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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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1. Scope This standard specifies the safety and interchangeability requirements, together with the test methods and conditions, required to show compliance of tubular fluorescent and other gas-discharge lamps with integrated means for controlling start

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