36C25220Q0313-002.docx
DOCX document Posted
- Attached to
- V225--Non-emergent ambulance services for the Clement J. Zablocki VA Medical Center in Milwaukee, WI.
- Solicitation number
- 36C25220Q0313
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36C25220Q0313 S02 Attachment A CCT Capabilities Confirmation.docx
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25220Q0313-0001000.docx | DOCX document | |
| 36C25220Q0313-001.docx | DOCX document | |
| 36C25220Q0313-005.pdf | ||
| 36C25220Q0313-003.pdf | ||
| 36C25220Q0313-004.pdf | ||
| 36C25220Q0313-006.pdf | ||
| 36C25220Q0313-007.pdf |
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Text version
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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