Information
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Conducted on
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Location
Default Section
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Odometer Reading
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Hours
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Fuel Level
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Oil Level
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Misc.
Vehicle Cab
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Gas Card
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Insurance Card
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Door Openers
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Gloves
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Maps
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Notes
Mechanical Check
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Emergency Lights
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Horn/Siren
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Tail/Brake Lights
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Head Lights
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Turn Signals
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Dash Gauges
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Trans Fluid
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Brake Fluid
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Steering fluid
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Coolant
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Tires at 60 PSI
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Notes
Compartment #1 Top
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4 Restraints w/ Straps<br>2 Packs Posey Restraints<br>1 OB Kit w/head warmer<br>6 Cold Packs<br>6 Hot Packs
Compartment #2 Bottom
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1 Pressure Infuser<br>4 Needle-less Locks<br>4 10ml Pre-filled Normal Saline Flushes<br>4 Start Kits<br>1 Container w/<br>2 1ml Syringes<br>2 3ml Syringes<br>2 12ml Syringes<br>2 35ml Syringes<br>2 18g Safety Needles<br>2 22g Filter Needles<br>1 Blood Draw Kit
Compartment #2
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4 Each 16g, 18g, 20g, and 22g IV Catheters<br>2 24g IV Catheters<br>1 2'' Cloth Tape<br>2 1'' Cloth Tape<br>2 1" Coban<br>2 Macro Drip Tubing<br>2 Micro Drip Tubing
Compartment #3 (Linen)
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8 Sheets<br>8 Pillowcases <br>
Compartment # 4 Bottom Left
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3 Non-Rebreather Masks<br>3 Nasal Cannulas<br>1 Pediatric Mask<br>1 Infant Mask<br>1 Tracheostomy Mask<br>2 Yankauer Tip Suction<br>1 each 8, 10, 14, 18Fr. Suction Catheters<br>1 Replacement Tubing-Portable Suction<br>2 Disposable Suction Container<br>2 Disposable Suction Lid w/ Tubing<br>1 Combitube<br>
Compartment #4 Bottom Right
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1 Pack Adult Electrodes<br>2 Packs Pediatric Electrodes<br>1 Adult Fast Patch<br>1 Pediatric Fast Patch<br>1 Zoll Monitor Paper<br>1 each Adult & Pediatric Transducers<br>5 Nail Polish Remover Pads<br>2 Neb Kits, w/2 Albuterol<br>1 BVM Neb Adapter<br>1 each Adult & Pediatric Aerosol Masks<br>4 Albuterol (extra)<br>1 each Adult & Pediatric ET Tube Holder<br>1 Pocket Mask<br>1 Cot Battery (spare)<br>1 Zoll Battery (spare)
Compartment #4 Top Left
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2 Gowns<br>1 Box TB Masks & Face Shields<br>2 Safety Glasses/Goggles<br>1 Burette Set
Compartment #3 Bottom
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3 Lactated Ringers 1000ml Bags<br>3 Normal Saline 1000ml Bags
Compartment #10
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1 Box each<br> Small Gloves<br> Medium Gloves<br> Large Gloves
Compartment #8 Top
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1 Each<br> 7.0, 7.5, 8.0 ET Tubes<br>1 Each<br> Adult & Pediatric Stylet<br>1 Spare Monitor Cable<br>1 Baby Bottle w/Nipple
Compartment #4 Top Right
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1 Infant BVM<br>1 Child BVM<br>1 Adult BVM<br>2 Chest Seals<br>2 Decompression Needles<br>1 CPAP<br>1 Pertrach<br>1 Container w/<br> Oral Airways 40, 60, 80, 90, and 100<br> Nasal Airways 12-30Fr.<br>
Compartment #11
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2 Sterile Burn Sheets
Under Bench Seat
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2 Rescue Helmets w/ Goggles<br>2 Disposable Yellow Blankets<br>1 Pillow<br>1 each<br> Bed Pan & Urinal<br>1 Full Oxygen Cylinder<br>5 Biohazard Bags<br>1 Body Bag<br>1 Child Safety Seat (inflatable)
Compartment #6 Bottom
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1 Region 6 Care Guidelines<br><br>Extra Blankets
Compartment #12
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2 Sterile Water, 1000ml<br>4 Graduated Cylinders<br>
Compartmment #1 Bottom
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6 Trauma Dressings<br>5 Triangular Bandages<br>1 Silver Swaddler<br>2 4'' Coban<br>8 4" Roller Gauze<br>20 Alcohol Preps<br>5 Blankets<br>3 ABD PADS<br>2 Vaseline Gauze<br>1 Box 4x4 Gauze Pads<br>1 Box 2x2 Gauze Pads
Entry Bag
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Drug Box<br><br>1 Dextrose 50%<br>2 Atropine Sulfate-1mg<br>2 Lidocaine-100mg<br>1 Glucagon<br>3 Epinephrine 1:10,000-1mg<br>1 Adenosine-6mg<br>1 Glucose Paste<br>2 Epinephrine 1:1000<br>1 Bottle Baby Aspirin<br>2 Narcan-2mg<br>2 3ml Syringes<br>12 Alcohol Preps<br>2 Amidodarone-150mg<br>1 Benedryl-50mg<br>1 Zofran-4mg<br>1 Nitro Tabs<br>1 Nitro Spray<br>1 Terbutaline-1mg<br>6 Lancets<br>2 22g Safety Needles<br>2 Filter Needles
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Pulse Oximetry Bag<br><br>4 "AA'' Batteries<br>4 Nail Polish Remover <br>1 Pulse Oximeter
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Trauma Pouch (Top Cover)<br><br>1 Trauma Bandage<br>4 ABD Pads<br>6 4x4's<br>1 1'' Cloth Tape<br>1 1" Coban<br>1 4'' Coban<br>1 Broselow Pediatric Emergency Tape<br>3 Refusal Sheets<br>1 Billing Sheet
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Main Compartment<br><br>1 Intubation Bag (Blue)<br>1 IV Bag (Red)<br>1 Drug Box<br>1 Pulse Ox<br>1 IO Kit<br>1 Oxygen Cylinder w/regulator
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IV Bag (Red)<br><br>1 1'' Coban<br>1 1" Cloth Tape<br>1 Trauma Shears<br>2 12ml Syringes<br>2 IV Start Kits<br>1 Blood Draw Kit<br>2 Saline Flushes<br>2 Each<br> 16g, 18g, 20g, & 22g IV Catheters<br>8 4x4's<br>1 Micro Drip Tubing<br>1 Macro Drip Tubing<br>1 50ml D5W<br>1 250ml NS<br>2 IV Locks<br>1 Sharps Shuttle
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Intubation Bag<br><br>3 Miller Blades<br>2 Macintosh Blades<br>7 Oral Airways<br>2 12ml Syringes<br>1 each<br> 2, 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5, 6.0, 6.5, 7.0, 7.5, & 8.0 ET Tubes<br>1 Meconium Aspirator<br>2 ''C'' Batteries<br>1 Viscous Lidocaine<br>1 Intubation Handle<br>1 1'' Cloth Tape<br>1 Adult ET TubeHolder<br>1 Pediatric ET TubeHolder<br>1 CO2 Detector
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EZ IO Kit<br><br>1 EZ IO Drill<br>2 Adult IO Needles<br>1 Pediatric IO Needle
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Narcotics Bag
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CONTACT SUPERVISOR IMMEDIATELY AND COUNT THE DRUGS.
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Sign to confirm narcotics are sealed.
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Right Side Compartment<br><br>1 Nebulizer w/Albuterol<br>1 Adult Aerosol Mask<br>1 Pediatric Aerosol Mask<br>1 CPAP
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Left Side Compartment<br><br>1 Adult Non-Rebreather Mask<br>1 Adult Nasal Cannula<br>
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Left Side Rear Compartment<br><br>1 Glucometer<br>1 B/P Cuff<br>1 Stethescope
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Outside Front Compartment<br><br>1 Adult Oxygen Sensor<br>1 Pediatric Oxygen Sensor<br>1 Pediatric Oxygen Mask<br>1 Pediatric BVM<br>1 Adult BVM
Compartment #9
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1 Bottle Baby Shampoo<br>1 Contact Lens Case<br>1 Oral Thermometer w/cover<br>1 Nose Clamp<br>1 Ring Cutter<br>1 Hemostat<br>1 Box Glucometer Strips<br>2 "C" Batteries (spare)<br>
Zoll Heart Monitor
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Left Pouch<br><br>1 Monitor Cable
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Right Pouch<br><br>20 Adult Electrodes
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Back Side Pouch<br><br>1 Pulse Ox Cable<br>1 12-Lead EKG Cable<br>1 Defibrillator Cable<br>1 Adult Fast Patch<br>1 Razor<br><br>1 Zoll Paper<br>1 Pediatric Fast Patch<br>1 Infant Fast Patch<br>2 packs Pediatric Electrodes<br>1 Power Cable<br>1 each <br> Adult & Pediatric Transducers<br>1 Zoll Battery if not in cabinet
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Front Pouch<br><br>1 Auto B/P Cuff
Exterior Rear Compartment
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2 Backboard w/4 straps<br>1 Stair Chair w/straps<br>1 Pediatric Board w/cover<br>1 Rescue Seat w/cover<br>1 Bag w/ <br> 2 Adult CIDS<br> 2 Pediatric CIDS<br> 6 Adult C-Collars<br> 4 Pediatric C-Collars<br> 1 Infant C-Collar<br> 2 2" Cloth Tape
Exterior Passenger Side Rear Compartment
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1 Splint Bag w/<br> 1 Sam Splint<br> 1 Kendrick Splint Set<br> 2 Arm (short & long)<br> 2 Leg (short & long) <br> 1 each<br> wrist & elbow splint<br>1 KED w/ cover and pillow<br>1 Sager Splint Set
Exterior Driver's Side Front Compartment
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1 Oxygen Cylinder (500 PSI Minimum)<br>1 Open End Wrench<br>1 Scoop Stretcher w/three orange straps
Intercept Bag
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Center<br><br>1 Dextrose 50%-50ml<br>1 Lidocaine 2%-100ml<br>1 Glucagon<br>1 1000ml NS<br>1 Micro Drop Tubing<br>1 Macro Drop Tubing<br>4 Pre-Filled 0.9 Flushes<br>1 Sodium Bicarbonate-50ml<br>1 Procainamide <br>1 1'' Tape
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Right Side<br><br>2 Narcan-2mg<br>4 Adenosine-6mg<br>3 Epinephrine 1:10,000-1mg<br>4 Furosemide or 160mg total<br>2 Magnesium Sulfate-2gm<br>1 Amiodarone-150mg<br>1 Ondansetron-4mg<br>1 Thiamine-200mg<br>1 Benadryl-50mg<br>1 Verapamil-5mg<br><br>1 Glucose Paste<br>1 High-Dose Atropine<br>1 High Does Epinephrine
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Left Side<br><br>1 500ml Hypertonic 3% Saline<br>1 50ml D5W<br>1 500ml Lidocaine-2g<br>1 250ml Dopamine-400mg
Repairs/Signature
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Are there any repairs needed?
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Crew Member #1 Signature
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Crew Member #2 Signature