Attachment A.pdf
PDF 147 KB Posted
- Solicitation number
- 36C24625R0055
About this file
This document is an Attachment A form for Specialty Care Transport (SCT) or Critical Care Transport (CCT) Confirmation for solicitation 36C24625R0055. The form requires offerors to confirm their capability to perform critical care transports, including the ability to transport a comprehensive list of 31 specific drugs and handle advanced medical equipment such as chest tubes, portable mechanical vents, VADs, and CVP lines.
The document outlines specific technical requirements for ambulance providers, including SmartPump capability for up to 6 IV drips, Zoll X Series Critical Care Monitor capabilities (continuous 12-lead EKG monitoring, 2-temperature monitoring, automatic blood pressure, capnography, and 2 arterial line monitoring). Potential contractors must sign and return this form confirming they can meet all criteria for Critical Care Transports, with the capability to handle Tier III transport requirements based on the EMS region where the ambulance is operating.
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Other files
| File | Type | Posted |
|---|---|---|
| S06 - 36C24625R0055 0001.pdf | ||
| P11 - QASP - NON EMERGENT FAYETTEVILLE NC AMBULANCE SERVICES.docx | DOCX document | |
| P02 - WD 15-4377 REV 29 7-8-2025.txt | TXT text file | |
| S02 -36C24625R0055 Fayetteville Non Emergent Ambulance Tranport Services .pdf | ||
| Attachment B.pdf |
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Text version
36C24625R0055
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)
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 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 .