LGH BLS Truck Checklist

Justin Ames

LGH BLS Truck 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

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

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

Print as PDF

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