Attachment A.pdf
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- Solicitation number
- 36C24625R0044_1
About this file
Attachment A is a Critical Care Transport (CCT) Capabilities Confirmation document for a VA ambulance services contract (Solicitation Number 36C24625Q0828). The document details the comprehensive drug and equipment requirements for Critical Care Transports, specifically requiring offerors to demonstrate capability to transport an extensive list of 31 different drugs and multiple medical equipment types, including chest tubes, portable mechanical vents, VADs, CVP lines, and Swan-Ganz lines.
The form mandates that ambulance providers must be capable of supporting transports up to Tier III, with specific technical capabilities including a Zoll X Series Critical Care Monitor that provides continuous 12-lead EKG monitoring and 2-temperature monitoring. Vendors must be able to manage up to 6 IV drips simultaneously and confirm their capability by signing the attached certification form. The document is part of a VA contract for ambulance services, specifically for the Fayetteville VAMC, requiring urgent and non-emergent stretcher transport services with varying levels of life support capabilities.
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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
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