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HomeMy WebLinkAboutbocc.con.117.1999CONTRACT till 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. RESTRICTIONS: None WAIVERS GRANTED: None THIS LICENSE IS VALID FROM: JANUARY 1, 1999 UNTIL DECEMBER 31, OF THE SAME CALENDAR YEAR L slie J. Lamon . Ch+irperson Pitkin County Bo. s of County Commissioners PITKIN COUNTY APPLICATION FOR AMBULANCE SERVICE LICENSE GENERAL INFORMATION Ambulance Service Name: Snowmass-Wildcat Fire Protection District Doing Business As: Snowmass-Wildcat Fire Protection District Office Address: 5275 Owl Creek Road/Box 6436 Snowmass Village CO STREET/PO BOX CITY STATE Office Communications: 970-923-2212 970-923-2212 81615 ZIP CODE VOICE FAX E-MAIL INTERNET ,SERVICE INFORMATION Service Area: 20 Square Miles Service Director: William L. Cowan Service Type: PUBLIC X PRIVATE_ BLS X ALS X - EMERGENT TRANSFERSPECIAL EVENTS X Number of Ambulances Licenesd: Two PHYSICIAN ADVISOR INFORMATION Physician Advisor Name: Dr. Grace Neiman Office Address: 0401 Castle Creek Road STREET/PO BOX Office Communications: 970-925-1120 Colorado License Number: 36540 Aspen CO CITY STATE 81611 ZIP CODE VOICE FAX E-MAIL 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 n Ambulance Service License has been issued based on false information constitutes grounds for license revocation, suspensio,'of operations and possible criminal prosecution. SERVICE DIRECTOR'S SIGNATURE 7/13/98 DATE �j�- 7/13/98 N AbVfSdR'S,UIGNAATTUKE'� DATE (FOR EMS COUNCIL USE ONLY) Date Received: l i it) 1 Ambulance Permits Attached: 3 NI %c. rr--31c y EMS Council Comments: EMS Council Recommendation: R.-Eton/1 aln V IA-3V A—. EMS Council Chairperson Signature: S(/ ()BELL NAME ,.. Date Referred to BoCC: 02799 BoCC Action: II'i3�'1 DATE Date: /6-2-7-5 PITKIN COUNTY APPLICATION FOR AMBULANCE VEHICLE PERMIT SERVICE INFORMATION Ambulance Service Name: Snowmass-Wildcat Fire Protection District Office Address: 5275 Owl Creek Road/P.0 Box 6436 Snowmass Village, CO 81615 STREET/PO BOX CITY STATE ZIP CODE Office Communications: 970-923-2212 970-923-2224 VOICE FAX E-MAIL INTERNET VEHICLE INFORMATION Designation: Medic 7 License Plate: VCW-807 VIN: 1GBJK34N6PE185047 Chassis Year: 1993 Make: Chevy Type: I X II III _ 4x4: yes x no - Insurance Company: Reidman Policy Number: CM1008628.01 Expiration: 3/99 Vehicle Location: : 5275 Owl Creek Road Snowmass Village CO STREET/PO BOX CITY STATE REQUEST FOR WAIVER (include reason for request) 81615 ZIP CODE 11/23/98 SERVICE DIRECTOR'S SIGNATURE - DATE (FOR AMBULANCE INSPECTOR'S USE ONLY) Clear CCIC: Clear NCIC: Insurance Card Present: \ 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: 2t C 8MMgt C",p °PPLJ✓A-t- �INSPECTORSSIONATURE tNS(C CIO f� POSITION IlSte'(et 9 DATE PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST SAFETY EQIJIPMENT 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. MI 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.. \i 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 and easily accessible in the patient compartment. Restraining devices for all items not in a securable cabinet EMERGENCY WARNING EQUIPMENT N-, 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 �+ 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. NI Portable radio with charger and/or cellular phone for back-up communications with dispatch and hospitals. MEDICAL EQUIPMENT AND SUPPLIES irway: 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. NAdult Bag -Valve -Mask with 1000cc bag, reservoir and adult mask. **All mask attachments must be 15mm** v Oxygen masks and cannulas capable of delivering oxygen to adults and infants at flows of at least 1-15 LPM. 1 PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST MEDICAL EQUIPMENT AND SUPPLIES agnostic: 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: N.: 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). N4 Short spineboard, ICED 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. \ ound 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. v Sterile burn sheets. Povidone and alcohol swabs or equivalent. �t Adhesive tape, including but not limited to, 1" and 2" per agency needs. \--; Sterile irrigation solution. gbstetrical 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. Infection Control: Exam gloves in small, medium and large sizes. Face and eye shields. Fluid -proof gowns with full length sleeves or equivalent. N,, 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. Multi -level wheeled gurney \j Stair chair or equivalent. `\ff Blankets. Patient compartment heater. 2 w PITKIN COUNTY VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service Name:N0w IV\RSS License Plate: t-t ' Ambulance Number: Meckic SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels & Tires Steering Alignment Suspension ' Service Brakes Parking Brake Driving Lights Visual Warning Systems Audible Warning Systems Electrical System Exhaust System Fuel System Glass, Mirrors Body & Sheet Metal l IZ Aky , 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. MEC 3 -ANIC'S NAME AGENCY/COMPANY S 22( PHONE NUMBER DATE 41. PITKIN COUNTY ADVANCED LIFE SUPPORT PROVIDER REQUIRED EQUIPMENT CERTIFICATION Ambulance Service Name: snowmass-wildcat Fire Prot. Dist. Ambulance Designation: Medic 7 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 PhysicianAdvisor for the Snowmass-Wildcat Fire Prot. Dist. , 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." PHYSICI OR'S SIGN RE 36540 11/23/98 COLORADO MEDICAL LICENSE NUMBER DATE SERVICE INFORMATION Ambulance Service Name: PITKIN COUNTY APPLICATION FOR AMBULANCE VEHICLE PERMIT Snowmass-Wildcat Fire Protection District Office Address: 5275 Owl Creek Road/P.O. Box 6436 Snowmass Village, CO 81615 STREET/PO BOX CITY STATE ZIP CODE Office Communications: 9 70-923-2212 970-923-2224 VOICE FAX E-MAIL INTERNET VEHICLE INFORMATION Designation: Medic 8 License Plate: VCR-815 VIN: 1GB1V34N1KJ116479 Chassis Year: 1989 Make: Chevy Type: I x II _ III , 4x4: yes x no Insurance Company: Reidman Policy Number: CM1008628-01 Expiration: 3/99 VehicleLocation:: 5275 Owl Creek Road Snowmass Village CO STREET/PO BOX CITY STATE REQUEST FOR WAIVER (include reason for request) 81615 ZIP CODE 11/23/98 SERVICE DIRECTOR'S SIGNATURE DATE (FOR AMBULANCE INSPECTOR'S USE ONLY) Clear CCIC: Clear NCIC: Insurance Card Present: \ Registration Card Present: Permit Fee Attached Basic Life Support Required Equipment List Attached v Mechanical Condition Certification Attached NI Advance Life Support Providerj�Required Equipment Certification Attached m Comments/Recomendation: 2-C (DJ 1 /76 ND k e vt— INSPECT S SIGNATURE u5t'(C ,A POSITION DATE in <ic PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST S\FFTY 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 1b. 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-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 and easily accessible in the patient compartment. Restraining devices for all items not in a securable cabinet ,kMERGENCY WARNING EQUIPMENT Audible warning device (siren) with at least 2 different tones. Visual waming devices (lights) with alternating red and/or blue flashing or rotating visible from all sides simultaneously and clear flashing or oscillating visible from front. S'OMMTJNICATIONS EQUIPMENT V 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. \j Portable radio with charger and/or cellular phone for back-up communications with dispatch and hospitals. MEDICAL EQUIPMENT AND STJPPLIES 4irway: N. 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. �1 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. �I 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 attachments must be 15mm** Oxygen masks and cannulas capable of delivering oxygen to adults and infants at flows of at least 1-15 LPM. PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST MEDICAL EQUIPMENT AND SIJPPLIES agnostic: Blood pressure cuffs in large adult, regular adult, child, infant and neonatal sizes. \j Stethoscopes in adult and pediatric sizes. \, Pulse oximeter with adult and pediatric sensors. mmobilization & Splinting: i 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). Short spineboard, KED or equivalent with appropriate straps to immobilize patients from head to pelvis. Pediatric spineboard or adult spineboard adaptable to pediatric use. N, 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. v Dressings, including but not limited to, trauma, ABD, gauze, occlusive and bandaids per agency needs. N Sterile bum sheets. Povidone and alcohol swabs or equivalent. N Adhesive tape, including but not limited to, 1" and 2" per agency needs. '- Sterile irrigation solution. Obstetrical Supplies: V 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. N Face and eye shields. Fluid -proof gowns with full length sleeves or equivalent. __ Disinfectant spray or wipes for personnel and equipment. Miscellaneous: • Oral glucose. N= 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. Multi -level wheeled gurney Stair chair or equivalent. Blankets. ems. Patient compartment heater. 2 • PITKIN COUNTY VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service Name: SNP" It'l ASS License Plate:W .01C Ambulance Number: McAic'8 SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels & Tires Steering Alignment Suspension ' Service Brakes Parking Brake Driving Lights Visual Warning Systems Audible Warning Systems / Electrical System Exhaust System Fuel System Glass, Mirrors Body & Sheet Metal -e \ S n y ce r , 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. Z,LJF.* 9'?3 22,2 (i-23 MECHANIC'S NAME AGENCY/COMPANY PHONE NUMBER DATE PITKIN COUNTY ADVANCED LIFE SUPPORT PROVIDER REQUIRED EQUIPMENT CERTIFICATION Ambulance Service Name: Snowmass-wildcat Fire Prot. Dist. Ambulance Designation: Medic 8 REQUIRED ALS EQUIPMENT 1. Alt 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 the Snowmass-wildcat Fire Prot. Dist. , 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 ADVI R'S SIGNATURE 36540 11/23/98 COLORADO MEDICAL LICENSE NUMBER DATE Clear CCIC: Clear NCIC: ' PITKIN COUNTY APPLICATION FOR AMBULANCE VEHICLE PERMIT SERVICE INFORMATION Ambulance Service Name: Snowmass-Wildcat Fire Protection District Office Address: 5275 Owl Creek Road/Box 6436 Snowmass Village CO 81615 STREET/PO BOX CITY Office Communications: 970-923-2212 970-923-2224 STATE ZIP CODE VOICE VEHICLE INFORMATION Designation: Medic 9 Chassis Year: 1998 Make: Insurance Company: Reidman Vehicle Location: : 5275 owl Creek Road STREET/PO BOX License Plate: FAX E-MAIL VBW-787 • VIN: 1GBJK34J1WF010615 IN1'ERNET Chevy Type: I i x II III Policy Number: GM1008628-01 Snowmass Village CO CITY STATE REQUEST FOR WAIVER (include reason for request) 4x4: yes x no Expiration: 3 / 9 9 81615 ZIP CODE SERVICE DIRECTOR'S SIGNATURE 7/11/9R DATE (FOR AMBULANCE INSPECTOR'S USE ONLY) Insurance Card Present: tNN4 � Registration Card Present: i1-4 Permit Fee Attached R Basic Life Support Required Equipment List Attached l Mechanical Condition Certification Attached Rqu Advance Life Support Provider Required Equipment Certification Attached Comments/Recommendation: YAS S Cii9<tcs t� ✓SPECTOR'S SIGNATURE Pops, -tVnrsul.twJcia r POSITION 8/A' erig DT PITKIN 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. oCV 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.. _ 4- _ Two "NO SMOKING -OXYGEN IN USE" signs, one in cab and one in patient compartment. -V Flashlight, 2-D cell equivalent or better with spare bulb and batteries or charger. y 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. A' Restraining devices for all items not in a securable cabinet EMERGENCY WARNING EQUIPMENT Audible warning device (siren) with at least 2 different tones. c 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 4- Mobile VHF radio with appropriate State, Pitkin County and individual agency frequencies. -r' 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: 'gr.- 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. a" --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. -V Bulb Syringe. 't Nasopharyngeal airways ' pediatric an adult sizes. �-- Oropharyngeal airways in p d adult sizes. Bite stick or equivalent (oropharyngeal airway). XFixed 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 attachments must be 15mm•* .1' Oxygen masks and cannulas capable of delivering oxygen to adults and infants at flows of at least 1-15 LPM. 1 PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST MEDICAL EQUIPMENT AND SUJPPI,IES Diagnostic: cj/ Blood pressure cuffs in large adult, regular adult, child, infant and neonatal sizes. Stethoscopes in adult and pediatric sizes. -V Pulse oximeter with adult and pediatric sensors. Imp�obilization & Splinting: -eOne lower extremity traction splint. Upper and lower extremity splints of any type (vacuum, air, SAM, wire, board, etc.). V Long spineboard, vacuum mattress or equivalent with appropriate accessories to immobilize patients from head to heels. One orthopedic stretcher (scoop). Short spineboard, ICED or equivalent with appropriate straps to immobilize patients from head to pelvis. Pediatric spineboard or adult spineboard adaptable to pediatric use. 4' 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: .e"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. Povidone and alcohol swabs or equivalent. .V Adhesive tape, including but not limited to, 1" and 2" per agency needs. A Sterile irrigation solution. Obstetrical Supplies: Sterile OB kit to include: towels, 4x4s, umbilical tape Or cord clamps, scissors, bulb syringe, sterile -d/ blanket and sterile gloves. Silver Swaddler and stocking cap or equivalents. Infection Control: -d' Exam gloves in small, medium and large sizes. ÷ Face and eye shields. Fluid -proof gowns with full length sleeves or equivalent. d� Disinfectant spray or wipes for personnel and equipment. Miscellaneous: Oral glucose. d� Activated charcoal. 'V- Heavy duty bandage scissors or shears capable of cutting clothing, belts, boots, etc. Spill -proof emesis container with at least 1 liter capacity. Y universal or separate male and female urinals. —Multi-level wheeled gurney Stair chair or equivalent. Jr" Blankets. Patient compartment heater. 2 PITKJN COUNTY VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service NameSnOW rnck,SS' �ir� License Plate:V }Ambulance Number: 9 SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels & Tires Steering Alignment Suspension Service Brakes Parking Brake Driving Lights Visual Warning Systems Audible Warning Systems Electrical System Exhaust System Fuel System 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. MECHANIC'S NAME/ AGENCY/COMPANY PHONE NUMBER DATE PITKIN COUNTY ADVANCED LIFE SUPPORT PROVIDER REQUIRED EQUIPMENT CERTIFICATION Ambulance Service Name: Snowmass-Wildcat Fire Prot. Dist. Ambulance Designation: Medic 9 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 and defibrillating 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 the Snowmass-Wildcat Fire Protection District 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." � 36540 7(1398 PHYSI IAN ADVISOR'S SIGNATU L-0RADO MEDICAL LICENSE NUMBER DATE