Equipment Check

• Date and time.

  Date

• Your name.

• Additional crew:

Isolette 18

• Location:

  in office

  in ambulance

• All equipment present and ready for service? <br><br>Equipment Bag / SBD Bag locked <br>NEO med Bag locked <br>One - IVAC pump charging <br>Two - Syringe pumps charging <br>Multiple - Flushes, Sweetease, heat packs <br>Vent Circuit, AMBU Bag, Green Mask <br>Clipboard <br><br>Oxygen and Air tanks greater than 1000 psi? <br>Nitric tank present? <br>Temperature greater than 36*C?

  Yes

  No

  N/A

Isolette 21

• Location:

  in office

  in ambulance

• All equipment present and ready for service? <br><br>Equipment Bag / SBD Bag locked <br>NEO med Bag locked <br>One - IVAC pump charging <br>Two - Syringe pumps charging <br>Multiple - Flushes, Sweetease, heat packs <br>Vent Circuit, AMBU Bag, Green Mask <br>Clipboard <br><br>Oxygen and Air tanks greater than 1000 psi? <br>Nitric tank present? <br>Temperature greater than 36*C?

  Yes

  No

  N/A

Isolette 22

• Location:

  in office

  in ambulance

• All equipment present and ready for service? <br><br>Equipment Bag / SBD Bag locked <br>NEO med Bag locked <br>One - IVAC pump charging <br>Two - Syringe pumps charging <br>Multiple - Flushes, Sweetease, heat packs <br>Vent Circuit, AMBU Bag, Green Mask <br>Clipboard <br><br>Oxygen and Air tanks greater than 1000 psi? <br>Temperature greater than 36*C?

  Yes

  No

  N/A

Voyager Isolette

• Location:

  in office

  in ambulance

• All equipment present and ready for service? <br><br>Equipment Bag / SBD Bag locked <br>NEO med Bag locked <br>One - IVAC pump charging <br>Two - Syringe pumps charging <br>Multiple - Flushes, Sweetease, heat packs <br>Vent Circuit, AMBU Bag, Green Mask <br>Clipboard <br><br>Oxygen and Air tanks greater than 1000 psi? <br>Nitric tank present? <br>Temperature greater than 36*C? <br>

  Yes

  No

  N/A

Flight Isolette1

• Location:

  in office

  in ambulance

• All equipment present and ready for service? <br><br>Equipment Bag / SBD Bag locked <br>NEO med Bag locked <br>One - IVAC pump charging <br>Two - Syringe pumps charging <br>Multiple - Flushes, Sweetease, heat packs <br>Vent Circuit, AMBU Bag, Green Mask <br>Clipboard <br><br>Oxygen and Air tanks greater than 1800 psi? <br>Temperature greater than 36*C?

  Yes

  No

  N/A

Flight Isolette 2 - Nitric

• Location:

  in office

  in ambulance

• All equipment present and ready for service? <br><br>Equipment Bag / SBD Bag locked <br>NEO med Bag locked <br>One - IVAC pump charging <br>Two - Syringe pumps charging <br>Multiple - Flushes, Sweetease, heat packs <br>Vent Circuit, AMBU Bag, Green Mask <br>Clipboard <br><br>Oxygen and Air tanks greater than 1800 psi? <br>Nitric tank present? <br>Temperature greater than 36*C? <br>

  Yes

  No

  N/A

Flight stretcher - PEDI

• Location:

  in office

  in ambulance

• All equipment present and ready for service? <br><br>Equipment Bag / SBD Bag locked <br>PEDI # 1 and PEDI # 2 Bags locked <br>Multiple - Flushes, Sweetease, heat packs <br>PediMate present and cleaned <br>Linens <br>Clipboard

  Yes

  No

  N/A

Stryker 1

• Location:

  in office

  in ambulance

• All equipment present and ready for service? <br><br>Equipment Bag / SBD Bag locked <br>PEDI # 1 and PEDI # 2 Bags locked <br>Multiple - Flushes, Sweetease, heat packs <br>Ventilator plugged in and charging <br>PediMate present and cleaned <br>Linens <br>Clipboard

  Yes

  No

  N/A

Stryker 2

• Location:

  in office

  in ambulance

• All equipment present and ready for service? <br><br>Equipment Bag / SBD Bag locked <br>PEDI # 1 and PEDI # 2 Bags locked <br>Multiple - Flushes, Sweetease, heat packs <br>Ventilator plugged in and charging <br>PediMate present and cleaned <br>Linens <br>Clipboard

  Yes

  No

  N/A

Other equipment.

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

  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

• Minimum of two spare RT bags sealed, present, and ready for service?

  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

• 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

• One spare / flight Phillips monitor / defibrillator present and ready for service? <br><br> Plugged in and charging if not currently in use.

  Yes

  No

  N/A

• Helipad FOD check complete?

  Yes

  No

  N/A

• Empty O2 amid Air tankers exchanged?

  Yes

  No

  N/A

• Drug Refrigerator / Pyxis temperature between 38-42*F and 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