AMBULANCE 1832 WEEKLY 11/22/13

• 1830 Weekly Check

• Conducted on

  Date

• Personal checking vehicle

  Select Allen Badger Matt Cappelen John Gray Pat Watson Scott Birchall Jeff Sherwood Andy Shiner Steve Tarczynski Mike Baumgart Ben Rittenhouse Joe Long Cody Conway Matt Bracken Neil Werner Jim Logan Dave VanDusen Greg Olsen Adam Mackey Dan Moreno Mike Pagliara Scott Lyng Scott Miller Scott Sulak John Sengmany Dave Almeda Bobby Putman John Mahoney John Yanni Brian Phelps Dan Bartelt Tony Marcuccelli John Loesch Chris Wampner Derek Kameyer Andrew Shultz Kevin Schrader Paul Ursini

  • Allen Badger
  • Matt Cappelen
  • John Gray
  • Pat Watson
  • Scott Birchall
  • Jeff Sherwood
  • Andy Shiner
  • Steve Tarczynski
  • Mike Baumgart
  • Ben Rittenhouse
  • Joe Long
  • Cody Conway
  • Matt Bracken
  • Neil Werner
  • Jim Logan
  • Dave VanDusen
  • Greg Olsen
  • Adam Mackey
  • Dan Moreno
  • Mike Pagliara
  • Scott Lyng
  • Scott Miller
  • Scott Sulak
  • John Sengmany
  • Dave Almeda
  • Bobby Putman
  • John Mahoney
  • John Yanni
  • Brian Phelps
  • Dan Bartelt
  • Tony Marcuccelli
  • John Loesch
  • Chris Wampner
  • Derek Kameyer
  • Andrew Shultz
  • Kevin Schrader
  • Paul Ursini

• Vehicle Miles:

• Vehicle Hours:

CAB

• Portable Radios ( 2 )

  YES

  NO

• Comments:

• Flashlight ( 1 )

  Good

  Needs Repair

• Comments:

• iPad Charged ( >75% )

  YES

  NO

• Comments:

• Gloves ( 1XL, 1L, 1M )

  YES

  NO

• Comments:

• Knox Box Key

  YES

  NO

• Comments:

• Passport Tags ( White & Red )

  YES

  NO

• Comments:

• Helmet Shields ( 2 )

  YES

  NO

• Comments:

• Safety Vests ( 2 )

  YES

  NO

• Comments:

• Road Triangles

  YES

  NO

• Comments:

• ERG Book

  YES

  NO

• Comments:

• Maps ( FRC, County, South Elgin )

  YES

  NO

• Comments:

• Garage Openers ( Station 3, Delnor, & St. Joes )

  Good

  Needs Repair

• Comments:

CLIPBOARD

• IF SHEETS ARE LOW PLEASE PRINT THEM OUT AND THEN HIT YES!

• 10 Run Sheets

  YES

  NO

• 10 Hippa Forms

  YES

  NO

• 10 AMA/Refusal Forms

  YES

  NO

• 10 Multiple Release Forms

  YES

  NO

• 5 EMS Rehab Forms

  YES

  NO

• 5 School Bus Form

  YES

  NO

• 3 Involuntary Form

  YES

  NO

MISC.

• Cab Vacuumed & Cleaned Out

  YES

  NO

• Comments:

• Additional Comments:

Exterior Cabinet #1

• O2 Bottle

  YES

  NO

• Comments:

• Air splints ( 1L, 1M, 1S, & Pump )

  YES

  NO

• Comments:

• Extension Cord (1)

  YES

  NO

• Comments:

Exterior Cabinet #2

• Body Bag

  YES

  NO

• Comments:

• Transfer Tarp

  YES

  NO

• Comments:

• Safety Blanket

  YES

  NO

• Comments:

• Wool Blanket

  YES

  NO

• Comments:

• Stair Chair

  YES

  NO

• Comments:

Exterior Cabinet #3

• SCBA ( 2 ) :<br>Everything in working order. Bottle full w/ no leaks

  Good

  Needs Repair

• SCBA ( A ) P.S.I. :

• SCBA ( B ) P.S.I. :

• Comments:

• SCBA ( A ) P.S.I. :

• SCBA ( B ) P.S.I. :

• Irons ( 1 halligan & 1 flat head axe )

  YES

  NO

• Comments:

Exterior Cabinet #4

• Adult & Peds Hare Traction

  YES

  NO

• Comments:

• Scoop Stretcher:<br>Clean and in working order

  Good

  Needs Repair

• Comments:

• Backboards w/ Straps:<br>1 w/ spider straps, 1 w/ seat-belts, 1 blank. All clean

  YES

  NO

• Comments:

• Child Car Seat

  YES

  NO

• Comments:

• C-Collar Bag

• Adult Collars ( 2 )

  YES

  NO

• PEDS/Infant Collars ( 3 )

  YES

  NO

• Baby No Neck Collar

  YES

  NO

• Adult Head Immobilizers ( 2 )

  YES

  NO

• PEDS/Infant Head Immobilizer ( 1 )

  YES

  NO

• Adult Head Immobilizers ( 2 )

  YES

  NO

• Comments:

• Child Head Immobilizers ( 2 )

  YES

  NO

• Comments:

• Peds Backboard:<br>Clean w/ all straps

  YES

  NO

• Comments:

• Extra Spider Straps

  YES

  NO

• Comments:

• Additional Comments:

Interior Cabinet #1

• BVM

• Adult ( 1 )

  YES

  NO

• Comments:

• Adult CO2 Detector ( 1 )

  YES

  NO

• Comments:

• Exp. Date:

• Child ( 1 )

  YES

  NO

• Comments:

• PEDS CO2 Detector ( 1 )

  YES

  NO

• Comments:

• Exp. Date:

• Infant ( 1 )

  YES

  NO

• Comments:

• Infant CO2 Detector ( 1 )

  YES

  NO

• Comments:

• Exp. Date:

• 500ml Sterile Water ( 2 )

  YES

  NO

• Comments:

• Exp. Dates:

• Exp. Dates:

• 1000ml Sodium Chloride ( 3 )

  YES

  NO

• Comments:

• Exp. Dates:

• Exp. Dates:

• 500ml Sodium Chloride ( 2 )

  YES

  NO

• Comments:

• Exp. Dates:

• Exp. Dates:

Interior Cabinet #2

• 1 Nebulizer tx w/ 1 Albuterol & 1 Atrovent

  YES

  NO

• Albuterol Dates:

• Atrovent Dates:

• Comments:

• Albuterol Dates:

• Atrovent Dates:

• 1 Inline Nebulizer Kit w/ 1 Albuterol & 1 Atrovent

  YES

  NO

• Albuterol Dates:

• Atrovent Dates:

• Comments:

• Atrovent Dates:

• Albuterol Dates:

• Oxygen Tubing

  YES

  NO

• Comments:

• Adult Nasal Cannula ( 3 )

  YES

  NO

• Comments:

• Adult NRB ( 3 )

  YES

  NO

• Comments:

• Peds NRB ( 3 )

  YES

  NO

• Comments:

• Peds Nasal Cannula ( 3 )

  YES

  NO

• Comments:

• Infant NRB ( 3 )

  YES

  NO

• Comments:

• Infant Nasal Cannula ( 3 )

  YES

  NO

• Comments:

• 1-Box Alcohol preps

  YES

  NO

• Comments:

• 1-Box Spare glucose test strips

  YES

  NO

• Comments:

• Exp. Date:

Narcotic Box

• Old Tag Number

• New Tag Number

• 80MG Etomidate<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• Versed 5MG/5ML Total of 15MG

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• Versed 5MG/1ML Total of 10MG

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• Fentynal 200MCG Total

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

ALS Drug Box (Top)

• 2- Amiodarone 150mg/3ml <br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 2-Albuterol 2.5mg/3ml<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 2-Atrovent 0.5mg/2.5ml<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 12- Aspirin 81mg <br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 2- Adenosine 6mg/2ml Vial<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 1- Benadryl 50mg/1ml<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 3-Epinephrine 1:1000 1mg/1ml<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 2- Complete dosage of Glucagon 1mg/1ml<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 2-Magnesium Sulfate 1GM/2ml<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 1-Nitroglycerin bottle >1/2 full<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 5-Sodium Chloride Inhalation Solution 3ml<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 1-Tetracaine <br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 2- Vasopressin 20 Unit Vial<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 1- Zofran 4mg/2ml vial<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 1- Zofran 4mg tabs<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 5-Bandaids

  YES

  NO

• Comments:

• 1-MAD Device

  YES

  NO

• Comments:

• 5-Lancets

  YES

  NO

• Comments:

• 5-Alcohol preps

  YES

  NO

• Comments:

• 1-Carpoject

  YES

  NO

• Comments:

ALS Drug Box Bottom

• 1-Dopamine 400mg/250ml IV Bag w/60 drop tubing <br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 2-Filter Straws

  YES

  NO

• Comments:

• 2-Filter Needles

  YES

  NO

• Comments:

• 2-1ml Syringe

  YES

  NO

• Comments:

• 5-3ml Syringe

  YES

  NO

• Comments:

• 4-5ml Syringe

  YES

  NO

• Comments:

• 2-10ml Syringe

  YES

  NO

• Comments:

• 1-20ml Syringe

  YES

  NO

• Comments:

• 1-60ml Syringe

  YES

  NO

• Comments:

• 1-18g X 1 1/2 Needle

  YES

  NO

• Comments:

• 1-20g X 1" Needle

  YES

  NO

• Comments:

• 1-21g X 1" Needle

  YES

  NO

• Comments:

• 1-22g X 1 1/2 Needle

  YES

  NO

• Comments:

• 1-23g X 1" Needle

  YES

  NO

• Comments:

• 1-25g X 1 1/2" Needle

  YES

  NO

• Comments:

ALS Boxed drugs

• 5- Atropine 1mg/10ml<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 1-Dextrose 25GM/50ml<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 7-Epinephrine 1:10,000 1mg/10ml<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 5- Lidocaine 100mg/5ml<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 2-Narcan 2mg/2ml <br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

• 1-Sodium Bicarbonate 50mEq/50ml<br>

  YES

  NO

• Exp. Date:

• Comments:

• Exp. Date:

Interior Cabinet #3

• Triage Tags ( 1 set )

  YES

  NO

• Comments:

• Drug Tags ( 1 bag )

  YES

  NO

• Comments:

• Rubberbands ( 1 bag )

  YES

  NO

• Comments:

• Safety Vest ( 1 )

  YES

  NO

• Comments:

• Spare Clipboard

  YES

  NO

• Comments:

Interior Cabinet #4

• Cavi Wipes ( 1 )

  YES

  NO

• Comments:

• Garbage Bags

  YES

  NO

• Comments:

Interior Cabinet #5

• N95 Masks ( 5 )

  YES

  NO

• Comments:

• Safety Glasses ( 3 )

  YES

  NO

• Comments:

Interior Cabinet #6

• Stethoscope w/ Accessories ( 1 )

  YES

  NO

• Comments:

• Multi Cuff BP Bag

• 1 Adult

  YES

  NO

• Comments:

• 1 Large Adult

  YES

  NO

• Comments:

• 1 Child

  YES

  NO

• Comments:

• 1 Infant

  YES

  NO

• Comments:

• 1 Thigh

  YES

  NO

• Comments:

• Gauge ( 1 )

  YES

  NO

• Comments:

• 1 Bag of Extra Pieces For Stethoscope

  YES

  NO

• Amount:

• Spare Child BP Cuffs ( 2 )

  YES

  NO

• Amount:

• Adult EtCO2 Cannulas ( 2 )

  YES

  NO

• Comments:

• Adult EtCO2 Tube Connectors ( 2 )

  YES

  NO

• Comments:

• Peds Electrodes 1pk.

  YES

  NO

• Comments:

• Adult Electrodes 1pk.

  YES

  NO

• Comments:

• EKG Paper ( 2 )

  YES

  NO

• Comments:

• Adult Defib Pads ( 1 )

  YES

  NO

• Expiration Date:

• Comments:

• Baby Bottle ( 1 )

  YES

  NO

• Comments:

• OB Kit ( 1 )

  YES

  NO

• Comments:

• Baby Bunting Foil ( 2 )

  YES

  NO

• Comments:

• 1-Box each S/M/Lg Gloves

  YES

  NO

• Comments:

Interior Cabinet #7

IV Box

• 10-Bandaids

  YES

  NO

• Comments:

• 5-Lancets

  YES

  NO

• Comments:

• 2-Mad Devices

  YES

  NO

• Comments:

• 5-Alcohol Preps

  YES

  NO

• Comments:

• 2-Tape

  YES

  NO

• Comments:

• 2-10 ml Saline flushes

  YES

  NO

• EXP Date:

• Comments:

• 2-18g X 1 1/2" Needle

  YES

  NO

• Comments:

• 2-21g X 1" Needle

  YES

  NO

• Comments:

• 2-22g X 1 1/2" Needle

  YES

  NO

• Comments:

• 2-23g X 1" Needle

  YES

  NO

• Comments:

• 2-25g X 1 1/2" Needle

  YES

  NO

• Comments:

• 2-Filter Straws

  YES

  NO

• Comments:

• 2-Filter Needles

  YES

  NO

• Comments:

• 1- 1ml Syringe

  YES

  NO

• Comments:

• 2- 3ml Syringe

  YES

  NO

• Comments:

• 1- 10/12ml Syringe

  YES

  NO

• Comments:

• 2-Butterfly Needles (21g&23g)

  YES

  NO

• Comments:

• 2-14g Angiocath

  YES

  NO

• Comments:

• 2-16g Angiocath

  YES

  NO

• Comments:

• 2-18g Angiocath

  YES

  NO

• Comments:

• 2-20g Angiocath

  YES

  NO

• Comments:

• 2-22g Angiocath

  YES

  NO

• Comments:

• 2-24g Angiocath

  YES

  NO

• Comments:

IV Cabinet

• 4-IV Start kits

  YES

  NO

• Comments:

• 5-Normal Saline 1000ml IV Bags

  YES

  NO

• Comments:

• 4-10 drop IV Tubing

  YES

  NO

• Comments:

• 2- 60 drop IV tubing

  YES

  NO

• Comments:

• 1-Pressure Infuser Bag

  YES

  NO

• Comments:

Interior Cabinet #8

• Survival Wrap ( 2 )

  YES

  NO

• Comments:

• Soft Restraints ( 2 sets )

  YES

  NO

• Comments:

• Towels ( 3 )

  YES

  NO

• Comments:

• Hand Sanitizer

  YES

  NO

• Comments:

• Red Biohazard Bag ( 5 )

  YES

  NO

• Comments:

• Pocket Mask ( 1 )

  YES

  NO

• Comments:

Interior Cabinet #9

• Adult Arm Slings

• 1 Large

  YES

  NO

• Comments:

• 1 Medium

  YES

  NO

• Comments:

• 1 Small

  YES

  NO

• Comments:

• Peds Slings ( 2 )

  YES

  NO

• Comments:

• SAM Splints ( 3 )

  YES

  NO

• Comments:

• Face Shields ( 5 )

  YES

  NO

• Comments:

• ACE Wraps ( 4 )

  YES

  NO

• Comments:

• 4" Kling ( 2 )

  YES

  NO

• Comments:

• 4 1/2" Kerlix ( 1 )

  YES

  NO

• Comments:

• Eye Pads ( 4 )

  YES

  NO

• Comments:

• Tape ( 4 )

  YES

  NO

• Comments:

• Petrolatum/Vaseline

• ( 2 ) 3x9

  YES

  NO

• Comments:

• ( 2 ) 3x18

  YES

  NO

• Comments:

• Arm Board ( 1 )

  YES

  NO

• Comments:

• Trauma Shears ( 1 )

  YES

  NO

• Comments:

• Triangle Bandages ( 3 )

  YES

  NO

• Comments:

• ACS Chest Seal Pads ( 1 )

  YES

  NO

• Comments:

Interior Cabinet #10

• 4x4 Gauze ( 15 )

  YES

  NO

• Comments:

• Trauma Dressing ( 4 )

  YES

  NO

• Comments:

• Burn Sheet ( 2 )

  YES

  NO

• Comments:

• Aluminum Foil ( 1 )

  YES

  NO

• Comments:

Interior Cabinet #11

• Isolation Kits ( 3 )

  YES

  NO

• Comments:

• Hot Packs ( 5 )

  YES

  NO

• Comments:

• Cold Packs ( 5 )

  YES

  NO

• Comments:

Roll Up Door

• CPAP ( O2 Bottle, Tubing, Mask w/ Filter, and Regulator )

  YES

  NO

• Comments:

• O2 Pressure:

• O2 Pressure:

• Portable Suction ( Test Unit To 300

  YES

  NO

• Comments:

Bench

• Wool Blanket

  YES

  NO

• Comments:

• Umbrella (1)

  YES

  NO

• Comments:

Spare Items

• 2-Flashlights

  Good

  Needs Repair

• Comments:

• Oxygen Bottle ( 2 )

  YES

  NO

• Comments:

• Emesis Basin ( 2 )

  YES

  NO

• Comments:

• Sheets ( 3 )

  YES

  NO

• Comments:

• Blankets ( 3 )

  YES

  NO

• Comments:

• Urinals ( 1 )

  YES

  NO

• Comments:

• Additional Comments:

TOP POCKET PEDS BAG

• Pediatric NRB Mask ( 1 )

  YES

  NO

• Comments:

• Pediatric Nasal Cannula

  YES

  NO

• Comments:

• Infant Nasal Cannula

  YES

  NO

• Comments:

• Pediatric Simple Mask

  YES

  NO

• Comments:

LEFT SIDE POCKET PEDS BAG

• Bone Marrow Needle

  YES

  NO

• Comments:

• 1000ml NS IV Bag

  YES

  NO

• Exp. Date:

• Comments:

• IV 10 Drip Tubing

  YES

  NO

• Comments:

• IV Start Kit

  YES

  NO

• Comments:

FRONT SIDE POCKET PEDS BAG

• BP Cuff and Stethoscope

  YES

  NO

• Comments:

• Pen Light

  YES

  NO

• Comments:

• Thermometer

  Good

  Needs Repair

• Comments:

RIGHT SIDE POCKET PEDS BAG

• CO2 Monitor

  YES

  NO

• EXP Date:

• Comments:

• EXP Date:

• 10ml Syringe

  YES

  NO

• Comments:

• Trauma Shears

  YES

  NO

• Comments:

• Lubricant ( 2 )

  YES

  NO

• Comments:

• Forceps

  YES

  NO

• Comments:

• Laryngoscope Handle working

  Good

  Needs Repair

• Comments:

• SAM Splint

  YES

  NO

• Comments:

• Saline Flushes ( 2 )

  YES

  NO

• Exp. Dates:

• Comments:

CENTER PEDS BAG

• Pediatric BVM

  YES

  NO

• Comments

• Infant BVM

  YES

  NO

• Comments:

• Broselow Tape

  YES

  NO

• Comments:

• 4X4 Gauze ( 2 )

  YES

  NO

• Comments:

• Gauze Rolls and Kling Wrap ( 4 )

  YES

  NO

• Comments:

• Tape

  YES

  NO

• Comments

• Meconium Aspirator

  YES

  NO

• Comments:

• Alcohol Preps ( 5 )

  YES

  NO

• Comments

• Bandaids ( 5 )

  YES

  NO

• Comments:

• ET Tube Holder ( 2 )

  YES

  NO

• Comments:

• Emisis Bag

  YES

  NO

• Comments:

Check Expiration dates on all equipment

• RED

• 22-24g IV

  YES

  NO

• Comments:

• 3.5 UC Tube

  YES

  NO

• Comments:

• 14 French NPA

  YES

  NO

• Comments:

• 0-1 Straight Blade

  YES

  NO

• Comments:

• 40-50mm OPA

  YES

  NO

• Comments:

• PURPLE

• 20-24g IV

  YES

  NO

• Comments:

• 4 UC Tube

  YES

  NO

• Comments:

• 18 French NPA

  YES

  NO

• Comments:

• 1 Straight Blade

  YES

  NO

• Comments:

• 50-60mm OPA

  YES

  NO

• Comments:

• YELLOW

• 18-22g IV

  YES

  NO

• Comments:

• 4.5 UC Tube

  YES

  NO

• Comments:

• 20 French NPA

  YES

  NO

• Comments:

• 1-2 Straight Blade

  YES

  NO

• Comments:

• 50-60mm OPA

  YES

  NO

• Comments:

• WHITE

• 18-22g IV

  YES

  NO

• Comments:

• 5 UC Tube

  YES

  NO

• Comments:

• 22 French NPA

  YES

  NO

• Comments:

• 1-2 Straight Blade

  YES

  NO

• Comments:

• 50-60mm OPA

  YES

  NO

• Comments:

• BLUE

• 18-20g IV

  YES

  NO

• Comments:

• 5.5 UC Tube

  YES

  NO

• Comments:

• 24 French NPA

  YES

  NO

• Comments:

• 2 Curved or Straight Blade

  YES

  NO

• Comments:

• 60-70mm OPA

  YES

  NO

• Comments:

• ORANGE

• 18-20g IV

  YES

  NO

• Comments:

• 6 C Tube

  YES

  NO

• Comments:

• 26 French NPA

  YES

  NO

• Comments:

• 2 Curved or Straight Blade

  YES

  NO

• Comments:

• 70-80mm OPA

  YES

  NO

• Comments:

• GREEN

• 16-20g IV

  YES

  NO

• Comments:

• 6.5 C Tube

  YES

  NO

• Comments:

• 30 French NPA

  YES

  NO

• Comments:

• 3 Curved or Straight Blade

  YES

  NO

• Comments:

• 80mm OPA

  YES

  NO

• Comments:

• Additional Comments:

Top Pocket

• NRB Mask ( 1 )

  YES

  NO

• Comments:

• Nasal Cannula ( 1 )

  YES

  NO

• Comments:

• Neb TX w/ 1 Albuterol & 1 Atrovent ( 1 kit )

  YES

  NO

• Albuterol Exp. Date:

• Atrovent Exp. Date:

• Comments:

• Albuterol Exp. Date:

• Atrovent Exp. Date:

Left Side Pocket

• Adult BVM w/ CO2 Monitor ( 1 )

  YES

  NO

• EXP. Date:

• Comments:

Vitals Side Pocket

• Blood Pressure Cuff ( 1 adult )

  Good

  Needs Repair

• Comments:

• SPO2 Monitor

  Good

  Needs Repair

• Comments:

• Stethoscope ( 1 )

  Good

  Needs Repair

• Comments:

• Glucometer Case

• Glucometer ( Make sure it is working )

  Good

  Needs Repair

• Comments:

• Test Strips ( 5 )

  YES

  NO

• Comments:

• Lancets ( 5 )

  YES

  NO

• Comments:

• Alcohol Preps ( 5 )

  YES

  NO

• Comments:

• Bandaids ( 5 )

  YES

  NO

• Comments:

Front Pocket

• 3- Tape

  Good

  Needs Repair

• Comments:

• Thermometer

  Good

  Needs Repair

• Comments:

• 1- Trauma Dressing

  Good

  Needs Repair

• Comments:

• 1- Burn Sheet

  Good

  Needs Repair

• Comments:

• 1- SAM Splint

  Good

  Needs Repair

• Comments:

• 1- Kerlex

  Good

  Needs Repair

• Comments:

• 2-Kling

  Good

  Needs Repair

• Comments:

• 1- 4X4 Tray

  Good

  Needs Repair

• Comments:

• 1- Ice Pack

  Good

  Needs Repair

• Comments:

• 1-500ml Sterile Water

  Good

  Needs Repair

• Comments:

• 1-Trauma Shears

  Good

  Needs Repair

• Comments:

• Pen light ( 1 )

  Good

  Needs Repair

• Comments:

• 1-Ring Cutter

  Good

  Needs Repair

• Comments:

• LG & XL gloves in zipper area

  Good

  Needs Repair

• Comments:

CENTER OF JUMP BAG

Center Compartment Clear Flap

• King Tubes

• Size 3 ( 1 )

  YES

  NO

• Comments:

• Size 4 ( 1 )

  YES

  NO

• Comments:

• Size 5 ( 1 )

  YES

  NO

• Comments:

• Intubation Kit

• Tube Holders ( 2 )

  YES

  NO

• Comments:

• Atrovent Exp. Date:

• Miller Laryngoscope Blades ( 3 ): Put Blade on handle to make sure light works

  YES

  NO

• Comments:

• Mac Laryngoscope Blades ( 3 ): Put Blades on handle to make sure light works

  YES

  NO

• Comments:

• Lubricant Packets ( 2 )

  YES

  NO

• Comments:

• ET Tubes

• 5.0 ( 1 )

  YES

  NO

• Comments:

• 5.5 ( 1 )

  YES

  NO

• Comments:

• 6.0 ( 1 )

  YES

  NO

• Comments:

• 6.5 ( 1 )

  YES

  NO

• Comments:

• 7.0 ( 1 )

  YES

  NO

• Comments:

• 7.5 ( 2 )

  YES

  NO

• Comments:

• 8.0 ( 2 )

  YES

  NO

• Comments:

• 8.5 ( 1 )

  YES

  NO

• Comments:

• 9.0 ( 1 )

  YES

  NO

• Comments:

• 10ml Syringe ( 1 )

  YES

  NO

• Comments:

• Benzocaine ( 1 )

  YES

  NO

• Exp. Dates:

• Comments:

• Forceps ( 2 )

  YES

  NO

• Comments:

• Stylets ( 1s, 1m, 1L )

  YES

  NO

• Comments:

• Nasopharyngeal ( 1 each of sizes 12-34 )

  YES

  NO

• Comments:

• Oropharyngeal ( 5 )

  YES

  NO

• Comments:

• Tape ( 1 )

  YES

  NO

• Comments:

• Surgical Masks ( 2 )

  YES

  NO

• Comments:

• Spare Batteries ( 2 C )

  YES

  NO

• Comments:

• Cric & Needle Decompression kit

• 2- 14g IV

  YES

  NO

• Comments:

• 2- 12 IV

  YES

  NO

• Comments:

• 1- 10g IV

  YES

  NO

• Comments:

• 5- Alcohol Preps

  YES

  NO

• Comments:

• Scalpel

  YES

  NO

• Comments:

• 3.0 ET Un-Cuffed Tube

  YES

  NO

• Comments:

IV Pouch

• IV Start Kit ( 2 )

  YES

  NO

• Comments:

• IV Tubing

  YES

  NO

• Comments:

• NS IV Bag

  YES

  NO

• EXP. Date:

• Comments:

• IV Catheters

• 14g IV

  YES

  NO

• Comments:

• 16g IV ( 1 )

  YES

  NO

• Comments:

• 18g IV ( 2 )

  YES

  NO

• Comments:

• 20g IV ( 2 )

  YES

  NO

• Comments:

• 22g IV ( 1 )

  YES

  NO

• Comments:

• 24g IV ( 1 )

  YES

  NO

• Comments:

• Sharps Container ( 1 ) make sure it's empty

  YES

  NO

• Comments:

ALS Drug Box

• ALS Drugs

• Old Drug Tag Number

• New Drug Tag Number

Center Zipper Compartment

• 2- Adult EZ-IO Needles

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 2- PEDS EZ-IO Needles

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• EZ-IO Gun

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 3- Alcohol Preps

  YES

  NO

• Comments:

• 2- Saline Flushes

  YES

  NO

• Comments:

Medication Pull Out Flaps

• 4- 81mg Aspirin

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 2- Amiodarone 150mg Vials

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Adenosine ( 18mg total )

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Benadryl ( 1 ) 50mg

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Epi 1:1000 ( 3 )

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Glucagon ( 1 )

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Magnesium Sulfate ( 2 )

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1-Nitroglycerin bottle

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Vasopressin ( 2 ) 40units

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Verapamil ( 2 ) 10mg

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Zofran Tablet ( 1 )

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Zofran Vial ( 1 )

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Etomidate 40 MG

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1- Fentynal 100MCG

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 1- Versed 5MG/5ML

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Versed 5MG/1ML Total of 10 MG

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

Boxed Medication Area

• 1- Atropine 1MG Preloads

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Dextrose 50% ( 1 )

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Epi 1:10,000 ( 4 )

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Lidocaine ( 1 )

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 2- Narcan 2mg/2ml

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• Sodium Bicarbonate ( 1 )

  YES

  NO

• Exp. Dates:

• Exp. Dates:

• Comments:

• 2-Oral Glucose Tubes

  YES

  NO

• Exp. Dates:

• Exp. Dates:

• Comments:

Syringe Area

• 2- 1 ML Syringe

  YES

  NO

• Comments:

• 2- 3 ML Syringe

  YES

  NO

• Comments:

• 2- 10 ML Syringe

  YES

  NO

• Comments:

• 1- 20 ML Syringe

  YES

  NO

• Comments:

• 2- Filter Straws

  YES

  NO

• Comments:

• 2- Filter Needles

  YES

  NO

• Comments:

• 2- 18g Needles

  YES

  NO

• Comments:

• 2- 21g Needles

  YES

  NO

• Comments:

• 2- MAD Device

  YES

  NO

• Comments:

• Additional Comments:

ZOLL Monitor

• Tested Monitor

  Good

  Needs Repair

• Comments:

• Adult Defib Pads ( 1 )

  YES

  NO

• Expiration Date:

• Comments:

• Expiration Date:

• Peds Defib Pads ( 1 )

  YES

  NO

• Expiration Date:

• Comments:

• Expiration Date:

• Defib Test Cord ( 1 )

  YES

  NO

• Comments:

• Adult Electrodes ( 1 pk )

  YES

  NO

• Comments:

• Peds Electrodes ( 1 pk )

  YES

  NO

• Comments:

• Spare Battery ( 1 ): Rotate battery

  YES

  NO

• Comments:

• 4 Lead Cables ( 1 ): Cleaned & Wrapped Up

  YES

  NO

• Comments:

• 12 Lead Cables ( 1 ): Cleaned & Wrapped Up

  YES

  NO

• Comments:

• Razor ( 1 )

  YES

  NO

• Comments:

• CO2 ET Tube Connecter ( 1 )

  YES

  NO

• Comments:

• CO2 Nasal Monitor ( 1 )

  YES

  NO

• Comments:

• SPO2 Sensor ( 1 )

  YES

  NO

• Comments:

• Infant SPO2 Sensor ( 2 )

  YES

  NO

• Comments:

Action Area

• Phone

  YES

  NO

• Comments:

• Protocol Book

  YES

  NO

• Comments:

• Calculator

  YES

  NO

• Comments:

• Trauma Sheers

  YES

  NO

• Comments:

Onboard Suction tested to 300mmhg

• Suction canister

  YES

  NO

• Comments:

• Suction tubing

  YES

  NO

• Comments:

• Yankauer

  YES

  NO

• Comments:

Suction Drawer

• 2-Suction tubing

  YES

  NO

• Comments:

• 2-Yankauer

  YES

  NO

• Comments:

• 1-Manual Suction with adapters

  YES

  NO

• Comments:

• 1-6fr suction catheter

  YES

  NO

• Comments:

• 1-8fr suction catheter

  YES

  NO

• Comments:

• 1-8fr suction catheter

  YES

  NO

• Comments:

• 2-10fr suction catheter

  YES

  NO

• Comments:

• 2-12fr suction catheter

  YES

  NO

• Comments:

• 2-16fr suction catheter

  YES

  NO

• Comments:

• 1-18fr suction catheter

  YES

  NO

• Comments:

LIGHTS

• IF ANYTHING IS NOT WORKING PLEASE WRITE IT UP IN EMERGENCY REPORTING

• Emergency Lights

  Good

  Needs Repair

• Comments:

• Headlights ( High & Low Beam )

  Good

  Needs Repair

• Comments:

• Turn signals

  Good

  Needs Repair

• Comments:

• Brake Lights

  Good

  Needs Repair

• Comments:

• Scene Lights

  Good

  Needs Repair

• Comments:

• Running Lights

  Good

  Needs Repair

• Comments:

• Reverse Lights

  Good

  Needs Repair

• Comments:

FLUID LEVEL

• IF FLUIDS ARE LOW PLEASE ADD, IF WE HAVE HERE, THEN PUT IT IN EMERGENCY REPORTING

• Fuel ( > 3/4 )

  GOOD

  LOW

• Comments:

• Oil

  GOOD

  LOW

• Comments:

• Coolant

  GOOD

  LOW

• Comments:

• Transmission

  GOOD

  LOW

• Comments:

• Power steering

  GOOD

  LOW

• Comments:

• Washer Fluid

  GOOD

  LOW

• Comments:

TIRE PRESSURE

• IF TIRES ARE LOW PLEASE ADD AIR AND THEN PUT IT IN EMERGENCY REPORTING

• Front Tires

  GOOD

  LOW

• Front Left PSI:

• Front Right PSI:

• Comments:

• Front Right PSI:

• Front Left PSI:

• Rear Tires

  GOOD

  LOW

• Left Inner PSI:

• Left Outer PSI:

• Right Inner PSI:

• Right Outer PSI:

• Comments:

• Left Inner PSI:

• Left Outer PSI:

• Right Inner PSI:

• Right Outer PSI:

ANY VEHICLE PROBLEMS WRITE UP IN EMERGENCY REPORTING

AFTER PRESSING FINISH GO TO AUDITS AND SEND CHECK

• Additional Comments:

• Officers Signature:

  Sign