Attachment A - Critical Care Transport Capabilities Confirmation.pdf
PDF 220 KB Posted
- Solicitation number
- 36C25226Q0492
About this file
This is a Critical Care Transport Capabilities Confirmation form that prospective ambulance service providers must complete and sign to demonstrate compliance with contract requirements for Critical Care Transports (CCTs).
Providers must certify their capability to transport patients requiring a comprehensive range of critical care medications and equipment. The drug supply list includes 29 medications spanning cardiac, sedation, vasoactive, antibiotic, and specialty infusion categories, including acetylcysteine, amiodarone, dobutamine, dopamine, fentanyl, heparin, insulin, lidocaine, lorazepam, midazolam, milrinone, nicardipine, nitroglycerin, norepinephrine, propofol, sodium bicarbonate, vasopressin, and TPA (pending). The equipment list requires chest tubes, portable mechanical ventilators with CPAP capability, all ventricular assist devices (VADs), central venous pressure (CVP) lines, and Swan-Ganz lines. Providers must have SmartPump capability supporting up to six intravenous drips simultaneously, with flexibility to provide their own tubing if incompatible with VA-supplied equipment. Additionally, providers must have transport-capable Zoll X Series Critical Care Monitors equipped with continuous 12-lead EKG monitoring, dual temperature monitoring, automatic blood pressure measurement, capnography, and dual arterial line monitoring. The form requires authorized personnel to sign and confirm the vendor meets all specified criteria for CCTs ordered under the contract, with fields for signature, name, and title.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Critical Care Transport Capabilities Confirmation:
If a transport is classified as a Critical Care Transport (CCT) the quoter 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 Diltiazem (Cardizem) Swan-Ganz line Dobutamine SmartPump Capability: up to 6 IV drips Dopamine Fentanyl (Sublimaze) Furosemide (Lasix) Heparin Hyperalimentation (TPN and lipids) Insulin Labetalol (Trandate) Lidocaine Lorazepam (Ativan) Magnesium Sulfate Mannitol Midazolam (Versed) Milrinone (Primacor) 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)
***Vendor can meet these criteria for CCTs ordered under this contract.
Signature:_____________________________
Name:________________________________
Title:_________________________________
*Any pump(s) capable for up to and including 6 infusion lines or IV drips as required by the patient. If the pumps are not compatible with VA supplied IV tubing, the contracted ambulance would need to provide their own tubing and be able to switch the tubing over prior to transport. *
Zoll X Series Critical Care Monitor Capabilities:
Continuous 12-lead EKG monitoring 2-Temperature Monitoring Automatic Blood Pressure Capnography 2 arterial lines monitoring
File details come from the government source that posted it. Updated .