Basalt Fire-Rescue Medic 40 Inspection Form

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Date: Cab Basalt Fire-Rescue Personnel: (4) Traffic vests Batteries (9V, AA, AAA) ERG (2) Bottles Hand Sanitizer Spot light (4) Bottles of water Map Book Assorted pens Fire size-up card Phone list sheet (glovebox) S, M, L, XL medical gloves Driver s Side Front Tall Compartment (2) Bio PPE Backpacks KED Pediatric Board Short Board Kitty litter Driver s Side Middle Compartment Stair chair Traffic triangle s in box Tow strap and Tire Iron Tool Box Jumber Cables Driver s Side Rear Compartment Adult & Pediatric full body vacuum splints w/lg. Pump Sm/Md/Lg vacuum splints w/sm. Pump (4) LED traffic lights Top Deck Stoke s basket (Secured) Passenger Side Rear Tall Compartment Streamlight flashlight Registration and Insurance Garage opener Mile marker sheet Sager splint Broom and dust pan Jumper Cables (2) wheel chocks Duck tape Yaktraks ABC fire extinguisher MCI tarps (red, yellow, green) 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 Black body bag 1 P age

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 HandTevy Jump Bag **Please refer to laminated itemized list at bottom of bag to ensure contents** Main EMS Jump Bag with the following: Outside Front RED Pouch Assorted bio bags Zippered Med Pouch Aspirin (4 tablets minimum) Atropine 1mg Tetracaine Dextrose 50% 25g/50mL (1) Oral Glucose Magnesium Sulfate 5g/10mL (2) Narcan 2mg (2) 1mL syringe with needle (2) Adenosine 12mg (2) 3mL syringe with needle (2) Albuterol 2.5mg (2) 5mL syringe Racepinephrine (Racemic Epi 2.25%) (2) 10mL Saline flushes (3) Amiodarone 150mg 10mL syringe (2) Epinephrine 1:1000 w/ 18ga filter needle 20mL syringe MAD (nasal atomizer) (2) 5mL Saline flushes Nitrostat 0.4mg/tablet (4 tablet minimum) 18ga needles & 18ga filter needle (2) IV Zofran 4mg 22ga needles (2) ODT Zofran 4mg 25ga safety needles (2) Haldol 5mg (6) small plunger syringes (2) Benadryl 50mg (4) Epinephrine 1:10,000 Outside Front GREEN pouch (2) Trauma dressings Burn Sheet ALS Airway Kit Curved (Macintosh) blades 1-4 10mL Syringe Straight (Miller) blades sizes 1-4 BAM Large laryngoscope handles Magill forceps (2) AA Batteries Bougie (2) C Batteries ET Tubes size 6.5-8.5 (2) 10ga x 3 IV decompression catheter Adult (blue) ET tube holder Scalpel (#10) Child (pink) ET tube holder Neosynephrine Tape Inside EMS Jump Bag Clear Pouch Side 2 Page

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 (2) Occlusive dressings 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 (Pulse Oximeter) 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 Handheld neb and mask neb Inner Zippered Pouch igel 3, 4, 5 Adult BVM OPA bag NPA bag 3 P age

Inside the Ambulance (Patient Compartment) Gurney Items on the Gurney Oxygen cylinder (minimum 1000psi) Pillow AVH/ VVH access cards Sheet Large and Small Megamovers 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 4 P age

Action Area (captain s seat/radio area) Below radio area (bins) Patient assessment guide AHA flipbook Trauma shears EMS field guide Spanish flipbook Adult defib pads Trauma activation card (taped to wall) Sliding Cabinet (beside radio) 2 razors Penlight Hand sanitizer Glucometer (lancets, test strips, bandaids, ETOH prep pads) *Functional test Oral/Rectal thermometer Ring cutter Items near the floor Sharps container (not full) Suction w/ canister, tubing, and hard tip *Functional test LifePak 15 (cardiac monitor) Right side pouch 4x electrode packet 10x electrode packet Pediatric defib pads 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 (2) Benzoin 5 P age

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 O2 extension tubing Handheld nebulizer Top Right Compartment Adult Mask nebulizer Yellow bag w/ King Vision screen (*Functional test) -Extra batteries, two King Vision blades, ET tubes 5-8, tube securing device 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/3mL (2) 10ga x 3in. IV catheter 60gtts Drip set Atropine 1mg Narcan (2) Epinephrine 1:10,000 1mg Oral Glucose Sodium Bicarbonate 50mEq (2) Lemon swabs (2) Albuterol 2.5mg/3mL Menthol Ointment Adenosine 12mg/4mL 6 P age

CPR Seat Beneath the seat Assortment of decon/ppe materials Sliding Compartment Above BP Cuff roll 7 P age

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) Occlusive dressings Bag of assorted Band-Aids (10) 4x4 s Box of 2x2 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) 250-500mL 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 8 P age

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 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 9 P age