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1.1 The Emergency Medical Services Management Information System (EMS-MIS) serves as a framework for the management and linkage of data documenting the complete emergency episode from onset through the pre-hospital, emergency department, and hospital phases to final discharge. This document establishes a standard guideline for the planning, development, and maintenance of an EMS-MIS framework, including linkage among pre-hospital, hospital, and other public safety or government agencies. The resultant EMS-MIS should be capable of monitoring the compliance of an EMS system with its established system standards, and provide an objective basis upon which different EMS systems can be comparatively evaluated.1.2 EMS-MIS Goals1.2.1 To manage data regarding response to a medical emergency.1.2.2 To provide a process for obtaining and documenting objective, reliable data.1.2.3 To provide information that can be used to affect operational changes in an EMS system leading to the delivery of better quality emergency medical care.1.2.4 To provide information to guide the rational investment of local, state, and national resources to improve and maintain EMS.1.3 This guide will standardize data needed for decision making at various levels of the EMS system, and offer suggestions as to the appropriate use of this information.1.4 This guide comments on several possible configurations for information flow and data processing, recognizing that no one configuration is best suited to all circumstances.1.5 This guide focuses on pre-hospital medical activities, including emergency responses, scheduled transports, and all interinstitutional transfers.1.6 This guide addresses EMS-MIS techniques applicable to the internal operations of outpatient and inpatient facilities as well as pre-hospital care providers.1.7 This guide will not address specialized data systems and applications such as trauma registries, but will allow for interfacing with such applications.1.8 This guide will not address computer-aided dispatch (CAD) systems, nor system status management (SSM) applications, but will allow for interfacing with such applications.

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Health information networks (HINs) have arisen in recent years as a way to share common information within organizational arrangements among those healthcare facilities that have been formed into large, more comprehensive integrated delivery systems (IDS) and managed care organizations (MCO) offering a full range of healthcare services, both inpatient and ambulatory.The specific organizational structures to which the MCO term was originally applied most probably have evolved into something quite different. Furthermore, IDS organizations are contracting with other organizations that have a market larger than a single IDS itself and are buying such services for themselves rather than offering them internally.These organizations will need a frame of reference for the global information needed to provide all of the services required during patient care. For a global Concept Model consult ADA Specification 1000.0–1000.18 and TR 1039.Pharmacotherapy will require a number of these services, including those of the clinical laboratory for therapeutic drug monitoring as well as pharmacy services of both resident and nonresident care organizations and stand-alone pharmacies to ensure freedom from medication errors and conduct ongoing investigations of both the outcomes of care and the management of resources related to pharmacotherapy.Pharmacotherapy functions include prescribing (clinical orders), dispensing, administering, and monitoring, which support “pharmaceutical care” defined as “provision of drug therapy to achieve desired therapeutic outcomes that improve a patient’s quality of life.” These functions address patients’ needs that require information support as noted in Table 1.Another aspect of the monitoring function is the development of instrumentation for testing at point of care (POCT) for high-value immediate-benefit services that support pharmacotherapy. POCT, however, needs supervision and training from skilled laboratorians for the actual performers, whether that supervision comes from within the IDS or outside of it. This range of operation is only achievable by distributed HIN structures that shall have the same quality of clinical and data services as offered by laboratories close at hand. Data management of POCT is documented separately (see CLSI POCT1, ASTP2), but such data management for support of pharmacotherapy shall be placed into the broader context of this practice and linked to CLSI LIS-9A. Thus, this practice should be used to first organize the global domain and then the interconnected subdomains.1.1 This practice applies to the process of defining and documenting the capabilities, logical data sources, and pathways of data exchange regarding pharmacotherapy information services within a given network architecture serving a set of healthcare constituents.1.2 This practice is not a technical implementation standard but, rather, describes how the implementation methods and techniques can be used to coordinate pharmacotherapy services logically within an electronic health record (EHR) systems environment involving participating organizations and sites connected by a networked communication system.1.3 This practice covers the content of the nodes and arcs of the resulting logical network involving EHR, pharmacy, and clinical laboratory-capable sites. This practice also considers the various purposes and organizational arrangements for coordinating pharmacotherapy services within the network boundaries and the considerations for connections among external networks.1.4 This practice refers to other standards for conventions within various data domains, such as pharmacy systems, clinical laboratory information management systems (CLIMS), and EHR systems, and for messaging conventions.1.5 This practice is intended to outline how integration of pharmacy, CLIMS, and EHR information systems can be undertaken to result in a transparent pharmacotherapy clinical decision support environment, regardless of the underlying implementation architecture, by describing the logical interoperability of information domains as facilitated by information and communications technology (ICT).1.6 This practice is directed at pharmacists, clinical pharmacologists, clinical laboratorians, information system managers, and information systems vendors for use in planning and implementing coordinated pharmacotherapy services through effective dialog.1.7 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

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This test method is useful in determining the relative efficacy between various treatments and naturally occurring wood-destroying agents. It is an initial means of estimating the tolerance limits of the biologically destructive agents or the threshold values of the chemical preservative, or both.This test method is not intended to provide quantifiable reproducible values. It is a qualitative method designed to provide a reproducible means of establishing relative efficacy between experimental contract levels.1.1 This test method covers the relative effectiveness of wood preservatives in small wood specimens exposed to a natural marine environment. It is not within the scope of this test method to determine the retention or duration of protection for commercial size piles and timbers.1.2 The requirements for preparing the material for testing and the test procedures appear in the following order: SectionSummary of Test Method Test Specimens Pretreatment Handling Treatment Procedure Post-Treatment Handling Assembly of Test Specimens Exposure Inspection Evaluation of Results Reports 1.3 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

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3.1 This guide suggests methods for organizing and operating state, regional, and local EMS systems, in accordance with Guide F1086. It will assist state, regional, or local organizations in assessing, planning, documenting, and implementing their specific operations. The guide is general in nature and able to be adapted for existing EMS Systems. For organizations that are establishing EMS System operations, the guide is specific enough to form the basis of the operational manual.1.1 This standard established guidelines for the organization and operation of Emergency Medical Services Systems (EMSS) at the state, regional and local levels. This guide will identify methods of developing state standards, coordinating/managing regional EMS Systems, and delivering emergency medical services through the local EMS System.1.1.1 At the state level this guide identifies scope, methods, procedures and participants in the following state structure responsibilities: (a) establishment of EMS legislation; (b) development of minimum standards; (c) enforcement of minimum standards; (d) designation of substate structure; (e) provision of technical assistance; (f) identification of funding and other resources for the development, maintenance, and enhancement of EMS systems; (g) development and implementation of training systems; (h) development and implementation of communication systems; (i) development and implementation of record-keeping and evaluation systems; (j) development and implementation of public information, public education, and public relations programs; (k) development and implementation of acute care center designation; (l) development and implementation of a disaster medical system; (m) overall coordination of EMS and related programs within the state and in concert with other states or federal authorities.1.2 At the regional level, this guide identifies methods of planning, implementing, coordinating/managing, and evaluating the emergency medical services system which exists within a natural catchment area and provides guidance on the use of these methods.1.3 At the local level, this guide identifies a basic structure for the organization and management of a local EMS system and outlines the responsibilities that a local EMS should assume in the planning, development, implementation and evaluation of its EMS system.(A) If there are no regional organizations, within the state, the State EMS will need to accomplish, either directly or through delegation, regional tasks.

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1.1 This guide covers the functional elements and data records of prehospital Health Status Information Services (HSIS) needed to provide individual health status data for HSIS subscribers. When an HSIS subscriber experiences a medical emergency and becomes an EMS patient, a prehospital EMS care provider can rapidly access the individual's health status data by means of telecommunications. Access to this data will enable the EMS provider to improve patient assessment, and thereby render more appropriate treatments. This will improve the EMS provider's ability to stabilize trauma and other emergency medical conditions, and to restore and sustain vital functions, while avoiding treatments that may aggravate the severity of the medical emergency because of preexisting conditions.1.2 In addition to improving on-site assessment, this guide will facilitate improved on-line medical direction of prehospital EMS care providers, particularly for persons experiencing life threatening medical emergencies.1.3 Health status records provide a chronology of a person's health/medical data, including past diagnosis and treatments. The data in these records provide a vital link between the person experiencing a medical emergency, the EMS care provider, and subsequent emergency services. In order to provide the most informed care, EMS care providers and persons providing EMS medical direction need to be aware of the injured or ill person's health status.1.4 This guide describes the minimum requirements for compiling, updating, computerizing, and storing individual's longitudinal health status data in authorized repositories, so as to protect patient privacy and confidentiality. This guide also describes requirements for providing authorized access and rapid transmittal of the data to attending EMS care providers in medical emergencies.1.5 While this guide addresses data needed for prehospital EMS, there is also a recognized essential, but largely unmet need for similar patient health status records for emergency medical care of patients in hospital emergency departments and in definitive medical care facilities. Many development projects are in process to address this unmet need. When available, such patient records are reviewed by attending physicians, in advance of hospital emergency medical care, to quickly access patient health status data that is needed for improved patient assessment and treatment and avoidance of treatments which may be contraindicated by preexisting conditions.1.5.1 Future changes to this guide will result in health status information records for prehospital emergency medical care and analogous information systems for hospital emergency medical care, harmonized with each other and with future standards for computerized longitudinal health care patient records (see Guides E 1744 and F 1629) which are being developed by ASTM Committee E31.1.5.2 This guide describes requirements that are based on current ASTM medical informatics standards and will be updated to harmonize with future versions of these rapidly evolving standards.1.6 The scope of this guide includes harmonization of the definitions of prehospital emergency medical services data element definitions used in this guide with definitions used in other ASTM standards. The definition of data elements in this guide will be the same as the definition of the data element in other ASTM standards. In cases where a data element used in this guide does not appear in another ASTM standard, the guide will use the definition specified for federal health services information systems (4, 5).

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2.1 This guide is not meant to mandate a specific structure or responsibility at the various levels but rather to suggest a means or method that will allow for the creation or further development of a state, regional, or local EMS system.2.2 This guide will assist state, regional, or local organizations in establishing EMS systems or refining existing EMS systems.1.1 This guide establishes optimum guidelines for the structures and responsibilities that will facilitate development, delivery, and assessment of Emergency Medical Services (EMS) on state, regional, and local levels.1.1.1 State Level—At the state level, this guide sets forth a basic structure for the organization and management of a state emergency medical services program and outlines the responsibilities of the state in the planning, development, coordination, and regulation of emergency medical services throughout the state.1.1.2 Regional Level—At the regional level, this guide addresses the planning, development, and coordination of a functional and comprehensive EMS system which consists of all personnel, equipment, and facilities necessary for the response to the emergently ill or injured patient, according to national and state lead agency standards.1.1.3 Local Level—At the local level, this guide sets forth a basic structure for the organization and management of a local EMS system and outlines the responsibilities that a local EMS should assume in the planning, development, implementation, and evaluating of its EMS system.

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4.1 This guide provides minimum training guidelines for safe and efficient ambulance operations.4.2 Ambulance providers and educators should follow this guide for the development of educational and training programs.4.3 This guide is intended to promote safe and efficient ambulance operations and to reduce morbidity, mortality, and property loss associated with ambulance operations.4.4 This guide is intended to assist those who are responsible for the development and implementation of policies and procedures for ambulance operations.4.5 Topics or concepts listed in this guide are intended to serve as an outline of materials to be covered in the training of ambulance operators.1.1 This guide provides minimum training standards for Emergency Medical Services (EMS) Ambulance Operators including legal aspects, operator qualifications and testing, history of EMS vehicle operations, vehicle types/equipment, safety, physical forces, mechanics, pre-run, operations, post-run, and special circumstances.1.2 This guide promotes the safe and efficient delivery of the ambulance, equipment, crew, passengers, and patients, during all phases of the delivery of EMS involving the ambulance, at all times exercising the highest degree of care for the safety of the public. This guide may be applied to the driving of other EMS vehicles that do not necessarily provide patient transportation.1.3 This guide shall be used as the basis for all programs relevant to the training of the emergency medical services operators.1.4 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety, health, and environmental practices and determine the applicability of regulatory limitations prior to use.1.5 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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This practice covers certified, tested, commercial type, EMSS ambulances built on chassis that are suitable for the intended application and meet the requirements herein, it also covers the design, construction, and procurement of emergency medical services systems ambulances. Types: type I-conventional truck, cab-chassis with modular ambulance body, type I-AD (additional duty-with increased GVWR, storage, and payload capacity)-A or B or neonatal, critical patient transport, or A or B with rescue and fire suppression package, type II-standard van, integral cab-body ambulance, type III-cutaway van, cab-chassis with integral or containerized modular body ambulance, and type III-AD (additional duty-with increased GVWR, storage, and payload capacity) A or B or neonatal, critical patient transport, or A or B with rescue, or fire suppression package, or both. Performance test, vehicle weight test, road test, water spray test, and oxygen system test shall be performed to meet the requirements prescribed.1.1 This practice covers certified, tested, commercial type, EMSS ambulances built on chassis that are suitable for the intended application and meet the requirements herein. The ambulances are front or rear wheel driven (4x2) or four wheel driven (4x4) and warranted as specified in Section 9. 1.1.1 Definition of Ambulance—An ambulance is a vehicle for emergency medical care which provides: a driver's compartment; a patient compartment to accommodate an emergency medical technician (EMT)/paramedic and two litter patients (one patient located on the primary cot and a secondary patient on a folding litter located on the squad bench) so positioned that the primary patient can be given intensive life-support during transit; equipment and supplies for emergency care at the scene as well as during transport; two-way radio communication; and, when necessary, equipment for light rescue/extrication procedures. The ambulance shall be designed and constructed to afford safety, comfort, and avoid aggravation of the patient's injury or illness. 1.1.2 This practice may be used to procure an ambulance and the applicable additional systems and equipment. 1.1.3 Purchasers should follow the ordering data in 9.2 to aid them with the preparation of their procurement specification, requisition, and contract. The purpose of this practice is to describe minimum requirements for design, construction, performance, equipment, testing, and appearance of EMSS ambulances that are authorized to display the “Star of Life” symbol so as to provide a practical degree of standardization. The reasons for such standardization are to provide ambulances that are easily detected, nationally recognizable, properly constructed, easily maintained, and, when appropriately equipped, will enable Emergency Medical Technicians (EMTs) to safely and reliably perform their functions as basic and advanced prehospital life support providers as set forth in national EMSS standard training guidelines. These functions include: 1.1.3.1 Responding to, providing appropriate basic or advanced life support, on-site, to persons reported experiencing acute injury or illness in a pre-hospital setting, and transporting them, while continuing such life support care, to an appropriate medical facility for definitive care. 1.1.3.2 Providing interhospital critical transport care. 1.1.3.3 Transporting essential personnel and equipment to and from the site of a multiple medical emergency or a triage site and transporting appropriately triaged patients to designated medical facilities. 1.1.3.4 Other functions deemed appropriate by EMSS ambulance service managers and approved by designated EMSS medical directors. 1.2 “Star of Life” Certification—Ambulance manufacturer/contractor shall furnish the purchaser(s) citing this practice an authenticated certification and label (see 6.19) that certifies a “Star of Life” ambulance and equipment complying with this practice and applicable amendments (if any) in effect on the date of manufacture (see 7.3). Ambulance vehicles so certified may display the registered “Star of Life” symbol, as defined by the U.S. Department of Transportation (DOT) and the National Highway Traffic Safety Administration (NHTSA), see Fig. 1. 1.3 Classification—“Star of Life” ambulance designs included in this practice may be described in terms of their body type (I, II, or III), class of drive (“1” for two rear wheel drive or “2” for four wheel drive), and floor configuration (A for Advanced Life Support or B for Basic Life Support). Such descriptions may be used to define a variety of ambulance designs which are eligible for certification as “Star of Life” ambulances. (To specify, see 9.2.2 and 9.2.3). Note 1—For optional advanced life support (ALS) applications, users should consider specifying a modular (Type I or III) ambulance. Modular ambulances provide additional space and compartmentation for cardiac monitors, drug cases, and so forth. The basic life support (BLS) configuration is standard on all types. 1.3.1 Type I—Conventional truck, cab-chassis with modular ambulance body (see Fig. 2). Class Configuration Two rear wheel driven (4x2)A or B Four wheel driven (4x4)A or B Configuration A: Elevating cot and squad bench for ALS (see 6.1.5.1 and 6.11.4). Configuration B: Elevating cot and squad bench for BLS (see 6.1.5.2). 1.3.1.1 Type I—AD (Additional Duty—with increased GVWR, storage, and payload capacity)—A or B or Neonatal, Critical Patient Transport, or A or B with Rescue and Fire Suppression Package (see 6.1.2.1). Class Configuration Two rear wheel driven (4x2)A or B* Four wheel driven (4x4)A or B* *As specified by purchaser. The configuration shall provide for a neonatal, critical patient transport, configuration A or B with fire suppression package and rescue capability when specified. 1.3.2 Type II—Standard van, integral cab-body ambulance (see 6.1.3 and Fig. 3). Class Configuration Two rear wheel driven (4x2)A** or B Four wheel driven (4x4)*A** or B *Requires conversion of chassis to four wheel drive (4x4), (see 6.1.6). **On a Type II, ALS features are limited, (see 9.2.3). 1.3.3 Type III—Cutaway van, cab-chassis with integral or containerized modular body ambulance (see 6.1.4 and Fig. 4). Class Configuration Two rear wheel driven (4x2)A or B Four wheel driven (4x4)*A or B *Requires conversion of chassis to four wheel drive (4x4), (see 6.1.6). Configuration A: Elevating cot and squad bench for ALS (see 6.1.5.1 and 6.11.4). Configuration B: Elevating cot and squad bench for BLS (see 6.1.5.2). 1.3.3.1 Type III—AD (Additional Duty—with increased GVWR, storage, and payload capacity) A or B or neonatal, critical patient transport, or A or B with rescue, or fire suppression package, or both (see 6.1.4.1). ClassConfiguration Two rear driven (4 × 2)A or B* Four wheel driven (4 × 4)A or B* *As specified by purchaser. The configuration shall provide for a neonatal, critical patient transport, configuration A or B with fire suppression package and rescue capability when specified. 1.4 Order of Precedence—In the event of a conflict between the text of this practice and the references cited herein, the text of this practice shall take precedence, except where required by law including Federal, State, and local laws and regulations. 1.5 The values stated in SI units are to be regarded as the standard. The values given in parentheses are for information only. 1.6 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use. FIG. 1 “Star of Life Symbol” FIG. 2 Type I Ambulance FIG. 3 Type II Ambulance FIG. 4 Type III Ambulance

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3.1 It is presumed for the purposes of this practice that the legal authority (agency) having responsibility for emergency services in a given jurisdiction also has a legal responsibility to provide workers’ compensation Insurance coverage for regular paid employees.3.2 Emergency services volunteers are presumed to be requested irregularly to provide special skills or assistance on behalf of the agency. As such, these volunteers act as part-time employees of the agency and are empowered to act to provide these services when specifically requested to do so, or pursuant to an approved plan or schedule, or under the supervision of a full-time employee.3.3 The legal authority incurs workers’ compensation insurance responsibility for emergency services volunteers (ESVs) while the ESV is actively providing services to the agency as defined in Section 5 of this practice. This period of activity shall be considered to be employment as defined by the state workers’ compensation statutes of the agency.3.4 When a legal authority (agency) requests the services of emergency services volunteers as defined by this practice to provide services, the agency shall assume responsibility for the injuries, medical treatment, loss of wages, and death of those emergency services volunteers while providing services as described in this practice.3.5 Responsibility for the injuries, medical treatment, loss of wages, and death of those emergency services volunteers while providing services as described in this practice shall be at the statutory limits of the workers’ compensation laws of the state of the agency requesting the services of the emergency services volunteer, and shall be administered in accordance with that agency's state workers’ compensation laws and regulations.3.6 Responsibility for workers’ compensation for members of emergency services units shall be the same as outlined in 3.1, and shall be provided by the agency normally directing the activities of the ESU.3.7 Responsibility for workers’ compensation for members of emergency services auxiliary units shall be the same as outlined in 3.1, and, unless provided for by other statute or agreement, shall be provided by the agency requesting the services and directing the activities of the AU.3.8 To provide an agency with trained personnel who are able to work in a safe and effective manner, it is generally required that the emergency service volunteer engage in training activity with the emergency service unit.3.8.1 A training plan is considered essential in establishing the basis for workers’ compensation insurance coverage during training. The plan serves as both prior notice to the responsible legal authority and documentation of training done to support the level of service provided. The training plan is considered to be a dynamic document, reflecting necessary changes due to weather, unit participation, newly identified skills, and rearranged priorities. As changes are made to the training plan, the revised plan is to be submitted to the agency.3.8.2 The training plan may be required by the agency, municipality, or government entity providing coverage and benefits in accordance with its contract for services or merely as a convenience to define activity periods.3.8.3 The training plan should establish goals and list measurable objectives. These goals provide a basis for a relationship between training and the incident response services provided. The plan should list all planned activity of the unit and who is expected to participate. This will delineate where insurance coverage is needed and expected. The plan should detail what supervision of activities and resources of the legal authority is expected. The plan should establish a means of accountability to the responsible legal authority for the unit's training activities, such as by check-in with a central dispatch, and listing on a formal activity roster.3.8.4 The training plan will contain the following elements to qualify for inclusion in workers’ compensation coverage:3.8.4.1 Identification of the emergency services unit.3.8.4.2 Definition of the period of time covered by the plan, usually a year.3.8.4.3 Establishment of the relationship of the ESU with the legal authority.3.8.4.4 Establishment of the overall plan goals.3.8.4.5 Broad outline of training plan (that is, field and classroom, equipment maintenance, training outside of the jurisdiction of the agency, and so forth).3.8.4.6 Specific outline of training plan (such as rappelling, nighttime field navigation, search and fire fighting techniques, medical applications, and so forth).3.8.4.7 Establishment of criteria for objective satisfaction.3.8.5 This training plan and activity must address techniques, skills and safety, and must be designed to enable the individual and the unit to meet recognized national standards or other standards as acceptable to the requesting agency.3.8.6 It is recognized that training for hazardous activity is often hazardous in and of itself, by the nature of the skills that the ESV is required to master.3.8.7 Since the agency is the beneficiary of this training, the ESV is said to be employed by the agency for the purposes of workers’ compensation benefits while engaging in training as a member of an emergency services unit. Covered training activities are those activities defined as official activities in a memorandum of understanding or other agreement between the ESU and the agency, where the agency is providing workers’ compensation benefits.3.9 An emergency services volunteer or unit may be requested by an agency to provide public education services. These services may include public appearances, preventative search and rescue (PSAR) programs, air search familiarization for ground search operations, first aid and CPR education, fire prevention education, and others.3.9.1 When engaged in such activities authorized by the agency, the ESV or ESU is considered to be employed by the agency for the purposes of workers’ compensation insurance.1.1 This practice defines the application of insurance benefits for emergency services volunteers and units in the manner and extent as provided for under the workers’ compensation statutes of the state in which the volunteer or unit provides services.1.2 This practice identifies the basic types of emergency service volunteer, and the types of activities that should be covered by workers’ compensation insurance.1.3 This practice includes both emergency service units who operate as organized resources to a public authority legally responsible for the provision of search and rescue and other emergency services, as well as those volunteers who respond to a general request to the public for their services.1.4 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety, health, and environmental practices and determine the applicability of regulatory limitations prior to use.1.5 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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4.1 Implementation of this practice will ensure that the EMS system has the authority commensurate with the responsibility to ensure adequate medical direction of all pre-hospital providers, as well as personnel and facilities that meet minimum criteria to implement medical direction of pre-hospital services.4.1.1 The state will develop, recommend, and encourage use of a plan that would ensure the standards outlined in this document can be implemented as appropriate at the local, regional, or state level (see Guide F1086).4.1.2 This practice is intended to describe and define responsibility for medical directions during transfers. It is not intended to determine the medical or legal, or both, appropriateness of transfers under the Consolidated Omnibus Budget Reconciliation Act and other similar federal or state laws, or both.1.1 This practice covers the qualifications, responsibilities, and authority of individuals and institutions providing medical direction of emergency medical services.1.2 This practice addresses the qualifications, authority, and responsibility of a Medical Director (off-line) and the relationship of the EMS (Emergency Medical Services) provider to this individual.1.3 This practice also addresses components of on-line medical direction (direct medical control) including the qualifications and responsibilities of on-line medical physicians and the relationship of the pre-hospital provider to on-line medical direction.1.4 This practice addresses the relationship of the on-line medical physician to the off-line Medical Director.1.5 The authority for control of medical services at the scene of a medical emergency is addressed in this practice.1.6 The requirements for a Communication Resource are also addressed within this practice.1.7 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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