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This document includes a critical care transport capabilities confirmation form and details of a related federal contract opportunity for ambulance services. The critical care transport capabilities confirmation form requires ambulance service providers to confirm they can supply certain drugs, equipment, and monitors as needed to support critical care transports for the Department of Veterans Affairs. The related federal contract opportunity is solicitation number 36C25220Q0044 to provide ambulance services including basic life support, advanced life support, and critical care transports at the Edward J Hines VA Hospital near Chicago, Illinois. The requirement includes vehicles, personnel, management, supplies, and equipment availability 24/7 along with necessary reporting. The contract would be a firm fixed-price ordering agreement for approximately five years. The solicitation is set aside based on priority order for service-disabled veteran-owned small businesses, veteran-owned small businesses, small businesses, and then full and open competition that could include large businesses.

36C25220Q0044 S02 Attachment A CCT Capabilities Confirmation.pdf

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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. able to provide the drug supply and equipment listed below. 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

File details come from the government source that posted it. Updated .