Attachment A.pdf
PDF 153 KB Posted
- Attached to
- V225--AMBULANCE SERVICE DURHAM VA
- Solicitation number
- 36C24625Q0828
About this file
Attachment A is a Critical Care Transport (CCT) Capabilities Confirmation form for a VA medical center ambulance service contract (Solicitation 36C24625Q0828). The document details the specific drug and equipment requirements for critical care transports, mandating that offerors demonstrate the ability to transport an extensive list of 30+ drugs (including Amiodarone, Dobutamine, Fentanyl, Heparin) and specialized medical equipment (chest tubes, portable mechanical vents, VADs, CVP lines).
The form requires potential ambulance providers to confirm capabilities for Tier III transports, including using a Zoll X Series Critical Care Monitor with continuous 12-lead EKG monitoring and two-temperature monitoring. Providers must also have SmartPump capability for up to 6 IV drips and be prepared to provide their own IV tubing if not compatible with VA-supplied equipment. The document includes a signature section for company representatives to formally attest to meeting these critical care transport capabilities.
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Other files
| File | Type | Posted |
|---|---|---|
| S06 - 36C24625Q0828 0003 Amendment Additional Clarifications.pdf | ||
| 36C24625Q0828 0002.pdf | ||
| S06 - 36C24625Q0828 0001 Question and Answer Amendement.pdf | ||
| Attachment B.pdf | ||
| D1 - WAGE Determination 15-4375.txt | TXT text file | |
| P11 - QASP -DURHAM AMBULANCE SERVICES.docx | DOCX document | |
| S02 - Durham Ambulance 36C24625Q0828 Final.pdf |
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Text version
36C24625Q0828
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) 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)
I hereby confirm that _______________________________ can meet the criterion for Critical Care Transports. (Company Name)
Signature of Company Representative Date
*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
Zoll X Series Critical Care Monitor Capabilities:
Continuous 12-lead EKG monitoring
2-Temperature Monitoring
A ti Bl d P
File details come from the government source that posted it. Updated .