July 11, 2018
Hurricane Andrew made a mess of communities in Florida (USA).
Months after its Aug. 23, 1992, landfall near Miami, meteorologists upgraded it to a Category 5 hurricane with 167 mph winds at one point and 17-foot storm surge. The storm killed 65 people and stripped thousands of homes to concrete foundations.
The storm was so destructive that meteorologists retired its name forever.
Hurricane Andrew’s fury prompted a statewide building code in Florida, passed in 2002. The rules (among other standards) require stronger fasteners on roofs of newly built structures to keep them from blowing off. For example, fasteners for asphalt shingles roofs in Florida must comply with American Society for Testing and Materials (ASTM) F-1667 (Standard Specification for Driven Fasteners: Nails, Spikes, and Staples). The standard covers material requirements and physical properties, such as ductility and tensile strength.
Standards are not always welcomed, despite their intent in the preservation of life and property. Some might say a particular standard is heavy-handed or some might feel victimized because they were left out of the process.
In medicine, most are familiar with the phrase Standard of Care. While the concept has evolved over the years and will continue to do so, it is generally accepted that the standard of care is what a minimally competent physician in the same field would do in the same situation, with the same resources.1
Standards are inescapable for people and organizations. They address a range of issues for the benefit of the whole. Concisely stated, “standards fuel the development and implementation of technologies that influence and transform the way we live, work, and communicate.”2
Standards are applied in operational law, regulations, and municipal and state codes. They guide best practices. ASTM’s 12,000+ standards are applicable to industry, infrastructure, defense, the environment, consumer products, and occupational health and safety.
Catastrophic events, such as Hurricane Andrew, led to ASTM standards for emergency management. The ASTM EMS Committee, formed in 1984, has four technical subcommittees, including one for communications.
The ASTM has since published standards and position statements addressing EMD system design, safety, and effectiveness. ASTM states in document F-1258 Standard Practice for Emergency Medical Dispatch (Section 4.1.2.):
There must be continuity in the delivery of EMD care. To safely and effectively provide correct medical care, the EMD that is medically directing, evaluating and coding, must maintain direct access to the calling party and must use a medically approved emergency medical dispatch priority reference system. The person giving the medical instruction to the caller must be the same person that asks the systematic interrogation questions.
The statement appears in the first version of F-1258 and in the most recent revision released in 2014. The document has changed markedly over the years. It never wavers from the value of EMD or the use of a dispatch priority reference system. Rather, modifications expand and reinforce an EMD’s significance to EMS. Section 5.4/F-1259-95 (2014), which was added in later revisions, encapsulates what IAED Founder Dr. Jeff Clawson, who invented the emergency dispatch protocols, has been preaching for years:
This practice [standards for EMDs] may assist in overcoming some of the misconceptions regarding emergency medical dispatching. These include the uncontrollable nature of the caller’s hysteria, lack of time of the dispatcher, potential danger and liability to the EMD, lack of recognition of the benefits of dispatch pre-arrival instructions, and misconceptions that red lights, siren, and maximal response are always necessary.
Wow! How many times have we heard that?
When you consider that the correct use of a protocol is the equivalent of a roof builder’s checklist, any omission can and often will blow the roof right off the house.
1 Moffett P, Moore G. “The Standard of Care: Legal History and Definition: the Bad and Good News.” The Western Journal of Emergency Medicine. 2011; Feb. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088386/ (accessed Jan. 15, 2018).
2 “What are Standards? Why are They Important?” Institute of Electrical and Electronics Engineers (IEEE). 2011; Oct. 3. https://beyondstandards.ieee.org/general-news/what-are-standards-why-are-they-important/ (accessed Jan. 15, 2018).
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