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ASTM F1149-93(1998)

(Practice)

Standard Practice for Qualifications, Responsibilities, and Authority of Individuals and Institutions Providing Medical Direction of Emergency Medical Services

Standard Practice for Qualifications, Responsibilities, and Authority of Individuals and Institutions Providing Medical Direction of Emergency Medical Services

SCOPE
1.1 This practice covers the qualifications, responsibilities, and authority of individuals and institutions providing medical direction of emergency medical services.
1.2 This practice addresses the qualifications, authority, and responsibility of a Medical Director (off-line) and the relationship of the EMS (Emergency Medical Services) provider to this individual.
1.3 This practice also addresses components of on-line medical direction (direct medical control) including the qualifications and responsibilities of on-line medical physicians and the relationship of the prehospital provider to on-line medical direction.
1.4 This practice addresses the relationship of the on-line medical physician to the off-line Medical Director.
1.5 The authority for control of medical services at the scene of a medical emergency is addressed in this practice.
1.6 The requirements for a Communication Resource are also addressed within this practice.

General Information

Status
Historical
Publication Date
09-Nov-1998
ICS
11.160 - First aid
Technical Committee
F30 - Emergency Medical Services
Drafting Committee
F30.03 - Organization/Management
Current Stage
Ref Project

Relations

Replaced By
ASTM F1149-93(2003) - Standard Practice for Qualifications, Responsibilities, and Authority of Individuals and Institutions Providing Medical Direction of Emergency Medical Services
Effective Date
10-Sep-2003
Referred By
ASTM F1220-95(2022) - Standard Guide for Emergency Medical Services System (EMSS) Telecommunications
Effective Date
10-Nov-1998
Referred By
ASTM F2318-15 - Standard Specification for Rotary Wing Basic Life Support, Advanced Life Support, and Specialized Medical Support Air Ambulances (Withdrawn 2024)
Effective Date
10-Nov-1998
Referred By
ASTM F1339-92(2016) - Standard Guide for Organization and Operation of Emergency Medical Services Systems
Effective Date
10-Nov-1998

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ASTM F1149-93(1998) - Standard Practice for Qualifications, Responsibilities, and Authority of Individuals and Institutions Providing Medical Direction of Emergency Medical ServicesASTM F1149-93(1998) - Standard Practice for Qualifications, Responsibilities, and Authority of Individuals and Institutions Providing Medical Direction of Emergency Medical Services
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ASTM F1149-93(1998) - Standard Practice for Qualifications, Responsibilities, and Authority of Individuals and Institutions Providing Medical Direction of Emergency Medical Services
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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 1149 – 93 (Reapproved 1998)
Standard Practice for
Qualifications, Responsibilities, and Authority of Individuals
and Institutions Providing Medical Direction of Emergency
Medical Services
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
practice medicine; prehospital providers must act only under
1.1 This practice covers the qualifications, responsibilities,
the medical direction of a physician.
and authority of individuals and institutions providing medical
3.4 direct medical control—when a physician or authorized
direction of emergency medical services.
communication resource personnel, under the direction of a
1.2 This practice addresses the qualifications, authority, and
physician, provides immediate medical direction to prehospital
responsibility of a Medical Director (off-line) and the relation-
providers in remote locations. (Also known as on-line medical
ship of the EMS (Emergency Medical Services) provider to
direction.)
this individual.
3.5 emergency medical services system (EMSS)—all com-
1.3 This practice also addresses components of on-line
ponents needed to provide comprehensive prehospital and
medical direction (direct medical control) including the quali-
hospital emergency care including, but not limited to; Medical
fications and responsibilities of on-line medical physicians and
Director, transport vehicles, trained personnel, access and
the relationship of the prehospital provider to on-line medical
dispatch, communications, and receiving medical facilities.
direction.
3.6 intervener physicians—a licensed M.D. or D.O., having
1.4 This practice addresses the relationship of the on-line
not previously established a doctor/patient relationship with the
medical physician to the off-line Medical Director.
emergency patient and willing to accept responsibility for a
1.5 The authority for control of medical services at the
medical emergency scene, and can provide proof of a current
scene of a medical emergency is addressed in this practice.
Medical License.
1.6 The requirements for a Communication Resource are
3.7 medical direction—when a physician is identified to
also addressed within this practice.
develop, implement, and evaluate all medical aspects of an
2. Referenced Documents EMS system. (syn. medical accountability.)
3.8 medical director off-line—a physician responsible for all
2.1 ASTM Standards:
aspects of an EMS system dealing with provision of medical
F 1031 Practice for Training the Emergency Medical Tech-
care. (Also known as System Medical Director.)
nician (Basic)
3.9 on-line medical physician—a physician immediately
F 1086 Guide for Structures and Responsibilities of Emer-
available, when medically appropriate, for communication of
gency Medical Services Systems Organizations
medical direction to non-physician prehospital providers in
3. Terminology
remote locations.
3.10 prehospital provider—all personnel providing emer-
3.1 Description of Terms Specific to This Practice
gency medical care in a location remote from facilities capable
3.2 communication resource—an entity responsible for
of providing definitive medical care.
implementation of direct medical control. (Also known as
3.11 protocols—standards for EMS practice in a variety of
medical control resource.)
situations within the EMS system.
3.12 standing orders—strictly defined written orders for
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
tion has not been established with an on-line physician.
Organization/Management.
Current edition approved August 15, 1993. Published October 1993. Originally
published as F 1149 – 88. Last previous edition F 1149 – 88.
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.
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 1149 – 93 (1998)
4. Significance and Use 5.3.1 Establishing system-wide medical protocols (includ-
ing standing orders) in consultation with appropriate special-
4.1 Implementation of this practice will ensure that the EMS
ists.
system has the authority, commensurate with the responsibility,
5.3.2 Recommending certification or decertification of non-
to ensure adequate medical direction of all prehospital provid-
physician prehospital personnel to the appropriate certifying
ers, as well as personnel and facilities that meet minimum
agencies.
criteria to implement medical direction of prehospital services.
5.3.2.1 Every system shall have an appropriate review and
4.1.1 The state will develop, recommend, and encourage
appeals mechanism, when decertification is recommended, to
use of a plan that would assure the standards outlined in this
assure due process in accordance with law and established
document can be implemented as appropriate at the local,
local policies. The Director shall promptly refer the case to the
regional, or state level (see Guide F 1086).
appeals mechanism for review, if requested.
4.1.2 This practice is intended to describe and define re-
5.3.3 Requiring education to the level of approved profi-
sponsibility for medical directions during transfers. It is not
ciency for personnel within the EMS system. This includes all
intended to determine the medical or legal, or both, appropri-
prehospital personnel, EMTs at all levels, prehospital emer-
ateness of transfers under the Consolidated Omnibus Budget
gency care nurses, dispatchers, educational coordinators, and
Reconciliation Act and other similar federal and/or state laws.
physician providers of on-line direction (see Practice F 1031).
5.3.4 Suspending a provider from medical care duties for
5. Medical Director
due cause pending review and evaluation.
5.1 Position—System Medical Director (Off-line Medical
5.3.4.1 Because the prehospital provider operates under the
Director).
license (delegated practice) or direction of the Medical Direc-
5.1.1 Each EMS system shall have an identifiable Medical
tor, the director shall have ultimate authority to allow the
Director who, after consultation with others involved and
prehospital provider to provide medical care within the pre-
interested in the system, is responsible for the development,
hospital phase of the EMS system.
implementation, and evaluation of standards for provision of
5.3.4.2 Whenever a Medical Director makes a decision to
medical care within the system.
suspend a provider from medical care duties, the process shall
5.1.1.1 All prehospital providers (including EMT (Emer-
be prescribed by previously established criteria.
gency Medical Technician) basics) shall be medically account-
5.3.5 Establishing medical standards for dispatch proce-
able for their actions and are responsible to the Medical
dures to assure that the appropriate EMS response unit(s) are
Director of the EMS agency (local, regional, or state) that
dispatched to the medical emergency scene when requested,
approves their continued participation.
and the duty to evaluate the patient is fulfilled.
5.1.1.2 All prehospital providers, with levels of certification
5.3.6 Establishing under what circumstances non-transport
above EMT basic, shall be responsible to an identifiable
might occur.
physician who directs their medical care activity.
5.3.6.1 All decisions by prehospital providers regarding
5.1.2 The Medical Director shall be appointed by, and
non-transport shall be based on defined protocol or on-line
accountable to, the appropriate EMS agency in accordance
communications.
with Guide F 1086.
5.3.6.2 Develop a procedure for record keeping when the
5.2 Requirements of a Medical Director:
reason for non-transport was the result of a patient’s refusal,
5.2.1 The medical aspects (see 5.3) of an emergency medi-
including the appropriate forms and review process.
cal service system shall be managed by physicians who meet
5.3.7 Establishing under which circumstances a patient may
the following requirements:
be transported against his or her will; in accordance with state
5.2.1.1 Licensed physician, M.D. or D.O.
law including, procedure, appropriate forms, and review pro-
5.2.1.2 Experience in, and current knowledge of, emergency
cess.
care of patients who are acutely ill or traumatized.
5.3.8 Establishing criteria for level of care and type of
5.2.1.3 Knowledge of, and access to, local mass casualty
transportation to be used in prehospital emergency care (that is,
plans.
advanced life support versus basic life support, ground, air, or
5.2.1.4 Familiarity with Communication Resource opera-
specialty unit transportation).
tions where applicable, including communication with, and
5.3.9 Establishing criteria for selection of patient destina-
direction of, prehospital emergency units.
tion.
5.2.1.5 Active involvement in the training of prehospital
5.3.10 Establishing educational and performance standards
personnel.
for Communication Resource personnel.
5.2.1.6 Active involvement in the medical audit, review, and
5.3.11 Establishing operational standards for Communica-
critique of medical care provided by prehospital personnel.
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.
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 1149 – 93 (1998)
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
they do not conflict with established system protocols and the
6.1 The Practice of Direct Medical Control:
private physician documents the orders in a manner acceptable
6.1.1 On-line medical direction capabilities shall exist and
to the EMS system.
be available within the EMS system, unless impossible due to
7.2.2 The Communication Resource shall be contacted for
distance or geographic considerations.
recordkeeping purposes to notify the on-line medical physi-
6.1.1.1 All prehospital providers, above the certification of
cian.
EMT basic, shall be assigned to a specific on-line communi-
7.2.3 When the medical orders of the private physician
cation resource by a predetermined policy.
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-l
...

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4.1 Implementation of this practice will ensure that the EMS system has the authority commensurate with the responsibility to ensure adequate medical direction of all pre-hospital providers, as well as personnel and facilities that meet minimum criteria to implement medical direction of pre-hospital services.  
4.1.1 The state will develop, recommend, and encourage use of a plan that would ensure the standards outlined in this document can be implemented as appropriate at the local, regional, or state level (see Guide F1086).  
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4.3 Using this guide, EMS institutions and organizations should be able to develop requirements for selection and utilization of ALS/EMT instructors for ALS/EMT training and education programs.
SCOPE
1.1 This guide is intended to assist emergency medical services (EMS) agencies and institutions in selecting and utilizing individuals who teach in EMT (emergency medical technician) training programs that include instruction in advanced life support knowledge and skills.  
1.2 This guide identifies six categories of instructor in an AEMT (advanced emergency medical technician) training program: adjunct instructor, clinical/field preceptor, practical skills instructor, associate instructor, course instructor/coordinator (I/C), and course administrator. The guide recognizes that an individual may, depending on his/her level of practice and the training program involved, function in any or all of these categories.  
1.3 This guide includes specific guidelines for qualifications, training, education, experience, scope of authority, responsibilities, continuing education, evaluation, and maintenance of competency when applicable.  
1.4 This guide does not include specific guidelines for the course administrator or the adjunct instructor. While the guide recognizes, by offering a definition of each category, that these types of individuals function in many AEMT training programs, the limited instructional roles played by these individuals preclude the need for specific selection and utilization guidelines.  
1.5 This guide is intended to apply to any individual who teaches in an AEMT training program regardless of the individual's present level of clinical practice.  
1.6 This guide intentionally omits references to length of pre-hospital care experience, teaching experience, and continuing education requirements. This guide also omits reference to waiver or equivalency. These issues should be addressed by the appropriate agency.  
1.7 This guide applies only to instructors who teach in AEMT training courses designed to prepare an individual for certification to practice above the level of the EMT. It does not apply to instructors who teach in specialized courses that do not in themselves qualify the individual for a level of EMT certification.  
1.8 This guide does not establish certification requirements. Such requirements should be established by the certifying agency in the jurisdiction in which the AEMT instructor will function. This guide may be used to provide considerable guidance to the jurisdiction responsible for establishing certification standards.  
1.9 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, health, and environmental practices and determine the applicability of regulatory limitations prior to use.
Note 1: Also see Practice F1031.  
1.10 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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ASTM F1654-95(2020)(Guide)
Standard Guide for Training and Evaluation of Individuals Who Are Responsible for or Perform Triage in a Prehospital Environment

SIGNIFICANCE AND USE
4.1 This guide is intended for use by those responsible for the development and implementation of training programs, that include competency evaluation, for triage in the prehospital environment.  
4.2 This guide is not intended to be used by itself, but as a component of Guide F1288.  
4.3 This guide acknowledges many types of individuals with varying levels of emergency medical training. It also establishes a minimum training standard and encourages the addition of optional knowledge, skill, and attitudinal objectives.  
4.4 A vital role in the development and operational application of triage is that of medical control. This guide should be used by medical directors in the determination of operational and medical protocols for use during MCIs and coordinated with those who are responsible for training.  
4.5 At the beginning of the program, students shall be informed of the course objectives and requirements for successful completion.
SCOPE
1.1 This guide covers minimum requirements for the training and evaluation of individuals who perform triage at an emergency medical incident involving multiple casualties in a prehospital environment.  
1.2 All training will be in accordance with Guide F1653.  
1.3 Included in this guide is a standard for knowledge and skill evaluation.  
1.4 Operating within the framework of this guide may expose personnel to hazardous materials, procedures, and equipment. For additional information see Practice F1031 and Guides F1219, F1253, F1285, F1288, F1453, and F1489.  
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, health, and environmental practices and determine the applicability of regulatory limitations prior to use. For specific precautionary statements, see the document cited in Footnote 3.  
1.6 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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ASTM F1268-90(2020)(Guide)
Standard Guide for Establishing and Operating a Public Information, Education, and Relations Program for Emergency Medical Service Systems

SIGNIFICANCE AND USE
4.1 It is essential to have the public's understanding and support for the EMS system to ensure its proper development and utilization.  
4.2 This guide encompasses those procedures, considerations, and resources that are necessary for a successful EMS public information, education, and relations program. Complex EMS systems may integrate or augment, or both, this guide in its entirety. Less complex systems may need to collaborate with other EMS organizations and related agencies. Responsibility for this guide will vary by level of authority, that is, state, regional, and local. (See Guide F1086.)  
4.3 The PIER tasks involve research, planning, production, distribution, and evaluation. Production requires significant resources and expertise and may be done most appropriately at the higher level, such as regional, state, and national levels.
SCOPE
1.1 The purpose of this guide is to provide national voluntary standards and recommendations to effectively provide emergency medical service system information and education to the public.  
1.2 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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ASTM F1653-95(2020)(Guide)
Standard Guide for Scope of Performance of Triage in a Prehospital Environment

SIGNIFICANCE AND USE
4.1 This guide is not intended to be used by itself, but as a component of Guide F1288. Merely conforming to the guidelines described herein will not ensure that adequate triage is carried out in a multiple casualty incident.  
4.2 The purpose of this guide is to establish a methodology for performing triage.  
4.3 Individuals responsible for performing triage must be proficient in triage methods and related life-saving techniques.  
4.4 A basic concept of triage is to do the greatest good for the greatest number of casualties.  
4.5 The assessment process must be focused so as to identify those most at risk of early death who are likely to be salvaged by rapid medical intervention.  
4.6 Triage allows the most efficient use of available resources.  
4.7 This guide acknowledges many types of individuals with varying levels of emergency medical training. It also establishes a minimum scope of performance and encourages the addition of optional knowledge, skills, and attitudinal objectives.  
4.8 A vital role in the development of and operational application of triage is that of medical control. This guide should be used by medical directors in the determination of operational and medical protocols for use during MCIs.  
4.9 This guide is intended to assist those who are responsible for defining the scope of performance of individuals who perform triage.  
4.10 For the purpose of this guide the word “injured” includes both sick or injured patients, or both.
SCOPE
1.1 This guide covers minimum requirements for the scope of performance for individuals who perform triage at an emergency medical incident involving multiple casualties in a pre-hospital environment.  
1.2 This guide acknowledges objectives based on an individual's required knowledge of signs and symptoms, patient assessment, and basic life support.  
1.3 Operating within the framework of this guide may expose personnel to hazardous materials, procedures, and equipment. For additional information see Practice F1031 and Guides F1219, F1253, F1285, F1287, F1288, F1489 and F1651.  
1.4 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, health, and environmental practices and determine the applicability of regulatory limitations prior to use. For specific precautionary statements, see Footnote 2.2  
1.5 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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