospital emergency units. 5.3.9 Establishing criteria for selection of patient destina-
5.2.1.5 Active involvement in the training of prehospital tion.
personnel. 5.3.10 Establishing educational and performance standards
5.2.1.6 Active involvement in the medical audit, review, and for Communication Resource personnel.
critique of medical care provided by prehospital personnel. 5.3.11 Establishing operational standards for Communica-
5.2.1.7 Knowledge of the administrative and legislative tion Resource.
process affecting the local, regional, and/or state prehospital 5.3.12 Conducting effective system audit and quality assur-
EMS system. ance.
5.2.1.8 Knowledge of laws and regulations affecting local, 5.3.12.1 The Medical Director shall have access to all
regional, and state EMS. relevant EMS records needed to accomplish this task. These
5.3 Authority of a Medical Director Includes but is not documents shall be considered quality assurance documents
Limited to: and shall be privileged and confidential information.

2
F 1149 – 93 (2003)
5.3.13 Insuring the availability of educational programs 7.1.3 The prehospital provider is responsible for the man-
within the system and that they are consistent with accepted agement of the patient and acts as the agent of medical
local medical practice. direction.
5.3.14 May delegate portions of his or her duties to other 7.2 Patient’s Private Physician Present:
qualified individuals. 7.2.1 When the patient’s private physician is present and
assumes responsibility for the patient’s care, the prehospital
6. Direct Medical Control (On-Line Medical Direction) provider should defer to the orders of the private physician if
6.1 The Practice of Direct Medical Control: they do not conflict with established system protocols and the
6.1.1 On-line medical direction capabilities shall exist and private physician documents the orders in a manner acceptable
be available within the EMS system, unless impossible due to to the EMS system.
distance or geographic considerations. 7.2.2 The Communication Resource shall be contacted for
6.1.1.1 All prehospital providers, above the certification of recordkeeping purposes to notify the on-line medical physi-
EMT basic, shall be assigned to a specific on-line communi- cian.
cation resource by a predetermined policy. 7.2.3 When the medical orders of the private physician
differ from system protocol, Communication Resource shall be
6.1.2 Specific local protocols shall exist which define those
contacted and the private physician placed in communication
circumstances under which on-line medical direction is re-
with the on-line physician. If the private physician and the
quired.
on-line physician are unable to agree on treatment, the private
6.1.3 On-line medical direction is the practice of medicine
physician must either continue to provide direct patient care
and all orders to the prehospital provider shall originate from or
and accompany the patient to the hospital, or defer all
be under the direct supervision and responsibility of a physi-
remaining care to the on-line physician.
cian.
7.2.4 The prehospital provider’s responsibility reverts to the
6.1.4 The receiving hospital shall be notified prior to the
systems Medical Director or on-line medical direction any time
arrival of each patient transported by the EMS system unless
the private physician is no longer in attendance.
directed otherwise by local protocol.
7.3 Intervener Physician Present and Non-Existent On-Line
6.2 The On-Line Medical Physician:
Medical Direction:
6.2.1 This physician shall be approved to serve in this
7.3.1 When an intervener physician has been satisfactorily
capacity by the system Medical Director (off-line).
identified as a licensed physician and has expressed his or her
6.2.1.1 This physician shall have received education to the willingness to assume responsibility and document his or her
level of proficiency approved by the off-line Medical Director intervention in a manner acceptable to the local emergency
for proper provision of on-line medical direction, including medical services system (EMSS), the prehospital provider
communications equipment, operation, and techniques. should defer to the orders of the physician on the scene if they
6.2.1.2 This physician shall be appropriately trained in do not conflict with system protocols.
prehospital protocols, familiar with the capabilities of the 7.3.2 If treatment by the intervener physician at the emer-
prehospital providers, as well as local EMS operational poli- gency scene differs from that outlined in a local protocol, the
cies and regional critical care referral protocols. physician shall agree in advance to assume responsibility for
6.2.2 This physician shall have demonstrated knowledge care, including accompanying the patient to the hospital.
and expertise in the prehospital care of critically ill and injured 7.3.3 In the event of a mass casualty incident or disaster,
patients. patient care needs may require the intervener physician to
6.2.3 This physician assumes responsibility for appropriate remain at the scene.
actions of the prehospital provided to the extent that the on-line 7.4 Intervener Physician Present and Existent On-Line
physician is involved in patient care direction. Medical Direction:
6.2.4 The on-line physician is responsible to the system 7.4.1 If an intervener physician is present and on-line
Medical Director (off-line) regarding proper implementation of medical direction does exist, the on-line physician should be
medical and system protocols. contacted and the on-line physician is ultimately responsible.
7.4.2 The on-line physician has the option of managing the
7. Authority for Control of Medical Services at the Scene case entirely, working with the intervener physician, or allow-
of Medical Emergency ing him or her to assume responsibility.
7.1 General: 7.4.2.1 If there is any disagreement between the intervener
7.1.1 Control of a medical emergency scene shall be the physician and the on-line physician, the prehospital provider
responsibility of the individual in attendance who is most should take orders from the on-line physician and place the
appropriately trained and knowledgeable in providing prehos- intervener physician in contact with the on-line physician.
pital emergency stabilization and transport. 7.4.3 In the event the intervener physician assumes respon-
7.1.2 When an advanced life support (ALS) squad, under sibility, all orders to the prehospital provider shall be repeated
medical direction, is requested and dispatched to the scene of to the Communication Resource for purposes of recordkeep-
an emergency, a doctor/patient relationship has been estab- ing.
lished between the patient and the physician providing medical 7.4.4 The intervener physician should document his or her
direction. intervention in a manner acceptable to the local EMS.

3
F 1149 – 93 (2003)
7.4.5 The decision of the intervener physician to accompany care personnel who have achieved a minimal level of compe-
the patient to the hospital should be made in consultation with tence and skill and are approved by the system Medical
the on-line physician. Director.
7.5 Nothing in this section implies that the prehospital 8.2.2 The Communication Resource shall assure that all
provider can be required to deviate from system protocols. requests for medical guidance, assistance, or advice by prehos-
7.6 Air Medical Emergency Medical Service (EMS) Assis- pital personnel will be promptly accommodated with an
tance at the Scene of a Medical Emergency (non-mass casu- attitude of utmost participation, responsibility, and coopera-
alty): tion.
7.6.1 Dispatch of air medical EMS assistance should be 8.2.3 The Communication Resource shall provide assurance
according to a pre-established state/regional/local EMS plan. that they will cooperate with the EMS system in collecting and
Dispatch according to this pre-established EMS plan should analyzing data necessary to evaluate the prehospital care
take into account, for example, the patient’s condition, re- program as long as patient confidentiality is not violated.
sponse time, proximity of the receiving facility, geographical 8.2.4 The Communication Resource will consider the pre-
ease of access by ground, flight safety, and mechanism of hospital provider to be the agent of the on-line physician when
injury. they are in communication, regardless of any other employee/
7.6.1.1 The decision to request air medical EMS assistance employer relationship.
at the scene of a medical emergency shall be the responsibility 8.2.5 The Communication Resource shall assure that the
of a qualified individual, identified to assume such authority by on-line physician will issue transportation instructions and
the pre-established state/regional/local EMS plan. hospital assignments based on system protocols and objective
7.6.2 When the air medical EMS assistance has arrived on analysis of patient’s needs and facility capability and proxim-
the scene, the following shall apply: ity.
7.6.2.1 There will be an orderly transfer of responsibility 8.2.5.1 No effort will be made to obtain institutional or
from the local EMS unit to the air medical EMS unit and its commercial advantages through the use of such transportation
medical control authority, according to local protocols. These instructions and hospital assignments.
protocols should include a method of determining when air 8.2.6 When the Communication Resource is acting as an
transport is appropriate. agent for another hospital, the information regarding patient
7.6.2.2 Medical direction (on-line/off-line) of the local EMS treatment and expected time of arrival will be relayed to the
unit retains responsibility until formally relinquished to the receiving hospital in an accurate and timely fashion.
medical direction (on-line/off-line) of the receiving air medical 8.2.7 Communication Resource shall conduct regular case
EMS unit. conferences involving the on-line physicians and prehospital
7.6.2.3 If there is a physician on-board the air medical EMS personnel for purposes of problem identification and provide
unit, this physician shall be considered an intervenor physician, continuing education to correct any identified problems.
unless on-line medical direction transfers responsibility to the 8.3 If the Communication Resource is located within a
physician. (See 7.3 and 7.4.) hospital facility, the hospital shall meet the requirements listed
7.6.2.4 After responsibility has been transferred to the air in 8.1 and 8.2 and the equipment used for on-line medical
medical EMS unit, the local EMS unit should cooperate with direction shall be located within the Emergency Department.
the air medical EMS unit, and/or assist the air medical EMS
unit crew as long as they are not required to exceed the levels 9. Medical Direction During Interfacility Transfers (Non-
of intervention permitted by their certification. Mass Casualty):
7.6.3 Air medical EMS should offer assistance only when
invited or requested, or both, unless no ground unit is available. 9.1 General Principles:
7.6.4 The transport destination for the patient should be 9.1.1 When an emergency patient arrives for initial evalua-
based upon a pre-established EMS plan that considers time and tion at a medical facility, that patient becomes the responsibil-
distance as well as the patient’s medical condition and the ity of that facility and its medical staff. This responsibility
capability of the receiving facility. continues until the patient is appropriately discharged, or until
7.6.4.1 If no pre-established EMS plan for patient transport the patient is transferred and the responsibility is assumed by
exists, the transport should follow the usual transport pattern of the personnel of a facility with equal or greater capability.
the requesting local EMS unit, unless otherwise indicated by 9.1.2 All transferring personnel should have standing orders
medical considerations. or protocols available for use as appropriate, in the event of
inability to communicate with on-line medical direction.
8. Requirements for Communication Resource (Medical 9.1.3 Patient medical records for any interfacility transfer
Control Resource) shall be the responsibility of the transferring facility.
8.1 Communication Resource shall be designated to partici- 9.1.4 A patient not receiving treatment, and expected to
pate in the EMS system according to a plan developed by a remain stable during interfacility transport may, with physician
state or regional authority. approval, be transferred by an appropriate medical transporta-
8.2 The Communication Resource shall meet the following tion provider with personnel certified at the level of Emergency
requirements: Medical Technician-Basic, or greater.
8.2.1 The Communication Resource shall assure adequate 9.1.5 When the patient has a probability of experiencing
staffing for the communication equipment at all times by health complications which cannot be managed within the scope of

4
F 1149 – 93 (2003)
practice of non-physician personnel, the transfer shall be off-line protocols, the medical transport provider should, if
managed by an appropriately trained physician, either on-line possible, contact the transferring facility or the receiving
or off-line. facility for additional orders. Or, if deemed necessary, the EMS
9.2 Interfacility Transfers Conducted by the Transferring on-line medical direction should be contacted for consultation.
Facility: 9.3 Interfacility transfers conducted by a receiving facility
9.2.1 When a patient is transferred to another facility, is when the transferring personnel are agents of the receiving
receiving treatment, medically unstable, or potentially medi- facility:
cally unstable, it is the responsibility of the transferring facility 9.3.1 When the transferring personnel includes a physician,
to assure that the medical transport agency has qualified the patient becomes the responsibility of the receiving facility
personnel and transportation equipment to complete the trans- as soon as the patient leaves the transferring facility.
fer. 9.3.2 When the transferring team does not include a physi-
9.2.2 The transferring personnel shall act as the agents of cian, the physician from the receiving facility who authorizes
the transferring facility and the physician approving the trans- the transfer is responsible for the patient. The receiving facility
fer, regardless of any other employer/employee relationship. must assure that the medical transport team has qualified
Communication between the transferring physician, the pre- personnel and transportation equipment to complete the trans-
hospital on-line medical direction, and the transferring person- port.
nel is required, with agreement between physicians regarding
medical care. (See 7.2.1 and 7.2.3.) 10. Keywords
9.2.3 When a patient experiences complications beyond 10.1 aeromedical; interfacility; medical control; medical
situations addressed in physician written orders, or beyond direction; on-line/off-line

ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

5
Designation: F 1177 – 02

Standard Terminology Relating to


Emergency Medical Services1
This standard is issued under the fixed designation F 1177; 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 3.1.3 Taber’s Cyclopedic Medical Dictionary, 16th Edition.4


1.1 This terminology covers standard definitions of terms 3.1.4 Mosby’s Emergency Dictionary.5
which apply to all F30 standards, but which are more precise 3.2 Definitions:
than common usage. adjunct instructor—an individual with specialized subject
2. Referenced Documents matter expertise, who, on occasion, instructs a specific topic
of a curriculum under the direction of the course instructor/
2.1 ASTM Standards: coordinator. F 1256, F 1257
F 1219 Guide for Training the Emergency Medical Techni- advanced life support—medically accepted life sustaining,
cian (Basic) to Perform Initial and Detailed Assessment2 invasive or non-invasive procedures; provided under the
F 1253 Guide for Training the Emergency Medical Techni- direction of a physician or other authorized health care
cian (Basic) to Perform Patient Secondary Assessment3 provider.
F 1254 Practice for Performance of Prehospital Manual ambulance—a vehicle for transportation of the sick and
Defibrillation2 injured, equipped and staffed to provide emergency medical
F 1255 Practice for Performance of Prehospital Automated care during transit.
Defibrillation2 ambulance service—a qualified provider of medical transpor-
F 1256 Guide for Selection and Practice of Emergency tation for patients requiring treatment or monitoring, or both,
Medical Services Instructor for Basic Life Support/ due to illness or injury.
Emergency Medical Technician (BLS/EMT) Training Pro- ambulance service provider—a person or organization, either
grams2 public or private, responsible for operation, maintenance,
F 1257 Guide for Selection and Practice of Emergency and administation of an ambulance service.
Medical Services Instructor for Advanced Life Support/ associate instructor—an individual who possesses the quali-
Emergency Medical Technician (ALS/EMT) Training fications and education/training of a course instructor/
Programs2 coordinator, but, in a specific course, assumes a supportive
F 1287 Guide for Scope of Performance of First Responders or assisting role to the course instructor/coordinator. This
Who Provide Emergency Medical Care2 individual may substitute for the course instructor/
3. Terminology coordinator in case of necessity or, in other courses, serves
as a course instructor/coordinator. F 1256, F 1257
3.1 Appropriate definitions for interpretation of terms used basic life support (BLS)—medically accepted non-invasive
in ASTM Emergency Medical Services standards shall be procedures used to sustain life.
determined in the following order: basic life support/cardiopulmonary resuscitation (BLS/
3.1.1 Specific definitions of terminology or description of CPR)—a set of skills that includes airway management,
terms provided in the standard. These will apply to use of the chest compressions, and others as defined by the American
term in that standard only. Heart Association. F 1254, F 1255, F 1287
3.1.2 ASTM Standard Terminology Relating to Emergency call rotation—a system in which emergency medical re-
Medical Services (F 1177). sponses are allocated sequentially to multiple providers.
clinical certification—a standardized process for evaluation
and recognition of an acceptable level of competence in a
1
This terminology is under the jurisdiction of ASTM Committee F30 on specific aspect of patient care. F 1256, F 1257
Emergency Medical Services and is the direct responsibility of Subcommittee clinical experience—exposure to and practice in an area of
F30.06 on Terminology. patient care. F 1256, F 1257
Current edition approved Sept. 10, 2002. Published October 2002. Originally
published as F 1177 – 88. Last previous edition F 1177 – 96a.
2
Annual Book of ASTM Standards, Vol 13.01.
3 4
Discontinued. See 1998 Annual Book of ASTM Standards, Vol 13.01. Taber’s Cyclopedic Medical Dictionary, 16th Edition, F. A. Davis Company,
Philadelphia, PA, 1989.
5
Mosby’s Emergency Dictionary, C. V. Mosby Company, St. Louis, MO, 1989.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1177 – 02
clinical/field preceptor—an individual who supervises and known as off-line medical control).
evaluates the students during clinical or field experiences intervener physician—a licensed M.D. or D.O., having not
under the direction of the course instructor/coordinator. previously established a doctor/patient relationship with the
F 1256, F 1257 emergency patient, who is willing to accept responsibility
clinical medical practice—patient diagnosis and treatment, for patient care, and who can provide proof of a current
including treatment protocols, which are the purview of medical license.
qualified professionals (as determined by the state or other medical direction—physician responsibility for the develop-
appropriate authority). ment, implementation, and evaluation of the clinical aspects
communication resource—an entity responsible for imple- of an EMS system.
mentation of direct medical direction, or entities responsible medical protocol—preestablished physician authorized proce-
for response and scene two-way communication, or both dures or guidelines for medical care of a specified clinical
(also known as medical control resource). situation, based on patient presentation (also known as
course administrator—an individual responsible for manag- standing orders).
ing administrative details of a course, separate from actual medical transportation services—the moving of patients
instruction of the course. F 1256, F 1257 from one location to another. Specific services include any or
course instructor/coordinator (I/C)—an individual who is all of the following: emergency and non-emergency medical
authorized by the appropriate entity to present and assess response and transportation; scheduled and non-scheduled
competence in all of the subject matter contained in a interfacility transfers, medical standbys, long-distance medi-
curriculum. This person also oversees all instruction in the cal transfers, air medical response and transport (helicopter
course and makes final evaluations concerning student and fixed wing aircraft); and stretcher and wheelchair
competence. F 1256, F 1257 transport services.
definitive care—a level of therapeutic intervention capable of medical transportation system—a sub-system of the emer-
providing comprehensive health care services for a specific gency medical services system consisting of an organization
condition. or collection of medical transport services which provide
delegated practice—the medical activities of providers per- transportation, treatment, and observation of patients for a
formed under the authority and direction of a licensed specific geographic area.
physician. mutual aid—the furnishing of resources, from one individual
direct medical control—the process of providing immediate or agency to another individual or agency, including but not
physician orders to EMS personnel through direct commu- limited to facilities, personnel, equipment, and services,
nication (also known as on-line medical control). pursuant to an agreement with the individual or agency, for
dispatch life support—the knowledge, procedures, and skills use within the jurisdiction of the individual or agency
used by trained emergency medical dispatchers in guiding requesting assistance.
care by means of post-dispatch (pre-arrival) instruction to off-line medical director—a physician responsible for all
callers. aspects of an EMS system dealing with the provision of
EMS region—a defined geographic area used for EMS plan- medical care (also known as System Medical Director).
ning, development, and coordination. on-line medical physician—a physician immediately avail-
emergency medical dispatcher (EMD)—a trained public able for communication of medical direction to non-
safety telecommunicator with additional training and spe- physician prehospital care providers in remote location.
cific emergency medical knowledge essential for the efficient pertinent patient information—information obtained from
management of emergency communications. all available resources that relates to the patient’s condition
emergency medical facility—a physical structure, excluding and problems. This information must be continuously up-
mobile vehicles, which has been approved by the appropriate dated. All information must be recorded and reported.
regulatory authority to receive emergency patients and F 1219, F 1253
which is equipped and staffed to evaluate and treat patients practical skills instructor—an individual who assists with
with life threatening conditions. practical skills instruction under the direction of the course
emergency medical services—the provision of services to instructor/coordinator. F 1256, F 1257
patients requiring immediate assistance due to illness or prehospital emergency medical services—a sub-system of
injury, including access, response, rescue, prehospital and the emergency medical services system which provides
hospital treatment, and transportation. medical services to patients requiring immediate assistance
emergency medical services (EMS) system—a coordinated due to illness or injury, prior to the patients’ arrival at an
arrangement of resources (including personnel, equipment, emergency medical facility.
and facilities) organized to respond to medical emergencies, prehospital provider—all personnel providing emergency
regardless of the cause. medical care in a location which is remote from facilities
health care provider—an organization, institution, or indi- which are capable of providing definitive medical care.
vidual authorized to provide direct patient care. sequential response—the assignment, according to local pro-
indirect medical direction—the physician management of all tocols, of emergency medical resources with varying levels
clinical aspects of an EMS system, including but not limited of care capability to the scene of an illness or injury based on
to planning, training, implementation, and evaluation (also information received from previously arrived, medically

2
F 1177 – 02
trained, on-scene responders. A sequential response differs levels of resource response. The two types of tiered response
from a simultaneous response. are sequential response (q.v.) and simultaneous response
simultaneous response—the assignment of multiple emer- (q.v.).
gency medical resources to the scene of an illness or injury trauma care system—a subsystem within the EMS system
based on initially available information and local opera- designed to manage the treatment of the trauma patient.
tional policies. These may have varying levels of care vehicle operation mode—the manner of operation of an
capability (for example ALS and BLS, ground and air). emergency medical vehicle, involving the use of warning
Subsequent care or transportation, or both, of the patient is devices and the exercise of driving privileges legally allowed
provided by the unit which most closely meets the patient’s for emergency vehicles.
needs. A simultaneous response differs from a sequential wilderness setting—situations in which the delivery of patient
response. care by EMS providers is adversely affected by logistical
standing orders—a type of medical protocol which provides complications, such as: an environment that is physically
specific written orders for actions, techniques, or drug stressful or hazardous to the patient, rescue personnel, or
administration when communication has not been estab- both; remoteness of the patient’s location, such that it causes
lished for direct medical direction. a delay in the delivery of care to the patient; or lack of
tiered response—a predetermined, protocol driven, level of adequate medical supplies, equipment, or transportation.
medical care and vehicle operation mode based on multiple F 30.02.05

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

3
Designation: F 1219 – 00

Standard Guide for


Training the Emergency Medical Technician (Basic) to
Perform Patient Initial and Detailed Assessment1
This standard is issued under the fixed designation F 1219; 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 and evaluation of additional data from the detailed survey and
1.1 This guide establishes the minimum training standard pertinent patient information.
for the performance of the initial assessment of ill or injured 3.1.2 focused detailed survey—the methodical physical ex-
patients of all ages. amination of the patient to evaluate conditions discovered
1.1.1 Frequently repeated inital surveys are an essential and during the primary survey and to find conditions not previously
integral part of the complete care of the acutely ill or injured identified.
patient. 3.1.3 initial assessment—the identification of a patient’s
1.2 This guide establishes the minimum training standard real or perceived problem(s) by means of the accumulation and
for the detailed assesment of ill or injured patients of all ages. evaluation of data from a scene evaluation, an initial and
1.3 This guide identifys the components of the focused pertinent patient information.
detailed assessment. 3.1.4 initial survey—the rapid assessment and management
1.4 This guide is one of a series which together describe the of the patient’s immediately life-threatening conditions.
minimum training standard for the emergency medical techni- 3.1.5 pertinent patient information—information obtained
cian (basic). from all available resources that relates to the patient’s
1.5 condition and problems. This information must be continu-
1.6 This standard may involve hazardous materials, opera- ously updated. All information must be recorded and reported.
tions, and equipment. This standard does not purport to 3.1.6 scene evaluation—a rapid evaluation of the environ-
address all of the safety concerns associated with its use. It is ment, conditions, and necessary resources.
the responsibility of the user of this standard to establish 4. Significance and Use
appropriate safety and health practices and determine the
applicability of regulatory limitations prior to use. 4.1 This guide establishes the minimum national training
standard for the performance of the initial assessment of the ill
2. Referenced Documents and injured patient of any age by the emergency medical
2.1 ASTM Standards: technician (basic).
F 1031 Practice for Training the Emergency Medical Tech- 4.2 This guide shall be used by those who wish to identify
nician (Basic)2 the minimum training standard of the emergency medical
technician (basic) as it relates to patient initial assessment.
3. Terminology 4.3 This guide establishes a minimum national standard for
3.1 Definitions of Terms Specific to This Standard: training the emergency medical technician (basic) in the
3.1.1 focused detailed assessment—identification of the pa- preformance of the detailed assessment of ill and injured
tient’s real or perceived problem(s) by means of documentation patients of all ages.
4.4 This guide shall be used by those who wish to identify
the minimum training standard of the emergency medicial
1
This guide is under the jurisdiction of ASTM Committee F30 on Emergency technician (basic) as it relates to a focused patient detailed
Medical Services and is the direct responsibility of Subcommittee F30.02 on assessment.
Personnel, Training, and Education.
Current edition approved Oct. 10, 2000. Published January 2001. 4.5 This guide shall be used as the basis to revise Practice
Originally published as F1219-89. Discontinued August 1998 and Reienstated as F 1031.
F 1219-00.
2
Annual Book of ASTM Standards, Vol 13.02.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1219 – 00
4.6 Every person who is identified as an emergency medical nents of the primary survey will be monitored during the
technician (basic) shall be trained in accordance with this detailed. The components of the detailed survey are:
guide. 8.3.1 Stabilize the cervical spine as indicated until in-line
immobilization can be preformed.
5. Scene Evaluation 8.3.2 Assess for altered mental status.
5.1 While approaching the scene and the patient the emer- 8.3.3 Determine vital signs:
gency medical technician (basic) will assess the scene for 8.3.3.1 Determine rate, rhythm and quality of respirations.
hazards, number of patients, need for additional resources, and 8.3.3.2 Determine rate, regularity and quality of the pulse.
then take appropriate action. 8.3.3.3 Measure blood pressure.
5.2 While approaching the patient the emergency medical 8.3.3.4 Asses caapillary refill time in pediatric patients.
technician (basic) will assess the patient and the environment 8.3.4 Examine the head:
for clues relating to the mechanism of injury or illness. 8.3.4.1 Inspect and palpate head for any signs of injury or
other abnormalities.
6. Initial Survey 8.3.4.2 Inspect for blood, fluid or freign objects in ears, nose
6.1 Frequently repeated initial surveys are an essential and and mouth.
integral part of the complete care of the acutely ill or injured 8.3.4.3 Extamine the eyes for signs of injury or other
patient. This guide identifies the preferred sequence for patient abnormalities.
Primary Initial assessment; however, it must be emphasized 8.3.5 Examine the skin-mucous membranes for any signs of
that much of the initial assessment is done simultaneously and injury or edema for color, temperature, and moistness.
not necessarily sequentially. The Initial survey addresses: 8.3.6 Inspect and palpate the neck for any signs of injury or
6.1.1 The ability of the patient to communicate, other abnormalities.
6.1.2 Cervical spine stability, 8.3.7 Examine the chest:
6.1.3 Airway patency, 8.3.7.1 Inspect and palpate the chest for any sins of injury or
6.1.4 Adequacy of ventilations, other abnormalities.
6.1.5 Adequacy of circulation, 8.3.7.2 Asses breath sounds, including auscultation of the
6.1.6 Life-threatening external bleeding chest.
6.1.7 Level of consciousness, and 8.3.8 Inspect and palpate the abdomen for any signs of
6.1.8 Clothing will be removed or loosened as needed to injury of other abnormalities.
evaluate life threatening conditions. 8.3.9 Assess the integrity of the pelvis.
6.2 The Initial survey shall be interrupted to manage imme- 8.3.10 Examine the perineal area:
diately life threatening problems. 8.3.10.1 Inspect the perneal for any signs of injury or other
6.3 Patients with life-threatening problems that cannot be abnormalities.
adequately corrected, as identified in the initial survey, shall be 8.3.10.2 In the event of an assault, evidence protection
transported immediately as an emergency transport. techniques must be practiced.
8.3.10.3 Assess for any signs of impending birth in women
7. Pertinent Patient Information of childbearing age.
7.1 Obtaining pertinent patient information shall be an 8.3.11 Examine each extremity:
ongoing process of collecting information from all available 8.3.11.1 Inspect and palpate for any signs of injury or other
resources throughout the entire contact with the patient. abnormalities.
7.2 Identify the chief complaint. 8.3.11.2 Assess peripheral circulation, movement and sen-
7.3 Obtain pertinent information about present illness or sation.
injury, including current medication. 8.3.11.3 Suggested acronym “PMS” (pulses-motor-
7.4 Suggested acronym: SAMPLE. sensory).
7.5 Obtain a pertinent past medical history, including aller- 8.3.12 Inspect and palpate the back and buttocks for any
gies. signs of injury or other abnormalities.
7.6 Locate any medical identification information.
9. Emergency Transport
8. Secondary Assessment 9.1 Patients with life-threatening problems idenified in the
8.1 A detailed assessment is conducted only after the field focused detailed survey shall be transported as an emergency
treatment of all life threatening conditions has been initiated. transport.
8.2 the detailed assessment may be focued on medical, 9.2 ALS intercept should be considered for critical or
trumatic or both entites. deterorating patients.
8.3 The components of the detailed survey should be
preformed following the completion of the initial survey. The 10. Keywords
selection and sequence of the components are dictated by the 10.1 assesment; detailed assessment; EMS; EMT; focused
patient’s condition and exisiting circumstances. The compo- medical; focused truama; initial assessment

2
F 1219 – 00
ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

3
Designation: F 1220 – 95 (Reapproved 2001)

Standard Guide for


Emergency Medical Services System (EMSS)
Telecommunications1
This standard is issued under the fixed designation F 1220; 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 Goal 1—State EMSS Communication Should Meet


Recog-
1.1 This guide covers telecommunications practices and nized Standards for Functional Performance 10
performance standards required to support all of the functions Goal 2—Local EMSS Communications Should be
of community EMSS on a statewide basis. It defines state Compat-
ible with, and Should Not Interfere with, EMSS
planning goals and objectives for EMSS communications. Communications in Neighboring Area 11
1.2 This guide is for planning, coordinating, integrating, and Goal 3—Local EMSS Communications Systems
evaluating telecommunications resources statewide to satisfy Should be
Compatible with, and Should Not Interfere with,
the functional needs of comprehensive community EMSS Other
systems. Types of Communications Systems 12
1.3 To facilitate a two-tiered planning approach recom- Goal 4—EMSS Communications Systems Should
Make
mended for EMSS communications, this guide identifies those Maximum Use of State and Common Resources
communications system features that should be coordinated on Where
Appropriate, Cost Effective, and Authorized 13
a statewide basis and defined in statewide (first tier) EMSS Goal 5—The State Should Act as the Representative
communications planning guidelines. Local (second tier) of
EMSS communications plans prepared in accordance with the Local EMSS in Dealing with Federal Agencies and
National Organizations 14
statewide guidelines should then be tailored to satisfy local Goal 6—The State Should Have a Program for Posi-
EMSS needs while providing compatibility and interoperabil- tive
ity of communications with other EMSS. Management of Its EMSS Communications Activities 15
Emergency Medical Radio Services (EMRS) Radio
1.4 The sections in this guide appear in the following Fre-
sequence: quencies (MHz) Appendix X1
Section Acronyms and Glossary for EMSS Communications Appendix X2
References
Scope 1
Referenced Documents 2
1.5 This standard does not purport to address all of the
Terminology 3 safety concerns, if any, associated with its use. It is the
Summary of Guide 4 responsibility of the user of this standard to establish appro-
Significance and Use 5
Functions and Categories of EMSS Communications 6
priate safety and health practices and determine the applica-
Telecommunications Functions 6.1 bility of regulatory limitations prior to use.
Telecommunications Categories 6.2
EMSS Functional Communications Requirements 7 2. Referenced Documents
General Information 7.1
Citizen Access 7.2 2.1 ASTM Standards:
EMSS Vehicle Dispatch and Coordination 7.3 F 1031 Practice for Training the Emergency Medical Tech-
Medical Coordination/Direction 7.4
Interservice Communications 7.5
nician (Basic)2
Radio Frequency Spectrum and Service Requirements 8 F 1149 Practice for Qualifications, Responsibilities, and
Radio Frequencies 8.1 Authority of Individuals and Institutions Providing Medi-
EMSS Radio Service Coverage 8.2
Operational Considerations 8.3
cal Direction of Emergency Medical Services2
Goals and Objectives for EMSS Communications 9 F 1221 Guide for Interagency Information Exchange2
F 1229 Guide for Establishing the Qualifications, Educa-
tion, and Training of EMS, Air-Medical Patient Care
1
This guide is under the jurisdiction of ASTM Committee F30 on Emergency Providers2
Medical Services and is the direct responsibility of Subcommittee F30.04 on
Communications.
Current edition approved Oct. 10, 1995. Published February 1996. Originally
2
published as F 1220 – 89. Last previous edition F 1220 – 89. Annual Book of ASTM Standards, Vol 13.02.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1220 – 95 (2001)
F 1254 Practice for Performance of Prehospital Manual government to take a coordinating role. Statewide planning for
Defibrillation2 coordinated use of radio frequencies for EMSS communica-
F 1258 Practice for Emergency Medical Dispatch2 tions is specifically needed.
F 1287 Guide for Scope of Performance of First Responders 5.2 The state is the logical unit to formulate the statutory
Who Provide Emergency Medical Care2 and regulatory framework for EMSS planning. State planning
F 1381 Guide for Planning and Developing 9-1-1 Enhanced for area-wide EMSS communications provides authority to
Telephone Systems2 accomplish coordination in the use of available radio frequen-
F 1418 Guide for Training the Emergency Medical Techni- cies, thus promoting multiagency cooperation to best serve the
cian (Basic) in Roles and Responsibilities.2 public needs.
F 1453 Guide for Training and Evaluation of First Respond- 5.3 With statewide planning, communities, counties, and
ers Who Provide Emergency Medical Care2 multicounty EMSS regions are provided with guidance to
F 1517 Guide for Scope of Performance of Emergency achieve the performance goals and objectives of their EMSS
Medical Services Ambulance Operations2 communications systems.
F 1552 Practice for Training, Instructor Qualification, and 5.4 The statewide EMSS communications performance
Certification Eligibility of Emergency Medical Dispatch- goals and objectives in Sections 10-15 address specific roles of
ers2 state governments in EMSS communications systems plan-
F 1560 Practice for Emergency Medical Dispatch Manage- ning. These performance goals and objectives should be
ment2 considered by states for evaluating, planning, and implement-
2.2 Federal Standards: ing of acceptable EMSS communications statewide.
Communications Act of 1934 (47 U.S.C. 405) (as
amended)3 6. Functions and Categories of EMSS Communications
Title 47, United States Code of Federal Regulations (47 6.1 Telecommunications Functions—The report “Commu-
CFR) on Telecommunications3 nications in Support of Emergency Medical Services,” given in
Ref (1),4 defines the following EMSS functions that require
3. Terminology telecommunications:
3.1 Definitions of Terms Specific to This Standard: 6.1.1 Medical emergencies requiring EMSS response
3.1.1 goal—a statement of broad direction, general purpose, should be reported immediately to appropriate community
or intent. A goal is general and timeless and is not concerned agencies that manage and control EMSS resources and ser-
with a specific achievement within a given time period. vices.
3.1.2 objective—a statement of desired accomplishment 6.1.2 Appropriate EMSS resources should respond to hu-
that can be measured within a specified time frame and under man health emergencies at any time and place.
determinable conditions. The attainment of an objective moves 6.1.3 Recognition of the need for and immediate response
the system toward a directly related goal. by EMSS resources to life threatening and serious injuries and
3.1.3 Communications terminology used in this guide and illness should be provided within a time period that will ensure
references are defined in Appendix X1, Acronyms and Glos- the greatest saving of lives and reduction of morbidity.
sary for EMSS Communications. 6.1.4 EMSS and other health agencies and professionals
should marshal their individual and collective resources (staff,
4. Summary of Guide equipment, supplies, and facilities) and coordinate their re-
4.1 This guide identifies the functions and requirements of sponses in the shortest effective time to meet individual and
EMSS telecommunications. Observance of the state EMSS mass medical emergency needs.
communications planning goals and objectives contained in 6.1.5 Emergency medical dispatchers should have special
this guide permits planning and implementation of compatible, training to provide guidance and direction to persons at the
interoperable, and reliable local EMSS communications which scene of a medical emergency pending arrival of trained
meet local needs while not interfering with the needs of prehospital EMSS personnel.
adjoining EMSS. 6.1.6 EMSS must be coordinated with other community
4.2 EMSS communications should satisfy all of the perfor- public safety emergency response services.
mance goals and objectives specified by those who use it and 6.1.7 The use of EMSS facilities (emergency departments,
those who are served by it. However, many constraints such as intensive care, and coronary care units, burn and trauma
costs, political, demographic and social preferences, existing facilities, and so forth) should be coordinated so as to avoid
legislation and time, limit what can be achieved. preventable delays in access to definitive emergency medical
care.
5. Significance and Use 6.1.8 For life threatening and serious medical emergencies
5.1 In situations in which the coordination of EMSS com- and in other instances requiring invasive prehospital emer-
munications among political subdivisions affects the health and gency medical care, appropriate physiological data and patient
safety of the state’s population, it is appropriate for state assessment information should be collected and transmitted

3 4
Available from Superintendent of Documents, U. S. Government Printing The boldface numbers in parentheses refer to the references at the end of this
Office, Washington, DC 20402. guide.

2
F 1220 – 95 (2001)
from the site of the emergency to the EMSS facility providing 7.2.2 For several years, numerous governmental commis-
on-line medical direction. sions, legislative bodies, private organizations, and citizen
6.1.9 Telecommunications relating to EMSS should be re- groups have recommended the establishment of a single,
corded, documented, saved, and used by EMSS managers to universal “Nationwide 9-1-1 Emergency Telephone Number”
review, evaluate, revise, and reorganize EMSS as necessary to to meet this need for improved emergency communications.
meet changing conditions and needs. The achievement of this recommendation was stated as a
6.1.10 Telecommunications should exist between EMSS matter of national policy in Bulletin No. 73-1 “National Policy
facilities and transport vehicles for safe interhospital transfer of for Emergency Telephone Number 8911’” issued by the Ex-
patients with life threatening and serious medical emergencies. ecutive Office of the President on March 21, 1973. The
6.1.11 Telecommunications should be used as needed, to “nine-one-one” concept provides a single number that is easy
improve utilization of all EMSS resources and to prevent or to use and remember. Moreover, implementation of the three-
mitigate adverse effects of medical emergencies. digit emergency telephone number 9-1-1, encourages coordi-
6.2 Telecommunications Categories—Based on the above nated efforts between those providing communications services
EMSS needs, the following categories of information exchange and emergency responses. The 9-1-1 concept should be in-
requiring telecommunications are defined in Ref (1) as being cluded in EMSS communication planning with other methods
necessary to support of EMS operations. of citizen access, primarily for its impact on response time and
6.2.1 EMSS Access—Exchanges of information related to enhanced coordination among participants. Citizen access
public access for reporting emergency medical situations to communications, primarily uses telephones, both public and
appropriate EMSS response organizations. private, to call 9-1-1 Public Safety Answering Points (PSAP).
6.2.2 EMSS Dispatch and Control—Exchanges of informa- 7.2.3 On the nation’s highways, citizen access to EMSS is
tion related to reducing response time, such as alerting, facilitated by use of mobile communications services that
dispatching, and controlling the movement of EMS vehicles. enable drivers to rapidly report observed motor vehicle acci-
6.2.3 Medical Coordination/Direction—Exchanges of in- dents and other emergency conditions to public safety service
formation related to the emergency patient and his care, such as providers. In areas having cellular telephone coverage, motor
transmission of physiological information and exchange of vehicle occupants with cellular telephone may make direct
patient assessment information and treatment information be- calls to the local 9-1-1 PSAP. This use of cellular telephone for
tween EMS personnel at the scene and physicians providing accessing public safety services is being facilitated through
on-line medical direction. rule changes initiated in 1994 by provisions of the Federal
6.2.4 EMSS Resource Coordination—Exchanges of infor- Communications Commission Rules under RM-8143 Docket
mation necessary for the effective coordination of all EMS No. 94-102; to ensure compatibility of cellular 9-1-1 calls with
resources.
enhanced 911 emergency calling systems. Also, Citizen Band
6.2.5 Interservice Coordination—Exchanges of information
(CB) mobile radio operators can report observed emergencies
for coordination of EMS activities with police, fire, govern-
to volunteer CB base station radio monitors who in turn relay
ment agencies, and other resources, such as public utilities and
the information to appropriate public safety response agencies
private contractors.
via the 9-1-1 emergency telephone number or some other
6.2.6 Disaster Coordination—Exchanges of information re-
prearranged telephone number. Similarly, mobile equipped
lated to the coordination of EMS activities with those of local,
amateur radio operators can report observed emergencies to
state, and national disaster response authorities.
appropriate public safety authorities via the 9-1-1 emergency
7. EMSS Functional Communications Requirements telephone number using amateur radio/telephone interconnect
7.1 An EMSS communications system should provide the services. Finally, motorists not equipped with mobile radio
means by which emergency resources can be accessed, mobi- communications, can report emergencies by stopping at the
lized, managed, and coordinated. To accomplish this, a com- nearest roadside site having a public telephone and dialing
munications system must incorporate operational provisions to 9-1-1. In some locations, a statewide toll-free 800 telephone
use sufficient wire-line and radio linkages and channels among access number is available for calling state police. The avail-
all EMSS participants over the service area of the EMSS (and ability of such 800 service should be indicated by road signs.
for disaster response, between EMSS service areas) to facilitate Such 800 calls may also be made via cellular radio. Calls
the EMSS functional needs described in 7.2 through 7.5 for received by the state police may be transferred to the appro-
communications. priate 9-1-1 answering point or directly to the designated
7.2 Citizen Access: response agency. The use of these numbers should include
7.2.1 The EMSS communications system should have the provisions for assuring caller identification and location and
ability to receive and process any incoming calls that report special screening by trained PSAP communicators.
emergencies and request emergency medical assistance. Per- 7.2.4 In areas in which the 9-1-1 system has not been
sons should be able to summon help rapidly in an emergency implemented, citizens may have to search through telephone
situation. They should be able to call for police, fire, rescue, directories for one of several listed police, fire, ambulance, and
and other emergency aid promptly, without confusion, and hospital emergency room numbers when a medical emergency
without familiarity with a particular community. Local, state- arises. Continuation of this practice delays the availability of
wide, and nationwide uniformity is needed to accomplish this emergency medical assistance and, in life threatening and
objective. serious medical emergencies, can cost lives and limbs. There is

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F 1220 – 95 (2001)
no technical reason why a basic or enhanced 9-1-1 emergency vice coordination. Provisions for such interservice radio
telephone number cannot be planned and implemented by any communications should be included in the system design.
telephone company in the United States. The universal “Na-
tional 9-1-1 Emergency Telephone Number” should be imple- 8. Radio Frequency Spectrum and Service Requirements
mented without further delay as a matter of national public 8.1 Radio Frequencies—All nonfederal telecommunica-
safety. tions systems in the United States are subject to the regulations
7.2.5 Telephone calls for emergency services made by of the Federal Communications Commission (FCC). There are
unattended automatic telephone calling devices should be radio frequencies nationally allocated primarily for dispatch of
received and screened by a private answering service and shall ground emergency medical vehicles, transport of patients, and
not be dialed in directly to the primary 9-1-1 or other general other EMS-related communications. Such radio communica-
public access number. tions are allowed under FCC Rules and Regulations (47 CFR,
7.3 EMSS Vehicle Dispatch and Coordination—When noti- Part 90) Private Land Mobile Radio Services, Subpart B,
fied of the need for an emergency medical response, the Public Safety Radio Services. These current FCC Rules clearly
communications system is used by trained emergency medical distinguish between emergency medical service communica-
dispatchers: tions, other types of medical communications, and other types
of emergency communications. Section 90.27 of the FCC
7.3.1 To interrogate emergency callers to determine the
Rules, defines the Emergency Medical Radio Services
nature and severity of the medical emergency,
(EMRS), and allocates radio frequencies exclusively for licens-
7.3.2 To provide on-site callers with pre-arrival instructions, ing eligible applicants to use for EMS communications. FCC
7.3.3 To dispatch the most appropriate EMS vehicles to the Rules and Regulations also permit EMS use of radio frequen-
site of the emergency promptly, cies allocated to other land mobile services such as the Special
7.3.4 To guide them directly to the site with minimum Emergency Radio Service, Local Government Radio Service;
delays, Law Enforcement Radio Service; Fire Radio Service; and
7.3.5 To direct them to an appropriate emergency medical Business Radio Service.
facility, and 8.1.1 Radio Frequencies for EMSS Communications—
7.3.6 To ensure that they become available for further Section 90.27 of the FCC Rules identifies users eligible for
assignment as soon as possible. licensing on frequencies allocated for EMRS.
8.1.2 Eligibility Criteria—As stated in the FCC Rules, the
7.3.7 While EMS vehicles are enroute to a patient, the
following are eligible for licensing to use the radio frequency
communications system is used to keep them informed regard-
spectrum allocated by the FCC for the Emergency Medical
ing access to the patient and patient condition.
Radio Service:“ Persons or entities engaged in the provision of
7.4 Medical Coordination/Direction—The EMSS commu- basic or advanced life support services on an ongoing basis are
nications system should provide EMS field personnel with a eligible ... to operate stations for transmission of communica-
channel of communications that permits the exchange of tions essential for the delivery or rendition of emergency
treatment information with an EMSS hospital, while at the medical services for the provision of basic or advanced life
scene of the medical emergency, in an EMS ambulance and support.” EMRS applicants are also eligible for licensing to use
while enroute to an EMS hospital. Such communications also frequencies in the Special Emergency Radio Service (SERS):
serves to alert the receiving medical facility before the patient’s “in order to interface with other entities using SERS channels
arrival and to provide for coordination between medical and to conduct necessary non-emergency communications.”5
facilities. In areas in which the need frequently arises, consid- 8.2 EMSS Radio Service Coverage—This guide addresses
eration should be given to equipping EMS ambulances with radio frequencies and radio service coverage currently autho-
high-power portable radios or vehicular relay equipment and rized and available under FCC Rules for use for land mobile
hand-held portables to permit the exchange of patient treatment communications for EMSS. In the Emergency Medical Radio
information while away from an EMS ambulance. Guidelines Service, there are seven high-band VHF frequencies, five 220
for medical coordination/direction are contained in Practice MHz frequency pairs, and 35 UHF band frequency pairs. Many
F 1149. of these frequencies are restricted for specific uses, such as
7.5 Interservice Communications—Medical emergencies paging, intersystem use, medical coordination, vehicle coordi-
often involve the response of other public safety and emer- nation, or shared with other Public Safety Radio Services.
gency services. Interservice communications are needed to Appendix X1 lists the frequencies and usage limitations. While
support daily EMSS operations and mutual aid agreements and there are no 800-MHz band frequencies specifically allocated
for mobilization, command, and control of all emergency to EMS, all EMRS eligible may license 800-MHz frequencies
response units during a disaster situation. Although the various allocated for Public Safety Radio Services. In addition, there
services generally operate on different radio frequencies, in- are other land mobile communications services such as cellular
terservice radio communications can be provided by use of systems, citizen band radio, and prospective satellite relayed
mobile relays, cross-band operations, cross-frequency patching land mobile radio communications systems that are available
at the radio consoles, interservice use of common radio
frequencies, trunked radio services, or other measures. Tele-
phone lines between communications control centers for vari- 5
Summary of FCC Report and Order, PR Docket No. 91-72, Federal Register,
ous emergency response agencies can also be used for interser- March 3, 1993.

4
F 1220 – 95 (2001)
for public use. It is not intended that this guide exclude EMSS should all be directed to adjust their radio equipment for
usage of such communications systems. In 1987, The FCC operation on the selected base station frequency and to respond
Report on Docket No. 87-112 points out, however, that such in sequence as required. Usage of radio frequencies can
public communications systems that are merely extensions of thereby be expanded to satisfy mass casualty and disaster EMS
the public telephone net are not amenable to planned usage for communications needs.
public safety services. The usage of any available radio 8.2.4 Geographic coverage and control for EMSS radio
spectrum for EMSS communications should be based on the communications can be provided by various communication
capability of such systems of communications to provide the subsystem arrangements as illustrated in Figs. 1-4.
necessary linkage to satisfy criteria with respect to reliability of 8.3 Operational Considerations:
coverage of the EMSS operating area, grade of service (prob- 8.3.1 Statewide communications planning, including inter-
ability of blockage and delay), and accountability, that apply to state, regional, and local planning, is essential to successful
EMSS communications as well as to other public safety EMSS operation. EMSS operational control should be care-
communications such as fire and law enforcement communi- fully established and supported with communications opera-
cations. tional procedures.
8.2.1 Radio frequencies listed in Appendix X1, and cur- 8.3.2 EMSS communications systems should be planned
rently available for EMSS communications are in the VHF and operated so as to be compatible and not interfere with the
“low band” (33 to 48 MHz), the VHF “high band” (150 to 173 communications of adjacent EMSS. Compatibility means that
MHz), the UHF band (453 to 468 MHz) and in the 800-MHz EMS vehicles from one community can communicate with
frequency range. The VHF high band and the UHF frequency EMS vehicles and EMSS facilities in surrounding communi-
bands, which are most commonly used for EMS communica- ties. Communications compatibility of EMS vehicles is needed
tions, and the 800-MHz frequencies are line of sight, with for day-to-day EMSS activities and EMS response-to-disaster
communications range primarily a function of transmitter situations. EMSS communications goals, objectives, and plan-
power output, antenna gain, antenna height, and terrain. For ning guidelines that follow are derived from Refs (4), (5), and
planning purposes, estimates of the geographic area over which (6).
intelligible voice radio reception can be achieved between a
9. Goals and Objectives for EMSS Communications
specific radio base station site and a vehicle equipped with
mobile radio can be made using computerized communications 9.1 Determination of state goals and objectives require a
model services such as those described in Ref (2). definition of the specific role of state government in EMSS
8.2.2 Preinstallation estimates of radio geographic coverage communications in its jurisdiction and in boundary areas with
should be verified by postinstallation field tests using opera- adjacent states. In general, state governments do not own or
tional communications equipment. It is important to ensure that operate EMSS communications systems and do not exercise
the transmitted signal strength from EMSS communications control over local systems. Instead, state governments act more
base stations is adequate to provide good radio reception in in the role of planners, coordinators, regulators, and facilita-
EMSS ambulances and other response vehicles over the entire tors.
area services by an EMSS.
8.2.3 A single radio base station operating on a specific
radio frequency channel or channel pair permits separate
two-way communications with a single radio-equipped EMSS
ambulance operating on the same radio frequency channel or
channel pair. If the need exists to communicate separately with
multiple EMSS mobile units simultaneously, then base station
sites must be equipped with multiple radio transmitter/
receivers each equipped to operate on a separate radio fre-
quency. To communicate by radio in an area provided with
multiple transmitter/receivers, and EMSS mobile unit must use
a radio transmitter/receiver that can be adjusted to operate on
any base station frequency that may be available at a given
time.
NOTE 1—FCC Definitions (47 C.F.R. Sec. 90.7):
8.2.3.1 Specific estimates of radio frequency requirements
mobile station—a station in the mobile service intended to be used
to support EMSS communications demands for large popula- while in motion or during halts at unspecified points. This includes hand
tions are contained in Ref (3). Guidelines for determining the carried transmitters.
number of base station radio transmitter/receivers and radio base station—a station at a specified site authorized to communicate
frequencies needed to assure reliable EMSS communications with mobile stations.
in support of the EMS demands of various populations will be mobile service—a service of radiocommunication between mobile and
set forth in a future ASTM standard guide. base stations or between mobile stations.
NOTE 2—EMTs in ambulances equipped as “mobile stations” conduct
8.2.3.2 In instances of mass casualty response, when the two-way radio communications directly with medical control personnel at
need exists for an EMSS base station to communicate the same EMSS resource hospitals equipped as “base stations.”
information to several ambulances, the ambulances involved FIG. 1 An EMS Base/Mobile Communications System

5
F 1220 – 95 (2001)

NOTE 1—FCC Definitions (47 C.F.R. Sec. 90.7):


mobile repeater station—a mobile station authorized to retransmit
automatically on a mobile service frequency, communications to or from
hand-carried transmitters.
hand carried transmitters—See definition of mobile station under Fig.
1.
mobile service–See definition under Fig. 1. NOTE 1—FCC Definition (47 C.F.R. Sec. 90.7):
portable radio—Syn. for hand-carried transmitter. mobile relay station—a base station in the mobile service authorized to
NOTE 2—An EMT equipped with a “hand-carried” (portable) duplex retransmit automatically on a mobile service frequency communications
radio, while located outside of an ambulance equipped as a duplex which originate on the transmitting frequency of the mobile station.
“mobile repeater station” can conduct two-way radio communications via NOTE 2—Mobile Relay:
the ambulance, with medical control personnel at EMSS resource hospi- Transmit = F1.
tals equipped as “base stations.” This extends the range of on-line medical Receive = F2.
control communications for patients outside of, but within portable radio Base and Mobile:
communications range of, an ambulance. Transmit = F2.
FIG. 2 Extending the Range of Communications for EMTs While Receive = F1.
Outside of an Ambulance—Typical Both-Way Vehicular Repeater NOTE 3—A “mobile relay” located at a remote location can extend the
area and range of coverage for both dispatch and medical control
communications.
9.2 A state can be thought of as divided into a number of FIG. 3 Extending the Area and Range of Coverage for EMSS
local EMS communications systems. The state’s primary Communications Between Ambulances, Hospitals, and a
concern is with the external interfaces and interactions of these Dispatch Center
local EMS communications systems with each other and with
their environments. The state government is not so much units passing through from other regions. Items such as voice
concerned with the other details of the design and operation of brevity codes and language must be standardized between
the individual local systems. Following is a description and regions.
comments on some of the important interfaces and relation- 9.5 A third level of interface is between a local EMS
ships. communications system and other types of emergency com-
9.3 The most important interface is the one between a local munications systems, such as law enforcement and emergency
EMS communications system and the population it serves. management and fire services, within the same area and with
Here, the concern of the state government should be that the neighboring areas. The concerns are again the avoidance of
system serves its intended functions. The focus is on the end interference (such as at shared radio sites) and assurance of
results: the character, quantity, and quality of service provided compatibility for multiagency operations. With the creation of
to the population, rather than the mechanics of how the service the Emergency Medical Radio Service, EMS agencies main-
is provided. Items of interest include the degree to which the tain their eligibility in the Special Emergency Radio Service
communications system supports the medical requirements for (SERS). For EMS communications using frequencies in the
basic life support or advanced life support, communications SERS, there is a concern for interference from school bus radio
parameters such as probability of place and time of coverage, communications and from hospital, veterinary and physician
communications practices, and operator training standards. business communications that are permitted by the FCC. A
9.4 The second level of interface is between a local EMS “frequency coordination” process must be carried out as part of
communications system and other EMSS communications the statewide EMS communications system planning process
systems in neighboring areas. There are two main concerns. to lessen instances of this interference potential.
First, as a minimum, the various communications systems 9.6 A fourth interface is from the local communications
should not interfere with each other. This requires consider- system to the state government. The primary concern of the
ation of coverage boundaries, fixed allocation of unique state is in ensuring that its population receives timely and
frequencies, and real-time coordination and sharing of com- appropriate emergency medical care in accordance with state
mon frequencies. Second, systems should be able to cooperate statutes and regulations and health care standards. Additional
constructively with each other in such matters as point-to-point concerns are efficient and effective use by the local systems of
communications and communications within an area to mobile resources provided by the state or otherwise shared in common

6
F 1220 – 95 (2001)
in many of these areas without substantial costs. In other cases,
the achievement of certain objectives will involve substantial
costs, and therefore, given the national and state economies,
those objectives must be considered long term.
10. Goal 1—State EMSS Communication Systems Should
Meet Recognized Standards for Functional
Performance
10.1 State government should work to ensure that recog-
nized standards for functional performance (end result delivery
of service to the public) are met. Specifically, EMS communi-
cations systems should conform at least to minimum perfor-
mance standards for public safety communications system
contained in “Report on Police” (Ref (7)) and “Report on the
Criminal Justice System” (Ref (8)), which have been broadly
accepted by state and local public safety services and APCO as
the basis for public safety communications systems planning
and design. To the extent possible in view of local needs,
resources, and capabilities, the standards should be applied
NOTE 1—FCC Definitions (47 C.F.R. Sec. 90.7): uniformly throughout the state so that residents in rural areas
land mobile radio system—a regularly interacting group of base, do not necessarily receive lower levels of service than do urban
mobile, and associated control and fixed relay stations intended to provide residents.
land mobile communications service over a single area of operation.
10.2 Objective—EMSS requirement should be explicitly
land mobile radio service—mobile service between base stations and
land mobile stations, or between land mobile stations. considered in plans for improvement of citizen-access commu-
NOTE 2—Real-time centralized coordination/control of base station and nications.
mobile relay frequencies and operations in an EMSS “land mobile radio” 10.2.1 Citizen-access communication systems (such as
can be accomplished by use of dedicated telephone lines, microwave 9-1-1) handle all types of emergencies and are thus inherently
links, or combinations of both. In this illustration, the Dispatch Center also broader in scope than EMSS. State EMSS authorities generally
serves as the EMSS communications control center. do not have the lead role in the development of citizen-access
FIG. 4 Centralized Control of Radio Communications in an EMSS
Land Mobile Radio System
systems. The statewide development of 9-1-1 in many states,
for example, has been assigned to the state emergency man-
agement or law enforcement authorities. State EMSS authori-
with multiple users. These might include radio sites, statewide ties should however participate in the statewide planning for
microwave and telephone systems, and various services such expanding the coverage and enhancing existing 9-1-1 systems
as maintenance and purchasing. Complaints from adjoining to ensure that EMSS requirements are taken into account.
states concerning radio communications interference in bound- Guidelines for planning and developing 9-1-1 enhanced tele-
ary areas should also be the concern of state government. phone systems are contained in Guide F 1381. Additional
9.7 A fifth interface is from the state to the federal govern- information regarding Emergency Medical Dispatch (EMD) is
ment. The state acts as a representative of local EMSS in contained in Practice F 1258, Practice F 1552, and Practice
dealing with federal agencies and other national organizations. F 1560. Following is a summary of the requirements for 9-1-1
9.8 Finally, the state must be concerned with management enhanced telephone systems as set forth in Guide F 1381:
of the state-level program. The management functions include 10.2.1.1 In any given area, there should be only one
ongoing planning; state and upper-level regional organizations; telephone number to call for requesting emergency assistance.
personnel qualifications, standards, and training; direction of It is a national goal that this number should be “9-1-1.” A
the program by laws, rules, funding incentives, other means; variety of supplemental and alternative arrangements exist in
and control of the program by means of information feedback, various areas of the United States and new alternative provi-
analysis, evaluation, and corrective action. sions for citizens access are being introduced and evaluated in
9.9 In summary, therefore, the areas of concern for defini- areas in which 9-1-1 implementation is not operationally or
tion of statewide goals and objectives are as follows: economically feasible. These alternatives include roadway
9.9.1 Functional performance standards, telephone call boxes, cellular radio emergency telephone
9.9.2 Interface with other EMS systems, numbers, and area code 800 toll free emergency numbers. Such
9.9.3 Interface with other types of systems, alternatives should include a single telephone number other
9.9.4 Utilization of state and common resources, than 9-1-1 for all types of emergencies or barring that, at least
9.9.5 National representation, and a single telephone number or other means of access for
9.9.6 State level management. reporting the existence of all medical emergencies. The single
9.10 Each of these areas is addressed as a separate goal in telephone number or means of access should be published on
the remaining sections of this guide. Each goal is followed by the inside cover of telephone directories, displayed in public
a listing of specific related objectives and a discussion of the telephone booths and otherwise prominently displayed to the
implications of each objective. Note that progress can be made public. Citizens should not have to look up EMSS ambulance

7
F 1220 – 95 (2001)
companies in the telephone directories to request emergency conjunction with a combined public safety dispatch center. The
medical assistance. They should not have to know their following requirements apply to an effective EMSS dispatch
location in relation to jurisdictional boundaries to determine center:
the proper number to call. Whatever means are provided, 10.3.1.1 The EMSS dispatch center should at all times
citizen public telephone access to emergency services should monitor and be aware of the current location, status, and
incorporate the following features: capability of all EMS response units in the area including
10.2.1.2 There should be no financial barrier to requesting private and public aeromedical units, ground ambulances, fire
emergency medical assistance. Coins should not be required department EMS units, first responders, and so forth.
for EMS calls from public phones. (This “dial tone first” 10.3.1.2 The EMSS dispatch center should be authorized
feature is usually provided in 9-1-1 systems.) Long distance and able to optimize the allocation of resources by preassigning
EMS calls should be toll-free. specific units to particular locations in anticipation of need and
10.2.1.3 Sufficient lines should be provided to ensure that relocating units as conditions change.
no more than one call for emergency medical assistance in 100 10.3.1.3 The EMSS dispatch center should have written
attempts receive a busy signal during the average busy hour policies and procedures for the assignment of specific combi-
(P.01 grade of service). nations of units to particular types of EMS incidents.
10.2.1.4 Sufficient answering positions and operators should 10.3.2 Computer-aided dispatching, which includes provi-
be provided to ensure that at least 90 % of the calls for sions for dispatching EMSS and other public safety services,
emergency medical assistance are answered within 10 s during can facilitate coordination of emergency medical responses.
the average busy hour. 10.4 Objective—EMSS dispatch should be as direct as
10.2.1.5 Call answerers should be provided with written possible:
protocols for distinguishing calls for emergency medical assis- 10.4.1 In the ideal case, the person who answers the call for
tance from other types of emergencies and should have emergency medical assistance is the radio dispatcher who can
adequate training to use the protocols effectively. make direct contact with the units to be assigned to the
incident. More commonly, however, one or more call transfers
10.2.1.6 Call transfer or information relay, if used, should
or information relays are necessary before the emergency
be fast and reliable. Call referral (telling the caller to hang up
information gets out to the response units who can actually act
and call a different number) should never be used for calls for
upon it. In any case, the chain of communications should be as
emergency medical assistance.
short, simple, and direct as possible. The EMS caller should
10.2.1.7 If call transfer is used, the caller should never have never have to talk to more than two people, for example, the
to talk to more than two people (for example, the 9-1-1 call 9-1-1 call answerer and the EMS dispatcher. Where the EMSS
answerer and the EMSS dispatcher). dispatcher must communicate with multiple units and locations
10.2.1.8 Where feasible and appropriate, the development for a given incident, the communications to all should occur
of alternative and backup systems for citizen access to emer- simultaneously (or as nearly so as possible) using common or
gency medical care should be encouraged. Such systems might similar means of communications. There should also be some
include the use of citizen band radio and monitoring networks, arrangement for positive feedback or an acknowledgment from
cellular telephone, and radio call boxes. Also, police stations, each unit that the dispatch message has been received and
fire stations, and government buildings equipped with two-way understood.
public safety radio service should be posted and made available 10.4.2 EMSS dispatch should be prompt. The delay be-
for walk-in access to emergency medical care. tween the time of first notification of a medical emergency and
10.2.1.9 There should be a plan of action to maintain public the receipt of the dispatch message by the responding EMSS
access to emergency medical care when the primary telephone unit (ambulance or first responder) should never exceed 2 min.
service of the 9-1-1 system becomes inoperative. The plan Using the standard practice described in Practice F 1258, 2 min
might include provisions for stationing radio equipped person- is sufficient for an emergency medical dispatcher, trained in
nel at central locations such as malls, major intersections, accordance with Practice F 1552, to interrogate a caller to
schools, and so forth. The plan should include provisions for determine the nature, severity, and most appropriate resource to
public safety announcements and alerts on local radio and dispatch.
television advising the public of the situation and what should 10.5 Objective—EMSS communications systems should
be done to report emergencies. support statewide EMSS program requirements and local
10.3 Objective—EMSS resources should be coordinated: EMSS standard operating procedures by providing the follow-
10.3.1 EMSS communications in a local area should be ing land mobile radio communications capabilities:
organized so as to guarantee for each caller that the nearest or 10.5.1 Provisions should exist for dispatch and coordination
most appropriate EMSS response unit(s) will be assigned to the communications as described in 7.3. Statewide EMSS program
call. This objective may be met by the use of “staging or requirements and local standard operating procedures should
move-up” plans to handle periods of peak EMS demand; by provide for prompt, reliable interagency coordination and
dynamic positioning of ambulances to enhance area-wide direct access to communications for EMSS ambulance dispatch
response readiness; by use of resource allocation protocols to and coordination as described in 10.3 and 10.4.
assure that the most appropriate response unit is used; and by 10.5.2 Provisions for medical coordination/direction com-
the development of an EMSS dispatch center usually in munications are described in 7.4. These provisions should

8
F 1220 – 95 (2001)
conform with statewide EMSS program requirements and EMSS dispatch centers and for medical direction from desig-
communication guidelines and should be incorporated in local nated EMSS hospitals over the entire territory defined by
EMSS communication plans so as to support local protocols statewide EMSS program requirements.
for on-line medical direction to prehospital EMS response 10.6.1.1 Each EMSS hospital should be able to communi-
personnel. cate with any EMS ambulance within its area of responsibility,
10.5.2.1 A local (regional) EMSS communications plan or to ambulances at any location which the hospital is the
should be prepared in accordance with state guidelines and nearest or most appropriate emergency medical facility for
should be kept updated. The plan should define the purposes issuing medical direction, or for exchange of patient pre-arrival
and scope of the system and communication system features information, or both.
selected to support normal EMSS medical coordination proce- 10.6.1.2 Each EMS ambulance should be able to commu-
dures. nicate with any radio-equipped EMSS hospital in the state,
10.5.2.2 In areas where EMS ambulances frequently en- when within range for mobile radio communications.
counter medical emergencies in which patients are remote from
10.6.1.3 Each EMSS ambulance should be able to commu-
ambulance access, consideration should be given to providing
nicate by radio with any EMSS dispatch facility in the state
for two-way radio voice communications from EMS ambu-
lance personnel at the immediate site of a medical emergency when within range for mobile radio communications.
to an EMSS hospital. This communication capability permits 10.6.2 State and local (regional) EMSS communications
on-line medical direction preparatory to moving a patient from plans should provide for statewide compatibility and interop-
a remote site to an EMS ambulance. erability of communications by defining statewide radio fre-
10.5.2.3 Provisions should exist for two-way voice commu- quency requirements and compatibility factors for EMSS
nications between EMS ambulances and designated EMSS dispatch centers and for EMSS hospitals.
hospitals for consultation on patient status, treatment, and 10.6.3 EMSS communications plans should specify a suffi-
transport destination. cient number of dispatch and medical coordination frequencies
10.5.2.4 Provisions should exist for two-way voice commu- to reliably support the peak demand for EMSS communica-
nications between EMS ambulances and non-EMSS hospitals tions with the same reliability as other public safety services.
destined to receive EMS patients, for consultation regarding 10.6.3.1 For instances of peak EMS demand such as mul-
patient arrivals, patient condition, and need for transfer to tiple casualty accidents, each EMSS hospital should be pro-
EMSS hospitals. vided with sufficient radio frequencies and base stations to
10.5.2.5 The decision to require that an EMSS have provi- support reliably a simultaneous EMS communications demand
sions for biomedical telemetry from EMS ambulances and equal to its capacity for simultaneous treatment of life threat-
from the immediate site of medical emergencies, is an “off- ening and serious medical emergencies for the duration of
line” EMSS medical control decision. If a decision is made to prehospital emergency medical care and transport to an EMSS
provide for biomedical telemetry, it should be incorporated into hospital.
the system design. 10.6.3.2 EMSS base stations should be equipped to avoid
10.5.2.6 Delay in EMSS hospital access to the channel interference from reception of radio communications intended
being used for medical direction should be minimized. This for other radio stations.
can be accomplished by prescribing communications proce- 10.6.3.3 Consideration should be given to providing for
dures restricting the duration of ambulance to hospital trans-
selective calling of EMSS hospitals by EMSS ambulances.
missions or by including design features to permit hospital
preemption of the ambulance to hospital communications 10.6.4 In developing the statewide EMSS communication
channel. The decision to provide communications system plan, consideration should be given to FCC licensing provi-
design features to permit EMSS hospitals to preempt a channel sions, the number of frequencies available, their transmission
in use by an EMS ambulance (doctor interrupt) should be a characteristics, other authorized users of the various radio
matter for “off-line” medical control. frequencies available for EMSS, and the impact of these
10.5.2.7 Provisions should exist for EMSS hospitals to features on the range of communication, and their adequacy for
arrange for direct two-way voice communications, as the need providing reliable communication for EMSS communication
arises, with any other hospital within the EMSS area of demands. Implementation of the FCC Rules on EMRS should
responsibility that is destined to receive patients by EMSS result in a gradual reduction in the probability of interference
ambulance. This may be accomplished by a variety of means and blockage of EMSS communications on these exclusive
such as direct radio link, if such exist, by radio-telephone EMS radio frequencies. However, there may be increased
interconnect, or by telephone. probability of interference and blockage of EMSS communi-
10.6 Objective—EMSS communications systems should cation by other authorized users on frequencies that are shared
meet recognized standards while conforming to statewide with non-EMS communications services.
EMSS program requirements and local EMSS communications 10.7 Objective—The EMSS communications system design
plans. Some of these statewide requirements are listed below: should ensure continued communications during disasters:
10.6.1 Statewide and local EMSS communications plans 10.7.1 EMSS communications are particularly important
should contain provisions for reliable communications between during disasters. To ensure that an EMS communications
EMSS ambulances for dispatch and routing from designated system can satisfy the special needs for emergency medical

9
F 1220 – 95 (2001)
response during a disaster, and not itself become disabled by beyond that for the period determined appropriate by appli-
the disaster, the system design should include the following cable state EMS communications guidelines.
considerations: 10.9.3 The reliability of radio coverage for two-way voice
10.7.1.1 The public-switched telephone network is suscep- communications between an EMSS hospital and an EMS
tible to traffic overload and physical disruption during disas- ambulance should be 0.95 or 95 %. This means that the medial
ters. Leased private lines are protected from traffic overload but signal level to and from an EMSS ambulance should exceed
not physical outage. The system design should therefore that necessary to provide 20 dB of quieting in the presence of
provide alternative and backup communication links, such as ambient noise in 95 % of the randomly selected locations
radio and microwave. Telephone lines coming into communi- within the service area. Proof-of-performance tests should be
cation centers should be protected from damage, and where made with the EMSS ambulance in motion.
possible, alternate routing from multiple telephone company 10.9.4 The equipment must be durable and easy to operate.
central offices should be used. This is particularly true for equipment to be used by EMTs,
10.7.1.2 Means should be provided to allow police, fire, physicians, and nurses.
rescue, and ambulance units from different agencies to com-
municate with each other directly during disaster operations. 11. Goal 2—Local EMSS Communications Should be
Available techniques include use of common disaster channels, Compatible with, and Should Not Interfere with,
multiagency multichannel radios, or cross-patch of channels at EMSS Communications in Neighboring Areas
public safety communications base stations.
11.1 Objective—EMSS communications coverage bound-
10.7.1.3 Fixed communications facilities should be pro-
aries should be defined and respected:
vided with independent standby power sources to avoid depen-
dency on commercial power. 11.1.1 Normal radio communication coverage boundaries
between neighboring EMSS should be mapped out and mutu-
10.7.1.4 Important locations in an area should be covered by
ally agreed upon. Measures should be taken to respect the
more than one radio site so that communication is not totally
boundaries and minimize interference outside the boundaries
lost in the event of failure of one radio site.
by prudent base station transmitter site designs, including use
10.7.1.5 Sufficient telephone lines, radio channel capacity, of directional antennas, limiting antenna elevations and radi-
and operating positions (or rapid expansion capability) should ated power, and other technical design features.
be designed into the system to handle heavy traffic loads
generated by disasters. 11.1.1.1 Interference can also be avoided by adoption of
appropriate standard operating procedures, for example, for
10.7.1.6 Disaster communications procedures should be VHF communications, adopt “listen-before-talk” channel
well defined with emphasis on interagency coordination. Di- monitoring policies.
saster procedures should be straight forward expansions of
day-to-day procedures rather than radical changes. 11.1.1.2 In UHF communications, centralized monitoring of
all MED channel traffic and real-time centralized assignment of
10.7.1.7 Disaster systems and procedures should be periodi- operating frequencies is one strategy for limiting interference
cally exercised. with other EMSS communications as well as with non-EMSS
10.8 Objective—Communication operators should be users of the same spectrum. Digitally Addressed Trunked
trained in both emergency medical services and in communi- Communications Systems (DATCS) technology defined in
cations: APCO Project 16A, includes provisions for minimizing such
10.8.1 Problems can be caused by physicians, nurses, and interference. This technological approach to minimizing inter-
EMTs inexperienced in the use of communications equipment ference was recommended in Ref (3).
and also by public safety communications center personnel not 11.2 Objective—Frequency allocations and usage should be
familiar with EMSS concepts and terminology. Sufficient coordinated statewide and nationally when appropriate. State
cross-training should therefore be provided on both sides to EMSS radio frequency usage plans are subject to changing
ensure that EMSS protocols and technical communications provisions of the FCC Rules and Regulations. The State Office
procedures are clearly understood and uniformly applied of Emergency Medical Services should assist with frequency
throughout the system. Physicians, nurses, and EMTs should coordination to establish a statewide frequency sharing pattern.
be cross-trained in EMD communications practices and proce- The following advisory sections describe some of the implica-
dures as described in Practice F 1258 on the EMD practice, and tions of current FCC Rules and Regulations on statewide
Practice F 1552 on EMS training. planning for coordinating the usage of radio frequencies
10.9 Objective—EMSS communications systems should available for communications so as to satisfy state EMSS
meet technical standards applicable to all public safety com- program goals and objectives.
munications systems: 11.2.1 EMS dispatching is done on both VHF and UHF
10.9.1 The system must meet all applicable FCC rules and frequencies and on frequencies in the 800 MHz band. In some
regulations. areas, where EMS is provided by local government or fire
10.9.2 All EMS communications should be recorded. The services, local government or fire service frequencies are being
recording should include date and time signals. As a minimum, used for EMS dispatching. In EMS systems in which dispatch-
communication recordings should be retained at least as long ing is to be performed on frequencies in different bands or
as other local public safety communication recordings and radio services, state EMS authorities should use frequency

10
F 1220 – 95 (2001)
coordination services in planning and selecting frequencies and 11.3 Objective—The provisions for continuous tone-coded
in planning base station radio coverage for EMS radio- squelch system (CTCSS) tones and other control tones and
dispatching systems. codes should be coordinated statewide, including along inter-
11.2.2 The UHF frequencies of MED-1 through MED-10 state boundaries. This coordination function is not provided by
are subject to statewide use and must be coordinated by a state FCC-esignated frequency coordinators and should be done by
frequency coordinator. The state EMS communications plan is state EMS authorities. All agencies should advise the state
used as the framework for coordination of these frequencies EMS authority of the tones used. Records and database should
and all mobile and portable radio equipment on these frequen- be established and maintained.
cies must incorporate all of the MED-1 through MED-10 11.4 Objective—Regional and local systems should be in-
channels. The state EMS communications plan should require terconnected with fixed radio links:
that a minimum of four channels be operational within each 11.4.1 At least one frequency should be designated within a
station, unless a specifically identified need is demonstrated to state as the standard frequency for interhospital communica-
and approved by the Office of Emergency Medical Services. tions for coordinating resources or response. This frequency
11.2.3 In some regions, such as large cities with populations should be implemented in all emergency hospitals and should
greater than 4 000 000, it may be desirable to implement all extend to EMS dispatch and communications control centers to
eight MED channels to prevent unsatisfactory communications permit hospital resources to be effectively coordinated with
because of overloading during the average daily busy hour. other public safety resources. Operating procedures should be
Real-time frequency coordination, where channels are assigned established on a uniform basis regionally and statewide. The
on an “as needed real-time basis,” in these instances should be VHF frequencies 155.400 and 155.340 MHz have been used in
used to reduce interference. The communications design many states for this purpose.
should be coordinated within the region. In the largest cities, 11.5 Objective—Mobile unit parameters should be stan-
even this communication capacity is insufficient to prevent dardized statewide for intersystem compatibility (interoper-
unsatisfactory communication blockage because of overload- ability):
ing during the average daily busy hour. In such instances, 11.5.1 The objective of interoperability is to enable every
consideration should be given to various alternatives for EMS mobile unit to travel anywhere in the state (for example,
reducing communication blockage such as changing commu- on a mutual aid assignment, or on a patient transport to a
nication protocols to reduce channel loading; using communi- distant specialty care facility, or for disaster response) and to
cation technology to facilitate real-time communication chan- remain in communications with an EMSS at all times.
nel sharing (digitally addressed trunking technology) or; based Achievement of this objective would require the following:
on FCC Rules on FCC Docket No. 87-112, planning for the use 11.5.1.1 All EMSS in a state should adhere to a common
of additional spectrum in the 821- to 824-/866-to 869-MHz mobile frequency plan. The plan should provide for a statewide
bands. Whatever means is used, both dispatching and medical set of common calling frequencies by which an EMS ambu-
coordination communication for EMSS should have a grade of lance operating out of its home region can call EMSS hospitals
service such that blockage occurs no more than five times in a for selection of a locally available radio frequency for medical
hundred attempts to access a channel (grade of service P.05). coordination communications.
11.2.4 In smaller cities and in rural areas, frequency coor- 11.5.1.2 EMSS ambulances should be equipped for and
dination services can be used to establish area-wide frequency informed of selective calling codes, and related equipment, and
sharing pattern to provide a suitable grade of service for selective calling procedures to enable them to communicate
EMSS. Spare communication capacity should be provided for with EMSS hospitals statewide.
multicasualty incidents and for disaster situations. Frequency 11.5.1.3 EMSS ambulances should be equipped with and
coordination services must be used and may be helpful in informed of tone-coded squelch, equipment, and procedures to
assisting small communities to develop EMS communication enable them to communicate with EMSS hospitals statewide.
plans that include provision for coordinated sharing of base 11.5.1.4 Equipment and procedures should be provided for
station usage among EMSS users. maintenance of radio contact with an EMSS ambulance trav-
11.2.5 In smaller cities and in rural areas, frequency coor- eling from one EMSS region to another.
dination services can be used to establish area-wide frequency 11.5.1.5 There should be statewide uniform training of
sharing pattern to provide a suitable grade of service for communications operators. For the EMS communications sys-
EMSS. Spare communication capacity should be provided for tem to function, the people, including the field teams, dispatch-
multicasualty incidents and for disaster situations. Communi- ers, hospital personnel, and the system users, must know how
cation capacity can be used to advantage for medical admin- to operate the telephone and radio equipment required for their
istrative communication and to permit rural physicians to stay communications. For example, the system users who use
in contact with their hospitals while they are on the road and public telephones to call for emergency assistance must know
otherwise away from their offices. Frequency coordination what number to call. The field teams, dispatchers, telecommu-
services must be used and may be helpful in assisting small nicators, and hospital and medical personnel must know how to
communities to develop EMS communication plans that in- operate their radio equipment and the procedures to use to
clude provision for coordinated sharing of base station usage establish and maintain radio contact. Although this may sound
among EMSS users and other non-EMSS eligible medical use elementary, if the people who must operate the EMS commu-
of the MED channels. nications equipment do not understand how the equipment or

11
F 1220 – 95 (2001)
the system functions, they will not use it. This leads to 12.4.1.3 Cross-channel radio patch equipment can be used
misunderstandings, confusion and frustration at a minimum to establish a temporary functional interconnection of multiple
and could result in interference or a more serious consequence, agency channels.
including loss of life at ALS levels. Provisions for such training 12.4.1.4 Verbal relay of messages by a dispatcher is possible
should be explicitly included in ASTM standards for training of if the dispatch communications center has base stations or
EMS personnel. See Practice F 1031*, Practice F 1149, Guide control equipment, or both, on all of the multiple agency
F 1229, Guide F 1287*, Guide F 1418, and F 1453*. frequencies.
NOTE 1—ASTM standard numbers marked with an “*” do not include
explicit provisions for communications training. Liaison should be con- 13. Goal 4—EMSS Communications Should Make
ducted between Subcommittees F30.02 on Training and F30.04 on Maximum Use of State and Common Resources
Communications to recommend changes to these standards. New stan- Where Appropriate, Cost Effective, and Authorized
dards being developed for the paramedic and the ambulance operator
should be reviewed to ensure that appropriate communications training is 13.1 Cost savings can be achieved by sharing such re-
included. sources as radio sites, microwave and telephone systems, and
system services such as centralized purchasing and training.
12. Goal 3—Local EMSS Communications Should Be This type of sharing also promotes interchange of ideas,
Compatible With, and Should Not Interfere With, standardization of equipment and procedures, and effective
Other Types of Communications Systems system interfaces.
12.1 EMSS communications should be coordinated with the 13.2 Objective—EMSS communication planners should be
law enforcement, fire, emergency management services and encouraged to share radio sites:
other public safety radio systems in their areas in terms of 13.2.1 In many states, the advantageous mountain top radio
frequency usage, site engineering, and intersystem communi- sites have already been developed. Some of these sites are
cations. operated by state agencies such as the Department of Trans-
12.2 Objective—EMSS frequencies should be coordinated portation, state police, and state educational organizations.
with other public safety frequencies. Some sites developed for specific EMSS communications may
12.2.1 Radio systems have the potential for mutually inter- also be usable by neighboring EMSS. The state should encour-
fering with collocated and nearby systems in the other public age sharing of sites by the following practices:
safety services, even if the systems operate on other frequen- 13.2.1.1 Identifying advantageous sites that could be
cies. For this reason EMS frequency assignments, site selec- shared.
tion, elevation, and radiated power should be coordinated and 13.2.1.2 Cataloging site characteristics such as location,
examined each time systems are modified or expanded. Such elevation, frequencies in use, shelter, rack and tower space
problems can usually be resolved by local communications available, and availability of commercial and standby power
technicians. State EMS offices should provide technical com- and telephone service.
munications assistance to resolve such problems that may arise 13.2.1.3 Developing uniform policies for cost allocation,
if needed technical assistance is not available locally. maintenance, interference avoidance by means of appropriate
12.3 Objective—EMSS should be “good neighbors” at use of cavities, filters, and so forth.
shared radio sites: 13.3 Objective—EMSS communication planners should be
12.3.1 EMS radio equipment cannot be arbitrarily installed encouraged to share state and common system components
at a site without consideration of the effect on systems already such as microwave and telephone:
using the site. Factors to be considered include the following: 13.3.1 There are many extensive state-operated microwave
12.3.1.1 Intermodulation analysis should be performed to systems for statewide interconnection of communication con-
predict likely levels of interference. trol centers and mountain-top radio sites and for support of
12.3.1.2 All of the radio equipment, including EMSS, state-owned government telephone services. These and similar
should use isolators and bandpass cavity filters. resources could be advantageously used in EMSS communi-
12.3.1.3 The minimum number of antennae should be used cations for such purposes as control of remote base stations and
with adequate spacing to avoid interference. repeaters, a backup alternative to commercial telephone facili-
12.3.1.4 Directional antennae should be used where appro- ties, and replacement of expensive leased telephone lines. To
priate. encourage sharing of these resources, states should inventory
12.3.1.5 Minimum radiated power should be used. them, make their characteristics and capabilities known to
12.4 Objective—EMS radio systems should be compatible EMSS planners, and develop policies for shared use.
with other public safety systems for multiagency operations: 13.4 Objective—EMSS communication planners should be
12.4.1 Compatibility can be achieved in the following ways: encouraged to make effective use of state-provided services.
12.4.1.1 EMSS and other public safety radios can be 13.4.1 State government should act on behalf of local
equipped with one or more special common mutual operating EMSS to take advantage of economies of scale and efficiencies
frequencies. not otherwise available to the local systems. Examples of
12.4.1.2 EMSS radios can be equipped with some of the opportunities in this area include the following:
working frequencies of the other public safety agencies and 13.4.1.1 Provide centralized purchasing through state con-
vice versa. tracts. This can be particularly advantageous for the purchase

12
F 1220 – 95 (2001)
of EMSS radio equipment using federal grants, and it probably penalty for each traffic violation. Other states have imposed a
could be extended to cover “pooled” purchases with private surcharge for EMSS for each renewal of a passenger motor
funds. vehicle registration.
13.4.1.2 Develop arrangements for statewide maintenance 14.4 Objective—The state should take an active role to
services. influence federal communication law and rule-making deci-
13.4.1.3 Offer engineering design services to local EMSS sions.
communications planners. 14.4.1 Local EMSS communications planners have little
13.4.1.4 Develop and provide standardized equipment power and few opportunities to affect or influence the devel-
specifications and request for proposal and contract boilerplate opment of federal laws and regulations that have impact on
materials. them. The state government has the power to affect events at
13.4.1.5 Offer or sponsor EMSS communications operator the national level and has many opportunities to do so. What is
training programs. needed is an organized program to channel states efforts in this
area. Such a program might include the following:
14. Goal 5—The State Should Act as the Representative
14.4.1.1 Review and comment, where appropriate, on FCC
of Local EMSS in Dealing with Federal Agencies and
notices of inquiry and rule-making proposals affecting EMSS
National Organizations
communications.
14.1 In most states, a state EMSS director, in the state 14.4.1.2 Review and comment on proposed regulatory
department of health acts as a fiscal agent in application and changes in other federal agencies, such as NHTSA, DHHS, and
distribution of grants for EMSS from a number of federal FEMA.
programs. There is a need for broadening the scope of activity 14.4.1.3 Use of state lobbyists in matters affecting EMSS
to encompass functions that affect EMSS statewide, may be communications.
beyond the capability of small local EMSS, and are legitimate
14.4.1.4 Informing state-elected representatives of the sig-
functions for state government. Following are some examples
nificance of issues affecting EMSS communications.
of such functions:
14.1.1 Monitoring activity at the federal and national level
15. Goal 6—The State Should Have a Program for
including federal and private foundation grant programs, laws,
Positive Management of Its EMSS Communications
and rule changes affecting EMSS communications.
Activities
14.1.2 Seeking out and securing new sources of funding.
14.1.3 Participating in the regulatory decision-making pro- 15.1 State EMSS directors should have an EMSS commu-
cess at the federal level, particularly by commenting on FCC nication management program to identify and resolve interstate
dockets that may impact on EMSS communications. as well as intrastate communication coordination problems.
14.2 Objective—The state government should monitor fed- 15.2 Objective—EMSS communication planning should be
eral and national level activity affecting EMSS communica- established as an ongoing process. In developing a state plan,
tions: the planner should be cognizant of the requirements of the FCC
14.2.1 The state should have a systematic mechanism for rules and address differences between the rules and the plan.
maintaining awareness of EMSS activity at the federal and For example, the state plan may require more frequencies for
national level, assessing the effects of that activity on EMSS specific uses above and beyond the requirements of the federal
communications, and communicating the findings to local rules.
EMSS planners. Activities of interest include: 15.2.1 Current detailed guidance and information for state-
14.2.1.1 Announcements of new federal or private founda- wide EMSS communications planning is contained in (4).
tion grant programs, changes in existing programs, and grant 15.2.2 Statewide EMSS communications planning is
awards. needed to resolve issues arising from shortages of spectrum
14.2.1.2 Significant new advances in EMSS communica- and other uncertainties. For example, in some situations, the
tions technology or system management. FCC rules permit EMSS to use radio frequencies allocated to
14.2.1.3 New or changed laws affecting EMSS. other land mobile services such as the Special Emergency
14.2.1.4 Changes in FCC Rules and Regulations and in Radio Service, local Government Radio Service, Law Enforce-
federal agency EMSS grant criteria. ment Radio Service, Fire Radio Service, Business Radio
14.3 Objective—The state should assist local EMSS plan- Service, and others. Such use, however, must meet eligibility
ners in identifying and securing outside sources of funds: requirements or be covered by cooperative use agreements
14.3.1 State EMSS directors play a critical role in this area with an existing licensee. These requirements should be
by administering grant funds for EMSS from various federal considered in the planning process. Even with the creation of
programs. The federal grant programs are generally limited to the Emergency Medical Radio Service, there are still insuffi-
“seed funding” and at best are limited and unreliable as long cient radio frequencies available to meet the demands of all
range funding sources. Local funding sources are also severely eligible users. Additionally, there are no specific provisions
limited. The need remains for specific improvements in EMSS within the FCC Rules and Regulations for EMS aeromedical or
communications. States should become active in locating and helicopter communications. These unique communications,
using new sources of funding such as private foundation grant including flight following and wide range radio coverage must
programs. In some states, statutes have been enacted to raise be addressed in future FCC rules and communications guide-
funds for EMSS by requiring a mandatory additional financial lines.

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F 1220 – 95 (2001)
15.2.3 The completion of a statewide EMSS communica- munication operators along the lines of existing EMT stan-
tion master plan and regional planning guidelines should be a dards. The state should also provide or sponsor communication
primary planning objective. As a next step, the state should training programs for communication center operators (profes-
encourage and support development of subsidiary regional sional telecommunicators), hospital communication equipment
level plans. After that, all of the plans at all levels should be operators (doctors and nurses), and mobile communication
reviewed at frequent intervals (at least every two years) and equipment operators (EMTs).
adjusted to adapt to changing conditions. While these plans are 15.5.3 The State EMS authority should participate in the
important, the planning process, and continuing contacts frequency coordination process required under Section 90.27
among state and local EMSS communication planners are of FCC Rules to assist eligible nongovernmental applicants to
paramount. Only through such an ongoing planning process is obtain licenses from the FCC to operate on the EMRS
it possible to get consensus on the many communication frequencies. This requires coordination with the International
system features that must be standardized statewide if EMSS Municipal Signal Association (IMSA) and the International
functional performance objectives are to be achieved. Association of Fire Chiefs (IAFC), which are the Federal
15.3 Objective—Statewide aeromedical communications Communication Commission recognized frequency coordina-
radio frequency plans should be developed and implemented to tors for the Emergency Medical Radio Service and the Special
enable emergency aeromedical services to communicate with Emergency Radio Service.
all necessary elements of other emergency medical and public 15.5.3.1 For radio license applications by entities in the
safety services. These plans should include: EMRS, FCC Rules Section 90.27 requires that an application
15.3.1 Radio frequencies for air/ground vehicle communi- be accompanied by a statement prepared by the governmental
cations to ensure that any aeromedical rotor-wing aircraft can body having jurisdiction over the state’s emergency medical
communicate with any ground EMS vehicle. service plans indicating that the applicant is included in the
15.3.2 Radio frequencies for air/hospital communications to state’s emergency plan or otherwise supporting the application.
ensure that any aeromedical rotor-wing aircraft can communi- The essential components of this statement attest that: the
cate with hospital emergency departments. applicant provides basic or advanced life support services on a
15.3.3 Provisions for an aeromedical communications cen- ongoing basis, the application is in conformance with (or not in
ter to ensure that any aeromedical rotor-wing aircraft can conflict with) the state’s EMC communications plan, and the
communicate with their communications center. statement is supported by an authorized signature.
15.3.4 As a precondition for such planning, state EMS 15.5.3.2 The state office of emergency medical service
authorities should support for authorization of such frequencies should establish a method by which the statement (letter or
from the Federal Communications Commission, The Federal authorization) is provided. This authorization procedure should
Aviation Administration, and certified frequency coordinators. be documented and filed with the IMSA/IAFC frequency
15.4 There is a need for some type of statewide organiza- coordinator. There should be a method established to determine
tional structure to carry out planning, implementation, and the applicant’s eligibility under the FCC’s Rules. The state
management of regional and local EMSS communications. EMS Director, or his designee, is normally the signatory for
This structure should be made responsive to current needs by establishing this eligibility. The designated person must be
shifting the focus of its work from the pursuit of specific grant knowledgeable of the technical aspects of the EMS communi-
funding objectives to the more substantive concerns of system cations systems within the state.
functional performance such as interregional cooperation, non- 15.6 Objective—The state should provide positive direction
interference, utilization of shared and common resources, and by means of laws, rules, and funding policies.
overall system management. In addition, the organization must 15.6.1 Generally, state laws and regulations regarding com-
be provided with state-level technical staff support. munications are nonexistent or weak because of preeminence
15.5 Objective—States should strengthen their own EMSS of FCC Rules and Regulations relative to communications.
communications personnel resources and assist with local and Ways should be sought by states to regulate communications in
regional personnel standards and training. matters affecting the safety of life, as with EMSS communi-
15.5.1 The agency of state government having overall cations. One obvious need is regional and local adherence to
responsibility for EMSS should be concerned and involved in the statewide EMS communication master plan, when ap-
technical communication matters. There should be a commu- proved, should be mandatory. There should be legal minimum
nication specialist on the state EMSS staff. This person should qualifications and requirements for EMSS communication
assume responsibility for much of the total state involvement operators since these people are just as important to patient
outlined in its EMSS communication master plan including safety and well-being as EMTs, and the state should ensure that
observance of functional performance standards, arbitration of they are well-qualified. State-level management responsibili-
intersystem interference problems, development of compatibil- ties and organizational structures for EMSS communications
ity standards, promotion of sharing of state and common should be clearly defined in state law.
resources, interface with federal and national organizations, 15.7 Objective—Mechanisms should be developed to pro-
and overall communication program management. vide for feedback of information on EMSS communications,
15.5.2 In addition, the state should help regional and local evaluation of the information, and corrective action.
systems in certain personnel areas. For example, the state 15.7.1 These mechanisms could include methods such as
should establish qualifications and standards for EMSS com- the use of periodic questionnaires, meetings, and problem

14
F 1220 – 95 (2001)
referrals. They could also extend to more direct and forceful 16. Keywords
methods such as an inspection program. In general, the state
16.1 emergency medical services; telecommunications
should assist local communications managers in early identi-
fication of problems and prompt and effective solutions.

APPENDIXES

(Nonmandatory Information)

X1. EMERGENCY MEDICAL RADIO SERVICE (EMRS) FREQUENCIES (MHz)

X1.1 VHF High Band 453.175/458.175 . . Biomedical telemetry permitted.8,9


X1.1.1 Base or Mobile: 460.525/465.525 . . Shared with Police and Fire services10
460.550/465.550 . . Shared with Police and Fire services10
155.325 ... Biomedical telemetry allowed in some areas.6 462.950/467.950 . . MED 9—Vehicle Coordination11,12
155.340 ... Biomedical telemetry allowed in some areas. 462.975/467.975 . . MED 10—Vehicle Coordination11,12
X1.1.1.1 May be designated by common consent as an 463.000/468.000 . . MED 1—Medical Coordination13
intersystem mutual assistance frequency under an area-wide 463.025/468.025 . . MED 2—Medical Coordination12
medical communications plan. 463.050/468.050 . . MED 3—Medical Coordination13
155.355 ... Biomedical telemetry allowed in some areas.6 463.075/468.075 . . MED 4—Medical Coordination13
155.385 ... Biomedical telemetry allowed in some areas.6 463.100/468.100 . . MED 5—Medical Coordination14
155.400 ... Biomedical telemetry allowed in some areas.6 463.125/468.125 . . MED 6—Medical Coordination14
X1.1.2 Mobile-only: 463.150/468.150 . . MED 7—Medical Coordination14
463.175/468.175 . . MED 8—Medical Coordination14
150.775 X1.2.2 Shared With All Other Public Safety Radio Services:
150.790 453.050/458.050 453.400/458.400 453.750/458.750
453.100/458.100 453.450/458.450 453.800/458.800
X1.1.3 Base/Mobile: 453.150/458.150 453.500/458.500 453.850/458.850
220.9025/221.90257 453.200/458.200 453.550/458.550 453.900/458.900
220.9075/221.90757 453.250/458.250 453.600/458.600 453.950/458.950
453.300/458.300 453.650/458.650
220.9125/221.91257 453.350/458.350 453.700/458.700
220.9175/221.91757
200.9225/221.92257 X1.3 90.53 Frequencies Available:
220.8025/221.8025.Public Safety/Mutual Aid (except PS)7 X1.3.1 Table X1.1 indicates frequencies available for as-
220.8075/221.8075.Public Safety/Mutual Aid (except PS)7 signment to stations in the Special Emergency Radio Service,
220.8125/221.8125.Public Safety/Mutual Aid (except PS)7 together with the class of station(s) to which they are normally
220.8175/221.8175.Public Safety/Mutual Aid (except PS)7 assigned and the specific assignment limitations that are
220.8225/221.8225.Public Safety/Mutual Aid (except PS)7 explained in X1.3.2. (Frequencies below 450 MHz indicated
220.8275/221.8275.Public Safety/Mutual Aid (except PS)7 for base or mobile stations may be authorized to fixed stations
220.8325/221.8325.Public Safety/Mutual Aid (except PS)7 on a secondary basis to stations in the mobile service):
220.8375/221.8375.Public Safety/Mutual Aid (except PS)7 X1.3.2 Explanation of assignment limitations appearing in
220.8425/221.8425.Public Safety/Mutual Aid (except PS)7 Table X1.1:
220.8475/221.8475.Public Safety/Mutual Aid (except PS)7
X1.2 UHF Band:
10
Intra- and inter-system mutual assistance allowed.
X1.2.1 Base/Mobile: 11
Licensees may transmit one-way alert paging to ambulance and rescue squad
personnel on a secondary basis on these frequencies.
453.025/458.025 . . Biomedical telemetry permitted.8,9 12
This frequency is primarily authorized for use in the dispatch of medical care
453.075/458.075 . . Biomedical telemetry permitted.8,9 vehicles and personnel for the rendition of medical services. This frequency may
also be assigned for intra- and inter-system mutual assistance. The frequency pairs
453.125/458.125 . . Biomedical telemetry permitted.8,9 462.950/467.950 and 462.975/467.975 may be referred to as MED-9 and MED-10,
respectively.
13
This frequency is authorized for use for operations in biomedical telemetry
6
Licensees may transmit one-way alert paging to ambulance and rescue squad stations. Entities eligible in this Radio Service may use this frequency on a
personnel on a secondary basis on these frequencies. secondary basis for any other permissible communications consistent with FCC
7
See FCC Rules 47 CFR, Subpart T for “Regulations Governing Licensing and Rules 90.27(a).
14
Use of Frequencies in the 220-222 MHz Band”. This frequency is authorized for communications between medical facilities
8
Paging licenses as of March 20, 1991 may continue to operate on a primary and personnel related to medical supervision and instruction for the treatment and
basis until January 14, 1998. transport of patients in the rendition or delivery of medical services. Entities eligible
9
Highway radio call box operations first licensed before March 31, 1980 in this Radio Service may use this frequency on a secondary basis for any other
permitted in accordance with FCC Rules §90.17(c) (11). permissible communications consistent with FCC Rules 90.27(a).

15
F 1220 – 95 (2001)
TABLE X1.1 Special Emergency Radio Service Frequency Table (ii) That evidence is submitted showing that an arrange-
Frequency or Band Class of Station(s) Limitations ment has been made with the coast station licensee for the
Kilohertz: handling of emergency communications permitted by §80.453
2000 to 3000 Fixed 1 and §90.47(d) of this chapter.
2726 Base or mobile 2
3201 do ...
(iii) That operation of the special emergency fixed station
Megahertz: shall at no time conflict with any provision of Part 80 of this
33.02 do 3, 25 chapter and further, that such operation in general shall
33.04 do 25
33.06 do 3, 25 conform to the practices employed by Public Ship Stations for
33.08 do 25 radiotelephone communication with the same Public Coast
33.10 do 3, 25 Station.
35.02 Mobile 27
35.64 Base 4 (2) This frequency is shared with the Local Government
35.68 do 4 Radio Service where it is available for state guard operations.
37.90 Base or mobile 3, 25
37.94 do 3, 25
(3) This frequency is shared with the Highway Maintenance
37.98 do 3, 25 Radio Service.
43.64 Base 4, 28 (4) This frequency will be assigned only for one-way paging
43.68 do 4
45.92 Base or mobile 25
communications to mobile receivers. Transmissions for the
45.96 do 25 purpose of activating or controlling remote objects on this
46.00 do 25 frequency are not authorized.
46.04 do 25
47.42 do 5, 25 (5) This frequency is reserved for assignment only to
47.46 do 25 national organizations eligible for disaster relief operation
47.50 do 25 under§ 90.41.
47.54 do 25
47.58 do 25 (6) The frequencies available for use at operational fixed
47.62 do 25 stations in the band 72 to 76 MHz are listed in §90.257(a) (1).
47.66 do 25
72.00 to 76.00 Operational-fixed 6
These frequencies are shared with other services and are
150 to 170 Base or mobile 30 available only in accordance with the provisions of §90.257.
Megahertz: (7) Frequencies in this band are available only for one-way
152.0075 Base 4, 31
155.160 Base or mobile 25
paging operations in accordance with §90.494 of this part.
155.175 do 25 (8) (Reserved).
155.205 do 25 (9) The frequencies in the band 10.55 to 10.68 GHz are
155.220 do 25
155.235 do 25 available for digital termination systems and for associated
155.265 do 25 internodal links in the Point-to-Point Microwave Radio Ser-
155.280 do 25 vice. No new licenses will be issued under this subpart but
155.295 do 25
157.450 Base 4, 11 current licenses will be renewed.
163.250 do 4 (10) (Reserved).
169–172 Mobile 33
450–470 Fixed 12
(11) Operations on this frequency are limited to 30-W
453.025 Base 26 transmitter output power.
453.075 do 26 (12) The requirements for secondary fixed use of frequencies
453.125 do 26
453.175 do 26
in this band are set forth in §90.261.
Megahertz: (13) (Reserved).
806 to 824 Mobile 21 (14) (Reserved).
851 to 869 Base or mobile 21
928 and above Operational-fixed 22 (15) (Reserved).
929 to 930 Base only 7 (16) (Reserved).
1427 to 1435 Operational-fixed, base or mobile 23 (17) (Reserved).
2450 to 2500 Base or mobile 24
10 550 to 10 680 do 9 (18) (Reserved).
(19) (Reserved).
(20) (Reserved).
(1) Appropriate frequencies in the band 2000 to 3000 kHz (21) Subpart S contains rules for assignment of frequencies
which are designated in Part 80 of this chapter as available to in the 806- to 824-MHz and 851- to 869-MHz bands.
Public Ship Stations for telephone communications with Public (22) Assignment of frequencies above 928 MHz for
Coast Stations may be assigned on a secondary basis to Special operational-fixed stations is governed by Part 94 of this
Emergency fixed stations for communication with Public Coast chapter.
Stations only, provided such stations are located in the United (23) This frequency band is available in this service subject
States and the following conditions are met: to the provisions of §90.259.
(i) That such fixed station is established pursuant to the (24) Available only on a shared basis with stations in other
eligibility provisions of §90.47 and that the isolated area services, and subject to no protection from interference as a
involved in an island or other location not more than 480 km result of the operation of industrial, scientific, or medical (ISM)
(300 statute miles) removed from the desired point of commu- devices. In the 2483.5- to 2500-MHz band, no applications for
nication and isolated from that point by water. new or modification to existing stations to increase the number

16
F 1220 – 95 (2001)
of transmitters will be accepted. Existing licensees as of July (34) (Reserved).
25, 1985, or on a subsequent date following as a result of (c) Additional frequencies available. In addition to the
submitting an application for license on or before July 25, frequencies shown in the frequency table of this section, the
1985, are grandfathered and their operation is coprimary with following frequencies are available in this service. (See also
the Radio Determination Satellite Service. §90.253.)
(25) A licensee regularly conducting two-way communica- (1) Substitution of frequencies available below 25 MHz may
tion operations on this frequency may, on a secondary basis, be made in accordance with the provisions of§ 90.263.
also transmit one-way alert-paging signals to ambulance and (2) (Reserved).
rescue squad personnel. (3) Frequencies in the band 73.0 to 74.6 MHz may be
(26) Paging licensees as of March 20, 1991 may continue to assigned to stations authorizing their use on or before Decem-
operate on a primary basis until January 14, 1998. ber 1, 1961, but no new stations will be authorized in this band,
(27) This frequency is available in this service only to nor will expansion of existing systems be permitted. (See also
persons eligible under the provisions of §90.38(a) for operation §90.257.)
of transmitters having a maximum power output of 3 W using (4) The frequency bands 31.99 to 32.00 MHz, 33.00 to 33.01
A1A, A1D, A2B, A2D, F1B, F1D, F2B, F2D, G1B, G1D, MHz, 33.99 to 34.00 MHz, 37.93 to 38.00 MHz, 39.00 to 39.01
G2B, or G2D emission. This frequency is also available in the MHz, 39.99 to 40.00 MHz, and 42.00 to 42.01 MHz are
Business Radio Service on a coequal basis with the Special available for assignment for developmental operation subject
Emergency Radio Service users. to the provisions of Subpart Q.
(28) No new licenses will be granted for one-way paging (5) Frequencies in the 421- to 430-MHz band are available
under§ 90.487 for use on this frequency after August 1, 1980. in the Detroit, Cleveland, and Buffalo areas in accordance with
This frequency is available to persons eligible for station the rules in §§90.273 through 90.281.
licenses under the provisions of §90.38(a) on a coequal basis (d) Limitation on number of frequencies assignable.
with one-way paging users under §90.487 before August 1, Normally only one frequency below 450 MHz will be assigned
1985 and on a primary basis after August 1, 1985. Only A1A, for mobile service operations by a single applicant in a given
A1D, A2B, A2D, F1B, F1D, F2B, F2D, G1B, G1D, G2B, G2D area. The assignment of an additional frequency will be made
emissions and power not exceeding 10 W will be authorized. only upon a satisfactory showing of need, except that:
Antennas having gain greater than 0 dBd will not be autho- (1) Additional frequencies above 25 MHz may be assigned
rized. Transmissions shall not exceed a 2-s duration. in connection with the operation of mobile repeaters in
(29) (Reserved). accordance with §90.247, notwithstanding this limitation.
(30) Rules concerning the use of this band for narrowband (2) An additional frequency may be assigned for paging
operations are set forth in §90.271. operations from those frequencies available under
(31) This frequency is removed by 22.5 kHz from frequen- §90.53(b)(4).
cies assigned to other radio services. Utilization of this (3) The frequency 155.340 MHz may be assigned as an
frequency may result in, as well as be subject to, interference additional frequency when it is designated as a mutual assis-
under certain operating conditions. In considering the use of tance frequency as provided in §90.53(b)(10).
this frequency, adjacent channel operations should be taken (4) Additional frequencies may be assigned for fixed station
into consideration. If interference occurs, the licensee may be operations.
required to take the necessary steps to resolve the problem. See (5) Frequencies in the 25 to 50 MHz, 150 to 170 MHz, and
§90.173(b). 450 to 512 MHz bands, and the frequency bands 903 to 904
(32) (Reserved). MHz, 904 to 912 MHz, 918 to 926 MHz, and 926 to 927 MHz
(33) Frequencies in this band will be assigned for low power may be assigned for the operation of automatic vehicle
wireless microphones in accordance with the provisions of§ monitoring (AVM) systems in accordance with §90.239, not-
90.265. withstanding this limitation.

X2. ACRONYMS AND GLOSSARY FOR EMS COMMUNICATIONS

X2.1 Acronyms ALI—automatic location identification.


A AM—amplitude modulation.
AAT—above average terrain. AMSL—above mean sea level.
AC—alternating current. ANI—automatic number identification.
ACD—automatic call distributor. APB—all points bulletin.
ACLS—advanced cardiac life support. APCO—Associated Public-Safety Communications Officers.
ACSB—amplitude compandored single-sideband. ASCII—American standard code for information interchange.
ADP—automatic data processing. ASTM—American Society for Testing and Materials.
AGL—above ground level. ASTRA—Automated Statewide Telecommunications and
ALS—advanced life support. Records Access.
ALERT—automatic law enforcement response team. ATLS—Advanced Trauma Life Support.

17
F 1220 – 95 (2001)
AT&T—American Telephone and Telegraph Company. ECG—electrocardiogram.
AVC—automatic volume control. EDP—electronic data processing.
AVI—automatic vehicle identification. EIA—Electronic Industries Association.
B EMD—emergency medical dispatcher.
balun—balanced-to-unbalanced line transformer. EMF—electromotive force.
BCD—binary coded decimal. EKG—electrocardiogram.
BFO—beat frequency oscillator. EMDPRS—emergency medical dispatch priority reference
BIT—binary digit. system.
BLS—basic life support. EMS—emergency medical service.
BPS—bits per second. EMSS—emergency medical service system.
BSC—binary synchronous communications. EMT—emergency medical technician.
C EMT-B—emergency medical technician-basic.
C—Celsius. EMT-AI—emergency medical technician-advanced interme-
CAD—computer-aided dispatch. diate.
CB—citizens band. EMT-D—emergency medical technician-defibrillator.
CCH—computerized criminal history. EMT-I—emergency medical technician-intermediate.
CCITT—International Telegraph and Telephone Consultative EMT-IV—emergency medical technician-intraveneous certi-
Committee. fied.
CCSA—common control switching arrangement. EMT-P—emergency medical technician-paramedic.
CCTV—closed circuit television. EOC—emergency operations center.
CCU—Coronary Care Unit or Critical Care Unit. EOM—end of message.
CDC—Cooperative Dispatch Center. ERCC—emergency resource coordination center.
CG—Channel Guard (R) Trademark of General Electric. ERP—effective radiated power.
CMED—Central Medical Emergency Dispatch. ESS—electronic switching system.
CMR—Common Mode Rejection. EST—Eastern Standard Time.
CMRR—Common Mode Rejection Ratio. ETA—Estimated Time of Arrival.
CNIL—Calling Number Identification and Location. ETV—Educational Television.
CO—Central Office. F
COG—Council of Governments. F—Fahrenheit.
COR—Coronary Observation Radio. FCC—U.S. Federal Communications Commission.
CPR—cardiopulmonary resuscitation. FCCA—Forestry Conservation Communications Association.
CJIS—Criminal Justice Information System. FEMA—Federal Emergency Management Agency.
CTCSS—continuous tone controlled squelch system. FET—field-effect transistor.
D FM—frequency modulation.
dB—decibel. freq.—frequency.
dBm—decibel referenced to 1 mW. FORTRAN—formula translation (computer language).
dBu—decibel referenced to 1 µV/m. FSK—frequency-shift keying.
dBv—decibel referenced to 1 V. FX—foreign exchange.
dBW—decibel referenced to 1 W. G
DC—direct current. GE—General Electric.
DCS—Division of Computer Services. GESS—General Electric Service Station.
DDD—direct distance dialing. GFW—ground fault warning.
DID—direct inward dialing. GHz—gigahertz (1000 MHz).
dod—direct outward dialing. GIGO—garbage in, garbage out.
DOD—U.S. Department of Defense. GMT—Greenwich mean time (Zulu).
DOT—U.S. Department of Transportation. GSA—General Services Administration.
DRG—diagnosis related grouping. GT&E—General Telephone and Electronics.
DP—double pole. H
DPDT—double pole double throw. HEAR—hospital emergency administrative radio.
DTMF—dual-tone multifrequency. HF—high frequency.
DPST—double pole single throw. HYSIS—highway safety information system.
E HV—high voltage.
EACOM—emergency and administrative communications Hz—hertz.
system. I
EAS—extended area service. I—current in amperes.
E & M—the receive and transmit leads of a signaling system. IAFC—International Association of Fire Chiefs.
EAX—electronic automatic exchange. IACP—International Association of Chiefs of Police.
ECC—emergency communications center. IC—integrated circuit.

18
F 1220 – 95 (2001)
ICO—individual channel oscillator. PM—Pulse Modulation.
ICOM—integrated circuit oscillator module. PSAP—public safety answering point.
ICU—intensive care unit. PSCC—Public Safety Communications Council.
ICX—intercity exchange link. PTT—press to transmit or push to talk.
IEEE—Institute of Electrical and Electronic Engineers. Q
IF—intermediate frequency. QEI—quantifiable evaluation indicator.
IMSA—International Municipal Signal Association.
R
IMTS—improved mobile telephone service.
RCU—remote control unit.
IRAC—interdepartmental radio advisory committee.
RF—radio frequency.
ISPERN—Illinois State Police Emergency Radio Network.
IT&T—International Telephone and Telegraph Corporation. Rx—receive.
ITU—International Telecommunication Union. S
J SERS—Special Emergency Radio Service.
JAN—Joint Army-Navy Specifications. SIRSA—Special Industrial Radio Service Association, Inc.
JETEC—joint electron tube engineering council. SMR—Specialized Mobile Radio.
JFET—junction field-effect transistor. SMSA—standard metropolitan statistical area.
JEMS—Journal of Emergency Medical Services. SPA—State Planning Agency.
K SWR—Standing Wave Radio.
kbps—kilobits per second. T
kHz—kilohertz (1000 hertz). TASI—time assignment speech interpolation.
L TCAM—telecommunications access method.
LATA—local access transport area. Telco—telephone company.
LMR—land mobile radio. TELPAK—see definition in glossary section.
LEAA—law enforcement assistance administration. TPL—terminal per line.
LETS—Law Enforcement Teletypewriter Service. TPS—terminal per station.
LORAN—long-range navigation. TSPS—see definition in Glossary section.
LSI—large-scale integration. Tx—transmit.
LOS—line of sight. U
LRO—lead regional organization. UHF—ultra-high frequency.
LSU—life support unit. UL—Underwriters Laboratories, Inc.
M UPS—uninterruptible power supply.
MAST—Military Assistance to Safety and Traffic. USITA—U.S. Independent Telephone Association.
MCCU—mobile coronary care unit. USFS—U.S. Forest Service.
MF—medium frequency. V
MHz—megahertz. V—volts.
MICT—Mobile Intensive Care Technician. VAC—volts, alternating current.
MICU—Mobile Intensive Care Unit.
VDC—volts, direct current.
MRCC—Medical Resource Coordination Center.
VHF—very high frequency.
N VOM—volt-ohm meter.
NABER—National Association of Business and Educational VOR—voice operated relay.
Radio, Inc.
VOX—voice operated switch.
NCIC—National Crime Information Center.
VSWR—voltage standing wave ratio.
NCMCN—North Carolina Medical Communications Net-
VTVM—vacuum tube voltmeter.
work.
VU—Volume Unit.
NEAR—National Emergency Aid Radio.
NHTSA—National Highway Traffic Safety Administration. W
NLETS—National Law Enforcement Telecommunications WATS—Wide Area Telephone Service.
System. WECO—Western Electric Company.
Nxx—see definition in glossary section. WPM—words per minute.
NPA—number plan area. X
O Xcvr.—transceiver.
O-D—origin-destination. Xfmr.—transformer.
ONI—operator number identification. Xmit.—transmit.
OTP—Office of Telecommunications Policy. Xmtr.—transmitter.
P Xtal—crystal.
PABX—Private Automatic Branch Exchange. Z
PBX—Private Branch Exchange. Z—impedance.
PL—Private Line (R) Trademark of Motorola. ZULU—time zone at Greenwich, England.

19
F 1220 – 95 (2001)
X2.2 FCC Codes and Names of Radio Services activity—the expenditure of time and resources.
Industrial: adapter—a device used for changing the terminal connec-
IB—business tions of a circuit or part to connect to another circuit or part
IF—forest products with unlike connections.
IM—motion picture alphabet, phonetic—a method of passing alphabetic infor-
IP—petroleum mation over a poor communication path with word substitution
IS—special industrial for letters. One phonetic alphabet is: Alfa; Bravo; Charlie;
IT—telephone maintenance Delta; Echo; Foxtrot; Golf; Hotel; India; Juliett; Kilo; Lima;
IW—power Mike; November; Oscar; Papa; Quebec; Romeo; Sierra; Tango;
IX—manufacturers Uniform; Victor; Whiskey; X-ray; Yankee; Zulu.
IY—relay press American Standard Code for Information Interchange
Motor Carrier: (ASCII)—an eight-level code for data transfer adopted by the
LI—interurban passenger American Standards Association to achieve compatibility be-
LJ—interurban property tween data devices.
LU—urban passenger
amplitude compandored single-sideband—a form of side-
LV—urban property
band modulation used for narrow channel transmission that
Land Transportation:
incorporates a pilot tone.
LA—automobile emergency
LR—railroad amplitude modulation (AM)—modulation in which the
LX—taxicab amplitude of the carrier-frequency current is varied above and
Public Safety: below its normal value in accordance with the audio, picture, or
PF —fire other intelligence signal to be transmitted.
PH —highway maintenance analog—physical representation of information such that
PL —local government the representation bears an exact relationship to the original
PP —police information. Pertaining to data in the form of continuously
PO —forestry conservation variable physical qualities.
PS—special emergency analog communication—system of telecommunications
RS—radiolocation used to transmit information other than voice which is some-
ZA—general mobile times used in telemetry.
Classes of Radio Stations (FCC): antenna—a system of wires or electrical conductors used
FB—base for reception or transmission of radio waves. Specifically, a
FB2—mobile relay radiator that couples the transmission line or lead-in to space
FB4—community repeater for transmission or reception of electromagnetic radio waves. It
FX1—control changes electrical currents into electromagnetic radio waves
MO—mobile and vice versa.
MO3—mobile/vehicular repeater antenna, isotropic—a theoretical antenna with identical
FXO—operational fixed radiation in every direction.
FX2—fixed relay antenna, parabolic—a directional antenna with a radiating
FX—fixed (or receiving) element and a paraboloid reflector that concen-
FLT—auxiliary test trates the power into a beam.
FXY—interzone
antenna polarization—the direction of the radiated electric
FXZ—zone
field in relation to the surface of the earth. Generally vertical in
LR—radio location
mobile radio use.
MR—radio location mobile
806- to 821-/851- to 866-MHz Bands: arc—a discharge of electricity.
Conventional Category Trunked arrester, lightning—a device designed to protect electrical
GB business YB equipment or property from damage by lightning.
GO industrial/land transportation YO
GP public safety/special emergency YP
assigned frequency—the frequency appearing on a station
GX commercial (SMRS) YX authorization from which the carrier frequency may deviate by
929 to 930-MHz Band: an amount not to exceed that permitted by the frequency
GS—private carrier paging systems tolerance.
Associated Public-Safety Communications Officers
X2.3 Glossary
(APCO) —a nonprofit public safety radio users group com-
X2.3.1 posed of administrators and communications technical, opera-
A tions, and command personnel.15
acoustic feedback—the transfer of sound waves from a loud
speaker or end terminal to any previous component within an
audio system, such as a microphone. Acoustic feedback may be
audible, subaudible, or superaudible. 15
Headquarters office is in New Smyrna Beach, FL 32070.

20
F 1220 – 95 (2001)
ASTM—a scientific and technical organization formed for beacon—a radio transmitter or lights designed to indicate
the development of standards on characteristics and perfor- exact geographical location or direction.
mance of materials, products, systems, and services.16 beam—a configuration of radiated energy whose rays are
attack time—the interval required after a sudden increase in sharply directional and parallel.
input signal to a transducer (transmitter, receiver, and so forth) beat—a regularly recurring pulsation from the combination
to attain a percentage of final output level as a result of this of two-tone or frequency waves of different frequencies.
increase. beat frequency—the frequency produced when signals of
attenuation—the decrease in amplitude of a signal during two different frequencies are combined and refracted. The beat
its transmission from one point to another. It may be expressed frequency is equal in value to the difference between the
as a ratio or, by extension of the term, in decibels. original frequencies.
attenuator—a device for reducing the energy of a wave bel—a unit of relative power, named after Alexander Gra-
without introducing distortion. Also called a pad, gain control, ham Bell, and used to express differences in power.
level adjustor, volume control, and so forth. beeper—a pocket-paging receiver that emits a beeping
audible signal—a buzzer, bell, or other audible sound sound upon receiving a page specifically directed to it.
device that indicates an incoming call. biomedical telemetry (biotelemetry)—the technique of
audio—pertaining to frequencies corresponding to normally monitoring or measuring vital biological parameters and trans-
audible sound waves. These frequencies range from 15 to mitting data to a receiving point at a remote location.
20 000 Hz. Biophone—trade name of Biocom, Inc. for portable telem-
aural—pertaining to the ear or sound. etry devices.
automatic gain control (AGC)—a receiver circuit that bit—a unit of digital information (abbreviation of “binary
maintains the output constant with wide variations in the digit”).
receiver input level. boom microphone—a microphone arranged on an arm-type
automatic volume control (AVC)—a self-acting gain con- mechanical support to permit better placement of the micro-
trol that maintains the output of a receiver constant despite phone.
variations in received signal strength. braid—a group of fibrous or metal filaments or threads
automatic number identification (ANI)—equipment for woven into a cylindrical shape to form a covering over one or
recording the calling party’s number without operator inter- more wires.
vention. broadcast—radio or television transmission intended for
B general reception.
back bone—a point-to-point communications system using Business Radio Service—a subpart of the Industrial Radio
several stations. Services section of the FCC rules.
back-to-back repeater—a repeater consisting of a receiver
busy indicator—an indicator provided at a control point to
and transmitter with the output of the receiver connected
indicate the in use condition of a circuit or channel.
directly to the input of the transmitter.
C
band (radio frequency)—a range of frequencies between
cable—one or more insulated or noninsulated wires used to
two definite limits. By international agreement, the radio
conduct electrical current or impulses. Grouped insulated wires
spectrum is divided into nine bands. For example, the very
are called a multiconductor cable.
high-frequency (VHF) band extends from 30 to 300 MHz.
calibrate—to determine error by comparison with a known
bandpass filter—passes frequencies within a specified band
standard.
and attenuates all frequencies outside that band.
bandwidth—(1) the width of a band of frequencies used for call, all—the alerting of all decoder-equipped units in a
a particular purpose and (2) the range of frequencies within system by the transmission of a single coded signal.
which a performance characteristic of a device is above call, group—the alerting of subdivided selective call groups
specified limits. For filters, attenuators, and amplifiers these by function, type of vehicle, location, and so forth by sending
limits are generally taken to be 3 dB (half-power) below the a single coded signal.
average level. call, individual—the alerting of a specific coded decoder
baseband—for microwave systems, the available frequency unit by sending a single coded signal.
band that the RF equipment is capable of transmitting. call answerer—the initial answerer of a call for assistance
base station—an item of fixed radio hardware consisting of whether by 9-1-1 or other telephone method.
a transmitter and a receiver. call sign—Federal Communications Commission assigned
baud—used to define the operating speed of a printing identifying letters and numbers used for identification of a
telegraph or data system. It is the total number of discrete radio station, transmitter, or transmission.
conditions or signal events per second. call referral method—the calling party is referred to a
baudot code—a five-unit code used for teletypewriter sig- secondary number.
nals. call relay method—the call is answered at the PSAP where
the pertinent information is gathered and then the interrogator
relays the information to the proper public safety agency for
16
ASTM Committee F30 is developing consensus standards for emergency their action. This can be accomplished by radio, intercom,
medical services. ASTM Headquarters is in West Conshohocken, PA. telephone, and so forth.

21
F 1220 – 95 (2001)
call transfer method—the PSAP interrogator determines circuit merit—a rating of overall circuit quality. Circuit
the proper responding agency and connects the user to that merit 85’ is clear circuit. Merit 83’ is readable with noise. Any
agency which then performs the necessary dispatching in rating below 83’ is not readable and generally unacceptable.
accordance with prearranged plans with cooperating agencies. class of service—service order code designation of the
call party hold—enables the public safety answering point combination of telephone service features (equipment, calling
to control the connection for confirmation and tracing of a call. area units, dial types) to which business and residence custom-
capture effect—an effect occurring in FM reception when ers subscribe. It is used for rating, identification, and assign-
the stronger of two signals on the same frequency suppresses ment purposes.
the weaker signal. coaxial cable—a transmission line in which one conductor
cardioid microphone—a microphone having a heart-shaped completely surrounds the other, the two being coaxial and
space response pattern of 180° in front and minimum response separated by a continuous solid dielectric or by dielectric
in the rear. spacers.
carrier—a radio signal generally without voice or other code dialing—a method of signaling or encoding and
information. decoding address codes by the use of standard telephone dial.
carrier control timer (CCT)—a device that limits the command and control center (central communications
length of time that the transmitter carrier is on. center)—a system that is responsible for establishing commu-
carrier frequency—the frequency of an unmodulated elec- nications channels and identifying the necessary equipment
tromagnetic wave produced by the transmitter. and facilities to permit immediate management and control of
cavity resonator—a space enclosed by a metal conductor in an EMS patient. This operation must provide access and
which oscillating electromagnetic energy is stored and whose availability to public safety resources essential to the effective
resonant frequency is determined by the geometry of the and efficient EMS management of the immediate EMS prob-
enclosure. lem.
cellular radio—a commercially available mobile or portable common mode rejection (CMR)—the ability of a differen-
radio telephone service. tial amplifier to reject unwanted signals.
Celsius—the metric scale of temperature in which water communications subsystem—comprises those resources
freezes at 0° and boils at 100°C. To convert a Celsius and arrangements for notifying the EMS system of an emer-
temperature to Fahrenheit, multiple by 9/5 and add 32. gency, for mobilizing and dispatching resources, for exchang-
central medical emergency dispatch (CMED)—see com- ing information, for remote monitoring of vital indicators, and
mand and control center. for the radio transmission of treatment procedures and direc-
central office—sometimes called a wire center; the smallest tions.
subdivision within the telephone system which has relatively communications system—a collection of individual com-
permanent geographic boundaries. munication networks, transmission system, relay stations, con-
change out—to replace. trol and base stations, capable of interconnection and interop-
channel element—a temperature-compensated crystal oscil- erations that are designed to form an integral whole. The
lator. individual components must serve a common purpose, be
channel guard—General Electric’s trademark for continu- technically compatible, use common procedures, respond to
ous tone-coded squelch system (CTCSS). control, and operate in unison.
channel, point-to-point—a radio channel used for radio comparator—a circuit that compares two or more signals
communications between two definite fixed stations. and selects the strongest or best.
channel, radio—an assigned band of radio frequencies of compression—in audio systems, reducing the volume range
sufficient width to permit its use for radio communication. The of the input signal so that the minimum output has less noise
necessary width of a channel depends on the type of transmis- and the maximum output has less distortion.
sion and the tolerance for the frequency of emission. compressor—a variable gain audio device used to provide a
channel, television—a band of radio frequencies 6 MHz relatively constant output level for a wide range of varying
wide used for television broadcast. input levels.
channelization—the assignment of circuits to channels and computer—an electrical device that can accept information,
the arrangement of those channels into groups. process it mathematically in accordance with previous instruc-
charge—to replenish the electrical potential in a battery or tions, and provide the results of this processing.
capacitor. cone of silence—the area directly over or under a vertical
charge, fast or quick—a method of quickly recharging transmitting antenna in which little or no signal is radiated.
batteries under controlled conditions. console—a cabinet housing electronic circuitry normally
charge, trickle—the continuous charge of a battery at a used in controlling other equipment such as transmitters and
slow rate. receivers installed at a remote location.
chart, 4/3 earth’s radius—a radio profile chart whose continuous tone-controlled squelch system (CTCSS)—a
horizontal lines are curved to correspond to an earth having a system wherein radio receiver(s) are equipped with a tone
radius 4⁄3 times larger than actual earth radius. responsive device which allows audio signals to appear at the
chassis—the framework on which parts of a radio or other receiver audio output only when a carrier modulated with a
electronic circuits are mounted. specific tone is received. The tone must be continuously

22
F 1220 – 95 (2001)
present for continuous audio output. CTCSS functions are DC control—a remote base station control scheme that
sometimes referred to by various trade names such as private requires metallic conductors and currents of different values to
line or PL (Motorola Communications & Electronics), Channel control the station’s various functions.
Guard or CG (General Electric Mobile Radio), or Quiet decoding—the conversion and recognition by the addressed
Channel (RCA). (receiving) unit of numerical address codes that have been
control console—a desk-mounted, enclosed piece of equip- transmitted through a communications system.
ment which contains a number of controls or circuits used to dedicated telephone line—a telephone wire pair, originat-
operate a radio station. ing at one point, and terminating at another point, operating in
control head—a device with appropriate controls, micro- a closed circuit. Also called a private line.
phone, volume, squelch, on/off, and so forth, generally defibrillator—an electrical device used to eliminate fibril-
mounted in a vehicle, from which control of the radio or lation of the heart muscle by the application of high voltage
mobile unit is performed. impulses.
control point—a position from which a radio system is
demodulation—the process of recovering the modulating
controlled and supervised.
information from a modulated signal.
control, remote—a control scheme for a radio system in
deviation ratio—the ratio of the maximum frequency de-
which all control functions are performed remotely via tele-
viation of the RF carrier to the highest frequency contained in
phone lines.
the modulating band.
consolette—(1) Motorola Communications name for a desk
top radio station and (2) a device for mounting a mobile dial tone first—allowance of a 9-1-1 or 80’ operator calls to
microphone, control head and speaker. be completed without the deposit of a coin in a telephone pay
continuous duty—(1) an unending transmission, (2) oper- station.
ating 100 % of the time, (3) EIA—full-load output under the digital—data represented in discrete, discontinuous form, as
manufacturers normal loading conditions for the class of contrasted with analog data represented in continuous form.
service for 24 h. digital dial code—a signaling technique generally used in
control, local—a control system packaged with the control VHF radio systems to bypass a receiver CTCSS system.
unit mounted directly on the base station. diplexer—a device that enables the use of two radio
coordination, frequency—the cooperative selection and transmitters, operating on different frequencies, on the same
allocation of radio frequencies such that all systems can antenna simultaneously.
operate with minimum interference. direct—in terms of communications circuits, means a dedi-
couple—to connect two circuits so that signals are trans- cated, instant method of communications. A dial telephone is
ferred from one to the other. not direct, a radio or a ring down line are direct.
coverage—in a radio communications system, the geo- direct dispatch method—a system in which all 9-1-1 call
graphic area where reliable communications exist; usually answering and radio dispatching is performed by the personnel
expressed in terms of miles extending radially from a fixed at the public safety answering point.
radio station. direct distance dialing (DDD)—telephone service that
crosstalk—the unwanted transfer of energy from one com- permits subscribers to dial their own long distance calls.
munication circuit to another by means of a mutual coupling. direct leased land lines—dedicated or designated point-to-
crystal—a piece of quartz or similar material that has been point wire circuits (telephone) used in transmitting voice or
ground thin and to the proper size to produce vibrations at the data communications. See: dedicated telephone line.
desired frequency. Used in radio transmission to generate, with
direct trunking—an arrangement in which a telephone line
a high degree of accuracy, the assigned carrier frequency of a
connection has no intermediate points before reaching the final
station.
destination (called) party.
cut over—to transfer from one system to another.
cycle—one complete reversal of an alternating current, directional antenna—an antenna that radiates radio waves
including a rise to the maximum level in one direction and a more effectively in some directions than in others.
return to zero. The number of cycles occurring in 1 s is the directivity—the value of the direction gain of an antenna in
frequency of the current. The word cycle is commonly used to the direction of its maximum value.
mean cycles per second (now called hertz). dish—a type of antenna. A parabolic reflector used in
D microwave systems.
dBm—decibels referenced to 1 mW. Used in communica- dispatch point—a position from which a radio system is
tion work as a measure of absolute power. Zero dBm equals 1 used but not a supervision or control point. Dispatch points are
mW. not usually listed on a station radio license.
dBV—decibels referenced to 1 V. distortion—unfaithful reproduction of audio or video sig-
dBW—decibels relative to 1 W (1 dBw = 30 dBm). nals as a result of change occurring in the wave form of the
decibel (dB)—a unit that expresses the level of power value original signal somewhere in the course of its transmission or
relative to a reference power value. Specifically, the level of reception. The lower the percentage of distortion, the more
power, value P, relative to a reference value, PR, in decibels is distortion free the system is and the more intelligible the
defined as dB = 10*log10(P/PR). message.

23
F 1220 – 95 (2001)
diversity—a method of radio transmission, or reception, or effective signal radiated—the rating basis for licensing
both, that counteracts the effects of fading by combining radio transmitters. Equal to the square root of the effective
several signals all bearing the same information. radiated power times the antenna height in feet above ground
doctor-interrupt—the ability of a physician or hospital- level.
based communicator to interrupt the voice or telemetry trans- EKG display console—a unit of electronic equipment
mission from a radio in the field. located in a hospital emergency room, or cardiac care unit, or
dual-tone-multifrequency (DTMF)—the simultaneous both, which displays EKG and records voice and data infor-
generation of two audio tones generally compatible to AT&T’s mation received from an EMS scene by transmission via radio
standard “Touch-Tone” frequencies. Used for control or sig- or telephone path. A demodulation display console.
naling purposes. A method of sending numerical information electrocardiogram (ECG or EKG)—a visual or hard copy
from an encoder by sending specific pairs of audio tones for trace of a patient’s electrical heartbeat information.
each digit, up to a total of 16. electrode—(1) either of the two terminals of an electric
source, such as a battery; (2) a conducting element through
duplex—the operation of transmitting and receiving appa-
which electric current enters or leaves an electrolyte, gas, or
ratus at one location in conjunction with associated transmit-
vacuum; (3) a conducting element, usually metallic (such as
ting and receiving apparatus at another location: the process of silver/silver chloride), with a conducting medium or electrolyte
transmission and reception being simultaneous. The simulta- (such as sodium chloride and water) attached to a patient to
neous transmission and reception of information. A duplexed obtain the electrical signals of the heart.
piece of equipment is capable of transmitting and receiving electromagnetic radiation—radiation associated with a pe-
simultaneously. Duplex systems generally use different trans- riodical varying electric and magnetic field and is traveling at
mitting and receiving frequencies. the speed of light, including radio waves, light waves, X-rays,
duplexed operation—the operation of associated transmit- and gamma radiation.
ting and receiving apparatus concurrently as in ordinary electromagnetic wave—a wave of electromagnetic radia-
telephones without manual switching between talking and tion, characterized by variations of electric and magnetic fields.
listening periods. For comparison, see simplex operation. emergency call—a call that requires immediate action.
duplexed/multiplexed telemetry unit—a radio device ca- emergency medical dispatcher (EMD)—a trained public
pable of simultaneous transmission and reception and concur- safety telecommunicator with additional training and specific
rent transmission of both voice and EKG information. emergency medical knowledge essential for the efficient man-
duplexer—a device that is used in radio equipment to agement of emergency medical communications.
provide simultaneous transmit and receive capabilities on a emergency medical dispatching—the reception and man-
single antenna. agement of requests for emergency medical assistance.
duplex, half—a system in which communication may be in emergency medical dispatch priority reference system
either direction but only one way at a time. Transmission in one (EMDPRS)—a medically approved reference system used by
direction at a time over a single channel. a local dispatch agency to dispatch aid to medical emergencies,
E which includes: systematized caller interrogation questions,
E & M signaling—an arrangement by which signaling systematized prearrival instructions, and protocols matching
between two points on a radio or carrier path is accomplished. the dispatcher’s evaluation of injury or illness severity with
vehicle response mode and configuration.
An M lead is associated with the transmit (or mouth) while the
E lead is associated with the receiver (or ear). Emergency Medical Service (EMS)—the service used in
responding to the perceived individual need for immediate
EACOM—Emergency and Administrative Communications medical care to prevent loss of life or aggravation of physi-
for hospitals. Tradename for a VHF radio system operating on ological or psychological illness or injury.
standard frequencies with a selective calling system between
emergency operations center (EOC)—(1) a secure, pro-
stations. The system is similar to Motorola Communications
tected facility designed and equipped for the use of community
HEAR radio system. officials to manage response of a community in time of
effective height—the true electrical height of an antenna emergency and (2) a communications center designed and
corresponding to a “perfect” antenna that will produce the operated by a community or within a geographic area for a
same field strength. The height of its center of radiation above combination of emergency resources, such as police, fire, and
the effective ground level. EMS.
effective radiated power (ERP)—the calculated power emergency resource coordination center (ERCC)—
output from an antenna system which incorporates all the gains generally a facility that has the resources and ability to
and losses in the antenna system. ERP is calculated as follows coordinate all emergency services (police, fire, EMS, and so
(1) convert power output of transmitter to dB referenced to 1 W forth) within a given geographic area. ERCC works in con-
(dBw); (2) subtract all transmission line losses including losses junction with a public safety answering point (PSAP) and may
in equipment between the transmitter and antenna (filter, be in the same facility or location.
diplexers, circulators, duplexers, and so forth) expressed in dB; enclosure—a housing such as a case, cabinet, cabinet rack,
(3) add the antenna’s power gain (expressed in dB reference to or console that is designed to provide protection and support to
a half-wave dimple; and (4) convert the results into watts. equipment.

24
F 1220 – 95 (2001)
encoding—the conversion of numerical address codes, such float—to operate a storage battery in parallel with a charger
as telephone number or message codes, into a format of tone or and a load at such voltage that the charger supplies the load
on-off pulses of audio tones for transmission over a commu- current and the battery supplies only transient peaks above the
nications system, usually for individual or group addressing, normal load.
such as for paging or selective calling. FM transmitter—a radio transmitter that emits or radiates a
exchange—a defined area, served by one or more telephone frequency modulated wave.
central offices, within which the telephone company furnishes folded dipole—a receiving or transmitting antenna com-
service. posed of two parallel dimples connected at the ends. The
exciter—the low-level stages of a transmitter which nor- connection to the receiver or transmitter is made at the center
mally consist of an oscillator, modulator, and multiplier. of one of the poles.
extender board—a printed circuit board that plugs into a forced disconnect—the capability of the 9-1-1 center to
module’s circuit connector at one end and the module on the disconnect a 9-1-1 call to avoid caller jamming of the incoming
other to maintain a circuit so that the module may be phone lines.
conveniently tested out of an inaccessible position. four wire operation—telephone operation in which the
F inbound audio signal is carried on one pair of wires and the
facility—a communications facility is anything used or outbound signal on another pair.
available for use in the furnishing of communications service. free space loss—the theoretical radiation loss that would
facsimile—the process by which pictures, images, and other occur in transmission if all variable factors were disregarded.
fixed graphic materials are scanned and the information con- Free space loss depends only on the frequency and the distance
verted into electrical signals for local use or transmission between antennas.
remotely to produce a likeness of the subject copy. frequency—the number of cycles, repetitions, or oscilla-
fading—the variation of radio field strength caused by a tions of a periodic process completed during a unit of time. The
gradual change in the transmission medium. frequency of waves in the electromagnetic spectrum (radio
fade margin—the number of decibels of attenuation that waves) is designated in hertz (Hz), kilohertz (kHz = 1000 Hz).
can be added to a specified radio frequency propagation path One hertz is equivalent to one cycle per second.
before the signal-to-noise ratio of the channel falls below a frequency band—a continuous range of frequencies extend-
specified minimum. ing between two limiting frequencies.
FCC Part 90—the section of the Federal Communications frequency coordination—see coordination, frequency.
Commissions Rules and Regulations that affects most EMS frequency deviation—frequency deviation of an FM signal
communications. is the change in the carrier frequency produced by the
Federal Communications Commission (FCC)—a board of modulating signal. The frequency deviation is proportional to
commissioners appointed by the President under the Commu- the instantaneous amplitude of the modulating signal.
nications Act of 1934 to formulate Rules and Regulations and frequency modulation (FM)—a method of modulating a
to authorize use of radio communications. The FCC regulates carrier-frequency signal by causing the frequency to vary
all communications in the United States by radio or wireline, above and below the unmodulated value in accordance with the
including television, telephone, radio, facsimile, and cable intelligence signal to be transmitted. The amount of deviation
systems. in frequency above and below the resting frequency is at each
feedback—the act of returning a portion of the output instant proportional to the amplitude of the intelligence signal
voltage of a circuit which includes amplification to the input of being transmitted. The number of complete deviations per
that circuit. second above and below the resting frequency corresponds at
feedback, acoustic—the feeding back of sound waves from each instant to the frequency of the intelligence signal being
a loudspeaker to a microphone in the same audio system. transmitted.
field strength—the strength of an electric, magnetic, or frequency response—the transmission loss or gain of a
electromagnetic field. Electromagnetic (radio) field strength is system, measured over the useful bandwidths, compared to the
expressed in microvolts per metre or millivolts per metre. loss or gain at some reference frequency (generally 1000 Hz).
fixed service—a service or radio communication between fresnel zone—the circular zone about the direct path be-
specified fixed points. Fixed station—(1) a radio station that is tween a transmitter and a receiver at such a radius that the
not mobile, (2) a station that is permanently installed, and (3) distance from a point on this circle to the receiving point has a
a base station in a mobile radio system. path length that is some multiple of a half wave length longer
fixed relay station—an operational fixed station established than the direct path.
from the automatic retransmission of radio communications fringe area—an area or locality at such a distance from the
received from either one or more fixed stations or from a transmitter that the signals received are weak.
combination of fixed and mobile stations and directed to a full-duplex operation—a method of operation of a radio
specified location. system that provides simultaneous two-way communications
F-Layers—the upper layers of ionization in the ionosphere. between two points. In EMS radio systems, provides for
The f-1 layer is about 130 miles above the earth. The f-2 layer mutual interrupt capabilities between the field technician and
height varies from about 250 miles during the day to about 150 the physician or medical direction at a hospital location.
miles at night. G

25
F 1220 – 95 (2001)
gain, of an antenna—the effectiveness of a directional harmful interference—any emission, radiation, or induc-
antenna in a particular direction, compared against a standard tion that endangers the functioning of a radio service or
(usually an isotopic antenna). The radio of standard antenna seriously degrades, obstructs, or repeatedly interrupts a radio
power to the directional antenna power that will produce the communication service.
same field strength in the desired direction. hand microphone—a microphone designed to be held in the
generator, standby power—a device that develops electri- hand. Sometimes called a “palm” microphone.
cal voltage from mechanical energy. An ac electrical power handset—a device similar to a telephone handset used in
source held in reserve and used to supply the necessary ac place of a hand microphone.
power when commercial power fails. hardcopy—a tangible printed copy of a message such as
generator, signal—a portable test oscillator that can be that obtained from a teleprinter.
adjusted to provide a test signal at some desired frequency,
hardware—the screws, nuts, clamps, anchors, connectors,
voltage, modulation, or waveform.
and so forth, used in the installation and maintenance of
geographical assignment—the assignment and use of com-
communications systems.
munications channels on a dedicated used basis within a given
geographic area. hardwire—to wire or cable directly between units of equip-
ment without passing through other media.
GHz—gigahertz (billion hertz, 1000 MHz).
gin pole—a pole which is used together with ropes and harmonic—an integral multiple of a fundamental frequency.
pulleys as a derrick for lifting heavy loads and for erecting The third harmonic of 20 Hz is 60 Hz. The fifth harmonic of 40
poles or towers. Hz is 200 Hz.
ground—a reference point. Also a connection, intentional or hash—noise signal produced by an electrical or mechanical
accidental, between an electrical circuit and the earth or its source.
equivalent. headphone—a device that can be placed on the head to
ground plane antenna—a type of vertical transmitting or allow individual listening to messages.
receiving antenna used primarily for short wavelength or high HEAR—Hospital Emergency Administrative Radio—
band communications. A ground plane antenna consists of a Motorola Communications and Electronics trade name for a
quarter-wave vertical element, and four radial elements spaced VHF radio system operating on standard frequencies with a
90° apart, and mounted on the base of the vertical element. selective calling system between stations. The system is similar
Antennas of this type are nondirectional and have a low angle to General Electric Mobile Radio Departments EACOM radio
of radiation. system.
ground wire—a conductor leading from the radio equip- helix—a single-layer, spiral wound coil usually having air or
ment to an electrical connection with the ground. foamed polyethylene core.
guard band—a narrow band of frequencies provided be- hetrodyne—(1) pertaining to the production of difference in
tween adjacent channels in certain portions of the radio frequencies (beat frequencies) by the combination of the two
spectrum to prevent interference between stations. frequencies and (2) to shift an incoming radio signal to a
guy anchor—the buried weight or mass to which the lower different frequency, often to a lower intermediate frequency.
end of a guy wire is attached. Hetordyne frequency—the beat frequency, which is the
H sum or difference between two frequency signals.
half-duplex channel—a communication channel providing hertz (Hz)—international unit of frequency identical to and
duplex operation at one end of the channel, but not the other. used instead of the old term cycles. One hertz is equal to one
Sometimes, the base station is operated in the duplex mode; cycle per second.
however, in EMS, the portable or mobile radio is often
high band—a portion of the VHF radio frequency spectrum
operated in the duplex mode, and the base station at the
from 150 to 174 MHz in which two-way radio operates.
hospital operated simplex, to permit the medical direction
physician to interrupt transmissions from the field technician. hollerith code—a twelve-level code which defines the
See also simplex. relation between an alphanumeric character and the punched
half-duplex operation—generally refers to the ability of holes in an 80-column data card.
directing medical personnel in EMS radio system to interrupt hookswitch—the device on which a handset or microphone
or 8break in’ on radio transmissions from field personnel to hangs when not in use. The handset operates a switch, or
give instructions or ask questions. Sometimes referred to as switches, that open the associated circuits.
“physician interrupt.” Requires duplexed communications hop—(1) the number of reflections from the ionosphere
equipment in the field. encountered by the radio wave in traveling from the transmitter
half-wave dipole antenna—a straight, ungrounded antenna to the receiver and (2) the number of radio links required to
having an electrical length equal to half the wave length of the span a given path.
signal being transmitted or received. Mounted vertically, it has hot line—direct circuit between two or more points for
a donut-shaped pattern, circular in the horizontal plane. immediate use without patching or switching. (See direct
ham—a term applied to an amateur radio operator, as leased land lines.) The hot line can use various signalling
opposed to business or commercial operators. A person that configurations (that is, ringdown, audio amplifier, and so
makes amateur radio operation a hobby. forth).

26
F 1220 – 95 (2001)
hot standby operation—a method of achieving reliable integrated circuit—a complete circuit consisting of transis-
operation by energizing two identical equipments fed by and to tors, capacitors, resistors, diodes, and so forth that is formed on
a switchable input and output. A sensing device causes transfer a single semiconductor substrate.
of input and output circuits when a failure is indicated. Integrated Circuit Oscillator Module (ICOM)—a fre-
hum—audio frequency interference which is at the fre- quency determining circuit used in General Electric radios
quency of the power supply or its harmonics. containing a crystal oscillator circuit and other circuits used to
humidity, relative—the ratio of the amount of water vapor generate the oscillator frequency.
the air contains to the maximum amount it could hold at the interface—a concept involving the specification of the
same temperature and pressure expressed in percent. interconnection between two equipments or systems. The
hybrid—(1) made up of several different components or a specification includes the type, quantity, and function of the
mixture of technologies. (2) A circuit required to convert interconnection circuits and the type and form of the signals to
four-wire operation to two wire, while maintaining isolation of be interchanged via these circuits.
the four-wire circuit. interference—interference in a signal transmission path is
I either extraneous power which tends to interfere with the
ignition noise—interference produced by sparks or other reception of the desired signals or the distribution of signals
ignition discharged in a vehicle. which results in loss of signal or distortion of information.
image—one of the two groups of sidebands generated in the intermittent—not continuously present; disappearing and
process of modulation, so called because one is the reverse reappearing.
(mirror image) of the other with respect to operating frequency. intermittent duty cycle—a duty cycle of 1 min on, 4 min
image frequency—in hetrodyne frequency converters, an off, or 20 % per electronic industries association (EIA).
undesired input frequency that can beat with the local oscillator intermodulation—the combination of two signals beating
to produce the intermediate frequency and thus appear in the together to form a third unusable signal that interferes with
receiver output. reception of the desired signal. In a radio receiver the method
of expressing in dB below the desired signal, the receiver’s
image rejection—the action of a receiver in suppressing the
rejection of the unwanted signal to its acceptance of correct
image frequency.
signals.
impedance—the total resistance that a circuit offers to the
intrinsically safe—a laboratory (UL) rating for equipment
flow of alternating current. Impedance is a combination of
considered approved to operate in areas in which hazardous
resistance and reactance. The ohm is used as a unit of
concentrations of flammable gases exist.
impedance measurement.
inverter—(1) any of several devices used to convert direct
impedance match—the condition in which the impedance current to alternating current, (2) a single input, single output
of one component is the same as the component to which it is device that changes the polarity of (inverts) a signal when
connected or attached. passing it from input to output. A negative signal at the input
impedance, characteristic—the importance of characteris- produces a positive signal at the output and vice versa. A
tic impedance lies in the fact that when a transmission line is differential EKG amplifier has a normal and an inverting input.
terminated, as with an antenna, in an impedance matching its ionosphere—the upper portion of the earth’s atmosphere
own, then all of the energy or power flowing along the line is beginning at about 50 miles above the surface of the earth; the
radiated by the antenna. If the impedance of the termination cause of radio signals being bent, and returned to earth.
(antenna) is not matched to the transmission line, a portion of
isolator—a passive RF device that permits transmission in
the energy will be reflected at the mismatch resulting in a lower
only one direction, absorbing energy in the opposite direction.
output from the antenna.
J
Improved Mobile Telephone Service (IMTS)—a mobile
jack—a connecting device ordinarily used to make electrical
radio telephone offering of a telephone company.
contact with mating contacts of a plug.
impulse—a surge of electricity having a single polarity. jacket—the outer covering on an insulated wire or cable.
indicator—a device used to inform of a condition or change jamming—the deliberate radiation, reradiation, or reflection
in condition. of electromagnetic energy with the object of impairing the use
induced—produced as a result of exposure to a changing of electronic devices, equipment, or systems.
electric or magnetic field. jumper—a short length of conductor used to bridge electri-
Industrial Radio Service—an FCC-designated radio ser- cal connections.
vice. junction box—a metal or other container into which wires
in-band signaling—the transmission of signaling tones or cables are led and connected.
within the frequency band of the channel. K
insertion loss—the loss introduced when a device or line key—a push-to-operate switch used for operating a trans-
section is interposed between two elements of a circuit. mitting circuit in a radio system.
insulation—any nonconductive material used to prevent the key telephone equipment—an instrument that has the
leakage of electricity from a conductor, such as rubber, glass, capability of multiple line terminations. Each line is accessed
mica, and so forth. by depressing an association button (key).

27
F 1220 – 95 (2001)
keypunch—a machine controlled by a typewriter-like key- line-of-sight distance—the straight-line distance from a
board that enables an operator to punch holes in predescribed radio station antenna to horizon. This represents the normal
places in a hollerith code. transmitting range of FM transmitting stations.
kilo—a prefix meaning one thousand. link—the portion of a radio relay system between adjacent
kbps—thousands of bits per second. radio stations.
kilohertz (kHz)—equal to 1000 cycles per second. Replaces load—(1) a device that receives power from a transmission
the term kilocycle. system and (2) the amount of electric power drawn by an
klystron—an electron tube in which the electrons are electric or electronic device.
periodically bunched by electric fields. Used as an RF oscilla- load, dummy—a device that can dissipate energy (into heat)
tor for microwave equipment. without radiating it.
knockout—a metal disk punched in the side of a metal loading, antenna—insertion of reactance in an antenna
terminal junction box or cabinet which can be punched out to circuit to improve its transmission characteristic in a given
allow entry of a cable or conduit. frequency band.
L loading, ice—the stress imposed on an antenna or antenna
land line—a generic term which refers to the public- structure caused by ice forming on its members.
switched telephone system. loading, wind—the stress imposed on an antenna or antenna
lag—the difference in phase angle expressed in electrical structure caused by wind.
degrees between the voltage and current that produced it. lobe—one of the three-dimensional petals representing the
land-mobile—an abbreviation for land to mobile communi- radiation or reception efficiency of a directional antenna.
cations such as between base stations and mobile radios or local government radio service—a service of radio com-
from mobile radio to mobile radio. munication defined by the FCC essential to official activities of
states, possessions, and territories, including counties, towns,
Land Mobile Radio Service—a mobile radio service de-
cities, and similar governmental subdivisions.
fined by the Federal Communications Commission—FCC
Rules and Regulations Part 90. local service area—that area that can be called on the
telephone without incurring multimessage units or a toll
LATA—local access and transport area boundaries for
charge.
telephone companies. The geographic area within which the
log—a list of radio stations showing frequency, location,
local telephone company provides local and long distance
power, and other data. Also a communication record for a
service.
station showing calls made, time, date, and other data. A
Law Enforcement Assistance Administration
detailed record.
(LEAA)—an administration under the United States Depart-
loop—(1) a short transmission line that connects a sub-
ment of Justice established by the Omnibus Crime Control and
scriber to a switchboard and (2) a closed path in which a signal
Safe Streets Act of 1968, restructured by the Justice Improve-
may circulate. This path may be within a piece of equipment,
ment Act of 1979 and abolished two years later.
such as a repeater or carrier terminal, or may be a complete
leased line—a pair of wires or a circuit, usually leased or carrier circuit.
rented from a telephone company, designed for exclusive use
loop resistance—the resistance presented to the signaling
between two fixed points for various communication control
portion of the terminating set by the wireline when the far end
functions.
of the wireline is short circuited.
life cycle—a test performed on a material device to deter- loss—a decrease in power suffered by a signal as it is
mine the length of time before failure. transmitted from one point to another, usually expressed in
line—a transmission line or power line. A system of one or decibels. Energy dissipated without accomplishing useful
more wires. work.
linear—describing a device in which the signal output loss, free space—the theoretical transmission loss between
voltage is directly proportional to the signal input voltage. A two radio antennas dependent only upon distance and fre-
straight line relationship. quency.
line, balanced—a two-wire line that has identical imped- loss, path—the reduction or attenuation of signal strength
ance from each wire. that occurs between the transmitted strength and the received
line equalizer—a connection in series with a telephone line signal strength.
that will alter the frequency response characteristics of the line. low band—a section of the VHF radio frequency spectrum
line, four-wire—a two-way transmission circuit using sepa- from 25 to 50 MHz in which mobile radio equipment is
rate paths for transmit and receive functions. licensed to operate.
line, lossy—a transmission line, usually a coaxial cable, that low loss—describing circuits and transmission line in which
is designed to have very high transmission loss per unit length. little energy is lost from the input to the output.
Used in tunnels, underground, or buildings for radio commu- lower sideband—the lower of two frequencies or of two
nications systems. groups of frequencies produced by a modulation process.
line of sight—an unobstructed path between two points. lug, spade—a connector which has an open end to slip under
Radio waves at those frequencies where signals travel in a a terminating screw.
straight line and are not reflected by the ionosphere. M

28
F 1220 – 95 (2001)
marginal—operating at the borderline of permissible limits. multichannel system—a radio system that uses more than
matrix—an array of horizontal and vertical input or output one radio channel. Also known as a multifrequency system.
leads with cross points at the intersections, used as a means of multicoupler, receiver—a device that permits several radio
switching from any input to any output. receivers to use the same antenna. Usually a broadband
mean—the arithmetic middle point of a range of values, amplifier with several output ports.
obtained by adding the highest and lowest values and dividing multifrequency operation—using radio equipment capable
by two. of operation on two or more frequencies.
median—the point below which there are as many instances multijurisdictional system—a system covering more than
as there are above. one political boundary or agency.
medical communications control console—an installation multipath—the propagation phenomenon that results in
of communications control equipment, usually located at a signals reaching a radio receiving antenna by two or more
hospital, which provides for control of the transmitting and paths usually resulting in a degradation of the original signal.
receiving equipment necessary for the medical communica- multiplex—transmitting two or more signals over the same
tions. medium. In EKG telemetry equipment, the ability to transmit
microwave—a term applied to radio waves in the frequency electrocardiograph (EKG) signals and voice signals concur-
range of 1000 MHz and upward. Microwave radio generally rently over the same transmitter.
performs the same functions as telephone cables and may be multiplex, frequency division—a multiplex system in
used for radio remote control purposes. which the total transmission bandwidth is divided into nar-
mobile—term used to describe equipment designed for rower bands each used for a single separate channel.
vehicular installation. multiplex, time division—a method of multiplexing in
mobile relay station—a fixed station established for the which the total frequency spectrum available is used by each
automatic retransmission of mobile service radio communica- channel, but only for part of the time. A sharing of transmission
tions that originate on the transmitting frequency of the mobile ability, first by one parameter, then by another.
stations and are retransmitted on the receiving frequency of the multitone—a method of signaling that involves two or more
mobile stations. tone signals produced simultaneously or sequentially.
mobile repeater station—a mobile station in the mobile mute—to silence or reduce sound level.
service authorized to retransmit automatically on a mobile N
service frequency communications originated by hand-held or netting—the process of adjusting a system’s transmitters
portable units or by other mobile or base stations directed to and receivers to the same operating frequencies.
such hand-carried units. net loss—the algebraic sum of the gains and losses between
mobile service—a service of radio communications be- two terminals of a circuit.
tween mobile and land stations, or between mobile stations. network—an orderly arrangement of stations intercon-
mobile station—a two-way radio station in the mobile nected through communications channels to form a coordi-
service intended to be used while in motion or during halts at nated entity.
unspecified points. nine-one-one (9-1-1)—a three-digit emergency telephone
mobile telephone service (MTS)—telephone service be- number accepted and promulgated by the telephone industry as
tween a fixed mobile radio base station and several vehicles the nationwide emergency number.
equipped with mobile radios. Nxx—the first three digits of a local telephone number that
mobile transmitter—a radio transmitter designed for instal- uniquely identifies that central office switching location within
lation in a vehicle, vessel, or aircraft and normally operated its area code number for nationwide long distance call routing.
while in motion. noise—interference characterized by undesirable random
mobile unit—a two-way radio equipped vehicle or person. voltages caused by an internal circuit defect or from some
Also, sometimes the two-way radio itself, when associated external source. Any extraneous signal tending to interfere with
with a vehicle or person. the proper and easy perception of those signals which are
modem—contraction of modulator-demodulator. intended to be received.
modular—a construction technique incorporating the use of noise blanker—a device used in mobile radio applications
standard size units for interchangeability. that senses the presence of undesired noise on the desired
modulate—to vary the amplitude (AM), frequency (FM), or channel and causes the desired signal to be interrupted for the
phase of a high-frequency wave or carrier in step with time period that the undesired noise signal is present. The time
amplitude variations of another wave (the modulating wave). period is controlled and measured in milliseconds so that the
The carrier is usually a sine wave while the modulating wave interruption of the desired signal is not audible.
is often a complex voice or EKG signal. noise level—volume of noise usually expressed in decibels.
modulator—the electronic circuit that combines the modu- noise limiter—a circuit that cuts off the noise peaks that are
lating wave with the carrier wave. In radio transmitters, the stronger than the highest peak of the desired signal being
final audio-frequency stage that mates the audio signal with the received.
carrier signal. In EKG telemetry, the circuit that combines the nomograph—a chart having three or more scales across
amplified EKG signal with the subcarrier (audio) signal for which a straightedge can be placed to provide a graphical
transmission by radio or telephone. solution for a particular problem. In mobile radio nomographs

29
F 1220 – 95 (2001)
may be used to determine frequency spread, estimated radio private automatic branch exchange (PBX)—a telephone
range, antenna height, and so forth. switchboard with many stations not individually identifiable to
O the telephone company’s switching network requiring an
octave—the interval between two frequencies having a ratio operator.
of two to one. private line (PL)—Motorola’s trademarked name for con-
ohm—an electrical unit of resistance. tinuous tone-controlled squelch system, CTCSS.
ohm’s law—the current in an electric circuit is directly propagation, electromagnetic—the travel of electromag-
proportional to the electromotive force in the circuit. In the netic waves through a medium or the travel of a sudden electric
form E = I*R, where E is the electromotive force (voltage), I is disturbance along a transmission line. Also called wave propa-
the current (amperage), and R is the resistance of the circuit gation.
(ohms). protect—to equip with devices for safeguarding from dam-
age by excessive voltages, current, or physical abuse.
omnidirectional—equally effective in all directions.
public safety agency—a functional division of a public
open—a break in circuit continuity.
agency that provides fire fighting, police, ambulance, emer-
outage—a disruption of communications from any cause, gency medical, or other emergency services.
whether planned or accidental. public safety answering point (PSAP)—the initial answer-
out-of-band signaling—transmission of signals by frequen- ing location of a 9-1-1 call and other calls for assistance.
cies outside of the voice band. public safety telecommunicator—an individual trained to
overload—a load greater than a device is designed to communicate by electronic means with persons seeking emer-
handle. gency assistance and with agencies and individuals providing
P such assistance.
paging—a one-way communications service from a base pull box—a box with a removable cover installed in a
station to mobile or fixed receivers that provide signaling or conduit run to facilitate pulling wire or cable into the conduit.
information transfer by such means as tone, tone-voice, tactile, pulse—a signal of short duration.
optical readout, and so forth. pulsed tone—a system of selective signaling using a keyed
pair—two wires of a signal circuit generally applied to on-off tone signal.
telephone wherein one wire is designated “tip” and the second push-to-talk or press-to-talk (PTT)—in radio or telephone
wire “ring.” systems, that method of communication over a speech circuit
passive—a device that does not contribute energy to the in which transmission occurs from only one station at a time,
signal it passes. the talker being required to keep a switch operated while he is
passive repeater—a device intentionally interposed in a talking. The keying button used to operate a radiotelephone
microwave transmission path to redirect or reflect energy. transmitter.
patch—a means of connecting one system to another. A Q
patch may be between radio systems, or radio to telephone, as quarter-wave antenna—an antenna electrically equal to
in a radio/phone patch. one fourth of the wavelength of the signal to be transmitted or
path, signal—the route by which intelligence is conveyed received.
from transmitter to receiver or through a circuit. quartz—an element consisting of pure silicon dioxide. The
personal radio—a small portable radio intended to be original piezoelectric material widely used to control the
carried by hand or on the person of the user. frequency of oscillators.
quartz crystal—a thin square or rectangular slice of quartz
PERT—program evaluation and review technique. A man-
which will vibrate at a frequency determined by its thickness.
agement tool for comparing actual with scheduled program
progress. quiet channel—RCA Corporation’s trademarked name for
continuous tone-controlled squelch system (CTCSS).
phase—the position at any instant which the periodic wave
quieting—reduction of system noise.
occupies in its cycle of 360°.
quick-call—Motorola Communications Company trade-
phone patch—an interconnection between radio and tele-
marked name for a system of selective calling, normally using
phone communications circuits which permits direct voice
two pairs of two tones each in sequence. Quick Call II uses a
interchange between telephone lines and radio system.
pair of sequential tones similar to General Electric’s Type 99
pigtail—a splice made by twisting together the bared ends of tone system.
two conductors. R
plug-in—describing any device having terminals so it can rack mounting—a method of mounting equipment in which
be connected by simply pushing it into a suitable socket or metal panels supporting the equipment are attached to pre-
connector. drilled steel channel rails or racks. The dimensions of the
portable—an easily transportable radio. panels, the spacing of the rails, and the size of the mounting
primary power—a reliable source of electrical power screws are standardized.
normally serving as the principle source of energy to equip- rack unit—in mobile radio, generally a rack mounting 19 in.
ment, such as the commercial 120-V ac power main. between rails and a height of 1.75 in. per unit.

30
F 1220 – 95 (2001)
radio—the transmission and reception of signals by means remote base station—a base station located away from the
of electromagnetic waves without a connecting wire. operating console to take advantage of improved coverage
radio-frequency power—the power associated with any offered by a better geographical location.
signal consisting of electromagnetic radiation which is used for remote control—the operation of a device from a distance
telecommunications. either electrically or by radio waves.
radio interference—undesired disturbance of radio recep- remote control equipment—the apparatus used for per-
tion. Man-made interference is generated by electric devices, forming monitoring, controlling, supervisory control, or a
with the resulting interference signals either being radiated combination of these functions at a distance by electrical
through space as electromagnetic waves or traveling over means.
power lines or other conducting media. Radio interference is repeater—a combination of apparatus for receiving either
also due to natural sources such as atmospheric phenomena, one-way or two-way communication signals and delivering
such as lightning. Radio transmitters themselves may addition- corresponding signals which are either amplified or reshaped or
ally interfere with each other. both.
radio network—a number of radio stations, fixed and repeater station—an operational fixed station established
mobile, in a given geographical area that are jointly adminis- for the automatic retransmission of radio communications
tered or communicate with each other by sharing the same received from any station in the mobile service.
radio channel or channels.
repeater station, remodulating—a microwave repeater sta-
radio common carrier (RCC)—an enterprise that is li-
tion in which the signal is demodulated to the original
censed by the FCC and Public Utilities Commission to provide
baseband frequencies and reinjected onto the modulator for
radio communications service to the public.
transmission to the distant station.
radio receiver—an instrument that amplifies radio fre-
resource management center—a center responsible for the
quency signals, separates the intelligence signal from the rf
allocation of those resources essential to the most effective and
carrier, amplifies the intelligence signal additionally, and con-
efficient resolution, or management or both, of the immediate
verts the intelligence signal to its original form.
problem. In most communities these resources include police,
radio relay system (radio relay)—a point-to-point radio
fire and emergency medical services. The resource manage-
transmission system in which the signals are received and
ment center is most effective when its responsibilities encom-
retransmitted by one or more intermediate radio stations.
pass the whole of public safety response.
radio transmitter—a radio-frequency power source that
generates radio waves for transmission through space. ringback—in a public safety answering center, permits the
answering point to ring the hung-up telephone on a held circuit.
radome—a dome-shaped cover for a parabolic antenna that
The feature is useful when a calling party has failed to provide
protects the antenna from the elements and their attenuating
all necessary information to the answering point before hang-
effects.
ing up.
range—distance over which a radio signal can be transmit-
ted for effective reception or the distance at which a usable ringdown—a type of signaling used in manual operation
signal can be received. telephone (as compared to dial) which uses a continuous or
pulsing ac signal transmitted over the line.
receiver—an electronic device used to detect and amplify
S
transmitted radio signals.
receiver, paging—a small, light, pocket-sized receiver used schematic diagram—a diagram or drawing that shows
for alerting individuals when they are away from their normal electrical connections of a radio or other electrical device by
communication instruments. means of symbols which are used to represent the components.
referral method—the calling party to a public safety search lock monitor—a receiver channel scanning scheme
answering point is referred to a secondary telephone number. that locks the receiver on the first channel received.
refraction—the change of direction experienced by a wave selective call—a system for alerting individual or groups of
of any form of radiated energy when passing from one medium stations by means of coded signals.
to another having a different dielectric constant or index of selectivity—the ability to select one particular signal from
refraction. other signals at nearby frequencies. This specification is
regional EMS system—an emergency medical service area important in urban areas where radio spectrum congestion
(trade, catchment, market, patient flow, geographic, or govern- exists. The more negative the dB rating, the better the speci-
mental) that provides essentially all of the definitive emergency fication.
medical care for all emergencies and for the most critically ill selective routing—a routing of telephone call to terminate at
and injured patients within the area. a PSAP determined by the location of the calling telephone.
relay—transmission forwarded through an intermediate sta- This is accomplished by using a computer to process the
tion. calling telephone number.
relay station—radio stations that rebroadcast signals the sensitivity—the characteristic of a radio receiver which
instant they are received, so that the signal can be passed on to determines the minimum input signal strength required for a
another station outside the range of the originating transmitter. given signal output. In FM, sensitivity is the signal level
reliability—the ability of an item to perform a required required to produce a given ratio of signal to noise. The more
function under stated conditions for a stated period of time. sensitive a receiver is, the weaker the signal it can receive.

31
F 1220 – 95 (2001)
service channel—in a microwave system, a voice channel squelch circuit—a circuit that reduces or lowers the noise
fused for maintenance and fault location. Also called an order that would otherwise be heard in a radio receiver between
wire. transmissions.
service life—the life expectancy of equipment under normal stability, frequency—the ability of a radio transmitter to
conditions of use. maintain any predetermined frequency, such as its assigned
side tone—the signal that reaches a telephone receiver from frequency. Measured in percent of the carrier. The lower the
the transmitter of the same set by way of a local path within the percentage the better the stability.
set. standing wave ratio (SWR)—a measure of the amount of
signal—the form of a radio wave in relation to the frequency lost transmitting power as a result of impedance differences
serving to convey intelligence in communication. between the transmission line and the antenna. The ratio of
signal-to-noise ratio—the ratio of the intensity of the reflected to incident waves that exists at some particular point
desired signal to that of the undesired noise signal, usually on a transmission line.
expressed in decibels. statewide EMS system—a network of EMS systems, inte-
signal strength—a measure of the field intensity caused by grated and coordinated at the state level.
a radio transmitter at a particular location within its operating strip chart recorder—an electromechanical device used to
range. Usually expressed as microvolts or millivolts of signal. make paperchart recordings of EKG information. Usually it
simplex—(1) single frequency operation whereby all base uses a heat-sensitive paper and a heated stylus.
stations and mobiles operate on one common frequency and (2) subcarrier—a frequency sensitive device used to generate a
operation on two different frequencies in a system that can modulated wave which in turn is applied as a modulating wave
communicate in two directions, but not simultaneously, such as to modulate another carrier. For EMS telemetry, the subcarrier
when a base station and a mobile radio operate on reversed frequency is 1400 Hz.
pairs of frequencies without duplexing. supergroup—in microwave systems, groups of 60 channels
simplex channel—a communication channel providing each, occupying a particular range of frequencies.
transmission in one direction only at any given time. For switched network—a complex of diversified channels and
comparison see duplex channel. equipment that automatically routes communications between
simplex operation—a method of radio operation in which the calling and called person or data equipment. The public
communication between two stations takes place in only one telephone system.
direction at a time. This includes ordinary transmit-receive
synthesizer, frequency—a highly precise crystal oscillator
operation, press-to-talk operation, voice-operated transmit, and
with frequency dividers used to provide the precise radio
other forms of manual or automatic switching from transmit to
frequency. A typical synthesizer can be set to small frequency
receive. Also called simplex.
increments and have an accurate output at the desired output
SINAD—the ratio of signal plus noise plus distortion to the frequency.
noise plus distortion; expressed in decibels. An EIA standard
synchronization—the process of making the carrier at the
method of measuring receiver sensitivity. Basically a measure
receiving end of a line or system match the frequency of the
of RF signal strength that will result in a readable signal.
carrier at the transmitting end.
siren—an acoustical or electromechanical device used as a
warning signal on emergency vehicles. system—a combination of two or more stations in such a
way as to provide communications.
software—the programs or instructions required to use a
T
computer or data processing device.
solid state—denoting the use of semiconductors instead of tandem trunking—an arrangement in which a telephone-
vacuum tubes or relays. line connection has one or more intermediate points that are
required or permitted usually on a controlled dial pulse basis
Special Emergency Radio Service (SERS)—that portion
before reaching the final destination (called) party.
of radio communications frequency resources authorized by
the FCC for use in the alleviation of emergency situations tariff—a document filed by a communications company
endangering life or property. See FCC Part 90. with the Public Utilities Commission which lists the services
spectrum—a continuous range of frequencies arranged in offered the public and a schedule of rates and charges.
order of wavelength or frequency within which waves have tarnish—a discoloration or stain on the surface of metal
some common characteristics, such as audio spectrum, radio caused by exposure to chemicals or the atmosphere. To dull or
spectrum, and so forth. The entire range of electromagnetic destroy the luster of metal.
radiation extending from the longest known radio waves to the tee—a three-way connection in the shape of the letter t.
shortest known cosmic rays. telecommunicator—see public safety telecommunicator.
spurious response—the response of a radio receiver to an telecommunications—all forms of electrical transmission
undesired frequency. of intelligence including: telegraph, telephone, radio, and
squelch—a circuit function that acts to suppress the audio television. Pertaining to the art and science of communication
output of a receiver when noise power exceeding a predeter- by these methods.
mined level is present. telemetry—the sensing and measuring of information at
squelch, carrier—a squelch system that responds to the some remote location and transmitting the data to a convenient
presence of an RF carrier signal. location to be read and recorded.

32
F 1220 – 95 (2001)
telpak—an acronym for “telephone package” a schedule of or mobile use, and using common circuit components for both
bulk discount rates for multiple private line telephone services transmitting and receiving.
such as AT&T long-lines series 500 tariff offering. transformer—an electrical device for voltage current trans-
telephone line—a telephone line from a telephone company formation, or impedance matching, or both.
central office that is connected to key or nonkey telephone transfer method—the PSAP interrogator determines the
equipment. proper responding agency and connects the user to that agency.
teletypewriter—an electromechanical device, similar to a To perform the necessary dispatching in accordance with
typewriter, such that messages typed on the keyboard of the prearranged plans with cooperating agencies.
transmitter unit are converted into electrical signals, which transient—a rapid, sometimes violent, fluctuation of volt-
when conveyed to the receiver unit, are printed on paper. age or current in a circuit usually of short duration caused by
ten signals—a series of coded messages designed to reduce switching or changes in load.
air transmission time and confusion in busy mobile radio transmitter—apparatus for the production and modulation
systems. of radio frequency energy for the purpose of radio communi-
thermal noise—very small noise voltages that are present in cation.
all conductors, caused by the thermal agitation of charged transmission line—a waveguide, coaxial line, or other
particles within the conductor. system of conductors used to transfer signal energy efficiently
third harmonic—a frequency wave having three times the from one location to another. In communications systems, the
fundamental frequency value. coaxial line between the base station and the antenna.
threshold—in an FM receiver, the point at which the peaks trunk—a circuit used for connecting a subscriber in a
of the incoming RF signal exactly equal the peaks of the central office to all other services in/out of the switching
internally generated thermal noise power or the point above equipment.
which increasing the input signal strength provides only a dB trunk line—a telephone line that terminates at a switch-
for dB improvement in the output signal-to-noise ratio. board rather than a telephone.
tip—the ball-shaped contact on the cord (tip) of a plug. One TSPS—an electronic operating position system whereby
of a pair of telephone wires (the other of which is called the operator-handled traffic is routed to its final destination via a
ring). central switching machine.
turret—a section of a communications control console,
tone—an audio or carrier of controlled amplitude and
containing switches, controls, meters, and so forth.
frequency used in a selective signaling system, or for equip-
ment control purposes. two-way radio—a radio that is able to transmit and to
receive.
tone code—a specified character of transmitted tone signals
two-wire operation—uses a single pair (two wires) for both
required to effect a particular selection or function.
transmitting and receiving.
tone-coded squelch—a system whereby a superimposed U
tone is transmitted with the radio carrier to protect against
Ultra High Frequency (UHF)—frequencies between 300
nuisance-type interference.
and 3000 MHz.
tone, Type 90—General Electric’s name for a system of ultrasonic—describing frequencies higher than those which
single-tone signaling. The tones are generally between 1000 are audible. Generally above 20 000 Hz.
and 2400 Hz in two bands. unbalanced line—a transmission line in which the voltages
tone, Type 99—General Electric’s name for its two-tone on the two conductors are unequal.
sequential selective signaling system. Sometimes called Sel- Underwriters Laboratories, Inc—a laboratory sponsored
Call. The tones are generally between 520 and 953 Hz. by the National Board of Fire Underwriters that examines and
topographic map—an accurately scaled map having con- tests devices, material, and equipment whose action may affect
tour lines which show the elevation above sea level. Used in casualty, fire, and life hazards.
preparing profiles of radio propagation paths. unmodulated—without modulation; the RF carrier signal
touch pad—a method of signaling or encoding and decod- alone as it exists during pauses in conversations.
ing address codes by the use of a simple numerical push button upper sideband—the higher of two frequencies or groups of
keyboard. frequencies produced by a modulation process.
Touchtone—a Bell System trademark used to describe their utility—a power, gas, or water service available to the
method of signaling and use of dual tone multifrequency public.
(DTMF) tones. V
tower, antenna—a tall antenna support structure used to Van Allen belts—radiation belts that surround the earth,
support one or more antennas or when an antenna must be consisting of electrons and protons at high energy levels.
mounted high above the ground or other support formation varactor—a semiconductor diode used as a variable capaci-
such as a building. tor. Used as a harmonic generator, frequency multiplier, and
traffic—used for messages handling by a radio communica- amplifier.
tions system. vehicular repeater station—a mobile station in the mobile
transceiver—the combination of radio transmitting and services authorized to retransmit automatically on a mobile
receiving equipment in a common housing, usually for portable service frequency, communications originated by hand-carried

33
F 1220 – 95 (2001)
portable units or by other mobile or base stations directed to wattmeter—a meter to indicate the rate at which electrical
such hand-carried units. energy is being used or produced.
Versatone—General Electric company tradename for a solid wave—a propagated periodic disturbance such as a radio,
state tuned tone determining element. light, or sound wave.
vertical antenna—a vertical steel tower, rod, or shaft used waveguide—a transmission line comprising a hollow con-
as an antenna. ducting tube within which electromagnetic waves may be
Very High Frequency (VHF)—frequencies between 30 and propagated. Generally used in microwave communications
300 MHz. systems.
Vibrasponder—Motorola Communications company trade- wavelength—the distance measured along the direction of
name for a tone determining vibrating reed element. propagation between two points that are in phase on adjacent
voice grade—a communications circuit that is nominally waves. A wavelength is the distance traveled by a wave in the
300 to 3000 Hz. time of one cycle. Electromagnetic waves include both light
voltage standing wave ratio (VSWR)—the ratio of the and radio waves and travel in space at approximately
maximum voltage to the minimum voltage along a transmis- 300 000 000 m/s. To determine the exact length of a wave,
sion line. It is the measure of the mismatch between the load divide 300 000 000 m by the frequency in hertz.
and the line.
wave, radio—an electromagnetic wave that travels through
volume control—a potentiometer voltage divider used to
space at the speed of light.
adjust the loudness of an audio circuit.
volume unit (VU)—a measure of the magnitude of sound wave, refracted—a radio wave that is bent (refracted) as it
from an electrical wave. Measured in decibels. travels into a second medium of propagation, such as from the
voting—automatic selection of remote radio receiver. All atmosphere to the ionized layers of the stratosphere.
incoming signals are compared for signal strength and the first weatherproof—so constructed or protected that exposure to
signal found that meets or exceeds a preset level is selected and the weather elements will not prevent proper operation.
sent to the audio amplifier. weathertight—so constructed that exposure to a driven rain
W will not result in the entrance of water.
watt—the unit of power. wire—a single metallic conductor.

REFERENCES

(1) “Communications in Support of Emergency Medical Services,” Ex- (5) “Emergency Medical Services Communications System Technical
ecutive Office of the President, Office of Telecommunications Policy, Planning Guide,” Report NTIA-SP-79-3, U.S. Department of Com-
November 1973. merce, March 1979.
(2) “Telecommunications Analysis Services—Reference Guide,” Institute (6) “Master Plan for Emergency Medical Services Communications in
of Telecommunications Sciences, January 1983. Oregon, Vol I, State-Level Plan,” Oregon State Health Division,
(3) “Emergency Medical Communication System Requirements for the Emergency Medical Services Division, June 1982.
Emergency Medical Communications Research Study, Contract No.
FCC-0058, Federal Communications Commission,” Advanced Tech- (7) “National Advisory Commission on Criminal Justice Standards and
nology Systems, Inc., October 9, 1973. Goals, Report on Police,” GPO, Washington, DC, 1973.
(4) “Planning Emergency Medical Communications—Volume One State- (8) “National Advisory Commission on Criminal Justice Standards and
Level Planning Guide,” National Association of State EMS Directors, Goals, Report on the Criminal Justice System,” GPO, Washington,
1995. DC, 1973.

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in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

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if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
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34
Designation: F 1221 – 89 (Reapproved 2001)

Standard Guide for


Interagency Information Exchange1
This standard is issued under the fixed designation F 1221; 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.

INTRODUCTION

This guide has been developed to address the need to provide for effective information exchange
between agencies involved in responding to emergency medical services (EMS) situations.
Communications in the context of this guide refers to the communications that need to occur (1)
prior to the EMS event, (2) during the EMS event, and (3) after the EMS event. Communications in
this guide includes face-to-face communications, telecommunications, and written communications.
Before EMS events, the agencies that need to work closely together in emergency medical situations
need to hold face-to-face meetings to develop communication plans that include an interagency
communications component. These communication plans need to include written protocols outlining
how the emergency response agencies will interface with each other during EMS events.
During the actual event, the agencies need to communicate either directly between emergency units,
or through dispatch centers, or face-to-face (for example, communications related to implementing
protocols or communications regarding decision making between agencies’ senior officials, or
combination thereof). After an emergency, there is a need for the agencies to critique the response.
This may include face-to-face meetings to review the events, written critique reports of the emergency
events, and revisions to the written protocols as may be found necessary by review of the events. (See
the Rationale in Appendix X1.)

1. Scope 1.7 The sections in this guide appear in the following


1.1 This guide covers the planning, operations, and evalua- sequence:
tion phases of interagency communications as part of a Section
Introduction
comprehensive EMS system. Scope 1
1.2 This is a guide for interagency communications within Referenced Document 2
an EMS system. Interagency communications involves the Terminology 3
Significance and Use 4
EMS responder and support agencies whose primary mission is Procedure 5
not to deliver prehospital emergency medical care. Rationale Appendix X1
1.3 The primary focus of this guide is to address interagency Keywords 6
References
communications necessary for ongoing EMS responses.
1.4 The guide also addresses interagency communications 1.8 This standard does not purport to address all of the
in any major EMS incident, including man-made or natural safety concerns, if any, associated with its use. It is the
disasters. responsibility of the user of this standard to establish appro-
1.5 The recommendations for drills/exercises for the evalu- priate safety and health practices and determine the applica-
ation of interagency communications during an EMS event are bility of regulatory limitations prior to use.
also incorporated into this guide.
1.6 Additional information can be found in Guide F 1220 2. Referenced Documents
and Refs 1-5.2 2.1 ASTM Standards:
F 1220 Guide for Emergency Medical Services System
(EMSS) Telecommunications3
1
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.04 on
Communications.
Current edition approved March 31, 1989. Published May 1989.
2
The boldface numbers in parentheses refer to the references at the end of this
3
guide. Annual Book of ASTM Standards, Vol 13.02.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1221 – 89 (2001)
3. Terminology or combination thereof, interagency communication docu-
3.1 Definitions of Terms: ments and protocols: face-to-face, telephone, or teleconfer-
3.1.1 citizen access—act of requesting emergency assis- ence.
tance for a specific event. 5.1.2 Drills—Interagency communication drills shall be
3.1.2 dispatch—act of sending emergency resources in re- conducted at a minimum of once annually. This drill should be
sponse to a specific event. used to evaluate procedures, protocols, communication path
3.1.3 interagency communication evaluation phase— availability, grade of service, and communication path activa-
interagency communications following an EMS incident for tion time. The exercise plans shall include performance param-
evaluation purposes. eters that will permit evaluation of interagency communica-
3.1.4 interagency communication operations phase— tion, procedures, protocols, communication paths, and
interagency communications during an EMS incident for executive times.
operational purposes. 5.2 Interagency Communications Operation Phase:
3.1.5 interagency communication planning phase— 5.2.1 Off-Line Communications—Documents developed in
interagency communications before an EMS incident for the planning phase are used for training and on-line reference
planning purposes. to implement operational procedures. Documents shall include
3.1.6 interagency communications—communications that information on agencies such as law enforcement, fire protec-
take place between EMS responders and agencies, nonmedical tion, public utilities, special response agencies, and public
in nature, that respond in conjunction with emergency medical information. This material shall uniquely identify each agency
services. and provide an interagency protocol for each agency. Each
3.1.7 intra-agency communications—communications that protocol shall clearly identify resources by: who, what, when,
take place between agencies, medical in nature, within an EMS and where for each EMS response.
system. 5.2.2 On-Line Communications—On-line methods that in-
3.1.8 ongoing EMS incident—any EMS incident that is clude face-to-face, telephone, teleconference, one-way, and
managed without multiple EMS response units. two-way radio shall be identified for each of the following
3.1.9 significant EMS incident—any EMS incident requir- elements of an EMS response for interagency communications:
ing multiple EMS response units including: multiple-casualty 5.2.2.1 EMS Access—Any agency that receives requests for
incidents, man-made or natural disasters. EMS assistance (for example, citizens, public safety personnel)
3.1.10 support agency—any agency providing nonmedical shall have immediate direct access to the EMS dispatcher.
support to EMS responders. 5.2.2.2 EMS Dispatch/Coordination—Any EMS dispatch/
3.1.11 vehicles—all modes of transportation, including air, coordination agency shall have immediate direct access to all
ground, or water, or combination thereof. supporting agencies.
5.2.2.3 Enroute to or from an EMS Incident—Interagency
4. Significance and Use coordination to or from vehicles enroute to or from the EMS
incident shall use two-way radio communication to the
4.1 This guide has been developed to facilitate communica- dispatch/coordination center and its immediate direct access
tions between agencies involved in the delivery of emergency interagency links.
medical services. This guide is intended to be applied by 5.2.2.4 Scene Coordination—Interagency communications
agencies providing emergency medical services to improve by the first arriving emergency agency at the scene of an EMS
their communications with EMS support agencies. It recom- incident shall be by two-way radio communication to the
mends necessary communication before, during, and after an dispatch/coordination center and its immediate direct access
EMS event. interagency links. Direct two-way radio communication for
on-scene interagency coordination is recommended. Alterna-
5. Procedure tive methods for interagency coordination at the scene may
5.1 Interagency Communication Planning Phase: include: relay through the dispatch/coordination center(s),
5.1.1 Methods—A plan is needed for the coordination of face-to-face communication, messenger, or other radio facili-
interagency communication activities during ongoing and sig- ties such as cellular radio telephone. When an on-scene
nificant EMS responses. This plan must include alternatives for command post is established, additional communication capa-
events which exceed or overwhelm the systems’ communica- bilities are required to provide on-scene interagency commu-
tion capability. Contingency plans for diminished system nication and communication between the command post and
capabilities, due to equipment or other failures, should also be the dispatch/coordination center or EOC.
addressed. The following methods should be used to develop 5.2.3 Drills/Exercises—During drills or exercises, addi-
the plan: tional qualified personnel must be available to monitor and
Meeting notices measure the process without affecting operations.
Meeting documentation 5.3 Interagency Communication Evaluation Phase:
Interagency communication agreement documents
Interagency communication protocols 5.3.1 Methods—The following methods should be used to
Public information documents evaluate interagency communication activities during ongoing
At a minimum one or more of the following communication and significant EMS responses:
processes shall be used annually to develop, review, or amend, Meeting notices

2
F 1221 – 89 (2001)
Meeting documentation 5.3.2 Drills/Exercises—Within 60 days following a signifi-
Interagency evaluation reports cant EMS incident, exercise, or drill, an evaluation report shall
Interagency communication agreement document reviewed
or revised be completed and distributed to all involved agencies including
Interagency communication protocol reviewed or revised recommended changes in procedures, protocols, and other
Public information documents
system elements.
At the earliest opportunity, not more than 60 days following
a drill or a significant EMS incident, an evaluation of inter- 6. Keywords
agency communication agreements and protocols shall be
conducted using one or more of the following communication 6.1 communications; emergency medical services; inter-
processes: face-to-face, telephone, teleconference. This pro- agency information exchange
cess shall be in addition to the recommended annual planning
process.

APPENDIX

(Nonmandatory Information)

X1. RATIONALE

X1.1 Those agencies who use this guide should carefully changes occur in communication technology or emergency
document when, why, and how specific rules or regulations, or medical practices, or both.
both, were developed. This will allow revisions to be made as

REFERENCES

(1) Communications Act of 1934 (47 U.S.C. 405) as amended and Title (4) Emergency Medical Services Communication Systems Technical
47 United States Code of Federal Regulations (47 CFR) on Telecom- Planning Guide, March 1979, NTIA, Reports Series NTIA SP793,
munications. U.S. Department of Commerce, National Telecommunications and
(2) Communication Manual, U.S. Department of Transportation, Na- Information Administration.
tional Highway Traffic Safety Administration, June 1978, DOT, (5) Guidelines for Developing an EMS Communications Plan, March
HS-802976, Department of Transportation, National Highway Traffic
1977, HSA-772036, U.S. Department of Health, Education and
Safety Administration, Washington, DC.
Welfare, Public Health Service Administration, Bureau of Medical
(3) EMS Communications Compatibility Study, November 1978, DOT,
Services, Box 911, Rockville, MD 20852.
HS-803858, final report prepared for Department of Transportation,
National Highway Traffic Safety Administration, Washington, DC
20590.

ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

3
Designation: F 1224 – 89 (Reapproved 2004)e1

Standard Guide for


Providing System Evaluation for Emergency Medical
Services1
This standard is issued under the fixed designation F 1224; 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.

e1 NOTE—Paragraph 10.1 was editorially revised in June 2004.

1. Scope 4.2 This guide covers the methods and materials that are
1.1 This guide covers providing system evaluation for necessary to evaluate quality for emergency medical services
emergency medical services (1),2 including authority, respon- systems at both the system operations and patient care levels.
sibility, objectives, approaches, data, applications, and imple- 5. Authority
mentation.
5.1 The authority for providing system evaluation for emer-
NOTE 1—This guide does not address evaluation for individual prehos- gency medical services rests with the entity that is utlimately
pital, hospital, or posthospital providers. (Related guides will be devel-
legally responsible for system operation and evaluation.
oped.)
6. Responsibility
2. Referenced Documents
6.1 The responsibility for providing system evaluation for
2.1 ASTM Standards: 3
F 1149 Practice for the Qualifications, Responsibilities, and emergency medical services systems rests with the directors of
Authority of Individuals and Institutions Providing Medi- the entities specified in 5.1.
6.2 The responsibility for providing adequate financial re-
cal Direction of Emergency Medical Services
F 1177 Terminology Relating to Emergency Medical Ser- sources and appropriate medical confidentiality for system
vices evaluation for emergency medical services rests with the
entities specified in 5.1.
3. Terminology 6.3 Independent evaluation of individual parts of the emer-
3.1 Definitions of Terms Specific to This Standard: gency medical services system by prehospital, hospital, or
3.1.1 system evaluation—a review of the performance of posthospital providers must be integrated with and must not be
emergency medical services systems by qualified, experienced substituted for system evaluation.
individuals. 7. Objectives
3.1.2 minimum data set—the minimum number of data
elements required for system evaluation. 7.1 System evaluation of quality for emergency medical
3.2 Definitions—See Terminology F 1177. services entails five objectives (2) including:
7.1.1 Setting priorities,
4. Significance of Use 7.1.2 Assessing outcome,
4.1 This guide establishes system evaluation as an essential 7.1.3 Identifying problems,
component of emergency medical services systems. 7.1.4 Effecting changes, and
7.1.5 Reassessing outcome.

1
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
8. Approaches
Medical Services and is the direct responsibility of Subcommittee F30.03 on 8.1 System evaluation of quality entails approaches of
Organization/Management. structure, process, and outcome, singly or combined (3).
Current edition approved Apr. 1, 2004. Published April 2004. Originally
approved in 1989. Last previous edition approved in 1996 as F 1224 – 89 (1996)e1. 8.2 The approaches specified in 8.1 should be applied at
2
The boldface numbers in parentheses refer to the references at the end of this both the system operations and patient care levels.
guide.
3
8.2.1 Applied at the system operations level (Table 1) these
For referenced ASTM standards, visit the ASTM website, www.astm.org, or
contact ASTM Customer Service at service@astm.org. For Annual Book of ASTM
approaches provide a means of identifying issues that require
Standards volume information, refer to the standard’s Document Summary page on further attention, including:
the ASTM website. 8.2.1.1 System operation, and

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1224 – 89 (2004)e1
TABLE 1 Approaches and Methods for System Evaluation for 10. Applications
Emergency Medical Services
10.1 Patients should be considered for evaluation by emer-
Evaluation Approaches Evaluation Methods
gency medical services systems when classified into the
Structure (standards) ASTM guides (to be developed) categories identified in Table 2.
Process (care) Medical direction (Guide F 1149) (1)
Outcome (results) Intermediate: preventable morbidity (4) 10.2 Emergency medical services systems incorporating
Final: preventable morbidity subsystems, such as those for burn, behavioral, cardiac, pedi-
preventable mortality(5)
Combined Preventable morbidity
atric, perinatal, toxicologic, or traumatic emergencies, may
Preventable mortality require categories in addition to those specified in Table 2.
Tracers (6) When required, such categories should be identified in their
Registries (7)
Generic Screens (8)
respective subsystem standards.
11. Implementation
11.1 Implementation of system evaluation for emergency
8.2.1.2 Individual patients. medical services entails eight steps, including:
8.2.2 Applied at the patient care level these approaches 11.1.1 Defining existing authority, responsibility, standards,
provide a means of evaluating care for patients that are and resources,
specified in 8.2.1.2. 11.1.2 Establishing goals and objectives,
8.3 Audits performed using the approaches specified in 8.1 11.1.3 Selecting an approach and method,
should examine two aspects of care, including: 11.1.4 Assembling data,
8.3.1 Compliance with system standards, and 11.1.5 Analyzing results,
8.3.2 Appropriateness of system standards. 11.1.6 Modifying standards,
11.1.7 Periodically disseminating findings, and
9. Data 11.1.8 Continually reevaluating the system.
9.1 Systemwide uniform recordkeeping constitutes an es- 12. Keywords
sential element of medical evaluation of emergency medical
12.1 emergency medical service; emergency medical ser-
services systems.
vices system; system evaluation
9.2 Emergency medical services system data sources sub-
ject to uniform recordkeeping include: TABLE 2 Evaluation Criteria
9.2.1 Prehospital care: dispatches, first responders, prehos- High-Yield (8)
pital providers, base stations; Deaths
9.2.2 Facility care: nonhospital-based emergency facilities, High-Risk
Critical care admissions
hospitals; Morbidity
9.2.3 Posthospital care: rehabilitation facilities, home care Instability—Symptoms: severe pain, dyspnea, etc.
programs; and Signs: severe injury, tachypnea, etc.
Procedures: thoracostomy, air transport, etc.
9.2.4 Government agencies: medical examiners. Diagnoses: shock, respiratory failure, etc.
9.3 Each source specified in 9.2 must collect and report the Regionalized Care
data contained in the minimum data set as determined by the Prospective—prehospital or emergency department triage
Transfers—interfacility
entity specified in 5.1. Retrospective—discharges, deaths
9.3.1 Data comprise three types, including: Administrative Review
9.3.1.1 Patient demographic data such as patient origin, Complaint—patient, provider or third-party
Prehospital Protocol Deviation—exceeding standard of care
etiologic factors, condition severity, and resource utilization; Patient Refusing Prehospital Care—against medical advice
9.3.1.2 System operation data such as elapsed times, patient Outliers
volumes, and protocol compliance; and Medical—mortality, morbidity, timeliness, etc.
Administrative—diagnostic related groups, cost, etc.
9.3.1.3 Patient care data such as procedures, diagnoses, and Randomized
outcomes.

2
F 1224 – 89 (2004)e1
REFERENCES

(1) Cayten, C. G., Evans, W. J.,“ EMS Systems Evaluation,” Boyd, D. R., (5) Rutstein, D. D., Berenberg, W., Chalmers, T. L., et al, “Measuring the
Edlich, R. F., Micik, S., eds, Systems Approach to Emergency Medical Quality of Medical Care: A Clinical Method,” New England Journal of
Care, Norwalk, CT, Appleton-Century-Crofts, 1983, Chapter 8. Medicine, 1976, Vol 294, pp. 582–584.
(2) Williamson, J. W., Aronovitch, S., Simonson, L., et al, “Health (6) Kessner, D. M., Kalk, C. E., Singer, J., “Assessing Health Quality—
Accounting: An Outcome-Based System of Quality Assurance: Illus- The Case for Tracers,” New England Journal of Medicine, 1973, Vol
trative Application to Hypertension,” Bulletin of the New York Acad- 288, pp. 189–194.
emy of Medicine, 1975, pp. 727–738.
(3) Donabedian, A., “Evaluating the Quality of Medical Care,” Milbank (7) Brooke, E. M., The Current and Future Use of Registers in Health
Memorial Fund Quarterly, 1966, Vol 44, pp. 166–206. Information Systems, Geneva, Switzerland, World Health Organiza-
(4) Pozen, M., et al, “Confirmation Parameters for Assessing Prehospital tion, 1974.
Care,” final report for the National Center for Health Services (8) Shortell, S. M., Richardson, W. C., Health Program Evaluation, St.
Research, Hyattsville, MD, 1980. Louis, MO, 1978.

ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

3
Designation: F 1229 – 01

Standard Guide for the


Qualification and Training of EMS Air Medical Patient Care
Providers1
This standard is issued under the fixed designation F 1229; 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.

INTRODUCTION

This guide describes the minimum qualifications and training of air medical providers. These
guidelines are built on a foundation of recognized courses that are used to train patient care providers.
The developers of this standard are experienced air medical providers and users with broad and
distinctive EMS backgrounds.

1. Scope F 1257 Guide for Selection and Practice of the Emergency


1.1 This guide applies to patient care providers onboard Medical Services Instructor for Advanced Life Support/
medical flights involved in the provision of patient care during Emergency Medical Technician (ALS/EMT) Training Pro-
air medical transport. It does not necessarily address the grams2
qualifications and training of additional specialty care provid- F 1274 Specification for Fixed Wing Advanced Life Sup-
ers or other allied health professionals during air medical port Transport Units3
transport. F 1453 Guide for Training and Evaluation of First Respond-
1.2 This guide establishes air medical nomenclature. ers Who Provide Emergency Medical Care2
1.3 This guide establishes minimum qualifications and F 1552 Practice for Training, Instructor Qualification, and
training requirements for the air medical patient care provid- Certification Eligibility of Emergency Medical Dispatch-
er(s) and the air medical director. ers2
1.4 This guide identifies the general content of the curricula F 1651 Guide for Training the Emergency Medical Techni-
for air medical training. cian (Paramedic)2
1.5 This standard does not purport to address all of the F 1705 Guide for Training Emergency Medical Services
safety concerns, if any, associated with its use. It is the Ambulance Operations2
responsibility of the user of this standard to establish appro- 2.2 U.S. Department of Transportation National Standard
priate safety and health practices and determine the applica- Curricula:4
bility of regulatory limitations prior to use. Emergency Medical Dispatcher
Emergency Medical Care—First Responder
2. Referenced Documents Emergency Medical Technician—Basic
2.1 ASTM Standards: Emergency Medical Technician—Intermediate
F 1031 Practice for Training the Emergency Medical Tech- Emergency Medical Technician—Paramedic
nician (Basic)2 Emergency Medical Services Instructor
F 1124 Specification for Rotary Wing Advanced Life Sup- Emergency Vehicles Operator’s Course
port Transport Units3 Air-Medical Crew Education
F 1256 Guide for Selection and Practice of the Emergency
3. Terminology
Medical Services Instructor for Basic Life Support/
Emergency Medical Technician (BLS/EMT) Training Pro- 3.1 Definitions of Terms Specific to This Standard:
grams2 3.1.1 aeromedicine, n—the branch of medicine that deals
with the physiological, psychological, pathological, and epide-
miological conditions, diseases, and disturbances that arise
1
This guide is under the jurisdiction of ASTM Committee F30 on Emergency from flying.
Medical Services and is the direct responsibility of Subcommittee F30.02 on 3.1.2 air medical, n—the practice of air medicine.
Personnel, Training, and Education.
Current edition approved Sept. 10, 2001. Published November 2001. Originally
published as F 1229 - 89. Last previous edition F 1229 - 00.
2 4
Annual Book of ASTM Standards, Vol 13.02. Available from U.S. Department of Transportation, 400 Seventh St., S.W.,
3
Discontinued. See 1999 Annual Book of ASTM Standards, Vol 13.01. Washington, DC 20590.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1229 – 01
3.1.3 air medical director, n—a physician who is licensed, 5.1.2 Altitude physiology and principles of atmospheric
or otherwise legally authorized to practice, and who functions physics (gas laws);
with an air medical operation as the individual ultimately 5.1.3 Aviation communications;
responsible for the quality of patient care. 5.1.4 Crash and survival procedures;
3.1.4 air medical operations, n—that aspect of air medicine 5.1.5 Familiarization with EMS systems in the service area;
involving policies, procedures, and protocols. 5.1.6 Hazardous materials response procedures;
3.1.5 air medical patient care providers, n—patient care 5.1.7 In-flight treatment modalities;
providers onboard medical flights. 5.1.8 Infection control;
3.1.6 air medicine, n—a discipline of medicine associated 5.1.9 Oxygen therapy in relation to altitude;
with the care and management of patients transported by 5.1.10 Patient assessment in the airborne environment;
aircraft. 5.1.11 Roles and responsibilities; and
3.1.7 educational experience, n—the accumulation of 5.1.12 Stress recognition and management.
knowledge and skills through education, training, and clinical
practice. 6. Flight Nurse—Qualifications and Training
3.1.8 qualification, n—possessing a recognized, definable 6.1 The minimum entry level for a flight nurse shall be the
body of knowledge or specific credential (certificate, license, body of knowledge and skills identified by the objectives
registration, or degree). contained in an accredited registered nursing program. Com-
mensurate with the patient care mission, the flight nurse shall
4. Significance and Use possess all of the knowledge and skills required of a flight
EMT-paramedic and may have additional training in the
4.1 This guide provides minimum guidance for the devel-
assessment and management of patients with special needs as
opment of air medical training programs.
prescribed by the air medical director.
4.2 This guide identifies additional subject areas of training
necessary to become an air medical patient care provider. 7. Air Medical Director, Flight Physician—Qualifications,
Training, and Educational Experience
5. Flight EMT-P (Flight Paramedic)—Qualifications and 7.1 The air medical director or flight physician shall be a
Training physician who is licensed or otherwise legally authorized to
5.1 The minimum entry level for a flight EMT-paramedic practice and who has had educational experience in those areas
shall be the body of knowledge and skills identified by both the of medicine and prehospital care that are commensurate with
required and optional objectives contained in the EMT- the patient care mission(s). Additional training shall include
Paramedic DOT National Standard Curriculum. Commensu- areas listed in 5.1.1-5.1.12.
rate with the patient care mission, additional training is at the
discretion of the air medical director. Additional areas include 8. Keywords
the following: 8.1 air medical providers; EMS; patient care providers;
5.1.1 Aircraft safety; training

ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

2
Designation: F 1254 – 90 (Reapproved 2001)

Standard Practice for


Performance of Prehospital Manual Defibrillation1
This standard is issued under the fixed designation F 1254; 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 defibrillation—the discharge of an electrical current


1.1 This practice covers guidelines for prehospital providers through the heart for the purpose of restoring a perfusing
performing manual defibrillation. cardiac rhythm. For the purpose of this document, defibrillation
1.2 This practice is one in a set of performance guidelines may include cardioversion.
for prehospital defibrillation. 3.1.3 manual defibrillator—a monitor/defibrillator that has
1.3 This practice is specifically not meant to deal with no capability for rhythm analysis and will charge and deliver a
equipment specifications, quality assurance, or training. shock only at the command of the operator.
1.4 This practice is limited to external defibrillators used in 3.1.4 operator—as outlined in this practice, an Emergency
the prehospital setting. Medical Technician (Practice F 1031) who has successfully
1.5 This standard does not purport to address all of the completed a course of training and may treat prehospital
safety concerns, if any, associated with its use. It is the cardiac arrest with a manual defibrillator. Legal functioning as
responsibility of the user of this standard to establish appro- an operator will be based upon licensure/certification require-
priate safety and health practices and determine the applica- ments as established by the authority or authorities having
bility of regulatory limitations prior to use. jurisdiction.
3.1.5 protocols—see Terminology F 1177.
2. Referenced Documents 3.1.6 service medical director—the physician who is medi-
2.1 ASTM Standards: colegally responsible for the patient care provided by the
F 1031 Practice for Training the Emergency Medical Tech- operator (Practice F 1149).
nician (Basic)2 3.1.7 standing orders—see Terminology F 1177.
F 1149 Practice for Qualifications, Responsibilities, and
4. Significance and Use
Authority of Individuals and Institutions Providing Medi-
cal Direction of Emergency Medical Services2 4.1 This practice establishes minimum guidelines for pre-
F 1177 Terminology Relating to Emergency Medical Ser- hospital manual defibrillation.
vices2 4.2 Any person who is identified as prehospital manual
2.2 American Heart Association Document: defibrillation operator shall be an Emergency Medical Techni-
National Standards and Guidelines for Cardiopulmonary cian, as defined by the authority or authorities having jurisdic-
Resuscitation (CPR) and Emergency Cardiac Care (ECC), tion, and shall meet the requirements of this practice.
American Heart Association (Current Edition)3 4.3 Using this practice, emergency medical service institu-
tions, organizations, and certification/licensing agencies should
3. Terminology be able to develop standards for the certification/licensing and
3.1 Definitions of Terms Specific to This Standard: practice of the prehospital manual defibrillation operator.
3.1.1 basic life support/cardiopulmonary resuscitation
5. Standards for Prehospital Manual Defibrillation
(BLS/CPR)—a set of skills that includes airway management,
chest compressions, and others defined by the American Heart 5.1 The operator shall be familiar with all operations of the
Association. defibrillator.
5.2 The operator shall be capable of performing prehospital
defibrillation in accordance with standing orders or protocols,
1
This practice is under the jurisdiction of ASTM Committee F30 on Emergency or both, developed or approved, or both, by the service medical
Medical Services and is the direct responsibility of Subcommittee F30.02 on director or other medical authority or authorities, or both,
Personnel, Training, and Education.
Current edition approved March 5, 1990. Published April 1990. having jurisdiction.
2
Annual Book of ASTM Standards, Vol 13.02. 5.3 The operator shall be capable of recognizing a patient
3
Available from the American Heart Association, 7320 Greenville Ave., Dallas, who is unresponsive, apneic and pulseless.
TX 75231.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1254 – 90 (2001)
5.4 The operator shall be capable of applying and activating 5.15.2.2 Call for help,
the defibrillator according to manufacturer’s recommendations 5.15.2.3 Dispatch (include advanced life support, where
and standing orders/protocols. available),
5.5 The operator shall be capable of assessing certain 5.15.2.4 Initiation of BLS/CPR,
cardiac rhythms, including at least ventricular fibrillation, 5.15.2.5 Arrival of the defibrillator at patient’s side,
ventricular tachycardia, and asystole. 5.15.2.6 Initial defibrillation,
5.6 If the operator determines from 5.4 that the cardiac 5.15.2.7 Departure to hospital, and
rhythm appears to be ventricular fibrillation, ventricular tachy- 5.15.2.8 Arrival at hospital.
cardia, or asystole, then the operator must be capable of 5.15.3 EMS system data in those systems that include these
reassessing the rhythm by checking the cables, leads, battery, elements, including time of:
and switches for potential operational malfunctions. 5.15.3.1 Activation of on-line medical control, and
5.7 The operator shall ensure that no one is in contact with 5.15.3.2 Arrival of advanced life support.
the patient or the defibrillator, and that no one present in the 5.15.4 Treatment, including documentation of treatment for
vicinity of the patient is exposed to any danger of accidental each rhythm encountered.
shock during charging and defibrillation. 5.15.5 Cardiac arrest patient outcome, including the rhythm
5.8 The operator shall be capable of accomplishing the tasks after each defibrillation attempt; return of pulse or spontaneous
listed in 5.3-5.7 within 90 s following patient contact. respiration, or both; and level of consciousness. Also, the
5.9 The operator shall be capable of recognizing that discharge disposition of the patient from the emergency de-
defibrillation energy was delivered. partment and the hospital.
5.10 The operator shall be capable of assessing the rhythm 5.16 The operator or the service, or both, using the defibril-
resulting from the defibrillation, and will be able to respond lator shall ensure that it is maintained in accordance with
according to standing orders/protocol. manufacturer’s recommendations.
5.11 The operator shall be capable of determining whether 5.17 The operator shall be capable of recognizing any of the
an organized rhythm is perfusing and whether BLS/CPR is possible failure modes of the device and shall document any
indicated. such failures to the service medical director.
5.12 The operator shall be capable of performing BLS/CPR 6. Operator Proficiency Requirements
as indicated.
6.1 The operator shall demonstrate continued proficiency in
5.13 The operator shall be capable of recognizing and
rhythm recognition and manual defibrillation in accordance
responding, in accordance with the standing orders/protocols,
with standing orders/protocol.
to patients who return to or remain in an unresponsive, apneic,
6.2 Proficiency shall include performance skills demonstrat-
and pulseless condition.
ing the ability to use the manual defibrillator correctly in a
5.14 The operator shall be capable of preparing the defibril- simulated environment.
lator for the next use. 6.3 There shall be documented evidence of initial and
5.15 The operator or the service, or both, utilizing the continuing education sufficient to establish and maintain pro-
manual defibrillator shall be capable of providing, at a mini- ficiency in use of the manual defibrillator as approved by the
mum, the following information for quality assurance pur- service medical director.
poses:
5.15.1 Patient data, including age; sex; whether arrest was 7. Keywords
witnessed or unwitnessed; and initial cardiac rhythm. 7.1 defibrillation; emergency medical services; manual
5.15.2 EMS system data, including time of: defibrillation; prehospital manual defibrillation; prehospital
5.15.2.1 Collapse/arrest, defibrillation

ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

2
Designation: F 1255 – 90 (Reapproved 2002)

Standard Practice for


Performance of Prehospital Automated Defibrillation1
This standard is issued under the fixed designation F 1255; 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 3.1.3 defibrillation—the discharge of an electrical current


1.1 This practice covers guidelines for the performance of through the heart for the purpose of restoring a perfusing
automated defibrillation. cardiac rhythm. For the purpose of this practice, defibrillation
1.2 This practice is one in a set of performance guidelines may include cardioversion.
for prehospital defibrillation. 3.1.4 operator—as outlined in this practice, a person who
1.3 This practice is specifically not meant to deal with has successfully completed a course of training and may treat
equipment specifications, quality assurance, or training. prehospital cardiac arrest with an automatic or semi-automatic
1.4 This practice is limited to external defibrillators used in defibrillator. Legal functioning as an operator will be based
the prehospital setting. upon licensure or certification requirements, or both, as estab-
1.5 This standard does not purport to address all of the lished by the authority or authorities having jurisdiction.
safety concerns, if any, associated with its use. It is the 3.1.5 protocols—See Terminology F 1177.
responsibility of the user of this standard to establish appro- 3.1.6 service medical director—the physician who is
priate safety and health practices and determine the applica- medico-legally responsible for the patient care provided by the
bility of regulatory limitations prior to use. operator (Practice F 1149).
3.1.7 standing orders—See Terminology F 1177.
2. Referenced Documents
4. Significance and Use
2.1 ASTM Standards:
F 1149 Practice for the Qualifications, Responsibilities, and 4.1 This practice establishes minimum guidelines for pre-
Authority of Individuals and Institutions Providing Medi- hospital automated defibrillation.
cal Direction of Emergency Medical Services2 4.2 This practice does not preclude the use of automated
F 1177 Terminology Relating to Emergency Medical Ser- defibrillators as prescribed by a licensed physician.
vices2 4.3 All persons who are identified as prehospital automated
2.2 American Heart Association Document: defibrillation operators shall meet the requirements of this
National Standards and Guidelines for Cardiopulmonary practice.
Resuscitation (CPR) and Emergency Cardiac Care (ECC), 4.4 Using this practice, emergency medical service institu-
American Heart Association (Current Edition)3 tions, organizations, and certification/licensing agencies should
be able to develop standards for the certification/licensing and
3. Terminology practice of the prehospital automated defibrillation operator.
3.1 Definitions of Terms Specific to This Standard:
5. Guidelines for Prehospital Automated Defibrillation
3.1.1 automated defibrillator—an automatic or semi-
automatic device, or both, capable of rhythm analysis and 5.1 The operator shall be familiar with all operations of the
defibrillation after electronically detecting the presence of automated defibrillator.
ventricular fibrillation and ventricular tachycardia. 5.2 The operator shall be capable of performing prehospital
3.1.2 basic life support/cardiopulmonary resuscitation defibrillation in accordance with standing orders, protocols
(BLS/CPR)—a set of skills that includes airway management, developed, approval by the service medical director or other
chest compressions, and others defined by the American Heart medical authority or authorities having jurisdiction, or a
Association. combination thereof.
5.3 The operator shall be capable of recognizing a patient
1
who is unresponsive, apneic and pulseless.
This practice is under the jurisdiction of ASTM Committee F30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.02 on
5.4 The operator shall be capable of preparing the auto-
Personnel, Training, and Education. mated defibrillator for operational use.
Current edition approved March 5, 1990. Published April 1990. 5.5 The operator shall be capable of applying and activating
2
Annual Book of ASTM Standards, Vol 13.02. the automated defibrillator according to the manufacturer’s
3
Available from the American Heart Association, 7372 Greenville Ave., Dallas,
TX 75231.
recommendations and standing orders/protocols.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1255 – 90 (2002)
5.6 The operator shall ensure that no one is in contact with 5.13.2.7 Departure to hospital, and
the patient or the automated defibrillator, and that no one 5.13.2.8 Arrival at hospital.
present in the vicinity of the patient is exposed to any danger 5.13.3 EMS System Data, in those systems that include
of accidental shock during charging and defibrillation. these elements, including time of:
5.7 The operator shall be capable of accomplishing the tasks 5.13.3.1 Activation of on-line medical control, and
listed in 5.3-5.5 and 5.6 within 90 s following patient contact. 5.13.3.2 Arrival of advanced life support.
5.8 The operator shall be capable of recognizing that 5.13.4 Treatment, including documentation of treatment for
defibrillation energy was delivered. each rhythm encountered.
5.9 The operator shall be capable of recognizing the success 5.13.5 Cardiac arrest patient outcome, including the rhythm
or lack of success of defibrillation and treat the patient after each defibrillation attempt; the return of pulse or sponta-
accordingly. neous respiration, or both; and the level of consciousness.
5.10 The operator shall be capable of performing BLS/CPR 5.14 The operator or the service, or both, utilizing the
as indicated. automated defibrillator shall ensure it is maintained in accor-
5.11 The operator shall be capable of recognizing and dance with manufacturer’s recommendations.
responding, in accordance with the standing orders or proto- 5.15 The operator shall be capable of recognizing any of the
cols, or both, to patients who return to or remain in an possible failure modes of the device and shall document any
unresponsive, apneic and pulseless condition. such failures to the service medical director.
5.12 The operator shall be capable of preparing the auto-
mated defibrillator for the next use. 6. Operator Proficiency Requirements
5.13 The operator or the service, or both, utilizing the 6.1 The operator shall demonstrate continued proficiency in
automated defibrillator shall be capable of providing, at a automated defibrillation in accordance with standing orders/
minimum, the following information for quality assurance protocol.
purposes: 6.2 Proficiency shall include performance skills demonstrat-
5.13.1 Patient data, including age; sex; whether the arrest ing the ability to use the automated defibrillator correctly in a
was witnessed or unwitnessed; pulselessness; and initial car- simulated environment.
diac rhythm as identified by the automated defibrillator. 6.3 There shall be documented evidence of initial and
5.13.2 EMS system data, including time of: continuing education sufficient to establish and maintain pro-
5.13.2.1 Collapse/arrest, ficiency in use of the automated defibrillator as approved by the
5.13.2.2 Call for help, service medical director.
5.13.2.3 Dispatch (include advanced life support, where
available), 7. Keywords
5.13.2.4 Initiation of BLS/CPR, 7.1 automated defibrillation; defibrillation; emergency
5.13.2.5 Arrival of automated defibrillator at patient’s side, medical services; prehospital automated defibrillation; prehos-
5.13.2.6 Initial defibrillation, pital defibrillation

ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

2
Designation: F 1256 – 90 (Reapproved 2002)

Standard Guide for


Selection and Practice of Emergency Medical Services
Instructor for Basic Life Support/Emergency Medical
Technician (BLS/EMT) Training Programs1
This standard is issued under the fixed designation F 1256; 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 1.7 This guide applies only to instructors who teach in basic
1.1 This guide is intended to assist emergency medical life support training courses designed to prepare an individual
services (EMS) agencies and institutions in selecting and for certification to practice as an EMT (basic) or first responder.
utilizing individuals who teach in EMT (emergency medical It does not apply to instructors who teach in specialized courses
technician) training programs which include instruction in that do not in themselves qualify the individual for a level of
basic life support knowledge and skills. EMT certification.
1.2 This guide identifies six categories of instructor in a 1.8 This guide does not establish certification requirements.
BLS/EMT (basic life support/emergency medical technician) Such requirements should be established by the certifying
training program: adjunct instructor, clinical/field preceptor, agency in the jurisdiction in which the BLS/EMT instructor
practical skills instructor, associate instructor, course will function. This guide may be used to provide considerable
instructor/coordinator (I/C), and course administrator. The guidance to the jurisdiction responsible for establishing certi-
guide recognizes that an individual may, depending on his/her fication standards.
level of practice and the training program involved, function in 1.9 This standard does not purport to address all of the
any or all of these categories. safety concerns, if any, associated with its use. It is the
1.3 This guide includes specific guidelines for qualifica- responsibility of the user of this standard to establish appro-
tions, training, education, experience, scope of authority, re- priate safety and health practices and determine the applica-
sponsibilities, continuing education, evaluation, and mainte- bility of regulatory limitations prior to use.
nance of competency when applicable. NOTE 1—Also see Practice F 1031.
1.4 This guide does not include specific guidelines for the
course administrator or the adjunct instructor. While the guide 2. Referenced Documents
recognizes, by offering a definition of each category, that these 2.1 ASTM Standards:
types of individuals function in many BLS/EMT training F 1031 Practice for Training the Emergency Medical Tech-
programs, the limited instructional roles played by these nician (Basic)2
individuals precludes the need for specific selection and
utilization guidelines. 3. Terminology
1.5 This guide is intended to apply to any individual who 3.1 Definitions of Terms Specific to This Standard:
teaches in BLS/EMT training programs regardless of the 3.1.1 adjunct instructor—an individual with specialized
individual’s present level of clinical practice. subject matter expertise, who, on occasion, instructs a specific
1.6 This guide intentionally omits references to length of topic of a curriculum under the direction of the course
prehospital care experience, teaching experience, and continu- instructor/coordinator.
ing education requirements. This guide also omits reference to 3.1.2 associate instructor—an individual who possesses the
waiver or equivalency. These issues should be addressed by the qualifications and education/training of a course instructor/
appropriate agency. coordinator, but, in a specific course, assumes a supportive or
assisting role to the course instructor/coordinator. This indi-
1
vidual may substitute for the course instructor/coordinator in
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.02 on
Personnel, Training and Education.
2
Current edition approved Jan. 10, 1990. Published February 1990. Annual Book of ASTM Standards, Vol 13.02.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1256 – 90 (2002)
case of necessity or, in other courses, serve as a course BLS/EMT programs. It must, at a minimum, contain the
instructor/coordinator. elements of the DOT EMS Instructor National Standard
3.1.3 basic life support—a level of pre-hospital emergency Curriculum.5
medical care that includes any or all first responder and 3.1.15 practical skills instructor—an individual who assists
EMT-basic procedures as defined by the National Standard with practical skills instruction under the direction of the
Curricula.3,4 course instructor/coordinator.
3.1.16 qualification—a requirement which shall be met by a
3.1.4 basic life support/emergency medical technician (BLS/
BLS/EMT instructor candidate prior to selection and practice
EMT) training program—a course of instruction that provides
as a BLS/EMT instructor.
an individual with the knowledge and clinical skills of emer-
gency medical care necessary to function at a level of first
4. Significance and Use
responder or EMT (basic) level of care. Such courses include,
but are not limited to, first responder and EMT-basic training 4.1 Since the quality of prehospital BLS/EMT training
programs. depends, in large measure, on the instructional abilities and
competencies of the BLS/EMT instructor, it is imperative that
3.1.5 BLS/EMT instructor—an individual who provides in-
the individual selected and used in this capacity possess the
struction in a training or education program for prehospital
qualifications and capabilities necessary to provide effective
BLS/EMT personnel. This term includes any individual who instruction.
functions as an adjunct instructor, clinical/field preceptor, 4.2 A BLS/EMT instructor must possess clearly defined
practical skills instructor, associate instructor, or course knowledge and skills competencies, have clearly defined re-
instructor/coordinator. sponsibilities and scope of authority related to instructional
3.1.6 certification—current, formal approval by the appro- programs, and meet other specific requirements pertinent to the
priate certifying agency to function at a specific level of level of instruction.
practice. This may also be referred to as approval or licensure. 4.3 Using this guide, EMS institutions and organizations
3.1.7 clinical certification—a standardized process for should be able to develop requirements for selection and
evaluation and recognition of an acceptable level of compe- utilization of BLS/EMT instructors for BLS/EMT training and
tence in a specific aspect of patient care. education programs.
3.1.8 clinical experience—exposure to and practice in an
area of patient care. BASIC LIFE SUPPORT INSTRUCTOR GUIDELINES
3.1.9 clinical/field preceptor—an individual who supervises
5. Course Instructor/Coordinator
and evaluates the students during clinical or field experiences
under the direction of the course instructor/coordinator. 5.1 An individual shall be considered eligible to serve as a
3.1.10 course administrator—an individual responsible for BLS/EMT course I/C (instructor/coordinator) when require-
managing administrative details of a course, separate from ments as outlined in 5.1.1 and 5.1.2 have been met by that
actual instruction of the course. individual.
5.1.1 Qualifications—Prior to entering the instructor train-
3.1.11 course instructor/coordinator (I/C)—an individual ing program, the course I/C candidate shall:
who is authorized by the appropriate entity to present and 5.1.1.1 Be at least a high school graduate or have a General
assess competence in all of the subject matter contained in a Equivalency Diploma (GED); preferably a higher education
curriculum. This person also oversees all instruction in the degree in a supportive discipline,
course and makes final evaluations concerning student compe- 5.1.1.2 Have prehospital patient care experience at least at
tence. the level being taught,
3.1.12 course medical director—the licensed physician who 5.1.1.3 Be certified at least at the level being taught,
provides medical direction for all didactic and clinical instruc- 5.1.1.4 Demonstrate, at the level being taught, current
tion and clinical practice experience included in a BLS/EMT competence in and knowledge of emergency care of the acutely
training program. ill or traumatized patient to the satisfaction of the appropriate
3.1.13 evaluation—the process of verifying clinical and agency, and
educational skills and knowledge competencies of a BLS/EMT 5.1.1.5 Demonstrate to the instructor training agency, read-
instructor. ing and language skills commensurate with resource materials
3.1.14 instructor training program—an educational pro- to be utilized in the BLS/EMT training program.
gram that provides a foundation of essential educational 5.1.2 Education/Training/Experience—The course I/C can-
principles to assist individuals to instruct in, or coordinate, didate shall:
5.1.2.1 Have served as a practical skills instructor, clinical
or field preceptor, and successfully completed a supervised

3
Emergency Medical Services, First Responder Training Course—Instructor’s
Lesson Plans (U.S. DOT/NHTSA Report No. DOT HS 900–, 1984).
4 5
Emergency Medical Technician—Ambulance: National Standard Emergency Medical Services Instructor Training Program: A National Standard
Curriculum—Instructor’s Lesson Plans (U.S. DOT/NHTSA Report No. DOT HS Curriculum—Instructor’s Lesson Plans, First Edition, 1986 (U.S. DOT/NHTSA
900–, 1984). Report No. HS 900–086, February 1986).

2
F 1256 – 90 (2002)
probationary teaching experience in a BLS/EMT training 5.1.4.12 Shall ensure that practical skills training equipment
program at the level to be taught to the satisfaction of the is maintained in a safe and acceptable operating condition,
appropriate agency, 5.1.4.13 Shall protect the privacy of students and the con-
5.1.2.2 Have advanced clinical certifications, provider or fidentiality of training course records as required by applicable
intructor, or both, as appropriate for the curriculum being laws and standards,
taught, 5.1.4.14 Should have knowledge of the administrative and
5.1.2.3 Be certified as a CPR instructor according to the legislative processes affecting the local, regional, or state
current standards as promulgated by the American Heart prehospital EMS system, or combination thereof, and
Association or the American Red Cross, 5.1.4.15 Should have knowledge of the laws and regulations
5.1.2.4 Become familiar with appropriate record keeping affecting the local, regional, or state prehospital EMS system,
processes for students, sponsoring agency, or state EMS or combination thereof.
agency, or both, and 5.1.5 Evaluation—The evaluation of a course I/C shall
5.1.2.5 Successfully complete an instructor training pro- include:
gram that includes the knowledge and skills objectives con- 5.1.5.1 Analysis of student outcomes,
tained in the DOT Instructor Curriculum.5 5.1.5.2 Classroom observation of the I/C, and
5.1.3 Scope of Authority—The course I/C shall have the 5.1.5.3 Review of students’ course evaluations.
authority to: 5.1.6 Maintenance of Competency—In order to maintain
5.1.3.1 Conduct BLS/EMT training programs with approval competency, the course I/C shall:
of appropriate EMS agency, 5.1.6.1 Maintain certification at least at the level being
5.1.3.2 Document to the appropriate agency those students taught,
successfully completing the BLS/EMT training program, and 5.1.6.2 Teach BLS/EMT related curriculum,
5.1.3.3 Regulate student behavior within the scope of the 5.1.6.3 Participate in continuing education programs, which
training program under the institutional guidelines for due may include:
process. (a) Practice-related topics, for example, management or
5.1.4 Responsibilities—The course I/C: administration, vehicle maintenance, or communications,
5.1.4.1 Should provide a positive role model by: (b) Clinical topics, and
(a) Maintaining personal mental and physical health, (c) Educational methods and materials.
(b) Maintaining appropriate personal hygiene and appear-
ance, 6. Associate Instructor
(c) Actively pursuing personal and professional develop-
ment, 6.1 The associate instructor shall possess the same qualifi-
(d) Recognizing personal limitations and seeking assis- cations, training and education as the course I/C.
tance when appropriate, 6.2 The associate instructor differs from the course I/C in
(e) Demonstrating competent, respectful, and caring in- that the associate instructor assumes a supportive and assisting
teractions with students, coworkers, and patients at all times, role to the course I/C in a specific BLS/EMT training program.
and
(f) Demonstrating professional behavior in the classroom 7. Practical Skills Instructor
or in the presence of students. 7.1 Qualifications—The practical skills instructor candi-
5.1.4.2 Shall ensure a safe and effective learning environ- date:
ment, 7.1.1 Should be at least a high school graduate or have a
5.1.4.3 Shall ensure competent training staff, General Equivalency Diploma (GED),
5.1.4.4 Shall maintain appropriate training records, 7.1.2 Shall have pre-hospital care experience or approval by
5.1.4.5 Shall teach the curriculum as adopted and defined by course I/C and course medical director, or both, and
the appropriate certifying agency, 7.1.3 Shall demonstrate to the satisfaction of the course I/C
5.1.4.6 Shall inform students of the criteria for successful and course medical director current competence in and knowl-
course completion, edge of the skill(s) being taught.
5.1.4.7 Shall consistently monitor student progress toward 7.2 Education/Training/Experience—The practical skills in-
terminal course objectives and provide appropriate feedback to structor candidate shall:
the students within guidelines established by the appropriate 7.2.1 Demonstrate mastery of the knowledge and skills
certifying agency, objectives contained in lessons 1, 8, and 9 of the DOT
5.1.4.8 Shall uphold state and national clinical standards for Instructor Curriculum,5
practice at the appropriate BLS/EMT level, 7.2.2 Successfully complete a supervised probationary
5.1.4.9 Shall evaluate the students for safe and effective teaching experience for the skill(s) to be taught to the satisfac-
performance, tion of the appropriate agency,
5.1.4.10 Shall orient, supervise and evaluate adjunct, prac- 7.2.3 Be certified as a CPR instructor according to the
tical skills, associate instructors, and clinical/field preceptors, current standards as promulgated by the American Heart
5.1.4.11 Shall coordinate student field or clinical activities Association or the American Red Cross, if CPR is among the
with the clinical/field preceptors, skills to be taught, and

3
F 1256 – 90 (2002)
7.2.4 Become familiar with appropriate record keeping 7.6.2 Teach the skills contained in a BLS/EMT related
processes for students, sponsoring agency, or state EMS curriculum.
agency, or both.
7.3 Scope of Authority—The practical skills instructor shall 8. Clinical/Field Preceptor
have authority to: 8.1 Qualifications—The clinical/field preceptor candidate
7.3.1 Conduct practical skills sessions under the direction of shall:
the course I/C, 8.1.1 Be certified in his/her area of practice,
7.3.2 Verify successful achievement of course skill objec- 8.1.2 Have experience in his/her area of expertise, and
tives, under the direction of the course I/C, and 8.1.3 Demonstrate to the satisfaction of the course I/C a
7.3.3 Regulate student behavior within the scope of the willingness and competence to work with students to assist
practical skills training program under the institutional guide- them in meeting pertinent course objectives in the setting in
lines for due process. which the clinical/field preceptor will function.
7.4 Responsibilities—Under the direction of the course I/C, 8.2 Education/Training/Experience—The clinical/field pre-
the practical skills instructor: ceptor shall complete an orientation that includes:
7.4.1 Should provide a positive role model by:
8.2.1 Roles and responsibilities of the BLS/EMT,
7.4.1.1 Maintaining personal mental and physical health,
8.2.2 Roles and responsibilities of the clinical/field precep-
7.4.1.2 Maintaining appropriate personal hygiene and ap-
tor, and
pearance,
8.2.3 Guidelines for carrying out, meeting or accomplishing
7.4.1.3 Actively pursuing personal and professional devel-
assigned responsibilities and duties.
opment,
8.3 Scope of Authority—The clinical/field preceptor shall
7.4.1.4 Recognizing personal limitations and seeking assis-
have authority to:
tance when appropriate,
8.3.1 Supervise student activities in the clinical/field setting
7.4.1.5 Demonstrating competent, respectful, and caring
as determined by stated course objectives,
interactions with students, co-workers, and patients at all times,
and 8.3.2 Document student performance in the clinical/field
setting, and
7.4.1.6 Demonstrating professional behavior in the class-
room or in the presence of students. 8.3.3 Regulate student behavior within the scope of the
clinical/field setting under the institutional guidelines for due
7.4.2 Shall ensure a safe and effective learning environment,
process.
7.4.3 Shall provide consistent and competent training assis-
tance to students, 8.4 Responsibilities—Under the direction of the course I/C,
the clinical/field preceptor:
7.4.4 Shall maintain appropriate student skills training
records, 8.4.1 Should provide a positive role model,
7.4.5 Shall teach the skills contained in the curriculum as 8.4.2 Shall provide a safe and effective learning environ-
adopted and defined by the appropriate certifying agency, ment,
7.4.6 Shall consistently monitor students’ progress toward 8.4.3 Shall provide consistent and competent supervision to
established course skill objectives and provide appropriate students,
feedback to the course I/C and the students within guidelines of 8.4.4 Shall maintain appropriate training records,
the appropriate certifying agency, 8.4.5 Shall assist the students in meeting the clinical/field
7.4.7 Shall evaluate, according to the curriculum, and dif- skills objectives,
ferentiate among students for safe and effective performance, 8.4.6 Shall consistently monitor students and provide appro-
7.4.8 Shall uphold state and national clinical standards for priate feedback to the course I/C and the students,
practice at the level being taught, 8.4.7 Shall assess students for safe and effective perfor-
7.4.9 Shall ensure that practical skills training equipment is mance, and
maintained in a safe and acceptable operating condition, and 8.4.8 Shall protect the privacy of students and the confiden-
7.4.10 Shall protect the privacy of students and the confi- tiality of training course records as required by applicable laws
dentiality of training course records as required by applicable and standards.
laws and standards. 8.5 Evaluation—The evaluation by the course I/C of a
7.5 Evaluation—The evaluation by the course I/C of a clinical/field preceptor in a BLS/EMT training program shall
practical skills instructor shall include: include:
7.5.1 Analysis of student practical skills outcomes, 8.5.1 Quality of training records,
7.5.2 Classroom observation of the practical skills instruc- 8.5.2 Clinical/field observation of the preceptor, and
tor, and 8.5.3 Review of students’ clinical experience evaluations.
7.5.3 Review of students’ course evaluations. 8.6 Maintenance of Competency—In order to maintain
7.6 Maintenance of Competency—In order to maintain competency, the clinical/field preceptor shall:
competency, the practical skills instructor shall: 8.6.1 Maintain certification in his/her area of practice, and
7.6.1 Maintain, to the satisfaction of the course I/C and 8.6.2 Maintain, to the satisfaction of the course I/C and
course medical director, current competence in and knowledge course medical director, current competence in and knowledge
of the skill(s) being taught. of the areas precepted.

4
F 1256 – 90 (2002)
9. Keywords
9.1 basic life support; emergency medical services instruc-
tor; emergency medical technician; training programs

ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

5
Designation: F 1257 – 90 (Reapproved 2002)

Standard Guide for


Selection and Practice of Emergency Medical Services
Instructor for Advanced Life Support/Emergency Medical
Technician (ALS/EMT) Training Programs1
This standard is issued under the fixed designation F 1257; 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 teach in specialized courses that do not in themselves qualify


1.1 This guide is intended to assist emergency medical the individual for a level of EMT certification.
services (EMS) agencies and institutions in selecting and 1.8 This guide does not establish certification requirements.
utilizing individuals who teach in EMT (emergency medical Such requirements should be established by the certifying
technician) training programs that include instruction in ad- agency in the jurisdiction in which the ALS/EMT instructor
vanced life support knowledge and skills. will function. This guide may be used to provide considerable
1.2 This guide identifies six categories of instructor in an guidance to the jurisdiction responsible for establishing certi-
ALS/EMT (advanced life support/emergency medical techni- fication standards.
cian) training program: adjunct instructor, clinical/field precep- 1.9 This standard does not purport to address all of the
tor, practical skills instructor, associate instructor, course safety concerns associated with its use. It is the responsibility
instructor/coordinator (I/C), and course administrator. The of the user of this standard to establish appropriate safety and
guide recognizes that an individual may, depending on his/her health practices and determine the applicability of regulatory
level of practice and the training program involved, function in limitations prior to use.
any or all of these categories. NOTE 1—Also see Practice F 1031.
1.3 This guide includes specific guidelines for qualifica-
tions, training, education, experience, scope of authority, re- 2. Referenced Documents
sponsibilities, continuing education, evaluation, and mainte- 2.1 ASTM Standards:
nance of competency when applicable. F 1031 Practice for Training the Emergency Medical Tech-
1.4 This guide does not include specific guidelines for the nician (Basic)2
course administrator or the adjunct instructor. While the guide
recognizes, by offering a definition of each category, that these 3. Terminology
types of individuals function in many ALS/EMT training 3.1 Definitions of Terms Specific to This Standard:
programs, the limited instructional roles played by these 3.1.1 adjunct instructor—an individual with specialized
individuals precludes the need for specific selection and subject matter expertise, who, on occasion, instructs a specific
utilization guidelines. topic of a curriculum under the direction of the course
1.5 This guide is intended to apply to any individual who instructor/coordinator.
teaches in ALS/EMT training programs regardless of the 3.1.2 advanced life support—a level of pre-hospital emer-
individual’s present level of clinical practice. gency medical care that includes all EMT-basic procedures and
1.6 This guide intentionally omits references to length of any or all additional procedures, interventions, or techniques
prehospital care experience, teaching experience, and continu- defined by the National Standard Curricula.3,4
ing education requirements. This guide also omits reference to 3.1.3 advanced life support/emergency medical technician
waiver or equivalency. These issues should be addressed by the (ALS/EMT) training program—a course of instruction that
appropriate agency. provides an individual with the knowledge and clinical skills of
1.7 This guide applies only to instructors who teach in emergency medical care necessary to function at a level of
advanced life support training courses designed to prepare an
individual for certification to practice as an EMT above the
level of the EMT (basic). It does not apply to instructors who 2
Annual Book of ASTM Standards, Vol 13.02.
3
Emergency Medical Technician—Intermediate: National Standard
Curriculum—Instructor’s Lesson Plans (U.S. DOT/NHTSA Report No. DOT HS
1
This guide is under the jurisdiction of ASTM Committee F30 on Emergency 900–091, August 1986).
4
Medical Services and is the direct responsibility of Subcommittee F30.02 on Emergency Medical Technician—Paramedic: National Standard Curriculum—
Personnel, Training and Education. Instructor’s Lesson Plans, 1985 (U.S. DOT/NHTSA Report No. DOT HS 900–089,
Current edition approved Jan. 10, 1990. Published February 1990. August 1986).

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1257 – 90 (2002)
EMT practice beyond the level of EMT (basic). Such courses 3.1.16 qualification—a requirement which shall be met by
include, but are not limited to, EMT-intermediate and EMT- an ALS/EMT instructor candidate prior to selection and prac-
paramedic training programs. tice as an ALS/EMT instructor.
3.1.4 ALS/EMT instructor—an individual who provides in-
struction in a training or education program for prehospital 4. Significance and Use
ALS/EMT personnel. This term includes any individual who 4.1 Since the quality of prehospital ALS/EMT training
functions as an adjunct instructor, clinical/field preceptor, depends, in large measure, on the instructional abilities and
practical skills instructor, associate instructor, or course competencies of the ALS/EMT instructor, it is imperative that
instructor/coordinator. the individual selected and used in this capacity possess the
3.1.5 associate instructor—an individual who possesses the qualifications and capabilities necessary to provide effective
qualifications and education/training of a course instructor/ instruction.
coordinator, but, in a specific course, assumes a supportive or 4.2 An ALS/EMT instructor must possess clearly defined
assisting role to the course instructor/coordinator. This indi- knowledge and skills competencies, have clearly defined re-
vidual may substitute for the course instructor/coordinator in sponsibilities and scope of authority related to instructional
case of necessity or, in other courses, serve as a course programs and meet other specific requirements pertinent to the
instructor/coordinator. level of instruction.
3.1.6 certification—current, formal approval by the appro- 4.3 Using this guide, EMS institutions and organizations
priate certifying agency to function at a specific level of should be able to develop requirements for selection and
practice. This may also be referred to as approval or licensure. utilization of ALS/EMT instructors for ALS/EMT training and
education programs.
3.1.7 clinical certification—a standardized process for
evaluation and recognition of an acceptable level of compe- ADVANCED LIFE SUPPORT INSTRUCTOR
tence in a specific aspect of patient care. GUIDELINES
3.1.8 clinical experience—exposure to and practice in an
area of patient care. 5. Course Instructor/Coordinator
3.1.9 clinical/field preceptor—an individual who supervises 5.1 An individual shall be considered eligible to serve as an
and evaluates the students during clinical or field experiences ALS/EMT course I/C when requirements as outlined in 5.1.1
under the direction of the course instructor/coordinator. and 5.1.2 have been met by that individual.
3.1.10 course administrator—an individual responsible for 5.1.1 Qualifications— Prior to entering the instructor train-
managing administrative details of a course, separate from ing program, the course I/C candidate shall:
actual instruction of the course. 5.1.1.1 Be at least a high school graduate or have a General
3.1.11 course instructor/coordinator (I/C)—an individual Equivalency Diploma (GED); preferably a higher education
who is authorized by the appropriate entity to present and degree in a supportive discipline,
assess competence in all of the subject matter contained in a 5.1.1.2 Have prehospital patient care experience at least at
curriculum. This person also oversees all instruction in the the level being taught,
course and makes final evaluations concerning student compe- 5.1.1.3 Be certified at least at the level being taught,
tence. 5.1.1.4 Demonstrate, at the level being taught, current
3.1.12 course medical director—the licensed physician who competence in and knowledge of emergency care of the acutely
provides medical direction for all didactic and clinical instruc- ill or traumatized patient to the satisfaction of the appropriate
tion and clinical practice experience included in an ALS/EMT agency, and
training program. 5.1.1.5 Demonstrate to the instructor training agency, read-
ing and language skills commensurate with resource materials
3.1.13 evaluation—the process of verifying clinical and
to be utilized in the ALS/EMT training program.
educational skills and knowledge competencies of an ALS/
5.1.2 Education/Training/Experience—The course I/C can-
EMT instructor.
didate shall:
3.1.14 instructor training program—an educational pro- 5.1.2.1 Have served as a practical skills instructor, clinical
gram that provides a foundation of essential educational or field preceptor, and successfully completed a supervised
principles to assist individuals to instruct in, or coordinate, probationary teaching experience in an ALS/EMT training
ALS/EMT programs. It must, at a minimum, contain the program at the level to be taught to the satisfaction of the
elements of the DOT EMS Instructor National Standard appropriate agency,
Curriculum.5 5.1.2.2 Have advanced clinical certifications, provider or
3.1.15 practical skills instructor—an individual who assists instructor, or both, as appropriate for the curriculum being
with practical skills instruction under the direction of the taught,
course instructor/coordinator. 5.1.2.3 Be certified as a CPR instructor according to the
current standards as promulgated by the American Heart
Association or the American Red Cross,
5 5.1.2.4 Become familiar with appropriate record keeping
Emergency Medical Services Instructor Training Program: A National Standard
Curriculum—Instructor’s Lesson Plans, First Edition, 1986 (U.S. DOT/NHTSA processes for students, sponsoring agency or state EMS
Report No. HS 900–086, February 1986). agency, or both,

2
F 1257 – 90 (2002)
5.1.2.5 Successfully complete an instructor training pro- 5.1.5.1 Analysis of student outcomes,
gram that includes the knowledge and skills objectives con- 5.1.5.2 Classroom observation of the I/C, and
tained in the DOT Instructor Curriculum.5 5.1.5.3 Review of students’ course evaluations.
5.1.3 Scope of Authority—The course I/C shall have the 5.1.6 Maintenance of competency—In order to maintain
authority to: competency, the course I/C shall:
5.1.3.1 Conduct ALS/EMT training programs with the ap- 5.1.6.1 Maintain certification at least at the level being
proval of the appropriate EMS agency, taught,
5.1.3.2 Document to the appropriate agency those students 5.1.6.2 Teach ALS/EMT related curriculum, and
successfully completing the ALS/EMT training program, and 5.1.6.3 Participate in continuing education programs, which
5.1.3.3 Regulate student behavior within the scope of the may include:
training program under the institutional guidelines for due (a) Practice-related topics, for example, management or
process. administration, vehicle maintenance, communications,
5.1.4 Responsibilities— The course I/C: (b) Clinical topics, and
5.1.4.1 Should provide a positive role model by: (c) Educational methods and materials.
(a) Maintaining personal mental and physical health,
6. Associate Instructor
(b) Maintaining appropriate personal hygiene and appear-
ance, 6.1 The associate instructor shall possess the same qualifi-
(c) Actively pursuing personal and professional develop- cations, training and education as the course I/C.
ment, 6.2 The associate instructor differs from the course I/C in
(d) Recognizing personal limitations and seeking assis- that the associate instructor assumes a supportive and assisting
tance when appropriate, role to the course I/C in a specific ALS/EMT training program.
(e) Demonstrating competent, respectful, and caring inter- 7. Practical Skills Instructor
actions with students, coworkers, and patients at all times, and
7.1 Qualifications— The practical skills instructor candi-
(f) Demonstrating professional behavior in the classroom
date:
or in the presence of students.
7.1.1 Should be at least a high school graduate or have a
5.1.4.2 Shall ensure a safe and effective learning environ-
General Equivalency Diploma (GED),
ment,
7.1.2 Shall have pre-hospital care experience or approval by
5.1.4.3 Shall ensure competent training staff,
the course I/C and course medical director, or both, and
5.1.4.4 Shall maintain appropriate training records, 7.1.3 Shall demonstrate to the satisfaction of the course I/C
5.1.4.5 Shall teach the curriculum as adopted and defined by and course medical director current competence in and knowl-
the appropriate certifying agency, edge of the skill(s) being taught.
5.1.4.6 Shall inform students of the criteria for successful 7.2 Education/Training/Experience—The practical skills in-
course completion, structor candidate shall:
5.1.4.7 Shall consistently monitor student progress toward 7.2.1 Demonstrate mastery of the knowledge and skills
terminal course objectives and provide appropriate feedback to objective contained in lessons 1, 8, and 9 of the DOT Instructor
the students within guidelines established by the appropriate Curriculum,5
certifying agency, 7.2.2 Successfully complete a supervised probationary
5.1.4.8 Shall uphold state and national clinical standards for teaching experience for the skill(s) to be taught to the satisfac-
practice at the appropriate ALS/EMT level, tion of the appropriate agency,
5.1.4.9 Shall evaluate the students for safe and effective 7.2.3 Be certified as a CPR instructor according to the
performance, current standards as promulgated by the American Heart
5.1.4.10 Shall orient, supervise and evaluate adjunct, prac- Association or the American Red Cross, if CPR is among the
tical skills, associate instructors, and clinical/field preceptors, skills to be taught, and
5.1.4.11 Shall coordinate student field or clinical activities 7.2.4 Become familiar with appropriate record keeping
with the clinical/field preceptors, processes for students, sponsoring agency or state EMS
5.1.4.12 Shall ensure that practical skills training equipment agency, or both.
is maintained in a safe and acceptable operating condition, 7.3 Scope of Authority—The practical skills instructor shall
5.1.4.13 Shall protect the privacy of students and the con- have authority to:
fidentiality of training course records as required by applicable 7.3.1 Conduct practical skills sessions under the direction of
laws and standards, the course I/C,
5.1.4.14 Should have knowledge of the administrative and 7.3.2 Verify successful achievement of course skill objec-
legislative processes affecting the local, regional, or state tives, under the direction of the course I/C, and
prehospital EMS system, or combination thereof, and 7.3.3 Regulate student behavior within the scope of the
5.1.4.15 Should have knowledge of the laws and regulations practical skills training program under the institutional guide-
affecting the local, regional, or state prehospital EMS system, lines for due process.
or combination thereof. 7.4 Responsibilities— Under the direction of the course I/C,
5.1.5 Evaluation—The evaluation of a course I/C shall the practical skills instructor:
include: 7.4.1 Should provide a positive role model by:

3
F 1257 – 90 (2002)
7.4.1.1 Maintaining personal mental and physical health, 8.1.3 Demonstrate to the satisfaction of the course I/C a
7.4.1.2 Maintaining appropriate personal hygiene and ap- willingness and competence to work with students to assist
pearance, them in meeting pertinent course objectives in the setting in
7.4.1.3 Actively pursuing personal and professional devel- which the clinical/field preceptor will function.
opment, 8.2 Education/Training/Experience—The clinical/field pre-
7.4.1.4 Recognizing personal limitations and seeking assis- ceptor shall complete an orientation which includes:
tance when appropriate, 8.2.1 Roles and responsibilities of the ALS/EMT,
7.4.1.5 Demonstrating competent, respectful, and caring 8.2.2 Roles and responsibilities of the clinical/field precep-
interactions with students, co-workers, and patients at all times, tor, and
and 8.2.3 Guidelines for carrying out, meeting or accomplishing
7.4.1.6 Demonstrating professional behavior in the class- assigned responsibilities and duties.
room or in the presence of students. 8.3 Scope of Authority—The clinical/field preceptor shall
7.4.2 Shall ensure a safe and effective learning environment, have authority to:
7.4.3 Shall provide consistent and competent training assis- 8.3.1 Supervise student activities in the clinical/field setting
tance to students, as determined by stated course objectives,
8.3.2 Document student performance in the clinical/field
7.4.4 Shall maintain appropriate student skills training
setting, and
records,
8.3.3 Regulate student behavior within the scope of the
7.4.5 Shall teach the skills contained in the curriculum as
clinical/field setting under the institutional guidelines for due
adopted and defined by the appropriate certifying agency,
process.
7.4.6 Shall consistently monitor students’ progress toward 8.4 Responsibilities— Under the direction of the course I/C,
established course skill objectives and provide appropriate the clinical/field preceptor:
feedback to the course I/C and the students within guidelines of 8.4.1 Should provide a positive role model,
appropriate certifying agency, 8.4.2 Shall provide a safe and effective learning environ-
7.4.7 Shall evaluate, according to the curriculum, and dif- ment,
ferentiate among students for safe and effective performance, 8.4.3 Shall provide consistent and competent supervision to
7.4.8 Shall uphold state and national clinical standards for students,
practice at the level being taught, 8.4.4 Shall maintain appropriate training records,
7.4.9 Shall ensure that practical skills training equipment is 8.4.5 Shall assist the students in meeting the clinical/field
maintained in a safe and acceptable operating condition, and skills objectives,
7.4.10 Shall protect the privacy of students and the confi- 8.4.6 Shall consistently monitor students and provide appro-
dentiality of training course records as required by applicable priate feedback to the course I/C and the students,
laws and standards. 8.4.7 Shall assess students for safe and effective perfor-
7.5 Evaluation—The evaluation by the course I/C of a mance, and
practical skills instructor shall include: 8.4.8 Shall protect the privacy of students and the confiden-
7.5.1 Analysis of student practical skills outcomes, tiality of training course records as required by applicable laws
7.5.2 Classroom observation of the practical skills instruc- and standards.
tor, and 8.5 Evaluation—The evaluation by the course I/C of a
7.5.3 Review of students’ course evaluations. clinical/field preceptor in an ALS/EMT Training Program shall
7.6 Maintenance of Competency—In order to maintain include:
competency, the practical skills instructor shall: 8.5.1 Quality of training records,
7.6.1 Maintain, to the satisfaction of the course I/C and 8.5.2 Clinical/field observation of the preceptor, and
course medical director, current competence in and knowledge 8.5.3 Review of students’ clinical experience evaluations.
of the skill(s) being taught, and 8.6 Maintenance of Competency—In order to maintain
7.6.2 Teach the skills contained in an ALS/EMT related competency, the clinical/field preceptor shall:
curriculum. 8.6.1 Maintain certification in his/her area of practice, and
8.6.2 Maintain, to the satisfaction of the course I/C and
8. Clinical/Field Preceptor course medical director, current competence in and knowledge
of the areas precepted.
8.1 Qualifications— The clinical/field preceptor candidate
shall: 9. Keywords
8.1.1 Be certified in his/her area of practice, 9.1 advanced life support; emergency medical services in-
8.1.2 Have experience in his/her area of expertise, and structor; emergency medical technician; training programs

4
F 1257 – 90 (2002)

ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

5
Designation: F 1258 – 95 (Reapproved 2001)

Standard Practice for


Emergency Medical Dispatch1
This standard is issued under the fixed designation F 1258; 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 systematized caller interrogation questions, systematized pre-


1.1 This practice covers the definition of responsibilities, arrival instructions, and protocols matching the dispatcher’s
knowledge, practices, and organizational support required to evaluation of injury or illness severity with vehicle response
implement, perform, and manage effectively the emergency mode and configuration.
medical dispatch function. 3.1.4 medical direction—the management and accountabil-
1.2 This practice is useful for planning and evaluating the ity for the medical care aspects of an emergency medical
training, implementation, and organizational support to satisfy dispatch (EMD) program including: the medical monitoring
the functional needs of emergency medical dispatching. oversight of the training of the EMD personnel; approval and
1.3 This standard does not purport to address all of the medical control of the operational emergency medical dispatch
safety concerns, if any, associated with its use. It is the priority reference system (EMDPRS); evaluation of the medi-
responsibility of the user of this standard to establish appro- cal care and prearrival instructions rendered by the EMD
priate safety and health practices and determine the applica- personnel; direct participation in the EMD system evaluation,
bility of regulatory limitations prior to use. quality, assurance, and quality improvement process and
mechanisms; and, responsibility for the medical decisions and
2. Referenced Documents care rendered by the emergency medical dispatcher and emer-
2.1 ASTM Standards: gency medical dispatch program.
F 1031 Practice for Training the Emergency Medical Tech- 3.1.5 public safety telecommunicator—an individual trained
nician (Basic)2 to communicate remotely with persons seeking emergency
F 1381 Guide for Planning and Developing 9-1-1 Enhanced assistance and with agencies and individuals providing such
Telephone Systems2 assistance.
F 1552 Practice for Training Instructor Qualification and 3.1.6 telephone aid—consists of “ad-libbed” telephone in-
Certification Eligibility of Emergency Medical Dispatch- structions provided by either trained or untrained dispatchers
ers2 and differs from DLS-based prearrival instructions in that the
F 1560 Practice for Emergency Medical Dispatch Manage- instructions provided to the caller are based on the dispatcher’s
ment2 knowledge or previous training in a procedure or treatment
without following a scripted prearrival instruction protocol.
3. Terminology They cannot be medically preapproved since they do not exist
3.1 Definitions of Terms Specific to This Standard: in written form.
3.1.1 emergency medical dispatcher (EMD)—a trained pub- 3.1.7 telephone treatment sequence protocols—specific
lic safety telecommunicator with additional training and spe- treatment strategies designed in a conversational script format
cific emergency medical knowledge essential for the efficient that direct the EMD step by step in giving critical prearrival
management of emergency medical communications. instructions such as CPR, Heimlich maneuver, mouth-to-
3.1.2 emergency medical dispatching—the reception and mouth breathing, and childbirth instruction.
management of requests for emergency medical assistance. 3.1.8 vehicle response configuration—the specific ve-
3.1.3 emergency medical dispatch priority reference system hicle(s) of varied types, capabilities, and numbers responding
(EMDPRS)—a medically approved system used by a dispatch to render assistance.
agency to provide aid to medical emergencies that includes: 3.1.9 vehicle response mode—the use of emergency driving
techniques, such as warning lights and siren, versus a routine
driving response.
1
This practice is under the jurisdiction of ASTM Committee F30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.04 on
Communications.
Current edition approved Oct. 10, 1995. Published December 1995. Originally
published as F 1258 – 90. Last previous edition F 1258 – 90.
2
Annual Book of ASTM Standards, Vol 13.02.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1258 – 95 (2001)
4. Summary of Practice recommendations concerning the development of a supportive
4.1 An emergency medical dispatcher is a trained public structure and program content.
safety telecommunicator with additional training and specific 4.6 Use of this practice is not intended to protect the EMD
emergency medical knowledge essential for assessment of or dispatch organization from liability for negligent actions or
medical emergencies and limited remote treatment and appor- failure to perform in accordance with established and approved
tionment of medical priorities. The EMD functions under the medical practices and protocols.
medical authority of an off-line medical director to receive and 4.7 The EMD must be certified through either state govern-
manage calls for emergency medical assistance through the ment processes or by professional medical dispatch standard-
systematic interrogation of callers, using procedures estab- setting organizations.
lished by the off-line medical director who remains responsible 4.7.1 When certification is achieved by recognition of a
for the medical quality assurance of the EMD program. professional medical dispatch standard-setting organization, it
4.1.1 The EMD’s role includes the ability to: shall clearly demonstrate compliance with all criteria enumer-
4.1.1.1 Remotely evaluate the patient or incident, ated in this practice and within Practice F 1560 and Practice
F 1552.
4.1.1.2 Interpret the requirement and need for emergency
medical resources,
5. Significance and Use
4.1.1.3 Allocate the appropriate resources,
4.1.1.4 Identify conditions requiring prearrival instructions 5.1 This practice is intended to promote the use of trained
and provide them to the caller when necessary, possible and telecommunicators in the role of emergency medical dis-
appropriate, patcher. It defines the basic skills and medical knowledge to
4.1.1.5 Coordinate the response of emergency medical and permit understanding and resolution of the problems that
other public safety resources, constitute their daily routine. To use trained telecommunicators
fully as functioning members of the emergency medical team,
4.1.1.6 Provide information to the responding units regard-
it is deemed necessary to upgrade the telecommunicators’
ing the emergency scene and patient, and
training by the addition of the concept of emergency medical
4.1.1.7 Record and retrieve emergency medical response dispatch priorities.
records.
5.2 All agencies or individuals who routinely accept calls
4.1.2 There must be continuity in the delivery of EMD care. for emergency medical assistance from the public and dispatch
To provide correct medical care safely and effectively, the emergency medical personnel shall have in effect an emer-
EMD that is medically directing, evaluating, and coding must gency medical dispatcher program in accordance with this
maintain direct access to the calling party and must use a practice. The program shall include medical direction and
medically approved emergency medical dispatch priority ref- oversight and an emergency medical dispatch priority refer-
erence system. The person giving the medical instruction to the ence system.
caller must be the same person that asks the systematic 5.3 The successful use of the EMD concept depends on the
interrogation questions. medical community’s awareness of the “prearrival” state of
4.1.3 To accomplish the above safely and effectively, the EMS affairs and their willingness to provide medical direction
EMD must use a medically approved EMDPRS that includes: in dispatch.
4.1.3.1 Systematized caller interrogation questions, 5.4 This practice may assist in overcoming some of the
4.1.3.2 Systematized prearrival instructions, and misconceptions regarding emergency medical dispatching.
4.1.3.3 Protocols that determine vehicle response mode and These include the uncontrollable nature of the caller’s hysteria,
configuration based on the EMD’s evaluation of injury or lack of time of the dispatcher, potential danger and liability to
illness severity. the EMD, lack of recognition of the benefits of dispatch
4.2 This practice is intended to be used by agencies as a prearrival instructions, and misconceptions that red lights,
baseline for establishing a certifying emergency medical dis- siren, and maximal response are always necessary.
patch training program that includes the implementation of the 5.5 The EMD is the member of the EMS response team with
emergency medical dispatch priority reference system, under the broadest view of the entire emergency system’s current
medical direction, and provides a means of evaluating the status and capabilities. The EMD has immediate lifesaving
EMD program. capability in converting the caller into an effective first
4.3 This practice will provide a common set of expectations responder. This practice recognizes the EMD’s role as includ-
for training, performance, and preplanned response based on ing:
understanding of the medical condition, thorough interroga- 5.5.1 Interrogation techniques,
tion, caller intervention, safe responses, and prearrival instruc- 5.5.2 Triage decisions,
tions. 5.5.3 Information transmission,
4.4 This practice establishes the EMD’s role and responsi- 5.5.4 Telephone medical intervention, and
bilities in receiving, managing, and dispatching calls for 5.5.5 Logistics and resource coordination during the event.
medical assistance and related agency coordination. 5.6 For the EMD, this practice supersedes any other EMSS
4.5 An organizational structure as defined in Practice standards under which an individual may be qualified, such as
F 1560 must be in place before implementing the EMD Practice F 1031. It is not the role of the EMD to generate a
program; therefore, this practice establishes some general specific diagnosis but rather to elicit accurately a finite body of

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F 1258 – 95 (2001)
information, assign the appropriate response, and to commu- 6.1.4.1 A mass casualty plan for notification and operation
nicate clearly among persons and units involved in the re- in a disaster situation,
sponse. The protocols for inquiry, response, and resource 6.1.4.2 A directory of emergency response resources and
coordination are essential and must not be modified based on information resources,
an individual’s possible experiences as a responder. 6.1.4.3 A written description of the communications system
5.7 As an initial contact with the EMS system, the EMD is configuration for the service area, and
subject to questioning of actions as they relate to medical 6.1.4.4 A record-keeping system, including report forms or
practice. This practice may be used by agencies as a recognized a computer data management system to permit evaluation of
baseline for EMD training, practice, and organization and is EMD compliance with the EMDPRS, evaluation of protocol
intended to supplant de facto standards that exist in some areas. effectiveness, and timeliness of interrogation and dispatch.
This practice will assist in developing sound EMD programs
that will reduce the need and potential for legal action and 7. Functions of Emergency Medical Dispatch
provide a common set of expectations for performance. 7.1 Receive and Process Calls for Assistance—The EMD
5.8 It will bring more accurate information into the dispatch must receive and record calls for emergency medical assistance
office by way of appropriate understanding of the medical from various sources. This function includes the establishment
condition and therefore better interrogation, caller intervention, of effective communication with the person requesting assis-
and decision-making. It allows for preplanned responses, safer tance, using the EMDPRS to evaluate the patient or situation,
responses (fewer units responding with lights and siren), fuel provide appropriate prearrival instructions, and select the most
and energy savings (smaller units and fewer units used when appropriate EMS system action in response to each call.
possible), and may save advanced lifesupport resources for true 7.2 Dispatch and Coordinate Appropriate, Available Re-
advanced life-support emergencies when a tiered-level re- sponse Resources—The EMD must select and dispatch the
sponse is available. necessary EMS vehicles and personnel to the scene of an
emergency in an appropriate time frame. The EMD functions
6. System Components in coordinating the movements of EMS vehicles en route to the
6.1 Emergency Medical Dispatch Priority Reference System scene, en route to the medical facility, and back to the base of
(EMDPRS): operations. This requires that the EMD have current knowl-
6.1.1 This system is a written, reproducible document in a edge of the status of all EMS resources in the dispatch area and
uniform format based on medical and administrative protocols. the geographic constraints that will affect the EMS response.
The emergency medical dispatch priority reference system This also requires that the EMD have dispatch-specific medical
directs the EMD to complete a full, programmed interrogation. training and understands the use of systematized interrogation
The information from the caller is paired with preset problem and response assignment protocols.
groups to determine the appropriate response level. It shall 7.3 Provide Information and Prearrival Instructions:
include the following: 7.3.1 To the caller, the EMD is the contact with the
6.1.1.1 A set of systematized caller interrogation (key) emergency response agency and must be prepared to provide
questions. The key questions must obtain the minimum amount emergency care instructions to callers waiting for an EMS
of information necessary to: response. These instructions should enable the caller to prevent
6.1.1.1.1 (a) Adequately establish the correct level of re- or reduce further injury to the victim and to do as much as
sponse, possible under the circumstances to intervene in any life-
6.1.1.1.2 (b) Establish the need for prearrival instructions, threatening situation that exists. These instructions should also
and include appropriate warnings and safety messages regarding
6.1.1.1.3 (c) Provide responders with adequate patient and potential dangers that can be reasonably foreseen through
incident information. correct use of the EMDPRS.
7.3.2 All dispatch life-support-based instructions and infor-
6.1.2 A set of systematized coding and response protocols
mation should be given directly from the EMDPRS rather than
that include:
ad lib. Federal Publication NIH No. 94-3287 on Emergency
6.1.2.1 Protocols that predetermine vehicle response mode
Medical Dispatching3 categorizes ad-lib instructions as “tele-
and configuration based on the EMD’s evaluation of injury and
phone aid” which, further defined, “may only ensure that the
illness severity as determined through key question interroga-
dispatcher has attempted to provide some sort of care to the
tion. These protocols must reflect a given EMS systems varied
patient through the caller but does not ensure that such care is
ability to respond, ranging from single-unit squads through
correct, standard, and medically effective or even necessary in
multiple-level (tiered) response.
the first place. Telephone aid, therefore, is usually considered
6.1.2.2 An established, medically approved, quantitative
as inappropriate and an unreliable form of dispatcher-provided
coding system for quality assurance/improvement and statisti-
medical care.”
cal analysis.
6.1.3 A set of systematic prearrival instructions that include:
6.1.3.1 Chief complaint specific caller and EMD advise, and
3
6.1.3.2 Scripted prearrival instructions. U.S. Department of Health and Human Services, Public Health Service,
National Institutes of Health, National Heart, Lung, and Blood Institute. NIH
6.1.4 In addition to the EMDPRS, an emergency medical Publication No. 94-3287, Emergency Medical Dispatching: Rapid Identification and
dispatch system should include: Treatment of Acute Myocardial Infarction, July 1994.

3
F 1258 – 95 (2001)
7.3.3 To the responding unit(s), the EMD must provide generic components present in most cases. Some of these are
accurate information regarding the patient, conditions at the noted in Appendix X1.
scene of response, other public safety unit responses, and other 8.1.2 Understand the difference between key questions
information regarding the situation. This information always asked in medical as opposed to trauma cases:
includes the chief complaint, patient’s age, status of conscious- 8.1.2.1 Medical case questions are generally based on
ness, and status of breathing. symptoms such as chest pain, breathing, level of conscious-
7.4 Coordinate With Other Agencies and Emergency ness, and so forth. The caller usually is with the victim or is
Services—The EMD must ensure the existence and mainte- personally familiar with the patient or their problem.
nance of an effective communication link between and among 8.1.2.2 Trauma case questions are generally based on the
all public safety services (that is, fire, police, rescue, aeromedi- type of incident rather than specific symptoms, since the caller
cal, hazardous materials, utility, and so forth) involved in the usually is a third-party observer not directly associated with the
EMS response to facilitate mutual aid and to coordinate patient. The question“ How far did the patient fall?,” as
services including such items as traffic control, fire suppres- opposed to, “What are the patient’s injuries?,” is more appro-
sion, and extrication. priate to successful, useful information gathering.
7.5 Necessary Skills of the Emergency Medical Dispatcher: 8.1.3 Understand the third-party caller limitation in regards
7.5.1 Ability to read and write English proficiently and to the difficulty of obtaining useful information when the caller
other language or communications skills necessary to function is not with the patient and does not know the patient.
in given area, 8.1.4 The EMD must be able to apply the following points:
7.5.2 Ability to speak clearly and distinctly on radio and
8.1.4.1 The concept of the hysteria threshold and the
telephone,
method of attaining it, for example, repetitive persistence.
7.5.3 Ability to remain calm, use reasoned judgment, and
8.1.4.2 Until the hysteria threshold is broken, the EMD
communicate effectively in stressful or crisis situations,
cannot be in control of a call.
7.5.4 Ability to use established interrogation and response
assignment protocols, 8.1.4.3 The EMD must realize that this threshold exists and
7.5.5 Ability to provide prearrival instructions appropriate can be reached in most all cases so that they do not give up
for the emergency situation to both the caller and responders, prematurely before obtaining control of the caller.
and 8.1.4.4 Increases in firmness or continued repetition in
7.5.6 Ability to retain a professional attitude with the caller questioning or requests may not be successful initially until the
specifically regarding courtesy and empathy for the situation threshold (that is different for each caller) is attained. At this
encountered. point the EMD obtains control.
7.5.7 Inappropriate EMD Activities: 8.1.4.5 Handling an unpleasant, uncooperative, or hysterical
7.5.7.1 Display of hostility toward or arguing with the caller by only obtaining the location of the incident and
caller, sending the response unit(s) is not acceptable.
7.5.7.2 Judgment of a situation based on past experience 8.2 Prearrival Instructions:
with the caller, 8.2.1 The objectives of giving prearrival instructions are:
7.5.7.3 Judgment of a situation severity based on previous 8.2.1.1 To assist the caller in keeping the patient from
personal experiences, further injury,
7.5.7.4 Unreasonably refusing to dispatch available units in 8.2.1.2 To enable the caller to do as much as possible to
accordance with the approved dispatch protocol, save a patient in a life-threatening situation, and
7.5.7.5 Premature termination of call for assistance, and 8.2.1.3 To transform a hysterical caller into a calmer rescuer
7.5.7.6 Failure to act or to dispatch in accordance with who no longer feels helpless.
protocol. 8.2.2 The following general instructions pertain to most
8. Medical Dispatch Practice callers:
8.2.2.1 Calm down,
8.1 The role of the EMD is to obtain specific medical
8.2.2.2 Don’t move the patient (except in situations that
information to prioritize accurately each medical response as
endanger the patient, such as fire, carbon monoxide, and so
listed in the emergency medical dispatch priority reference
forth),
system (EMDPRS). Using this system, the EMD asks key
questions about patient condition and incident types, deter- 8.2.2.3 Observe the area for hazardous situations,
mines the necessity for and gives prearrival instructions, and 8.2.2.4 Observe what the patient is doing,
selects predetermined response levels based on the medical 8.2.2.5 Identify the incident location by blinking the porch
significance of the information obtained. To accomplish this, lights, opening garage door, describing house, identifying
the EMD must: landmarks, and so forth,
8.1.1 Understand the basic philosophy of medical interro- 8.2.2.6 Remove obstacles to the responders by locking up
gation. Medical dispatch experts have shown that through the pets, sending children to neighbors, unlocking doors, obtaining
use of proper techniques and interrogation protocols signifi- elevators, opening gates, and so forth,
cantly more vital information can be obtained. While it may 8.2.2.7 Preserve material or articles relating to the injury,
seem the emotional, and at times, hysterical caller’s behavior is and
random and unpredictable, there are some very predictable, 8.2.2.8 Gather medications for responders.

4
F 1258 – 95 (2001)
8.2.3 General medical instructions commonly given to call- 8.3.3.4 Understand the immediate transport concept based
ers are as follows: on the nearness of the scene to advanced life support or the
8.2.3.1 Airway management (head tilt/chin lift), hospital with regard to the criticality of the patient,
8.2.3.2 Heimlich maneuver, 8.3.3.5 Understand how to assist in coordinating a rendez-
8.2.3.3 Mouth-to-mouth ventilation, vous, and
8.2.3.4 Remove pillows from behind head, 8.3.4 Solitary EMDs must perform all functions in an
8.2.3.5 CPR, integrated fashion.
8.2.3.6 Direct-pressure hemorrhage control, and 9. Organizational Support
8.2.3.7 Cool small burns in cold water.
8.2.4 The requisites of providing these instructions are as 9.1 The organizational support for the EMD function must
follows: consist minimally of the following:
9.1.1 Provision of EMS physician medical direction regard-
8.2.4.1 The EMD must be trained in basic life-support
less of whether the EMD function is carried on in a freestand-
techniques before the provision of prearrival instructions,
ing EMS communications center or a consolidated public-
8.2.4.2 Master the use of telephone treatment sequence
safety answering point or communications center.
cards, and
9.1.2 Provision of prospective, concurrent, and retrospec-
8.2.4.3 Understand the role of the trained versus untrained
tive supervision of the EMD function. Such supervision shall
citizen at the scene of the emergency.
consist of:
8.3 Roles of the EMD in emergency dispatch centers may
9.1.2.1 Reoccurring continuing education,
differ such as assigned subroles:
9.1.2.2 A real-time supervisor having medical dispatch ex-
8.3.1 The Interrogator’s Role:
perience and expertise,
8.3.1.1 Obtain from the calling party the address or location 9.1.2.3 A quality assurance program with random case audit
of the emergency (first and most important), including logging tape reviews on a regular scheduled basis,
8.3.1.2 Obtain from the calling party, or verify (in the case and
of E9-1-1 systems) the call-back telephone number at the 9.1.2.4 A risk management program including problem
calling location, review.
8.3.1.3 Obtain from the calling party the chief complaint, 9.1.3 Provision of written procedures and protocols includ-
8.3.1.4 Determine if the caller is with the patient, ing:
8.3.1.5 Obtain the approximate age of the patient, 9.1.3.1 A clear formal chain of command for establishment
8.3.1.6 Determine if the patient is conscious (yes, no, or of policies, procedures, and resolution of grievances related to
unknown), emergency medical dispatch,
8.3.1.7 Determine if the patient is breathing (yes, no, or 9.1.3.2 Administrative procedures for real-time resource
unknown), allocation in alternative response assignments,
8.3.1.8 Use the EMD priority reference system to: 9.1.3.3 An emergency medical dispatch priority reference
(1) Ask the systematized caller interrogation questions, system, and
(2) Convey to the “dispatcher” the appropriate response 9.1.3.4 Other local resource materials covering specific
assignment, and situations affecting the EMD, such as, disaster plans, hospital
(3) Give the calling party the listed telephone prearrival resources, specialty facilities, and so forth.
treatment instructions. 9.1.4 Provision of complete written and recorded documen-
8.3.2 The Dispatcher’s Role: tation of EMD activity and retention of these records.
8.3.2.1 Alert the appropriate response unit(s) as determined 9.2 Provision of initial EMD training and certification.
by the interrogator’s use of the EMD priority reference system, 9.3 Probationary on-the-job training.
8.3.2.2 Relay to responding unit(s): 9.4 Provision of continuing professional education and re-
(1) Location of incident, certification:
(2) Age and sex of patient, 9.4.1 Ongoing medical education,
(3) Chief complaint, 9.4.2 Basic life-support education and recertification,
(4) Status of conscious, 9.4.3 Skills practicum,
(5) Status of breathing, 9.4.4 Crisis management, and
(6) Other pertinent information, and 9.4.5 Field experience and accompaniment during actual
(7) Number of victims (if applicable). EMS field calls on a “ride-a-long” basis.
8.3.3 Other Functions: 9.5 Provision for maintaining and upgrading equipment to
8.3.3.1 Assist the emergency response unit(s) in finding the meet EMSS needs.
address or patient location, or both, NOTE 1—See Appendix X2.
8.3.3.2 Relay information between various units and re-
sponding agencies, 10. Keywords
8.3.3.3 Monitor and relay information between units, espe- 10.1 communications; dispatch; emergency medical
cially those that do not have compatible radio frequencies, dispatch

5
F 1258 – 95 (2001)

APPENDIXES

(Nonmandatory Information)

X1. MEDICAL INTERROGATION TECHNIQUES

X1.1 Hysteria Threshold—Many distraught callers have here to the phone.” The EMD should always ask where the
been shown to have a “threshold of hysteria” that can be patient is at the beginning of the telephone treatment sequence.
overcome and controlled by the practice of “repetitive persis-
tence.” This practice will assist with uncooperative caller X1.4 “Nothing’s Working” Phenomenon—The exception to
interrogation and facilitates giving prearrival instructions. The the control obtained once the hysteria threshold is reached
hysteria control threshold frequently may be easily attained, occurs when the caller is reminded of the distressed state of the
and once established, the caller is completely in control and victim at three different stages. First, when the victim is
repeats instructions word perfect. brought to the phone, they are also brought back into the sight
of the caller, who is unfortunately reminded of how bad the
X1.2 Repetitive Persistence—The most successful method victim looks. Second, when the EMD asks for verification of
of attaining the hysteria control threshold is repetitive persis- absent vital signs (breathing or pulse), the caller is likewise
tence. Repetitive persistence is performed by the EMD repeat- reminded. Third, when the caller is finally dutifully performing
ing over and over again, in the exact same wording, a request CPR or the Heimlich, and the victim is not revived from their
to calm down or to perform any other act desired. It has been initial actions, the caller may state, “nothing’s working” and in
demonstrated that this approach works nearly universally after frustration and despair will sometimes stop trying.
a limited number of repetitions. Altering the wording of a
request, it is believed, appears to the caller’s subconscious as X1.5 Some callers have the misconception that because
indecision or lack of control on the EMD’s part and is less they are performing the EMD’s instructions, the victim should
effective. respond or be revived. Callers will sometimes become frus-
trated and may lose composure when the victim fails to
X1.3 Bring-the-Victim-to-the-Phone Problem—The EMD respond to first-aid measures. This results in an event that can
must determine the location of the patient relative to the caller interrupt the treatment sequence. The EMD can overcome this
at the outset of the call. This will help avoid a possible later problem with appropriate encouragement, repetitive persis-
interruption of the telephone treatment sequence that may tence, and by mentioning that, “You are keeping the victim
occur when the caller directs others by yelling, “Bring him in going until the paramedics get there.”

X2. MEDICOLEGAL ISSUES OF EMERGENCY MEDICAL DISPATCH

X2.1 The agency and the EMD should understand the X2.2 Civil liability for the EMD or his organization can
importance of EMD performance evaluation. result from the following:
X2.1.1 Inappropriate performance or procedures, or both, X2.2.1 Caused action or omission by the EMD,
can cause injury or death, or both, to field personnel or
X2.2.2 Failure to supervise on the part of EMD supervisor,
civilians.
X2.1.2 Poor work habits can lead to lawsuits against the X2.2.3 Failure to observe recognized agency standards by
EMD and the parent department or agency. the EMD or the parent organization, and
X2.1.3 It is important that the EMD remain informed on the X2.2.4 Failure to observe recognized community or na-
correct procedures and protocols and follow them explicitly. tional practice standards.
X2.1.4 If procedures appear faulty, the EMD should inform
a supervisor for appropriate review.

X3. TELECOMMUNICATION ISSUES OF EMERGENCY MEDICAL DISPATCH

X3.1 The telecommunicator should be thoroughly familiar X3.1.3 Alert paging equipment and encoders,
with the applications of the following telecommunications X3.1.4 Telephone patch equipment,
equipment, procedures, and Federal Communications Com- X3.1.5 Biotelemetry equipment and MED radio systems,
mission (FCC) rules:
X3.1.6 Computer equipment, CAD equipment, and record
X3.1.1 Radio communications control console, keeping,
X3.1.2 Telephone equipment and recorders,

6
F 1258 – 95 (2001)
X3.1.7 Logging recorder equipment and tape management, X3.3.9.2 Nature of the response needed.
and X3.3.10 Caller Information (Who):
X3.1.8 Other specialized equipment, generators, tower X3.3.10.1 Call back telephone number,
lighting, and so forth. X3.3.10.2 Caller’s name when appropriate, and
X3.3.10.3 Victim’s name when appropriate.
X3.2 Relevant FCC Rules : X3.3.11 Time/Duration Information (When):
X3.2.1 Only trained and authorized personnel are permitted X3.3.11.1 Time the incident occurred,
to operate radio equipment. X3.3.11.2 How long incident has been underway (according
X3.2.2 Provisions for access to remote radio sites and base to caller’s perception), and
radio equipment shall be maintained. X3.3.11.3 When call was received.
X3.2.3 The station call sign shall be broadcast in accordance X3.3.12 Maintain a professional demeanor even when deal-
with FCC rules. ing with hostile callers.
X3.2.4 The FCC personnel are authorized to inspect com- X3.3.13 Repeat questions to obtain additional necessary
munication records and transmitter equipment at reasonable information or to clarify information.
times with proper identification and notice. X3.3.14 Record appropriate information in accordance with
X3.2.5 Transmission of false or deceptive information is local protocol.
prohibited. X3.3.15 Use plain language (not codes) and avoid jargon or
X3.2.6 Disclosure of radio messages monitored or inter- slang.
cepted to any uninvolved third party is prohibited. X3.3.16 Allow the caller to hear the dispatch of units, or
X3.2.7 Transmission of profane language is prohibited. inform the caller that the dispatch has been or is being made.
X3.2.8 The radio station license shall be displayed at the X3.3.17 Explain any waiting period such as having to relay
control points and transmitter location. or transfer the caller to another agency or individual.
X3.2.9 Radio equipment shall be maintained to required X3.3.18 Inform the caller not to hang up until they are told
technical standards. to do so.
X3.2.10 Users shall take reasonable precautions to avoid X3.3.19 Show interest in the caller:
causing harmful interference, including monitoring before X3.3.19.1 Use the caller’s name when possible (last name
transmission where practical. with appellation for adults; first name for children and teenag-
X3.3 Public Safety Telecommunicator-Caller ers).
Communication—The public safety telecommunicator is the X3.3.19.2 Calm and continually reassure the caller.
contact an emergency caller has with the emergency response X3.3.20 Direct the caller to perform helpful activities before
system. Prompt and efficient information gathering by the the arrival of responders.
telecommunicator aids in the dispatch of appropriate resources, X3.3.21 Accept responsibility for all emergency calls re-
allows preparation time for responding units, and alerts the ceived (whenever possible the system should provide internal
telecommunicator to significant events requiring prearrival methods for transferring or relaying of information).
instructions to the caller. As such, the public safety telecom- X3.3.22 Never leave an assigned work station (console)
municator should: without relief personnel in place.
X3.3.1 Answer telephone calls promptly (within 10 s of the
X3.4 Dispatch Procedures:
first ring).
X3.3.2 Identify the service to the caller in accordance with X3.4.1 Dispatch the appropriate units in a timely manner
the local protocol. upon determination of needed location and incident informa-
X3.3.3 Speak at a rate of no more than 80 to 100 words per tion.
minute. X3.4.2 Relay to appropriate responding units such items as:
X3.3.4 Speak directly into the microphone mouthpiece. X3.4.2.1 The location of the incident.
X3.3.5 Take control through an authoritative but courteous X3.4.2.2 Nature of incident/chief complaint.
manner. X3.4.2.3 All important supplemental information including:
X3.3.6 Focus the caller’s response to obtain key incident age and sex of patient(s), status of consciousness, status of
information. breathing, number of patients, and so forth.
X3.3.7 Elicit and record the following basic information X3.4.3 Avoid use of contractions or homonyms in directing
from the person requesting assistance: responding units.
X3.3.8 Location Information (Where): X3.4.4 Break long messages into short (10-s) segments.
X3.3.8.1 Location of the incident, X3.4.5 Confirm receipt of and understanding of informa-
X3.3.8.2 Location to which the responding unit(s) should be tion.
sent (if different), and X3.4.6 Assist responding units by giving directions to the
X3.3.8.3 Directions to the incident (if not commonly rec- incident address, hazards and obstacles en route, and accessi-
ognized). bility and conditions.
X3.3.9 Incident Information (What): X3.4.7 Update responders on changes in the status of the
X3.3.9.1 Primary nature of the event as described by the incident.
caller, and X3.4.8 Relay information between other responding units.

7
F 1258 – 95 (2001)
X3.4.9 Record information upon receipt, using a standard X3.4.11 Use appropriate signalling methods and techniques
report and recording format to document call reception, dis- based on a thorough knowledge of the communications system.
patch, scene arrival, scene departure, destination arrival, clear X3.4.12 Use proper radio communications techniques.
scene, and unit in service times.
X3.4.13 Perform all activities in compliance with FCC rules
X3.4.10 Provide supplemental or incident information as
and local standard operating procedures and protocols.
received from other sources.

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in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

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if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

8
Designation: F 1268 – 90 (Reapproved 2003)

Standard Guide for


Establishing and Operating a Public Information, Education,
and Relations Program for Emergency Medical Service
Systems1
This standard is issued under the fixed designation F 1268; 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.

INTRODUCTION

The Emergency Medical Service (EMS) system exists for only one reason—to serve the public. If
the system is to perform its functions, the public must be aware of it and must use it to the fullest
extent. Because the public is an essential part of the EMS system, every EMS system must support
a public information, education, and relations (PIER) component. However, because other elements
such as categorization, critical care protocols, communications, and provider training require as much
time and energy, plus the fact that most administrators lack orientation to public information
principles, there is a tendency to approach the public information, education, and relations component
in a less organized and scientific way. Consequently, PIER may suffer a lower priority and may
become a random or fragmented activity.
The fact is that people do not readily change their attitudes and behavior unless it is specifically and
immediately demonstrated to them that there is a need to do so. In this day of complex media message
sending, it is often difficult to get the attention of the general public in the first place. To achieve a
successful PIER program, it should be an organized and systematic effort, including:
(1) An assessment of the attitudes, awareness and knowledge about one’s health and access to the
health delivery system;
(2) A determination of the knowledge needs and identifiable components of the general public;
(3) A method for delivery of information that is relevant, accessible, understandable, acceptable,
usable, timely, and cost-effective;
(4) Ensure that, as much as possible, the information is integrated into attitudes and behaviors of
daily living; and
(5) Evaluate PIER objectives to assess whether or not behavioral changes have occurred, with
beneficial effect upon the individual and ultimately society, and adjusting future PIER activities as
indicated.
Education about health matters has to be interesting, enjoyable, uncomplicated, relevant, and have
some evidence of immediate concrete benefit to the individual’s activities. In EMS, some of the
programs are intrinsically appealing: for example, people might readily participate in CPR training as
it represents a dramatic and demonstrable learning process. However, citizens are less enthusiastic
about access information, abuse and misuse messages, or other facts which are to them, less dramatic
and apparently less relevant.

1. Scope
1.1 The purpose of this guide is to provide national volun-
1
This guide is under the jurisdiction of ASTM Committee F30 on Emergency tary standards and recommendations to effectively provide
Medical Services and is the direct responsibility of Subcommittee F30.03 on
Organization/Management.
emergency medical service system information and education
Current edition approved Sept. 10, 2003. Published October 2003. Originally to the public.
approved in 1990. Last previous edition approved in 1998 as F 1268 – 90 (1998).

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1268 – 90 (2003)
2. Referenced Documents therefore the EMS system arrives. If the public knowledge
2.1 ASTM Standards: concerning EMS can be improved, then it is likely that
F 1086 Guide for Structures and Responsibilities of Emer- appropriate utilization of EMS will increase.
gency Medical Services Systems Organizations2 6. Elements of a PIER Program for EMS
3. Terminology 6.1 The essential elements of an effective public informa-
3.1 Descriptions of Terms: tion, education, and relations program include, but are not
3.1.1 demographics—the study of the descriptive character- limited to:
istics of the population. They have long been used to divide or 6.1.1 An understanding of EMS system design and opera-
segment the population. tion.
3.1.2 external PIER attributes—for the public or user of the 6.1.2 Proper access to the system (9-1-1, telephone, call
EMS system. box).
3.1.3 internal PIER attributes—within the EMS system for 6.1.3 Self help, for example, CPR, First Aid, Vial of Life,
its participants and providers. Medic Alert, and other emergency data devices.
3.1.4 public education—an activity that conveys knowledge 6.1.4 Provision for the appropriate and timely release of
or training, or both, in specific skills. information on EMS related events, issues, and public relations
3.1.5 public information—an activity that factually teaches (damage control).
what the EMS system is and how to enter and use it. 6.1.5 Evaluation of EMS.
3.1.6 public information, education and relations (PIER) 6.1.5.1 Importance of user and provider input.
program—the totality of efforts in all three areas. It is ideally 6.1.5.2 How to effectively collect and assimilate input.
well integrated, unified, focused, with planning and systematic 6.1.6 Current health and safety habits as they relate to
execution. prevention and reduction of health risks for the public and
3.1.7 public information offıcer—a person who dissemi- providers.
nates appropriate and timely facts. 6.1.7 Provision for recruitment campaigns for career and
3.1.8 public relations—an activity used to foster positive volunteer personnel in EMS.
public attitudes and enhance trust and credibility about the 7. Organizational Commitment to and Authority for
EMS system and its providers. PIER
4. Significance and Use 7.1 There must be an organizational commitment from the
4.1 It is essential to have the public’s understanding and EMS system (See Fig. 1.)
support for the EMS system to ensure its proper development 7.2 To have an effective PIER program the chief executive
and utilization. officer (CEO) must be personally committed to PIER and be
4.2 This guide encompasses those procedures, consider- able to make definitive decisions concerning committment of
ations, and resources that are necessary for a successful EMS organizational resources. This CEO must assign a PIER
public information, education, and relations program. Complex director who has access to the CEO. This person may in some
EMS systems may integrate or augment, or both, this guide in small areas also be the CEO. The CEO must be continually
its entirety. Less complex systems may need to collaborate apprised of the progress of the PIER program.
with other EMS organizations and related agencies. Responsi- 7.3 The organization must designate a responsible and
bility for this guide will vary by level of authority, that is, state, committed public information and education person with
regional, and local. (See Guide F 1086.) demonstrated ability, who is accountable for the PIER pro-
4.3 The PIER tasks involve research, planning, production, gram. This person will also provide the mechanism for
distribution, and evaluation. Production requires significant establishing standard operating procedures for the occurrence
resources and expertise and may be done most appropriately at
the higher level, such as regional, state, and national levels.
5. Statement of the Problem
5.1 Despite the development and rapid expansion of emer-
gency medical services following the passage of the Highway
Safety Act of 1966 and the Emergency Medical Services
System Act of 1973, underutilization and improper utilization
of services still exists in the system. The general public lacks
information on how to access and use the EMS system
appropriately.
5.2 The public needs to learn what EMS is and especially
that it is a system, the importance of utilizing EMS, how to
access it, and what to do and not to do until the ambulance and
NOTE 1—In order to provide the elements of the PIER program, this
planning model should be followed.
2
Annual Book of ASTM Standards, Vol 13.02. FIG. 1 PIER Planning Model

2
F 1268 – 90 (2003)
of unplanned events, and appropriate training for PIO’s or emergency health data that may affect the EMS system. This
others assuming that role. The PIO’s responsibility may includes prehospital, hospital, and rehabilitation data.
include, but not be limited to the news media concerning the 9.2.7 Risk Variables (Possible Public Health Hazards and
nature and extent of an incident and emergency medical care, Possible Dangers in Particular Area or System)—These in-
for planned or unplanned events. clude insufficient medical facilities, cultural, occupational,
criminal, recreational, transportation, system maturity (ALS
8. Identify Resources and Funding versus BLS capabilities), weather, sanitation, disease, and
8.1 A successful PIER program must have a source of geographic considerations (rivers, mountains).
funding exclusively dedicated to PIER. Funding sources exist 9.2.8 Media Resources—These include type (radio, TV,
at federal, state, and local levels. print, public, private), availability, cost, public relations and
8.2 Greater expenditures may be required in areas where marketing firms, and contacts.
hard costs such as media space and time, and morbidity and 9.2.9 Contributory Variables—These include adjoining
mortality from medical/trauma emergencies are higher than systems/resources, political and financial considerations, type
national norms. and effectiveness of EMS management at all levels, and
applicable regulatory factors.
9. Develop System Profile and Identify Major Problem 9.3 Methods to Accomplish System Profile and Baseline
Areas Study:
9.1 In developing the system profile you should utilize 9.3.1 Compile data already in existence from:
existing data included in 9.2.1 to 9.3.1.10. If public perception 9.3.1.1 Census,
data is not readily available it may be necessary to collect the 9.3.1.2 Vital statistics (health, government, and planning
data using a valid research methodology. Development of the agencies, phone companies, realtors, and so forth),
profile will enable PIER personnel to identify broad problem 9.3.1.3 Commercial sources,
areas or possible problem areas, and other factors that may 9.3.1.4 Voluntary organizations (AHA, ARC, ATS),
affect the PIER program in a positive or negative manner. 9.3.1.5 National and state agencies,
9.2 A statistically valid comprehensive poll must be taken to 9.3.1.6 Current EMS system data,
establish a baseline of information on the EMS system opera- 9.3.1.7 College/universities,
tion. The required baseline components of the poll should 9.3.1.8 Chambers of commerce,
include: 9.3.1.9 Cultural/civic organizations, and
9.2.1 Demographic Variables—These include age, race, 9.3.1.10 Medical facilities registries.
sex, population characteristics and trends, income levels,
9.3.2 Collect data not currently in existence using valid
predominant languages, education levels, cultural factors, and
research methodologies. Identify appropriate technical exper-
other socioeconomic factors (religion, employment, and re-
tise who can assist with the research methodology.
lated).
9.2.2 System Utilization Variables—These include number
10. Develop Goals and Objectives
and type of EMS personnel (volunteer and paid) and attrition
rate, trends in EMS responses (coverage and response time), 10.1 This guide requires the development of tangible PIER
access type (9-1-1, tele, multi or single, number, radio, and so goals and objectives. Goals must be realistic and should be
forth), appropriate use or abuse problems, or both, and out- consistent with program needs. PIER objectives whether long
come costs and other utilization data. or short term, must be concise, consistent, attainable, measur-
9.2.3 Medical Facilities—These include number, location able, written, flexible, revised periodically, reliable, and ac-
(and service area), beds, type, trauma center designation, countable. Since objectives are, by definition, measurable, their
teaching facility, and the interface/cooperation with the EMS impact can be estimated.
system. 10.1.1 Measurement criteria and evaluation mechanisms
9.2.4 Current Public Information and Education should be identified in advance and minimal standards for
Programs—These include type and scope of existing pro- performance should be set. Baseline data will also help to
grams, effectiveness, program costs and funding sources, and determine priorities of the goals and objectives identified.
related programs of other organizations and institutions (for Goals and broad objectives should be analyzed according to the
example, AHA, ARC, and so forth). public as a whole, and specific objectives may be addressed to
9.2.5 Current Public Perceptions and Knowledge—This a distinct public segment.
includes knowledge of existing system structure, capabilities, NOTE 1—By way of example, baseline data can be gathered from
and quality, access to the system, self help programs (CPR, first system analysis to determine the false alarm rate, and from survey to
aid, and related programs), and current health habits, for determine the percentage of adult population who know 9-1-1. One goal
example, diet, smoking, exercise, substance abuse, and so might then be to “increase the appropriate use of 9-1-1.” Objectives might
forth, as it is related to prevention and reduction of emergency be (1) to ensure that 80 % of the adult population knows to dial 9-1-1 for
health risks. medical emergencies, and (2) to decrease false alarms to less than 2 % of
the total calls by ___ (date).
9.2.6 Emergency Health Data—This includes morbility/
mortality from critical care, subgroups of cardiac, trauma, 10.2 The final product of the goal setting process is a work
poison, drugs, burns, neonate, CNS, behavioral, and other plan that should include explicit goals and objectives.

3
F 1268 – 90 (2003)
11. Writing the PIER Plan determinations to be made of when or in what respect that
11.1 The work plan should include goals, objectives, imple- standard has been met. Standards are explicit conditions to be
mentation steps, required resources, and time lines. Manage- fulfilled, either in operating a process or as a characteristic or
ment roles, functions, and activities should be identified. an end state.
Identify specific problems anticipated in accomplishment of a 14.2 A basic evaluation process model includes information
goal: develop alternative solutions that are more realistic if about procedures; a comparison with a norm (expression of
necessary. what is desired); decision about program actions to be taken,
11.2 This guide requires the written preparation of a PIER compiling and reporting back their findings, and recycling as
plan and then the implementation of that plan, as well as the often as necessary to solve the original problem. Essential
evaluation of the effectiveness of the PIER plan and proper evaluation components include:
modification to meet changing needs on an ongoing basis. 14.2.1 Resource allocation,
11.3 There must be a process for the identification of public 14.2.2 Media/communication used,
information needs for the PIER plan and several methods and 14.2.3 Quality of technical/production aspects,
requirements are noted within this guide. 14.2.4 Funding resource status (increasing, stable, decreas-
11.4 The development of a PIER plan must include the ing),
following information to ensure the PIER plan is realistic and 14.2.5 Relationship between media and systems,
that it has tangible goals and measurable objective and is an 14.2.6 Number of people reached by media type and mes-
improvement over past performance data (see 9.2). sage disseminated,
14.2.7 Analysis of system utilization information as it
12. Assemble Resources
relates to PIER,
12.1 There are four types of resources that can be as- 14.2.8 Behavioral change/knowledge perception change,
sembled: human, information, financial, and materials/ and
equipment. Select from these resources as necessary to imple- 14.2.9 Timing of evaluation should also be considered
ment the plan. (what is reasonable or necessary deadline for completion/
12.2 Large organizations and institutions (for example, evaluation).
universities, corporations, hospitals, trauma centers, and so 14.3 And finally consider the needs as defined by goals and
forth) are excellent resources to assist with marketing, survey objectives, in relation to available time, money, and expertise.
development, and other PIER activities. It may be that one or more lower priorities must be revised or
13. Implementation and Operation of PIER Plan totally dismissed until additional money becomes available. In
other words, measure your goals and objectives against the
13.1 The PIER director must assign the work to his/her reality of expectations to achieve them.
employees.
13.2 Each employee must be trained for his/her task.
15. Performance Standards for Evaluation of EMS PIER
13.3 The relationship of public information goals and ob-
Programs
jectives to the development of other system components should
be analyzed to assess appropriate timing. Timing can be the 15.1 A statistically valid survey or other scientific valid
most important element. method of measuring the PIER will be completed annually. The
13.4 The director and employees must follow the schedule public’s knowledge and attitudes established in the baseline
of events devised for each project. evaluation, will be updated every 3 years, as a minimum.
13.5 The director and employees must confer quickly when 15.2 An ultimate goal is that 100 % of a community should
problems arise in carrying out a project. They must promptly know how to access the EMS system at all times.
specify and phase in solutions, amending workplans in that 15.3 There should be a 5 % improvement per year in the
process. public’s knowledge and attitude as established in the initial
13.6 Employees must continually report project results to system survey. An accepted minimum national practice will be
their supervisors. that 50 % of the population in every community have the
knowledge. The areas addressed in this requirement include:
14. Evaluate Plan prevention, knowing when to call, who to call, how to call,
14.1 Evaluation is a process of assessing past or proposed what to say, and what to do and not to do until the system
actions and their results against the criteria, goals and objec- arrives, including knowledge of resuscitation such as CPR and
tives, and other normative elements of the plan and defined knowledge of what to expect from the EMS system, to
problem. Assessment and appraisal are usually used as more facilitate the systems effective performance.
general terms than evaluation, connoting the drawing of 15.4 A minimum of 50 % of the distributed population
conclusions from the examination of a situation and its should know the direct or most effective way of accessing the
elements. Additionally, evaluation and measurement are not EMS system under usual circumstances. In extraordinary
synonymous, as measurement is basically a counting mecha- circumstances, such as vacationing in a rural area, the 50 %
nism, which is part of evaluation. For instance, criteria are should have enough knowledge to choose an appropriate
measurable components or test of a standard that permits means for ensuring EMS system activation and response.

4
F 1268 – 90 (2003)
ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

5
Designation: F 1285 – 90 (Reapproved 2003)

Standard Guide for


Training the Emergency Medical Technician (Basic) to
Perform Patient Examination Techniques1
This standard is issued under the fixed designation F 1285; 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 4. Significance and Use


1.1 This guide covers the minimum patient examination 4.1 This guide establishes the minimum national standard
techniques that the emergency medical technician (basic) shall for training the emergency medical technician (basic) to
be trained to use when assessing ill or injured patients of all perform patient examination techniques on patients of all ages.
ages. 4.2 This guide shall be used by those who wish to identify
1.2 This guide is one of a series which together describe the the minimum training standard for the emergency medical
minimum training standard for the emergency medical techni- technician (basic) as it relates to the performance of patient
cian (basic). examination techniques.
1.3 This standard does not purport to address the safety 4.3 This guide shall be used as the basis to revise Practice
concerns associated with its use. It is the responsibility of the F 1031.
user of this standard to establish appropriate safety and health 4.4 Every person who is identified as an emergency medical
practices and determine the applicability of regulatory limita- technician (basic) shall have been trained in accordance with
tions prior to use. this guide.
4.5 This guide does not stand alone and must be used in
2. Referenced Documents conjunction with the applicable documents cited in Section 2.
2.1 ASTM Standards:
F 1031 Practice for Training the Emergency Medical Tech- 5. Examination Techniques
nician (Basic)2 5.1 The emergency medical technician (basic) shall be
trained to perform the following examination techniques and to
3. Terminology recognize the differences that exist because of age and sex:
3.1 Definitions of Terms Specific to This Standard: 5.1.1 Assess respirations for rate, rhythm, and quality,
3.1.1 auscultation—examination by listening with a stetho- 5.1.2 Auscultate for breath sounds,
scope. 5.1.3 Assess rate and regularity of the following pulses:
3.1.2 inspection—examination by careful visualization of carotid, brachial, radial, femoral, and pedal,
the body or a part of the body. 5.1.4 Palpate blood pressure,
3.1.3 palpation—examination by touching with the hand. 5.1.5 Auscultate blood pressure,
5.1.6 Assess mental status and level of consciousness,
1
5.1.7 Inspect the body,
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.02 on
5.1.8 Palpate the body,
Personnel, Training and Education. 5.1.9 Assess sensory perception,
Current edition approved Sept. 10, 2003. Published October 2003. Originally 5.1.10 Assess motor function, and
approved in 1990. Last previous edition approved in 1998 as F 1285 – 90 (1998). 5.1.11 Assess airway patency.
2
Annual Book of ASTM Standards, Vol 13.02.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1285 – 90 (2003)

ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

2
Designation: F 1286 – 90 (Reapproved 2002)

Standard Guide for


Development and Operation of Level 1 Pediatric Trauma
Facilities1
This standard is issued under the fixed designation F 1286; 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 4. Significance and Use


1.1 This guide establishes minimum guidelines for the 4.1 The purpose of this guide is to provide guidelines for
development and operation of a pediatric trauma facility in a categorizing pediatric trauma centers to ensure consistency of
children’s or general hospital. A pediatric trauma facility is an pediatric trauma care throughout the nation. The guidelines
institution whose medical and administrative leadership has will form the quantitative basis for audit and ongoing quality
expressed the personal, institutional, and financial commitment assurance.
to optimal care of the injured child 24 h a day, 365 days a year. 4.2 This guide can be used in conjunction with objective
1.2 This guide defines the system, organizational structure, quality assurance outcome measures as outlined in Guide
clinical personnel, and physical equipment necessary for a F 1224.
pediatric trauma facility, whether freestanding or a joint 4.3 This guide can be used by local, regional, and national
adult/pediatric facility in either a children’s hospital or general authorities to establish pediatric trauma centers.
hospital committed to the care of injured children.
1.3 The criteria outline in this guide incorporates levels of 5. Implementation of Pediatric Trauma Facilities
categorization and their essential or desired characteristics. 5.1 The implementation of a pediatric trauma facility des-
ignation will be conducted consistent with the regulation of
2. Referenced Documents local, state, and federal government authorities having juris-
2.1 ASTM Standards: diction for this process.
F 1224 Guide for Providing System Evaluation for Emer- 5.2 The most significant ingredient necessary for optimal
gency Medical Services2 care of the pediatric trauma patient is commitment, both
personal and institutional. For the institutions, optimal care
3. Terminology means providing capable personnel who are immediately
3.1 Definitions: available, sophisticated equipment, services that are frequently
3.1.1 trauma care system—a coordinated network of emer- expensive to purchase and maintain, and priority of access to
gency medical systems (EMS) comprised of one or more laboratory, radiology, operating suites, and intensive care
trauma centers linked by triage protocols, appropriate commu- facilities and services. For the medical and nursing staff,
nications, transportation services, and prehospital care to optimal care means a commitment to the concept of adequate
manage effectively the injured child from initial injury to staffing, prompt availability, continuing education, and quality
complete rehabilitation. The trauma care system is a subsystem assurance.
within the EMS system. 5.3 It is recognized that a Level I pediatric trauma center
3.1.2 trauma center—a hospital that has made the institu- should be located in a facility providing comprehensive care
tional commitment to fulfill all criteria outlined in Sections 1 for children. The institutions must demonstrate a continuing
through 4 and where available be designated by the appropriate commitment to a high level of pediatric trauma care. Methods
authority. of demonstrating the commitment to the trauma system shall
3.2 Definitions of Terms Specific to This Standard: include, but not be limited to, a broad resolution that the
3.2.1 pediatric patient—a patient whose morphologic hospital governing body agrees to do the following:
growth potential has not been completed. In general, a patient 5.3.1 Participate in the operations and integration of a
less than 15 years old or consistent with local practice. regional or statewide system, to ensure pediatric patient care
data for system management, quality assessment, and opera-
1
tions research,
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.03 on
5.3.2 Establish policy and procedures for the maintenance
Organization/Management. of services essential for a trauma center/system,
Current edition approved July 9, 1990. Published August 1990.
2
Annual Book of ASTM Standards, Vol 13.02.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1286 – 90 (2002)
5.3.3 Ensure that all pediatric trauma patients will receive 6.2.2.1 A pediatric surgeon as chief of the pediatric trauma
medical care to the level of the institution’s accreditation, and service who shall have special interest and experience in major
5.3.4 Establish a priority admission for the pediatric trauma pediatric trauma care and the leadership skills to head a
patient to the full services of the institution, including adequate multidisciplinary team approach to the management of the
resuscitation facilities and personnel, operating room availabil- patient. This surgeon shall have a significant time commitment
ity, and intensive care unit availability. The Level I pediatric to major trauma care.
trauma center must assume the responsibility for ensuring 6.2.2.2 The pediatric trauma service shall have designated
prompt access for all patients requiring trauma care. pediatric specialists available 24 h per day for care of the major
5.3.5 Written transfer agreements to receive and transfer the trauma patients.
pediatric trauma patient must be in place. 6.2.2.3 Children with significant injuries shall undergo
5.3.6 The pediatric trauma center must have the capability evaluation by the trauma service and disposition to the appro-
to receive the pediatric trauma patient by ground or by air. priate hospital service.
6.2.2.4 All pediatric trauma patients shall be treated by
6. Criteria for Level I Pediatric Trauma Facilities personnel who are organized as a team and available in-house
6.1 Participation Requirements: from the major trauma service and the pediatric service 24 h
6.1.1 Designation as a Level I trauma center confers upon a per day with attending coverage as specified.
facility the recognition that it has the commitment, personnel, 6.2.2.5 A designated pediatric surgeon is responsible for
and resources to provide optimum medical and psychological multidisciplinary and interdepartmental coordination of effort
care for the critically injured child. to trauma care.
6.1.2 The center shall have appropriate support services for 6.3 Trauma Service Director:
the child and the family and commitment to the ongoing care 6.3.1 Fundamental to the establishment and organization of
and total rehabilitation of the patient. This shall include the a hospital’s pediatric trauma service is the recognition that the
following: individual identified and accountable for the operation of this
6.1.2.1 Evidence of appropriate social service intervention service must be qualified to serve in this capacity. The
and follow-up, following indicators shall be present:
6.1.2.2 Identification of members of the rehabilitation team, 6.3.1.1 Evidence of qualifications, including pediatric edu-
6.1.2.3 Discharge summary of the trauma care to the pa- cational preparation in pediatric surgery and a certificate of
tient’s private physician, where appropriate, and special qualifications in pediatric surgery,
6.1.2.4 Documentation in the patient’s medical record of the 6.3.1.2 Selection process as defined by the hospital’s medi-
post-discharge plan. cal staff bylaws,
6.1.3 A Level I pediatric trauma center shall demonstrate its 6.3.1.3 Participation in local/state/national trauma-related
capability to manage injured and their sequelae to major activities,
injuries or critical conditions such as: 6.3.1.4 Educational involvement such as the Advance
6.1.3.1 Signs of shock or hypotension associated with one Trauma Life Support (ATLS) course, teaching in the under-
or more system injuries, graduate, graduate, and postgraduate level training programs
6.1.3.2 Fractures of the axial skeleton, within the department of surgery. There shall be evidence of
6.1.3.3 Two or more proximal long-bone fractures, interface and collaboration between nursing management re-
6.1.3.4 Amputation or traumatic avulsion of one or more sponsible for the trauma nursing service and the physician
extremities proximal to digits, management responsible for the trauma service,
6.1.3.5 Suspected or actual spinal cord injuries, 6.3.1.5 Participation in research and publication efforts of
6.1.3.6 Head injuries, pediatric trauma,
6.1.3.7 One or more system injuries requiring pediatric 6.3.1.6 Evidence of active participation by the trauma pro-
intensive care, intracranial pressure monitoring, or mechanical gram director in the resuscitation or surgery, or both, of
ventilation support, and multisystem trauma patients,
6.1.3.8 Thermal or chemical injury. 6.3.1.7 A job description and organizational chart depicting
6.2 Service Requirements: the relationship between the trauma program director and other
6.2.1 Criteria guidelines embrace administrative and physi- hospital clinical services, and
cal attributes of individual trauma centers. By this means, 6.3.1.8 Evidence that a multidisciplinary method of provid-
autonomous functioning of the trauma service may be ensured, ing, monitoring, and evaluating trauma patients throughout
and its staffing and direction sharply defined. The definition of their hospital stay is in effect through the hospital organiza-
bed capacity, intensive care unit, operating room capability, tional plan.
and proximity to an availability of supporting services (radi- 6.4 Nursing Requirements:
ology, laboratory, and so forth) are important features of the 6.4.1 The hospital organization must define the roles of the
concept. The intent is to ensure the optimal coordination of nursing team members and their areas of responsibility, ac-
services for the trauma patient. countability, and authority.
6.2.2 The hospital shall have an organized, defined trauma 6.4.2 It is suggested that the trauma plan for the nursing
service within the institutional structure that shall consist of the department include the ability to immediately mobilize quali-
following: fied nursing resources.

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F 1286 – 90 (2002)
6.4.3 Essential to the overall coordination and integration of 6.6.2.5 Oral surgery,
the trauma center or system in the hospital is the designation of 6.6.2.6 Urologic surgery,
an individual as the pediatric trauma nurse coordinator. The 6.6.2.7 Hand surgery,
trauma nurse coordinator should be responsibile for monitoring 6.6.2.8 Burn,
and promoting all trauma-related activities associated with 6.6.2.9 Radiology,
patient care, and for providing documented evidence thereof. 6.6.2.10 Vascular radiology,
6.4.3.1 Participation in trauma educational activities sepa- 6.6.2.11 Neuroradiology,
rate from the institution’s in-house trauma education program 6.6.2.12 Mental health services,
as either program coordinator, consultant, or faculty member 6.6.2.13 Pediatric medicine,
shall be required. There must be evidence of specific pediatric 6.6.2.14 Pediatric critical care,
nursing practice application. There must be evidence of docu- 6.6.2.15 Neurosurgery, and
mentation of this participation.
6.6.2.16 Anesthesia.
6.4.4 The following indicators shall be present:
6.6.3 Pediatric Consultation—Specialists shall be on-staff
6.4.4.1 Evidence of qualification to include educational
and available on-site to respond for pediatric consultation in
preparation, certification, and experience in pediatrics,
the following areas:
6.4.4.2 Participation in local, state, and national pediatric
6.6.3.1 Cardiology,
trauma-related nursing activities,
6.6.3.2 Gastroenterology,
6.4.4.3 Evidence of participation in trauma research through
6.6.3.3 Hematology,
promotion or coordination,
6.6.3.4 Infectious disease,
6.4.4.4 A job description and organizational chart depicting
the relationship between the trauma nurse coordinator and 6.6.3.5 Psychiatry,
other services, and 6.6.3.6 Neurology,
6.4.4.5 Evidence of participation in the establishment of 6.6.3.7 Pulmonary disease,
systems to influence the nursing care of pediatric trauma 6.6.3.8 Clinical pathology,
patients. 6.6.3.9 Rehabilitation medicine, and
6.5 Department Requirements—There shall be surgery de- 6.6.3.10 Nephrology.
partments, divisions, services, or sections with designated 6.6.4 Subspecialists—All subspecialists in a Level I spe-
chiefs and staffed by qualified specialists with expertise in cialty pediatric trauma center shall be board certified subspe-
pediatrics in the following areas: cialists where appropriate.
6.5.1 Pediatric general surgery,
6.5.2 Orthopedic surgery, 7. Hospital Resource Requirements
6.5.3 Cardiac surgery, 7.1 General—A Level I pediatric trauma facility shall have
6.5.4 Vascular surgery, all of the hospital resources described in this section.
6.5.5 Neurosurgery, 7.2 Emergency Department:
6.5.6 Urology, 7.2.1 The hospital shall have an easily accessible and
6.5.7 Ear, nose, and throat, identifiable designated resuscitation area used for neonate,
6.5.8 Plastic and maxillofacial surgery, pediatric/adolescent major trauma patients.
6.5.9 Oral surgery, 7.2.2 The physical environment shall have areas for at least
6.5.10 Ophthalmic surgery, two simultaneous resuscitations.
6.5.11 Transplant or transfer agreement, 7.2.3 The hospital should demonstrate a commitment to
6.5.12 Reimplantation, or appropriate transfer agreement, pediatric emergency care, and demonstrate compliance with
and the following requirements:
6.5.13 Obstetrics and gynecologic surgery consultation. 7.2.3.1 The designated trauma resuscitation area must be of
6.6 Physician Requirements: adequate size to accommodate the full trauma resuscitation
6.6.1 Specialists—Specialists shall be available in-hospital team.
24 h per day, as follows: 7.2.3.2 Adequate facilities and personnel must be available
6.6.1.1 Pediatric surgical attendant or resident, within the emergency department to care simultaneously for
6.6.1.2 Pediatric attendant or resident, more than one multisystem trauma patient. Back up areas to
6.6.1.3 Anesthesiologist or resident, and accomplish this need not be separately designated but should
6.6.1.4 Neurosurgical attendant or resident, or surgical des- be immediately available.
ignee of chief of neurosurgery. 7.2.3.3 Under normal conditions, the emergency department
6.6.2 Attending Staff—Attending (on-site) staff with exper- shall be open at all times.
tise in pediatrics shall be on-call and promptly available in the 7.2.3.4 All closures of the emergency department, for what-
following areas: ever reasons, shall be documented with notification of appro-
6.6.2.1 Orthopedic surgery, priate authorities and institutions.
6.6.2.2 Ophthalmic surgery, 7.2.3.5 The institution shall develop formal written proto-
6.6.2.3 Ear, nose and throat, cols with neighboring trauma centers to accept trauma patients
6.6.2.4 Plastic surgery, when bypass is mandatory.

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F 1286 – 90 (2002)
7.2.4 Receiving Personnel—Emergency department or 7.2.6.7 Thoraco-abdominal injuries,
trauma receiving area personnel shall be comprised of at least 7.2.6.8 Amputation,
the following: 7.2.6.9 Burns, and
7.2.4.1 There shall be a designated physician qualified in 7.2.6.10 Toxicology.
emergency care and pediatrics, and a nursing director of the 7.2.7 Equipment and drugs in the emergency department, all
emergency department. sized as appropriate for the pediatric patient, shall include, but
7.2.4.2 There shall be 24-h in-house immediate coverage not be limited to, at least one of each of the following items:
and response to the emergency department with a team 7.2.7.1 Resuscitation stretcher,
approach to the initial management of the pediatric major 7.2.7.2 Airway control ventilator available, bag mask oxy-
trauma patient. gen (O2) suction, endotracheal tubes, laryngoscopes, tracheo-
7.2.4.3 A paging system shall function to immediately stomy set, and other appropriate respiratory equipment,
mobilize the team. 7.2.7.3 Electrocardiographic (ECG) monitor, oscilloscope,
7.2.5 Emergency Department Team—The team shall be intracranial pressure monitor, and defibrillators with internal
comprised of at least the following personnel who are imme- paddles,
diately available and responsible for resuscitation and stabili- 7.2.7.4 Central venous pressure monitors,
zation of the patient: 7.2.7.5 Intravenous insertion sets for pediatric patients,
7.2.5.1 Physician, with special competence in the care of the 7.2.7.6 Drugs and intravenous fluids for all emergency
critically injured pediatric patient who is a designated member situations with appropriate administrative devices,
of the trauma team and physically present in the emergency 7.2.7.7 Pediatric dose chart, immediately accessible and
department 24 h a day with training in emergency medicine prominently displayed,
and pediatrics, or appropriate subspecialities. 7.2.7.8 Mobile X-ray capability with 24-h in-house techni-
7.2.5.2 Pediatric Resident or Staff, PGY-3 (postgraduate cian,
year 3). 7.2.7.9 Communication between emergency transport sys-
7.2.5.3 Surgical Resident(s) or Staff, PGY-3/4. tem and emergency room personnel,
7.2.5.4 Anesthesiologist Physician—Initial response may be 7.2.7.10 Thoracotomy trays,
an anesthesiology resident at PGY 3/4 level responsible to 7.2.7.11 Peritoneal lavage tray,
attending anesthesiologist who is immediately available. When 7.2.7.12 Appropriate lighting for emergency surgery,
a residency trained pediatric anesthesiologist is not available 7.2.7.13 Pediatric pneumatic antishock garments,
there must be the ability to demonstrate the experience or 7.2.7.14 Pediatric suction equipment,
special education of the anesthesiologist in the pediatric age 7.2.7.15 Pediatric skeletal tongs and splinting,
group. 7.2.7.16 Neck immobilization device,
7.2.5.5 Respiratory Therapist. 7.2.7.17 Thermal control equipment for patient, blood, and
7.2.5.6 Registered Nurses—A minimum of two registered environment,
nurses per shift, functioning in trauma resuscitation, who have 7.2.7.18 Patient weighing devices,
documented experience in the care of injured children. 7.2.7.19 Intraosseous infusion set,
(a) All registered nurses shall be educated in trauma 7.2.7.20 Needle cricothyroidotomy set, and
nursing. 7.2.7.21 Cranial burr hole set.
(b) All registered nurses assigned to the department must 7.3 Operating Suite (Special Requirements)—The operating
receive training in pediatrics. suite shall be staffed and equipped to handle all children who
(c) The patient classification system utilized by the insti- are present in the emergency department and are in need of
tution should define the severity of injury or illness, which immediate surgical intervention, and, at a minimum, shall meet
indicates the number of nursing staff needed to adequately the following requirements:
provide patient care. 7.3.1 The operating room shall be adequately staffed and
(d) Appropriate nursing documentation for the trauma immediately available 24 h per day for trauma patients.
patient must be present. 7.3.2 A second staffed operating room shall be promptly
(e) Evidence of annual continuing education in pediatric available and staffed.
trauma care is required. 7.3.3 Nursing Personnel:
7.2.6 Equipment and Drugs—Equipment and drugs shall be 7.3.3.1 The operating room registered nursing staff shall
available to the emergency department 24 h per day for the have experience and shall be trained as both scrub and
resuscitation and stabilization of the following conditions or circulating nurses in the operating room.
injuries in the pediatric patient: 7.3.3.2 At least one registered nurse must be physically
7.2.6.1 Unstable or potentially unstable airway, present in the operating room.
7.2.6.2 Unstable or potentially unstable cardio-vascular sys- 7.3.4 Equipment—The operating room shall contain at least
tem, the following equipment:
7.2.6.3 Open and closed head injuries, 7.3.4.1 Cardiopulmonary bypass pump-oxygenator,
7.2.6.4 Open and closed fractures, 7.3.4.2 Operating microscope available,
7.2.6.5 Spinal cord or column injuries, 7.3.4.3 Thermal control equipment for patient, blood, and
7.2.6.6 Facial injuries, environment,

4
F 1286 – 90 (2002)
7.3.4.4 X-ray capability, There shall be another physician in-house who has experience
7.3.4.5 Pediatric endoscopes, all varieties, or promptly in pediatric trauma care.
available, 7.5.1.3 Nursing Staff:
7.3.4.6 Burr hole capability, (a) The patient classification system utilized by the insti-
7.3.4.7 Monitoring Equipment—Electrocardiographic tution should define the patient care workload of the nursing
(ECG), continuous blood pressure, ICP, and appropriate respi- staff.
ratory monitors (such as transcutaneous pO2, CO2 monitors), (b) The pediatric patient shall have nursing care given by a
7.3.4.8 Pediatric drug dose chart, registered nurse who has experience in pediatric nursing.
7.3.4.9 Pediatric anesthesia ventilator, 7.5.2 Patient Care—ICU equipment, drugs, and supplies
7.3.4.10 Image intensifier available, shall be available for the optimal treatment of the following
7.3.4.11 Fracture table available, and critical conditions or injuries:
7.3.4.12 Auto transfuser. 7.5.2.1 Unstable airway or pulmonary system,
7.4 Postanesthetic Recovery Room (PAR)—The postanes- 7.5.2.2 Unstable cardiac system,
thetic recovery room (pediatric intensive care unit is accept-
7.5.2.3 Unstable cardiovascular system,
able) shall consist of at least the following:
7.5.2.4 Head injuries with or without coma,
7.4.1 Nursing Personnel—Registered nurses and other es-
sential personnel shall be on duty 24 h a day, and must be 7.5.2.5 Axial skeletal injuries or fractures,
competent in postanesthesia care of the pediatric trauma 7.5.2.6 Spinal cord injuries,
patient. 7.5.2.7 Fractures, pre- or post-reduction, with or without
7.4.2 Anesthesiologist—An anesthesiologist with pediatric traction devices,
experience or physician with demonstrated experience in 7.5.2.8 Fluid electrolytes, or metabolic derangements,
airway management shall be available in-hospital 24 h per day. 7.5.2.9 Visceral injuries,
7.4.3 Equipment—Equipment for resuscitation and to pro- 7.5.2.10 Eye injuries, and
vide life support for the critically or seriously injured neonate, 7.5.2.11 Burns, or transfer agreement.
pediatric/adolescent shall include but not be limited to the 7.5.3 Equipment—Equipment of all sizes, as appropriate for
following: pediatric patients, shall include, but not be limited to, the
7.4.3.1 Airway control and ventilation equipment, including following:
laryngoscopes, assorted blades, airways, endotracheal tubes, 7.5.3.1 Airway Control Devices, including endotracheal
and bag-mask resuscitators of all sizes (this equipment must be tubes, ventilating equipment, O2 source and O2 concentration
readily available), devices, and suction,
7.4.3.2 Oxygen, air, and suction devices,
7.5.3.2 Electronic Monitors—Electrocardiographic monitor,
7.4.3.3 Electrocardiograph, internal and external pediatric heart rate monitors, respiratory monitors, doppler and tempera-
paddles, and defibrillator, ture,
7.4.3.4 Apparatus to establish and maintain hemodynamic
7.5.3.3 Other Equipment—Pediatric venous, intraosseous,
and ICP monitoring,
arterial access trays and catheters including catheterization
7.4.3.5 Appropriate standard intravenous fluids and admin-
venous pressure and Swanganz catheters, compartment pres-
istration devices, including intravenous catheters,
sure monitors, pediatric temperature control devices, pediatric
7.4.3.6 Sterile surgical set for emergency procedures such as dialysis machine, pediatric scales, skeletal traction attachments
thoracotomy and cut-down, and instruments, and sterile thoracotomy kit, pulse, oximetry,
7.4.3.7 Drugs and supplies necessary for emergency care, pressure monitors and other equipment necessary for the care
7.4.3.8 Temperature control devices for the patient (that is, of children,
radiant warmers), for parenteral fluids, and for blood,
7.5.3.4 Drugs—All necessary drugs for optimal treatment,
7.4.3.9 Temporary cardiac pacemaker, and
7.5.3.5 Sets—Intravenous, crystalloid solutions, and pediat-
7.4.3.10 Appropriate pressure monitoring.
ric administration sets,
7.5 Intensive Care Unit—The hospital shall have a pediatric
7.5.3.6 In-Unit and Intra-Hospital Communications, and
intensive care unit (ICU) that has separate comprehensive
pediatric intensive care capability and is capable of treating all 7.5.3.7 Standard Microtechnique, required for electrolytes,
pediatric major trauma patients requiring an ICU. blood count, arterial blood gases and platelets, urine/serum
7.5.1 ICU Personnel—The unit shall be staffed at a level to osmolality, coagulation studies, and capability to accept bac-
ensure appropriate nurse-patient ratios, as determined by writ- terial cultures, available 24 h in the laboratory.
ten nursing standards. Pediatric ICU personnel shall, at a 7.6 Pediatric Medical-Surgical Units—These are general
minimum, be comprised of the following: medical-surgical nursing unit beds.
7.5.1.1 A designated medical director for pediatric intensive 7.6.1 Nursing Staff:
care, and. 7.6.1.1 The patient classification system utilized by the
7.5.1.2 Physician on duty in ICU 24 h a day or immediately institution should define the work load that indicates the
available from inside the hospital. This physician should be number of nursing staff to adequately provide patient care.
credentialed by the institution in trauma care. The physician on 7.6.1.2 Pediatric trauma patients will receive nursing care
duty in the ICU is not the emergency department physician. from a registered nurse trained in pediatric care.

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F 1286 – 90 (2002)
7.6.2 Equipment—The equipment should support the cur- 7.11 Radiology—Radiological special capabilities shall be
rent status of the patient and be readily available. Equipment available and shall consist of the following:
for resuscitation and to provide support for the injured neonate, 7.11.1 Angiography of all types,
pediatric/adolescent patient shall include, but not be limited to, 7.11.2 Sonography,
the following: 7.11.3 Nuclear scanning,
7.6.2.1 Airway control and ventilation equipment, including 7.11.4 Computerized tomography, available 24 h per day,
laryngoscopes, assorted blades, airways, endotracheal tubes, and
bag-mask resuscitator of all sizes (this equipment must be 7.11.5 General angiography and cerebrovascular aortogra-
immediately available), phy, cardiac catheterization, and coronary capability.
7.6.2.2 Oxygen, air, and suction devices, 7.12 Blood Laboratory—Clinical laboratory services shall
7.6.2.3 Electrocardiograph, monitor, and defibrillator to in- be available 24 h per day and shall consist of the following:
clude internal and external paddles, 7.12.1 Standard microtechnique analysis of blood, urine,
7.6.2.4 All standard intravenous fluids and administration and other body fluids,
devices, including intravenous catheters designed with the 7.12.2 Blood typing and crossmatching,
capacity for delivering IV fluids and medication at rates and in 7.12.3 Coagulation studies,
amounts appropriate for children ranging in age from neonate 7.12.4 Comprehensive blood bank with at least ten units of
to adolescent, blood (all types) in-house, and access to community central
7.6.2.5 Drugs and supplies necessary for emergency care, blood bank and adequate hospital storage facilities,
and 7.12.5 Blood gases determinations immediately available,
7.6.2.6 Thoracotomy tube sets and cut down trays. 7.12.6 Serum and urine osmolality,
7.7 Rehabilitation Medicine: 7.12.7 Microbiology,
7.7.1 Rehabilitation Plan—There must be a clearly identi- 7.12.8 Written protocol that trauma patient receives priority,
fiable comprehensive trauma rehabilitation plan developed for and
every pediatric trauma patient. If the patient is transferred to 7.12.9 Toxicology testing.
another institution for rehabilitation, then records, outcome, 7.13 Social Service Capabilities:
and follow-up must be obtained. If a rehabilitation facility is 7.13.1 Social service intervention shall be available from
not associated with the institution, a formal written transfer the time of entry into the facility to the time of discharge.
agreement with a rehabilitation center specifically equipped for Social workers shall provide psycho-social services as part of
the care of the children shall be in place. an interdisciplinary team. They should be graduates of masters
7.7.1.1 The multidisciplinary pediatric trauma team shall level programs in social work.
define and implement a mechanism for discharge planning for 7.13.2 Social workers shall be available to the patient,
the pediatric trauma patient. patient’s family, significant others, the community, and mem-
7.7.1.2 The pediatric trauma rehabilitation plan developed bers of the interdisciplinary team as indicated.
for the pediatric trauma patient shall be under the direction of 7.13.3 There shall be adequate documentation in the pa-
a psychiatrist or a physician with special competence in tient’s record of the social work services provided.
pediatric trauma rehabilitation. 7.13.4 The social work team should participate in the
7.7.1.3 Ancillary services, such as physical therapy, occu- development and delivery of in-service training for the trauma
pational therapy, speech therapy, play therapy, nutritional center staff and the community.
therapy, etc., shall have a defined role in the rehabilitative care 7.14 Pastoral Counseling—The opportunity for spiritual
of the pediatric patient. counseling should be available. As the injury or illness of a
7.7.2 Nursing Staff: child frequently stresses the bonds of a family unit, it is
7.7.2.1 Nursing staff ratios for medical-surgical units caring suggested that there be the opportunity for all spiritual denomi-
for the rehabilitation of the post-acute trauma neonate, nations to receive clerical support. This can be accomplished
pediatric/adolescent patients shall be based upon a patient by developing a listing of clergy promptly available to the
classification system. facility.
7.7.2.2 When a separate rehabilitation unit exists, the nurs-
ing staff ratios shall be based on the institution’s classification 8. Education
system. 8.1 Formal programs in continuing medical education spe-
7.7.2.3 The education of the rehabilitation unit nurse shall cifically concerning pediatric trauma care shall be given by the
have emphasis on the pediatric trauma patient’s rehabilitation. hospital for the following personnel:
7.8 Burn Center—A transfer agreement with a burn center 8.1.1 Staff physicians,
shall be in effect if not in-house. 8.1.2 Nurses,
7.9 Spinal Cord Care—A team approach to the initial and 8.1.3 Allied health professionals (emergency medical
continued management of the acute spinal cord injury shall technicians/paramedics),
exist, and shall include the active participation of members of 8.1.4 Community physicians, and
the rehabilitation service or as stated in a transfer agreement. 8.1.5 Community nurses (registered nurses or licensed prac-
7.10 Hemodialysis—Hemodialysis capabilities shall be tical nurses).
available. 8.2 Public education shall be provided by trauma hospitals.

6
F 1286 – 90 (2002)
8.3 The hospital shall exhibit existing or planned pediatric 11.1.3 Trauma patient resuscitation and stabilization,
trauma prevention programs. There needs to be evidence of 11.1.4 Operating room support, laboratory, X-ray, respira-
active programs to increase the public awareness of trauma tory therapy, and pharmacy protocols; explicit recognition of
prevention. The trauma prevention program needs to be inter- the priority given to trauma patients,
nal and external to the facility. These programs can be 11.1.5 Trauma patient transport protocols—emergency
presented collectively with other hospitals and organizations. room to operating room, hospital to hospital,
8.4 The hospital must be able to document active involve- 11.1.6 Special audit for pediatric trauma deaths at least
ment in its local and regional emergency medical services every month, including autopsy data, and
(EMS) systems. The hospital can demonstrate involvement in 11.1.7 Monthly morbidity and cost-of-care review.
local and regional EMS programs by the following means: 11.2 Agreements—The trauma center or unit shall have the
8.4.1 When appropriate, participation in pediatric emer- following agreements:
gency medical technician training programs, 11.2.1 The hospital shall implement a process of peer
8.4.2 Joint educational programs to include equipment, review regarding the care of the pediatric major trauma patient.
supplies, and drugs specific to the neonate and pediatric 11.2.2 There shall be a system to permit all patients access
patient, to services regardless of financial status.
8.4.3 Participation in EMS system quality assessment and 11.2.3 The pediatric trauma center shall agree to an area-
quality assurance mechanism, and wide mortality audit.
8.4.4 Assistance in the development of regional policy and 11.2.4 The trauma center shall provide evidence of consul-
procedures. tation and appropriate transfer agreements with referring hos-
pitals (including organ procurement).
9. Disaster Plan
11.2.5 The trauma center shall provide telephone consulta-
9.1 Each hospital shall incorporate into its master disaster tion 24 h per day.
plan the utilization of its pediatric major trauma area for 11.2.6 There shall be a written by-pass policy.
children. 11.3 Trauma Conferences:
9.2 Each hospital shall participate in a process to incorpo- 11.3.1 Regular trauma conferences, such as the following,
rate its resources and activities into local and regional disaster are critical to the self evaluation and timely identification of
plans. problems for prompt resolution:
10. Research in Pediatric Trauma 11.3.1.1 Pediatric nursing audit,
11.3.1.2 Medical records review, and
10.1 Each hospital shall participate in a registry of all
11.3.1.3 Long term follow-up of trauma care.
pediatric major trauma admissions with pertinent treatment and
11.3.2 Every trauma admission shall be reviewed at these
outcome data as determined by the regional emergency medi-
conferences. Departmental morbidity and mortality confer-
cal services. The registry must include at a minimum:
ences do not exempt review by these conferences.
10.1.1 Severity of injury, including the probability of dying,
11.3.2.1 Conferences are intended to be major problem
10.1.2 Anatomic site of injury,
identification and problem solving sessions. Therefore, atten-
10.1.3 Nature of injury,
dance of designated personnel from hospital administration is
10.1.4 Mechanism of injury,
essential. Attendance is also expected to include physician and
10.1.5 Classification of patient injuries, including sub
nursing personnel, pediatric transport team members, trauma
groups,
call surgeons, involved consultants, the physician director of
10.1.6 Demographic information as to age, sex, etc.,
the ICU, social services, the prehospital agency, and rehabili-
10.1.7 Outcome, and
tation personnel. The conference should be chaired by the
10.1.8 Active involvement in the research of pediatric
trauma service director.
trauma care.
11.4 Adult and pediatric trauma may be reviewed at the
11. Protocols and Policies same conference.
11.1 The hospital shall provide written protocols and poli- 11.5 The multidisciplinary pediatric trauma conference,
cies to support a systematic and comprehensive approach to the shall be held at least every 3 months.
care of the pediatric trauma patient (including child abuse), as
follows: 12. Keywords
11.1.1 Trauma patient triage protocols, 12.1 hospital; pediatric trauma; pediatric trauma facility;
11.1.2 Trauma team response protocols, trauma center

7
F 1286 – 90 (2002)

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in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
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8
Designation: F 1287 – 90 (Reapproved 2002)

Standard Guide for


Scope of Performance of First Responders Who Provide
Emergency Medical Care1
This standard is issued under the fixed designation F 1287; 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 first responder (FR)—an individual trained to provide


1.1 This guide covers minimum requirements for the scope initial care for sick or injured persons in accordance with this
of performance of first responders who may be responsible for guide.
the initial care of sick and injured persons of all ages in the 4. Significance and Use
prehospital environment.
1.2 This guide includes objectives based on an individual’s 4.1 The purpose of this guide is to improve the quality of
acquired knowledge, including signs and symptoms; patient initial emergency medical care provided to the sick and
assessment; basic life support/cardiopulmonary resuscitation injured. As the first trained person at an emergency medical
(BLS/CPR); bleeding and shock; injuries to the skull, spine, scene, it is critical that the first responder be proficient in
chest, abdomen, and extremities; moving patients; medical and providing patient care and minimizing further complications
environmental emergencies; triage; gaining access; and haz- until more highly trained emergency medical service personnel
ardous situations that the first responder may encounter. intervene.
1.3 This standard does not purport to address all of the 4.2 In identifying these minima, the guide acknowledges
safety concerns, if any, associated with its use. It is the many types of first responder emergency medical care courses
responsibility of the user of this standard to establish appro- of study. This guide allows and encourages the addition of
priate safety and health practices and determine the applica- optional knowledge, skill, and attitudinal objectives. Programs
bility of regulatory limitations prior to use. such as those for law enforcement, firefighters, and ski patrol
are examples of this diversity meeting specific local commu-
2. Referenced Documents nity needs.
2.1 ASTM Standards: 4.3 This guide is intended to assist those who are respon-
F 1031 Practice for Training the Emergency Medical Tech- sible for defining the scope of performance for first responders.
nician (Basic)2 4.4 This guide is not intended to be used as a scope of
2.2 American Heart Association/American Red Cross performance for emergency ambulance personnel.
(AHA/ARC) Standards: 5. Objectives
Standards and Guidelines for Cardiopulmonary Resuscita-
tion and Emergency Cardiac Care3 5.1 Required Objectives—These objectives are not in an
order suggesting a particular performance sequence. The first
3. Terminology responder shall be able to:
3.1 Definitions of Terms Specific to This Standard: 5.1.1 Identify the roles and responsibilities of a first re-
3.1.1 basic life support/cardiopulmonary resuscitation sponder within the local emergency medical services (EMS)
(BLS/CPR)—a set of skills that includes airway management, system,
chest compressions, and others as defined by the American 5.1.2 Function within the medical-legal scope of care as a
Heart Association. first responder in the local EMS system,
5.1.3 Determine vital signs and identify normal ranges,
5.1.4 Identify and report various forms of emergency medi-
1
cal identification found on the patient,
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.02 on 5.1.5 Conduct a primary assessment for life threatening
Personnel, Training and Education. conditions,
Current edition approved May 25, 1990. Published July 1990.
2
5.1.6 Provide BLS/CPR in accordance with American Heart
Annual Book of ASTM Standards, Vol 13.02.
3
Reprinted from the Journal of the American Medical Association (JAMA).
Association/American Red Cross (AHA/ARC) standards,
Copies are available from the American Heart Association, 7272 Greenville Ave., 5.1.7 Control bleeding,
Dallas, TX 75231. 5.1.8 Dress and bandage soft tissue injuries,

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1287 – 90 (2002)
5.1.9 Care for a person in shock, 5.1.24 Provide initial care for:
5.1.10 Supplement respirations with available mechanical 5.1.24.1 Persons with behavioral problems,
aids to breathing, including oxygen, 5.1.24.2 Physically and sensory impaired persons,
5.1.11 Perform a secondary assessment, 5.1.24.3 Abused persons, and
5.1.12 Immobilize musculoskeletal injuries, 5.1.24.4 Dying persons,
5.1.13 Immobilize the spine, 5.1.25 Recognize a multiple casualty incident and initiate an
5.1.14 Move a sick or injured person from a hazardous appropriate response,
environment in such a manner that the chance of aggravating 5.1.26 Triage injured persons found at a multiple casualty
injuries is minimized, incident,
5.1.15 Move a person in conjunction with patient care 5.1.27 Recognize potential dangers at an emergency scene
activities in such a manner that the chance of aggravating and take appropriate actions to protect first responders and
injuries is minimized, other persons,
5.1.16 Care for a person who has non-traumatic chest pain, 5.1.28 Use available equipment to gain access to trapped
5.1.17 Care for a person who is experiencing respiratory and injured persons in order to provide life saving care, and
distress, 5.1.29 Assist with the delivery of a baby.
5.1.18 Care for a person who is experiencing a diabetic 5.2 Optional Objectives—The roles and responsibilities for
emergency, the provision of initial emergency medical care vary among
5.1.19 Care for a person who is experiencing seizure activ- first responders. When the responsibilities for initial emergency
ity, medical care are limited, the ability of a first responder to
5.1.20 Care for a person who has ingested, injected, inhaled, perform the tasks in 5.1 may be sufficient to ensure satisfactory
or absorbed a poison, care. When a first responder must care for a greater variety of
5.1.21 Care for a person who is experiencing an altered illnesses and injuries, the scope of performance must be
level of consciousness, expanded accordingly.
5.1.22 Care for a person who has thermal, chemical, or
electrical burns, 6. Keywords
5.1.23 Care for a person who is adversely affected by the 6.1 basic life support/cardiopulmonary resuscitation (BLS/
environment, CPR); emergency medical services (EMS); first responder (FR)

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in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

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2
Designation: F 1288 – 90 (Reapproved 2003)

Standard Guide for


Planning for and Response to a Multiple Casualty Incident1
This standard is issued under the fixed designation F 1288; 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 3.1.2.1 medical disaster—a type of significant medical in-


1.1 This guide covers the planning, needs assessment, cident which exceeds, or overwhelms, or both, the capability of
training, integration, coordination, mutual aid, implementation, local resources and of routinely available regional or multi-
provision of resources, and evaluation of the response of a jurisdictional medical mutual aid, and for which extraordinary
local emergency medical service (EMS) organization or medical aid from state or federal resources is very likely
agency to a multiple patient producing situation that may or required for further diagnosis and treatment.
may not involve property loss. This guide is limited to the 3.1.3 EMS control/medical group supervision— the first
pre-hospital response and mitigation of an incident up to and emergency medical services response at the incident scene, or
including the disposition of patients from the incident scene. designated by the local response plan or incident command to
1.2 This guide addresses the background on planning, be responsible for the overall management of the incident’s
scope, structure, application, federal, state, local, voluntary, EMS operation.
and nongovernmental resources and planning efforts involved 3.1.4 extrication management—the function of supervising
in developing, implementing, and evaluating an EMS annex, or personnel who remove entrapped victims.
component, to the local jurisdiction’s emergency operations 3.1.5 fatality management—the function designated by ex-
plan (EOP) as defined in the Federal Emergency Management isting plans, or the EMS control/medical group supervisor, to
Agency (FEMA) publication, Civil Preparedness Guide (CPG) organize, coordinate, manage, and direct morgue services.
1–8.2 3.1.6 incident commander—the individual responsible for
1.3 This standard does not purport to address the safety the overall on-site management and coordination of personnel
concerns associated with its use. It is the responsibility of the and resources involved in the incident.
user of this standard to establish appropriate safety and health 3.1.7 logistics resources management—the function respon-
practices and determine the applicability of regulatory limita- sible for acquiring personnel, equipment (including vehicles),
tions prior to use. facilities, supplies, and services as requested by the incident
commander.
2. Referenced Documents 3.1.8 medical communications management—the function
2.1 ASTM Standards: designated by the incident commander or EMS control/ medi-
F 1149 Practice for Qualifications, Responsibilities, and cal group supervisor to establish, maintain, and coordinate
Authority of Individuals and Institutions Providing Medi- effective communication between on-site and off-site medical
cal Direction of Emergency Medical Services3 personnel and facilities.
3.1.9 medical supplies management—the function desig-
3. Terminology nated by the incident commander to manage equipment and
3.1 Definitions of Terms Specific to This Standard: report to EMS control/medical group supervisor.
3.1.1 command post—the physical location from which 3.1.10 mental health coordinator—a qualified mental health
incident command exercises direction over the entire incident. professional responsible for coordinating the psychosocial
3.1.2 disaster—a sudden calamity, with or without casual- assessments and interventions for responders, affected indi-
ties, so defined by local, county, or state guidelines. viduals, and groups.
3.1.11 multiple casualty incident (MCI)—a type of signifi-
cant medical incident that may fall into the following catego-
1
This guide is under the jurisdiction of ASTM Committee F30 on Emergency ries:
Medical Services and is the direct responsibility of Subcommittee F30.03 on
Organization/Management.
Current edition approved Sept. 10, 2003. Published October 2003. Originally
approved in 1990. Last previous edition approved in 1998 as F 1288 – 90 (1998).
2
Available from FEMA, 500 C St., SW, Washington, DC 20472.
3
Annual Book of ASTM Standards, Vol 13.02.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1288 – 90 (2003)
3.1.11.1 extended—an incident for which local medical 4. Summary of Guide
resources are available and adequate to provide for field 4.1 This guide is based upon a body of knowledge on the
medical triage and stabilization, and for which appropriate planning, implementation, and evaluation of the emergency
local facilities are available and adequate for further diagnosis medical components of the local pre-hospital response to
and treatment. multiple casualty incidents.
3.1.11.2 major—an incident producing large numbers of 4.2 The body of knowledge on which the guide is based was
casualties, for which routinely available regional or multi- drawn from a wide variety of sources, including individual
jurisdictional medical mutual aid is necessary and adequate for authors, academic institutions, and federal, state, regional, and
further diagnosis and treatment. local organizations.
3.1.12 mutual aid—the coordination of resources, including
4.3 This guide is organized in such a way as to provide
but not limited to facilities, personnel, vehicles, equipment, and
those responsible for planning, implementing, and evaluating
services, pursuant to an agreement between jurisdictions pro-
the emergency medical components of the local pre-hospital
viding for such interchange on a reciprocal basis in responding
response to multiple casualty incidents with information they
to a disaster or emergency.
can readily use to ensure that their response is as expedient and
3.1.13 needs assessment—a preliminary survey of real or
appropriate as is reasonably possible.
potential hazards in a specific geographic area.
4.4 The guide was created to organize, collate, and distrib-
3.1.14 operations offıcer—individual who assists the inci-
ute related information in such a way as to be readily accessible
dent commander on issues relating to the operations of the
to people in the fields of emergency medical services and
incident.
emergency management.
3.1.15 public information—a function designated by the
4.5 This guide should not be perceived as an inflexible rule
incident commander for the dissemination of factual and timely
or standard but as a guide that should be adapted to the needs
reports to the news media.
of the individual community, and should be refined and
3.1.16 safety management—the function that identifies real
improved as the body of knowledge on which it is based
or potential hazards, unsafe environment or procedures at the
increases.
incident scene, and recommends the appropriate corrective or
preventive actions under the authority of the incident com-
5. Significance and Use
mander, to ensure the safety of all personnel at the incident
scene. 5.1 This guide is intended to assist the management of the
3.1.17 sector offıcers (group supervisors/leaders/ local EMS agencies or organizations in the design, planning,
managers)—qualified personnel who control a specific area or and response of their jurisdiction’s resources to multiple
task assignment. casualty incidents (MCIs).
3.1.18 staging area—the location where responding emer- 5.2 This guide does not address all of the necessary plan-
gency services equipment and personnel assemble for assign- ning and response of pre-hospital care agencies to an incident
ment. that involves the total destruction of community services and
3.1.19 staging management—the function designated by the systems.
incident commander that is responsible for the orderly assem- 5.3 This guide does not address the necessary design,
bly and utilization of resources in a designated area. planning, and response to be undertaken by a medical care
3.1.20 transportation management—the function desig- facility to an internal or external event that necessitates the
nated by the EMS control/medical group supervisor that is activation of the facility’s disaster plan.
responsible for the transportation of the patients from the 5.4 This guide provides procedures to coordinate and pro-
incident scene and for coordination with EMS control/ medical vide a systematic and standardized response by responsible
group supervisor, communications, and the incident com- parties, including the local elected officials, emergency man-
mander. agement officials, public safety officials, medical care officials
3.1.21 treatment area—the site at or near the incident for (pre-hospital and hospital), local EMS agencies/organizations
emergency medical treatment prior to transport. and others with objectives and tasks for the pre-hospital
3.1.22 treatment management—the function that is respon- management of a significant incident.
sible for the definitive on-scene medical treatment of patients. 5.5 This guide provides for the establishment of an incident
3.1.23 triage—the process of sorting and prioritizing emer- command system with position descriptions that identify mis-
gency medical care of the sick and injured on the basis of sion, functions, and responsibilities of the command structure
urgency and type of condition present, and the number of to be used at a MCI. The incident command functions include
patients and resources available in order to properly treat and but are not limited to staging, logistics, rescue/extrication,
transport them to medical facilities appropriately situated and triage, treatment, transportation (air, land, and water), commu-
equipped for their care. nications, and fatality management.
3.1.24 triage area—a location near the incident site to 5.6 This guide provides examples and other management
which injured persons should be brought, triaged, and taken tools that can assist in providing training objectives and
directly to the treatment area. decision making models for dispatch, response, triage, treat-
3.1.25 triage management—the function that is responsible ment, and transportation for local jurisdictions experiencing
for triage and preliminary treatment of casualties. multiple casualty incidents.

2
F 1288 – 90 (2003)
PLANNING 6.4.2.4 The type and quantity of mutual aid and support
services that might be required outside the normal jurisdic-
6. Planning tional services.
6.1 Purpose—Planning should be a cooperative effort be- 6.4.3 Components—There are three basic parts to a needs
tween local EMS providers and the jurisdiction in which they assessment:
deliver services. The plan should be written to establish the 6.4.3.1 Consideration of the potential for specific incidents,
emergency organization, basic policies, responsibilities, and 6.4.3.2 Evaluation of the potential harm resulting from the
actions required for support of local operations of emergency incident, and
medical/health plans. Plans should ensure rapid medical assis- 6.4.3.3 Evaluation of the resources required to respond to
tance to persons requiring aid due to an incident. Plans should the incident.
describe a system for coordination of alerting, dispatching, and 6.4.4 Approach—The following are suggested approaches
uses of medical personnel and resources whenever a local to completing a needs assessment:
emergency medical health agency requires assistance from 6.4.4.1 Form a team to identify the potential hazards, risks,
another EMS agency/jurisdiction. The plan should be designed and impact relating to potential MCIs.
to be an extension of day to day service, facilities, and 6.4.4.2 Consult the local or state civil defense/emergency
resources. preparedness offices for assessment information.
6.2 Goal—The plan ensures adequate and coordinated ef- 6.4.4.3 After identifying potential MCIs, evaluate them for
forts that will minimize loss of life, disabling injuries, and their potential hazards, risks, and impact.
human suffering by providing effective medical assistance 6.4.4.4 Evaluate the area’s resources.
through efficient use of medical and other resources in the 6.4.5 Resources Assessment—Consider the personnel re-
event of emergencies resulting in multiple casualty incidents. quired for performing such tasks as emergency medical ser-
6.3 Objectives—The primary objectives of a plan should vices, firefighting, and rescue. Inventory equipment for the job
include a process whereby: and evaluate its ability to perform the task. Prepare a written
6.3.1 Each EMS agency/jurisdiction should have a plan to description of what potential incidents exist, and the ability to
meet its own needs within its capabilities. respond to these incidents.
6.3.2 Each EMS agency/jurisdiction should enter into mu- 6.4.6 Once complete, the needs assessment becomes part of
tual aid agreements with other local or regional jurisdictions the plan.
which can be invoked when local capability to manage a
6.5 Plan Components—The plan should include provision
situation has been exceeded. Each jurisdictional plan should
for the following:
facilitate the access and utilization of local and state resources.
6.5.1 Organizational Structure for Response:
6.3.3 The EMS agency/jurisdiction’s plan should conform
6.5.1.1 The plan should define an overall incident organiza-
to appropriate regional and state plans.
tion based on a strategy of efficient and effective utilization of
6.3.4 Each EMS agency/jurisdiction should define training
resources.
requirements, and develop and utilize a training program based
6.5.1.2 The plan should address chain of command, includ-
on the needs assessment of the community.
ing transfer of authority of any officer or position.
6.3.5 The plan should be a coordinated interagency effort.
6.5.2 Organization of Manpower and Resources for Re-
Responsible agencies should have regular interaction in order
sponse:
to facilitate working relations during an incident.
6.3.6 Plans and procedures should be reviewed and revised 6.5.2.1 The plan should provide for delineation of respon-
regularly on the basis of tabletop exercises, simulated inci- sibilities and authority for all involved response personnel and
dents, or actual events. agencies.
6.4 Needs Assessment and Hazards Analysis: 6.5.2.2 The plan should address necessary resources for
6.4.1 A needs assessment is a preliminary survey of real or each level of event and prepare for availability and updating of
potential hazards in a specific geographic area. Basic to the those resources.
planning process is an understanding of the problems that 6.5.3 Response:
should be anticipated in the specific area. 6.5.3.1 The plan should provide for appropriate response to
6.4.1.1 A needs assessment lets the EMS agency/ MCIs.
jurisdiction know what to expect. 6.5.3.2 The plan should provide for organization and imple-
6.4.1.2 It prevents planning for unnecessary events. mentation of the following during MCIs:
6.4.1.3 It provides an incentive for the EMS agency/ (a) Incident command system,
jurisdiction’s plan. (b) Patient triage, treatment, and transportation areas,
6.4.1.4 It might indicate preventive measures. (c) Transportation dispatch and routing (ground, air, and
6.4.1.5 It creates an awareness of new hazards. water),
6.4.2 When the needs assessment is complete, the jurisdic- (d) Coordination with receiving hospitals (patient care ca-
tion should be able to make the following decisions: pacity inventory (PCCI)),
6.4.2.1 The type of planning desired, (e) Medical teams,
6.4.2.2 What types of response to emphasize, (f) Communications plan,
6.4.2.3 What resources will be needed to fulfill that re- (g) Psychosocial services,
sponse, and (h) Medical records, and

3
F 1288 – 90 (2003)
(i) Resource inventory list of equipment, services, and 6.8.1.3 Update the equipment inventory and distribution of
personnel. resources.
6.5.4 Coordination—Each EMS agency/jurisdiction should 6.8.2 Formal Agreement—The written agreement should
have plans and procedures that facilitate working with other also include:
response agencies during a MCI. Communications with these 6.8.2.1 Objectives:
organizations should be established on a regular basis to ensure (a) Definition of mutual aid,
a more effective response. The EMS agency/jurisdiction should (b) Assignment of review date,
effectively interact with the following: (c) Amendments, and
6.5.4.1 Hospitals, hospital consortia, skilled nursing facili- (d) Definitions used in plan.
ties, poison control centers, and other specialty care centers, 6.8.2.2 Participation:
6.5.4.2 Health department and mental health agencies, (a) Extent and limit of participation: emergency agencies,
6.5.4.3 Law enforcement agencies, adjacent counties and cities, state agencies, and out of state
6.5.4.4 Fire services, jurisdictions,
6.5.4.5 Other EMS agencies, (b) Point of contact,
6.5.4.6 Local companies and businesses, (c) Request for mutual aid,
6.5.4.7 Local/regional EMS councils, (d) Obligations of the plan,
6.5.4.8 Media, (e) Conditions for refusing to provide aid, and
(f) Withdrawal from plan.
6.5.4.9 Emergency management offices of the local jurisdic-
tion, 6.8.2.3 Organization:
(a) Local organization chart,
6.5.4.10 Local emergency planning committees (as defined
(b) Extent of authority of person initiating plan,
by law for hazardous materials (HAZMAT) mitigation),
(c) Line of authority in absence,
6.5.4.11 Specialty services such as CHEMTREC,
(d) Status of EMS agency,
HAZMAT teams (medical and mitigation), mine rescue teams,
(e) Maintenance of individual authority of requesting inci-
search teams, and so forth,
dent command or EMS control,
6.5.4.12 Social service agencies such as the American Red
(f) Local mutual aid plan operations exclusive of city or
Cross, Salvation Army, churches, and religious and community
county plan,
service groups,
(g) Assisting state or private institution,
6.5.4.13 City or county government,
(h) Assisting federal institution,
6.5.4.14 Neighboring jurisdictions, (i) Operation of city or county dispatch center,
6.5.4.15 State Government—Procedures for obtaining assis- (j) Preparation and use of participants’ inventory and re-
tance from state resources, including resources of the National sources,
Guard, and (k) Participation in the state EMS mobilization and mutual
6.5.4.16 Federal Government—Procedures for obtaining aid plan,
assistance from local installations of these agencies, including (l) Procedures to obtain activation,
military resources, U.S. Weather Service, or National Park (m) Authority and responsibility of EMS agencies and
Service; and procedures for obtaining assistance through the services, and
state from federal agencies such as the Department of Health (n) Coordination with other EMS services.
and Human Services or the Environmental Protection Agency. 6.8.2.4 Equipment Loss Replacement Procedures:
6.6 Legal Issues—Ensure that the plan is in compliance 6.8.2.5 Reimbursement.
with local, state, and federal laws and regulations. 6.8.2.6 Liability.
6.7 Psychosocial Services—Arrangements for psychosocial 6.8.2.7 Operation Command Procedures.
services should be an integral part of the planning process. 6.8.2.8 Post Incident Evaluation.
Efforts should be made to solicit involvement from profes- 6.8.3 Request—When requesting mutual aid for an incident,
sional clinicians who are experienced with medical systems. A specify the following:
coordinator should be assigned who participates as an active 6.8.3.1 Nature and location of the MCI,
member of the area planning effort. This team should be
6.8.3.2 Type of equipment and number of personnel re-
organized, in place, and available as part of any community
quested, and whether specialized personnel are needed,
response effort. Further, this team should participate in all
6.8.3.3 Location where assisting units shall report (staging
phases of the response, including planning and evaluation.
area), and
6.8 Mutual Aid
6.8.3.4 Radio frequencies assigned to the incident.
6.8.1 Planning Stage:
6.8.1.1 Define who will respond where and when, and what NOTE 1—The agency receiving the request should consider availability
of resources and provide the estimated response time to the staging area.
advanced life support procedures are authorized, and so forth.
6.8.1.2 Establish formal written agreements between juris- 6.8.4 Decision Plan— Develop a decision plan for deter-
dictions to mitigate potential problems before they occur. mining when to activate mutual aid agreements, request state
Establish protocols for requesting aid and conditions for aid, or recommend a state request for federal aid. Base the
refusing to provide aid. decision on resources, personnel, and number of patients.

4
F 1288 – 90 (2003)
6.9 Evaluation—The evaluation of an effective pre-hospital public safety agencies includes an incident commander or
EMS system response to a MCI must encompass an objective, unified command post with staff support officers, and then
as well as a subjective assessment of the planning, needs distinct operational areas: (1) Operations Branch/Section, in
assessment, training, communication, integration, coordina- charge of the actual tactical deployment of personnel and
tion, mutual aid, implementation, and provision of resources by resources; (2) Financial Branch/Section, for financial and
all organizations and agencies written into that area’s plan. expense/payment accountability, typically found and used with
Because of the lack of reliable EMS system MCI analysis, all state or federal government response; (3) a Planning Branch/
evaluators are urged to share their findings with the EMS and Section, to prepare short/long term objectives and strategic
emergency management communities. decisions for incident command; and (4) Logistics Branch/
6.9.1 Post Incident Analysis—A subjective assessment of Section, in charge of securing resources and supplies.
response to an actual incident should be held for all organiza- 7.1.2 The general ICS training courses currently taught
tions and agencies that participated in the response. All throughout the country do not specifically discuss the needs for
comments and concerns should be researched for validity and immediate on-scene responsibilities for EMS.
impact in changing the plan. 7.1.3 The concept used in the planning guide for incident
6.9.1.1 An objective assessment should involve all agencies command assumes that any EMS agency/jurisdiction having
involved in the response and use a pre-established critique tool authority to develop and implement an effective multiple
developed or accepted by the local planners. casualty incident response plan will have the necessary training
6.9.2 Though the format of the objective critique will differ and understanding of the generic incident command system.
from area to area, the following principles of evaluation are The intent of this planning guide, and specifically this section,
important to the goal of that area’s EMS system’s response to is to reinforce the acceptable job responsibilities and functions
MCIs: specifically required to mitigate a multiple casualty incident.
6.9.2.1 The critique tool should include but not be limited to This section does not address all of the components of an ICS
a minimum data set that should be collected as close to the that may be necessary in order for an EMS agency/jurisdiction
conclusion of the emergency state as is safe for responders and to develop, implement, or mitigate an incident within their
is considerate of medical well-being of victims and responders. jurisdiction.
6.9.2.2 The minimum data set should include but not be 7.1.4 This section does not include specific information for
limited to a collection of reproducible data that can be verified the operations section officer, fire operations, police operations,
and validated by subsequent investigators. public works, or hazardous materials teams. It does provide
6.9.2.3 Whereas summaries for the data should be a matter suggested job junctions for the key EMS positions. It does not
of public record accessible to responsible requesters, the actual imply that all positions must be staffed in every incident. The
collected data should be a matter of EMS confidentiality and ICS section was prepared and written to provide detailed
subject to release and disclosure only under subpoena. information for guidance for any EMS agency/jurisdiction
6.9.2.4 This confidentiality for information involving vic- needing such information. It is not intended to replace an EMS
tims and responders must be ensured by the area EMS agency agency/jurisdiction’s existing ICS plan as it relates to the EMS
and must not be confused with the purpose of the evaluations, job functions/descriptions of the agency’s established ICS
which is to improve the future response. plans.
6.9.2.5 The collected data on MCIs should be summarized
7.1.5 Job descriptions and functions should be developed
and made available.
for all key ICS positions by mutual agreement between
6.9.2.6 The data should be available for analysis by EMS
responding, responsible EMS agencies/jurisdictions as they
research groups.
relate to the overall incident command plan for a jurisdiction.
6.9.3 The implementation of the system evaluation after an
For the purposes of this planning guide, some job functions
incident may be accomplished by any qualified researcher (for
were merged together. It should be the responsibility of the
example, conducted by a formally trained researcher) or
EMS agency/jurisdiction writing the multiple casualty incident
participant evaluation group that has received the permission of
plans to address any or all of the job functions and ensure that
that area’s medical control to collect data.
the job functions developed are reviewed by the EMS agencies
6.9.3.1 Multi-disciplinary teams are suggested as systems
and jurisdictions having authority for multiple casualty plan-
evaluators for timely and efficient completion of the entire
ning, response, and mitigation.
critique tool.
7.1.6 The job descriptions and functions listed in this
IMPLEMENTATION section are models only and are designed to particularly
highlight functions and tasks that must be fulfilled in the EMS
7. Incident Command Structure operations section of an overall ICS. The model can be
7.1 Introduction implemented by a rural EMS agency/jurisdiction, as well as a
7.1.1 The concept of the incident command system (ICS) municipal EMS agency/jurisdiction. The system is devised
was first developed by Fire Suppression Services in an effort to around functional areas of management rather than staffing all
organize an effective response to forestfires, brush fires, and listed command positions.
major urban conflagrations. The ICS includes some fundamen- 7.1.7 Although specific functional areas are emphasized, it
tal practices of management and control of personnel and does not mean that other areas may not be developed, or that
resources. The general concept currently used by a majority of these may not be further subdivided. In any incident, any EMS

5
F 1288 – 90 (2003)
agency or jurisdiction could have several operating sectors 7.2.3.7 Coordinate and control aircraft traffic in the airspace
depending upon the incident situations. It is important to around the incident,
remember that, at most, a person given functional responsibil- 7.2.3.8 Receive situation reports from ancillary functions
ity within the ICS should not have more than four or five regarding the status of operations,
people under his direct supervision, or supervision should be 7.2.3.9 Demobilize incident, and
moved to the next lower level of command within the incident 7.2.3.10 Prepare written after-action report.
command structure. 7.2.4 The flow charts shown in Fig. 1 and Fig. 2 provide two
7.1.8 The functions of extrication, triage, treatment, and examples of incident command structures utilized during a
transportation are generally performed on all calls whether it be multiple casualty incident.
for two people or 200 people. The incident command model 7.3 EMS Control Sectors/Areas/EMS Management Func-
presented here for inclusion for a multiple casualty incident tions:
plan is one that is flexible and expandable in the particulars of 7.3.1 The EMS control/medical group supervisor is respon-
any given incident. sible for the overall EMS operations at an incident, and for
7.1.9 It should be the responsibility of the EMS agency/ designating EMS functions, as appropriate, managing pre-
jurisdiction having authority to ensure that the participants in hospital emergency care resources, and forwarding recommen-
the development of the multiple casualty incident planning dations to the incident command.
guide for their jurisdictions have necessary knowledge and 7.3.2 The EMS control/medical group supervisor’s function
training on general incident command concepts and organiza- is to ensure that supervision is provided for triage, transporta-
tion. tion, treatment, extrication, fatality management, and all EMS
7.2 Incident Command Duties—The function of incident personnel involved in the incident. In a smaller event, this may
command is the overall management and coordination of all be done by a single individual operating as incident com-
responding personnel and resources. The person assuming this mander, or in a larger event, with additional resources and
command will be identified primarily by the type of incident, personnel, this may be expanded to include a specific indi-
fire, medical, traffic, and so forth. vidual designated as EMS control/medical group supervisor
7.2.1 Upon arrival at the scene, an individual predetermined reporting to the operations section of incident command. The
by the jurisdiction having authority shall assume the incident EMS agency’s local operational plan should ensure for the
command function, and announce his name and title to the changeover from a single individual managing the entire
communications center for announcement to all other agencies incident to a delegation of authority. In either case, the tasks to
and others involved. be accomplished under EMS remain the same:
7.2.2 The incident commander should request a face-to-face 7.3.2.1 Report to the incident commander,
briefing with the emergency services personnel in charge at 7.3.2.2 Assess the situation, paying particular attention to
that time to obtain the following information: the following:
7.2.2.1 Nature and scope of the incident, (a) Nature and scope of the incident,
7.2.2.2 Current situation, (b) Type(s) of structure(s), vehicle(s), and so forth, involved,
7.2.2.3 Operational decisions made, (c) Number of patients anticipated,
7.2.2.4 Current manpower committed, (d) Type and extent of injuries anticipated,
7.2.2.5 Current resources committed, (e) Current pre-hospital EMS resources operating on the
7.2.2.6 Number of injuries and number of expected injuries, scene, and
7.2.2.7 Radio frequencies currently being used for the (f) Additional EMS resources anticipated,
incident, and 7.3.2.3 Based on assessment, request additional EMS equip-
7.2.2.8 Hazards that may hinder incident operation. ment and personnel as needed,
7.2.3 The incident commander should ensure that the fol- 7.3.2.4 Through communications, advise all area hospitals
lowing tasks are accomplished: and specialty centers of the nature and scope of the incident,
7.2.3.1 Establish a command post that should house to- and the anticipated number of patients that are injured,
gether the police, fire, EMS, and search and rescue, to facilitate 7.3.2.5 Designate triage, transportation, treatment, extrica-
making and implementing face-to-face decisions, tion, medical communications, and fatality management,
7.2.3.2 Announce location of command post, 7.3.2.6 Announce location of treatment area to all person-
7.2.3.3 Coordinate interagency on-scene and off-scene com- nel,
munications, 7.3.2.7 Coordinate with police, fire, and other agencies as
7.2.3.4 Ensure that proper record-keeping is done, including appropriate,
such information as who held what positions at what times, 7.3.2.8 Provide progress report to the incident commander,
notes, victim data, decision/command orders, log, communi- and
cations, resources, and personnel present, 7.3.2.9 Demobilize EMS operations.
7.2.3.5 Designate appropriate ancillary functions: EMS, fire 7.4 Extrication—The extrication function is responsible for
or rescue, logistics, staging, public information, the following:
7.2.3.6 Request additional manpower and equipment, as 7.4.1 Determining whether primary assessment and primary
appropriate, treatment are to be conducted on-site,

6
F 1288 – 90 (2003)

FIG. 1 Example 1—EMS Model for Management and Response

7.4.2 Evaluating resources needed for the extrication of 7.5.5 Transferring patient care to treatment area,
trapped patients and their removal to the treatment area, 7.5.6 Maintaining communication and coordinating activi-
7.4.3 Assessing possible safety hazards in the environment ties with treatment, extrication, and fatality management,
and ensuring that they have been neutralized prior to initiating 7.5.7 Requesting personnel and equipment, as needed,
extrication activities until relieved of this responsibility by 7.5.8 Coordinating the activities of all pre-hospital person-
safety management, nel assigned to triage, and
7.4.4 Requesting additional equipment and personnel, as 7.5.9 Managing all triage activities at the site and providing
needed, from incident command or EMS control/medical update to EMS.
group supervisor, 7.5.10 Triage reports to EMS control/medical group super-
7.4.5 Supervising all personnel assigned to the extrication visor.
function, 7.6 Treatment—The treatment function is responsible for
7.4.6 Sending progress reports to the incident commander the definitive on-scene treatment of patients, and for the
or EMS control/medical group supervisor, following:
7.4.7 Reporting to the incident command when all patients 7.6.1 Determining the number and type of injured expected,
have been extricated and delivered to the treatment area, and 7.6.2 Establishing priority areas for treatment (primary,
7.4.8 Coordinating activities with triage, treatment, and delayed, or minor),
fatality management. 7.6.3 Inventorying equipment and personnel necessary for
7.4.9 The extrication function reports to EMS control/ the supervision of care in their area,
medical group supervisor, and is designated by EMS control/ 7.6.4 Providing for the proper deployment and utilization of
medical group supervisor or the agency/jurisdiction having personnel,
authority. 7.6.5 Receiving the transfer of patient care from triage as
7.5 Triage—The triage function is responsible for the fol- the patients are transferred from the triage area to the treatment
lowing (procedures for the triage process are contained in area,
Section 9): 7.6.6 Ensuring that reassessment and re-triage of patients is
7.5.1 Sorting of patients to establish priorities for extrica- done as needed,
tion, treatment, and transportation, 7.6.7 Ensuring that appropriate treatment is rendered to
7.5.2 Ensuring that all patients are triaged, patients within the treatment area,
7.5.3 Directing and controlling patient removal teams as- 7.6.8 Providing guidance and direction to treatment team
signed to triage, personnel,
7.5.4 Ensuring that all patients are transferred to the appro- 7.6.9 Maintaining constant communication with transporta-
priate treatment areas, tion to ensure coordinated patient loading area,

7
F 1288 – 90 (2003)

FIG. 2 Example 2—EMS Model for Management and Response

7.6.10 Coordinating activities with triage, transportation, 7.7.8 Communicating with receiving facility regarding pa-
extrication, and fatality management, tient condition and status,
7.6.11 Managing all activities within the treatment area, and 7.7.9 Providing progress reports to EMS control/medical
7.6.12 Providing updates to EMS control/medical group group supervisor, and
supervisor. 7.7.10 Reporting to EMS control/medical group supervisor
7.6.13 Treatment reports to the EMS control/medical group when the last patient has been transported.
supervisor and supervises all personnel assigned to the treat- 7.7.11 The transportation function reports to the EMS
ment area. control/medical group supervisor and supervises ambulance,
7.7 Transportation— The transportation function is respon- paramedic, and other transport crews, and all other personnel
sible for the management of the transport of patients requiring assigned to the transportation area.
medical treatment from the incident scene, and for the follow- 7.8 Medical Communications—The medical communica-
ing: tions function is responsible for establishing, maintaining, and
7.7.1 Establishing a patient loading area, coordinating medical communications at the incident scene
7.7.2 Establishing or designating, or both, a medical com- between the hospital’s medical control and the treatment and
munications function, transportation functions as needed. These responsibilities in-
7.7.3 Arranging appropriate vehicles and methods of trans- clude:
port (ground or water vehicle or aircraft), 7.8.1 Establishing communications link with the designated
7.7.4 Maintaining a log of vehicle and patient destination, hospital medical control system,
7.7.5 Coordinating patient allocation and transportation 7.8.2 Acquiring hospital status information relating to pa-
with treatment and staging, tient handling capacity from hospital medical control and
7.7.6 Determining hospital and specialty referral center relaying it to transportation,
capabilities, and, through communications, updating their sta- 7.8.3 Obtaining patient-specific advanced life support or-
tus regularly, ders as necessary,
7.7.7 Assigning patients to be transported to each facility, in 7.8.4 Receiving basic patient information and injury status
accordance with pre-determined plans and policies or consul- from triage/treatment and relaying it to hospital medical
tations with medical facilities, or both, control,

8
F 1288 – 90 (2003)
7.8.5 Designating patient destination based on pre- 7.10.2 Logistics and Resources—The logistics and re-
determined bed availability assignment information to trans- sources function is responsible for acquiring personnel, equip-
portation, ment (including vehicles), and supplies as requested by inci-
7.8.6 Establishing additional medical communication as dent command, and for ensuring that the following tasks are
required, and accomplished:
7.8.7 Providing ongoing progress reports to transportation. 7.10.2.1 Establishing an on-site equipment and supply re-
7.8.8 Medical communications is a function designated by source area,
transportation. It reports to transportation or treatment, or both. 7.10.2.2 Inventorying equipment and supplies on the scene
7.9 Fatality Management—The function of fatality manage- and determining requirements of additional equipment and
ment is to supervise all personnel assigned to the morgue area. supplies,
Fatality management controls access to the area and organizes, 7.10.2.3 Receiving requests from the incident commander
coordinates, manages, and directs morgue functions, and is for equipment and resources that must be obtained from
responsible for the following: outside the incident area,
7.10.2.4 Requesting additional equipment and supplies as
NOTE 2—The function of fatality management may be assigned to any
emergency service responder until the arrival of the designated personnel they arrive at the scene and notifying incident command, if
(that is, medical examiner, coroner, funeral director). The function of appropriate, as to their assignment,
fatality management should only be assigned to experienced emergency 7.10.2.5 Maintaining inventory of arriving equipment and
responders. supplies,
7.9.1 Establishing a morgue area remote from the treatment 7.10.2.6 Making provisions for service, repair, and fuel for
area and not readily available to other victims, but accessible to all apparatus and equipment, and
vehicles, such as, emergency vehicles, law enforcement, or 7.10.2.7 Coordinating with other personnel, as appropriate.
coroner, 7.10.2.8 The logistics and resources function reports to the
7.9.2 Assessing resources needed on the scene, such as incident commander.
equipment, supplies, personnel, and community health and 7.10.3 Safety—The safety function monitors and assesses
social services, hazards and unsafe situations and develops measures to ensure
7.9.3 Keeping area off-limits to all personnel, except those personnel safety. Although emergency action may occur to stop
needed, unsafe actions, generally such actions should be corrected
7.9.4 Coordinating with law enforcement and assisting the through the incident commander. Other tasks include:
coroner’s office as necessary, 7.10.3.1 Surveying incident areas and identifying hazards
7.9.5 Keeping identity of deceased victims confidential, and potential hazards,
7.9.6 Maintaining records, including victims’ identities (if 7.10.3.2 Advising incident command of special equipment,
available), personal effects, location found, and so forth, and procedures, or teams needed to handle specific hazards,
7.9.7 Providing appropriate security to the morgue area. 7.10.3.3 Identifying and informing incident command of
7.9.8 Fatality management is designated by and reports to hazardous or potentially unsafe situations associated with the
EMS control/medical group supervisor or the agency/ incident on an ongoing basis,
jurisdiction having authority. 7.10.3.4 Exercising emergency authority to stop and prevent
7.10 Support Functions—Staging, logistics and resources, unsafe acts, and
safety, public information, and critical incident stress teams are 7.10.3.5 Investigating and documenting accidents and inju-
support functions to incident command. ries to emergency personnel and other events that have
7.10.1 Staging—The staging function is responsible for the occurred within incident areas and recommending appropriate
orderly assembly (in a designated area) and on-scene dispatch actions to eliminate or minimize risks.
of vehicles, equipment, and personnel, and for supervising air 7.10.3.6 The safety function reports to the incident com-
medical staging and all other personnel assigned to the staging mander.
area, and is responsible for: 7.10.4 Public Information—The public information func-
7.10.1.1 Establishing a staging area, tion disseminates factual and timely reports to the news media.
7.10.1.2 Announcing the staging area location to incident The individual performing this function should be the only
command and communications center, so that all responding person who deals with the media. The function is responsible
units will report to the staging area, for the following:
7.10.1.3 Establishing units for assignment as requested by 7.10.4.1 Contacting the incident commander for a briefing
incident command or transportation, upon arrival,
7.10.1.4 Requesting maintenance for vehicles, through lo- 7.10.4.2 Contacting the jurisdictional agency in charge to
gistics, at the staging area, as needed, coordinate public information activities,
7.10.1.5 Updating incident command of the status of cur- 7.10.4.3 Establishing a media area located away from the
rently available units, and command post,
7.10.1.6 Demobilizing staging area. 7.10.4.4 Acting as liaison to the press to identify their needs
7.10.1.7 The staging function reports to an operations of- and assist them in accessing special resources,
ficer or the incident commander. 7.10.4.5 Deciding what information should be released,

9
F 1288 – 90 (2003)
7.10.4.6 Never releasing names of patients prior to notifi- 8.1.2 Backup Systems—All systems should strongly con-
cation of next of kin, and sider redundancy and backup communication systems.
7.10.4.7 Giving information such as patients’ age, sex, a 8.2 Support Functions—An EMS communication system
general description of injury (multi-trauma, burns, and so must provide the means by which emergency resources can be
forth), and hospital where patient was taken when describing accessed, mobilized, managed, and coordinated. Telecommu-
injured patients. nications for support of EMS functions should include the
7.10.4.8 The public information function reports to the following categories:
incident commander. 8.2.1 Dispatching and controlling movements of emergency
7.10.5 Critical Incident Stress Team—The mental health vehicles,
coordinator leads the critical incident stress team. The critical 8.2.2 Alerting and notifying receiving health care facilities,
incident stress team is a pre-organized unit that is responsible 8.2.3 Communicating the transportation priority and patient
for the delivery of psychosocial support for victims and treatment care status,
responders who experience acute stress reactions as the result 8.2.4 Mobilizing medical response personnel,
of involvement in an incident. This function should include the 8.2.5 Interfacing with law enforcement, fire, and local
following responsibilities: government agencies and other mutual providers, and
7.10.5.1 Coordinating between incident command and pro- 8.2.6 Communicating with field personnel to update inci-
viders in hospitals or other appropriate agencies, or both, which dent response and response requirements.
provide follow-up services,
7.10.5.2 Functioning as advisor to incident command on 9. Patient Care
matters related to the psychosocial needs resulting from the NOTE 3—See Practice F 1149.
incident, 9.1 Patient Care Capacity Inventory—During an MCI the
7.10.5.3 Ensuring that training of psychosocial response day-to-day hospital care system continues to provide care. In
personnel is established and is appropriate, shifting to an MCI mode it is necessary for pre- and in-hospital
7.10.5.4 Verifying proper credentials of all psychosocial planners to acknowledge that people take care of patients. Bed
support staff, counts alone do not determine the ability to take care of
7.10.5.5 Reporting the availability of the critical incident patients. To provide the most effective care for the greatest
stress team at the scene to incident command, number of victims of an MCI, hospitals must assess their
7.10.5.6 Establishing an unobtrusive base of operations in capability to provide such MCI care. This assessment must be
the command post, reported to the EMS control hospital, agency, or officer for
7.10.5.7 Assigning members of the team to cover the assistance in the transportation of field ill or injured patients to
following: appropriate hospitals. The communication of this patient care
(a) Assessing the psychological status of emergency person- capacity inventory should be reported in two categories:
nel and victims of the incident, 9.1.1 Immediate—The ability to devote one of each of the
(b) Providing the opportunity for emotional ventilation or following to each patient for 1 hour:
participation in a defusing, which provides stress management 9.1.1.1 Anesthesiologist,
education, 9.1.1.2 Critical care or emergency care nurse,
(c) Providing information and support to significant others 9.1.1.3 Open surgical suite,
who arrive at the scene, 9.1.1.4 Physician (emergency medicine, critical care spe-
(d) Referring for follow-up services, as needed, and cialist, or general surgeon),
(e) Maintaining records as deemed appropriate. 9.1.1.5 Respiratory therapist or certified nurse anesthetist,
7.10.5.8 The critical incident stress team function reports to 9.1.1.6 Scribe, and
the incident commander. 9.1.1.7 Surgical nurse.
9.1.2 Delayed—The ability to devote one of each of the
8. Communications following to each patient for 1⁄2 hour:
9.1.2.1 Critical care nurse,
8.1 Requirements— EMS communications become particu-
9.1.2.2 Physician, and
larly important during a MCI, in order to ensure that an EMS
9.1.2.3 Scribe.
communications system can meet the special needs of an MCI,
and not itself become disabled by the MCI. The system design NOTE 4—These categories may be further broken down into more
should meet the following requirements: specific capacities or capabilities such as NDMS or Armed Services
8.1.1 Interagency Communications—Means should be pro- Medical Regulating Office (ASMRO) classifications.
vided to allow direct communications as needed among policy, 9.2 Triage: Field Triage During MCI
fire, hospitals, and EMS units from different agencies. Avail- 9.2.1 The process of triage consists of three levels: primary,
able techniques include use of radios (common disaster chan- secondary, and tertiary, with the following objectives:
nels, multiagency multichannel radios, or cross path of chan- 9.2.1.1 Primary Triage:
nels through dispatch center or mobile dispatch center), runner, (a) Rapid patient assessment and tagging (documentation)
and face-to-face communication. The fixed site facilities into three groups (see Fig. 3), and
should be provided with independent standby power sources to (b) Immediate (brief) life sustaining care, as necessary.
avoid dependence on commercial power. 9.2.1.2 Secondary Triage:

10
F 1288 – 90 (2003)
even with immediate care. Based on limited resources some
patients who are expected to die may not receive immediate
care. Those patients should be classified in the delayed or other
category based on local policies. As this is a difficult field
decision, actual practice may be to provide treatment and
transportation.
9.3 Standard Operations and Protocol Compatibility—
Cooperation of planning can minimize problems prior to
occurrence of an MCI. Work within the local EMS region
should be done to standardize basic life support (BLS) and
advanced life support (ALS) procedures and protocols for all
patients, including:
9.3.1 Airway management,
9.3.2 Shock,
9.3.3 Chest injuries,
9.3.4 Blunt trauma,
9.3.5 Head injuries,
9.3.6 Major orthopedic injuries, and
9.3.7 Medical emergencies.
9.4 Field Medical Records—Field medical records should
be based on information as available, to include times of
evaluation, treatment, and transport. The following information
should be completed prior to the patient’s arrival at the
hospital:
9.4.1 Age, sex, name if known, and address,
9.4.2 Chief complaint, injuries found, and medical problem,
9.4.3 Treatment provided and vital signs,
9.4.4 Agency providing treatment or transportation, or both,
FIG. 3 Primary Triage and
9.4.5 Hospital to which patient is transported.
(a) Document, tag, and sort patients, if not already per- 9.5 Medical Response Teams—Medical response teams can
formed, and be activated from a number of sources, including the follow-
(b) Provide medical treatment as appropriate and available. ing:
9.2.1.3 Tertiary Triage: 9.5.1 Local:
(a) Determine priority for disposition of the patient from the 9.5.1.1 Hospital Based Response Teams—Hospital based
incident site, and response teams may be able to respond to an incident in a short
(b) Evaluate condition of patients relevant to resources, period of time. The team composition varies, but usually
transportation, and available medical facilities. These factors consists of a physician and nurse or EMT-P, or both, who are
will determine their priority for disposition from the scene. trained in triage, field medicine, and the incident command
9.2.2 Triage Categories—Victims are placed into the fol- system. These teams will usually maintain an operational mode
lowing categories in accordance with the local standard of for a very short period of time until resupplied or until other
medical care during an MCI. For example, see algorithm in personnel become available.
Fig. 3. 9.5.1.2 HAZMAT Teams—Hazardous materials teams are
9.2.2.1 First Priority/Immediate—Victims who have seri- usually activated through the public health department or fire
ous life threatening injuries but have a high probability of department. They are activated whenever the possibility of
survival if they receive immediate care. exposure to hazardous materials exists, or whenever decon-
9.2.2.2 Second Priority/Delayed—Those victims who are tamination due to hazardous materials is needed.
seriously injured and whose lives are not immediately threat- 9.5.1.3 Psychosocial Teams—These teams are activated
ened. Triage status of these patients may change to priority one when calls are made to designated provider agencies and
patients based on medical resources at any time during the hospitals.
MCI, or upon consultation with on-line medical control, or 9.5.2 State—The State Office of Emergency Services should
both. be contacted regarding state sponsored teams.
9.2.2.3 Third Priority/Minor—Those victims who are in- 9.5.3 National—Disaster Medical Assistance Teams
jured but do not require immediate medical attention, and those (DMATs) from the National Disaster Medical System (NDMS)
apparently not physically injured. can be activated by the federal government during a disaster.
9.2.2.4 Fourth Priority/Dead/Mortally Injured—Those pa- NDMS is a federally coordinated system that will supplement
tients who are obviously dead as per local medical control or responses when the incident overwhelms local and state
victims with severe injuries with low probability of survival, capacity to respond. DMATs can only be activated through a

11
F 1288 – 90 (2003)
request from the state government. These are 29-member 10.3.4 Principles and practices for both pre-hospital and
teams consisting of physicians, nurses, emergency medical in-hospital MCI preparedness,
technicians, and other personnel that can be mobilized to 10.3.5 Field management of the MCI,
respond to a declared disaster. A unit of three DMATs can 10.3.6 Triage,
function independently. When teams are dispatched to the 10.3.7 Incident command system,
disaster site they will bring necessary supplies and equipment. 10.3.8 Drills and exercises,
10.3.9 Communications,
EVALUATION 10.3.10 Coordination with other agencies and services,
10.3.11 Incident-specific guidelines, such as hazardous ma-
10. Training terials incidents, rural versus urban incidents, terrorist inci-
10.1 It is essential that EMS staff at all levels be trained to dents, etc.,
meet their responsibilities in the course of an MCI. This is 10.3.12 Psychosocial impacts of MCIs on responders, vic-
critical for four reasons: (1) an MCI is unlikely to give advance tims, families, and the community, and
warning, which means that response must be rapid and 10.3.13 Evaluation and application of lessons learned from
effective; (2) as neither the time nor place of an MCI can be drills, exercises, and actual MCI response.
predicted, all staff must be trained to respond; (3) an MCI 10.4 Objectives—At the end of a training session, trainees
response will differ significantly from single-patient response; should be familiar with incident types, communication sys-
and (4) the ability of the EMS organization to respond tems, pre-planning phase functions, scene command functions,
effectively can mean the difference between life and death, and scene triage, special resources, staging management, patient
health and disability, to MCI victims. identification, procedures, medical control, transfer of com-
10.2 Levels of Training—Four levels of training are recom- mand procedures, PCCI (patient care capacity inventory), and
mended for the training of emergency management personnel: patient transport decision procedures.
basic, intermediate, mid-level, and senior management. 10.5 Training Drills and Exercises
10.2.1 Basic MCI Training is recommended for all field 10.5.1 Purpose—The purpose of a drill is to test the plan,
responders who will need to recognize an MCI, report it evaluate personnel performance, provide experience and train-
properly, and respond as effectively as possible during the first ing, meet licensure requirements, and draw attention to a
crucial minutes and hours. problem.
10.2.2 Intermediate MCI Training is recommended for 10.5.2 Defining Scope:
field responders and managers who will need to initially 10.5.2.1 Determine which agencies are involved and to
assume incident command positions and responsibilities, mo- what extent,
bilize additional EMS resources, and integrate the additional 10.5.2.2 Determine a realistic scenario from community’s
EMS resources into a well-coordinated response. problems, and
10.2.3 Mid-Level MCI Training is recommended for EMS 10.5.2.3 Define contingencies for bad weather, out of ser-
managers who may need to assume senior incident command vice equipment, and so forth.
responsibility and interface the EMS response with other 10.5.3 Planning the Drill:
emergency response such as police, fire, search and rescue, and 10.5.3.1 Establish a committee with personnel from various
public works. sections or agencies. The committee should have defined
10.2.4 Senior Management MCI Training is recommended responsibilities and appoint subcommittees as necessary.
for senior EMS managers and directors who may need to 10.5.3.2 Establish a timetable for the committee’s work and
interface with the news media, coordinate with local govern- for the drill date and times.
ment officials, and request or mobilize resources from beyond 10.5.4 Drill Management—Safety is the primary concern.
their immediate jurisdiction. Identify a safety officer who has authority to stop any portion
10.3 Curriculum—An MCI training curriculum should ad- of the drill.
dress, at a minimum, the following: 10.5.5 Insurance—The planning agency should consider a
10.3.1 Introduction/overview of National Interagency Man- temporary insurance policy for participants.
agement System response planning, 10.5.6 Evaluation—Develop evaluation criteria to test the
10.3.2 Developing the MCI response plan, plan/drill exercise and provide timely review of evaluation data
10.3.3 Roles, responsibilities, and resources of various re- and outcome of the drill with participating agencies. A drill
sponders, services, and levels of government, planning guidelines form is illustrated in Fig. 4.

12
F 1288 – 90 (2003)

FIG. 4 Drill Planning Guidelines


13
F 1288 – 90 (2003)

FIG. 4 Drill Planning Guidelines (continued)

14
F 1288 – 90 (2003)

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in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
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15
Designation: F 1328 – 00

Standard Guide for


Training Emergency Medical Technician (Basic) to Prepare
Patients for Medical Transportation1
This standard is issued under the fixed designation F 1328; 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 4.3 This guide shall be used as the basis to revise Practice
1.1 This guide establishes the minimum training standard F 1031.
for preparing ill or injured patients of all ages for medical 4.4 Every person who is identified as an emergency medical
transportation. technician (basic) shall have been trained to this standard.
1.2 This guide is one of a series that together describe the 4.5 This guide must be used in conjunction with Practice
minimum training standard for the emergency medical techni- F 1031, Guides F 1219, and JAMA Standards and Guidelines.
cian (basic). 5. General Guidelines
2. Referenced Documents 5.1 All emergency medical technicians (basic) shall be
2.1 ASTM Standards: trained to accomplish the following:
F 1031 Practice for Training the Emergency Medical Tech- 5.1.1 All patients must be reassessed frequently and at least
nician (Basic)2 prior to and following every therapeutic intervention.
F 1219 Guide for Training the Emergency Medical Techni- 5.1.2 Patients may have more than one problem and these
cian (Basic) to Perform Patient Initial and Detailed Assess- problems should be dealt with in the order of their severity.
ment2 5.1.3 Patients with life-threatening conditions which cannot
2.2 Other Documents:2 be resolved in the field should be immediately transported in
Standards and Guidelines for Cardiopulmonary Resuscita- accordance with local protocol.
tion and Emergency Cardiac Care. Reprinted from Journal 5.1.4 Patients shall be treated in a professional, caring, and
of the American Medical Association, lastest edition reassuring manner.
5.1.5 The emergency medical technician (basic) is respon-
3. Terminology sible for facilitating the delivery of definitive care by a higher
3.1 Definitions of Terms Specific to This Standard: level of care in both the field or hospital in the most expedient
3.1.1 management—the step(s) that constitute action taken manner available.
by the emergency medical technician (basic) for a patient in 5.1.6 Depending upon the patient’s condition ALS intercept
need of assistance due to a real or perceived traumatic or should be considered.
medical condition. 5.1.7 Transport should not be unnecessarily delayed. During
transport the patient should be continuously reassessed. The
4. Significance and Use patient’s problem and status should be reported to the receiving
4.1 This guide establishes the minimum national standard hospital or medical control as soon as possible without
for training the emergency medical technician (basic) to compromising patient care. Patients should be transported in a
prepare the ill and injured patient of all ages for medical safe manner.
transportation. This guide does not preclude additions to or 5.1.8 The emergency medical technician (basic) shall pro-
modification of these as authorized by local medical direction. vide all pertinent patient information to the receiving facility.
4.2 This guide shall be used by those who wish to identify 5.1.9 Upon completion of patient care responsibilities the
the minimum training standard for the emergency medical emergency medical technician (basic) will prepare the ambu-
technician (basic) as it relates to moving, lifting, and transport- lance and/or equipment and supplies to be ready to care for the
ing patients. next patient.
6. Position for Examination and Transport
1
This guide is under the jurisdiction of Committee F30 on Emergency Medical 6.1 The emergency medical technician (basic) shall be
Services and is the direct responsibility of Subcommittee F30.02 on Personnel
Training and Education.
trained to place each patient in the position most comfortable
Current edition approved Oct. 10, 2000. Published January 2001. to that patient. Exceptions are dictated by the following clinical
Originally published as F 1328-90. Discontinued situations:
2
Annual Book of ASTM Standards, Vol 13.02.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1328 – 00
6.1.1 spinal and head injury, 7.1.4 patient drags.
6.1.2 rapid extrication, HAZMAT 7.2 The emergency medical technician (basic) must be able
6.1.3 shock, to move patients utilizing the following mechanical devices:
6.1.4 musculoskeletal injuries, 7.2.1 stair chair,
6.1.5 obstetrical emergencies, 7.2.2 scoop stretcher,
6.1.6 unconscious patient, and 7.2.3 short/long board,
6.1.7 dangerous or disruptive patient, or both. 7.2.3.1 vehical extrication vests (KED, XP ect.)
7.2.4 simple stretcher,
7. Lifting and Moving 7.2.5 standard ambulance cot,
7.1 Utilizing proper body mechanics, the emergency medi- 7.2.6 improvised device, and
cal technician (basic) must be able to safely lift and move 7.2.7 splinting devices.
patients with the following methods:
7.1.1 log roll, 8. Keywords
7.1.2 straddle lift, 8.1 EMT; Emergency Medical Technician (basic); prepara-
7.1.3 single and multiple rescuer lifts and carries, and tion for medicine transportation; training.

ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

2
Designation: F 1329 – 00

Standard Guide for


Training the Emergency Medical Technician (Basic) in Basic
Anatomy and Physiology1
This standard is issued under the fixed designation F 1329; 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 4.4 Every person who is identified as an Emergency Medi-


1.1 This guide establishes the minimum national standard cal Technician (basic) shall be trained to this standard.
for training the emergency medical technician (basic) in basic 4.5 This guide must be used in conjunction with Practice
anatomy and physiology. F 1031, Guide F 1219 and Terminology F 1177.
1.2 This guide is one of a series which together describe the 5. Anatomy and Physiology
minimum training standard for the emergency medical techni-
cian (basic). 5.1 The Emergency Medical Technician (basic) shall de-
scribe the basic anatomy and physiology of the major body
2. Referenced Documents systems and the differences that exist because of age and
2.1 ASTM Standards: gender, which include:
F 1031 Practice for Training the Emergency Medical Tech- 5.1.1 Respiratory,
nician (Basic)2 5.1.2 Circulatory,
F 1177 Terminology Relating to Emergency Medical Ser- 5.1.3 Muscular,
vices2 5.1.4 Skeletal,
F 1219 Guide for Training the Emergency Medical Techni- 5.1.5 Nervous,
cian (Basic) to Perform Patient Initial and Detailed Assess- 5.1.6 Digestive,
ment2 5.1.7 Genitourinary,
5.1.8 Reproductive,
3. Terminology 5.1.9 Integumentary, and
3.1 Definitions of Terms Specific to This Standard: 5.1.10 Endocrine.
3.1.1 anatomy—the branch of science dealing with the
6. Anatomic Terms
structure of the human organism.
3.1.2 physiology—the science dealing with the functions of 6.1 The Emergency Medical Technician (basic) shall define
the human organism. anatomic terms, which include:
6.1.1 Medial,
4. Significance and Use 6.1.2 Lateral,
4.1 This guide establishes the minimum national training 6.1.3 Proximal,
standard in basic anatomy and physiology for the emergency 6.1.4 Distal,
medical technician (basic). 6.1.5 Superior,
4.2 This guide shall be used by those who wish to identify 6.1.6 Inferior,
the minimum training standard of the Emergency Medical 6.1.7 Anterior,
Technician (basic) as it relates to basic anatomy and physiol- 6.1.8 Posterior,
ogy. 6.1.9 Midline,
4.3 This guide shall be used as a basis to revise Practice 6.1.10 Right,
F 1031. 6.1.11 Left,
6.1.12 Mid-clavicular, and
6.1.13 Mid-axillary.
1
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.02 on 7. Keywords
Personnel, Training and Education.
Current edition approved Oct.10, 2000. Published December 2000. Originally 7.1 basic anatomy and physiology; emergency medical
published as F 1329 – 91. Last previous edition F 1329 – 91 (1998). technician (basic); emt
2
Annual Book of ASTM Standards, Vol 13.02.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1329 – 00
ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentioned
in this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
of infringement of such rights, are entirely their own responsibility.

This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years and
if not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standards
and should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a meeting of the
responsible technical committee, which you may attend. If you feel that your comments have not received a fair hearing you should
make your views known to the ASTM Committee on Standards, at the address shown below.

This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,
United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the above
address or at 610-832-9585 (phone), 610-832-9555 (fax), or service@astm.org (e-mail); or through the ASTM website
(www.astm.org).

2
Designation: F 1339 – 92 (Reapproved 2003)

Standard Guide for


Organization and Operation of Emergency Medical Services
Systems1
This standard is issued under the fixed designation F 1339; 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 2. Referenced Documents


1.1 This standard established guidelines for the organization 2.1 ASTM Standards:
and operation of Emergency Medical Services Systems F 1086 Guide for Structures and Responsibilities of Emer-
(EMSS) at the state, regional and local levels. This guide will gency Medical Services Organizations2
identify methods of developing state standards, coordinating/ F 1149 Practice for Qualifications, Responsibilities, and
managing regional EMS Systems, and delivering emergency Authority for Individuals and Institutions Providing Medi-
medical services through the local EMS System. cal Direction of Emergency Medical Services2
1.1.1 At the state level this guide identifies scope, methods, F 1220 Guide for Emergency Medical Services System
procedures and participants in the following state structure (EMSS) Telecommunications2
responsibilities: (a) establishment of EMS legislation; (b) F 1268 Guide for Establishing and Operating Public Infor-
development of minimum standards; (c) enforcement of mini- mation, Education and Relations Programs for Emergency
mum standards; (d) designation of substate structure; (e) Medical Services Systems2
provision of technical assistance; (f) identification of funding F 1285 Guide for Training the Emergency Medical Techni-
and other resources for the development, maintenance, and cian (Basic) to Perform Patient Examination Techniques2
enhancement of EMS systems; (g) development and imple- 2.2 American Ambulance Association
mentation of training systems; (h) development and implemen- Standards and Accreditation Document3
tation of communication systems; (i) development and imple-
mentation of record-keeping and evaluation systems; (j) 3. Significance and Use
development and implementation of public information, public 3.1 This guide suggests methods for organizing and operat-
education, and public relations programs; (k) development and ing state, regional, and local EMS systems, in accordance with
implementation of acute care center designation; (l) develop- Guide F 1086. It will assist state, regional, or local organiza-
ment and implementation of a disaster medical system; (m) tions in assessing, planning, documenting, and implementing
overall coordination of EMS and related programs within the their specific operations. The guide is general in nature and
state and in concert with other states or federal authorities. able to be adapted for existing EMS Systems. For organiza-
1.2 At the regional level, this guide identifies methods of tions that are establishing EMS System operations, the guide is
planning, implementing, coordinating/managing, and evaluat- specific enough to form the basis of the operational manual.
ing the emergency medical services system which exists within
a natural catchment area and provides guidance on the use of 4. State Guide
these methods. 4.1 Establishment of EMS Legislation:
1.3 At the local level, this guide identifies a basic structure 4.1.1 Methods and Procedures—The legislative process
for the organization and management of a local EMS system varies from state to state. The EMS lead agency should seek a
and outlines the responsibilities that a local EMS should description of the process in its state from:
assume in the planning, development, implementation and 4.1.1.1 The legislature’s staff or clerk offices.
evaluation of its EMS system. 4.1.1.2 The legislative liaison, or other appropriate staff of
the governmental unit housing EMS (its “umbrella”).
4.1.1.3 The legal counsel assigned to EMS.
1
This guide is under the jurisdiction of ASTM Committee F30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.03 on
Organization/Management.
2
Current edition approved Sept. 10, 2003. Published October 2003. Originally Annual Book of ASTM Standards, Vol 13.02.
3
approved in 1992. Last previous edition approved in 1998 as F 1339 – 92 (1998). Available from the American Ambulance Association.

Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.

1
F 1339 – 92 (2003)
TABLE 1 Levels of Organization
State RegionalA Local
Standard Setting Legislation Regional policies Employment standards
Regulations Regional protocols Operating policies
Guidelines/policies/procedures Assistance re: personnel
State protocols
System Coordination Statewide coord. and planning System planning Daily operations
Licensure/certification Implementation
Facility licensure Inter-organizational coordination
Service approval/licensure Regional SMI
Training approval Medical audit/QA
MIS/QA Operational coordination
Inter-regional coord. System evaluation
Inter-state coord. Personnel authorization accreditation
Statewide SMI planning
Design of sub-state structure
Service Delivery Training Training coordination First response
Technical assistance Group purchasing Ambulance (BLS, ALS; ground, helicopter, fixed wing)
Communications guidelines Technical assistance Hospital services
Funding PI&E PI&E
PI&E
A
If there are no regional organizations, within the state, the State EMS will need to accomplish, either directly or through delegation, regional tasks.

4.1.2 Legislative proposals are commonly subject to the to their success. Hearing announcements and progress reports
following processes: generated by the legislature or umbrella unit legislative liaison
4.1.2.1 Drafting—The standard-setting or other goal is put are useful. A legislative “hotline” is also commonly available
into general form by the agency, citing the sections of statute it and of use in tracking bills but personal contact with legislative
believes are affected. The entities listed in 4.1.1-4.1.1.3 may be aides and/or committee staff and legal counsels are even more
a resource, or may be required to be involved, in this proposal useful.
development. 4.1.4 Participants in the EMS Legislative Process:
4.1.2.2 Sponsorship—The proposal may be submitted 4.1.4.1 Drafting/Sponsorship Resources may include:
through the agency’s “umbrella” department to become an (a) Umbrella unit legislative liaison,
official part of the administration’s legislative initiative. (b) Assistant attorney general assigned to EMS,
Whether this is true or not, the umbrella’s legislative liaison (c) Legislators/aides to legislators,
will generally seek the sponsorship of appropriate legislators (d) Staff/legal counsel to committee likely to consider bill,
for the bill unless the bill is opposed by the administration. and
Sponsorship might be sought directly by the agency or by third (e) Agency staff, or staff of other agencies.
parties on the agency’s behalf under certain circumstances 4.1.4.2 Formally Required Reviews/Approvals and/or Infor-
where practical. mal, Politically Expedient, Reviews/Approvals may be sought
4.1.2.3 Final Drafting and Introduction—The bill may be from:
drafted in the form technically required for consideration by (a) Umbrella unit commissioner/head (cabinet level),
the legislature in the umbrella unit and/or legislative counsels (b) Other agency heads with any potential interest,
offices. It is then read in the legislature and generally referred (c) State EMS and other advisory boards with potential
to a committee. interest,
4.1.2.4 Committee Consideration—The committee usually (d) REMSO staffs and advisory councils, and
holds a public hearing at which the agency and others may (e) EMS, fire, physician, nurse and other organized, active
testify in favor of or against the bill, or neutrally. In subse- EMS-related professional associations.
quent, scheduled work sessions the bill is considered, changed 4.1.4.3 Resources for Monitoring Legislative Progress:
as necessary, and some action usually voted. Agency and (a) Legislature staff/clerk offices and their publications (for
lobbyist attendance at work sessions is common and often example, hearing notices) and hotline,
influential. (b) Committee members and their aides,
4.1.2.5 Adoption/Rejection—Bills voted out to the legisla- (c) Committee staffers and legal counsels, and
ture by committee, favorably or otherwise, are then read and (d) Sponsors of bill and their aides.
voted on by that body. 4.1.4.4 Public Hearing Testimony Resources:
4.1.2.6 Governor—Bills adopted by the legislature may be (a) Those listed in 4.1.4.1, a to e, (sponsoring), 4.1.4.2, a
signed, not signed (but not vetoed), or vetoed by the governor. to e, (review/approval), and 4.1.4.3, a to d, (monitoring),
Bills that are vetoed may be returned to the legislature to (b) Hospital/prehospital personnel, and
attempt to override the veto. Bills that are not vetoed generally (c) Consumers.
become law immediately if designated as emergency bills, or 4.1.4.5 Governor’s Offıce Resources:
some time after the legislature adjourns as prescribed by law. (a) Umbrella unit commissioner/head (cabinet level),
4.1.3 The timing of legislative proposal submissions, and (b) Aides to Governor (if known and appropriate), and
the tracking of their progress to assure agency input are critical (c) Legislators and aides with links to Governor.

2
F 1339 – 92 (2003)
4.2 Development of Minimum Standards: be legally binding. They are useful, though, in defining and
4.2.1 Methods and Procedures—A variety of standard- clarifying required licensure/certification processes for provid-
setting mechanisms exist, from that which is formal and ers and in providing immediate direction to providers where
explicitly housed in the state’s laws to that which is the least such direction is not provided in law, rules, or elsewhere.
formal, for instance, the non-binding opinion of EMS staff 4.2.2.5 Protocols—Virtually unique to EMS in their re-
which is standard-setting to the extent of the dissemination and gional or statewide application, treatment protocols may be
“rightness” of the opinion and the perceived expertise of the used to set clinical and operational standards and to define
staff. The most commonly employed method and procedures scope of practice. Protocols are most effective when they are
are listed below. given power of law by virtue of specific reference in statute
4.2.1.1 Origins of Standards—State standards should be (for example, “Treatment shall be in accord with protocols
derived from the ASTM process. When this process has not established by the medical director of the state (or regional)
provided a standard in a needed area, standards set by the EMS agency.”). Protocol-development may require a
National Association of State EMS Directors and/or, second- consensus-building process among the state’s medical advisory
arily, by other EMS-related professional associations should be committee, regional medical directors and others.
used as a foundation. 4.2.2.6 Contracts and/or Letters of Agreement—Generally
4.2.1.2 When utilizing standards documents generated by in return for funding or other resources, regional and local
other than the ASTM process, these should be critically structures and providers may agree to certain standards of
reviewed by experts from a range of EMS-related clinical, performance. For example, state funding of training courses or
administrative, training, planning, regulatory and other disci- ambulance equipment items may be afforded with agreement
plines. In these cases, this process should assure that all on standards for course content or equipment use. States
interested parties have an opportunity to comment. Federal generally have a standard process and forms for contracts and
standards, in law and otherwise, may exist in certain areas of grants. Consult the purchasing and/or contracts office or legal
EMS which may affect a state’s future receipt of federal funds; counsel assigned to EMS.
these should be reviewed for consistency with planned stan- 4.2.3 Participants in the Development of Minimum Stan-
dards. dards:
4.2.2 Specific Methods and Procedures: 4.2.3.1 By Legislation—See 4.1.
4.2.2.1 Legislation—Used for setting broad, legally-binding 4.2.3.2 By Rules/Regulations:
standards. Sets the responsibilities of the state, regional, and (a) Agency staff (drafting),
local EMS structures; defines areas of rule or regulation- (b) Legal counsel assigned to EMS (review),
making authority, and sets general minimum standards for the (c) REMSO staffs/advisory councils/committees (review),
system as a whole. See 4.1. (d) State advisory council/committees (review),
4.2.2.2 Rules/Regulations—Used to set more specific stan- (e) State EMS-related professional associations (review),
dards for system design and operation including, but not (f) Impartial legal counsel (approval),
limited to, the interaction of state, regional, and local EMS (g) Secretary of state (records/announces proposals, certi-
structures in provider operation (for example, licensure, train- fies adopted rules),
ing course approval); requirements for and terms of operation (h) Legislature (subject to review),
(usually through licensure or certification) for EMS personnel, (i) Umbrella unit staff and head (review/approval unless
vehicles, equipment and services; organization of EMS train- EMS agency has own rule-making authority), and
ing for certification or licensure; organization of certification or (j) Providers/general public.
licensure testing; scope of practice; causes and procedures for 4.2.3.3 By Executive Order:
disciplinary actions. This process is governed by the adminis- (a) Agency staff (drafting),
trative procedures act (“APA”) of the state and generally (b) Legal counsel assigned to EMS (review),
requires the EMS rule-making authority to publish notices and (c) Umbrella unit head/commissioner (cabinet level),
hold hearings on proposed changes. Consult the state’s APA (d) Governor; governor’s staff,
and discuss with the legal counsel assigned to EMS. (e) State advisory council/committees,
4.2.2.3 Executive Order—The Governor may be empow- (f) Consider those listed in 4.2.3.2 for review.
ered to take actions which have a standard-setting impact. 4.2.3.4 By Policies/Procedures:
Consult the legal counsel assigned to EMS or the Governor’s (a) Agency staff (drafting and review),
staff. (b) REMSO staff (review), and
4.2.2.4 Policies/Procedures—Used by the state agency to (c) Consider umbrella unit/advisory council review.
govern the details of its operations and interactions with 4.2.3.5 By Protocols:
providers. Examples could include the personnel licensure/ (a) Agency staff,
certification application form, procedures for in-state grant (b) REMSO staff,
programs, or a policy for the administration of state licensure (c) State/regional medical directors and medical advisory
examinations. These are generally created outside of legislative boards, and
or rule-making ar