Engine 1820 ALS Equipment WEEKLY ON MONDAY'S

• 1830 Weekly Check

• Conducted on

  Date

• Personnel 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:

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

• 1 Involuntary Form

  YES

  NO

• Additional Comments:

ALS Drug Bag, Narcotics

• Old Tag Number

• New Tag Number

• Versed 5MG/1ML Total of 10MG

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• Fentynal 200MCG Total

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• Etomidate 40MG Total

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

ALS Drugs

• ALS Drugs: PLEASE MAKE SURE TO GET DRUGS EXCHANGED 30 DAYS BEFORE EXPIRATION DATE.

• Aspirin 12-81mg Tablets

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 2-Atrovent 0.5mg

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 2- Albuterol 2.5mg

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 2- Amiodarone 150mg Vials

  YES

  NO

• Exp. Dates:

• Comments:

• Exp. Dates:

• 3- 6mg Adenosine Vials

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 1- Benadryl 50 mg

  YES

  NO

• Comments:

• Exp. Dates:

• Expiration Dates:

• 4- Epinephrine 1:1000 1mg/1ml Ampules

  YES

  NO

• Comments:

• Exp. Dates:

• Expiration Dates:

• Glucagon

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• Magnesium Sulfate 1Gm/2ml Vial

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 1- Nitroglycerine bottle 0.4mg >1/2 full

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 1- Tetracaine bottle

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 2- Vasopressin 20 Unit vial

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 2- Zofran 4mg Vial

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 2- Zofran 4mg Tablet

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• MAD Device ( 3 )

  YES

  NO

• Comments:

• 1- Dopamine 400mg in 250ml IV bag with 60 Drip Tubing

  YES

  NO

• Comments:

• Exp. Dates:

• Expiration Dates:

• Filter Straws ( 2 )

  YES

  NO

• Comments:

• Filter Needle ( 2 )

  YES

  NO

• Comments:

• 1ml Syringe ( 2 )

  YES

  NO

• Comments:

• 3ml Syringe ( 5 )

  YES

  NO

• Comments:

• 2- 5ML Syringes

  YES

  NO

• Comments:

• 10mL Syringe ( 2 )

  YES

  NO

• Comments:

• 20mL Syringe

  YES

  NO

• Comments:

• 60mL Syringe

  YES

  NO

• Comments:

• Alcohol Preps

  YES

  NO

• Comments:

• Needles

• 18g x 1 1/2"

  YES

  NO

• Comments:

• 20g x 1"

  YES

  NO

• Comments:

• 21g x 1"

  YES

  NO

• Comments:

• 22g x 1 1/2"

  YES

  NO

• Comments:

• 23g x 1"

  YES

  NO

• Comments:

• 25g x 1 1/2"

  YES

  NO

• Comments:

PreLoads

• 4-Atropine 1mg Preload

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 1- Dextrose 50% 50ml/25 Gm

  YES

  NO

• Comments:

• Exp. Dates:

• Expiration Dates:

• 2- Epinephrine 1:10,000 1mg Preload

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 4-Lidocaine 100mg/5ml Preload

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 2-Narcan 2mg/2ml

  YES

  NO

• Expiration Dates:

• Comments:

• Exp. Dates:

• 1- 50mEq Sodium Bicarbonate w/ 60mL Syringe and Needle ( 1 )

  YES

  NO

• Comments:

• Exp. Dates:

• Expiration Dates:

Advanced Airway Pocket

• Size 4 King Tube

  YES

  NO

• Comments:

• Size 5 King Tube

  YES

  NO

• Comments:

• 60 ml Syringe

  YES

  NO

• Comments:

• 2 - Stylets (1 small, 1 large)

  YES

  NO

• Comments:

• 2 - Tube Holders

  YES

  NO

• Comments:

• UnCuffed ET Tubes 2 through 5

  YES

  NO

• Comments:

• Cuffed Tubes 5.5 through 9

  YES

  NO

• Comments:

Vital Signs Pocket

• Blood Pressure Cuffs (Infant, Child, Adult, Large Adult, Thigh)

  YES

  NO

• Comments:

• Stethoscope

  YES

  NO

• Comments:

• Glucometer (Bandaids, lancets, test strips, alcohol preps)

  YES

  NO

• Comments:

• SPO2 sensor

  YES

  NO

• Comments:

IV Pocket

• 2 - 14G IV Catheters

  YES

  NO

• Comments:

• 2 - 16G IV Catheters

  YES

  NO

• Comments:

• 2 - 18G IV Catheters

  YES

  NO

• Comments:

• 2 - 20G IV Catheters

  YES

  NO

• Comments:

• 2 - 22G IV Catheters

  YES

  NO

• Comments:

• 2 - 24G IV Catheters

  YES

  NO

• Comments:

• Tape

  YES

  NO

• Comments:

• Sharps Shuttle

  YES

  NO

• Comments:

• IV Start Kit

  YES

  NO

• Comments:

• IV Bag

  YES

  NO

• Comments:

• IV Tubing (10 drip)

  YES

  NO

• Comments:

• Short Arm Board

  YES

  NO

• Comments:

Airway Pocket

• Pediatric Wheel

  YES

  NO

• Comments:

• Laryngoscope Handle

  YES

  NO

• Comments:

• (4) Oropharyngeal

  YES

  NO

• Comments:

• Nasopharyngeal 12fr. through 30fr. (with Surgical Lub)

  YES

  NO

• Comments:

• Miller Blades 0 through 3 ( 1 each )

  YES

  NO

• Comments:

• Mac Blades 1 through 4 ( 1 each )

  YES

  NO

• Comments:

• Forceps

  YES

  NO

• Comments:

• 4 - Faceshield

  YES

  NO

• Comments:

ZOLL Monitor

• Tested Monitor

  YES

  NO

• Comments:

• Adult Defib Pads ( 1 )

  YES

  NO

• Expiration Date:

• Comments:

• Peds Defib Pads ( 1 )

  YES

  NO

• Expiration Date:

• Comments:

• Defib Test Cord ( 1 )

  YES

  NO

• Comments:

• Adult Electrodes minimum of 12

  YES

  NO

• Comments:

• Peds Electrodes minimum of 12

  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 ( 2 )

  YES

  NO

• Comments:

• SPO2 Sensor ( 1 )

  YES

  NO

• Comments:

• Infant SPO2 Sensor ( 2 )

  YES

  NO

• Comments:

Top Pocket

• Adult NRB (2)

  YES

  NO

• Comments:

• Adult Nasal Cannula (2)

  YES

  NO

• Comments:

• Infant Nasal Cannula

  YES

  NO

• Comments:

• Pediatric Nasal Cannula

  YES

  NO

• Comments:

• Infant NRB

  YES

  NO

• Comments:

• Pediatric NRB

  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:

• Oxygen Tank (min. 200 psi)

  YES

  NO

• Comments:

• Adult BVM with CO2 sensor

  YES

  NO

• Comments:

• Child BVM with CO2 sensor

  YES

  NO

• Comments:

• CPAP Mask

  YES

  NO

• Comments:

• Pocket Mask

  YES

  NO

• Comments:

• (5) 3ml NS Vials

  YES

  NO

• Comments:

• EZ-IO Drill

  YES

  NO

• Comments:

• NS Flush

  YES

  NO

• Comments:

• (2) 14G 2" Needles

  YES

  NO

• Comments:

• Iodine & Alcohol Preps

  YES

  NO

• Comments:

• Scalpel

  YES

  NO

• Comments:

• Forceps

  YES

  NO

• Comments:

• IV 10 Drip Tubing

  YES

  NO

• Comments:

• IO Needles (pediatric, adult, large adult)

  YES

  NO

• Comments:

• Expiration Dates:

• Pressure Infuser Bag

  YES

  NO

• Comments:

• Scalpel

  YES

  NO

• Comments:

Left Side Pocket

• Portable Suction

  YES

  NO

• Comments:

• Red Bio Bags

  YES

  NO

• Comments:

Right Side Pocket

• OB Kit

  YES

  NO

• Comments:

Front Left Pocket

• (2) Ice Packs

  YES

  NO

• Comments:

• (2) Hot Packs

  YES

  NO

• Comments:

• 500ml NS Irrigation

  YES

  NO

• Comments:

• Arm Slings (small, medium, large)

  YES

  NO

• Comments:

• Emisis Bag

  YES

  NO

• Comments:

• (2) Triangle Bandages

  YES

  NO

• Comments:

Front Right Pocket

• 4X4 Gauze

  YES

  NO

• Comments:

• ACS Chest Seal Pad

  YES

  NO

• Comments:

• Abdominal Pads

  YES

  NO

• Comments:

• 4" & 6" Cling

  YES

  NO

• Comments:

• ACE Wrap

  YES

  NO

• Comments:

• Medium Gauze Roll

  YES

  NO

• Comments:

• Vaseline Gauze 1"X8" & 3"X9"

  YES

  NO

• Comments:

• Tape

  YES

  NO

• Comments:

• Trauma Shears

  YES

  NO

• Comments:

• (2) SAM Splints

  YES

  NO

• Comments:

• (2) Eye Pads

  YES

  NO

• Comments:

Large Back Pocket

• (2) Multi Trauma Dressings

  YES

  NO

• Comments:

• Burn Sheet

  YES

  NO

• Comments:

• Blue Gown

  YES

  NO

• Comments:

• (3) Isolation Kits

  YES

  NO

• Comments:

• Large & XL Gloves

  YES

  NO

• Comments:

• Additional Comments: