daily ambulance inspection checklist · daily ambulance inspection checklist saxonburg vfc...

Daily Ambulance Inspection Checklist

Saxonburg VFC Ambulance l 210 Horne Ave. l ?P.O. Box 530 l Saxonburg, PA 16056 l (724) 352-3300

AMBULANCE OPERATION

Ambulance Equipment

Plugged in (electrical)............................. ___

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

Telephone (operational) ........................ ___

Emergency Lights (operational).............. ___

Fuel (above ½ tank) ............................... ___

Key (starts unit) ...................................... ___

Tires (proper inflation, tread depth) ........ ___

Inspection Sticker (up to date)................ ___

Insurance Card....................................... ___

IV Warmer working (seasonal) .............. ___

Windows clean ...................................... ___

Unit clean (outside) ................................ ___

Drivers Compartment

1-Hand lights (6-12v)................................. ___

1-Spotlight (working) ................................ ___

2-Protective Gear (Bunker coat, pants) .....___

1-Emergency Response Guide Book ........ ___

Driver’s Log Book (mileage recorded) .... ___

Map / Information Book .......................... ___

Garage Door Opener.............................. ___

Hospital Map Book ................................. ___

Keys / Gas Card..................................... ___

Clean / Trash Removed ......................... ___

Trip sheets box (with extra tripsheets) .... ___

Completed patient paperwork/turned in .. ___

Accountability Ring................................. ___

DRIVER-SIDE COMPARTMENTS

DA Compartment (Oxygen)

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

1-Regulator (2500-50psi) .......................... ___

2-Padded Board Splints (54”).................... ___



Reeves Stretcher ................................... ___

Scoop Stretcher ..................................... ___

1-Fire Extinguisher (2A:10BC, charged).... ___

1-Folding litter ........................................... ___

DB Compartment (Tool)

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

2-Bunker Helmet (Hard Hat)...................... ___

2-Clear eye protection............................... ___

4-Disposable blankets (yellow) ................. ___

Access Equipment Toolbox ...... # ______

DC Compartment (Drawer)

2-Leather work gloves............................... ___

3-Flares (30 min)....................................... ___

Tow strap............................................... ___

Battery jumper cables ............................ ___

Wheel simulator wrench......................... ___

2-Goggles ................................................. ___

DD Compartment (VacuSplint)

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

1-Vacu-Splint Mattress Adult (with pump) . ___

1-Vacu-Splint Mattress Child (with pump) . ___

Vacu-Splint Kit (L, M, & S and pump)..... ___

Air-Splint Kit (6 pieces) .......................... ___

1-Hand lights (6-12v)................................. ___

Primary Trauma Bag .................. # ______

PASSENGER-SIDE COMPARTMENTS

PD Compartment (Backboard)

2-Long backboard (straps).........................___

1-KED (adult).............................................___

1-Pediatric immobilization board................___

1-Stair chair ...............................................___

PC Compartment (C-Collar)

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

Cervical Collar Bag

1-C-spine collar (infant)..............................___

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

2-C-spine collars (no-neck)........................___

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

1-C-spine collars (regular) .........................___

1-C-spine collars (tall) ................................___

-- OR --

3-C-spine collars (adjustable) ....................___

PB Compartment (Side Door)

2-Oxygen cylinder D (>500 psi)..................___

1-Oxygen cylinder D (on cot) .....................___

2-Flowmeter (1-25 lpm) with guard ............___

1-Wrench (as required)..............................___

1-Folding litter/cot ......................................___

Unit clean / tidy (inside) ..........................___

PA Compartment (Drug Box)

1-Portable suction unit (& water)................___

1-Suction tubing.........................................___

1-Rigid suction catheter .............................___

1-French suction catheter ..........................___

MAST with pump (adult) ........................___

MAST with pump (child).........................___

Pediatric Kit............................... # ______

Auto Vent Kit ............................. # ______

Drug Box (locked) .................... # ______



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................ ___

Aluminum foil (roll) ................................. ___

Suction Cabinet

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......... ___

Airway Cabinet

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

3-Partial or non-rebreather (adult) ............. ___

2-Nasal cannual (capnography)................. ___

1-Stoma mask........................................... ___

1-BVM with supply tubing (adult) ............... ___

1-Pocket mask (valve/Ox port) .................. ___

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

1-Partial rebreather (pediatric)................... ___

Action Area/Cabinet

1-Portable Radio (high band)..................... ___

1-Penlight.................................................. ___

1-Bandage/trauma shears ......................... ___

1-BP cuff (wall).......................................... ___

1-Oral or tympanic thermometer................ ___

1-Disposable Tissues (box) ....................... ___

3-Emesis Container................................... ___

1-Hand Cleaner (alcohol) .......................... ___

4-Disposable Drinking Cups (3oz) ............. ___

2-Flowmeter (1-25 lpm) ............................. ___

1-BP Cuff (Large) ...................................... ___

1-BP Cuff (Pediatric) ................................. ___

On-Board Suction Cabinet

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

1-Suction tubing........................................ ___

1-Suction catheter (rigid)........................... ___

IV Fluids Cabinet

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

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

IV Warmer functioning (seasonal) ......... ___

EKG Monitor Area/Cabinet

1-LFPK-12 Defibrillator/Monitor ................. ___

2-Spare battery (charged) ......................... ___

1-Spare role EKG paper............................ ___

1-ECG Cables (3 lead set) ........................ ___

1-ECG Cables (12 lead adapter) ............... ___

20-Electrodes (adult)................................. ___

2-Defibrillation Pads (adult, set of 2) ......... ___

1-Re-usable Pulse-Ox Sensor................... ___

1-Auto BP Cuff (adult)............................... ___

1-Auto BP Cuff (large)............................... ___

1-Atuo BP Cuff (child) ............................... ___

2-Razors ................................................... ___

1-Defibriltion pads (adult, extra) ................ ___

1-Defibriltion pads (child, extra)................. ___

1-BVM, Adult (extra).................................. ___

1-BVM, Child (extra).................................. ___

Specialty Cabinet

4-Trauma dressings (10"x30"),.................. ___

4-Occlusive dressings (3"x4") ................... ___

2-Sterile Burn sheets (48”'x48”)................. ___

1-IV Infuser set ......................................... ___

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)................... ___

3-Straps (9’) .............................................. ___

Extra cot straps (2-3) ............................. ___

Stretcher

Cot (present, clean, working, made) .......___

Linens (extra sheet, towel) ......................___

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

3-Stretcher straps ......................................___

Bottom carrier (clean) .............................___

Extra blanket (seasonal) .........................___

Cot blanket (seasonal)............................___

Linen Cabinet

4/8 Blankets (cloth and clean)....................___

4-8-Sheets.................................................___

3-6-Pillow Cases........................................___

2-Pillows ....................................................___

2-Face Cloths ............................................___

8-10-Towels...............................................___

Dressings/Bandages Cabinet

1-Flowmeter (1-25 lpm)..............................___

25-Sterile gauze pads (4”x4").......................___

6-Cling rolls (clean / wrapped) ...................___

4-Adhesive tape rolls (asst sizes) ..............___

8-Triangle bandages (safety pins)..............___

2-Nose bleed clips .....................................___

Fluid/Irrigation Cabinet

2-Sterile water (liters, unbreakable) ..........___

1-Hydrogen Peroxide (>50cc) ....................___

2-Saline solution (500cc, sterile) ...............___

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) .............___

1-Extra pillow (with case) ...........................___

1-Pedimate (child restraint)........................___

Extra bio-hazard bags (small) .................___

Garbage (empty, not overflowing) ...........___



Primary Jump Bag

Lid Bag (Not Expired)

3-Oral Glucose (15g dextrose gel)............ ___

1-Activated Charcoal (50g)........................ ___

1-IV Glucose (50g, D50)............................ ___

2-IV Epinephrine (1mg each)..................... ___

1-SL Nitroglycerine spray .......................... ___

8/12 tablets-Children’s Aspirin................... ___

2- Albuterol vials........................................ ___

Main Compartment

1-Stethoscope........................................... ___

1-BP cuff (adult) ........................................ ___

1-Pulse Oximeter (with sensors)................ ___

1-Penlight.................................................. ___

1-Bandage/trauma shears ......................... ___

1-Emesis Bag............................................ ___

1-Bottle Hand Wash (anticeptic)................ ___

1-Sharps container (small, not full) ............ ___

1-BVM (with supply tubing)........................ ___

1-Glucometer Kit (strips, lancets) .............. ___

1-Nebulizer................................................ ___

2-Albuterol vials (non expired) ................... ___

Side Compartment (Left)

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

1-Partial or non-rebreather (adult) ............. ___

1-Oxygen supply tubing............................. ___

Side Compartment (Right)

1-Occlusive dressings (3"x4").................... ___

1-Trauma dressings (3"x10")..................... ___

Sterile gauze pads (3"x3") ..................... ___


1/2-Cling rolls (clean / wrapped) ................ ___

1-Adhesive tape roll (1”) ............................ ___

Primary Jump Bag

Front Compartment

2-Sterile Catheters (14ga) ........................ ___






1-Macro drop IV tubing sets (10-20 gtts) .. ___

1-Normal Saline (0.9%, 1000ml) .............. ___

2-Tourniquets ........................................... ___

10-Alcohol wipes (wrapped) ........................ ___

6-8-Op Sites (sterile)................................... ___

6-8-Dressing (2”x2”) .................................... ___

Tape (2-3 rolls, assorted) ........................ ___

1-Blood Draw Kit (normal) ......................... ___

Chemstrips (min of 6 strips) ................... ___

3-NSS syringe (5ml-AVH) ......................... ___

3-NSS syringe (5ml-BMH)......................... ___

3-IV-Cap with Extension (AVH) ................. ___

2-IV-Cap with Extension (BMH)................. ___

10-Alcohol wipes (wrapped) ........................ ___

1-Carpuject holder .................................... ___

1-Syringe (10cc)........................................ ___

Rear Compartment

Intubation Kit................................. # ______

ALS Drug Drawer

General

1-Blood Draw Kit (stroke)...........................___

2-Nebulizers ..............................................___

1-Blood Draw Kit........................................___

IV Kit

2-Sterile Catheters (14ga) .........................___



2-Sterile Catheters (20 ga) ........................___



2-Micro drop IV tubing sets (50-60 gtts) ....___

2-Macro drop IV tubing sets (10-20 gtts) ...___

2-Tourniquets ...........................................___

Alcohol wipes (wrapped)..........................___

Op Sites (sterile)......................................___

Medications (Not Expired)

6-Epinepherine (1mg) ................................___

3-Atropine (1mg)........................................___

1-Glucose (D50, 50g) ................................___

1-Sodium Bicarb (1mEq) ...........................___

2-Lidocaine (100mg) .................................___

2-Fouresomide (40mg) .............................___

1-SL Nitroglycerine (spray) .......................___

Miscellaneous

4-Stine-ease vial ........................................___

3-Hand Cleaner .........................................___

1-

1-

Ambulance Kit Inspection


Locked Kits

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 ......................................... ___

Primary 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").................... ___



6-Cling rolls (clean / wrapped) ................... ___

4-Adhesive tape rolls (asst sizes).............. ___

4-Triangle bandages (safety pins) ............. ___

Exposure Control .....................# _______

4-Caps .................................................... ____

4-Pants (assorted sizes) ......................... ____

4-Shirts (assorted sizes) ......................... ____

4-Shoe covers (pairs).............................. ____

4-Masks/Filters........................................ ____

OB/GYN Kit

1-Sterile OB Kit ......................................... ___

1-Sterile Bulb Syringe................................ ___

1-Sterile Thermal Blanket (silver) .............. ___

1-Meconium Aspirator ............................... ___

Pediatric Kit................................... ______

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

1-BP cuff (child) ........................................ ___

BP cuff (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 (3”x3”, 4”x4”) ............................... ___

Pulse Ox sensor (pediatric).................... ___

Syringe (10cc)........................................ ___

AutoVent Bag ............................# _______

1-Oxygen Cylinder (>1200 psi).................. ___

1-Oxygen regulator (with guard) ................ ___

1-Auto Vent (working) ............................... ___

1-Adapter/connector ................................. ___

1-Airway (set)............................................ ___

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

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

1-#1 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 .............................................___

Phlebotomy Kit (Standard-AVH)

1-Red-Top Blood Tube ............................____

2-Green-Top Blood Tube .........................____

1-Purple-Top Blood Tube.........................____

1-Blue-Top Blood Tube............................____

1-Hub (with needle/needless adapter)......____

1-Needle (20 ga)......................................____

1-BioHazard Bag (small, sealable)...........____

Labels..................................................____

Phlebotomy Kit (Stroke)

1-Red-Top Blood Tube ............................____

1-Camo-Top Blood Tube .........................____

1-Purple-Top Blood Tube.........................____

1-Blue-Top Blood Tube............................____

1-Hub (with needle/needless adapter)......____

1-Needle (20 ga)......................................____

1-BioHazard Bag (small, sealable)...........____

Labels..................................................____

daily ambulance inspection checklist · daily ambulance inspection checklist saxonburg vfc...

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