ASTM F1339-92(2003)
(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NOTICE: This standard has either been superseded and replaced by a new version or withdrawn.
Contact ASTM International (www.astm.org) for the latest information
Designation:F1339–92 (Reapproved 2003)
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 2. Referenced Documents
1.1 Thisstandardestablishedguidelinesfortheorganization 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 Organizations
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 Services
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) Telecommunications
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 Systems
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 Techniques
enhancement of EMS systems; (g) development and imple- 2.2 American Ambulance Association
mentation of training systems; (h) development and implemen- Standards and Accreditation Document
tation of communication systems; (i) development and imple-
3. Significance and Use
mentation of record-keeping and evaluation systems; (j)
3.1 This guide suggests methods for organizing and operat-
development and implementation of public information, public
ing state, regional, and local EMS systems, in accordance with
education, and public relations programs; (k) development and
implementation of acute care center designation; (l) develop- Guide F 1086. It will assist state, regional, or local organiza-
tions in assessing, planning, documenting, and implementing
ment and implementation of a disaster medical system; (m)
overall coordination of EMS and related programs within the their specific operations. The guide is general in nature and
able to be adapted for existing EMS Systems. For organiza-
state and in concert with other states or federal authorities.
1.2 At the regional level, this guide identifies methods of tions that are establishing EMS System operations, the guide is
specific enough to form the basis of the operational manual.
planning, implementing, coordinating/managing, and evaluat-
ing the emergency medical services system which exists within
4. State Guide
a natural catchment area and provides guidance on the use of
4.1 Establishment of EMS Legislation:
these methods.
4.1.1 Methods and Procedures—The legislative process
1.3 At the local level, this guide identifies a basic structure
varies from state to state. The EMS lead agency should seek a
for the organization and management of a local EMS system
description of the process in its state from:
and outlines the responsibilities that a local EMS should
4.1.1.1 The legislature’s staff or clerk offices.
assume in the planning, development, implementation and
4.1.1.2 The legislative liaison, or other appropriate staff of
evaluation of its EMS system.
the governmental unit housing EMS (its “umbrella”).
4.1.1.3 The legal counsel assigned to EMS.
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.
Current edition approved Sept. 10, 2003. Published October 2003. Originally Annual Book of ASTM Standards, Vol 13.02.
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.
F1339–92 (2003)
TABLE 1 Levels of Organization
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 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 FormallyRequiredReviews/Approvalsand/orInfor-
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.
F1339–92 (2003)
4.2 Development of Minimum Standards: be legally binding. They are useful, though, in defining and
clarifying required licensure/certification processes for provid-
4.2.1 Methods and Procedures—A variety of standard-
ers and in providing immediate direction to providers where
setting mechanisms exist, from that which is formal and
such direction is not provided in law, rules, or elsewhere.
explicitly housed in the state’s laws to that which is the least
4.2.2.5 Protocols—Virtually unique to EMS in their re-
formal, for instance, the non-binding opinion of EMS staff
gional or statewide application, treatment protocols may be
which is standard-setting to the extent of the dissemination and
used to set clinical and operational standards and to define
“rightness” of the opinion and the perceived expertise of the
scope of practice. Protocols are most effective when they are
staff. The most commonly employed method and procedures
given power of law by virtue of specific reference in statute
are listed below.
(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-buildingprocessamongthestate’smedicaladvisory
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-binding
(a) Agency staff (drafting),
standards. Sets the responsibilities of the state, regional, and
(b) Legal counsel assigned to EMS (review),
local EMS structures; defines areas of rule or regulation-
(c) REMSO staffs/advisory councils/committees (review),
making authority, and sets general minimum standards for the
(d) State advisory council/committees (review),
system as a whole. See 4.1.
(e) State EMS-related professional associations (review),
4.2.2.2 Rules/Regulations—Used to set more specific stan-
(f) Impartial legal counsel (approval),
dards for system design and operation including, but not
(g) Secretary of state (records/announces proposals, certi-
limited to, the interaction of state, regional, and local EMS
fies adopted rules),
structures in provider operation (for example, licensure, train-
(h) Legislature (subject to review),
ing course approval); requirements for and terms of operation
(i) Umbrella unit staff and head (review/approval unless
(usually through licensure or certification) for EMS personnel,
EMS agency has own rule-making authority), and
vehicles, equipment and services; organization of EMS train-
(j) Providers/general public.
ingforcertificationorlicensure;organizationofcertificationor
4.2.3.3 By Executive Order:
licensure testing; scope of practice; causes and procedures for
(a) Agency staff (drafting),
disciplinary actions. This process is governed by the adminis-
(b) Legal counsel assigned to EMS (review),
trative procedures act (“APA”) of the state and generally
(c) Umbrella unit head/commissioner (cabinet level),
requires the EMS rule-making authority to publish notices and
(d) Governor; governor’s staff,
hold hearings on proposed changes. Consult the state’s APA
(e) State advisory council/committees,
and discuss with the legal counsel assigned to EMS.
(f) Consider those listed in 4.2.3.2 for review.
4.2.2.3 Executive Order—The Governor may be empow-
4.2.3.4 By Policies/Procedures:
ered to take actions which have a standard-setting impact.
(a) Agency staff (drafting and review),
Consult the legal counsel assigned to EMS or the Governor’s
(b) REMSO staff (review), and
staff.
(c) Consider umbrella unit/advisory council review.
4.2.2.4 Policies/Procedures—Used by the state agency to
4.2.3.5 By Protoc
...
Questions, Comments and Discussion
Ask us and Technical Secretary will try to provide an answer. You can facilitate discussion about the standard in here.