1、Designation: F1654 95 (Reapproved 2012)Standard Guide forTraining and Evaluation of Individuals Who are Responsiblefor or Perform Triage in a Prehospital Environment1This standard is issued under the fixed designation F1654; the number immediately following the designation indicates the year oforigi
2、nal adoption or, in the case of revision, the year 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.1. Scope1.1 This guide covers minimum requirements for the train-ing and eva
3、luation 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 F1653.1.3 Included in this guide is a standard for knowledge andskill evaluation.1.4 Operating within the framework of
4、 this guide mayexpose personnel to hazardous materials, procedures andequipment. For additional information see Practice F1031 andGuides F1219, F1253, F1285, F1288, F1453 and F1489.1.5 This standard does not purport to address all of thesafety concerns, if any, associated with its use. It is theresp
5、onsibility 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:23F1031 Practice
6、 for Training the Emergency Medical Tech-nician (Basic)F1177 Terminology Relating to Emergency Medical Ser-vicesF1219 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
7、 Perform Patient Secondary Assessment4F1285 Guide for Training the Emergency Medical Techni-cian (Basic) to Perform Patient Examination TechniquesF1288 Guide for Planning for and Response to a MultipleCasualty IncidentF1453 Guide for Training and Evaluation of First Respond-ers Who Provide Emergency
8、 Medical CareF1489 Guide for Performance of Patient Assessment by theEmergency Medical Technician (Paramedic)4F1653 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 (RED)those patients
9、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 survival, despite immed
10、iate 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-ment, provision of
11、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.3.1.7 third priority/minor (GREEN)those patients whoare
12、 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 condition present as well as the number ofpatients and resources.
13、3.2 For definitions of other terms used in this guide, refer toTerminology F1177.1This guide is under the jurisdiction of ASTM Committee F30 on EmergencyMedical Services and is the direct responsibility of Subcommittee F30.02 onPersonnel, Training and Education.Current edition approved July 1, 2012.
14、 Published August 2012. Originallyapproved in 1995. Last previous edition approved in 2007 as F1654 95 (2007).DOI: 10.1520/F1654-95R12.2For referenced ASTM standards, visit the ASTM website, www.astm.org, orcontact ASTM Customer Service at serviceastm.org. For Annual Book of ASTMStandards volume inf
15、ormation, refer to the standards Document Summary page onthe ASTM website.3Most recent “Standards and Guidelines for Cardiopulmonary Resuscitation andEmergency Cardiac Care” as reprinted from the Journal of the American MedicalAssociation, available from American Heart Association, 7272 Greenville A
16、ve.,Dallas, TX 75231.4Withdrawn. 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.4. Significance and Use4.1 This guide is intended for use by those re
17、sponsible forthe development and implementation of training programs, thatinclude competency evaluation, for triage in the prehospitalenvironment.4.2 This guide is not intended to be used by itself, but as acomponent of Guide F1288.4.3 This guide acknowledges many types of individualswith varying le
18、vels of emergency medical training. It alsoestablishes a minimum training standard and 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 m
19、edical directors in the determination of operationaland medical protocols for use during 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 Per
20、formance Objectives5.1 Individuals who are responsible for, or perform triage in,the pre-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 req
21、uire performance ofall objectives.5.1.1 Health and Safety HazardsDescribe the presence 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 re
22、quire utilization of triageskills.5.1.2.1 Describe a multiple casualty incident,5.1.2.2 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.
23、4 Describe the general principles of providing triage.5.1.3 Resources:5.1.3.1 Describe 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
24、 may not be available.5.1.3.3 Describe methods for requesting needed resources.5.1.4 Incident 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 medic
25、al control during an MCI, the application ofprotocols and the use of standing orders, 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 i
26、dentify safe areas for theplacement of patients.5.1.6.3 Demonstrate methods for directing 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
27、method(s) to assess circulatory status.(c) Demonstrate method(s) to assess level of conscious-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 control
28、ling gross hemor-rhage.5.1.6.6 Describe methods for assigning a triage priority toeach 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 ap
29、plica-tion in identifying patient priorities in an MCI.5.1.6.8 Describe methods to transfer 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 Descri
30、be the purpose of ongoing triage.5.1.7.2 Demonstrate methods for reassessing patients 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 c
31、are facility.5.1.7.4 Describe the resources needed to provide patientcare at the scene.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 triageprio
32、rity, assessment, treatment rendered, and patient identifi-cation.5.1.7.7 Describe methods to transport patients based upontriage priority and transport capability.5.1.7.8 Describe methods to communicate patient informa-tion.5.2 Optional ObjectivesDescribe the principles of theIncident Command Syste
33、m (ICS).6. Evaluation6.1 A method to evaluate the students knowledge andperformance of these objectives shall be established.6.2 There shall be a method for remediation.F1654 95 (2012)27. Keywords7.1 emergency medical service (EMS); incident commandsystem (ICS); triageASTM International takes no pos
34、ition 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 riskof infringement of such rights, are entirely their own responsibil
35、ity.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 standard or for additional standardsand should be addressed to AS
36、TM International Headquarters. Your comments will receive careful consideration at a 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
37、 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). Permission rights to photocopy the standard may also be secured from the ASTM website (www.astm.org/COPYRIGHT/).F1654 95 (2012)3
