ASTM F1653-1995(2007) Standard Guide for Scope of Performance of Triage in a Prehospital Environment《入院前治疗类选法的执行范围用标准指南》.pdf

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1、Designation: F 1653 95 (Reapproved 2007)Standard Guide forScope of Performance of Triage in a PrehospitalEnvironment1This standard is issued under the fixed designation F 1653; the number immediately following the designation indicates the year oforiginal adoption or, in the case of revision, the ye

2、ar 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.INTRODUCTIONTriage is a word taken from the French verb trier, that means “to sort”. During the time of theNapoleonic wars,

3、 a technique for assigning priorities to the treatment of battlefield casualties wasestablished in order to maximize the use of limited resources. The basic principle of triage is to do thegreatest good for the greatest number of casualties. Care is provided first to those with the most seriousemerg

4、encies and to those who are most salvageable. This technique is identified as essential for gooddisaster medical care.1. Scope1.1 This guide covers minimum requirements for the scopeof performance for individuals who perform triage at anemergency medical incident involving multiple casualties in apr

5、e-hospital environment.1.2 This guide acknowledges objectives based on an indi-viduals required knowledge of signs and symptoms, patientassessment and basic life support.1.3 Operating within the framework of this guide mayexpose personnel to hazardous materials, procedures, andequipment. For additio

6、nal information see Practice F 1031,Guides F 1219, F 1253, F 1285, F 1287, F 1288, F 1489 andF 1651.1.4 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 heal

7、th practices and determine the applica-bility of regulatory limitations prior to use. For specificprecautionary statements, see Footnote 3.22. Referenced Documents2.1 ASTM Standards:3F 1031 Practice for Training the Emergency Medical Tech-nician (Basic)F 1177 Terminology Relating to Emergency Medica

8、l 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-cian (Basic) to Perform Patient Secondary Assessment4F 1285 Guide for Training the Emergency Medical Techni-cian (

9、Basic) to Perform Patient Examination TechniquesF 1287 Guide for Scope of Performance of First RespondersWho Provide Emergency Medical CareF 1288 Guide for Planning for and Response to a MultipleCasualty IncidentF 1489 Guide for Performance of PatientAssessment by theEmergency Medical Technician (Pa

10、ramedic)4F 1651 Guide for Training the Emergency Medical Techni-cian (Paramedic)3. Terminology3.1 Definitions of Terms Specific to This Standard:3.1.1 ongoing triage, nthe continuing process of patientassessment and prioritization in a multiple casualty incident.(Also known as secondary and tertiary

11、).3.1.2 primary triage, nthe initial process of rapid assess-ment, provision of life saving interventions and assignment ofvisual priority identification to each patient in a multiplecasualty incident.3.1.3 triage, nthe process of sorting and prioritizing careof the sick and injured on the basis of

12、urgency and type ofcondition present, as well as the number of patients and1This 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 Feb. 1, 2007. Publi

13、shed February 2007. Originallyapproved in 1995. Last previous edition approved in 2002 as F 1653 95(2002).2Most recent “Guidelines for Cardiopulmonary Resuscitation and EmergencyCardiac Care,” as reprinted from the Journal of the American Medical Association,available from American Heart Association

14、, 7272 Greenville Ave., Dallas, TX75231.3For 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.4Withdrawn.1Copyright

15、 ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.resources available. The objective is to properly treat andtransport patients to medical facilities appropriately situatedand equipped for their care.3.2 For definitions of other terms used in th

16、is guide, refer toTerminology F 1177.4. Significance and Use4.1 This guide is not intended to be used by itself, but as acomponent of Guide F 1288. Merely conforming to the guide-lines described herein will not ensure that adequate triage iscarried out in a multiple casualty incident.4.2 The purpose

17、 of this guide is to establish a methodologyfor performing triage.4.3 Individuals responsible for performing triage must beproficient in triage methods and related life-saving techniques.4.4 A basic concept of triage is to do the greatest good forthe greatest number of casualties.4.5 The assessment

18、process must be focused so as toidentify those most at risk of early death who are likely to besalvaged by rapid medical intervention.4.6 Triage allows the most efficient use of available re-sources.4.7 This guide acknowledges many types of individualswith varying levels of emergency medical trainin

19、g. It alsoestablishes a minimum scope of performance and encouragesthe addition of optional knowledge, skills and attitudinalobjectives.4.8 A vital role in the development of and operationalapplication of triage is that of medical control. This guideshould be used by medical directors in the determi

20、nation ofoperational and medical protocols for use during MCIs.4.9 This guide is intended to assist those who are respon-sible for defining the scope of performance of individuals whoperform triage.4.10 For the purpose of this guide the word “injured”includes both sick or injured patients, or both.5

21、. Objectives5.1 Required ObjectivesThese objectives are in an ordersuggesting a particular performance sequence although somemay be performed concurrently. Some incidents may notrequire performance of all objectives. Individuals who performtriage shall be able to:5.1.1 Identify health and safety haz

22、ards and initiate appro-priate actions.5.1.2 Recognize an incident that may require triage.5.1.3 Determine the need for and request additional re-sources.5.1.4 Initiate incident command Guide F 1288.5.1.5 Identify conditions which may dictate a decision totreat patients at the scene or transfer them

23、 to a designatedtreatment area.5.1.6 Initiate Primary Triage.5.1.6.1 Identify victims who appear to be uninjured orminimally injured and able to help themselves, and direct themto a designated area of safety.5.1.6.2 Perform a rapid assessment of the remaining vic-tims. Check respiratory status, circ

24、ulatory status and level ofconsciousness.5.1.6.3 Immediate medical interventions should be limitedto opening the airway and controlling gross hemorrhage. Theseinterventions should not stop the process of triage.5.1.6.4 Assign a triage priority to each victim, including theuninjured, and use a visual

25、 marker for individual identification.Patients are placed into the following categories in accordancewith the assessment outcome and in accordance with the localstandard of medical care:(a) First Priority/Immediate (RED)Those patients withserious injuries that are life threatening but have a highpro

26、bability of survival.(b) Second Priority/Delayed (YELLOW)Those patientswho are seriously injured and whose lives are not immediatelythreatened. The triage category of these patients may change tofirst priority based on medical resources at any time during anincident.(c) Third Priority/Minor (GREEN)T

27、hose patients whoare injured but do not require immediate medical attention andthose apparently not physically injured.(d) Fourth Priority/Dead/Mortally Wounded (BLACK)Those patients who are obviously dead as determined bymedical protocol or those patients with severe injuries and alow probability o

28、f survival, despite immediate care. As this isa difficult field decision, actual practice may be to providetreatment and transportation.5.1.6.5 Arrange for transfer of patients based on highestpriority first, to a location where they can receive the appro-priate level of care.5.1.7 Initiate Ongoing

29、Triage.5.1.8 Document triage priority, assessment, treatment ren-dered and patient identification.5.1.9 Continue transferring patients by highest priority asresources become available.5.1.10 Triage is a dynamic process. It will be repeated andperformed as necessary during an event and in other phase

30、s ofthe continuum of care.5.2 Optional Objectives:5.2.1 Demonstrate a knowledge of the principles of theIncident Command System (ICS).5.2.2 Describe critical incident stress, its impact on rescuersand the availability of resources.6. Keywords6.1 emergency medical service (EMS); incident commandsyste

31、m (ICS); triageF 1653 95 (2007)2ASTM 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 expressly advised that determination of the validity of any such patent rights, and the riskof

32、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 revised, either reapproved or withdrawn. Your comments are invited either for revision of this st

33、andard 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

34、 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 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 1653 95 (2007)3