County of Renfrew Paramedic Service FRONTLINE VEHICLE CHECKLIST

Transcription

1 County of Renfrew Paramedic Service FRONTLINE VEHICLE CHECKLIST (CHEVROLET) Base: Date: Vehicle #: (revised: 28 July 2017) MECHANICAL CHECK Recording / Miscellaneous Engine Compartment Computer c/w Charger 1 Engine Oil Level Zip Pack c/w: Windshield Washer Fluid Level - Fuel / Expense Log 1 Radiator Coolant Level - Health Care Facility Access Code Sheet 1 Radiator Hoses CoR Folder c/w: Belts - CoR Issues Management Input Form 4 Batteries - CoR Incident/Accident Report Form 4 Engine Start and Witness Statement Engine Start - CoR Exposure Report Form 4 Brake Pedal (depress then next step) - CoR Motor Vehicle Collision Report 4 Start Vehicle - WSIB (Form 6, Form 8) Each 4 Fuel (min ¾ full) - WSIB Exposure Incident Form 4 - ACR 4 Emergency Lighting Ownership and Insurance Headlights - Low/High Beams Credit Card 4-Way Flashers Spare Vehicle Key Running Lights Other Maps of Area / Map Book Signal Lights Emergency Lights: Primary/Secondary OXYGEN BAG Wigwags "D" Tank c/w Regulator Valve (min1000psi) 1 Parking Lights/Tail Lights O2 Mask 3-in-1 Adult and Pediatric (Each) 1 License Plate Lights Nasal Cannula 1 Brake Lights ETCO2 Nasal Cannula (>20kg) - Adult 1 Backup Lights/Alarm BVM - Adult c/w Bacterial Filter 1 Emergency Brake Test OPA (50, 60, 70, 80, 100, 110 mm) Each 1 Flood Lights NPA (26, 30, 34 Fr) Each c/w Lubricant 1 Wipers/Washer Fluid Pump PORTABLE SUCTION (see p.6 for items) 1 Interior Electrical (Dvr Compartment) DEFIB EQUIPMENT CHECK Radio Comms Test (Main & Portable x 2) 4-Lead Cable 1 Back Up Camera (for applicable vehicles) SPO2 Sensor 1 All Gauges BP Cuff - Reg Adult 1 Horn, Siren & PA System Monitor Electrodes Pkg - Adult (min 20) 1 Anti-Theft Switch Monitor Electrodes - Pediatric 8 Interior Lights Alcohol and Nail Polish Remover Pads A/C, Heater & Fan 12-Lead Cable 1 Diesel Exhaust Fluid Check Defib Cable 1 Safety Equipment (Dvr Compartment) Defib Pad Package - Adult 2 Fire Extinguisher (5lbs & Charged) 1 Defib Pad Package - Pediatric 1 Flares (Burning and Electronic) Each 2 Paper roll 1 High Visibility Tape Roll 1 Razor and Skin Prep Tape (Each) 1 Flashlight 2 BP Cuffs: (Lrg, Reg, Child and Sml Child, Cell Phone c/w Charger 1 Infant) Each 1 Gloves (Sml, Med, Lrg, XLrg) Box Each 1 SPO2 Sensor Wrap: (Adult, Peds, Inf) Each 2 Hand Sanitizer 1 ETCO2 Filterline 1 Page 1 of 7

2 DEFIB OPERATIONAL CHECK IV KIT cont'd User Test c/w Strip Section B A B Battery Strength Check Needle - Blunt Fill - 18G 1½" 4 Date/Time Check Cannula - Blunt Plastic 2 Simulator Operational Test (As Required) Cannula - Vial Access 2 Nasal Atomizer 1 Main Backpack Outer / Upper Pouch: Needle 18G 1½" 2 INTUBATION KIT Needle 21G 1½" 2 Side A A B Needle 23G 1" 2 Magill Forceps 9" 1 Syringe 1cc - 25G 5/8" 2 Blade - Miller - Size 3 1 Syringe 3cc - 25G 5/8" 2 Blade - MacIntosh - Size 4 1 Syringe 10cc 2 Blade - MacIntosh - Size 3 1 Section C A B Tape - Pink 1 roll 1 0.9% NaCl Preload Syringe - 10ml 3 Laryngoscope Handle (disposable) 1 IV Catheter - 16G 2 Middle Section A B IV Catheter - 18G 3 Lidocaine Spray - 30ml bottle 1 IV Catheter - 20G 3 Lidocaine Spray Nozzle 1 IV Catheter - 22G 3 Syringe 10cc 2 IV Catheter - 24G 2 Side B A B Tourniquet 3 ETCO2 Filterline 1 Section D A B OPA 100mm 1 Alcohol Swab 8 Thomas Tube Tie - Adult 1 Gauze 2x2 4 ETT c/w Stylette (6.0, 6.5, 7.0, 7.5, 8.0 mm) 1 Tegaderm 6 Outer Pouch A B Tape - Clear (Transpore) 1 roll 1 Endotrol Tube - Nasal (6, 7, 8 mm) Each 1 Bandaids 4 ETT Extension 1 IV Extension Set 3 Lubricating Jelly Pack 3 Razor 2 Nasal Decongestant - 20ml bottle 1 IV Kit - Outside Pouch / Front A B Tube Check Bulb 1 Respichamber 1 Wrapped Around Kit A B MDI Adapter 1 C-Collar - Adjustable Adult 1 Nebulizer Mask - Adult 1 Salbutamol MDI (puffer) - 100mcg 1 Main Backpack Outer / Lower Pouch: Salbutamol nebule - 2.5mg 10 IV KIT - Section A A B 0.9% NaCl - 10ml vial 2 IV Kit - Outside Pouch / Rear A B Acetaminophen 325mg - bottle 1 0.9% NaCl Bag - 250ml or 500ml 1 Adenosine Injection Preload - 12mg/4ml 1 Solution Set - 10cc 1 Adenosine Injection Preload - 6mg/2ml 1 Sharps Shuttle 1 Ampoule Cracker 4 Sterile Water 100ml bottle 1 ASA - 81mg chewable tabs - bottle 1 Diphenhydramine(Benadryl) 25mg - box 1 x Calcium Gluconate 10ml vial - 1g/10ml 2 Polysporin (Polymyxin B) - tube 1 x D10 (10% Dextrose) - 100ml bag 1 Dimenhydrinate (Gravol) ampoule - 50mg/ml 2 MEDICATION POUCH Diphenhydramine(Benadryl)1mlvial50mg/ml 2 (Located inside Inner Compartment) Epinephrine ampoule - 1mg/ml (1:1000) 6 Amiodarone vials 900mg TOTAL x Glucagon - 1mg 1 Atropine Sulphate ampoule - 0.6mg/1ml 3 x Glucose - Oral - 31mg tube 1 Epinephrine Preload - 1mg/10ml 4 x Ibuprophen 400mg - bottle 1 Furosemide (Lasix) ampoule -40mg/4ml 2 x Naloxone (Narcan) 2ml vial - 1mg/ml 3 Syringe 10cc 2 x Nitrospray bottle - 0.4mg 1 Needle - Blunt Fill - 18G 1½" 2 x Ketorolac Tromethamine- 1ml vial -30mg/ml 1 Page 2 of 7

3 Main Backpack PEDIATRIC KIT - Outer / Large Side Pouch: Inside Flap O2 Isolation Mask: 0.9% NaCl Preload Syringe - 10cc 2 (Lrg and Sml Adult; Child) Each 1 Angiocath 18G 1.16" catheter (chest needle) 1 Suction Catheters (10, 14 Fr) Each 1 Asherman Chest Seal 1 V-Vac Kit c/w: Side A (Handle, Canister, Catheter, Adapter) Each 1 Emesis Bag 1 Main Backpack Broselow Pediatric Emergency Tape 1 - Outer / Upper Side Pouch: BP Cuff - Pediatric - Manual 1 Sharps Container - 0.6L 1 Glucometer - complete 1 Main Backpack Thermometer c/w Probe Covers 1 - Outer / Lower Side Pouch: BVM - Child c/w: 1 Emesis Bag 1 - Bacterial Filter and Child Facemask Glucometer - complete 1 BVM - Infant c/w: Bacterial Filter and 1 Thermometer - Ear - c/w Probe Covers 1 - Infant and Neonate Facemask(Each) O2 Mask 3-in-1 - Pediatric 1 Main Backpack Nebulizer Mask - Pediatric 1 - Inner Compartment: ETCO2 Nasal Cannula (10-20kg) - Pediatric 1 BP Cuff - Adult - Manual 1 Suction Catheter - 6Fr 2 Bougie Tube 1 Side B Faceshield 2 0.9% NaCl Bag - 250ml 1 Pressure Infuser Bag 1 IO/CHEST BAG (red) Solution Set - 60cc 1 0.9% NaCl Preload Syringe - 10ml 2 Syringe - 60cc 1 Angiocath 12G 3" (chest needle) 2 Intraosseous Needle (Manual) - 18G 1 Asherman Chest Seal 2 Kling 4" 2 Intraosseous Needle (Manual) - 15G 1 Epinephrine - 1mg/10ml (1:10 000) 2 Kling 4" 2 Amiodarone vial -150mg/3ml 2 Pressure Release Valve (chest needle valve) 2 Tape - Pink 1" roll 1 PEDIATRIC INTUBATION KIT (pink) Main Compartment KING LT BAG (green) Blade - Miller - size 0 1 ETCO2 Filterline 1 Blade - Miller - size 1 1 King LT (size 3, 4, 5) Each 1 Blade - Miller - size 2 1 Tape - Pink 1" roll 1 Blade - MacIntosh - size 2 1 Thomas Tube Tie - Adult 1 ETT: (2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5mm)Each 1 Magill Forceps - 7" 1 PRELOAD BAG (black) Laryngoscope Handle - Peds - c/w AA Batt 1 Sodium Bicarbonate 8.4% Preload 1 Lidocaine Spray - 30ml bottle 1-50 meq(mmol)/50ml Lidocaine Spray Nozzle 1 D5W (5% Dextrose) - 100ml bag 2 Outer Pouch Solution Set - 10cc 1 Batteries AA - spare 2 Bulb Syringe - 2oz 1 IV FLUID BAG (maroon) ETCO2 Filterline 1 0.9% NaCl Bag ml 1 Laryngoscope Spare Bulb 1 Dopamine 250ml bag - 200mg/250ml 1 Lubricating Jelly Pack 2 IV A-Flo Regulator 1 Meconium Aspirator 1 Pressure Infuser Bag 1 Stylette mm 1 Solution Set - 10cc 1 Stylette mm 1 Solution Set - 60cc 1 Tape - Pink 1" roll 1 Thomas Tube Tie - Pediatric 1 EZ-IO KIT (yellow) (see p.6 for items) 1 C-Collar (wrapped around intubation kit) 1 Page 3 of 7

4 2 nd IV KIT (Attached to Pediatric Kit) SHELF 4 Burn Kit 1 TRAUMA BAG Pedimate c/w Auxillary Strap 1 Outside Pouch c/w: - Sterile Water 250 ml 1 Emergency Blanket - Yellow 2 - Cold Pack 1 Stretcher Slider Sheet 4 - Emesis Bag 2 - Quick Splint - malleable 1 SHELF 5 Side A: - Kling 4 2 BIN 5A: - Kling 6 2 Bandaids - box 1 - Triangular 6 Emergency Blanket - Foil 1 Side A Pouch: - Abdominal Pad 2 Emesis Bag 4 Flap 1: - Antiseptic Towelette 6 Gauze 4 x Noseclip 1 Noseclip 1 - Shears 1 Shears 1 Flap 1 Pouch: - Pressure Dressing - Small 2 Tape - Cloth 1" roll 1 - Pressure Dressing - Large 2 Tape - Micropore 1" roll 1 Flap 2 Pouch: - Gloves: Lrg - pair 1 Tape - Transpore 1" roll 1 - Tape: Adhesive Cloth - 1 roll 1 Tape - Pink 1" roll 1 - Tape: Micropore - 1 roll 1 BIN 5B: - Hand Sanitizer - 4 oz bottle 1 Abdominal Pad 2 Side B: - Eye Pad 4 Eye Pad 4 - Gauze 4x4 6 Kling 4" 2 Kling 6" 2 REAR ELECTRICAL Pressure Dressing - Small 2 Patch Phone Pressure Dressing - Large 2 Interior Lights High/Low Triangular 6 Cabinet Lights BIN 5C: Exhaust Ventilation Cold Pack 3 A/C, Heater Hot Pack 3 OTHER: REAR EQUIPMENT Teddy Bear 1 SHELF 1 Obs Kit - APGAR Card and Receive Blanket 1 Blankets 4 PR Stickers SHELF 2 SHELF 6 Flannels/Sheets 5 BIN6A: Pillow Cases 5 Alcohol Prep Pad 10 Towels 5 Defib Paper Roll 1 Monitor Electrode Pkg - Adult 1 SHELF 3 Nail Polish Remover Pad 6 Suction Canister (with filter)(300cc) - Portable 1 Razor 2 Suction Canister c/w Lid (1200cc) - Vehicle 1 Skin Prep Tape 1 BioHazard Bags (Large & Small) Each 3 BIN 6B: Soaker Pads 2 Quick Splint - malleable 1 V-Vac Cartridge 1 Sterile Water ml bottle 2 Urinal 1 BIN 6C: Bed Pan 1 Quick Connect Strap 4 Powder Dam 1 BIN 6D: Toilet Paper Roll 1 BP Cuff - Adult XLrg - Manual 1 BP Cuff - Adult - Manual 1 BP Cuff - Child - Manual 1 Stethoscope 1 Page 4 of 7

5 SHELF 7 SHELF 10 BIN 7A: INTUBATION KIT - complete 1 "D" Tank Regulator 1 Facemask - Sml Adult 1 CPAP BAG c/w: Humidified O2 1 CPAP Machine with Connector Hose 1 O2 Flowmeter Nipple 1 CPAP Head Harness (spare) 1 BIN 7B: CPAP Mask (Small, Large) Each 1 BVM Bacterial Filter 1 CPAP Medium Mask Kit with Tubing 1 Lubricating Jelly Packet 6 NPA (26, 30, 34 Fr) Each 2 SHELF 11: ACP SUPPLIES OPA (50, 60, 70, 80, 100, 110mm) Each 2 BIN 11A: KING LT BAG (green) Intraosseous Needle - (Manual) - 18G 1 ETCO2 Filterline 1 Intraosseous Needle - (Manual) - 15G 1 King LT (size 3, 4, 5) Each 1 Solution Set - 10cc 4 Tape - Pink 1 roll 1 Thomas Tube Tie - Adult 1 BIN 11B: OTHER: Cannula - Blunt Plastic 2 BVM - Adult with Bacterial Filter 1 Cannula - Vial Access 2 IV Catheter (18G, 20G) Each 3 SHELF 8 IV Extension Set 3 BIN 8A: Needle - Blunt Fill - 18G 1½" 6 Hand Sanitizer - 4oz bottle 1 Needle - 18G 1½" 2 Isolation Gown 4 Needle - 21G 1½" 2 N95 Mask (9210) 4 Needle - 23G 1" 2 N95 Mask (1870) 3 0.9% NaCl Preload Syringe - 10cc 6 N95 Mask - VFlex (9105S) 3 0.9% NaCl - 10ml vial 3 Surgical Mask 4 Syringe (1cc, 3cc, 10cc) Each 2 BIN 8B: Tourniquet 3 Suction Catheter (10, 14 Fr) Each 2 Suction Filter with 5 Tubing 1 OTHER: Suction Tip - Wide Bore 1 D10 (10% Dextrose) - 100ml bag 2 Suction Tip - Yankauer 1 0.9% NaCl Bag - 250ml 1 Suction Tubing 1 0.9% NaCl Bag - 500ml 1 V-Vac Suction Adapter 1 V-Vac Suction Catheter 1 PRELOAD BAG (black) V-Vac Suction Double Male Connector 1 Epinephrine Preload - 1mg/10ml (1:10 000) 4 BIN 8C: Sodium Bicarbonate 8.4% Preload 1 ETCO2 Nasal Cannula (10-20kg) - Pediatric 2-50 meq(mmol)/50ml Nebulizer Mask - Pediatric 1 D5W (5% Dextrose) - 100ml bag 2 O2 Mask 3-in-1 - Pediatric 2 Solution Set - 10cc 1 BIN 8D: ETCO2 Nasal Cannula (>20kg) - Adult 2 IV FLUID BAG (maroon) Nasal Cannula 2 0.9% NaCl Bag ml 1 Nebulizer Mask - Adult 1 Dopamine 250ml bag - 200mg/250ml 1 O2 Mask 3-in-1 - Adult 4 IV A-Flo Regulator 1 O2 Tubing 2 Pressure Infuser Bag 1 Solution Set - 10cc 1 SHELF 9 Solution Set - 60cc 1 Kleenex box 1 Spare CPAP Medium Mask Kit with Tubing 1 Channel Lock Pliers 1 Extended Cuff Glove (S, M, L, XL) Box Each 1 Page 5 of 7

6 OTHER REAR EQUIPMENT OUTSIDE CUPBOARDS "D" Tanks (Full tag) 4 Spinal Board 2 "M" Tank (min 700psi) 1 O2 Wall Flowmeter 2 (MCI Kit located with spinal boards) Vehicle Suction (550mmHg in 5 sec) c/w: 1 MCI KIT to include: - Suction Filter with 5 Tubing 1 - Emergency Response Guide 1 - Suction Tip - Yankauer 1 - Triage Tags 50 - Suction Tubing 1 - Reference Cards (set of 4) 1 Gloves (Sml, Med, Lrg, XLrg) Box Each 1 - Multi-purpose Vest (orange) 2 Disposable Disinfectant Wipes - Canister 1 - Site Coordinator Vest (green) 1 Sharps Container - 1 Quart 1 - Light Stick 6 Sharps Container - larger size than 1Quart 1 - Grease Pencil 2 Fire Extinguisher (5lbs) - Charged 1 CPR Board 1 Scoop Stretcher 1 Spare Pillow 1 Quick Connect Straps for Scoop (in pouch) 4 LCSU Spare Battery (secure in vehicle) 1 Canvas Sleeve - Pole Stretcher 1 Carrying Poles - Pole Stretcher 2 Speed Splint 2 PORTABLE SUCTION (LCSU) - Located in Oxygen Bag c/w: SAGAR Splint Kit c/w: 1 - Suction Unit 1 - Sagar Traction Bar 1-300cc Canister (filter included) 1 - Ischial Strap 1 - Suction Tubing 1 - Ankle Harness (right and left) Each 1 - Suction Tip (Yankaeur,Wide Bore) Each 1 - Cravat - XLong 1 - Suction Catheters (10, 14 Fr) Each 1 - Cravat - Long 1 - Sterile Water 100ml bottle 1 - Cravat - Short 2 - Flat Tip Screwdriver 1 - Figure 8 Strap 1 KED c/w: 1 EZ-IO KIT - Pad 1 - Located in Main Backpack c/w: - Head/Chin Strap 1 - EZ-IO Driver 1 - EZ-IO Needle Set (15mm, 45mm) Each 1 Stairchair - Tracked Chair c/w Straps 1 - EZ-IO Needle Set (25mm) 2 Extension Strap for Tracked Stairchair 2 - Alcohol Swab 4 Stairchair - Regular chair c/w Straps 1 - Kling 4" 2 Bolt Cutter 1 - Tape - Clear (Transpore) 1 roll 1 Prybar (min 5ft) 1-0.9% NaCl Preload Syringe - 10ml 2 Windshield Washer Fluid Jug 1 Coolant Jug 1 STRETCHER SPINAL IMMOBILATION KIT 2 Stryker Power Cot c/w: 1 Each Kit to Include: - Straps,IV Pole,Defib Pole,Pillow,Linen 1 - C-Collar - Adult - adjustable 3 - C-Collar - Child - adjustable 2 - Quick Connect Strap 4 VEHICLE CONDITION - Head Roll 2 Clean - Inside/Outside - Tape - Adhesive Cloth - 2" roll 1 Surface Undamaged - Tape - Adhesive Cloth - 1" roll 1 - Tape - Micropore - 2" roll 1 - Tape - Micropore - 1" roll 1 Page 6 of 7

7 PRINT NAME INITIAL OASIS # PRINT NAME INITIAL OASIS # PATIENT COMPARTMENT CUPBOARD LEGEND (MX160) SHELF Open Space 5 9 Phone/Lights 6 10 PATIENT COMPARTMENT CUPBOARD LEGEND (New Chev-MX164) SHELF 1 (Blankets) SHELF 3 and 4 Supplies BVM / King LT Bag Preload Bag / IV Fluid Bag Bins 8 C,D Bins 7 A,B Bins 11 A,B and Other Supplies SHELF 2 (Sheets, Towels, Pillowcases) Bins 5 A,B,C SHELF 5 Other Supplies Bins 8 A,B LP15 Mount Bins 6 A,B,C,D SHELF 9 (Spare CPAP Medium Mask Kit with Tubing, Extended Cuff Gloves, Channel Lock Pliers) Suction/Lights Open SHELF 10 Supplies (Intubation Kit / CPAP Kit) Page 7 of 7