PWS_Ambulance Services_20Jun24.pdf

Attachment 1, PWS Page 1 of 21

Solicitation # FA480124R0004 Contract # TBD

Performance Work Statement (PWS) for

ADVANCE LIFE SUPPORT (ALS)

(Ambulance) SERVICES at Holloman AFB, NM 20 June 2024

DAVID S. OH, Capt, USAF, MSC Date Contracting Officer’s Representative (COR) Medical Logistics Flight Commander, 49th Healthcare Operations Squadron

LYNNE M. BUSSIE, Col, USAF, MSC Date Functional Commander Commander, 49th Medical Group

PATTI J. REN, Civ, DAF Date Quality Assurance Program Coordinator (QAPC) 49th Contracting Squadron

CALLIE SPENCER, Civ, DAF Date Contracting Officer (CO) 49th Contracting Squadron

OH.DAVID.S S.1460302516 Digitally signed by OH.DAVID.S S.1460302516 Date: 2024.06.20 15:10:19 -06'00'

BUSSIE.LYNNE.M.1060075170 Digitally signed by BUSSIE.LYNNE.M.1060075170 Date: 2024.06.20 15:41:51 -06'00'

REN.PATTI.J.1083572775 Digitally signed by REN.PATTI.J.1083572775 Date: 2024.06.21 10:56:00 -06'00'

SPENCER.CALLIE.MARIE.150120

Digitally signed by

SPENCER.CALLIE.MARIE.1501206950

Date: 2024.06.21 11:42:37 -06'00'

20-Jun-202

20-Jun-202

21-Jun-202

21-Jun-202

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. SERVICE SUMMARY (SS)

3.0 GOVERNMENT- FURNISHED PROPERTY/SERVICES

3.1. General

3.6. Utilities

3.7. Communications

3.8. Specialized Training

3.9. Control Procedures

4.0. GENERAL INFORMATION

4.1. Continuation of Mission Essential Services

4.2. Quality Control

4.3. Quality Assurance

4.4. Language Requirements

4.5. Contractor Personnel

4.6. Identification of Contractor Personnel

4.7. Certification Requirements

4.8. License/Registration

4.9. Documentation

4.10. Required Training

4.11. Information Assurance Awareness Training and Education

4.12. Health Requirements

4.13. Environmental Protection & Safety

4.14. Records

4.15. Patient Information

4.16. Security Requirements

4.17. Records Management IAW AFI 33-164, Records Disposition

4.18. Certificate of Insurance (COI)

5.0. APPENDICES

5.1. Workload Estimates

5.2. Acronyms

5.3. Applicable Publications and Forms

5.4. MOU Between 49 MSG and 49 MDG .................................................................................... Separate Document

5.5. MOU Between 49 MDG and AMR .......................................................................................... Separate Document

5.6. AF Form 552, Air Force Patient Care Report .......................................................................... Separate Document

5.7. AFSPC Form 1924, Daily Event Log ...................................................................................... Separate Document

5.8. DD 2569, Third Party Collection Program/Medical Services Account ................................... Separate Document

5.9. MGI 48-1 Aircraft Mishap, In-Flight, and Ground Emergency Response .............................. Separate Document

5.10. Air Force Ambulance Services Minimum Training Standards ............................................. Separate Document

5.11. Joint Prehospital Emergency Care Protocols ........................................................................ Separate Document

5.12. Intubation Currency MFR ..................................................................................................... Separate Document

Attachment 1, PWS Page 1 of 21

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 twelve

(12) 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 Christus Health®, 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 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.

1.1.4. The Contractor shall make themselves available to meet during business hours for one hour once a week. Additionally, shall respond to inquiries or other communication requests made during business hours within 24 hours or faster for urgent concerns.

1.1.5. The Contractor will conduct equipment/vehicle function checks at the beginning of each shift to ensure operability. The forms used for documentation are generated by the 49 MDG and will be stored by 49 MDG Primary Care Flight, for a minimum of 3 years to provide proper verification during inspections. Notify the Primary Care Flight Chief COR 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 (FS) for all situations listed in the Medical Group Instruction (MDGI) 48-1 (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, PWS Page 2 of 21 can range from 1 hour to 1 weeklong 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 located on AF Form 2569.

1.2.5.1. The Contractor shall provide each patient involved in the response AF Form 2569 (page 4 “Billing Information”) for the patient(s) to fill out.

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

1.2.5.3. The Contractor shall turn completed AF Form 2569 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 special events requiring on-site ambulance support. These events may include but are not limited to: Change of Command Ceremonies, Base Sporting Events, Annual HAFB Marathon, Air Shows, Community-Involved Wing Events, and other activities deemed appropriate by the 49 MDG.

1.2.6.1. For the following events, the Contractor shall provide additional personnel for each shift to perform emergency transport services. For these special events, the additional personnel must consist of two (2) EMTs, one (1) of whom must be an EMT-P. HAFB shall provide a primary and secondary ambulance (the primary ambulance will be equipped to meet the ACLS standards for patient transport services).

1.2.6.2. Support for these events range between 1-24 hours (Air Shows generally consist of 2 days of 12-hour shifts).

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 48-1 (Appendix 5.9).

1.3.2. Patients will be transferred to Christus Health® in Alamogordo per recommendation by medical control. Historical data shows that HAFB transports approximately seventeen (17) patients to Christus Health® per month. (Appendix 5.1)

1.4.2. If transport is needed to a location outside of Otero County, transportation will be arranged by the 49 MDG staff. MDGI 48-1 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."

Attachment 1, PWS Page 3 of 21

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 American Medical Response Ambulance Service Inc. (AMR) will be dispatched 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 Christus Health®.

1.4.6. The Contractor shall coordinate patient transport with Christus Health®.

1.4.7. The Contractor shall transport patients to Christus Health® 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, Change of Command Ceremonies, Base Sporting Events, Annual HAFB Marathon, Air Shows, Community-Involved Wing Events, and other activities deemed appropriate by the 49 MDG.

1.4.9.1. For the following events, the Contractor shall provide additional personnel for each shift to perform emergency transport services. For these special events, the additional personnel must consist of two (2) EMTs, one (1) of whom must be an EMT-P. HAFB shall provide a primary and secondary ambulance (the primary ambulance will be equipped to meet the ACLS standards for patient transport services).

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’s on HAFB, 24-hours, 7 days a week, 365 days a year. 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.

Attachment 1, PWS Page 4 of 21

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 FS 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 FS.

1.5.8. The Contractor shall receive initial and annual competency training on the following checklists and IFE responses: Laser Eye Injuries, Decompression Illness, Smoke and Fume Exposure, Hydrazine Exposure, Aircrew Disorientation, Hypoxia, G-Induced Loss of Consciousness (G-LOC) and Loss of Cabin Pressure at >18,000 feet. This competency training will be conducted by qualified personnel in the Flight Operational Medicine or Aerospace Medicine Flight. All training must be documented initially and annually on an AF Form 1098 and will be kept in the contractor’s Competency Assessment Folder (CAF) for verification of completed training.

1.5.9. The Contractor shall coordinate IFE patient transport with Christus Health® as directed by the on-call FS.

1.5.10. 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 conducted at a designated location on base. During this training, the Fire Department will set fire to mock buildings and aircraft to maintain currency in skills regarding the extinguishing of live fire.

1.5.11. The Contractor shall maintain a valid ID on file for all contractor personnel assigned to HAFB. A copy of the member’s ID, credentials, and certifications must be stored in the member’s CAF folder that resides with the 49 MDG.

Attachment 1, PWS Page 5 of 21

2.0. SERVICE SUMMARY (SS)

Performance Objective

PWS

Para

Performance Threshold

SS-1 Basic Service Provide 24-hour coverage, 7 days a week, 365 days a year, with no exceptions of a certified EMT-P, plus Emergency Medical Technician-Intermediate (EMT-I) and/or EMT- Basic 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 twelve (12) 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 48-1 (Appendix 5.9) including, but not limited to timeliness, legibility, accuracy, content and signature & Government Furnished Property Control Procedures (See Section 3 of PWS)

4.8. inclusive

100%

SS-4 Certification Requirements/License Maintain current Basic Life Support (BLS), ACLS, and National Registry of Emergency Medical Technicians (NREMT) Paramedic and EMT certification(s) on file for contract personnel. ACLS is not required for EMT- Basics.

4.6. – 4.7.

100%

SS-5 Health Requirements/Hepatitis Ensure physical examinations and required immunizations are current and remain on file for contract personnel.

Contractor will need to provide proof during in-processing of all mandated vaccinations or will be required to receive them in a timely manner per the 49 MDG’s public health policy and mandates. If the contractor opts not to get vaccinated per the MDG’s employee healthcare policy, they will not be allowed to work under the 49 MDG and base operations.

4.11. – 4.11.2. 100%

Solicitation # FA480124R0004

3.0 GOVERNMENT- FURNISHED PROPERTY/SERVICES.

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

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

$124,460.00

Good 49,756 Odometer Reading as of February 2024

Alternate Ambulance 2008 Ford 350 XLT Super Duty (4X4)

VIN # 1FDUF4HT3JEC82026

18B01087

$124,460.00

15,827 Odometer Reading as of February 2024

Alternate Ambulance 2006 Ford 350 XLT Super Duty (4X2)

VIN # 1FDUF4HT7LED62609

20B00482

$117,859.00

7522 Odometer Reading as of February 2024

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 workspace 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 annual refresher training in the use of the 100 percent oxygen system via Aviator's mask for treatment of Decompression Sickness (DCS).

This will be documented in the Contractor’s CAF folder and formal training will be conducted by a

Attachment 1, PWS Page 7 of 21 qualified member of the Aerospace Medical Flight.

3.9. Control Procedures. The service provider shall maintain an accountability system of all GFP. The service provider shall sign a receipt for all property provided by the government and shall immediately report items, in writing, missing or in non-working order to the COR. Such receipt is indicated through a submitted report from the service provider that includes inventory and missing items or non-working property to the COR on a semiannual basis IAW with the Semiannual Report Contract Data Requirements List (CDRL) (See PWS 4.8.4) or at the request of the government.

Attachment 1, PWS Page 8 of 21

4.0. GENERAL INFORMATION.

4.1. Continuation of Mission Essential Services. IAW Defense Federal Acquisition Regulation Supplement (DFFARS) 252.237-7023 policy, it is determined that Advanced Life Support services in PWS Section 1 are essential for Contractor performance during a crisis situation. Contractor shall submit its Mission-Essential Contractor Services Plan (MECSP) within 7 days after award.

4.2. 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 COR 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, Service 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 CO for review and acceptance, NLT 7 days after award.

4.3. 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 COR 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 COR will document the results of the surveillance and this documentation will become official Air Force (AF) record of the Contractor's performance. The COR shall conduct, document, track, and analyze Contractor performance via monthly scheduled surveillances. Monthly Surveillance Reports must include an accurate accounting of hours worked per the Contractor, specific performance element ratings, and any additional comments regarding the Contractor’s provision of care. The Contractor shall provide a copy of the monthly schedule of EMT shifts to the COR NLT 3 days before the month. 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 will be used to develop metrics to track the Contractor's overall compliance with contract terms and conditions.

Documentation is required to record, evaluate, and report Contractor performance. On a monthly basis, the COR will complete a narrative summary of the ALS Contractor’s performance utilizing SPM SmartForm (COR Status Report) located in SPM. The COR will brief COR Management on the results of the surveillance. This information is a toll to provide the Government with a snapshot view of the Contractor’s performance and when applicable, provide information for compiling the annual CPARS.

Upon completion, the monthly COR Status Report is approved by the CO and kept in the SPM online file.

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

4.5. Contractor Personnel. The Contractor shall provide a primary point of contact (POC) (Contract(/Project) 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 CO 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 CO to discuss any issues. A point of contact shall be available Monday through Friday between 0600-1800.

Attachment 1, PWS Page 9 of 21

4.6. 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 additional cost to the Government. Further, any uniform worn must be a wash and wear fabric. Contractor personnel shall present a neat and professional appearance at all times.

4.7. Certification Requirements. Contractor shall provide copies of all certification requirements (initially, yearly, and upon any changes) to the COR and for placement in their CAF folders. The 49 MDG Credentialing Manager does not track these requirements. That responsibility falls on the 49 Education and Training Flight and COR. The following is needed:

4.7.1. Current BLS certification and ACLS certification is required of all paramedics and EMT-I. It is highly recommended paramedics also obtain Pediatric Advanced Life Support (PALS) certification.

EMT-Basics are only required to maintain a BLS certification. It is highly recommended EMT-Basics obtain their ACLS certification within one year of employment. NOTE: BLS/CPR is an annual requirement. The 49 MDG may provide recurring BLS/CPR training under Red Cross on a space available basis at no cost to the contractor. The contractor also has the option to complete the course on their own time at no additional cost to the Government.

4.7.2. For EMT-P, a valid current unrestricted State of New Mexico paramedic certification. For EMT- Basics, a valid current unrestricted State of New Mexico EMT-Basic certification. For EMT-Is, a valid current unrestricted State of New Mexico EMT-I certification.

4.7.3. Appropriate continuing medical education, training documents, and driver education certifications (Emergency Vehicle Operator Course (EVOC), Coaching the Emergency Vehicle Operator Course (CEVO) or a bare minimum of a Class “E” New Mexico Driver’s License).

4.7.4. Contractor personnel must have current certification with the Health Insurance Portability Accountability Act involving handling of patient information.

4.8. License/Registration. Contractor personnel shall possess a valid unrestricted EMT-Basic, EMT-I, or EMT-P license to provide paramedic services in New Mexico, respective to the minimum requirements listed within this PWS.

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

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

4.9.1. 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).

4.9.2. 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 and will be stored in a secure location in the 49 MDG.

4.9.3. The Contractor shall submit Government Furnished Property Inventory Reports IAW the Semiannual CDRL. (Attachment 5, CDRL)

Attachment 1, PWS

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

4.10.1. 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 48-1. (Appendix 5.9)

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

4.10.2.1 All newly assigned personnel should be complete with flight line training within 180 days of hire. In order to receive certification to drive on the flight line, contractor must undergo training as established by the Airfield Management Element. Contractors must test and receive a passing score in order to receive certification. Flight line training and testing will be arranged by a qualified person in the Flight Operational Medical Clinic or Aerospace Medicine Flight.

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

4.10.4. Contractors are required to test and maintain certification on the USAF Emergency Medical Service (EMS) Protocols. Testing will be proctored by qualified personnel from the 49 MDG Education and Training Element. Contractor must strictly adhere to the USAF EMS Protocols for provision of care at all times.

4.10.5. It is required by the Air Force State Office of Emergency Medical Services for all Paramedics to conduct four live intubations annually to maintain currency and credentialling to perform Endotracheal Intubation within the Air Force EMS System, IAW Appendix 5.11. The training for the live intubations will be provided and facilitated through or by 49 MDG. However, some training events will be conducted in El Paso or Christus Health® and will (add up) to 12 hours per EMT-P, not including travel.

Any travel and associated time shall be covered and incorporated within the contract at no additional cost to the government. Contractors shall provide proof of currency through verifiable off-duty employment or through any other personally procured training source with qualified preceptors. The Contractor shall maintain currency on this certification on an annual basis, with no exceptions.

4.10.6. 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.

4.10.7. 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.

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

4.11. Information Assurance Awareness Training and Education.

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

4.11.2. The Contractor shall 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.

Attachment 1, PWS

4.11.3. The Government shall 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.

4.12. Health Requirements.

4.12.1. Contractor personnel providing services under this contract shall 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.

4.12.2. The Contractor shall submit proof of the physical examination, TB test and immunizations within 10 days of commencement of employment.

4.13. 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.

4.14. 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.

4.15. Patient Information.

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

4.15.2. Contractor personnel shall comply with guidelines set forth in the Privacy Act of 1974 and the

Health Insurance Portability Accountability Act.

4.15.3. 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 CO.

4.16. Security Requirements. Project is unclassified, access to classified information not required.

4.16.1. 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 can only be persons possessing 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 credential: 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.

4.16.2. Foreign National Employees. The Contractor must obtain foreign national visitor approval for all employees requiring access to HAFB who are not U.S. citizens. The 49 Mission Support Group (MSG)/CC is the approval authority; the 49 MSG/CC may delegate approval authority to the 49

SFS/CC.

Contract # TBD

Attachment 1, PWS Page 12 of 21 shall be forwarded to 49 SFS/S5AV for coordination. 49 SFS/S5AV will submit the completed form to the 49 MSG/CC or 49 SFS/CC (if delegated) for approval. The CO listed on the Foreign Visit Request Form will be contacted when a final decision has been made.

4.16.2.3 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.

4.16.2.4 Employees who are not U.S. citizens will not be allowed to enter the installation until properly approved via the procedures outlined above in 1.6.2. through 1.6.2.2.

4.16.3. 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 Air Force (AF) restricted areas or other sensitive areas designated by the installation commander. The list shall be provided to the CO and sponsoring agency security assistant. An updated listing shall be provided when an employee's status or information changes (e.g. terminated for cause, reassignment, retirement, etc.) or when a new employee is added.

4.16.4. Security Training. The sponsoring unit will provide contractor personnel with initial and annual security training as outlined in DoDM 5200.01 V3 AFMAN 16-1404, V3, Enclosure 5. The Contractor shall provide initial and follow-on training to contractor personnel who work in AF controlled/restricted areas. Air Force restricted areas and controlled areas are explained in AFI 31-101, Integrated Defense.

4.16.5. Pass and Identification Items. The Contractor shall ensure the pass and identification items required for contract performance are obtained for employees. Employees shall only be granted access to the installation to perform functions directly related to their respective contract.

4.16.5.1 All contractor employees requiring access to HAFB shall be identified on a HAFB Visit Access Request (VAR) form. The Contractor shall submit a completed VAR through the CO to 49 SFS Pass and Registration (49 SFS/S5AV) NLT 7 duty/business days, and for foreign nationals, 14 duty/business days, prior to requiring access to the installation.

4.16.6. Retrieving Identification Media. The Contractor shall return all identification media from employees who depart for any reason before the contract expires; e.g., terminated for cause, reassignment, retirement, etc. The Contractor will notify the Government within 24 hours when unable to retrieve identification media from contract employees.

4.16.7. Travel Restrictions: Contractors are prohibited in areas of the installation other than their appropriate place of work and the routes to and from installation entry/exit points.

4.16.8.2 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.

4.16.8.3 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.

Attachment 1, PWS Page 13 of 21

4.16.9. Weapons, Firearms, and Ammunition. Employees are prohibited from possessing weapons, firearms, or ammunition on themselves or within military, contractor, or privately owned vehicles while on HAFB.

4.16.10. Controlled Unclassified Information (CUI). The Contractor shall comply with DoDI 5200.48 DAFI 16-1403, Controlled Unclassified Information (CUI), requirements. This publication establishes policy, assigns responsibilities, and prescribes procedures for CUI throughout the DoD and establishes the official DoD CUI Registry.

4.16.11. 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.

4.16.12. 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.

4.16.13. Controlled/Restricted Areas. The Contractor shall implement local base procedures for entry to AF controlled/restricted areas where contractor personnel will work.

4.16.13.1 Escorted Entry Procedures: Unless granted unescorted entry all contractor employees will be escorted while in AF controlled/restricted areas on HAFB. When escorted, employees shall remain with their assigned escort at all times while in controlled/ restricted areas. Escort responsibility rests with the sponsoring agency. An escort briefing will be provided to all escorted employees prior to entering a controlled/restricted area. Persons providing escort are responsible for providing this briefing.

Escort officials assume responsibility for the safe and secure conduct of escorted employees and are required to maintain constant surveillance and control of employees at all times while in a controlled/restricted area.

4.16.14. Photography. Photography in or within the close proximity of an AF controlled/restricted area, flight line, or taxiway is strictly prohibited. Contractors that wish to take photos shall coordinate with their COR or Government Program Manager who will coordinate with the appropriate owning unit Security Manager for a photography clearance memorandum prior to taking photos.

4.16.17. Contractor Level I Antiterrorism Awareness Training. Each contract employee must accomplish Antiterrorism Awareness (AT) Training as stated in the provision/clause DFARS 252.204- 7004, LEVEL 1 ANTITERRORISM AWARENESS TRAINING FOR CONTRACTORS. This training provides contractor employees with the requisite knowledge necessary to remain vigilant for possible terrorist threats. Coordination for training should be done by the requiring Antiterrorism Representative (ATR) after contract award. Tracking for each contractor or subcontractor employee is the responsibility of the COR or unit ATR. Contractor employees are required to complete Level I antiterrorism awareness training within 30 days of requiring access and annually thereafter. AT certificates for each

Attachment 1, PWS Page 14 of 21 contract employee must be submitted to the COR or unit ATR. Level I AT awareness training can be taken at JKO https://jkodirect.jten.mil/Atlas2/faces/page/login/Login.seam.

4.17. Records Management IAW AFI 33-364, Records Disposition. Procedures and Responsibilities (section 2.10) 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. Records relating to work that contractors perform are maintained according to Air Force Records Information Management System (AFRIMS RDS), the Federal Acquisition Regulation, and the Defense Federal Acquisition Regulation Supplement, as applicable. When contractors create data for the government’s use, the contract must identify the background data that contractors must deliver to the government for possible reuse. Before identifying the background data that contractors must deliver to the government, Contract Manager and CO must coordinate with records and information managers, historians and other government agencies as appropriate to ensure that all government needs are met, especially when the data supports new missions or programs. When the background data includes electronic records, the contractor must deliver enough technical documentation to allow the Air Force or other agencies to use the data. Manage all data created for government use or legally controlled by the government according to the records management procedures in this instruction.

4.17.1. Freedom of Information ACT (FOIA) and Privacy Act (PA) (November 2019). The Contractor shall comply with DoDM 5400.7_R, DoD Freedom of Information Act (FOIA) Program, DoD5400_7- R_AFMAN33-302, Freedom of Information Act 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.

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

4.18. Certificate of Insurance (COI). Working on Government Installation. In accordance with FAR 28.306, Insurance under fixed-priced contracts, paragraph (b)(1), Contractor shall carry the minimum coverage of insurance as outlined in FAR 28.307-2, Liability; (a) Workers' Compensation and employer's liability; (b) General liability; (c) Automobile liability; and if applicable (d) Aircraft public and passenger liability or (e) Vessel liability. The Contractor shall also provide proof of insurance coverage within fourteen (14) days of award to the Contracting Officer. Note: COI document (e.g.

ACORD 25) shall have the 13-digit "Contract", not solicitation, Number on the document.

Attachment 1, PWS Page 15 of 21 https://jkodirect.jten.mil/Atlas2/faces/page/login/Login.seam

5.0. APPENDICES.

APPENDIX 5.1

WORKLOAD ESTIMATES

These workload estimates are based off the past two years (2022 & 2023) 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 Christus Health® Monthly average Average round trip time for transport to Christus Health® ........................................... 30 minutes

1.2.2. / In-Flight Emergencies Monthly average ......................................................................................................................... 4-6 Monthly average for in-flight emergencies requiring actual medical care Average time spent from flight line arrival to release from Fire Chief ......................... 30 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 ......................................................................................................................... 4-6 Monthly average for in-flight emergencies requiring actual medical care Average time spent from flight line arrival to release from Fire Chief ......................... 30 minutes

Attachment 1, PWS Page 16 of 21

APPENDIX 5.2 ACRONYMS

ACLS Advanced Cardiac Life Support AF Air Force AFI Air Force Instruction AFMAN Air Force Manual AFPD Air Force Policy Directive AFSPC Air Force Space Command AMR American Medical Response Ambulance Service Inc.

ARE Ambulance Response Element BLS Basic Life Support CC Commander CDRL Contract Data Requirements List CES Civil Engineering Squadron

CONS

Contractor Performance Assessment Report System CUI Controlled Unclassified Information DAF Department of the Air Force DCS Decompression Sickness DD Department of Defense Form DOD Department of Defense ECC Emergency Control Center EMS Emergency Medical Services EMT Emergency Medical Technician EMT-Basic Emergency Medical Technician - Basic EMT-I Emergency Medical Technician - Intermediate EMT-P Emergency Medical Technician - Paramedic EOL Event of the day log ER Emergency Room FOIA Freedom of Information Act FS Flight Surgeon HAFB Holloman Air Force Base HAZMAT Hazardous Material IAW In Accordance With IFE In-Flight Emergency MDG Medical Group MDGI Medical Group Instruction MOU Memorandum of Understanding MSG Mission Support Group MTF Medical Treatment Facility NLT No Later Than NREMT National Registry of Emergency Medical Technicians PA Privacy Act

Attachment 1, PWS Page 17 of 21

PSR Patient Safety Report PWS Performance Work Statement QCP Quality Control Plan SF Standard Form SFS Security Forces Squadron SGH Chief of Medical Staff SS Service Summary TB Tuberculosis USAF United States Air Force VAR Visit Access Request

Attachment 1, PWS Page 18 of 21

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 2020 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

28 Mar 2023 Entire Document

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

DD Form 1423-1 Contract Data Requirements List (CDRL) – Government Property Inventory Report Request Feb 2001**

Forms and other documents, such as the MDG O-26 Form and DD 2005 can be found in the 49 MDG Library/Catalog. The DD Form 1423-1 can be found at the acq.osd.mil site listed below. * http://www.usa-federal-forms.com/pdf-form-fillable-savable-usaf.html

* * https://www.acq.osd.mil/dpap/dars/dfars/html/previous/dd1423-1.pdf

Solicitation # FA480124R0004 Contract # TBD

Attachment 1, PWS Page 19 of 21 http://www.e-publishing.af.mil/ http://www.usa-federal-forms.com/pdf-form-fillable-savable-usaf.html http://www.acq.osd.mil/dpap/dars/dfars/html/previous/dd1423-1.pdf

APPENDIX 5.4

MOU BETWEEN THE 49 MSG AND 49 MDG

See attached.

APPENDIX 5.5

MOU BETWEEN THE 49TH MEDICAL GROUP AND AMR

APPENDIX 5.6

AF FORM 552, AIR FORCE PATIENT CARE REPORT

APPENDIX 5.7

AFSPC FORM 1924 DAILY EVENTS LOG

APPENDIX 5.8

DD 2569, THIRD PARY COLLECTION PROGRAM/MEDICAL SERVICES ACCOUNT

APPENDIX 5.9

MGI 48-1, AIRCRAFT MISHAP, IN-FLIGHT, AND GROUND EMERGENCY

RESPONSE

APPENDIX 5.10

AIR FORCE AMBULANCE SERVICES MINIMUM TRAINING STANDARDS

APPENDIX 5.11

JOINT PREHOSPITAL EMERGENCY CARE PROTOCOLS

APPENDIX 5.12

Intubation Currency MFR

Attachment 1, PWS Page 20 of 21

5.0. APPENDICES.