Ambulance Equipment Requirement Checklist

• Audit Title

• Ambulance #

• Conducted on

  Date

• Prepared by

• Location
  Address

• Instructions:
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  1. Specify the quantity of each item in the Intermediate Life Support Ambulance.
  2. To add a Corrective Measure click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
  3. Complete audit by providing digital signature.
  4. Share your report by exporting as PDF, Word, Excel or Web Link.
  
  Specific Requirements:
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  Unless otherwise stated, all equipment listed below is per vehicle and not per operational base.

Airway Equipment

• Oropharyngeal airway No. 00

• Oropharyngeal airway No. 0

• Oropharyngeal airway No. 1

• Oropharyngeal airway No. 2

• Oropharyngeal airway No. 3

• Oropharyngeal airway No. 4

• Yankauer-type hard suction catheter (adult)

• Yankauer-type hard suction catheter (paediatric)

• Neonatal suction catheters size No. 5 French

• Neonatal suction catheters size No. 6 French

• Neonatal suction catheters size No 8 French

• Paediatric suction catheter size No. 10 French

• Adult suction catheter size No. 12 French

• Adult suction catheter size No. 14 French

• Portable suction apparatus (Combination of battery and electrically operated)

• Manual hand operated portable suction apparatus (as a back up device)

• Stethoscope (combination of diaphragm and bell type head)

• Commercially packaged, disposable sterile Needle Cricothyroidotomy Kit including alcohol swab, 14 gauge IV canula, jet insufflation device and endotracheal tube adapter.

Endotrachael Intubation equipment:

• Magill forceps - Adult

• Magill forceps - Paediatric

• 10ml syringes

• 20ml syringes

• Pair sharp, clean scissors

Breathing / Ventilation Equipment:

• Adult oxygen masks providing 40% inhaled oxygen with tubing

• Adult non-re breather masks providing 100% inhaled oxygen with tubing

• Adult oxygen nebuliser masks including tubing and fluid reservoir

• Nasal cannula with tubing

• Pediatric oxygen masks providing 40% inhaled oxygen with tubing

• Pediatric non-re breather masks providing 100% inhaled oxygen with tubing

• Pediatric oxygen nebuliser masks including tubing and a fluid reservoir

• Oxygen T-Piece with tubing

• Adult Bag-Valve-Mask with Reservoir and adult mask (size 4)

• Pediatric Bag-Valve-Mask with Reservoir and pediatric mask (size 1)

• Neonatal Bag-Valve-Mask with Reservoir and neonatal mask (size 0)

• Oxygen Humidification Device

• Please proceed to the next section for Part 2.

Oxygen Supply:

• Minimum of a portable oxygen cylinder. Size “D”

• Portable oxygen cylinder gauge with flow meter

• Fitted oxygen cylinder/s, size “F” capable of supplying a minimum of 30 minutes of oxygen at a flow rate of at least 15 liters per minute

• Fitted oxygen cylinder gauge with flow meter

Ventilator

• Anti-bacterial ventilation circuit filter for use with both manual as well as mechanical ventilation methods

Diagnostic /Therapeutic Equipment:

• Sphygmomanometer including adult, pediatric and neonatal cuffs

• Pupil torch

• Glucometer and blood glucose monitoring strips

• Pulse Oximeter (if not included as a feature of an ECG monitor or electronic patient monitor)

• Automated External Defibrillator (AED) (annual calibration not required due to self-testing and self- calibration of the unit)

• Automated External Defibrillator (AED) that is approved by the manufacturer for use in a moving vehicle, To be used in combination with a Vital Signs Monitor that includes visual 3 lead ECG Monitoring and a ECG rhythm printer/recorder feature (Vital Signs Monitor requires annual calibration certification)

• ECG monitor and defibrillator featuring 3 lead ECG monitoring capability, 3 lead cable, AED capability, AED pads, manual defibrillation, recorder / printer with paper and hard defibrillation paddles (requires annual calibration certification)

• ECG monitor and defibrillator featuring 3 lead ECG monitoring capability, external cardiac pacing, cardioversion, pacing/AED pads, manual defibrillation, recorder / printer with paper and hard defibrillation paddles (requires annual calibration certification)

• Defibrillation gel

• End Tidal CO2 Monitor – Capnograph (if not included as a feature of an ECG monitor or electronic patient monitor)

Miscellaneous Disposable Equipment:

• Boxes of disposable examination gloves (Small)

• Boxes of disposable examination gloves (Medium)

• Boxes of disposable examination gloves (Large)

• Infection Control N95 Face Mask

• Wound dressing 254mm x 762mm (multi-trauma dressing)

• Wound dressings 100mm x 100mm

• Wound dressings 100mm x 200mm

• Hydrogel Burn Dressing 100mm x 100mm

• Hydrogel Burn Dressing 200mm x 200mm

• Hydrogel Burn Dressing 200mm x 450mm

• Gauze swabs (100mm x 100mm)

• Roll of 25 mm adhesive tape (zinc oxide)

• Roll of 10 mm adhesive tape (hypo-allergenic)

• 75mm elasticised bandages

• 100mm elasticised bandages

• Sealed maternity pack (including 2 x sealed & sterile surgical blades, 4 x sealed sanitary pads, 2 x sealed space blankets, 4 x sealed & sterile umbilical cord clamps, 1 x sealed & sterile mucous extractor)

• Regurgitation bags

• Large kidney bowl / receiver (may not be a bedpan)

• Sealed space blanket

• Clear safety goggles

• Range of nasogastric tubes

• Please proceed to the next section for Part 3.

Intravenous Therapy Equipment:

• Alcohol Swab (30mm x 30mm)

• 14 gauge intra-venous catheters

• 16 gauge intra-venous catheters

• 18 gauge intra-venous catheters

• 20 gauge intra-venous catheters

• 22 gauge intra-venous catheters

• 24 gauge intra-venous catheters

• 60 micro drops / ml – Administration Sets

• 15 drops / ml or 20 drops / ml- Administration Sets

• 10 drops / ml – Blood Administration Set

• High Capacity 10 drops / ml Administration Set

• Volume Control Administration Set (eg. Buretrol,

• 200ml Normal Saline – IV Fluid

• 1000ml Ringers Lactate – IV Fluid

• 1000ml Balsol – IV Fluid

• 500ml Synthetic Colloid e.g. Haemacell / Haes- sterile

• Transparent, waterproof, IV securing dressing (ie. Tegaderm or similar) minimum of 10cm x 12cm dimensions

• Infusion flow regulators (eg Dial-a-Flow, Dosi Flow)

• 3 Way Stopcock

• Spencer Wells Artery Forceps

• Pressure Infusion Bags

Drugs and Drug Therapy Equipment:

• Activated Charcoal

• Glucose powder or gel

• Entonox with demand value and regulator

• 50 ml syringes

• 20 ml syringes

• 10 ml syringes

• 5 ml syringes

• 2 ml syringes

• 1 ml syringes

• 16 gauge needles

• 20 gauge needles

• Aspirin

• Dextrose 50%

• Fenoterol

• Ipratropium Bromide

• Salbutamol

• Drugs according to the HPCSA scope of practice for ECP Paramedics (per ambulance / vehicle)

• Please proceed to the next section for Part 4.

Transport and Immobilization Equipment:

• Hard/Stiff Neck Cervical Collars – Small

• Hard/Stiff Neck Cervical Collars – Medium

• Hard/Stiff Neck Cervical Collars – Large

• Full set of Soft Cervical Collars (Small, Medium,Large)

• Patient Extrication Device – Adult (KED)

• Patient Extrication Device – Paediatric (KED)

• Long spine board

• Scoop stretcher

• Vacuum Mattress

• Set Head Blocks

• Spider harness

• Lower extremity traction splint – Adult

• Lower extremity traction splint – Paediatric

• Long splints – Leg

• Short splints – Arm

• PASG/MAST suit (optional)

Other:

• Pillow

• Sheet

• Blanket

• Bedpan/urinal

• Waste disposal facility (enclosed container)

• Red, medical waste disposal plastic bags

• Enclosed, commercially manufactured, disposable sharps container

• Suitably manufactured Jump Bag for safe, clean and secure storage and transportation of medical equipment

• Suitably manufactured Drug Pouch for safe, clean and secure storage and transportation of medication and administration accessories

• Pair rescue scissors

• High visibility, reflective vest and / or jacket

• Safety helmet

• Fire Extinguisher (minimum of 2KG dry powder)

• Thermometer (standard)

• Casebook or patient record sheet

• Declaration of death book

• Map book or fitted GPS device

• Completed by:

  Sign