ASTM F1652-95
(Guide)Standard Guide for Providing Essential Data Needed in Advance for Prehospital Emergency Medical Services
Standard Guide for Providing Essential Data Needed in Advance for Prehospital Emergency Medical Services
SCOPE
1.1 This guide covers the functional elements and data records of prehospital Health Status Information Services (HSIS) needed to provide individual health status data for HSIS subscribers. When an HSIS subscriber experiences a medical emergency and becomes an EMS patient, a prehosptial EMS care provider can rapidly access the individual's health status data by means of telecommunications. Access to this data will enable the EMS provider to improve patient assessment, and thereby render more appropriate treatments. This will improve the EMS provider's ability to stabilize trauma and other ermergency medical conditions, and to restore and sustain vital functions, while avoiding treatments that may aggravate the severity of the medical emergency because of preexisting conditions.
1.2 In addition to improving on-site assessment, this guide will facilitate improved on-line medical direction of prehospital EMS care providers, particularly for persons experiencing life threatening medical emergencies.
1.3 Health status records provide a chronology of a person's health/medical data, including past diagnosis and treatments. The data in these records provide a vital link between the person experiencing a medical emergency, the EMS care provider, and subsequent emergency services. In order to provide the most informed care, EMS care providers and persons providing EMS medical direction need to be aware of the injured or ill person's health status.
1.4 This guide describes th minimum requirements for compiling, updating, computerizing, and storing individual's longitudinal health status data in authorized repositories, so as to protect patient privacy and confidentiality. This guide also describes requirements for providing authorized access and rapid transmittal of the data to attending EMS care providers in medical emergencies.
1.5 While this guide addresses data needed for prehospital EMS, there is also a recognized essential, but largely unmet need for similar patient health status records for emergency medical care of patients in hospital emergency departments and in definitive medical care facilities. Many development projects are in process to address this unmet need. When available, such patient records are reviewed by attending physicians, in advance of hospital emergency medical care, to quickly access patient health status data that is needed for improved patient assessment and treatment and avoidance of treatments which may be contraindicated by preexisting conditions.
1.5.1 Future changes to this guide will result in health stauts information records for prehospital emergency medical care and analogous information systems for hospital emergency medical care, harmonized with each other and with future standards for computerized longitudinal health care patient records (see Guides E 1744 and F 1629) which are being developed by ASTM Committee E31.
1.5.2 This guide describes requirements that are based on current ASTM medical informatics standards and will be updated to harmonize with future versions of these rapidly evolving standards.
1.6 The scope of this guide includes harmonization of the definitions of prehospital emergency medical services data element definitions used in this guide with definitions used in other ASTM standards. The definition of data elements in this guide will be the same as the definition of the data element in other ASTM standards. In cases where a data element used in this guide does not appear in another ASTM standard, the guide will use the definition specified for Federal health services information systems (4, 5).
General Information
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Standards Content (Sample)
NOTICE: This standard has either been superseded and replaced by a new version or discontinued.
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Designation: F 1652 – 95
Standard Guide for
Providing Essential Data Needed in Advance for Prehospital
Emergency Medical Services
This standard is issued under the fixed designation F 1652; 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 projects are in process to address this unmet need. When
available, such patient records are reviewed by attending
1.1 This guide covers the functional elements and data
physicians, in advance of hospital emergency medical care, to
records of prehospital Health Status Information Services
quickly access patient health status data that is needed for
(HSIS) needed to provide individual health status data for
improved patient assessment and treatment and avoidance of
HSIS subscribers. When an HSIS subscriber experiences a
treatments which may be contraindicated by preexisting con-
medical emergency and becomes an EMS patient, a prehospital
ditions.
EMS care provider can rapidly access the individual’s health
1.5.1 Future changes to this guide will result in health status
status data by means of telecommunications. Access to this
information records for prehospital emergency medical care
data will enable the EMS provider to improve patient assess-
and analogous information systems for hospital emergency
ment, and thereby render more appropriate treatments. This
medical care, harmonized with each other and with future
will improve the EMS provider’s ability to stabilize trauma and
standards for computerized longitudinal health care patient
other emergency medical conditions, and to restore and sustain
records (see Guides E 1744 and F 1629) which are being
vital functions, while avoiding treatments that may aggravate
developed by ASTM Committee E-31.
the severity of the medical emergency because of preexisting
1.5.2 This guide describes requirements that are based on
conditions.
current ASTM medical informatics standards and will be
1.2 In addition to improving on-site assessment, this guide
updated to harmonize with future versions of these rapidly
will facilitate improved on-line medical direction of prehospi-
evolving standards.
tal EMS care providers, particularly for persons experiencing
1.6 The scope of this guide includes harmonization of the
life threatening medical emergencies.
definitions of prehospital emergency medical services data
1.3 Health status records provide a chronology of a person’s
element definitions used in this guide with definitions used in
health/medical data, including past diagnosis and treatments.
other ASTM standards. The definition of data elements in this
The data in these records provide a vital link between the
guide will be the same as the definition of the data element in
person experiencing a medical emergency, the EMS care
other ASTM standards. In cases where a data element used in
provider, and subsequent emergency services. In order to
this guide does not appear in another ASTM standard, the
provide the most informed care, EMS care providers and
guide will use the definition specified for Federal health
persons providing EMS medical direction need to be aware of
the injured or ill person’s health status.
1.4 This guide describes the minimum requirements for
A number of projects are in process to develop such information systems. One
compiling, updating, computerizing, and storing individual’s Ref (1)1 is the Trauma Care Information Management System project funded under
the Defense Technology Transfer Program that addresses health status data for both
longitudinal health status data in authorized repositories, so as
prehospital and hospital emergency medical care. Another companion development
to protect patient privacy and confidentiality. This guide also
project (2)2, also funded under the Defense Technology Transfer Program, is the
describes requirements for providing authorized access and
Development of Interoperability Platforms for the National Health Information
System. In addition, in 1994 alone, the National Institute for Standards and
rapid transmittal of the data to attending EMS care providers in
Technology awarded sixteen cooperative agreements totaling over $100M for
medical emergencies.
applied research in related medical informatics (3)3. It is expected that scheduled
1.5 While this guide addresses data needed for prehospital
completion of these projects in three to five years will produce medical informatics
EMS, there is also a recognized essential, but largely unmet products and processes that will enter competition in the next decade for adoption
for national healthcare use.
need for similar patient health status records for emergency
Each of these major development projects will impact on the evolution of
medical care of patients in hospital emergency departments and
computerized patient health status information data bases for prehospital and
in definitive medical care facilities. Many development
hospital emergency medical care.
It is planned that testing and evaluation of the results of these projects will lead
to the development of standards for such hospital information systems. Such
standards will in turn be harmonized with the standards now used and being
This guide is under the jurisdiction of ASTM Committee F-30 on Emergency
developed regarding information preparatory to patient hospital admission for
Medical Services and is the direct responsibility of Subcommittee F30.03 on
non-emergent medical care. (See Specification E 1238, Guide E 1239, Guide
Organization/Management.
E 1384, Specification E 1633, and Guides E 1744 and F 1629.)
Current edition approved Oct. 10, 1995. Published December 1995.
Copyright © ASTM, 100 Barr Harbor Drive, West Conshohocken, PA 19428-2959, United States.
F 1652
services information systems (4, 5). accessing, and transmitting data for an individual’s uniform
health status record so as to enable pre-hospital EMS providers
2. Referenced Documents
to rapidly access the data for improved assessment and
2.1 ASTM Standards:
appropriate treatment of an individual experiencing a medical
E 1238 Specification for Transferring Clinical Laboratory emergency.
Data Messages Between Independent Computer Systems
5.2 Lack of health status information on an individual’s
E 1239 Guide for Description of Reservation/Registration/
preexisting medical conditions, such as data on allergies,
Admission Discharge, Transfer (R-ADT) Systems for Au-
diseases, medications being used, previous medical care, and
tomated Patient Care Information Systems
so forth, may result in application of standard prehospital
E 1384 Guide for Description of Content and Structure of
medical treatments that may be contraindicated and sometimes
an Automated Primary Record of Care
fatally incorrect.
E 1633 Specification for Coded Values in the Primary
5.3 At present, most people do not carry their health status
Record of Care
data on their person. An individual’s health status data may be
E 1744 Guide for a View of Emergency Medical Care in the
distributed at various locations such as in hospital records, in
Computerized Patient Record
physicians’ files in various formats including hand-written
F 1629 Guide for Establishing and/or Operating Emergency
paper forms. Some organizations, such as health maintenance
Medical Services Management Information Systems
organizations, schools, camps, and sports groups, attempt to
maintain specific sets of health status data. Retrieval and
3. Terminology
transfer of selected information needed in emergencies from
3.1 Definition:
such records is usually slow and incomplete.
3.1.1 health status information services (HSIS)—a generic,
5.4 Currently, when a person suffers a medical emergency,
non-proprietary term that describes the functional elements
pre-hospital EMS providers must rely on word-of-mouth
(data, resources, procedures, and processes) that constitute an
information from the patient or from on-scene relatives or
information system designed, developed, and operated to
friends, for health status data that may be critical to selection
provide individual health status data for subscribers in accor-
and outcome of appropriate pre-hospital treatment. Often such
dance with this guide.
data are not available because the patient is unconscious,
otherwise unresponsive, or unaccompanied.
4. Summary of Guide
5.5 Increasingly, individuals with serious allergies, disease,
4.1 This guide describes the standard functional elements
or other health problems are being advised by their doctors to
that should exist to provide HSIS, namely:
obtain and wear a tag (a durable bracelet or necklace) contain-
4.1.1 An inventory of data elements that should be ad-
ing selected health status information so as to help ensure that
dressed in compiling individual health status records.
in the case of a medical emergency, prehospital EMS providers
4.1.2 Uniform data element definitions for health status
will be alerted to preexisting conditions. Such tags may also
data. (See Guide F 1629 and Refs (4, 5, and 6).)
contain the wearer’s name, address, and phone number for
4.1.3 Guidance for encoding of HSIS computerized data.
identification purposes; and may indicate the presence on the
(See Specifications E 1238 and E 1633.)
wearer of a personal medical information card with further
4.1.4 A computerized HSIS data base of the health status
health status data as well as the name and telephone number of
records of individuals who subscribe to a HSIS service.
the wearer’s doctor or health care organization, or both. This
4.1.5 A template and uniform format for on-site display or
tag may also indicate the telephone number for accessing
print out of an individual’s health status data, for use by a
additional health status data for the wearer. Thus, this guide can
prehospital EMS provider who has been authorized to access
be used by providers of such health status tags, to give their
the record. (See Guide E 1744 and Ref (6).)
subscribers added safeguards from prehospital and hospital
4.1.6 A confidential HSIS access password (or number) that
medical misadventure.
can be made available by an individual or an authorized
5.6 Use of this guide will lead to improved access by
surrogate to an on-scene EMS provider or to an off-scene
prehospital EMS providers to health status data needed to
medical director to authorize access to an individual’s health
better assess a persons conditions and select the appropriate
status record for a particular emergency medical episode. (See
treatments while avoiding treatments that may be contraindi-
Guide E 1744.)
cated because of the individual’s preexisting health status.
4.1.7 Provisions for updating and correcting an individual’s
Information needed by a prehospital EMS provider to access
health status record and for “refreshing” the individuals con-
this health status data may be provided by word of mouth by
fidential HSIS access password (or number) after each use.
the person, through information provided on a health status tag
5. Significance and Use
worn by the person, on a patient’s wallet card, or by interro-
gation of HSIS providers by means of the EMS communica-
5.1 This is a guide for recording, computerizing, storing,
tions system. (See 5.10.)
5.7 The lack of mobile communications and computer
The boldface numbers given in parentheses refers to a list of references at the
technology in ambulances, in some EMS systems, may make it
end of the text.
impossible for prehospital emergency medical care providers
Annual Book of ASTM Standards, Vol 14.01.
Annual Book of ASTM Standards, Vol 13.01. to directly access the injured or ill person’s health status
F 1652
records described in this guide. In such cases, the desired 6.1.2.5 Date (of physician’s certification),
health status record may be accessed by the medical facility
6.1.2.6 Date (of last professional medical record from which
providing prehospital medical direction by means of wire-line
data is included), and
computer modem connection, and used as a basis for providing
6.1.2.7 Signature (physician’s).
improved on-line medical direction, particularly in instances of
6.1.3 Individual Identification—The health status record
life threatening medical emergencies.
should include the following data that identify the individual
5.8 In addition to the primary use for EMS, existing HSIS
and relates him/her to a particular record.
are being adapted to other applications that reduce duplication
6.1.3.1 Individual’s Record Number—This number is used
of effort, help underwrite the costs of HSIS, and promote
by the HSIS provider for filing/locating the individual’s record:
updating and accuracy of individuals’ health status data.
6.1.3.2 Name,
5.8.1 For youth, HSIS record data may also serve as “ever
6.1.3.3 Address,
green” immunization records, and as the health status data
6.1.3.4 Date of birth,
format for qualification for participation in school sports
6.1.3.5 Telephone number (home),
programs, extra school athletic activities, and for other youth
6.1.3.6 Telephone number (work),
programs where health status registration is required.
6.1.3.7 Social security number,
5.8.2 Organizations should meet these minimum require-
6.1.3.8 Religion,
ments for a preexisting inventory and history form.
6.1.3.9 Medical insurance carrier name (primary),
5.8.3 Adaptations of HSIS for applications other than EMS
6.1.3.10 Medical insurance policy number (primary),
require development of appropriate data templates based on the
6.1.3.11 Medical insurance carrier name (secondary),
needs of the HSIS users, the HSIS providers, and the informed
6.1.3.12 Medical insurance carrier number (secondary),
prior consent of HSIS subscribers to the release of specific data
6.1.3.13 Name of designated primary contact (for minors,
to the HSIS users for specific predefined applications.
usually a parent or guardian; for adult usually the spouse or
5.9 It is significant that different versions of HSIS are
other close associate),
currently being marketed by companies interested in becoming
6.1.3.14 Telephone numbers of primary contact,
HSIS providers. It is important that national voluntary consen-
sus standards exist so as to help ensure that competitive HSIS 6.1.3.15 Names of personal physicians (include all licensed
professionals or providers such as psychiatrists, dentists, orth-
meet minimum requirements as set forth in this guide.
5.10 Prehospital EMS providers and persons responsible for odontists, and so forth),
providing prehospital emergency me
...
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