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MOH STANDARDS FOR EMERGENCY AMBULANCE SERVICE (2014)

These standards are for the reference of agencies operating or intending to

operate an emergency ambulance service.

The standards spell out the minimum requirements which the agency must
comply with when operating an emergency ambulance service.

Contents:

1. Definitions.. 2
2. Emergency Ambulance Service Provider .... 2
3. Emergency Ambulance Service Vehicle 3
4. Emergency Ambulance Service Crew 4
4.1 Composition 4
4.2 Medical Transporter/Ambulance Driver. 4
4.3 Emergency Medical Technician.. 4
4.4 Ambulance Paramedic.. 5
4.5 Ambulance Nurse.. 6
4.6 Ambulance Doctor. 6
5. Ambulance Vehicle Equipment and Medical Equipment 7

APPENDIX 1: Definition of Medical Emergency.... 8

APPENDIX 2: List of Approved Qualifications... 10
APPENDIX 3: List of Medical Equipment for Ambulances... 11

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EMERGENCY AMBULANCE STANDARDS

1. Definitions

1.1 Emergency Ambulance means a conveyance, including

ground, air or sea craft that is used or intended to be used for
transport of Emergency patients.

1.2 Emergency Ambulance Service means a service provided by

Ambulances that is available to the public for the conveyance of
Emergency patients.

1.3 Emergency Ambulance Service Provider or Emergency

Ambulance-SP means any entity that is recognised by MOH to
provide an Ambulance Service.

1.4 Emergency patient means a patient who has or sustains a

medical emergency as defined in Appendix 1. Such patients
include those being conveyed to emergency departments of
hospitals for immediate attention or critically ill patients being
transferred from one hospital to another for continuation of
medical treatment.

2. Emergency Ambulance Service Provider (Emergency Ambulance-

SP)

2.1 All entities that provide or intend to provide the Emergency

Ambulance Service must be recognised as an Emergency
Ambulance-SP by MOH. The Emergency Ambulance-SP must
be a company or a business entity registered with the
Accounting and Corporate Regulatory Authority or a bona fide
registered voluntary or charitable organisation.

2.2 The Emergency Ambulance-SP must have the following to run

the Emergency Ambulance Service:

a. A qualified person (Emergency Medicine specialist or Singapore

Medical Council registered medical practitioner, as approved by
the Director of Medical Services) engaged by the Emergency
Ambulance-SP, to supervise and advise on the patient care
provided and to ensure the required training, competency and
certification of the emergency ambulance staff.
b. A system compatible for communication with the Singapore Civil
Defence Force (SCDF) or other designated medical dispatch
system for ambulances.
c. Written protocols of care for patients transported and a training
programme to ensure the proficiency of ambulance staff in
carrying out these protocols in accordance with such
standards/guidelines issued by the Director of Medical Services.
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d. Ambulance medical equipment and medical supplies as detailed

in section 5.
e. A system for performance monitoring, reporting and evaluation
of the services provided.
f. A medical record system and an ambulance log system (manual
and/or electronic recording system) for purposes of quality
assurance and audit.
g. Safety standards to ensure that patients and the Emergency
Ambulance Service crew are protected from unnecessary risks
as provided under any written law or as directed by the Land
Transport Authority (LTA).

2.3 The Emergency Ambulance-SP shall have in place a system for

infection control, including:

a. Protocols for handling patients with infectious diseases,

including instructions on appropriate action to take in the event
of an exposure to blood or body fluids/substances including
needle-stick injuries and other incidents.
b. Protocols for training and use of Personal Protective Equipment
(PPE) such as N95 mask, hair cover, gloves, gown/apron, face
shield/goggles, disinfectants.
c. Decontamination of vehicles after transport of patients with
infectious diseases, or in event of contamination by body fluids,
and protocols for storage, transportation and disposal of waste
in accordance with any written law or such standards/guidelines
issued by the Director of Medical Services from time to time.
d. Immunisations for vehicle crew as stipulated by MOH for health
care workers.

2.4 The Emergency Ambulance-SP shall be subject to a system of

medical oversight as determined by MOH. This will include an
audit of the Emergency Ambulance-SP as a service, including
equipment audit, provider currency certification, transport record
review and a proficiency assessment of providers.

2.5 All Emergency Ambulances may attend to and ferry non-

emergency patients.

2.6 An Emergency Ambulance can ferry an emergency patient only

if all the Emergency Ambulance Standards are complied with.

3. Emergency Ambulance Service Vehicle

3.1 Each Emergency Ambulance vehicle shall meet such vehicle

specifications as may be prescribed by LTA, including any
requirements for inspection and maintenance to ensure that the
vehicle is fit for its purpose.

3.2 The minimum equipment in each vehicle shall be maintained as

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listed in section 5. Such equipment shall be functional and

effective at all times when the Emergency Ambulance is in
operation.

3.3 Each Emergency Ambulance shall bear the letterings

EMERGENCY AMBULANCE on the front, both sides and
rear of the vehicle.

3.4 The Emergency Ambulance vehicle may use the siren and
beacon lights only when transporting an emergency patient.

4. Emergency Ambulance Service Crew

4.1 Each Emergency Ambulance Service vehicle shall be staffed by

at least a 2-man crew; a 3-man crew is recommended. This
could be:
At least one Medical Transporter/Emergency Medical
Technician (EMT)/Paramedic, with one crew leader who is an
Ambulance Paramedic/Nurse/Doctor or similar combinations.

4.2 Medical Transporter/Ambulance Driver

a. The Medical Transporter shall have the minimum

qualifications/experience as follows:

i. Possess a valid licence to drive the vehicle

ii. Trained in defensive driving and be well aware of the use
of sirens and beacon lights during conveyance of
emergency patients
iii. Be currently certified in Cardio-Pulmonary Resuscitation
(CPR) and Automated External Defibrillation (AED)
usage by a National Resuscitation Council- (NRC-)
accredited agency
iv. Understand the usage of stretchers and able to assist in
the care of and evacuation of a patient/casualty

4.3 Emergency Medical Technician (EMT)

a. The EMT shall be certified through an EMT course, approved by

MOH (see Appendix 2).

b. The EMT shall also be currently certified in Basic Cardiac Life

Support (BCLS) and AED usage by an NRC-accredited agency
and in first aid by an NRC- or a National First Aid Council-
(NFAC-) accredited agency.

c. The EMT shall undergo recertification by agents approved by

MOH at least once every two years.

d. The EMT shall be able to:

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i. Use all equipment on board and be familiar with the

relevant medical protocols.
ii. Use various types of stretchers and body immobilisation
devices.
iii. Perform basic life support on infants, children and adults.
Proficient with the use of bag valve mask.
iv. Independently initiate the use of an AED.
v. Perform standard first aid and give oxygen supplement.
vi. Measure and monitor the patients vital signs, i.e. pulse
rate, blood pressure, temperature and respiratory rate
and give SaO2.
vii. Monitor intravenous peripheral lines and flow of drip of
stable patients.
viii. Transfer and maintain patients with nasogastric tubes,
tracheostomy tubes, and/or urinary catheters.
ix. Perform basic emergency procedures such as control of
external bleeding and application of dressings, bandages,
slings and splints.
x. Establish contact with the receiving hospital if the need
arises.
xi. Appropriately use PPE and apply standard precautions to
prevent the transmission of infectious agents during
patient care.
xii. Assist the Emergency Ambulance Paramedic or Nurse or
Doctor in the conduct of the various procedures for the
care of the patient who is being managed by the
Emergency Ambulance Service.

4.4 Ambulance Paramedic

a. The Ambulance Paramedic shall be qualified under a paramedic

course approved by MOH (see Appendix 2).

b. The Ambulance Paramedic shall also be currently certified in

Basic Cardiac Life Support (BCLS) and AED by an NRC-
accredited agency.

c. The Ambulance Paramedic shall undergo recertification by

agents approved by MOH at least once every two years.

d. The Ambulance Paramedic shall be able to:

i. Assess and independently manage trauma and non-

trauma emergencies in patients of all age groups within
the framework of medical protocols provided by the
Emergency Ambulance Service.
ii. Organise and prioritise treatment and evacuation in
multiple casualty incidents.
iii. Use various types of stretchers and body immobilisation
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devices provided by the Emergency Ambulance Service.

iv. Carry out emergency basic procedures to control external
haemorrhage, apply dressings, bandages, slings and
splints.
v. Provide immediate care to casualties during the process
of extrication and disentanglement from entrapments.
vi. Assess and maintain the patients airway, including the
use of adjuncts such as the oropharyngeal airway or
Laryngeal Mask Airway (LMA).
vii. Perform basic life support on infants, children and adults.
viii. Be currently certified in CPR and AED usage by an NRC-
accredited agency.
ix. Perform a 12-lead electrocardiogram, monitor the
patients electrical rhythm and transmit the 12-lead
electrocardiogram to the receiving hospital, if appropriate
and required.
x. Independently initiate the use of an AED.
xi. Obtain intravenous access, administer designated
intravenous medications and perform intravenous
infusions as per ambulance care protocols.
xii. Obtain capillary blood glucose sample and institute
treatment for hypoglycaemia.
xiii. Assess and manage an emergency childbirth.
xiv. Administer basic emergency medications including
nebulisation.
xv. Auscultate chest for abnormal chest sounds.
xvi. Appropriately use PPE and apply standard precautions to
prevent the transmission of infectious agents during
patient care.
xvii. Manage patients with nasogastric tubes, intravenous
plugs or urinary catheters or other tubes and cannula.

4.5 Ambulance Nurse

a. Must be a registered Staff Nurse with the Singapore Nursing

Board and have clinical capability equivalent to or exceeding the
Ambulance Paramedic (see 4.4d above), including current Basic
Cardiac Life Support (BCLS)/AED certification.

4.6 Ambulance Doctor

a. Must be registered with Singapore Medical Council Board and

have clinical capability equivalent to or exceeding the
ambulance paramedic (see 4.4d above), including current BCLS
and Advanced Cardiac Life Support (ACLS) certification.

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5. Emergency Ambulance Vehicle and Medical Equipment

5.1 Each Emergency Ambulance service vehicle shall contain the

following vehicle and medical equipment:

a. Vehicle Equipment

i. Siren and Wail Sound Horn or Two Tone-Horn

ii. Red Beacon Light
iii. VHF Radio Network Communication or Mobile Phone or
Other Ambulance to Hospital Communication Equipment
iv. Fire Extinguisher
v. Current Singapore Street Directory or electronic
equivalent
vi. Passenger Seat and Safety Belts
vii. Attendant Seat and Safety Belts
viii. Frosted or Tinted Side and Rear Window Glass
(excluding the front side windows)
ix. Global Positioning System (GPS) /Automatic Vehicle
Location/ other navigation system
x. Any other equipment specified by MOH or any other
authority

b. Medical Equipment see Appendix 3

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Appendix 1

DEFINITION OF MEDICAL EMERGENCY

A Medical emergency is an injury or a condition of acute or sudden onset

that poses an immediate threat to a person's life or long term health. These
include bleeding, severe or increasing pain or a change in the vital signs of
life, such as the level of consciousness or signs of difficulty in breathing. A
chronic condition or a condition for which a patient is currently receiving
treatment may suddenly deteriorate into a medical emergency.

Common Situations Involving Medical Emergencies

Road traffic accident

Industrial accident
Fall from heights
Mass casualties
Transfer of critically ill patients between hospitals/nursing homes
Severe burns
Stroke
Heart attack
Poisoning
Breathing difficulty from a variety of causes
Altered mental states

Common Causes of Medical Emergencies

All limb or life threatening cases, or any case of doubt

Multiple injuries
Large or open wound
Head injury
Fracture or dislocation
Laceration, stabbing or other penetrating injury
Burn (thermal or chemical) or scald
Near-drowning, poisoning or suicide
Bee and insect sting, snake or animal bite
Acute coronary syndrome
Haemorrhagic or ischaemic stroke or other acute neurological disorders
Acute, non-traumatic surgical emergencies

Examples of Medical Emergencies

Acute chest pain, including angina or acute myocardial infarct

Difficulty breathing
Acute abdomen
Internal bleeding, including haematuria, haematemesis or melena
Loss of consciousness or acute change in mental state or behaviour
Sudden onset weakness or paralysis
Seizures
Severe allergic reaction (anaphylaxis)
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Severe pain or increasing pain

Sepsis

NB The above descriptions serve only as a guide. Wherever possible, and in

situations of doubt, appropriate medical advice should be sought from a
registered medical practitioner.

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Appendix 2

LIST OF APPROVED QUALIFICATIONS

1. Emergency Medical Technician

a. WSQ Higher Certificate for Emergency Medical Technician (effective

31 Dec 2014)
b. Any other Emergency Medical Technician (Basic) qualification as
approved by the Director of Medical Services from time to time

2. Paramedic

a. Singapore Civil Defence Force (SCDF) or Singapore Armed Forces

(SAF) Paramedic Level 3 or equivalent (SAF Medical Training Institute)
b. Higher National Institute of Technical Education Certificate (NITEC) in
Paramedic and Emergency Care
c. Justice Institute of British Columbia (JIBC) Paramedic Academys
Primary Care Paramedic
d. Nanyang Polytechnic Advanced Diploma in Paramedicine
e. Any other Paramedic or Emergency Medical Technician (Intermediate)
qualification as approved by the Director of Medical Services from time
to time

3. Medical Transporter
To have obtained all of the following:
a. Valid driving license
b. Current NRC-accredited CPR/AED certificate
c. Certificate in Defensive driving issued by any of the driving centres
below:
i. Bukit Batok Driving Centre (BBDC)
ii. Singapore Safety Driving Centre (SSDC)
iii. ComfortDelGro Driving Centre (CDC)

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Appendix 3

MEDICAL EQUIPMENT FOR EMERGENCY AMBULANCES

(Note: this list is aimed at describing the MINIMUM STANDARDS required,
rather than to be a comprehensive, prescriptive list)
A. Airway and Ventilation Equipment
1. Portable and fixed suction apparatus with a regulator
o Wide-bore tubing, rigid pharyngeal curved suction tip; tonsillar
and flexible suction catheters.
2. Portable oxygen apparatus capable of metered flow with adequate
tubing
3. Portable and fixed oxygen-supply equipment
o Variable flow regulator
4. Oxygen-administration equipment
o Adequate-length tubing; oxygen face mask (adult and child
sizes), non-rebreathing mask (adult and child sizes), nebuliser
mask (adult and child sizes) ; nasal cannulas
5. Bag-valve mask (manual resuscitator)
o Hand-operated, self re-expanding bag; adult (>1000 mL) and
child (450750 mL) sizes, with oxygen reservoir/accumulator;
valve (clear, disposable); and mask (adult, child, infant, and
neonate sizes)
6. Airways
o Oropharyngeal (sizes 0-5; adult and child sizes)
7. Pulse oximeter with paediatric and adult probes
8. 10-mL non-Luer lock (Luer slip) syringes
9. Alternative airway devices (e.g. a rescue airway device such as the
oesophageal-tracheal double-lumen airway [OTDLA], laryngeal tube,
or laryngeal mask airway [LMA]) , for adult and children
10. Lubricating jelly (water soluble)

B. Intravenous Kit/Bag
1. Crystalloid solutions, such as Ringer's lactate or normal saline solution
2. Alcohol wipes and povidone-iodine wipes
3. Intravenous-fluid pole or roof hook
4. Intravenous catheters, 1424 gauge
5. Venous tourniquet
6. Syringes of various sizes
7. Needles, various sizes (1 at least 1 in for intramuscular injections)
8. Intravenous administration sets (microdrip and macrodrip)
9. Intravenous arm boards, adult and paediatric
10. Transparent dressing

C. Cardiac
1. Automated External Defibrillator (AED). The AED should have
paediatric capabilities, including child-sized pads and cables
2. Portable, battery-operated monitor/defibrillator
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o With printer/recorder, defibrillator pads, quick-look paddles or

electrode, or hands-free pads, ECG leads, adult and paediatric
chest attachment electrodes, adult and paediatric paddles
o AED mode
o Pulse oximetry, heart rate, blood pressure, 12-lead ECG
monitoring/transmission capability

D. Immobilisation Devices
1. Cervical collars
o Adult sizes (small, medium, large, and other available sizes)
2. Head immobilisation device (not sandbags)
o Firm padding or commercial device (adult sizes)
3. Lower extremity (femur) traction devices
o Lower extremity limb-support slings, padded ankle hitch,
padded pelvic support, traction strap (adult sizes)
4. Upper and lower extremity immobilisation devices
o Joint-above and joint-below fracture (sizes appropriate for
adults), rigid support constructed with appropriate material
(cardboard, metal, pneumatic, vacuum, wood, or plastic)
5. Impervious backboards (long, radiolucent preferred) and extrication
device
o Extrication device (head-to-pelvis length) and long (transport,
head-to-feet length) with at least 3 appropriate restraint straps
(adult sizes)
o Scoop backboard

E. Trauma Kit/Bag
1. Commercially packaged or sterile burn sheets
2. Triangular bandages (minimum of 2 safety pins each)
3. Elastic or crepe or gauze roll bandages of various sizes (large and
small)
4. Sterile gauzes and pads (various sizes)
5. Adhesive tape (various sizes (including 1 and 2 in), hypoallergenic
6. Arterial tourniquet

F. Miscellaneous
1. Sphygmomanometer/blood pressure monitor (paediatric and adult
regular- and large-sized cuffs)
2. Adult stethoscope
3. Length/weight-based tape or appropriate reference material for
paediatric equipment sizing and drug dosing based on estimated or
known weight
4. Ear thermometer or digital thermometer
5. Paramedic scissors for cutting clothing, belts, and boots
6. Cold packs
7. Sterile saline solution for irrigation (1-L bottles or bags)
8. Flashlights
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9. Blankets, trolley sheets or linens and pillows

10. Triage tags
11. Disposable emesis bags or basins
12. Wheeled cot (conforming to national standard at the time of
manufacture)
13. Folding stretcher with restrainers
14. Patient care charts/forms
15. Glucometer or blood glucose measuring device (with reagent strips)
16. Infant blood pressure cuff
17. Paediatric stethoscope
18. Canvas litter
19. First Aid box (standard)/ Medical bag

G. Infection Control Kit/Bag

1. Eye protection (full peripheral glasses or goggles, face shield)
2. Face protection (e.g. surgical masks per applicable local guidance)
3. Gloves, non-sterile
4. Coveralls or gowns
5. Hair covers
6. Shoe covers
7. Waterless hand cleanser, commercial antimicrobial (towelette, spray,
liquid)
8. Disinfectant solution for cleaning equipment
9. Standard sharps containers, fixed and portable
10. Disposable trash bags for disposing of bio hazardous waste
11. Respiratory protection (for example, N95 or N100 respirator --- per
applicable local guidance)

H. Injury-Prevention Equipment
1. Traffic-signaling devices (reflective material triangles or other reflective,
non-igniting devices)
2. Reflective safety wear for each crew member.

I. Medications (Pre-loaded Syringes When Available)

Medications may vary depending on the licensing requirements. Drug dosing
in children should use processes that minimize the need for calculations,
preferably a length-based system. In general, medications may include:
o Cardiovascular medication such as nitroglycerin spray/ tablets,
aspirin,
o Cardiopulmonary/respiratory medications such as salbutamol (or
other inhaled agonist) and nebuliser
o 10% dextrose solution
o Analgesics
o Antiepileptic medications such as diazepam or midazolam
o Nebuliser
o Intramuscular oxytocin
o Intravenous adrenaline 1:10,000 (for cardiac arrest)
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OPTIONAL EQUIPMENT
This is intended to assist ambulance providers in choosing equipment that
can be used to ensure delivery of quality pre-hospital care. Use should be
based on certified capability of providers.
1. Large-bore needle (should be at least 3.25 in long for needle chest
decompression in large adults)
2. Neonatal blood pressure cuff
3. Infant cervical immobilisation device
4. Topical haemostatic agent
5. Appropriate chemical, biological, radiologic, nuclear, explosive
personal protective equipment (CBRNE PPE), including respiratory
and body protection
6. Applicable chemical antidote autoinjectors (at a minimum for crew
members' protection; additional for victim treatment based on local
protocol; appropriate for adults and children)
7. Respirator
o Volume-cycled, on/off operation, 100% oxygen, 4050 psi
pressure (child/infant capabilities)
8. Blood-sample tubes, adult and paediatric
9. Automatic blood pressure device
10. Nasopharyngeal (16F-34F; adult and child sizes)
11. Nasogastric tubes, paediatric feeding tube sizes 5F and 8F, sump tube
sizes 8F16F
12. Paediatric laryngoscope handle
13. Size 1 curved laryngoscope blade
14. 3.5- to 5.5-mm cuffed endotracheal tubes
15. Needle cricothyrotomy capability and/or cricothyrotomy capability
(surgical cricothyrotomy can be performed in older children in whom
the cricothyroid membrane is easily palpable, usually by the age of 12
years)
16. Laryngoscope handle with extra batteries and bulbs
17. Laryngoscope blades, sizes 04, straight ; sizes 24, curved
18. Endotracheal tubes, sizes 2.55.5 mm uncuffed and 68 mm cuffed (2
each), other sizes optional
19. Meconium aspirator adaptor
20. Stylettes for endotracheal tubes, adult and paediatric
21. Magill forceps, adult and paediatric
22. End-tidal CO2detection capability
23. Colourimetric (adult and paediatric) or quantitative capnometry
24. Transcutaneous cardiac pacemaker, including paediatric pads and
cables , Either stand-alone unit or integrated into monitor/defibrillator
25. Protective helmet
26. Intra-osseous needles or alternative vascular access devices
appropriate for children and adults
27.Mechanical CPR device
28.Stair chair or carry chair
29.Saline drops for infants

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30.Short backboard
31.Cervical collars -Rigid for children aged 2 years or older (child sizes)
32.Head immobilisation device (not sandbags)
o Firm padding or commercial device (child sizes)
33.Lower extremity (femur) traction devices
o Lower extremity limb-support slings, padded ankle hitch,
padded pelvic support, traction strap (child sizes)
34.Upper and lower extremity immobilisation devices
o Joint-above and joint-below fracture (sizes appropriate for
children), rigid support constructed with appropriate material
(cardboard, metal, pneumatic,vacuum, wood or plastic)
35.Impervious backboard (long, radiolucent preferred) and extrication
device
o Extrication device (head-to-pelvis length) and long (transport,
head-to-feet length) with at least 3 appropriate restraint straps
(chin strap alone should not be used for head immobilisation)
and with padding for children and handholds for moving
patients (child sizes)
36.Paediatric backboard and extremity splints
37.Obstetric Kit/Bag
a) Kit (separate sterile kit)
o Towels, bulb suction, self-retaining cord clump, umbilical cord
scissors, artery forceps, cotton ball, under pad (incontinence
sheet), tray, gallipot, poly sheet, mucus extractor, sanitary pad,
sterile gloves, syringe, needle
o Neonatal blanket and head cover, aluminium-foil roll, or
appropriate heat-reflective material (enough to cover newborn)

OPTIONAL MEDICATIONS
1. Adrenaline autoinjector (adrenaline for anaphylaxis)
2. Oral glucose
3. Atropine, antiarrhythmic agents (e.g. adenosine and amiodarone),
calcium-channel blockers, blockers, vasopressor for infusion
4. Ipratropium bromide, 1:1000 epinephrine, furosemide
5. 50% dextrose solution (and sterile diluent or 25% dextrose solution for
paediatrics)
6. Sodium bicarbonate, magnesium sulphate, glucagon, naloxone
hydrochloride, calcium chloride
7. Sterile water for injection

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PRE-HOSPITAL EMERGENCY CARE
2014 EMERGENCY AMBULANCE STANDARD

Frequently Asked Questions Emergency Ambulances

(Please refer to the 2014 Emergency Ambulance Standards for more details)

1. What are Emergency Ambulances?

Ans: Emergency Ambulances are modes of transport intended to be used for patients who
has or sustains a medical emergency. Please refer to Appendix 1 of the 2014 Emergency
Ambulance Standards for a list of medical emergencies.

2. Why is the 2014 Emergency Ambulance Standard introduced?

Ans: Over the years, there have been instances of ambulances being ill-equipped and/or
manned by poorly-trained personnel. Such deficiencies would present a definite risk to
patients in situations of medical emergencies. As reported in the media in November 2013,
the private ambulance driver lied about having a drivers license to get the job. He lost
control of the ambulance vehicle while speeding, resulting in the patient sustaining multiple
injuries and subsequently dying. There have also been complaints of ambulances not being
properly equipped with oxygen tanks and medical device, malfunctioning of Automated
External Defibrillator and of ambulances abusing their privileges, such as turning on their
emergency lights and siren to get priority in traffic, when there is no emergency case on
board.

The 2014 Emergency Ambulance Standard is introduced to ensure a higher standard of

patient care and medical capability with enhanced proficiency requirements for the
emergency ambulance crew and a revised list of equipment. Please refer to the 2014
Emergency Ambulance Standard for more details.

3. Are there any specifications on naming and dimensions for the vehicle faade?
Ans: The front, rear and both sides of the vehicle should indicate EMERGENCY
AMBULANCE. Wordings on the vehicle faade would be acceptable as long as they can be
easily read. Please refer to the enclosed Annex for illustration.

4. Would there be references provided for the required protocols mentioned in sections
2.2 and 2.3 of the 2014 Emergency Ambulance Standards?
Ans: Guidelines will be provided to assist Private Ambulance Operators (PAOs) in
developing their respective protocols for:
a) Infection control;
b) Management of patient records and vehicle log system (manual and/or electronic
recording system); and
c) Care for patients being transported.

These guidelines serve to provide a minimum standard of care. PAOs should develop their
own protocols based on these minimum standards, under the supervision of a qualified
person (minimally a registered medical practitioner under the Singapore Medical Council for
emergency ambulance).

5. What are the technical requirements that the emergency ambulance must meet?
Ans: The Land Transport Authority (LTA) requires all vehicles, including emergency
ambulances, to be registered for use in Singapore to comply with the registration and
technical requirements set out in the Road Traffic Act and its subsidiary legislations. For
more details on the technical requirements, including seat belts, exhaust emission

1
standards, safety glass, etc, please refer to the document Self-Import and Register A Goods
Vehicle at LTAs OneMotoring wesite via the following url link:

http://www.onemotoring.com.sg/publish/onemotoring/en/lta_information_guidelines/buy_a_n
ew_vehicle/self_importation_.html

On 2014 Emergency Ambulance Standards - Manpower and Crew

1. Who are Emergency Medical Technicians (EMTs)? Where can I go to be certified as

an EMT?
Ans: EMTs is a category of healthcare workers with specific skill sets to handle patients with
less acute/serious conditions as compared to Paramedics. For the purpose of EMT training
and certification, the Workforce Development Agency (WDA), has launched a Workforce
Skills Qualifications (WSQ) Higher Certificate in Pre-Hospital Emergency Medical Services
for Emergency Medical Technician, conducted by SingHealth Alice Lee Institute of
Advanced Nursing (IAN). The participant will receive the full certification of an EMT upon
successful completion of this training.

2. Who are Medical Transporters (MTs)?

Ans: Medical Transporters are drivers of emergency ambulances and MTS vehicles who
need to fulfil the following requirements:
(i) Possessing a valid driving license,
(ii) Possessing a defensive driving certificate, and
(iii) Being currently CPR-AED certified

3. Can individuals sign up for training courses without existing employment?

Ans: Yes, individuals who have no prior experience, and are interested in a career in the pre-
hospital care sector can register for WSQ Higher Certificate in Healthcare Support (PHEMS)
as long as they meet the admission criteria.

4. What are the admission criteria and charges for the training courses?
Ans: The list of recognised courses and institutions are stipulated in Appendix 2 of the 2014
Standards. Please refer to the respective institutions websites for their admission criteria
and charges for these courses.

5. Are nurses under conditional registration allowed to practice in an emergency

ambulance?
Ans: With reference to section 4.5 of the 2014 Emergency Ambulance Standards, a Staff
Nurse with conditional registration is allowed to practice as crew leader in the emergency
ambulance fleet for the organisation they are registered under. All requirements specific to
the roles of crew members are stipulated in the 2014 Emergency Ambulance Standards.

6. What are the recognised qualifications of foreign paramedics/EMTs?

Ans: MOH is developing a framework to recognise the credentials of foreign
paramedic/EMT. More information will be released at a later date.

For PAOs with existing Emergency Ambulances

1. When will the 2014 Enhanced Standards come into force?

Ans: PAOs are given until September 2017 to comply with the 2014 Enhanced Standards.
PAOs can voluntarily comply with the 2014 Enhanced Standards starting September 2015.

2. Why is there a long lead time between the release of 2014 Enhanced Standards and
its implementation?

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Ans: The long lead time allows PAOs sufficient time to ramp-up capabilities in manpower
and medical equipment, to comply with the 2014 Enhanced Standards by September 2017.
To assist PAOs in meeting the new manpower requirements, SingHealth Alice Lee Institute
of Advanced Nursing (IAN), which is the provider for EMT training, will work with PAOs who
may be interested to participate in healthcare job fairs to offer train and place positions.

3. What happens if I cannot meet or I do not want to comply with the 2014 Enhanced
Standards?
Ans: By 2017, all PAOs of emergency ambulances and MTS services must be licensed by
Ministry Of Health. Unlicensed PAOs will no longer be allowed to provide ambulance and
medical transport services.

4. What if I want to comply earlier with the new 2014 Enhanced Standards?
Ans: PAOs are strongly encouraged to comply with the Enhanced Standards early so as to
allow ample time for PAOs to level up their fleet and manpower to meet the 2014 Enhanced
Standards.
PAOs can voluntarily comply with the 2014 Enhanced Standards starting September 2015.
MOH will conduct audits to assess if PAOs who voluntarily comply meet these standards. An
MOH-issued documentary proof of compliance will be awarded to PAOs who have complied.
More information on the voluntary compliance will be released at a later date.

Implications to Operations

1. What are the implications for PAOs providing services listed in the 1-777 directory or
to healthcare institutions?
Ans: The implications to PAOs are as such:
(a) PAOs listed in the 1-777 directory must ensure that their vehicles comply with the 2014
Enhanced Standards by September 2016
(b) All PHMCA-licensed Healthcare Institutions (including nursing homes) will only engage
the services of emergency ambulances and MTS vehicles that have complied with the 2014
Enhanced Standards. More information will be release at a later date.

2. Section 2.2 of the 2014 Emergency Ambulance Standards indicates that a qualified
person [is] to be engaged by the service providers to ensure the required training,
competency and certification of the staff. Who does a qualified person refer to?
Ans: PAOs running emergency ambulances will be required to minimally engage a
Singapore Medical Council registered medical practitioner for the oversight of emergency
ambulances.

3. Can PAO engage Emergency Medicine (EM) specialists on a part-time basis (as
opposed to full-time) to supervise and advise on the patient care provided?
Ans: Yes, PAO can engage part-time EM specialists, provided sufficient oversight is
ensured. The PAO and the engaged EM specialist will be held accountable for any
malpractice during the course of operations of the emergency ambulance.

4. Can EM specialists supervise more than one PAO?

Ans: Yes, EM specialists can supervise more than one PAO, provided sufficient oversight is
ensured. The PAO and the engaged EM specialist will be held accountable for any
malpractice during the course of operations of the emergency ambulance.

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VEHICLE MOCK-UP FOR FAADE SPECIFICATION

EMERGENCY AMBULANCE