S02 - Attachment A - Specialty Care Transport or Critical Care Transport Confirmation.docx
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- Solicitation number
- 36C25226Q0304
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This is a Performance Work Statement attachment that establishes the critical care transport (CCT) and specialty care transport (SCT) requirements for ground ambulance services under Veterans Integrated Service Network (VISN) 12, Station 585. Prospective offerors must confirm their capability to transport patients requiring advanced medical support, including specialized drugs and equipment, as part of their contract performance.
The attachment details comprehensive requirements for CCT/SCT capability, including a drug supply list of 24 medications spanning vasopressors, sedatives, antibiotics, and other critical care pharmaceuticals such as amiodarone, dobutamine, dopamine, propofol, and TPA (pending). Equipment requirements include chest tubes, portable mechanical ventilators with CPAP capability, all ventricular assist devices (VADs), central venous pressure (CVP) lines, Swan-Ganz lines, and smart pump capability supporting up to six simultaneous IV infusion lines. The equipment list specifies a Zoll X Series Critical Care Monitor with capabilities for continuous 12-lead EKG monitoring, temperature monitoring, automatic blood pressure, capnography, and two-arterial line monitoring. Offerors must sign and return the completed form confirming their organization's ability to meet these criteria for CCT transports ordered under the five-year contract period (April 1, 2026 through March 31, 2031). If contracted ambulance providers' pumps are incompatible with VA-supplied IV tubing, they must provide and install their own tubing prior to transport.
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Performance Work Statement (PWS)
GROUND AMBULANCE
VISN 12/Station 585 NAICS 621910
Attachment A Specialty Care Transport (SCT) or Critical Care Transport (CCT) 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 Specialty Care Transport (SCT) or Critical Care Transport (CCT), 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 .