AEMS Truck Check 2.0

• Conducted on

  Date

• Prepared by

• Unit

  17

  18

  19

  20

• Previous Crew?

Cab

• Unit condition left from previous crew

  Good

  Fair

  Poor

  N/A

• Unit plugged in?

  Yes

  No

• Computer charged?

  Yes

  No

  N/A

• ESO updated?

  Yes

  No

  N/A

• Cab clean?

  Yes

  No

• Fuel 3/4 min.

  Yes

  No

• Wipers/fluid in working order?

  Yes

  No

• Safety Vests

  Yes

  No

• Flashlights

  Yes

  No

• Radio working?

  Yes

  No

• Map book, ERG, Binoculars

  Yes

  No

• Refusals, run sheets X5 each

  Yes

  No

• Fuel & maintenance log

  Yes

  No

• Gloves SM MD LG XL

  Yes

  No

• Tires Checked

  Safe

  At Risk

  N/A

• Truck Started?

  Yes

  No

  Had Issues

  Not checked

• All emergency lights, misc lights, and blinkers in working order?

  Compliant

  Non-Compliant

  Not Checked

• Sirens, back up alarm, and horn in working order?

  Compliant

  Non-Compliant

  Not Checked

Outside Compartments

• Main O2 (min 500)

• Body Vacuum Splint

  Yes

  No

  N/A

• KED

  Yes

  No

• Frac Pac

  Yes

  No

• Vacuum Splints

  Yes

  No

• OTD

  Yes

  No

• Traction Splint

  Yes

  No

• Fire Rehab clipboard

  Yes

  No

• Ped/Adult head blocks X2 each

  Yes

  No

• Ped/Adult C Collars X2 each

  Yes

  No

• LSP X2 with spider straps X2

  Yes

  No

• Pediatric Splints

  Yes

  No

• Pediatric LSB

  Yes

  No

Power Cot

• Stretcher Clean?

  Good

  Fair

  Poor

  N/A

• Battery Charged?

  Yes

  No

• Mattress damaged?

  Yes

  No

• Power cot in working order?

  Yes

  No

  N/A

• Power load in working order?

  Yes

  No

  N/A

• Power load free of damage and slides on track?

  Yes

  No

  N/A

PT Care Area

• PT area/ handrails/handles clean and trash empty?

  Good

  Fair

  Poor

  N/A

• Portable O2 (Min. 500)

• Adult BVM X2

  Yes

  No

• Pediatric BVM X2

  Yes

  No

• Infant BVM X2

  Yes

  No

• LP paper

  Yes

  No

• EKG electrodes

  Yes

  No

• 1000 mL Normal saline X2 (Sodium Chloride 0.9%)

  Yes

  No

• 1000mL Lactated Ringers X1

  Yes

  No

• IV Kit fully stocked? (X4 of Flushes, each IV cath, start kits, saline locks)

  Yes

  No

• Drip sets X2, Dial flow X1

  Yes

  No

• Unit Suction with yaunker and tubing unopened

  Yes

  No

• Portable suction with Yaunker and tubing unopened

  Yes

  No

• EZ IO drill

  Yes

  No

• Pressure bag

  Yes

  No

• Stabilizer for IO

  Yes

  No

• EZ IO needles sz 15,25,45 (2 each)

  Yes

  No

• Child seat restraint

  Yes

  No

• Lucus

  Yes

  No

  N/A

• Lucas charged with extra batteries?

  Yes

  No

  N/A

• Video Laryngoscope charged with extra batteries

  Yes

  No

  N/A

• Blades for Video Laryngoscope

  Yes

  No

  N/A

• PPE Masks, gowns, shields

  Yes

  No

• Sampson Straps

  Yes

  No

• Mega mover and seated mover

  Yes

  No

• Gloves SM MD LG XL

  Yes

  No

Airway Cabinet

• NRB X2

  Yes

  No

• Nasal Cannulas X2

  Yes

  No

• O2 connectors

  Yes

  No

• Capnography NC with O2 tubing X1

  Yes

  No

• Nebulizer Set/Mask X1 each

  Yes

  No

• O2 Humidifier (2 in 20)

  Yes

  No

• OPA's - 40, 50, 60, 70, 80,90, 100, 110

  Yes

  No

• NPA's - 20, 22, 24, 26, 28, 30, 32, 34, 36

  Yes

  No

• King Airways/I-Gel - Sz 2, 2.5, 3, 4, 5

  Yes

  No

• I-Gel Strap

  Yes

  No

• ET Tubes sz 8, 7.5, 7, 6.5, 6, 5.5, 4.5, 4, 3, 2.5, 2

  Yes

  No

• Syringe 10mL, 60mL

  Yes

  No

• Stylets sz 6,8,10, 14

  Yes

  No

• Lubricant

  Yes

  No

• Bougie X2

  Yes

  No

• French Suction Caths sz 6, 8, 10, 12, 14, 16

  Yes

  No

Cabinet #2

• CPAP LG & MD

  Yes

  No

• Sterile water X2

  Yes

  No

• Saline bottles X2

  Yes

  No

Trauma Cabinet

• 4X4's

  Yes

  No

• Abdominal pads

  Yes

  No

• Quick clot

  Yes

  No

• Vaseline gauze

  Yes

  No

• Chest Seal

  Yes

  No

• Roller, ACE, Coban, Triangle Bandages (X2 each)

  Yes

  No

• Cold/Hot packs

  Yes

  No

• Band Aid Kit

  Yes

  No

• Burn Sheets

  Yes

  No

• Tourniquet

  Yes

  No

• Triage Tags

  Yes

  No

Misc. Cabinet

• Sheets, Blankets, pillow case

  Yes

  No

• Towel, wash cloths

  Yes

  No

• Toilet paper

  Yes

  No

• Urinals/bed pans

  Yes

  No

• OB Kit

  Yes

  No

• Biohazard bags

  Yes

  No

• Thermal Blanket

  Yes

  No

Pediatric Cabinet

• Infant NRB

  Yes

  No

• Ped Neb

  Yes

  No

• Ped NC

  Yes

  No

• Ped stethoscope, sticky Spo2, electrodes

  Yes

  No

• King/I-gel sz 0, 1

  Yes

  No

Jump Bag

• Capnography NC with O2 tubing

  Yes

  No

  N/A

• Emesis Bag

  Yes

  No

• Bandaging Supplies

  Yes

  No

• Adult NC, Nebulizer, Neb Mask, NRB

  Yes

  No

• Albuterol X5 2.5mg/3mL

  Yes

  No

• DuoNeb (Ipratropium Bromide 0.5mg + Albuterol Sulfate 3mg/3mL)

  Yes

  No

• BP Kit with cuffs, stethoscope, penlight, sphygmomanometer<br>

  Yes

  No

• Thermometer

  Yes

  No

• Pulse Ox

  Yes

  No

• Glucometer Kit with glucose, lancets, test strips, alcohol pad

  Yes

  No

• Glucometer test on Mondays (record numbers on sheet)

  Pass

  Fail

  N/A

• ET Tubes 6.5, 6, 5.5, 4.5, 4, 3

  Yes

  No

• King Airways 2,2.5,3,4,5

  Yes

  No

• Intubation Kit

  Yes

  No

• Mac and Miller Blades sz 0-4 in each style

  Yes

  No

• Adult and Ped laryngoscope

  Yes

  No

• 1000 mL 0.9% NS Roll with IV supplies (Flush X1 - needles, dripset, start kit, saline lock X1)

  Yes

  No

• 1000 mL LR roll with IV supplies (Flush X1 - needles, dripset, start kit, saline lock X1)

  Yes

  No

• BVM

  Yes

  No

• Pediatric supplies

  Yes

  No

• Extra O2 bottle

  Yes

  No

Medications

• Narcotics check on Log RX

  Yes

  No

  N/A

• All Narcotics accounted for?

  Yes

  No

  N/A

• Epi Vials 1mg/mL X2 with draw syringe and needle

  Yes

  No

• Naloxone 2mg/2mL with aspirators X2

  Yes

  No

• Aspirin 81mg tablets (min. 12 tabs)

  Yes

  No

• D10 - 25g dextrose/250mL

  Yes

  No

• Oral Glucose 15g/1.1 oz X2 (one in Glucose kit)

  Yes

  No

• Ondansetron 4mg/2ml

  Yes

  No

• Ondansetron ODT 4mg

  Yes

  No

• Ketorolac 30mg/mL

  Yes

  No

• Diphenhydramine 50mg/1mL

  Yes

  No

• Methylprednisone 125mg/2mL

  Yes

  No

• Nitro 0.4mg tablets

  Yes

  No

• Famotidine 10mg/1 mL

  Yes

  No

• Diltiazem 25mg/5mL

  Yes

  No

• Ice pack changed?

  Yes

  No

Life Pak

• Clean and free of damage? (including all equipment)

  Good

  Fair

  Poor

  N/A

• Auto Test pass?

  Pass

  Fail

  N/A

• Batteries fully charged?

  Yes

  No

• Extra battery fully charged?

  Yes

  No

• LP paper

  Yes

  No

• Electrodes

  Yes

  No

  N/A

• Adult/Ped Defibrillator pads X2

  Yes

  No

• EKG cables

  Yes

  No

  N/A

• Pulse Ox, adult/ped,infant finger probes

  Yes

  No

• B/P Cuffs Regular, Large, pediatric

  Yes

  No

• Adult/Pediatric Capno NC X2 each

  Yes

  No

  N/A

• Adult Pediatric Capno Intubated X2 each

  Yes

  No

  N/A

• Hand towels and razors X2 each

  Yes

  No

  N/A

• Dashboard signals/alerts? (Change oil, check engine light, ect...)

• Strange noises, oil leaks, any other potential issues?