S02 - Attachment A - Critical Care Transport Capabilities Confirmation.docx
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- Attached to
- V225--Non-Emergency Ambulance Services (676) 5-Year Ordering Period 9/1/2025 - 8/31/2030
- Solicitation number
- 36C25225Q0652
About this file
This document is an Attachment A Critical Care Transport (CCT) Capabilities Confirmation form for a VA ambulance services contract. The form details comprehensive requirements for critical care medical transport, including an extensive list of required drugs (such as Amiodarone, Dobutamine, Heparin, and Propofol) and specialized medical equipment (including chest tubes, portable mechanical vents, CPAP, and Zoll X Series Critical Care Monitor). The document mandates that ambulance providers must be capable of managing up to 6 IV drip lines, supporting complex patient transport scenarios, and maintaining advanced monitoring capabilities like continuous 12-lead EKG, dual temperature monitoring, automatic blood pressure, and capnography.
The form is part of solicitation 36C25225Q0652 for Non-Emergency Ambulance Services issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 12, with a 5-year ordering period from 9/1/2025 to 8/31/2030. Prospective offerors are required to sign and return the form, confirming their ability to meet the specified critical care transport criteria. The document serves as a critical qualification checklist for ambulance service providers seeking to participate in this VA contract opportunity, ensuring a high standard of medical transport capabilities.
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Text version
Attachment A
Critical Care Transport Capabilities Confirmation If a transport is classified as a Critical Care Transport (CCT) the offeror must be capable of transporting the drugs and/or equipment as required by the patient (listed below), up to and including Tier III, if necessary, based on the EMS region the ambulance provider is functioning in. Prospective offerors must sign and return this form confirming they can meet these criteria for CCTs ordered under this contract.
| Drug Supply List: | Equipment List: | ||
| Acetylcysteine (Acetadote, Mucomyst) | Chest tubes | ||
| Amiodarone (Cordarone) | Portable mechanical vents; including CPAP | ||
| Antibiotics | All VADs | ||
| Blood and Blood Products | CVP lines | ||
| Diltiazem (Cardizem) | Swan-Ganz line | ||
| Dobutamine | SmartPump Capability: up to 6 IV drips |
Dopamine Fentanyl (Sublimaze) *Any pump(s) capable for up to and including 6 infusion lines or IV drips as required by the patient. If the pumps are not compatible with VA supplied IV tubing, the contracted ambulance would need to provide their own tubing and be able to switch the tubing over prior to transport. *
Furosemide (Lasix) Heparin Hyperalimentation (TPN and lipids) Insulin Labetalol (Trandate) Lidocaine Lorazepam (Ativan) Magnesium Sulfate Mannitol Midazolam (Versed)Zoll X Series Critical Care Monitor Capabilities:
Continuous 12-lead EKG monitoring 2-Temperature Monitoring Automatic Blood Pressure Capnography 2 arterial lines monitoring
Milrinone (Primacor) Nicardipine (Cardene) Nitroglycerin (NitroStat, Nitro-Dur, Nitro-Bid) Norepinephrine (Levophed) Octreotide (Sandostatin) Ondansetron (Zofran) Pantoprazole (Protonix) Phenylephrine (Neo-Synephrine) Potassium Chloride Propofol Sodium Bicarbonate Vasopressin (Pitressin) TPA* (Pending)
I hereby confirm that _______________________________ can meet the criterion for Critical Care Transports.
(Company Name)
| _____________________________________ | ______________ | |
| Signature of Company Representative | Date |
File details come from the government source that posted it. Updated .