AMbulance service standard_-1363739151

National Minimum requirement for
Ambulance Services
Food, Medicines and Healthcare Administration and

Control Authority of Ethiopia
Nov, 2016
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Table of Contents
Contents page
Table of Contents........................................................................................................................................1
Acknowledgment.........................................................................................................................................3
Forward.......................................................................................................................................................4
Introduction.................................................................................................................................................5
SECTION ONE: GENERAL......................................................................................................................6
1. Scope...............................................................................................................................................6
2. Normative References.....................................................................................................................6
3. Terminologies and Definitions........................................................................................................6
SECTION TWO: LICENSURE..................................................................................................................8
2.1 Application for Licensure............................................................................................................8
2.2 Initial/ New Licensure.................................................................................................................9
2.3 Requirements for License Renewal...........................................................................................10
2.4 Removal Permits, Change of Operation and Forfeiture of License............................................12
2.5 Suspension and Revocation of a License...................................................................................12
2.6 Right to Fair Hearing.................................................................................................................15
2.7 Information to be disclosed........................................................................................................15
SECTION THREE: GOVERNANCE...................................................................................................16
SECTION FOUR: PATIENT RIGHTS AND RESPONSIBILITIES........................................................17
4.1 Informed Consent......................................................................................................................17
4.2 Client Rights..............................................................................................................................17
4.3 Client Responsibilities...............................................................................................................18
SECTION FIVE: HUMAN RESOURCE MANAGEMENT....................................................................20
5.1. General Requirements................................................................................................................20
5.2. Staffing Plan..............................................................................................................................21
5.3. Job Description and Orientations...............................................................................................21
5.4. Continuing education.................................................................................................................22
5.5. Medical Staff.............................................................................................................................23
5.6. Employee’s Health.....................................................................................................................23
5.7. Dress Code and Employee Identification Badge........................................................................24
SECTION SIX: AMBULANCESERVICE REQUIREMENTS................................................................25
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6.1 Ambulance service requirement for basic life support (BLS)....................................................25
6.2 Ambulance service requirement for advanced life support (ALS).............................................30
6.3 Ambulance service requirement for special care life support (SCLS)........................................36
6.4. Service requirements for air ambulance.....................................................................................42
6.5. Infection Prevention...................................................................................................................51
6.6. Sanitation and Waste Management............................................................................................56
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Acknowledgment
The Food, Medicine and Healthcare Administration and Control Authority would like to extend
its special acknowledgment to members of the regulatory legal development team.
Last but not least, the Authority would also like to extend its gratitude to all these who directly
and indirectly give their contribution on the development of this requirement.
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Forward
The Ethiopian Government with continued support and collaboration from the development
partners, as well as the effort of the general public on its health has achieved a lot towards
improving the health status of its citizens. The Ethiopian health policy focuses on prevention and
promotion of health services and is being implemented through the Health Extension Program
(HEP).
From the very outset, the government recognized that health problems in the country are huge in
magnitude and complex in nature. We are also aware that solving these multi-faceted problems
of the sector requires time and concerted efforts of the government, the private sector, non-
governmental organizations, multilateral and bilateral development partners, and above all the
public at large.
The document systematically outlines the major processes to be addressed in order to provide
quality health care services. It begins with an explanation of the basis for the development of the
requirement followed by a description of the requirement based on Practice, Premises,
Professional and Product to deliver quality health services. The required human resources and
infrastructure are explained, including the management of the required equipments. Provision of
health care commodities and adequate safety procedures are addressed. For effective monitoring
of health care services, there must be a functional regulatory system, which can better inform and
improve the quality of health care services.
I would like to appreciate and thank all institutions and individuals who have been involved in
the preparation of this valuable operational document. I also would like to thank all development
partners for their valuable contribution and comments during the preparation of the requirement.
I would like to thank the Regulatory Legal Development Team (RLDT) of FMHACA, who
developed this document, for their unbitten courage and endurance throughout the preparation of
this document.
Finally I also call upon health professionals and interested parties to continue their usual support
in updating this document by forwarding comments and suggestions, since it is a new concept to
Ethiopia, to the Food, Medicines and Healthcare Administration and control Authority of
Ethiopia through P.O. Box 5681, Tel. 251-11 552 41 22, e-mail: regulatory@fmhaca.gov.et,
Addis Ababa, Ethiopia
YEHULU DENEKEW ALAMNEH

Director General,
Food, Medicines and Healthcare Administration and
Control Authority (FMHACA) of Ethiopia
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Introduction
The Federal Ministry of Health has recently finalized the new design for health sector reform
which reorganizes the health sector along its three major functions: service provider, purchaser
and regulatory arm. In the new design the regulation of both public and private facilities towards
ensuring quality service and high professional requirement falls under the Food, Medicine and
Health Care Administration and Control Authority (FMHACA).
The FMHACA is undertaking various initiatives to ensure the quality of health services. One of
the major initiatives with this regard is the development of health facility requirement; as the
provision of quality health service by each level of health care necessitates the availability of
regulatory requirements for each health care service. Moreover, the exiting regulatory
requirements are not comprehensive and do not take into account the new service delivery
design. Thus, in order to protect the public from such sub-requirement services and promote
quality of health service, the FMHACA as a lead agency has developed this facility requirement.
In the development of this requirement, the FMHACA has used the following guiding principles:
1. Regulatory requirements shall be prepared for all health facilities according to the new
health care tier system
2. All the public and private health care delivery facilities shall be treated by uniform
requirements to avoid double requirements in the health sector.
3. The service provided by the health facilities should be quantitatively and qualitatively
standardized so as to enable informed decision making with regard to what, where, when
and how services be provided.
4. Regulatory requirements are substantial evidences for ensuring quality of healthcare
services.
5. Stakeholders shall be part of the regulatory requirements development and
implementation processes
6. Benchmarking best practices within and outside the country
Accordingly, the Authority has developed this requirement to:

1. Ensure quality of health service,
2. Use as essential guidance and handy reference and
3. Use as a tool for inspection and licensing of ophthalmic medium clinics.
In general, this requirement is intended for use in licensing, inspection and ensuing enforcement
actions. They are also designed to be useful for consumers and providers as a mechanism for
privately assessing the quality of health service provided and for rational health investment.
The authority recommends to all health facilities to strive in fulfilling the requirements stipulated
under their respective documents. It is expected that the fruition these facilities’ effort would
ensure the quality of health service through the development of qualified and competent health
professionals and by generating innovative ideas and methodologies to solve health service
problems.
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SECTION ONE: GENERAL
1. Scope
1.1. This Ethiopian national minimum requirement shall be applicable for all ambulance
services new and existing, governmental, non-governmental and private.
1.2. The document covers the minimum requirements with respect to practices, premises,
professionals and products or materials put into use for ambulance services.
2. Normative References
The latest editions of the following laws, regulations, directives and guidelines shall be taken as
part and parcel of this Ethiopian Requirement.
2.1. Ethiopian Food, medicine and Healthcare Administration and Control Proclamation No.
661/2009
2.2. Ethiopian Food, Medicine and Healthcare Administration and Control Regulation No.
189/2010
2.3. Health Policy of Ethiopia
2.4. Drug Policy of Ethiopia
2.5. Commercial Code of Ethiopia
2.6. Criminal Code of Ethiopia
2.7. Medicines Waste Management and Disposal Directive No 2/2011
2.8. Ethiopian National Guideline for Healthcare Waste Management, 2008
2.9. Ethiopian Building Proclamation, No. 624/2009
3. Terminologies and Definitions

3.1 Appropriate Organ
Shall mean a state government organ authorized to implement food, medicine and healthcare
administration and control activities at a state level;
3.2 Authority
Shall mean the Ethiopian Food, Medicine and Healthcare Administration and Control Authority.
3.3 Proclamation
Shall mean the Ethiopian Food, Medicine and Healthcare Administration and Control
proclamation No 661/2009.
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3.4 Appropriate Law
Shall mean a law issued by a state to implement regulatory activities regarding food, medicine
and healthcare.
3.5 Person
Shall mean any physical or juridical person
3.6 Authorized Person
Shall mean any ambulance service staff who is responsible for a given service
3.7 Ambulance
Any public, privately governmentally or non governmentally owned land vehicle especially
constructed or modified and equipped, intended to be used and maintained or operated by,
ambulance services for the transportation, upon the roads, streets and highways of the country, of
individuals who are sick, injured, or otherwise incapacitated or helpless.
3.8 Ambulance service
Shall mean any initial medical care or service given an ill or injured patient in the vehicle before
arriving to the appropriate receiving health care facility.
3.9 Ambulance services requirement
Shall mean requirements which are specific/ peculiar to the Ambulance service as described in
the document.
3.10 Basic life support (BLS)
Shall mean which is a level of medical care which is used for victims of life-threatening illnesses
or injuries until they can be given full medical care.
3.11 Advanced Life Support (ALS)

Shall mean which is a set of life-saving protocols and skills that extend basic life support to
further support the circulation and provide an open airway and adequate ventilation (breathing).
3.12 Special Care life Support (SCS)

Shall mean level of care that is provided to patients with an immediate life-threatening illness or
injuries associated with single or multiple organ system failure.
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SECTION TWO: LICENSURE
2.1 Application for Licensure
2.1.1 No person shall operate ambulance service in Ethiopia, whether governmental,
nongovernmental or private, without being licensed as required by appropriate law and
this requirement.
2.1.2 Any person desiring to ambulance service shall:
a. Complete the application form which shall contain information stated under
article 2.1.5;
b. Pay the prescribed license fee; and
c. Provide any information or document stated on the application form
2.1.3 An application for the initial licensure of ambulance service shall be submitted to the
appropriate organ no later than ninety (90) days prior to the stated date of operation.
The license fee shall accompany the application.
2.1.4 The first pre-licensing inspection shall be conducted by the appropriate organ upon
application without service fee. In case of failure to comply with this requirement
during the first pre-licensing inspection, the applicant has the right to reapply not
more than two times upon paying service fee. If the applicant fails to comply with this
requirement for the third time, its application for licensure shall be suspended for
three months.
2.1.5 The application for ambulance service license shall state the following:
a. Identification of the applicant/owner (name, citizen, address) and evidence for
ownership (if the applicant is an authorized delegate, written delegation letter
shall be submitted);
b. Previous owner and license number for existing ambulance service;
c. Name and location of the ambulance service;
d. Surrounding area of the ambulance service;
e. Types of services to be rendered.
f. Responsible person for each service of ambulance service;
g. Name, qualification, nationality and license copy of licensee;
h. Staffing (Number, type, qualification, work experience & original release and
license copy of all health professionals);
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i. Number and type of administrative staff;
j. Organizational structure;
k. Name of the Manager and person in charge in absence of the Manager;
l. Type of ownership: (Governmental, nongovernmental, private for profit, private
for non- profit, other governmental);
m. Vehicle design and its description;
n. Proposed use of idle space;
o. Owner of the building; (if rental, the agreement paper shall be submitted);
p. And other requirements which shall be made in close consultation with the
stakeholders and according to the rules and regulations of the region and the
country as well.
2.1.6 All applicants shall demonstrate that they have the capacity to operate ambulance
service in accordance with this requirement.
2.1.7 An application for a license or change in service shall be denied if the applicant cannot
demonstrate that the premises, products, personnel and health care services are fit and
adequate in accordance with this requirement.
2.1.8 The appropriate organ shall consider an applicant's prior history in operating a health
care facility either in all the regional states of the country in making licensure decision.
Any evidence of licensure violations representing serious risk of harm to patients shall
be considered by the appropriate organ, as well as any record of criminal convictions
representing a risk of harm to the safety or welfare of patients.
2.1.9 A license issued by the appropriate organ shall not be applicable for use by any other
person or at any facility other than the designated one in the license. Whenever, there is
change in licensee or premises, the license shall be updated.
2.1.10 A license issued to ambulance service in a specified address can’t be used for another
facility.
2.2 Initial/ New Licensure

2.2.1 Every standalone ambulance service shall have a separate license. The appropriate
organ shall issue each license in the name of the owner and licensee only for the
premises and person named as applicant in the application and the license shall not be
valid for use by any other person or at any place other than the designated in the
license.
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2.2.2 Ambulance service license shall specify the following:
The name, and professional license and registration number of the licensee;
a. The name and address of the ambulance service;
b. Ownership of the ambulance service;
c. Name of the owner,
d. License number, issuance and expiration dates of the license.
e. Signature and stamp of the appropriate organ and
f. Notices/reminders prepared by the appropriate organ
2.2.3 Prior to initial licensure of the ambulance service, the appropriate organ shall conduct
an on-site inspection to determine compliance with the applicable laws and
requirements governing the service.
2.2.4 The appropriate organ shall give a written report of the findings to the ambulance
service upon the conclusion of the inspection.
2.2.5 The ambulance service with deficiencies shall correct them and submit written proof of
correction of deficiencies.
2.2.6 The appropriate organ shall conduct a follow-up inspection to determine correction of
deficiencies cited within ten (10) days following the one hundred and eighty (180) day
correction period or upon notification from ambulance service that the deficiencies
have been corrected.
2.2.7 The appropriate organ shall deny the application for licensure to ambulance service that
has not corrected deficiencies. The applicant shall reapply for licensure when
deficiencies are corrected.
2.2.8 The appropriate organ shall conduct an unannounced on-site inspection of the
ambulance service shortly after the beginning of operation to assess the ambulance
service’s continued compliance with the laws and requirements governing the service.
2.2.9 The original license shall be posted in a conspicuous place at reception at all times.
2.2.10 The appropriate organ shall issue a replacement license where the originally issued
license has been confirmed as lost or destroyed upon submission of an application
supported by an affidavit.
2.3 Requirements for License Renewal

2.3.1 A license, unless suspended or revoked or under consideration in pending case, shall be
renewable annually and the ambulance service shall submit an application for license
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renewal to the appropriate organ no later than sixty (60) days before the expiration date
of the current license.
2.3.2 Without prejudice to article 2.3.1;
a. Subsequent to submitting renewal application, the owner shall pay the
prescribed license fee
b. License renewal shall be made during the first quarter of each fiscal year
(Hamle 1 to Nehassie 30) based on routine inspection findings over the year
c. In case of failure to renew license within the prescribed period, license may be
renewed upon paying penalty (50% of renewal fee) within one month
d. In case of failure to renew license as per article 2.3.2 (c), license shall be
considered as cancelled
2.3.3 Every applicant who needs to renew a license shall;
a. Apply to the appropriate organ filling the form prescribed by the appropriate
organ;
b. Pay the prescribed license renewal fee;
c. Provide copies of professional licenses for all permanent and temporarily
employed health professionals of the institution and
d. Provide additional information or document upon written request by the
appropriate organ.
2.3.4 The appropriate organ may conduct background checks on the applicant or licensee to
determine its suitability or capability to operate or to continue operating a health care
facility. Background checks shall consist of, but not be limited to, the following:
a. Verification of licensure status;
b. Verification of educational credentials;
c. Verification of residency status;
d. Verification of solvency and
e. Contacts with federal and State government officials to determine outstanding
warrants, complaints, criminal convictions, and records of malpractice actions.
2.3.5 The appropriate organ shall renew a license for ambulance service in substantial
compliance with the applicable laws and this requirement.
2.3.6 When the licensee can not avail himself for a period not more than 30 days for any
reason, he/she shall assign an equivalent professional temporarily but with prior
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notification to the appropriate organ. If the licensee is going to be absent for more than
the stated period, he/she shall replace the license.
2.4 Removal Permits, Change of Operation and Forfeiture of License

2.4.1 No ambulance service facility or part thereof shall move from the premises for which a
license has been issued to any other premises without first having obtained a permit to
move from the appropriate organ to the premises not covered by the license issued to
the ambulance service.
2.4.2 Without the prejudice to article 2.4.1, permit in change of address shall indicate the
special conditions governing the moving of the ambulance service or part of it as the
appropriate organ may find to be in the interest of the public health.
2.4.3 Without prior approval of the appropriate organ, change of licensee shall not be made.
2.4.4 The ambulance service shall notify the appropriate organ whenever there is change of
owner.
2.4.5 The licensee shall inform the appropriate organ any change in operation. Change of
operation means any alteration of services that is substantially different from that
reported on the ambulance service’s most recent license application.
2.4.6 Any transfer as to person or place without the approval of the appropriate organ shall
cause the immediate forfeiture of the license. That is the license shall not be assignable
or transferable and shall be immediately void if the ambulance service ceases to
operate, if its ownership changes, or if it is relocated to a different site.
2.4.7 When change of ownership of ambulance service is contemplated, the facility shall
notify the appropriate organ in writing and give the name and address of the proposed
new owner.
2.4.8 When change of licensee of ambulance service is contemplated, the Specialty center
shall notify the appropriate organ in writing and give the name and address of the
proposed new licensee.
2.5 Suspension and Revocation of a License

2.5.1. The appropriate organ may suspend or revoke a license or order closure of a service,
order to quit patient transporting, where it finds that there has been a substantial failure
to comply with this requirement.
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2.5.2. Without prejudice to grounds of suspension provided under relevant laws, the
appropriate organ shall suspend the license for 3 to 12 months in any of the following
grounds:
a. Where the ambulance service is legally suspended;
b. Where the ambulance service fails to practice medical ethics;
c. Where the ambulance service engages in rendering services which are outside
the competence of the facility for which the license is obtained;
d. Where the ambulance service fails to allow inspection pursuant to the law and
this requirement;
e. When the ambulance service allows a practitioner who has been suspended by
appropriate organ from practicing his profession;
f. Members of the governance or the manager or other key staff member are
convicted of a serious offence involving the management or operation of an
ambulance service, or which is directly related to the integrity of the facility or
the public health or safety;
g. When the ambulance service fails to implement or fulfill comments and
corrections given by the appropriate organ;
h. When the ambulance service shown any act which constitutes a threat to the
public health or safety;
i. When the ambulance service fails to observe laws relating to health services and
this requirement;
j. When the ambulance service fails to submit relevant information required under
this requirement.
2.5.3. Without prejudice to grounds of revocation provided under relevant laws, the
appropriate organ shall revoke the ambulance service license from one to two years on
any of the following grounds:
a. Where the license is proved to have been obtained by submitting false
information;
b. Allows a practitioner who is not licensed pursuant to the appropriate law or
who has been revoked by appropriate organ from practicing his profession;
c. Where any of its permanent health personnel is found registered/ employed as
a permanent staff in any other facility;
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d. Where the faults referred to in Article 2.5.2 have been committed for the
second time;
e. Where the license is found transferred or rented to another person;
f. Where the ambulance service changes types of services, name, address and the
licensee without obtaining permission from the appropriate organ;
g. Where the license is not renewed in accordance with Section 2.3 of this
requirement;
h. Where the ambulance service is legally closed or ceases operation;
i. Where the ambulance service is found operating while suspended by
appropriate organ;
j. Where the ambulance service is found operating out of the scope of services
stated under this requirement;
2.5.4. At least 30 days prior to voluntary surrender of its license where approved by the
appropriate organ, or order of revocation, refusal to renew, or suspension of license, the
ambulance service must notify the public the intended closure.
2.5.5. Each license in the licensee's possession shall be the property of the appropriate organ
and shall be returned to the appropriate organ immediately upon any of the following
events:
a.Suspension or revocation of the license;
b. Refusal to renew the license;
c.Forfeiture of a license; or
d. Voluntary discontinuance of the operation by the licensee.
2.5.6. If the appropriate organ determines that operational or safety deficiencies exist, it may
require that all client/patient transporting of ambulance service cease. This may be done
simultaneously with, or in lieu of, action to revoke license and/or impose a fine. The
appropriate organ shall notify to the facility in writing of such determination.
2.5.7. The license shall be returned to the appropriate organ within five (5) working days from
voluntary surrender, order of revocation, expiration, or suspension of license.
2.5.8. The appropriate organ shall issue to the ambulance service a written notification on
reasons for denial, suspension or revocation of the license.
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2.6 Right to Fair Hearing
2.6.1 Any applicant made subject to action by the appropriate organ for denial or suspension
or revocation of license or who is assessed a fine under terms of this section shall have
the right to a fair hearing in accordance with relevant laws.
2.6.2 Fair hearing shall be provided/ arranged by the appropriate organ whenever there is an
official compliant submitted to this body and it shall be open for media.
2.7 Information to be disclosed

2.7.1 Evidence based information received by the appropriate organ through inspection and
other true sources about the ambulance service shall be disclosed to the public in such a
way to indicate the public a decision maker or self-regulatory for its own health.
2.7.2 Whenever public disclosure is necessary, the appropriate organ shall forward inspection
reports to the ambulance service at least 15 days prior to public disclosure.
2.7.3 Any citizen has the right to obtain information on the official profile of services of any
licensed ambulance service from the appropriate organ.
2.7.4 Anyone who is interested in establishing ambulance service shall have the right to be
provided with information concerning the requirements required by the appropriate
organ at any working day.
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SECTION THREE: GOVERNANCE
3.1 Technically the ambulance service shall be led/ managed by the Licensee, i.e., technical
manager.
3.2 The ambulance service shall submit periodic reports to the respective organs to which it is
responsible.
3.3 The head of the ambulance service or the Licensee shall be responsible for:
a. The protection of patients’ health, safety, and well- being;
b. Meeting patient needs;
c. Reporting information on suspect of abuse, neglect and exploitation for children
&people with mental in competence;
d. Meeting regulatory requirements and other relevant laws
e. Responding to reports from the appropriate regulatory body;
f. Total administration of the service.
GOVERNANCE
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SECTION FOUR: PATIENT RIGHTS AND RESPONSIBILITIES
4.1 Informed Consent
4.1.1 Each ambulance service shall protect and promote each client’s rights.
4.1.2 For undertaking any type of treatments an informed consent shall be required
from the client or client’s next of kin or guardian.
4.1.3 For undertaking any type of procedures and treatments an informed consent shall
be required from the patient or patient’s next of kin or guardian.
4.1.4 An informed consent may not be required during emergency cases or life
threatening situations where the patient is not capable of giving an informed
consent and his or her next of kin or guardian is not available.
4.1.5 The ambulance service shall comply with relevant laws, national and
international codes of ethics in the cases of vulnerable groups like children,
women, geriatric patients etc when someone other than the patient can give
consent.
4.1.6 No photographic, audio, video or other similar identifiable recording is made
without prior informed written consent.
4.1.7 A ambulance service facility shall post list of fees & Service charges for clients in
a visible place.
4.2 Client Rights

Every client of ambulance service shall at least have the following rights,
4.2.1 To receive safe health services,
4.2.2 To receive treatment and medical services without discrimination based on race,
age, color, religion, ethnicity, national or social origin, sex, sexual preferences,
handicap, diagnosis, source of payment or other status;
4.2.3 To retain and exercise to the fullest extent possible all the constitutional and legal
rights to which the client is entitled by law;
4.2.4 To be informed of the names and functions of the ambulance service staff who
are providing direct care to the client.
4.2.5 To have personal and physical privacy.
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4.2.6 To be treated with courtesy, consideration, and respect for the client’s dignity and
individuality i.e. the right to care that respects the client’s personal values and
beliefs;
4.2.7 To refuse medication and treatment and to be informed of the medical
consequences of refusing treatment except conditions which are threatening to the
general public health;
4.2.8 To be free from physical and mental abuse, neglect, sexual harassment, sexual
violence and exploitation;
4.2.9 To have personal and physical privacy during medical treatment and medical
care,
4.2.10 To get confidential care confidential treatment. Information in the patient's
records shall not be released to anyone outside the ambulance service facility
except the followings;
a. If the client has approved the request,
b. If the release of the information is required and permitted by law.
c. If the patient's identity is masked
4.2.11 To obtain a copy of the patient's medical record, as per the requirements set under
the medical record section of these requirements;
4.2.12 To present his or her suggestion or grievances.
4.2.13 To choose their treating nurse if
a. There is conflict among the patient and the staff or
b. The patient has justifiable reason or
c. The facility has another alternative.
4.3 Client Responsibilities

Every client shall have the following responsibilities:
4.3.1 To cooperate with the staff;
4.3.2 To provide, to the best of the client’s knowledge, accurate and complete
information regarding past medical history if necessary;
4.3.3 To respect the clinic staff;
4.3.4 To observe the ambulance service policies and procedures, including those on
smoking, alcohol use, cellular phones, noise;
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4.3.5 Not to litter the premises and ambulance vehicles.
4.3.6 Report any changes in his/her condition or anything that appears unsafe to her/his
self (the patient) or others during transportation.
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SECTION FIVE: HUMAN RESOURCE MANAGEMENT
5.1. General Requirements

5.1.1. The ambulance service shall have responsible person who organizes /carries out the
major functions of Human Resource Management (HRM).
5.1.2. The ambulance service shall ensure that all health professionals recruited are licensed
as per the registration and licensing requirement of the appropriate organ.
5.1.3. The ambulance service shall ensure and maintain evidence of current active licensure,
registration, certification or other credentials for employees and contract staff prior to
letting to work and shall have procedures for verifying that the current status is
maintained.
5.1.4. Whenever a licensed health-care professional is terminated as a result of a job-related
incident, the facility shall refer a report of the incident to the appropriate organ.
5.1.5. Each person who is involved in the performance of duties involving direct patient
care shall have an occupational health screening prior to entering active status and
once every five (5) years thereafter. A health professional shall not conduct health
examination for himself/ herself.
5.1.6. The facility shall keep on file the medical checkup reports of all staff and shall make
available during inspection by the appropriate organ.
5.1.7. Each person who is involved in direct patient care and who has been absent from duty
because of an illness that required to be reported to the MOH shall, prior to returning
to duty, obtain certification from a physician or other qualified health professional, as
provided for in the facility’s policies, that he or she may return to duty without
apparent danger of transmitting the cause of the illness to any patient.
5.1.8. The facility shall regularly follow the Immunization status of all employees and all
other persons who routinely come in contact with patients or patient areas against
selected communicable disease. Immunizations shall be in accordance with current
guidelines developed by the Federal Ministry of health (FMoH).
5.1.9. The facility shall update the employment record for all staff. The record shall contain
to a minimum: information on credentials, health examination (fitness for duty), work
history, current job description, and evidence of orientation, in-service education /
training and copies of annual evaluation.
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5.1.10. The facility shall notify the appropriate organ while hiring or terminating medical
staff.
5.2. Staffing Plan

5.2.1. The ambulance service shall avail as a minimum the staff requirements stated under
this requirement.
5.2.2. The staffing plan shall define the following elements:
a. The total number and types of staff needed for the ambulance service.
b. The total number of staff currently available for the ambulance service,
c. The required education, skills, knowledge, and experience required for each
professional.
d. The process and time period for reviewing and updating the plan shall be
indicated. (The plan is periodically reviewed and updated as required, but it shall
be done at least every two years.)
e. Expected/ existing workload.
5.3. Job Description and Orientations

5.3.1. All staff shall be provided with current written job descriptions and be oriented to
their specific job responsibilities at appointment.
5.3.2. The job description shall include the title and grade of the position, specific function
of the job, job requirement, reporting mechanism, evaluation criteria and description
of job site and work environment.
5.3.3. The orientation program for all employees shall include three levels of orientation:
the facility wise, service wise and job specific.
5.3.4. Organizational and administrative structure of the ambulance service facility shall be
posted in a visible place and orientation to all staff working in the facility shall be
provided by the service head.
5.3.5. Orientation to facility’s policies, including all environmental safety programs,
infection control, and quality improvement shall be provided.
5.3.6. Staff members who are not licensed to practice independently shall have their
responsibilities defined in their updated job descriptions.
5.3.7. The ambulance service facility shall organize a system of provide & maintain
evidence of an orientation program for all new staff and, as needed, for existing staff
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who are given new assignments. The orientation program shall include an explanation
of:
a. Job duties and responsibilities,

b. Ambulance service facility’s and ambulance vehicle sanitation and infection
control programs;
c. Organizational structure within the facility ;
d. Patient rights;
e. Patient care policies and procedures relevant to the job;
f. Personnel policies and procedures;
g. Emergency procedures;
h. Reporting requirements for abuse, neglect or exploitation
i. What to rescored & report
5.4. Continuing education

5.4.1. The facility shall encourage and facilitate that staffs receive training in order to
perform assigned job responsibilities.
5.4.2. The professional in the ambulance service facility shall receive ongoing Continuing
Professional Development (CPD) or continuous medical education (CME) to
maintain or advance his or her skills and knowledge.
5.4.3. The CPD/ CME shall be relevant to the setting in which they work as well as to the
continuing advancement of the ambulance service.
5.4.4. The facility shall decide the type and level of training for staff in accordance with
National CPD guideline and then carry out and document a program for this training
and education.
5.4.5. The ambulance service facility shall provide and maintain evidence of CPD or CME
for staff. A record shall be maintained including dates, topics and participants.
5.4.6. The ambulance service facility shall periodically test staff knowledge, skill and
attitude through demonstration, mock events and other suitable methods. This testing
shall be documented.
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5.5. Medical Staff
5.5.1. The health professional shall be responsible to the governing authority for medical
care and treatment provided in the ambulance service care as per these requirement
and shall:
a. Participate in a Quality Assurance/ Performance Improvement program to
determine the status of patient care and treatment;
b. Abide by ambulance service and medical staff policies;
c. Establish a disciplinary process for infraction of the policies
5.5.2. There shall be regular medical staff meetings to review the clinical patient care works
& administrative duties.
5.6. Employee’s Health

5.6.1. The ambulance service shall institute systems and processes that minimize
employees’ risks; protect employees and provide access to care when needed.
5.6.2. A comprehensive Occupational Health and Safety (OHS) program shall have the
following components:
a.Staff dedicated to coordinate OHS activities,
b. Policies and Procedures that define components of the program,
c.Training for staff on program components.
5.6.3. The requirements outlined below define the core elements of an OHS program and
specify minimum requirements needed to address OHS issues.
a.The ambulance service facility shall have an occupational health and safety
policy and procedures in place to identify, assess and address identified health and
safety risks to staff and prevent those risks that will potentially compromise their
health and safety.
b. The ambulance service facility assesses and documents safety risks
through formalized, structured assessments that are done at regular intervals.
c.Interventions shall be designed and implemented to address the risks that are
identified.
5.6.4. The ambulance service facility shall have a mechanism in place to address/ protect
injuries that could lead to the transmission of blood-borne diseases (needle stick and
other injuries).
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5.6.5. The ambulance service facility shall provide personal protective equipment, and
facilitate access to prophylaxis measure.
5.6.6. The ambulance service shall provide the following facilities to employees:
a. Cafeteria (meal for duty)… Optional
b. Break room Duty room (bed, table and chair, closet with lock),
c. Adequate toilet and shower facilities,
5.7. Dress Code and Employee Identification Badge

For areas involving direct patient contact:
5.7.1. Footwear shall be safe, supportive, clean, and non-noise producing,

5.7.2. Artificial nails are prohibited. Natural nails must be kept short and no jewelry shall be
worn on finger or wrist,
5.7.3. Hair must be worn in a way that prevents contamination and does not present a safety
hazard,
5.7.4. The ambulance service facility shall provide uniforms to employees. And employees
shall wear the facility uniforms all the time while on duty.
5.7.5. The dressing shall not interfere in any way the service provision.
5.7.6. The ambulance service facility may specify a particular style and/or color of uniform
with different style/color code; separate for each human resource category,
5.7.7. The employee shall keep the uniform neat, wrinkle free and in good repair,
5.7.8. The ambulance service facility shall prepare and make sure identification badges are
worn by employees.
5.7.9. The identification badge shall be worn at all times while at work and be easily visible
with name & profession.
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SECTION SIX: AMBULANCESERVICE REQUIREMENTS
6.1Ambulance service requirement for basic life support (BLS)
6.1.1 Practice
6.1.1.1 The ambulance service shall provide to every emergency patient who needs the service
without any discrimination.
6.1.1.2 The ambulance service may provide for clients who need the service without any
prerequisite and discrimination.
6.1.1.3 The ambulance service shall be available 24 hrs a day and 365 days a year
6.1.1.4 The ambulance service shall provide the following services:
a. Patient transportation service from health facility to other health facilities and from
home to the health facility.
b. Clinical examinations including brief history, vital signs, very pertinent physical
examination and glucose test when needed
c. Clinical life saving support that includes:
 ABC of life treating
 Oxygen administration
 Splinting
 Delivery attending
 Immobilization
 Iv securing
 pain management
 Oxygen administration, monitoring of vital signs, basic
emergency medical care)
6.1.1.5 The ambulance service shall comply with the patient rights stated under this requirement.
6.1.1.6 The ambulance service shall register patient/clients:
Identification, address, arrival time, finding and treatment given if any.
6.1.1.7 Upon arrival to the intended health facility the ambulance staff shall transfer the patient
to the emergency service. The handover of patients shall be accompanied by a written
document which at least includes: identification, address, arrival time, finding and
treatment given if any.
6.1.1.8 Upon arrival if there is placenta, severed extremity or other body part the ambulance staff
shall handover the patient with stated body parts to the receiving health facility.
25
6.1.1.9 If death happens on the way to a health facility the dead body shall be taken to the health
facility and death shall be confirmed and certified by authorized health professional.
6.1.1.10 The health facility shall receive the dead body and dead body care shall provide by the
facility.
6.1.1.11 Ambulance vehicles shall serve only for designated services.
6.1.1.12 After providing a service the vehicle shall be cleaned and made standby.
6.1.1.13 Each item after providing service equipment transported in an ambulance shall be check
every time and shall be properly restrained in the ambulance.
6.1.1.14 Each ambulance should carry extrication equipment appropriate for the level of
extrication the ambulance service provides
6.1.1.15 All communications equipment shall be maintained in good working order. The
communications equipment must be capable of transmitting and receiving clear voice
communications.
6.1.1.16 Each ambulance responding to a request for service shall be staffed with at least two
staffs without driver.
6.1.1.17 Each person transported in an ambulance shall be properly restrained in the ambulance.
6.1.1.18 Each ambulance service shall establish a communications linkage and consult with the
local health care facilities.
6.1.1.19 Each ambulance care provider shall ensure that he or she follows every direction or
instruction issued by a communications officer with respect to the assignment of calls to
ambulances.
6.1.1.20 The driver of an ambulance, in which a patient/client is being transported, shall transport
the patient/client to a facility as directed by a communications officer ordering the
movements of the ambulance. In the absence of a direction from a communications
officer, the driver will transport the patient to the closest health care facility that can
provide the care apparently required by the patient.
6.1.1.21 The ambulance vehicle should be kept clean and tidy and should have a name board as
specified in the contract in English and respective local language, on the vehicle.
6.1.1.22 Vehicle should be regularly serviced and maintained so as to avoid any break down.
6.1.1.23 The ambulance vehicle should be insured. Under no circumstances uninsured vehicle
shall be used.
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6.1.1.1 The ambulance shall have telephone/radio communication means with the health
facilities, and the ambulance team.
6.1.2 Premises
6.1.2.1 The ambulance service facility shall have a base office.
6.1.2.2 There shall be store room for medical equipment and supplies.
6.1.2.3 There shall be at least one ambulance vehicles dedicated only for ambulance service.
6.1.2.4 The ambulance shall be parked within its base office compound or the local health
facility which have contractual agreement.
6.1.2.5 The ambulance shall have adequate space for accommodating at least: a stretcher couch,
one family attendant and at least two nurses/medical care giver and medical items needed
for providing immediate life saving support
6.1.2.6 The ambulance shall be labeled and have a siren.
6.1.2.7 The ambulance shall have adequate internal light and ventilation.
6.1.2.8 The ambulance shall fulfill requirements of road transport authority.
6.1.3 Professionals
6.1.3.1 The ambulance service shall be led by either of the following licensed health
professionals with at least one year relevant work experience.
 Emergency medical technician professionals
 Paramedics
 Nurse
6.1.3.2 The minimum number of personnel for ambulance service shall include:
a) nurse or Emergency medical technician professionals or Paramedics per ambulance per
shift # 1
b) Licensed driver per vehicle per shift # 1
c) Telephone operator and coordinator per shift # 1
d) Diploma nurse or Trained care giver per ambulance per shift # 1
e) Cleaner #2
6.1.3.3 The health professionals shall be trained on emergency medical services
6.1.3.4 The driver shall be oriented on emergency situation management
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6.1.4 Products
6.1.4.1 The BLS ambulance service shall include the following medical equipments and
supplies:
a. Ventilation and Airway Equipment
 Oxygen cylinder(2)
 O2 Face Mask(Adult & Pedi)
 non- rebrether mask adult and pedi
 O2 Nasal Catheter adult and pedi
 Ambubag Adult and pedi
 Nasopharengial Air Way d/t size
 Oropharengial Air way(1-4)
 Suction Chateter adult and child
b. Immobilization Devices
 Cervical collars large medium and small

 Soft
 Hard
 Arm Splint Adult and pedi
 Leg splint Adult and pedi
c. Hemorrhage Control/Trauma kit
 Cotton Roll 100gm
 Elastic Bandege small,medium & large
 Roll Bandege(Guaze Bandege)18cm x 5cm
 Sterile Guaze 10 x 10
 Adhesive Plaster
 Triangulare Bandege
 Scisores
 Arterial Tourniquet
d. Obstetrical Kit
 Kit (separate sterile kit) sterile scissors

 Towels Larg
 sterile gloves
 sterile gauze pads
 clamps for cord
 bulb suction
 Container for carrying placenta

 blanket small And Large
 Oxitoxin/ergometrine
e. Diagnostic and Miscellaneous
 BP Apparatuse/Sphygmomanometer
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 Stethescope
 Thermometer
 Pulsoximeter
 Functional flash light
 Linen
 Pillows
 Towels
 NGT
 Folly catheter
 Canulla of Diff.Size(16-24)
 Syringe with needel 5ml &10ml
f. Infection Control
 goggles
 face shield/Mask e.g., N95 or N100
 Gloves non sterile/disposable
 overalls or gowns
 Standard sharps containers
 disposable trash bags/Basket
g. Injury-prevention Equipment/PPE
 Restraint systems for all passengers and patients transported in ground
ambulances.
 Shoes
 Reflective safety wear
h. Communication
 Phone
i. Emergency medicine and analgesics
 Adrenalin 1ml inj
 oral glucose
 Nitroglycerin sublingual tablet
 Asprine 300 mg tab
 Hydrochortison 100mg inj
 Tramadol 50mg inj
 Diclofinac 75 mg inj
 Diazepam 10mg in 2ml inj
 Panadol Po 1gm
 Diclofinac 50 mg po
j. IV Fluids
 R/L 1000ml
 N/S 1000ml
 D/W 1000ml
 40% Glucose
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6.2Ambulance service requirement for advanced life support (ALS)
6.2.1 Practice
without any discrimination.
d. Patient transportation service from health facility to other health facilities and from home
to the health facility.
e. Clinical examinations including brief history, vital signs, very pertinent physical
f. Clinical life saving support that includes:
 ABC of life
 oxygen administration
 Splinting
 Immobilization
 Iv securing
 pain management
 Advanced airway management;
 ECG monitoring; and defibrillation,
 Ventilator management;
 Circulatory management and support
30
facility and death shall be confirmed.
facility.
communications.
ambulances.
31
6.2.1.21 The ambulance vehicle should be kept clean and tidy and should have a name board as specified
in the contract in English and respective local language, on the vehicle.
6.2.1.23 The ambulance vehicle should be insured. Under no circumstances uninsured vehicle shall be
used.
6.2.2. Premises
6.2.2.1. The ambulance service facility shall have a base office.
6.2.2.2. There shall be store room for medical equipment and supplies.
6.2.2.3. There shall be at least two ambulance vehicles dedicated only for ambulance
service.
6.2.2.4. The ambulance shall be parked within its base office compound or the local health
6.2.2.5. The ambulance shall have adequate space for accommodating at least: a stretcher
couch, one family attendant and at least two nurses/medical care giver and medical
items needed for providing immediate life saving support
6.2.2.6. The ambulance shall be labeled and have a siren.
6.2.2.7. The ambulance shall have adequate internal light and ventilation.
6.2.2.8. The ambulance shall fulfill requirements of road transport authority.
6.2.3. Professionals
6.2.3.1. The ambulance service shall be led by either of the following licensed health
 Emergency professionals
 Anesthesia professionals
 Emergency Nurse
6.2.3.2. The minimum number of personnel for ambulance service shall include:
a) Emergency professionals or anesthesia professionals or emergency nurse per ambulance
per shift # 1
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e) Cleaner #2
6.2.3.3. The health professionals shall be trained on advanced life support.
6.2.3.4. The driver shall be oriented on emergency situation management
6.2.4. Products
6.2.4.1. The ALS ambulance service shall include the following medical equipments and
supplies:
k. Ventilation and Airway Equipment
l. Immobilization Devices

 Soft
 Hard
m. Hemorrhage Control/Trauma kit
 Scisores
n. Obstetrical Kit

 Towels Larg
 sterile gloves
 clamps for cord
 bulb suction
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o. Diagnostic and Miscellaneous
 Stethescope
 Thermometer
 Pulsoximeter
 Linen
 Pillows
 Towels
 NGT
 Folly catheter
p. Infection Control
 goggles
q. Injury-prevention Equipment/PPE
ambulances.
 Shoes
r. Communication
 Phone
s. Emergency medicine and analgesics
 oral glucose
 Panadol Po 1gm
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t. IV Fluids
 R/L 1000ml
 N/S 1000ml
 D/W 1000ml
 40% Glucose
u. Intubation kit
 Respirator
 Chest tube set
 Cardiac monitor
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6.3Ambulance service requirement for special care life support (SCLS)
6.3.1 Practice
without any prerequisite and discrimination.
g. Patient transportation service from health facility to other health facilities and from home
to the health facility.
h. Clinical examinations including brief history, vital signs, very pertinent physical
i. Clinical life saving support that includes:
 ABC of life
 oxygen administration
 Splinting
 Immobilization
 Iv securing
 pain management
 Advanced airway management;
 ECG monitoring; and defibrillation,
 Ventilator management;
 Circulatory management and support
 Manual defibrillation/cardio version
 Central line
 Cardiac pacing
 Chest decompression
 Surgical airway management
36
 Intraosseous line
 Advanced trauma care
facility and death shall be confirmed.
facility.
communications.
ambulances.
37
6.3.1.21 The ambulance vehicle should be kept clean and tidy and should have a name board as specified
in the contract in English and respective local language, on the vehicle.
6.3.1.23 The ambulance vehicle should be insured. Under no circumstances uninsured vehicle shall be
used.
6.3.2 Premises
6.3.2.1. The ambulance service facility shall have a base office.
6.3.2.3. There shall be at least two ambulance vehicles dedicated only for ambulance
service.
6.3.2.4. The ambulance shall be parked within its base office compound or the local health
6.3.2.5. The ambulance shall have adequate space for accommodating at least: a stretcher
couch, one family attendant and at least two nurses/medical care giver and medical items
needed for providing immediate life saving support
6.3.2.6. The ambulance shall be labeled and have a siren.
6.3.2.7. The ambulance shall have adequate internal light and ventilation.
6.3.2.8. The ambulance shall fulfill requirements of road transport authority.
6.3.3 Professionals
6.3.3.1. The ambulance service shall be led by either of the following licensed health
 Emergency professionals
38
 Anesthesia professionals
 Traumatologist
6.3.3.2. The minimum number of personnel for ambulance service shall include:
a) Emergency professionals or anesthesia professionals or traumatologist per ambulance per
shift # 1
e) Cleaner #2
6.3.3.3. The health professionals shall be trained on special care life support.
6.3.3.4. The driver shall be oriented on emergency situation management
6.3.4 Products
6.3.4.1. The special care life support ambulance service shall include the following medical
equipments and supplies:
a. Ventilation and Airway Equipment
b. Immobilization Devices

 Soft
 Hard
c. Hemorrhage Control/Trauma kit
 Scisores
39
d. Obstetrical Kit

 Towels Larg
 sterile gloves
 clamps for cord
 bulb suction

e. Diagnostic and Miscellaneous
 Stethescope
 Thermometer
 Pulsoximeter
 Linen
 Pillows
 Towels
 NGT
 Folly catheter
f. Infection Control
 goggles
g. Injury-prevention Equipment/PPE
ambulances.
 Shoes
h. Communication
 Phone
i. Emergency medicine and analgesics
40
 oral glucose
 Panadol Po 1gm
j. IV Fluids
 R/L 1000ml
 N/S 1000ml
 D/W 1000ml
 40% Glucose
k. Intubation kit
 Respirator
 Chest tube set
 Cardiac monitor
 Cut down set
 Central line set

 Air way management
kit
 Pace making kit
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6.4. Service requirements for air ambulance
6.4.1. Practice
6.4.1.1. The air ambulance service shall be provided to every emergency patient or client
who needs the service without any prerequisite and discrimination
6.4.1.2. The air ambulance service shall be available 24 hrs a day and 365 days a year
6.4.1.3. The air ambulance service shall provide the following services:
a. Patient transportation service to the hospital and from the hospital to other health
facilities.
b. Clinical examinations including brief history, vital signs, very pertinent physical
c. Clinical life saving support that includes:
 Advanced airway management, oxygen administration, severe asthma management
 Bleeding control
 Fluid resuscitation
 Cardiac emergencies and advanced cardiac critical care
 Attending labor
 Pregnant women with any medical emergency
 Immobilizing a fracture
 Up on the occurrence of handicap by natural accident, car accident, electrical and
fire accident
 Managing seizure disorder
 Providing emergency medicines as per emergency medicines list for ambulance
services.
 May Provide transportation service for chronic patient
6.4.1.4. The air ambulance service shall comply with the patient rights stated under this
requirement.
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6.4.1.5. The air ambulance service shall register all clients: identification, arrival time, findings,
treatment given and Patient's outcome at the time of arrival at destination. Patient’s
change in condition during transport, Safety practices, if any.
6.4.1.6. Every procedure, medication and clinical condition shall be communicated to the
patient or family member or caregivers or next of kin
6.4.1.7. Upon arrival the air craft/ ambulance staff shall transfer the patient to the emergency
service in the intended health facility. The handover of patients shall be accompanied by
a written document which includes: identification, arrival time, findings, treatment given
and Patient's outcome at the time of arrival at destination.
6.4.1.8. The air ambulance service shall avail ground ambulance for transporting patients if
necessary.
6.4.1.9. Upon arrival if there is placenta, severed extremity or other body part the
aircraft/ambulance staff shall handover the patient with stated body parts to the
receiving health facility.
6.4.1.10. If death happens on the way to a health facility the dead body shall be taken to the
hospital and death shall be confirmed. Dead body care shall be provided by the facility
and the facility shall receive the dead body as per the requirement of dead body care.
6.4.1.11. Air craft/ ambulance shall serve only for emergency services.
6.4.1.12. After providing a service the Air craft/ ambulance shall be cleaned and made standby.
6.4.1.13. After providing services each medical equipment in the air craft/ ambulance shall be
check every time and shall be properly restrained in the air craft/ ambulance.
6.4.1.14. Each air craft/ ambulance should carry extrication equipment appropriate for the level
of extrication the ambulance service provides
6.4.1.15. All communications equipment shall be maintained in good working order. The
communications.
6.4.1.16. Each air craft/ ambulance responding to a request for service shall be staffed with at
least two staffs without pilot.
6.4.1.17. Each person transported in an air craft/ ambulance shall be properly restrained in the
ambulance.
6.4.1.18. Each air craft/ ambulance service shall establish a communications linkage and consult
with the local, nationwide and worldwide health care facilities.
43
6.4.1.19. Each air craft/ ambulance care provider shall ensure that he or she follows every
direction or instruction issued by a communications officer with respect to the assignment
of calls to air craft/ ambulance.
6.4.1.20. The pilot of an air craft/ ambulance, in which a patient/client is being transported, shall
transport the patient/client to a facility as directed by a communications officer ordering
the movements of the air craft/ ambulance. In the absence of a direction from a
communications officer, the pilot will transport the patient to the closest health care
facility that can provide the care apparently required by the patient.
6.4.1.21. The air craft/ ambulance should be kept clean and tidy and should have a name board as
specified in the contract in English and respective local language, on the air craft/
ambulance.
6.4.1.22. Air craft/ ambulance should be regularly serviced and maintained.
6.4.1.23. The air craft/ ambulance should be insured and coordinated. Under no circumstances
uninsured air craft/ ambulance shall be used.
6.4.1.24. The air craft/ ambulance ensure that ground transport is appropriate and safe for
the patient’s specific disease process/needs. For example: patients requiring use of
a hyperbaric chamber are usually transported by ground, but in some geographic
locations, the distance would be prohibitive for ground transport.
6.4.2. Premises
6.4.2.1. The air craft/ ambulance service facility shall have a base office.
6.4.2.3. There shall be at least one air craft/ ambulance dedicated only for ambulance
medical care service.
6.4.2.4. The parking of the air craft/ ambulance shall be within the local air port.
6.4.2.5. The air craft/ ambulance shall have telephone/radio communication means with
the hospitals, other health facilities, public and the ambulance team.
6.4.2.6. The air craft/ ambulance shall have adequate space for accommodating at least :-
a stretcher couch, one family attendant and at least two nurses/medical care giver and
medical items needed for providing immediate life saving support.
6.4.2.7. The air craft/ ambulance shall fulfill requirements of aviation transport authority.
44
6.4.2.8. Configuration of the aircraft/ambulance interior must not compromise the ability to
provide appropriate care or prevent providers from performing emergency
procedures if necessary.
6.4.2.9. Belt locations must be adjustable along the length of the stretcher to
accommodate patients’ specific medical situations, for example, pregnant patients
or specific injury locations.
6.4.2.10. The service's mission and ability to transport two or more patients must not
compromise the airway or stabilization or the ability to perform emergency
procedures on any on-board patient.
6.4.2.11. The aircraft/ambulance must have an entry that allows loading and unloading
without excessive maneuvering(no more than 45 degrees about the lateral axis and
30 degrees about the longitudinal axis) of the patient, and does not compromise
functioning of monitoring systems, intravenous lines, and manual or mechanical
ventilation.
6.4.2.12. The aircraft/ambulance must have access for simultaneous airway management if
there is a two-patient configuration.
6.4.2.13. There must be access and necessary space to ensure any on-board patient's
6.4.2.14. Airway is maintained and to provide adequate ventilatory support from the
secured, seat- belted position of medical transport personnel.
6.4.3. Professionals
6.4.3.1. The ambulance service shall be led by either of licensed
 Specially trained Physician
 BSc nurse or (emergency nurse) three years of critical care experience
 Level 4 ambulance service and emergency care provider.
 Emergency medical technician professionals
 Anesthetics
6.4.3.2. Minimum requirements for personnel of the ambulance service shall include:
f) Nurses # 4
g) Ambulance service and Emergency care provider/optional
h) Licensed pilot per aircraft/ambulance per shift # 1
i) Trained Telephone operator and coordinator per shift # 1 ( with clinical background)
45
j) Cleaner #2
6.4.3.3. Staffs shall be trained on emergency medical services.
6.4.3.4. The pilot shall be oriented on emergency situation management
6.4.4. Products
6.4.4.1. The ambulance service shall include the following medicines, supplies and
medical equipments:
 Minimum Equipment For Basic Life Support

o Ventilation And Airway Equipment
o Portable suction unit, and a house (fixed system) or backup suction unit, with wide
bore tubing, rigid pharyngeal curved suction tip, and soft catheter suction tips to
include pediatric sizes 6 fr. through 14 fr.
o bulb syringe
o House oxygen and portable medical oxygen cylinder, each with a variable flow
regulator.
o Transparent, non-re breather oxygen masks and nasal cannula in adult sizes, and
transparent, non-re breather oxygen masks in pediatric sizes.
o Transparent masks for infants, neonate patients, children and adults. A
nasopharyngeal airway in adult sizes 24 fr. through 32 fr.
o Oropharyngeal airways in adult and pediatric sizes to include: infant, child, small
adult, adult and large adult.
o A mechanical ventilator and circuit appropriate to age and scope of care must be
on board for critical care transports as pertinent to the scope of care of the
medical transport service.
o Equipment for alternative airways must be on board transport vehicles at all
times and protocol for management of missed airway attempts.
o Minor surgical set (forceps, scissors, kidney dish, stitch, sterile gauze, needle holder)
in a drum
o Emergency trachiostomy(wide bore needle insertion),
o airway, laryngeal mask, intubation set
 Patient Assessment Equipment

o Blood pressure cuffs to include large adult, regular adult, child and infant sizes.
46
o Stethoscope, sphygmomanometer, thermometer.
o Penlight.
o Glucometer
o Pulse oxymeter with adult and pediatric probes.
o Portable, battery operated cardiac monitor- defibrillator with strip chart recorder and
adult and pediatric EKG electrodes and defibrillation capabilities.
 Splinting Equipment
o Lower extremity traction splint.
o Upper and lower extremity splints.
o Long board, scoop™, vacuum mattress or equivalent with appropriate accessories to
immobilize the patient from head to heels.
o Short board, or equivalent, with the ability to immobilize the patient from head to
pelvis.
o Pediatric spine board or adult spine board that can be adapted for pediatric use.
Adult and pediatric head immobilization equipment.
o Fetal (Doppler heart rate) monitoring is required for high risk OB transports.
 Adult and pediatric cervical spine immobilization equipment (collars of different sizes)
 Delivery sets
 Dressing Materials
o Bandages - various types and sizes
o Multiple dressings (including occlusive dressings), various sizes sterile burn sheets.
 Adhesive tape Obstetrical Supplies
o Sterile ob kit to include: towels, 4x4 dressings, umbilical tape or cord clamps,
scissors, bulb syringe, sterile gloves and thermal absorbent blanket.
o Neonate stocking cap or equivalent.
 Miscellaneous Equipment
o Heavy bandage scissors, shears or equivalent capable of cutting clothing, belts,
boots, etc.
o Two working flashlights.
o Blankets and appropriate heat source for the ambulance patient compartment.
47
o Log book (stating time of call, time of arrival, time of return)
o Registration book ( with columns including patient identification, impression,
treatment given if any)
o Bed (couches) with fixed chair that is designed for ambulances, wheel chair,
emergency light
o Personal protective devices (gown, mask, gloves, goggles)
o Waste disposing containers
 Ambulance service Medical Treatment Protocols.
 Communications Equipment
o Portable radio or telephone(walking-talking)
o Two-way communications that will enable the ambulance personnel to communicate
with:
o Ambulance service’s dispatch.
o medical control facility or a physician
o receiving facilities
o mutual aid agencies
 Extrication Equipment(optional)
 Body Substance Isolation (BSI) Equipment Properly Sized To Fit All Personnel
o Non-sterile disposable gloves, to include a minimum 1 box of latex free gloves.
o Protective eyewear.
o Non-sterile surgical masks.
o Safety protection gear for extrication consistent with the ambulance service
extrication capabilities.
o Sharps containers for the appropriate disposal and storage of medical waste and
biohazards.
o HEPA (High Efficiency particulate air filter) masks, which can be of universal size.
 Safety Equipment
o A set of three (3) warning reflectors.
o One (1) ten pound (10 lb.) or two (2) five pound (5 lb.) ABC fire extinguishers, with
a minimum of one extinguisher accessible from the patient compartment and
vehicle/air craft interior.
48
o Child safety seat or appropriate protective restraints for patients, crew,
accompanying family members and other vehicle occupants.
o Properly secured patient transport system (i.e. wheeled stretcher).
o Triage tags.
o Support material for immobilization purpose
 Ventilation Equipment
o adult and pediatric endotracheal intubation equipment to include stylets and an
endotracheal tube stabilization device and endotracheal tubes uncuffed range from 2/5
- 5/5, and cuffed size range from 6.0-8.0.
o Laryngoscope and blades, straight and/or curved of sizes 0-4.
o Adult and pediatric magill forceps.
o End tidal co 2 detectors or alternative device, for determining end tube placement.
 Intravenous Equipment
o Adult and pediatric intravenous solutions and administration equipment
o Adult and pediatric intravenous arm boards.
 The head of the stretcher is capable of being elevated at least 30 degrees for patient
care and comfort.
 Pharmacological Agents
o Pharmacological agents and delivery devices are as per emergency medicine list for
ambulance services.
Activated Charcoal Tablet, 125mg, 250mg
Powder for reconstitution,15gm/120ml, 25gm
Gel, 300ml
Diclofenac Injection, 25mg/ml in 3ml ampoule, 75mg/ml
Oxygen Inhalation
Adrenaline (Epinephrine) Injection, 0.1%in 1ml ampoule, 1:1000 1mg/ml
Hydralazine Injection, 20mg/ml in 1ml ampoule
Sodium Chloride Injection 0.9% (Normal Saline), 10ml, 20ml,
500ml, 1000ml; 235mg/ml, 3% in 500ml
Injection, 30%- 30mg in 10ml
Dextrose Injection, 5% in 500ml, 1000ml, 10% in
500ml, 1000ml, 40% in 20ml; 50% in 50ml
Diazepam Injection, 5mg/ml in 2ml ampoule
Phenytoin Injection, 50mg/ml in 5ml vial
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Powder for injection, 250mg/ vial
Atropine Sulfate Injection, 1mg/ml in 1 ml ampoule
Isosorbide dinitrate Tablet (sublingual), 5 mg, 10 mg
Ergometrine Maleate Injection, 0.25 mg/ml, 0.5 mg/ml
Phytomenadione (Vitamin K) Injection, 10mg/ml in 1ml ampoule
Magnesium Sulfate Injection, 2%, 5%, 10%, 20%, 50% in 20ml
Salbutamol Oral inhalation, 0.1mg/dose;
Nebulizer solution,2.5mg/2.5ml
o Pediatric "length based" device for sizing drug dosage calculations and sizing
equipment.
50
6.5. Infection Prevention
6.5.1. practices
6.5.1.1. All activities performed for infection prevention shall comply with the national infection
prevention guidelines.
6.5.1.2. Infection prevention and control shall be effectively and efficiently governed and
managed.
6.5.1.3. The ambulance service shall identify the procedures and processes associated with the
risk of infection and shall implement strategies to reduce infection risk.
6.5.1.4. The ambulance service shall perform the following infection risk-reduction activities:
a. equipment cleaning and sterilization in particular invasive equipment
b. disposal of infectious waste and body fluids
c. handling and disposal of blood and blood components
d. disposal of sharps and needles
6.5.1.5. The following written policies and procedures shall be maintained:
a. Hand hygiene
 Standard precautions for hand hygiene
 Personal protective measures
 Monitoring and surveillance of hand hygiene practices
b. Transmission-based precautions
 Contact precautions
 Droplet precautions
 Airborne precautions
c. Post-Exposure Prophylaxis programming (PEP) for some communicable
diseases like rabies, HIV, meningitis
 Standard precautions to follow
 PEP policy
 Procedures for PEP
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d. Environmental infection prevention
 General ambulance service hygiene
 Structural Ambulance vehicle infection prevention
e. Waste management
 Cleaning medical instruments
 Implementation of a disposal system
 Handling medical waste
 Waste removal
6.5.1.6. The following specific standard precautions shall be practiced and the ambulance service
shall have its own guidelines:
a. Hand hygiene shall be performed before and after direct patient contact, after
touching blood, body fluids, secretions, excretions, and contaminated items,
both immediately after removing gloves and other protective equipment and
between client contacts.
 Thorough hand washing
 Use disinfectants
 Standard procedure for using anti-septic cleaner
b. The ambulance service staff shall consider that every patient/client is infectious
c. The ambulance service shall have personal protective equipment such as gloves,
mask, eye protection (goggles) and face shield
 Gloves shall be worn in the following situations but not limited to:
o When there is direct contact with exposed wounds, blood, body fluids,
body organs or any type of lesion.
o When drawing blood or handling medical instruments
o When there is contact with a client who might be infectious.
o When handling contaminated items.
o When cleaning client areas.
 Gowns shall be worn when but not limited to:
o Splattering of blood, body fluids or excretions
o Performing waste collection for infectious waste,
o Handling any type of medical waste,
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 Masks, goggles, or other types of face shields shall be worn when but
not limited to:
o Splattering of blood or body fluids to the face,
o When performing cough-producing and aerosol-generating
procedures.
o Handling bio hazardous
o Performing waste collection for hazardous or non-hazardous waste.
d. Any type of face shield that is apparently soiled or splattered with body fluids
shall be washed and sterilized with a disinfectant.
e. The ambulance service shall develop, monitor, and enforce a disinfection policy
and procedures regarding vehicles and equipment to be used on a regular basis
and to be used as appropriate when vehicles and equipment are exposed to a
person with a suspected or confirmed communicable disease.
f. Procedures shall be developed and implemented cleaning, and disinfecting
environmental surfaces especially frequently touched surfaces by clients (the
ambulance vehicle).
g. Used needles shall not be recapped, bent, broken, or manipulated by hand.
Single handed scoop technique shall only be used when recapping is required.
h. Safety features shall be used when available and used “sharps” shall be placed
in a puncture-resistant container specially designated bin for hazardous waste.
6.5.1.7. There shall be transmission-based precautions and the ambulance service shall
have its own guideline for the followings:
a. Contact precautions
 Shall be taken when patients have symptoms of respiratory infections
and when performing any high risk respiratory care or procedure on all
patients (any procedure that has the potential to generate respiratory
droplets).
 Shall be taken to reduce the risk of transmission through direct and
indirect contact with an infectious client/patient.
 Shall be taken when a client is known to have a specific disease that is
easily transmitted by direct contact.
53
 Shall be taken for known multi-drug resistant disease, such as some
forms of TB.
 Shall exercise strict barrier precautions for any type of contact with the
patient/client and their surrounding environment.
 Do not share medical equipment between clients before sterilization
 Clean surfaces used by clients on daily basis
 Clean medical equipment
b. Droplet precautions
 For any patient where there is significant risk to the staff of being
splashed by body fluids (e.g. vomiting, uncontrolled hemorrhage,
excessive coughing)
c. Airborne precautions (for diseases like SARS ,TB, Swine flu, etc)
6.5.1.8. Each Ambulance service shall train all staff on how to minimize exposure to
blood-borne diseases. These include:
a. Immediate first aid
b. Reporting exposures
c. Assign area for starter packs 24-hours access per day
d. Counseling and testing for exposed staff
e. Reporting and monitoring protocols
f. Evaluate PEP program
6.5.1.9. The infection prevention committee or designate shall have written protocols,
procedures and shall oversee the following activities and this shall be documented:
a. Developing the ambulance service annual infection prevention and control plan
with costing, budgeting and financing
b. Monitoring and evaluating the performance of the infection prevention program
by assessing implementation progress as well as adherence to IPC practice
c. Assessing and promoting improved IPC practice within the ambulance service.
d. Developing an IEC strategy on IP for health-care workers
e. Ensuring the continuous availability of supplies and equipment for patient/client
care management
f. Monitoring, providing data and measuring the overall impact of interventions on
reducing infection risk
54
6.5.1.10. The ambulance service shall provide regular training on infection prevention and
control practice to staff
6.5.1.11. The following training guidelines shall be available
a. Prevention of the spread of infections
b. Improving the quality of patient/client service
c. Promoting safe environment for both clients and staff
6.5.2. premises
6.5.2.1. The ambulance service shall have a room or area for temporary storage of waste
containers,
6.5.2.2. The ambulance service shall have a centralized sterilization room
6.5.2.3. The ambulance service shall have incinerator with ash and burial pits. (optional)
6.5.3. professionals
6.5.3.1. The ambulance service shall have a designated staff to serve as IP infection
prevention and control officer.
6.5.3.2. The officer shall be a licensed IP trained staff and knowledgeable of infection
prevention principles and health care epidemiology.
6.5.4. products
6.5.4.1. The ambulance service shall have the following adequate supplies and equipment
needed for infection prevention and control practice.
a. Waste management equipment and supplies:
 Safety boxes
 Garbage bins
 Plastic garbage bags
 Wheelbarrows
b. Cleaning
 Mop
 Cleaning cloth
 Bucket
 Detergent
 Broom
 Bleach
55
 Dust mop
c. Instrument processing:
 Autoclaves and steam sterilizers
 Test strips
 Oven
 Storage shelves for the medical equipment
 Chemicals &disinfectants: 0.5% chlorine solution (diluted bleach)
 Brushes (tooth brush for small items)
d. Hand hygiene
 Portable hand washing basins
 Alcohol based hand rub
 Water container with faucet
 Personal Towels
 Soap dispenser
 Paper Towels
e. Personal Protectivoe Equipment
 Heavy duty glove
 Surgical glove
 Plastic apron
 Eye shield
 Boots
 Other protective shoes
 Caps
 Dust mask
 Face shield
56
6.6. Sanitation and Waste Management
6.6.1. practices
6.6.1.1. The Ambulance service environment shall ensure the following conditions:
a. Clean sanitation and safe environment,
b. Access to continuous, safe and ample water supply
6.6.1.2. There shall be access to continuous, safe and ample water supply for the
ambulance service
6.6.1.3. There shall be written procedures to govern the use of sanitation techniques for
the ambulance service.
6.6.1.4. If the ambulance service has ground water source, there shall be a written policy
and procedures for ground water treatment,
6.6.1.5. Infectious and medical wastes shall be handled and managed according to the
recent Health Care Waste Management National Guidelines/Directives.
6.6.1.6. Infectious and non infectious medical waste contained in disposable containers
shall be placed temporarily for disposal or transport in leak proof drums, pails or portable
bins. The containment system shall be leak proof, have tight-fitting covers and be kept
clean and in good repair.
6.6.1.7. Reusable containers for infectious medical waste and general medical waste shall
be thoroughly washed and decontaminated each time emptied according to the recent
Health Care Waste Management National Guidelines/ Directives
6.6.1.8. Reusable pails, drums, or bins used for containment of infectious waste shall not
be used for containment of waste to be disposed of as noninfectious waste or for other
purposes except after being decontaminated by procedures described in the latest Health
Care Waste Management National Guidelines/ Directives.
6.6.1.9. Segregation of health care waste shall includes the following procedures:
a. Separate different types of waste as per the guideline,
b. The ambulance service shall provide colored waste receptacles specifically
suited for each category of waste,
c. Segregation shall take place at the source (in the vehicle).
d. There shall be 3 bin systems used to segregate different types of waste in the
ambulance service.
57
Segregation category
6.6.1.10. Color Container M
Non risk waste Black bag or bin e
Infectious waste Yellow bag or bin d
i
Sharp waste Yellow safety box
c
Heavy Metal Red secure container
a
Chemical bottles White bag or bin
l
Hazardous chemical wastes yellow bag or bin
waste shall be disposed according to Health Care Waste Management National

Guidelines/Directives by one of the following methods:
a. By incineration,
b. By sanitary landfill,
c. By burial at an approved landfill,
d. Chemical sterilization,
e. Gas sterilization (shall be handled safely).
6.6.1.11. The ambulance service shall have an organized waste disposal and/ or removal
system and shall ensure the safe handling of all wastes.
6.6.1.12. The ambulance service shall provide agreement document if it chooses to dispose
its medical wastes in nearby health facility.
6.6.1.13. Chemical and radioactive waste shall not be disposed of as solid waste or medical
waste, & shall be disposed as per appropriate national guideline (Ethiopian
Radiation Protection Authority requirements).
6.6.1.14. The ambulance service shall have a medical waste management plan which
includes at least the following:
a. Temporary storage of medical waste,
b. Segregation of medical waste,
c. Transport of medical waste,
d. Disposal of medical waste,
6.6.1.15. The ambulance service shall routinely clean and sanitize patient areas (vehicle) at
least twice daily and more when ever needed. Areas where there is blood splash
shall be cleaned immediately.
58
6.6.1.16. The ambulance service shall ensure ambulance vehicles have appropriate
ventilation system.
6.6.1.17. Housekeeping items shall be cleaned and sanitized regularly.
6.6.1.18. The ambulance service shall have Sewage disposal plan which shall fulfill the
following conditions (according to HealthCare Waste Management National
Guidelines/ Directives):
a. A functional sewerage system,
b. Dispose of sanitary waste through connection to a suitable municipal sewerage
system,
c. A designated waste storage room for solid waste &/ or a septic tank for liquid
waste,
d. Written procedures defining instrument processing procedures (disinfection
and sterilization).
6.6.1.19. The ambulance service shall have the following supportive sanitation measures:
a. Clean water where there is no plumbing,
b. Hand hygiene practice,
c. Sterilization of medical instruments,
d. Alternatives to protective equipment.
6.6.2. premises
6.6.2.1. The ambulance service sanitary system shall have:
e. Adequate flushing toilets and hand washing basins,
f. Incinerator (if it is allowed to this service by the national waste management
and disposal directives),
g. Plot of land for Safe ash pit, Burial pit, Garbage bins, (if the ambulance service
disposes waste by its own incinerator)
h. Secured area for solid waste accumulation.
6.6.3. professionals
6.6.3.1. Ambulance service sanitation service shall be administered together with
infection prevention activities.
59
6.6.3.2. In addition, the ambulance service shall have:
a) Housekeeping staff such as cleaners and waste handlers,
b) The ambulance service shall officially designate staff in charge of handling waste
on a regular basis.
6.6.3.3. The assigned staff shall be responsible for the collection and disposal of waste
products in the ambulance service.
6.6.3.4. Continuing education shall be provided to all personnel engaged in sanitation
activities on the relevant procedures.
6.6.3.5. Staff shall be oriented on personal protection methods.
6.6.4. products
6.6.4.1. The ambulance service shall have the following equipment and supplies required
for sanitation activities but not limited to:
a.Incinerator / optional/
b. Safety boxes
c.Leak proof containers for waste
d. Trolley to transport waste
e. PPE (personal protective equipments)
f. Autoclave.
g. Pressure cooker/dry oven.
h. Cleaning supplies (detergents, disinfectants and other cleaning solutions etc).
i. Mops and dust bins
60

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National Minimum requirement for

Food, Medicines and Healthcare Administration and

YEHULU DENEKEW ALAMNEH

Accordingly, the Authority has developed this requirement to:

3. Terminologies and Definitions

3.11 Advanced Life Support (ALS)

3.12 Special Care life Support (SCS)

2.2 Initial/ New Licensure

2.3 Requirements for License Renewal

2.4 Removal Permits, Change of Operation and Forfeiture of License

2.5 Suspension and Revocation of a License

2.7 Information to be disclosed

4.2 Client Rights

4.3 Client Responsibilities

5.1. General Requirements

5.2. Staffing Plan

5.3. Job Description and Orientations

a. Job duties and responsibilities,

5.4. Continuing education

5.6. Employee’s Health

5.7. Dress Code and Employee Identification Badge

5.7.1. Footwear shall be safe, supportive, clean, and non-noise producing,

 Cervical collars large medium and small

 Kit (separate sterile kit) sterile scissors

 Container for carrying placenta

e. Diagnostic and Miscellaneous

 Cervical collars large medium and small

 Kit (separate sterile kit) sterile scissors

o. Diagnostic and Miscellaneous

 Chest tube set

 Cervical collars large medium and small

 Kit (separate sterile kit) sterile scissors

 Container for carrying placenta

e. Diagnostic and Miscellaneous

 Chest tube set

 Cut down set

 Central line set

 Pace making kit

 Minimum Equipment For Basic Life Support

 Patient Assessment Equipment

waste shall be disposed according to Health Care Waste Management National

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