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ASTM F1149-93(2008)

(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
Implementation of this practice will ensure that the EMS system has the authority, commensurate with the responsibility, to ensure adequate medical direction of all prehospital providers, as well as personnel and facilities that meet minimum criteria to implement medical direction of prehospital services.
The state will develop, recommend, and encourage use of a plan that would assure the standards outlined in this document can be implemented as appropriate at the local, regional, or state level (see Guide F 1086).
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 and/or state laws.
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
31-Jan-2008
ICS
11.160 - First aid
Technical Committee
F30 - Emergency Medical Services
Drafting Committee
F30.03 - Organization/Management
Current Stage
Ref Project

Relations

Replaces
ASTM F1149-93(2003) - Standard Practice for Qualifications, Responsibilities, and Authority of Individuals and Institutions Providing Medical Direction of Emergency Medical Services
Effective Date
01-Feb-2008
Referred By
ASTM F1220-95(2022) - Standard Guide for Emergency Medical Services System (EMSS) Telecommunications
Effective Date
01-Feb-2008
Referred By
ASTM F2318-15 - Standard Specification for Rotary Wing Basic Life Support, Advanced Life Support, and Specialized Medical Support Air Ambulances
Effective Date
01-Feb-2008
Referred By
ASTM F1339-92(2016) - Standard Guide for Organization and Operation of Emergency Medical Services Systems
Effective Date
01-Feb-2008

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ASTM F1149-93(2008) - Standard Practice for Qualifications, Responsibilities, and Authority of Individuals and Institutions Providing Medical Direction of Emergency Medical ServicesASTM F1149-93(2008) - 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(2008) - Standard Practice for Qualifications, Responsibilities, and Authority of Individuals and Institutions Providing Medical Direction of Emergency Medical Services
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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:F1149 −93(Reapproved 2008)
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 3.2 communication resource—an entity responsible for
implementation of direct medical control. (Also known as
1.1 This practice covers the qualifications, responsibilities,
medical control resource.)
and authority of individuals and institutions providing medical
3.3 delegated practice—only physicians are licensed to
direction of emergency medical services.
practice medicine; prehospital providers must act only under
1.2 This practice addresses the qualifications, authority, and
the medical direction of a physician.
responsibility of a Medical Director (off-line) and the relation-
3.4 direct medical control—when a physician or authorized
ship of the EMS (Emergency Medical Services) provider to
communication resource personnel, under the direction of a
this individual.
physician, provides immediate medical direction to prehospital
1.3 This practice also addresses components of on-line
providers in remote locations. (Also known as on-line medical
medical direction (direct medical control) including the quali-
direction.)
fications and responsibilities of on-line medical physicians and
3.5 emergency medical services system (EMSS)—all com-
the relationship of the prehospital provider to on-line medical
ponents needed to provide comprehensive prehospital and
direction.
hospital emergency care including, but not limited to; Medical
1.4 This practice addresses the relationship of the on-line
Director, transport vehicles, trained personnel, access and
medical physician to the off-line Medical Director.
dispatch, communications, and receiving medical facilities.
1.5 The authority for control of medical services at the
3.6 intervener physicians—a licensed M.D. or D.O., having
scene of a medical emergency is addressed in this practice.
notpreviouslyestablishedadoctor/patientrelationshipwiththe
emergency patient and willing to accept responsibility for a
1.6 The requirements for a Communication Resource are
also addressed within this practice. medical emergency scene, and can provide proof of a current
Medical License.
2. Referenced Documents
3.7 medical direction—when a physician is identified to
2
develop, implement, and evaluate all medical aspects of an
2.1 ASTM Standards:
F1031 Practice for Training the Emergency Medical Tech- EMS system. (syn. medical accountability.)
nician (Basic)
3.8 medical director off-line—a physician responsible for all
F1086 Guide for Structures and Responsibilities of Emer-
aspects of an EMS system dealing with provision of medical
gency Medical Services Systems Organizations
care. (Also known as System Medical Director.)
3.9 on-line medical physician—a physician immediately
3. Terminology
available, when medically appropriate, for communication of
3.1 Description of Terms Specific to This Practice
medical direction to non-physician prehospital providers in
remote locations.
3.10 prehospital provider—all personnel providing emer-
1
This practice is under the jurisdiction ofASTM Committee F30 on Emergency
gency medical care in a location remote from facilities capable
Medical Services and is the direct responsibility of Subcommittee F30.03 on
Organization/Management. of providing definitive medical care.
Current edition approved Feb. 1, 2008. Published March 2008. Originally
3.11 protocols—standards for EMS practice in a variety of
approved in 1988. Last previous edition approved in 2003 as F1149 – 98(2003).
situations within the EMS system.
DOI: 10.1520/F1149-93R08.
2
For referenced ASTM standards, visit the ASTM website, www.astm.org, or
3.12 standing orders—strictly defined written orders for
contact ASTM Customer Service at service@astm.org. For Annual Book of ASTM
actions, techniques, or drug administration when communica-
Standards volume information, refer to the standard’s Document Summary page on
the ASTM website. tion has not been established with an on-line physician.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959. United States
1

---------------------- Page: 1 ----------------------
F1149−93 (2008)
4. Significance and Use 5.3 Authority of a Medical Director Includes but is not
Limited to:
4.1 ImplementationofthispracticewillensurethattheEMS
5.3.1 Establishing system-wide medical protocols (includ-
system has
...

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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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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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SIGNIFICANCE AND USE
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.  
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4.3 This practice adopts the knowledge and skill objectives contained in the NHSTA curriculum (latest version) as the standard practice for training those persons who provide emergency medical care at the basic life support level and are known as Emergency Medical Technicians. The actual lesson plans contained in the referenced document are recommended for use; however, each instructor may modify the order of presentation according to local needs.  
4.4 This practice outlines a comprehensive course that covers most common emergencies encountered by the Emergency Medical Technician. Emergency Medicine Technician courses that do not include all of the knowledge and skill objectives of this practice may not be referred to as meeting this standard.
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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.
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 which include instruction in basic life support knowledge and skills.  
1.2 This guide identifies six categories of instructor in an EMT (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 EMT training programs, the limited instructional roles played by these individuals preclude the need for specific selection and utilization guidelines.  
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SCOPE
1.1 This practice covers the qualifications, responsibilities, and authority of individuals and institutions providing medical direction of emergency medical services.  
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1.6 The requirements for a Communication Resource are also addressed within this practice.  
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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.  
4.2 An AEMT 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 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.  
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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.
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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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4.3 This guide shall be used as the basis to revise Practice F1031.  
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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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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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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.  
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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.  
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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.  
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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 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.  
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