OPERATOR CASUALTY RESPONSE EXERCISE

STATEMENT OF WORK FOR MEDICAL REQUIREMENTS 1.0 OBJECTIVE: Naval Special Warfare is to offer training courses that will develop the knowledge, skills, and confidence necessary for the military to provide emergency life-saving care to the critically incurred. 2.0 TASK 1: Operational Emergency Medical Knowledge Grand Total: $_________ Course of instructions is intended for FMF (8404) Corpsman who are current medial providers or are field based medical providers supporting High-Risk evolutions. Physicians, Nurses, and PA's with a tactical responsibility with their job descriptions are able to attend. 2.1 Classroom with approximately 55 contact hours will be spent in the classroom for sixteen (16) persons. Subjects will include but not limited to: o Basic Life Support/CPR-HCP o Pharmacology o Standard Medications o Extended Care Transport o Non-traumatic Abdomen o Tactical Combat Casualty Care o Triage o Weapons of Mass Destruction o Environmental Injuries o Allergic Reaction o Ocular Injuries o Pre-Hospital Trauma Life Support o Public Health o Advanced Cardiac Life Support o Pediatric Advanced Life Support 2.2 Skills Labs/TCC scenarios with approximately 20 hours will be spent performing hands-on skills during our - labs and TCCC based training scenarios. Subjects will include but not limited to: o Motor Vehicle Extraction o Confined Space Extraction o Military Operations in Urban Terrain o - Street Medicine o Care Under Fire o Tactical Field Care o CASEVAC o Exfiltration Problems o Convoy Operations o Teamwork in Problem Solving 2.3 Range with approximately 20 contact hours will be spent on the weapons training ranges. Subjects will include but not limited to: o Weapons Familiarization o Gun Handling o Marksmanship o Combat Mindset o Team Maneuver o Field Evacuation o Communication o Roles/Responsibilities 2.4 Place of Performance: Contractor's Site 3.0 TASK 2: Live Tissue Certification Exercise Grand Total: $_________ 3.1 Contractor shall provide three days of didactice live tissue scenarios for up to 100 personnel using TCCC guidelines and live tissue combat injury practical experience. 3.1.1 The training will take place at Fort Irwin on three consecutive days (3 hours per day) for up to 32 participants each day with a student instructor ratio of 4 to 1. 3.2 The Contractor will must have at least one veterinary technician and one physician available to debrief the training for all three days. The physician must be board certified in one of the following specialties by the American Board of Medical Specialties (ABMS): Emergency Medicine, Family Medicine, Internal Medicine, Anesthesiology, or any of the surgical specialties. 3.3 The Contractor will arrange their own food, water, transportation and berthing. 3.4 Each exercise will include briefing on use of live tissue, including equipment familiarization. Contractor/Instructors will teach immediate response procedures including currently fielded hemostatic products. The tactical care exercise will include live tissue ballistic and blast injury casualties incorporated into unit specific tactical scenarios under unit leadership. 3.4.1 Live tissue training and knowledge of ballistic injuries are unique requirements of operator preparation which significantly benefit special operations units. Due to size, muscle distribution, and anatomy, porcine models are the best model for human trauma, particularly in regards to ballistic injury. Incorporating live tissue training into tactical scenarios is the highest standard of casualty response preparedness. 3.5 Description of Work to be Performed: 3.5.1 Management of Hemorrhage - Practical exercises throughout the exercise will enhance operator confidence and understanding of the principles of managing blood loss in the tactical environment. 3.5.2 Airway Management - The focus of this instruction is designed to establish the early recognition and intervention of respiratory distress. The tools available to the operator are limited; however, the management of airway obstruction must not be overlooked in the immediate actions for casualty care. Airway management is the second priority for the management of battlefield casualties and quick recognition of the signs and symptoms associated with obstruction and distress are vital to the immediate outcome of the casualty. Practical exercises are designed to provide the basic skills of airway management with respect to the phases of casualty care, and include the discussion of airway adjuncts and the performance of the various improvised and practiced techniques. 3.5.3 Chest Injury Management - Techniques for the management of life threatening chest injuries are discussed and performed along with the observation and participation in the reduction of a tension pneumothorax injury. The ability to recognize casualties who ar suffering from respiratory distress in the field and provide the competency to perform emergent intervention and subsequent management. 3.5.4 Abdominal Injury Management - The ability to practice and build confidence in the manipulation and treatment of a live abdominal injury is unmatched. The live tissue model provides the feedback necessary for the Special Operator to understand and develop competent skills for the management of abdominal injuries using improvised and practiced techniques. 3.5.5 Combat Injury Management Exercise - This exercise is a culmination of all the previous skills learned. Attendees are presented with the treatment of multiple critically injured patients in the field. Injuries representative of true combat modalities are presented (e.g. ballistic, blast, fragmentation, etc). Emphasis is placed on the immediate management of life threatening injuries and the continued assessment and management fo casualties through out the timeline of casualty care. 3.5.6 Teams and Contractors/Instructors assigned (no more than 4 personnel per casualty). 3.5.7 Casualties down, brushed, cooled, and placed on litter stands. 3.5.8 Contractor/Instructor places neck cutdown IV - demonstrating tissue handling techniques 3.5.8.1 Vital signs and field record 3.5.8.2 Emergency crico-thyroidotomy with IV trocar 3.5.8.3 Surgical crico-thyroidotomy placement 3.5.8.4 Lacerations 3.5.8.5 FAST I Intra-osseous device 3.5.8.6 Hemorrhage control techniques 3.5.8.6.1 Direct pressure 3.5.8.6.2 Israeli dressing / Ace wrap 3.5.8.6.3 Tourniquet 3.5.8.6.4 Quikclot 3.5.8.6.5 Hemcon Dressing 3.5.8.7 Observe subcutaneous emphysema 3.5.8.8 Observe and provide immediate treatment of evisceration 3.5.8.8.1 Control/Dry dressing 3.5.8.8.2 Moist dressing 3.5.8.8.3 Plastic film 3.5.8.9 Create and relieve tension pneumothorax 3.5.8.10 Observe open pneumothorax (sucking chest wound) 3.5.8.11 Treat sucking chest wound 3.5.8.11.1 Seal wound and burp 3.5.8.11.2 Asherman value 3.5.8.12 Observe and provide field treatment for combat wound simulation 3.5.8.13 Re-assess and compare evisceration treatments 3.5.9 All remaining casualties have IV cutdown established. Team tactical scenarios as per Team Leadership (pre-coordinated). 3.5.9.1 Ballistic injury and immediate response, by Team 3.5.9.1.1 9 mm handgun 3.5.9.1.2 AK-47 3.5.9.1.3 Non-military rounds 3.5.9.1.4 .223 (M-16 equivalent) 3.5.9.2 Blast injury (depends on availability of flash-bangs) 3.5.9.3 Contractor/Instructor lead necropsy of wounds and treatments including ballistic wound tracks. 3.6 Deliverables - Contractor shall provide: 3.6.1 Training plan and required Instructors 3.6.2 All required equipment 3.6.3 All supplies not available from unit/local resources 3.6.4 Animals 3.6.5 Veterinary Supervision 3.6.6 USDA approved protocol and Animal Welfare Act Compliance 3.6.7 Disposal of Remains/Hazardous Waste 3.7 Government shall provide: 3.7.1 Available Class VIII medical supplies 3.7.2 Appropriate Range Site 3.7.3 Desired Weapons for ballistic demonstration 3.7.4 Artillery simulators or flash bangs or det cord/devise for blast injury 3.7.5 Onsite coordination and support. 3.8 Place of Performance: 3.8.1 Contractor Site reference Statement of Work paragraph 3.1 3.8.2 Fort Irwin, California reference Statement of Work paragraph 3.1.1 4.0 TASK 3: Combat Casualty Care Grand Total: $_________ 4.1 Contractor will provide Live Tissue Combat Injury Practical at a site local to NSW Group One on three consecutive days for up to 100 participants. 4.1.1 Live tissue exercise will include live tissue use briefing / equipment familiarization, instructor lead practical experience in immediate response procedures including currently fielded hemostatic products. 4.1.2 Tactical Care exercise will include live tissue ballistic and blast injury casualties incorporated into unit specific tactical scenarios under unit leadership. 4.2 Contractor shall provide: 4.2.1 Training plan and required Instructors 4.2.2 All required equipment 4.2.3 All supplies not available from unit / local resources 4.2.4 Animals 4.2.5 Veterinary supervision 4.2.6 USDA approved protocol and Animal Welfare Act Compliance 4.2.7 Disposal of remains / Hazardous Waste 4.3 Government shall provide: 4.3.1 Available Class VIII medical supplies 4.3.2 Appropriate range site 4.3.3 Desired weapons for ballistic demonstration 4.3.4 Artillery simulators or flash bangs or det cord / device for blast / landmine injury 4.3.5 Onsite coordination and support 4.4 Major Learning Objectives: 4.4.1 Management of Hemorrhage - Instruction will provide a review of the hemostatic ladder, starting with the concepts and techniques surrounding applied pressure and finally ending with the discussion of the latest hemostatic agents. Practical exercises throughout this time will enhance operator confidence and understanding of the principles of managing blood loss through the use of the latest pressure dressings, tourniquets and hemostatic agents carried in the field. 4.4.2 Airway Management - Instruction is designed to establish the early recognition and intervention of respiratory distress. The tools available to the operator are limited; however, the management o airway obstruction cannot be overlooked in the immediate action of casualty care. Airway management is the second priority for the management of battle field casualties and quick recognition of the signs and symptoms associated with obstruction and distress are vital to the immediate outcome of the casualty. Practical exercises during this time are designed to provide the basic skills of airway management with respect to the phases of casualty care and so include the discussion of airway adjuncts and the performance of the various improvised and practiced techniques. 4.4.3 Chest Injury Management - Techniques for the management of life threatening chest injuries are discussed and performed along with the observation and participation in the reduction of a tension pneumo-thorax injury. The ability to recognize casualties who are suffering from respiratory distress due to chest injury is a true benefit of live tissue use. This exposure provides the attendees the ability to recognize respiratory distress in the field and the competence to perform emergent reduction and management. 4.4.4 Abdominal Injury Management - The ability to practice and build confidence in the manipulation and treatment of a live abdominal injury is unmatched. The live tissue model provides the feedback necessary for the attendee to understand and develop competent skills for the management of abdominal injury using improvised and practiced techniques. 4.4.5 Combat Injury Management Exercise - This final exercise is a culmination of all the previous skills practiced. Attendees are presented with the treatment of a critically injured patient in the field. Injuries representative of true combat modalities are presented (e.g. ballistic, blast, fragmentation, etc.)** Emphasis is placed on the immediate management of life threatening injuries and the continued assessment and management of casualties through out the timeline of casualty care. ** Activities will require some coordination with the unit to implement. 5.0 Statement of Work Task 2 paragraph 3.0 and Task 3 paragraph 4.0: 5.1 Contractor shall have full time on staff veterinarian to ensure appropriate care and compliance with Animal Use requirements. 5.2 Five years of proven ability to provide this type of training discretely to military and other federal units without incident or adverse reaction 6.0 Training Schedule: Schedule is to be determined (TBD). The Government Representative will coordinate the training schedules with the Contractor Representative. 7.0 Period of Performance: Contract Award through 30 September 2008 8.0 This acquisition incorporates the following FAR clauses: 52.212-1 Instructions to Offerors-Commercial Items (Jan (2004) 52.212-3 Offeror Representations and Certification-Commercial Items (Jan 2004) 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders-Commercial Items (Jan 2004) The following clauses are incorporated by reference in 52.212-5 paragraph (a): Protest after Award (Aug 1996) (31 U.S.C. 3533); paragraph (b) 52.222-6 Equal Opportunity (Apr 2002) (E.O. 11755) 52.222.35 Equal Opportunity for Special Disabled Veterans, Veterans of the Vietnam Era and other Eligible Veterans (Dec 2001) (38 U.S.C. 4212) 52.222-36 Affirmative Action for Workers with Disabilities (Jun 1998) (29 U.S.C. 793) 52.222-37 Employment Reports on Special Disabled Veterans, Veterans of the Vietnam Era and other eligible Veterans (Dec 2001) 52.212-4 Contract Terms and Conditions-Commercial Items (Oct 2003) 52.252-2 Clauses Incorporated by Reference (Feb 1998) DFARS 252.12-7000 Offeror Representations and Certification-Commercial Items (Nov 1995) DFARS 252.212-7001 Contract Terms and Conditions Required to Implement Statutes or Executive Orders Applicable to Defense Acquisitions of Commercial Items (Sep 2004) FAR 52.204-7 Central Contractor Registration (Oct 2003) DFARS 252.204-7004 Alternate A Required Central Contractor Registration (Nov 2003) 9.0 GOVERNMENT REPRESENTATIVES: 9.1 Technical Representative: Paul Contreras NSWG-1 Medical Work # 619-437-2729 9.2 Contracting Officer: Gloria Kelley N41 Naval Special Warfare Work # 619-522-7698