No. S 1050
Healthcare Services Act 2020
Healthcare Services
(Emergency Ambulance Service and
Medical Transport Service)
(Amendment No. 2) Regulations 2024
In exercise of the powers conferred by section 57 of the Healthcare Services Act 2020, the Minister for Health makes the following Regulations:
Citation and commencement
1.  These Regulations are the Healthcare Services (Emergency Ambulance Service and Medical Transport Service) (Amendment No. 2) Regulations 2024 and come into operation on 1 January 2025.
Amendment of regulation 2
2.  In the Healthcare Services (Emergency Ambulance Service and Medical Transport Service) Regulations 2022 (G.N. No. S 2/2022) (called in these Regulations the principal Regulations), in regulation 2 —
(a)before the definition of “applicable service”, insert —
“ “acute hospital” means an approved permanent premises of an acute hospital service licensee;
“acute hospital service licensee” means a person licensed under the Act to provide an acute hospital service;
“adult cardiac critical care service”, in relation to an emergency ambulance service, has the meaning given by paragraph 1 of the Schedule;
“adult general critical care service”, in relation to an emergency ambulance service, has the meaning given by paragraph 2 of the Schedule;
“ambulance doctor” means a fully registered medical practitioner or conditionally registered medical practitioner who holds —
(a)a valid practising certificate under the Medical Registration Act 1997; and
(b)one or more valid certifications certifying competency —
(i)in the provision of Advanced Cardiac Life Support; and
(ii)in the use of Automated External Defibrillation;
“ambulance nurse” means an individual who —
(a)is a registered nurse or an enrolled nurse;
(b)holds a valid practising certificate under the Nurses and Midwives Act 1999; and
(c)holds one or more valid certifications certifying competency —
(i)in the provision of Basic Cardiac Life Support; and
(ii)in the use of Automated External Defibrillation;
“ambulance paramedic” means an individual who holds one or more valid certifications certifying competency —
(a)for appointment as a paramedic, following the individual’s successful completion of a course recognised by the Director‑General;
(b)in the provision of Basic Cardiac Life Support; and
(c)in the use of Automated External Defibrillation;”;
(b)after the definition of “Clinical Governance Officer”, insert —
“ “conditionally registered medical practitioner” means a person registered in Part II of the Register of Medical Practitioners in accordance with section 21(1) or (2) of the Medical Registration Act 1997;”;
(c)after the definition of “emergency ambulance service licensee”, insert —
“ “emergency medical technician” means an individual who holds one or more valid certifications certifying competency —
(a)for appointment as an emergency medical technician, following the individual’s successful completion of a course recognised by the Director‑General;
(b)in the provision of Basic Cardiac Life Support;
(c)in the use of Automated External Defibrillation; and
(d)in the provision of first aid;”;
(d)after the definition of “General Regulations”, insert —
“ “isolation service”, in relation to an emergency ambulance service, has the meaning given by paragraph 3 of the Schedule;”; and
(e)after the definition of “medical transport service licensee”, insert —
“ “paediatric critical care service”, in relation to an emergency ambulance service, has the meaning given by paragraph 4 of the Schedule;”.
New regulation 4
3.  In the principal Regulations, after regulation 3, insert —
Specified services
4.  For the purposes of section 9A(1) of the Act, the services set out in the Schedule are specified services for an emergency ambulance service.”.
Amendment of regulation 9
4.  In the principal Regulations, in regulation 9 —
(a)in paragraph (2)(b), before “a crew leader”, insert “subject to paragraph (2A),”;
(b)after paragraph (2), insert —
(2A)  If a licensee wishes to deploy as a crew leader to an approved emergency ambulance or approved medical transport an ambulance doctor who is a conditionally registered medical practitioner, the licensee must, before deploying that ambulance doctor, notify the Singapore Medical Council.”;
(c)after paragraph (3), insert —
(3A)  Where a licensee deploys a conditionally registered medical practitioner mentioned in paragraph (2A) as a crew leader, the licensee must ensure that the conditionally registered medical practitioner —
(a)complies with all conditions and restrictions imposed on his or her registration by the Singapore Medical Council under the Medical Registration Act 1997 in relation to his or her deployment as a crew leader; and
(b)performs the duties and functions of a crew leader under the supervision of an ambulance doctor who is a fully registered medical practitioner and is employed or engaged by the licensee.”; and
(d)in paragraph (8), delete the definitions of “ambulance doctor”, “ambulance nurse”, “ambulance paramedic” and “emergency medical technician”.
New regulations 9A, 9B, 9C and 9D
5.  In the principal Regulations, after regulation 9, insert —
Service crew of adult cardiac critical care service
9A.—(1)  Despite anything in regulation 9(2), this regulation applies to an emergency ambulance service licensee that is approved to provide an adult cardiac critical care service (called in this regulation the applicable EAS licensee).
(2)  An applicable EAS licensee that uses or intends to use extracorporeal membrane oxygenation on any emergency patient in the course of providing the adult cardiac critical care service must ensure that each service crew deployed to an emergency ambulance used to provide the adult cardiac critical care service includes the following members:
(a)a driver who satisfies the requirements in regulation 9(2)(a);
(b)a crew leader who is an ambulance doctor and —
(i)is registered under section 22 of the Medical Registration Act 1997 as a specialist in the branch of cardiothoracic surgery; or
(ii)is granted clinical privileges by an applicable acute hospital service licensee to manage patients who require the use of extracorporeal membrane oxygenation;
(c)a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the adult cardiac critical care service as is acceptable to the Director‑General.
(3)  An applicable EAS licensee that uses or intends to use an intra‑aortic balloon pump on any emergency patient in the course of providing the adult cardiac critical care service must ensure that each service crew deployed to an emergency ambulance used to provide the adult cardiac critical care service includes the following members:
(a)a driver who satisfies the requirements in regulation 9(2)(a);
(b)a crew leader who is an ambulance doctor and —
(i)is registered under section 22 of the Medical Registration Act 1997 as a specialist in the branch of cardiology or cardiothoracic surgery; or
(ii)is granted clinical privileges by an applicable acute hospital service licensee to manage patients who require the use of an intra‑aortic balloon pump;
(c)a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the adult cardiac critical care service as is acceptable to the Director‑General.
(4)  Where a crew leader mentioned in paragraph (2)(b) or (3)(b) is a conditionally registered medical practitioner, the applicable EAS licensee must additionally comply with regulation 9(2A) and (3A).
(5)  In this regulation, “applicable acute hospital service licensee” means either of the following:
(a)the acute hospital service licensee of the acute hospital to which an emergency patient is conveyed, unless sub‑paragraph (b) applies;
(b)where an emergency patient is conveyed from an acute hospital to another acute hospital, the acute hospital service licensee of either acute hospital.
Service crew of adult general critical care service
9B.—(1)  Despite anything in regulation 9(2), this regulation applies to an emergency ambulance service licensee that is approved to provide an adult general critical care service (called in this regulation the applicable EAS licensee).
(2)  An applicable EAS licensee must ensure that each service crew deployed to an emergency ambulance used to provide the adult general critical care service includes the following members:
(a)a driver who satisfies the requirements in regulation 9(2)(a);
(b)a crew leader who is an ambulance doctor and —
(i)is registered under section 22 of the Medical Registration Act 1997 as a specialist in the branch of anaesthesiology, cardiology, cardiothoracic surgery, emergency medicine, general surgery or intensive care medicine;
(ii)holds —
(A)one or more valid certifications in the provision of Fundamental Critical Care Support; or
(B)one or more valid certifications equivalent to the certification specified in sub‑paragraph (A) as is acceptable to the Director‑General;
(iii)has been trained by a medical practitioner registered under section 22 of the Medical Registration Act 1997 in any branch of medicine specified in sub‑paragraph (i); or
(iv)is granted clinical privileges by an applicable acute hospital service licensee to manage patients who require —
(A)the use of a chest tube or mechanical ventilator, as the case may be; or
(B)the administration of any inotrope, sedative or paralytic by continuous intravenous infusion,
as the case may be;
(c)a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the adult general critical care service as is acceptable to the Director‑General.
(3)  Where a crew leader mentioned in paragraph (2)(b) is a conditionally registered medical practitioner, the applicable EAS licensee must additionally comply with regulation 9(2A) and (3A).
(4)  In paragraph (2)(b), “applicable acute hospital service licensee” means either of the following:
(a)the acute hospital service licensee of the acute hospital to which an emergency patient is conveyed, unless sub‑paragraph (b) applies;
(b)where an emergency patient is conveyed from an acute hospital to another acute hospital, the acute hospital service licensee of either acute hospital.
Service crew of paediatric critical care service
9C.—(1)  Despite anything in regulation 9(2), this regulation applies to an emergency ambulance service licensee that is approved to provide a paediatric critical care service (called in this regulation the applicable EAS licensee).
(2)  An applicable EAS licensee must ensure that each service crew deployed to an emergency ambulance used to provide the paediatric critical care service includes the following members:
(a)a driver who satisfies the requirements in regulation 9(2)(a);
(b)a crew leader who is a fully registered medical practitioner or conditionally registered medical practitioner and —
(i)holds a valid practising certificate under the Medical Registration Act 1997;
(ii)holds one or more valid certifications certifying competency in the provision of Advanced Paediatric Life Support; and
(iii)satisfies any of the requirements in paragraph (3);
(c)a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the paediatric critical care service as is acceptable to the Director‑General.
(3)  The requirements mentioned in paragraph (2)(b)(iii) are the following:
(a)the fully registered medical practitioner or conditionally registered medical practitioner mentioned in paragraph (2)(b) (called in this paragraph the applicable medical practitioner) is registered under section 22 of the Medical Registration Act 1997 as a specialist in the branch of anaesthesiology, emergency medicine, neonatology or paediatric intensive care;
(b)the applicable medical practitioner holds —
(i)one or more valid certifications in the provision of Paediatric Fundamental Critical Care Support; or
(ii)one or more valid certifications equivalent to the certification specified in sub‑paragraph (i) as is acceptable to the Director‑General;
(c)the applicable medical practitioner has been trained by a medical practitioner registered under section 22 of the Medical Registration Act 1997 in any branch of medicine specified in sub‑paragraph (a);
(d)the applicable medical practitioner is granted clinical privileges by an applicable acute hospital service licensee to manage patients who require —
(i)the use of extracorporeal membrane oxygenation, an intra‑aortic balloon pump, a chest tube or a mechanical ventilator, as the case may be; or
(ii)the administration of any inotrope, sedative or paralytic by continuous intravenous infusion,
as the case may be.
(4)  Where a crew leader mentioned in paragraph (2)(b) is a conditionally registered medical practitioner, the applicable EAS licensee must additionally comply with regulation 9(2A) and (3A).
(5)  In paragraph (3), “applicable acute hospital service licensee” means either of the following:
(a)the acute hospital service licensee of the acute hospital to which an emergency patient is conveyed, unless sub‑paragraph (b) applies;
(b)where an emergency patient is conveyed from an acute hospital to another acute hospital, the acute hospital service licensee of either acute hospital.
Service crew of isolation service
9D.—(1)  This regulation applies to an emergency ambulance service licensee that is approved to provide an isolation service (called in this regulation the applicable EAS licensee).
(2)  Despite anything in regulation 9(2), the applicable EAS licensee must ensure that each service crew deployed to an emergency ambulance used to provide the isolation service includes the following members:
(a)a driver who satisfies the requirements in regulation 9(2)(a);
(b)a crew leader who satisfies the requirements in regulation 9(2)(b)(i);
(c)a service crew member who is an ambulance doctor, ambulance nurse, ambulance paramedic or emergency medical technician or any other individual with such knowledge or expertise relating to the provision of the isolation service as is acceptable to the Director‑General.
(3)  Where a crew leader mentioned in paragraph (2)(b) is a conditionally registered medical practitioner, the applicable EAS licensee must additionally comply with regulation 9(2A) and (3A).
(4)  Without affecting regulation 9(5), the applicable EAS licensee must ensure that —
(a)each service crew member (other than the driver) deployed to an emergency ambulance used to provide that service undergoes refresher training in the proper and safe handling and use of a portable medical isolation unit at least once a year; and
(b)accurate and complete records of all refresher training mentioned in sub‑paragraph (a) are maintained.”.
Amendment of regulation 15
6.  In the principal Regulations, in regulation 15, after paragraph (5), insert —
(6)  In the case of an emergency ambulance service licensee that is approved to provide a specified service, the written care protocols mentioned in paragraph (2)(a) must additionally include written protocols relating to the following:
(a)the safe and proper provision of the specified service;
(b)the safe and proper handling and operation of any equipment used in the provision of the specified service;
(c)where the provision of the specified service involves the administration of any substance to a patient, the safe and proper handling and administration of the substance.”.
Amendment of regulation 16
7.  In the principal Regulations, in regulation 16 —
(a)in paragraph (1), replace “A licensee” with “Unless paragraph (1A) or (1B) applies, a licensee”;
(b)after paragraph (1), insert —
(1A)  An emergency ambulance service licensee that is approved to provide an adult cardiac critical care service, adult general critical care service or paediatric critical care service must ensure that both of the following persons are positioned next to the emergency patient at all times while he or she is being conveyed, so that those persons can readily monitor the condition of the patient:
(a)the crew leader;
(b)the service crew member mentioned in regulation 9A(2)(c) or (3)(c), 9B(2)(c) or 9C(2)(c), as the case may be.
(1B)  An emergency ambulance service licensee that is approved to provide an isolation service must ensure that both of the following persons are positioned next to the patient at all times while he or she is being conveyed, so that those persons can readily monitor the condition of the patient:
(a)the crew leader;
(b)the service crew member mentioned in regulation 9D(2)(c).”; and
(c)after paragraph (7), insert —
(7A)  Paragraphs (7B) and (7C) apply to an emergency ambulance service licensee (called in this regulation the relevant EAS licensee) that is approved to provide any specified service and that conveys or intends to convey a patient who requires that specified service from an acute hospital (X) to another acute hospital (Y).
(7B)  Unless paragraph (7C) applies, the relevant EAS licensee must, before conveying the patient to Y, ensure that the acute hospital service licensee of Y has agreed to the admission of the patient to Y.
(7C)  Where the relevant EAS licensee knows that the patient has voluntarily discharged himself or herself from the care of the acute hospital service licensee of X, the relevant EAS licensee must, before conveying the patient to Y, inform the acute hospital service licensee of Y that the patient will be conveyed to Y.”.
Amendment of regulation 22
8.  In the principal Regulations, in regulation 22(1), after “16(1)”, insert “, (1A), (1B)”.
New Schedule
9.  In the principal Regulations, after regulation 22, insert —
THE SCHEDULE
Regulations 2 and 4
Specified services for
emergency ambulance service
1.  Adult cardiac critical care service, being the provision of an emergency ambulance service to an emergency patient who is 16 years of age or older, where —
(a)the emergency patient requires continuous clinical intervention or continuous life supportive measures while he or she is being conveyed; and
(b)the provision of the service requires the use of any of the following equipment on the emergency patient:
(i)extracorporeal membrane oxygenation;
(ii)intra‑aortic balloon pump.
2.  Adult general critical care service, being the provision of an emergency ambulance service to an emergency patient who is 16 years of age or older, where —
(a)the emergency patient requires continuous clinical intervention or continuous life supportive measures while he or she is being conveyed; and
(b)either of the following applies:
(i)the provision of the service requires the use of any of the following equipment on the emergency patient:
(A)chest tube;
(B)mechanical ventilator;
(ii)the emergency patient has been administered with, or requires the administration of, any inotrope, sedative or paralytic by continuous intravenous infusion.
3.  Isolation service, being the provision of an emergency ambulance service using a portable medical isolation unit on a patient while the patient is being conveyed in an emergency ambulance, where that patient is assessed to require the use of that equipment by a medical practitioner or a person registered, permitted or otherwise authorised to practise medicine in a foreign country or territory under the law of that country or territory.
4.  Paediatric critical care service, being the provision of an emergency ambulance service to an emergency patient who is below 16 years of age, where —
(a)the emergency patient requires continuous clinical intervention or continuous life supportive measures while he or she is being conveyed; and
(b)either of the following applies:
(i)the provision of the service requires the use of any of the following equipment on the emergency patient:
(A)chest tube;
(B)extracorporeal membrane oxygenation;
(C)intra‑aortic balloon pump;
(D)mechanical ventilator;
(ii)the emergency patient has been administered with, or requires the administration of, any inotrope, sedative or paralytic by continuous intravenous infusion.”.
[G.N. Nos. S 397/2023; S 836/2023; S 382/2024]
Made on 19 December 2024.
LAI WEI LIN
Permanent Secretary
(Policy and Development),
Ministry of Health,
Singapore.
[MOH 78:44/1; AG/LEGIS/SL/122E/2020/13]