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Republic of the Philippines

Province of Cagayan
Matilde A. Olivas District
Hopital
PHILHEALTH ACCREDITED

GUIDELINES ON THE USE OF HOSPITAL AMBULANCE

AUTHORIZED USE

1. Transfer of patient from the hospital to other health facility.


2. Transport of patient to other diagnostic center (back and forth).
3. Transfer of patient from other health facility in CAGAYAN to MAODH is allowed if the
ambulance is in Kalibo.
4. Transport of bedridden patient from the patient’s residence to MAODH.
5. Transport of bedridden patient from the hospital to the patient’s residence within
CAGAYAN.
6. Transport of bedridden patient from the hospital to the airport or seaport.
7. In instances where the patient for transfer died en-route to the referral hospital, the ambulance can go
back to the MAODH in order for the MAODH Doctor on duty to pronounce the death of the patient or the
ambulance can go to any nearby hospital for the pronouncement of death. In the event that the patient was
brought to other hospital, then the hospital ambulance is no longer responsible in bringing back the
patient’s dead body.
8. In special circumstances, when en-route to the hospital where the patient is being referred either in
APARRI or TUGUEGARAO, the patient died in the ambulance, as special consideration due to
distance, the ambulance vehicle may be used in transporting back the patient to MAODH.
9. In special circumstances, for transport of the medical supplies and drugs and medicines that are
urgently needed by the hospital.
10. In exigency of service, for transport of hospital personnel from their residences when they are
urgently needed to report for duty especially during the occurrence of natural calamities, disasters and
other emergencies.

AMBULANCE FEE

1. Ambulance Rental as per Provincial Ordinance: MAODH


to TUGUEGARAO P 1,000
MAODH TO APRRI P 200

2. For patient’s going to Aparri or Tuguegarao or to any point in Cagayan, the patient/patient’s
folks/representative should pay the corresponding ambulance rental to cover the fuel cost as well as the
maintenance of the vehicle as per Provincial Ordinance.
3. In cases where there are two or more patients who are transported at the same time, then the
ambulance fee shall be shared equally by the said patients.
3. Payment of ambulance fee:
During office hours (Mon – Sun, 8:00 AM – 12:00 NN, 1:00 PM – 5:00 PM)
Payment should be given at the Administrative Office
Official Receipt of the diesel fuel is given to the patient/patient’s
folks/representative in case of patient going to Tuguegarao and can be
claimed from the office the following day; a copy of the request for ambulance use
which serves as the provisional receipt will be given upon payment; this payment
will be used for the purchase of diesel fuel for the ambulance
In cases of transport to Aparri or Tuguegarao, the Official Receipt of the
hospital is issued upon payment of ambulance rental
Refueling of the ambulance shall be arranged by the Administrative
Office

After office hours


Payment should be given to the Nurse on duty and a copy of the request for
ambulance use which serves as the provisional receipt is issued
Official Receipt as mentioned above can be claimed during office hours the
following day
The ambulance driver is not authorized to transact for payment from the patient,
patient’s folks/representative. He is also not authorized to get the payment from the
Nurse on duty for the refueling of the ambulance. Payment can only be given to him
if with written instructions or verbal instructions (personal or through telephone)
from the Administrative Officer or the Chief of Hospital.

PERSONS AUTHORIZED TO NOTIFY THE AMBULANCE DRIVER

1. During office hours (Mon – Sun, 8:00 AM – 12:00 NN, 1:00 PM – 5:00 PM)
Administrative Office Personnel on duty

2. After office hours:


Doctor on duty
Nurse on duty
Nursing attendant on duty
Security guard on duty
IW on duty

Important Note: The ambulance driver upon notification should be told of the reason for
transport and the severity of the patient’s condition.

AMBULANCE CALL

1. All calls to the ambulance driver for request for ambulance use should be recorded in the logbook.

2. The time of call and the time the ambulance driver arrived should also be recorded in the
logbook.

3. In case the ambulance driver cannot be contacted after 3 to 5 attempts of calling, the hospital
personnel assigned should ask the Security Guard on duty or the IW on duty to go to the residence of
the ambulance driver and personally tell him of the need for ambulance use.

4. In case the ambulance driver is not around and cannot be contacted then the hospital personnel
assigned should notify Rhoan Druja (Administrative Officer) and he will be the one to find a way for
the patient’s transport.

5. In case the ambulance is not in MAODH upon notification, the ambulance driver should inform the
hospital so that other mode of transport (use of other ambulance) can be arranged.
6. In case where the driver will not go back directly to the hospital upon going back from transport of
patient, the ambulance driver should notify the hospital of his whereabouts.

PROCEDURE

1. The Doctor on duty will make a Referral Slip and call the health facility where the patient is being
referred.

2. For patients for diagnostic purposes and own request for transfer, the Nurse on duty will ask the
patient’s folks/representative for the preferred ambulance to use (whether hospital ambulance or
municipal ambulance). If they prefer to use to municipal ambulance, the patient’s folks/representative
should be the one to ask the permission of the Municipal Mayor. If they prefer to use the hospital
ambulance, then it is the duty of the hospital personnel to notify the ambulance driver of the hospital. For
emergency cases, the hospital ambulance is the preferred mode of transport of patients.

3. The Nurse on duty will fill-up the Request for Ambulance Use Form and instruct the patient’s
folks/representative to bring the said form together with the Referral Slip to the Administrative Office.

4. The patient’s folks/representative will be asked to pay the corresponding amount for ambulance fee.
In extreme emergency cases wherein due to the patient’s condition, immediate transfer is needed and the
patient/patient’s folks/representative cannot pay the ambulance fee, then the patient’s
folks/representative should sign a Promissory Note with the date of payment indicated.

5. The hospital personnel will notify the ambulance driver of the request for ambulance use.

6. Upon arrival to the hospital, the ambulance driver will prepare a Trip Ticket to be signed by the Chief
of Hospital or the Doctor on duty, Administrative Officer or the Administrative Personnel on duty, and
the patient’s folks/representative.

7. The Security Guard on duty should note on the logbook the time the Ambulance Driver arrived in the
hospital, the time the ambulance leave the hospital for transport of patient and the time the ambulance
returned to the hospital.

8. The Nurse on duty will call the Nursing Attendant on duty and the IW on duty and prepare the
patient for transfer from the ward/room to the ambulance vehicle.

9. Transport of patient to the referred facility.

10. In case where the patient who is referred to Tuguegarao is immediately referred to other hospital
facility, the ambulance driver should notify the hospital of the said plan. The ambulance driver should
also inform the patient’s folks/representative of the corresponding ambulance fee. If the payment is
made, he should turn-over the payment to the Cashier upon his arrival to the hospital during office
hours or on the following day if after office hours.

AMBULANCE CONDUCTION

1. Conduction of patients for transfer by the hospital personnel (doctors, nurses, nursing attendants,
or midwife) is allowed in the following cases:
a. Emergency cases as defined below
b. For diagnostic purposes where a conducting nurse is specifically requested by the diagnostic
center being referred to
2. Conduction should be authorized by the Chief of Hospital or the doctor on duty and the Chief Nurse
or the nurse on duty. A travel order should be issued for the hospital personnel who will be conducting
and should be recommended by the Chief Nurse or the nurse on duty and approved by the Chief of
Hospital or the doctor on duty.

3. Conduction of patients during emergency cases mentioned above should be done by the hospital
personnel (doctor, nurse, nursing attendant, midwife) on duty. In cases where there is only one doctor,
one nurse and one nursing attendant or midwife who are on duty, then the nurse on duty should look for
the one who is off duty that is available who will conduct the patient. In such case, the
patient/patient’s folks/representative cannot demand for conduction by the on-duty personnel since
there are more patients who needed care who will be left in the hospital as compared to only one
patient for conduction. In cases where the nurse on duty cannot find anyone who will conduct the
patient, then the patient’s folks/ representative will be the one to find the one who will conduct the
patient on the ambulance. In cases where ambulance conduction by a health personnel is advised and
no one is available to conduct then the patient’s folks/representative should sign a waiver where the
transport of the patient to other health facility is without the company of qualified health personnel.

COMPLAINTS

1. Complaints regarding the ambulance and the ambulance driver should be made in writing and
address to the Chief of Hospital through the Administrative Officer IV.

2. Complaints should be recorded in the logbook and should be acted upon immediately.

3. Complaints aired over the radio should be answered after thorough investigation and data gathering.

DEFINITION OF TERM
Emergency Cases:
The hospital considers the following cases as emergency which may warrant transfer of
patient upon the discretion of the attending physician or the doctor on duty:
1. Trauma cases
With head injury and neurologic deficits
With multiple injuries
With fractures, especially open fractures
With spinal cord injury
Stab wounds/Hacked wounds
Gunshot wounds
2. OB/Gyne cases
OB patients(nulligravid or multigravid) in labor or PROM Pre-
eclampsia or hypertensive OB patients
Patients with severe vaginal bleeding
Patients with ectopic pregnancy
3. Surgical cases
Acute abdomen Acute
appendicitis
Acute cholecystitis with cholelithiases
Incarcerated Hernia
4. Medical cases
Severe Respiratory Distress
Neurologic cases
Stroke (GCS Score < 10)
Seizure Disorder Acute
Myocardial Infarction Severe GI
Bleeding Poisoning
Dengue Hemorrhagic Fever Stages 3 and 4
5. Other cases as determined by the Attending Physician or the Doctor on duty

Prepared by:

Dr. Mary Jane S. Sualog Mrs. Luzvilla D. Ascaño Mr. Rex S. Robles
Medical Specialist I Chief Nurse Administrative Officer IV

Noted by:

Dr. Mary Jean A. Gelito


OIC – Chief of Hospital

Recommending Approval: Mr. Rex

Victor B. Consemino
PGADH, EEDD

Approved by:
HON. CARLITO S. MARQUEZ
Provincial Governor

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