POLICY ON SAFETY OF LAND

AMBULANCES
MINISTRY OF HEALTH MALAYSIA
2019

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This Guidelines was coordinated by:
Medical Development Division, Ministry of Health
First published in Malaysia in year November 2019 by
Emergency Medicine & Trauma Services

Procedure was coordinated by

Emergency Services Unit
Medical Services Development Section
Medical Development Division
Ministry of Health Malaysia
© The Ministry of Health 2019 www.moh.gov.my

Institute for Medical Research Cataloguing in Publication Data

A Catalogue record for this book is available from the
Institute for Medical Research, Ministry of Health Malaysia

National Library of Malaysia Cataloguing in Publication Data

A Catalogue for this book available from the
National Library of Malaysia
MOH/P/PAK/426.19(BP)-e
ISBN 978-967-2173-74-8
All Right Reserved: no part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means, electronic, mechanical, photocopy,
recording or otherwise without prior notice, permission of the Ministry of Health
Malaysia.

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ACKNOWLEDGEMENTS

Emergency Services Unit would like to acknowledge YBhg Datuk Dr Noor Hisham
Abdullah, Director-General and YBhg Dato’ Dr Hj Azman Bin Hj Abu Bakar, ex-
Deputy Director-General (Medical) whose special interest and commitment in
developing the Emergency Services in Malaysia especially in Pre Hospital Care and
Ambulance Services has been the driving force in the development of this document.
The Ministry of Health also appreciates the contributions by the members of the
Special Committee for Development of Policy for Ambulance Safety in Pre Hospital
Care and Ambulance Services whose great commitment and continuing enthusiasm
are strongly admired.
The Emergency Services Unit also acknowledge the contributors and cooperation by
the Working Group for the development of this policy.
Many thanks to all parties who have been directly or indirectly involved in the
publication of this document.

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Contents

ACKNOWLEDGEMENTS .......................................................................................................... 3
FOREWORD BY DIRECTOR-GENERAL OF HEALTH MALAYSIA ......................................... 6
FOREWORD BY THE DEPUTY DIRECTOR-GENERAL OF HEALTH (MEDICAL), MOH ........ 7
FOREWORD HEAD OF MALAYSIAN EMERGENCY AND TRAUMA SERVICES ................... 8
GLOSSARY OF TERMINOLOGIES .......................................................................................... 9
GLOSSARY OF ABBREVIATIONS ..........................................................................................11
1. INTRODUCTION ...............................................................................................................12
2. POLICY DOCUMENT STATEMENT .................................................................................13
3. OBJECTIVES ....................................................................................................................13
4. ESTABLISHMENT OF AMBULANCE SAFETY COMMITTEE ..........................................14
4.3. NATIONAL AMBULANCE SAFETY COMMITTEE ....................................................14
4.4. STATE AMBULANCE SAFETY COMMITTEE ...........................................................14
4.5. DISTRICT HEALTH OFFICE AND HOSPITAL AMBULANCE SAFETY
SURVEILLANCE ACTIVITIES....................................................................................15
5. MANDATORY AMBULANCE SAFETY INCIDENT OR COLLISION REPORTING ...........17
6. AMBULANCE INCIDENT OR COLLISION INVESTIGATION ...........................................18
7. LAND AMBULANCE SPECIFICATION .............................................................................19
7.4. TECHNICAL SPECIFICATIONS OF LAND AMBULANCE ........................................19
8. PROCUREMENT OF LAND AMBULANCES ....................................................................20
9. AMBULANCE OPERATIONS AND MANAGEMENT ........................................................21
9.1. SUPERVISION OF LAND AMBULANCE OPERATIONS ...........................................21
9.2. ROAD WORTHINESS OF LAND AMBULANCE ........................................................21
9.3. SERVICE MAINTENANCE OF AMBULANCE ...........................................................22
9.4. REPAIR MAINTENANCE OF AMBULANCE .............................................................22
9.5. PRE-DEPARTURE AND POST DEPLOYMENT SAFETY INSPECTION ...................23
10. AMBULANCE DRIVING POLICY......................................................................................24
10.1. NUMBER OF OCCUPANTS IN AN AMBULANCE ..................................................24
10.2. SAFETY PRECAUTIONS PRIOR TO SETTING THE VEHICLE IN MOTION ...........24
10.3. USE OF RESTRAINTS IN AN AMBULANCE ..........................................................24
10.4. GENERAL STATEMENTS ON DRIVING OF AMBULANCE ....................................25
10.5. DRIVING OF AMBULANCE DURING LIGHTS AND SIREN RESPONSE ...............25
10.6. USE OF DISTRACTING DEVICES ...........................................................................26

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 10.7.JOURNEY MANAGEMENT AND PLANNING .........................................................26
11. HUMAN RESOURCE MANAGEMENT AND SAFETY STANDARDS ..............................27
11.1. RECRUITMENT AND TRAINING OF AMBULANCE DRIVERS ..............................27
11.2. MEDICAL FITNESS FOR AMBULANCE DRIVERS ................................................27
11.3. AMBULANCE DRIVER DRIVING HOURS ..............................................................27
11.4. POLICY ON SUBSTANCE ABUSE .........................................................................28
11.5. REGULATION VIOLATION AND TRAFFIC OFFENCES MONITORING ................28
APPENDIX 1 ............................................................................................................................29
APPENDIX 2 ............................................................................................................................30
APPENDIX 3 ............................................................................................................................31
APPENDIX 4 ............................................................................................................................32
APPENDIX 5 ............................................................................................................................33
APPENDIX 6 ............................................................................................................................37
APPENDIX 7 ............................................................................................................................38
APPENDIX 8 ............................................................................................................................41
REFERENCES .........................................................................................................................42
COMMITTEE MEMBERS .........................................................................................................43

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FOREWORD BY DIRECTOR-GENERAL OF HEALTH MALAYSIA

Ambulance Services is the most visible and

crucial component in Pre-Hospital Care. It is
the initial segment in the continuum of health
care. The Ministry of Health has placed great
importance on this frontline activity to benefit
the community in Malaysia.
I would like to thank and congratulate the
Medical Development Division and the
Emergency Medicine and Trauma Services
for their continuing effort in development and
improvement in standards of care for pre
hospital care service. Many challenges arise
from implementation of the ambulance
services, and as paramount for patient and
staff safety, this policy was developed to
safeguard and elevate the quality and safety
of the service. It strengthens the Safety-First
Datuk Dr Noor Hisham bin Abdullah work culture within all MOH facilities and uses
Director-General of Health Malaysia surveillance methodology to measure the
success implementation.

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FOREWORD BY THE DEPUTY DIRECTOR-GENERAL OF HEALTH (MEDICAL),
MOH

Ambulances services play a major role in

ensuring that patients receive the appropriate
care for their needs. With the increasing scope
and coverage of the service, many challenges
are encountered when providing patient care.
There is a need for a policy to be developed
and these measures shall standardize and
improve the quality of ambulance services as
well as raise the credibility of the existing
system.

This led to the combined effort between the

medical development division of ministry of
health with the emergency services and
trauma in which the first policy for land
ambulances was first tabled in 2015. From
Datuk Dr Hj. Rohaizat bin Hj Yon there on, ongoing work has been put forth into
Deputy Director-General of Health setting a guide for managing, maintaining and
(Medical), MOH supporting such service. This policy is a
product of those efforts and will help guide
especially the administrative aspect in
maintaining and support the services.
I would like to thank those who were involved from the Medical Development Division, the
Emergency Medicine and Trauma Services and the working group for putting through the
effort to help develop this policy.
May it guide us going forward.

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FOREWORD HEAD OF MALAYSIAN EMERGENCY AND TRAUMA SERVICES

Pre hospital Care and Ambulance Service is a

crucial component of patient care in the chain
of survival at the first contact point. It is of
utmost importance for MOH to ensure the
services are delivered in a safe manner.
As an emergency response vehicle, land
ambulance must be maintained in safe and
reliable operational conditions at all times. This
can be achieved via effective operation and
management on Pre Hospital Care Services
(PHCS).
This policy serves as guidance for the
managerial and operational group to ensure
ambulances safety in pre hospital care
services in MOH. However, non MOH PHCS
Dr Mahathar Bin Abd Wahab are encouraged / welcomed to adapt the policy
Head of Emergency and Trauma Services,
to enhance their services.
MOH
Ambulance safety encompasses wide aspects
which include the procurement of the vehicle,
daily operational practice, vehicle
maintenance, accident prevention and
surveillance and we have included this in this
policy.
I would like to take this opportunity to congratulate the Working Committee for the effort
of producing this important policy which would serve as a standard in ensuring ambulance
safety in this country.

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GLOSSARY OF TERMINOLOGIES

Aggressive Driving Driving in a selfish, bold or pushy manner, without

regard for the rights or safety of other users of the
roadway.
Ambulance Specialized vehicle used or intended for the care and
transportation of ill or injured persons to, from or
between places of treatment.
Ambulance Accident / Any incident involving land ambulances in which the first
Collision harmful event involves a motor vehicle in motion coming
into contact with another vehicle, property, person(s) or
animal(s).
Ambulance Drivers All individuals trained and certified to operate and drive
Ambulances.
Ambulance Main Original vehicle specifications components from its
Component manufacturer that includes chassis, suspension, engine,
exhaust system, steering and passive vehicle safety
devices such as airbags, brakes, anti-lock braking
system (ABS) and others
Ambulance Medical Any patient care equipment or interface being utilized or
Equipment used in the management of patients in the ambulances
Ambulance Modified Vehicle component that has been customized for patient
Component care which includes patient's compartment, electrical
outlet, oxygen outlet, oxygen dock, stretcher and locking
mechanism, loading area, lights and siren.
Ambulance Safety An event or circumstances or series of events that could
Incidents have or may have: (a) result in death, injury to a patient;
(b) loss of or damage to a system or service; (c) cause
environmental damage; (d) adversely affect an activity
or function.
Distracting Devices Devices with potential to divert driver’s attention from
operations of a motor vehicle such as but not limited to
mobile communication devices, Mobile Data Terminals,
Global Positioning System (GPS), MP3 players, etc.

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 High risk driving Drivers known to display aggressive driving behaviours
behaviour such as speeding, tailgating, failure to signal a lane
change, and running red lights or stop signs. Such
behaviour may be identified via direct supervision or
using verbal or formal feedback mechanism by team
members.
Loading Capacity Difference between Gross Vehicle Weight and the Net
Vehicle Weight
Net Vehicle Weight Unloaded weight of vehicle after modified to
specification of an ambulance with all fixed installations
including the weight of a driver taken as 70kg
Operational experts Person(s) experienced in processes involved in
planning and execution Pre-Hospital Care Services
Patient Individual with medical condition or illness that requires
appropriately trained personnel to provide medical care
or suitable transport or both.
Permissible Gross Permissible total weight of vehicle which includes the
Vehicle Weight gross vehicle weight, sanitary, medical and technical
equipment weight, the weight of maximum numbers of
passengers taken as 70kg per person, and any reserve
weight.
PHCAS Providers Institutions or organizations that render emergency
medical care outside of healthcare facility and
transportation of patients to a healthcare facility.
PHCAS Responders Individuals employed, certified and credentialed by a
PHCAS Provider to provide medical care outside of a
medical facility under the direction of a Medical Advisor.
Responders include First Responders, Emergency
Medical Responders and Assistant Medical Officer.

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GLOSSARY OF ABBREVIATIONS

AMAC - Ambulance Main Component

AMOC - Ambulance Modified Component
ASC - Ambulance Safety Committee
BER - Beyond Economic Repair
EMTS - Emergency Medicine and Trauma Services
GPS - Global Positioning System
MECC - Medical Emergency Coordinating Centre
MOH - Ministry of Health Malaysia
NASC - National Ambulance Safety Committee
OEHU - Occupational and Environmental Health Unit
OHU - Occupational Health Unit
PHCAS - Pre Hospital Care and Ambulance Services
SHO - State Health Department
SIRIM - Standards and Industrial Research Institute of Malaysia
TSLA - Technical Specifications of Land Ambulance

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1. INTRODUCTION

1.1. Pre-Hospital Care and Ambulance Services (PHCAS) is the provision of

medical care and intervention to patients or victims at scene, during transfer or
between hospitals by trained and credentialed providers under the supervision
of a Medical Advisor. It covers wide range of medical illness from minor illness
and injury to life threatening conditions.

1.2. The scope of service provided include:

1.2.1. Ambulance Services

1.2.2. Major medical incident and disaster management

1.2.3. Mass gathering and major event medical coverage

1.2.4. Medical Emergency Coordinating Centre (MECC) for selected MOH

hospitals; or Ambulance Dispatch Centre for the rest.

1.3. Safe operational management of land ambulance services require adherence

to the following values.

1.3.1. An organizational approach that prioritizes safety in all aspects of land

ambulances operations.

1.3.2. Ambulances and equipment that complies with operational

specifications and safety standards.

1.3.3. Human resource management that emphasizes on safety in every

aspect of land ambulance operations.

1.3.4. Surveillance of land ambulance safety incidents or accidents through

mandatory reporting system.

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2. POLICY DOCUMENT STATEMENT

2.1. This policy shall serve as Ministry of Health (MOH) safety standards in safe
operations and management of land ambulance services, hence providing
guidance to all relevant stakeholders within and outside of MOH.

2.2. This policy shall cover key areas of safety in land ambulance operations such
as organization, vehicle, operational and occupational safety standards.

2.3. This policy shall be read with the Emergency Medicine and Trauma Services
(EMTS) policy and other policy related to PHCAS published by Ministry of
Health, Malaysia.

2.4. The policy document shall be reviewed periodically every 5 years or whenever
the need arises.

3. OBJECTIVES

3.1. To provide safety standards for land ambulance services for all MOH PHCAS
Provider.

3.2. To mandate a compulsory reporting programme or feedback system for

ambulance safety incidents or collisions.

3.3. To advocate organizational approach to safe operations and managements of

land ambulances.

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4. ESTABLISHMENT OF AMBULANCE SAFETY COMMITTEE

4.1. MOH shall establish an Ambulance Safety Committee (ASC) at National, State,
Health and Hospital levels.

4.2. These committees shall provide guidance on safety standards on land

ambulance services in MOH.

4.3. NATIONAL AMBULANCE SAFETY COMMITTEE

4.3.1. MOH shall establish a subcommittee under the MOH Technical

Committee on PHCAS on ambulance safety called National Ambulance
Safety Committee (National ASC) (Appendix 1).

4.3.2. The members of the committee shall be as in Appendix 2. The Director

General of Health Malaysia shall appoint a PHCAS specialist from the
Emergency and Trauma Services as the chairman of the committee.

4.3.3. The Occupational Health Unit (OHU) of the Disease Control Division
Ministry of Health Malaysia shall be the secretariat to this committee.

4.3.4. The functions of the National ASC shall include:

4.3.4.1. Form a National Ambulance Incident or Collision Inquiry

Team to investigate any fatal collisions involving land
ambulances.

4.3.4.2. Review reports pertaining on any ambulance safety incidents

or collisions involving land ambulances resulting in serious
injuries or loss of ambulance operations of more than 14 days
from State Ambulance Safety Committee (State ASC).

4.3.4.3. Propose policy and guidelines on safety of land ambulance

services to the MOH Technical Committee on PHCAS.

4.4. STATE AMBULANCE SAFETY COMMITTEE

4.4.1. The State Health Director shall establish a State Ambulance Safety
Committee under the State Technical Committee on Prehospital Care
and Ambulance Services (Appendix 3).

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 4.4.2. The members of the committee shall be as in Appendix 4. The State
Health Director shall appoint a PHCAS specialist from the Emergency
and Trauma Services as the chairman of the committee.

4.4.3. State Occupational and Environmental Health Unit (OEHU) of Public

Health Division shall be the secretariat to this committee.

4.4.4. Functions of the State ASC shall include

4.4.4.1. Monitor compliance to the policies and safety standards of

land ambulance services by hospitals and health facilities.

4.4.4.2. Receive mandatory reports on all ambulance safety incidents

or collisions involving land ambulances services from MOH
facilities.

4.4.4.3. Maintain an updated registry of incidents or collision involving

land ambulance services.

4.4.4.4. Appoint State Ambulance Incident or Collision Inquiry

Team to investigate any incidents or collisions involving land
ambulances that resulted in injuries or loss of ambulance
operations. Reports of the investigation shall be submitted to
the National Ambulance Safety Committee.

4.5. DISTRICT HEALTH OFFICE AND HOSPITAL AMBULANCE SAFETY

SURVEILLANCE ACTIVITIES

4.5.1. Surveillance of all ambulance safety incidents or collisions in MOH

hospitals shall be an activity under the Hospital Quality Unit.

4.5.1.1. Hospital Director shall appoint representative of PHCAS Unit

to be part of the Incident Reporting Committee.

4.5.1.2. Reporting of ambulance safety incidents or collisions in MOH

Hospitals shall comply with MOH directives on Incident
Reporting and Learning System.

4.5.2. Surveillance of all ambulance safety incidents or collisions in MOH

Primary Health Care facilities shall be an activity under the Quality Unit
of District Health Offices.

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 4.5.3. Hospital Directors and District Health Officers shall

4.5.3.1. Establish local operational directives to ensure operations of

land ambulance services comply with MOH policy, guidelines
and safety standards.

4.5.3.2. Ensure mandatory reporting of land ambulance safety

incidents or collisions.

4.5.3.3. Perform internal inquiry on all land ambulance safety incidents

or collisions.

4.5.3.4. Submit internal inquiry reports on all land ambulance safety

incidents or collisions to the State ASC.

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5. MANDATORY AMBULANCE SAFETY INCIDENT OR COLLISION
REPORTING

5.1. MOH PHCAS Providers shall implement a mandatory reporting of any land
ambulance safety incidents or collisions.

5.2. The reporting procedure shall be an addition to any existing directives such as:
5.2.1. Treasury Directives on handling ambulance collisions. [Pekeliling
Perbendaharaan (WP4.2/2013: Kemalangan Yang Melibatkan
Kenderaan Kerajaan Malaysia].

5.2.2. Notification of Occupational Accident and Dangerous Occurrence Form

(WEHU A1/A2 form) for land ambulance safety incidents or collisions
resulting in injuries to healthcare worker.

5.3. MOH PHCAS Responders shall report any land ambulance safety incidents or
collisions to their respective Hospital or District Health Office Quality Unit.

5.3.1. All ambulance safety incidents shall be reported to the Quality Unit using
the current Incident Reporting form.

5.3.2. All ambulance collisions shall be reported to the Quality Unit using the
current Incident Reporting form and an additional AMB/IR/1
(Appendix 5) form within 24 hours of the incident.

5.4. Hospital or District Health Office Quality Unit shall then submit a copy of the
form to the State ASC and National ASC within 48 hours of the incident OR on
the next working day (whichever earlier).

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6. AMBULANCE INCIDENT OR COLLISION INVESTIGATION

6.1. State ASC shall investigate any land ambulance safety incidents or collisions
that resulted in injuries or loss of ambulance operations.

6.1.1. State Occupational and Environmental Health Unit (OEHU) upon

receiving notification from any facility shall initiate an investigation no
later than 7 days after the date of incident or collision.

6.1.2. The investigation report shall be submitted to the National ASC no later
than 14 days after the date of incident or collision.

6.2. State ASC shall appoint an Ambulance Incident or Collision Inquiry Team
to facilitate with the investigation.

6.2.1. The investigation committee shall comprise of land ambulance service

clinical, technical and operational experts.
6.2.2. This investigation shall also be jointly done with relevant Occupational
Health Officers.

6.2.3. The experts shall not be restricted to only MOH personnel.

6.3. The National ASC shall appoint a National Ambulance Incident or Collision
Inquiry Team to investigate any incident or collision involving land ambulance
services.

6.4. Summary of this process shall be as in Appendix 6

6.5. The Occupational Health Unit (OHU), Ministry of Health Malaysia as the
secretariat of National ASC shall maintain records of all investigation report
from State ASC.

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7. LAND AMBULANCE SPECIFICATION

7.1. Procurement of land ambulances shall adhere to current Technical

Specifications of Land Ambulances (TSLA).

7.2. TSLA shall be developed, maintained and updated by the Subcommittee on

PHCAS Equipment Standard and Specifications.

7.3. MOH Technical Committee on PHCAS shall appoint operational and technical
experts to form a Subcommittee on PHCAS Equipment Standard and
Specifications.

7.4. TECHNICAL SPECIFICATIONS OF LAND AMBULANCE

7.4.1. The specifications for land ambulances shall emphasize service needs,
safety and protection of all individuals in the vehicle (Appendix 7).

7.4.2. The design, construction, modification and testing processes of

ambulance shall comply with local or international standards.

7.4.3. TSLA shall be used as a reference document for all land ambulance
procurement process.

7.4.4. TSLA shall be reviewed at least once in five (5) years or when the need
arises.

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8. PROCUREMENT OF LAND AMBULANCES

8.1. Procurement proceedings or procedures shall abide by the rules governing

assets procurement in MOH.

8.2. All procurement proceedings or procedures shall have consultation and

presence of PHCS operational and technical experts.

8.3. The ambulance specifications shall conform to the current and approved TSLA.

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9. AMBULANCE OPERATIONS AND MANAGEMENT

9.1. SUPERVISION OF LAND AMBULANCE OPERATIONS

9.1.1. All MOH PHCAS Provider shall ensure daily ambulance operations
management comply safety requirements stipulated in this policy.

9.1.2. MOH PHCAS Supervising Assistant Medical Officer has the following
operational safety supervision function:

9.1.2.1. Submission of mandatory incident or collision reporting to

individual Hospital or Health ASC.

9.1.2.2. Ensure Ambulance Drivers receives training and certification

in defensive driving techniques. [Surat Pekeliling Ketua
Pengarah Kesihatan Bilangan 17/2012: Penambahbakan
Garispanduan Latihan Pemanduan Ambulan
Kementerian Kesihatan Malaysia].

9.1.2.3. Ensure Ambulance Drivers undergo Medical Fitness

Examination. [Medical Examination Standard for
Vocational Driver Licensing]

9.1.2.4. Ensure daily vehicle pre-departure and post-deployment

safety inspection is performed by the PHCAS Responders.

9.1.2.5. Ensure management of ambulance breakdown and reporting

performed in accordance to MOH guidelines. [Garis
Panduan Penyelenggaraan Ambulans Di Hospital Dan
Klinik Kesihatan 2014].

9.1.2.6. Perform inspection of ambulance returning from service and

repair maintenance before scheduled to daily operations.

9.1.2.7. Report of ambulances with repetitive breakdown or

maintenance for Ambulance Main Components (AMAC) to the
Hospital Operations Engineer /Assistant Hospital Operations
Engineer / State Engineer.

9.2. ROAD WORTHINESS OF LAND AMBULANCE

9.2.1. All ambulances shall undergo yearly safety inspections by an authorized

government agency.

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 9.2.2. MOH shall prioritize the replacement of ambulances proposed or
certified as Beyond Economic Repair (BER).

9.2.3. Ambulances with identified or suspected to have breakdown of AMAC

shall not be used in operations until repair or maintenance is performed
and verified.

9.2.4. Hospital Operations Engineer /Assistant Hospital Operations Engineer /

State Engineer shall be informed of ambulances with repetitive
breakdown or maintenance.

9.2.4.1. Hospital Operations Engineer / Assistant Hospital Operations

Engineer / State Engineer shall provide recommendation to
Hospital Director or District Health Officer on its road-
worthiness.

9.3. SERVICE MAINTENANCE OF AMBULANCE

9.3.1. The service maintenance schedule for AMAC shall be carried out based
on vehicle manufacturer recommendation.

9.3.2. All service and repair maintenance for AMAC shall be done at authorized
service facilities.

9.3.3. All AMAC spare parts shall be replaced with genuine parts as specified
by the vehicle manufacturer.

9.3.4. Service maintenance works for AMAC shall be completed within 24

hours.

9.3.5. All ambulances upon returning from service maintenance shall be

inspected by the MOH PHCAS Supervising Assistant Medical Officer.

9.4. REPAIR MAINTENANCE OF AMBULANCE

9.4.1. All breakdown maintenance work for the AMAC shall be carried out at
authorized service facilities.

9.4.2. All breakdown maintenance work for the Ambulance Modified

Components (AMOC) shall be carried out by the supplier during the
warranty period or at authorized service facilities after the warranty
period.

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 9.4.3. All breakdown maintenance repairs shall be completed in not more than
14 days.

9.4.3.1. If the repair takes more than 14 days, a replacement

ambulance and/or a 3rd party repair facility shall be used as
per concession agreement.

9.4.3.2. Replacement ambulance provided by 3rd party repair facility

shall comply with the current TSLA.

9.5. PRE-DEPARTURE AND POST DEPLOYMENT SAFETY INSPECTION

9.5.1. All ambulances shall undergo a pre-departure ambulance and medical

equipment safety inspection at beginning of every shift or prior to
deployment.

9.5.2. All facilities shall use a standard pre-departure ambulance and medical
equipment checklist.

9.5.3. All ambulances shall undergo a post-deployment safety check at the end
of every shift or deployment to identify necessary breakdown or repair
maintenance works.

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10. AMBULANCE DRIVING POLICY

10.1. NUMBER OF OCCUPANTS IN AN AMBULANCE

10.1.1. The maximum number of occupants in an ambulance shall be based

on the seating arrangement availability and maximum allowable
Loading Capacity.

10.1.1.1. All ambulances shall display a signage stating the

maximum allowable occupants.

10.1.2. Relatives of patients shall be advised against and discouraged from

travelling in the ambulance with the patient by the PHCS Responder.

10.1.3. PHCAS Provider shall have an Ambulance Passenger Indemnity

Form that are signed by relatives insisting on travelling in the
ambulance with the patient (Appendix 8).

10.2. SAFETY PRECAUTIONS PRIOR TO SETTING THE VEHICLE IN

MOTION

10.2.1. Ambulance Drivers shall ensure that no person is in the process of

mounting, dismounting, standing on top of, or on the outside of, the
vehicle prior to setting the vehicle in motion.

10.2.2. Ambulance Drivers shall ensure that all occupants and the patient
inside an ambulance are seated and properly restrained prior to setting
the vehicle in motion.

10.3. USE OF RESTRAINTS IN AN AMBULANCE

10.3.1. Every occupant in an ambulance must be seated on individual

assigned seats with restraints.

10.3.2. All ambulances shall display a signage instructing on the use of seat-
belts.

10.3.3. Patients shall be restrained using shoulder straps, chest, pelvic and
legs restraints.

10.3.4. PHCAS Responders providing direct patient care inside an ambulance

shall be permitted to temporarily release their seat belt. Responders
should minimize time without protection.

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 10.3.5. Ambulance Drivers shall provide verbal warnings to unrestrained
PHCAS Responders regarding changes in the vehicle’s motion, such
as acceleration or deceleration, turning and stopping.

10.4. GENERAL STATEMENTS ON DRIVING OF AMBULANCE

10.4.1. Ambulance Drivers shall abide by all traffic rules, unless the use of
lights and siren response is indicated.

10.4.2. Ambulance Drivers shall abide by the posted speed limit and drive at
a speed that is safe and prudent, based on road and weather
conditions and the design and capability of the particular vehicle.

10.4.3. Ambulance Drivers shall exercise extreme caution while driving at

emergency incident locations.

10.4.4. Ambulance Drivers shall abide by all directions on movement,

positioning or repositioning orders given by law enforcement officials.

10.4.5. The use of ambulance beacon lights is only permitted when travelling
with a patient.

10.5. DRIVING OF AMBULANCE DURING LIGHTS AND SIREN

RESPONSE

10.5.1. The use of lights and siren shall be based upon the clinical requirement
of the patient; and be limited to the following situations:

10.5.1.1. Responding to a suspected critically ill patient based on

telephone triage protocols.

10.5.1.2. Responding to or transporting a critically ill patient.

10.5.1.3. Medical direction authorizing the use of lights and siren.

10.5.2. The use of lights and siren is not to be seen as a privilege to disregard
traffic rules but as an alert to other road users to give the right-of-way
to an ambulance.

10.5.3. Ambulance Drivers shall not assume the right-of-way but exercise
extreme caution to ensure right-of-way has been given by other road
users.

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 10.5.4. Ambulance Drivers shall not employ aggressive driving techniques to
force the right-of-way. The use of voice amplification device such as
ambulance hailer is allowed, and the driver shall politely but firmly
request the right-of-way.

10.5.5. When provided with the right-of-way, the Ambulance Driver shall
operate with due regard to the safety of civilian traffic and occupants
at all times.

10.5.6. The ambulance shall come to a full stop when entering an intersection
with a red light, or a stop sign. Only when the driver visually confirms
the right-of-way, shall the vehicle enter the intersection.

10.5.7. The ambulance shall remain in a single traffic lane. Changing of lanes
is acceptable only when it is essential to do so and the intention to
change lane shall be made known to other road users.

10.5.8. Ambulances shall not travel in opposite direction to traffic under any
conditions, unless directed by traffic authority.

10.6. USE OF DISTRACTING DEVICES

10.6.1. Operating of distracting devices by Ambulance Drivers while the

vehicle is in motion is prohibited.

10.7. JOURNEY MANAGEMENT AND PLANNING

10.7.1. Inter-facility transfer of patients shall be planned based on patient’s

requirement and observe the safety precautions for accompanying
staff. [Surat Pekeliling Ketua Pengarah Kesihatan Bil. 5 Tahun
2017 Keselamatan anggota mengiringi pesakit dalam ambulans
Kementerian Kesihatan Malaysia]

10.7.2. For transfers of non-critical patients, the AOS shall decide on the time
of travel, based on road conditions, time of day and environmental
hazards.

10.7.3. AOS must ensure presence of two drivers for journey of more than 4
hours per trip (journey to destination and return). [Occupational
Safety and Health Industry Code of Practice for Road Transport
Activities, 2010]

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11. HUMAN RESOURCE MANAGEMENT AND SAFETY STANDARDS

11.1. RECRUITMENT AND TRAINING OF AMBULANCE DRIVERS

11.1.1. All Ambulance Drivers shall have a valid driving license, based on the
vehicle class of the Ambulance.

11.1.2. All Ambulance Drivers shall undergo defensive driving training

approved by the MOH. There shall be a mechanism of recertification
of trained Ambulance Drivers.

11.1.3. MOH PHCAS Providers shall be conduct continuous, scheduled and

periodic safety and health training education for all Ambulance Drivers.

11.2. MEDICAL FITNESS FOR AMBULANCE DRIVERS

11.2.1. All Ambulance Drivers shall be certified to be medically fit to drive.

11.2.2. MOH PHCAS Providers shall be responsible for assigning a Primary

Care Physician or Medical Officer for Ambulance Drivers with known
pre-morbid diseases.

11.2.3. Drivers with poor disease-control based on the current clinical practice
guideline for the respective disease shall be prohibited from
Emergency Ambulance Services or driving with the use of lights
and siren until deemed fit by the assigned Primary Care Physician or
Medical Officer.

11.3. AMBULANCE DRIVER DRIVING HOURS

11.3.1. The AOS shall be responsible for managing Ambulance Drivers

working hours.

11.3.2. Ambulance Drivers shall be allowed to be on duty for only 12

consecutive hours, except with written permission by the Hospital
Director or District Health Officer.

11.3.3. Ambulance Drivers that have been on duty for more than 12 hours
shall be allowed a minimum of 12 hours resting time before
recommencing active driving duty.

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 11.3.4. Ambulance Drivers shall drive for a maximum of four (4) continuous
driving hours. [Occupational Safety and Health Industry Code of
Practice for Road Transport Activities, 2010]

11.3.5. All land ambulance operations with driving time of more than 4 hours
shall have two Ambulance Drivers assigned to allow rotation of driving.
[Occupational Safety and Health Industry Code of Practice for
Road Transport Activities, 2010]

11.4. POLICY ON SUBSTANCE ABUSE

11.4.1. Ambulance Drivers shall not be under the influence of any substance
that impairs their capability to operate a vehicle during working hours.

11.4.2. Ambulance Drivers shall undergo substance abuse screening

procedures, based upon request by the Head of Institution.

11.4.3. Ambulance Drivers tested positive for substance abuse shall be

subjected to disciplinary procedures.

11.5. REGULATION VIOLATION AND TRAFFIC OFFENCES MONITORING

11.5.1. Ambulance Drivers shall be liable to any legal or punitive action for any
violation of regulation and traffic offences.

11.5.2. Any Ambulance Drivers involved in a collision resulting in death or

disability shall be prohibited from Emergency Ambulance Services or
driving with the use of lights and siren pending investigation by
State ASC.

11.6. Any Ambulance Drivers, who are considered as having a high risk driving
behavior, shall be prohibited from driving an ambulance.

11.6.1. MOH facilities shall have local operational policies on handling drivers
with high risk driving behavior such as training, monitoring and
disciplinary process.

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 APPENDIX 1
MOH TECHNICAL COMMITTEE ON PHCAS

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 APPENDIX 2
NATIONAL AMBULANCE SAFETY COMMITTEE

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 APPENDIX 3

STATE TECHNICAL COMMITTEE ON PRE HOSPITAL CARE AND AMBULANCE SERVICES

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 APPENDIX 4

STATE AMBULANCE SAFETY COMMITTEE

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 APPENDIX 5

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 APPENDIX 6
AMBULANCE SAFETY INCIDENT AND COLLISION INVESTIGATION FLOW

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 APPENDIX 7

SAFETY ELEMENTS IN LAND AMBULANCE TECHNICAL SPECIFICATIONS

1. CHASSIS OF AMBULANCES

1.1. Ambulance chassis shall meet the operational requirements, such as the local
barriers, terrain and hazard challenges, of the service.

1.2. Specific manufacturer recommendations pertaining to the chassis must be

strictly adhered to during the design process.

1.3. The chassis of ambulances shall meet current accepted local or

internationally accepted standards for Frontal Collision Impact Test and
Lateral Collision Impact Test.

2. PASSIVE VEHICLE SAFETY TECHNOLOGY

2.1. All ambulances shall be provided with current vehicle safety technology
systems.
2.2. All ambulances shall also be provided with run flat tyre protection systems.

3. AMBULANCE INTERIOR, SEATING AND RESTRAINTS

3.1. Seating allocation and maximum allowable occupants within a vehicle shall
be calculated based upon the permissible Gross Vehicle Weight specified by
the chassis manufacturer.

3.2. Each occupant shall be provided with a seatbelt for all seating positions. All
seatbelts shall comply with the current accepted local or international
standards.

3.3. The fixtures and installation in the patient compartment shall be free of all
sharp projections, edges or corners.

3.4. The interior surface finishing shall be of material which allows disinfection and
decontamination cleansing processes using soap, water, and disinfectants for
infection control.

3.5. Patient stretchers shall have a stretcher secured and occupant restraint
systems.

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 3.6. The stretcher occupant restraining system shall include restraints for
shoulders, pelvic and legs. It shall be adjustable to accommodate occupants’
weight ranging from 15kg to 150kg. It also shall have a quick-release
mechanism.

4. VEHICLE VISIBILITY

4.1. Ambulances shall be provided with a standard highly visible base body colour
that promotes maximum visibility during dusk, daylight, and dawn and night
time.

4.2. To further promote visibility and recognition regardless of weather, terrain or

environment, additional colours may be used on the external surface of
ambulances.

4.3. The use of micro-prismatic reflective material that adheres to current

accepted local or international standards shall be used to facilitate night time
visibility. It shall indicate the outline and direction of the vehicle.

4.4. Ambulances shall be equipped with an integrated light and sound system with
an audible emergency siren and a warning light system with flashing lights.
The system adheres to current accepted local or international standards.

4.5. Ambulances shall also be equipped with emergency warning lights at the
forward edge of each front fender that flash in an alternating pattern. The
emergency warning lights shall serve as an intersection warning lights
system.

5. MEDICAL EQUIPMENT

5.1. All medical devices, equipment and objects shall have specific stowing,
fixation or restraint systems to prevent damage or injury to occupants whilst
the vehicle is in motion.

5.2. Resuscitation equipment shall be located within reach of the responder in the
rear facing seat with minimal movement.

5.3. All ambulances should be equipped with current technology designed to free
the hands of responders during transportation.

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6. COMMUNICATIONS EQUIPMENT

6.1. Ambulances shall be equipped with a communications device that allows

exchange of information through various medium between the vehicles and
the coordinating MECC.

6.2. Ambulance’s staff should use current hands-free technology during

communication.

6.3. All vehicles shall be provided with a Navigation System or equivalent for
tracking and monitoring purpose.

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 APPENDIX 8
Ambulance Passenger Indemnity Form

I ____________________________________________________, NRIC number

__________________ acknowledge to have received information regarding risks of
travelling in an ambulance by
_____________________________________________________ a staff of Ministry of
Health Malaysia.
I hereby irrevocably and unconditionally undertake and agree to the following:
1. Indemnify MOH and ambulance staff against all actions, claims, demands, costs
(including legal costs), losses and expenses;
2. Not to hold MOH and ambulance staff responsible or make any claim against
MOH and ambulance staff in respect of any loss, damage or injury arising as
aforesaid;
3. I will keep confidential and not disclose any and all information relating to MOH,
ambulance staff and patients;
4. I will not film, photograph or record any of your patients or any other without first
obtaining the verbal consent of such patient;
5. I will not film, photograph or record any of MOH staff without first obtaining the
verbal consent of such staff;
6. I will not film, photograph or record on private property without first obtaining the
verbal consent of those persons responsible for the property;
7. I will not publish any of film, photograph or record as mentioned above in any
form of public media unless permitted by the MOH.

DATE:
SIGNED by
NAME:
WITNESS:
Signature: ____________________________________________
Occupation: ____________________________________________

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REFERENCES

1. Emergency Medicine and Trauma Services Policy Ministry of Health Malaysia.

2. Tata Amalan Industri Keselamatan dan Kesihatan Pekerjaan bagi Aktiviti

Pengangkutan Jalan 2010; Jabatan Keselamatan Dan Kesihatan Pekerjaan
Kementerian Sumber Manusia, Malaysia

3. Akta Pengangkutan Jalan (APJ)1987

4. Sentinel Events Policy and Procedures, Joint Commission of Health; 2017

5. EMS Provider And Patient Safety During Response And Transport: Proceedings
Of An Ambulance Safety Conference; Pre hospital Emergency Care; 16(1); 2012

6. Medical Vehicles and Their Equipment – Road Ambulances; DIN EN 1789: 2010-
11

7. Australian/New Zealand Standard Ambulance Restraint Systems; AS/NZS

4534:1999

8. Ambulance Vehicle Standards Code, January 2010, Emergency Health Services,

Health Policy and Service Standards Development Branch, Alberta Health and
Wellness.

9. Ambulance Crash Characteristics Defined by the Popular Press: A Retrospective

Analysis; September 9, 2009.

10. The Frequency of Medical Examination as a Pre-Condition for Licensing Of

Commercial Vehicle Drivers in Malaysia (2009). MER06/2009, Malaysian
Institute of Road Safety Research.

11. American National Standard on Safe Practices for Motor Vehicle Operations;
ANSI/ASSE Z15.1 – 2012

12. Pekeliling Perbendaharaan WP 4.1/2013: Pengurusan Kenderaan Kerajaan.

13. Pekeliling Perbendaharaan WP 4.2/2013 : Kemalangan Kenderaan yang

Melibatkan Kenderaan Kerajaan

14. Garis Panduan Penyelenggaraan Ambulans Di Hospital Dan Klinik Kesihatan

2014, Bahagian Perkhidmatan Kejuruteraan Kementerian Kesihatan Malaysia.

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COMMITTEE MEMBERS

Advisors
1. YBhg Datuk Dr Noor Hisham b. Abdullah
Director General of Health Malaysia

2. YBhg Dato’ Dr Hj Azman Bin Hj Abu Bakar

Former Deputy Director of Health (Medical)

3. YBhg Datuk Dr Hj. Rohaizat Bin Hj.Yon

Deputy Director Of Health (Medical)

4. YBhg Dato’ Dr Hj Bahari Bin Dato’ Tok Muda Che Awang Ngah
Director Medical Development Division

5. YBhg Datin Sri Dr Asmah Bin Samat

Deputy Director Medical Development Division

Chairman
1. Dr Sabariah Faizah bt Jamaluddin
Former Head of Emergency Medicine and Trauma Services, MOH

2. Dr Mahathar Bin Abd Wahab

Head of Emergency Medicine and Trauma Services, MOH
Technical Committee Members
1. Dr Sarah bt Shaikh Abdul Karim
Emergency Physician
Emergency & Trauma Department, Hospital Sungai Buloh

2. Dr Rosidah bt Ibrahim
Consultant & Head
Emergency & Trauma Department, Hospital Serdang

3. Dr Fatahul Laham b. Mohamed

Emergency Physician & Head
Emergency & Trauma Department, Hospital Sultanah Bahiyah, Alor Setar

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 4. Dr Sharfudin b. Noordin
Assistant Director
Medical Practice Division, Ministry of Health

5. Ir. Tuan Hj Rosmahadi b. Ali

Senior Principal Assistant Director
Engineering Division, Ministry of Health

6. Dr Kasuadi b. Hussin
Senior Principal Assistant Director
Emergency Services Unit, Medical Development Division
Ministry of Health

7. Dr Wee Tong Ming

Emergency Physician
Emergency & Trauma Department, Hospital Sungai Buloh

8. Dr Ramzuzaman b. Ismail
Emergency Physician
Emergency & Trauma Department, Hospital Raja Permaisuri Bainun, Ipoh

9. Dr Rachel Koshy
Public Health Physician
Family Health Development Division (Primary Care)
Ministry of Health

10. Dr Norlen b. Mohamed

Director
Malaysian Institute Research and Safety (MIROS)

11. Mohd Fairuz b. Mohd

Engineer
Engineering Services Division, Ministry of Health

12. Dr Sirajuddin b. Hashim

Senior Principal Assistant Director
Occupational Health Unit, Disease Control Division
Ministry of Health

13. Dr Rosnah bt Ramly

Senior Principal Assistant Director
Violence & Injury Prevention Unit, Disease Control Division
Ministry of Health

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 14. Dr Nor Mashitah bt Hj Jobli
Senior Assistant Principal Director
Emergency Services Unit, Medical Development Division
Ministry of Health

15. En. Joseph Kajangan

Chief Assistant Medical Officer
Hospital Queen Elizabeth, Kota Kinabalu Sabah

16. Tuan Hj Hadzir b. Sukirman

Chief Assistant Medical Officer
Emergency & Trauma Department, Hospital Sultanah Bahiyah, Alor Setar

17. Tuan Hj Azamuddin b. Mohammud

Chief Assistant Medical Officer
Hospital Kuala Lumpur

18. En Ahmad Yushree b. Mohd Salim

Senior Assistant Medical Officer
Emergency & Trauma Department, Hospital Tengku Ampuan Afzan, Kuantan

19. En. Samsuri b. Md Isa

Senior Assistant Medical Officer
Emergency & Trauma Department, Hospital Tengku Ampuan Afzan, Kuantan

20. En. Hosni b. Abdullah

Cheif Assistant Medical Officer
Emergency & Trauma Department, Sarawak General Hospital, Kuching

21. En. Mohd Azrol b. Abdul Jalil

Senior Assistant Medical Officer
Medical Assistant Board, Medical Practice Development Division
Ministry of Health

22. En. Shuhaimi b. Romli

Senior Assistant Medical Officer
Emergency & Trauma Department, Hospital Sultanah Bahiyah, Alor Setar

23. En Azman b. Husin

Chief Assistant Medical Officer
Kuala Pilah Health District, Negeri Sembilan

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 24. En Mohd Arif b. Mohd Yusoff
Senior Assistant Medical Officer
Emergency Services Unit, Medical Development Division
Ministry of Health

25. En Mohd Aswadi b. Abdul Rahman

Senior Assistant Medical Officer
Emergency Services Unit, Medical Development Division
Ministry of Health

26. En Yusri b. Mahmad

Senior Assistant Medical Officer
Emergency Services Unit, Medical Development Division
Ministry of Health

27. En Mohd Faiz b. Johari

Senior Assistant Medical Officer
Emergency Services Unit, Medical Development Division
Ministry of Health

Secreteriat
1. Puan Noor Azmah bt Ahmad Zaki
2. Cik Yusfarina bt Yamsuri

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© Emergency Medicine & Trauma Services
Ministry of Health Malaysia
www.moh.gov.my

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