MH 9:01
REMINDER TO ALL PRIVATE AMBULANCE OPERATORS ACCREDITED UNDER THE VOLUNTARY ACCREDITATION SCHEME ON THE NEED TO COMPLY WITH THE STANDARDS FOR EAS AND MTS On 16 January 2020, the Ministry announced that private ambulance operators ( PAO(s ) providing ambulance services will be regulated as either Emergency Ambulance Services or Medical Transport Services under the Healthcare Services Act ( HCSA would be implemented in January 2022. Prior to these HCSA service regulations coming into force, the Ministry had introduced the Voluntary Accreditation Scheme ( VAS ) in January 2018 to enhance patient safety and help PAOs transit smoothly into the new service regulations under HCSA. PAOs assessed to have met the 2017 MOH Regulatory Standards for EAS and MTS are accredited under the VAS and the list of accredited PAOs are published on the Healthcare Institutions ( HCI ) Directory1 .
GENERAL AUDIT FINDINGS 2. The Health Regulation Group has been conducting audits on accredited PAOs to ensure compliance to the Standards. These audits involve the review of administrative documents (e.g. certificates, qualifications and training records of the ambulance crew, conveyance records, vehicle maintenance records, list of equipment, consumables and medications, and protocols for life-saving and infection control practices), and physical inspection of the ambulance vehicles.
3. To date, following audits conducted by the Ministry, the accreditation status of two (2) PAOs have been revoked on grounds of failing to comply with the Standards. In general, the lapses identified by the Ministry were:
a) Failure to ensure that staff assigned to manage conveyance involving the use of PMIUs , were trained on the proper use and handling of PMIU;
b) Failure to ensure that staff, including outsourced staff, had the capability and competency to provide proper patient care during the handling and transport of a patient, which includes:
i. Failure to perform emergency procedures and life support during an emergency;
ii. Failure to monitor vitals during the conveyance of a patient;
iii. Failure to escalate a rapidly deteriorating case to HQ for clinical deterioration;
iv. Failure to obtain patient medical history and vitals prior to conveyance; and
v. Poor patient handover practices;
c) Deploying an Emergency Medical Technician and an Ambulance Driver only on an EAS-accredited ambulance for a EAS case, without a trained and certified paramedic on board;
d) Failure to maintain a medical record system and an ambulance log system the conveyance;
e) Lack of Standard Operating Procedures on the use of specialised equipment; and failure of training and assessment of the competency of crew members in the use of such equipment;
f) Failure to adhere to Infection Prevention and Control measures such as the improper doffing of PPE and poor hand hygiene practices;
g) Failure to maintain as part of the minimum list of equipment required for emergency ambulances, items such as medications and consumables.
4. The PAOs have since been removed from the list of accredited PAOs maintained on the HCI Directory. Corresponding reference to their common fees have also been removed from the MOH website. The PAOs were ordered to stop business operations and recommended to undertake an internal review on its processes and institute measures to ensure Standards can be met. As applications for VAS have closed since 30 Jun 2021, the PAOs will have to apply for service licences accordingly under HCSA.
REMINDER TO COMPLY WITH THE STANDARDS FOR EAS & MTS5. All PAOs are reminded to adhere to the Standards at all times so as to ensure safe and appropriate care for the conveyed patients. The deployment of an appropriate crew team comprising members of the right certification and competence must commensurate with the accepted conveyance case at all times. PAOs, when engaged by clients/patients to provide EAS/MTS, are unique details of each EAS/MTS vehicle is tied to the licence held by the PAOs and the PAOs will be held responsible/accountable for all activities undertaken by the EAS/MTS vehicles under their licence. Under HCSA, it is an offence to operate an ambulance vehicle with a vehicle registration number that is not In the event the case is outsourced to another PAO, a formalised arrangement with the outsourced PAO must be in place. The original PAO engaged by the clients/patients still remains ultimately responsible for the safety of the patient and must ensure at all times that the outsourced PAO meets the necessary licensing, training, competency and requirements.
6. PAOs accredited under the VAS are reminded to comply with the Standards for EAS and MTS in order to remain eligible for the following:
a) Listing on the HCI Directory as an accredited PAO under the VAS which is accessible by Members of the Public;
b) Vehicle-related tax exemptions (e.g. certificate of entitlement and road tax exemptions) for new vehicles that the PAOs intend to add to their current ambulance fleet; and
c) Conversion of its accreditation for its EAS and MTS under the VAS into a service licence seamlessly under the HCSA when the relevant regulations come into force.
7. The Ministry will continue to conduct compliance checks on PAOs and will take action against any PAO who fails to comply with the Standards for EAS and MTS.
8. For further clarifications on this Circular, please e-mail elis@moh.gov.sg.
Thank you
ADJ ASSOC PROF (DR) RAYMOND CHUA DEPUTY
DIRECTOR OF MEDICAL SERVICES
HEALTH REGULATION GROUP
MINISTRY OF HEALTH
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