1、Designation: F 1339 92 (Reapproved 2003)Standard Guide forOrganization and Operation of Emergency Medical ServicesSystems1This standard is issued under the fixed designation F 1339; the number immediately following the designation indicates the year oforiginal adoption or, in the case of revision, t
2、he 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 standard established guidelines for the organizationand operation of Emergency Medical Services Syste
3、ms(EMSS) at the state, regional and local levels. This guide willidentify methods of developing state standards, coordinating/managing regional EMS Systems, and delivering emergencymedical services through the local EMS System.1.1.1 At the state level this guide identifies scope, methods,procedures
4、and participants in the following state structureresponsibilities: (a) establishment of EMS legislation; (b)development of minimum standards; (c) enforcement of mini-mum standards; (d) designation of substate structure; (e)provision of technical assistance; (f) identification of fundingand other res
5、ources for the development, maintenance, andenhancement of EMS systems; (g) development and imple-mentation of training systems; (h) development and implemen-tation of communication systems; (i) development and imple-mentation of record-keeping and evaluation systems; (j)development and implementati
6、on of public information, publiceducation, and public relations programs; (k) development andimplementation of acute care center designation; (l) develop-ment and implementation of a disaster medical system; (m)overall coordination of EMS and related programs within thestate and in concert with othe
7、r states or federal authorities.1.2 At the regional level, this guide identifies methods ofplanning, implementing, coordinating/managing, and evaluat-ing the emergency medical services system which exists withina natural catchment area and provides guidance on the use ofthese methods.1.3 At the loca
8、l level, this guide identifies a basic structurefor the organization and management of a local EMS systemand outlines the responsibilities that a local EMS shouldassume in the planning, development, implementation andevaluation of its EMS system.2. Referenced Documents2.1 ASTM Standards:F 1086 Guide
9、 for Structures and Responsibilities of Emer-gency Medical Services Organizations2F 1149 Practice for Qualifications, Responsibilities, andAuthority for Individuals and Institutions Providing Medi-cal Direction of Emergency Medical Services2F 1220 Guide for Emergency Medical Services System(EMSS) Te
10、lecommunications2F 1268 Guide for Establishing and Operating Public Infor-mation, Education and Relations Programs for EmergencyMedical Services Systems2F 1285 Guide for Training the Emergency Medical Techni-cian (Basic) to Perform Patient Examination Techniques22.2 American Ambulance AssociationSta
11、ndards and Accreditation Document33. Significance and Use3.1 This guide suggests methods for organizing and operat-ing state, regional, and local EMS systems, in accordance withGuide F 1086. It will assist state, regional, or local organiza-tions in assessing, planning, documenting, and implementing
12、their specific operations. The guide is general in nature andable to be adapted for existing EMS Systems. For organiza-tions that are establishing EMS System operations, the guide isspecific enough to form the basis of the operational manual.4. State Guide4.1 Establishment of EMS Legislation:4.1.1 M
13、ethods and ProceduresThe legislative processvaries from state to state. The EMS lead agency should seek adescription of the process in its state from:4.1.1.1 The legislatures staff or clerk offices.4.1.1.2 The legislative liaison, or other appropriate staff ofthe governmental unit housing EMS (its “
14、umbrella”).4.1.1.3 The legal counsel assigned to EMS.1This guide is under the jurisdiction of ASTM Committee F30 on EmergencyMedical Services and is the direct responsibility of Subcommittee F30.03 onOrganization/Management.Current edition approved Sept. 10, 2003. Published October 2003. Originallya
15、pproved in 1992. Last previous edition approved in 1998 as F 1339 92 (1998).2Annual Book of ASTM Standards, Vol 13.02.3Available from the American Ambulance Association.1Copyright ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.4.1.2 Legislativ
16、e proposals are commonly subject to thefollowing processes:4.1.2.1 DraftingThe standard-setting or other goal is putinto general form by the agency, citing the sections of statute itbelieves are affected. The entities listed in 4.1.1-4.1.1.3 may bea resource, or may be required to be involved, in th
17、is proposaldevelopment.4.1.2.2 SponsorshipThe proposal may be submittedthrough the agencys “umbrella” department to become anofficial part of the administrations legislative initiative.Whether this is true or not, the umbrellas legislative liaisonwill generally seek the sponsorship of appropriate le
18、gislatorsfor the bill unless the bill is opposed by the administration.Sponsorship might be sought directly by the agency or by thirdparties on the agencys behalf under certain circumstanceswhere practical.4.1.2.3 Final Drafting and IntroductionThe bill may bedrafted in the form technically required
19、 for consideration bythe legislature in the umbrella unit and/or legislative counselsoffices. It is then read in the legislature and generally referredto a committee.4.1.2.4 Committee ConsiderationThe committee usuallyholds a public hearing at which the agency and others maytestify in favor of or ag
20、ainst the bill, or neutrally. In subse-quent, scheduled work sessions the bill is considered, changedas necessary, and some action usually voted. Agency andlobbyist attendance at work sessions is common and ofteninfluential.4.1.2.5 Adoption/RejectionBills voted out to the legisla-ture by committee,
21、favorably or otherwise, are then read andvoted on by that body.4.1.2.6 GovernorBills adopted by the legislature may besigned, not signed (but not vetoed), or vetoed by the governor.Bills that are vetoed may be returned to the legislature toattempt to override the veto. Bills that are not vetoed gene
22、rallybecome law immediately if designated as emergency bills, orsome time after the legislature adjourns as prescribed by law.4.1.3 The timing of legislative proposal submissions, andthe tracking of their progress to assure agency input are criticalto their success. Hearing announcements and progres
23、s reportsgenerated by the legislature or umbrella unit legislative liaisonare useful. A legislative “hotline” is also commonly availableand of use in tracking bills but personal contact with legislativeaides and/or committee staff and legal counsels are even moreuseful.4.1.4 Participants in the EMS
24、Legislative Process:4.1.4.1 Drafting/Sponsorship Resources may include:(a) Umbrella unit legislative liaison,(b) Assistant attorney general assigned to EMS,(c) Legislators/aides to legislators,(d) Staff/legal counsel to committee likely to consider bill,and(e) Agency staff, or staff of other agencie
25、s.4.1.4.2 Formally Required Reviews/Approvals and/or Infor-mal, Politically Expedient, Reviews/Approvals may be soughtfrom:(a) Umbrella unit commissioner/head (cabinet level),(b) Other agency heads with any potential interest,(c) State EMS and other advisory boards with potentialinterest,(d) REMSO s
26、taffs and advisory councils, and(e) EMS, fire, physician, nurse and other organized, activeEMS-related professional associations.4.1.4.3 Resources for Monitoring Legislative Progress:(a) Legislature staff/clerk offices and their publications (forexample, hearing notices) and hotline,(b) Committee me
27、mbers and their aides,(c) Committee staffers and legal counsels, and(d) Sponsors of bill and their aides.4.1.4.4 Public Hearing Testimony Resources:(a) Those listed in 4.1.4.1, a to e, (sponsoring), 4.1.4.2, ato e, (review/approval), and 4.1.4.3, a to d, (monitoring),(b) Hospital/prehospital personn
28、el, and(c) Consumers.4.1.4.5 Governors Offce Resources:(a) Umbrella unit commissioner/head (cabinet level),(b) Aides to Governor (if known and appropriate), and(c) Legislators and aides with links to Governor.TABLE 1 Levels of OrganizationState RegionalALocalStandard Setting Legislation Regional pol
29、icies Employment standardsRegulations Regional protocols Operating policiesGuidelines/policies/procedures Assistance re: personnelState protocolsSystem Coordination Statewide coord. and planning System planning Daily operationsLicensure/certification ImplementationFacility licensure Inter-organizati
30、onal coordinationService approval/licensure Regional SMITraining approval Medical audit/QAMIS/QA Operational coordinationInter-regional coord. System evaluationInter-state coord. Personnel authorization accreditationStatewide SMI planningDesign of sub-state structureService Delivery Training Trainin
31、g coordination First responseTechnical assistance Group purchasing Ambulance (BLS, ALS; ground, helicopter, fixed wing)Communications guidelines Technical assistance Hospital servicesFunding PIthese should be reviewed for consistency with planned stan-dards.4.2.2 Specific Methods and Procedures:4.2.
32、2.1 LegislationUsed for setting broad, legally-bindingstandards. Sets the responsibilities of the state, regional, andlocal EMS structures; defines areas of rule or regulation-making authority, and sets general minimum standards for thesystem as a whole. See 4.1.4.2.2.2 Rules/RegulationsUsed to set
33、more specific stan-dards for system design and operation including, but notlimited to, the interaction of state, regional, and local EMSstructures in provider operation (for example, licensure, train-ing course approval); requirements for and terms of operation(usually through licensure or certifica
34、tion) for EMS personnel,vehicles, equipment and services; organization of EMS train-ing for certification or licensure; organization of certification orlicensure testing; scope of practice; causes and procedures fordisciplinary actions. This process is governed by the adminis-trative procedures act
35、(“APA”) of the state and generallyrequires the EMS rule-making authority to publish notices andhold hearings on proposed changes. Consult the states APAand discuss with the legal counsel assigned to EMS.4.2.2.3 Executive OrderThe Governor may be empow-ered to take actions which have a standard-setti
36、ng impact.Consult the legal counsel assigned to EMS or the Governorsstaff.4.2.2.4 Policies/ProceduresUsed by the state agency togovern the details of its operations and interactions withproviders. Examples could include the personnel licensure/certification application form, procedures for in-state
37、grantprograms, or a policy for the administration of state licensureexaminations. These are generally created outside of legislativeor rule-making arenas. This makes them easier to create thanlaws or rules but also much less binding upon the EMS systemand its providers. In fact, these are generally
38、not considered tobe legally binding. They are useful, though, in defining andclarifying required licensure/certification processes for provid-ers and in providing immediate direction to providers wheresuch direction is not provided in law, rules, or elsewhere.4.2.2.5 ProtocolsVirtually unique to EMS
39、 in their re-gional or statewide application, treatment protocols may beused to set clinical and operational standards and to definescope of practice. Protocols are most effective when they aregiven power of law by virtue of specific reference in statute(for example, “Treatment shall be in accord wi
40、th protocolsestablished by the medical director of the state (or regional)EMS agency.”). Protocol-development may require aconsensus-building process among the states medical advisorycommittee, regional medical directors and others.4.2.2.6 Contracts and/or Letters of AgreementGenerallyin return for
41、funding or other resources, regional and localstructures and providers may agree to certain standards ofperformance. For example, state funding of training courses orambulance equipment items may be afforded with agreementon standards for course content or equipment use. Statesgenerally have a stand
42、ard process and forms for contracts andgrants. Consult the purchasing and/or contracts office or legalcounsel assigned to EMS.4.2.3 Participants in the Development of Minimum Stan-dards:4.2.3.1 By LegislationSee 4.1.4.2.3.2 By Rules/Regulations:(a) Agency staff (drafting),(b) Legal counsel assigned
43、to EMS (review),(c) REMSO staffs/advisory councils/committees (review),(d) State advisory council/committees (review),(e) State EMS-related professional associations (review),(f) Impartial legal counsel (approval),(g) Secretary of state (records/announces proposals, certi-fies adopted rules),(h) Leg
44、islature (subject to review),(i) Umbrella unit staff and head (review/approval unlessEMS agency has own rule-making authority), and(j) Providers/general public.4.2.3.3 By Executive Order:(a) Agency staff (drafting),(b) Legal counsel assigned to EMS (review),(c) Umbrella unit head/commissioner (cabin
45、et level),(d) Governor; governors staff,(e) State advisory council/committees,(f) Consider those listed in 4.2.3.2 for review.4.2.3.4 By Policies/Procedures:(a) Agency staff (drafting and review),(b) REMSO staff (review), and(c) Consider umbrella unit/advisory council review.4.2.3.5 By Protocols:(a)
46、 Agency staff,(b) REMSO staff,(c) State/regional medical directors and medical advisoryboards, and(d) Consider those listed in 4.2.2.2 for review.4.2.3.6 By Contracts/Letters of Agreement:(a) Agency staff,F 1339 92 (2003)3(b) REMSO (contractor or reviewer),(c) Local system/provider (contractor),(d)
47、Legal counsel assigned to EMS,(e) Consider umbrella unit/advisory council review,(f) Impartial legal counsel for contract approval,(g) Budget office if funding involved (approval/encumbrance), and(h) Purchasing/contract review if funding involved.4.3 Enforcement of Minimum Standards:4.3.1 Methods an
48、d ProceduresEnforcement may be ac-complished in a variety of formal and informal ways. The moreformal methods are discussed below, however, it is worthconsidering informal means (for example, peer pressure, train-ing approaches, meetings with town and hospital officials andothers with whom the non-c
49、omplying individual or organiza-tion routinely interacts). If formal methods of enforcement areused, due process should be ensured. The need to enforce maybe discovered when a specific complaint is made, fromincidental information derived from the media and othersources, from routine quality assurance processes, fromservice/vehicle inspections, and from the EMS managementinformation system when it is used to link training, licensure,and run/patient reporting to monitor compliance with licensurerequirements.4.3.1.1 Of Enforcing Laws, Rules or Regulations, Execu
