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daily ambulance check
daily ambulance check
Westford Fire

daily ambulance check

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Free daily ambulance check Checklist

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Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location

  • Personnel

  • Ambulance

  • Group

  • Notes

AED

  • Pads (2)

  • Spare battery (1)

  • Razor / face cloth (1)

  • Green light blinking

  • Remove battery and perform user test. Take out of service if necesary.

  • Pedi key

  • Scissors

  • Pocket mask

BLS Primary bag

  • Sealed

  • Aspirin

  • Epi pens - adult

  • Epi pens -pedi

  • Oral glucose

  • BVM - adult and pedi

  • Glucometer & supplies

  • Pulse oximeter

  • Bandaging supplies

  • MAT tourniquet

BLS airway bag

  • Oxygen level

  • Adult NRB (2)

  • Adult cannulas (2)

  • Pedi NRB (2)

  • Pedi cannulas (2)

  • O2 tubing (1)

  • Each size OPA (1)

  • Each size NPA (1)

  • Adult BVM (1)

  • Pedi BVM (1)

Portable suction

  • Working

  • Complete

Outside compartments

  • Sufficient spinal immobilization equipment

  • Long boards (3)

  • Adult collars (2)

  • 9' straps (3)

  • Pedi collars (2)

  • Quick clip straps (10)

  • KED (1)

  • Pedi board

  • Adult traction splint (1)

  • Pedi traction splint (1)

  • Lucas

  • Main oxygen

Work area

  • Run forms / refusals (10)

  • Face shields (10)

  • O2 devices (4 each)

  • Adult BVM (1)

  • Pedi BVM (1)

  • Oral airway kit

  • Nasal airway kit

  • Oral glucose (1)

  • Activated charcoal (1)

  • Adequate bandaging supplies

  • Adequate linens

Installed suction

  • Working

  • Complete

  • Tubing

  • Yankauer tip

  • Gloves

  • Face shield

Cab

  • Fuel

  • All lights working

  • Gloves

  • Cell phone

  • CO meter

  • Keys

  • Binoculars

  • ANSI highway vests (2)

Vehicle ALS supplies

  • 1000cc saline (6)

  • 500cc saline (5)

  • 250cc saline (2)

  • 100cc saline (2)

  • Macro drip sets (10)

  • Extension sets (5)

  • Buretrols (2)

  • Saline flushes (10)

  • Pressure infuser (1)

  • Restock IV catheters

  • Alcohol preps (20)

  • Venigaurds (10)

  • Tourniquets (4)

ALS primary bag - blue

  • King Lt (2,3,4)

  • Aspirin

  • Saline - 500cc bag

  • Macro drip set

  • Nebulizer

  • Nitro spray

  • Oral glucose

  • Quick trache

  • Face/eye shields (2)

  • Glucomter and supplies

  • Glucometer

  • Test strips

  • Lancets

  • Alcohol preps

  • Band-aids

  • Sufficient IV supplies

  • 14 ga catheters (4)

  • 16 ga catheters (4)

  • 18 ga catheters (4)

  • 20 ga catheters (4)

  • 22 ga catheters (4)

  • 24 ga catheters (2)

  • Flushes (4)

  • Tegaderms

  • Extension sets (4)

  • 2x2 or 4x4 gauze (8)

IO drill

  • Sealed

  • Driver

  • Adult needle set (2)

  • Pedi needles set (2)

  • AD needle (1)

Primary ALS airway kit

  • Each size ET tube 6.0-9.0mm (1)

  • 6.0 tube

  • 6.5 tube

  • 7.0 tube

  • 7.5 tube

  • 8.0 tube

  • 8.5 tube

  • 9.0 tube

  • 10cc syringes (2)

  • Adult handle (1)

  • Each size laryngoscope blade (2,3,4 Mac/Miller)

  • Mac 2

  • Mac 3

  • Mac 4

  • Miller 2

  • Miller 3

  • Miller 4

  • Magill forceps - adult & pedi (1)

  • Stylets (2)

  • Adult tube holder

  • Adult easy cap (1)

  • EtCo2 probe (1)

  • Chest decompression catheters (2)

  • Hurricane spray (1)

  • Lidocaine jelly (1)

  • Neo-synephrine (1)

  • BAAM (1)

  • Bougie (1)

Primary bag meds

  • Epi 1:10,000 (2)

  • Atropine (2)

  • Dextrose 50 % (1)

  • Epi pen adult 0.3mg (1)

  • Epi-pen pedi 0.15 mg (1)

  • Lidocaine 100mg (1)

  • Lasix 100 mg (1)

  • Narcan (2)

  • Benadryl (1)

  • Thiamine (1)

  • Glucagon (1)

  • Albuterol (3)

  • Atrovent (3)

  • Cardizem (1)

  • Adenosine 6mg (1)

  • Adenosine 12 mg (1)

  • Zofran (1)

  • Each size syringe (3)

  • 1cc (3)

  • 3cc (3)

  • 5cc (3)

  • 10cc (3)

  • Each size needle (3)

Cardiac monitor

  • User test

  • Spare battery (1)

  • 5 lead cable (1)

  • 12 lead cable (1)

  • Adult combo pads (2)

  • Pedi combo pads (2)

  • Spare paper (1)

  • Razors (2)

  • Electrodes (25)

  • Adult Spo2 probe (1)

  • Pedi Spo2 probe (1)

  • Etco2 probe - ET (2)

  • Etco2 probe - cannula (2)

  • Rectal / esophageal temp probe (1)

  • AC power cord (1)

  • Spare 5/12 lead and therapy cable

Broselowe bag

  • Sealed

  • Broselowe tape

  • Pedi handle

  • Adult handle

  • Laryngoscope blades: 00 - 3

  • Each rescue airway (1)

  • Pedi Magill (1)

  • Adult Magill (1)

  • Each size stylette (1)

  • Pedi tube holder (1)

  • Pedi easy cap (1)

  • OB kit (1)

  • Pedi BVM (1)

  • Infant BVM (1)

  • Muconium adapter (2)

  • Pedi arm board (1)

  • Pedi IV kit

Secondary ALS bag - orange

  • Sealed

Drug box

  • Drug box

  • Sealed

  • Adenosine 6mg (1)

  • Adenosine 12mg (2)

  • Albuterol (6)

  • Amiodirone (3)

  • Aspirin (8)

  • Atropine (4)

  • Atrovent (5)

  • Benadryl (3)

  • Calcium chloride (1)

  • Cardizem (2)

  • Dextrose 25% (1)

  • Dextrose 50% (1)

  • Dopamine (1)

  • Epi 1:1,000 - 1mg (2)

  • Epi 1:10,000 (5)

  • Epi - racemic (2)

  • Epi pen 0.3 adult (1)

  • Epi pen .15mg pedi (1)

  • Lasix 100 mg (1)

  • Glucagon (1)

  • Lidocaine drip (1)

  • Lido 100 mg (4)

  • Lopressor (2)

  • Mag sulfate (4)

  • Nitro paste (3)

  • Nitro spray (1)

  • Sodium bicarb 8.4% (1)

  • Sodium bicarb 4.2% (1)

  • Narcan (3)

  • Solu-medrol (2)

  • Thiamine (3)

  • Zofran (2)

  • Each size syringe (3)

  • Each size needle (3)

  • Micro drip sets (2)

  • Vial spikes (3)

daily ambulance check
Westford Fire

daily ambulance check

Use this Template
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