ED,/ EST. 1883

TRANSMITTAL

BOCC Agenda Item # MEETING DATE: 05/02/2016

Name: Don Angell

Dept : MC SO Emergency Management

STRATEGIC PLAN PRIORITY #:

Date Submitted: 04/25/2016

Phone: 970-252-4043

STRATEGIC BUSINESS PLAN ITEM TO EXPLAIN: Priority # 3 Provide for Public Safety, Priority # 4 Effective & Responsive Government

Discussed with County Manager? ✓ Yes I No Reviewed by County Attorney? ✓ Yes

Included in Current Year Budget? IV Yes 1 No Program is...

ANNUAL EXPENSE: N/A ✓

OR REVENUE: N/A NEW ONGOING TEMPORARY

Additional Employees Required? Yes ✓ Vo Subject to Annual Renewal? T6 7 Yes 1--- No

If so, how many?

Is this a Bid Award? Flies F-1,0 Is this a Grant? ❑ Yes Ive No

County's Match? N/A

Bidders and Bid Amounts

— Attach a Summary of Bids Received

FOR MUNIS ENTRY: Mandatory Information

Org # N/A

Obj # N/A Project Code N/A

What Fiscal Policies and Rules Did You Follow?

All of the required policies and rules

Purchase Amount:

N/A

Reviewed by Procurement? yes Budget Amendment Attached? N/A

Is this to be communicated to the Public? BOCC Review and Discussion w/County Manager

Yes - 4/18/16 @ 1445 I Press Release Editorial Board

I I Newsletter Article I I Other

SUMMARY: This is to allow TransCare Ambulance to trade out one old ambulance and replace it

with a newer unit with less miles on the unit. The new ambulance has been inspected and is ready

for service. All appropriate documentation has been provided and TransCare Ambulance is currently

licensed until 7/1/16 in which they will renew their license.

• insi z r ia. name. mor D scribe col r the

)4Lt. gram

Ae. nd,...other d tinguishing characteristics.

At-

Registered Owne (If differeafrofn ap licant): 71 Address: 47,-:) 3 7.5

Markings on both sides'? Yes

Date ambulance place in service.

No

Montrose County APPLICATION FOR AMBULANCE VEHICLE PERMIT

VEHICLE INFORMATION:

c,O Year. C*1 Make: Model (Type):

Manufacturers I.D. Number (V.1.N.): /41//0/P/M,./157M

Colorado State License Plate Number.

Specific location of where registration and proof of insurance are kept: L__11j.

Does this ambulance meet the r BASIC minimum required equipment list or th SUPPORT minimum required equipment as defined by the State of Colorado? complete the appropriate inventory. t.e. ATTACHMENT Di Basic or D2 Advance

crt, 5k ---4DVANCED LIFE or NO Inspector will

Does this ambulance contain all equipment necessary to perform the level of service as set forth by the protocols of your agency? e-5 If no, please explain:

Is this ambulance maintained on a regular basis and in safe operating condition?

INSURANCE INFORMATION:

&ell: 4.)/e:e— ,,,....._,,,,,

Agent 1) Vef iti.2.,- ' /W. ,c) IC 1,ei 7.-ilg Phone #: i-̀ 7‘) ;72 zi./:, ,,.7,..„2.

Company'

TRANAMB-01 CHRISL

COLORADO INSURANCE IDENTIFICATION CARD

COMPANY NUMBER COMPANY X COMMERCIAL PERSONAL

Arch Insurance Company

POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE

MAPK08381301 04/13/2016 04/13/2017

YEAR MAKE/MODEL VEHICLE IDENTIFICATION NUMBER

2008 International 4300 1HTMNAAM58H644412

AGENCY/COMPANY ISSUING CARD Mountain West In & Fin Sery LLC 100 E. Victory Way Craig, CO 81625

INSURED

TransCare. Inc. dba TransCare Ambulance PO Box 3586 Montrose, CO 81402

BI and PD Coverage Provided SEE IMPORTANT NOTICE ON REVERSE SIDE

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.

ACORD 50 CO (2007/03) ACORD CORPORATION 2006-2007. All rights reserved.

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Montrose County AMBULANCE VEHICLE INSPECTION

LLA 1-k T 1` ‘Nik k-A

Attach Your Comp' Inspection Fora -

MINIMUM EQUIPMENT FOR BASIC LIFE SUPPORT AMBULANCES

Ventilation and Airway Equipment

Portable suction unit. and a house (fixed system) or back up suction unit. with wide bore tubing. rigid 1 pharyngeal curved suction tip. and soft catheter suction tips to include pediatric sizes 6 fr.

through 14 fr. 1 Bulb Syringe

House oxygen and portable oxygen bottle with a variable flow regulator Transparent. non rebreather oxygen masks and nasal cannula in adult sizes and transparent. non rebreather oxygen masks pediatric sizes Hand operated, self-inflating bag-valve mask resuscitators with oxygen reservoirs and standard 15 mm/21mm fittings in the following sizes:

500cc bag for infant and neonate 750cc bag for children 1000cc bag for adult

Transparent masks for infant. neonate patients, child and adult Nasopharyngeal airways in adult sizes 24 fr. through 32 fr. Oropharyngeal airways in adult and pediatric sizes to include: infant. child. small adult. adult and large adult

Patient Assessment Equipment

Cl

Blood pressure cuffs to include large adult. regular adult, child and infant sizes

ftethoscoee

Penlight

Splinting Equipment

Lower extremity traction splint Upper and lower extremity splints Long board, Scoop TM. vacuum mattress or equivalent with appropriate accessories to immobilize the patient from head to heels Short board. K.E.D. or equivalent, with the ability to immobilize the patient from head to pelvis Pediatric seine board or adult se ine board that can be adaeted for eediatric use Adult and pediatric head immobilization equipment Adult and pediatric cervical spine immobilization equipment per medical director protocol

Dressing Material ■ Bandages — Various types and sizes per agency needs and medical director protocol Multiple dressings (including occlusive dressings). various sizes per ambulance service requirements needs and medical director protocol Sterile burn sheets Adhesive tape per ambulance service requirements needs and medical director protocol

Obstetrical Supplies

Sterile OB Kit to include towels. 4 x 4 dressings. umbilical tape or cord clamps. scissors. bulb syringe. sterile gloves and thermal absorbent blanket

Communications Equipment

LOCATION OF VEHICLE/AGENCY

, All communications equipment shall be maintained in good working order. The communications equipment must be capable of transmitting and receiving clear voice communications Two-way communications that will enable the ambulance personnel to communicate with:

1,1.71./G1,e1 , Cal 1 .1.0.1.41 1,.., ...7,I V1 ,1,,

Medical control facility or physician Receiving facilities

i Mutual aid agencies

Extrication Equipment III

Each ambulance should carry extrication equipment appropriate for the level of extrication the ambulance service provides in accordance with the requirements established by the County in which the ambulance is licensed. Body Substance Isolation (BSI) Equipment properly sized to fit all personnel Non-sterile disposable glOVes to include a minimum 41 box of latex free gloves Protective eyewear Non-sterile sursical masks Safety protection gear for extraction consistent with the ambulance service extrication capabilities Sharps containers for and appropriate and storage of medical waste and biohazards

HEPA masks may be universal size

/Safety Equipment ■ A set of three (3) warning reflectors One (1) ten pound (10 lb.) or two (2) five pound (5 lb.) ABC fire extinguishers. with a minimum of one (1) extinguisher accessible from a patient compartment and vehicle extractor i N.,-%.1.,:. -...i=1/4.).->t. Child safety seat or appropriate protective restraints for patients, crew. accompanying family members and other vehicle occupants Properly secures patient transport system (i.e. wheeled stretcher)

Date of Inspection

Date for Re-inspection

INSPECTED BY:

C.)

ler 7 9 I L.

AMBULANCE SERVICE TYPE:

Basic Life Support

Advanced Life Support

Non-emergency

Name

Signature

AMBULANCE SERVICE TYPE:

Basic Life Support

Advanced Life Support

Non-emergency

LOCATION OF VEHICLE/AGENCY

TC a 1ASC-40.--1:*i...

Date of Inspection 9 t 6

Montrose County

AMBULANCE VEHICLE INSPECTION

LA-va 14 1— NA_ R R tek. Li

Attach YOU! Comninter" ALE Insppction Porrr

MINIMUM EQUIPMENT FOR ADVANCED LIFE SUPPORT AMBULANCES 1641/41

/ Basic Life Support ■

'—eVentilation Equipment ■

Adult and . pediatric endotracheal intubation equipment to include stylets and an endotracheal tube stabilization device per Medical Director protocol and endotracheal tubes uncuffed range from 2/5 —5/5 and cuffed size range from 6.0 — 8.0 Laryngoscope and blades. straight and/or curved sizes 0-4

Adult and pediatric Magill forceps

End tidal CO2 detector or alternative device. approved by the DFA for determining ET tube placement

Patient Assessment Equipment ■

Portable battery operated cardiac monitor-defibrillator with strip chart recorder and adult and pediatric EKG electrodes and defibrillation capabilities Pulse oximeter with adult and pediatric probes

Electronic blood glucose measuring device

Intravenous Equipment .

Adult and pediatric intravenous solutions and administration equipment per medical doctor protocol

/ Adult and pediatric intravenous arm boards

Pharmacological Agents ■

Pharmacological agents and delivery devices per medical director

Pediatric "length-based" device for sizing drug dosage calculations and sizing equipment

Date for Re-inspection

do% (

INSPECTED BY: t.4.

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