Attachment A - Critical Care Transport Capabilities.docx
DOCX document 19 KB Posted
- Attached to
- V225--Ground Ambulance Service Cheyenne
- Solicitation number
- 36C25925R0038
About this file
This is an attachment detailing Critical Care Transport (CCT) capabilities requirements for ground ambulance services in Cheyenne, WY for the Department of Veterans Affairs Veterans Health Administration. The document outlines the mandatory drug supply list and equipment requirements that ambulance providers must be capable of transporting and utilizing during critical care transports.
The required capabilities include the ability to transport and administer 27 specific medications (including various cardiac drugs, antibiotics, and sedatives) and essential medical equipment such as chest tubes, portable mechanical vents, CPAP devices, and VADs. The provider must have SmartPump capability for up to 6 IV drips and a Zoll X Series Critical Care Monitor with specific monitoring capabilities including continuous 12-lead EKG, dual temperature monitoring, automatic blood pressure, capnography, and dual arterial line monitoring. Providers must sign the form confirming their ability to meet these CCT criteria, including the provision of compatible IV tubing if their pumps are not compatible with VA-supplied tubing.
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Text version
Attachment A
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 | ||
| Diltiazem (Cardizem) | Swan-Ganz line | ||
| Dobutamine | SmartPump Capability: up to 6 IV drips |
Dopamine Fentanyl (Sublimaze) *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. *
Furosemide (Lasix) Heparin Hyperalimentation (TPN and lipids) Insulin Labetalol (Trandate) Lidocaine Lorazepam (Ativan) Magnesium Sulfate Mannitol Midazolam (Versed)Zoll X Series Critical Care Monitor Capabilities:
Continuous 12-lead EKG monitoring 2-Temperature Monitoring Automatic Blood Pressure Capnography 2 arterial lines monitoring
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)
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 .