1、Designation: F 1654 95 (Reapproved 2007)Standard Guide forTraining and Evaluation of Individuals Who are Responsiblefor or Perform Triage in a Prehospital Environment1This standard is issued under the fixed designation F 1654; the number immediately following the designation indicates the year ofori
2、ginal 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 requirements for the train-ing and
3、evaluation of individuals who perform triage at anemergency medical incident involving multiple casualties in aprehospital environment.1.2 All training will be in accordance with Guide F 1653.1.3 Included in this guide is a standard for knowledge andskill evaluation.1.4 Operating within the framewor
4、k of this guide mayexpose personnel to hazardous materials, procedures andequipment. For additional information see Practice F 1031 andGuides F 1219, F 1253, F 1285, F 1288, F 1453 and F 1489.1.5 This standard does not purport to address all of thesafety concerns, if any, associated with its use. It
5、 is theresponsibility of the user of this standard to establish appro-priate safety and health practices and determine the applica-bility of regulatory limitations prior to use. For specificprecautionary statements, see the document cited in Footnote 3.2. Referenced Documents2.1 ASTM Standards:2F 10
6、31 Practice for Training the Emergency Medical Tech-nician (Basic)3F 1177 Terminology Relating to Emergency Medical Ser-vicesF 1219 Guide for Training the Emergency Medical Techni-cian (Basic) to Perform Patient Initial and Detailed Assess-ment4F 1253 Guide for Training the Emergency Medical Techni-
7、cian (Basic) to Perform Patient Secondary Assessment4F 1285 Guide for Training the Emergency Medical Techni-cian (Basic) to Perform Patient Examination TechniquesF 1288 Guide for Planning for and Response to a MultipleCasualty IncidentF 1453 Guide for Training and Evaluation of First Respond-ers Who
8、 Provide Emergency Medical CareF 1489 Guide for Performance of PatientAssessment by theEmergency Medical Technician (Paramedic)4F 1653 Guide for Scope of Performance of Triage in aPrehospital Environment3. Terminology3.1 Definitions of Terms Specific to This Standard:3.1.1 first priority/immediate (
9、RED)those patients withserious injuries that are life threatening but have a highprobability of survival.3.1.2 fourth priority/dead/mortally wounded (BLACK)Those patients who are obviously dead as determined by localmedical protocol or those patients with severe injuries and alow probability of surv
10、ival, despite immediate care.3.1.3 injured, adjmeans both sick and injured patients.3.1.4 ongoing triage, nthe continuing process of patientassessment and prioritization in a multiple casualty incident.(Also known as secondary and tertiary.)3.1.5 primary triage, nthe initial process of rapid assess-
11、ment, provision of life saving interventions and assignment ofvisual priority identification to each patient in a multiplecasualty incident.3.1.6 second priority/delayed (YELLOW)those patientswho are seriously injured and whose lives are not immediatelythreatened.1This guide is under the jurisdictio
12、n of ASTM Committee F30 on EmergencyMedical Services and is the direct responsibility of Subcommittee F30.02 onPersonnel, Training and Education.Current edition approved Feb. 1, 2007. Published February 2007. Originallyapproved in 1995. Last previous edition approved in 2002 as F 1654 95(2002).2For
13、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.3Most recent “Standards and Guidelines for Cardiopulmonary Resusci
14、tation andEmergency Cardiac Care” as reprinted from the Journal of the American MedicalAssociation, available from American Heart Association, 7272 Greenville Ave.,Dallas, TX 75231.4Withdrawn.1Copyright ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United
15、States.3.1.7 third priority/minor (GREEN)those patients whoare injured but do not require immediate medical attention andthose apparently not physically injured.3.1.8 triage, nthe process of sorting and prioritizingemergency medical care of the sick and injured on the basis ofurgency and type of con
16、dition present as well as the number ofpatients and resources.3.2 For definitions of other terms used in this guide, refer toTerminology F 1177.4. Significance and Use4.1 This guide is intended for use by those responsible forthe development and implementation of training programs, thatinclude compe
17、tency evaluation, for triage in the prehospitalenvironment.4.2 This guide is not intended to be used by itself, but as acomponent of Guide F 1288.4.3 This guide acknowledges many types of individualswith varying levels of emergency medical training. It alsoestablishes a minimum training standard and
18、 encourages theaddition of optional knowledge, skill, and attitudinal objec-tives.4.4 A vital role in the development and operational appli-cation of triage is that of medical control. This guide should beused by medical directors in the determination of operationaland medical protocols for use duri
19、ng MCIs and coordinatedwith those who are responsible for training.4.5 At the beginning of the program, students shall beinformed of the course objectives and requirements for suc-cessful completion.5. Required Performance Objectives5.1 Individuals who are responsible for, or perform triage in,the p
20、re-hospital environment shall be trained in the followingskills. These objectives are listed in a suggested instructionaland performance order, although some may be performedconcurrently. Some incidents may not require performance ofall objectives.5.1.1 Health and Safety HazardsDescribe the presence
21、 ofconditions or situations and actions to be taken when thereexists a potential hazard to rescuers, victims, or bystanders.5.1.2 Incident RecognitionDescribe the elements of amultiple-casualty incident that may require utilization of triageskills.5.1.2.1 Describe a multiple casualty incident,5.1.2.
22、2 Describe why, when resources are limited, thegreater may be served by obtaining additional resources, andmanaging existing resources, rather than providing patient careimmediately,5.1.2.3 Define triage, and5.1.2.4 Describe the general principles of providing triage.5.1.3 Resources:5.1.3.1 Describe
23、 the concept of triage of doing the greatestgood for the greatest number of casualties.5.1.3.2 Describe existing and potential incident conditionsand situations under which additional resources are needed butmay or may not be available.5.1.3.3 Describe methods for requesting needed resources.5.1.4 I
24、ncident ManagementDescribe the methods forimplementation of the local emergency incident managementsystem as it relates to multi-casualty events.5.1.5 Medical ControlDescribe the role and responsibili-ties of medical control during an MCI, the application ofprotocols and the use of standing orders,
25、on-scene, or on-linemedical control.5.1.6 Primary Triage:5.1.6.1 Demonstrate the method(s) to identify victims whoappear to be uninjured or minimally injured and able to helpthemselves.5.1.6.2 Describe methods to identify safe areas for theplacement of patients.5.1.6.3 Demonstrate methods for direct
26、ing uninjured orminimally injured victims to a designated area(s).5.1.6.4 Describe the performance of a rapid assessment ofremaining victim(s).(a) Demonstrate method(s) to assess respiratory status.(b) Demonstrate method(s) to assess circulatory status.(c) Demonstrate method(s) to assess level of co
27、nscious-ness.5.1.6.5 Describe methods for performing immediate lifesaving aid without stopping the triage process.(a) Demonstrate method(s) for opening and maintainingan airway.(b) Demonstrate method(s) for controlling gross hemor-rhage.5.1.6.6 Describe methods for assigning a triage priority toeach
28、 victim, including the uninjured.(a) Define triage priorities.(b) Demonstrate methods to visually identify each victimbased on their individual triage priority.5.1.6.7 Describe the categories of triage and their applica-tion in identifying patient priorities in an MCI.5.1.6.8 Describe methods to tra
29、nsfer patients based upontriage priority and transport capability and availability. Thismay need to be accomplished several times on and off site untildefinitive care is provided.5.1.7 Ongoing Triage:5.1.7.1 Describe the purpose of ongoing triage.5.1.7.2 Demonstrate methods for reassessing patients
30、andrevising triage priorities when required.5.1.7.3 Describe conditions or situations which may dictatea decision to either treat patients at the scene, transfer them toa designated treatment area or a definitive care facility.5.1.7.4 Describe the resources needed to provide patientcare at the scene
31、.5.1.7.5 Describe the rationale for the continued assessmentand treatment of patients.5.1.7.6 Describe essential elements of patient information tobe documented for maintaining incident status to include triagepriority, assessment, treatment rendered, and patient identifi-cation.5.1.7.7 Describe met
32、hods to transport patients based upontriage priority and transport capability.5.1.7.8 Describe methods to communicate patient informa-tion.F 1654 95 (2007)25.2 Optional ObjectivesDescribe the principles of theIncident Command System (ICS).6. Evaluation6.1 A method to evaluate the students knowledge
33、andperformance of these objectives shall be established.6.2 There shall be a method for remediation.7. Keywords7.1 emergency medical service (EMS); incident commandsystem (ICS); triageASTM International takes no position respecting the validity of any patent rights asserted in connection with any it
34、em mentionedin this standard. Users of this standard are expressly advised that determination of the validity of any such patent rights, and the riskof infringement of such rights, are entirely their own responsibility.This standard is subject to revision at any time by the responsible technical com
35、mittee and must be reviewed every five years andif not revised, either reapproved or withdrawn. Your comments are invited either for revision of this standard or for additional standardsand should be addressed to ASTM International Headquarters. Your comments will receive careful consideration at a
36、meeting of theresponsible technical committee, which you may attend. 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 Driv
37、e, 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 1654 95 (2007)3
