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Daily Ambulance Inspection Checklist

PC Compartment

AMBULANCE OPERATION

EKG Monitor Area/Cabinet

2-CID Blocks (with strap) .......................... ___

Ambulance Equipment

Cervical Collar Bag

Radio (operational)................................. ___


Telephone (operational) ........................ ___
Emergency Lights (operational).............. ___
Key (starts)............................................. ___
IV Warmer (seasonal) ........................... ___
On-Board suction ................................... ___
Main Oxygen cylinder (above 500psi)..... ___

Drivers Compartment
2-Hand lights (6-12v)................................. ___
2-Protective Gear (Bunker coat, pants) .....___
1-Emergency Response Guide Book ........ ___
Drivers Log Book ................................... ___

DRIVER-SIDE COMPARTMENTS
DA Compartment

2-C-spine collars (small) ........................... ___


2-C-spine collars (medium) ....................... ___
2-C-spine collars (large)............................ ___
2-C-spine collars (pediatric) ...................... ___
C-spine collars (infant) ........................... ___

PB Compartment (Side Door)


2-Oxygen cylinder D (500 psi) ................... ___
2-Flowmeter (1-25 lpm)............................. ___
1-Wrench (non-sparking) .......................... ___
1-Folding litter/cot ..................................... ___

PA Compartment
1-Portable suction unit (& water) ............... ___
MAST with pump (adult)........................ ___
MAST with pump (child) ........................ ___
Pediatric Kit...............................# _______

1-Oxygen cylinder M (500 psi)................... ___


1-Regulator (2500-50psi)........................... ___
2-Padded Board Splints (54) .................... ___
2-Padded Board Splints (36) .................... ___
2-Padded Board Splints (15) .................... ___
Reeves Stretcher ................................... ___
Scoop Stretcher ..................................... ___
1-Fire Extinguisher (2A:10BC, charged) .... ___

DB Compartment

INSIDE COMPARTMENTS
Documentation Cabinet
25-State Approved Triage Tags .................. ___
1-Infection Control Plan............................. ___
10-Spare Trip Sheets .................................. ___
Extra pens (black/.blue) ......................... ___
Extra patient information pads................ ___

Airway/Suction Cabinet

Bag Buster ............................................. ___


2-Bunker Helmet (Hard Hat)...................... ___
2-Clear eye protection............................... ___
Access Equipment Toolbox...... # _______

DC Drawer
2-Leather work gloves ............................... ___
3-Flares (30 min)....................................... ___
Tow strap ............................................... ___
Battery jumper cables ............................ ___

DD Compartment

1-Nasal cannula (adult) ............................ ___


1-Partial or non-rebreather (adult) ............. ___
1-BVM with supply tubing (adult)............... ___
1-Pocket mask (valve/Ox port) .................. ___
2-Sterile Suctioning Catheters (rigid) ........ ___
1-Sterile Suction catheters, FR6 ............... ___
1-Sterile Suction catheters, FR8 ............... ___
2-Sterile Suction catheters, FR10/12 ........ ___
2-Sterile Suction catheters, FR14/16 ........ ___

Action Area

SCBA / Face Mask (pressurized) ........... ___


Vacu-Splint Mattress (with pump)........... ___
Vacu-Splint Kit (L, M, & S and pump)..... ___
Air-Splint Kit (6 pieces)........................... ___
Hand lights (6-12v) ................................. ___
Trauma Bag ............................... # _______

PASSENGER-SIDE COMPARTMENTS
PD Compartment
2-Long backboard (straps) ........................ ___
1-KED (adult) ............................................ ___
Pediatric immobilization board................ ___
Stair chair............................................... ___

1-Stethoscope........................................... ___
1-Penlight.................................................. ___
1-Bandage/trauma shears......................... ___
1-Sphygmomanometer (adult)................... ___
1-Sphygmomanometer (large) .................. ___
1-Oral or tympanic thermometer ............... ___
1-Disposable Tissues (box)....................... ___
1-Emesis Container .................................. ___
4-Disposable Drinking Cups (3oz)............. ___
2-Flowmeter (1-25 lpm)............................. ___

On-Board Suction Cabinet


1-Electric suction unit (with water)............. ___
1-Suction tubing ........................................ ___
1-Suction tubing ........................................ ___

IV Fluids Cabinet
4-Normal Saline (0.9%, 1 liter) ................. ___
4-Normal Saline (0.9%, 1 liter) ................. ___

Saxonburg VFC Ambulance

l 210 Horne Ave.

P.O. Box 530


?

1-LFPK-12 Defibrillator/Monitor..................___
1-Spare battery ..........................................___
1-ECG Cables (3 lead set).........................___
1-ECG Cables (12 lead adapter)................___
6-Electrodes (adult) ...................................___
2-Defibrillation Pads (adult, set of 2) ..........___
1-Re-usable Pulse-Ox Sensor ...................___
1-BP Cuff (adult)........................................___
1-BP Cuff (larget).......................................___
1-BP Cuff (child) ........................................___

Specialty Cabinet
4-Trauma dressings (10"x30"), ..................___
4-Occlusive dressings (3"x4") ....................___
2-Sterile Burn sheets (48'x48) .................___
2-OB/GYN Kit ................................ # _______

Infectious Disease Cabinet


4-Eye protection, clear and disposable ......___
4-Face mask (disposable) .........................___
4-Gowns or coat ........................................___
4-Surgical caps..........................................___
4-Surgical foot coverings (set) ...................___
1-Straps (9)...............................................___

Linen Cabinet
2-Blankets (cloth and clean) ......................___
4-Sheets ....................................................___
2-Pillow Cases ...........................................___
1-Pillows ....................................................___
4-Towels ....................................................___

Drug Drawer
2-Sterile Catheters (14ga) .........................___
2-Sterile Catheters (16ga) .........................___
2-Sterile Catheters (18ga) .........................___
2-Sterile Catheters (20ga) .........................___
2-Sterile Catheters (22ga) .........................___
1-Sterile Catheters (24ga) .........................___
2-Micro drop IV tubing sets (50-60 gtts) ....___
2-Macro drop IV tubing sets (10-20 gtts) ...___
2-Tourniquets ...........................................___
Alcohol wipes (wrapped) .........................___

Dressings/Bandages Cabinet
1-Flowmeter (1-25 lpm)..............................___
25-Sterile gauze pads (3"x3") ......................___
6-Cling rolls (clean / wrapped) ...................___
4-Adhesive tape rolls (asst sizes) ..............___
8-Triangle bandages (safety pins)..............___

Fluid/Irrigation Cabinet
2-Sterile water (liters, unbreakable) ............___
4-Cold packs (chemical) ............................___
4-Hot packs (chemical) ..............................___

Bench Seat Cabinet


1-Urinal......................................................___
1-Bed Pan .................................................___
1-Sharps Container (labeled secured) .......___
3-Disposable bags (red, biohazard) ...........___
1-HARE Traction Splint (adult)...................___
1-HARE Traction Splint (pediatric) .............___

Saxonburg, PA 16056

l (724) 352-3300

Daily Ambulance Inspection Checklist


Access Equipment Toolbox .... # _______
1-Large Screwdriver, straight blade ........... ___
1-Large Screwdriver, phillips blade............ ___
1-Regular Screwdriver, straight blade...... ____
1-Pliers, slip joint (8") ................................ ___
1-Pliers, needle nose (6") .......................... ___
1-Pliers, lineman's (7") .............................. ___
1-Pliers, arc joint (8")................................. ___
1-Pliers, locking (8") .................................. ___
1-Hand-held Sledge Hammer (3 lbs.), 10" ___
1-Impact Sheet Metal Cutting Tool ............ ___
1-Short Pry Bar (12")................................. ___
1-Cold chisel (7"x3/4")............................... ___
1-Hacksaw ................................................ ___
2-Extra blades ........................................... ___
1-Cutting Lubricant .................................. ____
1-Adjustable wrench (10") ......................... ___
1-Center punch ......................................... ___

Trauma Bag............................... # _______


BP Cuff / Stethoscope............................ ___
Trauma Shears ...................................... ___
Nasal cannula (adult) ............................ ___
Partial or non-rebreather (adult) ............. ___
BVM with supply tubing (adult) ............... ___
2-Trauma dressings (10"x30"), .................. ___
2-Occlusive dressings (3"x4").................... ___
Sterile gauze pads (3"x3") ..................... ___
3-Cling rolls (clean / wrapped) ................... ___
2-Adhesive tape rolls (asst sizes).............. ___
2-Triangle bandages (safety pins) ............. ___

1-Pediatric sizing tape/chart ...................... ___


1-Sphygmomanometer (child) ................... ___
Sphygmomanometer (pediatric) ............. ___
1-Nasal cannula (pediatric) ...................... ___
1-Partial or non-rebreather (pediatric) ....... ___
1-Partial or non-rebreather (infant) ............ ___
1-BVM with supply tubing (infant).............. ___
3-OP airways (asst sizes, clean) ............... ___
6-Electrodes (pediatric) ............................. ___
2-Defibrillation pads (pediatric, set of 2) .... ___
2-Intraosseus needles (14-18ga) .............. ___
1-Laryngoscope small handle & batteries . ___
1-#0 Straight blade & light......................... ___
1-#1 Straight blade & light......................... ___
1-#1 Curved blade & light.......................... ___
1-#2 Curved blade & light.......................... ___
1-Spare Light bulb..................................... ___
1-Spare batteries (set) .............................. ___
2-2.5mm-3.0mm ET tubes (uncuffed) ....... ___
2-3.5mm-4.0mm ET tubes (uncuffed) ....... ___
2-4.5mm-5.0mm ET tubes ........................ ___
2-Sterile Flexible stylet (pediatric) ............. ___
1-Magill forceps (pediatric)........................ ___
Meconium Aspirator ............................... ___
Tape (asst sizes) ................................... ___
Thermometer ......................................... ___
Cling (2 / 3 )......................................... ___
Gauze (3x3, 4x4) ............................... ___
Pulse Ox sensor (pediatric).................... ___
Syringe (10cc)........................................ ___

1-Bandage shears .....................................___


1-Sphygmomanometer (adult) ...................___

ALS Front Pouch


2-Sterile Catheters (14ga) .........................___
2-Sterile Catheters (16ga) .........................___
2-Sterile Catheters (18ga) .........................___
2-Sterile Catheters (20ga) .........................___
2-Sterile Catheters (22ga) .........................___
1-Sterile Catheters (24ga) .........................___
1-Micro drop IV tubing sets (50-60 gtts) ....___
1-Macro drop IV tubing sets (10-20 gtts) ...___
1-Normal Saline (0.9%, 1 liter) ..................___
2-Tourniquets ...........................................___
10-Alcohol wipes (wrapped).........................___

Phlebotomy Equipment
2 Blood Tubes ...................................__?__
2 Hub .................................................__?__
2 Needles ..........................................__?__

Medications
3-Oral Glucose (40% dextrose gel15g) ......___
1-Activated Charcoal (50g) ........................___

Airway / Intubation Kit ..............# _______

Survival Bag
1-Blanket............................................... __?__
1-Heat source?...................................... __?__
1-Emergency Jump Kit.......................... __?__

OB/GYN Kit
1-Sterile OB Kit ......................................... ___
1-Sterile Bulb Syringe................................ ___
1-Sterile Thermal Blanket (silver) .............. ___
1-Meconium Aspirator ............................... ___

Saxonburg VFC Ambulance

Pediatric Kit.................................. ______ Primary Jump Bag

1-Laryngoscope handle & batteries........... ___


1-#1 Straight blade & light......................... ___
1-#2 Straight blade & light......................... ___
1-#3 Straight blade & light......................... ___
1-#3 Curved blade & light.......................... ___
1-#4 Curved blade & light.......................... ___
1-Spare Light bulb..................................... ___
1-Spare batteries (set) .............................. ___
2-5.5mm-6.0mm ET tubes ........................ ___
2-6.5mm-7.0mm ET tubes ........................ ___
2-7.5mm-8.0mm ET tubes ........................ ___
2-8.5mm-9.0mm ET tubes ........................ ___
5-NP airways (assorted sizes)................... ___
6-OP airways (assorted sizes, clean) ........ ___
1-Sterile Flexible stylet (adult) ................... ___
2-Lubricating surgical jelly (sterile) ............ ___
1-Magill forceps (adult).............................. ___
Tube tamer ............................................ ___

l 210 Horne Ave.

P.O. Box 530


?

Saxonburg, PA 16056

l (724) 352-3300