National Policy on Ambulance Use and Services

January 7, 2010

DOH ADMINISTRATIVE ORDER NO. 2010-0003

 

I. Background

Ambulance service is one of the vital health services for the delivery of pre-and post hospital care to a sick patient or to an injured patient resulting from an emergency or a disaster.

It includes transporting the patient from the incident site to the emergency room of the receiving hospital for definitive care, transferring the patient to another hospital for further diagnostic and treatment purposes and, as a special health service, rendering emergency medical care and life support to sustain the stability of the patient in transit to and from the hospital.

All these require a vehicle, called an ambulance, carrying the necessary medical care providers and appropriate life saving equipment, which is designed to comfortably accommodate a recumbent sick or injured patient and allow easy movement of the medical care providers for continuous care of the patient.

Ambulance Service also includes transporting medical care providers, blood and emergency supplies.

This national policy on ambulance use and services has been crafted to govern all stakeholders in their provision of such a critical and crucial service.

II. Objective

To provide guidance to all concerned agencies on the proper design, equipping, staffing and utilization of ambulance services to protect and save the lives of patients and to enable the medical care providers to properly perform their corresponding duties.

III. Scope and Coverage IcDHaT

This policy applies to all hospitals, health facilities, and all other agencies, whether government or private, providing ambulance services.

IV. Definition of Terms

A. Ambulance — a vehicle designed and equipped for transporting sick or injured patients to, from, and between places of treatment by land, sea or air, affording safety and comfort to the patients and avoiding aggravation of illness or injury.

B. Ambulance Driver — a person who possesses a valid professional driver's license, who has undergone Basic Life Support Training and, who has been issued an appropriate identification card by the DOH.

C. Ambulance Service — a vital health service for the delivery of pre and post hospital care to patients, from the site of incident to the emergency room of the appropriate receiving hospital for definitive care. It is also for transfer of the patient to another hospital for further diagnostic and treatment.

D. Disaster — an actual threat to public health and safety where the local government and the emergency services are unable to meet the immediate needs of the community.

E. Emergency — an actual threat to an individual's life or to public health and safety which needs immediate response.

F. Medical Care Providers — doctors, nurses and paramedical personnel from either government or private institutions performing pre and post hospital care to sick and or injured people resulting from an emergency or a disaster.

V. Policy Statements

A. Every emergency or disaster victim shall be transported safely to and from the nearest appropriate hospital for definitive care.

B. The ambulance shall be used to transport a patient especially the critically ill/serious and/or injured.

C. The ambulance shall also be used to transport medical care providers and blood and emergency supplies. EaHcDS

D. No ambulance shall be used for purposes other than those found in the sections entitled "Background" and "Policy Statements" of this AO.

E. The ambulance shall not be used to transport cadavers.

F. The safety and protection of the patient as well as the medical care providers shall be of primary consideration.

G. All agencies providing ambulance services shall comply with the standards and guidelines of the Department of Health.

H. All hospitals are required to have ambulance services unless allowed by DOH regulations to contract out these services.

I. The ambulance shall be properly marked and identified.

J. The Ambulance Service shall:

1. Have appropriately trained and competent personnel

2. Provide appropriately staffed ambulances

3. Have ambulance/s which:

a. is/are equipped according to the type, classification and level of hospital and ambulance service.

b. is/are regularly maintained.

c. is/are always properly cleaned, sanitized and decontaminated, before and after patient and medical care provider transport.

K. The Ambulance Service of the hospital should preferably be under the direct supervision of the Emergency Department with support from the hospital Administrative Department.

L. Standards and Guidelines shall be developed, coordinated, and disseminated by the DOH among agencies providing ambulance services. SaDICE

M. Only licensed ambulance service providers shall be allowed the sole use of the word AMBULANCE to appear on their ambulances.

N. Ambulance medical care providers and ambulance drivers shall preferably be covered by appropriate additional insurance.

VI. Implementing Mechanisms

A. Department of Health

1. National Center for Health Facility Development

a. Prepares the National Development Plan for Ambulance Service.

b. Develops policies, standards and guidelines for mobilization of ambulance service, the management and care of patients in the ambulance, the safety and protection of the medical care providers, etc.

c. Establishes standards for continuous quality improvement (CQI) of ambulance services.

2. Bureau of Health Devices and Technology

a. Establishes standards and guidelines for ambulance design

3. Health Emergency Management Service

a. Undertakes capability building for medical care providers and ambulance drivers

4. Bureau of Health Facilities and Services

a. Establishes licensing standards for ambulance services and ensures their implementation through regulation. The license of hospital-based ambulance service shall be part of the hospital license. All other ambulance services shall require a separate license. cDCSTA

5. Centers for Health Development

a. Monitors compliance of ambulance service providers with DOH policies, standards and guidelines.

B. Philippine Health Insurance Corporation (PHIC)

1. Develops a scheme to ensure that ambulance service is part of PhilHealth reimbursable packages.

2. Requires hospitals to comply with DOH CQI standards.

C. Hospitals (Government or Private)

1. Comply with DOH national policies, standards and guidelines for ambulance use and services.

2. Develop standard operating procedures for ambulance service.

3. Ensure continuous training of all personnel involved in ambulance service.

4. Ensure regular maintenance of the ambulance.

D. Department of Transportation and Communications through a Memorandum of Agreement with the DOH

D.1 Land Transportation Office

a. Maintains an ambulance database in coordination with the DOH.

b. Develops and implements a fast lane for registration of all ambulances.

c. Assists in monitoring of ambulance use.

D.2 Toll Regulatory Board TAIESD

a. Designates an emergency lane for ambulances, free of toll charge

E. Philippine Charity Sweepstakes Office

1. Complies with DOH national policies, standards, and guidelines for ambulance design.

2. Coordinates closely with the DOH relative to ambulance distribution.

3. Observes the DOH standard ambulance design in procuring ambulances.

4. Releases ambulances given to agencies and Local Government Units only after proper training of the assigned medical care providers and ambulance drivers.

F. Bureau of Fire Protection

• Comply with DOH national policies, standards and guidelines for ambulance use and services.

G. Private and Public Groups providing ambulance service

• Comply with DOH national policies, standards and guidelines for ambulance use and services.

H. Local Government Units

• Pursuant to a Memorandum of Agreement between the DILG and the DOH, comply with DOH national policies, standards and guidelines for ambulance use and services and support the corresponding standard operating procedures developed by the local hospitals.

I. Hospital Associations and Private Hospital Associations

1. Support the type of ambulances recommended for specific hospitals IDEHCa

2. Provide training and networking support

J. Philippine National Red Cross

1. Complies with DOH national policies, standards and guidelines.

2. Develops corresponding standard operating procedures.

3. Provides training for medical care providers and ambulance drivers and networking support to ambulance service providers.

K. Philippine National Police (Highway Patrol Group) and Metro Manila Development Authority

1. Comply with DOH national policies, standards and guidelines for ambulance use and services.

2. Ensure that traffic enforcers assist, direct and provide clear roadways for Ambulances.

3. Assist in monitoring ambulance use.

4. Apprehend violators of proper ambulance use.

L. Armed Forces of the Philippines

1. Comply with DOH national policies, standards and guidelines for ambulance use and services.

2. Provide support for continuous ambulance operation needs from land to air or sea transfer.

VII. Manual of Standards and Guidelines

The Undersecretary of Health for the Policy and Standards Development Team for Service Delivery of the DOH shall organize and oversee the Technical Working Group/s that will prepare corresponding Manuals of Standards and Guidelines for Ambulance Design, Services and Training in consultation with ambulance service providers, emergency medicine experts and other stakeholders. TAacCE

The above implementing agencies shall develop their own Standard Operating Procedures to fit their roles and responsibilities.

VIII. Repealing Clause

Provisions from previous issuances and other related orders that are inconsistent or contrary to this Order, are amended and modified accordingly.

IX. Effectivity

This Order shall take effect immediately.

(SGD.) FRANCISCO T. DUQUE III, MD, MSc.Secretary of Health