1、Designation: F1655 95 (Reapproved 2013)Standard Guide forTraining First Responders Who Practice in Wilderness,Delayed, or Prolonged Transport Settings1This standard is issued under the fixed designation F1655; the number immediately following the designation indicates the year oforiginal adoption or
2、, in the case of revision, the year of last revision. A number in parentheses indicates the year of last reapproval. Asuperscript epsilon () indicates an editorial change since the last revision or reapproval.1. Scope1.1 This guide covers minimum training standards for firstresponders who may care f
3、or sick or injured persons in thespecialized pre-hospital situations of the wilderness, delayed,or prolonged transport settings, including catastrophic disas-ters.1.2 This guide establishes supplemental or continuing edu-cation programs that will be taught to individuals trained to thefirst responde
4、r level by an appropriate authority.1.3 This guide does not provide training to be used,ordinarily, in the traditional EMS or ambulance transportationenvironments.1.4 Included in this guide is a standard for the evaluation ofthe knowledge and skills defined within this guide.1.5 Successful completio
5、n of a course based on this guideneither constitutes nor implies certification or licensure.1.6 This guide does not establish medical protocols, nordoes it authorize invasive procedures without specific authori-zation and medical control.1.7 The values stated in inch-pound units are to be regardedas
6、 standard. No other units of measurement are included in thisstandard.1.8 Operating within the framework of this guide mayexpose personnel to hazardous materials or environments,procedures, and equipment or all of these.1.9 This standard does not purport to address all of thesafety concerns, if any,
7、 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:2F1177 Terminology Relating to Emergency Medical Ser-
8、vicesF1453 Guide for Training and Evaluation of First Respond-ers Who Provide Emergency Medical CareF1490 Terminology Relating to Search and Rescue (With-drawn 2011)33. Terminology3.1 Definitions:3.1.1 access, nthe process of reaching the patient/subjectand establishing physical contact.3.1.2 basic
9、life support/cardiopulmonary resuscitation(BLS/CPR) , na set of skills that includes airwaymanagement, chest compressions, and others as defined by theAmerican Heart Association.3.1.3 definitive care, na level of therapeutic interventioncapable of providing comprehensive health care services for asp
10、ecific condition. (See Terminology F1177.)3.1.4 evacuation, nthe process used between the time ofextraction and transportation. (See Terminology F1490.)3.1.5 extraction, nthe process of initial assessment,treatment, stabilization, and packaging of the patient as well asthe removal of the patient/sub
11、ject from the immediatelyhazardous environment. (See Terminology F1490.)3.1.6 first responder, nan individual trained in accordancewith Guide F1453.3.1.7 transportation, nthe use of a dedicated vehicle forthe removal of the patient to a medical facility or definitive carefacility.3.2 Definitions of
12、Terms Specific to This Standard:1This guide is under the jurisdiction of ASTM Committee F30 on EmergencyMedical Services and is the direct responsibility of Subcommittee F30.02 onPersonnel, Training and Education.Current edition approved Aug. 1, 2013. Published August 2013. Originallyapproved in 199
13、5. Last previous edition approved in 2007 as F1655 95(2007).DOI: 10.1520/F1655-95R13.2For 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 Document Summary
14、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 States13.2.1 delayed or prolonged transport, n when time be-tween patient injury and
15、arrival to a definitive care facility isgreater than 60 min.3.2.2 non-traditional EMS environment, n environmentsnot readily accessible to a ground ambulance.3.2.3 wilderness first responder (WFR), n an individualtrained to meet the requirements of this guide.3.2.4 wilderness setting, nsituations in
16、 which EMS deliv-ery is complicated by one or more of the following four factors:(1) remoteness as far as logistics and access; (2) a significantdelay in the delivery of care to the patient; (3) an environmentthat is stressful to both patients and rescuers; and (4) a lack ofequipment and supplies.4.
17、 Significance and Use4.1 Individuals will be initially or concurrently trained inaccordance with U.S. D.O.T. Course Guide for First Respond-ers4and Guide F1453.4.2 This guide does not suggest a particular training se-quence.4.3 This guide may be used by individuals developingtraining programs for no
18、n-traditional EMS environments.4.4 This guide acknowledges the need to provide additionalspecific training for first responders who will practice in thewilderness, delayed or prolonged transport settings.4.5 Individuals responsible for training first respondersshould identify those who will practice
19、 in the wilderness,delayed or prolonged transport settings and must ensure thatsuch personnel are competent in all skills needed for the uniquesettings.5. Illustrative Examples5.1 Wilderness Settings:5.1.1 In May 1983, two climbers were at about 18 000 ft,near Denali Pass on Mount McKinley, Alaska.
20、These climberstook a tumbling 800 ft fall before coming to rest. One of theclimbers was only responsive to pain, with a lacerated face andthe pick end of his ice axe impaled in the right side of his chest,just below the nipple line. A nearby climbing party responded.They first attempted to stabilize
21、 the ice axe in place as perstandard EMS protocols. They improvised a rescue tobogganusing two plastic sleds, but moving the patient was verydifficult with the ice axe still in his chest. And, with tempera-tures ranging from 50 to 70 F (in accordance with Na-tional Park Service reports), rescuers we
22、re unable to keep himfrom rapidly cooling. The danger of cold exposure and thedifficulty with transportation created by the impaled ice axe ledrescuers to remove it.5.1.2 After removing the ice axe, the patient began torewarm, the rescuers were able to evacuate him expeditiously,and he went on to ma
23、ke a full recovery.5.2 Rural (Delayed/Prolonged Settings)A man was driv-ing along a gravel road in a remote rural area of NorthernIdaho. He stooped to clear a fallen tree from the road, and inthe attempt, he fell and dislocated his right shoulder. Hemanaged to call for help with his CB radio. About
24、2 h later, anambulance arrived. The EMTs on the ambulance checked thepulse and sensation in his right arm, and found them to benormal. The man pleaded with them to pull on his shoulder andrelocate it; he had a similar dislocation of the left shoulder inthe past, and he knew that it could be reduced
25、with a little help.However the EMTs, mindful of their training, insisted on“splinting it in position” and drove him six hours to the nearesthospital, mostly along bumpy secondary roads.The patient wasmoaning and intermittently screaming the entire time, in severepain. Later he wrote to various autho
26、rities criticizing the careprovided to him.5.3 Disaster (Delayed/Prolonged Settings):5.3.1 It was rush hour, and the freeways were crowded, butotherwise the day was like any other. Suddenly the earth shook,and a freeway collapsed, entombing motorists in a mass ofconcrete and twisted metal.5.3.2 For
27、four days, rescuers attacked the mass of rubblewith every tool available from pliers to massive constructionequipment. They had given up hope of finding any one elsealive when they found a 57 year old construction worker alive,his lower extremities being trapped and crushed.5.3.3 No medical personne
28、l were available to render caresuch as IV hydration, so the construction workers immediatelyextricated him. Despite later attempts at hydration, he laterdeveloped kidney failure and then sepsis; he died a few dayslater.5.4 Borderline Wilderness Settings:5.4.1 Several years ago, a light civil aircraf
29、t crashed near thetop of Tinker Mountain in southwest Virginia. Atop TinkerMountains rugged, cliff-strewn ridgeline is the AppalachianTrail; the area is a favorite of hikers and climbers. The aircraftwas located from the air, and a team responded to the site. Thequickest way to reach the site was fr
30、om a road near the bottomof the ridge. Those responding to the site fell into two groups:mountain rescue team members and “regular” fire/EMS per-sonnel. Protocols for the fire/EMS personnel required them,when responding to an air crash, to wear full turnout gear andself-contained breathing apparatus
31、, and to carry fire suppres-sion equipment. The standard practice for the mountain rescuewas to carry minimal lightweight equipment, to dress appro-priately for the weather and brush, to drink plenty of fluids, andto pace themselves.5.4.2 The Virginia summer weather was particularly hot andhumid, an
32、d the mountainside very steep. Soon many of thefire/EMS personnel were disabled from heat exhaustion, andone even had to be evacuated. The mountain rescue personnelwere able to handle all necessary extrication and fire suppres-sion with what they had carried and whatever they couldimprovise at the s
33、cene.5.4.3 Survivors were treated appropriately for burns andshock, evacuated and then transported to a local hospital.4U.S. D.O.T. HS 900-025, Course Guide, Emergency Medical Services, FirstResponder Training Course, March 1979. Available from the StandardizationDocuments Order Desk, Bldg. 4, Secti
34、on D, 700 Robbins Ave., Philadelphia, PA191115098. Attn: NPODS.F1655 95 (2013)26. Educational Objectives6.1 Wilderness First Responders shall be trained to performthe following (these objectives do not suggest any specifictraining order):6.1.1 Describe the specific differences between the trainingof
35、 First Responders who practice in the traditional EMSenvironment and those who practice in the wilderness, pro-longed or delayed transport settings where traditional patientcare is not sufficient or appropriate.6.1.2 Recognize the differences in patient care required bypractice in the wilderness, pr
36、olonged or delayed transportsettings.6.1.3 Describe any additional or specialized anatomy orphysiology knowledge required.6.1.4 Identify and demonstrate the management of thefollowing medical problems in the wilderness, delayed orprolonged transport settings:6.1.4.1 Abdominal pain,6.1.4.2 Vomiting,6
37、.1.4.3 Diarrhea,6.1.4.4 Diabetes,6.1.4.5 Seizure disorders,6.1.4.6 Respiratory distress (for example, asthma, altitude),6.1.4.7 Allergies,6.1.4.8 Hypertension,6.1.4.9 Cardiac emergencies, and6.1.4.10 Dental emergencies.6.1.5 Identify and demonstrate the management of illness orinjury related to or c
38、aused by the environment in thewilderness, delayed or prolonged transport settings, includingthe following:6.1.5.1 Altitude (for example, acute mountain sickness, highaltitude pulmonary edema, high altitude cerebral edema, solarradiation),6.1.5.2 Barotrauma,6.1.5.3 Cold (for example, hypothermia, fr
39、ostbite),6.1.5.4 Heat (for example, heat stroke, heat exhaustion,burns),6.1.5.5 Electrical and lightning,6.1.5.6 Exposure to plant or animal (for example, insect,reptile, arachnid, marine) toxins,6.1.5.7 Drowning, near-drowning, and cold waterimmersion, and6.1.5.8 Dehydration.6.1.6 Describe the prop
40、er disinfection of water and identifyand manage illnesses associated with improper water disinfec-tion.6.1.7 Describe and demonstrate the skills needed to manageopen wounds in the wilderness, delayed, or prolonged transportsettings.6.1.8 Describe and demonstrate the skills needed to manageorthopedic
41、 problems in the wilderness, delayed or prolongedtransport settings, including dislocations, fractures, and openfractures.6.1.9 Describe and demonstrate the skills needed to managespinal injuries and associated problems in the wilderness,delayed, or prolonged transport settings.6.1.10 Describe and d
42、emonstrate the skills needed to man-age specific problems associated with cardiorespiratory arrestin the wilderness, delayed, or prolonged transport settings.6.1.11 Describe the uses, side effects, administrationconcerns, and needed authorities for non-prescription andprescription medications in the
43、 wilderness, delayed, or pro-longed transport settings.6.1.12 Describe measures necessary to prevent illness orinjury occurring in the wilderness, delayed, or prolongedtransport settings, including management of immediate stressreactions.6.1.13 Describe specific problems related to rendering carein
44、severe weather, in environmental extremes, when equipmentis not readily available, when access is limited, and when thereis little or no additional assistance.6.1.14 Describe and demonstrate as feasible, clothing,survival, emergency communications and bivouac skills nec-essary in environmental extre
45、mes.6.1.15 Demonstrate patient packaging skills in thewilderness, delayed, or prolonged transport settings.6.1.16 Describe and demonstrate documentation require-ments for recording patient care.6.1.17 Describe any unique or specialized requirements orobligations imposed by the EMS system or other le
46、gal prin-ciples.6.1.18 Describe any medical control requirements and pro-cesses.6.1.19 Describe the principles of disease transmission andbody fluid isolation and demonstrate the use of personalprotection techniques.7. Evaluation7.1 Policies for evaluation, grading, pass/fail criteria, reme-diation
47、and re-education shall be established and distributed toall students.7.2 End of course cognitive and psychomotor evaluationsthat measure the competency of the WFR in the objectives ofthis guide shall be given.8. Keywords8.1 delayed; first responder; pre-hospital; prolonged; wil-dernessF1655 95 (2013
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