RFI_--_EMS_--_QA.docx

HSFE70-16-I-0026

Questions & Answers

1. Section 1, page 2. Can the “Capabilities” section be modified to read as follows?

FEMA has a need for medically related support services to include but not limited to:

a. Medical Transportation

i. Ground Ambulances – Basic Life Support (BLS)

ii. Ground Ambulances – Advanced Life Support (ALS)

iii. Ground Ambulances – Bariatric ALS

iv. Ground Ambulances – Critical Care Transport (CCT)

v. Paratransit support

vi. Medical Airlift

b. Medical Personnel

i. Emergency Medical Technician (EMT)

ii. Paramedic

iii. Critical Care Paramedic (CCP) or Advanced Practice Paramedic (APP)

iv. Critical Care Clinical Specialist, e.g., Respiratory Therapist, Perfusionist, etc.

v. Critical Care Registered Nurse (CCRN) or Advanced Practice RN

vi. Physician Specialist (M.D. or D.O.)

c. Field Operations Team (FOT)

d. Communication Support Team (CST)

e. Planning and Exercise Support Services

f. Critical Care Transport and Critical Care Fixed Location Support

Answer: Fixed Location Support will likely not be considered, See future solicitation

Rationale:

With the inclusion of Critical Care services, the various levels and types of services should be delineated.

2. Section 1, page 2. This RFI lists four zones (48 states). Will the subsequent solicitation be for two contracts, Zones 1 & 2 combined and Zones 3 & 4 combined, or will it be one solicitation for all four zones combined?

Answer: One solicitation for all four zones.

3. Section 1, page 3 (first paragraph). Can the “full zone requirement” section be modified to read as follows?

A “full zone requirement” shall consist of the following resources:

· 300 medically staffed ground ambulances (a combination of ALS and BLS)

· 25 medically staffed aircraft (combination of fixed-wing and rotary-wing)

· 3,500 paratransit seats (Contractor shall determine which types of paratransit vehicles to be deployed)

· 150 medical support personnel (combination of EMTs, paramedics, and Critical Care Clinicians)

· 1 Operations Support Team (to be determined by scope of task)

· 1 Communications Support Team (to be determined by scope of task)

Optional – This resource would be part of a full zone only if there was a Critical Care component needed with the deployment.

· 5-10 Critical Care Transport Ambulances with a minimum of 2 attendants one of which shall be a Critical Care Clinician

It shall be the sole responsibility of the Contractor to properly staff all deployed resources for safe, effective, and continuous operations. When resources are ordered to respond to an event, it is expected that the Contractor provide enough personnel and assets as necessary to perform the required duties 24 hours a day, seven (7) days a week during the period of performance stipulated in each Task Order.

Answer: See future solicitation

3. Section 1, page 3, Vehicle Identification. Can this section be revised to read as follows?

Vehicle Identification All transportation resources deployed pursuant to this contract shall display FEMA-approved placards with the following characteristics: Identify them as FEMA Federal EMS Ambulance or Paratransit Contractors; Contractor’s identifying logo; distinct unit number issued by Contractor; and type or level of resource/asset. The Contractor may elect to store caches of reserve ambulances. At time of activation, these vehicles will be marked with special placards identifying them as reserve ambulances. FEMA shall require that vehicles and personnel are properly identified as FEMA contract assets.

Answer: See future solicitation

Rationale:

This contract has evolved and is no longer just a “National Ambulance Contract”. It truly involves all aspects of emergency medical services (EMS); therefore, it should more appropriately be called the FEMA Federal EMS Contract.

4. Section 1, page 3 (last paragraph). Can “Reserve Ambulance Cache” be modified as follows?

The Contractor may stockpile caches of reserve ambulances. These ambulances are to be used for Task Order response only and will not be used in non-Task Order daily EMS operations. The Contractor shall ensure that these resources are not part of a state or local Emergency Management Assistance Compact (EMAC). Since it is unknown where these vehicles will be deployed, they will not be required to be registered or licensed by any state department of motor vehicles. They will not be required to be permitted/licensed as an ambulance by any state or local EMS authority since they will not be used for routine EMS response any state or local jurisdiction. All reserve ambulances shall be properly equipped and Fully Mission Capable (FMC) when deployed.

They will be required to display a placard on the vehicle that identifies them as a resource to be used only pursuant to this FEMA contract. If these vehicles do have license plates from the state(s) where the Task Order occurs, they will be allowed to respond pursuant to this contract.

Answer: See future solicitation

Rationale:

It is unreasonable and impractical to have the reserve ambulances fully stocked and mission capable when they are sitting in storage facilities. The medical supplies are temperature-sensitive and they need to be stored in a climate-controlled environment until ready for use or they will deteriorate. The performance standard for the Contractor should be that all ambulances arriving at the check-in site be fully stocked and mission capable when deployed.

5. Page 4, add new paragraph after “Services”. Can a new paragraph called “Utilization of In-State and Contiguous-State Resources” be added to read as follows?

Utilization of In-State and Contiguous-State Resources The Contractor is precluded from utilizing ground ambulance resources from affected state(s) with disaster declarations unless authorized by state EMS authorities. The Contractor is precluded from utilizing ground ambulances from state(s) contiguous to affected state(s) with disaster declarations if the ambulances are part of an Emergency Management Compact (EMAC) agreement between affected state(s) and contiguous state(s). Furthermore, the Contractor shall assure that subcontractor personnel, vehicles or other resources provided are not committed to state and local emergency response plans.

Rationale:

It certainly makes sense that ambulance services that have EMAC agreements have a primary obligation to respond to EMAC request. However, there are ambulance resources in every state that are not part of an EMAC agreement. They are not owned or controlled by the state or EMAC; therefore, they should not be prohibited from responding as a Federal asset under the FEMA contract. Furthermore, in large states such as Texas and California, it may be difficult to meet the 24-hour response time requirement unless uncommitted in-state ambulances are allowed to respond. There have been situations in previous disasters where there were available non-EMAC in-state ambulances that could have responded much faster than out-of-state ambulances but were not allowed because of this restriction.

Answer: See future solicitation

6. Section 1, page 4. Can the section “Critical Care Ambulances” be revised as follows?

Critical Care Services The Contractor shall provide up to 5% of full zone deployment of ALS ambulances outfitted with additional biomedical equipment, drugs and supplies to transport Critical Care patients. Critical Care services are defined as medical services that includes specialized medical interventions such as intravenous infusions including vasopressors, vasoactive compounds, antiarrhythmics, fibrinolytics, tocolytics (anti-contraction medications), and/or and other parenteral pharmaceuticals unique to the patient’s special health care needs or special monitors or procedures such as mechanical ventilations, multiple monitors, or any other specialized device or procedure beyond the DOT/NHTSA minimum standards for Paramedics, certified by the referring physician as unique to the patient’s health care needs, commensurate with the scope of practice of a clinician with specialty care experience or board certification. These Critical Care services may be in the form of Critical Care ambulances and Critical Care fixed location support.

Critical Care ground ambulances are staffed by a minimum of one driver and two medical attendants, one of which must be a certified Critical Care Paramedic, Advanced Care Paramedic, Critical Care RN, Advanced Practice RN or licensed physician (M.D. or D.O.) with specialized training in Critical Care or Emergency Medicine.

Rationale:

Rather than refer to the AAMS standards, perhaps it would be better to simply articulate the current AAMS standards in narrative format. By doing this, the definition remains consistent throughout the term of the contract. If FEMA cites the “AAMS standards”, what happens if the standards change during the term of the contract?

The rationale for removing the sentence “This capability is made available to the state/local entities for no longer than 72 hours” is because AMR is capable of providing this service for greater than 72 hours. There is great expense and logistical efforts to effect a deployment and subsequent demobilization; therefore, to limit the Critical Care deployment to 72 hours would diminish the incentive to provide this service.

Answer: See future solicitation

7. Section 1, Page 4, last paragraph, Medical Airlift Services Transportation. Can this revised to read as follows?

Medical Airlift Services The Contractor shall provide medical airlift services (fixed-wing and rotary-wing) to include aircraft with flight and air medical crew (AMC) capable of providing Critical Care (CC) and Advanced Life Support (ALS) medical supplies and equipment as specified in the Task Order. The Contractor shall provide a recommendation based on the available number of fixed-wing and rotary-wing aircraft by type to FEMA for successful accomplishment of the mission.

Rationale:

It would be an inefficient use of an expensive resource to use air ambulances for BLS transport. None of the air ambulances has only BLS medical attendants. All of them have ALS and/or Critical Care medical attendants.

8. Section 1, Page 4, Para-transit Vehicles. Can the word “para-transit” be changed to “paratransit”?

Rationale:

Throughout the RFI, the term “para-transit” is used. We recommend changing it to “paratransit” (without the hyphen). The Merriam-Webster dictionary spelling of Paratransit. National transportation organizations all spell paratransit without the hyphen. Taxicab, Limousine and Paratransit Association (TLPA), American Public Transportation Association (APTA) all use the term “paratransit”.

Answer: See future solicitation

9. Section 1, Page 5, Medical Personnel Services and Fixed Location Medical Support. Can these two paragraphs be combined into one paragraph and revised to read as follows?

Medical Personnel Services The Contractor shall have the capability of providing a maximum of 150 medical personnel per zone in addition to ground ambulance personnel. These personnel may be assigned as Fixed Location Medical Support personnel and stationed within airheads, triage centers, or other fixed locations. These personnel shall perform all requirements specified in the Task Orders awarded under this IDIQ contract. All personnel assigned to these positions shall possess the appropriate certifications and licenses. These personnel may include:

· Emergency Medical Technician (EMT)

· Paramedic

· Critical Care Clinicians

· Critical Care Paramedic (CCP)

· Advanced Practice Paramedic (APP)

· Critical Care Clinical Specialist, e.g., Respiratory Therapist, Perfusionist, etc.

· Critical Care Registered Nurse (CCRN)

· Advanced Practice Registered Nurse (APRN)

· Certified Nurse Practitioner (CNP)

· Clinical Nurse Specialist (CNS)

· Physician Specialist (M.D. or D.O.)

Rationale:

Now that Critical Care services are being added, it would seem to make sense to include the Critical Care Clinicians as medical personnel. In addition, combining the “Medical Personnel Services” paragraph along with the “Fixed Location Medical Support” paragraph seems logical.

Answer: See future solicitation

10. Section 1, Page 6, first paragraph, Ground Resources - Ambulances. Can this paragraph be modified to read as follows?

The Contractor shall provide ground ambulance vehicles. All Types shall be non-HazMat and comply with OSHA Standards, 1910.120 (Level D), 1910.134 (respiratory protection), and 1910.130 (bloodborne pathogens):

· Type 1 – ALS, Non-HazMat

· Type 2 – BLS, Non-HazMat

· Type 3 – Bariatric ALS, Non

· Type 4 – Critical Care Transport – two medical attendants, one of which must be a certified Critical Care Paramedic, Advanced Care Paramedic, Critical Care RN, or Advanced Practice RN

· Type 5 – Critical Care Transport – two medical attendants, one of which must be a licensed physician (M.D. or D.O.)

Answer: See future solicitation

Rationale:

The FEMA Typed Resource Definitions provide a foundation for describing traditional EMS resources, however they are not applicable in this contract because they do not address bariatric or Critical Care ground ambulance services. Moreover, many of them provide “Interim Guidance” and are not officially final. If they are finalized and officially published after the contract award, the Contractor would be held to a different standard, which is unreasonable. We also removed Med-Evac Bus (≥ 4 litters) from the list of resources because there are relatively few of these resources nationwide, they are not regulated, and they have never been used on any previous deployment.

11. Section 1, Page 6, Paratransit Vehicles. Can this paragraph be modified to read as follows?

Contractor shall provide paratransit vehicles as follows:

· Type 1 – Sedan/Minivan (1-7 seats)

· Type 2 – Full-size van (8-15 seats)

· Type 3 – Minibus (16-25 seats)

· Type 4 – Transit Bus (>25 seats)

· Type 5 – Minivan (1-3 seats with wheelchair lift)

· Type 6 – Full-size van (4-10 seats with wheelchair lift)

· Type 7 – Minibus (11-25 seats with wheelchair lift)

· Type 8 – Transit Bus (>25 seats with wheelchair lift)

Rationale:

In the paratransit industry, there are eight common vehicle types, not six.

Answer: See future solicitation

12. Section 1, Page 6, Air Resources, Fixed-Wing Aircraft. Can this paragraph be modified to read as follows?

Contractor shall provide the following type of fixed-wing air ambulances. All air ambulances will have at least three crewmembers (pilot and two medical attendants).

· Type 1 – Critical Care and ALS, 2 or more litter patients

· Type 2 – Critical Care and ALS, 1 litter patient

· Type 3 – Neonatal specific

Rationale:

We recommend removing the Type III fixed-wing aircraft. Due to CAMTS regulations, all flights operating under a medical flight must fly FAA part 135. The type III fixed-wing Visual Flight Rules (VFR) will not fly under these regulations. We do not know of any FAA 135 Operators that operate their airplanes VFR only. We also recommend removing the Type IV fixed-wing aircraft. It is unlikely that any aircraft would be staffed with only a Basic Life Support (BLS) crew.

Answer: See future solicitation

13. Section 1, Page 6, Rotary-Wing Aircraft. Can this paragraph be modified to read as follows?

Contractor shall provide the following rotary-wing air ambulances. All air ambulances shall have at least three crewmembers (pilot and two medical attendants).

· Type 1 – Critical Care and ALS, 2 or more litter patients, IFR or VFR

· Type 2 – Critical Care and ALS, 1 litter patient, IFR or VFR

· Type 3 – Neonatal Specific, IFR or VFR

Rationale:

Any reference to air ambulances with only one medical attendant should be eliminated because they will likely be transporting critically ill or injured patients that have complex medical conditions that require two attendants.

Answer: See future solicitation