(Version: 28 July 2017) County of Renfrew Paramedic Service STORES ORDER FORM with MIN / Levels LOW SUPPLY BASE Arnprior - Barry's Bay - Petawawa - Deep River Base Ordering: Date Ordered: Medic (s) Ordering: Order Filled By: Date Filled: ITEM DESCRIPTION MIN Abdominal Pad 6 12 ACR 20 30 Alcohol Prep Pad 50 1 box (200) APGAR Card for OBS kit 1 2 Asherman Chest Seal 1 2 Backboard 2 4 Bag Backpack (Red) 1 1 Bag CPAP (Yellow) 1 1 Bag Immobilization (Blue) 1 1 Bag Intubation Kit (Blue) 1 1 Bag IO/Chest Pouch (Red) 1 1 Bag IV Kit (Red) 1 1 Bag IV Fluids Pouch (Burgundy) 1 1 Bag KED (Green) 1 1 Bag King LT Pouch (Green) 1 1 Bag EZ-IO (Yellow) 1 1 Bag O2 (Blue) 1 1 Bag Pediatric Kit (Blue) 1 1 Bag Pediatric Intubation Pouch (Pink) 1 1 Bag Preload Pouch (Black) 1 1 Bag Sagar 1 1 Bag Scoop Pouch (for connect straps) 1 1 Bag Thermometer Pouch 1 1 Bag Trauma (Blue) 1 1 Bag MCI (Orange) 1 1 Bag Medication Pouch (Navy Blue) 1 1 Bag Narcotics Pouch (Black) 1 1 Bag NPA Pouch (Yellow) - Vehicle 1 1 Bag OPA Pouch (Blue) - Vehicle 1 1 Bag NPA Pouch (Yellow) - O2 Bag 1 1 Bag OPA Pouch (Blue) - O2 Bag 1 1 Bandaids 3/4" 25 1 box (100) Batteries AA 2 4 Batteries AAA 2 4 Batteries 3V - Glucometer 1 2 Batteries 6V 1 1 Batteries 9V 1 2 Bed Pan Fracture Style 1 3 Bio-Hazard Bag Large (33 x 40) 2 4 Bio-Hazard Bag Medium (24 x 30) 2 4 Bio-Hazard Bag Small (11 x 14) 2 4 Bio-Hazard Bag Large - Stericycle Yellow Bag 2 4 Blanket Receiving (for Obs Kit) 1 2 Pembroke and Renfrew only Page 1 of 8
Bolt Cutter 24" Bougie Tube 1 2 BP Cuff XLarge Adult (manual) 1 2 BP Cuff Adult (manual) 1 2 BP Cuff Child (manual) 1 2 BP Cuff Control Knob (manual) 1 1 Broselow Tape Pediatric Reference Tape 1 1 Bulb Syringe 2 oz 1 2 Burn Kit Complete 1 1 BVM Adult 4 6 BVM Child 1 2 BVM Infant 1 2 BVM Bacterial Filter 4 6 Cannula Blunt Plastic 15 30 Cannula Vial Access 15 30 Carabineer Large - O2 bag / Backpack 1 2 Carabineer Small - Vehicle Keys 1 2 Car Wash/ Wax Jug - 20 L 0.25 1 Car Wash/ Wax Pump Chest Strap for Backpack 1 1 Cold Pack 6 12 C-Collar Adult (Universal) 5 10 C-Collar Pediatric (Universal) 3 6 Cleaning Solution Oxivir Tb Wipe - 6"x7" 2 4 Cleaning Solution Oxivir Tb Wipe - 11"x12" 1 2 Cleaning Solution Oxivir Tb RTU Bottle - 946ml 1 1 Cleaning Solution Oxivir Five 16 Concentrate RTD Bottle - 1.5L 1 1 Cleaning Solution Oxivir Five 16 Concentrate RTD Hook-Up Kit 1 1 Cleaning Solution Oxivir Plus Disinfectant Cleaner - J.Fill - 2.5L 1 2 Cleaning Solution Stride Neutral Cleaner - J.Fill - 2.5L 1 2 Computer Paper 1 pkg 3 pkg Coverall Booties - disposable 4 pair 8 pair Coverall 5XL - disposable - no boot attached 2 4 Coverall 4XL - disposable - no boot attached 2 4 Coverall 3XL - disposable - boot attached 2 4 Coverall 2XL - disposable - boot attached 2 4 Coverall XL - disposable - boot attached 2 4 Coverall Large - disposable - boot attached 2 4 Coverall Medium - disposable - boot attached 2 4 Coverall Small - disposable - boot attached 2 4 CPAP Head Harness 1 2 CPAP Mask - Large 1 2 CPAP Mask - Medium with Tubing 1 2 CPAP Mask - Small 1 2 CPAP PortoVent Machine CPAP PortoVent Machine - Hose 1 1 CPR Board 1 1 D5W Solution 100ml 2 3 Defib Pads Adult 2 4 Defib Pads Pediatric 1 1 Emergency Blanket Yellow (54 x 80) 4 6 Emergency Blanket Foil 4 6 Emesis Bag Vomi Bag 10 20 Endotracheal Tube 8.0 mm (w stylette) 1 3 Endotracheal Tube 7.5 mm (w stylette) 1 3 Endotracheal Tube 7.0 mm (w stylette) 1 3 Endotracheal Tube 6.5 mm (w stylette) 1 3 Endotracheal Tube 6.0 mm (w stylette) 1 3 Endotracheal Tube 5.5 mm (uncuff) 1 2 Page 2 of 8
Endotracheal Tube 5.0 mm (uncuff) 1 2 Endotracheal Tube 4.5 mm (uncuff) 1 2 Endotracheal Tube 4.0 mm (uncuff) 1 2 Endotracheal Tube 3.5 mm (uncuff) 1 2 Endotracheal Tube 3.0 mm (uncuff) 1 2 Endotracheal Tube 2.5 mm (uncuff) 1 2 Endotrol Tube 8 mm - Nasal (cuffed) 1 2 Endotrol Tube 7 mm - Nasal (cuffed) 1 2 Endotrol Tube 6 mm - Nasal (cuffed) 1 2 ETCO2 Circuit - OEM Filterline 4 8 Eye Pad 4 8 Eye Wash Solution 1 L 1 1 Face Mask Small Adult 2 3 Face Mask Child (Toddler) 2 3 Face Mask Infant 1 2 Face Mask Neonatal 1 2 Faceshield 4 8 Fire Extinguisher 1 1 Flare 4 6 Flashlight 6V 1 1 Folder for vehicle admin documentation 1 1 Forceps Magill (Adult 9") 1 2 Forceps Magill (Pediatric 7") 1 2 Fuel Envelope 2 2 Garbage Bag Black (30 x 38) - X-Strong 0.5 box 1 box Garbage Bag Clear (30 x 38) 0.5 box 1 box Garbage Bag White (20 x 22) 0.5 box 1 box Gauze 4 x 4 10 20 Gauze 2 x 2 10 1 box (25) Glasses Safety (Ztek Pyramex) 2 6 Glasses Safety (to fit over prescription glasses) 1 3 Gloves Xlarge 4 6 Gloves Large 4 6 Gloves Medium 4 6 Gloves Small 4 6 Gloves Xsmall 1 2 Gloves Warming Gloves - Xlarge 4 6 Gloves Warming Gloves - Large 4 6 Gloves Warming Gloves - Medium 4 6 Glucometer 1 2 Glucometer Test Strips 2 3 Goggles 1 3 Gown Isolation - Universal 6 12 Gown Isolation - 2XL 4 8 Hand Lotion 1600 ml "Clinishield" (refill for wall) 1 1 Hand Sanitizer 1600 ml "Clinishield" (refill for wall) 1 1 Hand Sanitizer 8 oz pump 1 2 Hand Sanitizer 4 oz 3 6 Hand Sanitizer Individual Wipe 0.25 box 1 box Hand Soap 1600 ml "Clinishield" (refill for wall) 1 1 Hand Soap Dispenser - Wall Mount Headlamp 1 1 Head Immobilizer Roll 4" x 6" 6 8 Helmet Spare for base 1 1 Helmet Disposable Cap Liner - Large - 24" 2 4 Helmet Disposable Cap Liner - Small - 21" 2 4 Holster 1 1 Hot Pack 6 12 Humidified O2 1 1 Page 3 of 8
I Gel O2 #5 2 3 I Gel O2 #4 2 3 I Gel O2 #3 2 3 Intraosseous EZ-IO - Needle Set - 45mm 1 2 Intraosseous EZ-IO - Needle Set - 25mm 2 3 Intraosseous EZ-IO - Needle Set - 15mm 1 2 Intraosseous Needle - Adult (15G) 2 3 Intraosseous Needle - Pediatric (18G) 1 2 IV A-FLO Regulator (gravity flow) 2 3 IV Catheter - 24 G 15 25 IV Catheter - 22 G 15 25 IV Catheter - 20 G 25 50 (1box) IV Catheter - 18 G 25 50 (1box) IV Catheter - 16 G 15 25 IV Catheter - 18 G (1.16") Angiocath (thoroctomy) 2 4 IV Catheter - 12 g (3") Angiocath (thoroctomy) 2 4 IV Extension Set - 0.8mL 10 20 IV Pressure Infuser Bag - 1000ml 2 3 KED Complete 1 1 KED Back Pad 1 1 KED Head/Chin Strap 1 1 King LT #5 2 3 King LT #4 2 3 King LT #3 2 3 Kling 6" 6 12 Kling 4" 10 20 Labels Blue (morphine) 1 roll 1 roll Labels Green (benadryl) 1 roll 1 roll Labels Green (gravol) 1 roll 1 roll Labels Grey (epinephrine) 1 roll 1 roll Labels Orange (diazepam) 1 roll 1 roll Labels Purple (adenosine) 1 roll 1 roll Labels Purple (narcan) 1 roll 1 roll Labels White 1 roll 1 roll Lancets 25 50 Lap Top Charger 1 1 Laryngoscope Blade - Fiberoptic - Mac 4 (Adult) 2 4 Laryngoscope Blade - Fiberoptic - Mac 3 (Medium Child) 2 4 Laryngoscope Blade - Fiberoptic - Mac 2 (Child) 1 2 Laryngoscope Blade - Fiberoptic - Miller 3 (Adult) 2 4 Laryngoscope Blade - Fiberoptic - Miler 2 (Child) 1 2 Laryngoscope Blade - Fiberoptic - Miller 1 (Infant) 1 2 Laryngoscope Blade - Fiberoptic - Miller 0 1 2 Laryngoscope Fiberoptic - Bulb - replacement 1 1 Laryngoscope Handle - ADULT - Disposable - Fiberoptic 2 4 Laryngoscope Handle - PEDIATRIC - Non-disposable - Fiberoptic 1 2 Laryngoscope McGrath 1 1 Laryngoscope Blade - McGrath - Mac 2 1 2 Laryngoscope Blade - McGrath - Mac 3 1 2 Laryngoscope Blade - McGrath - Mac 4 1 2 Laryngoscope Blade - McGrath - XBlade 1 2 Light Stick 6 10 LP 15 BP Cuff - Thigh 1 2 LP 15 BP Cuff -Large Adult - 16x42 1 2 LP 15 BP Cuff -Regular Adult 1 3 LP 15 BP Cuff - Child 1 3 LP 15 BP Cuff -Infant 1 2 LP 15 Cable - BP 1 1 Pembroke and Renfrew only Page 4 of 8
LP 15 Cable - Defib 1 1 LP 15 Cable - 4 Lead 1 1 LP 15 Cable - 12 Lead 1 1 LP 15 Cable - External Extension 1 1 LP 15 Cable - Right Angle Power 1 1 LP 15 Paper Roll 6 12 LP 15 Rear Pouch 1 1 LP 15 Side Pouch 1 1 LP 15 Shoulder Strap 1 1 LP 15 SPO2 Extension 1 2 LP 15 SPO2 Sensor Probe - reusable 1 2 LP 15 SPO2 Sensor - Adhesive wrap - ADULT 2 4 LP 15 SPO2 Sensor - Adhesive wrap - PEDIATRIC 2 4 LP 15 SPO2 Sensor - Adhesive wrap - INFANT 2 4 Lubricating Jelly 6 12 Map Book Map Art (Ontario Backroads) 1 1 Mask N95 (9210+) 10 20 Mask N95 (1870) 10 20 Mask VFlex (9105S) 10 20 Mask Surgical 10 20 MCI Kit Complete 1 1 MCI Kit Disaster Tags 25 50 MCI Kit Grease Pencil 1 2 MCI Kit MCI Card - Ambulance Site Coordinator (GREEN) 1 1 MCI Kit MCI Card - Incident Card (RED) 1 1 MCI Kit MCI Card - Traffic Control Officer (BLUE) 1 1 MCI Kit MCI Card - Triage Officer (ORANGE) 1 1 MCI Kit Trans Canada Emergency Response Guidebook 1 1 MCI Kit Vest - Ambulance Site Co-Ordinator (GREEN) 1 1 MCI Kit Vest - 3-Way Flip - Traffic Control/Triage/Ambulance (ORANGE) 1 1 MDI Respichamber 3 4 MDI Adaptor 2 4 Meconium Aspirator 1 3 Monitoring Pads Adult 4 pkg 8 pkg Monitoring Pads Pediatric 12 1 pkg (30) Nail Polish Remover Pads 25 50 Nasal Airway 34 Fr. 2 6 Nasal Airway 30 Fr. 2 6 Nasal Airway 26 Fr. 2 6 Nasal Atomizer w/o syringe 2 4 Nasal Cannula Straight tip 10 20 Nasal Cannula ETCO2 - Adult 6 12 Nasal Cannula ETCO2 - Child 4 6 Needle Blunt Fill Needle 18G 1 1/2" 15 30 Needle 23 g 1" 5 15 Needle 21 g 1 1/2" 5 15 Needle 18 g 1 1/2" 5 15 Noseclip 4 8 Not In Service Sign 1 2 O2 Mask - NRB - Adult -- 3:1 10 20 O2 Mask - NRB - Pediatric -- 3:1 4 10 O2 Mask - FloMax2 - Large Adult 2 4 O2 Mask - FloMax2 - Small Adult 2 4 O2 Mask - FloMax2 - Child 2 4 O2 Nebulizer - Adult 6 12 O2 Nebulizer - Pediatric 4 8 O2 Nipple Connectors 2 4 O2 Regulator "M" 1 1 Page 5 of 8
O2 Regulator "D" 1 1 O2 Tubing 4 8 O2 Wall Flowmeter 1 1 Obstetrical Kit Complete 1 1 Oral Airway 110 mm 4 6 Oral Airway 100 mm 4 6 Oral Airway 80 mm 4 6 Oral Airway 70 mm 4 6 Oral Airway 60 mm 4 6 Oral Airway 50 mm 4 6 Papertowel Pedimate Complete 1 1 Pedimate 678 Auxiliary Strap 1 1 Penlight 1 3 Pole Stretcher Canvas 1 1 Pole Stretcher Poles Powder Dam 8 oz. Bottle 1 2 Pressure Dressing Large 10 20 Pressure Dressing Small 10 20 Prybar min 5 ft. Quick Connect Straps 8 14 Razor 4 10 Radio Clip 1 1 Radio Lanyard 1 1 Sagar Complete 1 1 Sagar Ankle Strap - Left 1 1 Sagar Ankle Strap - Right 1 1 Sager Figure 8 Strap 1 1 Sagar Ischial Strap 1 1 Sagar Strap - XLong (53") 1 2 Sagar Strap - Long (32") 1 2 Sagar Strap - Short (24") 2 4 Saline IV - 1000 ml 4 8 Saline IV - 500 ml 8 16 Saline IV - 250 ml 4 10 Saline Pre-Loaded Syringe (10ml) 10 30 Saline Vial 10 ml 10 20 Scoop 1 1 Sharps Container Sharps Shuttle (inside IV Kit) 2 6 Sharps Container (1 QT / 1.2L) (inside Backpack) 2 6 Sharps Container (1 QT / 1.2L) (by patch phone) 1 3 Sharps Container (2.5 QT)Sprinter 1 3 Sharps Container (3.2 QT / 3.0L) Round - in Chevrolet 1 3 Sharps Container (5.1 L / 5.4QT)between captain chair and garbage 1 3 Sharps Container (2 GAL) for new Chevrolet style 1 3 Sharps Container (6 GAL / 22.7L) 1 1 Shears 8" 2 4 Shift Envelope 30 70 Skin Prep Tape Hair Removal Tape 1 2 Soaker Pads Underpads 10 15 Solution Set 60 CC Drip Set 2 4 Solution Set 10 CC Drip Set 8 16 Splint Speed Splint (Yellow) 2 4 Splint Quick Splint - malleable 2 4 Stairchair EZ Glide Track Ferno 59-T Stairchair chest/leg strp - EZ Glide 1 2 Stairchair extension strap - EZ Glide 1 2 Stairchair head pad - EZ Glide 1 1 Stairchair old style Page 6 of 8
Stairchair chest /leg strap - old style 1 2 Stairchair Foot Strap - old style 1 1 Sterile Water 250ml 4 10 Sterile Water 100ml 2 6 Stethoscope Vehicle 1 3 Stickers PR - Ambulance 10 40 Stopcock Pressure Release Valve (Chest Needle Valve) 1 3 Stretcher Maintenance Stickers (cot) 20 1 roll (100) Stretcher Battery - Stryker Stretcher Battery Charger - Stryker Stretcher AC Power Supply - Stryker 1 1 Stretcher DC Cable - Stryker 1 1 Stretcher Mattress - Stryker Stretcher Tarp - Upper - Stryker 1 1 Stretcher Tarp - Lower - Stryker 1 1 Stretcher Back Pouch Set - Stryker 1 1 Stretcher Restraint System Set - Stryker (shoulder harness and 2 leg straps) 1 2 Stretcher Shoulder Harness Set - Stryker 1 1 Stretcher Strap - Leg/Hip - Stryker 2 4 Stylette 5.0-7.0 mm 2 3 Stylette 2.5-4.5 mm 2 3 Suction Cannister - 1200 cc - Vehicle 1 3 Suction Cannister - 300 cc - LCSU4 - Portable 1 3 Suction Catheter - # 14 Fr 2 4 Suction Catheter - # 10 Fr 2 4 Suction Catheter - # 5-6 Fr 2 3 Suction Handheld (V-VAC) Starter Kits (includes: Catheter,Adapter,Double Male Connector) 1 1 Suction Handheld (V-VAC) - Adapter Tips 1 2 Suction Handheld (V-VAC) - Catheter 1 2 Suction Handheld (V-VAC) - Cartridge 1 2 Suction Handheld (V-VAC) - Double Male Connector 1 2 Suction Handheld (V-VAC) - Handle 1 2 Suction Portable (LCSU4) - Full Unit 1 1 Suction Portable (LCSU4) - AC/DC Adapter Charger 1 1 Suction Portable (LCSU4) - 12V DC Cable 1 1 Suction Portable (LCSU4) - Battery Charger 1 1 Suction Portable (LCSU4) - Battery NiMH 12V 1 1 Suction Filter with 5" tubing 2 6 Suction Tip - Wide Bore Oral 2 4 Suction Tip - Yankeur with control 2 6 Suction Tubing (6 ft.) 2 6 Syringe 60cc 1 2 Syringe 10cc 10 20 Syringe 3cc 25g 5/8" needle 10 20 Syringe 1cc 25g 5/8" needle 10 20 Tape Adhesive 2 " (cloth) 2 4 Tape Adhesive 1 " (cloth) 4 8 Tape Micropore 2" (soft cloth) 2 4 Tape Micropore 1" (soft cloth) 4 8 Tape Pink 1" 4 8 Tape Transpore 1 " (clear) 4 8 Teddy Bear 2 4 Tegaderm 0.5 box 1 box (100) Thermometer Ear Thermometer 1 1 Thermometer No-Touch Thermometer 1 1 Thermometer Probe Covers 1 3 Page 7 of 8
Thomas Tube Tie Adult 3 6 Thomas Tube Tie Pediatric 2 3 Toilet Paper Tourniquet IV 10 1 box (25) Tourniquet Trauma 2 4 Towelette Antiseptic - Benzalkonium Chloride 6 12 Towelette Lens Cleaning Anti-fog 0.5 box 1 box (100) Transfer Sheet Z-Slider 2 10 Triangular 8 16 Tubecheck AMBU - with bulb 2 4 Tube Extension 15 ml 2 4 Urinal with cover 1 4 VSA Report Envelope 15 30 Window Punch/Seatbelt ResQMe Cutter 1 1 Zip Lock Bag Big Bag - Large - 38cmx38cm 0.5 box 1 box Zip Lock Bag Large - Freezer 0.5 box 1 box Zip Lock Bag Medium - Freezer 0.5 box 1 box Zip Pack 1 1 OTHER ITEMS REQUESTED: Page 8 of 8