Equipment Check

• Date and time.

  Date

• Your name.

• Additional crew:

Isolette 22- Baby Place Deliveries - Old Bronchotron

• Location:

  in office

  in ambulance

  on a call

• All equipment present and ready for service? <br><br>Misc- Flushes, Sweetease, heat packs, Resp saline Saline bullets<br>Misc- premie hat, eye cover, neowrap <br>Vent Circuit, NeoTee, Masks<br>Phasitron circuit <br>Oxygen and Air tanks greater than 1000 psi? <br>Temperature 36-37 C

  Yes

  No

  N/A

Isolate 19- Voyager (Crossvent with TXP)

• Location:

  in office

  in ambulance

  on a call

• All equipment present and ready for service? <br><br>1 IVAC pump charging <br>2 Syringe pumps charging <br>Harness secured<br>Misc- Flushes, Sweetease, heat packs, Resp saline Saline bullets<br>Misc- premie hat, eye cover, neowrap <br>Vent Circuit, NeoTee, Masks<br>Phasitron circuit<br>Oxygen and Air tanks greater than 1000 psi? <br>Nitric Tank present?<br><br>

  Yes

  No

  N/A

Flight Aviator 2015-1

• Location:

  in office

  in ambulance

  on a call

• All equipment present and ready for service? <br><br>2 Syringe pumps charging <br>Harness secured<br>Misc- Flushes, Sweetease, heat packs, Resp saline Saline bullets<br>Misc- premie hat, eye cover, neowrap <br>Vent Circuit, NeoTee, Masks<br>Clipboard <br>Nitric Tank present? (Where applicable)<br>Oxygen and Air tanks greater than 1800 psi? <br>

  Yes

  No

  N/A

Flight Aviator 2010-1

• Location:

  in office

  in ambulance

  on a call

• All equipment present and ready for service? <br><br>2 Syringe pumps charging <br>Harness secured<br>Misc- Flushes, Sweetease, heat packs, Resp saline Saline bullets<br>Misc- premie hat, eye cover, neowrap <br>Vent Circuit, NeoTee, Masks<br>Clipboard <br>Oxygen and Air tanks greater than 1800 psi? <br>Nitric tank present? (Where applicable)<br><br>

  Yes

  No

  N/A

Flight stretcher - PEDI

• Location:

  in office

  in ambulance

  on a call

• All equipment present and ready for service? <br><br>Multiple - Flushes, Sweetease, heat packs <br>PediMate present and clean<br>Linens <br>Clipboard

  Yes

  No

  N/A

Stryker 2012-1

• Location:

  in office

  in ambulance

  on a call

• All equipment present and ready for service? <br><br>Multiple - Flushes, Sweetease, heat packs <br>Ventilator plugged in and charging <br>1 IVAC charging<br>2 Syringe Pumps charging<br>PediMate present and cleaned <br>O2 tank >1000 psi<br>Stryker battery solid green<br>Linens <br>Clipboard

  Yes

  No

  N/A

Stryker 2012-2

• Location:

  in office

  in ambulance

  on a call

• All equipment present and ready for service? <br><br>Multiple - Flushes, Sweetease, heat packs <br>Ventilator plugged in and charging <br>1 IVAC charging<br>2 Syringe Pumps charging<br>PediMate present and cleaned <br>O2 tank >1000<br>Stretcher battery solid green<br>Linens <br>Clipboard

  Yes

  No

  N/A

Stryker / Aviator 2015-2

• Location:

  in office

  in ambulance

  on a call

• All equipment present and ready for service? Multiple Flushes, S....<br>

  Yes

  No

  N/A

Other equipment.

• Day and Mid RN phones present? <br><br>Plugged in and charging if not currently in use.

  Yes

  No

  N/A

• Are all 3 iPads present, charged and functioning?

  Yes

  No

  N/A

• Are all 3 iPad chargers and 3 cords present?

  Yes

  No

  N/A

• Three SunStar EMS Toughbook EPCRs present and ready for service? <br><br>Plugged in and charging if not currently in use.

  Yes

  No

  N/A

• Four EZ-IOs present and ready for service? <br><br>

  Yes

  No

  N/A

• Eight (8) RN bags present and sealed?

  Yes

  No

  N/A

• Six (6) RT bags present and sealed?

  Yes

  No

  N/A

• Three portable I-STAT machines ready for service? <br><br>Including: <br>Five cartridges per case and multiple cap gas tubes for each case.

  Yes

  No

  N/A

• Have the ISTATS had their last scheduled QC? (0600 and 1800).

  Yes

  No

  N/A

• Four Transilluminators present and ready for service? <br><br>Plugged in and charging if not currently in use.

  Yes

  No

  N/A

• One portable ETCO2 present and ready for service? <br><br>Plugged in and charging if not currently in use.

  Yes

  No

  N/A

• Twelve helmets present and ready for service?

  Yes

  No

  N/A

• Five inflatable PFDs present and ready for service? <br><br>Including survival pack and HEEDS 3.

  Yes

  No

  N/A

• Is the refreshment refrigerator stocked?

  Yes

  No

  N/A

• One spare Phillips monitor/defibrillator present and ready for service? <br><br> Plugged in and charging.

  Yes

  No

  N/A

• Helipad FOD check complete?

  Yes

  No

  N/A

• Empty O2 and Air tanks exchanged in tank room?

  Yes

  No

  N/A

• Refrigerator, Pyxis, and drug bag drawers- All meds accounted for / no discrepancies?

  Yes

  No

  N/A

• I herby affirm that all information listed is accurate and correct as indicated in this report. EMT signature:

  Sign