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Home My WebLink Aboutbocc.con.049.2001 CONTRACT #O`/%- GO/ PITKIN COUNTY AMBULANCE LICENSE FOR: SNOWMASS-WILDCAT FIRE PROTECTION DISTRICT MEDIC 7, MEDIC 8, MEDIC 9 GRANT OF LICENSE/PERMIT The undersigned, representing the Board of County Commissioners of Pitkin County, Colorado, do hereby grant a license to the above named applicant to provide ambulance service within Pitkin County. This license shall have upon it any restrictions listed below, shall be granted any waivers listed below, and shall be valid for the dates listed below, unless revoked by the Board pursuant to the provisions of Pitkin County Resolution No. 87-7 and any applicable laws of the State of Colorado. r RESTRICTIONS: None WAIVERS GRANTED: None THIS LICENSE IS VALID FROM: January 1, 2001 UNTIL DECEMBER 31, OF THE SAME CALENDAR YEAR APPROVED BY BOCC Mick Ireland, Chairperson ON y - S -G Pitkin County Board of County Commissioners IP1Tx11v COUNTY APPLICATION FOR AMBULANCE SERVICE LICENSE GENERAL INFORMATION \\ Ambulance Service Name: jt�0 W tr ASS W 6A CfKi �Rf- BkaE�O u Doing Business As:� 1� 445 Phbo V Office Address:�L:),-,Y, k-P`��JCp ��Nol,1M�A 1�`A�t S�C'6 STREET/PO BOX CITY STATE ZIP CODE Office Communications: 'a3 - VOICE FAX E-MAIL INTERNET SERVICE INFORMATION Service Area:� Service Director: Lx} t,�1F(�• 1_ - Ct� rJaN Service Type: PUBLIC PRIVATE_ BLSY ALS\ T EMERGEN TRANSFER_ SPECIAL EVENTS_ Number of Ambulances Licenesd: PHYSICIAN DVISOR-IrNNF�ORMATION Physician Advisor Name: 1 �l �7Rti� �k p Csolorado License Number: 3-7 Q3(, Office Address:CH Q 1 CA�kA E- Floc W STREET/PO BOX CITY STATE ZIP CODE Office Communications: ,-)-i0'S4'-{ -'I j a GCS is NFA VOICE FAX E-MA INTERNET I hereby certify that the information provided In this application is true to the best of my knowledge and belief and contains no willful misrepresentation or falsification.Determination that an Ambulance Service License has been issued based on false Information constitutes grounds for license revocation,suspension of operations and possible criminal prosecution. SERVICE DIRECTOR'S SIGNATURE DATE PHYSICIAN ADVISOR'S SIGNATURE DATE (FOR EMS COUNCIL USE ONLY) Date Received: 151 o I Ambulance Permits Attached: e-5'- 3 EMS Council Comments: Nor` EMS Council Recommendation: Pass P•%% 3 cam�s .n a hyPt 1 PA P.>�9 EMS Council Chairperson Signature: sue- NAME DATE Date Referred to BoCC: LM42-)--0/ BoCC Action CALK - 0 Date: �-�5 •I PITKM COUNTY 3 APPLICATION FOR AMBULANCE VEHICLE PERMIT SERVICE INFORMATION ` Ambulance Service Name:SMO(D.�MA`ix� -W�tar-hT �Rngf y T G 1 ON �15�R t G-h Office Address:'-�� C ` 3 G \6 rk L c £ (70 Ml r) STREET/PO BOX CITY 1,J STATE ZIP CODE Office Communications: :A2G Q-��-`42a4 sw C?gA,kq�4 VOICE FAX E-MAIL INTERNET VEHICLE INFORMATION Designation: ;c- `� License Plate:\'Q ' -1`i3-1 VIN:'1 GbTK3VZ t L.1f 0 l 0 G I Chassis Year: Make:&"JV `` �-+ Type: I_X II _ III_ 4x4: yes-Y,-- no I, VFiS Insurance Company:QMt rr,\Q�N k 'CR)t Foy Policy Number:CM-` Expiration: 3-,13-01 Vehicle Location: bM5 C�� ( f2 `Q Cc) g 1( ) I STREET/PO BOX CITY U STATE ZIP CODE REQUEST FOR WAIVER (include reason for request) P oO SERVICE DIRECTOR'S SIGNATURE DATE (FOR AMBULANCE INSPECTOR'S USE ONLY) � / Clear CCIC: Clear NCIC: Insurance Card Present :/ Registration Card Present: V ,, Permit Fee Attached Basic Life Support Required Equipment List Attached echanical Condition Certification Attached Advance Life Support Provider Required Equipment Certification Attached Comments/Recommendation: ;_u f G � f vy , r L", L c 4 SPECTOR'S SIGNATURE POSITION U IT PITKM COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST SAFETY EQUIPMENT One 2-1/2 lb. or larger ABC fire extinguisher, accessible from the patient compartment and having been serviced within the last year per NFPA 10 Section 4. One 5 lb. or larger ABC fire extinguisher, accessible from outside the vehicle and having been serviced 4 within the last year per NFPA 10 Section 4.. Two "NO SMOKING-OXYGEN IN USE" signs, one in cab and one in patient compartment. Flashlight, 2-D cell equivalent or better with spare bulb and battAies or charger. Set of 3 reflective warning devices. One reflective vest, coat or equivalent for each member of the crew normally assigned. At least one "SHARPS" container, clearly labeled and easily accessible in the patient compartment. Restraining devices for all items not in a securable cabinet EMERGENCY WARNING EQUIPMENT _ !,_Audible warning device (siren) with at least 2 different tones. 4—Visual warning devices (lights) with alternating red and/or blue flashing or rotating visible from all sides simultaneously and clear flashing or oscillating visible from front. COMMUNICATIONS EQUIPMENT Mobile VHF radio with appropriate State, Pitkin County and individual agency frequencies. Mobile UHF radio with appropriate State, Pitkin County, hospital and individual agency frequencies. _ Portable radio with charger and/or cellular phone for back-up communications with dispatch and hospitals. MEDICAL. EQUIPMENT AND SUPPLIES Airway: Fixed suction system with wide bore tubing, rigid pharyngeal curved suction tip and soft catheter suction tip with sizes from 5 Fr. to 14 Fr. -Portable suction system with wide bore tubing, rigid pharyngeal curved suction tip and soft catheter suction tip with sizes from 5 Fr. to 14 Fr. X Bulb Syringe. Nasopharyngeal airways in pediatric and adult sizes. Oropharyngeal airways in pediatric and adult sizes. ��Bite stick or equivalent (oropharyngeal airway). _`�Fixed oxygen system with a minimum storage capacity of 125 cubic feet(M cylinder) and a minimum delivery capability for three patients simultaneously at flows of at least 1-15 LPM. X Portable oxygen system with a minimum storage capacity of 15 cubic feet (D cylinder) and a minimum delivery capability for one patient at flows of at least 1-15 LPM. Infant Bag-Valve-Mask with 500cc bag, reservoir and newborn, infant and child masks. Adult Bag-Valve-Mask with 1000cc bag, reservoir and adult mask. **All mask attaclunents must be 15nun** Oxygen masks and cannulas capable of delivering oxygen to adults and infants at flows of at least 1-15 LPM. 1 PITKLIV COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST MEDICAL. EQUIPMENT N AND SUPPLIES Dia�ttostic: Blood pressure cuffs in large adult, regular adult, child, infant and neonatal sizes. Stethoscopes in adult and pediatric sizes. Pulse oximeter with adult and pediatric sensors. 1mYnobilization & Splinting: One lower extremity traction splint. Upper and lower extremity splints of any type (vacuum, air, SAM, wire, board, etc.). _Long spineboard, vacuum mattress or equivalent with appropriate accessories to immobilize patients from head to heels. _ One orthopedic stretcher(scoop). k Short spineboard, KED or equivalent with appropriate straps to immobilize patients from head to pelvis. Pediatric spineboard or adult spineboard adaptable to pediatric use. _ Adult and pediatric sized head immobilization equipment for each long spineboard and/or scoop stretcher carried. Rigid cervical immobilization collars in tall adult through infant sizes. Wound Care: Bandages, including but not limited to, roller gauze, triangular and elastic per agency needs. Dressings, including but not limited to, trauma, ABD, gauze, occlusive and bandaids per agency needs. Sterile burn sheets. _,r Povidone and alcohol swabs or equivalent. _Adhesive tape, including but not limited to, 1" and 2" per agency needs. Sterile irrigation solution. Obstetrical Supplies: j( Sterile OB kit to include: towels, 4x4s, umbilical tape or cord clamps, scissors, bulb syringe, sterile blanket and sterile gloves. Silver Swaddler and stocking cap or equivalents. Infection Control: Exam gloves in small, medium and large sizes. Face and eye shields. Fluid-proof gowns with full length sleeves or equivalent. Disinfectant spray or wipes for personnel and equipment. Miscellaneous: al glucose. EActivated charcoal. Heavy duty bandage scissors or shears capable of cutting clothing, belts, boots, etc. Spill-proof emesis container with at least 1 liter capacity. universal or separate male and female urinals. Multi-level wheeled gurney Stair chair or equivalent. Blankets. 4—Patient compartment heater. 2 PITKIN COUNTY ADVANCED LIFE SUPPORT PROVIDER REQUIRED EQUIPMENT CERTIFICATION Ambulance Service Name: Ambulance Designation: REQUIRED ALS EQUIPMENT 1. All equipment and supplies listed on the Basic Life Support Required Equipment List. 2. Pediatric diagnostic equipment, age/weight/vital signs chart and drug dosage/equipment size list. 3. Adult,pediatric and neo-natal vascular access supplies and equipment as authorized in medical protocols approved for this ambulance service. 4. Adult,pediatric and neo-natal endotracheal intubation equipment as authorized in medical protocols approved for this ambulance service. 5. Cardiac monitor/defibrillator with printer and adult and pediatric monitoring, defibrillating and pacing capabilities as authorized in medical protocols approved for this ambulance service. 6. Pharmacological agents and administration equipment and supplies as authorized in medical protocols approved for this ambulance service. 7. Any additional equipment and supplies needed to perform other procedures as authorized in medical protocols approved for this ambulance service. As Physician Advisor for ',N ( l , ---; , I certify that this ambulance carries the equipment and supplies listed above and meets the minimum requirements, established by the State of Colorado and Pitkin County, to provide medical care and transportation of the sick and injured at the Advanced Life Support level. Provision of Advanced Life Support is limited as described in 3-CCR-713-6, Section 4 "Medical Acts Allowed EMTs and Paramedics." S >& 3 PHYSICIAN ADVISOR'S SIGNATURE COLORADO MEDICAL LICENSE NUMBER DATE PITKhV COUNTY VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service Name: 6r Ole rCk"r- F,,z 0eot License Plate:'yold -7ss�lAmbulance Number: SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels & Tires Steering k Alignment Suspension k Service Brakes Parking Brake Driving Lights y' Visual Warning Systems Audible Warning Systems Electrical System Exhaust System Fuel System X ° Glass, Mirrors Body& Sheet Metal professing to be a motor vehicle mechanic with training in all of the systems listed above, have evaluated the condition of these systems on the ambulance indicated above and have determined this ambulance to be in safe operating condition. This evaluation does not warrantee the future safety and/or operability of this ambulance due to conditions beyond my control. t�IC�� (f; ` O Y PP (`176 J)? i MECHANIC'S NAME AGENCY/COMPANY PHONE NUMBER DATE PITICIN COUNTY APPLICATION FOR AMBULANCE VEHICLE PERMIT SERVICE INFORMATION Ambulance Service Name:�Itux�,@s -W6kc- k4 Office Address:,&nx C H,3G GEInt.I(`nAs NS, ��&Q e— (2z 17, �J STREET/PO BOX CITY STATE ZIP CODE Office Communications: q-�-moo `d q SwF P 2s N EA VOICE FAX E-MAIL INTERNET VEHICLE INFORMATION Designation: E J lL License Plate:VK)A"'�0-1 VIN: 1 &�k�Lt Woff'. I 'Y 50 LD Chassis Year: � ` 19 3 Make: (',)ref 4k6\t-)r Type: I II_ III_ 4x4: yes no Insurance Company:WMf-h�CAN Policy Number: CM- 1 Expiration: 3 22-0 Vehicle Location: : S a`1 OW� atk. , o AJ S , cnf;SS y Ca �i rj STREET/PO BOX CITY STATE ZIP CODE REQUEST FOR WAIVER(include reason for request) 1tj i s W- DO SERVICE DIRECTOR'S SIGNATURE DATE (FOR AMBULANCE INSPECTOR'S USE ONLY) Clear /CCIC: Clear NCIC: Insurance Card Present._ Registration Card Present: X Permit Fee Attached Basic Life Support Required Equipment List Attached Mechanical Condition Certification Attached Advance Life Support Provider Required Equipment Certification Attached Comments/Recommendation: uJ, o INSPECTOR'S SIGNATURE POSITION IDDATE PITMv COMNrY C/ BASIC LIFE SUPPORT I REQUIRED EQUIPMENT LIST SAFETY EO IUIU PMV T One 2-1/2 lb. or larger ABC fire extinguisher, accessible from the patient compartment and having been serviced within the last year per NFPA 10 Section 4. One 5 ►b. or larger ABC fire extinguisher, accessible from outside the vehicle and having been sei viced within the last ,year per NFPA 10 Section 4.. Two"NO SMOKING-OXYGEN IN USE"signs, one in cab and one in patient compartment. Flashlight, 2-D cell equivalent or better with spare bulb and batteries or charger. Set of 3 reflective warning devices. One reflective vest, coat or equivalent for each member of the crew normally assigned. At least one "SHARPS" container, clearly labeled aid easily accessible in the patient compartment. _ Restmining devices for all items not in a securable cabinet EM1 Ii K;Y WARNING EQUIPMM4 VCAudible warning device (siren) with at least 2 different tones. Visual warning devices (lights) with alternating red and/or blue flashing or rotating visible fiom all sides simultaneously and clear flashing.or oscillating visible from front. COMMUNICATIONS EQUIPMENT Mobile VIIP radio with appropriate State, Pitkin County and individual agency frequencies. Mobile UlIL' radio with appropriate State, Pitkin County, hosp4al and individual agency frequencies. Portable radio with charger and/or cellular phone for back-up communications with dispatch and hospitals. MEDICAL, EQUIPMENT AND SUPPLIES Airvway: T Fixed suction system with wide bore tubing, rigid pharyngeal curved suction tip and soft catheter suction tip with sizes from 5 Fr. to 14 Fr. Portable suction system with wide bore tubing, rigid pharyngeal curved suction tip and sof t catheter suction tip with sizes from 5 Fr. to 14 Fr. Bulb Syringe. Nasopharyigeal airways in pediatric and adult sizes. Oropharyngeal airways in pediatric and adult sizes. Bite stick or equivalent (oropharyngeal airway). Fixed oxygen system with a minimum storage capacity of 125 cubic feet (M cylinder) and a minimum delivery capability for three pal ients simultaneously at flows of at least 1-15 LPM. _ Portable oxygen system with a minimum storage capacity of 15 cubic feet (D cylinder) any t a minimum delivery capability for one patient at flows of at least 1-15 LPM. Inf tit Bq-Valve-Mask with 50Urc bag, reservoir and newborn, infant and child masks. Adult Bag-Valve-Mask ,with 1000cc bag, reservoir and adult mask. **Al mask attachments must be 15uun** Oxygen masks and camtulas capable of delivering oxygen to adults and infants ai flows of at least '-15 LPM. 1 PITKIN COUNTY 16 BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST MEDICAL EQUIPMENT AND SUPPLIES Dliw ostic: Blood pressure cuffs in large adult, regular adult, child, infant and neonatal sizes. Stcihoscopes in adult and pediatric sizes. Pulse oximeter with adult and pediatric sensors. Inimobili..ation & Splinting: 0j - lower extremi ty traction splint. Upper and lower extremity splints of any type (vacuum, air, SAM, wire, board, etc.). Loi,g spineboard, vacuum ivattress or equivalent with appropriate accessories to immobilize patients from head to heels. _ One orthopedic stretcher(scoop). /� Short spineboard, KED or equivalent with appropriate straps to immobilize patients from head to pci^is. Pediatric spineboard or adult spineboard adaptable to pediatric use. T�7 Adult mid pediatric, sized 1- ad immobilization equipment for each long spineboard and/or s,:oop streo_Irer carried. ARigid cervical inmrobilization collars in tall adult through infant sizes. nd Care: Bandages, including but i t limited to, roller gauze, triangular and elastic per agency needs. Dressings, including but not limited to, trauma, ABD, gauze, occlusive and bandaids per ag- ucy needs. Sterile turn sheets. , _ Povido, -o and alcohol swans or equivalent. _ Adhesive tape, including I-it not limited to, 1"and 2" per agency needs. Sterile irrigation solution. Obstetrical Supplies: Sterile OB kit to include: luwels, 4x4s, umbilical tape or cord clamps, scissors, bulb syringe, sterile blanket and sterile gloves. Silver Swaddler and stocking cap or equivalents. Infection Control: Exam gloves in small, medium and large sizes. Face and eye shields. Fluiii proof gowns with full length sleeves or equivalent. Disinfectant spray or wipes for personnel and equipment. Miscellaneous: Oral glucose. Activated charcoal. Heavy duty bandage scissors or shears capable of cutting clothing, belts, boots, etc. Spill-proof emesis cc gainer with at least 1 liter capacity. universal or separate :hale and female urinals. _ Multi-level wheeled F irney Stair chair or equivalent. Blankets. Patient compartment hea ;r. 2 PITKIIV COUNTY ADVANCED LIFE SUPPORT PROVIDER REQUIRED EQUIPMENT CERTIFICATION Ambulance Service Name: -�A)G(,'fy,�) L..,JrIcor nre (ct, 06i Ambulance Designation: 7 REQUIRED AL.S EQUIPMENT 1. All equipment and supplies listed on the Basic Life Support Required Equipment List. 2. Pediatric diagnostic equipment, age/weight/vital signs chart and drug dosage/equipment size list. 3. Adult, pediatric and neo-natal vascular access supplies and equipment as authorized in medical protocols approved for this ambulance service. 4. Adult, pediatric and neo-natal endotracheal intubation equipment as authorized in medical protocols approved for this ambulance service. 5. Cardiac monitor/defibrillator with printer and adult and pediatric monitoring, defibrillating and pacing capabilities as authorized in medical protocols approved for this ambulance service. 6. Pharmacological agents and administration equipment and supplies as authorized in medical protocols approved for this ambulance service. p 7. Any additional equipment and supplies needed to perform other procedures as authorized in medical protocols approved for this ambulance service. As Physician Advisor for S^ 0•——,, , - .� 1 d 1 , I certify that this ambulance carries the equipment and supplies listed above and meets the minimum requirements, established by the State of Colorado and Pitkin County, to provide medical care and transportation of the sick and injured at the Advanced Life Support level. Provision of Advanced Life Support is limited as described in 3-CCR-713-6, Section 4 "Medical Acts Allowed EMTs and Paramedics." PHYSICIAN ADVISOR'S SIGNATURE COLORADO MEDICAL LICENSE NUMBER DATE PITKIIV COUNTY J VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service Name: ikn-t. License Plate: V-W=&j Ambulance Number: 7 SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels & Tires Steering Alignment Suspension Ix Service Brakes X Parking Brake X Driving Lights X Visual Warning Systems Audible Warning Systems Electrical System Exhaust System Fuel System Glass, Mirrors Body & Sheet Metal Ix ->n professing to be a motor vehicle mechanic with training in all of the systems listed above, have evaluated the condition of these systems on the ambulance indicated above and have determined this ambulance to be in safe operating condition. This evaluation does not warrantee the future safety and/or operability of this ambulance due to conditions beyond my control. MECHANIC'S NAME AGENCY/COMPANY PHONE NUMBER DATE PITKM COUNTY 3 APPLICATION FOR AMBULANCE VEHICLE PERMIT ,SERVICE INFORMATION Ambulance Service Name:•.(yW(rWss— ( ) 1 1C A+ g112'E ON C Office Address: i�; T LH3(p VI AAa%L Cc) (V u lJ STREET/PO BOX CITY V STATE ZIP CODE Office Communications: VOICE FAX E-MAIL INTERNET VEHICLE II�N/�F`OIRMATION Designation:1 IY�IG� License P1ate:\JUK - g 13- VIN: Chassis Year: Make:C hkVQ&i-� Type: I )( II_ III _ 4x4: yes no_ �` VFIs Insurance Company:�MtiR�U0,W ��4ti2e1l�T�Vc PolicyNumber: I Pr\`-/lUe3'�(��g-3 Expiration: 3-23 O� Vehicle Location: : K�15 C)u,1\ C�ukk.-R(S� �1�WWIYW` V��l 0� S I 1 STREET/PO BOX CITY STATE ZIP CODE REQUEST FOR WAIVER(include reason for request) e SERVICE DIRECTOR'S SIGNATURE DATE (FOR AMBULANCE INSPECTOR'S USE ONLY) Clear CCIC: Clear NCIC: Insurance Card Present: A, Registration Card Present: Permit Fee Attached Basic Life Support Required Equipment List Attached Mechanical Condition Certification Attached _ Advance Life Support Provider Required Equipment Certification Attached Comments/Recommendation: In r e Z� I e� • yL k�* e (1v/c 4 INSPECTOR'S SIGNATURE POSITION DAE PITKM COUNTY ' BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST MEDICAL EQUIPMENT AND SUPPLIES Diagnostic: Blood pressure cuffs in large adult, regular adult, child, infant and neonatal sizes. Stethoscopes in adult and pediatric sizes. Pulse oximeter with adult and pediatric sensors. Immobilization& Splinting: One lower extremity traction splint. Upper and lower extremity splints of any type (vacuum, air, SAM, wire, board, etc.). K Long spineboard, vacuum mattress or equivalent with appropriate accessories to immobilize patients from head to heels. One orthopedic stretcher(scoop). Short spineboard, KED or equivalent with appropriate straps to immobilize patients from head to pelvis. Pediatric spineboard or adult spineboard adaptable to pediatric use. Adult and pediatric sized head immobilization equipment for each long spineboard and/or scoop stretcher carried. K_Rigid cervical immobilization collars in tall adult through infant sizes. Wound Care: Bandages, including but not limited to, roller gauze, triangular and elastic per agency needs. _ZC Dressings, including but not limited to, trauma, ABD, gauze, occlusive and bandaids per agency needs. Sterile bum sheets. Povidone and alcohol swabs or equivalent. Adhesive tape, including but not limited to, 1" and 2"per agency needs. Sterile irrigation solution. Obstetrical Supplies: Sterile OB kit to include: towels, 4x4s, umbilical tape or cord clamps, scissors, bulb syringe, sterile blanket and sterile gloves. Silver Swaddler and stocking cap or equivalents. Inf ction Control: Exam gloves in small, medium and large sizes. Face and eye shields. -X Fluid-proof gowns with full length sleeves or equivalent. _ Disinfectant spray or wipes for personnel and equipment. Miscellaneous: Oral glucose. Activated charcoal. Heavy duty bandage scissors or shears capable of cutting clothing, belts, boots, etc. Spill-proof emesis container with at least 1 liter capacity. universal or separate male and female urinals. I Multi-level wheeled gurney X Stair chair or equivalent. 1C Blankets. Patient compartment heater. 2 PITKM COUNTY 5 BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST SAFETY EQUIPMENT One 2-1/2 lb. or larger ABC fire extinguisher, accessible from the patient compartment and having been serviced within the last year per NFPA 10 Section 4. One 5 lb. or larger ABC fire extinguisher, accessible from outside the vehicle and having been serviced within the last year per NFPA 10 Section 4.. Two "NO SMOKING-OXYGEN IN USE" signs, one in cab and one in patient compartment. Flashlight, 2-13 cell equivalent or better with spare bulb and batteries or charger. Set of 3 reflective warning devices. One reflective vest, coat or equivalent for each member of the crew normally assigned. At least one "SHARPS" container, clearly labeled and easily accessible in the patient compartment. Restraining devices for all items not in a securable cabinet FMERGENCY WARNING EQUIPMENT Audible warning device (siren)with at least 2 different tones. — Visual warning devices (lights) with alternating red and/or blue flashing or rotating visible from all sides simultaneously and clear flashing or oscillating visible from front. COMMUNICATIONS EQUIPMENT N_Mobile VHF radio with appropriate State, Pitkin County and individual agency frequencies. Mobile UHF radio with appropriate State, Pitkin County, hospital and individual agency frequencies. Portable radio with charger and/or cellular phone for back-up communications with dispatch and hospitals. MEDICAL. EQUIPMENT ANDSUPPLIES Airway: 4 Fixed suction system with wide bore tubing, rigid pharyngeal curved suction tip and soft catheter suction tip with sizes from 5 Fr. to 14 Fr. Portable suction system with wide bore tubing, rigid pharyngeal curved suction tip and soft catheter suction tip with sizes from 5 Fr. to 14 Fr. Bulb Syringe. Nasopharyngeal airways in pediatric and adult sizes. Oropharyngeal airways in pediatric and adult sizes. Bite stick or equivalent (oropharyngeal airway). Fixed oxygen system with a minimum storage capacity of 125 cubic feet (M cylinder) and a minimum delivery capability for three patients simultaneously at flows of at least 1-15 LPM. Portable oxygen system with a minimum storage capacity of 15 cubic feet (D cylinder) and a minimum delivery capability for one patient at flows of at least 1-15 LPM. Infant Bag-Valve-Mask with 500cc bag, reservoir and newborn, infant and child masks. Adult Bag-Valve-Mask with 1000cc bag, reservoir and adult mask. "All mask attaclunents must be 15num" YOxygen masks and cannulas capable of delivering oxygen to adults and infants at flows of at least 1-15 LPM. 1 PITKLN COUNTY , (� ADVANCED LIFE SUPPORT PROVIDER REQUIRED EQUIPMENT CERTIFICATION Ambulance Service Name: �fi wL.'.�e.�36 W, 4cc i T�ivt [,cn . 0,t t. Ambulance Designation: REQUIRED AL•S EQUIPMENT I. All equipment and supplies listed on the Basic Life Support Required Equipment List. 2. Pediatric diagnostic equipment, age/weight/vital signs chart and drug dosage/equipment size list. 3. Adult, pediatric and neo-natal vascular access supplies and equipment as authorized in medical protocols approved for this ambulance service. 4. Adult, pediatric and neo-natal endotracheal intubation equipment as authorized in medical protocols approved for this ambulance service. 5. Cardiac monitor/defibrillator with printer and adult and pediatric monitoring, defibrillating and pacing capabilities as authorized in medical protocols approved for this ambulance service. 6. Pharmacological agents and administration equipment and supplies as authorized in medical protocols approved for this ambulance service. r 7. Any additional equipment and supplies needed to perform other procedures as authorized in medical protocols approved for this ambulance service. As Physician Advisor for I certify that this ambulance carries the equipment and supplies listed above and meets the minimum requirements, established by the State of Colorado and Pitkin County, to provide medical care and transportation of the sick and injured at the Advanced Life Support level. Provision of Advanced Life Support is limited as described in 3-CCR-713-6, Section 4"Medical Acts Allowed EMTs and Paramedics." PHYSICIAN ADVISOR'S SIGNATURE COLORADO MEDICAL LICENSE NUMBER DATE PITKM COUNTY 17 VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service Name: JnDv�mrs ��i;e. P'r.>t License Plate: Ambulance Number: SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels & Tires Steering Alignment k Suspension X Service Brakes X Parking Brake Driving Lights Visual Warning Systems Audible Warning Systems y� Electrical System Exhaust System Fuel System Glass, Mirrors Body& Sheet Metal I, r 1,A'4 `'f'y�C a professing to be a motor vehicle mechanic with training in all of the systems listed abo e, have evaluated the condition of these systems on the ambulance indicated above and have determined this ambulance to be in safe operating condition. This evaluation does not warrantee the future safety and/or operability of this ambulance due to conditions beyond my control. Lf p4ef� F rf `�7C K ul1 I-IE C-I MECHANIC'S NAME AGENCY/COMPANY PI[ONE NUMBER DATE