Healthcare Services (Emergency Ambulance Service and Medical Transport Service) Regulations 2022

the provisions of these Regulations apply in addition to the provisions of the General Regulations; and

the provisions of these Regulations prevail if, and to the extent that, there is any inconsistency between these Regulations and the General Regulations insofar as the matter relates to a licensee.

registration under section 22 of the Medical Registration Act 1997 as a specialist in the branch of anaesthesiology, emergency medicine, general surgery or intensive care medicine;

at least 10 years of work experience in any or any combination of the following branches of medicine:

anaesthesiology;

emergency medicine;

general surgery;

intensive care medicine;

valid certifications of competency in both of the following:

appointment as a Clinical Governance Officer of the emergency ambulance service; (ii)the provision of Advanced Cardiac Life Support.

a fully registered medical practitioner who —

holds a valid practising certificate under the Medical Registration Act 1997;

has at least 5 years of work experience, including at least one year of work experience in the branch of anaesthesiology, emergency medicine, general surgery or intensive care medicine; and

has valid certifications of competency in all of the following:

appointment as a Clinical Governance Officer of the medical transport service;

the provision of Basic Cardiac Life Support;

the use of Automated External Defibrillation;

subject to paragraph (3), a registered nurse who —

holds a valid practising certificate under the Nurses and Midwives Act 1999;

has at least 5 years of work experience in carrying out acts of nursing for or in relation to anaesthesia, emergency medicine, general surgery or intensive care medicine or any other branch of medicine involving the management of acute and critical patients as approved by the Director‑General; and

has valid certifications of competency in all of the following:

appointment as a Clinical Governance Officer of the medical transport service;

the provision of Basic Cardiac Life Support;

the use of Automated External Defibrillation.

in the case of a fully registered medical practitioner — a decision or an order made under Part 7 of the Medical Registration Act 1997 by a Disciplinary Tribunal appointed under that Act; or

in the case of a registered nurse — a decision of the Singapore Nursing Board made in exercise of the powers under section 19(1) read with section 19(2) or (3) of the Nurses and Midwives Act 1999.

maintain an ambulance log system in respect of the movements of every approved emergency ambulance or approved medical transport, as the case may be;

ensure that —

the performance of the applicable service provided by the licensee is continuously monitored and evaluated; and

the licensee and each Clinical Governance Officer appointed by the licensee are informed periodically of the performance of the applicable service;

ensure that, in relation to a relevant event —

the occurrence of the relevant event is contemporaneously and accurately recorded;

the circumstances of the relevant event are reviewed to identify its causes; and

appropriate steps are taken to prevent or reduce the likelihood of the recurrence of the relevant event; and

develop and implement written protocols, written care protocols and processes to ensure that the applicable service is provided safely and in accordance with the Act, the licence conditions imposed under section 13(1) of the Act and any other written law.

any adverse event affecting the care and safety of patients using the applicable service; or

any finding or observation that indicates or implies that the care and safety of patients using the applicable service may have been adversely affected.

a driver who —

holds a valid driving licence under the Road Traffic Act 1961 to drive an emergency ambulance or a medical transport, as the case may be;

is trained in defensive driving by a body recognised by the Land Transport Authority of Singapore;

holds one or more valid certifications certifying competency —

in the use of Automated External Defibrillation; and

in the provision of cardio‑pulmonary resuscitation; and

possesses appropriate competencies in the care and evacuation of patients;

subject to paragraph (2A), a crew leader who is any of the following:

where the crew leader is deployed to an approved emergency ambulance — an ambulance doctor, a relevant ambulance nurse or an ambulance paramedic;

where the crew leader is deployed to an approved medical transport — an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician.

complies with all conditions and restrictions imposed on his or her registration by the Singapore Medical Council under the Medical Registration Act 1997 in relation to his or her deployment as a crew leader; and

performs the duties and functions of a crew leader under the supervision of an ambulance doctor who is a fully registered medical practitioner and is employed or engaged by the licensee.

an individual who is training to be a driver of an emergency ambulance or a medical transport, as the case may be; or

an individual who is training to be an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician.

a driver who satisfies the requirements in regulation 9(2)(a);

a crew leader who is an ambulance doctor and —

is registered under section 22 of the Medical Registration Act 1997 as a specialist in the branch of cardiothoracic surgery; or

is granted clinical privileges by an applicable acute hospital service licensee to manage patients who require the use of extracorporeal membrane oxygenation;

a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the adult cardiac critical care service as is acceptable to the Director-General.

a driver who satisfies the requirements in regulation 9(2)(a);

a crew leader who is an ambulance doctor and —

is registered under section 22 of the Medical Registration Act 1997 as a specialist in the branch of cardiology or cardiothoracic surgery; or

is granted clinical privileges by an applicable acute hospital service licensee to manage patients who require the use of an intra-aortic balloon pump;

a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the adult cardiac critical care service as is acceptable to the Director-General.

the acute hospital service licensee of the acute hospital to which an emergency patient is conveyed, unless sub-paragraph (b) applies;

where an emergency patient is conveyed from an acute hospital to another acute hospital, the acute hospital service licensee of either acute hospital.

a driver who satisfies the requirements in regulation 9(2)(a);

a crew leader who is an ambulance doctor and —

is registered under section 22 of the Medical Registration Act 1997 as a specialist in the branch of anaesthesiology, cardiology, cardiothoracic surgery, emergency medicine, general surgery or intensive care medicine;

holds —

one or more valid certifications in the provision of Fundamental Critical Care Support; or

one or more valid certifications equivalent to the certification specified in sub-paragraph (A) as is acceptable to the Director-General;

has been trained by a medical practitioner registered under section 22 of the Medical Registration Act 1997 in any branch of medicine specified in sub-paragraph (i); or

is granted clinical privileges by an applicable acute hospital service licensee to manage patients who require —

the use of a chest tube or mechanical ventilator, as the case may be; or

the administration of any inotrope, sedative or paralytic by continuous intravenous infusion,as the case may be;

a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the adult general critical care service as is acceptable to the Director-General.

the acute hospital service licensee of the acute hospital to which an emergency patient is conveyed, unless sub-paragraph (b) applies;

where an emergency patient is conveyed from an acute hospital to another acute hospital, the acute hospital service licensee of either acute hospital.

a driver who satisfies the requirements in regulation 9(2)(a);

a crew leader who is a fully registered medical practitioner or conditionally registered medical practitioner and —

holds a valid practising certificate under the Medical Registration Act 1997;

holds one or more valid certifications certifying competency in the provision of Advanced Paediatric Life Support; and

satisfies any of the requirements in paragraph (3);

a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the paediatric critical care service as is acceptable to the Director-General.

the fully registered medical practitioner or conditionally registered medical practitioner mentioned in paragraph (2)(b) (called in this paragraph the applicable medical practitioner) is registered under section 22 of the Medical Registration Act 1997 as a specialist in the branch of anaesthesiology, emergency medicine, neonatology or paediatric intensive care;

the applicable medical practitioner holds —

one or more valid certifications in the provision of Paediatric Fundamental Critical Care Support; or

one or more valid certifications equivalent to the certification specified in sub-paragraph (i) as is acceptable to the Director-General;

the applicable medical practitioner has been trained by a medical practitioner registered under section 22 of the Medical Registration Act 1997 in any branch of medicine specified in sub-paragraph (a);

the applicable medical practitioner is granted clinical privileges by an applicable acute hospital service licensee to manage patients who require —

the use of extracorporeal membrane oxygenation, an intra-aortic balloon pump, a chest tube or a mechanical ventilator, as the case may be; or

the administration of any inotrope, sedative or paralytic by continuous intravenous infusion,as the case may be.

the acute hospital service licensee of the acute hospital to which an emergency patient is conveyed, unless sub-paragraph (b) applies;

where an emergency patient is conveyed from an acute hospital to another acute hospital, the acute hospital service licensee of either acute hospital.

a driver who satisfies the requirements in regulation 9(2)(a);

a crew leader who satisfies the requirements in regulation 9(2)(b)(i);

a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the isolation service as is acceptable to the Director-General.

each service crew member (other than the driver) deployed to an emergency ambulance used to provide that service undergoes refresher training in the proper and safe handling and use of a portable medical isolation unit at least once a year; and

accurate and complete records of all refresher training mentioned in sub-paragraph (a) are maintained.

each certification held by the member is valid throughout the duration of the member’s deployment; and

the member undergoes continuing training and education provided by a body recognised by the Director-General to maintain the member’s competencies in performing his or her duties.

ensure that the member —

attends any training recommended by a Clinical Governance Officer as being appropriate for the member; and

is kept up to date on the latest clinical developments and the licensee’s written protocols and written care protocols; and

maintain accurate records of —

the member’s status as a medical practitioner, a registered nurse or an enrolled nurse, if applicable;

the member’s certifications, including the validity of each certification; and

the training that the member has attended or undergone.

the fixed partition installed behind the driver’s seat and any forward-facing front seat alongside the driver’s seat and separating those seats from the rest of the vehicle;

the permanent roof and floor of the vehicle; and

the tailgate or doors opening at the rear of the vehicle.

each approved emergency ambulance or approved medical transport is equipped with the appropriate facilities and equipment for the safe operation of the approved emergency ambulance or approved medical transport (as the case may be) and the safe and effective conveyance of and delivery of care to patients; and

all facilities and equipment mentioned in sub‑paragraph (a) are properly maintained and replenished or replaced as necessary.

has a system allowing communications with the Singapore Civil Defence Force or any other medical dispatch system designated by the Director-General;

is fitted with an adequate number of passenger seats and attendant seats which are equipped with safety belts;

is equipped with appropriate navigational tools;

is installed with frosted or tinted windows in the patient compartment to ensure patient privacy; and

is equipped with a fire extinguisher.

a siren;

a wail sound horn or two‑tone horn;

red beacon lights.

is travelling to the location of an emergency patient; or

is conveying an emergency patient.

does not bear the words “EMERGENCY AMBULANCE”, or any abbreviation or derivative of those words, in any language; and

is not fitted with any siren or beacon lights mentioned in regulation 12(3).

for the triaging of patients, including assessing whether an individual is an emergency patient before the individual is conveyed; and

to ensure the appropriate management and care (including the appropriate use of medical supplies and equipment) of patients using the applicable service provided by the licensee.

develop and implement written care protocols for the appropriate assessment, management and care of patients, including —

the criteria for determining whether a patient is an emergency patient and can be conveyed by the licensee in a safe and timely manner;

the assessment of each patient, before the patient is conveyed by the licensee, in accordance with the criteria mentioned in sub‑paragraph (i); and

the management, care and escalation of patients whose medical condition deteriorates while being conveyed by the licensee;

ensure that the service crew members deployed to each approved emergency ambulance or approved medical transport (as the case may be) are trained and proficient in implementing the written care protocols mentioned in sub‑paragraph (a); and

where the licensee assesses, in accordance with the written care protocols mentioned in sub‑paragraph (a), that the licensee cannot safely convey the patient — make appropriate alternative arrangements for the safe and timely conveyance of the patient.

a triaging framework, including for determining whether an individual is an emergency patient;

the appropriate management of patients depending on whether or not a patient is an emergency patient and in accordance with the nature and acuity of the patient’s medical condition, including the determination of the appropriate relevant hospital to which the patient should be conveyed;

the manpower and equipment requirements when conveying patients;

the handing over of patients conveyed to another licensee or any other person (including a person authorised by a licence under the Act to provide a licensable healthcare service other than an applicable service), including the recording and communication of information relating to the medical condition of patients.

written protocols relating to the use of any siren, horn or beacon light mentioned in regulation 12(3) that is fitted to an approved emergency ambulance; and

written care protocols relating to the conditions for the use of approved emergency ambulances to convey patients who are not emergency patients.

the safe and proper provision of the specified service;

the safe and proper handling and operation of any equipment used in the provision of the specified service;

where the provision of the specified service involves the administration of any substance to a patient, the safe and proper handling and administration of the substance.

the crew leader;

the service crew member mentioned in regulation 9A(2)(c) or (3)(c), 9B(2)(c) or 9C(2)(c), as the case may be.

the crew leader;

the service crew member mentioned in regulation 9D(2)(c).

must convey the patient to the healthcare institution specified; and

must not (directly or indirectly) influence, persuade or coerce, or attempt to influence, persuade or coerce, the patient to be conveyed to another healthcare institution.

an emergency patient who is in a state, or in imminent danger, of cardiovascular collapse;

an emergency patient (other than an emergency patient mentioned in sub‑paragraph (a)) who has not, or whose next of kin or carer has not, informed the emergency ambulance service licensee that the patient wishes to be conveyed to a specific hospital.

is also a relevant licensee of that healthcare institution; or

has a contract or other arrangement with the relevant licensee of that healthcare institution under which A exclusively conveys patients to that healthcare institution.

each approved emergency ambulance has an adequate supply of appropriate medicines and medical supplies and equipment;

each approved medical transport has an adequate supply of appropriate medical supplies and equipment; and

the medicines and medical supplies and equipment mentioned in sub‑paragraph (a) or (b) (as the case may be) are used or administered in accordance with the advice of a Clinical Governance Officer, any written care protocols mentioned in regulation 15(1)(b) and any written law relating to the use or administration of the medicines or medical supplies and equipment, as the case may be.

maintain and update an inventory of all medicines and medical supplies and equipment available for use in each approved emergency ambulance or approved medical transport, as the case may be; and

ensure that all medical supplies and equipment are —

in good working condition at the time the approved emergency ambulance or approved medical transport (as the case may be) is dispatched; and

regularly checked, maintained and replenished or replaced when necessary.

in every approved emergency ambulance or approved medical transport, as the case may be; and

if the licensee has an Internet website, a blog or a page on any social media or social network Internet website — on that Internet website or blog or page on that social media or social network Internet website.

base fee for the applicable service;

medication;

the use of any equipment, such as equipment for continuous monitoring of the patient’s condition while being conveyed by the licensee;

consumables;

additional charges, if any.

obtain from the patient or the next of kin or carer of the patient (A) all information relating to the patient’s condition; and

having regard to the information mentioned in sub‑paragraph (a), provide A with an estimate of the charges mentioned in paragraph (1).

the licensee, after assessing the patient’s medical condition, reasonably concludes that the patient requires additional or different care or monitoring; and

higher or additional charges are payable for the additional or different care or monitoring mentioned in sub‑paragraph (a).

must, as far as reasonably practicable —

inform the patient or the next of kin or carer of the patient (B) of the higher or additional charges payable for the additional or different care or monitoring mentioned in paragraph (5)(a) and the basis for those charges; and

obtain written acknowledgment, signed by B, that B has been informed of the higher or additional charges payable;

must not (directly or indirectly) influence, persuade or coerce, or attempt to influence, persuade or coerce, B to agree to the higher or additional charges; and

where B does not agree to the higher or additional charges — must not refuse to convey or continue conveying the patient without first making appropriate alternative arrangements for the safe and timely conveyance of the patient.

in the licensee’s application to renew the licensee’s licence to provide the applicable service; and

at any other time or at the frequency specified by the Director-General.

base fee for the applicable service;

medication;

the use of any equipment, such as equipment for continuous monitoring of the patient’s condition while being conveyed by the licensee;

consumables;

additional charges, if any;

the total amount of the fees payable by the patient.