Information
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Perrysville VFC - QRS Inspection
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Vehicle Bag
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Document No.
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Conducted on
Vehicle/Equipment
Vehicle/Equipment:
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Vehicle Inspection Valid
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Vehicle Insurance Valid
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Vehicle Registration Valid
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No Smoking/Oxygen Equipped Sign in Cab
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Fasten Seat Belts Sign in Cab
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High-visibility Safety Apparel <br>(1 per crew member)
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Blankets (2)
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Fire Extinguisher <br>(5# ABC dry chem or CO2) (Current Insp.)
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Radio Equipment Operational (meets regional comm. requirements)
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Current Version Statewide EMS Protocols
Infectious Control Kit: *Disposable - one set/pair per responding crew member:
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Exam Gloves*
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Eye Protection - Clear & Disposable*
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N-95 Respirator Mask*
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Gown/Coat*
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Surgical Cap*
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Foot Coverings*
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Red Bags <br>(per infectious control plan)
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Sharps container <br>(per infectious control plan)
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Hand Disinfectant/cleaner
Pediatric Kit:
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Pediatric Stethoscope
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Infant Bag Valve Mask Device <br>(450cc)
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Neonatal Bag Valve Mask Device <br>(450cc)
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Pediatric High Concentration Mask
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Infant High Concentration Mask
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Pediatric Nasal Cannula
Suction Equipment:
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Portable Suction Unit <br>(Achieves 300mm/Hg in 4 Sec.)
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Suction Catheters: <br>(2 pharyngeal -sterile)
BLS Jump Bag
Optional Equipment (Reference Scope of Practice)
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Naloxone
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Expiration
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Pulse Oximetry
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Instant Glucose (45 grams-40% dextrose-d-glucose gel) or (food grade substitute)
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Expiration
Patient Assessment/Diagnostic Measurements:
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Bandage Shears
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Penlight
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Adult Sphygmomanometer
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Thigh Sphygmomanometer
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Adult Stethoscope
Airway Management:
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Oropharyngeal Airways - <br>(6 different sizes)
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Nasopharyngeal Airways <br>(5 different sizes)
Oxygen Delivery Devices:
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Adult Bag Valve Mask Device <br>(700cc)
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Adult High Concentration Mask
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Adult Nasal Cannula
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Non-Sparking wrench/tank opening device
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Portable O2 flow meter 0-25 lpm
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Portable Oxygen Capacity with a min. of 300 liters <br>(Exchange if less than 500 PSI)
Bleeding Control and Wound Management:
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Multi-Trauma (10" x 30" ) (4)
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Occlusive ( 3" x 4" ) (4)
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Sterile Gauze Pads ( 4" x 4" ) (25)
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Triangular Bandages (8)
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Sterile Burn Sheets (4' x 4') (2)
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Soft Self Adhering Gauze ( 6 rolls )
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Adhesive Tape ( 4 rolls assort., 1 must be hypoallergenic)
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Commercial "Tactical" Tourniquet (2)
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Regional Approved Triage Tags (20)
Defibrillation
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Automated External Defibrillator
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Adult Defibrillator Pads
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Expiration
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Pediatric Defibrillator Pads
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Expiration
Immobilization:
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RWVEMSA Cervical Collar Bag
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Mutli Size
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Pediatric
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Head Immobilization Device
Miscellaneous
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Hand light (2)
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RWVEMSA Mass Bleeding bag, <br>DO NOT INSPECT
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Please sign to complete QRS Vehicle/Equipment Inspection
