1、Designation: F1653 95 (Reapproved 2012)Standard Guide forScope of Performance of Triage in a PrehospitalEnvironment1This standard is issued under the fixed designation F1653; the number immediately following the designation indicates the year oforiginal adoption or, in the case of revision, the year
2、 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.INTRODUCTIONTriage is a word taken from the French verb trier, that means “to sort”. During the time of theNapoleonic wars, a
3、technique for assigning priorities to the treatment of battlefield casualties wasestablished in order to maximize the use of limited resources. The basic principle of triage is to do thegreatest good for the greatest number of casualties. Care is provided first to those with the most seriousemergenc
4、ies and to those who are most salvageable. This technique is identified as essential for gooddisaster medical care.1. Scope1.1 This guide covers minimum requirements for the scopeof performance for individuals who perform triage at anemergency medical incident involving multiple casualties in apre-h
5、ospital environment.1.2 This guide acknowledges objectives based on an indi-viduals required knowledge of signs and symptoms, patientassessment and basic life support.1.3 Operating within the framework of this guide mayexpose personnel to hazardous materials, procedures, andequipment. For additional
6、 information see Practice F1031,Guides F1219, F1253, F1285, F1287, F1288, F1489 andF1651.1.4 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 establish appro-priate safety and health practice
7、s and determine the applica-bility of regulatory limitations prior to use. For specificprecautionary statements, see Footnote 3.22. Referenced Documents2.1 ASTM Standards:3F1031 Practice for Training the Emergency Medical Tech-nician (Basic)F1177 Terminology Relating to Emergency Medical Ser-vicesF1
8、219 Guide for Training the Emergency Medical Techni-cian (Basic) to Perform Patient Initial and Detailed Assess-ment4F1253 Guide for Training the Emergency Medical Techni-cian (Basic) to Perform Patient Secondary Assessment4F1285 Guide for Training the Emergency Medical Techni-cian (Basic) to Perfor
9、m Patient Examination TechniquesF1287 Guide for Scope of Performance of First RespondersWho Provide Emergency Medical CareF1288 Guide for Planning for and Response to a MultipleCasualty IncidentF1489 Guide for Performance of Patient Assessment by theEmergency Medical Technician (Paramedic)4F1651 Gui
10、de for Training the Emergency Medical Techni-cian (Paramedic)3. Terminology3.1 Definitions of 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 Edu
11、cation.Current edition approved July 1, 2012. Published August 2012. Originallyapproved in 1995. Last previous edition approved in 2007 as F1653 95 (2007).DOI: 10.1520/F1653-95R12.2Most recent “Guidelines for Cardiopulmonary Resuscitation and EmergencyCardiac Care,” as reprinted from the Journal of
12、the American Medical Association,available from American Heart Association, 7272 Greenville Ave., Dallas, TX75231.3For 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 th
13、e standards Document Summary page onthe ASTM website.4Withdrawn. The last approved version of this historical standard is referencedon www.astm.org.1Copyright ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.3.1.1 ongoing triage, nthe continuing
14、 process of patientassessment and prioritization in a multiple casualty incident.(Also known as secondary and tertiary).3.1.2 primary triage, nthe initial process of rapid assess-ment, provision of life saving interventions and assignment ofvisual priority identification to each patient in a multipl
15、ecasualty incident.3.1.3 triage, nthe process of sorting and prioritizing careof the sick and injured on the basis of urgency and type ofcondition present, as well as the number of patients andresources available. The objective is to properly treat andtransport patients to medical facilities appropr
16、iately situatedand equipped for their care.3.2 For definitions of other terms used in this guide, refer toTerminology F1177.4. Significance and Use4.1 This guide is not intended to be used by itself, but as acomponent of Guide F1288. Merely conforming to the guide-lines described herein will not ens
17、ure that adequate triage iscarried out in a multiple casualty incident.4.2 The purpose of this guide is to establish a methodologyfor performing triage.4.3 Individuals responsible for performing triage must beproficient in triage methods and related life-saving techniques.4.4 A basic concept of tria
18、ge is to do the greatest good forthe greatest number of casualties.4.5 The assessment process must be focused so as toidentify those most at risk of early death who are likely to besalvaged by rapid medical intervention.4.6 Triage allows the most efficient use of available re-sources.4.7 This guide
19、acknowledges many types of individualswith varying levels of emergency medical training. It alsoestablishes a minimum scope of performance and encouragesthe addition of optional knowledge, skills and attitudinalobjectives.4.8 A vital role in the development of and operationalapplication of triage is
20、 that of medical control. This guideshould be used by medical directors in the determination ofoperational and medical protocols for use during MCIs.4.9 This guide is intended to assist those who are respon-sible for defining the scope of performance of individuals whoperform triage.4.10 For the pur
21、pose of this guide the word “injured”includes both sick or injured patients, or both.5. Objectives5.1 Required ObjectivesThese objectives are in an ordersuggesting a particular performance sequence although somemay be performed concurrently. Some incidents may notrequire performance of all objective
22、s. Individuals who performtriage shall be able to:5.1.1 Identify health and safety hazards and initiate appro-priate actions.5.1.2 Recognize an incident that may require triage.5.1.3 Determine the need for and request additional re-sources.5.1.4 Initiate incident command Guide F1288.5.1.5 Identify c
23、onditions which may dictate a decision totreat patients at the scene or transfer them to a designatedtreatment area.5.1.6 Initiate Primary Triage.5.1.6.1 Identify victims who appear to be uninjured orminimally injured and able to help themselves, and direct themto a designated area of safety.5.1.6.2
24、 Perform a rapid assessment of the remaining vic-tims. Check respiratory status, circulatory status and level ofconsciousness.5.1.6.3 Immediate medical interventions should be limitedto opening the airway and controlling gross hemorrhage. Theseinterventions should not stop the process of triage.5.1.
25、6.4 Assign a triage priority to each victim, including theuninjured, and use a visual marker for individual identification.Patients are placed into the following categories in accordancewith the assessment outcome and in accordance with the localstandard of medical care:(a) First Priority/Immediate
26、(RED)Those patients withserious injuries that are life threatening but have a highprobability of survival.(b) Second Priority/Delayed (YELLOW)Those patientswho are seriously injured and whose lives are not immediatelythreatened. The triage category of these patients may change tofirst priority based
27、 on medical resources at any time during anincident.(c) Third Priority/Minor (GREEN)Those patients whoare injured but do not require immediate medical attention andthose apparently not physically injured.(d) Fourth Priority/Dead/Mortally Wounded (BLACK)Those patients who are obviously dead as determ
28、ined bymedical protocol or those patients with severe injuries and alow probability of survival, despite immediate care. As this isa difficult field decision, actual practice may be to providetreatment and transportation.5.1.6.5 Arrange for transfer of patients based on highestpriority first, to a l
29、ocation where they can receive the appro-priate level of care.5.1.7 Initiate Ongoing Triage.5.1.8 Document triage priority, assessment, treatment ren-dered and patient identification.5.1.9 Continue transferring patients by highest priority asresources become available.5.1.10 Triage is a dynamic proc
30、ess. It will be repeated andperformed as necessary during an event and in other phases ofthe continuum of care.5.2 Optional Objectives:5.2.1 Demonstrate a knowledge of the principles of theIncident Command System (ICS).5.2.2 Describe critical incident stress, its impact on rescuersand the availabili
31、ty of resources.6. Keywords6.1 emergency medical service (EMS); incident commandsystem (ICS); triageF1653 95 (2012)2ASTM 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 a
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34、 If you feel that your comments have not received a fair hearing you shouldmake your 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. Indi
35、vidual 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). Permission rights to photocopy the standard may also be secured from the ASTM website (www.astm.org/COPYRIGHT/).F1653 95 (2012)3
