1、Designation: F 1086 94 (Reapproved 2002)Standard Guide forStructures and Responsibilities of Emergency MedicalServices Systems Organizations1This standard is issued under the fixed designation F 1086; the number immediately following the designation indicates the year oforiginal adoption or, in the
2、case of revision, the year of last revision. A number in parentheses indicates the year of last reapproval. Asuperscript epsilon (e) indicates an editorial change since the last revision or reapproval.1. Scope1.1 This guide establishes optimum guidelines for the struc-tures and responsibilities that
3、 will facilitate development,delivery, and assessment of Emergency Medical Services(EMS) on state, regional, and local levels.1.1.1 State LevelAt the state level, this guide sets forth abasic structure for the organization and management of a stateemergency medical services program and outlines the
4、respon-sibilities of the state in the planning, development, coordina-tion, and regulation of emergency medical services throughoutthe state.1.1.2 Regional LevelAt the regional level, this guideaddresses the planning, development, and coordination of afunctional and comprehensive EMS system which co
5、nsists ofall personnel, equipment, and facilities necessary for theresponse to the emergently ill or injured patient, according tonational and state lead agency standards.1.1.3 Local LevelAt the local level, this guide sets forth abasic structure for the organization and management of a localEMS sys
6、tem and outlines the responsibilities that a local EMSshould assume in the planning, development, implementation,and evaluating of its EMS system.2. Significance and Use2.1 This guide is not meant to mandate a specific structureor responsibility at the various levels but rather to suggest ameans or
7、method that will allow for the creation or furtherdevelopment of a state, regional, or local EMS system.2.2 This guide will assist state, regional, or local organiza-tions in establishing EMS systems or refining existing EMSsystems.3. Descriptions of EMS Systems3.1 State EMS SystemA state EMS system
8、 includes all ofthe components of all EMS systems within the state, however,particular emphasis is placed upon the following:3.1.1 Legislation establishing authority and responsibilityfor EMS systems.3.1.2 Development and enforcement of minimum regula-tions and standards.3.1.3 Development and dissem
9、ination of a statewide planand goals for EMS systems.3.1.4 Provision of technical assistance.3.1.5 Funds for the development, maintenance, and en-hancement of EMS systems.3.1.6 Supportive components, including training, communi-cations systems, record keeping and evaluation, public educa-tion, and a
10、cute care center designation.3.1.7 Overall coordination of EMS programs within thestate and in concert with other states or federal authorities asneeded.3.2 Regional EMS SystemA recommended method ofstructuring substate EMS systems to provide for EMS plan-ning, development, and coordination is to de
11、lineate specificgeographic areas within which one organization is designatedas responsible for the arrangement of personnel, facilities, andequipment for the effective, coordinated, and expeditiousdelivery of health care services in a region (3.2.1) underemergency conditions occurring as a result of
12、 the patientscondition or because of accidents, natural disasters, or similarsituations.3.2.1 RegionTo implement a regional EMS system, thestate lead agency will identify the geographic or demographicarea that is a natural catchment area for EMS provision formost, if not all, patients in the designa
13、ted area. Since thiscannot be a perfect definition from an EMS delivery point ofview, administrative and coordinating efficiency considerationswill have to be made in establishing boundaries. The state leadagency should determine and define the substate structure forplanning, coordination, and provi
14、sion of emergency medicalservices. When a regional EMS system lies near a state bordersuch that appropriate and efficient care of patients will requirecooperation of prehospital system in another state and medicalcenters in another state, the state lead agency will develop aplan with the adjoining s
15、tate lead agency. This plan mustprovide for the triage and transfer of patients across the stateborder under supervision of the REMSO.3.2.2 Regional EMS Organization (REMSO)A REMSO isa staffed organization responsible and accountable to the state1This guide is under the jurisdiction of ASTM Committe
16、e F30 on EmergencyMedical Services and is the direct responsibility of Subcommittee F30.03 onOrganization/Management.Current edition approved Oct. 15, 1994. Published December 1994. Originallypublished as F 1086 87. Last previous edition F 1086 87.1Copyright ASTM International, 100 Barr Harbor Drive
17、, PO Box C700, West Conshohocken, PA 19428-2959, United States.EMS lead agency for coordinating the system in a regionincluding system operations, and organization and coordina-tion of resources. A REMSO should have a medical directorand other technical expertise in order to provide the necessaryass
18、istance to its EMS system. A REMSO should work on aregional or subregional basis in liaison with professionalsocieties, public safety, other governmental agencies, localEMS systems, and legislative bodies to establish standards andprogram policies for continued system improvement.3.2.2.1 The REMSO s
19、hould be a substate unit of govern-ment or a private entity that may be single or multi-jurisdictional. The REMSO should have the capacity andauthority to receive and disburse public and private funds andmust be designated by the state EMS lead agency.3.3 Local EMS SystemThe local EMS system may beo
20、rganized as a community EMS council and should include allprovider groups, private and public, involved in EMS deliveryincluding ambulance or rescue services, hospitals or hospitalcouncils, psychosocial services, local boards of health, policeand fire departments, other related governmental and quas
21、i-governmental or political subdivisional bodies, and consumers.3.3.1 The local EMS system must have linkages to substateand state EMS systems.3.3.2 The local EMS system should be in compliance withlocal ordinances and state and federal laws that govern EMSdelivery.4. Standardization4.1 Standard set
22、ting is a major component of the state EMSsystem operation. This includes, but is not limited to:4.1.1 Legislation.4.1.2 Regulations.4.1.3 Guidelines.4.1.4 Licensure.4.1.5 Training.4.1.6 Certification.4.1.7 Data collection and evaluation.5. System Coordination5.1 System coordination is a function of
23、 the state EMSsystem but may be delegated to a regional EMS organization(REMSO). System coordination includes, but is not limited to:5.1.1 Regional system planning.5.1.2 Operational coordination at a regional level.5.1.3 Regional data collection and processing.5.1.4 Evaluation.5.1.5 Continuing educa
24、tion.5.1.6 Coordination of mass casualty incident response.NOTE 1If there are no regional organizations within the state, the stateEMS will need to accomplish these tasks.6. Service Delivery6.1 Service delivery is the major component of local EMSsystems. Realizing that patient care is the ultimate g
25、oal of EMSsystems, service delivery includes, but is not limited to:6.1.1 Public information and education.6.1.2 Notification.6.1.3 Dispatch.6.1.4 First response.6.1.5 BLS/ALS ambulance.6.1.6 Air transport.6.1.7 Medical facilities.6.1.8 Psycho-social services.6.1.9 Evaluation and quality assurance.7
26、. State EMS System Structure7.1 Agency OrganizationEach state should have a singleagency with overall responsibility for the states role inemergency medical services.7.1.1 Organizationally, this agency should be located in thestate government structure such that it reflects the programshealth orient
27、ation.7.1.2 The agency should have a representative advisorycouncil, commission, or board to provide advice to the execu-tive and legislative branches on policies, procedures, programsand funding for emergency medical services statewide. Alter-natively, the agency may have a board with the authority
28、 toadopt or approve rules and regulations. Such a body shouldalso serve as a mechanism for obtaining public support andparticipation in the program.7.2 PersonnelThe agency should have adequate manage-rial, technical, and clerical staff to carry out its responsibilities.7.2.1 There should be a design
29、ated director who is afull-time employee of the state.7.2.2 If the director is not a physician, there should be amedical director who serves at least on a part-time basis,depending on the needs of the program.7.3 Legislation:7.3.1 There should be comprehensive legislation that estab-lishes the EMS p
30、rogram, outlines its basic responsibilities, andprovides the authority necessary to effectively carry out theseresponsibilities.7.3.2 There should be legislation authorizing the establish-ment of minimum standards for emergency medical services inthe state.7.3.3 There should be legislation specifyin
31、g penalties fornoncompliance with the established minimum standards.7.3.4 There should be legislation to provide funding for theEMS program.7.4 Substate Structure:7.4.1 The state EMS agency should determine and definethe substate framework for the planning, coordination, andprovision of emergency me
32、dical services. This guide suggeststhat certain responsibilities, authority, and accountability maybe delegated to regional and local EMS systems. Althoughspecific suggestions are offered in this guide, the intent is toallow flexibility in configuring state and substate structures tomeet the functio
33、nal needs of the system.7.4.2 The state should designate the regional boundaries, theregional EMS organization within each region, and the re-gional organizations responsibilities, authority, accountability,and provisions for servicing the EMS needs of its constituentstate political subdivisions. Wh
34、en a REMSO falls near theborder of another state it is essential that the state lead agencydevelop a plan with the bordering states lead agency so thatthe regional EMS system can triage and transfer patients acrossthe border as required by the patients condition.7.4.3 If local EMS systems have a “co
35、uncil” or similarF 10862organizational structure, the state should have appropriatecommunication channels to apprise them and the regional EMSsystems of relevant information.8. State EMS System Responsibilities8.1 Regulatory:8.1.1 The state should have the authority and responsibilityfor establishin
36、g minimum standards for the essential elementsof the EMS system.8.1.2 The state EMS agency should ensure that ambulanceservices are licensed and certified, that vehicles and equipmentare inspected, and that ambulance personnel are licensed andcertified.8.1.3 The state EMS agency should have the resp
37、onsibilityto enforce the regulations, including the authority to takeappropriate action to revoke or suspend the license or certifi-cation of those not in compliance. Revocation and suspensionprocedures should afford all litigants due process and providefor appeal.8.2 Planning and Standard Developme
38、nt:8.2.1 The state EMS agency should develop and dissemi-nate a state EMS plan that does the following:8.2.1.1 Describes the structure and framework for the de-velopment of EMS on a statewide basis.8.2.1.2 Describes the current status of EMS and identifiesstatewide needs and priorities.8.2.1.3 Outli
39、nes statewide goals for emergency medicalservices.8.2.1.4 Is reviewed in accordance with the review cycle ofthe state health plan and with appropriate revisions made.8.2.1.5 Is coordinated with the health planning agency andis integrated into the overall state health plan.8.2.1.6 Is coordinated with
40、 the state emergency manage-ment agency and integrated where appropriate into the stateemergency operations plan.8.2.2 The state EMS agency should establish standards andguidelines for the development of EMS systems which:8.2.2.1 Address all components of an EMS system. Thesecomponents include but a
41、re not limited to: transportation,planning, critical care system development, evaluation, publicinformation and education, training, certification, medical con-trol, communications, mass casualty care, and others referredto within this guide.8.2.2.2 Address the needs of patients in the followingclin
42、ical target groups: behavior, burns, cardiac emergencies,obstetrical/perinatal emergencies, neonatal/pediatric emergen-cies, poisoning, head and spinal cord injuries, trauma, andother medical emergencies.8.2.2.3 Identify the responsibilities of the various entitiesand levels of government involved i
43、n the system.8.3 Technical AssistanceThe state EMS agency shouldprovide technical assistance to local units of government, EMSproviders, and to the REMSOs. This should include, but not belimited to, the following:8.3.1 Developing guidelines, model procedures, manuals,etc.8.3.2 Serving as a clearingh
44、ouse and referral center forinformation.8.3.3 Consulting with public officials, hospital administra-tors, ambulance service directors, EMS medical directors, etc.8.3.4 Centralize EMS statistical data processing and provideactivity reports to EMS providers and organizations involvedin the provision a
45、nd coordination of EMS.8.4 FundingThe state government should provide fundsto support the development, maintenance, and enhancement ofemergency medical services systems including, but not limitedto, the following:8.4.1 Administrative and programmatic support of the stateEMS agency.8.4.2 Administrati
46、ve and programmatic support of regionalEMS organizations (REMSOs) in the form of direct funding orfacilitation of other funding.8.4.3 Grants to local EMS systems (or community EMScouncils), ambulance providers, local governments, hospitals,and other appropriate agencies for improvement of the EMSsys
47、tem if such funds are available.8.5 ProgramsThe state EMS agency should establishand/or operate supportive statewide programs for the develop-ment of emergency medical services to include, but notnecessarily be limited to, the following:8.5.1 Programs for the training and certification of prehos-pit
48、al EMS personnel.8.5.2 Programs for planning, developing, and coordinatingEMS communication systems. This should include citizenaccess, coordination, dispatch, and medical command/control.8.5.3 Programs for the evaluation of the system includingthe establishment of an EMS patient record keeping syst
49、emwith, at a minimum, a standard run form or data set; thecollection and tabulation of general statistics; and the devel-opment of programs to monitor, evaluate and outline definitiveaction steps to ensure optimal systems integrity of substate(regional) and local EMS systems.8.5.4 Programs of statewide public education (PE) includ-ing the development of PE materials of importance to thecitizens and EMS providers of the state.8.5.5 Programs for application for designation as special-ized acute care (trauma, burns, poison, pediatrics, etc.) centers,as necessary, to in
