The URL can be used to link to this page

Home My WebLink Aboutbocc.con.036.2000 CONTRACT # - GIG? PITKIN COUNTY AMBULANCE LICENSE FOR: BASALT & RURAL FIRE PROTECTION DISTRICT MEDIC 41, MEDIC 42, MEDIC 43 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, 2000 UNTIL DECEMBER 31, OF THE SAME CALENDAR YEAR C§ - ) Lof APPROVED BY BOCC Shellie Roy Harper, Chairperson ON Pitkin County Board of County Commissioners Sop 22 99 03: 35p Aspen Ambulance District (970)544-1576 p. 1 APPLICATION FOR AMBULANCE SERVICE LICENSE GENERAL INFORMATION Ambulance Service Name: l3ASA L t c4- "F-f}I_ f AC P(2fl1-V c Tbr► bIST-R is i Doing Business As: 71A S F'R c p E tl Office Address: P-0. %x 8oi TbAsA L; Ca 1 STREETMO BOX MY STATE ZIP CODE Office Communications:(9---to� -"-obw Soy-06 z S— 3 CA i f s tt®-(.fur t tJ I A VOICE PAX E-MAIL Is"m SERVICE INFORMATION _ Service Area F Rf Peo rEz-i-,,•l Service Director: SmE ft%.)4At) Service Type: Pupic ✓ PRIVATE_ K.S. ALS_ZEMEROEM/TRANSFER SPECIAL EVENTS__ Number of Ambulances Licensed 3 PHYSICIAN ADVISOR TNF0RMATI0N I _.hysician Advisor Name: Colorado License Number: Office Address: v<i Gc BOX CITY STATE ZIP CODE (/ .ice Communications: 9 t s. 5o,1 3 9 s r -C � VOICE FAX EMAIL IIPrERidE7 I herby cettify that the Information provided In this application Is true to the best of my knowledge and beiW and contains no willful misrep eatation or falsification.Deteralsation that an Ambulance Service I Jcense has been Issued bated on fsbe f nation to dtutea grounds for leease rew Lion,snspeas10 of dons and possible criminal prosecution. S VI�I=E 'SSIGMTURE DATE 9 ADVISOR':SIGNATURE DATE (FOR EMS COL74CIL USE ONLY) Dace Received: 3 z ,00 Ambulance Permits Attached: tom, — 3 EMS Council Comments: to fl rA1-- EMS Council Recommendation: A SS F%u. 3 A44a sc�nv�c C �.» ,�LA cArorJ EMS Council Chaitrperson Signature:_�i�' -^ CAL t J!+L�c, 3 J z-6 0 NAME DATE Date Referred to BoCC: BoCC Action: Date: Sap 22 99 03t35p Aspen Ambulance District tofu, a."p-aaio p,4 Pt l LRl1T cou l APPLICATION FOR AMBULANCE VEHICLE PERMIT SERVICE INFORMATION Ambulance Service Name: '?AsAL-- 4 2u(ZA` FtRL PRaTFcTto►.; �IsttietcT Office Address: ?•G• fox gul 3h co BIb2 I STREEneo sox CITY STATE ZIP CODE Office Communications:�6-,)O� -404,ob45- -3pq -0,Zs 34 s f,rc 0 ro t"nei ,4bk VOICE FAX E-MAIL rNTERNET `,HICLF INFORMATION Designation; l License Plate: VC-W �9 0 VIN: I Cr 9 H K 3ILINX Pt 7 5 33-f g Chassis Year: f 9 L Make: G M L Type: I-L II_ III— 4x4:yes-Y-1 no Insurance Companr 4/ F I s Policy Number:v ri& c i. Cbo 0rl s- 3 Expiration: I 1 O Vehicle Location: : 70 (s rA o rr 46 `3Ast"l- co e I t.-L I STREET/PO BOX CRY STATE ZIP CODE ---�JPQTTIP,ST FOR WAIVER(inchtde reason for request) &Mgaz - /) SERVKE D1U '; ATtJ?J DATE (FOR AMBULANCE tNMPECTOR'S WK 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: �—• �• �C/,�$l GHQ /}SnFyI /�M'� J7t 1.7U�'�' �t ts�i 3�Z 810 0 OR'S SIGNATURE P xnwN DATES Sap 22 99 03: 35p Aspen Rmbulanca District (970)544-1578 p.3 >+'F f mCOUNTY �• i BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST SAFJaY 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-D all equivalent or better with span bulb and batteries or charger. _ et of 3 reflective warning devices. ✓ e reflective vest,coat or equivalent for each member of the crew normally assigned. t least one"SHARPS"container,clearly labeled and easily accessible in the patient compartment. Restraining devices for all items not in a securable cabinet — Audible warning device(siren)with at least 2 different tortes. �( 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. 1 Mobile VHF radio with appropriate State,Pitkat County and individual agency frequencies. Ir 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. -AEDI('AI.F UIPMF-NT AND SUPP1,109 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. ✓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. 1-- 'Nascpharyngeal airways in pediatric and adult sizes. ✓Oropharyngeal airways in pediatric and adult sizes. ✓bite stick or equivalent(oropharyngeai 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. ✓Po table oxygen system with a minimum storage capacity of IS 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. l ••All mask attachments must be 1Smm•• l ygen masks and cannulas capable of delivering oxygen to adults and infants at flows of at least 1-15 LPM. 1 Sep 22 99 03: 36p Aspen Rmbulenoe District (9701544-1578 p.4 ,Pff"COUNTY BASIC Llll6'E SUPPORT REQUIRED EQUIPMENT LIST MMI A . VQUIPMFn AHD C IPPLIFS Diagnostic: c/Slood 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. Imtnob)ffization &Splinting: ne lower extra pity 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,KID or equivalent with appropriate straps to immobilize patients from head to pelvis. � Pediatric spineboard or adult spineboard adaptable to pediatric use. Aduit and pediatric sized head immobilization equipment for each long spineboard and/or scoop stretcher arced. Rigid cervical immobilization collars in tall adult through infarct sizes. Wound Care: j,,::f8andages, including but not limited to,roller gauze,triangular and elastic per agency needs. Ui_ L`Tessings,including but not limited to,trauma,ABD,gauze,occlusive and ban"&per agency needs- crile burn sheets. —'lovidone and alcohol swabs or equivalent Adhesive tape,including but not limited to, 1"and 2"per agency steeds. fterile irrigation solution. ,bstetrical Supplies: „/Sterile OB kit to include: towels,4x4s,umbilical tape or cord clamps, scissors,bulb syringe,sterile blanket ind sterile gloves. ✓Silver Swaddler and stocking cap or equivalents. Infection Control: ✓Exam gloves in small, medium and large sizes. (race and eye shields. ✓ Fluid-proof gowns with full length sleeves or equivalent Disinfectant spray or wipes for personnel and equipment. Miscellaneous: ✓Ural glucose. ✓Activated charcoal. -7 Heavy duty bandage scissors or shears capable of cutting clothing,belts,boots.etc. ✓pill-proof emesis container with at least 1 liter capacity. Lni versal or separate male and female urinals. Multi-level,wheeled gumey ✓Stair chair or equivalent. j ✓Blankets. ��Patient compartment heater. 2 Avram nspen Hmoulance District (870)544-1578 p;s' f7T1tI1V G`OUNTY ADVANCED LIFE SUPPORT PROVIDER REQUIRED EQUIPMENT CERTIFICATION Ambulance Service Name: rtsr�4-T ARE Dr-r r-, Ambulance Designation: REQ Jj Fn A .c 1RUIJIPMENT l•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. ' kduIt,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 iatubation equipment as authorized in medical protocols approved for this ambulance service. S. Cardiac monitorkde5btillator with printer and adult and pediatric monitoring and defibrillating capabilities as authorized in medical protocols approved for this ambulance service. I. Phumacologieal 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 ASAI-T d Z Rk(_ �iaIE PR1TV-CJNwJ N SI-A%C ,I certify that this ambulance carries the equipment and supplies listed above and mom 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 ADVISOR'S SIGNATU(rE COLORADO MEDICAL LICENSE NUMBER DATE • 4 asp ed 58 03:37p Aspen Ambulance District (970)544-1579 p,g ` r Pi s ti/d4 C00 L I VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service Name:�AsA L: :P,,xx , rrPn License Plate: Ambulance Number: VY)-91 SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels& Tires eenng ` 1, Alignment V NJ+ .q. ; nb i4 NoTe Suspension `v T;��, ► s�. .� Service Brakes PA� W_mg BrakeLiisarnin SystemSystems \ \ —Electrical System $01c o,� 4Lec� (¢ ,':% 1 LJ t System Fuel System �7,�\ . . say ► , .� . ., Glass,Mirrors \ cv.�y Gw11 1 otj< to cw .✓a Body&Sheet Meta[ i, CP4—jbo 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 andlor operability of this ambulance due to conditions beyond my control. 6RA� +JENToJ /�sea,. �iAc �eP� I�it�+��c �92J-SS32 21a)o> MECHANIC'S NAME ACENCY=MPANY PHONE NUMBER GATE Sop 22 99 03: 35p Rspon Rmbuismao District LUYU)aq+-ia-in p,4•yt:.:. 1Pff"CiOM I APPLICATION FOR AMBULANCE VEHICLE PERMIT SERVICE INFORMATION Ambulance Service Name: 'RKpa)) A-pb "A#- C,rz F P?-6T C IZAr) b+sTRw-T Office Address: ?•i,• 4,� Rol RAsft1-T- Co Rlb-2I STREETIP0 Box CRY STATE ZIP CODE Office Communications: 0 10) L4-06"715- =oy I Z f0 T.(*f J II� DICE FAX E-MAIL rNTE 7,HICLE INFORMATION Designation: PA CD I c '4 L License Plate: t/(31 1 u 4 y VIN: I G 6 T- 3`I N It t r 1916 O z_ Chassis Year: 19 q 0 Make: C Ifty Type:I X II_ III` 4x4:yes 2�- no Insurance Compan . VF1S PolicyNtuttber:VFkSC-L oo0e9g5-•3 Expiration: fr I Vehicle Location: : 1089 Tw i)kkvr C&k"aA-LC- co s1(92? STREET/PO BOX CRY STATE ZIP CODE QUEST FOR W T R(include reason for request) o2 oMA:eTOR•;s ATUM Are (FOR AMBULANCE&WECTOWS E39 ONLY) Clcar 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 CommentsRecommendadon: ASS �J �V��KC-�v ASO�y QM3ylla�+c� btJTRQr.DrAE�Iv�t 3't8�'oa INSPECTOR'S SIGNATURE POSITION DATE Sap 22 99 03: 35p Aspen Ambulameo District (970)544-1578 p. 3 f ff"V C011MY M �2Z BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST SSAFFTY FQUIPMENT ✓ 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.. wo'W0 SMOKINO-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. et of 3 reflective warning devices. e 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 FMF.R lPN _Y WARNING .O . P NT ✓' Audible warning device(siren)with at least 2 different togs. �`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 fiont. COMMUIGCATIONS ECI YPiiable VHF radio with appropriate State,Pitkirl Coutrty and individual agency firqueacies. obilewith appropriate State,Piddn County,hospital and individual agency fiequencies. ortable radio with charger and/or cellular phone for back-up communications with dispatch and hospitals. JEDICAI. RQUI_PMFNT AND SUPPL.IF;� "Fixed suction system with wide bore tubing,rigid pharyngeal curved suction tip and soft catheter suction tip witA 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. Nascpharyngeal airways in pediatric and adult sizes. :4-�ropharyngeal 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. i ✓ Infant Bag-Valve-Mask with 500ce 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 camiulas capable of delivering oxygen to adults and infants at flows of at least 1-15 LPM. /f Sap 22 99 03: 36p nspem Hmbulanos District (970 1 544-1S78 p.4 PI l tl//1 col a BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST MEDICAL. FOUiPMFVT AND SUPPLIES Diapastic: J Blood pressure cuffs i e a regular adult,child,infant and neonatal sizes. thoscopes in adult and pediatric sizes. ✓ Pulse oximeter with adult and pediatric sensors. In7bi-lization &Splinting: One lower extremity traction splint. pper 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 maps to immobilize patients from head to pelvis. c/Pediatric spineboard or adult spineboard adaptable to pediatric use. 67 Adult and pediatric sized head immobilization equipment for each long spineboard and/or scoop stretcher carried. i ✓Rigid cervical immobilization collars in tall adult through infant sizes. woun�.Care: /Bandages, including but not limited to,roller gauze,triangular and elastic per agency needs. ,Dressings,including but not limited to,trauma,AHD,gauze,occlusive and bamWdsper agency needs. V Sterile bum sheets. �-7?ovidone and alcohol swabs or equivalent. esive tape, including but not limited to, I"and 2"per agency needs. _Sterile irrigation solution. .ostetrical Supplies: ✓Sterile OB kit to include: towels,403,umbilical tape or cord clamps, scissors,bulb syringe,sterile ,blanket ind sterile gloves. ✓ Silver Swaddler and stocking cap or equivalents. [nfectipn Control: Exam gloves in small, medium and large sizes. GfFacc and eye shields. 4/ Fluid-proof gowns with full length sleeves or equivalent. Disinfectant spray or wipes for personnel and equipment. Miscellaneous: ✓Ural glucose. ✓Activated charcoal. :3%1eavy duty bandage scissors or shears capable of cutting clothing,belts,boots,etc. 'pill-proof emesis container with at least 1 liter capacity. Z- tUiiiversal or separate male and female urinals. �f uiti-level,wheeled gurney ✓,8tair chair or equivalent. -Blankets. Patient compartment heater. 2 Sap a? 93 03: 37p Aspen Rmbulance District (970)544-1578 P-4 ,, Pf fff COUNTY ADVANCED LIFE SUPPORT PROVIDER REQUIRED EQUIPMENT CERTIFICATION Ambulance Service Name: 70SAC i 4 124ieA-L- Gar- f R°-('Er"Ambulance Designation: REQU[ E2 A .0 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 monitor6fibrillator with printer and adult and pediatric monitoring and defibrillating capabilities as authorized in medical protocols approved for this ambulance service. 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'5AsA T 4 avAm. F•Rr PRo ir-c=-florJ Djsi*%c ' ,I certify that this ambulance carries the equipment and supplies listed above and meet;tha 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 S / 3�� ov PHYSICUMO 3 SIGNATURk COLORAW 161EDICAL UCENSE NUMBER DATE asp ee U5 U3: 37p Aspen Ambulance District (970)544-1578 p,g IPffmcow ! I VEHICLE SAFETY AND OPERABILITY CERTIFICATION Ambulance Service Name: r License Plate-OT-f0l Ambulance Number: M'qL SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels& Tires caring Alignment Suspension � Co�� vac fear ,ih acV Service Brakes Parking Bake Driving Lights I �., Visual Waning systenis Audible Warning Systems electrical system t System Fuel System Glass,Mirrors Body&Sheet Metal \, I, lg7Z,A,.., ��s a,a ,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 andlor operability of this ambulance due to conditions beyond my control. 9-Z 5532 2�8)co MECHANXI NAME AGENCY/COMPANY PHONE NUMBER DATE Sap 22 99 03: 35p Hspen Rmbulanea District taiu, a.4dw-rain p.c,,rye;•r, Pff"V V011wy APPLICATION FOR AMBULANCE VEHICLE PERMIT SERVICE INFORMATION Ambulance Service Name: 3asALT -4 1ZwP A%- FcRF Office Address: P•o. L)t 6ci Ilttsr+�T Co 61 L L) ST'REE rtro BOX CRY STATE ZIP CODE Office Communicationskcr)v) -1-04-o& fs- u-i bb'i S K.s f reCC, raf n'r f- ?1/,+ VOICE FAX E-MAIL INTERNEr ',IHICL.E INFORMATION Designation y 3 License Plate: O'"(0-1 VIN: Chassis Year: i 9 Make: FoXo Type:I_ II_ III X 4x4:yes X no_ Insurance Comp&+ y F 15 Policy Ntmtber:v f t s c L CM 6?i s- 3 Expiration: ► i o Vehicle Location: : Z- 1165- �-'Rylotr ffw r-4iN (Ng rel t-fk C4D 6,to 4I- STREETMO Box CITY STATE ZIP CODE TEST FOR WAIVER(include reason for request) Dd salt E RECrOR•; MArt,W DATE (FOR AMBULANCE INSPECTORS tGZ 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 CommentsrRecommendation: OR'S SIGNATURE POS DATE—v Sop 22 99 03: 35p Rspon Ambulance District (9701544-1578 p.3 AIT MCOI TY �13 BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST SAFETY ENT One 2-1/2 lb. or larger ABC fire extinguisber,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 thin the last year per NFPA 10 Section 4.. Two"NO SMOKING-OXYGEN IN USE"signs,one in cab and one in patient compartment. lashlight,2-D cell equivalent or better with spare bulb and batteries or charger. et of 3 reflective warning devices. e reflective vest, coat or equivalent for each member of the crew normally assigned. least one"SHARPS"container,clearly labeled and easily accessible in the patient compartment.Restraining devices for all items not in a securable cabinet LIYARNFNG EQUIPMENT / Audible warning device(siren)with at least 2 different tones. ✓ Visual w#ning devices(lights)with alternating red and/or blue flashing or rotating visible from all sides simultaneously and clear flashing or oscillating visible from front_ TONS EQWMENT Mobile VHF radio with appropriate State,Pitkin County and individual agency frequencies. Mobile UHF radio with appropaate State,Pitkin County,hospital and individual agency frequencies. — Portable radio with charger and/or cellular phone for back-up communications with dispatch and hospitals. -AEDI�FQIJI PMFNT AND SUPPLIES ✓ 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. V-1 Portable suction system with wide bore tubing,rigid pharyngeal curved suction tip and soft catheter uction tip with sizes from 5 Fr. to 14 Fr. Bulb Syringe. Nascpharyngeal airways in pediatric and adult sizes. =ropharyngeai airways in pediatric and adult sizes. zee 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 1 S cubic feet(D cylinder)and a minimum delivery capability for one patient at flows of at least 1-1 S LPM. i 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 caaaulas capable of delivering oxygen to adults and infants at flows of at least 1-15 LPM. 1 Sep 22 99 03: 36p Aspen Ambulance District (9701544-1578 p.4 f7Tm COUNTY BASIC LIFE SUPPORT REQUIRED EQUIPMENT LIST MEDICAL .0,I1iPMF\IT 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. Irnmol1ikzation&Splinting: .�e lower extremity traction splint. per 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. e orthopedic stretcher(scoop). hort spineboard,KED or equivalent with appropriate straps to immobilize patients from head to pelvis. ediatric spineboard or adult spineboard adaptable to pediatric use. Adult and pediatric sized head immobilization equipment for each long spineboard and/or scoop stretcher carried. 1 ✓ Rigid cervical immobilization collars in tall adult through infant sizes. Wound Care: andages,including but not limited to,roller gauze,triangular and elastic per agency needs. _,Dressings,including but not limited to,trauma,ABD,gauze,occlusive and bandai&per agency needs. 'le burn sheets. c/ r 'done and alcohol swabs or equivalent. Adhesive tape,including but not limited to, l"and 2"per agency needs. �terile irrigation solution. .oste 'cal Supplies: Sterile OB kit to include: towels,4x4s,umbilical tape or cord clamps,scissors,bulb syringe,sterile ,k+tanket ind sterile gloves. / S� ilver Swaddler and stocking cap or equivalents. Infection Control: ---'*'Exam gloves in small, medium and large sizes. L.�Facc and eye shields. ✓Fluid-proof gowns with full length sleeves or equivalent. ✓Disinfectant spray or wipes for personnel and equipment. Miscellaneous: ✓Ural glucose. ctivated charcoal. !eavy duty bandage scissors or shears capable of cutting clothing,belts, boots,etc. ill-proof emesis container with at least 1 liter capacity. 1versal or separate male and female urinals. " ulti-level,wheeled gurney l_✓,Stair chair or equivalent. Patient Patient compartment heater. 2 Sep 22 99 03: 37p Aspen Ambulance District (970)544-1578 P•!'l � f'1TJCIJV COUNTY ADVANCED LIFE SUPPORT PROVIDER REQUIRED EQUIPMENT CERTIFICATION Ambulance Service Name:3fttow-F 4-1�go - F+te- A,-,v-c lu j 61s>f``Lzabulance Designation: A3 RFOLIIREn A FnUIPMENT 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 endotraeheal incubation equipment as authorized in medical protocols approved for this ambulance service. S. Cardiac moniWrldefibsillator with printer and adult and pediatric monitoring and defibrillating capabilities as authorized in medical protocols approved for this ambulance service. 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 pertm other procedures as authorized in medical Protocols approved for this ambulance service. As Physician Advisor for 7Ar�T- 4 ?i R-A� F,Ae Isyttc r ,I certify that this ambulance carries the equipment and supplies listed above and meets this 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." 253 S P1tYSIC44 ADVISORS 310NAT URE COLORADO MEDICAL LICENSE NUMBER DATE asp ec as u3:37p Rspen Rmbulance District (9701544-1578 P(1 t81Ls ` OV[7L I VEHICLE SAFETY AND OPERABILITY CERTIFICATION —J Ambulance Service Name: ,jrspr!�T "i R,A,erri FPJ License Plate:V65(oM Ambulance Number: -`f3 SYSTEMS ACCEPTABLE NOT ACCEPTABLE COMMENTS Wheels&Tires cenng �l Alignment Suspension A 6,b Service Brakes `v Parking Brake Driving Lights 1 Visual Warning systerns Audible Warning System Electrical System t 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 ancl`or operability of this ambulance due to conditions beyond my control. A)Boa tee cot �hac ('�ecNwac C12S-iS 37. 2)frL )JECHAN'T'S NAME AGENCY)COMPANY PHONE NUMBER DIATE