Republic of the Philippines
Department of Health
OFFICE OF THE SECRETARY
JUN 29 2016
ADMINISTRATIVE ORDER
No. 2016 -_p029.
SUBJECT: Licer of Ambt
Ambulance Service Providers
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.”
‘The current licensing standard requires hospital facilities to provide ambulance services.
However, ithas 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 inthis 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.
1, OBJECTIVE
‘These rules and regulations are promulgated to protect the public and assure the safety of
patients and personnel by:
1. By setting the minimum standards and requirements for ambulances and ambulance
service providers; and
2. Ensuring the safety of patients, personnel and the general public.
Il. SCOPE AND COVERAGE
‘These rules and regulations shall apply to all government and private land ambulances and
ambulance service providers.
Page 1 of 11
ye
‘alldiog 1, San Lazare Compound, Rizal Avenue, Sia Crux, 1003 Manlla@ Trunk Line 651-7800 Direct Line: 7119801
Pax: 743-1029; 743-1786 « URL hia wma. 20yh;e-mall: sec@doh.gouoh 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 vietims 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 vietims 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 of 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 iil
9. Health Facilities and Services Regulatory Bureau (HFSRB)-the Bureau of DOH
charged with the implementation of these rules and regulations.
10. Medical directive - a system of physician-directed quality assurance that provides
wen and public accountability for medical care in pre-hospital setting.
Page 2 of iy” 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.
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.
cc. 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
pal government agencies such as, but not limited to, DOH hospitals, LGU and
Page 3 of 1
po 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.
¢. ACCORDING TO INSTITUTIONAL CHARACTER
1. Institution-based — ambulance service provider that operates as part of a
health facility (ie. hospital, infirmary, ete.)
Non-institution-based — ambulance service provider that operates
endently. May be located inside or outside the premises of a health
facility.
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 Trade and Industry (DT!) 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.
‘The ambulance service provider shall ensure that each personnel has
obtained the minimum trainings stipulated in this Order.
Page 4 of 11 pw b.
e
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.
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
seope/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.
‘mbulance vehicles shall have Emergency Warning Light System and
siren-Public Address System.
Page 5 of 4, 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, Bach ambulance service provider shall have documented policies and
procedures on its administrative and technical Standard Operating
Procedures (SOP) for the provision of its services.
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.
All patients being transported by ambulance shall have standard patient
record form.
Pass 6 ofa {. 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):
‘Name, sex and age of patient;
‘Name of attending physician, when applicable;
Origin and destination;
Date and time of dispatch and return of ambulance;
Reason for transfer/transport.
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. (ie. Hospital to Airport/Ports or vice versa)
. Reason for referral/transport
cc. Date, time and description of Adverse Events e.g. number of deaths en
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,
Page 7 ta 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.
There shall be a written plan and program of proper disinfection and
preventive maintenance of the ambulance vehicles.
‘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.
VL 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.phi.
Proof of ownership
1, Department of Trade and Industry (DTD;
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
Registration of the vehicle(s) from the Land Transportation Office
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,
Page 8 of 11 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
hitp:/hfsrb.doh.gov.ph!.
b. DOH annual ambulance statistical report
c. other relevant records as may be required by DOH
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 level 2
and 3 hospital-based ambulance service providers.
b. Regional Offices for Infirmary and Level 1 hospital-based ambulance
service providers
Pay the corresponding fee, and submit a copy of the official receipt to HFSRB or
Regional Office, whichever is applicable.
‘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
‘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
ib
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.
‘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
2,
Ambulances and ambulance service providers shall be monitored regularly.
‘The HFSRB or RO Director and/or his authorized representative(s) shall conduct
periodic monitoring visits utilizing the Assessment Tool for licensure of
ambulances.
ar 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
Vil. 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.
VILL 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.
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 concemed 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
1 Offense ‘Suspension of DOH-LTO for thirty (30) days_| "PhP 20,000.00
2 Offense ‘Suspension of DOH-LTO for ninety (90) days |" PAP 50,000.00
3" Offense Cancellation of DOH-LTO PhP 100,000.00,
Page 100f11_/ 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 HESRB 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.
XI. TRANSITORY PROVISION
‘Norinstitution-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 provi
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.
JANETTE . LORETO-GARIN, MD, MBA-H.
tary of Health
Page 11 of 11 Republi of the Philippines
Department of Health
OFFICE OF THE SECRETARY
Annex A
AO 2016 -
Official DOH Ambulance Logo
LICENSED BY THE DOH
——
Building 1, San Lazaro Compound, Rizal Avene, Sax Cruz, 1003 Manila Tank ine 651-7800 Diet Line 7119501
ae: 243-1029, 7431786 9 URL: hp dh gov ph; ema cueszadah gg Republic of the Philippines
Department of Health
OFFICE OF THE SECRETARY
Annex B
AO 2016 -
‘Required Emergency Equipment, Supplies and Medicines
ITEM (QUANTITY
‘A. Ambulance Compartment / Body
“Tempered glass division (separating the driver to the body)
‘Air condition with control
Electric (internal and external) supply bulbs
Fire Extinguisher (rating 2A10BC)
Flash lights with extra batteries and bulbs
Ambulance wheeled cot with mounted cot fastening system
Folding Stretcher / Poles (1 set) and Canvas (2)
‘Orthopedic (scoop) stretcher
30] 0] ~3] >] 4] =] -9}09] |
‘Overhead aluminum grabrail on the ceiling on top of the
patient/stretcher
B._ Communication Equipment
1. Two-way radio communication - installed Tunit
2. Cellular phone T unit
3._Intra-vehicle intercom system (between driver and body)
C. Ventilation and Airway Equipment
1. Suction Apparatus and accessories
‘a. Portable Suction Machine Tunit
b. Flexible suction catheters Fr. 5 - Fr. 14 1 piece each
2. Portable oxygen equipment / Installed
‘a. Portable oxygen tank - secured T unit
’b. Flow regulator unit
3._ Bag valve mask resuscitator with rebreather bag
a. Adult Tpiece
b._ Pediatric — pressure relief valve T piece
c._Infant — pressure relief bag T piece
&_ Nebulizer unit
1D. Monitoring and Defibrillation (trained team)
1, Automatic external defibrillator (AED) Tunit
2.__Defibriflator pads - disposable 1 pair
E,_ Immobilization Devices
1. Rigid cervical collars (small, medium, large) piece each
2. Firm padding or commercial head immobilization device T piece
3. Lower extremity traction devices (supporting slings, padding, | I piece each
traction strap)
4. Upper and Lower extremity immobilization devices
‘a._Joint above and joint below fracture T piece each
’b. Rigid support appropriate material (cardboard, metal, T piece each
pneumatic, vacuum, wood or plastic), various sizes)
¢._ Resistant straps or cravats 3 pieces
‘Bulking 1, Sa Lazaro Compovnd, Rial Aven, St Cruz, 1003 Nail
ax: 743-100, 743-1786 URL: ip. Sh gh ema
rank Line 651-7800 Dia Line 71-9801
sco
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