Basalt Fire-Rescue Medic 41 Inspection Form

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Date: Personnel: Cab (4) Traffic vests Batteries (9V, AA, AAA) ERG (2) Bottles Hand Sanitizer Spot light Streamlight flashlight (4) Bottles of water Registration and Insurance Map Book Fire size-up card Phone list sheet Mile marker sheet Driver s Side Front Tall Compartment Garage opener Assorted pens S, M, L, XL medical gloves 2 Bio PPE Backpacks ABC fire extinguisher Pediatric Board Driver s Side Middle Compartment SCBA (functional test) >4200psi Traffic triangle s in box Tow strap Tool Box Driver s Side Rear Compartment Full body vacuum splint w/lg. Pump Sm/Md/Lg vacuum splints w/sm. Pump Top Deck Stoke s basket (Secured) Passenger Side Rear Tall Compartment Broom and dust pan Jumper Cables 2 wheel chocks Box kitty litter Yaktraks 2 backboards Scoop stretcher Stair-chair Sager traction splint Passenger Side Middle Small Compartment (2) O2 Cylinders >1500psi MCI tarps (red, yellow, green, black) KED device (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

Passenger Side Front Compartment (behind passenger seat) Spare Stryker battery in charging dock Portable suction unit w/ tubing + tip (*switch out with battery currently on cot) (*functional test while UNPLUGGED from charger) MCI/ Triage box kit Protocol binder 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 (2) 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) 10mL 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 Small/Large laryngoscope handles (2) Magill forceps (2) AA Batteries Bougie ET Introducer (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 2 P age

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 Band-Aids Diagnostics Pouch RAD 57 (Pulse Oximeter) Tympanic thermometer Glucometer w/ strips, lancets, preps, Band-Aids, 2x2 s IO Pouch IO Gun (functional) Needles (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 3 P age

Inside the Ambulance (Patient Compartment) Powercot (operational w/ fresh battery) Items on the Powercot 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 (2) HWY Emergency blankets Pillow Pedi-mate child securing device Blanket Yellow roll of padding Assortment of towels Sharps container (not full) 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 Above Passenger Side Door (Examination Gloves Cabinet) Medium, Large, XL Gloves 4 P age

Action Area (captain s seat/radio area) Below radio area (bins) Patient assessment guide AHA flipbook PALS flipbook EMS field guide Spanish flipbook Adult defibrillation pads Trauma activation card Sliding Cabinet (beside radio) 2 razors Penlight Hand sanitizer 4x electrode packet 10x electrode packet Pediatric defibrillation pads Trauma shears Glucometer (lancets, test strips, Band-Aids, 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 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 Blue bag w/ CPAP inside Handheld nebulizer Adult Mask nebulizer Top Right Compartment O2 extension tubing Ventilator 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 BP Cuff roll (blue) Medi-Sonic Doppler Tray 1 (Saline bags) 100mL NaCL 250mL NaCL Tray 2 (Pharmaceuticals) Dextrose 50% 25g Amiodarone 150mg Infant BVM 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 Bottom Left Compartment 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 Suction Tray (2) hard tip suction ACS chest seal Suction tubing French 5-16 (2) 10ga x 3in. IV catheter 6 P age

CPR Seat Beneath the seat (2) Blankets sheet Vitals Pouch Blood Pressure cuff Stethoscope Sliding Compartment Above (2) headlamps 7 P age

Trauma Compartment (Rear-most Drive s Side Sliding Compartments) Top Left Stuffed animals Bandage Tray 1 (2) SAM splints Tactical tourniquet (2) cling-wrap QuickClot hemostatic gauze 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 Box of 2x2 s Top Right OB kit Pedi arm boards Emesis basin Urinal Bed pan Bottom Left (10) 4x4 s Kleenex box Decon wipes (singles) Bio-hazard bags Bio-hoop emesis bags (2) 250-500mL NaCL bottles (2) blue chux (2) 250mL Sterile water bottles 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 IV tourniquets Saline bags shelf Transpore tape (2) warm 1000mL NaCl Buretrol drip set (1) warm 500mL NaCl (2) 10gtts drip sets (3) cool 500mL NaCl (1) 60gtts drip set (2) blood tube kits Bottom Right Burn kit Roll of foil (4) Cold packs (4) Hot packs Pelvic splint (4) Ebola shields (2) Small Tyvek suits (2) Trauma dressings (2) Large Tyvek suits Tub of sanitizing wipes 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 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 9 P age