ASTM F1258-1995(2014) Standard Practice for Emergency Medical Dispatch《应急医疗调度的标准实施规程》.pdf

1、Designation: F1258 95 (Reapproved 2014)Standard Practice forEmergency Medical Dispatch1This standard is issued under the fixed designation F1258; the number immediately following the designation indicates the year oforiginal adoption or, in the case of revision, the year of last revision. A number i

2、n parentheses indicates the year of last reapproval. Asuperscript epsilon () indicates an editorial change since the last revision or reapproval.1. Scope1.1 This practice covers the definition of responsibilities,knowledge, practices, and organizational support required toimplement, perform, and man

3、age effectively the emergencymedical dispatch function.1.2 This practice is useful for planning and evaluating thetraining, implementation, and organizational support to satisfythe functional needs of emergency medical dispatching.1.3 This standard does not purport to address all of thesafety concer

4、ns, if any, associated with its use. It is theresponsibility of the user of this standard to establish appro-priate safety and health practices and determine the applica-bility of regulatory limitations prior to use.2. Referenced Documents2.1 ASTM Standards:2F1031 Practice for Training the Emergency

5、 Medical Tech-nician (Basic)F1381 Guide for Planning and Developing 9-1-1 EnhancedTelephone Systems (Withdrawn 2008)3F1552 Practice for Training Instructor Qualification andCertification Eligibility of Emergency Medical Dispatch-ersF1560 Practice for Emergency Medical Dispatch Manage-ment3. Terminol

6、ogy3.1 Definitions of Terms Specific to This Standard:3.1.1 emergency medical dispatcher (EMD)a trained pub-lic safety telecommunicator with additional training and spe-cific emergency medical knowledge essential for the efficientmanagement of emergency medical communications.3.1.2 emergency medical

7、 dispatchingthe reception andmanagement of requests for emergency medical assistance.3.1.3 emergency medical dispatch priority reference system(EMDPRS)a medically approved system used by a dispatchagency to provide aid to medical emergencies that includes:systematized caller interrogation questions,

8、 systematized pre-arrival instructions, and protocols matching the dispatchersevaluation of injury or illness severity with vehicle responsemode and configuration.3.1.4 medical directionthe management and accountabil-ity for the medical care aspects of an emergency medicaldispatch (EMD) program incl

9、uding: the medical monitoringoversight of the training of the EMD personnel; approval andmedical control of the operational emergency medical dispatchpriority reference system (EMDPRS); evaluation of the medi-cal care and prearrival instructions rendered by the EMDpersonnel; direct participation in

10、the EMD system evaluation,quality, assurance, and quality improvement process andmechanisms; and, responsibility for the medical decisions andcare rendered by the emergency medical dispatcher and emer-gency medical dispatch program.3.1.5 public safety telecommunicatoran individual trainedto communic

11、ate remotely with persons seeking emergencyassistance and with agencies and individuals providing suchassistance.3.1.6 telephone aidconsists of “ad-libbed” telephone in-structions provided by either trained or untrained dispatchersand differs from DLS-based prearrival instructions in that theinstruc

12、tions provided to the caller are based on the dispatchersknowledge or previous training in a procedure or treatmentwithout following a scripted prearrival instruction protocol.They cannot be medically preapproved since they do not existin written form.3.1.7 telephone treatment sequence protocols spe

13、cifictreatment strategies designed in a conversational script formatthat direct the EMD step by step in giving critical prearrivalinstructions such as CPR, Heimlich maneuver, mouth-to-mouth breathing, and childbirth instruction.3.1.8 vehicle response configurationthe specific vehicle(s)of varied typ

14、es, capabilities, and numbers responding to renderassistance.1This practice is under the jurisdiction of ASTM Committee F30 on EmergencyMedical Services and is the direct responsibility of Subcommittee F30.04 onCommunications.Current edition approved June 1, 2014. Published June 2014. Originallyappr

15、oved in 1990. Last previous edition approved in 2006 as F1258 95 (2006).DOI: 10.1520/F1258-95R14.2For referenced ASTM standards, visit the ASTM website, www.astm.org, orcontact ASTM Customer Service at serviceastm.org. For Annual Book of ASTMStandards volume information, refer to the standards Docum

16、ent Summary page onthe ASTM website.3The last approved version of this historical standard is referenced onwww.astm.org.Copyright ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959. United States13.1.9 vehicle response modethe use of emergency drivingtechniques,

17、 such as warning lights and siren, versus a routinedriving response.4. Summary of Practice4.1 An emergency medical dispatcher is a trained publicsafety telecommunicator with additional training and specificemergency medical knowledge essential for assessment ofmedical emergencies and limited remote

18、treatment and appor-tionment of medical priorities. The EMD functions under themedical authority of an off-line medical director to receive andmanage calls for emergency medical assistance through thesystematic interrogation of callers, using procedures estab-lished by the off-line medical director

19、who remains responsiblefor the medical quality assurance of the EMD program.4.1.1 The EMDs role includes the ability to:4.1.1.1 Remotely evaluate the patient or incident,4.1.1.2 Interpret the requirement and need for emergencymedical resources,4.1.1.3 Allocate the appropriate resources,4.1.1.4 Ident

20、ify conditions requiring prearrival instructionsand provide them to the caller when necessary, possible andappropriate,4.1.1.5 Coordinate the response of emergency medical andother public safety resources,4.1.1.6 Provide information to the responding units regard-ing the emergency scene and patient,

21、 and4.1.1.7 Record and retrieve emergency medical responserecords.4.1.2 There must be continuity in the delivery of EMD care.To provide correct medical care safely and effectively, theEMD that is medically directing, evaluating, and coding mustmaintain direct access to the calling party and must use

22、 amedically approved emergency medical dispatch priority ref-erence system. The person giving the medical instruction to thecaller must be the same person that asks the systematicinterrogation questions.4.1.3 To accomplish the above safely and effectively, theEMD must use a medically approved EMDPRS

23、 that includes:4.1.3.1 Systematized caller interrogation questions,4.1.3.2 Systematized prearrival instructions, and4.1.3.3 Protocols that determine vehicle response mode andconfiguration based on the EMDs evaluation of injury orillness severity.4.2 This practice is intended to be used by agencies a

24、s abaseline for establishing a certifying emergency medical dis-patch training program that includes the implementation of theemergency medical dispatch priority reference system, undermedical direction, and provides a means of evaluating theEMD program.4.3 This practice will provide a common set of

25、 expectationsfor training, performance, and preplanned response based onunderstanding of the medical condition, thoroughinterrogation, caller intervention, safe responses, and prearrivalinstructions.4.4 This practice establishes the EMDs role and responsi-bilities in receiving, managing, and dispatc

26、hing calls formedical assistance and related agency coordination.4.5 An organizational structure as defined in Practice F1560must be in place before implementing the EMD program;therefore, this practice establishes some general recommenda-tions concerning the development of a supportive structure an

27、dprogram content.4.6 Use of this practice is not intended to protect the EMDor dispatch organization from liability for negligent actions orfailure to perform in accordance with established and approvedmedical practices and protocols.4.7 The EMD must be certified through either state govern-ment pro

28、cesses or by professional medical dispatch standard-setting organizations.4.7.1 When certification is achieved by recognition of aprofessional medical dispatch standard-setting organization, itshall clearly demonstrate compliance with all criteria enumer-ated in this practice and within Practice F15

29、60 and PracticeF1552.5. Significance and Use5.1 This practice is intended to promote the use of trainedtelecommunicators in the role of emergency medical dis-patcher. It defines the basic skills and medical knowledge topermit understanding and resolution of the problems thatconstitute their daily ro

30、utine. To use trained telecommunicatorsfully as functioning members of the emergency medical team,it is deemed necessary to upgrade the telecommunicatorstraining by the addition of the concept of emergency medicaldispatch priorities.5.2 All agencies or individuals who routinely accept callsfor emerg

31、ency medical assistance from the public and dispatchemergency medical personnel shall have in effect an emer-gency medical dispatcher program in accordance with thispractice. The program shall include medical direction andoversight and an emergency medical dispatch priority refer-ence system.5.3 The

32、 successful use of the EMD concept depends on themedical communitys awareness of the “prearrival” state ofEMS affairs and their willingness to provide medical directionin dispatch.5.4 This practice may assist in overcoming some of themisconceptions regarding emergency medical dispatching.These inclu

33、de the uncontrollable nature of the callers hysteria,lack of time of the dispatcher, potential danger and liability tothe EMD, lack of recognition of the benefits of dispatchprearrival instructions, and misconceptions that red lights,siren, and maximal response are always necessary.5.5 The EMD is th

34、e member of the EMS response team withthe broadest view of the entire emergency systems currentstatus and capabilities. The EMD has immediate lifesavingcapability in converting the caller into an effective firstresponder. This practice recognizes the EMDs role as includ-ing:5.5.1 Interrogation techn

35、iques,F1258 95 (2014)25.5.2 Triage decisions,5.5.3 Information transmission,5.5.4 Telephone medical intervention, and5.5.5 Logistics and resource coordination during the event.5.6 For the EMD, this practice supersedes any other EMSSstandards under which an individual may be qualified, such asPractic

36、e F1031. It is not the role of the EMD to generate aspecific diagnosis but rather to elicit accurately a finite body ofinformation, assign the appropriate response, and to commu-nicate clearly among persons and units involved in the re-sponse. The protocols for inquiry, response, and resourcecoordin

37、ation are essential and must not be modified based onan individuals possible experiences as a responder.5.7 As an initial contact with the EMS system, the EMD issubject to questioning of actions as they relate to medicalpractice. This practice may be used by agencies as a recognizedbaseline for EMD

38、training, practice, and organization and isintended to supplant de facto standards that exist in some areas.This practice will assist in developing sound EMD programsthat will reduce the need and potential for legal action andprovide a common set of expectations for performance.5.8 It will bring mor

39、e accurate information into the dispatchoffice by way of appropriate understanding of the medicalcondition and therefore better interrogation, caller intervention,and decision-making. It allows for preplanned responses, saferresponses (fewer units responding with lights and siren), fueland energy sa

40、vings (smaller units and fewer units used whenpossible), and may save advanced lifesupport resources for trueadvanced life-support emergencies when a tiered-level re-sponse is available.6. System Components6.1 Emergency Medical Dispatch Priority Reference System(EMDPRS):6.1.1 This system is a writte

41、n, reproducible document in auniform format based on medical and administrative protocols.The emergency medical dispatch priority reference systemdirects the EMD to complete a full, programmed interrogation.The information from the caller is paired with preset problemgroups to determine the appropri

42、ate response level. It shallinclude the following:6.1.1.1 A set of systematized caller interrogation (key)questions. The key questions must obtain the minimum amountof information necessary to:(1) Adequately establish the correct level of response,(2) Establish the need for prearrival instructions,

43、and(3) Provide responders with adequate patient and incidentinformation.6.1.2 A set of systematized coding and response protocolsthat include:6.1.2.1 Protocols that predetermine vehicle response modeand configuration based on the EMDs evaluation of injury andillness severity as determined through ke

44、y question interroga-tion. These protocols must reflect a given EMS systems variedability to respond, ranging from single-unit squads throughmultiple-level (tiered) response.6.1.2.2 An established, medically approved, quantitativecoding system for quality assurance/improvement and statisti-cal analy

45、sis.6.1.3 Aset of systematic prearrival instructions that include:6.1.3.1 Chief complaint specific caller and EMD advise, and6.1.3.2 Scripted prearrival instructions.6.1.4 In addition to the EMDPRS, an emergency medicaldispatch system should include:6.1.4.1 A mass casualty plan for notification and

46、operationin a disaster situation,6.1.4.2 A directory of emergency response resources andinformation resources,6.1.4.3 A written description of the communications systemconfiguration for the service area, and6.1.4.4 A record-keeping system, including report forms ora computer data management system t

47、o permit evaluation ofEMD compliance with the EMDPRS, evaluation of protocoleffectiveness, and timeliness of interrogation and dispatch.7. Functions of Emergency Medical Dispatch7.1 Receive and Process Calls for AssistanceThe EMDmust receive and record calls for emergency medical assistancefrom vari

48、ous sources. This function includes the establishmentof effective communication with the person requestingassistance, using the EMDPRS to evaluate the patient orsituation, provide appropriate prearrival instructions, and selectthe most appropriate EMS system action in response to eachcall.7.2 Dispat

49、ch and Coordinate Appropriate, Available Re-sponse ResourcesThe EMD must select and dispatch thenecessary EMS vehicles and personnel to the scene of anemergency in an appropriate time frame. The EMD functionsin coordinating the movements of EMS vehicles en route to thescene, en route to the medical facility, and back to the base ofoperations. This requires that the EMD have current knowl-edge of the status of all EMS resources in the dispatch area andthe geographic constraints that will affect the EMS response.This also requires that the EMD have dispatch-spec