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Home My WebLink Aboutbocc.con.007.2002CONTRACT # 4107- i s' 2- PITKIN COUNTY AMBULANCE LICENSE FOR: MOUNTAIN AMBULANCE MEDIC 15, MEDIC 16, MEDIC 17 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: For winter operation only for transport of basic life support patients to Aspen Valley Hospital for Ski Mountains (Aspen Highlands, Buttermilk, Ajax Mountain and Snowmass) WAIVERS GRANTED: See attached waiver list THIS LICENSE IS VALID FROM: January 1, 2002 UNTIL DECEMBER 31, OF THE SAME CALENDAR YEAR 7 APPROVED BY BOCC Patty Clapper, Chairperson ON Ur 3//3 Pitkin County Board of County Commissioners ZCt / (114,A I PITKIN COUNTY APPLICATION FOR AMBULANCE SERVICE LICENSE GENERAL INFORMATION Ambulance Service Name: Aspen Emergency Services P.C. Doing Business As: Mountain Ambulance Office Address: P.O. Box 5338 Snowmass Village CO 81615 STREET/PO BOX CITY STATE ZIP CODE Office Communications: 379-7892 923-5620 dr•gonfly@sopris.net VOICE FAX E-MAIL INTERNET SERVICE INFORMATION Service Area: Aspen/Snowmass Ski Areas (4) Service Director: Charles Kirsten Service Type: PUBLIC PRIVATE ••• BLS ••• ALS EMERGENT TRANSFER ••• SPECIAL EVENTS Number of Ambulances Licensed: Three (3) (Medic 15 / Medic 16 / Medic 17) PHYSICIAN ADVISOR INFORMATION Physician Advisor Name: John Glismann Colorado License Number: 25302 Office Address: P.O. Box 5338 STREET/PO BOX Office Communications: 923-2068 VOICE Snowmass Village, CITY 923-5620 FAX CO 81615 STATE. ZIP CODE aes(a,rofnet E-MAIL INTERNET 1 hereby certify that the information provided in this application is true to the best of my knowledge and belief and contains no willful misrepr sentation or falsification. Determination that : ' mbulance Service License has been issued based on false informat' n co itut s gr,ORds for license revocation, suspensio operptions : •d possible criminal prosecutio raA iR VICE DIREC R'S SIGNATURE DATE P SICIAN ADVISOR'S SIGNATURE DATI (FOR EMS COU , USE ONLY) EMS Council Comments: U.viv) ,hr t tg MRh ) Date Received: t/ 3 J L'✓ Ambulance Permits Attached: `i t —3 &v' I- c (a irl"' t-*Tr -‘1') Rci�jiPW':1=. �fiilY�ii�.l 1.,J.u.J LA . r EMS Council Recommendation FAA", Nv �.tv�7 r to " fcjt m.%nag L 'Eta_ r-_ EMS Council Chairperson Signature: !J L✓o-twee, NAME DATE � r f73AStCL•, CM. «i pr f•'anatii- To I\sot ‘J:'autay v,Lost},rni •" fAj `a V.l tNio.+NlyAkmi AT Ayo Arl qv V7,-*04 NNa SNkLi wAss Date Referred to BOCC: BOCC Action: Date: 9- PITKIN COUNTY APPLICATION FOR AMBULANCE VEHICLE PERMIT SERVICE -INFORMATION Ambulance Service Name: Mountain Ambulance Office Address: POBox 5338 Snowmass Village , CO 81615 STREET/PO BOX CITY STATE ZIP CODE Office Communications: 379-7892 923 5620 dragonfly(Msopris.net VOICE FAX E-MAIL VEHICLE INFORMATION Designation: Medic 17 License Plate VBS9090 VIN: IGKEV16KOHF529225 INTERNET Chassis Year: 1987 Make: Chevy Type: I _II *** III_ 4x4: yes *** no Insurance Company: Burns & Wilcox Ltd. Policy Number: CA00142209 Expiration: 11/13/02 Vehicle Location: 111 Trauma In Snowmass Village, CO 81615 STREET/PO BOX CITY STATE ZIP CODE REQUEST FOR WAIVER (include reason for request) See attached paperyyd"rk SERXICE DIRECTO}L".:'NATURE DATE -'YZL (FOR AMBULANCE INSPECTOR'S USE ONLY) Clear CCIC: Clear NCIC: t Insurance Card Present: Registration Card Present: Permit Fee Attached • Basic Life Support Required Equipment List Attached 't Mechanical Condition Certification Attached N/A Advance Life Support Provider Required Equipment Certification Attached Comments/Recommendation: I Gs3-eCk INSPECTORS SIGNATURE POSITION DATE 3 PITKIN COUNTY APPLICATION FOR AMBULANCE VEHICLE PERMIT SERVICE -INFORMATION Ambulance Service Name: Mountain Ambulance Office Address: POBox 5338 Snowmass Village CO STREET/PO BOX CRY STATE 81615 ZIP CODE Office Communications: 379-7892 923 5620 dragonfly@sopris.net VOICE FAX E-MAIL INTERNET VEHICLE INFORMATION Designation: Medic 15 License Plate: VBS6522 VIN: S36LHJG6926 Chassis Year: 1980 Make: Ford E350 Type: I I1 *** QI 4x4: yes no ***. Insurance Company: Burns & Wilcox Ltd. Policy Number: CA00142209 Expiration: 11/13/02 Vehicle Location: 111 Trauma In Snowmass Village, CO 81615 STREEriPO BOX CITY STATE REQUEST FOR WAIVER (include reason for request) See attachey1 ape ork 7 ZIP CODE :D T_ NATURE DATE (FOR AMBULANCE. INSPECTOR'S USE ONLY) Clear CCIC: Clear NCIC: /Insurance Card Present: Registration Card Present: Permit Fee Attached 4" Basic Life Support Required Equipment List Attached X Mechanical Condition Certification Attached N/A Advance Life Support Provider Required Equipment Certification Attached Comments/Recommendation: INSPECTORS SIGNATURE POSITION DATE Y kc t� PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST SAFETY EQIJIPMENT fe 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. 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-D cell equivalent or better with spare bulb and batteries or charger. Set of 3 reflective warning devices. nriC2 One reflective vest, coat or equivalent for each member of the crew normally assigned. 1` 4 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. 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. fOMMIJNICATIONS 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 SIIPPI IWS 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. 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 ��t 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** J~ 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 Diagnostic: Blood pressure cuffs in large adult, regular adult, child, infant and neonatal sizes. Stethoscopes in adult and pediatric sizes. t, �.c_41 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.). Long spineboard, vacuum mattress or equivalent with appropriate accessories to immobilize patients from head to heels. wU'vc-L\ 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. 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 bum sheets. Povidone and alcohol swabs or equivalent. Adhesive tape, including but not limited to, 1" and 2" per agency needs. u'Q A. —Sterile irrigation solution. ,ostetrical Supplies: T" 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. Inftion 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: 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 Stair chair or equivalent. Blankets. ��Patient compartment heater. 2 Mountain Ambulance Waiver Request Safety Equipment -Set of three reflective warning devices -Reflective vests etc., -Sharps container Communications Euuipment -Mobile VHF/UHF radio Medical Eouipment and Supplies -Fixed Oxygen System -Infant and Neonatal BP cuffs -Pulse Ox -Scoop Obstetrical supplies -OB kit -Silver swaddler and cap Miscellaneous -multilevel wheeled gurney -Stairchair - Pick up zones are always the same. - daytime operation hours only. - No sharps present. - Aspen Skiing Company Patrol radios (two each ambulance) - Short transport times - Patients not transported - Patients not transported - patients transported in Stokes litter PITKIN COUNTY VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service Name: 1\l -'/k CC VVI ") License Plate: \4'. cit,Cl VAmbulance Number: M I 7 SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels & Tires �%" eering / Alignment j" Suspension ...----- Service Brakes / Parking Brake / Driving Lights Visual Warning Systems Audible Warning Systems .,-- Electrical System / xhaust System / Fuel System / Glass, Mirrors / Body & Sheet Metal I, 'NU.* , 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. S t TY\ AOTz.c‘c/5 (2 0 MECHANICS NAME AGENCY/COMPANY PHONE NUMBER DATE CO INSURANCE IDENTIFICATION CARD IG'TAT) COMPANY NUMBER GC,MPANV Scottsdale Insurance Co POLICY NUMBER EFFECTIVE DATE EXPIRATiCN GATE CACC149287 11/13/2001 11/13/2002 YEAR MAKE/MODE. VEHICLE IDENTIFICATIOt. NUMBER 1921 Suburban 1GKEV16K0HFS29225 AGENCY/COMPANY IESU!NG CARD Talbot Stapleton Agency 981 Cowen Drive Suite H Carbondale, CO 8162S INSURED ▪ Aspen Emergency Services PO Box 5338 Snowmass Village CO 81615 L 6FE IMPORTAIIT NOTICE CD REVERSE CIPE THIS CARD MUST BE KEPT IN THE INSURE[) VEHICLE AND PRESENTED UPON DEMAND IN CASE OF ACCIDENT: Report al! accidents to your Agent/Company as soon as possible. Obtain the following information: 1. Name and address Of each driver, passenger and witness. 2. Name of Insurance Company and policy number rah each vehicle involved. ACM. 50 1ve3) rq ACDAO GOAPORATION 1J83 U Arlk V IrnP11V! Ord in: I. Lf)Cri uIC r, PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST SAF .T-Y EQUIPMENT One 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. One 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.. 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. ----Met of 3 reflective warning devices. wc.4Vtk One reflective vest, coat or equivalent for each member of the crew normally assigned. U a 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. 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. obile UHF radio with appropriate State, Pitkin County, hospital and individual agency frequencies. rtable radio with charger and/or cellular phone for back-up communications with dispatch and hospitals. 4EDICAL EQUIPMENT ANI) STIPP!,IES 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. ortable 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. r----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. Vu" 3l Infant Bag -Valve -Mask with 500cc bag, reservoir and newborn, infant and child masks. Adult Bag -Valve -Mask with I000cc 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. 1 /0 PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST MEDICAL EQUIPMENT AND SUPPI,IFS Diagnostic: "Mood pressure cuffs in large adult, regular adult, child, infant and neonatal sizes. Stethoscopes in adult and pediatric sizes. w'MQJ.Pulse oximeter with adult and pediatric sensors. Immobilization & Splinting: One lower extremity traction splint. r—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. �" -c\ ne 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. �dult 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. Povidone and alcohol swabs or equivalent. -Adhesive tape, including but not limited to, I" and 2" per agency needs. / Sterile irrigation solution. .bstetrical 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. Disinfectant spray or wipes for personnel and equipment. Miscellaneous: i� Oral glucose. T�Activated charcoal. e 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. rMulti-level.wheeled gurney Stair chair or equivalent. — Blankets. ratient compartment heater. 2 Mountain Ambulance Waiver Request Safety Equipment -Set of three reflective warning devices -Reflective vests etc., -Sharps container Communications Equipment -Mobile VHF/UHF radio Medical Equipment and Supplies -Fixed Oxygen System -Infant and Neonatal BP cuffs -Pulse Ox -Scoop Obstetrical supplies -OB kit -Silver swaddler and cap Miscellaneous -multilevel wheeled gurney -Stairchair - Pick up zones are always the same. - daytime operation hours only. - No sharps present. - Aspen Skiing Company Patrol radios (two each ambulance) - Short transport times - Patients not transported - Patients not transported - patients transported in Stokes litter PITKLN COUNTY VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service Name: d'� y v� AIM IM License Plate: U 35 692Lbulance Number: l l / S SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels & Tires i eering / Alignment j Suspension ./ Service Brakes .--- Parking Brake Driving Lights / Visual Warning Systems Audible Warning Systems Electrical System Exhaust System / Fuel System j Glass, Mirrors / Body & Sheet Metal h 1 Lie - CTF--\ , 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. MECHANICS NAME C' y^'`�e,c&arc✓c AGENCY/COMPANY gZ� PHONE NUMBER 11 - Z<1-U DATE l3 CO INSURANCE IDENTIFICATION CARD ISTATEI COMPANY NUMBER COMPANY Scottsdale Insurance Co POLICY NUMBER EEEECTNE DATE EXPIRATION DATE CA00149287 11/13/2001 11/13/2002 YEAR MAKE/MODEL VEHICLE IDENTIPICATI(N NUMBER 1980 Ford Van S36LHJG6926 AGENCY/COMPANY ISSUING CARD Talbot Stapleton Agency 991 Cowen Drive Suite B Carbondale, CO 81623 IIV5URED ''Aspen Emergency Services PO Box S338 Snowmass Village CO 8161S 1. SEE IMPORTANT NOTICE ON REVERSE 610E THIS CARD MUST BE KEPT IN THE INSURED VEHICLE AND PRESENTED UPON DEMAND IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as soon as possible. Obtain the following information: 1. Name and address of each driver, passenger and witness, 2. Name of Insurance Company and policy number for each vehicle involved. ACORO 50 I1B91 81 ACORD CORPORATION 19113 T• d V91T"HI1 IAJIV3J7 i1013 d2i lUHld1 Ntt:Q 0f •E IY PITKIN COUNTY APPLICATION FOR AMBULANCE VEHICLE PERMIT SERVICE -INFORMATION Ambulance Service Name: Mountain Ambulance Office Address: POBox 5338 Snowmass Village , CO 81615 STREET/PO BOX CITY STATE LIP CODE Office Communications: 379-7892 923 5620 dragonfly@sopris.net VOICE FAX E-MAIL VEHICLE INFORMATION INTERNET Designation: Medic 16 License Plate: VBS9987 VIN: 1GDHK34W4DV528867 Chassis Year: 1983 Make: GMC Type: I _II III *** 4x4: yes no *** . Insurance Company: Burns & Wilcox Ltd. Policy Number: CA00142209 Expiration: 11/13/02 Vehicle Location: 111 Trauma In Snowmass Village CO 81615 STREET/PO BOX CITY STATE REQUEST FOR WAIVER (include reason for request) See attached 7 ppperwprk O SER - DIRECTOR NATURE DATE ZIP CODE (FOR AMBULANCE INSPECTORS USE ONLY) Clear CCIC: Clear NCIC:�' Insurance Card Present: ,1 egistration Card Present: a Permit Fee Attached 4C Basic Life Support Required Equipment List Attached Mechanical Condition Certification Attached N/A Advance Life Support Provider Required Equipment Certification Attached Comments/Recommendation: -Tcrs-SCA) ds_ INSPECTORS SIGNATURE POSITION DATE PITKIN COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST SAFF,TY 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 Ib. 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. Wc.;tsQne 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. 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 EOUIPMEN'L •J.:\ 44 Mobile VHF radio with appropriate State, Pitkin County and individual agency frequencies. "v� tvlobile 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. 4EDICAL EQUIPMENT ANI) SI1PPi,IFS 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. 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. n ant 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" J —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 Diagnostic: / Blood pressure cuffs in large adult, regular adult, child, infant and neonatal sizes. / Stethoscopes in adult and pediatric sizes. �.ritiwC,i? 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.). 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. � 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. J e- Dressings, including but not limited to, trauma, ABD, gauze, occlusive and bandaids per agency needs. Sterile burn sheets. Povidone and alcohol swabs or equivalent. Adhesive tape, including but not limited to, 1" and 2" per agency needs. ,- Sterile irrigation solution. .ostetrical 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. r"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. Multi-level.wheeled gurney tapir Stair chair or equivalent. Blankets. Patient compartment heater. 2 Mountain Ambulance Waiver Request Safety Equipment -Set of three reflective warning devices -Reflective vests etc., -Sharps container Communications Equipment -Mobile VHF/UHF radio Medical Equipment and Supplies -Fixed Oxygen System -Infant and Neonatal BP cuffs -Pulse Ox -Scoop Obstetrical supplies -OB kit -Silver swaddler and cap Miscellaneous -multilevel wheeled gurney -Stairchair - Pick up zones are always the same. - daytime operation hours only. - No sharps present. - Aspen Skiing Company Patrol radios (two each ambulance) - Short transport times - Patients not transported Patients not transported - patients transported in Stokes litter PITKIN COUNTY VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service Name: Al (-v� ttv>t tat License Plate: () Eb99%Ambulance Number: 141 — I G SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels & Tires j eering ....--- Alignment i Suspension Service Brakes ----- Parking Brake Driving Lights / Visual Warning Systems ,---- Audible Warning Systems j Electrical System / xhaust System j" Fuel System / Glass, Mirrors .-- Body & Sheet Metal i' IL l? £' .-` T , 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. MECHANICS NAME S y-1 kT"i 1 I -CYI -CA AGENCY/COMPANY PHONE NUMBER DATE lf CO INSURANCE IDENTIFICATION CARD (STATE) COMRANY NUMDEP (DMPANV Scottsdale Insurance Co POLICY NUMBER EFF OTIYE DATE EXPIRATION DATE CA00148287 11/13/2001 11/13/2D02 YEAR MARE/MODEL VEHICLE IDENTIFICATION NUMBER 1983 GMC VAN 1GDRK34W4DV528867 AGGENCV,,r.cMPANY ISSUING CARD Talbot Stapleton Agency 9P1 Cowen Drive Suite B Carbondale, CO 81623 INSURED rAspen Emergency Services PO Box 5338 Sncwmass village CO B1615 L SEE IMPDRTANI NCiCE On newest SIDE THIS CARD MUST BE KEPT IN THE INSURE[) VEHICLE AND PRESENTED UPON DEMAND IN CASE OF ACCIDENT Report all accidents 10 your Acent/Company as soon as possible. Obtain the following 'nformation: 1. Name and address of each driver, passenger and witness. 2. Name at Insurance Company and polity number for each vehicle involved. ADORD 40 11/831 a ACORD CORPORATION 1001 ",ON S "dC1=id'1` 1:161 1 V80: 1 i '.,P, ' E 9°