Policy Document On Responsible Ambulance Care 2013 PDF

Policy Document on
Responsible Ambulance Care
Policy Document on
Responsible Ambulance Care
Colofon
Foreword
Ambulancezorg Nederland
PO box 489
8000 AL Zwolle
The Netherlands
phone: +31 (0)38 422 5772
info@ambulancezorg.nl
www.ambulancezorg.nl
We are delighted to present the new version of the Policy Document on Responsible Ambulance Care [Nota
Verantwoorde Ambulancezorg]. The policy document offers a captivating kaleidoscopic view of the current
situation within ambulance care, which forms an exceptional part of the healthcare sector.
Text
Editorial board
Tekstbureau Taallent
Translation
Balance BV, Amsterdam & Maastricht
Design
Vormix, Maarssen
Illustrations
Studio Lakmoes & Anne van den Berg Illustraties
Printing
HSGB
Version 4.0,February 2013, adopted by:

Nederlandse Vereniging van Medisch Managers Ambulancezorg
V&VN Ambulancezorg
Ambulance care is exceptional for a number of reasons. The first is the profound change our sector has
undergone over the past fifteen to twenty years, which is greater than that experienced by any other sector. We
have developed from a simple, vulnerable transport service into a high-quality, mobile care provider. We are now
accustomed to our current status, but take a look across the border and you will notice that the level of quality
within the Dutch ambulance care sector is very high.
Our sector is also unique because our work is conducted in two worlds. The first is the world of healthcare, in
which we are the mobile partner of all care services in principle. We are also a partner for parties active in the
domain of public order and safety. We therefore operate in two worlds, which requires our staff to be versatile.
They must possess an outstanding talent for cooperation and be able to deal with cultural differences.
Finally, ambulance care is also exceptional because the public places considerable trust in our care, according to
research. This is invaluable, especially at a time when trust in institutions is dwindling. It is imperative that we
not only cherish but also maintain this trust. We do so by taking a critical look at our own business every day to
see what we can do better and how we can elevate ambulance care to an even higher level.
This lies at the very heart of the Policy Document on Responsible Ambulance Care: providing an overview of the
status of the care we provide. Where are we, what issues do we face and what are the new challenges? It is also
a living document: new developments and initiatives demand adaptation and change.
For this reason we update this document at regular intervals. I hope that not only we but also all our chain
partners will join us in permanently exploring which amendments are needed - within our partnership too - to
provide patients with the best possible level of care. This is a crucial theme for the future. Necessary changes
are constantly required due to developments within the care sector and the domain of safety. But in these times
of economic crisis, the financial leeway for maintaining ambulance care is minimal. Anyone wishing to attain
a higher level with the same financial resources must therefore conclude that cooperation is needed more
than ever. Joining forces, working together and entering into new relationships will have to be a focal point that
transcends the personal interests of everyone.
We are open to this: open to intensifying the cooperation with our partners in both worlds of care and safety.
Using new social challenges as our starting point, we want to jointly find better answers to the needs of citizens.
That is the real challenge in the years ahead. The Policy Document on Responsible Ambulance Care offers
something to hold onto, provides direction and aims to encourage dialogue.
Finally, this is an appropriate opportunity to thank everyone who has helped draw up this policy document.
Hans Simons,
Chair, Ambulancezorg Nederland
Policy Document on Responsible Ambulance Care | foreword
Contents
Policy Document on Responsible Ambulance Care | foreword
Foreword
Guide
10
Ambulance care: mobile link in the (acute) care chain
11
1.1
1.2
1.3
1.4
Introduction
What is ambulance care?
Where does ambulance care begin?
Ambulance care as a binding factor
12
12
13
13
Responsible ambulance care: statutory framework
15
2.1
2.2

2.3
Introduction
Care Institutions (Quality) Act
2.2.1 Responsible care
2.2.2 Conscious policy
2.2.3 Quality system
2.2.4 Quality annual report
Monitoring and enforcement
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16
16
16
17
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17
Responsible ambulance care: the cornerstones
19
3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8

Introduction
Available and accessible care
Transparency
Professional, high-quality and safe
Information, permission, documentation and privacy
Continuity of care and coordination with chain partners
Handling of complaints and client experience
Participation and good governance
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4.1
4.2

4.3
4.4

4.5

The Ambulance Dispatch Centre: gateway to ambulance care

Distribution and availability
4.2.1 Reference framework for distribution and availability
4.2.2 Dynamic ambulance management
4.2.3 Cross-border ambulance care
The right care at the right moment: triage
Integrated available care of the Regional Ambulance Service
4.4.1 Emergency and planable
4.4.2 High-complexity and low-complexity care
Care differentiation
4.5.1 Care ambulance
4.5.2 Rapid responder
4.5.3 Specialist transport
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Policy Document on Responsible Ambulance Care | contents
4.5.4 Mobile Medical Team

4.5.5 First Responder
4.5.6 Differentiation in the Ambulance Dispatch Centre
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45
9.1
9.2

Handling of complaints
Client experience
46
46
Transparency
29
10 Participation and good governance
47
5.1
5.2
5.3
5.4
5.5
5.6
5.7
Clarity for the patient and referrer

Transparent care process
Long-term policy plan
Management information
Annual report
Sector report
External assessment and certification
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10.1 Patient participation

10.2 Good governance
48
48
Professionalism, quality and safety
33
6.1
6.2

6.3

6.4
6.5
6.6
6.7
6.8

Professionalism
Key positions
6.2.1 Nurse dispatch centre operator
6.2.2 Ambulance nurse
6.2.3 Ambulance driver
6.2.4 Ambulance unit
6.2.5 Job differentiation
Expertise and competencies
6.3.1 Expertise
6.3.2 Competencies
Protocol care
High-quality and functional equipment
Medical management
Continuous improvement
Safety
6.8.1 Patient safety
6.8.2 Safe working environment
6.8.3 Preventing incidents; safe incident reporting
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7.1
7.2
7.3
7.4
7.5
7.6
General information
Information for individual patients
Permission
Documentation
Privacy protection
Professional secrecy
8.1

8.2
Cooperation with chain partners

8.1.1 Chain agreements
8.1.2 Regional Acute Care Consultations
8.1.3 Scaled-up care
Responsible care handover
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Appendices
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Appendix 1 - Ambulance care statutory framework

1.1 Interim Ambulance Care Act [Twaz]
1.2 Care Institutions (Accreditation) Act [Wet toelating zorginstellingen]
1.3 Individual Healthcare Professions Act [Wet Beroepen in de Individuele Gezondheidszorg]
1.4 Medical Treatment Contracts Act [WGBO]
1.5 Clients Right of Complaint (Healthcare Sector) Act [Wet Klachtrecht Clinten Zorgsector (WKCZ)]
1.6 Participation (Clients of Care Institutions) Act [Medezeggenschap Clinten Zorginstellingen (WMCZ)]
1.7 Medical Appliances Act [Wet op de medische hulpmiddelen]
1.8 Psychiatric Hospitals (Compulsory Admissions) Act [Wet bijzondere opneming in psychiatrische
ziekenhuizen (BOPZ)]
1.9 Personal Data Protection Act [Wet bescherming persoonsgegevens (Wbp)]
1.10 Road Traffic Act [Wegenverkeerswet (WvW)] and Traffic Code [Reglement verkeersregels en
verkeerstekens (RVV)]
1.11 Security Regions Act [Wet veiligheidsregios (WVR)]
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Appendix 2 - National Professional Code for Nurses and Carers [Nationale Beroepscode van
Verpleegkundigen en Verzorgenden]
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Appendix 3 - A sector in development

1 Introduction
2 Developments in the care sector
3 Developments in quality
4 Developments in nursing professional practice and education
5 Labour market trends
Composition of working group for the Policy Document on Responsible Ambulance Care
List of abbreviations
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65
Reference list 2013
67
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Guide
The Policy Document on Responsible Ambulance Care is structured as follows. Chapter 1 paints a picture of
ambulance care provision. What does ambulance care entail? Who provides ambulance care? Which chain
partners do Regional Ambulance Services work with?
Chapter 2 gives an overview of the Care Institutions (Quality) Act , upon which this policy document is based.
Responsible ambulance care is of course determined by a considerably wider range of acts. Appendix 1 contains
a summary of these acts. Where necessary, the policy document refers to this statutory framework.
Chapter 3 describes the essence of what responsible ambulance care means to the ambulance sector. The
description per theme is timeless and constitutes as it were the constitution for the sector when it comes to
responsible care.
The following chapters describe the various themes in greater detail. The text contains frequent references to
national frameworks and guidelines. These are listed per chapter in the reference list, which is in a separate
appendix to the policy document.
The appendices contain descriptions of the statutory framework, the professional code for ambulance care
providers and future developments within the sector. They form an intrinsic part of the policy document and
feature information essential for interpreting the document properly.
10
Policy Document on Responsible Ambulance Care | guide
Ambulance care: mobile link

in the (acute) care chain
Policy Document on Responsible Ambulance Care | chapter 1
11
1.1 Introduction
1.3 Where does ambulance care begin?
Over 700 ambulances are available in the Netherlands, ready to provide ambulance care 24 hours a day, 7 days
a week. More than 5,000 ambulance care professionals provide emergency and planned ambulance care. The
Ambulance Dispatch Centre deploys ambulances on more than one million trips every year. Approximately
740,000 of these involve emergency medical assistance and around 350,000 involve planned ambulance care.
A small percentage of emergency medical situations fall under medical assistance in the case of accidents and
disasters. This assistance is based on assistance provided in normal circumstances.
Ambulance care begins when the Ambulance Dispatch Centre receives a call. The Ambulance Dispatch Centre
is responsible for the process of intake, care needs assessment, care assignment, care coordination and care
instruction 7 days a week, 24 hours a day. The Ambulance Dispatch Centre is responsible for ensuring that the
right (ambulance) care is provided at the right moment and/or that the handover of the patient to other care
or emergency services proceeds as smoothly as possible. The Ambulance Dispatch Centre is the gateway for
ambulance care and also serves as a portal for other emergency services. It is also responsible for coordinating
the deployment of other care providers. The Ambulance Dispatch Centre is therefore the coordinator of
ambulance care.
Ambulance care has developed relatively quickly from a transport service into a care service that operates
as a fully-fledged link within the chain of emergency medical assistance. Ambulance care is provided by
the Regional Ambulance Service [Regionale Ambulancevoorziening, RAV]. In accordance with the Interim
Ambulance Act [Twaz], the Regional Ambulance Service is the legal entity designated to maintain the dispatch
centre and provide or arrange the provision of responsible ambulance care. This involves ambulance care in
normal situations as well as disasters and accidents. The Regional Ambulance Service is a care institution in
accordance with the Care Institutions (Accreditation) Act [WTZi].
1.2 What is ambulance care?

Ambulance care is the (mobile) care provided professionally to a patient with a condition or injury, with
due observance of that which is required on the basis of generally available medical and nursing knowledge
and, if necessary, the adequate transport of a patient or the referral of a patient to another care provider. The
main objective of ambulance care is to prevent or limit damage to health according to the patients care
requirements. The Ambulance Dispatch Centre is responsible for performing a care needs assessment, and
assigning and dispatching ambulance care. The ambulance care process starts the moment the emergency
operator takes a call, and continues up to and including the moment the patient is handed over.
The description above is a more detailed version of the ambulance care definition in Section 1, subsection d of
the Interim Ambulance Care Act: ambulance care is care provided to ill or injured patients in order to treat their
condition or injury:
provide medical assistance and transport by ambulance;
provide medical assistance via an ambulance nurse with a special vehicle equipped for that purpose and
clearly recognisable as such.
1.4 Ambulance care as a binding factor

The Regional Ambulance Service strives for optimal care. The quality of the care provided depends to a large
extent on the expertise of the care providers concerned. In order to fulfil the necessary quality criteria, the
ambulance care sector has a national training framework that is uniform and of a high quality. This training
framework is based on applicable legal frameworks and areas of expertise determined by the sector for
various professionals and corresponding attainment targets. The quality of the training framework is assessed
independently.
Ambulance care is the binding factor within the acute care network, which involves on-site collaboration with
care providers such as general practitioners, midwives, the acute care service of the mental healthcare services
[GGZ] and the mobile medical team (MMT). It also involves the responsible handover of the patient within
the chain. This can take the form of a referral by the Ambulance Dispatch Centre, or the transfer of a patient
by the ambulance team to another care institution, such as a hospital. Ambulance care operates as a mobile
care provider, literally and figuratively, between the links of the (acute) care chain. The Regional Ambulance
Service also works closely with partners in the chain of public order and safety such as the police, fire brigade
and the Medical Assistance in Accidents and Disasters Organisation [GHOR]. They cooperate under normal
circumstances as well during large-scale accidents and disasters. This cooperation is not only limited to within
national borders, but also extends beyond together with Belgian and German care and emergency assistance
partners.
The frameworks for ambulance care can be summarised as follows, based on the description above:
a need for medical care exists1;
the patient undergoes treatment, observation, nursing and/or care on site and/or while being transported;
the care needs assessment and deployment of care is performed by the Ambulance Dispatch Centre;
implementation is ensured by an organisation designated in accordance with the Interim Ambulance
Care Act.
Need for medical care: a medical reason exist that necessitates a particular type of care, treatment or medication.
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2.
Responsible ambulance care:

statutory framework
14
15
2.1 Introduction
2.2.3 Quality system
The Policy Document on Responsible Ambulance Care is based on the Care Institutions (Quality) Act (KWZ)].
This chapter describes the key points of this act, which is applicable to all institutions in the healthcare sector
and therefore to the Regional Ambulance Service as well. The Care Institutions (Quality) Act is a framework
act, i.e. it only provides a general description of what a care institution must comply with. The individual care
institution is responsible for indicating how it satisfies these statutory requirements. An increasing number of
sectors are relying on umbrella organisations for this compliance. Since 1999, the ambulance sector has been
ensuring sector-wide compliance through national umbrella organisations for ambulance organisations and
professionals.
A care institution must monitor the quality of the care provided systematically and improve it where possible.
The care institution must have a quality system for this purpose in which all quality-related activities are
harmonised with one another. A quality system describes the standards that an institution thinks it should
meet. Systematically recording data relating to these activities and the quality of the care provided yields
an insight into the results of the pursued quality policy. A care institution can opt to allow an independent
organisation to assess and certify the quality system. Such an independent quality mark gives the organisation
a quality boost but also demonstrates to the outside world that the institution is serious about quality. This is
certainly applicable to the ambulance sector. Since the act came into force, the independent testing of Regional
Ambulance Services by an external body has received wide support. As a result, every single ambulance
organisation has been certified.
When the Interim Ambulance Care Act [Twaz] came into effect on 1 January 2013, a new statutory framework
also came into force. Appendix 1 therefore devotes a separate section to this act. Other acts also applicable to
ambulance care are outlined in Appendix 1.
2.2.4 Quality annual report
2.2 Dutch Care Institutions (Quality) Act

The Regional Ambulance Service is a care institution in accordance with the Care Institutions (Quality) Act. The
act stipulates that care institutions must satisfy a number of criteria in order to provide good-quality care. These
criteria are described and explained here. The following chapters examine how they are implemented within
ambulance care.
2.2.1 Responsible care

Institutions must provide responsible care. In other words: care that is of a high quality, efficient and effective,
and coordinated and geared to the actual needs of the patient. A care institution must therefore develop a
vision for the concept of responsible care on its own or at the level of an umbrella organisation. It then has the
obligation to create conditions so that this responsible care can actually be provided.
2.2.2 Conscious policy

The Care Institutions (Quality) Act emphasises the provision of responsible care based on conscious policy.
This entails working on providing such care in a deliberate manner. The act specifies the aspects that the care
institution must, in any event, include in its quality policy:
a clear distribution of tasks and responsibilities: it must be evident which members of staff perform which tasks
and who is responsible;
high-quality personnel and equipment: an institution must have a sufficient number of staff with the
appropriate skills and right equipment. This means that care providers possess the right competencies and
maintain these with the help of refresher courses and in-service training.
The Care Institutions (Quality) Act obliges institutions to publish a quality annual report. The act stipulates that
the care institution must focus in this report on the quality of the provided care and the pursued quality policy.
The institution must also devote special attention to how patients and their interest groups are involved in this.
No structure requirements are imposed on the quality annual report. It may form part of the general annual
report. However, the act does stipulate the period during which the report must be ready and the organisations
to which it must be submitted.
2.3 Monitoring and enforcement

Although institutions are personally responsible for the quality of care, it is necessary to independently monitor
their compliance with the act. This is the task of the Healthcare Inspectorate [IGZ].
The supervision focuses primarily on the quality policy of the care institution and the presence of a quality
system.
The Care Institutions (Quality) Act has granted additional powers to the Healthcare Inspectorate in order
to maintain the quality of care. The Healthcare Inspectorate can order that measures be taken should
situations arise that pose a serious risk to the health of patients. The minister is personally authorised to
issue an instruction to a care institution if there is a shortcoming in the care that is provided. The Healthcare
Inspectorate must have access to sufficient information in order to monitor institutions. An important
condition is that the Inspectorate must be notified about emergencies that have occurred in an institution. The
Care Institutions (Quality) Act obliges the care provider to report every emergency that has taken place within
the institution to the Healthcare Inspectorate.
Institutions where people can stay longer than 24 hours must provide mental healthcare that corresponds to
patients beliefs. This requirement does not apply to Regional Ambulance Services, but does not detract from
the fact that ambulance care providers must respect patients beliefs.
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17

the cornerstones
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19
3.1 Introduction
The Care Institutions (Quality) Act defines responsible care as: care that is high quality, efficient and effective,
and coordinated and geared to the actual needs of the client. The further interpretation of these terms by
the ambulance sector is based on a number of categories. The patient is the focal point. This also ties in
with the vision and policy of the government laid down in legislation and with the vision of patients and
consumer organisations. It revolves around the accessibility and availability of care, the ability to choose and
compare types of care, the quality and safety of care, a strong legal position within the care relationship, good
coordination between care providers, a low-threshold and effective complaints and dispute procedures, the
right to participate in decision-making and good governance among care providers.
The sector also stands for sustainability, reliability and transparency. These core values are reflected in
the implementation of the cornerstones. Based on this framework, responsible ambulance care may be
summarised as follows:

1. is available and accessible;
2. is transparent;
3. is professional, high quality and safe;
4. is clearly and unequivocally defined, with the patients privacy being guaranteed;
5. is perfectly in line with the care provided by partners in the chain;
6. provides for the proper handling of complaints in an accessible manner;
7. provides for patient participation and is offered by organisations that meet the requirements of
good governance.
The following sections describe the seven cornerstones of responsible ambulance care in greater detail.
3.2 Available and accessible care

Accessibility
Ambulance care is available via Ambulance Care Dispatch Centres [MKA] 24 hours a day, 7 days a
week.

Distribution and availability
Ambulance care is distributed effectively. This means that in the event of urgent, life-threatening
situations, ambulance care is available in accordance with the national benchmark.

The right care at the right time: triage
The Ambulance Care Dispatch Centre uses a triage system to ensure a patient receives the right
care at the right time, in both standard and scaled-up situations.

Care differentiation
The Regional Ambulance Service harmonises care as best as possible with the patients needs and
demand for care.
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3.3 Transparency

Transparency for the client and the referrer
The Regional Ambulance Service provides as much information as possible to (potential) patients
and (potential) referrers about the care that is offered.

Transparent care process

The ambulance care process is clear to everyone involved (patients and chain partners).

Long-term policy plan
The Regional Ambulance Service has a long-term policy plan, which formulates its long-range
vision of responsible ambulance care and the specific details.

Management information
The Regional Ambulance Service has management information available, which highlights the
results of the ambulance care process and facilitates control of the process where necessary.

Annual report
Each year, the Regional Ambulance Service gives an account of its activities and the results it has
achieved by means of an annual report.

Sector report
The Regional Ambulance Service provides the agreed data for the sector report on an annual basis.

External assessment and certification
The Regional Ambulance Service has a certified quality system that guarantees and highlights the
quality of the care provided.
3.4 Professional, high quality and safe

Qualified and competent

Ambulance care is provided by qualified and competent staff.

Professionalism and involvement

Ambulance care providers approach and treat patients with professionalism and respect.

Protocol care
National protocols guarantee the uniformity of ambulance care and ensure it is transparent and
verifiable.

High-quality and functional equipment
High-quality, functional equipment is used to provide ambulance care.

Medical final responsibility
The Regional Ambulance Service ensures that the medical quality of the care provided is
guaranteed to best effect.

Continuous improvement
The Regional Ambulance Service harmonises the available care as closely as possible with the
patients demand for care and the needs of society.

Safety

The safety of the patient when care is provided and during transport is guaranteed to best effect.

Preventing incidents
The Regional Ambulance Service uses a system geared to preventing incidents during the
provision of ambulance care and responding correctly if an incident occurs.
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3.5 Information, permission, documentation and privacy

Information for individual patients
Patients and/or their next-of-kin are given as much information as possible about the care they are
or will be receiving.

Permission
Ambulance care providers act in accordance with the statutory requirements relating to obtaining
permission. In urgent cases where it is not possible to obtain permission, ambulance care
providers act in accordance with professional standards and assume their responsibilities as
responsible care providers.

Documentation
Information relating to the client and the care provided is recorded by the Ambulance Dispatch
Centre operator and the ambulance care provider and included in a patient file.

Privacy protection
Ambulance care providers guarantee the patients privacy out of respect for the patient and in
accordance with the professional confidentiality that they are obliged to observe.
3.6 Continuity of care and coordination with chain

partners

Cooperation with chain partners
The Regional Ambulance Service works closely with other care providers within the region to
guarantee the continuity of care.

Responsible care handover
The Regional Ambulance Service ensures that, if necessary, patients are handed over responsibly
to other care providers or that other care providers are engaged
3.7 Handling of complaints and client experience

Handling of complaints
Patient complaints are dealt with professionally. Complaints can be prevented by dealing with
patients comments carefully.

Client experiences
The Regional Ambulance Service conducts periodic client experience investigations. The results of
these help ensure improvements where required.

3.8 Participation and good governance

22

Patient participation
The Regional Ambulance Service has a patient participation structure and procedure, which is
geared to the character of emergency care provision.

Good governance

The Regional Ambulance Service meets the requirements of good governance.
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4.1 The Ambulance Dispatch Centre: gateway to

ambulance care
The Ambulance Dispatch Centre is an integral part of the Regional Ambulance Service and plays a central role
in the ambulance care process. It is the gateway to ambulance care, which starts the moment the operator
takes a call. The Ambulance Dispatch Centre is responsible for the process of intake, care needs assessment,
care assignment, care coordination and care instruction, 7 days a week, 24 hours a day. It determines whether
the deployment of an ambulance is necessary and/or desirable and the level of urgency.
The Ambulance Dispatch Centre is also responsible for coordinating the deployment of other care providers
and referring the patient to other care providers or emergency services.
It is therefore the coordinator of ambulance care and the gatekeeper for access to acute care. The Ambulance
Dispatch Centres responsibilities and functions are independent of the scale on which it is organised.
4.2 Distribution and availability

4.2.1 Reference framework for distribution and availability
The Reference Framework for Coverage & Availability [Landelijk Referentiekader Spreiding & Beschikbaarheid]
forms the basis for available capacity for ambulance care in the Netherlands and how ambulances are
distributed across various locations. It is a model description of the distribution of ambulance locations and
the availability of ambulances on a national and regional level. The framework is also used for the regional
distribution of the national macro budget. It contains clear starting points and conditions on a national level for
regular, regional ambulance care.
The Regional Ambulance Services implement the reference framework on a regional level by drafting a regional
distribution and availability plan. The 15-minute standard is a planning standard, not a health standard. This
does not imply that the factor of time plays no role within ambulance care. In fact, everything within ambulance
care is geared to providing on-site care as quickly as possible during acute, life-threatening situations. Time
standards are essential for coordinating processes. However, these must be medically substantiated, more so
than has been the case up until now. The ambulance sector is working on this by augmenting management
information with medical aspects. The reference framework is based on open Regional Ambulance Service
regions. These regions assist one another: when emergency assistance is required somewhere, this is provided
by the nearest ambulance, even if it is located in another region. This means that a Regional Ambulance Service
has a performance undertaking to provide neighbourly assistance to a Regional Ambulance Service from a
neighbouring region, or that a Regional Ambulance Service receives assistance from a neighbouring region.
4.2.2 Dynamic ambulance management

The Ambulance Dispatch Centre is legally accountable for providing responsible ambulance care within its care
area. This means, among other things, that the Regional Ambulance Service is striving to deploy available care
capacity as efficiently and effectively as possible. Dynamic ambulance management is one of the tools used
to this end. At regional level, ambulance vehicles are positioned by the Ambulance Dispatch Centre within the
region or move around the region in such a way that they are fully deployable. The Ambulance Dispatch Centre
is responsible for coordinating this process and is assisted by ICT facilities in the centre.
At national level, dynamic ambulance management means that Ambulance Dispatch Centres can deploy
available ambulances from other regions within the own region if they can be on site quicker. This increases
available care capacity and benefits patient care. The reference framework also assumes that Regional
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Ambulance Services can call on the ambulance capacity of a neighbouring region or regions for the deployment
of ambulances in specific areas. Every Ambulance Dispatch Centre has an insight into real-time ambulance
capacity and the positions of all available ambulances at that moment in order to ensure dynamic ambulance
management at a supra-regional level. Regional Ambulance Services use the national covenant to make
agreements on how to deal with open borders and on the conditions under which ambulances from other
Regional Ambulance Services can be deployed. The Ambulance Dispatch Centre plays a central role in the
process of dynamic ambulance management.
4.2.3 Cross-border ambulance care

In regions that border Germany and Belgium, the Regional Ambulance Service makes agreements with
dispatch centres and ambulance organisations from the neighbouring country. These agreements concern
mutual assistance, either systematically or occasionally. National agreements on cross-border cooperation form
part of the regional agreements.
4.3 The right care at the right moment: triage

Professional triage must be performed when someone contacts the Ambulance Dispatch Centre. Triage is
described as determining the dynamic process of urgency and indicating the follow-up process. Triage must be
clear and tailored to the patients needs. The sector is currently developing the triage method to achieve greater
quality-related improvements. The form and content of the various systems are being shaped further within
the context of this quality-related improvement. The systems used must comply with national criteria. Nurse
dispatch centre operators are skilled in the application of this method. The sector intends to create a uniform
triage system in the future.
4.4 Integrated available care of the Regional Ambulance

Service
4.4.1 Emergency and planable
The integrated available care of the Regional Ambulance Service comprises emergency and planable (nonemergency) care. Emergency requests for care require the ambulance service to arrive on site as quickly as
possible. The nurse dispatch centre operator determines the trip urgency. The intention is to provide care
and, if necessary, transport the patient. The situation on site determines what happens next: provide care
and transport, provide care only or refer the patient to another care provider. An assessment of deployed
resources is performed afterwards. Planable ambulance care, also referred to as ordered transport in daily
practice, involves the care and transport of patients between the home address or place of residence and care
institutions for diagnosis, therapy or admission. Agreements relating to pick-up and drop-off times and the
destination are made with the patient or the person requesting care. Urgency within ambulance care indicates
the level of emergency of an ambulance trip. The sector uses the following urgency classification.
A1 urgency (A1 trip)

n emergency trip on the instructions of the operator in the event of an acute threat to the patients vital
A
functions or in the event this danger can only be excluded after the ambulance unit has performed an
assessment on site.
The deployment is assigned as quickly as possible and the ambulance unit must reach the scene as fast as
possible. The ambulance always uses flashing lights and sirens (in accordance with the Sector Guideline for
Visual and Audio Signals [Brancherichtlijn OGS]).
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A2 urgency (A2 trip)

A trip on the instructions of the operator in response to a request for care that does not entail an immediate
threat to life, but may involve (serious) damage to health and which requires the ambulance to reach the
destination as quickly as possible. The ambulance can use flashing lights and sirens.
B urgency (B trip)
A trip on the instructions of the operator in response to a request for care without an A1 or A2 urgency, with an
agreed on time or time interval for pick-up and drop-off.
4.4.2 High-complexity and low-complexity care

The required care can be high-complexity and low-complexity in nature for emergency as well as planable
ambulance care. Low-complexity care situations can be defined as predictable, non-threatening situations.
Patients in need of low-complexity ambulance care have stable vital functions and it can be reasonably expected
that their vital functions will not be endangered during or due to transport. High-complexity care situations are
predictable and often life-threatening situations that cannot reasonably be expected. Patients in need of highcomplexity ambulance care may have unstable vital functions and/or these functions may become endangered
during transport.
4.5 Care differentiation

Regional Ambulance Services aim to harmonise available care as closely as possibly with the patients demand
for care. This intention to provide tailored care has yielded various types of differentiation within ambulance
care. This relates to differentiation in terms of function as well as transport. In addition to tailor-made care,
quality, safety and efficiency are essential aspects of care differentiation. Care differentiation also contributes
significantly to improving services. Another aspect is that differentiation within the organisation lends an
entirely new dynamic in the area of personnel. This not only creates a healthy staff diversity, but also expands
potential (internal) career paths. However, care differentiation must always comply with the basic principles of
responsible care. The statutory framework stipulates that care differentiation must meet several criteria:
a. deployment criteria have been defined that determine which level of care under which conditions is
applicable as responsible ambulance care;
b. care differentiation is not at the expense of the deployment of equipment and staff needed to provide
responsible ambulance care under normal and scaled-up conditions. If available, a differentiated type of
ambulance care complies with national frameworks or guidelines. The following sections describe the most
common types of care differentiation within the sector.
4.5.1 Care ambulance

The care ambulance provides care to patients with a low-complexity demand for care. For low-complexity
ambulance care, it is sufficient to work according to routines, standard procedures and/or combinations
of (standard) procedures. Medical or nursing (Advanced Life Support) supervision and/or treatment is not
necessary. The care ambulance provides a number of care-related activities, maintains, stimulates and supports
the self-reliance of the person requesting care, and offers corresponding psychosocial support. The care
needs assessment for and deployment of the care ambulance occurs from the Ambulance Dispatch Centre
in accordance with criteria determined by the Regional Ambulance Service on the basis of the national quality
framework. The team in the care ambulance comprises a care ambulance supervisor and a care ambulance
driver. The competencies of these ambulance care providers are harmonised with the complexity of the
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demands for care and match national competency profiles. The care ambulances design and equipment
complies with the national quality framework.
4.5.2 Rapid responder

A rapid responder is an ambulance nurse who acts completely independently at the scene, whether or not he or
she is waiting for an ambulance or another care provider. A rapid responder provides regular ambulance care
at ALS (Advanced Life Support) level. The key difference with the regular ambulance is that the rapid responder
acts as a solo unit and cannot provide transport. Depending on the regional situation, the rapid responder
travels around in different types of vehicles such as motorcycles, cars or bicycles. The rapid responder is
directed by the Ambulance Dispatch Centre using deployment criteria specified beforehand.
4.5.3 Specialist transport

It is essential that seriously ill patients receive the right care at the right moment. This can sometimes mean
that these patients have to be transported (once they have been stabilised) because there is no place for
them in the hospital or because they require a higher level of Intensive Care (IC) than what was available at
the moment they were admitted to hospital. An IC patient is transported when there is a lack of (continuous)
effective care at the patients location. Specialist transport refers to the transport of the patient between two
hospitals (sites) under the supervision of a specialist team in a vehicle equipped specifically for that purpose. A
distinction is made between different types of specialist transport.
Mobile Intensive Care Unit

Most cases will involve elective IC transport that is planable and performed by a Mobile Intensive Care Unit
(MICU). To ensure the quality of this transport, it should ideally be implemented in a coordinated manner by
coordination centres and transport companies specially equipped for this purpose. Seven MICU coordination
centres in the Netherlands have been designated to this end and they work together with an appointed Regional
Ambulance Service. A clear division of responsibilities exists in this partnership. The MICU coordination
centre organises the inter-clinic transport of an IC patient, under the supervision of an MICU team. This
team comprises an IC doctor or intensive care specialist and an MICU nurse, both of whom are skilled in
MICU transport. The Regional Ambulance Service is responsible for the purchase and maintenance of an IC
ambulance, in accordance with technical guidelines developed for this purpose. It is also responsible for the
deployment of competent drivers who have received additional training to transport IC patients in an MICU and
for the availability of the MICU. A coordination centre requests MICU transport via the Ambulance Dispatch
Centre.
Emergency IC transport
Emergency IC transport is performed by a regular ambulance. Patients are usually unstable and urgently
require swift treatment elsewhere. Delaying transport in anticipation of the arrival of an MICU is irresponsible.
The patient requires IC-level care and the ambulance team is therefore supplemented by a specialist doctor
from the dispatching or receiving hospital. Emergency IC transport may not be delayed by discussions about
responsibilities and deployment. In accordance with ministerial instructions, every hospital must prepare for
this type of transport by making internal agreements about the availability of manpower and IC equipment.
NICU and PICU

Two types of transport and care also exist where the ambulance care to be provided exceeds the protocols of
the ambulance nurse and the ambulance unit is supplemented by a specialist nurse and/or a specialist doctor.
The Paediatric Intensive Care Unit (PICU) provides the inter-clinic intensive care transport of a patient under 18
27
years of age. The Neonatal Intensive Care Unit (NICU) provides the inter-clinic transport of a (newborn) baby.
The supervising doctor is usually a neonatologist.
4.5.4 Mobile Medical Team

The ambulance team can call on the Mobile Medical Team (MMT) for additional medical help in the case of
exceptional situations, very seriously wounded patients and/or large-scale accidents. An MMT comprises a
specialist doctor, a specialist nurse and a driver or pilot. The MMT provides specialist acute medical care at the
scene to victims of serious accidents and disasters. The MMT is linked to a trauma centre. Four of the eleven
trauma centres in the Netherlands have a trauma helicopter. The care that the MMT provides is supplementary
to regular ambulance care.
4.5.5 First responder

The Regional Ambulance Service can decide to deploy first responders in order to provide the necessary care to
the patient as quickly as possible in emergency situations. A first responder is a care provider that is the first to
arrive at the scene and competent in providing first aid in a situation where this is required while awaiting the
arrival of an ambulance. This can be the police, fire brigade or a general practitioner. The deployment of a first
responder is determined using criteria specified beforehand. First responders are deployed after the Ambulance
Dispatch Centre has sent an ambulance unit. The guiding principle for the deployment of the first responder
is that this may never cause a delay in ambulance care. The Regional Ambulance Service uses national
agreements when deploying a first responder. In addition to professional care providers, trained volunteers are
also deployed as first responders. These volunteers are notified via an alert system by the Regional Ambulance
Service. The Regional Ambulance Service makes clear agreements with the relevant organisations regarding
the deployment of volunteers as first responders. These agreements relate to the registration of volunteers and
equipment, the training of these individuals and aftercare.

Transparency
4.5.6 Differentiation in the Ambulance Dispatch Centre

Numerous developments are taking place in the Ambulance Dispatch Centre during the publication of this
amended Policy Document on Responsible Ambulance Care. The size of the centre is changing, which may
result in task and job differentiation. Examples include: the distinction between intake and dispatch or the
deployment of operators with specific logistical skills to coordinate planable, low-complexity transport. A
development is also visible where operators who are not nurses are being deployed for intake purposes and are
supported by a question protocol that is completely demand-driven. The sector has not expressed its opinion
about these developments.
The Regional Ambulance Service is responsible for the Ambulance Dispatch Centre and ambulance transport.
It is a care institution within the framework of the Care Institutions (Quality) Act. This act and other relevant
legislation regarding care (Medical Treatment Contracts Act [WGBO], Individual Healthcare Professions Act
[Wet BIG]) are therefore fully applicable to the Regional Ambulance Service, including the care provided by the
Ambulance Dispatch Centre. This means that taking the call, giving initial medical advice, assessing the need
for care and whether or not an ambulance or another facility of the Regional Ambulance Service or a chain
care institution must be deployed, are also intrinsic elements of the (ambulance) care process. These activities
therefore fall within the statutory framework of the healthcare sector, in both the daily and the scaled-up
situation. The sector views triage as a high-risk activity, which is why this statutory framework must be complied
with. The sector has defined the interpretation of this.
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5.1 Clarity for the patient and referrer
5.3 Long-term policy plan
Patients must have a clear idea of the types of questions they can ask through the Ambulance Dispatch Centre
and the type of response they can then expect. This means, first of all, that the Regional Ambulance Service
must have clear information on hand for (potential) patients. When a patient approaches the Ambulance
Dispatch Centre with a request for acute care, the operator informs the requester whether or not help is on the
way and specifies the nature of this help. Ambulance care providers on site tell the patient what type of help he
or she will receive. It must also be clear to referrers what they can expect from the Regional Ambulance Service
and ambulance care providers. The Regional Ambulance Service uses the long-term policy plan to clarify its
vision, goals and activities. It also communicates these through regional partnerships. Finally, the Regional
Ambulance Service makes agreements with its chain partners that clearly define what partners may or can
expect from ambulance care.
The Regional Ambulance Service regularly draws up a long-term policy plan in which it describes its view on
responsible ambulance care and how it wishes to implement this. The Regional Ambulance Services ambitions
are formulated in objectives that help the organisation as it systematically works on making them a reality. The
role of chain partners and the way in which cooperation in the region takes shape is also expressed in the longterm plan. Finally, the long-term plan focuses on medical assistance during accidents and disasters.
5.2 Transparent care process

The following steps in the ambulance care process can be distinguished, regardless of the manner in which
ambulance care is provided:
Care intake and needs assessment: ambulance care starts the moment the Ambulance Dispatch Centre
operator answers the telephone. The operator assesses the request for assistance and indicates whether,
and if so, what type of ambulance care is required and with which level of urgency;
Care assignment and coordination: the operator ensures that the correct care is provided at the right moment
and in the right place, and that the deployed care providers receive the necessary information;
Care) advice: the Ambulance Dispatch Centre operator gives recommendations or instructions to the caller
or person requesting care in anticipation of the arrival of the ambulance at the scene in order to allow the
care provision process to run as smoothly as possible. Sometimes assistance in the form of (care) advice
from the operator is sufficient or the patient is referred to another care provider.
Ambulance care provision: the ambulance care provider examines the patient on site, makes a preliminary
diagnosis and treats the patient. If transport is required, the patient is prepared accordingly. Treatment
is continued while the patient is being transported. The driver ensures that the patient is transported
responsibly;
Handover: the provision of care concludes upon handover. This can be a handover to other care providers or
family caregivers. In all situations, the correct and complete transfer of information, oral and/or written, is
essential.
Follow-up care: if required by the patient, his or her family members or a caller, follow-up care is provided
by the operator and/or the ambulance care provider, or by others on their behalf. This follow-up care may
involve the provision of information.
The various steps in the process of ambulance care provision are distinguishable from one another, yet they
also correspond seamlessly. The provision of good care does not necessarily require a patient to complete the
entire process. Sometimes care comprises care advice provided by the Ambulance Dispatch Centre operator or
on-site assistance without the need for an ambulance.
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5.4 Management information

A Regional Ambulance Service must have information on how the ambulance care process functions for
the sake of optimal transparency. It records data in the various phases of the process for this purpose. This
management information also allows the process to be steered. The Regional Ambulance Service compiles
management information in accordance with sector-specific agreements. The national registration of data in a
uniform manner provides an insight into the functioning of ambulance care provision at a national level. The
national Management Information (MI) process comprises the following components:
Uniform Glossary of Ambulance Care Terms [Uniform Begrippenkader Ambulancezorg (UBK)]. This glossary
clearly defines and describes all terms relating to the logistical aspects of ambulance care provision;
Basic Set Ambulance Care [Basisset Ambulancezorg (BSA)]. It stipulates the information that must be
recorded on the trip forms during the provision of ambulance care;
MI core set. The MI core set is the data set recorded by all Regional Ambulance Services upon which the
annual sector report is based. The Regional Ambulance Service follows sector-specific agreements applicable
to the MI process with regard to the definition and registration of the MI core set. The information is
requested and processed by an independent institution.
5.5 Annual report

In accordance with statutory requirements, every year the Regional Ambulance Service accounts in writing for
the quality of the care policy, care management and care implementation. It is free to decide how the pursued
quality policy will be reported on: in a separate report or as an integrated part of the organisations annual
report.
5.6 Sector report

Since 2007 the sector has accounted for aspects of ambulance care provision at national level. It uses a sector
report for this purpose and publishes national and regional information about preceding years. All Regional
Ambulance Services generate this information by registering a core set of data defined by the sector. The
Regional Ambulance Service provides the requested data in accordance with sector-specific agreements.
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5.7 External assessment and certification

The Regional Ambulance Service uses a quality system that guarantees the quality of the care provided
and allows it to be improved continuously. A type of hallmark is issued through external assessment and
certification of the quality system. This makes it clear to users of ambulance care (patients and chain partners)
that the care organisation is properly run. It has been agreed at sector level that the Regional Ambulance
Service will use a sector-specific certification system for external assessment and certification. It allows itself
to be assessed regularly on the basis of this certification system and in accordance with the certifying bodys
requirements for (re)certification.
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6.1 Professionalism
The ambulance sector and its ambulance care providers are a guarantee of professionalism. This term relates
to the professional manner in which individual care providers act, but also to the professional group and
organisations responsible for creating the conditions to act professionally and stimulate professionalism.
However, the essence of professional conduct lies with the individual professional and the definition of the
various professional roles that he or she must be able to fulfil. The essence of professionalism is the willingness
and ability of the individual professional to:
constantly ask himself/herself what good care is for this care requester in this situation;
make a well-considered assessment in this respect;
do this together with the care requester or others (depending on the situation);
act according to this consideration;
do this in such a way that the care requester feels that he or she has been acknowledged as a person;
account for his or her actions;
learn from experience.
6.2 Key positions

Professionalism is one of the task and competency areas of ambulance care providers.
Specific points for consideration include:
a reflective professional attitude. In other words, the professional carefully weighs up the choices he or she
makes and the decisions he or she takes: substantive, procedural and moral;
map out personal professional development and define personal questions that help him or her learn
(guaranteeing expertise);
help develop professional standards;
give feedback to colleagues within the own professional organisation.
Several key positions can be distinguished within ambulance care which are described below.
6.2.1 Nurse dispatch centre operator

The Ambulance Dispatch Centre is the first link in the ambulance care chain. The nurse dispatch centre
operator shapes the ambulance dispatch centre process. He or she ensures that the process of intake, care
needs assessment, care advice and coordination and care instruction is implemented properly. The nurse
dispatch centre operator must continuously strike a balance between the individual interests of the patient and
the monitoring and maintenance of a state of readiness. The nurse dispatch centre operator has to anticipate
circumstances that (can) influence the state of readiness. This individual communicates with various people
and organisations, including citizens who require care and ambulance teams, but also general practitioners,
doctors, nurses specialising in casualty and trauma care, the police and the fire brigade. The nurse dispatch
centre operator requires a specific expertise due to the variety and potential complexity of requests for care that
are received and must be assessed as regards their urgency and appropriate available care. The nurse-dispatch
centre operator is skilled in deciding whether or not and how ambulance care will be provided. This individual
provides protocol care in accordance with a triage system that complies with national requirements. He or
she has also followed a training programme recognised by the sector. An accreditation process for continuing
education is currently being implemented within ambulance care, based on attainment targets recognised by
the sector.
34
Operators who are not nurses can also work in an Ambulance Dispatch Centre. They are deployed in the
2
logistical process of assigning ambulance trips .
6.2.2 Ambulance nurse

Ambulance care work is based on specific medical and nursing actions. The ambulance nurse has the expertise
and competencies to provide ambulance care in the broadest sense. The ambulance nurse uses scientific
knowledge, skills and a professional attitude to provide patient-oriented care within the area of expertise. The
key tasks of the ambulance nurse involve diagnosis and treatment as well the optimisation, improvement
and maintenance of the patients quality of life. Most of the actions performed by the ambulance nurse are
nursing-related. He or she also performs medical actions, a limited number of which are reserved procedures.
Ambulance nurses have specific expertise to carry out specific reserved procedures without supervision or the
intervention of a principal. This functional independence is applicable provided statutory requirements for
issuing assignments are met.
The following reserved procedures are considered part of the ambulance nurses area of expertise:
a. performing elective cardioversion;
b. performing defibrillation;
c. the intubation or extubation of the windpipe using an oral or nasal tube;
d. performing a drainage puncture in the event of a tension pneumothorax;
e. performing a coniotomy.
As a general nurse, the ambulance nurse already possesses the functional independent authorisation to:
a. administer a subcutaneous, intramuscular or intravenous injection;
b. perform a bladder catheterisation on adults and insert a stomach tube or a drip (intravenous and
intraosseous);
c. perform a venipuncture and a neonatal heel prick.
The ambulance nurse performs actions on a level that complies with the quality criteria of (emergency) medical
and nursing actions. These criteria are described in the competency profile of the ambulance nurse and provide
the basis for the sectors training policy.
The ambulance nurse can work in an ambulance unit but also be deployed as a rapid responder. He or she has
completed a training programme recognised by the sector. An accreditation process for (continuing) education
is currently being implemented within ambulance care, based on attainment targets recognised by the sector.
evelopments concerning the deployment of dispatch centre operators who are not nurses are described in
D
paragraph 4.5.
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6.2.3 Ambulance driver

The ambulance driver is the person who drives the ambulance and assists the ambulance nurse. The
ambulance driver possesses specific driving and medical assistance skills for this purpose. The ambulance
driver plays a key role in communication with the patient and chain partners. The driver ensures a safe place to
work at the scene. The ambulance driver is responsible for driving the ambulance to a patient or incident in a
safe manner and for transporting the patient inside the ambulance in a safe manner. The driver has completed
a driving course providing specific driving skills that permit him or her to drive a priority vehicle. The ambulance
driver has completed a training programme recognised by the sector.
6.3 Expertise and competencies

6.3.1
Expertise
Ambulance care work is based on a specific medical and nursing actions. Patients who are or are not in a lifethreatening condition sometimes receive the care they require from the ambulance unit. An ambulance unit
comprises an ambulance nurse, either with or without an ambulance driver. Both professionals jointly provide
the required care on the basis of their own expertise and background, and their personal responsibilities. An
increasing number of ambulance nurses operate independently, such as the rapid responder. In such a case,
this independent ambulance nurse is the ambulance unit.
The quality of ambulance care that is provided depends largely on the expertise of care providers. This imposes
stringent requirements on the qualities of ambulance care providers. These requirements are laid down in a
statutory framework. The ambulance sector has also established several national frameworks. Specific expertise
is required for every key position within ambulance care. The sector has specified the desired minimal expertise
for key positions, in terms of (basic) training and required competencies. It has also defined recognition and
assignment criteria for training programmes relating to these key positions. The starting point within the
sector is that all care professionals active in the primary ambulance care process should enrol in a (continuing)
education programme recognised by the sector as quickly as possible upon entering service. Maintaining
expertise is essential for the provision of high-quality care. The ambulance sector has concluded national
agreements on the development and maintenance of expertise. The Regional Ambulance Service also offers
regional, additional training that corresponds to individual and organisational learning requirements. Sectorspecific agreements on professional development and registration in the quality register are applicable to
professionals pursuant to the Individual Healthcare Professions Act.
6.2.5 Job differentiation
6.3.2 Competencies
The availability of skilled care professionals and equipment is adapted to the patients needs, now and in the
future. The treatment of patients within the ambulance care sector care is becoming increasingly focused on
target groups. This is causing differentiation within available care, which could also lead to differentiation in
care positions within the Regional Ambulance Service. This also applies to the Ambulance Dispatch Centre,
which has acquired increasingly complex duties due to social, professional and technical developments. This
necessitates differentiation at additional levels. Intake and dispatch are viewed as two separate processes that
each impose specific requirements on the operators competencies.
Ambulance care providers are governed by the Individual Healthcare Professions Act [Wet BIG]. The training
criteria and required competencies of individual ambulance care providers are geared to the content of their
professional practice (area of expertise) and the requirements of the Individual Healthcare Professions Act.
The job competencies of ambulance care providers are assessed partly through training and development
in accordance with national and regional standards. The individual professional, the medical manager for
ambulance care and the Regional Ambulance Service are personally responsible for the acquisition and
maintenance of this professionals competencies. The competency policy of the Regional Ambulance Service
complies with statutory requirements and sector-specific agreements.
6.2.4 Ambulance unit
A Regional Ambulance Service can ensure job differentiation in different ways:

vertical differentiation: several job levels with another level of responsibility (care ambulance supervisor, acute
care nurse specialist; Ambulance Dispatch Centre operator);
horizontal differentiation: within one job level, various substantive tasks are accentuated in connection with
product differentiation and development within ambulance care or acute care (rapid responder). In addition
to effects on care quality and care effectiveness, differentiation within the organisation also introduces an
entirely new dynamic into the area of personnel. This not only creates healthy staff diversity, but also expands
potential (internal) career paths.
With job differentiation, the level of expertise of the ambulance care provider must be adapted to (the
complexity of) the patients request for care and the implementation of (a part of) the care process. The
Regional Ambulance Service must ensure that the following aspects at least are organised properly:
a clear job and competency description;
the establishment of a minimal expertise;
the monitoring of competencies;
a clear division of responsibilities within applicable statutory frameworks.
The jobs comply with national (quality) frameworks, if available.
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6.4 Protocol care

National protocols are used within ambulance care. They guarantee the uniformity of ambulance care provision
and ensure that a patient receives the same (ambulance) care regardless of his or her location. In accordance
with the Individual Healthcare Professions Act, a protocol can also be considered as an instruction issued by
the doctor to the functional, independently operating ambulance nurse. Finally, protocols must be regarded as
the professional standard that ambulance care providers use in their work, within the context of the Medical
Treatment Contracts Act [WGBO]. The purpose of standards and protocols is to help ambulance care providers
take the right decisions and evaluate treatment (afterwards). The ambulance care provider may decide to
deviate from the protocol based on the patients condition and circumstances. This is the responsibility of
the individual professional. In this case, the deviating procedure and the corresponding reasons must be
documented properly. It is also important that the individual professional has been trained in making such a
(moral) decision.
The Regional Ambulance Service can also use regional protocols within the context of regional (cooperation)
agreements during the implementation of pilots or on the basis of new medical insights. This procedure does
not affect the quality of the provided care. It is important that this be communicated in accordance with the
path agreed on nationally.
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6.5 High-quality and functional equipment

Ambulance care is provided using high-quality, functional equipment. The following material facilities are
concerned:
material and equipment for the provision of care;
ambulances;
ICT facilities.
Material and equipment

The material and equipment used within ambulance care are efficient and effective, and comply with all quality
criteria imposed on them. The material and equipment are in line with patients needs and applicable protocols,
and comply with other relevant laws and regulations.
Ambulances
It is extremely important that vehicles used to transport patients meet the (quality) criteria imposed on them.
Ambulances and equipment are subject to statutory frameworks and (European) standards.
ICT facilities
High-quality ICT facilities that function properly are essential for effectively supporting the ambulance care
process. Good communication and data exchange between the Ambulance Dispatch Centre and ambulance
care providers are crucial for ambulance care. ICT also plays a pivotal role in improving the exchange of
patient information between the various links of the (acute) care chain. The Regional Ambulance Service has
sound communication systems that comply with relevant national requirements. It also has good systems for
business processes and management information.
6.6 Medical management

The Regional Ambulance Service is responsible for providing responsible ambulance care. The Regional
Ambulance Service must therefore fully embed the medical responsibility for care that will be and is provided
within the organisation. Medical management is set up in such a way that:
the quality of medical aspects of ambulance care provision is guaranteed;
the competence of ambulance care providers is monitored;
final responsibility for medical management lies in the hands of a doctor;
availability is guaranteed 24 hours a day, 7 days a week.
The job structure of medical management ambulance care can be subdivided into the main areas of patient
care, education and research. Tasks belonging to the result areas of policy, implementation and supervision
are distinguished within these main areas. In the Regional Ambulance Services approach to the job structure
for medical management, all elements from the job structure must be safeguarded throughout the Regional
Ambulance Services organisation.
The Medical Manager Ambulance Care [MMA] is a doctor affiliated to a Regional Ambulance Service. This
doctors tasks include:
monitoring the competencies and skills of ambulance care providers in accordance with the Individual
Healthcare Professions Act [Wet BIG];
assuming responsibility for formulating medical policy, monitoring the implementation of medical policy
and applying protocols within ambulance care;
ensuring medical coordination with chain partners;
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monitoring the implementation of the rights and obligations of the patient and care provider laid down in
the Medical Treatment Contracts Act [WGBO].
6.7 Continuous improvement

The Regional Ambulance Service aims to provide optimal, responsible ambulance care and therefore
constantly harmonises its available care as closely as possible with patients demands for care. Its quality
system continuously and systematically focuses on retaining and improving the quality of the existing care
that is provided. The Regional Ambulance Service strives to renew its available care through healthcare
innovation. Healthcare innovation can focus on the provision of care to patients or on the material and medical
devices used for this purpose. An important starting point is that innovation should occur in a responsible
and professional manner and help enhance the quality of ambulance care. The Regional Ambulance Service
observes the requirements imposed by the quality system when setting up care processes. If research is
conducted in the interest of quality improvement and innovation, the Regional Ambulance Service complies
with assessment requirements for research proposals, where required.
6.8 Safety
6.8.1 Patient safety
The provision of safe care within the ambulance care sector is a very important theme: responsible care is safe
care. The safety of patients must be guaranteed while ambulance care is being provided. Unsafe situations
must be avoided and accidental injury to patients during the entire ambulance care process must be minimised
from the moment the Ambulance Dispatch Centre receives the call up until the moment the patient is handed
over to other care providers. Ambulance care involves high-risk moments, regardless of the patient category.
It also has to deal with patient categories that entail additional safety-related risks. In other words: ambulance
care professionals have to be extra alert when patient safety is concerned. This relates to the physical
characteristics of these categories, the nature or complexity of the injury or how complaints are presented.
The ambulance sector is doing everything it can to minimise avoidable, accidental injury. But there is always
room for improvement, however, which is why ambulance care associations have developed a patient safety
programme. It goes without saying that the Regional Ambulance Service is personally responsible for ensuring
patient safety. In this, it complies with statutory requirements and sector-specific agreements. Individual care
providers are also personally responsible for providing safe patient care by implementing national guidelines,
for example.
6.8.2 Safe working environment

Patient safety as well as staff safety must be guaranteed during the provision of ambulance care. Ambulance
care providers usually operate in situations that also expose them to (health) risks. Both the organisation and
the professional are personally responsible for minimising these risks. The Regional Ambulance Service is
responsible for providing safe material and medical devices, and for formulating management and emergency
plans, but also for assisting care providers after traumatic situations. The Regional Ambulance Service is
also expected to periodically identify workplace risks relating to health, safety and welfare (Risk Inventory
& Evaluation [RI&E]) and take measures if required. The care provider is responsible for applying national
guidelines and protocols that focus on the care providers safety and the correct use of resources that have
been provided.
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6.8.3
Preventing incidents; safe incident reporting
The quality system of the Regional Ambulance Service is also geared to preventing incidents during the
provision of ambulance care and responding effectively if an incident occurs. Part of the safety management
system involves reporting and registering incidents and near-incidents (Safe Incident Reporting [Veilig
Incidenten Melden (VIM)]) and developing a sound policy for this purpose. In the event of a disaster, the
Regional Ambulance Service acts in accordance with statutory requirements.
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Information, permission,
documentation and privacy
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7.1
General information
The Regional Ambulance Service provides information about ambulance care that is geared to patients.
This information is clear and easy to understand. It is also intended for potential patients.
7.2 Information for individual patients

Ambulance care providers inform patients and/or their family members about the care they provide. They act in
accordance with statutory requirements and the professional code of conduct.
7.3 Permission
The law stipulates that patients must grant permission for the provision of ambulance care. Ambulance care
providers give the necessary information that patients and/or their legal representatives use to grant such
permission. Ambulance care often involves situations where a patient is unable to give permission. In such
cases ambulance care providers act in accordance with professional standards and based on their responsibility
as a good care provider.
7.4 Documentation
The Ambulance Dispatch Centre operator and ambulance care providers record information during the
ambulance care process. This is important as it helps harmonise the provision of ambulance care as closely as
possible with the patients request for care. Information is also recorded to evaluate the care that was provided.
Finally, recording information helps ensure that care is transferred safely. Information recorded during the
ambulance care process is saved and stored in compliance with legal requirements.
Continuity of care and coordination

with chain partners
7.5 Privacy protection

Patients who receive ambulance care are in a vulnerable position. Ambulance care providers are aware of this
and act accordingly. This is also laid down in the professional code of conduct for ambulance care providers.
Regional Ambulance Services and ambulance care providers must also be aware of privacy-related aspects
involving the use of the Internet and social media, and sharing information and images online via computers
and mobile phones. They must act with care and make agreements in this regard using the guideline endorsed
by the sector.
7.6 Professional secrecy

Ambulance care providers are obliged to observe professional secrecy. Statutory regulations are complied with
when providing information about patients to third parties. In addition to care institutions within the care chain,
ambulance care providers frequently work with partners from the safety chain. Ambulance care providers can
also provide information to these partners (such as the police). Statutory requirements and national guidelines
are observed when providing medical and other confidential information about patients.
42
43
8.1 Cooperation with chain partners

8.1.1
Chain agreements
Like a link in the (acute) care chain, the Regional Ambulance Service works closely together with other care
providers within its care area. It moves between the links of the (acute) care chain and plays a crucial role in
guiding patients through the care process as effectively as possible. On the one hand, the cooperation focuses
on guaranteeing and optimising the continuity of care provision within the chain. On the other hand, it focuses
on ensuring effective and demand-driven care: the right care at the right moment and tailored to the care
requesters needs. The Regional Ambulance Service makes agreements with its chain partners regarding the
coordination of care processes, duties and responsibilities, and the exchange of information. It also develops
concrete cooperation activities with its chain partners. Effective cooperation with the various disciplines (fire
brigade and police) within the safety chain is vital. The Regional Ambulance Service draws up covenants and
makes agreements with chain partners to ensure the continuity of patient care.
8.1.2 Regional Acute Care Consultations

Regional Acute Care Consultations [Regionaal Overleg Acute Zorg (ROAZ)] are held at trauma region level and
aim to ensure optimal coordination within the chain. The trauma centre coordinates these consultations. The
Regional Ambulance Service participates in these in accordance with the requirements of the Care Institutions
(Accreditation) Act [WTZi].
8.1.3
Scaled-up care
Handling of complaints and

client experience
De RAV is ook verantwoordelijk voor het leveren van verantwoorde ambulancezorg in het kader van The
Regional Ambulance Service is also responsible for providing responsible ambulance care within the context
of disaster response and crisis management. It must meet requirements relating to the Ambulance Dispatch
Centre. Requirements relating to training and practice, deployment during events and preparation for
deployment during a disaster or crisis are also imposed on the Regional Ambulance Service. In addition, it
must satisfy requirements relating to ambulance assistance, casualty distribution and the casualty tracking
system. It is imperative for partners within the care and safety chain to work closely together during disasters
and crises. This cooperation is based on sound communication, a clear division of responsibilities and an
insight into available capacities. The Regional Ambulance Service and its partners make good agreements
in this regard based on the national covenant. It also complies with national agreements concerning the
education, training and practice [OTO] of staff.
8.2 Responsible care handover

The treatment of patients must be a continuous process from the moment the call is received up until actual
intramural care is provided. The handover of information, oral and/or written, is essential for the links in the
chain that take over the treatment of the patient. The information must be transferred in a clear manner and
none of it may go missing. When using digital and electronic registration and exchanging data electronically, the
Regional Ambulance Service must ensure that its systems have been configured for this purpose at the required
moment and meet the requirements imposed in this regard.
44
45
9.1 Handling of complaints

The aim of Regional Ambulance Services and individual ambulance care providers is to provide responsible,
optimal care. However, situations can always arise in which this care does not meet the expectations of patients
and/or their family members. The Regional Ambulance Service provides a complaint procedure for such
situations, in accordance with the statutory framework.
9.2 Client experience

The Regional Ambulance Service regularly examines patients experiences with the care it has provided. This is
one of the requirements of the Care Institutions (Quality) Act. The manner in which patients experiences are
examined is geared to the various target groups of the Regional Ambulance Service. It uses the results of these
surveys to improve the provision of care.
46
10
47
10.1 Patient participation

It is important to ask patients about their care-related expectations and possibilities for improvement in
order to harmonise available care as best as possible with their requests and needs. A structure for patient
participation is required by law. The Regional Ambulance Service believes in the importance of giving shape
and form to patient participation. It is a challenge for it to find a form that is aligned to the specific character of
ambulance care provision.
10.2 Good governance

The Regional Ambulance Service is obliged to observe the transparency requirements of the Care Institutions
(Accreditation) Act [WTZi] regarding good governance, proper internal supervision and orderly business
operations.
48
Appendices

Appendix 1 Ambulance care statutory framework

Appendix 2 National Professional Code of Conduct for Nurses and Carers
[Nationale Beroepscode van Verpleegkundigen en Verzorgenden]

Appendix 3 A sector in development
Composition of working group for the Policy Document on Responsible

Ambulance care List of abbreviations
Policy Document on Responsible Ambulance Care | appendices
49
Appendix 1 Ambulance care statutory framework
This appendix provides a summary of legislation applicable to ambulance care. This legislation is an important
cornerstone of the Policy Document on Responsible Ambulance Care, which is evident in the numerous
references to statutory requirements. The reference list specifies all applicable legislation for each chapter.
The full legislative texts are available at www.overheid.nl, a website that provides access to information about
government organisations.
1.1
Interim Ambulance Care Act [Twaz]
The Interim Ambulance Care Act [Tijdelijke wet ambulancezorg (Twaz)] came into force on 1 January 2013. It
replaced the Ambulance Transport Act [Wet ambulancevervoer (WAV)]. The Interim Ambulance Care Act will
remain in force for a period of five years, during which work will be carried out on a permanent statutory
regulation. Section 1, subsection 1d of the Act defines ambulance care and extends the definition thereof
compared to the Ambulance Transport Act. Ambulance care now entails:
a. providing medical assistance and transport by ambulance, or;
b. providing medical assistance via an ambulance nurse with a special vehicle equipped for that purpose and
clearly recognisable as such.
The definition of an ambulance comprises more than just an ambulance vehicle: it now includes a motor
vehicle equipped for patients as well as a craft or helicopter. The Ambulance Transport Act referred to a Central
Post for Ambulance Transport [Centrale Post Ambulancevervoer (CPA)] but the Interim Ambulance Care Act
now calls it a Dispatch Centre [meldkamer]. The new Dispatch Centre is still part of the general dispatch centre
referred to in Section 35, subsection 1 of the Security Regions Act [Wet veiligheidsregios]. Under the Interim
Ambulance Care Act, the Dispatch Centre is an integral part of the Regional Ambulance Service. Regional
Ambulance Services are designated by the Minister of Health, Welfare and Sport (Section 6 of the Interim
Ambulance Care Act). This Regional Ambulance Service is responsible for:
a. maintaining a Dispatch Centre;
b. providing or arranging the provision of ambulance care (Section 4 of the Interim Ambulance Care Act).
Ambulance care is care provided to ill or injured patients in order to treat their condition or injury and transport
them by ambulance, or medical assistance provided via an ambulance nurse with a special vehicle equipped
for that purpose and clearly recognisable as such (Section 1, subsection 1d of the Interim Ambulance Care Act).
The Dispatch Centre decides whether or not ambulance care will be provided, who will provide it and how it will
be provided (Section 5 of the Interim Ambulance Care Act). Section 6 stipulates who can be designated as a
Regional Ambulance Service in a region. Further requirements that a Regional Ambulance Service must comply
with are set out in the policy rules of the Minister of Health, Welfare and Sport (Section 6, subsection 3).
1.2
1.3

Individual Healthcare Professions Act [Wet op de Beroepen in de Individuele

Gezondheidszorg (Wet BIG)]
The Individual Healthcare Professions Act came into force on 1 December 1997. The purpose of the Act is to
improve and monitor the quality of professional practice and protect the client against inexpert and careless
actions performed by professionals. The Act applies to ambulance nurses, nurse dispatch centre operators
and doctors, with respect to the protection of titles within ambulance care. The basic principle of the Individual
Healthcare Professions Act is that care providers are free to practice within the area of individual healthcare.
However, this freedom does not apply to all practices. Some practices are deemed by the legislator to be
of such a high risk that they can only be performed by doctors, i.e. reserved procedures (Section 36 of the
Individual Healthcare Professions Act). The Act distinguishes between professionals who are independently
authorised to perform reserved procedures, such as doctors, and between professionals who are not
independently authorised to perform reserved procedures, such as nurses. Someone who is not independently
authorised may perform reserved procedures under certain conditions on the instructions of an independently
3
authorised individual (doctor) . Doctors authorised to issue an assignment (in this case recommendations
and instructions) to ambulance care providers are not present in ambulances and the Ambulance Dispatch
Centre. The nurse dispatch centre operator is the actual person who makes the care needs assessment for
the ambulance care to be provided, determines the urgency, or refers a patient directly to chain partners. The
ambulance nurse then decides on the care and treatment procedure (reserved or high-risk) that the patient
requires. The legally required instruction issued by the doctor to the Ambulance Dispatch Centre operator and
ambulance nurse to provide care and the manner in which this must occur is embedded within ambulance care
guidelines and protocols. This is decisive for the responsibilities of the Regional Ambulance Service board and
the Ambulance Dispatch Centre in relation to the proper implementation of these protocols and standards,
both nationally and regionally, and ensuring that this proper implementation is established, complied with and
monitored.
Care Institutions (Accreditation) Act [Wet toelating zorginstellingen (WTZi)]
The Care Institutions (Accreditation) Act came into force on 1 January 2006. The purpose of the act is to
gradually create greater freedom and responsibility for care institutions by reducing government involvement
in the capacity and construction of care institutions. Care institutions must have an authorisation in order
to provide care that is covered by the Care Insurance Act [Zorgverzekeringswet] or the Exceptional Medical
Expenses Act [AWBZ]. This makes it possible to determine whether or not the institution complies with specific
requirements. The main requirements concern the accessibility of acute care and the transparency of the
governance structure and operational management (good governance). The key terms here are transparency,
independence, broad accountability and the close involvement of stakeholders. The Regional Ambulance
Service is subject to the Care Institutions (Accreditation) Act. The implementation decision designated the
Regional Ambulance Service as an institution that has received authorisation. This authorisation was in the
50
form of a permit issued by the province (Ambulance Transport Act). Now that the Interim Ambulance Care Act
has entered into force, this is a designation from the Minister of Health, Welfare and Sport. The policy rules
of the Admission of Care Institutions Act include an obligation for all providers of acute care to participate in
Regional Acute Care Consultations [Regionaal Overleg Acute Zorg (ROAZ)]. The Regional Ambulance Service is a
partner in these mandatory consultations on the acute care chain. The regional consultations survey acute care
available in the region and propose solutions to problems, at the initiative of the hospital with accreditation for
a regional trauma centre from the region concerned. Agreements stemming from these consultations must
be observed. The institution uses its annual report to account for the manner in which it has observed these
agreements. The Care Institutions (Quality) Act [Kwaliteitswet zorginstellingen (KWZ)] obliges the Regional
Ambulance Service to monitor its own quality and maintain and improve it in relation to responsible care and
qualitative policy by establishing a quality system.
Policy Document on Responsible Ambulance Care | appendix 1
Ambulance nurses occupy a unique position under Section 39 of the Individual Healthcare Professions Act
regarding the performance of reserved procedures. This is worked out in greater detail in the Decree on
Functional Independence [Besluit Functionele Zelfstandigheid]. This implies that the Act deems the expertise
of the nurses occupational group to be of such a level that they may perform certain procedures without any
supervision or intervention by the doctor. With a view to the functional independent performance of
Although the legislator has not considered all potentially high-risk procedures as reserved, this does not imply that the procedure concerned
does not require skilled and careful implementation. On the advice of the Individual Healthcare Provision Council, high-risk procedures are
in principle handled in the same manner as reserved procedures.
51
reserved (and other high-risk) procedures, the instruction issued by a doctor is still required, together with the
requirement that the nurse is competent. The functional independence of an occupational group does not
imply that supervision and intervention by the doctor are no longer possible. The principal and the contractor
retain their personal responsibility for the careful provision of care. The possibility remains that the contractor
may request supervision or intervention, or that the principal will personally decide to do so.
1.4

Medical Treatment Contracts Act [Wet op de geneeskundige behandelingsovereenkomst (WGBO)]
The Medical Treatment Contracts Act came into force on 1 April 1995. The act stipulates the rights and
obligations of the client and care provider arising from the agreement on medical treatment. It provides for
the obligation to give information, the consent requirement, the representation and position of minors, and
privacy. The Medical Treatment Contracts Act also defines the legal relationship between the care provider
and the client. One aspect of this is the obligation anchored in the act that requires the care provider to
comply with and work according to the professional standard, the norms that have been developed within
the occupational group. The care providers obligation to keep a medical file also merits further attention. The
professional standard is anchored as a norm for the actions of care providers within the Medical Treatment
Act, and under Section 7:453 of the Dutch Civil Code as follows: In providing medical treatment, the care
provider must observe the standards of a prudent care provider and, in doing so, must act in accordance with
the responsibilities laid upon him by the professional standard for care providers. The Medical Treatment
Contracts Act assumes that a treatment agreement exists between the care provider (operator, ambulance
nurse) and the patient. The patient who asks for assistance enters into a treatment agreement with the Regional
Ambulance Service. This organisation must ensure that this agreement has an effect on the operator-client
relationship and the ambulance nurse-patient relationship. The professional standard is used to determine
whether the Ambulance Dispatch Centre operator or ambulance nurse have provided the care of a good care
provider, or have failed imputably in this regard. Care providers are obliged to observe professional secrecy due
to the unique nature of their profession. That obligation also gives rise to a confidentiality requirement that the
professional must observe. Professional secrecy can be observed in two ways. Firstly, the care provider has an
oath of secrecy vis--vis everyone else. Secondly, the care provider has a statutory privilege of non-disclosure
that can be invoked during court proceedings. The oath of secrecy is also anchored in the Medical Treatment
Contracts Act under Section 7:457 of the Dutch Civil Code.
1.5 Clients Right of Complaint (Healthcare Sector) Act [Wet Klachtrecht Clinten
Zorgsector (WKCZ)]
The Clients Right of Complaint (Healthcare Sector) Act of 1995 contains a number of provisions with
obligations for the care provider with regard to the handling of clients complaints in the healthcare sector.
The act stipulates that the board of the Regional Ambulance Service is the care provider. The care provider is
responsible for the effective handling of clients complaints about the provided care. In short, this involves the
following: ensuring that clients complaints are handled by a complaints officer and setting up a complaints
committee that complies with all statutory requirements, defined in greater detail in Section 2 of the Clients
Right of Complaint (Healthcare Sector) Act. Pursuant to the act, every Regional Ambulance Service must have
an independent complaints committee or be affiliated to an independent complaints committee. In this way
patients complaints about the provided ambulance care (or lack thereof) can be assessed easily.
1.6 Participation (Clients of Care Institutions) Act [Wet Medezeggenschap Clinten

Zorginstellingen (WMCZ)]
The Participation (Clients of Care Institutions) Act came into force on 1 June 1996. The act ensures that clients
of an institution can participate in the decision-making process via the management board and a client board.
52
To this end, the act provides for the establishment of a client board in institutions and open access for clients to
relevant documents such as the annual report and complaints procedure.
1.7
Medical Appliances Act [Wet op de medische hulpmiddelen]
The Medical Appliances Act specifies safety requirements for medical equipment used in the healthcare
sector in order to prevent injuries to the client as much as possible. The Regional Ambulance Service has a
responsibility in this regard, in addition to the medical device manufacturers responsibility and accountability.
The decree regarding the sterilisation of medical devices also falls under this act. The Medical Appliances Act
provides for the handling, storage, resterilisation, etc. of sterile products.
1.8 Psychiatric Hospitals (Compulsory Admissions) Act [Wet bijzondere opneming

in psychiatrische ziekenhuizen (BOPZ)]
The Psychiatric Hospitals (Compulsory Admissions) Act came into force on 17 January 1994. The act comprises
regulations applicable to an involuntary (forced) admission as well as regulations applicable to the patients
stay in the institution. The provisions regarding compulsory admission are particularly important to ambulance
care. This involves admission via temporary authorisation, detention, the assessment committee or judicial
authorisation upon personal request. The Regional Ambulance Service makes agreements with mental
healthcare institutions, general practitioners, the police and judicial authorities regarding the procedure(s) to be
followed and responsibilities for assisting these clients.
1.9
Personal Data Protection Act [Wet Bescherming Persoonsgegevens (Wbp)]
The Personal Data Protection Act came into force on 1 September 2001. The act stipulates the rights of
someone whose personal information is used and the obligations of organisations or companies that utilise
personal data. It lays down requirements for the processing of personal data. A Regional Ambulance Service
organisation:
may only collect and process personal data if it has a good reason to do so, or if the citizen concerned has
consented to the use of his or her data;
may not process more data than that strictly required for the purpose for which it has been collected;
may not keep the data longer than is necessary;
must take appropriate technical and organisational measures to protect data;
must, in principle, always inform the citizen concerned about processing of his or her data.
The registration of personal data by healthcare professionals falls under the Exemptions Decree
[Vrijstellingenbesluit] of the Personal Data Protection Act. If the conditions stipulated therein are complied with,
there is no need to report the processing of this data to the regulatory authority.
1.10 Road Traffic Act [Wegenverkeerswet (WvW)] and Traffic Code [Reglement

verkeersregels en verkeerstekens (Rvv)]
The Road Traffic Act and Traffic Code lay down general traffic rules and specific rules governing priority vehicles
as well as the use of signals. The use of flashing lights and sirens (Sector Guideline for Visual and Audio Signals
[Brancherichtlijn OGS]) is based on Section 29 of the Traffic Code of 1990. This Section stipulates that drivers of
motor vehicles used for the police and fire brigade, ambulances and motor vehicles of other emergency services
designated by the Minister of Transport, Public Works and Water Management, may utilise flashing lights and
sirens to indicate they are performing an urgent task. Pursuant to Section 91 of the Traffic Code of 1990, as
priority vehicles these vehicles may deviate from the rules of this Traffic Code in so far as this is required to
perform their task. The ambulance sector has drawn up a sector guideline to help Regional Ambulance Service
boards and drivers of priority vehicles apply these rules responsibly. This sector guideline specifies situations
53
where the use of flashing lights and sirens is permitted. The sector guideline also contains a code of conduct
for drivers of priority vehicles to ensure the safety of the client, the driver, other vehicle occupants and fellow
road users. Many of these requirements have now been laid down in law and the sector guideline is therefore
supplementary.
1.11
Security Regions Act [Wet veiligheidsregios (WVR)]
The Security Regions Act came into force on 1 October 2010. The new act replaces the Fire Services Act
[Brandweerwet] of 1985, the Medical Assistance during Accidents and Disasters Act [Wet geneeskundige
hulpverlening bij ongevallen en rampen (Wghor)] and the Disasters and Major Accidents Act [Wet rampen en zware
ongevallen (WRZO)]. It also stipulates the administrative context and basic requirements for the organisation of
emergency services, the tasks of the management board of a security region and the minimum requirements
for emergency services, such as the regional fire brigade and medical services, and for the equipment they
use. The Security Regions Decree [Besluit veiligheidsregios] imposes further regulations for security regions and
the fire brigade. Agreements have been made concerning the arrival times of the fire brigade. Key tasks and
minimum requirements have been defined for positions within the security regions (for regional fire brigades,
medical services and several multidisciplinary positions). The aim of personnel regulations is to provide a
nationwide guarantee for the quality of positions within the security region. The Security Regions Personnel
Decree [Besluit personeel veiligheidsregios] stipulates that the minister lays down rules for positions in the fire
brigade, within the Medical Assistance during Accidents and Disasters Organisation [GHOR] and within the
organisation of disaster response and crisis management. The positions are detailed in the Regulations for
Security Region Personnel [Regeling personeel veiligheidsregios].
Appendix 2 N
ational Professional Code of Conduct for
Nurses and Carers [Nationale Beroepscode
van Verpleegkundigen en Verzorgenden]
Introduction
The professional conduct of ambulance care providers is based on the National Professional Code of Conduct
for Nurses and Carers [Nationale Beroepscode van Verpleegkundigen en Verzorgenden] of the Dutch Nurses
and Carers Association [Verpleegkundigen & Verzorgenden Nederland (V&VN)]. This code defines professional
standards and values for professional practice. It provides ambulance care providers with guidelines and
support for day-to-day professional practice. The code clarifies what society as a whole and individual patients
and clients in particular can expect from nurses and carers. It has been formulated against the backdrop of the
Universal Declaration of Human Rights, the Convention on the Rights of the Child and the Dutch Constitution. The
Individual Healthcare Professions Act, Contracts in respect of Medical Treatment from the Dutch Civil Code,
Book 7, Title 7, Chapter 5, and the Care Institutions (Quality) Act have also been used.
Structure of the professional code

The professional code is divided into four chapters: the basic principles of the profession, the nurse/carer in
relation to the care requester, in relation to other care providers and in relation to society. This classification is
also used in the professional code of conduct for the International Council of Nurses. The National Professional
Code of Conduct is intended for nurses, carers and other care providers. To optimise the readability of the
code, the articles refer to as a nurse/carer. This appendix describes the essence of the professional code. The
complete version of the code is available at www.venvn.nl.
1 Basic principles of professional practice

1.1 As a nurse/carer, I am personally responsible for the way in which I provide care.
1.2 As a nurse/carer, I maintain the knowledge and skills needed to practise my profession responsibly.
1.3 As a nurse/carer, I only perform actions that fall within the scope of my expertise.
1.4 As a nurse/carer, I supervise nursing and care students and interns in the development of their nursing/
care skills.
1.5 As a nurse/carer, I support and initiate activities that improve the quality of care and the development of
the profession.
1.6 As a nurse/carer, I help ensure that care is provided safely.
1.7 As a nurse/carer, I help ensure that available resources are used responsibly.
1.8 As a nurse/carer, I adapt my jewellery, body decoration elements and clothing to the requirements of the
profession.
2 The nurse/carer in relation to the care requester

2.1 As a nurse/carer, I assume that every care requester is entitled to care.
2.2 As a nurse/carer, I focus on the interests of the care requester in the provision of care.
2.3 As a nurse/carer, I coordinate, where possible, the provision of care with the care needs, standards and
values, and cultural and philosophical views of the care requester.
2.4 As a nurse/carer, I ensure that a care relationship develops with the care requester (and/or this persons
representative).
2.5 As a nurse/carer, I acknowledge and respect the role of the care requester and family members as care
partners.
2.6 As a nurse/carer, I ensure that the care requester (and/or this persons representative) receives the
information he or she needs.
54
55
2.7 As a nurse/carer, I seek consent from the care requester (and/or this persons representative) before I
start providing care.
2.8 As a nurse/carer, I act responsibly in relation to the reporting of information about the care requester in
the nursing or care file.
2.9 As a nurse/carer, I am aware of the care requesters rights in relation to the nursing or care file and handle
these in a responsible manner.
2.10 As a nurse/carer, I treat confidential information about the care requester scrupulously.
2.11 As a nurse/carer, I respect and protect the care requesters privacy.
2.12 As a nurse/carer, I respect the professional boundaries of my relationship with the care requester.
2.13 As a nurse/carer, I have the right to refuse engaging in certain activities on the grounds of conscientious
objection.
3 The nurse/carer in relation to other care providers

3.1 As a nurse/carer, I work together with other care providers to provide the care requester with the necessary
care.
3.2 As a nurse/carer, I respect the expertise, experience and contributions of other care providers.
3.3 As a nurse/carer, I oversee and monitor the care provided to the care requester.
3.4 As a nurse/carer, I continue ensuring the quality of the care provided to the care requester when tasks are
transferred to other care providers.
3.5 As a nurse/carer, I respect the professional boundaries of my relationship with other care professionals.
3.6 As a nurse/carer, I protect the care requester against unethical, incompetent, unsafe or in any other way
insufficient care provided by other care providers.
3.7 As a nurse/carer, I support other care providers who wish to conduct themselves according to the
professional code of conduct but experience difficulties in doing so.
3.8 As a nurse/carer, I assist with the development, implementation and evaluation of the policy of the
institution or organisation where I work.
4 The nurse/carer in relation to society

4.1 As a nurse/carer, I help improve public health within the care domain.
4.2 As a nurse/carer, I participate in scientific research focussing on improving public health and individual
care for care requesters.
4.3 As a nurse/carer, I support activities undertaken by the professional group to create conditions for
practising the profession responsibly.
4.4 As a nurse/carer, I also provide care outside my working environment on the basis of my professional
expertise to anyone in need of emergency care.
4.5 As a nurse/carer, I help protect the environment within the care domain.
4.6 As a nurse/carer, I devote myself, individually and collectively, to distributing available resources fairly and
handling these responsibly.
4.7 As a nurse/carer, I do not participate in (commercial) activities that affect the independence, reliability and
credibility of myself and/or the professional group.
56
Appendix 3 A sector in development

1
Introduction
The Policy Document on Responsible Ambulance Care describes what responsible ambulance care means to
the ambulance sector. The policy document contains a number of general starting points and describes how
these are developed by means of national and sector-specific agreements. The starting points in this policy
document are also applicable to new, future developments. And these are plentiful. The entire care sector is in a
state of flux, and the ambulance sector therefore finds itself in an similar position. New opportunities and new
challenges are arising. This appendix discusses several key developments. These may be within the ambulance
sector itself, or developments within the care sector that concern the ambulance sector. The appendix describes
these developments and how the ambulance sector responds to them on its own or in cooperation with
chain partners. It does so, for example, by drawing up vision documents and policy agendas, formulating
views or setting up pilots. Appendix 3 contains the reference list for documents that detail the developments
(future studies by advisory bodies, policy memoranda from the government), and documents in which the
ambulance sector sets out its vision and plans for the future (position papers and future agendas). These vision
documents, memoranda or pilot results will become part of the policy document the moment they result in
sector-specific agreements.
Developments in the care sector
2.1
Tailored care
The demand for tailored care is growing due to demographic trends such as low birth rates, the ageing
population, interculturalisation, the increasing number of single persons and medical-technical treatment
options in various care settings. In addition, the ageing population will cause an increase in the number of
people with chronic illnesses. The demand for care will grow accordingly. More and more regions and Euregios
such as South Limburg, North-East Groningen and Zeeuws-Vlaanderen have to or will have to deal with a
declining population. However, other regions will also face this problem in the years ahead. Population decline
affects economic dynamism, the demand for goods and services, the labour market and the use of space.
Significant changes are also taking place in the healthcare market itself, such as the shift from a supply-driven
approach towards a demand-driven approach. Secondary care is experiencing a shift towards more treatment
and less nursing: the number of hospital beds is clearly decreasing in favour of outpatient consultations and
day treatment. This trend is also causing changes in the demand for care and the composition and duties of
healthcare personnel. All of these developments also have an effect on ambulance care: in terms of the demand
for ambulance care, but also in the nature of this demand.
The ambulance sector wants to anticipate these trends and is already making every effort to do so. It is
increasing care capacity and continuing to develop differentiated care, ranging from high complexity to low
complexity. Examples include the Mobile Intensive Care Unit (MICU), the rapid responder and the care
ambulance. The shift towards demand-driven care is also creating scope within ambulance care for the
deployment of care professionals with specific knowledge and competencies for providing this care. In addition,
this is enabling differentiation in the supply of work within the context of sustainable deployment.
57
2.2
Developments in the Ambulance Dispatch Centre
A number of measures were initiated during the previous cabinet period that have had a major impact on
developments in the Ambulance Dispatch Centre:
the coalition agreement of the first Rutte cabinet stipulated that existing dispatch centres will be reduced to a
single dispatch centre organisation with three sites;
the Ministry of Health, Welfare and Sport has listed bottlenecks in the development and organisation of
acute care, which ambulance care is part of;
the cabinet has decided to reorganise the police force by reducing the 25 police regions to ten districts under
one national police organisation;
the Ministry of Security and Justice, in coordination with the Ministry of Health, Welfare and Sport and after
consulting practitioners in the field, decided in February 2012 to establish one national dispatch centre
organisation with a maximum of ten sites.
in line with the Security Regions Act, the Dutch Government has decided to implement the regionalisation of
the fire brigade in all regions;
in the Interim Ambulance Care Act, the Government has stipulated that the Regional Ambulance Service is
responsible for maintaining the Ambulance Dispatch Centre. This act came into force on 1 January 2013.
The creation of one national dispatch centre organisation is the most important step in the entire process that
has an effect on the Ambulance Dispatch Centre.
In February 2012 the Ministry of Security and Justice set out the vision of the Dispatch Centre of the Future in
a letter to the Dutch House of Representatives. This letter defines the direction in which the dispatch centre of
the future will develop. In principle, a maximum of ten supra-regional dispatch centres will be created and will
all fall under one national management organisation. Two such dispatch centres have already been established
in anticipation of this development: the East Netherlands Dispatch Centre and the North Netherlands Dispatch
Centre.
The white column (Ministry of Health, Welfare and Sport, the ambulance care sector and the Medical
Assistance during Accidents and Disasters Organisation [GHOR] has expressed its vision of developments
relating to the dispatch centre. It is important for the white column that several starting points are used to
formulate a vision of the dispatch centre of the future. Firstly, quality and effectiveness are leading to ensure the
best, uniform care is provided to whoever requests it. Secondly, a careful transition process towards economies
of scale must be selected to facilitate the implementation of changes. Thirdly, it must be clear for each column
which requests can and must be multidisciplinary in nature. Two factors are essential for the ambulance care
sector: intake by a nurse dispatch centre operator within the Ambulance Dispatch Centre and control over the
competence and working method of staff who work there. This is the only way the Regional Ambulance Service
can ensure responsibility for the quality and effectiveness of ambulance care (and statutory responsibility for
maintaining the Ambulance Dispatch Centre). Fourthly, developments relating to the dispatch centre of the
future may not affect the integration of the Ambulance Dispatch Centre within the chain of acute care. Finally,
it is essential that the white column can participate in setting up multiple processes and that the director of the
Regional Ambulance Service has control over his mono-disciplinary dispatch centre processes as well as over
staff and resources.
The common starting points for this transition towards to the dispatch centre of the future and the path
taken to make this a reality will be laid down in a Transition Agreement on the Dispatch Centre of the Future
[Transitieakkoord meldkamer van de toekomst] and signed by the parties concerned. Independent data
and pilots will be used to assess the effects of multidisciplinary intake so that the scope of the request by a
multidisciplinary operator centralist can be determined in greater detail. Within eighteen months after the
transition agreement has been signed, it must be clear how intake, extended intake and dispatch collectively
ensure that emergency requests are handled properly. It is important to clarify the effect of multidisciplinary
58
and mono-disciplinary requests. The ambulance care sector also wishes to create opportunities during the
coming period for setting up pilots in the Ambulance Dispatch Centre, with or without the cooperation of chain
partners in order to continue improving the provision of (acute) care. The conditions for these pilots will be
jointly specified by the sector.
2.3
Cooperation within the chain
Working and thinking in care chains provides a greater choice in treatment for care requesters, a more
job-specific approach and more extensive cooperation between chain partners. The development of a triage
method for the acute care chain is a concrete example of cooperation within the chain. Within the trauma
region, Regional Acute Care Consultations (ROAZ) are also responsible for ensuring the continuity of acute care
provision. This will ultimately lead to chain agreements on the specific content of available care across the chain
and the responsibilities of various parties. Transparency, optimal communication and information exchange,
with clients privacy being guaranteed, are also important themes that chain partners (must) agree on. Finally,
the joint initiation and implementation of scientific research is a key development in cooperation within the
chain. The Dutch Government has stimulated this through research programmes, but practitioners in the field
are also increasingly being called on to take the initiative. The ambulance sector has responded to this call by
starting development on a research agenda in cooperation with the chain partners.
Developments in quality
3.1
Quality policy
Several developments are also evident within the quality policy of care institutions, which are influenced by
government choices. These developments focus on the following priorities:
making quality visible and measurable;
increasing the influence of clients;
making care safer.
Making quality visible and measurable

The performances of institutions and the experiences of clients must be compared in order to properly assess
the quality of care. That is possible if all care sectors provide measurement points (indicators). Indicators are
being developed and made openly accessible in various ways. Care institutions publish their information on
websites such as KiesBeter.nl, a public website featuring information about health, care services and health
insurance. This process is supervised and managed by the Ministry of Health, Welfare and Sport and the
Healthcare Inspectorate. Institutions will be increasingly obliged to measure care quality using quality indicators
and publish the results. This obligation has been applicable to all mental healthcare services and nursing,
homecare and convalescent institutions as well as hospitals since 2010. A similar line will also be identified
for ambulance care. The benchmark, which is part of the Interim Ambulance Care Act, will also contain quality
indicators, for example. The sector itself wants to undertake the development of quality indicators. Ambulance
care performance has so far only been expressed in planning and logistical standards. The sector wants to
underpin the quality of care with more substantive indicators. Since 2013, the Netherlands Care Institute
[Zorginstituut Nederland] has been stimulating the development of standards and indicators within the care
sector. This institute takes the initiative if parties active in the field fail to do so.
Increasing the influence of clients

Clients must be able to exert more influence on available care. The Dutch Government wants to enable this by
offering accessible information, improving the legal position of clients and making additional funds available
to interest groups. There are numerous laws that provide for the rights of clients. The Dutch Government
59
intends to entrench these rights in a new law called the Patients Rights (Care Sector) Act [Wet clintenrechten
zorg (Wcz)]. The purpose of this act is to strengthen and clarify the clients legal position. The underlying idea
is that the inclusion of rules on the relationship between the care provider in a single statutory regulation
will help harmonise the rights and obligations of both parties more effectively. Although it is unclear whether
this proposal will actually be realised, the train of thought that clients play a key role in the provision of
care through freedom of choice and participation is acquiring greater form and content. It is and remains a
challenge with ambulance care to involve patients more actively in the provision of care. Despite this, Regional
Ambulance Services are not shying away from the challenge and are continuing to look for opportunities.
Examples of this are the development of the patient card within the patient safety programme and the
development of a Consumer Quality index for ambulance care.
Making care safer

Minimising avoidable, accidental injury to patients is crucially important to the Dutch Government. Various
sectors have therefore introduced patient safety programmes over the past few years. Such a programme
has also been implemented within the ambulance care sector. The programmes are based on the personal
responsibility of care institutions for the implementation of patient safety. Patient safety does not end when
a programme finishes. It is important that patient safety be embedded within the organisation in such a way
that it continues to develop. The challenge for the sectors will also be the fact that cross-connections are being
sought though chain projects.
3.2
Scientific research
In the pursuit of continuously improving the quality of care provision, it is important that care standards
and care-related guidelines are evaluated methodically and developed and amended on the basis of the
latest insights. Scientific research is used for this purpose. This especially applies to ambulance care as well,
where care providers work with professional, national standards and guidelines. The sector acknowledges
the importance of scientific research for the further (substantive) development of ambulance care and is
increasingly taking the initiative in this regard. New care professionals such as the nurse specialist play an
important role here. Partnerships with research institutes and care chain partners are being sought on a
national and regional level in order to develop evidence-based guidelines and protocols, which can be used to
provide optimal care. A research agenda for ambulance care, which the sector is currently working on together
with chain partners and other stakeholders, must support this development.
4 Developments in nursing professional practice and

education
4.1
Review of the occupational structure
The need to respond to societys changing demands for care with greater speed and flexibility has given rise
to a new occupational structure for nursing. This structure only contains the occupational levels of nurse and
nurse specialist. In addition to this vertical classification into two areas, there is also a horizontal, job-specific
classification into sub-areas: preventive care, acute care, intensive care and chronic care. In each sub-area a
distinction is made between the nature of the condition: somatic, mental and/or behavioural. This results
in nursing care clusters. Further differentiation (ambulance care) is possible for each cluster. The horizontal
classification makes a clear distinction between generic competencies within a sub-area (acute care) and
specific competencies for differentiation (ambulance care). The new structure increases the deployability and
flexibility of nurses within a sub-area, and stimulates chain thinking.
60
4.2
Task reallocation
Another development is the reallocation of tasks and the deployment of a new type of professional (not a
doctor) who is authorised to perform limited medical tasks. This has resulted in several new positions within
the healthcare sector, such as the nurse specialist (formerly nurse practitioner) and the physician assistant
(PA). The nurse specialist performs tasks relating to cure and care: medical and nursing tasks are combined.
In the new classification for nursing professions, the nurse specialist falls under Section 14 of the Individual
Healthcare Professions Act. The title of nurse specialist is therefore protected, which means that nurse
specialists are independently authorised to diagnose and perform a number of reserved procedures on their
own. Examples of this include carrying out minor surgical interventions and prescribing medication. In addition
to independent, medical tasks, the nurse specialist plays a role in innovation and applied scientific research.
The PA supports a doctor during clinical work and is therefore primarily active in medical patient care. The
ambulance sector will have to focus on how to deploy these new positions within the Regional Ambulance
Service. At Regional Ambulance Service level, initiatives relating to this theme are already being developed, such
as the deployment of the nurse specialist as a rapid responder, within the partnership with general practitioners,
as a consultant for fellow ambulance nurses and in research activities.
4.3
Bachelors Degree Programme in Medical Assistance
Another development in line with the one mentioned above is the Bachelors Degree Programme for Medical
Assistance [Bacheloropleiding Medische Hulpverlening (BMH)]. The programmes profile is based on a solid
medical foundation linked to practice-based specialisations. The intention is that this study programme will
supplement the existing in-service training system for the positions and professions concerned. It distinguishes
between the following specialisations for the time being: ambulance care provider, emergency care provider,
triage specialist and anaesthesiology assistant. The programmes first students started in 2010 and its first
graduates are expected in 2014. The ambulance sector is open to new ways of recruitment for the provision of
ambulance care. It is important, however, that a new position such as the Bachelors Degree Programme for
Medical Assistance be legally safeguarded (in the Individual Healthcare Professions Act). Furthermore, this
programme must be able to independently provide ambulance care in the broadest sense.
4.4
Quality of professional practice, professional development and registration
The Individual Healthcare Professions Act sets out minimum requirements for the quality of professional
practice. The professional must have the required training in order to be registered. The professional will then
have to demonstrate every five years that he or she has worked a minimum number of hours (quantitative
requirement). Registration and re-registration occurs within the register maintained under the Individual
Healthcare Professions Act and is mandatory. But work experience alone is not enough to help patients
and clients in a professional manner and guarantee quality. Nurses and carers must actively work on their
professional development to keep abreast of the latest developments within their profession. This is supported
at national level from professional associations, united within the Dutch Nurses and Carers Association
[Verpleegkundigen & Verzorgenden Nederland (V&VN)], using the Quality Register V&V [Kwaliteitsregister V&V].
This quality register enables (specialist) nurses to maintain their expertise in an demonstrable and transparent
manner by taking accredited training courses and allowing these to be registered. Since June 2009, areas of
expertise have been added to the Quality Register V&V in phases. Ambulance care is one of these areas of
expertise. Nurse specialists have their own, statutory quality register.
61
Labour market trends
5.1
Labour market policy
The growing demand for care and imminent shortage of personnel will compel the care sector to take further
steps within the labour market in the near future. Various studies from 2010 reveal that the care sector will
require more than 400,000 additional staff over the following fifteen to twenty years if the policy remains
unchanged. In addition to this extra demand for labour, there will also be a need for replacements. The number
of ageing care staff and the retirement of elderly staff will increase. All of this means that care will continue
placing a huge demand on the labour market while the ageing and declining population will reduce the number
of available employees in this labour market in the near future. The existing labour market position for care
staff is generally favourable, but meeting the demand for care in the future will be highly challenging. There is a
risk of labour market shortages due to these developments, even in an attractive sector such as the ambulance
sector. The shortages are expected primarily among nurses and dispatch centre operator nurses. Less
information about drivers (and other positions) is available, but no problems are apparent at this moment.
Nevertheless, the ambulance sector also faces the challenge of having enough, qualified and healthy staff to
cope with the demand for care. This requires an active labour market policy at national and regional level. At
sector level, labour market policy is being developed to provide a sufficient supply of labour for nurses now and
in the future. This is in addition to what is already happening within the various Regional Ambulance Services in
this area. The sectors strategic policy focuses on several aspects:
stimulating recruitment;
retaining and promoting staff.
5.2
5.3
Retention and promotion of staff
Themes such as good employership and sustainable deployment are important for retaining existing staff for
the care sector. This entails the efficient and effective deployment of staff and keeping them employed up to an
increasingly higher age, within or outside the sector itself. The following activities in this area are more concrete:
sustainable deployment: focus on the sustainable deployment of staff and work together with the chain in this
regard;
mobility in the sector: stimulate mobility in the acute care sector through career guidance policy, the creation
of career paths across sector boundaries and the exchange of staff within the care sector;
benchmark for staff commitment (using an employee satisfaction survey, for example).
Magnet institutions is a notable development within labour market policy.
These institutions have several (organisational) features that make them more appealing to staff, increase
job satisfaction and also enhance the quality of care. The Federation of Patients and Consumer Organisations
in the Netherlands [Nederlandse Patinten Consumenten Federatie (NPCF)] and the Dutch Nurses and Carers
Association [V&VN] are busy adapting this American concept of magnet hospitals to the situation in the
Netherlands.
Stimulating recruitment
Job vacancies in the ambulance sector are filled relatively easily at the moment. However, this does differ from
region to region. That is why it is important to stimulate the recruitment of students within the care sector and
of staff into the ambulance sector. The sectors policy focuses on the following activities:
labour market communication: promote the ambulance sector on the labour market and align it with the
cross-sector labour market agenda;
expand recruitment opportunities: develop new recruitment processes for specialist nurses and nurse
specialists in cooperation with other chain partners and examine lateral recruitment (with the help of
Accreditation of Prior Learning policy);
job differentiation: formulate a policy for job differentiation and possible task reallocation.
This can increase the career prospects of care providers and make the profession more appealing to them and
new students.
62
63
Composition of working group for the Policy Document

on Responsible Ambulance care
Chairperson:
Piet Huizinga, RAV IJsselland and Ambulance Oost (on behalf of Ambulancezorg Nederland)
Members:
Ms M. Biekart, AmbulanceZorg Rotterdam-Rijnmond (on behalf of the Dutch Association of Medical Managers
[Nederlandse Vereniging van Medisch Managers] Ambulancezorg)
Ms I. Bolt-Riepma, UMCG Ambulancezorg (on behalf of V&VN Ambulancezorg)
Mr H. Gubbels, RAV South Limburg (on behalf of V&VN Ambulancezorg)
Mr R. Meppelder, Connexxion Ambulancezorg (on behalf of the Dutch Association of Medical Managers
[Nederlandse Vereniging van Medisch Managers] Ambulancezorg)
Mr J. van Rhijn, RAV Central Holland (on behalf of Ambulancezorg Nederland)
Mr H. van der Werff, RAV Groningen (on behalf of Ambulancezorg Nederland)
Support:
Ms M. Hoogeveen, Ambulancezorg Nederland, secretary
Ms L. Prins, Ambulancezorg Nederland, project support
List of abbreviations
ALS
AWBZ
Advanced Life Support

Exceptional Medical Expenses Act [Algemene wet bijzondere ziektekosten]
BSA
Basic Set Ambulance Care [Basisset Ambulancezorgezorg]
BOPZ Psychiatric Hospitals (Compulsory Admissions) Act [Wet bijzondere opneming in psychiatrische
ziekenhuizen]
BSN
Citizen Service Number [Burger Service Nummer]
BMH
Bachelors Degree Programme for Medical Assistance [Bacheloropleiding Medische Hulpverlening]
CPA
CQi
Central Post for Ambulance Transport [Centrale Post Ambulancevervoer]

Consumer Quality index
EVC
Accreditation of Prior Learning [Erkenning van Verworven Competenties]
GGZ
Mental Healthcare Services [Geestelijke Gezondheidszorg]
GHOR Medical Assistance during Accidents and Disasters [Geneeskundige Hulpverlening bij Ongevallen en
Rampen]
ICN
IGZ
International Council of Nurses

Healthcare Inspectorate [Inspectie voor de Gezondheidszorg]
KWZ
Care Institutions (Quality) Act [Kwaliteitswet zorginstellingen]
MI
MICU
NICU
MKA
MMA
MMT
Management Information
Mobile Intensive Care Unit
Neonatal Intensive Care Unit
Ambulance Dispatch Centre [Meldkamer Ambulancezorg]
Medical Manager Ambulance Care [Medisch Manager Ambulancezorg]
Mobile Medical Team
OGS
Sector Guideline for Visual and Audio Signals [Brancherichtlijn Optische en Geluidssignalen]
OTO Education, Training and Practice [Opleiden, Trainen en Oefenen]
PA
PICU
Physician Assistant
Paediatric Intensive Care Unit
RAV
Regional Ambulance Service [Regionale Ambulancevoorziening]
RI&E
Risk Inventory and Evaluation
RIVM National Institute for Public Health and the Environment [Rijksinstituut voor Volksgezondheid en Milieu]
RVV
Dutch Traffic Code [Reglement Verkeersregels en Verkeerstekens]
ROAZ Regional Acute Care Consultations [Regionaal Overleg Acute Zorgketen]
SHE
64
Policy Document on Responsible Ambulance Care | appendix working group
Emergency assistance [Spoedeisende Hulpverlening]
Policy Document on Responsible Ambulance Care | list of abbreviations
65
Twaz
Interim Ambulance Care Act [Tijdelijke wet ambulancezorg]
UBK
Uniform Glossary of Ambulance Care Terms [Uniform Begrippenkader Ambulancezorg]
VIM
VWS
Safe Incident Reporting [Veilig Incidenten Melden]

Ministry of Health, Welfare and Sport [Ministerie van Volksgezondheid Welzijn en Sport]
WAV
Ambulance Transport Act [Wet ambulancevervoer]
WAZ
Ambulance Care Act [Wet ambulancezorg]
WBP
Personal Data Protection Act [Wet bescherming persoonsgegevens]
Wcz
Patients Rights (Care Sector) Act [Wet clintenrechten zorg]
Wet BIG Individual Healthcare Professions Act [Wet op de Beroepen in de Individuele Gezondheidszorg]
WMCZ Participation (Clients of Care Institutions) Act [Medezeggenschap Clinten Zorginstellingen]
WGBO Medical Treatment Contracts Act [Wet op de Geneeskundige Behandelingsovereenkomst]
Wghor Medical Assistance during Accidents and Disasters Act [Geneeskundige Hulpverlening bij Ongevallen
en Rampen]
WKCZ Clients Right of Complaint (Healthcare Sector) Act [Wet Klachtrecht Clinten Zorgsector]
WTZi
Care Institutions (Accreditation) Act [Wet Toelating Zorginstellingen]
Wvr
Security Regions Act [Wet veiligheidsregios]
WvW
Road Traffic Act [Wegenverkeerswet]
ZvW
Care Insurance Act [Zorgverzekeringswet]
Reference list 2013 Policy Document on Responsible

Ambulance Care
Chapter 1
Ambulance care: mobile link in the (acute) care chain
1.1 Sector report Ambulance Services in 2011 [Ambulances-in-zicht 2011]

Ambulancezorg Nederland, 2012

Interim Ambulance Care Act [Tijdelijke wet ambulancezorg], sections 4 and 6

Ministry of Health, Welfare and Sport [Ministerie van Volksgezondheid Welzijn en Sport], 2012


Ministry of Security and Justice [Ministerie van Veiligheid en Justitie], 2010
1.2 Uniform Glossary of Ambulance Care Terms [Uniform Begrippenkader Ambulancezorg]



Ministry of Health, Welfare and Sport, 2012
1.4 Area of expertise and attainment targets for an ambulance nurse [Deskundigheidsgebied en eindtermen ambulanceverpleegkundige]

Netherlands Board of Hospital Education [College Zorgopleidingen], 2012
Chapter 2
Responsible ambulance care; statutory framework
2.1

2.2

2.3

Healthcare Institutions Quality Act [Kwaliteitswet Zorginstellingen]

Healthcare Institutions Quality Act [Kwaliteitswet Zorginstellingen]
Brochure from Ministry of Health, Welfare and Sport, 1997
Certification system for ambulance care [Certificatieschema ambulancezorg]
Foundation for Harmonisation of Quality Assessment in the Care Sector, 2011
Healthcare Institutions Quality Act
Chapter 3
Responsible ambulance care: the cornerstones
3.1
Rights of patients and clients in the healthcare sector

www.rijksoverheid.nl
3.1 Programme Seven Rights for the Client in the Healthcare Sector: Investing in the Care Relationship [Zeven rechten voor de clint in de zorg: Investeren in de zorgrelatie]

Chapter 4
4.2.1 Reference Framework for Distribution and Availability [Referentiekader Spreiding en Beschikbaarheid Ambulancezorg] 2008
National Institute for Public Health and the Environment [Rijksinstituut voor Volksgezondheid en
Milieu] 2008
4.2.2

Policy Memorandum and National Covenant for Dynamic Ambulance Management [Beleidsnotitie en landelijk convenant Dynamisch Ambulancemanagement]

66
Policy Document on Responsible Ambulance Care | list of abbreviations
Policy Document on Responsible Ambulance Care | reference list 2013
67
4.2.3 Cross-Border Communication Directive [Richtlijn grensoverschrijdende communicatie]

Regional Numbering C2000 and Cross-Border Ambulance Care [Regionummering C2000 en
grensoverschrijdende ambulancezorg]

4.3

Triage System Schedule of Requirements for Ambulance Dispatch Centres [Plan van eisen MKAtriagesysteem]
Ambulancezorg Nederland and Dutch Association of Medical Managers [Nederlandse Vereniging van
Medisch Managers]

4.4.1 Uniform Glossary of Ambulance Care Terms [Uniform Begrippenkader Ambulancezorg]

Sector Guideline for Visual and Audio Signals [Brancherichtlijn optische en geluidssignalen] in case
of emergency medical assistance

Ambulancezorg Nederland and V&VN Ambulancezorg, 2009
4.5
Interim Ambulance Care Act Decree [Tijdelijke wet ambulancezorg], Section 8

4.5.1
Quality Framework for Ambulance Care [Kwaliteitskader Zorgambulance]

Ambulancezorg Nederland and Dutch Association of Medical Managers

4.5.2 First Responder Policy Document and National Directive [Beleidsdocument en richtlijn first aid
and rapid responder]

4.5.3
Emergency IC Transport [Spoed IC-transport]

Government Gazette [Staatscourant] no. 211, 31 October 2012


4.5.4
MMT Deployment and Cancellation Criteria [MMT inzet- en cancelcriteria]

National Network for Acute Care [Landelijk Netwerk Acute zorg and Ambulancezorg Nederland,
2011]
4.5.5 First Responder Policy Document and National Directive [Beleidsdocument en richtlijn first and
rapid responder]

4.5.6 Operator Deployment within the Ambulance Dispatch Centre [Inzet centralist op de Meldkamer
Ambulancezorg]

Chapter 5
Transparency
5.2

5.4


Basic Set Ambulance Care [Basisset Ambulancezorgezorg]
Management Information Core Set [Kernset managementinformatie]
68
Process Description of Ambulance Information Policy [Procesbeschrijving ambulance-informatiebeleid]


Management Information Manual [Handboek Managementinformatie]


National Institute for Public Health and the Environment

www.rivm.nl
5.5
Healthcare Institutions Quality Act [Kwaliteitswet zorginstellingen]


Healthcare Institutions Admission Act [Wet toelating zorginstellingen]


Interim Ambulance Care Act [Tijdelijke wet ambulancezorg], sections 9 and 10

5.6
Management Information Manual


Process Description of Ambulance Information Policy

5.7
Certification System for Ambulance Care

Chapter 6
6.1 Guideline for Nurses and Carers: Individual Professionalism [Handreiking voor verpleegkundigen
en verzorgenden: individuele professionaliteit]

Nurses and Carers Netherlands [Verpleegkundigen en Verzorgenden Nederland], June 2012
National Professional Code of Conduct for Nurses and Carers [Nationale Beroepscode van

verpleegkundigen en verzorgenden]

Nurses and Carers Netherlands, 2007
6.2
CanMED framework

http://knmg.artsennet.nl/Opleiding-en-Registratie/Modern-opleiden/CanMEDS.htm
6.2.1 Triage System Schedule of Requirements for Ambulance Dispatch Centres [Plan van eisen
MKA-triagesysteem]

Ambulancezorg Nederland and Dutch Association of Medical Managers [Nederlandse Vereniging van
Medisch Managers]


Ambulance Care Training Policy [Opleidingsbeleid ambulancezorg]

www.ambulancezorg.nl/werken en leren

Manual for Accreditation Request Educational Programmes CZO

Netherlands Board of Hospital Education [College Zorgopleidingen], 2010
6.2.2 Individual Healthcare Professions Act [Wet Beroepen op de Individuele Gezondheidszorg]

Decree 524 on Functional Independence within the Context of the Individual Healthcare

Professions Act [Besluit 524 functionele zelfstandigheid in het kader van de Wet BIG]

Area of Expertise and Attainment Targets for Ambulance Nurse Educational Programme
[Deskundigheidsgebied en eindtermen ambulanceverpleegkundige]

Netherlands Board of Hospital Education, 2012
69
Attainment Targets for Subject-Related Activities for the Structure of the Ambulance Nurse
Educational Programme [Eindtermen van het vakinhoudelijk handelen voor de inrichting van de
opleiding tot ambulanceverpleegkundige]

Dutch Association of Medical Managers and Ambulancezorg Nederland 2012

Ambulance Care Training Policy

www.ambulancezorg.nl/werken en leren

Manual for Accreditation Request Educational Programmes CZO


Area of Expertise and Attainment Targets for an Ambulance Nurse

6.2.3

www.ambulancezorg.nl/academievoorambulancezorg
6.2.5


Individual Healthcare Professions Act

Former Ministry of Welfare, Public health and Culture and the Ministry of Justice, 1993
Decree on Temporary Independence of Nursing Specialists [Besluit tijdelijke zelfstandigheid
verpleegkundig specialisten]


Quality Framework for Ambulance Care [Kwaliteitskader Zorgambulance]

Ambulancezorg Nederland and Dutch Association of Medical Managers Ambulancezorg

and V&VN Ambulancezorg, 2012
6.3.1
Interim Ambulance Care Act [Tijdelijke wet ambulancezorg], section 12



Former Ministry of Welfare, Public Health and Culture and the Ministry of Justice, 1993


www.ambulancezorg.nl/werkenenleren
Area of Expertise and Attainment Targets for Ambulance Nurse Educational Programme
[Deskundigheidsgebied en eindtermen ambulanceverpleegkundige]

Quality Registry for Nurses and Carers [Kwaliteitsregister Verpleegkundigen en Verzorgenden]

www.kwaliteitsregistervenvn.nl
6.3.2

Decree 524 on Functional Independence within the Context of the Individual Healthcare Professions Act

Decree on Periodic Registration within the Context of the Individual Healthcare Professions Act
[Besluit periodieke registratie Wet BIG]


Ministerial Decree on Periodic Registration [Ministeriele regeling periodieke registratie]

Description of the Medical Management Job Structure [Beschrijving functiegebied Medisch Management]

70
Division of Responsibilities within Ambulance Care [Verantwoordelijkheidsverdeling binnen de

ambulancezorg]

Ambulancezorg Nederland, Ambulancezorg Professional Association and Stichting LAMP, 2005
6.4
National Ambulance Care Protocol 7.2 [Landelijk Protocol Ambulancezorg]

Triage System Schedule of Requirements for Ambulance Dispatch Centres [Plan van eisen MKAtriagesysteem]



Medical Treatment Act [Wet op de Geneeskundige Behandelingsovereenkomst]




Status of Protocols and Guidelines [Status van protocollen en richtlijnen]

Ambulancezorg Nederland, Ambulancezorg Professional Association and Stichting LAMP, 2005

Protocol Development Procedure [Procedure protocolontwikkeling]



6.5
NEN standard 1789 and 1865

Netherlands Standardisation Institute [Nederlands Normalisatie Instituut], 2007

Working Conditions Act [Arbeidsomstandighedenwet]

Ministry of Social Affairs and Employment [Ministerie van Sociale Zaken en Werkgelegenheid], 2007

Health and Safety Catalogue for Ambulance Care [Arbocatalogus Ambulancezorg]

Social Partners in the Ambulance Care Sector [Sociale partners in de sector ambulancezorg]



National Ambulance Care Protocol 7.2


NEN standards

www.nen.nl
National Numbering Plan [Nationaal Nummerplan ]for Ambulancezorg Nederland, version 5.1

Policy Memorandum and National Covenant for Dynamic Ambulance Management [Beleidsnotitie en landelijk convenant Dynamisch Ambulancemanagement]

6.6
Description of the Medical Management Job Structure




Medical Treatment Act

6.7


Ethical Assessment of Research Proposals [Ethische toetsing van onderzoeksvoorstellen]

www.nvmo.nl
71
6.8.1 Programme for Patient Safety and Ambulance Care [Programma patintveiligheid Ambulancezorg] 2010-2013



Interim Ambulance Care Act Decree [Tijdelijke wet ambulancezorg], Section 8

Administrative Agreements on Patient Safety and Ambulance Care [Bestuurlijke afspraken
patintveiligheid ambulancezorg]



Hygiene Guidelines for Ambulance Services [Hyginerichtlijnen voor de ambulancediensten]

Working Group for Infection Prevention [Werkgroep Infectiepreventie], 2012
Sector Guideline for Visual and Audio Signals [Brancherichtlijn optische en geluidssignalen] in case
of emergency medical assistance

Directive on Incident Management on Rush-Hour and Buffer Lanes/First Safety-Related
Measures During Incidents [Richtlijn Incidentmanagement bij spits- en bufferstroken/eerste
veiligheidsmaatregelen bij incidenten]

Ministry of Transport, Public Works and Water Management [Ministerie van Verkeer en Waterstaat],
2003


6.8.2
Working Conditions Act [Arbeidsomstandighedenwet]

Ministry of Social Affairs and Employment [Ministerie van Sociale Zaken en Werkgelegenheid], 2007

Health and Safety Catalogue for Ambulance Care

Social Partners in the Ambulance Care Sector

NEN standard 1789 and 1865

Netherlands Standardisation Institute, 2007
Practical Guidelines for Physical Workload in Ambulance Care [Praktijkrichtlijnen fysieke belasting
ambulancezorg]

LOCOmotion, commissioned by SOVAM and BBC-A, 2005

Practical Guidelines for Physical Workload in Ambulance Care

Smits and Beerends, commissioned by SOVAM and BBC-A, 2006

Measures During Incidents

Ministry of Transport, Public Works and Water Management, 2003

Sector Guideline for Visual and Audio Signals in case of emergency medical assistance


Driving Guidelines for Ambulance Care [Rijtechnische richtlijnen ambulancezorg]



6.9


Administrative Agreements on Patient Safety and Ambulance Care


Healthcare Institutions Quality Act, section 14a

72
Chapter 7
7.2
Medical Treatment Act [Wet op de geneeskundige behandelingsovereenkomst]


verpleegkundigen en verzorgenden]

Nurses and Carers in the Netherlands 2007
7.3
Medical Treatment Act


National Ambulance Care Protocol [Landelijk Protocol Ambulancezorg ] 7.2

7.4


Personal Data Protection Act [Wet bescherming persoonsgegevens]

Ministry of Justice [Ministerie van Justitie], 2001


Directive on Data Processing Ambulance Dispatch Centre [Richtlijn gegevensverwerking

meldkamer ambulancezorg]


7.5
National Professional Code of Conduct for Nurses and Carers

Social Media Guideline for Nurses and Carers [Handreiking Sociale Media voor verpleegkundigen
en verzorgenden]

7.6


Personal Data Protection Act

Ministry of Justice, 2001


Guideline for Professional Secrecy and Data Exchange between Ambulance Care, Police and
Public Prosecution Service [Richtlijn beroepsgeheim en uitwisseling gegevens tussen ambulancezorg,
politie en openbaar ministerie]


Guideline for Processing of Noise Data in the Ambulance Dispatch Centre [Verwerking Geluidsgegevens in de MKA]


Chapter 8
8.1.1 Interim Ambulance Care Act Decree [Regeling Tijdelijke wet ambulancezorg], Section 11

Guideline for Data Exchange Between General Practitioner- Ambulance Service-Emergency
Care [Richtlijn gegevensuitwisseling huisarts-ambulancedienst-spoedeisende hulp] Ambulancezorg
Nederland, Dutch College of General Practitioners [Nederlands Huisartsen Genootschap], (National
73
ICT Institute for Healthcare [Nationaal ICT Instituut in de Zorg], Netherlands Society of Emergency
Physicians [Nederlandse Vereniging van Spoedeisende Hulp Artsen], 2009

Guideline for Ambulance Care on Water [Richtlijn ambulancezorg op het Water]

Model Covenant between Ambulancezorg Nederland and the Ambulance Care and Medical
Assistance in Accidents and Disasters Organisation [Model convenant ambulancezorg en GHOR]

Ambulancezorg Nederland, GHOR Nederland, 2010
Measures During Incidents [Richtlijn Incidentmanagement bij spits- en bufferstroken /richtlijn
eerste veiligheidsmaatregelen bij incidenten]

Ministry of Transport, Public Works and Water Management, 2003
First Responder Policy Document and National Directive [Beleidsnotitie en landelijke richtlijn First
and Rapid responder]

8.1.2

Memorandum and Covenant on Regional Acute Care Consultations [Notitie en Convenant

Regionaal Overleg Acute Ketenzorg]


Interim Ambulance Care Act Decree [Regeling Tijdelijke wet ambulancezorg], Section 10

8.1.3

Ministry of Security and Justice, 2010

GHOR Knowledge Publications

GHOR Nederland, 2012

Interim Ambulance Care Act Decree [Tijdelijke wet ambulancezorg], Sections 17, 18, 20 and 21

National Covenant between Ambulancezorg Nederland and the Medical Assistance in

Accidents and Disasters Organisation [Landelijk convenant ambulancezorg en GHOR]

Ambulancezorg Nederland, GHOR Nederland, 2011
National Covenant on Education, Training and Practice [Landelijk Convenant Opleiden, Trainen
en Oefenen]

Ambulancezorg Nederland, GHOR Nederland, GGD Nederland, Dutch Association of Out-OfHours Clinics [Vereniging Huisartsenposten Nederland], Dutch Association of Hospitals [Nederlandse
Vereniging van Ziekenhuizen], National Association of Trauma Centres [Landelijke Vereniging van
Traumacentra], National Network for Acute Care [Landelijke Netwerk Acute Zorg], National Association of General Practitioners [Landelijke HuisartsenVereniging], Federation of Dutch Academic
Medical Centres [Nederlandse Federatie van Universitair Medische Centra], 2009
National Policy Framework for Education, Training and Practice [Landelijk Beleidskader OTO]

Ambulancezorg Nederland, GHOR Nederland, GGD Nederland, Dutch Association of Out-OfHours Clinics [Vereniging Huisartsenposten Nederland], Dutch Association of Hospitals [Nederlandse
Vereniging van Ziekenhuizen], National Network for Acute Care [Landelijke Netwerk Acute Zorg],
National Association of General Practitioners [Landelijke HuisartsenVereniging], Federation of Dutch
Academic Medical Centres [Nederlandse Federatie van Universitair Medische Centra], 2012
8.2 Model Guideline and Model Authorisation Information Material for Access to E-Speed dossier
[Modelrichtlijn en model voorlichtingsmateriaal autorisatie voor toegang tot het e-spoed dossier],

version 1.0
74
Ambulancezorg Nederland, Royal Dutch Medical Association [Koninklijke Nederlandse Maatschappij ter bevordering der Geneeskunst], Dutch College of General Practitioners, National ICT Institute
for Healthcare, Dutch Patients and Consumers Federation [Nederlandse Patinten Consumenten
Federatie], 2007


Guideline for Data Exchange between General Practitioners- Ambulance Service-Emergency
Care [Richtlijn gegevensuitwisseling huisarts-ambulancedienst-spoedeisende hulp] Ambulancezorg
Nederland, Nederlands Huisartsen Genootschap, Nationaal ICT Instituut in de Zorg, Nederlandse
Vereniging van Spoedeisende Hulp Artsen, 2009
Chapter 9
9.1

9.2

Clients Right of Complaint (Healthcare Sector) Act [Wet klachtrecht clinten zorgsector]
Healthcare Institutions Quality Act [Kwaliteitswet zorginstellingen]
Chapter 10
10.1 Participation of Clients of Care Institutions Act [Wet medezeggenschap clinten zorginstellingen]

10.2

Appendix 2 Professional Code of Conduct for Ambulance Care


Verpleegkundigen en Verzorgenden]

Nurses and Carers in the Netherlands, 2007
Appendix 3
A sector in development

Developments in the care sector
2.1
Name and Utilise Population Decline [Bevolkingskrimp benoemen en benutten]

Social and Economic Council [SER], 2011
2.2
Letter from Minister of Security and Justice regarding Ambulance Care Dispatch Centre

Ministry of Security and Justice, February 2012

Letter from Minister of Health, Welfare and Sport regarding Ambulance Care Dispatch Centre

Ministry of Health, Welfare and Sport, March 2012

Position Paper on Ambulance Care Dispatch Centre


Explanation to Position Paper on Ambulance Care Dispatch Centre

Policy Agenda for Out-Of-Hours Clinics+Regional Ambulance Service [Beleidsagenda HAP+RAV]
2013-2014

Ambulancezorg Nederland and Dutch Association of Out-Of-Hours Clinics, 2012
2.3
Netherlands Triage System

www.nederlandstriagesysteem.nl
75
Memorandum and Covenant on Regional Acute Care Consultations [Notitie en Convenant

Regionaal Overleg Acute Ketenzorg]


E-Speed Programme

www.nictiz.nl

Speed Care Programme

www.zonmw.nl/spoedzorg

Policy Agenda for Out-Of-Hours Clinics+Regional Ambulance Service 2013-2014

Ambulancezorg Nederland and Dutch Association of Out-Of-Hours Clinics [Vereniging Huisartsenposten Nederland], 2012

Developments in quality
3.1
Aiming for Quality [Koersen op kwaliteit]




Government Policy on Quality

www.overheid.nl

Quality Institute [Kwaliteitsinstituut]

www.cvz.nl

Safety Management System Care [VMS Zorg]

www.vmszorg.nl

GGZ Patient Safety Programme

www.ggznederland.nl/patientveiligheid
Patient Safety Programme Ambulance Care [Patintveiligheidsprogramma ambulancezorg],

2010-2013
Ambulancezorg Nederland and Dutch Association of Medical Managers [Nederlandse Vereniging

van Medisch Managers]

Ambulancezorg and V&VN Ambulancezorg, 2010

Developments in nursing professional practice and education
4.2
Competent = Qualified [Bekwaam is bevoegd]

Council for Public Health and Health Care [Raad voor de Volksgezondheid en Zorg], 2011
4.3 Bachelors Degree Programme in Medical Assistance (Bachelor of Health)

HAN University of Applied Sciences, Faculty of Health and Social Studies, 2008
4.4
Quality Registry for Nurses and Carers [Kwaliteitsregister Verpleegkundigen en Verzorgenden]

www.kwaliteitsregistervenv.nl

Labour market trends
5.1
Healthcare Innovation Platform [Zorginnovatieplatform]

Care for People, People for Care [Zorg voor mensen, mensen voor de zorg], 2009
Labour Market Policy for the Care Sector Towards 2025 [Arbeidsmarktbeleid voor de zorgsector
richting 2025]

Prismant, 2010
The Long-Term Demand For and Availability of Care Personnel [De lange termijn vraag naar en
het aanbod van personeel in de zorg]

H. Erken, P.M. Koot and J. Kuijpers, 2010

Labour Shortages in the Care Sector [Arbeidstekorten in de zorg]
Economisch Statische Berichten 95 (2010) 4598 p. 726 728.
76
Letter to Parliament regarding the Labour Market: Confidence in Professionals [Vertrouwen in

professionals]

Ministry of Health, Welfare and Sport, March 2011
5.2.
Magnet Hospitals: Features [Magneetziekenhuizen: kenmerken]

Dutch Nurses Association (V&VN), 2008
77

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Policy Document on

Responsible Ambulance Care

Version 4.0,February 2013, adopted by:

Policy Document on Responsible Ambulance Care | foreword

Policy Document on Responsible Ambulance Care | foreword

Ambulance care: mobile link in the (acute) care chain

Responsible ambulance care: statutory framework

Responsible ambulance care: the cornerstones

Available and accessible care

The Ambulance Dispatch Centre: gateway to ambulance care

Policy Document on Responsible Ambulance Care | contents

4.5.4 Mobile Medical Team

Handling of complaints and client experience

10 Participation and good governance

Clarity for the patient and referrer

10.1 Patient participation

Professionalism, quality and safety

Information, permission, documentation and privacy

Continuity of care and coordination with chain partners

Cooperation with chain partners

Policy Document on Responsible Ambulance Care | contents

Appendix 1 - Ambulance care statutory framework

Appendix 3 - A sector in development

Reference list 2013

Policy Document on Responsible Ambulance Care | contents

Policy Document on Responsible Ambulance Care | guide

Ambulance care: mobile link

Policy Document on Responsible Ambulance Care | chapter 1

1.3 Where does ambulance care begin?

1.2 What is ambulance care?

1.4 Ambulance care as a binding factor

Policy Document on Responsible Ambulance Care | chapter 1

Policy Document on Responsible Ambulance Care | chapter 1

Responsible ambulance care:

Policy Document on Responsible Ambulance Care | chapter 1

Policy Document on Responsible Ambulance Care | chapter 2

2.2.3 Quality system

2.2.4 Quality annual report

2.2 Dutch Care Institutions (Quality) Act

2.2.1 Responsible care

2.2.2 Conscious policy

2.3 Monitoring and enforcement

Policy Document on Responsible Ambulance Care | chapter 2

Policy Document on Responsible Ambulance Care | chapter 2

Responsible ambulance care:

Policy Document on Responsible Ambulance Care | chapter 2

Policy Document on Responsible Ambulance Care | chapter 3

Responsible ambulance care:

3.2 Available and accessible care

Policy Document on Responsible Ambulance Care | chapter 3

3.4 Professional, high quality and safe

Policy Document on Responsible Ambulance Care | chapter 3

3.5 Information, permission, documentation and privacy

3.6 Continuity of care and coordination with chain

Available and accessible care

3.7 Handling of complaints and client experience

3.8 Participation and good governance

Policy Document on Responsible Ambulance Care | chapter 3

Policy Document on Responsible Ambulance Care | chapter 4

4.1 The Ambulance Dispatch Centre: gateway to

4.2 Distribution and availability

4.2.2 Dynamic ambulance management

Policy Document on Responsible Ambulance Care | chapter 4

3.6 Continuity of care and coordination with chain