ASTM F1258-1995(2006) Standard Practice for Emergency Medical Dispatch《应急医疗调度》.pdf

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1、Designation: F 1258 95 (Reapproved 2006)Standard Practice forEmergency Medical Dispatch1This standard is issued under the fixed designation F 1258; the number immediately following the designation indicates the year oforiginal adoption or, in the case of revision, the year of last revision. A number

2、 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 practice covers the definition of responsibilities,knowledge, practices, and organizational support required toimplement, perform, and

3、manage effectively the emergencymedical dispatch function.1.2 This practice is useful for planning and evaluating thetraining, implementation, and organizational support to satisfythe functional needs of emergency medical dispatching.1.3 This standard does not purport to address all of thesafety con

4、cerns, if any, associated with its use. It 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.2. Referenced Documents2.1 ASTM Standards:2F 1031 Practice for Training the Emerg

5、ency Medical Tech-nician (Basic)F 1381 Guide for Planning and Developing 9-1-1 EnhancedTelephone SystemsF 1552 Practice for Training Instructor Qualification andCertification Eligibility of Emergency Medical DispatchersF 1560 Practice for Emergency Medical Dispatch Manage-ment3. Terminology3.1 Defin

6、itions of Terms Specific to This Standard:3.1.1 emergency medical dispatcher (EMD)a trained pub-lic safety telecommunicator with additional training and spe-cific emergency medical knowledge essential for the efficientmanagement of emergency medical communications.3.1.2 emergency medical dispatching

7、the reception andmanagement of requests for emergency medical assistance.3.1.3 emergency medical dispatch priority reference system(EMDPRS)a medically approved system used by a dispatchagency to provide aid to medical emergencies that includes:systematized caller interrogation questions, systematize

8、d pre-arrival instructions, and protocols matching the dispatchersevaluation of injury or illness severity with vehicle responsemode and configuration.3.1.4 medical directionthe management and accountabil-ity for the medical care aspects of an emergency medicaldispatch (EMD) program including: the m

9、edical monitoringoversight of the training of the EMD personnel; approval andmedical control of the operational emergency medical dispatchpriority reference system (EMDPRS); evaluation of the medi-cal care and prearrival instructions rendered by the EMDpersonnel; direct participation in the EMD syst

10、em evaluation,quality, assurance, and quality improvement process andmechanisms; and, responsibility for the medical decisions andcare rendered by the emergency medical dispatcher and emer-gency medical dispatch program.3.1.5 public safety telecommunicatoran individual trainedto communicate remotely

11、 with persons seeking emergencyassistance and with agencies and individuals providing suchassistance.3.1.6 telephone aidconsists of “ad-libbed” telephone in-structions provided by either trained or untrained dispatchersand differs from DLS-based prearrival instructions in that theinstructions provid

12、ed to the caller are based on the dispatchersknowledge or previous training in a procedure or treatmentwithout following a scripted prearrival instruction protocol.They cannot be medically preapproved since they do not existin written form.3.1.7 telephone treatment sequence protocolsspecifictreatmen

13、t strategies designed in a conversational script formatthat direct the EMD step by step in giving critical prearrivalinstructions such as CPR, Heimlich maneuver, mouth-to-mouth breathing, and childbirth instruction.3.1.8 vehicle response configurationthe specific ve-hicle(s) of varied types, capabil

14、ities, and numbers respondingto render assistance.1This practice is under the jurisdiction of ASTM Committee F30 on EmergencyMedical Services and is the direct responsibility of Subcommittee F30.04 onCommunications.Current edition approved March 1, 2006. Published March 2006. Originallyapproved in 1

15、990. Last previous edition approved in 2001 as F 1258 95 (2001).2For 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 websi

16、te.1Copyright ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.3.1.9 vehicle response modethe use of emergency drivingtechniques, such as warning lights and siren, versus a routinedriving response.4. Summary of Practice4.1 An emergency medical d

17、ispatcher is a trained publicsafety telecommunicator with additional training and specificemergency medical knowledge essential for assessment ofmedical emergencies and limited remote treatment and appor-tionment of medical priorities. The EMD functions under themedical authority of an off-line medi

18、cal director to receive andmanage calls for emergency medical assistance through thesystematic interrogation of callers, using procedures estab-lished by the off-line medical director who remains responsiblefor the medical quality assurance of the EMD program.4.1.1 The EMDs role includes the ability

19、 to:4.1.1.1 Remotely evaluate the patient or incident,4.1.1.2 Interpret the requirement and need for emergencymedical resources,4.1.1.3 Allocate the appropriate resources,4.1.1.4 Identify conditions requiring prearrival instructionsand provide them to the caller when necessary, possible andappropria

20、te,4.1.1.5 Coordinate the response of emergency medical andother public safety resources,4.1.1.6 Provide information to the responding units regard-ing the emergency scene and patient, and4.1.1.7 Record and retrieve emergency medical responserecords.4.1.2 There must be continuity in the delivery of

21、EMD care.To provide correct medical care safely and effectively, theEMD that is medically directing, evaluating, and coding mustmaintain direct access to the calling party and must use amedically approved emergency medical dispatch priority ref-erence system. The person giving the medical instructio

22、n to thecaller must be the same person that asks the systematicinterrogation questions.4.1.3 To accomplish the above safely and effectively, theEMD must use a medically approved EMDPRS that includes:4.1.3.1 Systematized caller interrogation questions,4.1.3.2 Systematized prearrival instructions, and

23、4.1.3.3 Protocols that determine vehicle response mode andconfiguration based on the EMDs evaluation of injury orillness severity.4.2 This practice is intended to be used by agencies as abaseline for establishing a certifying emergency medical dis-patch training program that includes the implementat

24、ion of theemergency medical dispatch priority reference system, undermedical direction, and provides a means of evaluating theEMD program.4.3 This practice will provide a common set of expectationsfor training, performance, and preplanned response based onunderstanding of the medical condition, thor

25、ough interroga-tion, caller intervention, safe responses, and prearrival instruc-tions.4.4 This practice establishes the EMDs role and responsi-bilities in receiving, managing, and dispatching calls formedical assistance and related agency coordination.4.5 An organizational structure as defined in P

26、racticeF 1560 must be in place before implementing the EMDprogram; therefore, this practice establishes some generalrecommendations concerning the development of a supportivestructure and program content.4.6 Use of this practice is not intended to protect the EMDor dispatch organization from liabili

27、ty for negligent actions orfailure to perform in accordance with established and approvedmedical practices and protocols.4.7 The EMD must be certified through either state govern-ment processes or by professional medical dispatch standard-setting organizations.4.7.1 When certification is achieved by

28、 recognition of aprofessional medical dispatch standard-setting organization, itshall clearly demonstrate compliance with all criteria enumer-ated in this practice and within Practice F 1560 and PracticeF 1552.5. Significance and Use5.1 This practice is intended to promote the use of trainedtelecomm

29、unicators in the role of emergency medical dis-patcher. It defines the basic skills and medical knowledge topermit understanding and resolution of the problems thatconstitute their daily routine. To use trained telecommunicatorsfully as functioning members of the emergency medical team,it is deemed

30、necessary to upgrade the telecommunicatorstraining by the addition of the concept of emergency medicaldispatch priorities.5.2 All agencies or individuals who routinely accept callsfor emergency medical assistance from the public and dispatchemergency medical personnel shall have in effect an emer-ge

31、ncy medical dispatcher program in accordance with thispractice. The program shall include medical direction andoversight and an emergency medical dispatch priority refer-ence system.5.3 The successful use of the EMD concept depends on themedical communitys awareness of the “prearrival” state ofEMS a

32、ffairs and their willingness to provide medical directionin dispatch.5.4 This practice may assist in overcoming some of themisconceptions regarding emergency medical dispatching.These include the uncontrollable nature of the callers hysteria,lack of time of the dispatcher, potential danger and liabi

33、lity tothe EMD, lack of recognition of the benefits of dispatchprearrival instructions, and misconceptions that red lights,siren, and maximal response are always necessary.5.5 The EMD is the member of the EMS response team withthe broadest view of the entire emergency systems currentstatus and capab

34、ilities. The EMD has immediate lifesavingcapability in converting the caller into an effective firstresponder. This practice recognizes the EMDs role as includ-ing:5.5.1 Interrogation techniques,5.5.2 Triage decisions,5.5.3 Information transmission,5.5.4 Telephone medical intervention, and5.5.5 Logi

35、stics and resource coordination during the event.5.6 For the EMD, this practice supersedes any other EMSSstandards under which an individual may be qualified, such asF 1258 95 (2006)2Practice F 1031. It is not the role of the EMD to generate aspecific diagnosis but rather to elicit accurately a fini

36、te body ofinformation, assign the appropriate response, and to commu-nicate clearly among persons and units involved in the re-sponse. The protocols for inquiry, response, and resourcecoordination are essential and must not be modified based onan individuals possible experiences as a responder.5.7 A

37、s an initial contact with the EMS system, the EMD issubject to questioning of actions as they relate to medicalpractice. This practice may be used by agencies as a recognizedbaseline for EMD training, practice, and organization and isintended to supplant de facto standards that exist in some areas.T

38、his practice will assist in developing sound EMD programsthat will reduce the need and potential for legal action andprovide a common set of expectations for performance.5.8 It will bring more accurate information into the dispatchoffice by way of appropriate understanding of the medicalcondition an

39、d therefore better interrogation, caller intervention,and decision-making. It allows for preplanned responses, saferresponses (fewer units responding with lights and siren), fueland energy savings (smaller units and fewer units used whenpossible), and may save advanced lifesupport resources for true

40、advanced life-support emergencies when a tiered-level re-sponse is available.6. System Components6.1 Emergency Medical Dispatch Priority Reference System(EMDPRS):6.1.1 This system is a written, reproducible document in auniform format based on medical and administrative protocols.The emergency medic

41、al dispatch priority reference systemdirects the EMD to complete a full, programmed interrogation.The information from the caller is paired with preset problemgroups to determine the appropriate response level. It shallinclude the following:6.1.1.1 A set of systematized caller interrogation (key)que

42、stions. The key questions must obtain the minimum amountof information necessary to:(1) Adequately establish the correct level of response,(2) Establish the need for prearrival instructions, and(3) Provide responders with adequate patient and incidentinformation.6.1.2 A set of systematized coding an

43、d response protocolsthat include:6.1.2.1 Protocols that predetermine vehicle response modeand configuration based on the EMDs evaluation of injury andillness severity as determined through key question interroga-tion. These protocols must reflect a given EMS systems variedability to respond, ranging

44、 from single-unit squads throughmultiple-level (tiered) response.6.1.2.2 An established, medically approved, quantitativecoding system for quality assurance/improvement and statisti-cal analysis.6.1.3 Aset of systematic prearrival instructions that include:6.1.3.1 Chief complaint specific caller and

45、 EMD advise, and6.1.3.2 Scripted prearrival instructions.6.1.4 In addition to the EMDPRS, an emergency medicaldispatch system should include:6.1.4.1 A mass casualty plan for notification and operationin a disaster situation,6.1.4.2 A directory of emergency response resources andinformation resources

46、,6.1.4.3 A written description of the communications systemconfiguration for the service area, and6.1.4.4 A record-keeping system, including report forms ora computer data management system to permit evaluation ofEMD compliance with the EMDPRS, evaluation of protocoleffectiveness, and timeliness of

47、interrogation and dispatch.7. Functions of Emergency Medical Dispatch7.1 Receive and Process Calls for AssistanceThe EMDmust receive and record calls for emergency medical assistancefrom various sources. This function includes the establishmentof effective communication with the person requesting as

48、sis-tance, using the EMDPRS to evaluate the patient or situation,provide appropriate prearrival instructions, and select the mostappropriate EMS system action in response to each call.7.2 Dispatch and Coordinate Appropriate, Available Re-sponse ResourcesThe EMD must select and dispatch thenecessary

49、EMS vehicles and personnel to the scene of anemergency in an appropriate time frame. The EMD functionsin coordinating the movements of EMS vehicles en route to thescene, en route to the medical facility, and back to the base ofoperations. This requires that the EMD have current knowl-edge of the status of all EMS resources in the dispatch area andthe geographic constraints that will affect the EMS response.This also requires that the EMD have dispatch-specific medicaltraining and understands the use of systematized interrogationand response assignment protocols