ASF Standards · Medical Transport · Standard 6
Standard 6 — Emergency Response During Transport
Criteria in this standard
6.1 — Cardiac Arrest / Life-Threatening Event Protocol
6.2 — Nearest Appropriate Facility Diversion Capability
6.3 — Vehicle Breakdown or Accident Contingency
6.4 — Mass Casualty / Multi-Patient Surge Plan
6.5 — Post-Incident Debrief and Review
6.2 — Nearest Appropriate Facility Diversion Capability
6.3 — Vehicle Breakdown or Accident Contingency
6.4 — Mass Casualty / Multi-Patient Surge Plan
6.5 — Post-Incident Debrief and Review
6.1
Cardiac Arrest / Life-Threatening Event Protocol
Non-Negotiable
A written protocol governs crew response to cardiac arrest or other immediately life-threatening deterioration during transport, including whether to stop, continue, or divert, with crew trained and drilled on this decision-making, not improvising in the moment.
In plain terms: Crew know exactly what to do in a genuine cardiac arrest, including the stop-or-continue decision — drilled, not figured out in the moment under real pressure.
| Transport category | Standalone MTO | Hospital-operated | Ambulance service |
|---|---|---|---|
| Applicability | Full | Full | Full |
Why this matters
The decision of whether to stop the vehicle to provide optimal resuscitation, continue toward the destination, or divert to a nearer facility carries genuine trade-offs that are difficult to reason through clearly during an actual cardiac arrest. A drilled response, where the decision logic has already been worked through and practiced, functions very differently under real stress than a document crew have only read.
What good looks like
- Crew describe the stop-versus-continue criteria without hesitation.
- The protocol has actually been drilled, not only distributed as a document.
- A documented instance exists of the protocol being followed, or a drill record.
Common failure modes
- Crew hesitate or give inconsistent answers when asked about the decision criteria.
- The protocol exists as a document that’s been read but never practiced.
- No drill record or real event record exists to demonstrate the protocol functions.
Worked example
In practice
A transport organization reviewing its cardiac arrest response readiness.
BeforeA written protocol existed describing the stop-versus-continue decision, but it had never been drilled. When asked individually, different crew members gave inconsistent answers about when to stop versus continue toward the destination.
ActionThe organization ran a scenario-based drill specifically on the stop-versus-continue decision, using realistic simulated situations, and repeated this drill quarterly to maintain consistency across all crew.
AfterThe Monitor asked three crew members individually about the decision criteria and received consistent, confident answers, and reviewed the quarterly drill schedule and completion records. Criterion verified.
If you are starting from zero — do this first
- Ask several crew members individually about the stop-versus-continue decision criteria.
- If answers are inconsistent, clarify and formalize the decision logic.
- Run a scenario-based drill, not just document distribution.
The most common mistake: Distributing a written protocol and treating it as sufficient preparation, without ever actually drilling the decision through a realistic scenario, leaving the protocol untested until a genuine emergency occurs.
Self-assessment questions
1. Can crew describe the stop-versus-continue decision criteria without hesitation? — Hesitation in an actual cardiac arrest costs time that directly affects outcome.
Evidence: Crew interview
Evidence: Crew interview
2. Has this protocol actually been drilled, not only distributed as a document? — A drilled response functions very differently under real stress than one only read about.
Evidence: Drill record
Evidence: Drill record
3. Is there a documented instance of this protocol being followed during an actual event? — Where none has occurred, confirm the drill record instead.
Evidence: Event record or drill record
Evidence: Event record or drill record
Common reasons for a PARTIAL answer
- A protocol exists but has never been drilled through a realistic scenario.
- Different crew members give inconsistent answers about decision criteria.
Implementation plan
| When | What |
|---|---|
| Week 1 | Interview crew individually to check decision-criteria consistency. |
| Week 2 | Clarify and formalize the decision logic if gaps are found. |
| Week 3 | Run a scenario-based drill for all crew. |
| Ongoing | Repeat the drill on a quarterly schedule. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| ASK | Individual crew interview | Asks crew members separately about decision criteria to check for genuine consistency. |
Evidence base
Joint Commission International. Accreditation Standards for Medical Transport Organizations, 1st ed. Oak Brook (IL): JCI; 2021.
6.2
Nearest Appropriate Facility Diversion Capability
Non-Negotiable
Crew have real-time access to information on the nearest appropriate facility along any route, with a defined, practiced process for diverting there when a patient’s condition requires it, rather than continuing to the originally planned destination regardless.
In plain terms: Crew can quickly find and divert to the nearest genuinely appropriate facility if the patient needs it — and they can decide this themselves, without waiting on distant approval.
| Transport category | Standalone MTO | Hospital-operated | Ambulance service |
|---|---|---|---|
| Applicability | Full | Full | Full |
Why this matters
A rigid commitment to the originally planned destination, regardless of how a patient’s condition changes en route, overlooks the reality that the nearest appropriate facility can sometimes be the safer choice. A diversion decision that requires lengthy remote approval before crew can act undermines the entire purpose of having the capability — the value lies specifically in crew being able to act quickly based on their direct clinical assessment.
What good looks like
- Crew have actual, current nearby-facility information accessible en route.
- A documented instance exists of diversion actually occurring when needed.
- Crew can decide to divert directly, without needing distant approval first.
Common failure modes
- Facility information is outdated or requires a call back to dispatch to access.
- No example exists of diversion ever actually being used in practice.
- Diversion requires lengthy remote sign-off before crew can act.
Worked example
In practice
A long-distance transport where the patient’s condition worsened significantly mid-route.
BeforeCrew had to call dispatch and wait for a supervisor’s approval before diverting to a nearer facility, a process that took several minutes during an actual deteriorating situation, because the organization treated any deviation from the planned destination as requiring management sign-off.
ActionThe organization redefined policy to give crew direct authority to divert based on their own clinical assessment, with notification to dispatch happening simultaneously rather than as a prerequisite, and equipped vehicles with a real-time facility-mapping tool.
AfterThe Monitor reviewed a subsequent diversion event where crew made and acted on the decision within two minutes, notifying dispatch simultaneously rather than waiting for approval. Criterion verified.
If you are starting from zero — do this first
- Check whether diversion currently requires remote approval before crew can act.
- Give crew direct authority to divert based on clinical assessment.
- Equip vehicles with current, accessible nearby-facility information.
The most common mistake: Requiring crew to obtain remote approval before diverting, treating any deviation from the planned destination as a management decision rather than trusting crew’s direct clinical judgment in the moment.
Self-assessment questions
1. Do crew have actual, current access to nearby facility information en route, not relying on memory or an outdated reference? — Current, accessible information, not something that requires a call back to dispatch to look up.
Evidence: Facility information tool or reference
Evidence: Facility information tool or reference
2. Is there a documented instance of diversion actually occurring when needed? — Evidence the capability functions in practice, not just exists in theory.
Evidence: Diversion event record
Evidence: Diversion event record
3. Is the decision to divert made by crew directly, without needing to wait for distant approval that could cause dangerous delay? — A diversion decision requiring lengthy remote sign-off undermines the purpose of having the capability.
Evidence: Diversion decision policy
Evidence: Diversion decision policy
Common reasons for a PARTIAL answer
- Diversion requires remote approval, adding delay.
- Facility information isn’t genuinely current or easily accessible en route.
Implementation plan
| When | What |
|---|---|
| Week 1 | Review current diversion decision authority and approval requirements. |
| Week 2 | Grant crew direct diversion authority based on clinical assessment. |
| Week 3 | Equip vehicles with current facility information tools. |
| Ongoing | Review any diversion event for decision speed and appropriateness. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Diversion policy and event review | Checks diversion decision authority and reviews any actual diversion event for decision speed. |
Evidence base
Joint Commission International. Accreditation Standards for Medical Transport Organizations, 1st ed. Oak Brook (IL): JCI; 2021.
6.3
Vehicle Breakdown or Accident Contingency
Core
A written contingency plan covers vehicle breakdown or accident during a patient transport, including backup vehicle dispatch, patient safety measures, and notification protocols, tested at a defined interval.
In plain terms: There’s a real, tested plan for what happens if the vehicle breaks down or crashes mid-transport — specifically covering keeping the patient safe and comfortable during the wait, not just getting a new vehicle there.
| Transport category | Standalone MTO | Hospital-operated | Ambulance service |
|---|---|---|---|
| Applicability | Full | Full | Full |
Why this matters
A breakdown contingency plan focused purely on vehicle recovery logistics misses the most clinically relevant part of the scenario — what happens to the patient during the unplanned stop. Backup vehicle response time is a specific assumption that’s often untested and can prove considerably more optimistic than reality, which only testing reveals.
What good looks like
- The plan specifically addresses patient safety during the breakdown period.
- Backup vehicle dispatch has actually been tested, with a known realistic response time.
- Crew know their specific role during a breakdown.
Common failure modes
- The plan focuses on vehicle recovery logistics, not patient safety during the wait.
- Backup response time is assumed rather than actually tested.
- Only management knows the plan exists; crew don’t know their specific role.
Worked example
In practice
A breakdown contingency plan reviewed for the first time since it was written.
BeforeThe plan covered calling a backup vehicle, assumed to arrive “promptly,” with no documented patient safety measures for the waiting period and no record of the plan ever being tested.
ActionThe organization tested backup vehicle dispatch for real, discovering actual response time was twenty-two minutes rather than the assumed ten, revised the plan accordingly, and added specific patient safety and comfort measures for the waiting period.
AfterThe Monitor reviewed the test record showing realistic response time documentation and the patient safety measures now built into the plan, with crew able to describe their specific role. Criterion verified.
If you are starting from zero — do this first
- Add specific patient safety measures for the breakdown waiting period if missing.
- Actually test backup vehicle dispatch to get a real response time.
- Brief crew on their specific role during a breakdown.
The most common mistake: Assuming backup vehicle response time without ever actually testing it, which frequently proves considerably more optimistic than what a real test reveals.
Self-assessment questions
1. Does the plan specifically address patient safety during the breakdown period, not just vehicle recovery logistics? — Patient safety and comfort during an unplanned stop is the most clinically relevant part of this scenario.
Evidence: Written contingency plan
Evidence: Written contingency plan
2. Has backup vehicle dispatch actually been tested, with a known realistic response time? — An untested assumption about backup response time often proves optimistic.
Evidence: Test record
Evidence: Test record
3. Do crew know their specific role during a breakdown, not just that a plan exists? — A plan known only to management doesn’t function during an actual roadside event.
Evidence: Crew interview
Evidence: Crew interview
Common reasons for a PARTIAL answer
- Backup response time is assumed rather than genuinely tested.
- The plan lacks specific patient safety measures for the waiting period.
Implementation plan
| When | What |
|---|---|
| Week 1 | Review the current plan for patient safety measure coverage. |
| Week 2 | Conduct a real backup vehicle dispatch test. |
| Week 3 | Revise the plan based on test findings and brief crew on their role. |
| Ongoing | Re-test backup dispatch on a defined interval. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Plan and test record review | Reviews the contingency plan for patient safety content and checks for a genuine dispatch test record. |
Evidence base
Joint Commission International. Accreditation Standards for Medical Transport Organizations, 1st ed. Oak Brook (IL): JCI; 2021.
6.4
Mass Casualty / Multi-Patient Surge Plan
Core
Where the organization’s scope includes response to mass casualty or multi-patient events, a written surge plan covers resource allocation, triage coordination with other responders, and communication with receiving facilities.
In plain terms: If the organization actually responds to mass casualty events, there’s a real plan specific to its own operations — not a generic template, and not written in isolation from other responders.
| Transport category | Standalone MTO | Hospital-operated | Ambulance service |
|---|---|---|---|
| Applicability | Where applicable | Where applicable | Full |
Why this matters
A generic mass casualty template, not adapted to the organization’s actual fleet size, typical operating area, and real relationships with other responders, provides limited genuine readiness. Mass casualty events virtually always involve coordination across multiple organizations, which means a plan written in isolation, without reference to how other responders will actually be coordinating, misses the most operationally critical element.
What good looks like
- The plan is specific to the organization’s actual scope and operating area.
- The plan specifically addresses coordination with other responders.
- The plan has been exercised, even at a tabletop level, within a defined interval.
Common failure modes
- A generic template is adopted without adaptation to actual operations.
- The plan focuses only on internal resource allocation, not external coordination.
- No exercise, even tabletop, has ever been conducted.
Worked example
In practice
A regional transport organization with a generic mass casualty plan.
BeforeThe organization’s mass casualty plan was adapted from a generic industry template, with no reference to the organization’s actual fleet size or any coordination arrangement with the regional fire service or other transport providers.
ActionThe organization rewrote the plan specific to its actual resources and established a formal coordination agreement with the regional emergency management authority, then ran a tabletop exercise involving those partner organizations.
AfterThe Monitor reviewed the revised plan, the coordination agreement, and the tabletop exercise record showing genuine multi-organization participation. Criterion verified.
If you are starting from zero — do this first
- Check whether your current plan is adapted to your actual resources and area, not a generic template.
- Build or formalize coordination arrangements with other regional responders.
- Run at least a tabletop exercise with relevant partners.
The most common mistake: Adopting a generic industry-standard mass casualty template without adapting it to the organization’s actual fleet size, typical operating area, and real relationships with other regional responders.
Self-assessment questions
1. Is the plan specific to the organization’s actual scope and typical operating area, not a generic template? — A plan written for a different context than the organization’s real operations is of limited practical use.
Evidence: Written surge plan
Evidence: Written surge plan
2. Does the plan specifically address coordination with other responders, not just internal resource allocation? — A mass casualty event rarely involves this organization alone.
Evidence: Coordination agreement or arrangement
Evidence: Coordination agreement or arrangement
3. Has the plan been exercised, even at a tabletop level, within a defined interval? — An untested surge plan frequently reveals gaps only once genuinely tested.
Evidence: Exercise record
Evidence: Exercise record
Common reasons for a PARTIAL answer
- The plan is a generic template not adapted to actual operations.
- No formal coordination exists with other regional responders.
Implementation plan
| When | What |
|---|---|
| Week 1 | Review the current plan against actual organizational resources. |
| Week 2 | Establish or formalize coordination arrangements with other responders. |
| Week 3 | Plan and schedule a tabletop exercise. |
| Ongoing | Exercise the plan on a defined interval with partner organizations. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Plan and exercise review | Reviews the surge plan’s specificity and checks for a genuine exercise record involving other responders. |
Evidence base
World Health Organization. Mass Casualty Management Systems: Strategies and guidelines for building health sector capacity. Geneva: WHO; 2007.
6.5
Post-Incident Debrief and Review
Standard
Following any significant clinical event, breakdown, or diversion during transport, a structured debrief is conducted with involved crew, with findings feeding into the organization’s corrective action process.
In plain terms: After anything significant happens, the crew actually talk it through properly — and what they find genuinely leads to real changes, not just a conversation that goes nowhere.
| Transport category | Standalone MTO | Hospital-operated | Ambulance service |
|---|---|---|---|
| Applicability | Full | Full | Full |
Why this matters
A near-miss with a fine outcome still carries genuine lessons, but these are easily lost if debriefs happen only after events with poor outcomes. The real value of a debrief lies specifically in its connection to corrective action — an insightful conversation that never translates into an actual process change has captured the lesson without acting on it, which means the same situation can recur.
What good looks like
- A debrief is actually conducted after significant events, including near-misses.
- Debrief findings genuinely feed into corrective action, with traceable follow-through.
- The debrief environment is genuinely blameless, encouraging honest input.
Common failure modes
- Debriefs happen only after events with poor outcomes, not near-misses.
- Findings stay as an informal conversation with no link to corrective action.
- A punitive debrief environment discourages honest, complete accounts.
Worked example
In practice
A near-miss where a scheduling error nearly resulted in an acuity mismatch.
BeforeA dispatch error nearly sent a basic-level crew on a critical-acuity transport, caught just before departure. Because the outcome was ultimately fine, no formal debrief occurred, and the scheduling process gap that allowed the near-miss remained unaddressed.
ActionThe organization extended its debrief requirement explicitly to near-misses, not only events with actual poor outcomes, and built a direct link from debrief findings into the corrective action tracking system.
AfterThe Monitor reviewed a subsequent near-miss debrief record and traced its finding directly to a specific corrective action that closed the scheduling process gap. Criterion verified.
If you are starting from zero — do this first
- Confirm debriefs are explicitly required for near-misses, not just poor-outcome events.
- Build a direct link between debrief findings and the corrective action process.
- Establish and communicate a genuinely blameless debrief approach.
The most common mistake: Reserving formal debriefs for events with an actual poor outcome, missing the valuable lessons available from near-misses that happened to resolve without lasting harm.
Self-assessment questions
1. Is a debrief actually conducted after significant events, not skipped if the outcome was ultimately fine? — A near-miss with a fine outcome still carries lessons worth capturing.
Evidence: Debrief record
Evidence: Debrief record
2. Do debrief findings actually feed into corrective action, or do they stay as an informal conversation with no follow-through? — A debrief with no link to corrective action produces insight that goes nowhere.
Evidence: Corrective action traceability
Evidence: Corrective action traceability
3. Is the debrief genuinely blameless, encouraging honest input rather than defensive accounts? — A punitive debrief environment discourages the honesty needed to actually learn from an event.
Evidence: Debrief culture assessment
Evidence: Debrief culture assessment
Common reasons for a PARTIAL answer
- Near-misses with fine outcomes don’t trigger a formal debrief.
- Debrief findings aren’t traceable to specific corrective actions.
Implementation plan
| When | What |
|---|---|
| Week 1 | Extend the debrief requirement explicitly to near-misses. |
| Week 2 | Build a direct link from debrief findings to corrective action tracking. |
| Week 3 | Communicate and reinforce a blameless debrief approach to all crew. |
| Ongoing | Review debrief-to-corrective-action traceability periodically. |
How the Monitor verifies this
| Method | What | Detail |
|---|---|---|
| DOCUMENT | Debrief-to-action traceability review | Selects a debrief record and traces it to a specific resulting corrective action. |
Evidence base
Joint Commission International. Accreditation Standards for Medical Transport Organizations, 1st ed. Oak Brook (IL): JCI; 2021.