Loading...
Res 19-08RESOLUTION NO. 19-08 A RESOLUTION OF THE CI1Y COMMISSION OF THE CITY OF DELRAY BEACH, FLORIDA, REQUESTING FUNDS FROM THE PALM BEACH COUNTY EMERGENCY MEDICAL SERVICES GRANT AWARD PROGRAM FOR FY 2007/2008. WHEREAS, the Delray Beach Fire-Rescue Department represents the emergency medical services interests of the City of Delray Beach; and WHEREAS, the Delray Beach Fire-Rescue Department is requesting funding for FY 2008/2009 through the Palm Beach County Emergency Medical Services Grant Award program for the purchase of four (4) GlideScope Rangers. WHEREAS, the City of Delray Beach Fire-Rescue Department is eligible to receive funds collected by the Office of Emergency Medical Services pursuant to Chapter 401.113, Florida Statutes; and WHEREAS, the equipment to be purchased with these funds will enhance the City's overall emergency medical services operation and improve the delivery and level of emergency medical care provided to the citizens of and visitors to the City of Delray Beach and the entire Fire-Rescue service area; NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF DELRAY BEACH, FLORIDA, AS FOLLOWS: Section 1. The City Commission of the City of Delray Beach is supportive of this initiative to secure grant funds for this service enhancement; and Section 2. That the Mayor of the City of Delray Beach is hereby authorized to execute all documents which are necessary to complete the request for funds from the Palm Beach County Emergency Medical Services Grant Award program. PASSED AND ADOPTED in regular session on this 17`h day of June, 2008. ~~~ ATTEST: A ting Deputy City Clerk MEMORANDUM TO: Mayor and City Commissioners FROM: David C James, Fire-Rescue Chief THROUGH: City Manager DATE: June 11, 2008 SUBJECT: AGENDA ITEM 8.D. -REGULAR COMMISSION MEETING OF JUNE 17, 2008 PALM BEACH COUNTY GRANT/EMERGENCY MEDICAL SERVICES/RESOLUTION NO. 19-08 ITEM BEFORE COMMISSION A resolution of the City Commission indicating support of an application for an Annual Non-Matching Grant from Palm Beach County, Department of Emergency Medical Services. BACKGROUND The Fire-Rescue Department is submitting an application for an Annual Non-Matching Supplemental Grant from Palm Beach County, Department of Emergency Medical Services to purchase four (4) G1ideScope Ranger endotracheal intubation tools. Each unit costs $10,970.00 and they are to be purchased through Verathon Medical, the sole source vendor for this item. The total cost of the G1ideScope Rangers is estimated to be $43,932.00. The total price reflects the cost of the Rangers, six stylet guides, on site training, and one year customer care warranty. This piece of medical equipment is revolutionary for its efficiency in controlling a patient's airway in the prehospital setting. Historically, airway maintenance has been problematic for Paramedics nationwide. Proper maintenance, however, is crucial to survivability. The G1ideScope Ranger was first introduced at the EMS Expo in Baltimore in March 2007. Fortunately, Division Chief Connor and retired Division Chief Moreland were in attendance and were able to speak with not only representatives from the company, but also the founder and inventor as well. The success rates, coupled with its ease of use, has led to this equipment being used throughout Iraq and Afghanistan in Army hospitals. Additionally, it has gradually found its way to Emergency Rooms and Operating Rooms throughout our country for patients who present as a "difficult" or challenging airway. Dr. Randall Wolff, our EMS Medical Director, highly recommends this equipment based upon his personal experience as an Emergency Room Physician. The Fire-Rescue Department currently owns one G1ideScope Ranger, and has had unprecedented success since its inclusion in our inventory. In the first three months of its use, 22 out of a possible 23 patients were successfully intubated in the prehospital setting. This represents a 96% success rate, which well exceeds the national average. RECOMMENDATION Approve a resolution indicating the City's support of this application. RESOLUTION NO. 19-08 A RESOLUTION OF THF_. CII`Y COMMISSION OF THE CITY OF DELRc1Y BEACH, FLORIDA, REQUESTING FUNDS .FROM T.HE PALM BEACH COUNTY EMERGENCY MEDICAL SERVICES GRA1~T'T AWARD PROGRr'1M FOR FY 2007/2008. WHEREAS, the Delray Beach Fire-Rescue Department represents the emergency medical services interests of the City of Delray Beach; and WHEREAS, the Delray Beach Fire-Rescue Department is requesting funding for FY 2008/2009 through the Palm Beach County Emergency Medical Services Grant Award program for the purchase of four (4) GlideScope Rangers. WHEREAS, the City of Delray Beach Fire-Rescue Department is eligible to receive funds collected by the Office of Emergency 1Vledical Services pursuant to Chapter 401.1.13, Florida Statutes; and WHE1tEAS, the equipment to be purchased with these funds will enhance the City's overall. emergency medical services operation and improve the delivery and level of emergency medical care provided to the citizens of and visitors to th.e Cite of Delray Beach and the entire Fire-Rescue service area; NOW, 'THEREFORE, BE IT RESOLVED BY THT1 CITY COMMISSION OF THI; CITY OF DF3LKA1' BEACH, FLORIDA, AS FOLLOWS: Section 1. The City Commission of the City of Delray Beach is supportive of this initiative to secure grant funds for this service enhancement; and Section 2. That the Mayor of the City of Delray Beach .is hereby authorized to execute all documents which are necessary to complete the request for funds from the Palm Beach County Emergency Medical Services Grant Award program. hASSED AND ADOPTED in regular session on this the _ day of June, 2008. MAYOR A•rrES•T: City Clerk DEPARTMENT OF PUBLIC SAFETY DIVISION OF EMERGENCY MANAGEMENT OFFICE OF EMERGENCY MEDICAL SERVICES PALM BEACH COUNTY EMS GRANT AWARD APPLICATION PRIMARY GRANT REQUEST Note: The total for all your primary requests must not be more than $50,000.00. 1. Organization: Delray Beach Fire-Rescue Department Authorized Official: David C. James Title: Fire Chief Alternate Official: N/A Title: N/A Mailing Address: 501 W. Atlantic Avenue Delray Beach, FL 33444 Telephone: 561-243-7410 FAX: 561-243-7461 2. Authorized Contact Person: Danielle Connor Title: Division Chief - Emerr~ency Medical Services Mailing Address: 501 W. Atlantic Avenue Delray Beach, FL 33444 Telephone: 561-243-7440 FAX: 561-243-7461 3. Agency's Legal Status: City/Municipality 4. First Responders: Please attach a copy of your Memorandum of Understanding (MOU) with a licensed provider . If you do not Piave a MOU, attach documentation that you made reasonable efforts to get one, that you cooperate with the provider, or that you requested but did not receive a response from the providers in your area. 5. Your Federal Tax ID Number: VF 59-6000308 6. Identify the EMS county plan goals this project will accomplish in whole or in part. A copy of the goals is attached to this application. 2D: Identify and implement new technology and procedures into the EMS system to improve patient outcome. This does not apply to specialized response units. 7. Communications Projects: All grant applications which involve communications equipment and/or services, in total or in part, will be reviewed by the State of Florida Division of Information Technology. FINAL APPROVAL MUST BE OBTAINED PRIOR TO ANY PURCHASE COMMITMENT. Copy of approval from the State must be submitted to the County EMS Office with request for reimbursement. PRIMARY EMS GRANT AWARD APPLICATION ORGANIZATION: Delray Beach Fire-Rescue 8. Background: Describe your agency, its operations, and how it relates to other EMS agencies in your area. Also, provide a description of your major resources including the number of employees, vehicles, and equipment. The Delray Beach Fire-Rescue Department responds to all calls for assistance within the City of Delray Beach and contracted areas of the Town of Gulf Stream and Town of Highland Beach. These services include fire suppression, special operations, fire prevention and safety, CPt2/AED training to the public, injury prevention, disaster response and emergency medical services includi~ig ALS and BJLS transportation. We began our EMS service in the 1950's providing basic first aid, evolving into the paramedic level of service~in 1979. Currently, we provide first response medical assessment and treatment at the advanced life support level and transportation to local hospitals, vicluding stroke and trauma centers. Additionally, we employ mutual aid agreements with all neighboring agencies. Our annual budget is 522.4 million. We have 154 full time employees. We opeA•ate six (6) paramedic rescue vehicles with (3) in reserve for back-up and maintenance, all with cellular phone capabilities. Our remaining fleet consists of seven (7) Engines, three (3) Aerial Trucks, one (1) Brush 'f ruck, one {1) Special Operations Truclc, one (1) Tanker, two (2) Command vehicles, two {2) Special Events Response Vehicles (SERV), one (1) Public Education unit, twelve (12) staff cars for a total of thirty-eight {38) units. Other resources are provided under an existing countywide mutual aid agreement. 9. Grant History: Briefly describe your current and previous grant awards for the past three years. Explain how this application does not conflict or duplicate them. ~ In the past three (3) years, Delray Beach ire-Rescue has received grant awards that enhanced our medical equipment and response including Stryker Power Cot Stretchers, AED's, ALS upgrade for Fire Suppression vehicle {Engine), Capnography upgrade for our Zoll M Series Defibrillator/Monitors, and a new SERV unit with At_,S package. This application that is presently being submitted is not in conflict with these previous giant awards, nor does it duplicate them. PRIMARY EMS GRANT AWARD APPLICATION ORGANIZATION: Delray Beach Fire-Rescue 10. Project Need Statement: Write a clear,. concise statement describing the need(s) addressed by this project. This must include: 1} numeric data; 2} time frame for the data; 3) source of the data, and; 4} the involved target population and geographic area. In addition to providing basic life support (BL5), D13h'R provides advanced life support (ALS) with minimal risk to patients whenever possible, The main field indications for ALS are severe trauma, cardiac arrest, disease pathologies, and other causes of coma. Airway management is a challenging issue for ]EMS personnel. During endotracheal intubation (ETT), getting the clearest view possible of the larynx and vocal cords secures accurate placement and enhances intubation success rates. While endotracheal intubation (ETT) continues to be considered the gold standard for ensuring oxygenation, ventilation and protecting lungs from gastric contents and blood, difficulties typically occur in 7%-1.0% of prehospital cases. Moreover, ETT is a difficult skill to acquire and maintain, especially without neuromuscular blocking agents (NM}3As) or paralytic agents, which may contribute to higher success rates. Errors can occur in around 22% of prehospital intubation cases and risk of. esophageal intubation is higher when NMBAs are not used. Complications arise when inexperienced EMTs and paramedics undertake ETT. However, paramedics generally perform ETT in out-of-control, chaotic and stressful settings in which it can be difficult to secure a.n airway and that compromise intubation success rates when using a tz•aditional laryngoscope. These complications make it difficult to get a clear view of the larynx and vocal chords and can contribute to poor outcomes for pre-hospital ETT. Complications include: • Severe trauma • Head trauma • Unconsciousness • Cases involving children In severe or head trauma cases, blood or other secretions in the upper airway may make it difficult to visualize the glottic opening and increase the risk of infection. In cases where cardiac arrest has occurred, it may be difficult to manipulate the head and neck. Moreover, these complications may also rule out alternative approaches to airway management such as awake or drug-induced intubation. In such cases, unrecognized esophageal placement is more likely-which can be fatal. In such settings, airway management needs to be supported by the best possible techniques, training and interventions. Research has shown how difficult it can be to acquiz•e reliable data about prehospital intubation outcomes-for instance, whether outcomes differ according who is intubatiog, where the intubation takes place, under which. circumstances (e.g. cardiac arrest, trauma}, and which techniques are used. Nonetheless, clinical studies report that in emergency out-of- hospital incubations, up to 25% of endotracheal tubes are misplaced, with 66% of misplaced tubes being inserted into the esophagus. In a study of patients with severe head injuries undergoing endotracheal intubation, the odds of death were approximately Q times greater for patients intubated outside the hospital. One recent study compared prehospital ETT patient and EMS characteristics and concluded that while it is generally agreed that it is especially challenging to intubate in prehospital settings, there is an absence of good research to show whether paramedics are better or worse than other personnel. Indeed, for such an error prone area, prehospital intubationts relatively under researched. Nonetheless, research shows that prehospital attempts at intubation often require multiple attempts that have the potential to compromise outcomes. Moreover, traditional laryngoscopes have been used for placement of endotracheal tubes in the practice of anesthesia for over one hundred years and they remain the instruments most used by EMS providers in pre-hospital situations. Ylowever, alternate airway devices may contribute to better outcomes. For instance, a recent field study observed some success in using a King LTD non-visualized airway after three failed intubation attempts or where EMS personnel initially felt that endotracheal intubation would be difficult. Accordingly, airway instruments have been developed that are specifically designed to improve line of sight and visualization. There is some evidence that new fiber optic and video technologies have value in prehospital intubation, because they minimize the likelihood of poor outcomes by optimizing visualization, reducing the risks of esophageal intubattons, and limiting the potential for procedural errors. Fiber optic video laryngoscope uses a fiber optic camera to display an unobstructed view of a patient's airway and provides a live, color view of the entire airway. It is designed to provide real-tune, reliable visualization during iuntubation and ease of tube access through the oropharynx. According to data provided by DBFR Dispatch CAD and EMS Patient Care Reports, during the fiscal year 2007 DBFR responded to 9688 EMS calls and transported 5891 patients to medical facilities. At this time, DBFR deploys six rescue trucks with one supervisor who is available to attend cardiac and respiratory arrest and potentially difficult airways, who is trained in the use of paralytics and AI.,S. On average, DBFR has averaged 58 intubations per year (61 in 2007) with a success rate of around 60%. Since November 2007, DBFR has been using fiber optic laryngoscope to support 'intubation for cardiac arrest patients. .This instrument was purchased through local fundraising after our Medical Director used it successfully. Current available data suggests that since DBFR began using fiber optic laryngoscope to support intubation for difficult airways, intubation success rates have risen to nearly 100%, especially in circumstances where anatomical and circumstantial difficulties have complicated intubation efforts. Our goals are: To increase the number of successful outcomes from prehospital intubation ® To reduce on-site times ~ To reduce tube misplacement ° To transport patients to hospital more quickly To improve mortality and morbidity outcomes The suburban coverage area is 3.75 square miles for first due response. The jurisdiction is comprised of 75% residential, 22% commerciaUindustrial and 3% wild Iand, undeveloped. The permanent resident population is 64,095. The community that DBFR serves is one in which over 30% of the population is over the age of 65 and for whom the likelihood of cardiac and/or respiratory problems is high. In addition, demand for our services peaks during the winter months when the population swells with a predictable seasonal influx (so-called snowbirds). 11. Project Outcome Statement: Write a concise quantifiable statement describing the, degree to which the need(s) will. be changed by the project. This. must contain the same four characteristics as the need statement and indicate the evaluation methods used to measure the efficiency and/or effectiveness of the project's outcome. Our proposed solution is to place fiber optic laryngoscopes in all six response vehicles and train our paramedics to use this instrument. Routine use of this instrument for cardiac and respiratory arrest will reduce on-site time, improve site to hospital transportation time, and reduce complications. More important, it will improve patient outcomes and proportionately increase the chance for return of spontaneous circulation of cardiac arrest patients. The number of patients successfully incubated with the Glide Scope will be tracked and compared against statistics from previous years. Additionally, on scene times for cardiac and respiratory arrests will be analyzed. Effectiveness will be measured by improved success rates with prehospital intubation. PRIMARY EMS GRANT AWARD APPLICATION ORGANIZATION: Delray Beach Fire-Rescue 12. Major Activities and Time Frames: If grant is awarded, you must follow your schedule. If, for some reason, the schedule cannot be followed, please advise the EMS Office of the activity change. Please indicate time frame as 1St quarter, 2nd quarter, 3rd quarter, 4tn quarter and fill in the year. First Quarter = October 1 through December 31 Second Quarter = January 1 through March 31 Third Quarter =April 1 through June 30 Fourth Quarter = July 1 through September 30 Activit Order Glide Scope Rangers Conduct in-service training and education on use, pnaintenance, and proper cleaning of equipment Implement new equipment into inventory and begin use Analyze intubation success rates, on scene times, and effectiveness of ,equipment Time Frames li first Quarter Second Quarter 'T'hird Quarter fourth Quarter PRIMARY EMS GRANT AWARD APPLICATION ORGANIZATION: Delray Beach Fire-Rescue 13. Budget: The applicant must submit a written price quote for each line item. For equipment include, the cost per item, quantity, and cite vendor information. For each type of position, include the pay per hour, number of hours, and cost of each benefit. For expenses, include unit costs (if rental, give the cost per square foot). Items/Quantities and Positions/FTEs Cost Per Unit Total (Se® Attached) (4)Four GlideScope Rangers $10970.00 $43,880.00 Shipping/Handling $ 52.00 Total $43,932.00 PRIMARY EMS GRANT AWARD APPLICATION ORGANIZATION: Delray Beach Fire-Rescue 14. Medical Director's Approvals: These are required for all projects which involve professional education, medical equipment,' or both. (1) Professional Education: All continuing education described in this application will be developed .and conducted with my input and approval. Medical Director: Printed Name: signature Date (2) Medical Equipment: I hereby affirm my authority and responsibility for the use of all medical equipment in this project. Medical Director: ~ ~~~ G.1 L signature Date Printed Name: Randall Wolff, M.D. 1S. Resolution: A resolution from the Governing Board(s},i.e. City Commission, Town Council, Board of Directors, etc. is required once the Grant is awarded and before the purchase of any items. This resolution will certify that monies from the EMS County Grant Award will. (1} Improve and expand prehospital services in that coverage area. (2) Will not be used to supplant existing provider's budget allocation. (3} Meets the goals and objectives of the EMS County Grant Plan. 16. Certification: I, the undersigned official of the previously named entity, certify that to the best of, my knowledge and belief, all information contained in this application and its attachments are true and correct. I understand my signature acknowledges that I will comply fully with the State Bureau of Emergency Medical Services' and Palm Beach County's Rules and Regulations governing the administration of the State of Florida Emergency Medical Services Grant Program for Counties. ~ f~ r , Authorized Official: P zgna ~ ~ ~~ Da e Printed Name: David C. James Tit.~e: Fire Chief .~ ~°'~1' 20001 Norkh Creek Parkway Bothell, WA 98011 1 840-331-2313 1 425-867-1348 1425-883-2896 Tax Sales Agreernen~ Date: 5/16/2008 ~ Acute, Dept. O Extended Care € x Other_PreHospital Facility^ ^ Primary Care i O Urology Verathon Inc. Use Only Sales Order #: #: 780820 Incident #: _ Sales Rep: Darren Cruz - Rep. #: 1505 Note: 310163 Bitting Address ____ Company: City of Delra Fire Rescue Shipping Address Company: Same as Bilking , Purchasing Contact: Danielle Connor #Dept.: Fire Rescue i End User: Dept.: ~ ~~~ IAddress: 501 W. Atlantic Ave - Address: i ~ City: Delray Beach State: FL County: Zip: 33444-2555. {Tel.: 561-243-7442 Fax: Cify: County: Tel .: Fax: State: Zip; j { E-mail Address: Connor ci.delra -beach.fl.us tE-mail Address: 1. ( t Quanti Part Number Description G Unit Price Extended Price 4 4 0270-0374 GlideSco e Ran er Sin le Use S stem * Includes Ran er GVL Sco e f '~ Includes Std First Yr Cust Care Wart Included ; 4 0803-0005 St let Guide (Pre-Sha ed 6 er pack Included ` p 4 0900-0425 On-Site In-Service Training Included j Subtotal: $ 10,970.00 $ 43,880.00 ~ $ - i O Trade In Modei # Unit SIN: Probe SIN: S -~ i * ScanPofnt~relfant units (6x00 series) require annual renewal of ScanPofnt® plan. Buyer's Initial: Payment Information _.___._-_..______ k Subtotal $ 43,880.00 0 Credit Card X Invoice Shipping/Handling: $ 52.00 i Customer Purchase Order #: _ Total $ 43,932.00 + Tax S ecial Stii in Instructions: ~ i Tax Exempt?: 0 YES (supply certificate) X NO Buyer's Initial: 0003-0111-14-01 ti M. Evans Sales Agreement '~~ Page 1 of 2 This Sales Agreement (this "Agreement's is entered into as of the date written above (the "Effective Date"} by and between Verathon Inc.. ("VerathonT'^ and ("Client°). VerathonT"' and Client acknowledge and agree to be bound by this agreement, Including the Terms and Condftions of Sale on page 2. The parties have caused this Agreement to be executed below by their authorized representatives. The parties agree that a facsimile or electronic copy of this Agreement will be treated in all res acts as the orl Inal. Order Confirmation: This Sales Agreement (the "Agreement') constitutes a binding and enforceable contract by and between Verathon Inc.. ("Seller") and the above customer ("Buyer"). 5ellet's acceptance of Buyer's order is expressly cond'Rioned upon Buyer's assent to these terms and conditions to the exclusion of any additional or different terms or condlflons, which assent shalt be presumed conclusively from Buyer's failure to timely object to writing or from Buyer's acceptance of any of the product ordered. No modification of any provision will 6e valid unless set forth in writing, signed by bofh parties. Seller and Buyer agree a facsimile or electronic copy of this Agreement will be treated in all respects as an original. Delivery: Delivery is FOB Bothell, Washington, USA. Title and risk of toss pass to Buyer upon tender to carcter; provided, however, Seller reserves a purchase money security interest In the product and any accounts receivable, general intangibles or proceeds arising from the sale, license or other disposition there from, until the entire amount due Seller for the product has been paid in foil. Buyer agrees to pay reasonable shipping costs. Seller will not be liable for any decay or failure to deliver resulting from conditions beyond Seller's reasonable control orwhich would cause Seller to Incur unreasonable expense. Terms of Payment: Upon each shipment, Seller will Issue an invoice to Buyer. If deemed necessary by Seller, partial shipments shall be made and invoiced at their value..Buyer agrees to accept partial shipments. Payment terms are net thirty (30) days from the date of the invoice, and any outstand(ng balance shall bear Interest at a rate of one and one-half percent (1.5%} per month. All payments shall be in United States dollars. Seller may change its credit terms and/or suspend performance under any order when, in the opinion of Seller, Buyer's financial condition or record of payment so warrants. Taxes: Buyer agrees to pay any and ail sales, use, excise, personal property and any other tax related to the sale of the product, even if such amount Is not included In the invoiced amount. If Seller pays any tax on Buyer's behalf, Buyer agrees to reimburse Seller for any such payment. Washington Law: This Agreement shall be construed, enforced and governed by the laws of the State of Washington, without reference to conflicts of laws provisions. Venue for any action brought to Interpret or enforce any provision of this Agreement shall be in the state or federal courts situated in King County, Washington. Each party agrees that such courts shall have exclusive iurisdiction over env such suit. and each party hereby submits to such iurisdiction. Warranty: Buyer may return the product for a full refund at any time during the first thirty (30} days following the date of invoice ("Warranty Period"). Buyer shall not he entitled to a refund after the Warranty Period. The product must be returned to the address below and must. reference a retum authorization number issued 6v Customer Cara Department Verathon Inc. 20001 North Creek Parkway Bothell. WA 98011 1 800-331-2313 THIS WARRANTY IS GIVEN BY SELLER WITH RESPECT TO THE PRDDUCT IN LIEU OF ANY OTHER WARRANTIES, EXPRESS OR IMPLIED. SELLER DISCLAIMS ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. BUYER'S RIGHT TO RECEIVE A FULL REFUND PURSUANT TO THE TERMS OF THIS AGREEMENT SHALL BE THE SOLE AND EXCLUSIVE REMEDY PROVIDED TO BUYER FOR BREACH OF THIS WARRANTY. IN NO EVENT SHALL SELLER BE LIABLE TO BUYER OR ANY OTHER PARTY FOR EXEMPLARY, INCIDENTAL, INDIRECT, SPECIAL OR CONSEQUENTIAL DAMAGES OF ANY KIND ARISING OUT OF THIS AGREEMENT OR THE RELATIONSHIP OF BUYER AND SELLER. For US $1,000.00 deductible, or the local currency equivalent, a Client owned ScanPoint® scanner (6x00 series} will be replaced with a new scanner if it is rendered inoperable as a result of an accidental drop, The US $1,000.00 deductible charge can be applied on an unlimited basis per scanner. Scanners dropped the first time or multiple times are included. It is not the policy of Verathonr"" or its wholly owned subsidiaries to replace scanners, accidentally dropped, with no deductible fee or charoe. For additional terms and conditions. ofease refer to your ScanPointC~ product. Problems with aClient-ovmed computer, network or programs instatied therein are not included in this warranty. Verathon Inc. will service such problems for an additional fP.P. Indemnlftcatlon; Attorneys' Fees: Buyer agrees to indemnify and hold Seller harmless against all claims, damages and attorneys' fees arising or otherwise in relation to, or resulting from the installation, maintenance or operation of the equipment. (f any legal action or other proceeding is brought for the enforcement or interpretation of this Agreement, the successful or prevalling party shalt be entitled to recover reasonable attorneys' fees and costs, in addition to any other relief to which it maybe entitled, including those incurred on appeal or in bankruptcy proceedings. Waiver; Severability: The Failure of Seller to enforce any provision of this Agreement shall not constitute a waiver of such provision. If any provision of this Agreement Is held to be invalid, illegal or unenforceable in any respect, then that provision shall be amended to achieve as Heady as possible the same economic and practical effect as the original provision and the remaining provisions of this Agreement shall in no way be affected. Assignment; Successors: Buyer may not assign or otherwise transfer its rights or obilgatfons under this Agreement without the prior written consent of Seller. No attempt to assign or transfer in violation of this provision will be binding upon Salter. This Agreement is binding upon and enforceable against any successor or permitted asslon, Seller's Acceptance Printed Name rtue Signature Date Suyer's Acceptance & Agreement Prin d Name Title gnature Dato 0003-0111-14-01 M. Evans Sales A i'eement Pa e 2 of 2 G~~de~ca~e® ~vle ~aurce ~e~d~~ Lette~° `: Document# ~9o0°~ZJ t°4J~7°o 1 i/EIRAT~fal`~ ` ; .. Title GlideScope® Sole Source Vendor Letter This document and the {nfonnation herein aze proprietary to Verathon lnc and shall AUthOf .~. McNerney ECN # 5821 not be reproduced ar disclosed in whole or pazt without the express written permission Refer to MasterControi for Electronic Approval Signatures Date 04/10/2008 of Verathon fnc. Porm 0005-0011-08-92 Security Public Pag®1 of 2 ©2002-2008, Verathon Inc. May 16, 2008 To Whom It May Concern: From: Verathon Inc. and Verathon Medical(Canada} U.L.C. RE: Sole Source Certification GlideScope®products and services from Verathon Inc. and Verathon Medical (Canada) U.L.C. are patented under the following numbers and countries: USA 6 142,144 __ USA 6 543,447 USA ___ _ 6 655377 International Patents Pendin This patent protection causes the following products to be exclusively supplied as Sole Source items by Verathon Inc. and Verathon Medical (Canada) U.L.C.: GlideSco e® Tortable GVL®S stem 0270-0315 0270-0317 0270-0320 GlideSco e® Classic GVI.~_ System _ 0270-0323 0270-0324, 0270-0325 0270-0326 GlideSco e® Classic Lo-Pro 0270-0328, 0270-0329, 0270-0330 0270-0331 GlideSco e~ Classic Standard Adult 0270-0333 0270-033b GlideScope® Portable Standard Adult 0270-0338, 0270-0341, 0270-0344_ GlideSco e® Portable Standard Adult with G1ideRite K.it 0270-0351., 0270-0352 0270-0353 GlideScope®~ Ran er S stem 0270-0374 GlideSco e~ Cobalt sin le-use 0270-0382 GlideSco~e~ _____ Ran er Sl.n le-Use ___ 0270-0420 GlideSco e® GVL® Lar e S stem 0574-0001 GlideSco e® GVL Mid-Size S stem ~ 0574-0007 GlideSco e® _ _GVL® Small System 0574-0010 ___ ~______________ GlideSco e® GVL® Ran er 05740018 Thank you for your consideration of our unique application specific devices. Sincerely, ~eraCd .~V~c~Ylorrow Gerald McMoirow CFO, Chairman and Founder © 2002-2007, Verathon Inc. All rights reserved. 0900-1231-02-01