Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
JAN 25 2018

ADMINISTRATIVEORDER
No. 2914* 2mg » 0001

SUBJECT: Revised Rules and Regulations Governing the Licensure of Land

Ambulances and Ambulance Service Providers

I. BACKGROUND AND RATIONALE

On July 12,2016, the Department of Health (DOH) through the Health Facilities and
Services Regulatory Bureau (formerly Bureau of Health Facilities and Services) published
Administrative Order (A.O.) No. 2016-0029 titled “Rules and Regulations Governing the
Licensure of Ambulances and Ambulance Service Providers” dated June 29, 2016.

The aforementioned A.O. was drafted in line with Section VI. A. 4. of AD. No. 2010-
0003 titled “National Policy on Ambulance Use and Services” which stated 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 policy was envisioned to remedy the issue on the misuse of
ambulance vehicles and the mislabeling of other vehicles as ambulances in the country.
Moreover, it seeks to establish that ambulances operate with competent personnel and
appropriate equipment in order to respond to medical emergencies, provide quality care and
ensure patient safety.

However, in consideration of the plight of stakeholders who could not readily comply
with the standards and requirements prescribed in the policy, the DOH decided to issue out
Department Circular (DC) No. 2016-0357 titled Extension of Moratorium Period for
Compliance for All Ambulance and Ambulance Service Providers. The DC. provided a
moratorium for all ambulance service providers to comply until December 31, 2017 while the
AD. underwent policy review.

After the conduct of several consultative meetings with stakeholders and considering
the context in which ambulance service providers currently operate, this Order hereby
provides the revised mandatory minimum standards and requirements for the licensure of
land ambulances and ambulance service providers.

II. OBJECTIVE
These rules and regulations are promulgated to protect the public and ensure the
safety of patients and personnel by setting the minimum standards and requirements for land
ambulances and ambulance service
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Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila 0 Trunk Line 651—7800 local 11 13, 1108, 1135
Direct Line: 711-9502; 711-9503 Fax: 743-18290 URL: http://www.doh.gov.ph; e-mail: officeofsoh@doh.govph
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.

2. Ambulance Service Provider (ASP) - a health facility, institution or entity whether

government or privately owned providing ambulance services.

3. 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 Cardio-
Pulmonary Resuscitation, basic and advanced airway management, tracheal
intubation, medications, electrical therapy and intravenous (IV) access.

4. Advance Life Support (ALS) - a set of life saving protocols and skills that extend
BLS to further 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 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.

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.

7. Emergency Medical Technician (EMT) - trained professional who provide out of

hospital emergency medical care and transportation for critical and emergent
patients who access the emergency medical services (EMS) system. (Ohio National
Registry ofMedical Technicians, 201 7)

8. First Aid —is the immediate assistance provided to a sick or injured person until
professional help arrives. Referred to as Standard First Aid (SFA) in this Order.
(International Federation ofRed Cross and Red Crescent Societies, 2016)

9. HFSRB— Health Facilities and Services Regulatory Bureau

10. Land Ambulance- a vehicle designed and equipped with basic or advance life
transporting patients to, from, and between places of treatment by

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11. Medical Direction— allows a paramedic or EMT to contact a physician from the
field via radio or other means to obtain instruction on further care of a patient

12. Medical emergencies - any acute or life-threatening condition that requires

immediate intervention by a competent personnel

13. Patient Transport Vehicle (PTV) - any form of land vehicle designed to transport
patients whose condition is of a non-life threatening nature.

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 used for the purpose by which
it was granted a license to operate.

3. No land vehicle of any kind shall bear on its body the label or marking of the
word “AMBULANCE” unless it has been duly licensed and categorized as a
land ambulance by the Department of Health.

4. Every ambulance service provider shall be organized to provide safe, quality,

effective and efficient ambulance services for patients which shall be made
available at all times.

5. Ambulance service providers of privately owned ambulances shall be

registered with the Department of Trade and Industry (DTI) or with the
Securities and Exchange Commission (SEC), whichever is applicable.

6. For ambulance service providers of government owned ambulances, a local

government ordinance/board resolution or its equivalent as proof of ownership
of ambulance vehicles shall be required.
7. All ambulance service providers shall have an Operations Control and
Dispatch Center of their ambulance/s whether it be a business office or space
and shall ensure adequate parking spaces for their ambulance/s.

8. Ambulance service providers shall ensure that they are part of a functional
referral network within the area/vicinity where they 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
(OSS) system for hospitals and other health facilities, and shall be reflected in
the health facility DOH-LTO. There shall only be one (1) DOH—LTO for the
health facility indicating the number of licensed ambulances.
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 10. Ambulance service providers of non-institution-based ambulances shall secure
a separate DOH-LTO.

ll. Ambulance service providers shall strictly 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
vehicles for inspection. Any additional vehicle shall be applied for inspection.
Only when found compliant shall the additional vehicle be included in the
existing list of approved ambulances of the ASP. Moreover, in cases when a
vehicle will no longer be used as an ambulance, the ASP shall inform
HFSRB/RO-RLED through a letter indicating the plate or conduction sticker
number of the said vehicle for delisting. The delisted vehicle shall then no
longer bear the marking “AMBULANCE” and the DOH Ambulance logo
should 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. Patient Transport Vehicles shall be used to transport patients whose condition
is of a non-life threatening nature such as but not limited to scheduled visits to
a physician’s office for treatment, routine physical examinations, x-rays or
laboratory tests, or upon discharge from a hospital.

15. Patient Transport Vehicles should not bear the marking of the word
“AMBULANCE” but shall instead be labeled as “PATIENT TRANSPORT
VEHICLE.”

16. Patient Transport Vehicles shall not be licensed by the HFSRB but shall be
registered with the Bureau using a prescribed form.

VI. SPECIFIC GUIDELINES

A. CLASSIFICATIONOF LAND AMBULANCES

1. ACCORDINGTO OWNERSHIP

a. Government — owned, managed and operated wholly by government

agencies/institutions such as, but not limited to, DOH hospitals, Local
Government Units (LGU) and LGU-run hospitals, the Bureau of Fire
Protection (BFP) and the Philippine National Police (PNP) of the
Department of the Interior and Local Government (DILG), the
Philippine Coastguard of the Department of Transportation (DOTr),
the Armed Forces of the Philippines (AFP) of the Department of
National Defense (DND), M tropolitan Manila Development
Authority (MMDA) and
others/(fl

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 b. 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 through single
proprietorship, partnership, corporation, cooperative, foundation,
religious, non—government organization and others.

2. ACCORDINGTO INSTITUTIONAL CHARACTER

a. Institution-based — ambulance that is owned, operated, maintained

and used by a health facility (i.e. hospital, infirmary, etc.) regulated by
the Department of Health.

Non-institution-based/ Free-Standing ambulance that is operated

—

independently from a health facility but may be used to service a health

facility through a notarized Memorandum of Agreement (MOA)
/service contract or its equivalent.

B. CATEGORIZATION OF LAND AMBULANCES

1. Type I- ambulance capable of providing Basic Life Support (BLS)

2. Type II- ambulance capable of providing Advance Life Support (ALS)

C. CATEGORY OF AMBULANCES REQUIRED AMONG HEALTH

FACILITIES

l. Ambulances are part of the licensing requirements of several types of

health facilities. The category of ambulance required from a health
facility shall be commensurate to the services provided by the health
facility as shown in the table below:

Type of Category of Ambulance If Outsourced with a DOH Licensed

Facility Required Ambulance Service Provider (ASP)
Specialty 0 The ambulance servicing the
and Hospitals should be Type 11
Level 3 0 There should be a MOA between the
Hospitals Type 11 (ALS) Ambulance hospital and the ASP (whether
government or privately owned)
Level 2 o The ambulance vehicle should be
Hospitals stationed at the hospital at all times.

Type I (BLS) Ambulance + o The ambulance servicing the

Level. 1
MOA with a hospital of Hospitals may either be Type I or
Hospltals higher level. Type II
0 There should be a MOA between the
Infirmaries May opt to have a Type II hospital and the ASP (whether
Ambulance government or privately owned)

2. Hospitals and infirmaries may opt to have own atient Transport

Vehicles (PTV)1n addition to their ambulances/14“;P
their
 3. Birthing facilities at a minimum are required to enter a MOA with
ambulance service providers (whether government or privately owned)
but may also opt to own an ambulance. This shall be complemented
with a MOA with a health facility of higher level. In cases wherein the
birthing home’s referral facility is also the ambulance service provider,
one MOA will suffice as long as the terms for ambulance services are
clearly stipulated in the said MOA.

4. All facilities opting to enter a MOA with any DOH licensed ambulance
service provider shall take into consideration that the ASP servicing
the facility should be able to respond and provide ambulance services
within a reasonable time. Moreover, DOH licensed ASPs entering into
MOA/s with health facilities should do so in accordance with their
service capacity and capability.

D. STANDARDS

1. AMBULANCE BODY

a. An ambulance vehicle shall be able to accommodate the patient, and

the required number of personnel and equipment.

b. The ambulance shall have a non-porous partition between the driver

and the body of the ambulance.

c. DOH Licensed Ambulances shall bear the following markings:

i. Front: The reflecton'zed and capitalized word “AMBULANCE”

which is spelled out in reverse (mirror image). The height of
each letter shall be no less than 10 centimeters and the word
shall be seen at least six (6) meters away.

ii. Side: Each side of the ambulance body shall have the
capitalized word “AMBULANCE” not less than 15 cm in
height.

The name and logo of the licensee, the administrative division

(Region, Province, City, Municipality and Barangay) to which
the ambulance is affiliated with may be indicated on the sides
of the ambulance provided that the logo/font size used should
not be more than the height of the word “AMBULANCE.” This
shall be placed below the word “AMBULANCE.”

iii. Rear: The reflectorized and capitalized word “AMBULANCE”

not less than 15 cm in height and the prescribed DOH
ambulance logo to be issued by the DOH once the application
for a license is approve (Refer to Annex B: Official DOH
Ambulance Logo)?”

Page 6 of 15
 iv. The licensee may also opt to mount the blue “Star of Life”
emblem on any part of the ambulance vehicle.

V. There shall be no restrictions on the color of the ambulance

vehicle or on the color of the letterings.

vi. Any other signage or pictures outside of what is prescribed

herein are not allowed.

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

e. Ambulance vehicles shall have Emergency Warning Light System and

Siren-Public Address System.

2. PERSONNEL

Each ambulance shall be manned by an adequate number of qualified,

trained and competent staff to ensure efficient and effective delivery of
quality ambulance services.

a. A minimum of at least two (2) ambulance personnel, 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.

b. The minimum qualifications and trainings required from ambulance

personnel shall be in accordance to the type of ambulance they operate
as follows:

W
Category of Minimum . . .
Ambulance Qualifications Training Requirements

0 Standard First Aid (SFA)

Graduate of any 0 Basic Life Support (BLS)
Type I health related 4
year course Starting CY 2020 onwards:
o SFA + BLS + Emergency Medical
Technician (EMT) Training-Basic
CY 2018:
0 Standard First Aid (SFA)
0 Basic Life Support (BLS)
Licensed 01‘ 0 Advance Cardiac Life Support
Type 11 Registered Nurse (ACLS)
(RN)
Starting CY 2020 onwards:
SFA + BLS + ACLS + EMT Training-
Advance /Paramedic Training

//
P go 7
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 C. There shall be staff development and continuing education program to
upgrade the knowledge, attitude and skills of staff.

3. EQUIPMENT, MEDICINES AND SUPPLIES

Every ambulance shall have available and operational prescribed

equipment, medicines and supplies.
‘

a. Each ambulance shall be adequately equipped with appropriate

equipment, medicines and supplies. (Refer to Annex C: Assessment
Tool for Licensing a Land Ambulance and Ambulance Service
Provider)
There shall be a program for calibration, preventive maintenance and
repair of equipment, including decontamination and disinfection.

There shall be a contingency plan in case of equipment breakdown and

malfunction, especially during patient transport.

There shall be a program for the management of temperature sensitive

medication.

4. 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 licensing a land ambulance and ambulance service provider, other
policy guidelines and/or related issuances.

a. Ambulance service provider shall have documented policies and

procedures on its administrative and technical Standard Operating
Procedures (SOP) for the provision of its ambulance services.

Ambulance service provider shall have documented policies and

procedures on the establishment of its referral system.

Non-institution—based/ Free-Standing ambulance service providers

servicing the public independently shall have a MOA with a hospital
for which they can bring their clients for the needed health services.
[This clause is not applicable in cases of extreme medical emergencies
or in cases when patients prefer another ambulance service provider.]

Ambulances shall have devices to communicate to the operation center

of the ambulance service provider and the referral hospital/health
facility for recording and effective management of cases.

There shall be gu' lines in the implementation of medical direction

when needed.

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5. 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 which may include electronic
communications or otherwise allowed under Republic Act (R.A.) 8792,
otherwise known as the “Electronic Commerce Act of 2000.” Moreover,
management of data or information should be in adherence to RA. 10173
also known as the “Data Privacy Act of 2012.”

a. Hospital/Facility 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.

b. 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:
i. Name, sex and age of patient;
ii. Name of attending physician, when applicable;
iii. Origin and destination;
iv. Date and time of dispatch and return of ambulance;
V. Reason for transfer/transport;
vi. Disposition of patient.

c. Submission of Reports

All ambulance service providers shall submit an annual report

utilizing the template provided by DOH (Refer to Annex D: DOH
Annual Statistical Report for Ambulance Service Providers). The
deadline for the yearly submission is every 31St of March of the
following year (ex. CY 2018 report will be due on March 31, 2019).

6. ENVIRONMENTALMANAGEMENT

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:

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

b. There shall be a written plan and program of proper disinfection and

preventive maintenance of the ambulance vehicles.
M
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 c. The use of Personal Protective Equipment (PPEs) and adherence to
infection control policies shall be strictly observed.

d. There shall be procedures for the proper disposal of infectious wastes

and toxic and hazardous substances in accordance with RA. 6969
known as “Toxic and Hazardous Substances and Nuclear Wastes Act”
and other related policy guidelines and/or issuances.

VII. PROCEDURAL GUIDELINES

A. The processing of application for DOH-LTO shall be as follows:

Type of HFSRB RO-RLED

Application
Initial/ Institution-based: Institution-based:
Renewal Ambulances of Levels 2 and 3 Hospitals, Level 1 Hospitals,
Ambulatory Surgical Clinics, Dialysis Clinics, Birthing Homes and
Medical Facilities for Overseas Workers and Infirmaries
Seafarers, etc.

Non-institution-based:

Government owned:
Ambulances of Barangay Health Stations, Rural
Health Units, Health Centers, City Health Offices,
Municipal Health Offices, Provincial Health Offices,
LGUs, BFP, PNP, Coastguard, AFP, MMDA, etc.

Privately owned

B. The processing of applications shall be within thirty (30) days starting from the
time of receipt of the complete application documents to the issuance or non-
issuance of the DOH-LTO.

C. APPLICATION FOR INITIAL DOH—LTO

l. Ambulance service providers of institution-based ambulances shall follow

the One-Stop Shop (OSS) system for hospitals and other health facilities.

2. Ambulance service providers of non-institution—based ambulances shall

follow the consecutive steps: (Refer to Annex A for the Process Flow in the
Licensure of Land Ambulances and Ambulance Service Providers- Initial)

a. Ambulance service providers shall submit the following relevant

documents to HFSRB/ RO-RLED:

i. Duly accomplished application form can be

fort/2W
downloaded from hfsrb.doh.gov.ph.

Pageégls
 ii. Proof of ownership:

For Ambulance Service Providers of Government owned

ambulances:

a) Enabling Act or Board Resolution or its equivalent

b) Cooperative Development Authority Registration with
Articles of Cooperation and By—laws, whenever applicable

For Ambulance Service Providers of Privately owned

ambulances:

a) Department of Trade and Industry (DTI) or Securities and

Exchange Commission (SEC) Registration with Articles of
Incorporation and By—laws;
b) Cooperative Development Authority Registration with
Articles of Cooperation and By-laws, Whenever applicable

iii. Registration of the vehicle(s) from the Land Transportation

Office

iv. License of the ambulance driver/s as Professional Driver, from

the Land Transportation Office

b. Pay the corresponding fee, and submit a copy of the official receipt
to HF SRB/ RO-RLED.

c. The HFSRB/ RO-RLED shall receive and evaluate the .

completeness of documentary requirements submitted including

proofs of payment. A complete application means that the required
documents, as specified in the application checklist of HFSRB/RO-
RLED, have been submitted. If incomplete, the client shall be
given thirty (30) days to submit the complete documentary
requirements. The application payment will be forfeited if the
complete documentary requirements are not submitted within thirty
(30) days.

(1. For complete applications, the inspection team of HFSRB/RO-

RLED shall inspect the ambulance vehicle/s. The applicant shall
ensure that all key staff, pertinent records, and ambulance vehicles
are made available to HFSRB/RO-RLED during inspection visits.

If during inspection, the ambulance vehicle/s is/are found non-

compliant to the standards and requirements for the licensing of
ambulances, the inspection team from the concerned offices shall
notify the applicant of their deficiencies and the ASP shall be given
time to comply within the prescribed timeline (maximum of 30
days). The counting of days to process the application shall be
stopped (“stop-clock”) until all deficiencies have been complied
with. Failure to complete the compliance within the
prescfb/d
Page , l of 15
 timeline given shall mean disapproval of the application and
forfeiture of payment. The HFSRB/RO-RLED shall then send the
Letter of Denial with the noted deficiencies to the applicant.

If found compliant during inspection, the inspection team shall

recommend the issuance of the DOH-LTO.

e. The Director IV of HFSRB/RO Director, or in his/her absence or

unavailability or when delegated, the Director 111 of HFSRB/RO,
shall approve the issuance of the DOH-LTO.

f. Once the DOH-LTO has been issued to the ambulance service

provider, each compliant ambulance vehicle of the licensed ASP
shall be given the Official DOH Ambulance Logo with its
corresponding plate or conduction sticker number, ambulance
category and the year until when the DOH-LTO of the ASP will be
valid. The logo shall then be mounted at the rear of the vehicle.
Moreover, all ambulance vehicles should have a copy of the DOH-
LTO of the ASP.

D. APPLICATION FOR RENEWAL OF DOH-LTO

1. Ambulance service providers of institution-based ambulances shall follow the

One-Stop Shop (088) system for the renewal of their DOH-LTO.

Ambulance service providers of non-institution—based ambulances shall follow

the consecutive steps:

a. Submit the following documents:

i. Duly accomplished application form. This form can be

downloaded from hfsrb.doh.gov.ph.
ii. DOH annual ambulance statistical report ‘

iii. other relevant records as may be required by DOH

b. The same steps and timelines outlined in Section VII. C.2. b.-f. of this
Order shall apply.

The DOH-LTO of an ambulance service provider 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 for an initial DOH-LTO.

E. MONITORING

1. Licensed service providers and its ambulances shall be monitored

regularly. mance

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 2. The HFSRB or RO-RLED shall conduct periodic monitoring visits utilizing
the assessment tool for licensing a land ambulance and ambulance service
provider.

3. The applicant shall ensure that all key staff, records, premises and facilities are
made available to HFSRB or RO-RLED during monitoring activities.

4. A Notice of Violation shall be issued immediately for non-compliance with

these rules and regulations.

VIII. VALIDITY OF LICENSE TO OPERATE

The DOH-LTO of ambulance service providers of institution-based ambulances shall
be valid for one (1) year only following the OSS system for hospitals and other health
facilities, while for ASP of non-institution-based ambulances, the DOH-LTO shall be valid
for three (3) years from January of the first year to December of the third year.

IX. SCHEDULE OF FEES

of DOH-LTO of an
A. A non-refundable fee shall be charged for the application
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 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 AD. 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 AD. No. 2008 — 0028
“Schedule of Fees for the One-Stop Shop System for the Regulation of Medical
Facilities for Overseas Workers and Seafarers and Non-Hospital Based. . .”, other
policy guidelines and/or relevant issuances.

X. 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.

XI. INVESTIGATIONOF CHARGES AND COMPLAINTS

The Health Facilities and Services Regulatory Bureau or the Regional Office Director
and/or his authorized representative(s) shall investigate complaints and verify if ambulance
service provider concerned or any of its personnel is liable for an alleged violation. The
HFSRB or R0 Director may order the preventive suspension of operation of the concerned

Page 13 of 15
ambulance service provider pending investigation which shall not be more than ninety (90)
days.

XII. SANCTIONS AND PENALTY

Imposable penalties for violations hereof shall be in accordance with AD. No. 2007—
0022 titled “Violations under 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-Hospital-Based Dialysis Clinics and Non-Hospital-
Based Ambulatory Surgical Clinics with Ancillary Services”, and related issuances or
guidelines.

In case of death or serious physical injury (as defined by Article 263 of the Revised
Penal Code of the Philippines) of the patient, passengers, pedestrians or the general public,
the DOH-LTO of the ambulance service provider shall be automatically revoked if such
death or injury was found or determined by the appropriate authority to be due to the
negligence or misuse of the ambulance service. 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.

Ambulance service providers whose DOH-LTO has been revoked shall be prohibited
from applying for another DOH-LTO as an ASP for a minimum of one (1) year.

XIII. APPEAL
Any hospital or other health facility aggrieved by the decision of the HFSRB Director
or Regional Director may, within ten (10) days after receipt of the notice of decision file a
notice of appeal to the Head of the Office for Health Regulation (OHR). All pertinent
documents and records of the appellant shall then be elevated by HFSRB or the Regional
Office to the OHR. The decision of the Head of the OHR if still contested maybe brought on
a final appeal to the Secretary of Health within ten (10) days after receipt of the decision from
OHR. The Secretary of Health’s decision shall be absolute and executory.

XIV. TRANSITORYPROVISIONS
A. For application of DOH-LTO for CY 2018, ambulance service providers of both
institution-based and non-institution-based ambulances may file their applications and
pay the corresponding fees at either HFSRB or RO-RLED until December 15, 2017.

B. Applications filed starting January 2018 should follow section VII. A of this
Order.

XV. REPEALING CLAUSE

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

/\/
Page 14 of 15
XVI. 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 in force.

XVII. EFFECTIVITY
This Order shall take effect after fifteen (15) days after its publication in two
newspapers of general circulation.

, UQUE III, M.D., MSC.

Se etary of Health

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 Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

M
ANNEX A
A0. No. 2018-

PROCESS FLOW IN THE LICENSURE OF LAND AMBULANCES AND AMBULANCE SERVICE PROVIDERS- INITIAL

PROCESS FLOW TIME TABLE

'
Step 1: Applicant shall fill out application form for the Licensure of
Land Ambulances and Ambulance Service Providers

flep 2: Applicant shall prepare/secure/submittogether with the application form the following
documents:
a. Proof of ownership
For Ambulance Service Providers of Government owned ambulances:
\
1. Enabling Act or Board Resolution or its equivalent
2. Cooperative Development Authority Registration with Articles of Cooperation and Ey-Iaws, whenever
applicable
For Ambulance Service Providers of Privately owned ambulances:
1. Department of Trade and Industry (DTI) or Securities and Exchange Commission (SEC) Registration with
Articles of Incorporation and By-laws;
2. Cooperative Development Authority Registration with Articles of Cooperation and By-Iaws, whenever

''
applicable

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

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

Step 3: Applicant shall secure Order of Payment and Pay the corresponding fee
to the DOH Central Office/R0 Cashier

4: Application will be received by HFSRB/RO-RLED including the proof of payment

[Step
for evaluation of documentary requirementsas specified in the application checklist

I 3 Days

Incomplete Complete

Applicant has 30 days to Step 5: HFSRB/Ro-RLED shall inspect the

submit complete ambulance vehicle/s
documentary
requirements.‘
Application payment will be
forfeited if complete
documentaryrequirements

l
Non-compliant Compliant
are not submitted within 30

“mph-"9d W’Ih'” 3” ““75

1
HFSRB/RO-RLED shall Step 6: HFSRB/RO-
inform the applicant of RLED shall
their deficiencies and recommend the
ElVe" ”me m C°mPIV issuance of the DOH-
within 30 days" LTO

', 27 Days

Step 7: Director IV of
If applicant fails to HFSRB/RO Director or
'th' 30 ”applicant
Director I" Of
I
-

zzapgptIicaTion complied within 30

be disapproved days, proceed to HFSRB/RO, SIIaII
will
and payment Step 5 approve the Issuance
of the DOH-LTO

I l
forfeited

HFSRB/RO-RLED Step 8: Official DOH

shall send the Letter Ambulance Logo shall
of Denial with the be given for each
noted deficiencies compliant ambulance
to the applicant

l
_

vehicle of the licensed

ASP

End of Process
A
Re-application and New Payment Effigfinfip'pmm
GO BACKTO STEP 3 01/26/2018
Page of
1 1

*The counting of days to process the application shall be stopped ("stop-clock") until all deficiencies have been complied with.
 Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

ANNEX B
A.O. No. 2018- 000]

OFFICIAL DOH AMBULANCE LOGO

LICENSED BY THE DOH

PLATE NUMBER :

AMBULANCE
CATEGORY
VALID UNTIL

CONTROL NO.

*Conduction sticker number shall be indicated if the vehicle has no plate number yet
DOH-A ASP-Logo-Annex B
Revisionzoo
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 Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU
ANNEX C
A.O. No. 2018- 000i

ASSESSMENT TOOL FOR LICENSING A LAND AMBULANCE AND

AMBULANCE SERVICE PROVIDER

I. GENERAL INFORMATION

Name of Ambulance Service Provider (ASP):

Complete Address:

Email
Tel/Fax Nos: Address:

Name of Owner:

Category:

E Type I - BLS Ambulance Cl Type 11— ALS Ambulance

Ownership:

E] Government: Cl Private

I: National |:l Single Proprietorship

El Local D Corporation

Others (specify) Others (specify)

Institutional Character:

D Institution-based [:l Non-institution-based/Free-Standing

Type of application:

El Initial Cl Renewal

DOH License Number (ASP):

DOH—A ASP-LTO-AT—Annex C
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 ANNEX C
A.O. No. 2018- OOOI
II. TECHNICAL REQUIREMENTS
Instruction: In the appropriate box, place a check mark (\/) if the ambulance or ambulance service
provider is compliant or X-mark if not compliant.

1. Land Transportation Office

Registration under the name of
the Ambulance Service Provider

For Institution-based:

Designated area that will house

the policies, files, records, etc. of
the ASP and which shall serve as
the operations control and
dispatch center of ambulance/s.

For Non-institution-based:

Operations control and dispatch

center of ambulance/s whether it
be a business office or space
ASP office has adequate parking
spaces for the ambulance/s they
own (when applicable).

A. 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 land ambulances, other policy guidelines
and/or related issuances.
1. Documented policies and
procedures on:
a. Administrative and technical
standard operating
procedures (SOP) for the
provision of its services
b. Establishment of its referral
system
For health facilities (ex.
hospitals, infirmaries and
birthing facilities) with
outsourced ambulance services:

Notarized Memorandum of
Agreement (MOA) between the
health facility and ASP

DOH-A ASP—LTO—AT-Annexc
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 ANNEX C
A.O. N0. 2018- 000!

For Non-institution-based/ Free-

Standing ambulance service
providers servicing the public
independently:

Notarized Memorandum of
Agreement (MOA) with a
hospital
3. Schedule of Retention and
Disposal of Records and other
relevant information
4. Quality Assurance Program
5. Continuous Quality
Improvement
a. Client satisfaction survey
with analysis
b. Handling and resolution of
complaints
6. Copies of the clinical protocol
for each specific case
B. 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 which may include electronic communications or
otherwise allowed under RA. 8792 known as “Electronic Commerce Act of 2000.” Moreover, management
of data or information should be in adherence to RA. 10173 also known as the “Data Privacy Act of 2012.”
1. Hospital Referral Form-
completely and accurately filled
out; kept secured and
confidential
2. Logbook - completely and
accurately filled out with the
following contents:

Name, sex and age of patient

a.
b. Name of attending physician
(when applicable)
0. Origin and destination
d. Date and time of dispatch and
return of ambulance
e. Reason for transfer/transport
f. Disposition of patient
3. File of the Annual Statistical
Report (for renewal) -
completely and accurately filled
out

DOH-A ASP-LTO-AT-Annexc
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 ANNEX C
A.O. N0. 2018- 000!
STANDARDS
, TypeI \
,;\

C. ENVIRONMENTALMANAGEMENT
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. Written plan and program of
proper disinfection and
preventive maintenance of the
ambulance vehicles
3. Adequate personal protective
equipment (PPEs)
4. Procedures for the proper
disposal of infectious wastes and
toxic and hazardous substances
in accordance with RA. 6969
known as “Toxic and Hazardous
Substances and Nuclear Wastes
Act” and other related policy
guidelines and/or issuances
D. EQUIPMENT, MEDICINES AND SUPPLIES
Every ambulance shall have available and operational prescribed equipment, medicines and supplies.
1. There shall be a program for
calibration, preventive
maintenance and repair of
equipment, including
decontamination and
disinfection.
There shall be a contingency
plan in case of equipment
breakdown and malfunction,
especially during patient
transport.
There shall be a program for the
management of temperature
sensitive medication.

DOH-A ASP-LTO-AT-AnnexC
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 ANNEX C
50- No- 2.9185 0 ,

, V
Tylpel «
\

TypeIllCéll’Itl ”
LTO PLATE OR CONDUCTION STICKER NUMBER:
E. AMBULANCE BODY
An ambulance vehicle shall be able to accommodate the patient, and the required number of personnel and
equipment.
1. Safety non-porous partition
(separating the driver and the
body of the ambulance
2. Electric (internal and external)
supply bulbs
3. Overhead grab rail on the
ceiling on top of the
patient/stretcher
4. Inverter power source
5. Licensed Ambulances shall bear
the following markings:
a. Front: The reflectorized and
capitalized word
“AMBULANCE” which is
spelled out in reverse (mirror
image). The height of each
letter shall be no less than 10
centimeters and the word
shall be seen at least six (6)
meters away.
b. Side: Each side of the
ambulance body shall have
the capitalized word
“AMBULANCE” not less
than 15 cm in height.
c. Rear: The reflectorized and
capitalized word
“AMBULANCE” not less
than 15 cm in height and the
prescribed DOH ambulance
logo to be issued by the
DOH once the application
for a license is approved
No other signage or pictures
outside of what is prescribed.
(May opt to mount the blue
“Star of Life” emblem on
any part of the ambulance
vehicle)
6. Adequate and stable cabinet/s
that can appropriately store the
required equipment, medicines
and supplies
DOH-A ASP-LTO-AT-Annexc
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01/26/2018
Page 5 of 12
 ANNEX C
A.O. N0. 2018- 0001
STANDARDS AND
REQUIREMENTS Type I Type II , COMPLIANT REMARKS
(AMBULANCE VEHICLE)
7. Emergency Warning Light
System and Siren-Public
Address System
F. PERSONNEL
Each ambulance shall be manned by an adequate number of qualified, trained and competent staff to ensure
efficient and effective delivery of quality ambulance services.
1. Minimum of two (2) ambulance
personnel excluding the driver is
required for every ambulance
dispatched.

Each staff shall be trained from a

DOH-recognized training
provider, in the following:
a. Standard First Aid
b. Basic Life Support
c. Advanced Cardiac Life
Support gt
\
.
_
’

,
.

d, Emergency Medical Starting CY 2020 Starting CY

Technician (EMT) onwards: 2020 onwards:

Tram??? W1” be m EMT Training- EMT Training-

transztlon Basic Advanced
/Paramedic
Training
2. Driver
There shall be one (1) driver for
every shift. Each driver shall
have the following:
a. Valid professional driver’s
license
b. Certificate of Proficiency
from TESDA (NC 11)
3. Complete 201 files of each
personnel containing:
a. PRC ID
b. Certificate of
Trainings attended
Job description
c.
d. Notarized Contract of
Employment
4. Schedule of duties or shift of
personnel
5. Staff development and
continuing education program to
upgrade the knowledge, attitude
and skills of staff

DOH-A ASP-LTO-AT-AnnexC
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 ANNEX C
A.O. No. 2018- ODQI

LIST OF EQUIPMENT, MEDICINES AND SUPPLIES

‘Each amublance sahl b adquately equlpped with appropriate quipment’ediinsand suoplies.

A. ‘véfiiiléfidii 51a“ Aiiway magma

" '

1. Suction apparatus and accessories

a. Portable or Mounted Suction
Machine
b. Flexible suction catheters
Fr. 5,8,12 and 14
2. Portable oxygen
equipment/installed
a. Portable oxygen tank with
regulator
b. Oxygen mask No. 2,3 and 4
(for newborn, infant and adult)
3. Bag valve mask resuscitator with
rebreather bag for adult, pediatric
and infant
4. Endotracheal tubes (pedia and
adult)
5. Airways (pedia and adult)
6. Nebulizer with nebulizer kit
7 Laryngoscope set (pedia and adult)
B. Monitoring and/or Defibrillation
1. Defibrillator AED
Manual with
cardiac monitor
2. Defibrillator pads — disposable
3. Sphygrnomanometer, Non-
mercurial
- Pediatric cuff
- Adult cuff
4. Stethoscope (pediatric and adult)
C. Immobilization Devices
1. Rigid cervical collars (small,
medium, large)
2. Firm padding or commercial head
immobilization device
3. Lower extremity traction devices
(supporting slings, padding,
traction strap)
4. Upper and Lower extremity
immobilization devices
a. Joint above and joint below
fracture
b. Rigid-support appropriate
material (cardboard, metal, pneumatic,
vacuum, wood or plastic)—various sizes

DOH-A ASP-LTO-AT-AnnexC
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 ANNEX C

c. Resistant straps or cravats

d. Orthopedic (scoop)
stretcher/ Long back board
D. Dressings and Bandages
1. Sterile burn sheets
2. Triangular bandages
3. Sterile Dressings
a. lO”x30” or larger
b. ABDs, 10”x12” or larger
c. 4”x4” gauze sponges
Sterile gauze rolls (various
sizes)
Non-sterile elastic bandages
(various sizes)
Sterile occlusive dressing
3”x8” or larger
Adhesive tape roll
a. Various sizes of 2” or 3”
hypoallergenic
b. Various sizes of 2” or 3”
non-
hypoallergenic/ordinary
E. Obstetrical Delivery Set
1. Sterile delivery kit
2. Wrap / blanket for newborn
F. Infection Control
1. Eye protection (full peripheral
glasses or goggles or face
shield)
.N HEPA Masks / Surgical
Masks
Non-sterile and Sterile Gloves
Jumpsuits or Gowns
Shoe covers
NQP‘PP’

Hand sanitizer or 70% alcohol

Sharps container (puncture
proof)
G. Miscellaneous
1
. Blood Glucose Meter with
strips
2. Thermometer, non-mercurial
3. Heavy bandage or paramedic
scissors for cutting clothes,
belts and boots
4. Alcohol swabs
5. Heat and Cold packs or their
equivalent

DOH-A ASP-LTO-ATAnnex C
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 ANNEX C
A.O. N0. 2018- 01

.M

6. Flash lights w1th extra batter1es

and bulbs
7. Blankets, sheets, linen or paper
8. Pillows, pillow case and towels
9. Disposable emesis bags or
basins
10. Bed pan
1 1. Urinal
12. Incontinence pads — disposable
13. Lubricating jelly
H. Communication Equipment
Communication devices exclusive for
ambulance use between the OPCEN,
ambulance vehicles and referral
facilities which may be any of the
following:
1. Radio Licensed hand-
held radio with
base station
2. Cellular Phone
I. Patient Transport
1. Ambulance wheeled cot with
mounted cot fastening system
J. Injury Prevention Equipment
1. Fire Extinguisher I

K. IV Therapy Supplies
1. IV Administration set
(Macro/Micro)
2. IV cannula (019, 20, 21, 23, 25,26)
3. Syringes (50ml, 30ml, 10m1, 3ml lml)
L. Medicines / Fluids
1. Activated Charcoal
Salbutamol nebules
3. Sterile water for irrigation, 1
liter
4. Sterile water for injection,
10ml
5. Intravenous fluids
- D5 LRS 1 Liter
- D5 NSS 1 Liter
- D5 Water 1 Liter
- D5 0.3NaCl 500ml
- Plain LRS
- Plain NSS
6. Normal saline water
(injectable)
7. Dextrose 50%/50ml vial
8. Plasma Expander

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 ANNEX C

"

M. Controlled Medications
Sealed Drug / Code Box to be opened only under a Physician 0r Paramedics supervision.
This should be regularly checkedfor expired items by Physician-in—charge 0r Paramedics
1. Atropine Sulfate 1mg/m1
ampule
E9 Epinephrine 1mg/1ml tubaxes

(1M, Intracardial, IV) ampule

Diazepam 10mg ampule/vial
Dobutamine 250mg ampule
Lidocaine 1gm/25m1 Vial
>19???“

Adenosine 6mg/2ml ampule

Human Regular Insulin
1
00mg/ml vial
8. Calcium Gluconate 10%
1mg/1 Oml ampule/Vial
9. Potassium Chloride
20mg/10ml Vial
10. Furosemide 100mg/10m1 vial
and 20mg/2ml ampule
11. Magnesium Sulfate 50%
l gm/2ml ampule
12. Dopamine 400mg5m1 Vial
l3. Diphenhydramine 50mg/ml
ampule
14. Sodium bicarbonate 10ml
ampule
15. Digoxin 0.1mg/m1 ampule and
0.5mg/2ml ampule
16. Nitroglycerine spray /
sublingual / patch
17. Verapamil 5mg/2ml ampule

DOH-A ASP-LTO-AT-AnnexC
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Page100f12
 ANNEX C
Name of Ambulance
A°O' N 0' 2018'Ml_
Service Provider:
Date of Inspection:

RECOMMENDATIONS:
For Licensing
[ ] For Issuance of License To Operate as AMBULANCE SERVICE PROVIDER
Validity from to
LTO Plate or Conduction Sticker Number (Vehicle/s):
1. 4.
2. 5.
3 6.
*Use additional sheet/s if needed
[ ] Issuance depends upon compliance to the recommendations given and submission of the following
within days from the date of inspection

[ ] Non-issuance. Specify reason/s:

Inspected by:
Printed name Signature Position/Designation

Received by:
Signature:
Printed Name:
Position/Designation:
Date:

DOH-A ASP-LTO-AT-AnnexC
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 ANNEX C
A.O. N0. 2018- QQQ]
Name of Ambulance
Service Provider:
Date of Monitoring:
DOH License Number
(ASP):
LTO Plate or Conduction Sticker Number (Vehicle/s):
1.
2. .V'

3.
*Use additional sheet/s if needed

RECOMMENDATIONS:
For Monitoring
[ ] Issuance of Notice of Violation

[ ] Non-issuance of Notice of Violation

[ ] Others. Specify

Monitored by:
Printed name Signature Position/Designation

Received by:
Signature:
Printed Name:
Position/Designation:
Date:

DOH-A ASP-LTO—AT-Annex C
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Page 12 of12
 Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

ANNEX D
A.O. No. 2018- 000!

ANNUAL STATISTICAL REPORT FOR AMBULANCE SERVICE PROVIDERS

Name of Ambulance Service Provider:

License Number: Validity: to
Number of Ambulance Vehicles:

A. Total Ambulance Conduction (Per Vehicle)

Total number of conductions

Total Hospital to Hospital Conduction
Total Other Health Facilities* to Hospital
Conduction
Hospital to Home Conduction

Home to Hospital Conduction

Hospital to other routes (i.e. hospital to
airport) or vice versa

B. Average Response Time of Ambulances (Annual):

C. Top Ten (10) Reasons for Referral/Transport

1.

3.

D. Adverse Events During Transport (including deaths)

Date Time Desc tion

Total Number of Deaths (if any):

*May include infirmaries, birthing homes, etc.

DOH-A ASP—AR-Annex D
Revision:00
1/26/2018
Page 1 of 1
 Republic of the Philippines
Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

ANNEX E
A.O. No. 2018- 000!

SCHEDULE OF FEES IN THE LICENSURE OF LAND AMBULANCES AND

AMBULANCE SERVICE PROVIDERS

Institution—based* For Non-institution—based**

(e. g. Hospitals, Infirmaries ) (e.g. LGUs)
AMBULANCE
SERVICE PHP 5,000.00 / year PHP 15,000.00 / 3 years
PROVIDER
AhflléglfélgCE PHP 1,000.00 / unit / year PHP 3,000.00 / unit / 3 years

*DOH-LTO VALIDITY: 1
year
**DOH-LTO VALIDITY: 3 years

DOH-A ASP-Fees—AnnexE
Revisionzoo i

01/26/201 8
Pace 1 of 1