36C25219Q0914-002.docx

DOCX document 15 KB Posted Nov 5, 2019

Attached to: Ambulance Services at the Captain James A. Lovell Health Care Center (FHCC) in North Chicago, IL to include Basic Life Support (BLS), Advanced Life Support (ALS), and Critical Care Transports (CCT).
Solicitation number: 36C25219Q0914
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 12

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36C25219Q0914 S02 Attachment A CCT Capabilities Confirmation.docx

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S06 36C25219Q0914 0005.pdf	PDF	Jun 18, 2020
36C25219Q0914-0004009.docx	DOCX document	Mar 12, 2020
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Critical Care Transport Capabilities Confirmation If a transport is classified as a Critical Care Transport (CCT) the offeror must be capable of transporting the drugs and/or equipment as required by the patient (listed below), up to and including Tier III if necessary, based on the EMS region the ambulance provider is functioning in. Prospective offerors must sign and return this form confirming they can meet these criteria for CCTs ordered under this contract.

Drug Supply List:			Equipment List:
Acetylcysteine (Acetadote, Mucomyst)	Chest tubes
Amiodarone (Cordarone)		Portable mechanical vents; including CPAP
Antibiotics			All VADs
Blood and Blood Products		CVP lines
Diltazem (Cardizem)		Swan-Ganz line
Dobutamine			SmartPump Capability: up to 6 IV drips
Dopamine				*Any pump(s) capable for up to and
Fentanyl (Sublimaze)			including 6 infusion lines or IV drips as
Furosemide (Lasix)			required by the patient. If the pumps are
Heparin					not compatible with VA supplied IV tubing,
Hyperalimentation			the contracted ambulance would need to
(TPN and lipids)				provide their own tubing and be able to
Insulin					switch the tubing over prior to transport.*

Labetalol (Trandate)

Lidocaine		Zoll X Series Critical Care Monitor Capabilities:
Lorazepam (Ativan)	Continuous 12-lead EKG monitoring
Magnesium Sulfate	2-Temperature Monitoring
Mannitol		Automatic Blood Pressure
Midazolam (Versed)	Capnography
Milrinone (Primacor)	2 arterial lines monitoring

Nicardipine (Cardene) Nitroglycerin (NitroStat, Nitro-Dur, Nitro-Bid) Norepinephrine (Levophed) Octreotide (Sandostatin) Ondansetron (Zofran) Pantoprazole (Protonix) Phenylephrine (Neo-Synephrine) Potassium Chloride Propofol Sodium Bicarbonate Vasopressin (Pitressin) TPA* (pending)

I hereby confirm that		can meet the criterion for Critical Care Transports.
	(Company Name)

Signature of company representative Date

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