Rules and Regulations Governing the Licensure of Ambulances and Ambulance Service Providers

June 29, 2016

DOH ADMINISTRATIVE ORDER NO. 2016-0029

 

I. Background and Rationale

Section VI.A.4. of Administrative Order No. 2010-0003 entitled "National Policy on Ambulance Use and Services" states that the "Bureau of Health Facilities and Services shall establish 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." HTcADC

The current licensing standard requires hospital facilities to provide ambulance services. However, it has been observed that the term 'ambulance' has been misused. There are ambulances that operate without competent personnel, appropriate equipment and life-saving drugs capable of responding to medical emergencies.

Regulation is the first step to ensure that health facilities and services comply with the quality standards that will not put patients' lives at risk. It is in this light that the Health Facilities and Services Regulatory Bureau (HFSRB) sets the basic requirements as well as the minimum structural inputs in relation to ambulance design, physical facilities, manpower, and equipment for the operation of ambulance and ambulance service providers that support the right of patients to safe and quality health care.

In view of the above, this Order aims to establish mandatory minimum requirements for ambulances and ambulance service providers in line with the Kalusugan Pangkalahatan (Universal Health Care) strategic thrust to improve access to safe, quality and affordable health services.

II. Objective

These rules and regulations are promulgated to protect the public and assure the safety of patients and personnel by:

1. To set the minimum standards and requirements for ambulances and ambulance service providers; and

2. To ensure the safety of patients, personnel and the general public.

III. Scope and Coverage

These rules and regulations shall apply to all government and private land ambulances and ambulance service providers.

IV. Definition of Terms

For purposes of this Order, the following terms, abbreviations and definitions apply:

1. Ambulance — a vehicle designed and equipped for transporting sick or injured patients to, from, and between places of treatment by land, water or air, affording safety and comfort to the patients and avoiding aggravation of illness or injury. This excludes rapid response vehicles such as, but not limited to, motorcycles, cars and other vehicles designed to transport patients but are not equipped to respond to medical emergencies.

2. Advanced Cardiac Life Support (ACLS) — a group of interventions used to treat and stabilize adult victims of life-threatening cardiorespiratory emergencies and to resuscitate victims of cardiac arrest. These interventions include CPR, basic and advanced airway management, tracheal intubation, medications, electrical therapy and intravenous (IV) access.

3. Automated External Defibrillator (AED) — an external computerized defibrillator designed for use in unresponsive victims with no breathing and no signs of circulation.

4. Basic Life Support (BLS) — a group of actions and interventions used to resuscitate and stabilize victims of cardiac or respiratory arrest. These BLS actions and interventions include recognition of a cardiac or a respiratory emergency or stroke, activation of the emergency response system, CPR and relief of foreign-body airway obstruction.

5. Cardio-Pulmonary Resuscitation (CPR) — any maneuvers or techniques designed to restore circulation, or a technique combining artificial ventilation and chest compressions designed to perfuse vital organs or restore circulation to a victim of cardiopulmonary arrest.

6. Department of Health-License to Operate (DOH-LTO) — a formal authority issued by DOH to an individual, agency, partnership or corporation to operate an ambulance. It is a prerequisite for accreditation of a health facility or service provider by any accrediting body recognized by DOH.

7. Emergency Medical Services (EMS) — medical service designed to provide timely pre-hospital or out of hospital acute medical care and/or transport to definitive care, to patients with sudden and life-threatening injuries or emergencies.

8. First Aid — initial emergency care given to a person who is injured or suddenly becomes ill.

9. Health Facilities and Services Regulatory Bureau (HFSRB) — the Bureau of DOH charged with the implementation of these rules and regulations. aScITE

10. Medical directive — a system of physician-directed quality assurance that provides professional and public accountability for medical care in pre-hospital setting.

11. Medical emergencies — any acute or life-threatening condition that requires immediate intervention by a competent personnel.

12. Regional Office (RO) — the Regional Health Office of DOH.

13. Signage — any form of written announcement installed, posted, hanged, painted or otherwise displayed in a public place.

V. Implementing Mechanisms

A. General Guidelines

1. Ambulance service providers shall secure registration for all vehicles at the Land Transportation Office (LTO) prior to application for license to operate.

2. Ambulance service providers shall secure DOH-LTO per vehicle to be issued by HFSRB.

3. Ambulance service providers shall ensure that they are part of a functional referral network within the area/vicinity where they are allowed to operate.

4. Stakeholders shall strictly comply with the standards, criteria and requirements prescribed in the Assessment Tool for licensure of ambulances and ambulance service providers.

5. The DOH-LTO of ambulance service providers shall be valid for three (3) years, from January of the first year to December of the third year.

a. Institution-based ambulance services shall be included in the One-Stop Shop (OSS) licensure system for hospitals and other health facilities. The DOH-LTO of the ambulance shall be reflected in the health facility DOH-LTO. Hence, a separate DOH-LTO is not required.

b. Non-institution-based ambulance service providers shall secure a separate DOH-LTO.

c. The plate or conduction sticker number AND Certificate of Registration (CR) number of each ambulance vehicle shall be reflected in the DOH-LTO of the ambulance service providers.

6. Ambulance vehicles from non-licensed ambulance service providers shall be forwarded to the Land Transportation Office for appropriate action.

B. Specific Guidelines

1. Classification of Ambulance Service Providers

a. According to Ownership

1. Government — owned, managed and operated wholly by the specific government agencies such as, but not limited to, DOH hospitals, LGU and LGU-run hospitals, BFP and PNP of DILG, Coastguard of DOTC, AFP of DND, MMDA and others.

2. Private — owned, established and operated with funds through donation, principal, investment or other means by any individual, corporation, association or organization. A private health facility may be a single proprietorship, partnership, corporation, cooperative, foundation, religious, non-government organization and others.

b. According to Functional Capacity

Land Ambulance — minimum of four-wheeled vehicles designed and equipped for the provision of BLS and capable of transporting and monitoring patients over terrain.

c. According to Institutional Character

1. Institution-based — ambulance service provider that operates as part of a health facility (i.e., hospital, infirmary, etc.)

2. Non-institution-based — ambulance service provider that operates independently. May be located inside or outside the premises of a health facility.

2. Standards

Every ambulance service provider shall be organized to provide safe, quality, effective and efficient ambulance services for patients.

a. Ambulance Service Provider

1. A private ambulance service provider shall be registered with the Department of Trade and Industry (DTI) or with the Securities and Exchange Commission (SEC), whichever is applicable. For government ambulance services, a local government ordinance or board resolution stating ownership of ambulance vehicles shall be required.

2. The ambulance service provider shall be housed in a business office/space that can also serve as the Operations Control and Dispatch Center of the ambulances. The office shall have adequate parking spaces for the ambulance/s they own.

3. The ambulance service provider shall have a minimum ratio of 1 set of personnel for every 2 ambulances owned. A minimum set of personnel consists of two (2) responders and a driver.

4. The ambulance service provider shall ensure that each personnel has obtained the minimum trainings stipulated in this Order. HEITAD

b. Personnel

Each ambulance service provider shall have an adequate number of qualified, trained and competent staff to ensure efficient and effective delivery of quality ambulance services.

1. A minimum of at least two (2) responders, excluding the driver, is required for every ambulance dispatched. Additional staff depends on the nature of the emergency as determined by the management of the service provider.

2. There shall be staff development and continuing education program to upgrade the knowledge, attitude and skills of staff.

3. Responders shall be Standard First Aid, BLS, EMT and ACLS-trained from a DOH-recognized training provider.

c. Ambulance

1. An ambulance vehicle shall be able to accommodate the patient, and the required number of personnel and equipment.

2. The ambulance vehicle shall be registered with the LTO under the name of the ambulance service provider.

3. Ambulances shall bear the following markings:

a. The word AMBULANCE shall be seen at the back and at front of the vehicle, which is spelled out in reverse. The height of each letter shall be no less than 0.15 meters and the word shall be seen at least six (6) meters away. 

b. The prescribed DOH logo (Refer to Annex-A: Official DOH Ambulance Logo). This logo shall be placed on both sides of the ambulance. On top of the DOH Logo, the phrase LICENSED BY DOH shall be placed.

c. Any signage and other images outside of what is prescribed by DOH are not allowed.

4. Vehicles labeled as ambulances which are used outside of its intended scope/purpose shall not be allowed. Violators shall be dealt accordingly.

• i.e., Funeral parlors using and misusing the term 'AMBULANCE' in their multipurpose transport vehicles shall be reported to the concerned Local Government Unit (LGU) or to Department of Health (DOH) for appropriate action.

5. Ambulance vehicles shall have Emergency Warning Light System and Siren-Public Address System.

d. Equipment, Medicines and Supplies

Every ambulance shall have available and operational prescribed equipment, medicines and supplies.

1. Each ambulance shall be adequately equipped with appropriate equipment, medicines and supplies. (Refer to Annex B: Required Emergency Equipment, Supplies and Medicines)

2. Each ambulance shall have adequate and stable cabinet/s that can appropriately store the required equipment, medicines and supplies. These storage shall be easily accessible but properly secured at all times.

3. The use of Personal Protective Equipment (PPEs) and adherence to infection control policies shall be strictly observed.

4. There shall be a program for calibration, preventive maintenance and repair of equipment, including decontamination and disinfection.

5. There shall be a contingency plan in case of equipment breakdown and malfunction, especially during patient transport.

e. Service Delivery

Every ambulance service provider shall ensure that the services delivered to patients comply with the standard quality embodied in the Assessment Tool for licensure of ambulances, other policy guidelines and/or related issuances.

1. Each ambulance service provider shall have documented policies and procedures on its administrative and technical Standard Operating Procedures (SOP) for the provision of its services. ATICcS

2. Each ambulance service provider shall have documented policies and procedures on the establishment of its referral system.

a. The inter-facility referral network shall be strengthened through linkages of all levels of care and partnerships (of hospital and EMS).

b. Ambulance service providers shall have a Memorandum of Agreement (MOA) with hospital facilities. The MOA shall not apply when the patient expresses preference for a certain facility and in cases of extreme medical emergencies.

3. Ambulances shall have communication devices linked to the operations center of the ambulance service provider and the referral hospital for recording and effective management of cases.

4. Medical direction shall be part of the ambulance service.

5. All patients being transported by ambulance shall have standard patient record form.

f. Information Management

Every ambulance service provider shall maintain a system of communication, recording and reporting of the patient's condition as well as the results of examinations.

1. Hospital Referral Form

Each form shall be kept confidential and shall contain sufficient information to identify the patient and to justify the treatment provided, which includes the information of transfer/referral of patient to another physician or health facility.

2. Logbook

Ambulance service providers shall maintain a logbook which shall be signed by the head of the DOH licensing team during inspection and/or monitoring visits. The logbook shall contain, but not be limited to, the following information (Refer to Annex C: Logbook of Accomplishments for Inspection and Monitoring):

a. Name, sex and age of patient;

b. Name of attending physician, when applicable;

c. Origin and destination;

d. Date and time of dispatch and return of ambulance;

e. Reason for transfer/transport;

f. Disposition of patient.

3. Submission of Reports

Ambulance service providers shall submit an annual report utilizing the template provided by DOH on or before 31 March. The report shall contain, but not be limited to, the following information. (Refer to Annex D: DOH Annual Statistical Report for Ambulance Service Providers)

a. Number of ambulance conductions stating Regional Office, Province, Municipality, City, including the type of the health facility:

1. Inter-facility hospital to hospital

2. Other health facilities to hospital (e.g., Medical Out-Patient Clinics, RHU, birthing facility, infirmary, drug abuse and treatment centers, psychiatric custodial care facility, nursing homes)

3. Home to hospital

4. Hospital to Home

5. Other routes, specify. (i.e., Hospital to Airport/Ports or vice versa)

b. Reason for referral/transport TIADCc

c. Date, time and description of Adverse Events e.g., number of deaths en route, if any. In case of ambulance death referred by a hospital, the referring hospital shall issue the death certificate. Otherwise, the City/Municipal Health Officer, where the patient died, shall issue the death certificate.

g. Environmental Management

Every ambulance service provider shall ensure that the environment is safe for its patients and staff including members of the public as necessary and that the following measures and/or safeguards shall be observed:

1. The ambulance shall be properly ventilated, lighted, clean and safe.

2. The ambulance shall have a partition between the driver and the compartment or body. The partition shall be air-tight bulkhead with transparent viewing panel.

3. There shall be a written plan and program of proper disinfection and preventive maintenance of the ambulance vehicles.

4. There shall be procedures for the proper disposal of infectious wastes and toxic and hazardous substances in accordance with R.A. 6969 known as "Toxic and Hazardous Substances and Nuclear Wastes Act" and other related policy guidelines and/or issuances.

VI. Procedural Guidelines

A. Application for Initial DOH-LTO

1. Ambulance owners and ambulance service providers shall submit the following relevant documents to HFSRB:

a. Duly accomplished application form. This form can be downloaded from http:/hfsrb.doh.gov.ph/.

b. Proof of ownership

1. Department of Trade and Industry (DTI);

2. Securities and Exchange Commission (SEC) Registration with Articles of Incorporation and By-laws;

3. Enabling Act or Board Resolution for government;

4. Cooperative Development Authority Registration with Articles of Cooperation and By-laws, whenever applicable. cSEDTC

c. Registration of the vehicle(s) from the Land Transportation Office

d. License of the ambulance driver/s as Professional Driver, from the Land Transportation Office

2. Pay the corresponding fee, and submit a copy of the official receipt to HFSRB.

3. Once the application has been approved, the ambulance service provider shall be given a copy of the Official DOH Ambulance Logo and this shall be mounted accordingly to each ambulance vehicle prior to the issuance of the DOH-LTO. Each ambulance vehicle shall have a copy of DOH-LTO of the ambulance service provider.

B. Application for Renewal of DOH-LTO

1. Ambulance owners and ambulance service providers shall prepare following relevant documents prior to application.

a. Duly accomplished application form. This form can be downloaded from http:/hfsrb.doh.gov.ph/.

b. DOH annual ambulance statistical report

c. Other relevant records as may be required by DOH

2. Applicants shall submit the application to the following offices, which shall receive and process the renewal application.

a. HFSRB for non-institution-based ambulance service providers and Levels 2 and 3 hospital-based ambulance service providers.

b. Regional Offices for Infirmary and Level 1 hospital-based ambulance service providers.

3. Pay the corresponding fee, and submit a copy of the official receipt to HFSRB or Regional Office, whichever is applicable.

4. Once the application has been approved, the ambulance service provider shall be given a copy of the Official DOH Ambulance Logo and this shall be mounted accordingly to each ambulance vehicle prior to the issuance of the DOH-LTO. Each ambulance vehicle shall have a copy of DOH-LTO of the ambulance service provider.

5. The DOH-LTO of an ambulance shall be cancelled automatically without notice upon failure to submit a duly accomplished application form and to pay the proper fee beyond thirty (30) days from the date of expiration stated in its license. Thereafter, the service provider shall apply as initial DOH-LTO.

C. Inspection

1. The HFSRB or RO, as the case may be, shall conduct licensure inspections utilizing the Assessment Tool for licensure of ambulances within fifteen (15) working days upon submission of complete requirements.

2. The applicant shall ensure that all key staff, pertinent records, and ambulances are made available to HFSRB/RO Director and/or his authorized representative(s) during inspection visits.

D. Monitoring

1. Ambulances and ambulance service providers shall be monitored regularly.

2. The HFSRB or RO Director and/or his authorized representative(s) shall conduct periodic monitoring visits utilizing the Assessment Tool for licensure of ambulances.

3. The applicant shall ensure that all key staff, records, premises and facilities are made available to HFSRB or RO Director and/or his authorized representative(s) during monitoring activities.

4. A Notice of Violation shall be issued immediately for non-compliance with these rules and regulations.

VII. Schedule of Fees

A. A non-refundable fee shall be charged for the application of DOH-LTO of an ambulance.

B. All fees/checks shall be paid to the order of DOH in person or through postal money order [or through bank to bank payments as soon as the system becomes functional].

C. All fees, surcharges and discounts shall follow the current DOH prescribed schedule of fees in A.O. No. 2007-0001 "Revised Schedule of Fees for Certain Services Rendered by the Bureau of Health Facilities and Services and Centers for Health Development . . .", A.O. No. 2007-0023 regarding "Schedule of Fees for the One-Stop Shop Licensure System for Hospitals", and A.O. No. 2008-0028 "Schedule of Fees for the One-Stop Shop Licensure System for Non-Hospital Based Facilities . . .", other policy guidelines and/or relevant issuances. 

VIII. Violations

Ambulance service providers found violating any provision of these rules and regulations and its related issuances and relevant policy guidelines, and/or commission/omission of acts by personnel operating an ambulance under this Order shall be penalized and/or its DOH-LTO suspended or revoked. SDAaTC

IX. Investigation of Charges and Complaints

The Health Facilities and Services Regulatory Bureau or the Regional Office Director and/or his authorized representative(s) shall investigate the complaint and verify if the hospital or other health facility concerned or any of its personnel is liable for an alleged violation. The HFSRB or RO Director may order the preventive suspension of operation of the concerned ambulance service provider. The preventive suspension shall not be more than ninety (90) days. Upon completion of the deficiencies noted during the investigation, the preventive suspension can be lifted immediately, and impose the appropriate penalty for the violation.

X. Sanctions and Penalty

After a thorough investigation of charges and complaints, the following penalties shall be imposed:

Number of Offense	Penalty	Fine
1st Offense	Suspension of DOH-LTO for	PhP20,000.00
	thirty (30) days
2nd Offense	Suspension of DOH-LTO for	PhP50,000.00
	ninety (90) days
3rd Offense	Cancellation of DOH-LTO	PhP100,000.00

In case of serious injury or death of the patient, passengers, pedestrians or the general public due to the negligence or misuse of the ambulance service, the DOH-LTO of the ambulance service provider shall be automatically revoked. This is without prejudice to any criminal or civil charges or both that may be filed by the aggrieved party against the ambulance service provider.

Other imposable penalty for violations hereof shall be in accordance with A.O. No. 2007-0022 entitled "Violations under the One-Stop Shop Licensure System for Hospitals" and violation provision under A.O. 2008-0027 known as "One-Stop Shop Licensure System for Non-Hospital Based Facilities . . .," its related issuances and this Order.

XI. Appeal

The management of the ambulance service provider aggrieved by the decision of the Director of HFSRB or RO may, within ten (10) days after receipt of the notice of decision, file a notice of appeal to the Office of the Secretary of Health. Thereupon, HFSRB shall promptly certify and file a copy of the decision, including all documents and transcript of hearings on which the decision is based, with the Office of the Secretary for review. The decision of the Secretary of Health shall be final and executory.

XII. Transitory Provision

Non-institution-based ambulance service providers shall be given one (1) year from approval of this Order to comply with the requirements. For hospital-based ambulance service providers, these requirements shall apply immediately. Once the one year moratorium has lapsed, all applications shall be subjected to the requirements set forth by this Order.

XIII. Repealing Clause

Provisions from previous issuances that are inconsistent or contrary to the provisions of this Order shall be deemed impliedly or expressly amended or revoked.

XIV. Separability Clause

In the event that any provision or part of this Order is declared unauthorized or rendered invalid by any Court of law, those provisions not affected by such declaration shall remain valid and effective.

XV. Effectivity

This Administrative Order shall take effect after fifteen (15) days following the completion of publication in two newspapers of general circulation. acEHCD

(SGD.) JANETTE P. LORETO-GARIN, MD, MBA-HSecretary of Health

ANNEX A

Official DOH Ambulance Logo

ANNEX B

Required Emergency Equipment, Supplies and Medicines

		Item		Quantity
A.	Ambulance Compartment/Body
	1.	Tempered glass division (separating the driver to the body)
	2.	Air condition with control
	3.	Electric (internal and external) supply bulbs
	4.	Fire Extinguisher (rating 2A10BC)
	5.	Flash lights with extra batteries and bulbs
	6.	Ambulance wheeled cot with mounted cot fastening system
	7.	Folding Stretcher/Poles (1 set) and Canvas (2)
	8.	Orthopedic (scoop) stretcher
	9.	Overhead aluminum grabrail on the ceiling on top of the
		patient/stretcher
B.	Communication Equipment
	1.	Two-way radio communication-installed	1 unit
	2.	Cellular phone	1 unit
	3.	Intra-vehicle intercom system (between driver and body)
C.	Ventilation and Airway Equipment
	1.	Suction Apparatus and accessories
		a.	Portable Suction Machine	1 unit
		b.	Flexible suction catheters Fr. 5-Fr. 14	1 piece each
	2.	Portable oxygen equipment/Installed
		a.	Portable oxygen tank-secured	1 unit
		b.	Flow regulator	1 unit
	3.	Bag valve mask resuscitator with rebreather bag
		a.	Adult	1 piece
		b.	Pediatric — pressure relief valve	1 piece
		c.	Infant — pressure relief bag	1 piece
	4.	Nebulizer	1 unit
D.	Monitoring and Defibrillation (trained team)
	1.	Automatic External Defibrillator (AED)	1 unit
	2.	Defibrillator pads — disposable	1 pair
E.	Immobilization Devices
	1.	Rigid cervical collars (small, medium, large)	1 piece each
	2.	Firm padding or commercial head immobilization device	1 piece
	3.	Lower extremity traction devices (supporting slings, padding,	1 piece each
		traction strap)
	4.	Upper and Lower extremity immobilization devices
		a.	Joint above and joint below fracture	1 piece each
		b.	Rigid support appropriate material (cardboard, metal,	1 piece each
			pneumatic, vacuum, wood or plastic, various sizes)
		c.	Resistant straps or cravats	3 pieces
	5.	Full body vacuum mattress — used for head, spine, and	1 piece
		head-to-feet immobilization
	6.	Sandbags — for initial on-site immobilization only	1 piece
F.	Dressings and Bandages
	1.	Sterile burn sheets	3 pieces
	2.	Triangular bandages	3 pieces
	3.	Sterile Dressings
		a.	10"x30" or larger	3 packs
		b.	ABDs, 10"x12" or larger	3 packs
		c.	4"x4" gauze sponges	4 packs
	4.	Sterile gauze rolls (various sizes)	5 pieces each
	5.	Non-sterile elastic bandages (various sizes)	1 piece each
	6.	Sterile occlusive dressing 3"x8" or larger	3 pieces
	7.	Adhesive tape roll
		a.	Various sizes of 2" or 3" hypoallergenic	1 piece
		b.	Various sizes of 2" or 3" non-hypoallergenic/ordinary	1 piece
G.	Obstetrical
	1.	Individual disposable delivery kit — sterile	1 set
	2.	Wrap/blanket for newborn	1 piece
H.	Infection Control
	1.	Eye protection (full peripheral glasses or goggles or
		face shield)
	2.	HEPA Masks/Surgical Masks
	3.	Non-sterile and Sterile Gloves	1 pair each
	4.	Jumpsuits or Gowns	1 unit
	5.	Shoe covers	1 pair
	6.	Hand sanitizer or 70% alcohol
	7.	Disinfectant solution for cleaning equipment
	8.	Disposable trash bags — color-coded
I.	Miscellaneous Supplies
	1.	Sphygmomanometer (non-mercurial, with infant, pediatric
		and adult cuff)
	2.	Stethoscope (pediatric and adult)
	3.	Weighing scale for pediatric equipment sizing
	4.	Tape measure
	5.	Thermometer (infrared)
	6.	Heavy bandage or paramedic scissors for cutting clothes,
		belts and boots
	7.	Alcohol swabs x 20 pcs.	1 pack
	8.	Cold packs
	9.	IV Administration set (Macro/Micro)
	10.	Blankets, Sheets, Linen, or paper
	11.	Pillows, Pillowcase and towels
	12.	Disposable standard sharps containers
	13.	Disposable emesis bags or basins
	14.	Bed pan
	15.	Urinal
	16.	Syringes (50ml, 30ml, 10ml, 3ml, 1ml)	1 piece each for 50ml
				and 30ml
				5 pieces for 10ml, 3ml
				and 1ml
	17.	Gauge needles (various sizes)
	18.	Incontinence pads — disposable
	19.	Antibacterial lubricating jelly	1 tube
	20.	Patient report forms (as prescribed in succeeding Annexes)
J.	Medications/Fluids
	1.	Activated Charcoal	1 pack
	2.	Oral glucose, 10 ml	1 piece
	3.	Sterile water for irrigation, 1 liter	1 bottle
	4.	Intravenous fluids (various dissolution, sizes, concentration)	1 piece each
	5.	Normal saline water (injectable)	1 piece
	6.	Sterile water for injection, 10ml	1 piece
	7.	Ventolin nebules	3 pieces
	8.	Dextrose 50%/50ml vial	1 piece
K.	Controlled Medications
	Sealed Drug/Code Box to be opened only under a Physician or Paramedics supervision.
	This should be regularly checked for expired items by Physician-in-charge or Paramedics.
	1.	Atropine Sulfate 1mg/ml ampule	5 pieces
	2.	Isoproterenol 1mg/5ml ampule	1 piece
	3.	Epinephrine 1mg/1ml tubaxes (IM, Intracardial, IV) ampule	5 pieces
	4.	Diazepam 10mg ampule/vial	1 piece
	5.	Dobutamine 250mg ampule	1 piece
	6.	Lidocaine 1gm/25ml vial	1 piece
	7.	Adenosine 6mg/2ml ampule	1 piece
	8.	Human Regular Insulin 100mg/ml vial	1 piece
	9.	Calcium Gluconate 10% 1mg/10ml ampule/vial	1 piece
	10.	Potassium Chloride 20mg/10ml vial	1 piece
	11.	Furosemide 100mg/10ml vial and 20mg/2ml ampule	2 pieces each
	12.	Magnesium Sulfate 50% 1gm/2ml ampule	1 piece
	13.	Bretylium 500mg/10ml vial	1 piece
	14.	Dopamine 400mg/5ml vial	1 piece
	15.	Diphenhydramine 50mg/ml ampule	1 piece
	16.	Sodium bicarbonate 10ml ampule	1 piece
	17.	Digoxin 0.1mg/ml ampule and 0.5mg/2ml ampule	2 pieces for 0.1mg/ml
				ampule
				1 piece for 0.5mg/2ml
				ampule
	18.	Calcium Chloride 10% ampule/vial	1 piece
	19.	Nitroglycerine spray/sublingual/patch	1 piece

 

ANNEX C

Template Format for the Logbook of Accomplishments for Inspection and Monitoring

 

ANNEX D

Annual Statistical Report for Ambulance Service Providers

 

Published in The Philippine Star on July 12, 2016.