J.1. SOW_Emergency Air Ground Transportation_09-16-24 FINAL.pdf

Solicitation No. 75A50224R00022 September 16, 2024

ATTACHMENT J.1

Statement of Work Emergency Air and Ground

Transportation 2024

Background

The Department of Health and Human Services (HHS) Administration for Strategic Preparedness and

Response (ASPR) leads the nation’s medical and public health preparedness for, response to, and recovery from disasters, and other public health emergencies, according to the National Response

Framework and the responsibilities of Emergency Support Function # 8. ASPR, along with its Office of the

National Disaster Medical System (NDMS), collaborates with hospitals, healthcare coalitions, biotech firms, community members, state, local, tribal, and territorial governments, and other partners across the country and the globe to improve readiness and response capabilities.

The Federal Emergency Support Functions (ESFs) identify the specific support activities to be provided by each agency involved in emergency response. The movement of medical evacuees is one of the components of ESF-8, Public Health, and Medical Services, which is managed by the Department of

Health and Human Services (HHS).

The National Disaster Medical System (NDMS) is a partnership between the Department of Health and

Human Services (HHS), the Department of Defense (DOD), the Department of Veterans Affairs (VA), and the Department of Homeland Security (DHS) to provide ESF-8 support during public health emergencies and disaster response.

In the case of a National or International disaster/emergency that requires a mass movement of US citizens, or other US-authorized personnel from various locations, HHS is required to provide air and ground transportation to medical staff, medical patients, non-medical evacuees, their Non-Medical

Attendants (NMAs), family members, associated luggage, essential cargo, basic medical assistance for medical evacuees and their family members, and sometimes transport of self-contained isolation units called the “Box” (described below), within the Continental United States (CONUS), US Territories and

Freely Associated States or from overseas (Outside the Continental US or OCONUS) back to CONUS, or from OCONUS (foreign or domestic) to another OCONUS (foreign or domestic) location, and possibly to a secondary location thereafter within CONUS or OCONUS (foreign or domestic) for medical care or return home.

Project Overview

ASPR is seeking contractors to provide services for air and aeromedical transportation, ground transportation, and movement of medical workers, medical and non-medical evacuees, their Non-Medical

Attendants (NMAs), family members, associated luggage, essential cargo, basic medical assistance, and sometimes transport isolation units called the “Box.” The coverage area for these services shall include

CONUS, OCONUS, US Territories, and Freely Associated States.

The contractor may be tasked with providing medical care and supervision to patients. At the same time, in transit (air and ground), the contractor shall be able to source and manage medical personnel who are qualified to provide medical care to medical patients while in transit.

The contractor shall be able to source and manage a full range of aircraft, from single-passenger air/aeromedical ambulances to the largest aircraft capable of carrying over 400 passengers.

The contractor shall be able to source and manage a full range of ground transportation including charter buses of all sizes, rental vans, and vehicles, ambulances of all types, and other specialty vehicles (which are detailed below).

NDMS directly supports the movement and treatment of highly infectious disease patients on the ground and via the air. The types of patients transported under this contract may include those who have been exposed to a Chemical, Biological, Radiological, or Nuclear (CBRN) event or infectious disease.

Any individuals transported after a CBRN, or infectious disease event will be cleaned and cleared by the

United States Government (USG) for travel before arrangements are authorized.

NDMS is currently working to develop self-contained isolation units to further that requirement.

Contractors on this contract shall participate in training exercises with NDMS and possibly other government entities on the utilization of the isolation system for the transportation of infectious patients to and from one of thirteen (13) treatment facilities located throughout the United States. The contractor shall also provide transportation for the self-contained isolation units as needed. This may require sourcing specialty vehicles such as box trucks, forklifts, cranes, and/or any logistic equipment necessary to move the isolation unit safely.

Wide-body, cargo aircraft that has a rear loading ramp that is or is similar to a C-130/L-100 or C-27 aircraft is required to transport the “Box” by air. The “Box” dimensions are roughly 7.5 ft. tall x 7.5 ft.

wide x 35 ft. long.

TASKS

The contractor shall perform the following Tasks:

TASK 1:

Transportation of Non-Medical Evacuees

The contractor shall provide air and ground transportation services for non-medical evacuees, including all necessary personal baggage, supplies, and cargo.

The Contractor shall provide all ground and air transportation, management, administrative, and technical support, expertise, supervision, labor, and all materials, supplies, and equipment

(except as otherwise specified herein) necessary to plan, schedule, coordinate, and carry out Air and Ground Transportation Support Services.

The Contractor shall perform National and International air and ground transportation services as specified in issued task orders. ASPR has responded to events in austere locations that have incurred major damage and possibly lack basic infrastructure. As a part of this contract, the contractor shall provide air and ground transportation services in austere locations as required.

ASPR has previously deployed teams to Africa in support of the Ebola Medical mission; to Haiti after a major earthquake; and to Puerto Rico following Hurricanes Irma and Maria. In performing this contract, the contractor may be required to transport Non-Medical Evacuees to/from such locations before, during, or after an emergency event.

This task requires the sourcing, utilization, and management of a full range of ground and air transportation. This includes charter buses, rental vans and vehicles and other common commercial vehicles typically utilized for the transportation of people and basic equipment, medical supplies, and non-hazardous cargo as well as single to over-400-passenger aircrafts.

TASK 2

Transportation for Medical (Non-Infectious Disease) Patients

The contractor shall support medical transport missions for non-infectious disease patients. The contractor shall transport medical staff/crew, patients and their families, and essential luggage or cargo.

The Contractor shall provide all air and ground transportation, management, administrative and technical support, expertise, supervision, labor, all materials, supplies, and equipment (except as otherwise specified herein), necessary to plan, schedule, coordinate, and carry out air and ground transportation services.

This task requires the sourcing, utilization, and management of a full range of ground and air transportation. Vehicles shall include charter buses, all types of ambulances, rental vans and vehicles, and other common commercial vehicles typically utilized for the transportation of people, basic equipment, medical supplies, and non-hazardous cargo, and medical patients. For air transport, the contractor shall provide single-seater to up-to-400-passenger aircraft.

The contractor shall not be required to take special precautions such as those that are utilized for the movement of infectious or highly infectious disease patients. ASPR routinely responds to events in austere locations and places that have incurred major damage and possibly lack basic infrastructures. If the contractor is required to perform in austere locations, the contractor shall coordinate with NDMS regarding using HHS equipment or purchasing equipment for the use in these austere locations. If the Contractor is required per a task order to purchase equipment, they will be reimbursed for the purchase. All single item purchases over $5,000 shall be returned to the government upon completion of the IDIQ Task Order.

TASK 3

Transportation for Medical (Infectious Disease) Patients

The contractor shall support the movement of patient(s) who have contracted or have been exposed to infectious diseases. The contractor’s aircrews shall be proficient in the use of

Personal Protective Equipment (PPE), including, but not limited to, the use of N-95 or equivalent masks.

The Contractor shall provide all air and ground transportation, management, administrative and technical support, expertise, supervision, labor, all materials, supplies, and equipment (except as otherwise specified herein), necessary to plan, schedule, coordinate, and carry out air and ground transportation services.

This task requires the sourcing, utilization, and management of a full range of air and ground transportation. Vehicles shall include charter buses, all types of ambulances, rental vans and vehicles, and other common commercial vehicles typically used to transport people and basic equipment, medical supplies, non-hazardous cargo, and medical patients who require intermediate levels of infectious disease care.

Patients transported under this task will be deemed safe to travel under less strict protocols than the highly infectious disease patients who will be contained in the isolation units. Medical personnel and possibly airplane/ground crew will have to take extraordinary precautions, such as the use of hazmat suits and equipment and enhanced cleaning procedures.

TASK 4

Transportation for Medical (Highly Infectious Disease) Patients

HHS is developing a system that will require cargo aircrafts for the air transportation of self-contained isolation units as well as ground transportation such as box-trucks. These units, referred to above as the “Box” in a real-world disaster/event, shall be transported in a cargo aircraft and will carry the patient(s) and medical staff. The “Box” will be self-contained (to include power) but will require a cargo/wide body aircraft. The aircraft sizes will be determined once the

“Box” is built, and how many “Boxes” can fit in an aircraft will be determined. These planes must be configured for both passengers and the “Box”. This task will support the mission of the

National Emerging Special Pathogens Training and Education Center (NETEC) and the Regional

Emerging Special Pathogen Treatment Centers (RESPTCs), of which there are thirteen (13) locations.

The “Box” characteristics:

o Shall not introduce any safety hazard to the aircraft through its design or use (e.g., internal system compatibility that could lead to a fire) o Shall not interfere with any aircraft system (e.g., electrical, avionic, structural, or environmental). However, the system shall have access to external power while onboard the aircraft.

o When utilizing the “Box” system for the transportation of highly infectious patients, the medical staff will come from NDMS—the Contractor is not required to provide medical staff for the highly infectious disease missions in flight.

Additional Requirements per Tasks 1-4:

o The Contractor may be required to provide medical staff and medical care to patients when otherwise directed in the IDIQ Task Order Request when issued.

o The contractor shall perform a decontamination protocol after passengers deplane.

o The transportation of family members, luggage, and necessary cargo may be authorized.

o Transportation of hazardous materials will not be required on this contract, but oxygen tanks may be required.

TASK 5

Highly Infectious Disease Patient Transport Training

The National Emerging Special Pathogens Training and Education Center (NETEC) was founded by

HHS/ASPR and the Centers for Disease Control and Prevention (CDC). The NETEC works closely with the thirteen (13) U.S. Regional Emerging Special Pathogen Treatment Centers (RESPTCs) and others to advance special pathogen readiness.

Each contractor shall receive HHS-sponsored Infectious Disease Transportation Training through the NETEC.

An IDIQ Task Order Request will be developed, and HHS will provide the details of the training mission within it, including the contractor’s role and the requirements for handling the isolation box while being transported by air and ground.

The contractor’s role shall be to provide ground and air transportation. The ground transportation will be for self-contained isolation unit “Boxes” from a ground location to and from the aircraft along with NDMS medical staff for the duration of the ground transportation.

Ground transportation shall be provided from the origin for the “Box” and medical staff. The

“Box” and NDMS medical staff shall be transferred by air transportation provided by the

Contractor to the destination, where ground transportation will be waiting to take the “Box” and medical staff to a designated facility/destination. The origin and destination will be disclosed on each IDIQ Task Order Request. The patient or simulated patient will be in the “Box” and remain in the “Box” for the duration of the transportation for the purpose of HHS exercises.

The contractor shall transport the “Box” by air and then ground to/from one of the Regional

Emerging Special Pathogen Treatment Centers (RESPTCs), of which there are thirteen (13) centers. Listed below are three (3) centers that are part of the National Emerging Special

Pathogens Training and Education Centers (NETEC) partners and thirteen (13) centers that are part of the RESPTCs.

The following link is for the NETEC/RESPTC website, which has detailed information about the program.

https://netec.org/about-netec/partners-regional-contacts/

NETEC Partners o Emory University Hospital o University of Nebraska Medical Center o NYC Health + Hospitals/Bellevue

RESPTC Regional Treatment Centers o Region 1 Massachusetts General Hospital o Region 2 NYC Health + Hospitals/Bellevue https://netec.org/about-netec/partners-regional-contacts/ o Region 3 Johns Hopkins Hospital o Region 3 MedStar Washington Hospital Center o Region 4 University of North Carolina at Chapel Hill o Region 4 Emory University Hospital/Children’s Healthcare of Atlanta o Region 5 University of Minnesota Medical Center o Region 5 Corewell Health System o Region 6 University of Texas Medical Branch o Region 7 University of Nebraska Medical Center/Nebraska Medicine o Region 8 Denver Health and Hospital Authority o Region 9 Cedar Sinai Medical Center o Region 10 Providence Sacred Heart Medical Centers and Children’s Hospital

Project Objective

The aircraft(s) utilized shall be contractor-furnished aircraft, configured to air ambulance standards, when applicable. For performance of this contract, non-traditional large passenger or cargo aircraft may be converted to transport patients. These aircraft may not conform to traditional air ambulance standards, however, the standard of care on non-traditional aircraft shall be the same as that of licensed/certified air ambulances. The required configuration of aircraft(s) will be specified in each IDIQ Task Order Request.

The contractor shall not be entitled to any readiness/warm base fees.

The resulting Indefinite Delivery/Indefinite Quantity (IDIQ) contract (s) will be for services within the

Continental United States, US Territories, and Freely Associated States, or from Outside the Continental

United States (OCONUS) to the Continental United States (CONUS) or from OCONUS to another OCONUS

(foreign or domestic) location for the movement of USG patients, passengers, non-medical attendants, attending family members, medical attendants, medical staff and associated baggage, in some cases the isolation units called the “Box” and cargo.

IDIQ Task Order Request(s) will be issued when an actual event(s) occurs, and requirements are known.

The contractor(s) shall be underway in transporting of passengers, that vary in age and size, within 72 hours of a signed IDIQ Task Order with the maximum number of passengers of at least 1,000 patients with their NMAs, attending family members, medical staff, or evacuees with associated luggage, and/or cargo. This includes transportation of the isolation unit(s) called the “Box”.

The Contractor shall have a scalable aviation and ground capability that can: (1) perform medical evacuation of Patients/Passengers (both infectious and non-infectious); and (2) transport Patients in the isolation units called the “Box” for treatment.

The Contractor and their medical crews shall be credentialed from an accredited source and adhere to the principles and guidelines of the accrediting body such as the Commission on Accreditation of Medical

Transport Systems (CAMTS), the National Accreditation Alliance of Medical Transport Applications

(NAAMTA), Association of Critical Care Transport (ACCT), and/or a foreign accrediting body with equivalent standards.

The Contractor may be issued an IDIQ Task Order Request to coordinate ground ambulance and/or air transportation from origin to destination. Ground ambulances shall be non-HAZMAT (except for oxygen tanks) and comply with OSHA Standards, 1910.120 (Level D), 1910.134 (respiratory protection), and

1910.130 (bloodborne pathogens) or the foreign equivalent if not in the US. Ground transportation with wheelchair lifts shall adhere to 49 CFR Part 37 Transportation Services for Individuals with Disabilities

(ADA) or 49 CFR Part 604 Charter Service or the foreign equivalent if not in the US. Ground transportation (to include buses and vans) without wheelchair lifts may also be required.

Scope of Work

For each IDIQ Task Order that will be issued, the contractor shall provide air and/or ground transportation and pricing for each mission. HHS shall pay the positioning leg miles, the active leg miles, and the depositioning leg miles, if appropriate.

The Contractor shall provide all transportation, personnel, services, equipment, tools, fuel, oil, materials, facilities, supervision, and indirect materials necessary to perform air ambulance services, including enough ground personnel for adequate maintenance and ground operations in accordance with CFR Title

14 Part (located at https://drs.faa.gov/browse/FAR/doctypeDetails).

The aircraft information (tail number, plane type, etc.) and medical crew shall be confirmed for departure within three (3) hours of departure.

There may be catastrophic events that necessitate the modification of aircraft to meet mission requirements. In such instances, the Government will assist the Contractor in gaining the appropriate approvals, waivers, and/or certificates needed to accomplish this on each IDIQ Task Order. Each aircraft configuration will be addressed in each IDIQ Task Order Request.

The contractor may be tasked to transport one or more patients/non-medical attendants (NMAs)

(including their personal baggage) and/or cargo, passengers, or medical staff by filling the aircraft to capacity while performing missions under this contract. To compute aircraft payload, the Contractor shall use the Federal Aviation Administration (FAA) approved weight and balance methods and procedures.

U.S. Department of Health and Human Services, the Department of Defense, or the authorized medical officer from another USG partner agency will provide primary medical direction and control. If Federal medical control and direction is not available, and only as a last resort, the Contractor’s medical liaison shall provide medical control and direction. The contractor shall inform the Contracting Officer

Representative (COR) and Contracting Officer (CO) that medical direction is not available from a cognizant

USG agency prior to providing their own. Once patient care is transferred to the Contractor for air evacuation (whether at the point of origin or earlier in the evacuation process), the patient shall be under the Contractor’s Medical Director’s control and operating in accordance with government policy and procedures as approved under the Contractor’s licensure. The Federal government will provide a manifest either through HHS or DoD systems that will include the medical conditions of patients to be transported.

For air ambulance services, the contractor shall be approved and accredited for services from basic life support up to and including critical care life support that have CAMTS, NAAMTA, ACCT, and/or equivalency from foreign accreditation bodies. These credentials shall be readily available for review by the government upon request. An authorized HHS/ASPR representative will be identified in writing

(email) by the CO and/or COR once the IDIQ Task Order Request has been awarded.

https://drs.faa.gov/browse/FAR/doctypeDetails

It is the Contractor’s responsibility to utilize the appropriate aircraft and route (domestic or international) for the number of patient(s), passengers, and medical attendants who are scheduled to travel for each mission.

Upon receipt of a Request for Task Order Proposal at the Task Order level, the Contractor shall send an email within three (3) hours to EMG.PatientMovement@hhs.gov, the CO, and the COR of available resources and submit a proposal showing they can meet the IDIQ Task Order Request. The Contractor shall provide a daily report (after a Task Order has been issued) no later than 0800 EST or EDT (whichever is applicable). The email shall provide daily status and the location of available resources. Additionally, if air or ground transportation assets are later moved to other location(s) throughout the day, the

Contractor shall immediately send an email notifying Emergency Management Group (EMG) Patient

Movement, the CO, and the COR of the new location and availability.

The Government reserves the right to revise ordering procedures as requirements or ordering processes dictate.

A departure reliability rate of at least 95% must be maintained. The departure reliability rate is the percentage of total “on time” departures of all orders issued against the IDIQ. This rate is tracked by the ordering personnel (HHS/ASPR personnel at the site), who will communicate this information to the COR.

The Contractor is exempt from this reliability rate for situations that are beyond their control, e.g., weather, air traffic control restrictions, etc.

All aircraft must be licensed, operated, and maintained in accordance with all applicable rules and regulations of the FAA and Department of Transportation (DOT) or the appropriate foreign regulations from countries whose Civil Aviation authorities have negotiated a Bilateral Airworthiness Agreement with the FAA. The aircraft performing missions under this contract shall not be considered public aircraft. The contractor shall ensure all aircraft that operate over routes and into airfields specified under both

Instrumental Flight Rules (IFR) and Visual Flight Rules (VFR) conditions and rules have a current FAA authorization certificate or foreign equivalent Certificate. IFR capability authorization is not required for operations into airfields that do not have published IFR approach procedures. Large aircraft that are converted to transport multiple patients may be excluded from these regulations; however, all Critical

Care Transport (CCT) medical crews shall comply with the Scope of Practice Standards defined by the

Association of Critical Care Transport – Critical Care Transport Standards.

In-Transit Visibility (ITV) shall be maintained utilizing TRAC2ES (a DoD Information Technology (IT) system) and JPATS (an HHS IT system) to report status of medical evacuees and their family members, from reception at the origin through arrival at the destination and onward movement to medical care by HHS.

The Contractor shall provide a Project Manager who shall be responsible for all contract work performed under this IDIQ contract and has the authority to obligate the Contractor to the terms and conditions of the contract as well as the IDIQ Task Order Request. The Contractor shall provide the name and contact information for 24-hour contact and notification. There shall be at least one Alternate Project Manager designated by the Contractor and communicated to the Government in the event the Project Manager is unavailable to perform his/her duties. The Government may also request additional personnel and/or teams to support the receiving, triaging, and screening of patients as detailed in the Task Order Request for Proposal.

mailto:EMG.PatientMovement@hhs.gov

Copies of all medical documentation utilized for all services completed under each IDIQ Task Order

Request shall be scanned digitally and emailed to EMG.PatientMovement@hhs.gov, the CO, and the COR no later than 72 hours after the service is completed.

The Contractor shall provide qualified personnel with appropriate credentials to perform all requirements specified in IDIQ Task Order Request(s) awarded under this Contract. All subcontractors shall be with licensed and credentialed (in their State of origin) ambulance provider organizations.

All services performed under task orders placed against this IDIQ shall be submitted on invoices.

Invoices shall contain the following minimum information:

o Name of Supplier o IDIQ Contract Number o IDIQ Task Order Request Number o Contractor’s Unique Entity Identifier (UEI) number o Date of Service Request o Purchase Number o Itemized List of Services Furnished o Quantity, Unit Price, and Extension of each Service o Date Service was Provided

Invoices shall identify the IDIQ Task Order number, aircraft tail number used, date and time of each mission, quantity of actual flown miles, and the number of hours and level for each medical personnel used. Actual flown miles shall be invoiced showing positioning leg miles, live miles (# of patients/medical personnel/passengers onboard), and deposition leg miles (if a round-trip mission). Invoices shall also state the number of ground transportation vehicles for each mission.

NOTE: The Government’s obligation for payments of the positioning leg miles shall be for actual miles flown but shall not exceed the mileage between the Contractor’s primary operations origin location and the patient’s destination. For round-trip missions, the Government’s obligation for payment of depositioning leg miles shall be for actual miles flown, not exceeding the mileage between the patient’s origin and destination and the Contractor’s primary operations location.

Reimbursable expenses (if specified in issued task orders) shall be identified separately, and receipts shall be provided for all Other Direct Cost expenses claimed and submitted with the invoice.

Should the Government cancel a scheduled flight after the Contractor’s aircraft and/or the crew have already departed its home base enroute to the origin, the Government shall reimburse the Contractor actual miles an hour(s) incurred (beginning when the positioning leg miles started and concluding immediately when depositioning leg ends) at the mileage and medical personnel rates set forth in the price list.

Landing/Parking/Airport Fees: In the event the Contractor is directed to land at a civil airport by the

Government, the Contractor will be reimbursed at cost for airport fees assessed by the airport. Airport fees include landing fees, ramp fees, and parking fees and any other fees not mentioned that apply, the

Contractor shall contact the Contracting Officer for approval prior to incurring the cost. The Contractor shall provide copies of paid receipts and the invoices when submitting invoices to HHS.

Any Federal Transportation Taxes (reference Public Law 97-248, Tax Equity and Fiscal Responsibility Act of

1982) that the Contractor is required to pay in the performance of this contract shall be added to the

Contractor’s invoices as a separate line item, and the Government shall reimburse the Contractor for such taxes.

The Contractor shall be reimbursed for food and lodging if required to remain overnight while performing a mission under each IDIQ Task Order. Reimbursement shall be in accordance with the GSA Federal Travel

Regulation. Lodging and food shall not exceed the limits stated in Public Law 99-234 as provided in FAR

31.205- 46(a)(2). Lodging and food arrangements are the Contractor’s responsibility. Lodging and per diem rates for foreign countries shall not exceed the limits stated by the US Department of State in DSSR

925 (https://aoprals.state.gov/web920/per_diem.asp).

An invoice shall be submitted at least monthly or upon expiration of each IDIQ Task Order, whichever occurs first for all services performed during a billing period.

The Contractor shall utilize the department standard platform for the submission of invoices which is currently the Invoice Processing Platform (IPP). IPP is a secure, web-based, centralized program through which federal agencies better manage the invoicing process for goods and services, from purchase orders to payment notification.

Service Delivery Requirements

Performance Objective Performance Threshold

The Contractor shall maintain a reliability rate of at least 95%. 95% of the time, each IDIQ Task Order

The Contractor shall submit electronic copies of all medical documentation to the COR for all services completed under this IDIQ for each Task Order within 72 hours after the completion of the service.

100% of the time, each IDIQ Task Order

Summary invoice for all services performed for each IDIQ Task Order during a billing period, identifying the invoices covered therein, stating their total dollar value, and supported by receipt copies of the invoices.

100%, monthly or at the end of the IDIQ Task Order

Ability to be underway to transport up to 1,000 patients, their NMAs, attending family members, and associated luggage within 72 hours notification of a qualifying event.

100%, within 72 hours of acceptance of IDIQ Task Order

Definitions

• Medical Attendants shall be qualified in their position and staffed according to the patient care needs, as validated by the Government, and could include Emergency Medical Technicians (EMT), Paramedics, Registered Nurses, Advanced Practice Registered Nurses, Respiratory Therapists, Certified Registered Nurse Aestheticians, or Physicians.

https://aoprals.state.gov/web920/per_diem.asp

• Aeromedical Crew Member (ACM). An ACM is a person trained to one of the levels listed below who is a qualified care provider of aerospace medicine. An ACM that is invoiced under patient care shall not serve simultaneously as a required pilot or flight crew member of an air ambulance during aeromedical flight operations. The aircraft becomes a patient care unit specific to the needs of the patient(s).

o Aeromedical Crew Member (ACM Level 1). The ACM Level 1 shall include the knowledge and skills identified by the objectives contained in the EMT-A DOT. Additional training will be accomplished as described in the 1986, DOT “Air Ambulance Guidelines” (Air Ambulance Guidelines, DOT HS 806703 Revised May 1986, U.S. Department of Transportation, National Highway Traffic Safety Administration) which may be obtained from: U.S. Department of Transportation, Distribution Requirements Section, M-443.2, Washington, DC 20590 or the foreign equivalency from countries whose Civil Aviation authorities have negotiated a Bilateral Airworthiness Agreement with FAA.

o Aeromedical Crew Member (ACM Level 2). The ACM Level 2 shall possess all the knowledge and skills required of an ACM Level 1 in addition to the training requirements as is described in the 1986, DOT “Air Ambulance Guidelines” or the foreign equivalency from countries whose Civil Aviation authorities have negotiated a Bilateral Airworthiness Agreement with FAA.

o Aeromedical Crew Member (ACM Level 3). The ACM Level 3 shall possess all the knowledge and skills required of an ACM Level 2 and additional training will be accomplished as described in the 1986, DOT “Air Ambulance Guidelines” or the foreign equivalency from countries whose Civil Aviation authorities have negotiated a Bilateral Airworthiness Agreement with FAA.

o Aeromedical Crew Member (ACM Level 4). The ACM Level 4 shall be a licensed physician with additional aeromedical-oriented educational experience in the following areas: American Heart Association-Advanced Cardiovascular Life Support (AHA-ACLS), Advanced Trauma Life Support (ATLS), altitude physiology, and onboard treatment modalities or the foreign equivalency.

• Air Ambulance Service. An air carrier operating an aircraft used for air transportation that is specifically designed to accommodate the aeromedical needs of persons who are ill, injured, wounded, or otherwise mentally or physically incapacitated or helpless; who may require emergency medical care inflight; and who, in a physician’s opinion, cannot be safely transported on a standard commercial or charter flight.

• Respiratory Therapist. A Respiratory Therapist shall be currently credentialed by the National Board of Respiratory Care and must have at least three (3) years of relevant experience in critical respiratory care with emphasis on ventilators. Must have current AHA-ACLS, American Heart Association- Pediatric Advanced Life Support (AHA-PALS), an Advanced Trauma certification such as Prehospital Trauma Life Support (PHTLS), Cardiopulmonary Resuscitation (CPR) provider certification – or foreign equivalents – and have successfully completed a course in Altitude Physiology, Aircraft Flight Safety, and Communications.

• Certified Emergency Medical Technician (EMT). An EMT may be utilized on ground ambulance moves and may perform a rescue, first aid, resuscitation, and other services to the extent that he/she has been trained and is qualified to perform such services under the provisions of the national standard EMT training curriculum developed by the U.S. Department of Transportation

(DOT) or the foreign equivalency outside of the United States. An EMT must have a current CPR provider certification or the equivalent. The functions authorized above may be performed by the certified EMT under any of the following conditions:

o While he/she is at the scene of a medical emergency where voice contact is established with a physician and under a physician’s order.

o While he/she is at the scene of a life-threatening emergency and under a guideline that has been approved by the local medical authority, until voice communication with the physician is established.

• Critical Care Transport. Medical transport 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 ventilation, multiple monitors, external cardiac support (ventricular assist devices, etc.) 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 or board certification. The scope of Practice for Critical Care Medical Crews will be as defined by the Association of Critical Care Transport – Critical Care Transport Standards or the foreign equivalent.

• Paramedic. A certified paramedic may perform any services to the extent that he/she has been trained and certified to perform under the provisions of the national standard paramedic training curriculum developed by the DOT or the foreign equivalence outside of the US. A certified paramedic may perform the administration of other drugs or procedures for which the certified paramedic has received training, certification, and approval in their state of origin; is recognized, authorized, and approved in the primary state where employed; and which may be considered necessary by the ordering physician. In addition to the primary paramedic certification, the paramedic must also have and maintain currency in: AHA-ACLS, AHA-PALS, an Advanced Trauma certification such as PHTLS, CPR provider certification or the foreign equivalent and, for those paramedics who will be onboard aircraft, have successfully completed additional course work in Altitude Physiology, Aircraft Flight Safety, and Communications or the foreign equivalent. The scope of practice for EMTs and paramedics will follow the National Highway Traffic Safety Administration’s (NHTSA) published “National EMS Scope of Practice Model.” DOT HS 813 151 August 2021 or the foreign equivalency outside the US. The resource can be found at:

https://www.ems.gov/assets/National_EMS_Scope_of_Practice_Model_2019_Change_Notices_1_an d-_2_August_2021.pdf

The functions authorized above may be performed by the certified paramedic under any of the following conditions:

o While he/she is caring for a patient in a participating hospital under the direct supervision of a physician.

o While he/she is at the scene of a medical emergency where voice contact is established with a physician and under physician’s orders.

https://www.ems.gov/assets/National_EMS_Scope_of_Practice_Model_2019_Change_Notices_1_and-_2_August_2021.pdf https://www.ems.gov/assets/National_EMS_Scope_of_Practice_Model_2019_Change_Notices_1_and-_2_August_2021.pdf o While he/she is at the scene of a life-threatening emergency and under a guideline that has been approved by the local medical authority, until voice communication with a physician has been established.

Air Carrier Insurance Requirements

• Prior to performance of any services hereunder, the Contractor shall, at its own expense, procure from a financially and legally responsible insurance company, and maintain for the life of the contract, at least the minimum insurance coverage required by 14 CFR Part 205.4 or the equivalent from countries whose Civil Aviation authorities have negotiated a Bilateral Airworthiness Agreement with the FAA.

• The Contractor shall provide written verification of insurance coverage to the Contracting Officer prior to the contract award. The Contractor shall provide annual proof of insurance from the insurance provider to the CO. In the event of a planned cancellation or material change in policy coverage, thirty (30) days prior written notice shall be given to the CO. In the event of an unplanned cancellation or material change in policy coverage, notice shall be given to the CO as soon as possible.

Renewal of policy shall occur prior to any IDIQ Task Order Request being issued to ensure coverage in the event of misfortune.

• The Contractor shall include in its required insurance policies and endorsement that any cancellation or material change in the coverage which adversely affects the Government’s interests shall not be effective unless the Contractor gives the CO 30 days written notice as required by the IDIQ.

Additional Standards for Aircraft Operations

If applicable, all aircraft must be listed on the air carrier’s certificate, and flight crews must be trained, qualified, and scheduled in accordance with Federal Aviation Regulation (FAR Part 135) rules and other standards cited in this SOW, or, if using foreign resources, from countries whose Civil Aviation authorities have negotiated a Bilateral Airworthiness Agreement with the FAA and have confirmed with the FAA full regulatory compliance and equivalency with the FAA’s existing protocols. Larger aircraft that are converted to transport multiple patients may be exempt from FAR Part 135, however they may be subject to applicable international operations as defined in 14 CFR Parts 45, 47, and 91 or their foreign equivalents. In addition, air carriers shall comply with the following:

Air Operations

• Pilots are responsible for ensuring correct computing and documenting of the weight and balance for flights and for assuring that the gross weight and center of gravity do not exceed the aircraft’s limitations. Actual or interrogated weights must be used. Completed weight and balance forms from flights will be maintained for a minimum of 30 days.

• Contractor aircraft shall have the ability to be satellite tracked or make visible the tail number of the aircraft for commercially available tracking systems such as Flight Aware, but this is not a mandatory requirement.

• Companies are required to maintain the last 30 days documentation for flights to demonstrate compliance with the flight locating requirements of FAR 135.79.

• All fixed-wing missions shall be flown under Instrument Flight Rules (IFR) to the maximum extent possible.

• For Helicopter Operations only, multi-engine helicopters may be used for night aided and instrument flight rules (IFR) operations providing the operator’s certificate specifies such operations. Night operations unaided shall not be conducted.

Aircrew Requirements

• A pilot in command (PIC) and second-in-command (SIC) shall be used:

o For all fixed-wing, whole-plane charters o If the aircraft certificate requires a two-pilot crew or has seating configuration for ten (10) or more passengers o When the aircraft is operated under IFR and required to be operated with PIC/SIC configuration

• PIC and SIC (when required), must have at least 250 hours combined experience in their respective positions in the type of aircraft being operated. Type (as defined in FAR 135.293(b)) means any one of a group of airplanes as determined by the FAA to have a similar means of propulsion, the same manufacturer, and no significantly different handling or flight characteristics. For helicopters, type (as defined in FAR 135.293(b)) means a basic make and model.

o The PIC’s prior SIC time does not count toward the 250-hour requirement o The PIC must have 1,500 hours total pilot time and have logged 100 hours PIC time in the past twelve (12) months o The PIC must have at least ten (10) takeoffs and ten (10) landings, and 50 hours in the type and model aircraft being operated o Floatplane PICs must have at least 250 total hours in floatplane operations

• The Pilot in Command (PIC) and Second-in-Command (SIC) (when required) shall be Instrument Flight Rule (IFR) qualified, i.e., both shall hold a commercial instrument rating for all flights regardless of the weather or type of flight plan filed. (Not required for operations restricted to Visual Flight Rules (VFR) only.)

o Both pilots shall meet the currency requirements of FAR 135.247 or the foreign equivalent o The PIC shall have a current FAR 135.297 instrument proficiency check, and a current FAR Part

135.293 competency check or the foreign equivalent o The SIC shall have a current FAR 135.293 competency check or foreign equivalent to include as a minimum one precision approach, one non-precision approach, and one missed approach. The SIC must meet the instrument currency requirements of FAR 61.57(c) or the foreign equivalent.

▪ If the SIC is assigned to pilot only one type of aircraft, that pilot must meet the instrument requirements of this section in that type of aircraft.

▪ If the SIC is assigned to pilot more than one type of aircraft, that pilot must meet the instrument requirements of this section in each type of aircraft and the check shall alternate between the different types of aircraft that the pilot operates.

Aircraft

• Shall have two (2) or more engines (except for helicopters and floatplanes) o Meet the IFR performance requirements of FAR 135.181 or the foreign equivalent.

o Be turbine powered if more than nine (9) passengers are carried.

• Aircraft shall also meet the following standards o Shall be maintained in a good state of repair and appearance. Aircraft showing deterioration or neglect such as unrepaired cracks, punctures, loose rivets, missing fasteners, deterioration of interior, paint, or windows are unacceptable for use and may indicate the aircraft does not meet airworthiness requirements.

o Have on board, a complete set of aeronautical charts, and approach plates (for each required pilot), covering the area of operation and may be in the form of Electronic Flight Bag if approved by certificate.

o Have a first-aid kit and emergency equipment, accessible to the passengers and appropriate to the environment of operations.

o Have approved overwater flight equipment in accordance with FAR Part 91.205b(12) or the foreign equivalent, and helicopters will have emergency flotation gear (pop-out) or standard floatation gear (fixed floats).

▪ The Contractor shall have and exercise quality control and maintenance programs to ensure safety and shall provide a summary of these plans upon the request of the Government.

o Aircraft operated under a single pilot shall possess the following navigation and communication equipment:

▪ Directional gyro

▪ Artificial horizon

▪ Terrain Awareness and Warning System

▪ Radar Altimeter

▪ Rate of turn indicator

▪ Vertical speed indicator

▪ One type of Federal Aviation Administration (FAA)-approved navigation equipment such as an Automatic Direction Finder (ADF) receiver system, with ADF indicator; Very High Frequency Omnidirectional Range (VOR); Global Positioning System (GPS)/Loran, etc. A GPS shall be available for operations in remote areas where other navigational aids are not available.

▪ An Emergency Locator Transmitter (ELT)

▪ At least one Very High Frequency (VHF) receiver and transmitter o In addition to above, aircraft operated with two (2) pilots shall be equipped for Instrument Flight

Rules (IFR) operations and possess the following navigation and communication equipment.

▪ Two (2) independent navigation systems suitable for the location served, at least one (1) navigation system will include Very High Frequency Omnidirectional Range/ Distance Measuring Equipment (VOR/DME) capability

▪ Dual Very High Frequency (VHF) receivers and transmitters

▪ Capability to perform a precision approach other than a Ground-Controlled Approach (GCA).

▪ A transponder o The SIC position (when required to be filled) must include the following operable equipment:

▪ The ability to manipulate all primary and auxiliary flight controls, lift/drag devices, and landing gear

▪ Airspeed indicator

▪ Altimeter

▪ Artificial horizon

▪ Gyroscopic direction indicator or equivalent

▪ An independent navigation system

Ground Ambulances and Paratransit Seat Operation

The Contractor shall coordinate ground ambulance vehicles for either Continental United States (CONUS) or Outside the Continental United States (OCONUS) transfers from origination to destination, to medical care, or return home. It is anticipated that non-HAZMAT vehicles will be utilized (but could include oxygen tanks), and these vehicles shall comply with The Occupational Safety and Health Administration

(OSHA) Standards, 1910.120 (Level D), 1910.134 (respiratory protection), and 1910.130 (bloodborne pathogens) or the foreign equivalent if not in the US. The Contractor shall comply with the OSHA

Standards or the foreign equivalent in these instances as well. The Contractor shall provide the appropriate resources and staff to care for the patient based on his/her medical condition.

o Type I – Advanced Life Support (ALS) Non-HAZMAT o Type II – Basic Life Support (BLS) Non-HAZMAT o Type III – Bariatric ALS, Non-HAZMAT o Type IV – Critical Care Transport, Non-HAZMAT

Ground Transportation (Vans, Minibuses, Charter Buses)

The Contractor shall coordinate paratransit vehicles for either CONUS or OCONUS (foreign or domestic) transfers from origin to destination. The Contractor shall also transport luggage with patient, non-medical attendants, and associated family members. The Contractor may be required to provide any of the following types of equipment:

o Type I – Sedan/Minivan (1-7 seats) o Type II – Minibus (8-26 seats) o Type III – Transit Bus (>26 seats) o Type IV – Wheelchair Van (1-9 seats with wheelchair lift) o Type V – Americans with Disability Act (ADA) Minibus (10-26 seats with wheelchair lift) o Type VI – ADA Transit Bus (>26 seats with wheelchair lift)

Deliverables/Notices and Reports

Notice of accidents. When a Contractor’s equipment or personnel, in support of an HHS mission, are involved in an accident or incident, the Contractor shall transmit the following information by the most expeditious means available to EMG.PatientMovement@hhs.gov, the CO, and the COR.

o Carrier and trip number o Aircraft type and number/vehicle type for paratransit and license plate/or another identifier o Date and time of the accident o Last point of departure and point of intended landing of the aircraft/ground destination o Nature of the accident and the extent of damage to the aircraft/vehicle so far as it’s known o Total number of crew members and passengers on board o Number of injured and fatalities among the patients and contract personnel o Number of injured and fatalities identified as patient or contract personnel o Number of injured and/or fatalities of ASPR personnel o Condition of baggage or government-owned material, if any, on board

Patient Medical Incidents

The Contractor shall report all medical incidents that occur with any patients while in their care either while the patient is on the ground, in an ambulance or especially when the medical incident occurs in flight, or while passengers are under the control of the aircraft captain on missions performed in support of this IDIQ to the CO and the COR.

Period of Performance

One 12-month base year with four (4) 12-month option years.

Contract Type

The Government may award Firm Fixed Price (FFP), Time-and-Material (T&M), and hybrid FFP/T&M task orders under this IDIQ.