Attachment D-2 Critical Care Transport Capabilities Confirmation.docx
DOCX document 19 KB Posted
- Solicitation number
- 36C25624R0018
About this file
This document is an attachment confirming critical care transport capabilities required for a ground ambulance and patient transportation services contract with the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. The attachment lists drugs, equipment, monitor capabilities, and infusion pump requirements that any offeror providing critical care transports under the contract must be able to supply. These include various medications, chest tubes, ventilators, central venous pressure lines, transvenous pacemakers, and a Zoll X Series critical care monitor capable of continuous 12-lead EKG monitoring and two-temperature monitoring with automatic blood pressure and capnography for two arterial lines. Offerors must sign and return the form to confirm they can meet these criteria for critical care transports ordered under the contract.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25624R0018 Amendment 0002.pdf | ||
| 36C25624R0018 Solicitation Questions Answers and Changes thru Amendment 0002.xlsx | XLSX spreadsheet | |
| 36C25624R0018_Solicitation_Updated via Amendment 0001.docx | DOCX document | |
| 36C25624R0018 Amendment 0001.pdf | ||
| 36C25624R0018 Solicitation Questions Answers and Changes.xlsx | XLSX spreadsheet | |
| Attachment D-3 Business Associate Agreement.docx | DOCX document | |
| Attachment D-4 Wage Determinations.pdf | ||
| 36C25624R0018_Solicitation_HOU_Ambulance.docx | DOCX document | |
| Attachment D-1 Performance Work Statement HOU.docx | DOCX document |
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Text version
Attachment D.2
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 .