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ASTM F1149-22

(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

SIGNIFICANCE AND USE
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).  
4.1.2 This practice is intended to describe and define responsibility for medical directions during transfers. It is not intended to determine the medical or legal, or both, appropriateness of transfers under the Consolidated Omnibus Budget Reconciliation Act and other similar federal or state laws, or both.
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 pre-hospital 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.  
1.7 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.

General Information

Status
Published
Publication Date
14-Mar-2022
ICS
11.160 - First aid
Technical Committee
F30 - Emergency Medical Services
Drafting Committee
F30.03 - Organization/Management
Current Stage
Ref Project

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ASTM F1149-22 - Standard Practice for Qualifications, Responsibilities, and Authority of Individuals and Institutions Providing Medical Direction of Emergency Medical ServicesASTM F1149-22 - Standard Practice for Qualifications, Responsibilities, and Authority of Individuals and Institutions Providing Medical Direction of Emergency Medical Services
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ASTM F1149-22 - Standard Practice for Qualifications, Responsibilities, and Authority of Individuals and Institutions Providing Medical Direction of Emergency Medical Services
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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.
Designation:F1149 −22
Standard Practice for
Qualifications, Responsibilities, and Authority of Individuals
and Institutions Providing Medical Direction of Emergency
1
Medical Services
This standard is issued under the fixed designation F1149; 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 (´) indicates an editorial change since the last revision or reapproval.
1. Scope F1031 Practice for Training the Emergency Medical Tech-
nician (Basic)
1.1 This practice covers the qualifications, responsibilities,
F1086 Guide for Structures and Responsibilities of Emer-
and authority of individuals and institutions providing medical
gency Medical Services Systems Organizations
direction of emergency medical services.
1.2 This practice addresses the qualifications, authority, and
3. Terminology
responsibility of a Medical Director (off-line) and the relation-
3.1 Definitions of Terms Specific to This Standard:
ship of the EMS (Emergency Medical Services) provider to
3.1.1 communication resource—an entity responsible for
this individual.
implementation of direct medical control. (Also known as
1.3 This practice also addresses components of on-line
medical control resource.)
medical direction (direct medical control) including the quali-
3.1.2 delegated practice—only physicians are licensed to
fications and responsibilities of on-line medical physicians and
practice medicine; pre-hospital providers must act only under
the relationship of the pre-hospital provider to on-line medical
the medical direction of a physician.
direction.
1.4 This practice addresses the relationship of the on-line 3.1.3 direct medical control—when a physician or autho-
medical physician to the off-line Medical Director. rizedcommunicationresourcepersonnel,underthedirectionof
a physician, provides immediate medical direction to pre-
1.5 The authority for control of medical services at the
hospital providers in remote locations. (Also known as on-line
scene of a medical emergency is addressed in this practice.
medical direction.)
1.6 The requirements for a Communication Resource are
3.1.4 emergency medical services system (EMSS)—all com-
also addressed within this practice.
ponents needed to provide comprehensive pre-hospital and
1.7 This international standard was developed in accor-
hospital emergency care including, but not limited to: Medical
dance with internationally recognized principles on standard-
Director, transport vehicles, trained personnel, access and
ization established in the Decision on Principles for the
dispatch, communications, and receiving medical facilities.
Development of International Standards, Guides and Recom-
3.1.5 intervener physicians—a licensed M.D. or D.O., hav-
mendations issued by the World Trade Organization Technical
ing not previously established a doctor/patient relationship
Barriers to Trade (TBT) Committee.
with the emergency patient and willing to accept responsibility
for a medical emergency scene, and can provide proof of a
2. Referenced Documents
2 current medical license.
2.1 ASTM Standards:
3.1.6 medical direction—when a physician is identified to
develop, implement, and evaluate all medical aspects of an
1
This practice is under the jurisdiction ofASTM Committee F30 on Emergency EMS system. (syn. medical accountability.)
Medical Services and is the direct responsibility of Subcommittee F30.03 on
3.1.7 medical director off-line—a physician responsible for
Organization/Management.
Current edition approved March 15, 2022. Published March 2022. Originally
allaspectsofanEMSsystemdealingwithprovisionofmedical
approved in 1988. Last previous edition approved in 2013 as F1149 – 98 (2013),
care. (Also known as System Medical Director.)
which was withdrawn January 2022 and reinstated in March 2022. DOI: 10.1520/
F1149-22.
3.1.8 on-line medical physician—a physician immediately
2
For referenced ASTM standards, visit the ASTM website, www.astm.org, or
available, when medically appropriate, for communication of
contact ASTM Customer Service at service@astm.org. For Annual Book of ASTM
medical direction to non-physician pre-hospital providers in
Standards volume information, refer to the standard’s Document Summary page on
the ASTM website. remote locations.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959. United States
1

---------------------- Page: 1 ----------------------
F1149−22
3.1.9 pre-hospital provider—all personnel providing emer- 5.2.1.5 Active involvement in the t
...

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5.1 This practice is intended to promote the use of trained telecommunicators in the role of emergency medical dispatcher. It defines the basic skills and medical knowledge to permit understanding and resolution of the problems that constitute their daily routine. To use trained telecommunicators fully as functioning members of the emergency medical team, it is deemed necessary to upgrade the telecommunicators' training by the addition of the concept of emergency medical dispatch priorities.  
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5.4 This practice may assist in overcoming some of the misconceptions regarding emergency medical dispatching. These include the uncontrollable nature of the caller's hysteria, lack of time of the dispatcher, potential danger and liability to the EMD, lack of recognition of the benefits of dispatch prearrival instructions, and misconceptions that red lights, siren, and maximal response are always necessary.  
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1.1 This practice covers the definition of responsibilities, knowledge, practices, and organizational support required to implement, perform, and effectively manage the emergency medical dispatch function.  
1.2 This practice is useful for planning and evaluating the training, implementation, and organizational support to satisfy the functional needs of emergency medical dispatching.  
1.3 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.  
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Standard Practice for Emergency Medical Dispatch Management

SIGNIFICANCE AND USE
5.1 The emergency medical dispatcher should be a specially trained telecommunicator with specific emergency medical knowledge. Many of these personnel still perform in this role without the benefits of dispatch specific medical training and medically sound protocols. The majority perform their duties without appropriate medical management provided through a structured quality assurance/improvement environment. Training only prepares a new EMD for correct use of the EMDPRS. It cannot ensure that the EMDPRS is used as intended. Since the EMD is clearly defined as a prehospital medical professional, it is necessary to establish sound medical management processes through a multi-component QA/QI program administered by the EMD's agency in conjunction with the physician medical director. Prompt, correct, and appropriate patient care can be enhanced through the use of a standardized approach to quality assurance, especially the component of EMD performance assessment. This practice is intended for use by agencies, organizations, and jurisdictions having the responsibility for providing such services and assurances to the public through the correct management of the nation's emergency medical dispatchers.
SCOPE
1.1 This practice covers the function of the emergency medical dispatcher (EMD). This function is the prompt and accurate processing of calls for emergency medical assistance. The training and practice through the use of a written or automated medical dispatch protocol is not sufficient in itself to ensure continued medically correct functioning of the EMD. Their dispatch-specific medical training and focal role in EMS has developed to such a complexity that only through a correctly structured and appropriately managed quality assurance environment can the benefits of their practice be fully realized. The philosophies of emergency medical dispatch have established new duties to which the emergency medical dispatch agency must respond. It is important that their quality assurance/quality improvement (QA/QI) activities, including initial hiring, orientation, training and certification, continuing dispatch education, recertification, and performance evaluation be given appropriate managerial attention to help ensure the ongoing safety in the performance of the EMD. This practice establishes functional guidelines for these managerial, administrative, and supervisory functions.  
1.2 The scope of this practice includes:  
1.2.1 The entry level selection criteria for hiring emergency medical dispatchers;  
1.2.2 The orientation of new emergency medical dispatchers;  
1.2.3 Development of QA/QI mechanisms, management strategies, and organizational structures for use within a comprehensive emergency medical dispatch system;  
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1.2.5 Development and provision of continuing dispatch education activities for the emergency medical dispatcher;  
1.2.6 Requirements for initial certification and recertification of the emergency medical dispatcher;  
1.2.7 Provision for comparative analysis between different EMD program approaches available to the EMS community that conform to established EMD practice standards prior to implementation of an emergency medical dispatch program; and  
1.2.8 Guidelines for implementation of an emergency medical dispatch program.  
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Standard Guide for Selection and Practice of Emergency Medical Services Instructor for Emergency Medical Technician (EMT) Training Programs

SIGNIFICANCE AND USE
4.1 Since the quality of EMT training depends, in large measure, on the instructional abilities and competencies of the EMT instructor, it is imperative that the individual selected and used in this capacity possess the qualifications and capabilities necessary to provide effective instruction.  
4.2 An EMT instructor must possess clearly defined knowledge and skills competencies, have clearly defined responsibilities and scope of authority related to instructional programs, and meet other specific requirements pertinent to the level of instruction.  
4.3 Using this guide, EMS institutions and organizations should be able to develop requirements for selection and utilization of EMT instructors for EMT training and education programs.
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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 which include instruction in basic life support knowledge and skills.  
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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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4.1 The purpose of this practice is to provide standardized means of providing Emergency Medical Technician training. The practice should be used by all individuals and agencies that train such persons.  
4.2 Successful completion of this course of training neither constitutes nor implies certification or licensure.  
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4.1 Since the quality of pre-hospital AEMT training depends, in large measure, on the instructional abilities and competencies of the AEMT instructor, it is imperative that the individual selected and used in this capacity possess the qualifications and capabilities necessary to provide effective instruction.  
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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.  
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4.1 This guide establishes the minimum national standard for training the Emergency Medical Technician to perform patient examination techniques on patients of all ages.  
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SCOPE
1.1 This guide covers the minimum patient examination techniques that the Emergency Medical Technician shall be trained to use when assessing ill or injured patients of all ages.  
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Standard Guide for Scope of Performance of First Responders Who Provide Emergency Medical Care

SIGNIFICANCE AND USE
4.1 The purpose of this guide is to improve the quality of initial emergency medical care provided to the sick and injured. As the first trained person at an emergency medical scene, it is critical that the first responder be proficient in providing patient care and minimizing further complications until more highly trained emergency medical service personnel intervene.  
4.2 In identifying these minima, the guide acknowledges many types of first responder emergency medical care courses of study. This guide allows and encourages the addition of optional knowledge, skill, and attitudinal objectives. Programs such as those for law enforcement, firefighters, and ski patrol are examples of this diversity meeting specific local community needs.  
4.3 This guide is intended to assist those who are responsible for defining the scope of performance for first responders.  
4.4 This guide is not  intended to be used as a scope of performance for emergency ambulance personnel (see Practice F1031).
SCOPE
1.1 This guide covers minimum requirements for the scope of performance of first responders who may be responsible for the initial care of sick and injured persons of all ages in the prehospital environment.  
1.2 This guide includes objectives based on an individual's acquired knowledge, including signs and symptoms; patient assessment; basic life support/cardiopulmonary resuscitation (BLS/CPR); bleeding and shock; injuries to the skull, spine, chest, abdomen, and extremities; moving patients; medical and environmental emergencies; triage; gaining access; and hazardous situations that the first responder may encounter.  
1.3 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.  
1.4 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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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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Standard Guide for Training and Evaluation of First Responders Who Provide Emergency Medical Care

SIGNIFICANCE AND USE
4.1 This guide is for those responsible for the development and implementation of training and evaluation programs for first responders (FRs).  
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SCOPE
1.1 This guide covers the minimum training standards for First Responders (FRs) who may be responsible for the initial care of sick and injured persons of all ages in the prehospital environment.  
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1.4 This guide does not suggest a particular training sequence.  
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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 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.  
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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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