D.5 Attachment A Critical Care Transport Capabilities Confirmation.pdf
PDF 116 KB Posted
- Attached to
- V225--Ground Ambulance Service CIVAHCS
- Solicitation number
- 36C26325Q0172
About this file
This is a Critical Care Transport Capabilities Confirmation form (Attachment A) that prospective ambulance service providers must sign to confirm they can meet the requirements for Critical Care Transports (CCTs) for the Central Iowa VA Health Care System.
The form details comprehensive requirements for CCT providers, including a drug supply list of 31 medications (ranging from Acetylcysteine to Vasopressin, with TPA pending) and essential equipment requirements such as chest tubes, portable mechanical vents with CPAP, VADs, CVP lines, Swan-Ganz lines, and SmartPump capability for up to 6 IV drips. The provider must also have Zoll X Series Critical Care Monitor capabilities including continuous 12-lead EKG monitoring, 2-temperature monitoring, automatic blood pressure, capnography, and 2 arterial lines monitoring. If the provider's pumps are not compatible with VA-supplied IV tubing, they must provide their own tubing and be able to switch it prior to transport.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| D.1 CI Counties and Zips Codes.pdf | ||
| 36C26325Q0172.pdf | ||
| D.3 DOL WD 15-4999.pdf | ||
| D.6 Attachment B Veterans Transportation Service SOP.pdf | ||
| D.2 Quality Assurance Surveillance Plan.pdf | ||
| D.4 VA Business Associate Agreement_NonFederal.pdf | ||
| 36C26325Q0172_1.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .