PRINCE GEORGE S COUNTY, MARYLAND FIRE/EMERGENCY MEDICAL SERVICES DEPARTMENT GENERAL ORDERS Division 05 Emergency Medical Chapter 06 EMS Equipment Standardization February 2009 POLICY This General Order establishes minimum equipment guidelines for all emergency medical services (EMS) units that operate as part of the EMS Operational Program managed by the Prince George s County Fire/EMS Department. DEFINITIONS ALS Transport Unit an emergency response vehicle that is equipped and staffed at the Advanced Life Support level that has the capability to transport a patient. ALS First Response Unit an emergency response vehicle that is equipped and staffed at the Advanced Life Support level that does not have the capability to transport a patient. (i.e. Paramedic Engines, and Paramedic Supervisors) BLS Transport Unit an emergency response vehicle that is equipped and staffed at the Basic Life Support level that has the capability to transport a patient. BLS First Response Unit an emergency response vehicle that is equipped and staffed at the Basic Life Support level that does not have the capability to transport a patient. (i.e. Engine, Truck, Squad, Mini-pumper, etc.) PROCEDURES 1. General Provisions The benefits of EMS equipment standardization include, but are not limited to: Improving effectiveness in patient care Improving efficiency in supply and purchasing Reducing training requirements on all EMS providers To ensure consistency throughout the Department fleet, minimum levels of Emergency Medical Services (EMS) equipment/supplies for ambulances and first response units are required These inventories are the minimum levels that must be stocked on the units to be considered in compliance. Relevant check sheets for each EMS unit type are provided with this General Order. ALS Transport Unit, ALS First Response Unit, BLS Transport Unit BLS First Response Unit Station Officers and/or Volunteer Chiefs shall ensure that units remain in compliance with the minimum levels set forth in this General Order. Check sheets to ensure operational readiness are required to be completed daily. Completed check sheets shall be retained at the Station for a period of (3) three years. After that period the check sheets shall be discarded. N/A REFERENCES DIVISION 05 Emergency Medical Chapter 06 EMS Equipment Standardization 1
PRINCE GEORGE S COUNTY, MARYLAND FIRE/EMERGENCY MEDICAL SERVICES DEPARTMENT GENERAL ORDERS FORMS/ATTACHMENTS Attachment #1 ALS Transport Unit Check Sheet Attachment #2 ALS First Response Unit EMS Equipment/Supplies Check Sheet Attachment #3 BLS Transport Unit Check Sheet Attachment #4 BLS First Response Unit EMS Equipment/Supplies Check Sheet DIVISION 05 Emergency Medical Chapter 06 EMS Equipment Standardization 2
UNIT ALS UNIT CHECKSHEET WEEK BEGINNING DAY OF THE WEEK SUN MON TUE WED THU FRI SAT VEHICLE NUMBER STATION OXYGEN SUPPLY SUN MON TUE WED THU FRI SAT 2 FULL "E" BOTTLES 1 FULL "H" BOTTLE UNIT CAB SUN MON TUE WED THU FRI SAT FIRE MOBILE/PORTABLE RADIO GERMICIDAL TOWELETTES - VIONEX P.G. COUNTY ADC BOOK AREA MAP BOOKS HOSPITAL RESOURCE MANUAL HEARING PROTECTION STATION BAY DOOR OPENER PAT COLLECTOR RING HIGHWAY SAFET VESTS - MIN. 2 OUTSIDE DRIVER'S COMPARTMENT #1 SUN MON TUE WED THU FRI SAT OFFICER'S PROTECTIVE EQUIPMENT DRIVER'S PROTECTIVE EQUIPMENT CHILD SAFETY SEAT WHEEL CHOCK (2) MARK1 NERVE AGENT KITS - ORANGE (1) ATROPINE VIALS KIT - WHITE TOOL BOX OUTSIDE DRIVER'S COMPARTMENT #2 SUN MON TUE WED THU FRI SAT (2) COMPLETE SCBA (2) HANDLIGHTS JUMPER CABLES DOT FIRE EXTINGUISHER FLAT HEAD AXE HALLIGAN BAR SHOVEL DOT REFLECTIVE TRIANGLES FLARES - MIN. 12 OUTSIDE DRIVER'S COMPARTMENT #3 SUN MON TUE WED THU FRI SAT (3) LONG SPINE BOARDS REEVES STRETCHER SHORT SPINE BOARD KED DEVICE ADULT TRACTION SPLINT CHILD TRACTION SPLINT (2) 54" PADDED SPLINTS (2) 36" PADDED SPLINTS OUTSIDE OFFICER'S COMPARTMENT #1 SUN MON TUE WED THU FRI SAT (2) SPARE "E" OXYGEN BOTTLES DRUG BOX LOCKER Revised: 11/2008 Page 1
TRAUMA BAG PEDIATRIC BAG TRIAGE TAG/TAPE KIT SPARE INTUBATION KIT PORTABLE OXYGEN KIT "E" OXYGEN BOTTLE - MIN. 900 PSI (2) ADULT NASAL CANNULA (2) ADULT NON-REBREATHER O2 MASK (2) PEDIATRIC NASAL CANNULA (2) PEDIATRIC NON-REBREATHER O2 MASK (1) NEBULIZER KIT (1) ADULT AEROSOL MASK (1) PEDIATRIC AEROSOL MASK OXYGEN BOTTLE WRENCH ALS UNIT CHECKSHEET OUTSIDE OFFICER'S COMPARTMENT #2 SUN MON TUE WED THU FRI SAT "H" OXYGEN BOTTLE - MIN. 250 PSI STRYKER STAIR CHAIR INITIALS OF PERSON(S) CHECKING OUTSIDE OF THE UNIT INSIDE COMPARTMENT [A] SUN MON TUE WED THU FRI SAT (4) 15" PADDED SPLINTS (6) 9' RESTRAINING BELTS/STRAPS (2) HEAD ROLLS/IMMOBILIZERS (3) ADULT ADJUSTABLE COLLARS (3) PEDIATRIC COLLARS (2) BABY NO-NECK COLLARS INSIDE COMPARTMENT [B] SUN MON TUE WED THU FRI SAT (5) BURN SHEETS (5) TRAUMA DRESSINGS BOX OF 4X4 GAUZE PADS - MIN. 40 PADS (4) EYE PADS BOX OF BAND AIDS (2) 1" TAPE (2) 2" TAPE (2) 3" TAPE (12) TRIANGULAR BANDAGES (6) 4" KLING (6) 6" KLING (10) AMMONIA INHALANTS (5) COLD PACKS FORCEPS HEMOSTAT RING CUTTER (6) SANITARY PADS (4) 4X4 GAUZE PACKS INSIDE COMPARTMENT [C] SUN MON TUE WED THU FRI SAT (2) ADULT BVM W/ FACEPIECE (2) CHILD BVM W/ FACEPIECE Revised: 11/2008 Page 2
(2) INFANT BVM W/ FACEPIECE (6) ADULT NASAL CANNULA (6) ADULT NON-REBREATHER O2 MASK (6) PEDIATRIC NASAL CANNULA (6) PEDIATRIC NON-REBREATHER O2 MASK (6) NEBULIZER KITS (4) ADULT AEROSOL MASKS (4) PEDIATRIC AEROSOL MASKS (2) NEBULIZER-BVM ADAPTERS (2) CPAP DEVICES (2) OXYGEN SUPPLY TUBING (2) 10FR SUCTION CATHETERS (2) 14FR SUCTION CATHETERS (2) 18FR SUCTION CATHETERS (2) YANKUER SUCTION CATHETERS (1) 18FR SALEM SUMP TUBE (1) 14FR SALEM SUMP TUBE (1) 8/10FR SALEM SUMP TUBE (1) TOOMEY SYRINGE STERILE LUBRICANT PACKETS - MIN. 10 (2) ADULT COLORIMETRIC CO2 DETECTOR (2) PEDIATRIC COLORIMETRIC CO2 DETECTOR (5) NASAL CAPNOGRAPHY CIRCUITS (5) ET CAPNOGRAPHY CIRCUITS (5) ADULT ET TUBE HOLDERS (4) PEDIATRIC ET TUBE HOLDERS BOX OF SAFETY SHIELDS ALS UNIT CHECKSHEET INSIDE COMPARTMENT [D] SUN MON TUE WED THU FRI SAT ACTIVATED CHARCOAL W/O SORBITOL (5) ADENOCARD 6MG/3ML (6) ALBUTEROL BULLETS 2.5MG/3ML (15) ASPRIN 81MG - CHEWABLE (5) ATROPINE 1MG/10ML (6) ATROVENT BULLETS 500mcg/2.5ML (2) BENADRYL 50MG/1ML BRETHINE 1MG/1ML CALCIUM CHLORIDE 1GM/10ML (5) CAPTOPRIL TABLETS 25MG CARDIZEM KIT - 100MG & 100ML NaCl BAG (2) DEXTROSE 25GM/50ML DOPAMINE 400MG/250ML PRE-MIXED (3) EPINEPHRINE 1:1,000 1MG/1ML (10) EPINEPHRINE 1:10,000 1MG/10ML EPINEPHRINE 1:1,1000 30MG/30ML (2) GLUCAGON w/ solution 1MG/1ML (3) GLUTOSE ORAL GEL TUBE (2) HALDOL 5 MG/1ML (2) LASIX 100MG/10ML (4) LIDOCAINE 100MG/5ML (2) NARCAN 2MG/2ML (4) NITRO PASTE PACKETS w/ paper (2) NITRO TABLETS (bottles) Revised: 11/2008 Page 3
(4) SALINE BULLETS 3ML SODIUM BICARBONATE 50Meq/50ML ALS UNIT CHECKSHEET INSIDE COMPARTMENT [E] SUN MON TUE WED THU FRI SAT (4) BAAMS (1) 2.5MM ENDOTRACHEAL TUBE (1) 3.0MM ENDOTRACHEAL TUBE (1) 3.5MM ENDOTRACHEAL TUBE (1) 4.0MM ENDOTRACHEAL TUBE (1) 4.5MM ENDOTRACHEAL TUBE (1) 5.0MM ENDOTRACHEAL TUBE (1) 5.5MM ENDOTRACHEAL TUBE (2) 6.0MM ENDOTRACHEAL TUBE (2) 7.0MM ENDOTRACHEAL TUBE (2) 8.0MM ENDOTRACHEAL TUBE (2) 9.0MM ENDOTRACHEAL TUBE (2) 6FR STYLET (2) 14FR STYLET ADULT COMBITUBE ROLLUP KIT SMALL ADULT COMBITUBE ROLLUP KIT (2) 10CC SYRINGES HURRICANE SPRAY w/ TIPS LIDOCAINE JELLY (2) NASAL AIRWAY KIT SIZES 24,26,28,30,32FR (1) ORAL AIRWAY KIT SIZES 0-5 INSIDE COMPARTMENT [BENCH] SUN MON TUE WED THU FRI SAT SPARE SHEETS/BLANKETS INSIDE COMPARTMENT [M1] SUN MON TUE WED THU FRI SAT (3) 14GA IV CATHETERS (3) 16GA IV CATHETERS (3) 18GA IV CATHETERS (3) 20GA IV CATHETERS (3) 22GA IV CATHETERS (3) 24GA IV CATHETERS (6) 1CC SYRINGE (6) 3CC SYRINGE (6) 10CC SYRINGE (2) INTRAOSSEOUS NEEDLES - 15GA (2) CHEST DECOMPRESSION KITS INSIDE COMPARTMENT [M2] SUN MON TUE WED THU FRI SAT (3) VACUTAINER HOLDERS (10) VACUTAINER HUBS ASSORTED BLOOD TUBES (5) 18GA NEEDLE (5) 25GA NEEDLE (10) SALINE FLUSHES (6) LEVER LOCK CANNULAS (10) TOURNIQUETS BOX OF ALCOHOL PREPS (6) INJECTION PORTS Revised: 11/2008 Page 4
ALS UNIT CHECKSHEET (3) BETADINE SWABS INSIDE COMPARTMENT [M3] SUN MON TUE WED THU FRI SAT (10) BIOCCLUSIVE DRESSINGS (2) DUAL INJECTION SETS (2) 9" ARMBOARDS (2) INFANT ARMBOARDS (10) BLUNT CANNULAS (6) IV EXTENSION SETS INSIDE COMPARTMENT [Q1] SUN MON TUE WED THU FRI SAT PLASTIC BASIN (10) RED BAGS (10) YELLOW BAGS (10) TRASH BAGS (2) SCRUB BRUSH PAPER TOWELS BOX OF SURGICAL/VISOR MASKS (10) N99 MASK BOX OF BUBBLE TUBING INSIDE COMPARTMENT [Q2] SUN MON TUE WED THU FRI SAT PORTABLE SUCTION UNIT - OPERATIONAL CANNISTER W/ LID YANKAUER SUCTION CATHETER W/ TUBING SUCTION CATHETERS - 10,14, 18FR STERILE WATER BOTTLE (2) SUCTION UNIT BATTERIES (2) FACE SHIELDS & GLOVES SPARE SUCTION CANNISTERS & LIDS INSIDE COMPARTMENT [RF] SUN MON TUE WED THU FRI SAT EMERGENCY RESPONSE GUIDEBOOK (2) VEHICLE ACCIDENT PACKAGE (2) COMPLETE INJURY PACKAGE SMOKE ALARM & FORMS SPARE FORMS PROTOCOL BOOK INSIDE COMPARTMENT [S1] SUN MON TUE WED THU FRI SAT (25) ADULT ELECTRODES (5) PEDIATRIC ELECTRODE 4/PACKS SPARE ROLL ECG PAPER (2) SPARE ADULT COMBO PADS (2) SPARE PEDIATRIC COMBO PADS SPARE LIFEPACK12 BATTERY (4) 500cc STERILE WATER (2) DISPOSABLE SAFETY RAZORS INSIDE COMPARTMENT [S2] SUN MON TUE WED THU FRI SAT (5) 60gtts/ml ADMINISTRATION SETS (6) 10gtts/ml ADMINISTRATION SETS (4) 1000ml LACTATED RINGERS SOL'N Revised: 11/2008 Page 5
(4) 500ml LACTATED RINGERS SOL'N (2) PRESSURE INFUSORS BOX OF LANCETS ALS UNIT CHECKSHEET INSIDE COMPARTMENT [T] SUN MON TUE WED THU FRI SAT ALCARE SPRAY BOTTLE OF DISINFECTANT CLEANER (3) GOGGLES/ANSI EYE PROTECTION GERMICIDAL TOWLETTES INTERIOR GENERAL SUN MON TUE WED THU FRI SAT STRETCHER w/ APPROPRIATE STRAPS BLANKET/SHEET WASTEBASKET w/ RED LINER (2) SHARPS CONTAINERS WEEKLY UNIT SANITIZING ACTION WALL & SHELF SUN MON TUE WED THU FRI SAT (2) OXYGEN FLOW LITER DEVICE -MIN 25LPM FIXED SUCTION UNIT CANNISTER w/ LID YANKAUER CATHETER w/ TUBING BOX OF TISSUE BOX OF SMALL NITRILE GLOVES BOX OF MEDIUM NITRILE GLOVES BOX OF LARGE NITRILE GLOVES BOX OF EXTRA LARGE NITRILE GLOVES ADULT BP CUFF LARGE ADULT BP CUFF CHILD BP CUFF STETHOSCOPE TRAUMA SHEARS EMESIS BASIN BITE STICK STRETCHER BATTERY CHARGER SPARE STRETCHER BATTERY ALCARE DISPENSER INITIALS OF PERSON(S) CHECKING INTERIOR COMPARTMENTS RESPIRATORY KIT SUN MON TUE WED THU FRI SAT (1) 2.5MM ENDOTRACHEAL TUBE (1) 3.0MM ENDOTRACHEAL TUBE (1) 3.5MM ENDOTRACHEAL TUBE (1) 4.0MM ENDOTRACHEAL TUBE (1) 4.5MM ENDOTRACHEAL TUBE (1) 5.0MM ENDOTRACHEAL TUBE (1) 5.5MM ENDOTRACHEAL TUBE (2) 6.0MM ENDOTRACHEAL TUBE (2) 7.0MM ENDOTRACHEAL TUBE (2) 8.0MM ENDOTRACHEAL TUBE (2) 9.0MM ENDOTRACHEAL TUBE (2) 6FR STYLET Revised: 11/2008 Page 6
(2) 14FR STYLET (5) STERILE LUBRICANT PACKETS TUBE OF LIDOCAINE GEL (2) 10CC SYRINGES (2) ADULT ET TUBE HOLDERS (2) PEDIATRIC ET TUBE HOLDERS (2) ADULT COLORIMETRIC CO2 DETECTOR (2) PEDIATRIC COLORIMETRIC CO2 DETECTOR (2) NASAL CAPNOGRAPHY CIRCUITS (2) ET CAPNOGRAPHY CIRCUITS BAAMS CPAP DEVICE BITESTICK ADULT BVM w/face PIECE CHILD BVM w/face PIECE ADULT COMBITUBE ROLLUP KIT SMALL ADULT COMBITUBE ROLLUP KIT ADULT BP CUFF LARGE ADULT BP CUFF CHILD BP CUFF STETHOSCOPE TRAUMA SHEARS PENLIGHT LARGE MAGILL FORCEPS SMALL MAGILL FORCEPS #8/10FR SALEM SUMP TUBE #14FR SALEM SUMP TUBE #18FR SALEM SUMP TUBE TOOMEY SYRINGE NURSING DRUG HANDBOOK LARYNGOSCOPE HANDLE - operational #0 MILLER LARYNG. BLADE #1 MILLER LARYNG. BLADE #2 MILLER LARYNG. BLADE #3 MILLER LARYNG. BLADE #4 MILLER LARYNG. BLADE #1 MACINTOSH LARYNG. BLADE #2 MACINTOSH LARYNG. BLADE #3 MACINTOSH LARYNG. BLADE #4 MACINTOSH LARYNG. BLADE NASAL AIRWAY KIT SIZES 24,26,28,30,32FR HURRICANE SPRAY w/ TIPS GLUTOSE ORAL GEL TUBE ASSORTED SIZES OF NITRILE GLOVES (4) FACE/VISOR SHIELDS RING CUTTER HEMOSTAT FORCEP ALS UNIT CHECKSHEET LIFEPACK 12 MONITOR SUN MON TUE WED THU FRI SAT 4 LEAD PATIENT CABLE 12 LEAD PATIENT CABLE ADULT NIBP CUFF Revised: 11/2008 Page 7
LARGE ADULT NIBP CUFF ADULT ECG ELECTRODES - MIN 25 (3) PEDIATRIC ECG ELECTRODES 4PACK (2) ADULT COMBO PADS PEDIATRIC COMBO PAD SPARE ROLL OF LP12 PAPER SPARE LP12 BATTERY (2) NASAL CAPNOGRAPHY CIRCUITS (2) ET CAPNOGRAPHY CIRCUITS SPO2 SENSOR AND CABLE - if applicable LIFEPAK DAILY DOWNLOADING LIFEPAK WEEKLY SANITIZING ALS UNIT CHECKSHEET MAIN DRUG BOX - TOP TRAYS SUN MON TUE WED THU FRI SAT 4X4 GAUZE PADS ASSORTED BLOOD TUBES VACUTAINER HOLDER (5) VACUTAINER HUBS SAFETY RAZOR THERMOMETER AND COVERS (5) BAND AIDS (10) ALCOHOL PREPS (5) AMMONIA INHALANTS (6) LANCETS (3) 25GA NEEDLES (3) 18GA NEEDLES ROLL OF 1" TAPE (2) TOURNIQUETS (3) 14GA IV CATHETERS (3) 16GA IV CATHETERS (3) 18GA IV CATHETERS (3) 20GA IV CATHETERS (3) 22GA IV CATHETERS (3) 24GA IV CATHETERS (2) 1CC SYRINGES (2) 3CC SYRINGES (3) 10CC SYRINGES (4) LEVER LOCK CANNULA (4) INJECTION PORTS MAIN DRUG BOX - 2ND TRAYS SUN MON TUE WED THU FRI SAT (5) ADENOSINE 6MG/3ML (2) LASIX 100MG/10ML (4) ALBUTEROL BULLETS 2.5MG/3ML (3) ATROVENT BULLETS 500mcg/2.5ML (2) BRETHINE 1MG/1ML CALCIUM CHLORIDE 1GM/10ML (2) VALIUM 10MG/2ML (2) MORPHINE 10MG/1ML (2) NARCAN 2MG/2ML (2) BENADRYL 50MG/1ML (10) CAPTOPRIL 25MG TABLETS (2) ATROPINE 1MG/10ML Revised: 11/2008 Page 8
(4) EPINEPHRINE 1:10,000 1MG/10ML (3) LIDOCAINE 100MG/5ML (2) GLUCAGON w/solution 1MG (2) LASIX 100MG/10ML (2) HALDOL 5MG/1ML BOTTLE NITROGLYCERIN.4MG TABLETS (6) NITRO PASTE PACKETS w/paper (12) ASPRIN 81MG CHEWABLE (4) INHALATION SALINE 3ML (5) EPINEPHRINE 1:1,000 1MG/1ML EPINEPHRINE 1:1,000 30MG/30ML ALS UNIT CHECKSHEET MAIN DRUG BOX - BOTTOM SUN MON TUE WED THU FRI SAT 10gtt/ml IV ADMINISTRATION SET 60gtt/ml IV ADMINISTRATION SET 1000ml LACTATED RINGER SOL'N NEBULIZER KIT ADULT AEROSOL MASK PEDIATRIC AEROSOL MASK (2) 10CC SYRINGE 30CC SYRINGE 3" TAPE TRAUMA SHEARS INTRAOSSEOUS NEEDLES - 15GA DUAL INJECTION SET (4) IV EXTENSION SET DEXTROSE 25GM/50ML SODIUM BICARBONATE 50mEq/50ML DOPAMINE 400MG PREMIXED/250ML 9" ARMBOARD INFANT ARMBOARD (3) BETADINE SWABS (4) BENZOIN SWABS GLUCOMETER TEST KIT CARDIZEM KIT (100MG VIAL & 100ml NaCl) SHARPS CONTAINER (5) SALINE FLUSHES BROSELOW PEDIATRIC TAPE ASST. SIZES OF NITRILE GLOVES INITIALS OF PERSON CHECKING BOX Revised: 11/2008 Page 9
KITS ARE CHECKED ON SUNDAY AND AFTER EACH USE ALS UNIT CHECKSHEET TRAUMA BAG PEDIATRIC KIT MULTI-TRAUMA DRESSING CHILD BVM w/ FACE PIECE BURN SHEET INFANT BVM w/ FACE PIECE (4) TRIANGULAR BANDAGES BITE STICK (4) 4" KLING STOCKING CAP (4) 6" KLING 10FR SUCTION CATHETER (2) 4X4 SPONGE PACKS PEDIATRIC BULB SYRINGE (10) 4X4 GAUZE PADS PEDIATRIC NASAL CANNULA (10) ALCOHOL PREPS PEDIATRIC NON-REBREATHER O2 MASK (2) 1000ml LACTATED RINGERS SOL'N STETHOSCOPE (2) 10gtts/ml IV ADMINISTRATION SETS INFANT BP CUFF (2) DUAL INJECTION SETS CHILD BP CUFF (2) IV EXTENSION SETS 9" ARMBOARD (2) PRESSURE INFUSORS INFANT ARMBOARD (2) TOURNIQUETS (3) 14GA IV CATHETERS BACKUP INTUBATION KIT (3) 16GA IV CATHETERS LARYNGOSCOPE HANDLE - operational (3) 18GA IV CATHETERS #0 MILLER LARYNG. BLADE (3) 20GA IV CATHETERS #1 MILLER LARYNG. BLADE (3) 22GA IV CATHETERS #2 MILLER LARYNG. BLADE (2) CHEST DECOMPRESSION KITS #3 MILLER LARYNG. BLADE (3) BETADINE SWABS #4 MILLER LARYNG. BLADE (10) BIOCLUSIVE DRESSINGS #1 MACINTOSH LARYNG. BLADE 9" ARMBOARD #2 MACINTOSH LARYNG. BLADE ADULT BP CUFF #3 MACINTOSH LARYNG. BLADE LARGE ADULT BP CUFF #4 MACINTOSH LARYNG. BLADE STETHOSCOPE (1) 2.5MM ENDOTRACHEAL TUBE TRAUMA SHEARS (1) 3.0MM ENDOTRACHEAL TUBE (2) 1" TAPE (1) 3.5MM ENDOTRACHEAL TUBE (2) 2" TAPE (1) 4.0MM ENDOTRACHEAL TUBE (2) 3" TAPE (1) 4.5MM ENDOTRACHEAL TUBE BITE STICK (1) 5.0MM ENDOTRACHEAL TUBE (4) FACE/VISOR SHIELDS (1) 5.5MM ENDOTRACHEAL TUBE ASST. SIZES NITRILE GLOVES (2) 6.0MM ENDOTRACHEAL TUBE (2) 7.0MM ENDOTRACHEAL TUBE (2) 8.0MM ENDOTRACHEAL TUBE (2) 9.0MM ENDOTRACHEAL TUBE (2) 6FR STYLET (2) 14FR STYLET LARGE MAGILL FORCEPS SMALL MAGILL FORCEPS BAAMS ET TUBE HOLDER - ADULT/CHILD COLORIMETRIC EtCO2 - ADULT/CHILD (5) PACKETS OF KY JELLY TUBE OF LIDOCAINE JELLY (2) 10CC SYRINGES BITE STICK Revised: 11/2008 Page 10
UNIT ALS FIRST RESPONSE UNIT EMS EQUIPMENT/SUPPLIES CHECKSHEET WEEK BEGINNING DAY OF THE WEEK SUN MON TUE WED THU FRI SAT VEHICLE NUMBER LIFEPACK 12 MONITOR SUN MON TUE WED THU FRI SAT 4 LEAD PATIENT CABLE 12 LEAD PATIENT CABLE ADULT NIBP CUFF LARGE ADULT NIBP CUFF ADULT ECG ELECTRODES - MIN 25 (3) PEDIATRIC ECG ELECTRODES 4PACK (2) ADULT COMBO PADS PEDIATRIC COMBO PAD SPARE ROLL OF LP12 PAPER SPARE LP12 BATTERY (2) NASAL CAPNOGRAPHY CIRCUITS (2) ET CAPNOGRAPHY CIRCUITS SPO2 SENSOR AND CABLE - if applicable RESPIRATORY KIT SUN MON TUE WED THU FRI SAT (1) 2.5MM ENDOTRACHEAL TUBE (1) 3.0MM ENDOTRACHEAL TUBE (1) 3.5MM ENDOTRACHEAL TUBE (1) 4.0MM ENDOTRACHEAL TUBE (1) 4.5MM ENDOTRACHEAL TUBE (1) 5.0MM ENDOTRACHEAL TUBE (1) 5.5MM ENDOTRACHEAL TUBE (2) 6.0MM ENDOTRACHEAL TUBE (2) 7.0MM ENDOTRACHEAL TUBE (2) 8.0MM ENDOTRACHEAL TUBE (2) 9.0MM ENDOTRACHEAL TUBE (2) 6FR STYLET (2) 14FR STYLET (5) PACKETS OF KY JELLY TUBE OF LIDOCAINE JELLY (2) 10CC SYRINGES (2) ADULT ET TUBE HOLDERS (2) PEDIATRIC ET TUBE HOLDERS (2) ADULT COLORIMETRIC CO2 DETECTOR (2) PEDIATRIC COLORIMETRIC CO2 DETECTOR (2) NASAL CAPNOGRAPHY CIRCUITS (2) ET CAPNOGRAPHY CIRCUITS BAAMS CPAP BITESTICK ADULT BVM w/face PIECE CHILD BVM w/face PIECE ADULT COMBITUBE ROLLUP KIT SMALL ADULT COMBITUBE ROLLUP KIT ADULT BP CUFF LARGE ADULT BP CUFF CHILD BP CUFF Revised: 11/2008 Page 1
STETHOSCOPE TRAUMA SHEARS PENLIGHT LARGE MAGILL FORCEPS SMALL MAGILL FORCEPS #8/10FR SALEM SUMP TUBE #14FR SALEM SUMP TUBE #18FR SALEM SUMP TUBE TOOMEY SYRINGE NURSING DRUG HANDBOOK LARYNGOSCOPE HANDLE - operational #0 MILLER LARYNG. BLADE #1 MILLER LARYNG. BLADE #2 MILLER LARYNG. BLADE #3 MILLER LARYNG. BLADE #4 MILLER LARYNG. BLADE #1 MACINTOSH LARYNG. BLADE #2 MACINTOSH LARYNG. BLADE #3 MACINTOSH LARYNG. BLADE #4 MACINTOSH LARYNG. BLADE NASAL AIRWAY KIT SIZES 24,26,28,30,32FR HURRICANE SPRAY w/ TIPS GLUTOSE ORAL GEL TUBE ASSORTED SIZES OF NITRILE GLOVES (4) FACE/VISOR SHIELDS RING CUTTER HEMOSTAT FORCEP ALS FIRST RESPONSE UNIT EMS EQUIPMENT/SUPPLIES CHECKSHEET MAIN DRUG BOX - TOP TRAYS SUN MON TUE WED THU FRI SAT 4X4 GAUZE PADS ASSORTED BLOOD TUBES VACUTAINER HOLDER (5) VACUTAINER HUBS SAFETY RAZOR THERMOMETER AND COVERS (5) BAND AIDS (10) ALCOHOL PREPS (5) AMMONIA INHALANTS (6) LANCETS (3) 25GA NEEDLES (3) 18GA NEEDLES ROLL OF 1" TAPE (2) TOURNIQUETS (3) 14GA IV CATHETERS (3) 16GA IV CATHETERS (3) 18GA IV CATHETERS (3) 20GA IV CATHETERS (3) 22GA IV CATHETERS (3) 24GA IV CATHETERS (2) 1CC SYRINGES (2) 3CC SYRINGES Revised: 11/2008 Page 2
(3) 10CC SYRINGES (4) LEVER LOCK CANNULA (4) INJECTION PORTS ALS FIRST RESPONSE UNIT EMS EQUIPMENT/SUPPLIES CHECKSHEET MAIN DRUG BOX - 2ND TRAYS SUN MON TUE WED THU FRI SAT (5) ADENOSINE 6MG/3ML (2) LASIX 100MG/10ML (4) ALBUTEROL BULLETS 2.5MG/3ML (3) ATROVENT BULLETS 500mcg/2.5ML (2) BRETHINE 1MG/1ML CALCIUM CHLORIDE 1GM/10ML (2) VALIUM 10MG/2ML (2) MORPHINE 10MG/1ML (2) NARCAN 2MG/2ML (2) BENADRYL 50MG/1ML (10) CAPTOPRIL 25MG TABLETS (2) ATROPINE 1MG/10ML (4) EPINEPHRINE 1:10,000 1MG/10ML (3) LIDOCAINE 100MG/5ML (2) GLUCAGON w/solution 1MG (2) LASIX 100MG/10ML (2) HALDOL 5MG/1ML BOTTLE NITROGLYCERIN.4MG TABLETS (6) NITRO PASTE PACKETS w/paper (12) ASPRIN 81MG CHEWABLE (4) INHALATION SALINE 3ML (5) EPINEPHRINE 1:1,000 1MG/1ML EPINEPHRINE 1:1,000 30MG/30ML MAIN DRUG BOX - BOTTOM SUN MON TUE WED THU FRI SAT 10gtt/ml IV ADMINISTRATION SET 60gtt/ml IV ADMINISTRATION SET 1000ml LACTATED RINGER SOL'N NEBULIZER KIT ADULT AEROSOL MASK PEDIATRIC AEROSOL MASK (2) 10CC SYRINGE 30CC SYRINGE 3" TAPE TRAUMA SHEARS INTRAOSSEOUS NEEDLES - 15GA DUAL INJECTION SET (4) IV EXTENSION SET DEXTROSE 25GM/50ML SODIUM BICARBONATE 50mEq/50ML DOPAMINE 400MG PREMIXED/250ML 9" ARMBOARD INFANT ARMBOARD (3) BETADINE SWABS (4) BENZOIN SWABS GLUCOMETER TEST KIT CARDIZEM KIT (100MG VIAL & 100ml NaCl) Revised: 11/2008 Page 3
SHARPS CONTAINER (5) SALINE FLUSHES BROSELOW PEDIATRIC TAPE ASST. SIZES OF NITRILE GLOVES ALS FIRST RESPONSE UNIT EMS EQUIPMENT/SUPPLIES CHECKSHEET PORTABLE OXYGEN KIT SUN MON TUE WED THU FRI SAT "E" OXYGEN BOTTLE - MIN. 900 PSI (2) ADULT NASAL CANNULA (2) ADULT NON-REBREATHER O2 MASK (2) PEDIATRIC NASAL CANNULA (2) PEDIATRIC NON-REBREATHER O2 MASK (1) NEBULIZER KIT (1) ADULT AEROSOL MASK (1) PEDIATRIC AEROSOL MASK OXYGEN BOTTLE WRENCH PORTABLE SUCTION UNIT SUN MON TUE WED THU FRI SAT PORTABLE SUCTION UNIT - OPERATIONAL CANNISTER W/ LID YANKAUER SUCTION CATHETER W/ TUBING SUCTION CATHETERS - 10,14, 18FR STERILE WATER BOTTLE (2) SUCTION UNIT BATTERIES (2) FACE SHIELDS & GLOVES SPARE SUCTION CANNISTERS & LIDS TRAUMA BAG SUN MON TUE WED THU FRI SAT MULTI-TRAUMA DRESSING BURN SHEET (4) TRIANGULAR BANDAGES (4) 4" KLING (4) 6" KLING (2) 4X4 SPONGE PACKS (10) 4X4 GAUZE PADS (10) ALCOHOL PREPS (2) 1000ml LACTATED RINGERS SOL'N (2) 10gtts/ml IV ADMINISTRATION SETS (2) DUAL INJECTION SETS (2) IV EXTENSION SETS (2) PRESSURE INFUSORS (2) TOURNIQUETS (3) 14GA IV CATHETERS (3) 16GA IV CATHETERS (3) 18GA IV CATHETERS (3) 20GA IV CATHETERS (3) 22GA IV CATHETERS (2) CHEST DECOMPRESSION KITS (3) BETADINE SWABS (10) BIOCLUSIVE DRESSINGS 9" ARMBOARD ADULT BP CUFF LARGE ADULT BP CUFF Revised: 11/2008 Page 4
STETHOSCOPE TRAUMA SHEARS (2) 1" TAPE (2) 2" TAPE (2) 3" TAPE BITE STICK (4) FACE/VISOR SHIELDS ASST. SIZES NITRILE GLOVES ALS FIRST RESPONSE UNIT EMS EQUIPMENT/SUPPLIES CHECKSHEET INFECTION CONTROL SUPPLIES SUN MON TUE WED THU FRI SAT BOX SMALL NITRILE GLOVES BOX MEDIUM NITRILE GLOVES BOX LARGE NITRILE GLOVES BOX EXTRA LARGE NITRILE GLOVES (6) N99 MASKS (1) ALCARE ALL PURPOSE SPRAY CLEANER ROLL OF PAPERTOWELS (10) RED BAGS (10) TRASH BAGS VIONEX PEDIATRIC KIT SUN MON TUE WED THU FRI SAT CHILD BVM w/ FACE PIECE INFANT BVM w/ FACE PIECE BITE STICK STOCKING CAP 10FR SUCTION CATHETER PEDIATRIC BULB SYRINGE PEDIATRIC NASAL CANNULA PEDIATRIC NON-REBREATHER O2 MASK STETHOSCOPE INFANT BP CUFF CHILD BP CUFF 9" ARMBOARD INFANT ARMBOARD IMMOBILIZATION SUPPLIES SUN MON TUE WED THU FRI SAT (2) ADULT ADJUSTABLE COLLARS (2) CHILD COLLARS (2) BABY NO-NECK COLLARS Revised: 11/2008 Page 5
BLS AMBULANCE CHECKSHEET UNIT WEEK BEGINNING DAY OF THE WEEK SUN MON TUE WED THU FRI SAT VEHICLE NUMBER STATION OXYGEN SUPPLY SUN MON TUE WED THU FRI SAT 2 FULL "E" BOTTLES 1 FULL "H" BOTTLES UNIT CAB SUN MON TUE WED THU FRI SAT FIRE MOBILE/PORTABLE RADIO GERMICIDAL TOWELETTES (VIONEX) AREA MAP BOOKS VEHICLE ACCIDENT PACKAGE COMPLETE INJURY PACKAGE EAR PROTECTORS STATION BAY DOOR OPENER HIGHWAY SAFETY VESTS - MINIMUM 2 PAT COLLECTOR RING OUTSIDE COMPARTMENTS SUN MON TUE WED THU FRI SAT OFFICERS PROTECTIVE GEAR DRIVERS PROTECTIVE GEAR WHEEL CHOCK FLARES JUMPER CABLES HANDLIGHT REFLECTIVE TRIANGLES TRIAGE TAG/TAPE KIT (2) SCBA FIRE EXTINGUISHER (1) FLAT HEAD AXE (1) HALIGAN BAR LONG SPINE BOARDS - MINIMUM 2 (2) 54" PADDED SPLINTS (2) 36" PADDED SPLINTS (2) 15" PADDED SPLINTS CHILD SAFETY SEAT REEVES STRETCHER ADULT TRACTION SPLINT PEDIATRIC TRACTION SPLINT SHORT SPINE BOARD KED DEVICE STAIR CHAIR "H" OXYGEN BOTTLE - MIN. 250psi PORTABLE FIRST AID KIT SUN MON TUE WED THU FRI SAT STETHOSCOPE ADULT BP CUFF LARGE ADULT BP CUFF CHILD BP CUFF TRAUMA SHEARS (4) TRIANGULAR BANDAGES (3) 6"KLING (3) 4" KLING (3) 2" KLING Revised: 11/2008 Page 1
BLS AMBULANCE CHECKSHEET BOX OF BANDAIDS RING CUTTER TRAUMA PAD BURN SHEET VARIOUS SIZES OF NITRILE EXAM GLOVES GLUTOSE ORAL GEL - MINIMUM 3 TUBES 1" TAPE 2" TAPE 3" TAPE BITE STICK NASOPHARYNGEAL AIRWAY KIT (SIZES 20,24,28,30,32,36 FR) OROPHARYNGEAL AIRWAY KIT (ADULT-CHILD SIZES) (20) 4X4 STERILE GAUZE PADS (10) 2X2 STERILE GAUZE PADS (2) ICE PACKS ADULT EPI-PEN AUTOINJECTOR CHILD EPI-PEN JR AUTOINJECTOR PORTABLE OXYGEN KIT SUN MON TUE WED THU FRI SAT (1) "E" OXYGEN BOTTLE - (MIN. 900 PSI) OXYGEN REGULATOR "E" BOTTLE WRENCH (2) ADULT NASAL CANNULA (2) ADULT NON-REBREATHER O2 MASK (2) CHILD NON-REBREATHER O2 MASK ADULT BVM W/FACE PIECE CHILD BVM W/FACE PIECE PORTABLE SUCTION UNIT SUN MON TUE WED THU FRI SAT PORTABLE SUCTION UNIT W/CHARGED BATTERY SUCTION CANNISTER W/ LID BUBBLE TUBING SUCTION CATHETERS (10, 14, 18 FR CATHETERS) INSIDE COMPARTMENTS BANDAGING/SPLINTING SUPPLIES SUN MON TUE WED THU FRI SAT BOX OF 4X4 GAUZE PADS - MINIMUM 24 PADS BOX OF 2X2 GAUZE PADS - MINIMUM 24 PADS (4) EYE PADS (2) 1" TAPE (2) 2" TAPE (2) 3"TAPE (4) 6" KLING (4) 4" KLING (4) 2" KLING (12) TRIANGULAR BANDAGES (5) TRAUMA PADS (5) BURN SHEETS BOX OF BANDAIDS (4) ICE PACKS (4) STERILE WATER AIRWAY/RESUSCIATION SUPPLIES SUN MON TUE WED THU FRI SAT (5) ADULT NASAL CANNULA (5) ADULT NON-REBREATHER O2 MASK (5) CHILD NON-REBREATHER O2 MASK (2) ADULT BVM W/FACEPIECE Revised: 11/2008 Page 2
BLS AMBULANCE CHECKSHEET (2) CHILD BVM W/FACE PIECE BITESTICK NASOPHARYNGEAL AIRWAY KIT (SIZES 20,24,28,30,32,36 FR) OROPHARYNGEAL AIRWAY KIT (ADULT-CHILD SIZES) SUCTION CATHETERS (10, 14, 18 FR CATHETERS) IMMOBILIZATION SUPPLIES SUN MON TUE WED THU FRI SAT (6) 9' STRAPS (2) ADULT ADJUSTABLE COLLARS (2) CHILD COLLARS HEAD IMMOBILIZERS/TOWEL ROLLS FOR 2 PATIENTS INFECTION CONTROL SUPPLIES SUN MON TUE WED THU FRI SAT BOX SMALL NITRILE GLOVES BOX MEDIUM NITRILE GLOVES BOX LARGE NITRILE GLOVES BOX EXTRA LARGE NITRILE GLOVES (4) N99 MASKS (4) GOGGLES (1) ALCARE ALL PURPOSE SPRAY CLEANER ROLL OF PAPERTOWELS ONBOARD SUCTION UNIT W/CANNISTER&LID BOX OF BUBBLE TUBING (2) SCRUB BRUSH SHARPS CONTAINER - 4 QUART SIZE (10) RED BAGS (10) TRASH BAGS TRASH CANNISTER W/ RED BAGS VIONEX MISCELLANEOUS ITEMS/SUPPLIES SUN MON TUE WED THU FRI SAT COT WITH APPROPRIATE STRAPS STRYKER BATTERY CHARGER W/ SPARE BATTERY STETHOSCOPE ADULT BP CUFF LARGE ADULT BP CUFF CHILD BP CUFF ACTIVATED CHARCOAL W/O SORBITOL GLUTOSE ORAL GEL - MINIMUM 3 TUBES (2) OBSTETRICAL (OB) KIT TRAUMA SHEARS (3) SPARE SHEETS (3) SPARE BLANKETS ONBOARD OXYGEN REGULATOR SMOKE DETECTOR W/ FORMS BEE STING SWABS RING CUTTER TWEEZER AED SUN MON TUE WED THU FRI SAT AED (2) SETS OF ADULT PADS RAZOR Revised: 11/2008 Page 3
UNIT BLS FIRST RESPONSE UNIT EMS EQUIPMENT/SUPPLIES CHECKSHEET WEEK BEGINNING DAY OF THE WEEK SUN MON TUE WED THU FRI SAT VEHICLE NUMBER PORTABLE FIRST AID KIT SUN MON TUE WED THU FRI SAT STETHOSCOPE ADULT BP CUFF LARGE ADULT BP CUFF CHILD BP CUFF TRAUMA SHEARS (4) TRIANGULAR BANDAGES (3) 6"KLING (3) 4" KLING (3) 2" KLING BOX OF BANDAIDS RING CUTTER TRAUMA PAD BURN SHEET VARIOUS SIZES OF NITRILE EXAM GLOVES GLUTOSE ORAL GEL - MINIMUM 2 TUBES (2) 1" TAPE 2" TAPE 3" TAPE BITE STICK NASOPHARYNGEAL AIRWAY KIT (SIZES 20,24,28,30,32,36 FR) OROPHARYNGEAL AIRWAY KIT (ADULT-CHILD SIZES) (24) 4X4 STERILE GAUZE PADS (10) 2X2 STERILE GAUZE PADS STERILE WATER/SALINE 500CC (2) ICE PACKS PORTABLE OXYGEN KIT SUN MON TUE WED THU FRI SAT (1) "E OR D" OXYGEN BOTTLE - (MIN. 900 PSI) OXYGEN REGULATOR "E/D" BOTTLE WRENCH (2) ADULT NASAL CANNULA (2) ADULT NON-REBREATHER O2 MASK (2) CHILD NON-REBREATHER O2 MASK ADULT BVM W/FACE PIECE CHILD BVM W/FACE PIECE PORTABLE SUCTION UNIT SUN MON TUE WED THU FRI SAT PORTABLE SUCTION UNIT - BATTERY OR HAND POWERED SUCTION CANNISTER W/ LID BUBBLE TUBING OR APPROPRIATE TUBING YANKAUER SUCTION CATHETER SUCTION CATHETERS (10, 14, 18 FR CATHETERS) IMMOBILIZATION SUPPLIES SUN MON TUE WED THU FRI SAT (2) ADULT ADJUSTABLE COLLARS (2) CHILD COLLARS INFECTION CONTROL SUPPLIES SUN MON TUE WED THU FRI SAT BOX SMALL NITRILE GLOVES BOX MEDIUM NITRILE GLOVES BOX LARGE NITRILE GLOVES BOX EXTRA LARGE NITRILE GLOVES (6) N99 MASKS (1) ALCARE ALL PURPOSE SPRAY CLEANER ROLL OF PAPERTOWELS (10) RED BAGS (10) TRASH BAGS VIONEX Revised: 11/2008 Page 1 Appendix B