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Department of Health
OFFICE OF THE SECRETARY
JUN ? g ?016
ADMII\ISTRATTVE ORDER
No. 2016 - 007q
SUBJECT: Rules and Requlations Governins the Licensure of Ambulances and
The current licensing standard requires hospital facilities to provide ambulance services.
However, it has been observed that the term oambulance' has been misused. There are ambulances
that operate without competent personnel, appropriate equipment and life-saving drugs capable of
responding to medical emergencies.
Regulation is the first step to exrsure that health facilities and services comply with the
qualrty standards that will not put patients' lives at risk. It is in this light that the Health Facilities
and Services Regulatory Bureau (HFSRB) sets the basic requirements as well as the minimum
stnrctural inputs in relation to ambulance design, physical facilities, manpower, and equipment for
the operation of ambulance and ambulance service providers that support the right of patients to
safe and qualrty health care.
In view of the above, this Order aims to establish mandatory minimum requirements for
ambulances and ambulance service providers in line with the Kalusugan Pangkalahatan
(Universal Health Care) strategic thrust to improve access to safe, quality and affordable health
services.
il. OBIECTIVE
These rules and regulations are promulgatd to protect the public and assure the safety of
patients and personnel by:
1. By setting the minimum standards and requirements for ambulances and ambulance
service providers; and
Bufldfng 1, San lazaro Compoun4 Rizal Avenue, Sta. Cruz, 1003 Manlla oTrunk Line 651-7800 Direct Line: 711-9501
Faxz743-1829i743-1786 oURL: bt@ll$alq.dqh4or&pb e-mall: osec@doh.sov.ph
Iv. DEFINITION OF TERMS
For purposes of this Order, the following terms, abbreviations and definitions apply:
1. Ambulance - a vehicle designed and equipped for transporting sick or injured patients
to, from, and between places of treatment by land, water or air, affording safety and
comfort to the patients and avoiding aggravation of illness or injury. This excludes
rapid response vehicles such as, but not limited to, motorcycles, cars and other
vehicles designed to transport patients but are not equipped to respond to
medical emergencies.
2. Advanced Cardiac Life Support (ACLS) - a group of interventions used to treat and
stabilize adult victims of life-threatening cardiorespiratory emergencies and to
resuscitate victims of cardiac arrest. These interventions include CPR, basic and
advanced airway management, tracheal intubation, medications, electrical therapy
and intravenous (lV) access.
4. Basic Life Support (BLS) -a group of actions and interventions used to resuscitate
and stabilize victims of cardiac or respiratory arrest. These BLS actions and
interventions include recognition of a cardiac or a respiratory emergency or stroke,
activation of the emergency response system, CPR and relief of foreign-body airway
obstruction.
7. -
Emergency Medical Services (EMS) medical service designed to provide timely
pre-hospital or out of hospital acute medical care and/or transport to definitive care, to
patients with sudden and life-threatening injuries or emergencies.
8. First Aid - initial emergency care given to a person who is injured or suddenly
becomes ill.
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I 1. Medical emergencies any acute or life-threatening condition that requires
immediate intervention by a competent personnel
13. Signage any form of written announcement installed, posted, hanged, painted or
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otherwise displayed in a public place.
V. IMPLEMENTING MECHANISMS
A. GENERAL GUIDELINES
1. Ambulance service providers shall secure registration for all vehicles at the Land
Transportation Office (LTO) prior to application for license to operate.
3. Ambulance service providers shall ensure that they are part of a functional referral
network within the arealvicinity where they are allowed to operate.
4. Stakeholders shall strictly comply with the standards, criteria and requirements
prescribed in the Assessment Tool for licensure of ambulances and ambulance
service providers.
5. The DOH-LTO of ambulance service providers shall be valid for three (3) years,
from January of the first year to December of the third year.
a. Institution-based ambulance services shall be included in the One-Stop Shop
(OSS) licensure system for hospitals and other health facilities. The DOH-
LTO of the ambulance shall be reflected in the health facility DOH-LTO.
Hence, a separate DOH-LTO is not required.
b. Non-institution-based ambulance service providers shall secure a separate
DOH-LTO.
c. The plate or conduction sticker number AND Certificate of Registration (CR)
number of each ambulance vehicle shall be reflected in the DOH-LTO of the
ambulance service providers
B. SPECIFIC GUIDELINES
1. CLASSIFICATION OF AMBULANCE SERVICE PROVIDERS
a. ACCORDING TO OWNERSHIP
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LGU-run hospitals, BFP and PNP of DILG, Coastguard of DoTC, AFP of
DND, MMDA and others.
2. STANDARDS
Every ambulance service provider shall be organized to provide safe, quality,
effective and efficient ambulance services for patients.
4^ The ambulance service provider shall ensure that each personnel has
,.1) obtained the minimum trainings stipulated in this Order.
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b. PERSONNEL
Each ambulance service provider shall have an adequate number of qualified,
trained and competent staff to ensure efficient and effective delivery of quality
ambulance services.
AMBULANCE
2. The ambulance vehicle shall be registered with the LTO under the name of
the ambulance service provider.
5.n Ambulance vehicles shall have Emergency Warning Light System and
n-eublic Address SYstem'
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d. EQUIPMENT, MEDICINES AND SUPPLIES
Every ambulance shall have available and operational prescribed equipment,
medicines and supplies.
2. Each ambulance shall have adequate and stable cabinet/s that can
appropriately store the required equipment, medicines and supplies. These
storage shall be easily accessible but properly secured at all times.
e. SERVICE DELIVERY
Every ambulance service provider shall ensure that the services delivered to
patients comply with the standard quality embodied in the Assessment Tool
for licensure of ambulances, other policy guidelines and/or related issuances.
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INFORMATION MANAGEMENT
Every ambulance service provider shall maintain a system of communication,
t.roiding and reporting of the patient's condition as well as the results of
examinations.
2. Logbook
Ambulance service providers shall maintain a logbook which shall be
signed by the head of the DOH licensing team during inspection and/or
monitoring visits. The logbook shall contain, but not be limited to, the
following information (Refer to Annex C: Logbook of Accomplishments
for Inspection and Monitoring):
a. Name, sex and age of patient;
b. Name of attending physician, when applicable;
c. Origin and destination;
d. Date and time of dispatch and return of ambulance;
e. Reason for transfer/transport.
f. Disposition of patient.
3. Submission of Reports
Ambulance service providers shall submit an annual report utilizing the
template provided by DOH on or before 3l March. The report shall
coniain, but not be limited to, the following information. (Refer to
Annex-D: DOH Annual Statistical Report for Ambulance Service
Providers)
a. Number of ambulance conductions stating Regional Office, Province,
Municipality, City, including the type of the health facility:
l. Inter-facility hospital to hospital
2. Other health facilities to hospital (e.g. Medical Out-Patient Clinics,
RHU, birthing facility, infirmary, drug abuse and treatment
centers, psychiatric custodial care facility, nursing homes)
3. Home to hospital
4. Hospital to Home
5. Other routes, specify. (i.e. Hospital to Airport/Ports or vice versa)
b. Reason for refenal/transport
c. Date, time and description of Adverse Events e.g. number of deaths en
route, if any. In case of ambulance death referred by a hospital, the
referring hospital shall issue the death certificate. Otherwise, the
City/lr{unicipil Health Officer, where the patient died, shall issue the
death certificate.
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g. ENVIRONMENTAL MANAGEMENT
Every ambulance service provider shall ensure that the environment is safe for
its patients and staff including members of the public as necessary and that the
foliowing measures andlor safeguards shall be observed:
2. The ambulance shall have a partition between the driver and the
compartment or body. The partition shall be air-tight bulkhead with
' transparent viewing Panel.
4. There shall be procedures for the proper disposal of infectious wastes and
toxic and hazardous substances in accordance with R.A. 6969 known as
"Toxic and Hazardous Substances and Nuclear Wastes Act" and other
related policy guidelines and/or issuances.
2. Pay the corresponding fee, and submit a copy of the official receipt to HFSRB.
a
J. Once the application has been approved, the ambulance service provider shall be
given u .opy of the Official DOH Ambulance Logo and this shall be mounted
accordingly to each ambulance vehicle prior to the issuance of the DOH-LTO'
Each ambulance vehicle shall have a copy of DOH-LTO of the ambulance service
provider.
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B. APPLICATION FOR RENEWAL OF DOH-LTO
3. Pay the corresponding fee, and submit a copy of the official receipt to HFSRB or
Regional Office, whichever is applicable.
4. Once the application has been approved, the ambulance service provider shall be
given a copy of the Official DOH Ambulance Logo and this shall be mounted
accordingly to each ambulance vehicle prior to the issuance of the DOH-LTO.
Each ambulance vehicle shall have a copy of DOH-LTO of the ambulance service
provider
C. INSPECTION
1. The HFSRB or RO, as the case may be, shall conduct licensure inspections
utilizing the Assessment Tool for licensure of ambulances within fifteen (15)
working days upon submission of complete requirements.
2. The applicant shall ensure that all key staff, pertinent records, and ambulances are
made available to HFSRB/RO Director and/or his authorized representative(s)
during inspection visits
D. MONITORING
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3. The applicant shall ensure that all key staff, records, premises and facilities are
made available to HFSRB or RO Director and/or his authorized representative(s)
during monitoring activities.
B. All fees/checks shall be paid to the order of DOH in person or through postal money
order [or through bank to bank payments as soon as the system becomes functional].
C. All fees, surcharges and discounts shall follow the current DOH prescribed schedule
of fees in A.O. No. 2007 - 0001 "Revised Schedule of Fees for Certain Services
Rendered by the Bureau of Health Facilities and Services and Centers for Health
Developmeot...", A.O. No. 2007 - 0023 regarding "schedule of Fees for the One-
Stop Shop Licensure System for Hospitals"o and A.O. No. 2008 - 0028 "Schedule of
Fees for the One-Stop Shop Licensure System for Non-Hospital Based Facilities...",
other policy guidelines and/or relevant issuances.
VilI. 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.
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' In case of serious injury or death of the patient, passenger$, pedes*ians or the general
public due to the negligence or misuse of the arnbulance serviceo the DOH-LTO of the
arnbulance service provider shall be automatically revoked. This is without prejudice to any
criminal or civil charges or both that may be filed by the aggrieved party against the ambulance
service provider.
Other imposable penalty for violations hereof shall be in accordance with A.O. No. 2007
- 0022 entitled "Violations Under the One-Stop Shop Licensure System for Hospitals" and
o'One-Stop Shop Licensure System for
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violation provision under A.O. 2003 AA27 known as
Nan-Hospital Based Facilities...,o' its related issuances and this Order.
XI. APPEAL
The management of the ambulance service provider aggrieved by the decision of the
Direetor of HFSRB or RO may, within ten (10) days after receipt of the notice of decision, file a
notice of appeal to the Office of the Secretary of Health. Thereupou, HFSRB shall promptly
cenify atilfile a copy of the decision, including all documents and tanscript of hearings on
which the decision ii'based, with the Office of the Secretary for review. The decision of the
Secrefary of Health shall be final and execulory.
XII. TRANSITORYPROVISION
Non-institution-bassd ambulance service providers shall be given one {1) year from
approval of this Order to comply with the requirements. For hospital-based ambulance sewice
piooiders, these requirements shall apply imrnediately. Once the one year moratorium has
iapsed, ali applications shall be subjected to the requirements set for*r by this Order.
XIV. SSPARABILITYCLAUSE
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 effectiv
XV. ITTECTIYITY
This Administrative Order shall take effect after fi*een {15) days following the
completion of publication in two newspapers of general circulation.
Page ll ofll
Republic of the Philippines
Department of Health
OFFICE OF THE SECRETARY
Annex A
AO 2016 -
Building l, San Lazaro Compound, Rizal Avenue, Sta. Crua 1003 Manila r Trunk Line 651-7800 Direct Line: 7l l-9501
Fax: 743-1829;743-1786 o URL: httn://www.doh.eov.nh; e-mail: osec(rtldoh.eov.nh
Republic of the Philippines
Deparfinent of Health
OFFICE OF THE SECRETARY
Annex B
AO 2016
Required Emergency Equipment, Supplies and Medicines
ITEM OUAITTITY
A. Ambulance Compartment / Bodv
l. Tempered elass division (separatins the driver to the bodv)
2. Air condition with control
3. Electric (intemal and external) supply bulbs
4. Fire Extinguisher (rating 2AI0BC)
5. Flash lights with extra batteries and bulbs
6. Ambulance wheeled cot with mounted cot fastenins system
7. Folding Stretcher / Poles (l set) and Canvas (2)
8. Orthopedic (scoop) stretcher
9. Overhead aluminum grabrail on the ceiling on top of the
patienVsfetcher
B. Communication Equipment
l. Two-way radio communication - installed I unit
2. Cellular phone I unit
3. Inta-vehicle intercom system (between driver and bodv)
C. Ventilation and Airwav Eouioment
l. Suction Apparafus and accessories
a. Portable Suction Machine l unit
b. Flexible suction catheters Fr. 5 - Fr. 14 I oiece each
2. Portable oxygen equipment / Installed
a. Portable oxygen tank - secured 1 unit
b. Flow regulator I unit
3. Bag valve mask resuscitator with rebreather bas
a. Adult I piece
b. Pediatric - pressure relief valve I piece
c. Infant - pressure relief bag 1 piece
4. Nebulizer l unit
E. Immobilization Devices
1, Rigid cervical collars (small, medium,large) I piece each
2. Firm padding or cornmercial head immobilization device I piece
3. Lower extremity traction devices (supporting slings, padding, I piece each
traction strap)
4. Upper and Lower extemity immobilization devices
a. Joint above and ioint below fracture I oiece each
b. Rigid support appropriate material (cardboard, metal, I piece each
pneumatic, vacuum, wood or plastic), various sizes)
c. Resistant straps or cravats 3 oieces
Building l, San Lazaro Compound, Rizal Avenue, Sta" Cruz, 1003 Manila o Trunk Line 651-7800 Direct Line: 7l t-9501
Fax:743-1829:,743-1786 o URL: http://www.doh.eov.ph; e-mail: oseotrr)doh.sov.nh
Annex B
AO 2016 -
5. Full body vacuum mattress - used for head, spine, and head-to- I piece
feet immobilization
6. Sandbags - for initial on-site immobilization onlv I piece
ITEM OUAI\ITITY
F. Dressings and Bandages
l. Sterile burn sheets 3 pieces
2. Triangular bandages 3 oieces
3. Sterile Dressings
a. 10"x30" or larger 3 packs
b. ABDs, l0"xl2" or larger 3 packs
c. 4"x4" gawze sponges 4 packs
4. Sterile gavze rolls (various sizes) 5 pieces each
5. Non-sterile elastic bandages (various sizes) I pieceeach
6. Sterile occlusive dressing 3"x8" or larger 3 pieces
7. Adhesive tape roll
a. Various sizes of 2" or 3" hypoallereenic I piece
b. Various sizes of 2" or 3" non-hypoallereenic/ordinarv I piece
G. Obstetrical
1. Individual disposable delivery kit - sterile 1 set
2. Wrap / blanket for newborn I piece
H. Infection Control
I Eye protection (full peripheral glasses or goggles or face
shield)
2. HEPA Masks / Sweical Masks
3. Non-sterile and Sterile Gloves 1 paireach
4. Jumpsuits or Gowns I unit
5. Shoe covers I pair
6. Hand sanitizer or 70Yo alcohol
7. Disinfectant solution for cleaning equipment
8. Disposable tash bags - color-coded
I. Miscellaneous Supplies
l. Sphygmomanometer (non-mercurial, with infant, pediafiic and
adult cuff)
2- Stethoscope (pediatric and adult)
3. Weighing scale for pediatric equipment sizins
4. Tape measure
5. Thermometer (infrared)
6. Heavy bandage or paramedic scissors for cutting clothes, belts
and boots
7. Alcohol swabs x 20 pcs I pack
8. Cold packs
9. IV Administation set (Macro / Micro)
10. Blankets, Sheets, Linen, or paper
11. Pillows, Pillowcase and towels
12. Disposable standard sharps containers
13. Disposable emesis bags or basins
14. Bed pan
Annex B
AO 2016 -
15. Urinal
16. Syringes (50m1,30m1, l0ml,3ml lml) I piece each for 50ml and 30 ml
5 pieces for l0ml,3ml and lml
ITEM OUAI\ITITY
17. Gauee needles (various sizes)
18. Incontinence oads - disoosable
19. Antibacterial lubricatine iellv I tube
20. Patient reoort forms (as orescribed in succeedine Annexes)
J. Medications / tr'luids
l. Activated Charcoal 1 pack
2. Oral elucose. 10 ml I piece
3. Sterile water for irrieation. I liter I bottle
4. Intravenous fluids (various dissolution, sizes, concentation) I oiece each
5. Normal saline water (iniectable) I oiece
6. Sterile water for iniection. l0ml I piece
7. Ventolin nebules 3 pieces
8. Dextrose 507ol50m1 vial I piece
K. Controlled Medications
Sealed Drug / Code Box to be opened only under a Physician or Paramedics superttision.
This should be repalarly checked for expired items bv Physician-in-charge or Paramedics.
l. Atropine Sulfate lme/ml ampule 5 pieces
2. Isooroterenol lmp/Sml amoule I piece
3. Epinephrine lme/lml tubaxes (IM. Intracardial, IV) ampule 5 pieces
4. Diazeoam 10me amoule/vial l piece
5. Dobutamine 250ms amoule 1 piece
6. Lidocaine lenn/25m1 vial I piece
7. Adenosine 6ms.l2mlamoule I piece
8. Human Rezular Insulin 100me/ml vial I piece
9. Calcium Gluconate l0% lmgll0ml ampule/vial I piece
10. Potassium Chloride 20ms/l0ml vial I piece
11. Furosemide l0Ome/l0ml vial and20ms/2ml ampule 2 oieces each
12. Masnesium Sulfate 50% lwnl2ml ampule I oiece
13. Bretvlium 500me/l0ml vial I piece
14. Dooamine 400mp/5ml vial I piece
I 5. Diohenhvdramine 50me/ml amoule 1 piece
16. Sodium bicarbonate lOml amoule I piece
17. Digoxin 0.lmg/ml ampule and0.5mgl2ml ampule 2 pieces for 0.lmg/ml ampule
I piece for 0.5me/2ml ampule
18. Calcium Chloride 10% ampule/vial I piece
19. Nitroelycerine spray / sublineual I patch I piece
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Republic of the Philippines
Deparfrnent of Health
OF'FICE OF THE SECRETARY
Annex D
AO 2016 -
Total number of
conductions
Total Hospital to
Hospital Conduction
Hospital to Home
Conduction
Home to Hospital
Conduction
Hospital to other
routes (i.e. hospital to
airport) or vice Yenra
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Building l, San Lazaro Compound, Rizal Avenue, Sta. Cru4 1003 Manila o Trunk Line 651-7800 Direct Line: 7l l-9501
Fu<: 743-1829;743-1786 o URL: htto://wwrv.doh.e.ov.ph; e-mail: osec(zi)doh.eov.ph