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Home My WebLink Aboutbocc.con.005.2002CONTRACT # DO S' 200 a).. 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, 2002 UNTIL DECEMBER 31, OF THE SAME CALENDAR YEAR cee„, APPROVED BY BOCC Patty Clapper, Cairperson ON b=2 JIa /ck Pitkin County Board of County Commissioners 1 PITKIN COUNTY APPLICATION FOR AMBULANCE SERVICE LICENSE GENIE A .INFORMATT rN Ambulance Service Name: 4h/'4./;7?�ti s Doing Business As: Simi 85 &knvo Office Address: /goy /e 3(o 3f6wn ss asier fD. /G/S- STREET/PO BOX CITY STATE ZIP CODE Office Communications: 923-2Z/2 923 -222y/ suFct& ro/"let VOICE FAX E-MAIL INTERNET ,SFRVICR INFORMATION Service Area; iqu/rWnS$Y//t/Jai/ (47F Service Director: iakani 4. &Tam_ Service Type: PUBLIC X PRIVATE_ BLS X ALS )G EMERGENT )C TRANSFER_ SPECIAL EVENTS Number of Ambulances Licensed: , 7 PHYSICIAN ADVISOR INFQjTAZATION �ysician Advisor Name: ' - ij/,F/) Colorado Licence Number: 37036 Office Address: Di -it/ &si/e Vood_ Pan LJS l� STREET/PO Box C --ice Communications: `i7W-''4/V/--/zz2 VOICE FAX Q I STATE ''/G// ZIP CODE J E-MAIL INTERNET I hereby certify that the information provided in this application is tr a to the best of my knowledge and belief and contains no willful misrepresentation or falsification. Determination that an A,abulance 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 HYSICIAN ADVISOR'S SIGNATURE DATE (FOR EMS COUNCIL USE ONLY) Date Received: // //oz_ Ambulance Permits Attached: 4 - 3 EMS Council Comments: Nolje EMS Council Recommendation: pAss A.(L 3 4 Seav e.e (Antra EMS Council Chairperson Signature: _, 4cJ 6, i/ I/ ov /AME DATE Date Referred to BoCC: BoCC Action: Date: FIT/IN COUNTY APPLICATION FOR AMBULANCE VEHICLE PERMIT SFRVICE INFORMATION Ambulance Service Name:, '1eyyyiys //%swfib�27%llDYl �}�St Office Address: 64(36 idatfrfrig,55 Y Pi (l] 7/6 /f STREET/PO BOX CITY STATE ZIP CODE Office Communications: g43-22/2, 1 3.Sint-P era/nP% VOICE FAX E-MAIL INTERNET 'HICT.E INFORMATION Designation: Mi/i 7 Chassis Year: /Qq q License Plate j4 g'- fl VIN: /6/3Jk31)7 f 6/gsv 17 Make: (/may/ p/ t Type: I )( II _ III _ 4x4: yes _ no �c Insurance Company: ,4v A whuv Policy Number: /ry-/s /o2bzt'3 Expiration: 3-23-0/ Vehicle Location:: �72.7,< CIUL (?,seat Szw';Yi1S V/(q 9-76/6-- STREET/PO BOX CITY STATE ZIP CODE -,:EQUEST FOR WAIVER (include reason for request) SERVICE DIRECTOR'S SIGNATURE DATE Clear CCIC: Clear NCIC: (FOR AMBULANCE INSPECTOR'S USE ONLY) Insurance Card Present: L Registration Card Present: t.-/ Permit Fee Attached tasic Life Support Required Equipment List Attached //BMechanical Condition Certification Attached !/ Advance Life Support Provider Required Equipment Certification Attached Comments/Recommendation: INSPECTOR'S SIGNATURE irvaci 3 PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST SAFETY ROIJIPMENT )( 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. XOne 5 lb. or larger ABC fire extinguisher, accessible from outside the vehicle and having been serviced Xwithin the last year per NFPA 10 Section 4.. Two "NO SMOKING -OXYGEN 1N 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. YOne 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. NA Restraining devices for all items not in a securable cabinet ,S 1tt y cp itafets.d 5Ec:uiel EMERGENCY WARNING EQUIPMENT &Audible warning device (siren) with at least 2 different tones. I j 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 EOUIPMENT -\ Mobile VHF radio with appropriate State, Pitkin County and individual agency frequencies. J ,Mobile UHF radio with appropriate State, Pitkin County, hospital and individual agency frequencies. L./Portable radio with charger and/or cellular phone for back-up communications with dispatch and hospitals. QEDICAL EQUIPMENT AND SUPPLIES Airwa 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. L/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. //&ass pharyngeal airways in pediatric and adult sizes. ropharyngeal airways in pediatric and adult sizes. e 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. c--15-ortable 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. 1- 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•• L.,.--Oxygen masks and cannulas capable of delivering oxygen to adults and infants at flows of at least 1-15 LPM. 1 /41/4 @' 7 PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST MEDICAL FOUIPMENT ANT) STTPPH,IES Diagnostic: t —Blood pressure cuffs in large adult, regular adult, child, infant and neonatal sizes. L./Stethoscopes in adult and pediatric sizes. L—Ftilse oximeter with adult and pediatric sensors. Immobilization & Splinting: (/ One lower extremity traction splint. pper and lower extremity splints of any type (vacuum, air, SAM, wire, board, etc.). ong spineboard, vacuum mattress or equivalent with appropriate accessories to immobilize patients from head to heels. VOne orthopedic stretcher (scoop). //Short spineboard, ICED or equivalent with appropriate straps to immobilize patients from head to pelvis. yP"ediatric spineboard or adult spineboard adaptable to pediatric use. L.---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. / terile burn sheets. //iovidone and alcohol swabs or equivalent. L.—Adhesive tape, including but not limited to, 1" and 2" per agency needs. t/�terile irrigation solution. -ostetri al Supplies: //Sterile OB kit to include: towels, 4x4s, umbilical tape or cord clamps, scissors, bulb syringe, sterile anket and sterile gloves. Silver Swaddler and stocking cap or equivalents. Infection Control: L /Exam gloves in small, medium and large sizes. 1,...Face and eye shields. Fluid -proof gowns with full length sleeves or equivalent. L.."Disinfectant spray or wipes for personnel and equipment. Miscellaneous: t/6ral glucose. L..-Activated charcoal. wavy duty bandage scissors or shears capable of cutting clothing, belts, boots, etc. ,Spill -proof emesis container with at least 1 liter capacity. rsal or separate male and female urinals. Lti-level, wheeled gurney ,Sfair chair or equivalent. f P anent c compartment heater. 2 PITKIN COUNTY ADVANCED LIFE SUPPORT PROVIDER REQUIRED EQUIPMENT CERTIFICATION Ambulance Service Name:D5202jb0e117;(Q&P ,6 K4/6Ambulance Designation: REOUIRED ALS EQUIPMENT �Jl5i72gf 7 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. 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. c. 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, ,i7)(149415,5 7(t4gG h zp4't404 -),$ e1-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." X 7 PHYSICIAN ADVISOR'S SIGNATURE 3704 /1/470/ COLORADO MEDICAL LICENSE NUMBER DATE 4 PITKIN COUNTY VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service Name y,w//yri 6s eke," f /i', i /'e/icv 7GIbindr. License PlateW 737 Ambulance Number: # SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels & Tires x eering %( Alignment 3( Suspension X • Service Brakes 5( Parking Brake 'X Driving Lights Visual Wanting Systems Audible Warning Systems Electrical System �( )xhaust System Fuel System k Glass, Mirrors X Body & Sheet Metal �( % 1, , professing to be a motor vehicle mechanic with training in all of the systems listed above, ve 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. Atavvy I MECHANIC'S NAME • .9anz'i, N,� ir�y�eran fir-1z3 27/t Iz-12.6, AGENCY/COMPANY PHONE NUMBER DATE PITKIN COUNTY APPLICATION FOR AMBULANCE VEHICLE PERMIT $FRVICE INFORMATION Ambulance Service Name: Stiewi Lzks Midg /Sr 414f4 7J/lkaifr Office Address: Adis b ,3/0 Sn01 5 Ygl!7 6o. ?�/�!r TREET/PO BOX CITY STATE ZIP CODE Office Communications: 933 - 2.7n, j`Z,E5-22.4� , j ivy Ore', /- VOICE FAX E-M L INTERNET ;HICLE INFORMATION Designation: Rae/ ? License Plate: K'K-b'/,i ' VIN: /65#1/,5501//kj // 6'/79 Chassis Year: /Q? Make: kny'st12`, Type: I !/j_ III _ III _ 4x4: yes ,mac no Y�_ Insurance Com an q� Z'? P �/iaY✓%lr.�2 PolicyNumber:f/!y/-/A�8"�Z�-3 Expiration:3-23-D/ Vehicle Location:: 5-273" C/uit &i'e / Zl24X's'&zss We! / ad , 8!(B/S, STREET/PO BOX CITY3 STATE ZIP CODE J.EQUEST FOR WAIVER (include reason for request) SERVICE DIRECTOR'S SIGNATURE 'h�ho/4 DATE �. SSSit� so r D ti. m y g IZ ) PQAS c �/, pp SI Yk *`Mctjrl- r p c u5 b S r i s/3//ol IN ECTOR'S SIGNATU POSITION DATff t (FOR AMBULANCE INSPECTOR'S USE ONLY) Clear CCIC: Clear NCIC: Insurance Card Present: X Registration Card Present: X Permit Fee Attached t/ Basic Life Support Required Equipment List Attached //Mechanical Condition Certification Attached Advance Life Support Provider Required Equipment Certification Attached Comments/Recommendation: 51�IMrpS (� r1 /cc £ss e-F �i,;id gfcc, vtJ PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST SAFETY FOUIPMENT 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.` r/ne 5 Ib. or larger ABC fire extinguisher, accessible from outside the vehicle and having been serviced within the last year per NFPA 10 Section 4.. a "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. t of 3 reflective warning devices. Own -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 corn�partment. vRestraining devices for all items not in a securable cabinet •-5 f bW I - tutu / i u EMERGENCY WARNING EQUIPMENT 1 Audible warning device (siren) with at least 2 different tones. 1/ 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 EOUIPMENT '1 ✓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. I/Portable radio with charger and/or cellular phone for back-up communications with dispatch and hospitals. IEDICAL EQUIPMENT ANT) SITPPT,TES Airwap r/ 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 sucti n tip and soft catheter `_suction tip with sizes from 5 Fr. to 14 Fr. V— /7/1-t W/ /95 �1 ,n Bulb Syringe. / r/Nasopharyngeai airways in pediatric and adult sizes. Oropharyngeal airways in pediatric and adult sizes. t/ ite stick or equivalent (oropharyngeal airway). L Fixed oxygen system with a minimum storage capacity of 125 cubic feet (M cylinder) and a minimum Si //Portable oxygen system with a minimum storage capacity of 15 cubic feet (D cylinder) and a minimum elivery capability for three patients simultaneously at flows of at least 1-15 LPM. delivery capability for one patient at flows of at least 1-15 LPM. fant Bag -Valve -Mask with 500cc bag, reservoir and newborn, infant and child masks. Adult Bag -Valve -Mask with 1000cc bag, reservoir and adult mask. l "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. 1 9 PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST MEDICAL EQUIPMENT AND SUPPT,IFS Diagnostic: (/Blyyod pressure cuffs in large adult, regular adult, child, infant and neonatal sizes. !/Stethoscopes in adult and pediatric sizes. ulse oximeter with adult and pediatric sensors. 4 f {a Acp �p , t,�ds-o Immobi ization & Splinting: r One lower extremity traction splint. L.- 1pper and lower extremity splints of any type (vacuum, air, SAM, wire, board, etc.). G-among 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. L.-Pediatric spineboard or adult spineboard adaptable to pediatric use. ✓Adult and pediatric $ized head immobilization equipment for each long spineboard and/or scoop stretcher sanied. ('.s�6� SA- Se r yam,44 :a ✓Rigid cervical immobilization collars in tall adult through infant sizes. Wound Care: t /Bandages, including but not limited to, roller gauze, triangular and elastic per agency needs. ) i/Pressings, including but not limited to, trauma, ABD, gauze, occlusive and bandaids per agency needs. ✓Sterile burn sheets. LiPovidone and alcohol swabs or equivalent. (/Adhesive tape, including but not limited to, 1" and 2" per agency needs. (_Sterile irrigation solution. -oste al Supplies: LZ 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. Infectio-Control: 1/ Exam gloves in small, medium and large sizes. ace and eye shields. (/ Fluid -proof gowns with full length sleeves or equivalent. e/bisinfectant spray or wipes for personnel and equipment. Miscellaneous: ra lucose. cuvated charcoal. eavy 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. j,iiGlulti-level. wheeled gurney l 1/5� it chair or equivalent. J Blankets. iAraiient compartment heater. 2 PITKIN COUNTY ADVANCED LIFE SUPPORT PROVIDER REQUIRED EQUIPMENT CERTIFICATION Ambulance Service Namex S�Iawm155 t4e'Atj hm, Ambulance Designation: !!fl 2 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. 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. 1. 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 /Y/lh,S vvteaz%a- /Qka�j/)13(5/1'<(�•, 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." 3705c I 1.77 PHYSICIAN ADVISOR'S SIGNATURE COLORADO MEDICAL LICENSE NUMBER DATE it PITKIN COUNTY VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service Name: 3/7 lrN,l.55)`%�4174te t, License Plate: e.,481S Ambulance Number: '71 s p . ee h/DYL L94ntir SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels & Tires l� Steering !/ 1j - Alignment 4/ c> %��.r �� {� Suspension �._ C'', .-7// r;�,./ -I -57, _ L / Service Brakes ,.----- i Parking Brake ‘/ O { Driving Lights / - Visual Warning Systems v- (3 Audible Warning Systems t - 6) Electrical System (/ v )xhaust System v CI i Fuel System 67 47 Glass, Mirrors O4- Body & Sheet Metal t ; 7,7 iC - I CMG:', -1/ 4,f , professing to be a motor vehicle mechanic with training in all of the systems listed above, hgve 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 � l/? 970-9`23-S///exf-?av /3�y7, �G✓°' /la�vnGySf � c' d AGENCY/COMPANY PHONE NUMBER ATE PITKIN COUNTY 7 APPLICATION FOR AMBULANCE VEHICLE PERMIT SERVICE INFORMATION Ambulance Service Name: , Y/t'inz1 B5S L/zG,nmt Jj-p 71thelayi #A Office Address: 64(3er) STREET/PO BOX 511SOPOSS CITY STATE $/‘/S ZIP CODE Office Communications: 1X3-x2/L 7Z3-2221 Su/ erot:thd . VOICE FAX E-MluL INTERNEr ;HICLE INFORMATION Designation: meta, T. License Plate: Get 777 ' VIN: /66/k21J/y/c10/04/S Chassis Year: /997 Make: ( y/p/,J Type: I X II _ III VF<S Insurance Company: Alo gin,, Li/ iOh Policy Number: /7m _/,poftlo Z9 - 3 Vehicle Location:: S,Z75�OUJ(&'eAC SeleyyftcS Yale STREET/PO BOX CITY • N EQUFST FOR WAIVER (include reason for request) y0/1VF STATE 4x4: yes LC no Expiration: 3-2347/ 7/6/5— ZIP CODE SERVICE DIRECTOR'S SIGNATURE 7/30// DATE (FOR AMBULANCE INSPECTOR'S USE ONLY) Clear CCIC: Clear NCIC: Insurance Card Present: gistration Card Present: ✓Permit Fee Attached ✓Basic Life Support Required Equipment List Attached 'Mechanical Condition Certification Attached Advance Life Support Provider Required Equipment Certification Attached Commen s/Recommendation: SoNkso INSPECTOR'S SI ATURE- POSMON �Iir)9-7 etc 1-44"5 61 Y4c— 41, 7 PITKIiv COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST SAFETY FOIIPMENT yOne 2-1/2 Ib. or larger ABC fire extinguisher, accessible from the patient compartment and having been serviced within the last year per NFPA 10 Section 4.` 1---One 5 Ib. or larger ABC fire extinguisher, accessible from outside the vehicle and having been serviced � �thin the last year per NFPA 10 Section 4.. l/iwo "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. tAto reflective vest, coat or equivalent for each member of the crew normally assigned. least one "SHARPS" container, clearly labeled and easily accessible in the atient compartment. /Restraining devices for all items not in a securable cabinet .- S.dc.ua - S , F_ M ENCY WARNING EQUIPMENT udible warning device (siren) with at least 2 different tones. ��isual 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. t'Mobile UHF radio with appropriate State, Pitkin County, hospital and individual agency frequencies. V Portable radio with charger and/or cellular phone for back-up communications with dispatch and hospitals. 4EDICAL EOUIPMENT AND SUPPLIES Airway: L/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. i/Vortable suction system with wide bore tubing, rigid pharyngeal curved suction tip and soft catheter suction tip with sizes from 5 Fr. to 14 Fr. — !/— v4e-- t4.1/ /' tlb Syringe. ciNasopharyngeal airways in pediatric and adult sizes. l-Oropharyngeal airways in pediatric and adult sizes. mite stick or equivalent (oropharyngeal airway). L/1 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. t/Isortable oxygen system with a minimum storage capacity of 15 cubic feet (D cylinder) and a minimum elivery capability for one patient at flows of at least 1-15 LPM. L.Infant Bag -Valve -Mask with 500cc bag, reservoir and newbom, infant and child masks c%. Adult Bag -Valve -Mask with 1000cc bag, reservoir and adult mask. w _ss �d . o i 0vr l.at. "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 1 PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST MEDICAL FOUIPMENT AND SIIPPI,iES Diagnostic: //flood pressure cuffs in large adult, regular adult, child, infant and neonatal sizes. //Stethoscopes in adult and pediatric sizes. _ lse oximeter with adult and pediatric sensors. hi ism t.� DcP r ' AA S O ✓" Immobilization & Splinting: I IZ-One lower extremity traction splint. !/tipper and lower extremity splints of any type (vacuum, air, SAM, wire, board, etc.). �tsng spineboard, vacuum mattress or equivalent with appropriate accessories to immobilize patients from head to heels. 1...,.-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. tr.-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: L4andages, 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. GAdhesive tape, including but not limited to, I" and 2" per agency needs. //Sferile irrigation solution. ,ostetrical Supplies: �erile OB kit to include: towels, 4x4s, umbilical tape Or cord clamps, scissors, bulb syringe, sterile blanket and sterile gloves. 1111-ver Swaddler and stocking cap or equivalents. Infection Control: Exam gloves in small, medium and large sizes. Lace and eye shields. ✓Fluid -proof gowns with full length sleeves or equivalent. L..../Disinfectant spray or wipes for personnel and equipment. Miscellaneous: 1/ al glucose. Activated charcoal. ivy duty bandage scissors or shears capable of cutting clothing, belts, boots, etc. /Spill -proof emesis container with at least 1 liter capacity. L_-t iversal or separate male and female urinals. L—Multi-level. wheeled gurney )_ ir chair or equivalent. t/f3lankets. L ltient compartment heater. 2 PITKIN COUNTY ADVANCED LIFE SUPPORT PROVIDER REQUIRED EQUIPMENT CERTIFICATION Ambulance Service Name: flJintMc Vat, I/7/, fD%� ithAsPAmbulance Designation: REOUIRED ALS EOUIPMENT 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. 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. c. 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 l2DuJrysih5 1';/i.L/ 7M/7/horbv7?i , I certify that this ambulance carries the equipment and supplies listed above and nieets 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." SOR'S SIGNATU RE URE COLORADO MEDICAL LICENSE NUMBER lz74.70 DATE PITKIN COUNTY VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service Name YJ,3thrin55 k itifin` /'/i� �/ 1 'dltwi Abird/', License Platek'5W ?S7 Ambulance Number: % SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS I Wheels & Tires eering Alignment Suspension X Service Brakes Parking Brake x Driving Lights 1\ Visual Warning Systems \ Audible Warning Systems X Electrical System x _ xhaust System Fuel System Glass, Mirrors Body & Sheet Metal Y� I, n t4 6k1 (L/ , professing to be a motor vehicle mechanic with training in all of the systems listed above, lave 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. M CHANICS NAME n vie tea 14,11/ AGENCY/COMPANY PHONE NUMBER DATE /9