Basalt Fire-Rescue Medic 40 Inspection Form
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1 Date: Personnel: Cab 4 Traffic vests Batteries (9V, AA, AAA) ERG Streamlight flashlight 2 Bottles Hand Sanitizer Spot light 4 Bottles of water Map Book Assorted pens GPS (functional test) Tablet Registration and Insurance Fire size-up card AVH access card Phone list sheet Garage opener S, M, L, XL medical gloves Mile marker sheet Driver s Side Front Tall Compartment 2 Bio PPE Backpacks KED Pediatric Board Sager splint Short Board Broom and dust pan Kitty litter Yak-track Driver s Side Middle Compartment SCBA (functional test) >4200psi Stair chair Traffic triangle s in box 2 wheel chocks Tow strap and Tire Iron Duck tape Tool Box Yaktraks Jumber Cables ABC fire extinguisher Driver s Side Rear Compartment Pediatric vacuum splint Full body vacuum splint w/lg. Pump Sm/Md/Lg vacuum splints w/sm. Pump MCI tarps (red, yellow, green) (4) LED traffic lights Top Deck Stoke s basket (Secured) Passenger Side Rear Tall Compartment 2 backboards Scoop stretcher Passenger Side Middle Small Compartment (2) O2 Cylinders >1500psi (2) Backboarding Bags w/ the following items Spider straps Head blocks w/ straps Turley pad 2 towel rolls Adult C-collar 2 cloth tape roll in side pocket Pediatric C-collar 1 P age
2 Passenger Side Front Compartment (behind passenger seat) Portable suction unit w/ tubing + tip Cooler w/ Turley pad and 1000mL NaCL (*functional test while UNPLUGGED from charger) MCI/ Triage box kit Protocol binder Pediatric inflatable seat w/ pump Pediatric EMS Jump Bag with the following: Left Pouch ET tubes size 2-5 Right Pouch Stethoscope Infant/Pedi BP cuff Trauma shears Penlight Main Compartment OPA s Broslow Tape Pediatric BVM IV Start kit Infant BVM Assorted butterfly IV s Pediatric Non-rebreather mask Arm boards Pediatric Nasal Cannula Face shields O2 Extension tubing Cloth and transpore tape King tubes sizes 2, 2.5 Bulb suction Nebulizer kit Hot/Cold packs Mucous trap 2 P age
3 Main EMS Jump Bag with the following: Outside Front RED Pouch Assorted bio bags Zippered Med Pouch Aspirin (4 tablets minimum) Atropine 1mg Tetracaine Sodium Bicarb 50mEq/50mL (2) Oral Glucose Dextrose 50% 25g/50mL (2) Narcan 2mg Magnesium Sulfate 5g/10mL (2) Adenosine 12mg (2) 1mL syringe with needle (2) Albuterol 2.5mg (2) 3mL syringe with needle Racepinephrine (Racemic Epi 2.25%) (2) 5mL syringe (4) Amiodarone 150mg (2) 10mL Saline flushes (2) Epinephrine 1:1000 w/ 18ga filter needle 10mL syringe MAD (nasal atomizer) 20mL syringe Nitrostat 0.4mg/tablet (4 tablet minimum) (2) 10mL Saline flushes (2) IV Zofran 4mg 18ga needles & 18ga filter needle (2) ODT Zofran 4mg 22ga needles (2) Haldol 5mg 25ga safety needles (2) Benadryl 50mg (6) small plunger syringes (4) Epinephrine 1:10,000 Outside Front GREEN pouch (2) Trauma dressings ALS Airway Kit Curved (Macintosh) blades mL Syringe Straight (Miller) blades sizes 1-4 BAM Small/Large laryngoscope handles (2) Magill forceps (2) AA Batteries Bougie (2) C Batteries ET Tubes size (2) 10ga x 3 IV decompression catheter Adult (blue) ET tube holder Scalpel (#10) Child (pink) ET tube holder Neosynephrine Tape *EMS Jump Bag continued on page 4. 3 P age
4 Inside EMS Jump Bag Clear Pouch Side Pouch 1 Trauma Shears Tape Sharps shuttle Pen light Pens/ Paper Hand Sanitizer Pouch 2 Hot pack Cold pack Pouch 3 ACS chest seal 4x4 s Adaptic dressing 2x2 s ABD Pad Eye pads Pouch 4 ACE bandage Gauze roll (2) Triangle bandage Alcohol prep pads Assortment of bandaids Diagnostics Pouch RAD 57 Tympanic thermometer Glucometer w/ strips, lancets, preps, bandaids, 2x2 s IO Pouch IO Gun (functional) Neeldes (15mm, 25mm, 45mm) IV start kit 2% Lidocaine Pressure infuser Inside EMS Jump Bag O2 Cylinder Side BP Cuff Stethoscope 02 Cylinder (min. 1000psi) SAM splint Quick clot Tourniquet IV Pouch 500mL Normal Saline IV start kit 10gtts Drip set 14-24ga IV catheters Outer Zippered Pouch Adult/ Pediatric Nasal Cannula Adult/Pediatric Non-Rebreather Nebulizer Pouch with Adult/Pedi Handheld nebs and mask nebs Inner Zippered Pouch King LTS-D Airway s sizes 3, 4, 5 Adult BVM OPA bag NPA bag 4 P age
5 Inside the Ambulance (Patient Compartment) Gurney Items on the Gurney Oxygen cylinder (minimum 1000psi) Pillow Large Megamover Sheet Small Megamover Blanket Assorted towels Sani wipes Emesis bag Assorted gloves Bench Seat IV Roll (2) 14ga IV catheters (2) 24ga IV catheters (2) 16ga IV catheters 500mL 0.9% Sodium Chloride (2) 18ga IV catheters 10gtts drip set (2) 20ga IV catheters IV start kit (2) 22ga IV catheters Transpore tape Clipboard Stack of PCR s Orange VVH notepad Carbon monoxide carbon copies Carbon monoxide checklist Hope Center pamphlets Pen(s) Under Bench seat (left to right) (2) HWY Emergency blankets (2) Small Tyvek suits Pillow (2) Large Tyvek suits Blanket (4) Ebola shields Assortment of towels Above Bench seat (sliding cabinets) Adult C-collar (3) N95 masks Pediatric C-collar (2) P-100 masks (3) Pair safety glasses (4) surgical masks (3) Gowns (3) Bio-hoop bags SAM pelvic splint (2) towel rolls 5 P age
6 Action Area (captain s seat/radio area) Below radio area (bins) Patient assessment guide AHA flipbook PALS flipbook EMS field guide Spanish flipbook Adult defib pads Trauma activation card Sliding Cabinet (beside radio) 2 razors Penlight Hand sanitizer 4x electrode packet 10x electrode packet Pediatric defib pads Trauma shears Glucometer (lancets, test strips, bandaids, ETOH prep pads) *Functional test Oral/Rectal thermometer Ring cutter w/ extra blades calculator Items near the floor Sharps container (not full) Suction w/ canister, tubing, and hard tip *Functional test LifePak 15 (cardiac monitor) Right side pouch Bag of lubricating jelly Camera (2) ETCO2 Nasal cannula (2) Adult defib pads (2) ETCO2 Inline Pediatric defib pads Left side pouch 4-lead cables w/ 4x electrode packet 12-lead cables w/ 10x electrode packet Top middle pouch Adult NIBP cuff pre-attached Adult Large NIBP cuff Rear pouch 4x electrode packet 10x electrode packet Pediatric electrode packet Spare battery (full charge) SPO2 finger sensor Child NIBP cuff Infant NIBP cuff Pediatric SPO2 sensor Pediatric CO/SPO2 sensor Roll monitor paper 6 P age
7 Airway/Oxygen Admin Compartment Bottom Right Compartment Bag of NPA s Box of OPA s (2) Pediatric Nasal Cannula (2) Pediatric Non-rebreather (2) Adult Nasal Cannula (2) Mask nebulizer (2) Adult Non-rebreather Handheld nebulizer Adult Mask nebulizer Top Right Compartment O2 extension tubing Yellow bag w/ King Vision screen (*Functional test) -Extra batteries, two King Vision blades, ET tubes 5-8, tube securing device, and SALT airway Adult BVM Pediatric BVM Top Left Compartment CPAP w/ T piece adaptor Suction Tray Infant BVM Ventilator (2) hard tip suction ACS chest seal Suction tubing French 5-16 Bottom Left Compartment Saline bags tray 100mL NaCL 250mL NaCL Tray 2 (Pharmaceuticals) Dextrose 50% 25g Amiodarone 150mg Epinephrine 1:10,000 1mg Sodium Bicarbonate 50mEq (2) 10ga x 3in. IV catheter 60gtts Drip set Atropine 1mg Narcan (3) Albuterol 2.5mg/3mL Vicks Oral Glucose (2) Lemon swabs 7 P age
8 CPR Seat Beneath the seat Assortment of decon/ppe materials Vitals Pouch Blood Pressure cuff Sliding Compartment Above (2) headlamps BP Cuff roll Stethoscope 8 P age
9 Trauma Compartment (Rear-most Drive s Side Sliding Compartments) Top Right Stuffed animals Saline bags (2) 1000mL NaCl (2) 10gtts drip sets (2) 500mL NaCl (1) 60gtts drip set Buretrol drip set Bandage Tray 1 (2) SAM splints Tactical tourniquet (2) cling-wrap QuickClot hemostatic gauze Top Left Tub of sanitizing wipes Kleenex box Pedi arm boards Decon wipes (singles) Emesis basin Bio-hazard bags Urinal Bio-hoop emesis bags Bed pan (2) blood tube kits Bandage Tray 2 (3) triangle bandages (2) 2 cloth tape (5) conforming roll gauze 1 Transpore tape (3) ABD pads (2) Petroleum gauze Bag of assorted Band-Aids (3) Adaptic dressings Box of 2x2 s (10) 4x4 s IV Tray (3) of each IV catheter 14ga-24ga (2) buff cap (2) IV start kits Alcohol prep pads (5) Saline flush 2x2 s Tegaderms Transpore tape IV tourniquets (2) blue chux Bottom Sliding Compartment (2) mL NaCL bottles (2) 250mL Sterile water bottles Burn kit (4) Cold packs Roll of foil (4) Hot packs OB kit (2) Trauma dressings Syringe Tray (2) 60cc (3) 1cc (2) 20cc (4) 25ga safety needle (2) 10cc (5)18ga needle (5) 5cc (2) 18ga filter needle (5) 3cc w/ needle (5) 22ga needle (5) 1cc w/ needle (3) nasal atomizers 9 P age
10 Narcotics Clipboard with current month attached White seal # Functional Tests Fuel (3/4 tank minimum) Emergency lights Driving lights/ brights Turn signal lights Scene lights Brake lights Siren/ Horn CO Fire radio check VHF 800 radio check Engine Oil Windshield washer fluid Coolant Brake fluid/ power steering fluid Tire pressures (no red blinking lights) ODOMETER: NEXT SERVICE DUE DATE: Comments 10 P age
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