ASTM F1651-1995(2002) Standard Guide for Training the Emergency Medical Technician (Paramedic)《培训紧急救医师(护理人员)的标准指南》.pdf

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1、Designation: F 1651 95 (Reapproved 2002)Standard Guide forTraining the Emergency Medical Technician (Paramedic)1This standard is issued under the fixed designation F 1651; the number immediately following the designation indicates the year oforiginal adoption or, in the case of revision, the year of

2、 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 the training standard for the emer-gency medical technician (paramedic) to deal with emergen-cies.

3、 Primary care and wilderness/delayed/prolonged contexttraining for the emergency medical technician (paramedic) isnot within the scope of this guide, but may be dealt with inother ASTM standards.1.2 This guide identifies the knowledge and skills that allprograms that train the emergency medical tech

4、nician (para-medic) should include in their training program.1.3 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 practices and determine the applica-

5、bility of regulatory limitations prior to use.2. Referenced Documents2.1 ASTM Standards:F 1149 Practice for Qualifications, Responsibilities, andAuthority of Individuals and Institutions Providing Medi-cal Direction of Emergency Medical Services2F 1220 Guide for Emergency Medical Services Systems(EM

6、SS) Telecommunications2F 1254 Practice for Performance of Prehospital ManualDefibrillation2F 1255 Practice for Performance of Prehospital AutomatedDefibrillation2F 1258 Practice for Emergency Medical Dispatch2F 1288 Guide for Planning for and Response to a MultipleCasualty Incident2F 1489 Guide for

7、Performance of Patient Assessment by theEmergency Medical Technician (Paramedic)3F 1517 Guide for Scope of Performance of EmergencyMedical Services Ambulance Operations23. Terminology3.1 Definitions of Terms Specific to This Standard:3.1.1 auscultationexamination by listening with a stetho-scope.3.1

8、.2 EMSS communications subsystemcomprises thoseresource arrangements for notifying the EMS system of anemergency, for mobilizing and dispatching resources, forexchanging information, for remote monitoring of vital indi-cators, and for transmission of treatment procedures anddirections (see Guide F 1

9、220).3.1.3 human anatomythe branch of science dealing withthe structure of the human organisms.3.1.4 human physiologythe science dealing with the func-tions of the human living organism.3.1.5 incident command systemthe combination of facili-ties, equipment, personnel, procedures, and communicationso

10、perating within a common organizational structure withresponsibility for the management of assigned resources toeffectively accomplish stated objectives pertaining to an inci-dent.3.1.6 inspectionexamination by careful visualization ofthe body or a part of the body.3.1.7 managementactions taken by t

11、he emergency medi-cal technician (paramedic) for a patient in need of assistancedue to a real or perceived traumatic or medical condition.3.1.8 palpationexamination by touching with the hand(s).3.1.9 stressnonspecific response of the body to any de-mand made upon it.3.1.10 topographic anatomya study

12、 of all the structuresand their relationships in a given region.3.1.11 triagethe process of sorting and making prioritiesfor emergency medical care of the sick and injured on the basisof urgency and type of condition present, number of patients,and resources available.4. Significance and Use4.1 This

13、 guide establishes the national standard for trainingthe emergency medical technician (paramedic).4.2 This guide shall be used by those who develop thetraining curriculum to be used to train the emergency medicaltechnician (paramedic).4.3 Every person who is identified as an emergency medicaltechnic

14、ian (paramedic) shall have been trained to this guide.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 Oct. 10, 1995. Published December 1995.

15、2Annual Book of ASTM Standards, Vol 13.02.3Discontinued; See 2001 Annual Book of ASTM Standards, Vol 13.01.1Copyright ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.4.4 It is understood that the scope of the medical practice isconstantly evolv

16、ing. Therefore, this guide does not containrecommendations for the management of illnesses and injuries.Furthermore, it is not intended to supersede the protocols andstanding orders of the system medical director or the on-linemedical physician (see Practice F 1149).4.5 This guide does not standardi

17、ze the scope of practice ofthe emergency medical technician (paramedic).5. Anatomy and Physiology5.1 The emergency medical technician (paramedic) shalldescribe the anatomy and physiology of the major bodysystems and the differences that exist because of age andgender to the extent needed to assess a

18、nd manage patients withthe illnesses and injuries in the following sections, using thetechniques listed in this guide.6. Communications and Medical Terminology6.1 The emergency medical technician (paramedic) shall beable to communicate effectively, using standard medical termi-nology, about the illn

19、esses and injuries, and the techniques,listed in this guide.7. Pharmacology7.1 The emergency medical technician (paramedic) shall beable to apply theory and principles of pharmacological inter-vention to manage patients with the illnesses and injuries in thefollowing sections, using the techniques l

20、isted in this guide.8. Universal Blood and Body Fluid Precautions8.1 The emergency medical technician (paramedic) shall betaught the current local, state, Occupational Safety and HealthAdministration (OSHA), and Center for Disease Control(CDC) recommendations for preventing the transmission ofcommun

21、icable diseases. (See Refs (1, 2, and 3).)49. Examination Techniques9.1 The emergency medical technician (paramedic) shall betrained to perform the following examination techniques anduse appropriate modifications to accommodate the differencesthat exist because of age and sex:9.1.1 Assess respirati

22、ons for rate, rhythm, symmetry, andquality,9.1.2 Auscultate for breath sounds,9.1.3 Assess presence, rate, regularity, and quality of thefollowing pulses: carotid, brachial, radial, femoral, temporal,dorsalis pedis, and posterior tibial,9.1.4 Palpate blood pressure,9.1.5 Auscultate blood pressure,9.

23、1.6 Assess capillary refill,9.1.7 Assess mental status and level of consciousness,9.1.8 Assess pupils,9.1.9 Inspect the body,9.1.10 Palpate the body,9.1.11 Assess sensory perception,9.1.12 Assess motor function,9.1.13 Assess airway patency,9.1.14 Assess electrical activity of the heart,9.1.15 Assess

24、 blood glucose level,9.1.16 Assess temperature,9.1.17 Assess oxygen saturation level,9.1.18 Assess the skin and mucous membranes for color,temperature, turgor, and dampness,9.1.19 Assess the skin for basic primary skin rashes:9.1.19.1 Macules and patches,9.1.19.2 Papules and nodules,9.1.19.3 Wheals

25、(hives),9.1.19.4 Bullae (blisters), vesicles, and pustules, and9.1.19.5 Petechiae and purpura.9.1.20 Assess the fontanelle in infants, and9.1.21 Assess vision.10. Examination Devices10.1 The emergency medical technician (paramedic) shallbe trained to use the following:10.1.1 Blood glucose measuremen

26、t devices,10.1.2 Pulse oximeters,10.1.3 Blood collection devices,10.1.4 Sphygmomanometer,10.1.5 Stethoscope,10.1.6 Penlight,10.1.7 Thermometer,10.1.8 Cardiac rhythm monitor,10.1.9 Twelve-lead ECG monitor,10.1.10 Laryngoscope,10.1.11 Amplified listening device, and10.1.12 Exhaled CO2detection devices

27、.11. Patient Assessment11.1 The emergency medical technician (paramedic) shallbe educated to perform patient assessment in accordance withGuide F 1489.12. Illnesses and Injuries12.1 The emergency medical technician (paramedic) shalldemonstrate understanding of both the pathophysiology nec-essary to

28、recognize the clinical presentation and the manage-ment of the following in the prehospital context, including thedifferences that exist because of age and sex:12.1.1 Airway obstruction or compromise,12.1.2 Shock:12.1.2.1 Hypovolemic,12.1.2.2 Cardiogenic,12.1.2.3 Distributive, and12.1.2.4 Obstructiv

29、e.12.1.3 Wounds and impaled objects,12.1.4 Contusions,12.1.5 Orthopedic Injuries:12.1.5.1 Extremity fractures, closed and open,12.1.5.2 Extremity dislocations and subluxations, and12.1.5.3 Extremity sprains and strains.12.1.6 Head injuries,12.1.7 Face fractures,4The boldface numbers given in parenth

30、eses refer to a list of references at theend of the text.F 1651 95 (2002)212.1.8 Eye injuries,12.1.9 Spinal injuries:12.1.9.1 Strains, sprains, and fractures, and12.1.9.2 Back pain and herniated disks.12.1.10 Chest injuries, including:12.1.10.1 Pericardial tamponade,12.1.10.2 Flail chest,12.1.10.3 S

31、ucking chest wound,12.1.10.4 Rib fractures,12.1.10.5 Hemothorax, pneumothorax, and tension pneu-mothorax,12.1.10.6 Lung and heart contusions, and12.1.10.7 Great vessel injury.12.1.11 Pelvic fractures,12.1.12 Blunt or penetrating abdominal trauma,12.1.13 Poisonings, drug overdoses, and substance abus

32、e,12.1.14 Environmental illness and injury:12.1.14.1 Hypothermia and frostbite,12.1.14.2 Heat-related illness,12.1.14.3 Burns:(1) Thermal,(2) Electrical,(3) Chemical,12.1.14.4 Radiation exposure,12.1.14.5 Electrical and lightning injuries,12.1.14.6 Exposure to plant and animal toxins, both landand m

33、arine,12.1.14.7 Near-drowning and cold-water submersion,12.1.14.8 Altitude illness (acute mountain sickness, higha-ltitude pulmonary edema, high-altitude cerebral edema), and12.1.14.9 Barotrauma and decompression sickness.12.1.15 Obstetric and gynecological illness and injury:12.1.15.1 Newborn infan

34、t,12.1.15.2 Active labor,12.1.15.3 Imminent delivery,12.1.15.4 Uterine atony,12.1.15.5 Vaginal bleeding,12.1.15.6 Spontaneous abortion (miscarriage),12.1.15.7 Pre-eclampsia and eclampsia,12.1.15.8 Trauma in pregnancy,12.1.15.9 Abnormal presentations,12.1.15.10 Ectopic pregnancy,12.1.15.11 Pelvic inf

35、lammatory disease (PID),12.1.15.12 Abruptio placenta,12.1.15.13 Placenta previa, and12.1.15.14 Rape and sexual assault.12.1.16 Endocrine disorders:12.1.16.1 Diabetes mellitus,12.1.16.2 Hyperthyroidism and hypothyroidism,12.1.16.3 Adrenal insufficiency, and12.1.16.4 Hypocalcemic tetany.12.1.17 Respir

36、atory disorders:12.1.17.1 Respiratory failure and nonspecific respiratorydistress,12.1.17.2 Asthma,12.1.17.3 Chronic obstructive pulmonary disease,12.1.17.4 Pulmonary embolism,12.1.17.5 Toxic inhalations,12.1.17.6 Pneumonia, bronchitis, and active pulmonary tu-berculosis,12.1.17.7 Hyperventilation,1

37、2.1.17.8 Spontaneous pneumothorax,12.1.17.9 Bronchiolitis, and12.1.17.10 Apnea of infancy.12.1.18 Abdominal pain,12.1.19 Cardiovascular illness:12.1.19.1 Non-traumatic cardiac arrest,12.1.19.2 Hypertension,12.1.19.3 Angina and myocardial infarction,12.1.19.4 Abdominal aortic aneurysm,12.1.19.5 Aorti

38、c dissection,12.1.19.6 Congestive heart failure and pulmonary edema,12.1.19.7 Pre-excitation syndromes, for example, Wolff Par-kinson White,12.1.19.8 Cardiac rhythms:(1) Normal sinus rhythm,(2) Sinus tachycardia,(3) Sinus arrhythmia,(4) Sinus bradycardia,(5) Atrial fibrillation,(6) Atrial flutter,(7

39、) Atrial tachycardia,(8) Premature supraventricular complexes,(9) Supraventricular escape complexes,(10) Wandering pacemaker,(11) Paroxyxsmal supraventricular tachycardia (PSVT),(12) Ventricular escape complexes,(13) Premature ventricular complexes,(14) Ventricular tachycardia/toursades de pointes,(

40、15) Ventricular fibrillation,(16) Asystole,(17) Supraventricular tachycardia,(18) First-degree AV block,(19) Second-degree AV block (Wenkebach/Mobitz TypeI),(20) Second-degree AV block (classical Mobitz Type II),(21) Third-degree AV block,(22) Bundle branch block/aberrant ventricular conduc-tion,(23

41、) Junctional rhythms,(24) Pacemaker rhythms,(25) Electromechanical dissociation, and(26) Arterial occlusion and deep venous thrombosis.12.1.20 Neurological:12.1.20.1 Headache, including subarachnoid hemorrhage,12.1.20.2 Transient ischemic attack and cerebro-vascularaccident (stroke),12.1.20.3 Seizur

42、es,12.1.20.4 Syncope and near sycnope,12.1.20.5 Coma,12.1.20.6 Meningitis,12.1.20.7 Vertigo, and12.1.20.8 Impaired level of consciousness.12.1.21 Genitourinary illness:12.1.21.1 Kidney stones,12.1.21.2 Pyelonephritis,F 1651 95 (2002)312.1.21.3 End-stage renal disease,12.1.21.4 Testicular torsion, an

43、d12.1.21.5 Urinary retention.12.1.22 Ear/nose/throat emergencies:12.1.22.1 Epistaxis (nosebleed),12.1.22.2 Dental fractures,12.1.22.3 Epiglottitis and croup,12.1.22.4 Peritonsillar abscess,12.1.22.5 Jaw dislocation,12.1.22.6 Jaw fracture, and12.1.22.7 Laryngeal injury.12.1.23 Chest pain,12.1.24 Gast

44、rointestinal illness:12.1.24.1 GI bleeding, and12.1.24.2 Vomiting and diarrhea.12.1.25 Allergic reactions:12.1.25.1 Localized,12.1.25.2 Generalized, and12.1.25.3 Anaphylaxis.12.1.26 Infectious disease,12.1.27 Oncological illness (cancer):12.1.27.1 Spinal cord compression, and12.1.27.2 Airway comprom

45、ise.12.1.28 Terminal illness,12.1.29 Psychiatric and behavioral illness (situational, or-ganic, and primary psychiatric),12.1.30 Sickle cell disease and crisis, and12.1.31 Physical and emotional abuse in all age groups.13. Patient Management Techniques13.1 The emergency medical technician (paramedic

46、) shallbe trained in the use of the following patient managementtechniques and devices to the extent needed to manage theillnesses and injuries listed in this section:13.1.1 Respiratory management techniques:13.1.1.1 Techniques and devices to open and maintain theairway:13.1.1.2 Head-tilt-chin-lift,

47、13.1.1.3 Finger sweeps,13.1.1.4 Modified jaw thrust,13.1.1.5 Jaw thrust,13.1.1.6 Abdominal thrust,13.1.1.7 Chest thrust,13.1.1.8 Tongue-jaw-lift,13.1.1.9 Sellicks maneuver (cricoid pressure),13.1.1.10 Cricothyroidotomy,13.1.1.11 Oropharyngeal/nasopharyngeal airways,13.1.1.12 Orotracheal/nasotracheal

48、 intubation, and13.1.1.13 Suction devices:13.1.1.14 Mechanical suction,13.1.1.15 Filtered small-bore trap suction (for example,modified DeLee),13.1.1.16 Bulb syringe,13.1.1.17 Suction catheters:13.1.1.18 Rigid tonsillar suction catheter, and13.1.1.19 Flexible suction catheter,13.1.1.20 Techniques an

49、d devices to provide ventilatoryassistance:13.1.1.21 Mouth-to-mouth,513.1.1.22 Mouth-to-nose,513.1.1.23 Mouth-to-mouth and nose,513.1.1.24 Mouth-to-stoma,513.1.1.25 Mouth-to-mask5, and13.1.1.26 Positive pressure ventilatory devices,13.1.1.27 Oxygen delivery devices:13.1.1.28 Low-concentration oxygen delivery devices, and13.1.1.29 High-concentration oxygen delivery devices,13.1.1.30 Needle thoracostomy,13.1.2 Techniques for management of the compromisedcirculatory system:13.1.2.1 Direct pressure to the source of bleeding,13.1.2.2 Pressure dressings,13.1.2.3 Patient positioni