D.5 Attachment A Critical Care Transport Capabilities Confirmation.pdf
PDF 116 KB Posted
- Attached to
- V225--Ground Ambulance Services IDIQ SFVAHCS
- Solicitation number
- 36C26325Q0027
About this file
This document is an Attachment A to a federal contract opportunity, titled "Critical Care Transport Capabilities Confirmation." It specifies the requirements for critical care transport (CCT) services, including the types of drugs and equipment that must be available. Prospective offerors must sign and return this form to confirm they can meet these CCT criteria.
The related federal contract opportunity is for a 5-year, single-award IDIQ contract for ground ambulance services for the Sioux Falls, SD VA Health Care System. The solicitation number is 36C26325Q0027, and the estimated value is not provided. The contract is being issued by the Department of Veterans Affairs, Veterans Health Administration, Veterans Integrated Service Network 23.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26325Q0027_1.docx | DOCX document | |
| 36C26325Q0027.pdf | ||
| D.1 36C26325Q0027 line item template.xlsx | XLSX spreadsheet | |
| D.4 VA Business Associate Agreement_NonFederal.pdf | ||
| D.2 Quality Assurance Surveillance Plan.pdf | ||
| D.6 Attachment B Veterans Transportation Service SOP.pdf | ||
| D.3 DOL WD 2015-5369.pdf |
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Text version
Attachment A Critical Care Transport Capabilities Confirmation
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 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 .