ASTM F1339-92(1998)
(Guide)Standard Guide for Organization and Operation of Emergency Medical Services Systems
Standard Guide for Organization and Operation of Emergency Medical Services Systems
SCOPE
1.1 This standard established guidelines for the organization and operation of Emergency Medical Services Systems (EMSS) at the state, regional and local levels. This guide will identify methods of developing state standards, coordinating/managing regional EMS Systems, and delivering emergency medical services through the local EMS System.
1.1.1 At the state level this guide identifies scope, methods, procedures and participants in the following state structure responsibilities: a) establishment of EMS legislation; b) development of minimum standards; c) enforcement of minimum standards; d) designation of substate structure; e) provision of technical assistance; f) identification of funding and other resources for the development, maintenance, and enhancement of EMS systems; g) development and implementation of training systems; h) development and implementation of communication systems; i) development and implementation of record-keeping and evaluation systems; j) development and implementation of public information, public education, and public relations programs; k) development and implementation of acute care center designation; 1) development and implementation of a disaster medical system; m) overall coordination of EMS and related programs within the state and in concert with other states or federal authorities.
1.2 At the regional level, this guide identifies methods of planning, implementing, coordinating/managing, and evaluating the emergency medical services system which exists within a natural catchment area and provides guidance on the use of these methods.
1.3 At the local level, this guide identifies a basic structure for the organization and management of a local EMS system and outlines the responsibilities that a local EMS should assume in the planning, development, implementation and evaluation of its EMS system.
General Information
Relations
Standards Content (Sample)
NOTICE: This standard has either been superceded and replaced by a new version or discontinued.
Contact ASTM International (www.astm.org) for the latest information.
Designation: F 1339 – 92 (Reapproved 1998)
Standard Guide for
Organization and Operation of Emergency Medical Services
Systems
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 gency Medical Services Organizations
F 1149 Practice for Qualifications, Responsibilities, and
1.1 This standard established guidelines for the organization
Authority for Individuals and Institutions Providing Medi-
and operation of Emergency Medical Services Systems
cal Direction of Emergency Medical Services
(EMSS) at the state, regional and local levels. This guide will
F 1220 Guide for Emergency Medical Services System
identify methods of developing state standards, coordinating/
(EMSS) Telecommunications
managing regional EMS Systems, and delivering emergency
F 1268 Guide for Establishing and Operating Public Infor-
medical services through the local EMS System.
mation, Education and Relations Programs for Emergency
1.1.1 At the state level this guide identifies scope, methods,
Medical Services Systems
procedures and participants in the following state structure
F 1285 Guide for Training the Emergency Medical Techni-
responsibilities: a) establishment of EMS legislation; b) devel-
cian (Basic) to Perform Patient Examination Techniques
opment of minimum standards; c) enforcement of minimum
2.2 American Ambulance Association
standards; d) designation of substate structure; e) provision of
Standards and Accreditation Document
technical assistance; f) identification of funding and other
resources for the development, maintenance, and enhancement
3. Significance and Use
of EMS systems; g) development and implementation of
3.1 This guide suggests methods for organizing and operat-
training systems; h) development and implementation of com-
ing state, regional, and local EMS systems, in accordance with
munication systems; i) development and implementation of
Guide F 1086. It will assist state, regional, or local organiza-
record-keeping and evaluation systems; j) development and
tions in assessing, planning, documenting, and implementing
implementation of public information, public education, and
their specific operations. The guide is general in nature and
public relations programs; k) development and implementation
able to be adapted for existing EMS Systems. For organiza-
of acute care center designation; 1) development and imple-
tions that are establishing EMS System operations, the guide is
mentation of a disaster medical system; m) overall coordina-
specific enough to form the basis of the operational manual.
tion of EMS and related programs within the state and in
concert with other states or federal authorities.
4. State Guide
1.2 At the regional level, this guide identifies methods of
4.1 Establishment of EMS Legislation:
planning, implementing, coordinating/managing, and evaluat-
4.1.1 Methods and Procedures—The legislative process
ing the emergency medical services system which exists within
varies from state to state. The EMS lead agency should seek a
a natural catchment area and provides guidance on the use of
description of the process in its state from:
these methods.
4.1.1.1 The legislature’s staff or clerk offices.
1.3 At the local level, this guide identifies a basic structure
4.1.1.2 The legislative liaison, or other appropriate staff of
for the organization and management of a local EMS system
the governmental unit housing EMS (its “umbrella”).
and outlines the responsibilities that a local EMS should
4.1.1.3 The legal counsel assigned to EMS.
assume in the planning, development, implementation and
4.1.2 Legislative proposals are commonly subject to the
evaluation of its EMS system.
following processes:
4.1.2.1 Drafting—The standard-setting or other goal is put
2. Referenced Documents
into general form by the agency, citing the sections of statute it
2.1 ASTM Standards:
believes are affected. The entities listed in 4.1.1-4.1.1.3 may be
F 1086 Guide for Structures and Responsibilities of Emer-
a resource, or may be required to be involved, in this proposal
development.
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. Annual Book of ASTM Standards, Vol 13.02.
Current edition approved March 15, 1992. Published July 1992. Available from the American Ambulance Association.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.
NOTICE: This standard has either been superceded and replaced by a new version or discontinued.
Contact ASTM International (www.astm.org) for the latest information.
F 1339 – 92 (1998)
TABLE 1
A
State Regional 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.
4.1.2.2 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) A. Umbrella unit legislative liaison,
official part of the administration’s legislative initiative. (b) B. Assistant attorney general assigned to EMS,
Whether this is true or not, the umbrella’s legislative liaison
(c) C. Legislators/aides to legislators,
will generally seek the sponsorship of appropriate legislators
(d) D. Staff/legal counsel to committee likely to consider
for the bill unless the bill is opposed by the administration.
bill, and
Sponsorship might be sought directly by the agency or by third
(e) 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) A. Umbrella unit commissioner/head (cabinet level),
the legislature in the umbrella unit and/or legislative counsels
(b) B. Other agency heads with any potential interest,
offices. It is then read in the legislature and generally referred
(c) C. State EMS and other advisory boards with potential
to a committee.
interest,
4.1.2.4 Committee Consideration—The committee usually
(d) D. REMSO staffs and advisory councils, and
holds a public hearing at which the agency and others may
(e) E. EMS, fire, physician, nurse and other organized,
testify in favor of or against the bill, or neutrally. In subse-
active 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) A. Legislature staff/clerk offices and their publications
lobbyist attendance at work sessions is common and often
(for example, hearing notices) and hotline,
influential.
(b) B. Committee members and their aides,
4.1.2.5 Adoption/Rejection—Bills voted out to the legisla-
(c) C. Committee staffers and legal counsels, and
ture by committee, favorably or otherwise, are then read and
(d) 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) A. Those listed in 4.1.4.1, A to E, (sponsoring), 4.1.4.2,
signed, not signed (but not vetoed), or vetoed by the governor.
A 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) B. Hospital/prehospital personnel, and
attempt to override the veto. Bills that are not vetoed generally
(c) 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) A. Umbrella unit commissioner/head (cabinet level),
4.1.3 The timing of legislative proposal submissions, and
(b) B. Aides to Governor (if known and appropriate), and
the tracking of their progress to assure agency input are critical
(c) C. Legislators and aides with links to Governor.
to their success. Hearing announcements and progress reports
generated by the legislature or umbrella unit legislative liaison 4.2 Development of Minimum Standards:
are useful. A legislative“ hotline” is also commonly available 4.2.1 Methods and Procedures—A variety of standard-
and of use in tracking bills but personal contact with legislative setting mechanisms exist, from that which is formal and
aides and/or committee staff and legal counsels are even more explicitly housed in the state’s laws to that which is the least
useful. formal, for instance, the non-binding opinion of EMS staff
4.1.4 Participants in the EMS Legislative Process: which is standard-setting to the extent of the dissemination and
NOTICE: This standard has either been superceded and replaced by a new version or discontinued.
Contact ASTM International (www.astm.org) for the latest information.
F 1339 – 92 (1998)
“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
(for example, “Treatment shall be in accord with protocols
4.2.1.1 Origins of Standards—State standards should be
established by the medical director of the state (or regional)
derived from the ASTM process. When this process has not
EMS agency”). Protocol-development may require a
provided a standard in a needed area, standards set by the
consensus-building process among the state’s medical advisory
National Association of State EMS Directors and/or, second-
committee, regional medical directors and others.
arily, by other EMS-related professional associations should be
4.2.2.6 Contracts and/or Letters of Agreement—Generally
used as a foundation.
in return for funding or other resources, regional and local
4.2.1.2 When utilizing standards documents generated by
structures and providers may agree to certain standards of
other than the ASTM process, these should be critically
performance. For example, state funding of training courses or
reviewed by experts from a range of EMS-related clinical,
ambulance equipment items may be afforded with agreement
administrative, training, planning, regulatory and other disci-
on standards for course content or equipment use. States
plines. In these cases, this process should assure that all
generally have a standard process and forms for contracts and
interested parties have an opportunity to comment. Federal
grants. Consult the purchasing and/or contracts office or legal
standards, in law and otherwise, may exist in certain areas of
counsel assigned to EMS.
EMS which may affect a state’s future receipt of federal funds;
4.2.3 Participants in the Development of Minimum Stan-
these should be reviewed for consistency with planned stan-
dards:
dards.
4.2.3.1 By Legislation— See 4.1.
4.2.2 Specific Methods and Procedures:
4.2.3.2 By Rules/Regulations:
4.2.2.1 Legislation— Used for setting broad, legally-
(a) A. Agency staff (drafting),
binding standards. Sets the responsibilities of the state, re-
(b) B. Legal counsel assigned to EMS (review),
gional, and local EMS structures; defines areas of rule or
(c) C. REMSO staffs/advisory councils/committees (re-
regulation-making authority, and sets general minimum stan-
view),
dards for the system as a whole. See 4.1.
(d) D. State advisory council/committees (review),
4.2.2.2 Rules/Regulations—Used to set more specific stan-
(e) E. State EMS-related professional associations (re-
dards for system design and operation including, but not
view),
limited to, the interaction of state, regional, and local EMS
(f) F. Impartial legal counsel (approval),
structures in provider operation (for example, licensure, train-
(g) G. Secretary of state (records/announces proposals,
ing course approval); requirements for and terms of operation
certifies adopted rules),
(usually through licensure or certification) for EMS personnel,
(h) H. Legislature (subject to review),
vehicles, equipment and services; organization of EMS train-
(i) I. Umbrella unit staff and head (review/approval unless
ing for certification or licensure; organization of certification or
EMS agency has own rule-making authority), and
licensure testing; scope of practice; causes and procedures for
(j) J. Providers/general public.
disciplinary actions. This process is governed by the adminis-
4.2.3.3 By Executive Order:
trative procedures act (“APA”) of the state and generally
(a) A. Agency staff (drafting),
requires the EMS rule-making authority to publish notices and
(b) B. Legal counsel assigned to EMS (review),
hold hearings on proposed changes. Consult the state’s APA
(c) C. Umbrella unit head/commissioner (cabinet level),
and discuss with the legal counsel assigned to EMS.
(d) D. Governor; governor’s staff,
4.2.2.3 Executive Order— The Governor may be empow-
(e) E. State advisory council/committees,
ered to take actions which have a standard-setting impact.
(f) F. Consider those listed in 4.2.3.2 for review.
Consult the legal counsel assigned to EMS or the Governor’s
4.2.3.4 By Policies/Procedures:
staff.
(a) A. Agency staff (drafting and review),
4.2.2.4 Policies/Procedures—Used by the state agency to
(b) B. REMSO staff (review), and
govern the details of its operations and interactions with
(c
...
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