Information
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Vehicle
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Conducted on
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Mileage
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Crew
- Bay, Johnnie
- Bazzoni, Michael
- Berni, Dan
- Blackwell, Robert
- Bryant, Judy
- Burns, Tyler
- Campbell, Larry
- Covington, Larry
- Dahm, Charlie
- Davila, Dan
- Dietz, Jon
- Feth, Terry
- Fischer, Dennis
- Fischer, Dan
- Fischer, Tom
- Franke, Rex
- Goss, Nancy
- Hayes, Craig
- House, Tim
- Janes, Justin
- Jones, Daryle
- Kelly, Sean
- Knapp, Steve
- Krazl, Pat
- Lawson, Rob
- Light, Ryan
- Lofquist, Jeff
- Mathes, Matt
- Murray, Pat
- Orr, Duane
- Palmer, Jeremy
- Sanders, Scott
- Short, Keith
- Sommer, Jim
- Stewart, Calvin
- Straatman, Dale
- Stratman, Dee
- Sullivan, Don
- Sumpter, Bob
- Tallis, Frank
- Whelan, Tim
- Wiley, J.T.
- Williams, Chaun
Truck Maintenance
Fuel above 3/4 Engine oil Power steering fluid Brake fluid Engine coolant Washer fluid Transmission fluid (check with engine running) Tire pressure 115 psi
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Full / Low
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Action taken:
Operational check: Vehicle started Driving lights Emergency lights Siren, Queue Airhorn Light Tower Generator Pump CAFS Compressor
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Deficiencies noted?
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Action taken:
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Any new vehicle damage?
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Description
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Attach picture
EMS Bags
EMS cabinet
Portable suction: Yankauer tip Suction tubing Suction canister
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Action taken:
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Operated to verify battery?
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Action taken:
Pediatric bag: OB kit Macro drip set Micro drip set IV start kit IV catheter 18/20/22/24 (2 each) Infant BVM Electrodes (3 pkgs) Stethoscope BP cuff infant Meconium aspirator (2) Broselow Tape Field guide Newborn cap Pen light Stuffed Animal
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Action taken:
Meds (ped bag) Epi 1:10000 (4mg) Atropine (1mg) D25 (5g) Ped bicarbonate (10mEq) Normal Saline (500 mL)
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Actions Taken:
Monitor: BP cuffs S/M/L/XL ECG and 12 lead wires Pulse oximetry sensors Adult/Ped/Infant Electrodes (4 pkgs) FAST patches Adult/Ped (1 each) ET CO2 Adult Sensors Nasal Cannula/ET Tube (1 each) ET CO2 Ped Sensors Nasal Cannula/ET Tube (1 each) Electric shaver w/ heads Disposable shaver w/ heads Temperature probes skin/internal (1 each) Extra monitor paper Monitor manual
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Action taken:
Batteries checked? 12 lead faxed AND received?
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Action taken:
Daily Operational check performed.
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Action taken:
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Photo of Operational Check. (This is done at the beginning of each shift)
Oxygen bag: Adult Nasal Cannula (2), NRB (2), Nebulizer (1) Ped Nasal Cannula (2), NRB (2), Nebulizer (1) Nebulizer with mouth piece (1) O2 key Extra O2 Washer Vent circuit
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Action taken:
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Oxygen >1000 PSI
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Action taken:
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Ventilator tested
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Action taken:
Blue bag: BP cuffs Adult/Thigh (1 each) Stethoscope CPAP circuit w/ T-connector (1) Syringes 1mL/3mL/5mL/10mL (3 each) Glucometer w/lancets and strips Adult BVM King airway size 3/4/5 (1 each) Pen Light 2X2's Tourniquet (3) Trauma Shears Sharps container IV Caths 14/16/18/20/22/24 (2 each) IV start kits (3) IV drip set macro/micro (1 each) Convenience bags (2) 4x4 gauze Tape 1" Band aids Alcohol preps Saline locks IV extension loops Venigards Field guide EZ-IO bag: Drill Needles Blue/Pink/Yellow (2 each) Pressure infuser Saline flush (2)
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Action taken:
Meds (blue bag) Adenocard (30 mg) Albuterol (5 mg) Atropine (2 mg) Baby ASA (3 packs) Benadryl (100 mg) Calcium Chloride (1 g) Cordarone (300 mg) D50 (50g) Dopamine (1 bag in front pocket) Epi 1:1000 (1 mg) Epi 1:10000 (6 mg) Glucagon (1 set) Lasix (80 mg) Lidocaine (200 mg) Lidocaine EZ-IO bag (100 mg) Mag Sulfate (5 g) Narcan (4 mg) Nitro spray (1 bottle) Oral glucose (2 tubes in front pocket) Sodium bicarbonate (100 mEq) Solu-Medrol (250 mg) Thiamine (100 mg) Vasopressin (80 units) Zofran (8 mg) Fluids: Normal Saline (500 mL in front pocket)
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Actions Taken:
Intubation Roll: Macintosh blade 1/2/3/4 (1 each) Miller blade 0/1/2/3/4 (1 each) Laryngoscope blade (1 each) CHECK LIGHT ET tubes 2.5-8 (1 each) C batteries (2) Syringe 10mL (1) Stylet M/L (1 each) Bougie Introducer (2) Tape 1" (1) Magill forceps S/L (1 each) ETCO2 ET tube (1) Nasal airway all sizes (1 each) KY jelly (3 pkgs) Oral Airway; Ped/Adult/Large adult (2 each) ET holder Adult/Ped (1 each) Bite stick
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Action taken:
Evac-U-Splint bag: Small, Med, Large splints (1 each) Vacuum pump
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Action taken:
Trauma Bag: Equipment; Stethoscope BP cuff Large/Thigh (1 each) Trauma Shears Ring Cutter Pen Light Supplies; Multi-Trauma dressing (2) Burn Sheets (2) Cook Kit (1) Pertrach (1) Combine pads (6) Yellow blanket (1) Hot/Cold packs (2 each) Sterile Water (2) Gauze wrap 6"/3" (4 each) Triangle bandages (2) SAM Splint (1) Tape 1"/3" (1 each) IV Caths 14/16/18/20 (2 each) Alcohol preps (1 box) 4x4 Gauze Band aids IV start kits
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Action taken:
Fluids (trauma bag) 1000 mL Normal Saline (2)
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Actions Taken:
Driver Side
Front Bumper: 100' 1.75" hose with nozzle
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Actions taken:
Driver Side Cab: Safety Vest WT in charger Arson Investigation Kit Overhead Door Opener Head Set Gas Card
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Actions taken:
Driver Side Jump Seat: SCBA Hand Light Box Light Set of Irons Pick Head Axe Closet Hook Safety Vest WT in charger WT strap Headset Box of gloves
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Actions taken:
Center of Cab: Map Books 5 Gas Monitor CO monitor Pack Tracker Rad Detector
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Actions taken:
Pump panel: Hydrant wrench Small Spanners (2) 200' 1.75" pre-connect with Sabre Jet Nozzle
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Actions taken:
Driver Side Front Compartment: Circuit Breaker Box Light Tower Control Smooth Bore Stack Tips 1.5" Fog nozzle Double Female 2.5" (2) Double Male 2.5" (2) 2.5" Gated Hydrant Valve Piercing Nozzle TAC Stik 2.5" Fog Nozzle Cellar Nozzle 2.5" to 1.5" Reducer (2) 4" to 5" Stortz Threaded 4.5" to 4" Stortz Water Thief Compressed Air Adapter Hose Monitor Smooth Bore Stacked Tips Headset Cord Extension Fire Scene and Danger tape Flares Socket set Spark Plug Box Cooler Tool Box Monitor Base STL City Hydrant Wrench SCBA
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Actions taken:
Above Rear Wheels: Spare SCBA Bottles (2) over 4000 Psi
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Actions taken:
Driver Side Middle Compartment: Traffic cones (3) Hose Roller Foam Eductor Shark (2) Dry Chem bags (Chimney Bombs) Stop Leak Canvas Carry-All Hot Bag Stop Sign
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Actions taken:
Air Bag System: Air Bags (4) Air Bag Control Kit Air Bag Hoses (2)
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Actions taken:
Driver Side Rear Compartment: Milwaukee Saw DeWalt Cordless Tool Kit Bolt Cutters Pry Bar Chains with Hooks Ram Support
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Actions taken:
Holmatro Tools: Hydraulic Power System Hydraulic Ram (2) Hydraulic Spreaders Hydraulic Cutter
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Actions taken:
Top/Rear of Truck
Top of Truck: 4" Supply Line (900') 3" Hose Line (800') 2.5" Blitz Line with Smooth Bore Nozzle (200") Generator Monitor/Deck Gun
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Action Taken:
Ladder Rack: Extension Ladder (24') Roof Ladder (16') Attic Ladder (10') Pike Poles (8'), (10'), (12')
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Action Taken:
Rear Upper Compartment : Portable Air Hose Reel Stihl Chain Saw Cutters Edge Pneumatic Tool Kit Step Ladder Mixed Gas Can Regular Gas Can Electric Cord Reels (100'), (200') Hose Clamp Bar Oil Kobalt Pneumatic Socket Set Funnel Hearing Protection (Ear Muffs)
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Action Taken:
Rear Lower Compartment: Tarps (3) Pressurized Water Can ABC Fire Extinguisher Grease Fire Extinguisher (Class K)
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Action Taken:
Captain Side
Captain's Side Rear Compartment: Pry Axe Square Tip Shovel Round Tip Shovel A Tool Sledge Hammer Portable Flood lights (2) Electrical Junction Box (2) Extension Cord Reel (200') Push Broom Oil Dry Door Jack Electric Fan Extension Cord (35')
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Action Taken:
Above Rear Wheels: SCBA Bottles >4000 PSI (2)
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Action Taken:
Captain's Side Middle Compartment: Rope Rescue Backpack Life Safety Rope Utility Rope RIT Bag Water Rope (2) 5 Gas Monitor Below Grade Kit Hard Hats
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Action Taken:
Captain's Side Front Compartment: Forcible Entry Kit (Red) High Rise Kit (Black and Tan) 1.75" Hotel Pack 2.5" Hotel Pack (2) Gas PPV Fan Class B AR-AFFF (5 Gal) Squeegee
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Action Taken:
Captain's Side Pump Area: Hydrant Hose Pony Section LDH Spanner (4) Sabre Jet
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Action Taken:
Captain's Side Rear Seat: T-N-T Closet Hook Safety Vest Box Light Hand Light Thermal Imaging Camera (2) SCBA WT
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Action Taken:
Captain's Seat: Pass Tag Ring Knox Box Key Ring Binoculars Safety Vest WT (2) Spot Light SCBA Cell Phone W/Charger Headset Captain Tool Laptop (Restart Every Morning)
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Action Taken:
