Performance Work Statement - 2 Nov 2011.pdf

PERFORMANCE WORK STATEMENT

AMBULANCE SERVICES

2 November 2011

1.0 DESCRIPTION OF SERVICES. The Contractor shall provide qualified personnel, equipment, vehicles, supplies and materials (except as listed in Paragraph 3, Government Furnish Property and Services), to provide 24-hour paramedic and emergency ambulance services for patient transport at Robins AFB, GA. The responsibilities include (1) emergency paramedic response and patient transport, (2) in-flight emergency responses, (3) participation in Robins AFB and Military Treatment Facility (MFT) exercises, and (4) third party collections forms (DD Form 2569). Transport services supports approximately 500 calls per year and average between 30 to 50 calls per month.

1.1 EMERGENCY PARAMEDIC RESPONSE AND PATIENT TRANSPORT. The

Contractor shall provide ambulance response to emergencies as requested by Houston County Fire Rescue 911/Robins AFB dispatchers or RAFB Emergency Control Center (ECC). Patients will be transferred to Houston Medical Center, Warner Robins, or if required, to other Central Georgia medical treatment facilities as directed. The contractor shall respond to primary emergencies within (not to exceed) 7 minutes. For secondary back up calls, the contractor shall respond within (not to exceed) 13 minutes when two or more calls occur at the same time. Time begins from notification to the unit to the arrival time on scene. After the completion of the emergency ambulance run, the contractor shall complete and provide a State of Georgia run sheet to the Contracting Officer’s Representative (COR) within seven days of completion of the run.

1.2 In-Flight Emergency Response. The Contractor is responsible for serving as primary medical response to all in-flight emergencies. The contractor shall be notified to respond by the base fire department via the 911 Emergency Medical Systems/ECC. The responding unit will maintain radio contact with Fire Chief at all times while in-transit. Robins AFB will provide the EMS unit on duty a land mobile radio (LMR) with the Fire Chief frequency. The unit shall provide medical advice and guidance to Air Traffic Controllers for relay to endangered inbound aircraft. Falling under the authority of the Fire Chief or On-Scene Commander, the contractor shall follow all directives provided IAW CEMP 10-2.

1.3 Participation in Exercises and Training. The Contractor shall participate in all Robins AFB exercises as participation is a critical component to the successful execution of the MTF mission. The purpose of military exercises is to simulate real world events to prepare the medical community for potential crises or emergencies. The contractors shall prepare for the exercises and participate as if the situation was valid as deemed practicable. Example of exercises might include mid air collision of aircraft or any mass casualty exercises.

The contractor shall provide on scene ambulance coverage for 78 CES Live Pit Fire training, assistance with EMT Refresher courses, Readiness Skills Verification Programs, special events and semi-annual training with Flight Medicine/Field Response Team personnel. Once events are approved by the Government, the COR will send request to the Contractor to provide coverage.

1.4 Third Party Collection Forms (DD Form 2569). The Contractor shall not bill patients or insurance companies for ambulatory services. The 78th Medical Group will perform insurance billing and collection. The Contractor shall ensure complete patient identifying information is collected for all third party billing information (DD Form 2569). Identifying information includes name, SSN, DOB, address, and phone number.

2.0 SERVICES SUMMARY

Performance Objective Ref Para Performance Threshold Respond to emergencies 24 hours, 7 days a week

1.1 Response time from unit notification to

scene shall not exceed 7 minutes for primary call and 13 minutes for secondary or back up response

Accurate preparation of required run sheets

1.1, 3.2 Provided to COR within 7 days of completion of run

3.0 GOVERNMENT FURNISHED PROPERTY AND SERVICES.

3.1 Ambulance Bay. When the ambulance is not on a response, the Government shall provide space located at building 377 (fire station #1) 24 hours a day, 7 days a week for the ambulance crew. This also includes one ambulance bay. The contractor may house at the fire station and use the sleeping quarters. Back-up ambulance crews will also post at Fire Station #1 while assigned to the base. Access code to front entrance for entry after hours will be provided upon award of contract.

3.2 FORMS AND MAPS. The MTF will provide any required Government forms used in the performance of services. The State of Georgia Ambulance Run Sheet will be used to document all responses and patient transports. Also, MTF/Fire Department/ECC shall provide updated maps (Global Information System) to the contractor whenever updated maps become available.

The contractor shall limit copying and/or distribution of these maps due to security purposes.

3.3 COMMUNICATIONS. "Class C" telephones are available for calling local telephone numbers. The MTF will furnish land mobile radios for communication. If additional radios are required, the contractor shall notify the government to provide.

Description Manufactur er Model Serial

Number Acquisitio n Date

Acquisitio n Cost

Handheld 2-Way Radio

Motorola MTS-

466AAA0618 Oct 1985 $3.1K

Handheld 2-Way Radio

Motorola MTS-

466AAA0619 Oct 1985 $3.1K

4.0 GENERAL INFORMATION:

4.1.1 DOCUMENTATION. The Contractor shall ensure complete patient identifying information is on all documentation to be provided to the MTF relating to the transport, including third party billing information (DD Form 2569). The COR shall provide guidance for the contractor to maintain and dispose of those records, files, documents, and work papers if required. All records, files, documents, and related work papers provided by the Government shall remain Government property.

4.1.2 The COR shall conduct, document, track, and analyze contractor performance via regularly scheduled surveillances in accordance with the Quality Assurnace Surveillance Plan (QASP).

The surveillance results shall be maintained as Past Performance Information (PPI) and utilized to submit information into the Contractor Performance Assessment Report System (CPARS).

Surveillance results, along with the contractor’s submittals, and Medical Expense/Personnel Reporting System (MEPRS) will be used to develop metrics to track contractor’s overall compliance with contract terms and conditions.

4.2 SECURITY REQUIREMENTS. The contractor shall obtain base identification passes for each contractor employee requiring access to Robins AFB and the Flightline/Industrial Area.

Prior to driving on the Flightline, the contractor shall ensure all personnel required to operate vehicles on the Flightline are licensed, trained and certified. The contractor is responsible for scheduling the training through 78 OSS/OSAB, 926-2081 or 926-2732, with adequate lead time not to interfere with the contract schedule. Upon completion of the training, an AF Form 483 (Certificate of Competency) will be issued by the Airfield Manager’s office, which certifies that the individual has been trained on Flightline driving. This certification shall be in the possession of the vehicle operator when driving on the Flightline. The contractor may be required to designate a Flightline Driving Program Manager (FDPM) who will provide training and certification to all required contractor personnel. (AFI 13-213, Chapter 4 and RAFBI 13-206)

4.3 PERSONNEL REQUIREMENTS: The Functional Commander/Director has determined all services performed qualify as essential services. During crises, all services will respond and the contractor shall submit a contingency plan addressing the following elements:

Identify provisions fore the acquisition of necessary personnel and resources, if necessary for continuity of operations for up to 30 days or until normal operations resume

Challenges associated with maintaining contractor essential services during an extended event

The time lapse with the initiation of the acquisition of necessary personnel and resources and their actual availability on site

The components, processes and requirements for the identification , training, and preparedness for personnel who are capable of relocating to alternate facilities or performing work from home

Any established alert and notification procedures for mobilizing identified “essential contractor service” personnel

The approach for communicating expectations to contractor employees regarding their roles and responsibilities during a crisis (CDRL A002, Mission Essential Contingency Plan)

4.3.1 CONTRACTOR PERSONNEL: The Contractor shall designate a point of contact, in writing, to the Contracting Officer within two days after contract award. The Contractor shall provide telephone numbers and email address of the POC, who shall have full authority to act on behalf of the Contractor on matters relating to performance. The POC shall be available to meet on the installation with the COR and /or CO to discuss problem area(s). The POC shall be available Mon-Friday 0600-1800.

4.4 CERTIFICATION REQUIREMENTS. The contractor shall provide Emergency Medical Technicians and Paramedics that meets the State of Georgia certification requirements and licensing. In addition, the contractor shall ensure continuing medical education to include current Basic Life Support for Paramedics and Advanced Cardiac Life Support for Paramedics.

4.5 REQUIRED TRAINING. The contractor shall participate in training in conjunction with the Fire Department. This will include flight line training and special training related to flight line response. Newly assigned personnel will receive flightline training within 30 days of date of hire. Certification of current HAZMAT Awareness training is required for all ambulance response personnel. Personnel must complete First Responder Awareness Level and Decompression Sickness Training. The contractor shall provide proof of training within five duty days upon request. Also, the Flight Medicine Flight will provide initial and quarterly refresher training in the use of 100% Oxygen system via Aviator's mask for treatment of Decompression Sickness (DCS). Flight Medicine will provide at least one in- house exercise annually on the use of this system.

Required Training Accomplish By POC Flight line Training Within 30 days of first duty day Flight Medicine

HAZMAT Awareness Training

By award Contractor

First Responder Awareness Level

Provided by contractor by award

Contractor

100% Oxygen via Aviator's Mask for Treatment of DCS

Initial Quarterly Refresher Training

Flight Medicine Flight

Environmental Management Systems (EMS)

Within 30 days of contract start

78 CEG/CEV

4.5.1 ENVIRONMENTAL MANAGEMENT SYSTEM (EMS). Any contractor employee working on Robins Air Force Base will require EMS training. The prime contractor is responsible for ensuring that all subcontractors comply with this requirement within 30 days of contract start. Training will be provided by the 78 Civil Engineering Group Environmental Management Division (78CEG/CEV). Training can be obtained through:

1. Logon with Common Access Card (CAC) to 78 CEG/CEV website and click on EMS Awareness Training, choose option 1.

2. Without a CAC, request a copy of EMS training from 78 CEG/CEV Workflow mailbox.

https://geobase.robins.af.mil/emstraining/EMS_TRAINING_SLIDES/EMS_skin.swf

4.5.2 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.

4.5.3 Safety. Within 30 calendar days after contract award, the contractor shall develop and provide to the COR, a mishap prevention program/safety plan that insures a safe working environment for contractor personnel and provides protection for Government facilities and property. This program shall meet the requirements contained in Appendix C of the contract and all Federal, State, and Local Laws/Orders/Standards. These standards may require that contractor adopt certain practices, means, methods, or processes reasonably necessary and appropriate to protect workers on the job. Contractor shall understand the standards in the Appendix C and eliminate risk of hazards. The program shall be reviewed and accepted by the Government’s Safety Office and the CO. The contractor shall implement and maintain this program to conform to changes in the laws/orders/standards as required. (AFI 91-204 and AFMC Supplement 1, RAFBI 32-2001 and Appendix C) (CDRL A001, Health and Safety Plan)

4.6 PATIENT INFORMATION. Patient information, no matter how developed, shall be treated as privileged information. Contract personnel shall comply with guidelines set forth in the Privacy Act and the Health Insurance Portability Accountability Act. Lists and/or names of patient shall not be disclosed to or revealed in any way for any use outside the MTF without prior written permission by the Chief of Medical Staff and Contracting Office.

4.7 STATUS REPORT. The contractor shall submit a Status Report quarterly with the number of runs accomplished for each month during the quarter and the response time for each run. In addition, the contractor shall provide a complete listing of names and training dates for all paramedics and EMTs assigned.

5.0 APPENDICES

5.1 APPENDIX 1 – Referenced Publications

Publication Number

Name Date Referen ce

CEMP 10-2 Air Force Emergency Management Program Planning & Operations

1 Nov 2010 All

AFI 91-201 Safety Investigations and Reports 24Sep 2008 All

AFI91-201, AFMC

Supplement 1

Explosive Safety Standards 11 Jul 2011 All

RAFBI32-2001 The Fire protection Operations and Fire Prevention Program

3 May 2002 All

AFI 13-213 Radio Communications Phraseology, Discipline and Techniques

1 Jun 2011 Chapter

RAFBI 13-206 CONTROL AND OPERATION OF VEHICLES

ON ROBINS AFB AIRFIELD

28 Mar 2008 All