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LGH BLS Truck Checklist
LGH BLS Truck Checklist
Justin Ames

LGH BLS Truck Checklist

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Free LGH BLS Truck Checklist Checklist

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Title Page

  • Conducted on

  • EMT 1

  • EMT 2

  • Third rider (if applicable)

  • Location

  • Truck #

GENERAL VEHICLE CONDITION

  • IS THE EXTERIOR OF THE VEHICLE CLEAN AND FREE OF DAMAGE?

  • IF DAMAGE IS NOTED PLEASE TAKE A PHOTO OF THE DAMAGE AREA

  • IS THE INTERIOR CAB OF THE TRUCK CLEAN AND FREE OF DAMAGE?

  • IF DAMAGE IS NOTED PLEASE TAKE A PHOTO OF THE DAMAGE AREA

  • IS THE PATIENT COMPARTMENT CLEAN AND FREE OF DAMAGE?

  • IF DAMAGE IS NOTED PLEASE TAKE A PHOTO OF THE DAMAGE AREA

  • FUEL LEVEL

  • ENGINE OIL ACCEPTABLE?

  • WINDSHIELD WIPER FLUID ACCEPTABLE?

  • ANY INDICATION OF LEAKING FLUIDS?

  • HEADLIGHTS FUNCTIONAL?

  • EMERGENCY LIGHTS FUNCTIONAL?

  • SCENE LIGHTS FUNCTIONAL?

  • SIRENS FUNCTIONAL?

  • BACKUP ALARM FUNCTIONAL?

  • BREAK LIGHTS FUNCTIONAL?

  • TAIL LIGHTS FUNCTIONAL?

  • TURN LIGHTS FUNCTIONAL?

  • TRUCK MILEAGE

FIRST-IN KIT

  • (2) ADULT OPA

  • (2) CHILD OPA

  • (2) INFANT OPA

  • (1) 12F NPA

  • (1) 14F NPA

  • (1) 16F NPA

  • (1) 18F NPA

  • (1) 20F NPA

  • (1) 22F NPA

  • (1) 24F NPA

  • (1) 26F NPA

  • (1) 28F NPA

  • (1) 30F NPA

  • (1) 32F NPA

  • (1) 34F NPA

  • (12) LUBRICANT

  • (1) ADULT BVM

  • (1) CHILD BVM

  • (1) INFANT BVM

  • (1) POCKET MASK

  • THERMOMETER

  • THERMOMETER COVERS

  • PULSE OXIMETRY PROBE

  • (1) ADULT BP

  • (1) STETHOSCOPE

  • (1) PENLIGHT

  • (1) OB KIT

  • (1) RING CUTTER

  • (2) TUNG DEPRESSOR

  • (2) FACE/EYE MASK

  • (2) PAIR OF GLOVES (M&L)

  • (12) 4X4

  • (4) 5X9

  • (2) 10X30

  • (6) ROLLER BANDAGE

  • (4) CRAVATS

  • (2) TOURNIQUETS

  • (2) 2" TAPE

  • (1) BANDAGE SCISSORS

  • (1) STERILE WATER

  • (2) COLD PACKS

  • (1) BULB SYRINGE

  • (6) BAND-AIDS

  • (1) BURN SHEET

  • (2) HEPA FILTERS

FIRST-IN MEDICATIONS

  • ADULT EPI PEN EXPIRATION

  • PEDI EPI PEN EXPIRATION

  • (2) NALOXONE EXPIRATION

  • ASPIRN EXPIRATION

  • (2) GLUCOSE EXPIRATION

  • ALBUTEROL EXPIRATION

  • 3ML NS EXPIRATION

  • (2) ATOMIZERS

CABINET MEDICATIONS

  • ADULT EPI PEN EXPIRATION

  • PEDI EPI PEN EXPIRATION

  • (2) NALOXONE EXPIRATION

  • ASPIRIN EXPIRATION

  • (2) GLUCOSE EXPIRATION

  • ALBUTEROL EXPIRATION

  • 3ML NS EXPIRATION

  • (2) ATOMIZERS

AED

  • AED

  • (2) ADULT PADS EXPIRATION

  • (2) PEDI PADS EXPIRATION

  • RAZOR

  • TOWEL

PORTABLE O2

  • O2 PSI

  • O2 CYLINDER

  • O2 REGULATOR

  • O2 WRENCH

  • (2) ADULT NRB

  • (2) PEDI NRB

  • (2) ADULT NC

  • (2) PEDI NC

  • (1) O2 TUBING

  • (1) ADULT AEROSOL

  • (1) PEDI AEROSOL

  • (1) NEBULIZER

INSTALLED O2

  • O2 PSI

  • O2 CYLINDER

  • (2) FLOW METERS

  • WRENCH

STRETCHER O2

  • O2 PSI

  • O2 WRENCH

PORTABLE SUCTION

  • SUCTION UNIT

  • MEDLINE CHARGER

  • MIN. 600MMHG

  • (1) WIDE BORE TUBING

  • (1) SEMI-RIGID SUCTION TIP

  • (1) COLLECTION CANISTER

  • (2) PAIR OF GLOVES (M&L)

  • (2) FACE/EYE MASK

  • (1) STERILE WATER

INSTALLED SUCTION

  • SUCTION UNIT

  • MIN. 600 MMHG

  • (1) WIDE BORE TUBING

  • (1) SEMI-RIGID SUCTION TIP

  • (1) COLLECTION CANISTER

GLUCOMETER TEST

  • QC NUMBER

  • TIME OF QC

  • ALCOHOL PADS

  • LANCETS

AIRWAY CABINET

  • (1) ADULT BVM

  • (1) CHILD BVM

  • (1) INFANT BVM

  • (2) O2 TUBING

  • (4) ADULT NRB

  • (4) PEDI NRB

  • (4) ADULT NC

  • (4) PEDI NC

  • (2) ADULT OPA

  • (2) CHILD OPA

  • (2) INFANT OPA

  • (1) 12F NPA

  • (1) 14F NPA

  • (1) 16F NPA

  • (1) 18F NPA

  • (1) 20F NPA

  • (1) 22F NPA

  • (1) 24F NPA

  • (1) 26F NPA

  • (1) 28F NPA

  • (1) 30F NPA

  • (1) 32F NPA

  • (1) 34F NPA

  • (12) LUBRICANT

  • (1) O2 HUMIDIFIER

  • (2) SUCTION CATH (5,8,14FR)

  • (4) FACE/EYE MASKS

  • (1) WIDE BORE TUBING

  • (1) SEMI-RIGID SUCTION TIP

  • (1) COLLECTION CANISTER

  • (2) STERILE WATER

  • (1) ADULT AEROSOL

  • (1) PEDI AEROSOL

  • (1) NEBULIZER

WOUND/BANDAGE CABINET

  • (24) 4X4

  • (12) 5X9

  • (6) 10X30

  • (12) ROLLER BANDAGE

  • (8) CRAVATS

  • (4) 1" TAPE

  • (4) 2" TAPE

  • (2) BANDAGE SCISSORS

  • (4) STERILE WATER

  • (2) OCCLUSIVE DRESSING

  • (4) COLD PACKS

  • RING CUTTER

  • (5) SAM SPLINTS

  • (2) BURN SHEETS

  • (2) TOURNIQUETS

  • (2) PENLIGHTS

  • (1) OB KIT

IMMOBILIZATION/SPLINTS

  • REEVES

  • FULL SPINE BOARD

  • (8) 9' STRAPS

  • KED

  • (2) ADULT CERVICAL COLLAR

  • (2) PEDI CERVICAL COLLAR

  • 2" TAPE

  • ADULT TRACTION SPLINT

  • PEDI TRACTION SPLINE

  • FRACTURE PACK

EXTRICATION/TRANSPORT

  • STAIR CHAIR

  • TRANSFER SHEET

  • PEDI-MATE

PPE

  • SMALL GLOVES

  • MEDIUM GLOVES

  • LARGE GLOVES

  • EXTRA LARGE GLOVES

  • HAND SANITIZER

  • (2) GOWNS

  • (2) MASKS

  • (2) CAPS

  • (2) GOGGLES

SAFETY/VEHICLE EQUIPMENT

  • (2) ANSI VEST

  • (2) N-95

  • (2) PORTABLE RADIOS

  • (2) FIRE EXTINGUISHERS

  • (2) FLASHLIGHTS

  • CHOCK BLOCKS

  • (6) ROAD REFLECTORS

  • US DOT E.R.G

  • NIOSH GUIDE

  • BINOCULARS

  • SMART TRIAGE TAGS

  • (2) SAFETY GOGGLES

  • ROAD MAP

  • TOUGHBOOK

  • FUEL CARD

  • TRUCK PHONE

  • SHARPS CONTAINER

STRETCHER

  • 4-WHEELED COT

  • WATERPROOF MATTRESS

  • RESTRAINT STRAPS

  • WRIST/ANKLE SOFT RESTRAINTS

  • IV HOLDER

MISCELLANEOUS

  • LARGE BASIN

  • BED PAN

  • EMESIS BASIN

  • (8) SHEETS

  • (4) BLANKETS

  • (4) TOWELS

  • (2) PAPER TISSUES

  • (2) DRINKING CUPS

  • (2) TRASH BAGS

  • (2) BIO BAGS

  • LG ADULT BP CUFF

  • ADULT BP CUFF

  • CHILD BP CUFF

  • INFANT BP CUFF

  • STETHOSCOPE

  • (2) PILLOWS

  • (1) SANI WIPES

  • (5) EMESIS BAGS

EMT SIGNATURES

  • EMT 1

  • EMT 2

  • THIRD RIDER (IF APPLICABLE)

COMMENTS OR CONCERNS

  • COMMENTS OR CONCERNS

LGH BLS Truck Checklist
Justin Ames

LGH BLS Truck Checklist

Use this Template
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