D.2. Attachment A - Critical Care Transport Capabilities Confirmation.pdf
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- Solicitation number
- 36C24626Q0592
About this file
This document is an Attachment A form that serves as a Critical Care Transport (CCT) Capabilities Confirmation for ambulance providers responding to a federal contract opportunity with the VA.
Prospective offerors must confirm their capability to transport patients requiring critical care at Tier III level, if necessary, based on the EMS region in which they operate. The required capabilities encompass a comprehensive drug supply list including 29 medications such as amiodarone, dobutamine, dopamine, fentanyl, heparin, insulin, propofol, and vasopressin, with TPA listed as pending. On the equipment side, providers must supply chest tubes, portable mechanical ventilators with CPAP capability, all VADs, CVP lines, Swan-Ganz lines, and smart pumps capable of supporting up to six simultaneous IV drips or infusion lines. If the provider's pumps are incompatible with VA-supplied IV tubing, the contractor must provide their own tubing and possess the ability to switch it prior to transport. Additionally, ambulances 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. The form requires a company representative to sign and date the confirmation, affirming that their organization meets all specified criteria for CCTs ordered under the contract.
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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 CVP lines Blood and Blood Products Swan-Ganz line Diltiazem (Cardizem) Smart Pump Dobutamine 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)
*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
I hereby confirm that _______(Company Name)_________________ can meet the criterion for Critical Care Transports.
Signature of Company Representative Date
File details come from the government source that posted it. Updated .