Standard Operating Procedures - Manual

For Ambulance Operations

Standard OperatingProcedure

Contents
Introduction and Background ------------------- 29

General Standard Operating Procedures -- 30

Specific Standard Operating Procedures -- 33

Code of Conduct ---------------------------------------- 39

Annexure/SOP1-5----------------------------------------- 43
Section 1: Standard Operating Procedures for
Ambulance Operations
1.1. Introduction:

This manual provides Standard Operating Procedures (SOPs) for operating ambulances at the Rural
Hospitals (RH) / Block Primary Health Centres (BPHC) in West Bengal.

Standard Operating Procedures are a set of written instructions that should be followed in every sphere of
activity in order to achieve economy, efficiency, effectiveness and uniformity. In other words SOPs are
prescribed procedures that tell who will do what, where, when, why and how.

1.2 Background

Accessibility to emergency health services especially emergency obstetric care is still a major concern in
remote areas of West Bengal despite ambulance services being operated by the Red Cross Society, St. John’s
Ambulance, other NGOs and Private Bodies. Operating ambulance services in such areas will help to
improve accessibility, safety and security of patients because ambulance services are meant to bridge the gap
between the need for critical care of patients and timely care to be offered by hospitals / physicians for
diagnosis and treatment of ailing patients.

To meet this need for emergency health care Government of West Bengal decided to set up emergency
transportation services by involving reputed NGOs/CBOs/Trusts, etc to take-up day to day
operational management of ambulance services. Accordingly, 133Ambulance Services at the level of
Rural Hospitals (RH)/ Block Primary Health Centres (BPHC)/Primary Health Centres (PHC) managed by
NGOs/CBOs etc under PPP have become operational in eight districts of West Bengal from March 2005.
Encouraged by the initial success of the scheme, DoHFW has now decided to replicate this scheme in the
remaining Blocks of the eight districts as well as at the Block level in other districts of the state.

For successful and efficient running of ambulance services by these NGOs/CBOs/Trusts, etc it is
essential to have and follow Standard Operating Procedures that will direct all those involved in
ambulance operations to perform and accomplish tasks with a greater degree of efficiency, economy
and uniformity.

SOPs in the case of ambulance operations will be of two types, general and specific.

General SOPs will detail out the General Attributes and Conduct of Personnel/NGOs involved in
ambulance operations while specific SOPs will help direct people involved in ambulance operations to
respond to and act upon requests for ambulance services in specific ways.

Section 2 General Standard Operating

Procedures
2.1 General Attributes & Conduct of Personnel Involved in Ambulance Operations
2.1.1. Respect and Consideration

Ambulance Services personnel will treat all patients with respect and consideration regardless of their race,
color, sex, creed, culture, economic status and religious beliefs. There will be no discrimination on the basis
of race, sex, sexuality and sexual orientation.

2.1.2. Professional Execution

Both the driver and the attendant will ensure that the vehicle and related equipments are washed and cleaned
once daily and in between transportation of patients. The driver of the vehicle will check the status of fuel,
oxygen cylinder and other necessary equipment as per the checklist provided (Annexure/SOP- 1) every
morning as well as before leaving for a call. Both the driver and the attendant will complete all paperwork
related to ambulance operations in between calls and at the end of the day.

The cleaning of vehicle, cleaning of equipment, completion of paperwork, and continuing maintenance of
the vehicle are absolutely necessary for proper and timely functioning of ambulance services.

2.1.3. Attendance

Both the driver and the attendant will be available for ambulance duty at any point of time to perform the
duty. It is the responsibility of the operating partner to ensure that regular attendance and punctuality is
maintained at all points of time.
2.1.4. Uniform

Standard uniform code will be dark gray shirts and trousers. Both the driver and the attendant will wear
uniforms as specified above while on duty to promote professionalism and facilitate identification as
ambulance operations staff.

2.1.5. Physical Fitness

The Driver and the attendant will remain physically and mentally fit and sound so as to be able to perform
their duties at all times.

2.1.6. Patient Disposition

Patients should be transported to the hospital as per the guidelines specified in the Scheme

2.1.7. Communication Protocols

Proper communication protocols need to be maintained with the callers and patient party.

Guidelines/Protocols:

Simple, direct, professional and courteous language will be used at all times.

When an ambulance is dispatched on the basis of a call the dispatcher will ensure that the ambulance is
responding to the correct address.

Contact with the dispatch (ambulance and driver) will be maintained at all times.

Some commonly used Ambulance Operation terms are:

“Available” : ambulance is available to respond to a call.

“On call” : ambulance is picking up or transporting a patient

“Out of Service” : ambulance is not available to respond

“Received” : ambulance staff has received the information.

“Responding” : ambulance is en route to a call

“Status” : Find out the availability of ambulance

“Welfare Check” : To check the physical welfare of the ambulance staff

“On Scene” : Ambulance has arrived at call location.

“Transporting” : Ambulance is transporting the patient to a hospital. Must be followed

by hospital name.
“Arriving at Hospital” : Ambulance has arrived at the hospital (use name)

2.1.8 Mobile Phone

The NGO/CBO/Trust shall provide a mobile phone to the Driver of the Ambulance for enabling
the Driver to establish timely communication link with the RH/BPHC.

2.2 Infection Control By Ambulance Personnel

i. Use all protective gears for handling patients at all times

ii. When the possibility of exposure to blood or other body fluid exists, gloves are recommended. If hands
accidentally become contaminated with blood, they should be washed thoroughly as soon as possible.

iii. When there is a risk of eye or mouth contamination (for example, the patient is vomiting bloody material
or there is arterial bleeding), protective eyewear and masks are recommended.

iv. Masks should be worn by the ambulance staff or patient for those infectious agents transmitted by
airborne diseases like Tuberculosis, Chicken Pox, Measles and the like

v. Equipment should be thoroughly cleaned after each use.

vi. All significant exposures shall be reported to the Superintendent/ BMOH/MOIC immediately so that
necessary action can be taken.

Significant exposure is defined as the following:

i. Any puncture of the skin by a needle or other sharp object that has had contact with patient’s blood or
body fluids or with fluids infused into the patient.

ii. Blood spattered onto mucous membranes (e.g. mouth or eyes).

iii. Contamination of open skin (cuts, abrasions, blisters, open dermatitis) with blood, saliva, amniotic fluid,
etc..
2.3. Patient Care Reports/ Documentation

Documentation is one of the most important aspects of completing an ambulance call. Both the call receiver
as well as the driver of the ambulance must maintain and complete call reports. Patient Care Reports are
frequently referred to as Call Reports. The documentation norm will be –

a. Complete report on each patient for any call (Annexure/SOP- 2)

b. All call reports to be recorded in duplicate as the call occurs and the duplicate copy kept in office file.

c. All calls to be registered in the Log Book after the completion of the call (Annexure/SOP- 3)

Section 3: Specific Standard Operating

Procedures
The primary function of an ambulance is emergency transportation of obstetric care, accident and other
emergency health cases from the villages/places of residence to the RH/BPHCs or to the Sub-
Divisional/District/tertiary hospital or to a nearest private hospital. Request for ambulance services will
therefore come to the RH/BPHC through telephone or in the form of a personal caller for transporting
accident or obstetric care and other emergency health cases (termed hereunder as normal emergency cases)
as per guidelines mentioned below.

3.1A. Request For Ambulance Services Over Telephone For Transporting Emergency Cases

3.1A1. An employee of RH/BPHC authorized by the Superintendent/BMOH/MOIC will receive a phone

call requesting for ambulance services.

3.1A.2 Details of request will be noted in the ‘Request for Ambulance’ / Call Record form (Annexure 2) in
duplicate. Full address and clear direction for location of the patient supported by important landmarks will
also be noted down. The employee of RH/BPHC will in turn inform about user charges and mode of
payment to the caller.

3.1A.3 The filled-in form should be signed by Superintendent/BMOH or Medical Officer on duty or any
other person authorized by Superintendent/BMOH/MOIC before dispatch of the ambulance.

3.1A.4 Thereafter, the original of the form is to be handed over to the driver of the ambulance immediately.
The copy of the form should be kept in office file.
3.1A5. The concerned employee will immediately try to establish contact with the driver of the ambulance
and pass on the necessary information. If contact cannot be established with the driver of the ambulance
within 30 minutes, the same should be informed to the telephone caller so that the patient party can make
alternate transportation arrangements.

3.1A6. In case, the patient is to be transported to any center other than the RH/BPHC , the concerned
employee will intimate and obtain prior permission for the same from the Superintendent/BMOH/MOIC
and then pass on the necessary information to such center
3.1B Request For Ambulance Services In Person (By Patient’s Relatives or Neighbour) For
Transporting Emergency Cases

3.1B.1.Details of request will be noted in the ‘Request for Ambulance’ form (Annexure 2) in duplicate. Full
address and clear direction for location of the patient supported by important landmarks will also be noted
down. The employee of Superintendent/BPHC will in turn inform about user charges and mode of
payment to the caller.

3.1B.2 The filled-in form should be signed by Superintendent/BMOH or Medical Officer on duty or any
other person authorized by Superintendent/BMOH/MOIC before dispatch of the ambulance.

3.1B.3.Thereafter the original of the form is to be handed over to the driver of the ambulance immediately.
The copy of the form should be kept in office file.

3.1B.4.In case the Ambulance is out on duty, the concerned employee of Superintendent/BPHC will inform
the same to the person and request him/her to wait up to a maximum of half an hour

3.1B.5.The concerned employee will immediately try to establish contact with the driver of the ambulance
in the Driver’s mobile phone and pass on the necessary information. If contact cannot be established with
the ambulance within 30 minutes, the same should be informed to the personal caller so that the patient
party can make alternate transportation arrangements

3.1B.6. In case of ambulance being available the concerned employee of RH/BPHC will inform about its
availability and details of user charges and mode of payment to the personal caller, requesting for ambulance.

3.1B.7. In case, the patient is to be transported to any center other than the RH/BPHC, the concerned
employee will intimate and obtain prior permission for the same from the Superintendent/BMOH/MOIC
and then pass on the necessary information to such center.
3.2. Pick-up and transportation of patient

3.2A. If the ambulance is available at the RH/BPHC at the time of receipt of call/personal caller

3.2A.1. Before movement, the driver will check the status of fuel, oxygen cylinder and other necessary
equipment as per the ‘Check List’ provided to him (Annexure/SOP- 1)

3.2A.2. The driver / attendant will take with him the ‘Request for Ambulance’ and blank “Money Receipt”
form in duplicate (Money Receipt form: Annexure/SOP- 4)

3.2A.3. On reaching the pick-up point, the driver will produce ‘Request for Ambulance’ form and get the
same signed with the time of arrival for pick-up mentioned at the column provided, by the patient’s relative.

3.2A.4. The driver / attendant will also tell the patient’s family members to take with them the prescription
of the Doctor and other important reports.

3.2A.5. The driver and attendant will ensure safe shifting of the patient to the ambulance on a stretcher,
wherever required, with the help of the accompanying attendant and family members of the patient.

3.2A.6. Only two persons from the patient’s family will be allowed to accompany the patient in the
ambulance.

3.2A.7. The driver/attendant will ensure use of oxygen cylinder/other life saving equipment by the patient,
if required.
3.2B. In case the ambulance is not available at RH/BPHC during time of telephone call /personal
caller

3.2B.1. In case the ambulance is not posted at the RH/ BPHC at the time of receipt of request for
ambulance, the driver, on receiving a call from the RH/BPHC , needs to go to the place of the patient
directly from another location.

3.2B.2. He will use a blank ’Request for Ambulance’ form available with him and arrange to fill in all relevant
details in the form

3.2B.3. Thereafter, the procedures from 3.2A.1. to 3.2A.7. as mentioned above will be followed

3.2B.4. The Driver shall obtain a post facto approval in the Call Record from the
Superintendent/BMOH/MOIC.

3.3. Drop-in of the patient at RH/BPHC or other referral point/hospital

3.3.1. The driver / attendant will take the relatives accompanying the patient to the Medical Officer of
RH/BPHC Referral Hospital on duty for next course of action

3.3.2. The driver / attendant will then get the “ Request for Ambulance’ form signed along with mention
of ‘Time of release’ in the column provided by the family member of the patient, collect user charges and
hand over the properly filled money receipt.

3.3.3. The driver will fill the “Log Book” (Annexure/SOP- 3) kept in the Ambulance in the custody of the
driver and be produced to the Superintendent/ BMOH/MOIC whenever asked for.

3.3.4. The driver will inform of his arrival to the receiver of requests for ambulance at the RH/BPHC.
3.4. Transportation of Accident Emergency Patients

3.4A. Request For Ambulance Services Over Telephone For Transporting Accident Emergency
Cases

3.4A.1. An employee of RH/BPHC authorized by Superintendent/BMOH will receive a phone call

requesting ambulance services for transporting accident cases.

3.4A.2 Details of request will be noted in the ‘Call Record ’ form (Annexure/SOP- 2) in duplicate. Clear
directions for locations of the accident victims supported by landmarks will also be noted down.

3.4A.3. The filled-in form should be signed by the RH/BMOH/MOIC on duty before dispatch of the
Ambulance.

3.4A.4. Thereafter, the original of the form is to be handed over to the driver of the Ambulance immediately.
A copy of the form should be kept in the office file.

3.4A.5. In case the patient is to be transported to any centre other than the RH/BPHC, the concerned
employee will pass on the necessary information to such centre.

3.4A.6. In case the Ambulance is out on duty, at the time of the telephone call, the same should be intimated
to the telephone caller with a request to make an alternative arrangement in case of an extreme emergency.
However, the caller would also be requested to call back after 10 minutes in case no alternative arrangement
could be made by the caller for transportation of the patient.. In between, contact would be established with
the driver through phone and depending on the status, necessary actions would be taken.

3.4B. Request For Ambulance Services By A Personal Caller For Transporting Accident
Emergency Cases

3.4B.1. Details of request will be noted in the ‘Call Record’ form (Annexure/SOP- 2) in duplicate and the
same should be signed by the personal caller. Clear directions for locations of the accident victims supported
by landmarks will also be noted down.

3.4B.2. The filled-in form should be signed by the Superintendent/BMOH/MOIC on duty before dispatch
of the Ambulance.

3.4B.3. Thereafter, the original of the form is to be handed over to the driver of the Ambulance immediately.
A copy of the form should be kept in the office file.

3.4B.4. In case, the patient/s are to be transported to any center other than the RH/BPHC, the concerned
employee will pass on the necessary information to such center.
3.4B.5. In case the Ambulance is out on duty, the same will be intimated to the personal caller. However,
contact would be established with the driver through phone and depending on the status, necessary actions
would be taken.