ASTM F1517-94
(Guide)Standard Guide for Scope of Performance of Emergency Medical Services Ambulance Operations
Standard Guide for Scope of Performance of Emergency Medical Services Ambulance Operations
SCOPE
1.1 This guide covers minimum standards for the performance of emergency medical services (EMS) ambulance operators, including: operator qualifications, pre-run operation, and post-run aspects.
1.2 This guide shall promote the safe and efficient delivery of the ambulance, equipment, crew, passengers and patients, during all phases of the delivery of EMS involving the ambulance; at all times exercising the highest degree of care for the safety of the public. This guide may be applied to other EMS vehicles that do not necessarily provide patient transport.
1.3 This guide shall be used as the basis for training guides of the emergency medical services ambulance operator.
1.4 The values stated in SI units are to be regarded as the standard. The SI units given in parentheses are for information only.
1.5 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.
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Designation: F 1517 – 94
Standard Guide for
Scope of Performance of Emergency Medical Services
Ambulance Operations
This standard is issued under the fixed designation F 1517; 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 3.2 Definitions of Terms Specific to This Standard:
3.2.1 ambulance operations—the efficient delivery of the
1.1 This guide covers minimum standards for the perfor-
ambulance, equipment, crew, passengers and patients, during
mance of emergency medical services (EMS) ambulance
all phases of the delivery of EMS involving the ambulance at
operators, including: operator qualifications, pre-run operation,
all times exercising the highest degree of care for the safety of
and post-run aspects.
the public.
1.2 This guide shall promote the safe and efficient delivery
3.2.2 ambulance service provider—as outlined in this guide,
of the ambulance, equipment, crew, passengers and patients,
a person, company, corporation or political entity responsible
during all phases of the delivery of EMS involving the
for operation, maintenance, or policy making, or combination
ambulance; at all times exercising the highest degree of care
thereof, regarding emergency medical vehicle operations.
for the safety of the public. This guide may be applied to other
3.2.3 bona fide occupational qualification (BFOQ)—the
EMS vehicles that do not necessarily provide patient transport.
skills and knowledge relevant to the performance of a specific
1.3 This guide shall be used as the basis for training guides
task.
of the emergency medical services ambulance operator.
3.2.4 departure check—the visual check of the vehicle and
1.4 The values stated in SI units are to be regarded as the
surrounding area ensuring that equipment and supplies have
standard. The SI units given in parentheses are for information
been retrieved and properly stored and that all compartment
only.
doors are secured.
1.5 This standard does not purport to address all of the
3.2.5 egress check—the visual check of the vehicle and
safety concerns, if any, associated with its use. It is the
surrounding area prior to operating the ambulance.
responsibility of the user of this standard to establish appro-
3.2.6 emergency mode—as defined by individual state stat-
priate safety and health practices and determine the applica-
ues that refer to emergency vehicles, equipment, and opera-
bility of regulatory limitations prior to use.
tions.
2. Referenced Documents 3.2.7 full check—a comprehensive and systematic evalua-
tion of the ambulance at specified intervals, including docu-
2.1 ASTM Standards:
mentation of the inspection, any deficiencies found and their
F 1031 Practice for Training the Emergency Medical Tech-
corrective actions.
nician (Basic)
3.2.8 operator—a person who operates or assists with the
F 1177 Terminology Relating to Emergency Medical Ser-
operation of an ambulance.
vices
3.2.9 post-run—the managed return of the ambulance and
F 1230 Specification for Minimum Performance Require-
operators to optimal pre-run readiness.
ments for Emergency Medical Service (EMS) Ground
3.2.10 pre-run—all aspects of assuring response readiness.
Vehicles
3.2.11 quick check—an abbreviated version of the full
F 1258 Practice for Emergency Medical Dispatch
check, focusing on the major operational functions of the
3. Terminology
vehicle.
3.1 Definitions:
4. Significance and Use
3.1.1 The definitions given in Terminology F 1177 are
4.1 This guide provides minimum guidelines for safe and
applicable to this guide.
efficient ambulance operation.
3.1.2 ambulance—See Terminology F 1177.
4.2 All ambulance operations and operators should follow
this guide for the development of educational and training
programs.
This guide is under the jurisdiction of ASTM Committee F-30 on Emergency
Medical Services and is the direct responsibility of Subcommittee F30.02 on
4.3 This guide is intended to promote safe and efficient
Personnel, Training, and Education.
ambulance operations and to reduce morbidity, mortality, and
Current edition approved May 15, 1994. Published July 1994.
property loss associated with ambulance operations.
Annual Book of ASTM Standards, Vol 13.01.
Copyright © ASTM, 100 Barr Harbor Drive, West Conshohocken, PA 19428-2959, United States.
F 1517
4.4 This guide is intended to assist those who are respon- 6.3.4 Moving violations.
sible for the development and implementation of policies and 6.4 A review of motor vehicle accidents for the previous
procedures for ambulance operations. five years.
6.5 The operator shall possess a valid motor vehicle opera-
5. Medical Fitness to Drive
tors license, and any other certification required by state or
5.1 Because of the complex relationship of certain medical
local laws or regulations.
and mental impairments, a medical screening program shall be
7. Pre-Run
established by all EMS entities bestowing the privilege of
ambulance driving.
7.1 The operator shall have knowledge of and shall comply
5.2 The authorization of ambulance drivers must always be with all applicable federal, state statues, local ordinances, and
based on bona fide occupational qualifications (BFOQ) pursu-
regulations.
ant to the task of ambulance operation. The following consid- 7.2 The operator shall have knowledge of the provider’s
erations must be evaluated:
policies and procedures.
5.2.1 A medical exam of the applicant by a licensed M.D. or 7.3 The operator shall have knowledge of roads, highways,
D.O. attesting that the history and physical reveals no evidence
and the locations of and accesses to major public facilities
of any medical or physical condition which would prove within the service area.
detrimental to operating an ambulance.
7.4 The provider shall have a process by which the operator
5.2.2 Eye exam by a licensed ophthalmologist/optometrist is made aware of conditions that may affect traffic flow within
to include:
the service area (street closures, construction, special
5.2.2.1 Visual acuity, events . ).
5.2.2.2 Depth perception, 7.5 The provider shall have a process by which the operator
5.2.2.3 Peripheral vision, is made aware of present or forecasted environmental condi-
5.2.2.4 Night blindness, tions affecting traffic flow within the service area (ice, snow,
5.2.2.5 Color blindness, and rain . ).
5.2.2.6 Amblyopia. 7.6 Upon unit availability, the operator shall visually inspect
5.2.3 An examination of the medical history of the indi- the ambulance, and document the inspection in accordance
vidual, designed to identify drivers who may be impaired by: with one of the methods as shown in Table 1. The vehicle shall
5.2.3.1 Loss of consciousness,
be inspected for the following:
5.2.3.2 Cardiovascular disease, 7.6.1 Apparent body or glass damage,
5.2.3.3 Neurological/neurovascular disorder,
7.6.2 Proper function of emergency lights:
5.2.3.4 Mental illness, 7.6.2.1 Beacons or strobe,
5.2.3.5 Substance abuse/dependency,
7.6.2.2 Light bar,
5.2.3.6 Insulin-dependent diabetes, and 7.6.2.3 Tunnel lights/flashers, and
5.2.3.7 Rheumatic, arthritic, orthopedic, muscular, neuro-
7.6.2.4 Other warning lights.
muscular, or vascular disease that interferes with the ability to 7.6.3 Vehicle operating lights:
control and operate a motor vehicle safely.
7.6.3.1 Headlights (high/low),
5.2.4 The presence of a medical condition by itself may not 7.6.3.2 Emergency flashers,
constitute an impaired operator, but shall identify an area for
7.6.3.3 Parking/running lights,
consideration by the physician in making a determination of 7.6.3.4 Interior and exterior turn signal,
the medical fitness to operating an ambulance. 7.6.3.5 Brake lights,
7.6.3.6 Back up lights,
6. Qualifications to Drive
7.6.3.7 Flood or scene lights,
6.1 Authorization shall be based upon cognitive evaluation
7.6.3.8 Dome lights: cab and patient compartment, and
of the operator regarding laws, guidelines, and policies relating
7.6.3.9 Spotlights.
to ambulance operation during emergency and non-emergency
7.6.4 Damage, wear, and pressure in tires,
modes.
7.6.5 Damage, loose, or missing lugs on wheels,
6.1.1 The provider shall have a policy that addresses opera-
7.6.6 Proper opening, closing, locking, and seals of entry
tor fatigue.
and compartment doors,
6.2 An ambulance driving evaluation by the provider cov-
7.6.7 Fluid levels:
ering warning device operation, passing, intersection approach
7.6.7.1 Automatic transmission,
precautions, turning, backing, and parking techniques during
emergency and non-emergency modes.
TABLE 1 Emergency Medical Services Ambulance Maintenance
6.3 A review of the state motor vehicle record for the Guidelines for Checklist Completion
previous three years with specific attention to traffic convic-
Runs per Week Full Check, h Quick Check, h
tions concerning:
0 to 1 every 96 every 24
6.3.1 Speed, 2 to 3 every 72 every 24
4 to 7 every 48 every 24
6.3.2 Careless and imprudent driving,
8 to 50 every 24 every 12
6.3.3 Driving under the influence of alcohol or other mind-
50 + every 24 every 8
altering substances, and
F 1517
7.6.7.2 Battery, 7.7.7.3 Vehicle exterior, and
7.6.7.3 Brakes, 7.7.7.4 Vehicle interior.
7.7.8 Proper function of horn and each siren position,
7.6.7.4 Engine oil,
7.6.7.5 Engine coolant, 7.7.9 Vehicle cleanliness, and
7.7.10 Proper function of two-way radio and other commu-
7.6.7.6 Power steering, and
nications equipment.
7.6.7.7 Windshield washer.
7.6.8 Fluid leakage on, around, or under the vehicle,
8. Operations
7.6.9 Wear, abrasion, rigidity or sponginess of radiator, fuel,
8.1 Response Mode Management:
heater, and other hoses,
8.1.1 The response mode of the ambulance shall be deter-
7.6.10 Wear, abraded, or cracked engine drive or accessory
mined by dispatch protocol based on dispatch determinants as
belts,
approved by the medical director. These determinants shall be
7.6.11 Cleanliness of exterior, crew cab, and patient com-
consistent with Practice F 1258.
partments,
8.2 The operator shall, on the basis of known information,
7.6.12 Wear, abrasion, and proper function of operator,
determine the best route to the scene and end destination.
passenger, and patient restraint,
8.3 Before beginning the response, the operator shall con-
7.6.13 Indications and function of gages:
duct a brief egress check consisting of the following:
7.6.13.1 Electrical charging system,
8.3.1 Vehicle doors are securely closed and latched,
7.6.13.2 Emergency brake,
8.3.2 Vehicle hood is closed and securely latched,
7.6.13.3 Fuel,
8.3.3 Vehicle shore line is disconnected,
7.6.13.4 Oil pressure,
8.3.4 All equipment is secured,
7.6.13.5 Tachometer, and
8.3.5 Egress door is open, and
7.6.13.6 Temperature.
8.3.6 Patient stretcher is in place and secured.
7.6.14 Wear, abrasion, and proper function of windshield
8.4 Operational Check Sequence:
wipers,
8.4.1 Ensure crew is on board and properly restrained,
7.6.15 Proper function and aim of windshield washer,
8.4.2 Adjust the operator’s seat,
7.6.16 Proper function and clarity of two-way radio and
8.4.3 Adjust mirrors,
other communication devices,
8.4.4 Turn on battery(s),
7.6.17 Damage, stability, and adjustment of outside and
8.4.5 Start the engine,
inside mirrors,
8.4.6 Review all gages,
7.6.18 Proper function and clarity of emergency siren,
8.4.7 Adjust environmental controls consistent with appli-
public address, and other warning devices,
cable needs,
7.6.19 Proper adjustment of all seats,
8.4.8 Turn radio on and contact dispatch,
7.6.20 Proper adjustment and function of steering wheel,
8.4.9 Adjust the tilt wheel,
7.6.21 Charged and properly stored fire extinguishers,
8.4.10 Turn the headlights on,
7.6.22 Proper function of heating and air conditioning
8.4.11 Activate the emergency warning lights (if appli-
systems,
cable),
7.6.23 Proper inventory and condition of medical equip-
8.4.12 Turn on power to siren/public address control system
ment and supplies, and
(if applicable),
7.6.24 Level and alignment of chassis.
8.4.13 Partially open the driver side window,
7.7 The quick check shall be constituted by:
8.4.14 Evaluate brake pedal resistance,
7.7.1 Visually checking for any fluid leakage on or around
8.4.15 Place the vehicle in gear,
the ambulance,
8.4.16 Activate the siren (if applicable), and
7.7.2 Conducting vehicle warmup,
8.4.17 Activate the turn signal (if applicable).
7.7.3 Checking fluid levels:
8.5 Crew Roles—The operator/crew member is responsible
7.7.3.1 Fuel,
for:
7.7.3.2 Engine oil,
8.5.1 Operating the ambulance in a safe and efficient man-
7.7.3.3 Power steering,
ner, exercising the highest degree of care,
7.7.3.4 Water/coolant level,
8.5.2 Safely passing other vehicles,
7.7.3.5 Brake fluid,
8.5.3 Utilizing eye sweep,
7.7.3.6 Transmission fluid,
8.5.4 Maintaininga3to4-s following distance, and
7.7.3.7 Windshield washer fluid, and
8.5.5 Maintaining the vehicle at a speed that is safe for
7.7.3.8 Battery water level.
conditions.
7.7.4 Wear and tension of belts,
8.5.5.1 Under emergency response conditions the speed
7.7.5 Wear and pressure of tires,
shall not exceed that which is safe for road or environmental
7.7.6 Emergency lights,
conditions; in no case shall the speed exceed ten miles per hour
7.7.7 Function of lighting systems: over the posted speed limit.
7.7.7.1 Emergency lights,
8.5.5.2 Under non-emergency operations the operator shall
7.7.7.2 Running lights, comply with all local and state traffic laws.
F 1517
8.5.6 Controlling the operation of the appropriate audible operator must complete the previous steps of clearing each lane
warning device for the current traffic conditions. of traffic prior to crossing that lane.
8.5.7 Utilizing the vehicle communication system, 8.6.8 The operator should anticipate that any vacant lane to
8.5.8 Applying policies and procedures in the driving of the his left or right may become occupied by another vehicle which
ambulance, did not see or hear the ambulance’s warning systems.
8.5.9 Initiating a constant rate of acceleration, 8.6.9 The operator should be aware that other emergency
vehicles may be approaching the same intersection that the
8.5.10 Using engine compression in stopping of the ambu-
lance, operator has taken control of and the ambulance should not
enter the intersection until the other vehicles have stopped or
8.5.11 Maintaining smooth braking and cornering of the
proceeded through the intersection.
ambulance,
8.5.12 Assuring adequate stopping distance in traffic, 8.6.10 The operator should
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