1、Designation: F 1616 95 (Reapproved 2002)Standard Guide forScope of Performance of First Responders Who Practice inthe Wilderness or Delayed or Prolonged Transport Settings1This standard is issued under the fixed designation F 1616; the number immediately following the designation indicates the year
2、oforiginal adoption or, in the 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 covers minimum performance requirementsfor fi
3、rst responders who may initially provide care for sick orinjured persons in the specialized pre-hospital situations of thewilderness or delayed or prolonged transport settings, includ-ing catastrophic disasters.1.2 Individuals who will operate in the wilderness or de-layed or prolonged transport set
4、tings need to be aware of thephysical requirements necessary to be able to perform allidentified objectives and necessary skills required for thesetting.1.3 This guide establishes supplemental or continuing edu-cation programs that will be taught to individuals trained to thefirst responder level by
5、 an appropriate authority.1.4 This guide does not establish performance standards foruse in the traditional emergency medical services (EMS) orambulance transportation environment.1.5 This guide does not establish medical protocols; nordoes it authorize invasive procedures without specific authori-z
6、ation and medical control.1.6 Successful completion of a course based on this guidedoes not constitute or imply certification or licensure.1.7 This standard does not purport to address all of thesafety concerns, if any, associated with its use. It is theresponsibility of the user of this standard to
7、 establish appro-priate safety and health practices and determine the applica-bility of regulatory limitations prior to use.2. Referenced Documents2.1 ASTM Standards:F 1177 Terminology Relating to Emergency Medical Ser-vices2F 1287 Guide for Scope of Performance of First RespondersWho Provide Medica
8、l Care2F 1453 Guide for the Training and Evaluation of FirstResponders Who Provide Emergency Medical Care2F 1490 Terminology Relating to Search and Rescue22.2 Code of Federal Regulations:3Title 29, Part 1910.1030, Bloodborne Pathogens2.3 Department of Transportation Document:3U.S. DOT HS 900-25, Cou
9、rse Guide, Emergency MedicalServices: First Responder Training Course, 19793. Terminology3.1 Definitions:3.1.1 accessthe process of reaching the patient/subjectand establishing physical contact.3.1.2 basic life support/cardiopulmonary resuscitation(BLS/CPR)a set of skills that includes airway manage
10、ment,chest compressions, and others as defined by the AmericanHeart Association (AHA).3.1.3 definitive care (see Terminology F 1177)a level oftherapeutic intervention capable of providing comprehensivehealth care services for a specific condition.3.1.4 evacuation (see Terminology F 1490)the processu
11、sed between the time of extraction and transportation.3.1.5 extraction (see Terminology F 1490)the process ofinitial assessment, treatment, stabilization, and packaging ofthe patient/subject as well as removal of the patient/subjectfrom the immediately hazardous environment.3.1.6 first responderan i
12、ndividual trained to meet therequirements of Guide F 1287.3.1.7 transportationthe use of a specially designed ve-hicle to move a patient to a medical facility or definitive carefacility.3.2 Definitions of Terms Specific to This Standard:3.2.1 delayed or prolonged transport settingwhen thetime betwee
13、n patient injury and arrival at a definitive carefacility is greater than 60 min.3.2.2 nontraditional EMS environmentan environmentthat is not readily accessible to a ground ambulance.3.2.3 wilderness first responder (WFR)an individualtrained to meet the requirements of this guide.3.2.4 wilderness s
14、ettingsituations in which the delivery ofpatient care by EMS providers is complicated by one or moreof the following factors: (1) remoteness with respect tologistics and access; (2) a significant delay in the delivery of1This guide is under the jurisdiction of ASTM Committee F30 on EmergencyMedical
15、Services and is the direct responsibility of Subcommittee F30.02 onPersonnel, Training, and Education.Current edition approved Aug. 15, 1995. Published October 1995.2Annual Book of ASTM Standards, Vol 13.02.3Available from Standardization Documents Order Desk, Bldg. 4 Section D, 700Robbins Ave., Phi
16、ladelphia, PA 19111-5098, Attn: NPODS.1Copyright ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.care to the patient; (3) an environment that is physicallystressful to both patients and rescuers; and (4) lack of equip-ment, supplies, and transp
17、ortation.4. Significance and Use4.1 This guide is intended to expand the scope of thepractice of first responders and improve the emergency medicalcare delivered to patients in the wilderness or delayed orprolonged transport settings.4.2 This guide does not suggest a particular performancesequence.4
18、.3 Individuals will be trained initially or concurrently inaccordance with the U.S. DOT HS 900-25, Course Guide, andGuide F 1453.4.4 This guide may be used by individuals who developtraining programs for nontraditional EMS environments.4.5 This guide acknowledges the need for additional orspecific t
19、raining required for the wilderness or delayed orprolonged transport settings.5. Required Objectives5.1 The WFRs shall be able to accomplish the following:5.1.1 Identify specific subjects included within the scope ofGuide F 1287, where traditional patient care is not sufficient orappropriate, due to
20、 a patient being in the wilderness or delayedor prolonged transport settings; and manage such problems inan appropriate manner.5.1.2 Demonstrate a knowledge of anatomy and physiologysufficient to apply emergency care principles to the uniqueproblems found in the wilderness or prolonged or delayedtra
21、nsport settings.5.1.3 Identify and manage the following medical problemsin the wilderness or delayed or prolonged transport settings:5.1.3.1 Abdominal pain,5.1.3.2 Vomiting,5.1.3.3 Diarrhea,5.1.3.4 Diabetes,5.1.3.5 Seizure disorders,5.1.3.6 Respiratory distress (for example, asthma and alti-tude),5.
22、1.3.7 Allergies,5.1.3.8 Hypertension,5.1.3.9 Cardiac emergencies, and5.1.3.10 Dental emergencies.5.1.4 Identify and manage illness or injury related to orcaused by the environment in the wilderness or delayed orprolonged transport settings, including the following:5.1.4.1 Altitude illness (for examp
23、le, acute mountain sick-ness, high-altitude pulmonary edema, and high-altitude cere-bral edema);5.1.4.2 Barotrauma;5.1.4.3 Cold injury (for example, hypothermia and frost-bite);5.1.4.4 Heat illness (heat stroke and heat exhaustion);5.1.4.5 Electrical and lightning injuries;5.1.4.6 Exposure to plant
24、or animal (for example, insect,reptile, arachnid, and marine) toxins;5.1.4.7 Drowning, near-drowning, and cold water immer-sion; and5.1.4.8 Dehydration.5.1.5 Understand the proper disinfection of water, andidentify and manage illnesses associated with improper waterdisinfection.5.1.6 Identify and ma
25、nage open wounds in the wilderness ordelayed or prolonged transport settings.5.1.7 Identify and manage orthopedic problems in the wil-derness or delayed or prolonged transport settings, includingdislocations, fractures, and open fractures.5.1.8 Identify and manage spinal injuries and associatedprobl
26、ems in the wilderness or delayed or prolonged transportsettings.5.1.9 Identify specific problems with managing cardiopul-monary arrest in the wilderness or delayed or prolongedtransport settings.5.1.10 Identify the uses, side effects, and administrationconcerns for nonprescription medications and pr
27、escriptionmedications in the wilderness or delayed or prolonged trans-port settings.5.1.11 Identify measures necessary to prevent illness orinjury in the wilderness or delayed or prolonged transportsettings, including the management of immediate stress reac-tions.5.1.12 Identify unique problems rela
28、ted to rendering care insevere weather, in environmental extremes, when equipment isnot readily available, access is limited, and there is little or noadditional assistance.5.1.13 Identify clothing, survival techniques, emergencycommunications, and bivouac considerations necessary tosurvive in envir
29、onmental extremes.5.1.14 Understand patient packaging in the wilderness ordelayed or prolonged transport settings.5.1.15 Understand the need to document all care provided toany patient.5.1.16 Understand the EMS system and any unique legalaspects related to providing care in the wilderness or prolong
30、edor delayed transport settings.5.1.17 Understand the role of medical control as it relates tothe WFRs practice, including patient care and quality im-provement.5.1.18 Understand and demonstrate familiarity with theprinciples of disease transmission, body fluid isolation, and theuse of personal prot
31、ective equipment.5.1.19 The order of these objectives does not suggest aperformance sequence.6. Keywords6.1 delayed; first responder; prolonged; nontraditional; pre-hospital; wildernessF 1616 95 (2002)2REFERENCES(1) Pre-Hospital Committee, Wilderness Medical Society, “WildernessPre-Hospital Emergenc
32、y Care (WPHEC) Curriculum,” Journal of WildMedicine, Vol 2, No. 2, 1991, pp. 8087.(2) Rural Affairs Committee, National Association of EMS Physicians,“Clinical Guidelines for Delayed/Prolonged Transport: I, Cardiopul-monary Arrest,” Prehospital and Disaster Medicine, Vol 6, No. 3,JulySeptember 1991.
33、(3) Rural Affairs Committee, National Association of EMS Physicians,“Clinical Guidelines for Delayed/Prolonged Transport: II, Disloca-tions,” Prehospital and Disaster Medicine, Vol 8, No. 1, January-March 1993.(4) Rural Affairs Committee, National Association of EMS Physicians,“Clinical Guidelines f
34、or Delayed/Prolonged Transport: III, SpineInjury,” Prehospital and Disaster Medicine, Vol 8, No. 2, AprilJune1993.(5) Rural Affairs Committee, National Association of EMS Physicians,“Clinical Guidelines for Delayed/Prolonged Transport: IV, Wounds,”Prehospital and Disaster Medicine, Vol 8, No. 3, Jul
35、ySeptember1993.(6) Emergency Medical Services: First Responder Training Course, U.S.DOT HS 900-025, Course Guide, March 1979.(7) “Guidelines for Cardiopulmonary Resuscitation and Emergency Car-diac CareRecommendations of the 1992 National Conference,”Journal of the American Medical Association, Vol
36、268, No. 16, Oct.28, 1992, p. 2173.ASTM International takes no position respecting the validity of any patent rights asserted in connection with any item mentionedin this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the risk
37、of infringement of such rights, are entirely their own responsibility.This standard is subject to revision at any time by the responsible technical committee and must be reviewed every five years andif not revised, either reapproved or withdrawn. Your comments are invited either for revision of this
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39、our views known to the ASTM Committee on Standards, at the address shown below.This standard is copyrighted by ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959,United States. Individual reprints (single or multiple copies) of this standard may be obtained by contacting ASTM at the aboveaddress or at 610-832-9585 (phone), 610-832-9555 (fax), or serviceastm.org (e-mail); or through the ASTM website(www.astm.org).F 1616 95 (2002)3
