1、Designation: F 1339 92 (Reapproved 2008)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:2F 1086 Guid
9、e for Structures and Responsibilities of Emer-gency Medical Services Systems OrganizationsF 1149 Practice for Qualifications, Responsibilities, andAuthority of Individuals and Institutions Providing Medi-cal Direction of Emergency Medical ServicesF 1220 Guide for Emergency Medical Services System(EM
10、SS) TelecommunicationsF 1268 Guide for Establishing and Operating a PublicInformation, Education, and Relations Program for Emer-gency Medical Service SystemsF 1285 Guide for Training the Emergency Medical Techni-cian (Basic) to Perform Patient Examination Techniques2.2 American Ambulance Associatio
11、nStandards 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 implemen
12、tingtheir 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:1Th
13、is 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 Feb. 1, 2008. Published March 2008. Originallyapproved in 1992. Last previous edition approved in 2003 as F
14、 1339 92 (2003).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 page onthe ASTM website.3Available from the American Ambulance Associ
15、ation.1Copyright ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.4.1.1 Methods 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 legislatur
16、es staff or clerk offices.4.1.1.2 The legislative liaison, or other appropriate staff ofthe governmental unit housing EMS (its “umbrella”).4.1.1.3 The legal counsel assigned to EMS.4.1.2 Legislative proposals are commonly subject to thefollowing processes:4.1.2.1 DraftingThe standard-setting or othe
17、r 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 this proposaldevelopment.4.1.2.2 SponsorshipThe proposal may be submittedthrough the agencys “umbrella” d
18、epartment 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 legislatorsfor the bill unless the bill is opposed by the administration.Sponsorship might be sought dire
19、ctly 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 for consideration bythe legislature in the umbrella unit and/or legislative counselsoffices. It is the
20、n 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 against the bill, or neutrally. In subse-quent, scheduled work sessions the bill is considered, changedas
21、 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, favorably or otherwise, are then read andvoted on by that body.4.1.2.6 GovernorBills adopted by the leg
22、islature 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 generallybecome law immediately if designated as emergency bills, orsome time after the legislature adjourn
23、s 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 progress reportsgenerated by the legislature or umbrella unit legislative liaisonare useful. A legislative “ho
24、tline” 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 Legislative Process:4.1.4.1 Drafting/Sponsorship Resources may include:(a) Umbrella unit legislative li
25、aison,(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 agencies.4.1.4.2 Formally Required Reviews/Approvals and/or Infor-mal, Politically Expedient, Reviews/Approval
26、s 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 staffs and advisory councils, and(e) EMS, fire, physician, nurse and other organized, activeEMS-related
27、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 members and their aides,(c) Committee staffers and legal counsels, and(d) Sponsors of bill and their aide
28、s.TABLE 1 Levels of OrganizationState RegionalALocalStandard Setting Legislation Regional policies Employment standardsRegulations Regional protocols Operating policiesGuidelines/policies/procedures Assistance re: personnelState protocolsSystem Coordination Statewide coord. and planning System plann
29、ing Daily operationsLicensure/certification ImplementationFacility licensure Inter-organizational coordinationService approval/licensure Regional SMITraining approval Medical audit/QAMIS/QA Operational coordinationInter-regional coord. System evaluationInter-state coord. Personnel authorization accr
30、editationStatewide SMI planningDesign of sub-state structureService Delivery Training Training coordination First responseTechnical assistance Group purchasing Ambulance (BLS, ALS; ground, helicopter, fixed wing)Communications guidelines Technical assistance Hospital servicesFunding PIthese should b
31、e reviewed for consistency with planned stan-dards.4.2.2 Specific Methods and Procedures:4.2.2.1 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 gene
32、ral minimum standards for thesystem as a whole. See 4.1.4.2.2.2 Rules/RegulationsUsed to set 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 cou
33、rse approval); requirements for and terms of operation(usually through licensure or certification) 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 proced
34、ures fordisciplinary actions. This process is governed by the adminis-trative procedures act (“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.
35、2.3 Executive OrderThe Governor may be empow-ered to take actions which have a standard-setting 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 c
36、ould include the personnel licensure/certification application form, procedures for in-state 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 b
37、ut also much less binding upon the EMS systemand its providers. In fact, these are generally 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 d
38、irection is not provided in law, rules, or elsewhere.4.2.2.5 ProtocolsVirtually unique to EMS 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
39、 law by virtue of specific reference in statute(for example, “Treatment shall be in accord with 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 medi
40、cal directors and others.4.2.2.6 Contracts and/or Letters of AgreementGenerallyin return for 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
41、 with agreementon standards for course content or equipment use. Statesgenerally have a standard 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 Legislatio
42、nSee 4.1.4.2.3.2 By Rules/Regulations:(a) Agency staff (drafting),(b) Legal counsel assigned 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 (app
43、roval),(g) Secretary of state (records/announces proposals, certi-fies adopted rules),(h) Legislature (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 (dr
44、afting),(b) Legal counsel assigned to EMS (review),(c) Umbrella unit head/commissioner (cabinet 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 s
45、taff (review), andF 1339 92 (2008)3(c) Consider umbrella unit/advisory council review.4.2.3.5 By Protocols:(a) 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
46、) Agency staff,(b) REMSO (contractor or reviewer),(c) Local system/provider (contractor),(d) 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) Purchas
47、ing/contract review if funding involved.4.3 Enforcement of Minimum Standards:4.3.1 Methods and 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,
48、train-ing approaches, meetings with town and hospital officials andothers with whom the non-complying 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, fro
49、mincidental 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, ExecutiveOrders:(a) General information/education for those affected,(b) Specific verbal/written warnings of potential non-compliance and consequences,(c) Formal investigation by agency. Such investigationsmay le
