Atch_1_ALS_PWS_22Sep16_Final_Signed.pdf

Sol # FA4801-16-R-0007

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Performance Work Statement (PWS) for

ADVANCE LIFE SUPPORT (ALS)

(Ambulance) SERVICES At

Holloman AFB, NM

22 September 2016

BOBBY G. MIDDLETON, Civ, DAF Date

Contracting Officer Representative (COR)

Service Contract Manager, 49th Medical Operations Squadron

ERIC L. CARTER, MSgt, USAF Date

Subject Matter Expert (SME)

Superintendent, 49th Medical Operations Squadron

BONNIE E. STEVENSON, Lt Col, USAF, NC Date

Functional Commander

Commander, 49th Medical Operations Squadron

PATTI J. REN, Civ, DAF Date

Quality Assurance Program Coordinator (QAPC)

49th Contracting Squadron

SALLY D. ROBERTS, Civ, DAF Date

Contracting Officer (CO)

49th Contracting Squadron

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Table of Contents

Description Page

1.0 SCOPE OF WORK

1.1. Description of Services

1.2. Specific Areas of Responsibility

1.3. Emergency Paramedic Response and Patient Transport

1.4. Response to 911 Emergencies

1.5. Response to In-Flight Emergencies

2.0. SERVICES SUMMARY (SS)

3.0 GOVERNMENT- FURNISHED PROPERTY/SERVICES

3.1. General

3.2. Contractor Space and Equipment

3.3. Government Furnished Property (GFP)

3.4. Forms

3.5. Maps

3.6. Utilities

3.7. Communications

3.8. Specialized Training

4.0. GENERAL INFORMATION

4.1. Quality Control

4.2. Quality Assurance

4.3. Language Requirements

4.4. Contractor Personnel

4.5. Identification of Contractor Personnel

4.6. Certification Requirements

4.7. License/Registration

4.8. Documentation

4.9. Required Training

4.10. Information Assurance Awareness Training and Education

4.11. Health Requirements

4.12. Environmental Protection & Safety

4.13. Records

4.14. Patient Information

4.15. Security Requirements

5.0. APPENDICES

5.1. Workload Estimates

5.2. Acronyms

5.3. Applicable Publications and Forms

5.4. MOU Between The 49 MSG and 49 MDG

5.5. MOU Between The 49th Medical Group and AMR

5.6. AF Form 552, Air Force Patient Care Report

5.7. AFSPC Form 1924, Daily Event Log

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5.8. DD 2569, Third Party Collection Program/Medical Services Account/Other Health Insurance

5.9. MGI 44-12 Ambulance Operations, Patient Transfers & Patient Notifications ..... Separate Document

5.10. MGI 41-18, Ambulance Driver Training Inspection ............................................ Separate Document

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1.0. SCOPE OF WORK. The Contractor shall, except as specified in this Performance Work Statement

(PWS) as Government-furnished property or services, provide all personnel, supervision, and any items/services necessary to provide emergency patient response/transport services at Holloman AFB

(HAFB), New Mexico which includes all associated housing areas and limited surrounding area as defined in this PWS. The Contractor shall perform the requirements in this PWS and shall follow all applicable instructions and directives as identified by this PWS. NOTE: HAFB does not have an

Emergency Room.

1.1. Description of Services. The Contractor shall provide personnel for each shift to perform emergency transport services. Shifts must consist of two (2) Emergency Medical Technicians (EMTs), one (1) of whom must be an Emergency Medical Technician - Paramedic (EMT-P). HAFB shall provide a primary and secondary ambulance (the primary ambulance will be equipped to meet the Advanced

Cardiac Life Support (ACLS) standards for patient transport services). The Contractor shall provide 24-hour coverage, 7 days a week, 365 days a year with no exceptions. The Contractor shall also provide ambulance response to emergencies as requested by dispatch. The response time is not to exceed seven

(7) minutes with 90 percent compliance. Service shall include, but not be limited to:

1.1.1. The transfer and stabilization of patients from HAFB to the Government designated health care organization which is Gerald Champion Regional Medical Center (GCRMC), located 13.6 miles from

HAFB, ensuring the patient receives the appropriate level of care at all times.

1.1.2. The return of any Government equipment used while transporting the patient immediately following the transport.

1.1.3. The restocking of used/expiring supplies. The Contractor will work through the Medical Group

(MDG)-appointed person to order/obtain needed supplies through the Government medical supply system

Defense Medical Logistics Standard Support (DMLSS). Used supplies will be replaced within 1 hour following the transport.

1.1.4. The Contractor will use the Government gas pumps only. Each ambulance has its own electronic gas key which shall be used at the Government gas pumps.

1.1.5. The Contractor will conduct equipment/vehicle function checks at the beginning of each shift to ensure operability. The forms to be used for documentation of these checks are currently available in draft format at the 49 MDG. Notify the Non-Commissioned Officer in Charge (NCOIC) of any vehicle/equipment issues immediately upon identification. If patient care is affected, enter patient safety report (PSR) and include in event of the day log (EOL) and report.

1.2. Specific Areas of Responsibility. The Contractor shall be responsible for specific areas:

1.2.1. Emergency EMT-P and EMT-Basic response and patient transport. (PWS 1.3)

1.2.2. Response to 911 Emergencies. (PWS 1.4)

1.2.3. In-Flight Emergency (IFE) response. The Contractor will contact the on-call Flight Surgeon for all situations listed in the Medical Group Instruction (MDGI) 44-12 (Appendix 5.9). (PWS 1.5)

1.2.4. Participation in HAFB and 49 MDG exercises, as directed by the 49 MDG. Exercises are training opportunities for the advancement of teamwork.

1.2.4.1. HAFB and the 49 MDG have historically had approximately 6-9 exercises per year. Exercises

. Attachment 1 Page 5 of 34 can range from 1 hour to 1 week long and will require ambulance response/support during a portion of these times.

1.2.4.2. The Contractor will respond/support these exercises by providing appropriate simulated medical care based on the scenario input.

1.2.4.3. The Contractor shall cease exercise involvement in the event of a real world emergency (911 call) requiring a medical response.

1.2.5. Ensure completion of third party collection program form (DD Form 2569)

1.2.5.1. The Contractor shall provide each patient involved in the response a DD 2569 for the patient(s) to fill out.

1.2.5.2. The Contractor shall collect the completed DD 2569 from the patient(s).

1.2.5.3. The Contractor shall turn completed DD 2569s in to the 49 MDG Resource Management Office no later than (NLT) the next Government duty day. The Government is responsible for appropriate billing.

1.2.6. Any other events requiring on-site ambulance support. These events may include, but are not limited to: Change of Command ceremonies, on-base sports events, and other activities deemed appropriate by the 49 MDG.

1.3. Emergency Paramedic Response and Patient Transport.

1.3.1. The Contractor shall provide ambulance response to emergencies as requested by HAFB 911 dispatchers and by the HAFB Emergency Control Center (ECC) in accordance with (IAW) MDGI 44-12

(Appendix 5.9).

1.3.2. Patients will be transferred to GCRMC in Alamogordo per recommendation by medical control.

Historical data shows that HAFB transports approximately seventeen (17) patients to GCRMC per month.

(Appendix 5.1)

1.4. Response to 911 Emergencies.

1.4.1. The Contractor shall travel to response sites in a Government-provided medical response vehicle per directions received primarily from the E-911 dispatcher, HAFB Fire/Rescue, or 49th Security Forces

Squadron (49 SFS)/ECC.

1.4.2. If transport is needed to a location outside of Otero County, transportation will be arranged by the

49 MDG staff. Medical Group Instruction, MDGI 44-12 states if transport is "beyond a 60 mile radius from 49 MDG, Chief of Medical Staff (SGH) or MDG Commander (CC) will determine transport team."

1.4.3. Off-base response is limited to 2 miles east of the base and 7 miles west of the base (Appendix 5.1) until the arrival of the county ambulance service. This includes White Sands National Monument, if requested by the Department of Public Safety or Alamogordo West Volunteer Fire Department. All other off-base responses require approval of the 49 MDG CC or Chief of Medical Staff.

1.4.4. In the event the Contractor is unavailable to respond to a 911 call due to another call, HAFB

Fire/Rescue will be first responders and Otero County Emergency Medical Response will be dispatched

. Attachment 1 Page 6 of 34 via 911.

1.4.5. The Contractor shall coordinate in-field care in conformance with the instructions received from the established Medical Director located at GCRMC.

1.4.6. The Contractor shall coordinate patient transport with GCRMC.

1.4.7. The Contractor shall transport patients to GCRMC from HAFB or IAW PWS 1.4.2 & 1.4.3.

1.4.8. The Contractor shall ensure a paramedic remains with the patient(s) until a qualified member of the receiving hospital properly accepts the patient(s).

1.4.9. The Contractor shall provide on-scene ambulance coverage for special ceremonies/events. Special ceremonies may include, but are not limited to, the Air Force anniversary event and large formations of personnel for Commander's Calls.

1.4.10. The Contractor shall furnish patient care reports AF Form 552, Air Force Patient Care Form

(Appendix 5.6) to the Contracting Officer's Representative (COR), as required. Additional reports shall be furnished upon request if available.

1.5. Response to In-Flight Emergencies.

1.5.1. The Contractor is responsible for serving as the primary medical response to all flight line emergencies and IFE on HAFB, 24 hours a day, 7 days a week. The 49 MDG will provide back-up in-flight emergency coverage, during the normal duty day, in the event the Contractor is already engaged in another emergency call/transfer. On weekends and after hours, AMR will provide back-up ambulance response and AMR will be contacted by the Command Post or the Fire Department Dispatch Center

(Appendix 5.5, para 2).

1.5.2. The Contractor will be notified of the need to respond by the base fire department or the 911

Emergency Medical Systems/ECC.

1.5.3. The Contractor shall maintain radio contact with the Fire Chief at all times while in-transit. HAFB will provide an ambulance equipped with a radio that has the Fire Chief frequency.

1.5.4. The Contractor shall contact the on-call Flight Surgeon to provide medical advice and guidance to the air traffic controllers for relay to endangered inbound aircraft.

1.5.5. The Contractor shall fall under the authority of the Fire Chief or On-Scene CC and comply all directions provided by the Fire Chief or On-Scene CC; if both on scene, CC takes precedence over Fire

Chief.

1.5.6. The Contractor shall provide full paramedic care and treatment to patients and provide supplies, services and equipment necessary to maintain the patient's medical needs.

1.5.7. The Contractor shall coordinate IFE care as directed by the on-call Flight Surgeon.

1.5.8. The Contractor shall coordinate IFE patient transport with GCRMC as directed by the on-call

Flight Surgeon.

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1.5.9. The Contractor shall provide on-scene ambulance coverage for 49th Civil Engineer Squadron

(CES) live pit fire training to include weekends and non-duty hours. Live fire pit training is a location on base where the Fire Department trains personnel, using mock buildings/aircraft that are set ablaze. This provides the Fire Department staff with training on actual fires.

1.5.10. The Contractor shall maintain a valid ID on file for all contractor personnel assigned to HAFB.

1.6 Contractor Full-time Equivalent Reporting

1.6.1 The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for Holloman Air Force Base, NM via a secure data collection site. The contractor is required to completely fill in all required data fields at http://www.ecmra.mil.

1.6.2 Reporting inputs will be for the labor executed during the period of performance for each

Government fiscal year (FY), which runs 1 October through 30 September. While inputs may be reported any time during the FY, all data shall be reported no later than 31 October of each calendar year.

Contractors may direct questions to the Contracting Manpower Reporting Application (CMRA) help desk.

1.6.3 Uses and Safeguarding of Information: Information from the secure web site is considered to be proprietary in nature when the contract number and contractor identity are associated with the direct labor hours and direct labor dollars. At no time will any data be released to the public with the contractor name and contract number associated with the data.

1.6.4 User Manuals: Data for Air Force service requirements must be input at the CMRA link. User manuals for government personnel and contractors are available at the CMRA link at http://www.ecmra.mil.

1.7 For Official Use Only (FOUO) The contractor shall comply with DoDM 5200.01-V4/E3, DoD

Information Security Program: Controlled Unclassified Information (CUI), requirements. This manual sets policy and procedures for the disclosure of records to the public and for marking, handling, transmitting, and safeguarding FOUO material.

http://www.ecmra.mil/ http://www.ecmra.mil/

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2.0. SERVICES SUMMARY (SS)

Performance

Objective

PWS

Para

Performance

Threshold

SS-1 Basic Service

Provide 24-hour certified EMT-P and EMT-B personnel for patient stabilization and transport services.

1.1, 1.2.1 100% compliance

SS-2 Ambulance Response

Provide response time to emergencies not to exceed seven

(7) minutes and provide equivalent community standards for on-base response.

1.1.

90% compliance

SS-3 Documentation

Preparation of all required documents as listed in appendices to meet standards of the medical treatment facility (MTF) IAW MDGI 44-12 (Appendix 5.9) including, but not limited to timeliness, legibility, accuracy, content and signature.

4.8 inclusive 100% compliance

SS-4 Certification Requirements/License

Maintain current BLS, ACLS, and National Registry of

Emergency Medical Technicians (NREMT) Paramedic and EMT certification(s) on file for contract personnel.

4.6. – 4.7.

100% compliance

SS-5 Health Requirements/Hepatitis

Ensure physical examinations and required immunizations are current and remain on file for contract personnel.

4.11 – 4.11.2 100% compliance

SS-6 Defense Medical Human Relations System – internet (DMHRSi)

DMHRSi timesheet shall be completed every 2 weeks in compliance with 49 MDG requirements.

4.8.3.

100% compliance

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3.0 GOVERNMENT- FURNISHED PROPERTY/SERVICES.

3.1. General. The Government shall provide the following equipment, supplies and services listed below:

3.2. Contractor Space and Equipment. During normal duty hours 0730-1630, the Contractor will be housed in the 49 MDG, building 15. The Government shall provide the Contractor with a community communication room and private sleeping quarters. Note: The Government reserves the right to change room utilization if necessary.

3.3. Government Furnished Property (GFP). The Contractor is responsible for GFP as identified in

Attachment 4 (also listed below) and shall maintain IAW FAR 52.245-1 and FAR supplements, including

Procedures, Guidance and Information (PGI).

Description of item Plate Number Qty Acquisition Cost Condition

Primary Ambulance

2009 Ford 350 XLT Super Duty (4X4)

VIN # 1FDWF37R29EB09280

09B02456 1 $124,460.00

Good

36,169.7 Odometer

Reading as of September

Alternate Ambulance

2008 Ford 350 XLT Super Duty (4X4)

VIN # 1FDWF37R88EC15361

08B00873 1 $124,460.00

Good

26,830.9 Odometer

Reading as of September

Alternate Ambulance

2006 Ford 350 XLT Super Duty (4X2)

VIN # 1FDWF36P36EB00504

06B00238 1 $117,859.00

Good

33,277 Odometer Reading as of September 2016

3.4. Forms. The MTF will provide any required Government forms (i.e. AF Form 552) used in the performance of services. The MDG O-26 a/b will be used to document all responses and patient transports. The forms used by the Contractor will meet the State of New Mexico standards for ambulatory services.

3.5. Maps. The MTF shall provide base maps to the Contractor. The Government, for security purposes, shall limit copying and distribution by the Contractor of these maps. The Contractor shall abide by those limits.

3.6. Utilities. The Government will provide all potable water, sewer, electricity, heating, ventilation, and air conditioning requirements at the 49 MDG.

3.7. Communications. Two "Class C" telephones are available for calling local telephone numbers from the 49 MDG. Shared work space with access to Government computers will be provided at the 49 MDG.

The Government shall provide Common Access Cards to allow use of Government computers.

3.8. Specialized Training. The 49 MDG will provide initial and semiannual refresher training in the use of the 100 percent oxygen system via Aviator's mask for treatment of Decompression Sickness (DCS).

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4.0. GENERAL INFORMATION.

4.1. Quality Control. The Contractor shall develop and maintain a quality control program to ensure ambulatory services are performed IAW the requirements of this PWS. The SME will ensure the

Contractor's performance captures all of the key requirements of the contractor's Quality Control Plan

(QCP). Quality control checks will be performed and documented at each shift change. The Contractor shall develop a QCP and implement procedures to identify, prevent, and eliminate recurrence of defective services. As a minimum, the Contractor shall develop quality control procedures addressing the areas identified in Section 2, Services Summary and shall specifically address the Contractor's strategy to provide quality service, continual process improvement and correction of deficiencies. The plan shall be submitted to the Contracting Officer for review and acceptance, NLT the pre-performance conference.

4.2. Quality Assurance. The Government shall inspect and evaluate the Contractor's performance to ensure services are received IAW requirements set forth in this PWS. The SME will periodically inspect by watching actual task performance, physically checking an attribute of the completed task, checking a management information report, investigating customer complaints, or otherwise inspecting the task or its result to determine whether or not the performance meets the standards contained in this PWS. The SME will document the results of the surveillance and this documentation will become the official Air Force

(AF) record of the Contractor's performance. The SME shall conduct, document, track, and analyze

Contractor performance via monthly scheduled surveillances. The SME shall serve as the expert authority to assist the COR and supplement in production of documented surveillances. The COR may conduct surveillances at the discretion and direction of the SME. The surveillance results shall be maintained as past performance information and utilized to submit information into the Contractor

Performance Assessment Report System (CPARS). Surveillance results, along with the contractor's submittals and DMHRSi, will be used to develop metrics to track contractor's overall compliance with contract terms and conditions.

4.3. Language Requirements. Contractor personnel must be able to read, write, understand, and fluently speak English. All documentation will be completed in English.

4.4. Contractor Personnel. The Contractor shall provide a primary point of contact (POC) (Contract

Manager) and alternate(s). Alternate(s) shall act as the primary POC when the primary POC is not available. The Contractor's POC shall be designated in writing to the Contracting Officer within two (2) days of contract award. The Contractor shall provide telephone numbers and email address of the

Contract Manager and alternate(s) as these individuals may be contacted at any time during the term of the contract. The Contract Manager and alternate(s) shall have full authority to act for the Contractor on all matters relating to operation of this contract at HAFB. The Contract Manager and alternate(s) shall be available to meet on the installation with Government personnel designated by the Contracting Officer to discuss any issues. A point of contact shall be available Mon through Fri between 0600-1800.

4.5. Identification of Contractor Personnel. Contactor employees shall be easily recognizable as contractor personnel. This shall be accomplished by wearing clothing bearing the name or logo of the company or by wearing appropriate badges, which display the company name as well as the employee's name. The Contractor will determine if any specific uniform must be worn, e.g EMT pants, polo shirt with Contractor logo, etc). Uniforms, if selected, will be provided without cost to the Government.

Further, any uniform worn must be a wash and wear fabric. Contractor personnel shall present a neat and professional appearance.

4.6. Certification Requirements. Contractor shall provide copies of all certification requirements

(initially, yearly, and upon any changes) to the Contracting Office and 49 MDG Credentialing Office.

The following is needed:

. Attachment 1 Page 11 of 34

4.6.1. Current Basic Life Support (BLS) certification and Advanced Cardiac Life Support (ACLS) certification is required of all paramedics and EMTs.

4.6.2. For EMT-P, a valid current unrestricted State of New Mexico paramedic certification. For EMT-

Bs, a valid current unrestricted State of New Mexico EMT-B certification.

4.6.3. Appropriate continuing medical education, driver education certification and training files for each paramedic and EMT.

4.6.4. Contractor personnel must have current certification with the Health Insurance Portability

Accountability Act involving handling of patient information.

4.7. License/Registration. Contractor personnel shall possess a valid unrestricted EMT or EMT-P license to provide paramedic services in New Mexico.

4.7.1. Contractor personnel shall possess a valid New Mexico driver's license with an E endorsement.

4.8. Documentation. The Contractor shall prepare all documentation to meet or exceed established standards of the MTF to include, but not be limited to, timeliness, legibility, accuracy, content and signature.

4.8.1. The Contractor shall ensure complete patient identifying information is on all documentation to be provided to the MTF relating to the transport, including but not limited to third party collection program form (DD Form 2569).

4.8.2. The Contractor shall be required to complete an AF Form 552, Air Force Patient Care Report on each response and forward them to the COR by the next normal duty day. All records, files, documents, and related work papers provided by the Government remain Government property.

4.8.3. The Contractor shall complete and submit DMHRSi timesheets every two (2) weeks IAW established 49 MDG requirements.

4.9. Required Training. Training will be completed during normal duty hours. Contractor is responsible to ensure required training is accomplished.

4.9.1. The Contractor shall be available to conduct or participate in training in conjunction with the Fire

Department as required by HAFB. This will include flight line training and special training related to flight line response MDGI 41-18. (Appendix 5.10)

4.9.2. Newly assigned personnel will begin flight line training, provided by the Government, within 30 days of date of hire.

4.9.2.1 All newly assigned personnel should be complete with flight line training within 90 days of hire.

4.9.3. Certification of current Hazardous Material (HAZMAT) First Responder Awareness Training is required for all ambulance response personnel.

4.9.4. Personnel must complete First Responder Awareness Level and DCS Training. The Contractor is subject to provide proof of training within five (5) duty days upon request.

. Attachment 1 Page 12 of 34

4.9.5. The Contractor shall complete all MTF-specified orientation program(s), initial and annual training requirements, and comply with all MTF policies, procedures, productivity standards and instructions as provided by the MTF leadership. Specific orientation programs include, but are not limited to, MDG newcomer's orientation, flight line orientation and unit specific orientation.

4.9.6. The Contractor shall adhere to any new training requirements as applicable.

4.10. Information Assurance Awareness Training and Education.

4.10.1. The Contractor will complete initial Information Assurance training before being granted access to any Government Information System (network access).

4.10.2. The Contractor will also complete annual Information Assurance refresher training to ensure functional competency related to threats and system vulnerabilities, and protective measures taken to counter such disruptions.

4.10.3. The Government will arrange access to the training, which will be completed at the place of performance during the first two (2) weeks after contract award and annually thereafter.

4.11. Health Requirements.

4.11.1. Contractor personnel providing services under this contract must receive a pre-employment physical examination, tuberculosis (TB) skin testing and immunizations and be cleared by MDG prior to commencement of work, and annually thereafter. These exams, tests and immunizations will not be provided by the Government.

4.11.2. The Contractor shall submit proof of the physical examination, TB test and immunizations within

10 days of commencement of employment.

4.12. Environmental Protection & Safety. The Contractor shall be knowledgeable of, and comply with, all applicable federal, state, and local laws, regulations and requirements regarding environmental protection. In the event environmental laws or regulations change during the term of this contract, the

Contractor is required to comply as such laws come into effect.

4.13. Records. The Contractor shall be responsible for maintaining and distributing all Government required records which are specifically cited in this PWS. The Government has rights to review any

Contractor generated documentation Contractor maintains. The documentation will be provided to the

Government within five (5) days upon request.

4.14. Patient Information.

4.14.1. Patient information, no matter how developed, shall be treated as privileged information.

4.14.2. Contractor personnel must comply with guidelines set forth in the Privacy Act of 1974 and the

Health Insurance Portability Accountability Act.

4.14.3. Lists and/or names of patient(s) shall not be disclosed to or revealed in any manner for any use outside the MTF without prior written permission by the Chief of Medical Staff and the Contracting

Officer.

4.15. Security Requirements.

. Attachment 1 Page 13 of 34

4.15.1. Illegal Aliens. The Contractor shall not hire an illegal alien to work or perform any service on

HAFB. Employees who are not U.S. citizens must possess a current resident alien immigrant status

(green card) or if a non-resident immigrant, must possess a current Employment Authorization Document.

While on HAFB, non-U.S. citizen employees must be able to produce for inspection, the appropriate credentials: either a green card or Employment Authorization Document. Any illegal alien found on the installation shall be immediately detained by the base security forces and barred from the installation.

4.15.2. Foreign National Visitor Approval. The contractor must obtain visitor approval for all employees requiring access to HAFB who are not U.S. citizens. The 49th Mission Support Group (MSG)/CC is the approval authority; the 49 MSG/CC may delegate approval authority to the 49 SFS/CC.

4.15.2.1. The contractor must submit visit approval requests for all foreign national employees through the Contracting Officer to the 49 MSG/CC or 49 SFS/CC (if delegated) using the HAFB Foreign Visit

Request Form (available at the HAFB Welcome Center).

4.15.2.2. Once coordination through the Contracting Officer has been completed, the HAFB Foreign Visit

Request Form shall be forwarded to 49 SFS/S5AV (Welcome Center) for coordination. 49 SFS/S5AV will submit the completed form to the 49 MSG/CC or 49 SFS/CC (if delegated) for approval. The

Contracting Officer listed on the Foreign Visit Request Form will be contacted when a final decision has been made.

4.15.2.3. The Foreign Visit Request Form will be maintained by 49 SFS/S5AV and the Air Force Office of Special Investigation until the visit end date.

4.15.2.4. Employees who are not U.S. citizens will not be allowed to enter the installation until properly approved via the procedures outlined above.

4.15.3. Listing of Employees. The Contractor shall maintain a current listing of employees that require access to HAFB. The list shall include the employee's name, Social Security Number and type of investigation if contract work involves unescorted entry to AF restricted areas or other sensitive areas designated by the Installation CC. The list shall be provided to the Contracting Officer, who in turn will supply to the 49 MDG security managers. An updated listing shall be provided when an employee's status or information changes: i.e., terminated for cause, reassignment, retirement, etc., or when a new employee is added.

4.15.4. Security Training. The Contractor ensures all employees receive initial and recurring security education training from the 49 MDG security manager. Training must be conducted IAW Department of

Defense (DOD) Manual 5200.01, DoD Information Security Program, and AFI 16-1404, Air Force

Information Security Program. Contractor personnel who work in AF controlled/restricted areas must be trained IAW AFI 31-101, Integrated Defense.

4.15.5. Pass and Identification Items. The Contractor shall ensure the pass and identification items required for contract performance are obtained for employees. Upon initial assignment to HAFB, all new contractor employees shall be identified on a HAFB Visit Access Request (VAR). The contractor shall submit a fully completed VAR through 49th Contracting Squadron (CONS)/LGCA to 49 SFS/S5AV NLT seven (7) duty/business days, and for foreign nationals, 14 duty/business days prior to requiring access to

HAFB.

4.15.6. Retrieving Identification Media. The Contractor shall return all identification media and/or visitor passes from employees who depart for any reason before the contract expires; i.e., terminated for cause, . Attachment 1 Page 14 of 34 reassignment, retirement, etc. The contractor will immediately notify the Government (Contracting

Officer and Security Forces) within 24 hours, when unable to retrieve identification media from contract employees.

4.15.7. Security Investigation Requirement. Each potential Contractor employee shall be submitted for a

Tier 1 (T1) background investigation prior to the start of performance. Potential employees will process, through the 49 MDG security manager, a Standard Form (SF) 85, Security Questionnaire for Positions of

Trust upon notification of employment. The 49 MDG security manager will assist the employee in completing the SF 85 and will process all required security documentation pertaining to the investigation request. Upon completion of the SF 85 and required security documentation, the 49 WG/IP Personnel

Security Office will schedule an appointment, through the 49 MDG security manager, to submit the investigation request. No employee shall be allowed to work on HAFB without a "favorable" decision from the Air Force Central Adjudication Facility or "favorable" employment suitability determination by the unit CC. The Contractor may temporarily assign a potential employee pending a "favorable" T1 adjudication or a "favorable" employment suitability determination by the unit CC if the potential employee has submitted all required information to the Government and there is no known disqualifying information.

4.15.8. Traffic Laws. The Contractor and its employees shall comply with base traffic regulations.

Traffic regulations include, but are not limited to:

4.15.8.1. Employees shall wear a seatbelt when operating or riding in any vehicle (Government, Contractor, or private owned) while on the installation.

4.15.8.2. Speed limits on HAFB are 30 MPH unless otherwise posted. Be aware of reduced speed limits and exercise caution when driving in base housing and school zones.

4.15.8.3. All vehicle operators on the installation shall not use cell phones unless the vehicle is safely parked or unless they are using a hands-free device. The wearing of any other portable headphones, earphones or other listening devices (except for hand-free cellular phones) while operating a motor vehicle is prohibited.

4.15.9. Weapons, Firearms, and Ammunition. Employees are prohibited from possessing weapons, firearms, or ammunition on themselves or within Government, Contractor-owned or privately-owned vehicles while on HAFB.

4.15.10. For Official Use Only (FOUO). The contractor shall comply with DODM 5200.01, V4/E3, DOD Information Security Program: Controlled Unclassified Information (CUI), requirements. This manual sets policy and procedures for the disclosure of records to the public and for marking, handling, transmitting, and safeguarding FOUO material.

4.15.11. Reporting Requirements. Contractor personnel shall report to an appropriate authority any information or circumstances of which they are aware may pose a threat to the security of DOD personnel, Contractor personnel, resources, and classified or unclassified defense information.

Employees shall be briefed by their immediate supervisor upon initial on-base assignment.

4.15.12. Physical Security. The Contractor shall be responsible for safeguarding all Government property and controlled forms provided for Contractor use. At the end of each work period, all Government facilities, equipment, and materials shall be secured.

. Attachment 1 Page 15 of 34

4.15.13. Controlled/Restricted Areas. The Contractor shall implement local base procedures for entry to

AF controlled/restricted areas where Contractor personnel will work. An AF Form 2586, Unescorted

Entry Authorization Certificate, must be completed and signed by the 49 MDG security manager before a restricted area badge will be issued. Employees must have a completed and favorable T1 investigation before receiving a restricted area badge. Interim access may be granted IAW AFI 31-501, Personnel

Security Program Management.

4.15.14. Key Control. The Contractor shall establish and implement methods of making sure all keys/combinations issued to the Contractor by the Government are not lost or misplaced and are not used by unauthorized persons. The Contractor shall not duplicate any keys issued by the Government.

4.15.14.1. The Contractor shall immediately report to the COR or SME any occurrences of lost/duplicated keys, compromised lock combinations, or use by unauthorized persons.

4.15.14.2. In the event keys, other than master keys, are lost or duplicated, the Contractor may be required, upon written direction of the contracting officer, to re-key or replace the affected lock or locks without cost to the Government. The Government may, however, at its option, replace the affected lock or locks or perform re-keying and deduct the cost of such from the monthly payment due the Contractor.

In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the

Government and the total cost deducted from the monthly payment due the Contractor.

4.15.14.3. The Contractor shall prohibit the use of keys or combinations, issued by the Government, by any person other than the contractor's employees and the opening of locked areas by contractor employees to permit entrance of persons other than contractor employees engaged in performance of contract work requirements in those areas.

4.15.15. Unclassified Network Access (NIPRNET). When required for contract performance, the

Government will provide access to AF owned, leased, or controlled unclassified information systems or networks. Contractor employees will be held strictly accountable for actions they initiate on the network and will conduct business IAW USAF, Air Combat Command (ACC), and HAFB instructions and policies. The 49 MDG will ensure contractor employees receive Information Assurance training prior to network access. Contractor employees must have a completed and favorable T1 investigation prior to access being granted. Interim access may be granted IAW AFI 31-501, Personnel Security Program

Management.

4.16. Records Management (February 2015). The contractor shall provide accountability and ensure all records and documents generated during the period of this contract are made available to the government at all times. All information may be maintained electronically. All publications and forms will be available for contractor's use through the Holloman Publications Web Site. Any publications or forms that are required for the performance of this contract and are not available electronically are required to be maintained manually.

4.16.1. Freedom of Information ACT (FOIA) and Privacy Act (PA) (July 2015). The contractor shall comply with DOD 5400.7-R, DOD Freedom of Information Act (FOIA) Program and AFI 33-332, Air

Force Privacy and Civil Liberties Program. These regulations set policy and procedures for the disclosure of records to the public and for marking, handling, transmitting, and safeguarding Personally Identifiable

Information (PII) material.

4.16.2. Contractor Records. The contractor shall maintain all government records IAW AFMAN 33-363, Management of Records, paragraph 6.4., Contractor Support, in order to support the COR who is responsible for all lifecycle record management and all duties assigned to the organization's Record

. Attachment 1 Page 16 of 34

Professional (RP) (Tier-1 (T-1)). [AFI 33-360, Publications and Forms Management, Table 1.1 outlines description of the authorities for T-1.]

5.0. APPENDICES.

. Attachment 1 – Appendix 5.1 Page 17 of 34

APPENDIX 5.1

WORKLOAD ESTIMATES

These workload estimates are based off of the past two years (2014 & 2015) of data and reflect what the

49 MDG has responded to.

Paragraph Reference / Description

1.2.1. / Emergency Response Calls

Monthly average

Average response time from call to on-scene arrival ...................................................... 5 minutes

Average time spent on scene ......................................................................................... 15 minutes

1.3.2. / Number of Patients Actually Transferred to GCRMC

Monthly average

Average round trip time for transport to GCRMC ........................................................ 30 minutes

1.2.2. / In-Flight Emergencies

Monthly average ........................................................................................................................ 2-3

Monthly average for in-flight emergencies requiring actual medical care

Average time spent from flight line arrival to release from Fire Chief......................... 20 minutes

1.2.3. / Wing Exercises Requiring Ambulance Support

Yearly Average .......................................................................................................................... 5-7

1.5.9. / Live Pit Fire Training

Yearly average ........................................................................................................................... 4-5

1.4.9. / Special Ceremonies

Yearly average

Average time for special ceremonies ............................................................................... 1-2 hours

1.2.6. / On-Base Events (July celebration, ringside coverage for boxing, marathons, Wing formation runs)

Yearly average ........................................................................................................................... 7-9

Average time of on-base events ....................................................................................... 4-6 hours

1.2.5. / Change of Command Ceremonies

Yearly average

Average time for Change of Command ceremonies ............................................................. 1 hour

The following are workload projections for ambulance response/coverage. The mission of Holloman AFB is scheduled to change and this change will generate a higher demand for ambulance response/coverage.

In-Flight Emergencies

Monthly average ...................................................................................................................... 8-10

Monthly average for in-flight emergencies requiring actual medical care ................................ 4-5

Average time spent from flight line arrival to release from Fire Chief......................... 20 minutes

. Attachment 1 – Appendix 5.2 Page 18 of 34

APPENDIX 5.2 ACRONYMS

ACC Air Combat Command

ACEP American College of Emergency Physicians

ACLS Advanced Cardiac Life Support

ACS American College of Surgeons

AD Active Duty

AED Automated External Defibrillator

AF Air Force

AFI Air Force Instruction

AFMAN Air Force Manual

AFPD Air Force Policy Directive

AFSPC Air Force Space Command

AMA Against Medical Advice

AMBUS Ambulance Bus

AMR American Medical Response

ARE Ambulance Response Element

BLS Basic Life Support

CBT Computer Based Training

CC Commander

CES Civil Engineering Squadron

COBRA Consolidated Omnibus Budget Reconciliation Act

CONS Contracting Squadron

COR Contracting Officer Representative

CPARS Contractor Performance Assessment Report System

DAF Department of the Air Force

DCS Decompression Sickness

DMHRSi Defense Medical Human Relations System - internet

DMLSS Defense Medical Logistics Standard Support

DD Department of Defense Form

DOD Department of Defense

DPS Alamogordo Department of Public Safety

ECC Emergency Control Center

ECS Environmental Control System

EMS Emergency Medical Services

EMT Emergency Medical Technician

EMT-B Emergency Medical Technician - Basic

EMT-P Emergency Medical Technician - Paramedic

EOL Event of the day log

ER Emergency Room

FACC Fire Alarm Communication Center

FES Fire Emergency Services

FMC Flight Medicine Clinic

. Attachment 1 – Appendix 5.2 Page 19 of 34

FOIA Freedom of Information Act

FOUO For Official Use Only

FS Flight Surgeon

GCRMC Gerald Champion Regional Medical Center

GLOC G-induced Loss of Consciousness

HAFB Holloman Air Force Base

HAFBI Holloman Air Force Base Instruction

HAZMAT Hazardous Material

HIS Health Services Inspection

IAW In Accordance With

IFE In-Flight Emergency

LMR Land Mobile Radio

MCC Medical Control Center

MCI Mass-casualty Incident

MDG Medical Group

MDGF Medical Group Form

MDGI Medical Group Instruction

MOD Medical Officer of the Day

MOSC Medical On-scene Commander

MOU Memorandum of Understanding

MSDS Material Safety Data Sheets

MSG Mission Support Group

MTF Medical Treatment Facility

NLT No Later Than

NREMT National Registry of Emergency Medical Technicians

PAS Privacy Act Statement

PSR Patient Safety Report

Pt Patient

PWS Performance Work Statement

QCP Quality Control Plan

SDO Spatial Disorientation

SF Standard Form

SFS Security Forces Squadron

SG Surgeon General

SGH Chief of Medical Staff

SS Services Summary

T1 Tier 1

TB Tuberculosis

TOPA TRICARE Operations and Patient Administration

USAF United States Air Force

VAR Visit Access Request

WBAMC William Beaumont Army Medical Center

WG Wing

. Attachment 1 – Appendix 5.3 Page 20 of 34

APPENDIX 5.3

APPLICABLE PUBLICATIONS AND FORMS

Publications Title

Date (or superseded by current edition)

AFI 16-1404 AF Information Security Program

29 May 2015

Applicable Sections identified by Security Manager

AFPDI 31-101

Security Integrated Defense – U.S. Air Force

(Contractor personnel who work in AF controlled/restricted areas must be trained IAW

AFI 31-101)

28 Oct 2011

Entire Document

DoD Manual 5200.01 DoD Information Security Program

24 Feb 12/Chg 19 Mar 13

Applicable Sections identified by Security Manager

MOU

(attached-Appx 5.4)

Memorandum Of Understanding, Between The

49 MSG and 49 MDG

Oct 2014

Entire Document

MOU

(attached-Appx 5.5)

Memorandum of Understanding between The

49th Medical Group and American Medical

Response Ambulance Service, Inc.

28 DEC 2015

Entire Document

MGI 44-12

(attached-Appx 5.9

Ambulance Operations, Patient Transfers, and

Patient Notifications

15 Mar 2016

Entire Document

MGI 41-18

(attached-Appx 5.10) Ambulance Driver Training/Inspection 7 April 2016

The publications are available at the following website: www.e-publishing.af.mil. The MGIs will also be available in the 49 MDG Library/Catalog; this is a computerized database maintained at the 49 MDG.

Forms Title Date (or superseded by current edition)

AF Form 552

(sample attached-Appx 5.6) Air Force Patient Care Report 20120930

AF Form 1800 Operator's Inspection Guide And Trouble Report 20060901

AFSPC Form 1924

(sample attached-Appx 5.7) Daily Event Log 19940401 (IMT-VI)*

DD Form 2005 Privacy Act Statement Health Care Records Jun 2016

DD Form 2569

(sample attached-Appx 5.8)

Third Party Collection Program/Medical

Services Account/ Other Health Insurance Jul 2013

MDG Form O-26 49th Medical Group Patient Transfer Order 20160101

Forms and other documents, such as the MDG O-26 Form and DD 2005 can be found in the 49 MDG

Library/Catalog.

* http://www.usa-federal-forms.com/pdf-form-fillable-savable-usaf.html http://www.e-publishing.af.mil/ http://www.usa-federal-forms.com/pdf-form-fillable-savable-usaf.html

. Attachment 1 – Appendix 5.4 Page 21 of 34

APPENDIX 5.4

MEMORANDUM OF UNDERSTANDING, BETWEEN THE 49 MSG AND 49 MDG

DATED OCTOBER 2014

. Attachment 1 – Appendix 5.4 Page 22 of 34

. Attachment 1 – Appendix 5.4 Page 23 of 34

. Attachment 1 – Appendix 5.4 Page 24 of 34

. Attachment 1 – Appendix 5.4 Page 25 of 34

. Attachment 1 – Appendix 5.4 Page 26 of 34

Attachment 1 – Appendix 5.5 Page 27 of 34

APPENDIX 5.5

MEMORANDUM OF UNDERSTANDING BETWEEN 49TH MEDICAL GROUP

AND AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE, INC.

Attachment 1 – Appendix 5.5 Page 28 of 34

Attachment 1 – Appendix 5.6 Page 29 of 34

APPENDIX 5.6

AF FORM 552, AIR FORCE PATIENT CARE REPORT

Attachment 1 – Appendix 5.6 Page 30 of 34

Attachment 1 – Appendix 5.7 Page 31 of 34

APPENDIX 5.7

AFSPC FORM 1924, DAILY EVENT LOG

Attachment 1 – Appendix 5.8 Page 32 of 34

APPENDIX 5.8

DD 2569, THIRD PARTY COLLECTION PROGRAM/MEDICAL SERVICES

ACCOUNT/OTHER HEALTH INSURANCE

Attachment 1 – Appendix 5.8 Page 33 of 34

Attachment 1 – Appendix 5.9 & 5.10 Page 34 of 34

APPENDIX 5.9

MGI 44-12, AMBULANCE OPERATIONS, PATIENT TRANSFERS AND PATIENT

NOTIFICATIONS

AMBULANCE DRIVER TRAINING/INVENTORY/INSPECTION

SEE SEPARATE DOCUMENT

APPENDIX 5.10

MGI 41-18, AMBULANCE DRIVER TRAINING/INVENTORY/INSPECTION

SEE SEPARATE DOCUMENT

End PWS