Republi of Fiippiaes ‘Department of Health OFFICE OF THE SECRETARY JAN 22 208 ADMINISTRATIVE ORDER No. 204 2018-001 SUBJECT: Revised Rules and Regulatins Governing the Licensure of Land Ambulances and Ambulance Service Providers 1 BACKGROUND AND RATIONALE (On July 12,2016, the Department of Health (DOH) through the Health Facilities and Services Regulatory Bureau Gormerly Bureau of Health Facilites and Services) published ‘Administrative Onder (A.0.) No. 2016-0029 titeé “Rules and Regulations Governing the Licensure of Ambulances and Ambulance Service Providers” dated June 29, 2016. ‘The aforementioned A.0. was drafted in line with Section VI. A. 4. of A.O. No. 2010- (0008 titled “Natonal Policy on Ambulance Use and Services” which stated thatthe “Bureau of Health Facileies and Services shall establish lcensiag standards for ambulance services ‘and ensures their implementation through regulation. The license. of haspital-bared ‘ambulance sorvice shall be part ofthe hospital license. All other ambulance services shall require a separcte license’ The policy was envisioned :0 remedy te issue on the misuse of lambulance vehicles and the mislabeling of othor vehiles as ambulances in the country. Moreover, it seeks to establish that embulances operate with competent personnel and appropriate equipment in order to respond to medical emergencies, provide quality care and ensure patient salty However, in consideration ofthe plight of sakebolders who could not readily comply with the standards and requirements prseribed inthe policy, the DOH decided to issue out Department Circular (D.C.) No. 2016-0357 tiled Extension of Moratorium Period for Compliance for All Ambulance and Ambulance Servce Providers. The D.C. provided a ‘moratorium for all ambulance service providers to eomply until December 31, 2017 while the ‘A.0. underwentpoliy review. After the conduct of several consultative meetings with stakeholders and considering the context in which ambulance service provides currently operate, this Onder hereby provides the revised mandatory minimum standanis and requirements for the licensure of land ambulances and ambulance sevice providers. 1 OBJECTIVE, ‘These rules and regulations are promulgased to protest the public and ensure the safety of patients and personnel by setting the minimum standards and requirements for land mbulncesanambuimes service provider 4 of Wag, Sn Crs op Rial Ave, SG 105 Nani Te S-TDos 3, RTT Dit ine" 95 N36 Fae UM pn hp ge emt eeeIIL SCOPE AND COVERAGE ‘These rules and regulations shall apply tll government and private and ambulances and ambulance service providers. VW. DEFINITION OF TERMS For purposes ofthis Order, the following tems, ebbrevitions and definitions apply: |. Ambulance ~ a vehicle designed and equipped for transporting sick or injured patents to, from, and between paces of treatment by land, water or ai, affording safety and comfort to the pateas and avoiding ageravatio of illness or inj. 2. Ambulance Service Provider (ASP) -aealth facility, institution or entity whether government or privately ownec providing ambulance services. 3. Advanced Cardiac Life Support (ACLS) a group of interventions used to treat and stabilize adult victims of life-threatening cardiorspiratory emergencies and to resuscitate victims of cardioo arrest. These interventions include Cardio- Pulmonary Resuscitation, basie and advanced airway manegement, tracheal intubation, medications, electrical therapy and intravenous (IV) acess. 4. Advance Life Support (ALS) -a set of life saving protocols and skis that extend BLS to futher support the circulation and provide an open airway and adequate ventilation, 5. Basic Life Support (BLS) - a group of actions and interventions used to resuscitate and stabilize victims of cardise 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 forciga- body airway obstruction. 66. Department of Health ~ License to Operate (DOH-LTO) ~ a formal authority issued by DOH to an individual, agency, partnership or corporation to operate en ambulance. 7. Emergency Medicel Technician (FMT) - tained professional who provide out of hospital emergency medical eae and transportation for critical and emergent Patents who access the emergency medica services (EMS) system. (Ohio Navonal Regis of Medical Technicians, 2017) 8. First Aid ~is the immediate asistance provided toa sick or injured person until professional help arrives. Referred to as Standard First Aid (SFA) in this Order. (Gnverational Federation of Red Cras and Red Crescent Societies, 2016) 9, HFSRB—Health Facilities and Sevices Regulatory Bureas 10, Land Ambulance- a vehicle designed and equipped with basic or advance lite support fon transporting picts to, fiom, and between places of treatment by ae x Page 21511, Medical Direston- allows a paramedic or EMT to contact a physician from the Seld via radio or other means to obtain instruction on further care of a patient 12, Medical emergencies — any acute or life-threatming condition that requires immediste intervention by a competent personnel 13, Patent Transport Vehicle (PTV) - any form of land vehicle designed to transport, patients whore condition is ofa non-life thretening ature. 14, RO-RLED- Regional Office- Regulation Licensing and Enforcement Division GENERAL GUIDELINES 1. All vehicles shall be duly registered with the Land Transportation Office under the name of the ambulance service provider prior to application for DOH-License to Operate, 2, Licensed land ambulance vehicles shall only be ase forthe purpose by which itwas granted a license to operate 3, No land vehicle of any kind shall bea on its boly the label or marking ofthe word “AMBULANCE” unless it has been duly licensed and estegorized a8 8 land ambelance by the Department of Health 4, Bvery ambulance service provider shall be organized to provide safe, quality, effective and effcient ambulance services for patents which shall be made available at all ims, 5. Ambulance service providers of privately cwned ambulances shall be registered with the Department of Trade and Indusiry (DTI) or with the ‘Securities and Exchange Commission (SEC), whichever is applicable 6. For ambulance service providers of govermmert owned ambulances, local ‘goveramentordinance/board resolution or its equivalent as proof of ownership ‘ofambulance vehicles shal be required. 7. All ambulance service providers shall have an Operations Contol and Dispatch Center of their ambulancels whether it be a business office or space ‘and shall ensue adequate parking spaces for ther ambulance/s. 8. Ambulance service providers shall ensure that they are part of finctional ‘eferral network within the area/vicinity where tey shall operate 9. The DOH-LTO of ambulance service providers of institution based ambulances applying for a DOH-LTO shall be included in the One-Stop Shop (088) system for hospitals and other health faites, and shall be reflected in the health facility DOH-LTO. There shall only be one (1) DOH-LTO for the heh tying themunberoficesednbulne | f Page ors10, Ambulance sevice providers of non-institution-based embulances shall secure ‘separate DOH-LTO. 11, Ambulance service providers shall tilly comply with the standards, criteria ‘and requirements prescribed in the Assessment Tool for Licensing a Land “Ambulance and Ambulance Service Provider (Annex C). 12, Ambulance service providers (ASP) shall subject each of its ambulance \ehicles for inspection. Any ational vehicle shall be applied for inspection, Only when found complisat shall the addtional vehicle be included in the ‘existing list of approved ambulances of the ASP, Moreover, in cases when a vehicle will no longee be used as an ambulance, the ASP. shal inform HFSRE/RO-RLED through a lever indicating the plete or conduction sticker ‘number ofthe said vehicle for delisting. The delisted vehicle shall then no longer bear the marking “AMBULANCE” and the DOH Ambulance logo sould be removed, 13. Vehicles used to transport patients but are not equipped with Basic Life ‘Support (BLS) or Advance Life Support (ALS) shall be categorized as Patient ‘Transport Vehicles, 14. Patint Transport Vehicles shal be used to transport patients whose condition is of a non-life threatening nature such as but not limited to scheduled visits to 4 physician's office for treatment, routine physical examinations, xrays oF Inboratory tests, or upon discharge irom a hospital Patient Transport Vehicles should not bear the marking of the word “AMBULANCE” bot shal instead be labsled as “PATIENT TRANSPORT: VEHICLE.” 16, Patient Transport Vehicles shall not be licensed by the HESRB but shall be registered with the Bureau using a prescribed form ‘SPECIFIC GUIDELINES A. CLASSIFICATION OF LAND AMBULANCES 1, ACCORDING TO OWNERSHIP ® Government ~ owned, managed and operated wholly by goverment agencies/nsitutions such as, but not limited to, DOH hospitals, Local Government Units (LGU) and LGU-run hospitals, the Bureau of Fire Protection (BFP) snd the Philippine National Police (PNP) of the Deparment of the Intesor and Local Goverment (DILG), the Philippine Coastguard of the Department of Transporation (DOT?), the Armed Forces of the Philippines (AFP) of the Department of National Defense (DND), Metmpolitan Manila Development Authority (MMDA} and others Page fos. Private ~ owned, managed and operated with funds through donation, principal, investment or other means by any individual, corporation, association or organization. Private ownership may be tirough single proprctorship, partnership, corporation, cooperative, foundation, religious, non-government organization and others 2, ACCORDING TO INSTITUTIONAL CHARACTER. Institution-based ~ ambulance thet is owned, operated, msiniined and used by a healt facility (ie. hospital, infirmary, et.) regulated by ‘the Department of Health . Non-institution-based/ Free-Standing ~ ambulance that is operated independently fom health facility but may be used to service health facility throagh a notarized Memorandum of Agreement (MOA) ‘service contractor its equivalent. B. CATEGORIZATION OF LAND AMBULANCES ‘ype I- ambulance capable of providing Basic Life Support (BLS) 2, ‘Type Il ambulance capable of providing Advance Life Support (ALS) C. CATEGORY OF AMBULANCES REQUIRED AMONG HEALTH FACILITIES 1. Ambulances are pat of the licensing requirements of several types of ‘health faciitics. Ths category of ambulance required from a bealth facility shall be commensurate tothe services provided by the health facility as shown in the table below: [typeof | Category of Ambulance | 1fOutsoured with s DOH Lica ase Seeger (eee ae a joo = eee eae a cease eae Fa te pore gy en ees = eae, cao aceasta SEES | Level || MOA with a hospital of Hospitals may either be Type I or Hospitals | higher level. ‘Type IL ge eae Geechee ceed | eminem oe Soe = eg ta cy eat ethic oP3. Birthing faites at « minimum are required to enter a MOA with ambulance sevice providers (whether government or privately owned) ‘but may elo opt to ovrn an ambulance. This shall be complemented ‘with a MOA with a health facility of higher level. In eases wherein the birthing home's referal facility is also the amibulance service provider, ‘one MOA wil suffice as long as the tems for ambulance services are Clearly stipalted inthe said MOA. 4. All cilities oping to enter a MOA with any DOH licensed ambulance ‘service provider shall take into consideration that the ASP servicing the facility should be abe to respond and provide ambulance services ‘within a reasonable time. Moreover, DOH licensed ASPs entering into MOA/s with health ficilties should do so in accordance with theit service eapacty and capability, D. STANDARDS. 1. AMBULANCE BODY 4 An ambulance vehicle shall be able to accommodate the patient, and ‘the required numberof peronne! and equipment. , The ambulance shall have a non-porous partition between the driver and the body ofthe ambulance. DOH Licensed Ambulances shal! bear the following markings: i. Front The reflectorized and capitalized word “AMBULANCE”, ‘hick is spelled out in reverse (mirror image). The height of| cach iter shall be no less than 10 centimeters and the word shall te seen atleast six (6) meters away. fi, Side: Each side of the ambulance body shall have the capitalized word “AMBULANCE” ot less than 15 om ia high ‘The mune and logo of the licensee, the administrative division (Region, Province, City, Municipality and Barangay) to which the ambulance is afliated with may be indicated on the sides of the ambulance provided that the logoffont size used should ‘not be more than the height of the word “AMBULANCE.” This shal be placed below the word “AMBULANCE.” iii, Rear: The reflectorized and capitalized word “AMBULANCE” not lass than 15 cm in height and the prescribed DOH ambulance logo to be issued by the DOH once the application for a license is approves, (Refer to Annex B: Official DOH Snes2 iv. The licensee may also opt to mount the blue “Star of Life” emblem on any part of the ambulance vehicle. 1%. There shall be no restrictions ot the color of the ambulance vehicle oon the color ofthe lettering. vi. Any other signage or pictures cuside of what is prescribed herein are ot allowed. 4. Each ambulance shall have adequate and stable cabinets that can appropriately store the required equipment, medicines and supplies. These storages shall be easily accessible but properly secured at all times. © Ambulance vehicies shall have Emergen-y Waming Light System and Siren-Public Address System, PERSONNEL Each ambulance shall be manned by an afequate number of qualified, trained and competent staff to ensure efficent and effective delivery of quality ambulance services. | A minimom of at lest two (2) ambulance personnel, excluding the driver, is required for every ambulance dispatched. Additional staff pends on the nature of the emergency as determined by the ‘management ofthe service provider. . The minimum qualifications and trainings required from ambulance personne! shall bein accordance to the type of ambulance they operate 18 follows: ‘Category of | Minimum Ambulance | Qualifications THEne Rennes Sa pai ‘© Sundard Fist Aid (SFA) juste ofany | & Basie Life Support (BLS) ‘Type | health related 4 oe ‘year course ‘Starting CY 2020 oavands: + SFA BIS + Emergency Mois! L “Telnisian (EMT) Training Base ‘Standard First Aid (SEA) Bisi Life Suppor (BLS) Licensed or Advance Candie Life Suppoct Type | Registered Nurse cts) @Ny Stating CY 2020 onwards: SPAY BIS + ACLS + EMT Training ‘Advance Paradis Tring mae = \. ‘There shall be staff development and continuing education program to upgrade the knowiedge, attinale and skis of staff 3, EQUIPMENT, MEDICINES AND SUPPLIES Every ambulance shall have available and operational prescribed cuipment, medicines and supplies, ach ambulance shall be adequately equipped with appropriate equipment, medicines and suplies. (Refer to Annex C: Assessment ‘Tool for Licensing s Land Ambulance and Ambulance Service Provider) ', There shal be a program for calibration, preventive maintenance and repair of equipment, including decontamination and disinfection There shall bea contingency lan in case of equipment breakdown and malfunction, specially during patient transpor. 4. There shall be a program forthe management of temmpeeture sensitive medication. 4, SERVICE DELIVERY [Every ambulance service provider shall ensure thatthe services delivered to patients comply with the standard quality embodied inthe assessment too! for licensing a land ambulance and ambulance service provider, other policy guidelines andlor related issuances. 1. Ambulance service provide" shall have documented policies and ‘procedures on its administrative and technical Standard Operating Procedures (SOP) forthe provision of its ambalance services b, Ambulance service provide: shall have documented policies and ‘procedures on the establishment ots referral system, Non-insttuion-based/ Free-Standing ambulance service providers servicing the public independently shall have @ MOA with & hospital for which they can bring their cients forthe needed health services [This clause isnot applicablein cases of extreme medical emergencies ‘or in cases when patients prefer arather ambulance service provide.] «Ambulances shall have devioss to communicate tothe operation center of the ambulance service provider and the refecral hospita/health facility for recording and effetive management of cases. 4. There shall be gujdalines inthe implementation of madical direction Va5, INFORMATION MANAGEMENT Every ambulance service provider shall msintain a system of communication, recording and reporting ofthe patient's condition as well asthe resulls of examinations which may include electronic ‘communications or otterwise allowed under Republic Act (R.A.) $792, otherwise known asthe “Electronic Commerce Act of 2000.” Moreover, ‘management of data or information should bein adherence to R.A. 10173 also known asthe “Data Privacy Act of 2012." 1 Hlospital/Facility Referral Form Each form shall te Kept confidential and shall contain sufficient information to identify the patient and to justify the treatment provided, which includes the information oftranafereferal of patient te another physician or healt facility. . Logbook: Ambulance service providers shall maintain a logbook which shall be signe by the ead ofthe DOH licensing team during inspection and/or ‘monitoring visits. The logbook shall contain, but not be limited to, the following information: i. Name, sex and age of patent; fi, Name ofattending physician, when plicable iil, Origin and destination; iv. Date and time of dispatch and ret of ambulance; v. Reason for transfertranspor viv _Dispositon of patient Submission of Reperts All ambulance service providers shall submit an annual report uslizing the templite provided by DOH (Refer to Annex D: DOH Annual Statistical Report for Ambulance Service Providers). The deadline for the ysarly submission is every 31" of March of the following year (ex. CY 2018 report willbe due on March 31, 2019) 6, ENVIRONMENTAL MANAGEMENT Every ambulance service provider shall ensue that the environment is safe for its patents and sa including members ofthe pubic as necessary and thatthe following measures andior safeguards shal he observed 4. The ambulance shal be properly ventilated, lighted, clean and safe. i. There shall be a written plan and program of proper disinfection and a aniceso ey© The use of Personal Protective Equipment (PPEs) and adherence to infection contol polices shall be strictly observed. 4. There shall be procedures forthe proper disposal of infectious wastes and tonic and hazardous substances in accerdance with R.A. 6969 ‘known as “Toxie and Hazardous Substances and Nuclear Wastes Act” and other related policy guidelines andr issuances, Vil. PROCEDURAL GUIDELINES A. The processing of application for DOH-LTO shall be as fellows: Type ot RT RORLED Application intial”) asian asad Thathutioo asad Renewal | Ambulances of Levels 2 and3 Hospital, evel Hospitals ‘Ambulatory Surgical Clinics, Dialysis Clinics, __Blithing Homes and ‘Meda Facilities for Overseas Workers and Tafimmties Seafares, te. | ‘Norns: | Government owned: “Ambulances of Barangay Health Stations, Rural Health Units, Heath Centers, City Health Offices, ‘Manicipl Health Offices, Provincial Health Offices, LGUs, BFP, PNP, Coastguard, AFP, MDA, et, see ome ined saeeeeeeececec ee eeeeecececee | aeeeeeeeeeecececee| 1B. The processing of applications shall be within thitty (30) days starting fiom the time of receipt of the complete application documents tothe issuance or non- Jssuance ofthe DOH-LTO. APPLICATION FOR INITIAL DOE-LTO. 1, Ambulance service providers of instttion-based ambulances shall follow the One-Stop Shop (OSS) systema for hospitals an other health facilites. 2. Ambulance service providers of noninstitutiontused ambulances shall follow the consecutive steps: Refer to Annes A fer the Process Flow inthe Licensure of Land Ambulances and Ambulance Serce Providers Initial) ‘4. Ambulance service providers shall submit the following relevant documents to HFSRB/ RO-RLED: i. Duly accomplished application Sal) form can be Soa! Rohe dohfi, Proof of ownership: For Ambulance Service Providers of Government ove ambulances: 28) Fabling Actor Board Resolution o its equivalent ') Cooperative Development Authority Registration with ‘Articles of Cooperation and By-laws, whenever applicable For Ambulance Service Providers of Privately owned ambulances 8) Departient of Trade and Industry (DTD) or Securities and “Exchange Commission (SEC) Registration with Articles of| Incorporation and By-laws; ) Cooperative Development Authority Registration with ‘Ailes of Cooperation and By-laws, whenever applicable Registration ofthe vehicle(s) from the Land Transportation Office iv. License of the ambulance drivers as Professional Driver, from the Land Transportation Office , Pay the corresponding fe, and submit a copy ofthe offical receipt tHESRE/ RORLED. © The HFSRB/ RO-RLED shall receive and ovaluate the completeness of documentary requirements submitted including proofs of payment. A complete application means thatthe required ‘document, a5 specified in th application checklist of HFSRB/RO- RLED, have been submitted. If incomplete, the client shall be ‘given tiny GO) days to submit the complete documentary requirements. The application payment will be forfeited if the ‘complete documentary requirements are not submited within tity G0) days. 4. For complete spplications, the inspection team of HFSRB/RO- RLED shall inspect the ambulance vehicles. The applicant shall ensure that all key staf, pertinent rocords, an ansbulance vebicles tre made available to HESRB/RO-RLED during inspection vst If during inspection, the ambulance vehicle's isfare found non compliant to the standards and requirements for the licensing of ambulances, the inspection team fom the concerned offices shall notify the applicant of ther deficiencies and the ASP shal be given time to comply within the prescribed timeline (maximum of 30 days). The counting of days to process the applietion shall be stopped ("stop-lock”) until all deficiencies have been complied with, Failure to complete the compliance within the ae Page fh otistimeline given shall mean disapproval of the application and forfeiture of payment. The HFSRE/RO-RLED shall then send the Lester of Denial wit the noted deficiencies tothe applicant. If found compliant during inspection, the inspection team shall ‘recommend the issuance ofthe DOH-LTO, © The Director IV of HFSRB/RO Director, or in hisher absence or unavailability or when delegated, the Ditector III of HFSRBRO, shall approve the issuance of the DOH-LTO. £ Once the DOH-LTO has been issuad to the ambulance service provider, each compliant embulance vehicle ofthe licensed ASP Shall be given the Official DOH Ambulance Logo with ite corresponding plale or conduction sticker number, ambulance ‘clegory and the year until when the DOH-LTO of the ASP will be valid. The logo shall then be mounted at the ear ofthe vehicle Moreover, all ambulance vehicles shculd have a copy ofthe DOH LTO of the ASP. D. APPLICATION FOR RENEWAL OF DOH-LTO 1 Ambulance service providers of insttution-based ambulances shall follow the ‘One-Stop Shop (OSS) system forthe renewal oftheir DOH-LTO. 2. Ambulance service providers of non-intituton-tased ambulances shall follow ‘the consecutive steps ‘Submit the following documents: i Duly accomplished application form. This form can be downloaded from hf dob gov.zh. DOH annual ambulance statistical report {ii other relevant ecords as may be roqured by DOH '. The same steps and timelines outlined in Section VII.C2. b-£ ofthis (Order shall aly. 3. The DOH-LTO of an ambulance service provider shall be cancelled automatically without notice upon failure to submit a duly accomplished ‘pplication form and to pay the proper fee beyond thity (30) days from the date of expiration stated init license. Therealr, the service provider sbell apply for an initial DOH-LTO. FE, MONITORING 1. Licensed service providers and its anbulances shall be monitored 7 Page 12 oF 182. ‘The HFSRB or RO-RLED shall conduct periogie monitoring visits wilzing the assessment tool for Hcensing & land ambulance and ambulance service provider. 3. The applicant shall ensure tht all Key staf, records, premises and facilites are ‘mage available to HFSRB or RO-RLED during monitoring activities. 4. A Notice of Violation shall be issued immediatly for non-compliance with these rules and regulations. VIM. VALIDITY OF LICENSE TO OPERATE, ‘The DOH-LTO of ambulance service providers of insttion-based ambulances shall by valid for one (1) year only following the OSS system for hospitals and other health filtes, while for ASP of non-insttuion-based ambulances, the DOH-LTO shall be valid forthe (3) yeas ftom January of the first year to December ofthe third year IX. SCHEDULE OF FEES ‘A.A non-refundable fee shall be charged for the application of DOH-LTO of an ambulance service provider and its land ambulances (Refer to Annex E: Schedule of Fees in the Licensure of Land Ambulances and Ambulance Service Providers) B. All fesichecks shall be puid to the onder of DOE in person or through posta ‘money order [or through bank to bane payments as soon asthe system becomes functional). ©. 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.0. No, 2007 ~ 0025 regarding “Scheele of Fees for the One-Stop Shop Licensure System for Hospitals, and A.O. No. 2008 ~ 0028 “Schedule of Fees forthe One-Stop Shop System for the Regulation of Medical Facilities for Overseas Workers and Seafarers and Non-Hospital Based..." other policy guidelines andr relevant issuances. ‘VIOLATIONS Ambulance service providers found violating any provision of these rules and regulations and its related isruances and relevant’ policy guidelines, and/or cormmission/omission of acts by personnel operating an ambulance under this Order shall ‘be penalized and/or its DOH-LTO suspended or revoked, XI INVESTIGATION OF CHARGES AND COMPLAINTS. ‘The Health Facilities and Services Regulatory Bureau o: the Regional Office Director and/or bis authorized representative(s) shall investigate complaints and verify if ambulance service provider concemed or any ofits personnel is liable for an alleged violation. The HFSRB or RO Director may order the preventive suspension af operation of the co Page 3 otsambulance service provider pending investigation which shall not be more than ninety (90) days. XIL,_ SANCTIONS AND PENALTY mposable penalties for violations nerf shall be in accondance with A.O. No. 2007- (0022 titled “Violations uader the One-Stop Shop Licensure System for Hospitals", A.O. No. 2008-0027 known as “One-Stop Shop System for the Regulation of Medical Facilities for (Overseas Workers and Seafarers, Non-Hospial-Based Dialysis Clinies and Non-Hospital- Based Ambulatory Surgical Clinics with Ancillary Services", and reletod issuances or sguitelines, In case of death or serous physical injury (es defined by Article 263 of the Revised Pesal Code ofthe Philippines) of the patent, passengers, pedestrians or the general public, the DOH-LTO of the ambulance service provider shal! be automatically revoked if such dea or injury was found or deterainel by the appropriate authority to be due to the negligence or misuse of the ambulance service. This is without prejudice to any eximinal or civ charges or both that may be fied by the aggrieved party agsnst the ambulance service provide. Ambulance service providers whose DOH-LTO has been revoked shall be prohibited ‘om applying for another DOH-LTO as an ASP fora minimum of one (|) Year. XII APPEAL ‘Any hospital or other health facility aggrieved by the decision ofthe HFSRB Director or Regional Director may, within ten (10) days after receipt ofthe notice of decision file & notice of appeal to the Head of the Office for Health Regulation (OHR). All pertinent documents and records of the appellant shal then be elevated by HESRB or the Regional (Oflce tothe OHR. The decision ofthe Head of the OUR if sll contested maybe brought on ‘final appeal to the Secretary of Health win ten (10) days after receipt ofthe devsion from (OHR. The Secretary of Health's decision shall be absolute and executory XIV. TRANSITORY PROVISIONS ‘A. For application of DOH-LTO for CY 2018, ambulance service providers of both instrion-based and noa-instiition-based ambulances may file thet applications and pay the corresponding fees a eithe HFSRB or RO-RLED unt December 15, 2017 B. Applications filed starting January 2018 should follow section VIL. A of this ‘Onder. XV. REPEALING CLAUSE Provisions from previous issuances that ar inconsistent or contrary to the provisigns ‘ofthis Order shall be deemed impliedly or expressly amended or revoked kK Page 141sXVL. SEPARABILITY CLAUSE In the event that any provision or part of this Order is declared unauthorized or rendered invalid by any cour of lw, those provisions not affested by such declaration shall remain valid and in force, [XVI EFFECTIVITY ‘This Order shall take effect after fifeen (15) days after its publication in two newspapers of general relation Page 180018Replica he Pipes Deparment of Healte HEALTH FACILITIES AND SERVICES REGULATORY BUREAU ANNEX B. AO. No, 2018. 006) OFFICIAL DOH AMBULANCE LOGO LICENSED BY THE DOH PLATE NUMBER AMBULANCE CATEGORY VALID UNTIL [CONTROL NO. Conduction ster numb shal he Indicated if the veel hs no lee number yetRepub oft Pi ines Departmest of Health HEALTH FACILITIES AND SERVICES REGULATORY BUREAU ANNEX € AO. No. 2018-000 ASSESSMENT TOOL FOR LICENSING A LAND AMBULANCE AND AMBULANCE SERVICE PROVIDER 1. GENERAL INFORMATION "Name of Ambulance Servise Provider (ASP): Complete Address: Email Tel.Fax Nos: Aces, "Name of Owner - Seat Category type f+ BLS Ambulance CD typelt- ALS Ambulance ‘Ownership D Govermen: 0 Private O Netional Single Proprietorship 1D Local O Corperation Others (specif) Others (specify) __ Institstional Character Institution based 1 Non-insitution based Free-Standing ‘Type of application: OF teint Ci Renewal DOH License Number (ASP):ANNEX © 4.0. No. 2018-000) 1, TECHNICAL REQUIREMENTS Instraction: In the appropriate box, place a checkmark (i) ithe ambulance or ambulance service provider is compliant or X-mak if not compliant 1. Land Transportwion Office Registration under the name of | the Ambulance Service Provider | For ination based Designated ares that will house the polices fils, records, ec. of| ‘the ASP and which shall serve as the operations control and dispatch center of ambulances, For Non-institaion based Operations eon and dispute center of ambulances whether it bbe a business office or space 3.” ASP office has adequate parking spaces for the ambulancels they ‘own (when applicable), ‘SERVICE DELIVERY [Byery ambulance service provider shall ensure thatthe services delivered to patents comply with the standard quality embodied inthe Assessment Tool for licensure of land ambulances, othe: policy guidelines and/or related issuances 1. Documented policies and procedures on: ‘8 Administratve and technical Standard operating procedures (SO?) forthe provision ofits services ‘iy Establishmest ofits feral system 2 For health facilities (ex hospitals, infirmaries and birthing faites) with Noterized Memorandum — of ‘Agreement (MOA) between the ‘health facility and ASPFor Non-instintion-based/ Free- Standing anbulance service providers servicing. the public Independently Notarized Memorandum of | ‘Agreement (MOA) with a hospital ANNEX € A.0. No. 2018- 3. Schedule of Retention and Disposal of Records and other relevant information Quality Assurance Program 5. Continuous Quality Improvement ‘2. Client satisfaction survey with analysis », Handling and resolution of complains ‘© Copies ofthe nial protocol for each spectic ease 1B INFORMATION MANAGEMENT Every ambulance service provider shall maintain a system o patient's condition as well asthe results of examinations whic may include electronic communications ct ‘otherwise allowed under R.A. 8792 known as “Electronic Commerce Act of 2000." Moreover, ‘of date or information shouldbe in adherence to R.A. 10173 f communication, recording and reporting ofthe r, management also known as the "Data Privacy Act of 2012.” Hospital ReferalForm- completely ard accurately fled ‘out; kept secured and ‘onfidenta 7 Logbook completely and apouraely filled ou with the following contents: a Name, sex and age of patient ‘Name of atending physician (when applicable) «Origin and cestiation 4d. Date and tine of dispatch end retum of ambulance «Reason for ransfertranaport £. Disposition of patient 3. File of the Annual Siaistical Report (for renewal) ~ completely and accurately filled [ BatoANNEX € A.0. No. 2018. ‘ENVIRONMENTAL MANAGEMENT ‘Every ambulance serice provider shall ensure that the environment is safe for its patents end staff ‘including members ofthe public as necessary and thatthe following measures andlor safeguards shall be ‘observed. 1. The ambulance shall be properly ventilated, lighted, clean and safe, Waites plan and program oF proper disinfection” and preventive maintenance of the amiplance vehises J Adequate personal provecive ‘equipment (PPEs) Procedures for the proper disposal of infectious wastes and toxie and hazardous substances accordance with RA. 6969 known a5 “Toxic and Hazardous Substances and Nuclear Wastes ‘Act? and other related policy ‘puidelines and/or issuances ‘D. EQUIPMENT, MEDICINES AND SUPPLIES ‘Every ambulaaoe shall have available and operational prescribed equioment, mediines and su T. There shallbe progam for calibration, preventive ‘maintenance and repair of ‘equipment, including decontamination and Gisinfection. There shall be contingency plan in case of equipment breakdown ané malRunetion, expecially during patient transport 3. There shall be x program forthe ‘management o° temperature sensitive medication,ANNEX € 4.0. No.2018- LTO PLATE OR CONDUCTION STICKER NUMBER: AMBULANCE BODY ‘An ambulance vehicle shal beable to sesommodate the paint, ad the rogue number of personnel an igen 1. Safety non-porous partion (Geparating the driver and the body ofthe ambulance 2 Blecirc(inieral and extemal) xpply bulbs 3. Overhead grabrailon the ‘ailing ontop oF the patient stretcher 4 lnverter power source “5. Licensed Armbalances shall bam” ‘the following markings: a Front: The reflectoized and capitalized ‘word TAMBULANCE” which is spelled out in reverse (mirror image). The height of each letter shal temo ess than 10 centimeters and. the word Shall be seen atleast six (6) B Side: Each ide of the ambulance body shall have the capitalized word "AMBULANCE not lest than 15 cm in height © Rear: The ceflecorizad and capitalized word “AMBULANCE” not less than 15 om in height and the prescribed DOH ambulance Togo to be issued by the DOH. coce the spplication fora licenseis approved 1o other signage or pietires outside of what is prescribed. (May opt to mount the blue “Siar of je” emblem on any part of the ambulance whic Adequate and stable cabines that can appropriately store the required equipment, medicines and suppliesANNEX € A.O. No. 2018, Each ambulance shall be manned by an adequate numberof qualified, ttined and competent sai ensure cffcien and effective delivery of quality ambulance sev 7 ‘Minimum of two (2) ambulance persoanel exchiding the driver is required. for every ambulance dispatched. Each staff shal be tained from a DOH-tecognized taining _provider, in the following: ‘a Sandard Fist Aid ’b. Basie Life Support “Advanced Candie Life Support “T Eimergemsy Modest SartagCY 2000] Sartng CY ‘Techaiche (EMT) mnard 2000 onan: ‘Training: will be in aa arr transition Bae | Aan Peametes “eaning 2 Dever ‘There shall be one (1) driver for fevery shift. Each driver shall have the foloving: a. Valid professional driver's license ’. Centfcst of Proficiency from TESDA (NC I) ‘Complete 201 files of each personnel contining: PROD . CerfcstooF ‘Trainings atended © Jeb description Notarized Contract oF Employment Schadle of duties or sit oF personne! Siait development and continuing education program to ‘upgrade the knowledge, attitude and skills of sat?ANNEX € 4.0. No. 2018-0001 LIST OF EQUIPMENT, MEDICINES AND SUPPLIES Each ambulance shall be adequat ‘A. Ventilation and Airway Equipment with meaienes and supplies. ig ‘Suction gpparatus and accessories ‘a Portable or Mounted Suction Machine ‘by Flexible suaion catheters Fr. 58,12 und 14 Portable onyect ‘equipmenvinsaed ‘a. Porable oxygen tank With regulator ‘B. Oxygen mask No. 2.7 and 4 (for newborn infant and adult) Bag valve mask resasittor with rebreather bag for adult, patric and infant |___adutt | “Endotracheal tubes (pedia and ‘Airways (pedis and adult) [Nebulizer with nebaizer Kit ‘Laryngoscope st (pedia and adult ia B._ Monitoring andlor Defirilistion Detibriliator Vaal Z ‘Defibilaor pads —dioposable 3 ‘Sphygmomenometer, Non- mercurial, = Pediatic cut? = Adult out? a ‘Stethoscope (peliatic and adult) [Immobilization Devices 1 ‘Rigid cervical collars eal, medium, laze) 3 Firm padding or commercial head ‘immobilisation device a Lower exiremity traction devices (supporting slings, padding, traction strep) ‘Upper and Lower exremity ‘immobilization devices ‘Joint above and joint below Eacture ‘Rigid suppor appropriste material cea, me, pute, ‘Sowa od pari es._ Resistant saps or eravats ANNEX € A.0. No. 2018. ‘4 Orthopedic (scoop) stretcher! Long back board ‘D. Dressings and Bandages 1 Slerle bun shocts “Triangular bandage’ ‘Sterile Dressings ‘a 10°x30" or larger ‘b.ABDs, 10°x12" oF ager axa” gauie spony ‘Sterile gauze rls (various sizes) "Non-sterile caste bandages (various sizes) Sterile occlusive dressing 3°x8" or larger ‘Adhesive wperall ‘a. Various sizes of or hypoallergenic ‘Various sizes of or 3° bypoallergeni‘ondinary E, Obstetrical Delivery Set 7 Sterile delivery kit 2 ‘Wap /blanke! for newborn FE Infeetion Control 1 ‘Eye protection fll peripheral lasses or goggles or face shield) HEPA Masks Surgical Masks, "Non:stanife and Sterile Gloves Tumpsuits or Gowns ‘Shoe eovers Hand sanitizer or 10% alcohol ‘Shagps conaizer (puncture proof) ‘G Miscallansous 1 Blood Glucose Meter with stcips z "Thermometer non mercurial 3 Heavy bandage or paramedic scissors forcuting slethes, belts and boots ‘Alcohel swabs reat and Cold packs or thei equivalentFlash lights with extra batteries | and bulbs Pillows, pillow case and iowels Disposable emesis bags or basins 10, Bed Urinal 12 Incoatinenes pals — disposable 13 Lubricating el HE Communication Equipment ‘Communiceion devices exclusive for ambulsnce use betweer the OPCEN, ambulance vehicles an¢ refer facilities which may beany ofthe fallow 1. Radio 2 Callslar Phone Patient Transport T, Ambulance wheeled Sot with ‘mounted co! fastening system ‘S-Injury Prevention Equipment Fie Extinguisher TV cannula 28 7,73. 7526) ‘SFinges om 3 0 ae ‘Medicines / Fluids ‘Activated Charal Salbutamol nebales Sterile water for iigation, T Sterile water forinjection, Tom Tnsravenous aids = DSLRS | Lier D5 NSS Lier 2 Ds Water Lite 2 DS03NICI:00m! 2 Pain Les = Plain NSS Nomal saline water injectable) Dextrose S070 vial Plasme Expander ANNEX € 4.0. No. 2018. 901 Timed han ei ithANNEX € A.0. No. 2018- Coo) conics assim |'M. Controlled Medications Sealed Drug / Code Bax tobe opened only under a Physician or Paramedics supervision Epinephrine Tmg/Tmal boxes (QM, Inracardial, IV) ampale Caleiumn Gluconate 10% ‘mg/10ml ampule'vial Potassium Chloride 20mg/ 10m vial Furosemide 100mg/T0mi val and 20mg22ml ampule ‘Magnesium Sulfate 50% 1igm/mlampule Dopamine 420mg/ Sa vial Diphechydramine SOmgial ample ‘Sodium bicarbonate Tom sample Digoxin O-Img/ml ampule and .5mg/2mi ampule ‘Nitroglycerine sprayANNEX © [Name of Ambulance A.0. No. 2018-000] _ Service Provicer: Date of fnspection: RECOMMENDATIONS: For Licensing ua To For Issuance of License To Operate as AMBULANCE SERVICE PROVIDER Validity fom to. [LTO Plate or Conduction Sticker Number (Vehclels): fs a 2 a ay 6 Ue won ses needed Issuance deyend upon compliance to the recommendations given and submission ofthe following. within days from the date of inspection ‘issuance Specify reasons pected by: Printed name Signature Position Designation Received by: Signature: Printed Name:if ANNEX € 4.0. No. 2018-01 Name of Ambulance Service Provider: Date of Monitoring: DOH License Number casry LTO Plate or Conduction Sticker Number (Vehicle) 4 a 6. a al ae WaT RECOMMENDATIONS: For Monitoring [1 Teeuance of Notice of Violation [1 Non-istuance of Notice of Violation [1 Others. Specify Monitored by: Prited mame Signature Position Designation Received by: ‘Signature: Printed Name: Position Designation:Repti ofthe Philipines Department of Health HEALTH FACILITIES AND SERVICES REGULATORY BUREAU ANNEX D A.0.No. 2018 00, ANNUAL STATISTICAL REPORT FOR AMBULANCE SERVICE PROVIDERS "Name of Ambulance Service Provider: License Number Validity . "Nurber of Ambulance Vehicles: A, Total Ambulance Conduction (Per Vehicle) ‘Total namber of onductions ‘Total Hospital to Horpital Conduction "Total Other Health Faciities* to Hospital Conduction to Home Conduction | ae | Home to Hospital Conduction Hospital to other routes (Le. hospital to airport) oF vice versa B. Average Response Time of Ambulances (Annual: ©. Top Ten (10) Reasons for Referral/Transport L 2 3 D. Adverse Events During Transport (including deaths) Date "Time T ‘Total Number of Deaths (if any) Ma inde firma, brie home, eee] | SeogRepub oft 1 Phipinee Department of Heath HEALTH FACILITIES AND SERVICES REGULATORY BUREAU ANNEXE ‘AO. No. 2018-0001 SCHEDULE OF FFES IN THE LICENSURE OF LAND AMBULANCES AND AMBULANCE SERVICE PROVIDERS AMBULANCE SERVICE PROVIDI AMBULANCE VEHICLE Tastittion based” (eg: Hospitals, Infrmeries PHP 5,000.00; year PHP 1,000.00/ uait/ year For Nov-instttion-based™ (ex LGUs HIP 15,000.00 3 years PHP 3,000.00 unit /3 years *DOH-LTO VALIDITY: 1 yeer *7DOH-LTO VALIDITY: 3 years