1、Designation: F 1655 95 (Reapproved 2007)Standard Guide forTraining First Responders Who Practice in Wilderness,Delayed, or Prolonged Transport Settings1This standard is issued under the fixed designation F 1655; the number immediately following the designation indicates the year oforiginal adoption
2、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 training standards for firstresponders who may car
3、e for sick or injured persons in thespecialized pre-hospital situations of the wilderness, delayed,or prolonged transport settings, including catastrophic disas-ters.1.2 This guide establishes supplemental or continuing edu-cation programs that will be taught to individuals trained to thefirst respo
4、nder level by an appropriate authority.1.3 This guide does not provide training to be used, ordi-narily, in the traditional EMS or ambulance transportationenvironments.1.4 Included in this guide is a standard for the evaluation ofthe knowledge and skills defined within this guide.1.5 Successful comp
5、letion of a course based on this guideneither constitutes nor implies certification or licensure.1.6 This guide does not establish medical protocols, nordoes it authorize invasive procedures without specific authori-zation and medical control.1.7 The values stated in inch-pound units are to be regar
6、dedas the standard.1.8 Operating within the framework of this guide mayexpose personnel to hazardous materials or environments,procedures, and equipment or all of these.1.9 This standard does not purport to address all of thesafety concerns, if any, associated with its use. It is theresponsibility o
7、f the user of this standard to establish appro-priate safety and health practices and determine the applica-bility of regulatory limitations prior to use.2. Referenced Documents2.1 ASTM Standards:2F 1177 Terminology Relating to Emergency Medical Ser-vicesF 1453 Guide for Training and Evaluation of F
8、irst Respond-ers Who Provide Emergency Medical CareF 1490 Terminology Relating to Search and Rescue3. Terminology3.1 Definitions:3.1.1 access, nthe process of reaching the patient/subjectand establishing physical contact.3.1.2 basic life support/cardiopulmonary resuscitation(BLS/CPR), na set of skil
9、ls that includes airway manage-ment, chest compressions, and others as defined by theAmerican Heart Association.3.1.3 definitive care, na level of therapeutic interventioncapable of providing comprehensive health care services for aspecific condition. (See Terminology F 1177.)3.1.4 evacuation, nthe
10、process used between the time ofextraction and transportation. (See Terminology F 1490.)3.1.5 extraction, nthe process of initial assessment, treat-ment, stabilization, and packaging of the patient as well as theremoval of the patient/subject from the immediately hazardousenvironment. (See Terminolo
11、gy F 1490.)3.1.6 first responder, nan individual trained in accordancewith Guide F 1453.3.1.7 transportation, nthe use of a dedicated vehicle forthe removal of the patient to a medical facility or definitive carefacility.3.2 Definitions of Terms Specific to This Standard:3.2.1 delayed or prolonged t
12、ransport, nwhen time be-tween patient injury and arrival to a definitive care facility isgreater than 60 min.3.2.2 non-traditional EMS environment, nenvironmentsnot readily accessible to a ground ambulance.3.2.3 wilderness first responder (WFR), nan individualtrained to meet the requirements of this
13、 guide.3.2.4 wilderness setting, nsituations in which EMS deliv-ery is complicated by one or more of the following four factors:(1) remoteness as far as logistics and access; (2) a significantdelay in the delivery of care to the patient; (3) an environment1This guide is under the jurisdiction of AST
14、M 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 1655 95(2002).2For referenc
15、ed 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.1Copyright ASTM International, 100 Barr Harbor Drive, PO Box C700, West Co
16、nshohocken, PA 19428-2959, United States.that is stressful to both patients and rescuers; and (4) a lack ofequipment and supplies.4. Significance and Use4.1 Individuals will be initially or concurrently trained inaccordance with U.S. D.O.T. Course Guide for First Respond-ers3and Guide F 1453.4.2 Thi
17、s guide does not suggest a particular training se-quence.4.3 This guide may be used by individuals developingtraining programs for non-traditional EMS environments.4.4 This guide acknowledges the need to provide additionalspecific training for first responders who will practice in thewilderness, del
18、ayed or prolonged transport settings.4.5 Individuals responsible for training first respondersshould identify those who will practice in the wilderness,delayed or prolonged transport settings and must ensure thatsuch personnel are competent in all skills needed for the uniquesettings.5. Illustrative
19、 Examples5.1 Wilderness Settings:5.1.1 In May 1983, two climbers were at about 18 000 ft,near Denali Pass on Mount McKinley, Alaska. These climberstook a tumbling 800 ft fall before coming to rest. One of theclimbers was only responsive to pain, with a lacerated face andthe pick end of his ice axe i
20、mpaled in the right side of his chest,just below the nipple line. A nearby climbing party responded.They first attempted to stabilize the ice axe in place as perstandard EMS protocols. They improvised a rescue tobogganusing two plastic sleds, but moving the patient was verydifficult with the ice axe
21、 still in his chest. And, with tempera-tures ranging from 50 to 70 F (in accordance with Na-tional Park Service reports), rescuers were unable to keep himfrom rapidly cooling. The danger of cold exposure and thedifficulty with transportation created by the impaled ice axe ledrescuers to remove it.5.
22、1.2 After removing the ice axe, the patient began torewarm, the rescuers were able to evacuate him expeditiously,and he went on to make a full recovery.5.2 Rural (Delayed/Prolonged Settings)A man was driv-ing along a gravel road in a remote rural area of NorthernIdaho. He stooped to clear a fallen t
23、ree from the road, and inthe attempt, he fell and dislocated his right shoulder. Hemanaged to call for help with his CB radio. About 2 h later, anambulance arrived. The EMTs on the ambulance checked thepulse and sensation in his right arm, and found them to benormal. The man pleaded with them to pul
24、l on his shoulder andrelocate it; he had a similar dislocation of the left shoulder inthe past, and he knew that it could be reduced with a little help.However the EMTs, mindful of their training, insisted on“splinting it in position” and drove him six hours to the nearesthospital, mostly along bump
25、y secondary roads.The patient wasmoaning and intermittently screaming the entire time, in severepain. Later he wrote to various authorities criticizing the careprovided to him.5.3 Disaster (Delayed/Prolonged Settings):5.3.1 It was rush hour, and the freeways were crowded, butotherwise the day was li
26、ke any other. Suddenly the earth shook,and a freeway collapsed, entombing motorists in a mass ofconcrete and twisted metal.5.3.2 For four days, rescuers attacked the mass of rubblewith every tool available from pliers to massive constructionequipment. They had given up hope of finding any one elseal
27、ive when they found a 57 year old construction worker alive,his lower extremities being trapped and crushed.5.3.3 No medical personnel were available to render caresuch as IV hydration, so the construction workers immediatelyextricated him. Despite later attempts at hydration, he laterdeveloped kidn
28、ey failure and then sepsis; he died a few dayslater.5.4 Borderline Wilderness Settings:5.4.1 Several years ago, a light civil aircraft crashed near thetop of Tinker Mountain in southwest Virginia. Atop TinkerMountains rugged, cliff-strewn ridgeline is the AppalachianTrail; the area is a favorite of
29、hikers and climbers. The aircraftwas located from the air, and a team responded to the site. Thequickest way to reach the site was from a road near the bottomof the ridge. Those responding to the site fell into two groups:mountain rescue team members and “regular” fire/EMS per-sonnel. Protocols for
30、the fire/EMS personnel required them,when responding to an air crash, to wear full turnout gear andself-contained breathing apparatus, and to carry fire suppres-sion equipment. The standard practice for the mountain rescuewas to carry minimal lightweight equipment, to dress appro-priately for the we
31、ather and brush, to drink plenty of fluids, andto pace themselves.5.4.2 The Virginia summer weather was particularly hot andhumid, and the mountainside very steep. Soon many of thefire/EMS personnel were disabled from heat exhaustion, andone even had to be evacuated. The mountain rescue personnelwer
32、e able to handle all necessary extrication and fire suppres-sion with what they had carried and whatever they couldimprovise at the scene.5.4.3 Survivors were treated appropriately for burns andshock, evacuated and then transported to a local hospital.6. Educational Objectives6.1 Wilderness First Re
33、sponders shall be trained to performthe following (these objectives do not suggest any specifictraining order):6.1.1 Describe the specific differences between the trainingof First Responders who practice in the traditional EMSenvironment and those who practice in the wilderness, pro-longed or delaye
34、d transport settings where traditional patientcare is not sufficient or appropriate.6.1.2 Recognize the differences in patient care required bypractice in the wilderness, prolonged or delayed transportsettings.6.1.3 Describe any additional or specialized anatomy orphysiology knowledge required.3U.S.
35、 D.O.T. HS 900-025, Course Guide, Emergency Medical Services, FirstResponder Training Course, March 1979. Available from the StandardizationDocuments Order Desk, Bldg. 4, Section D, 700 Robbins Ave., Philadelphia, PA191115098. Attn: NPODS.F 1655 95 (2007)26.1.4 Identify and demonstrate the managemen
36、t of thefollowing medical problems in the wilderness, delayed orprolonged transport settings:6.1.4.1 Abdominal pain,6.1.4.2 Vomiting,6.1.4.3 Diarrhea,6.1.4.4 Diabetes,6.1.4.5 Seizure disorders,6.1.4.6 Respiratory distress (for example, asthma, altitude),6.1.4.7 Allergies,6.1.4.8 Hypertension,6.1.4.9
37、 Cardiac emergencies, and6.1.4.10 Dental emergencies.6.1.5 Identify and demonstrate the management of illness orinjury related to or caused by the environment in the wilder-ness, delayed or prolonged transport settings, including thefollowing:6.1.5.1 Altitude (for example, acute mountain sickness, h
38、ighaltitude pulmonary edema, high altitude cerebral edema, solarradiation),6.1.5.2 Barotrauma,6.1.5.3 Cold (for example, hypothermia, frostbite),6.1.5.4 Heat (for example, heat stroke, heat exhaustion,burns),6.1.5.5 Electrical and lightning,6.1.5.6 Exposure to plant or animal (for example, insect,re
39、ptile, arachnid, marine) toxins,6.1.5.7 Drowning, near-drowning, and cold water immer-sion, and6.1.5.8 Dehydration.6.1.6 Describe the proper disinfection of water and identifyand manage illnesses associated with improper water disinfec-tion.6.1.7 Describe and demonstrate the skills needed to manageo
40、pen wounds in the wilderness, delayed, or prolonged transportsettings.6.1.8 Describe and demonstrate the skills needed to manageorthopedic problems in the wilderness, delayed or prolongedtransport settings, including dislocations, fractures, and openfractures.6.1.9 Describe and demonstrate the skill
41、s needed to managespinal injuries and associated problems in the wilderness,delayed, or prolonged transport settings.6.1.10 Describe and demonstrate the skills needed to man-age specific problems associated with cardiorespiratory arrestin the wilderness, delayed, or prolonged transport settings.6.1.
42、11 Describe the uses, side effects, administration con-cerns, and needed authorities for non-prescription and prescrip-tion medications in the wilderness, delayed, or prolongedtransport settings.6.1.12 Describe measures necessary to prevent illness orinjury occurring in the wilderness, delayed, or p
43、rolongedtransport settings, including management of immediate stressreactions.6.1.13 Describe specific problems related to rendering carein severe weather, in environmental extremes, when equipmentis not readily available, when access is limited, and when thereis little or no additional assistance.6
44、.1.14 Describe and demonstrate as feasible, clothing, sur-vival, emergency communications and bivouac skills necessaryin environmental extremes.6.1.15 Demonstrate patient packaging skills in the wilder-ness, delayed, or prolonged transport settings.6.1.16 Describe and demonstrate documentation requi
45、re-ments for recording patient care.6.1.17 Describe any unique or specialized requirements orobligations imposed by the EMS system or other legal prin-ciples.6.1.18 Describe any medical control requirements and pro-cesses.6.1.19 Describe the principles of disease transmission andbody fluid isolation
46、 and demonstrate the use of personalprotection techniques.7. Evaluation7.1 Policies for evaluation, grading, pass/fail criteria, reme-diation and re-education shall be established and distributed toall students.7.2 End of course cognitive and psychomotor evaluationsthat measure the competency of the
47、 WFR in the objectives ofthis guide shall be given.8. Keywords8.1 delayed; first responder; pre-hospital; prolonged;wildernessASTM 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 e
48、xpressly 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 committee and must be reviewed every five years andif not rev
49、ised, 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 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 Drive, PO Box C700, West Conshoho
