Attachment A.docx
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- Solicitation number
- 36C24627R0009
About this file
This is a Critical Care Transport (CCT) and Specialty Care Transport (SCT) Confirmation form for solicitation 36C24627R0009, issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 6 for non-emergent ambulance transport services at the Fayetteville NC VA Coastal Healthcare System VA Medical Center.
The form requires prospective offerors to confirm their capability to provide Critical Care Transport services, including the ability to transport and administer a comprehensive range of medications and operate specialized medical equipment. Required drug supplies include vasopressors (dopamine, dobutamine, norepinephrine), cardiac medications (amiodarone, diltiazem, labetalol), sedatives (lorazepam, midazolam, propofol), antibiotics, blood products, and other critical care pharmaceuticals including TPA (pending). Equipment requirements include portable mechanical ventilators with CPAP capability, chest tubes, central venous pressure lines, Swan-Ganz catheters, ventricular assist devices, and infusion pump systems capable of managing up to six simultaneous IV drips with compatible tubing. The ambulance must be equipped with a Zoll X Series Critical Care Monitor capable of continuous 12-lead EKG monitoring, dual temperature monitoring, automatic blood pressure measurement, capnography, and dual arterial line monitoring. Contractors must sign and return this form confirming their ability to meet all specified criteria for CCTs ordered under the contract.
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36C24627R0009 Attachment A
Specialty Care Transport (SCT) or Critical Care Transport (CCT) 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 .