AMBULANCE INVENTORY

VEHICLE AND REASON FOR INSPECTION

MM slash DD slash YYYY

AMBULANCE EQUIPMENT CHECKLIST

Disposable equipment is acceptable where applicable; equipment/supplies shall not be expired

FIRST-IN KIT/BAG

1.1 First-In Kit items may be incorporated into other units (i.e. portable oxygen unit) and vice versa. (Qty: 1 Bag). Each first-in kit must include the following (1.2 - 1.24)
1.2 Oropharyngeal airways (individuälly wrapped and sterile) ADULT/CHILD/INFANT (Qty: 2 ea)
1.3 Small dressings gauze (sterile) 4" x 4" (Qty: 4)
1.4 Medium dressings gauze (sterile) 5" x 9" (Qty: 4)
1.5 Large dressings gauze (sterile) 10" x 30" (Qty: 2)
1.6 Hemostatic dressing approved by the Committee on Tactical Combat Casualty Care (Qty: 4)
1.7 Soft roller, self-adhering bandage 4" x 5 yds (Qty 2)
1.8 Bioclusive dressing with one-way release valve (individually packaged) (Qty: 1)
1.9 Cravats/triangular bandages 40" wide. (Qty: 4)
1.10 Tourniquets approved by the Committee on Tactical Combat Casualty Care for control of arterial bleeding (Qty: 2)
1.11 Adhesive tape (2") hypoallergenic. 5 yds (Qty: 1)
1.12 Bandage scissors (7") or equivalent (Qty: 1)
1.13 Sphygmomanometer ADULT (Qty: 1)
1.14 Stethoscope (Qty: 1)
1.15 Penlight-type flashlight (Qty: 1)
1.16 Sterile water or saline solution (in an unbreakable container) 500 ml. (Qty: 1)
1.17 Bulb syringe (sterile/wrapped) 3oz for irrigation purposes (Qty: 1)
1.18 Cold packs (instant) (Qty: 2)
1.19 Carbon Monoxide monitor (CO monitor) for measuring ambient air (Qty: 1)
1.20 Adhesive bandages (i.e. Band-Aids) 3/4". (Qty: 6)
1.21 Exam type gloves (single use, latex-free) (2 pairs)
1.22 Glucometer (kit with control solution, test strips, antiseptic wipes, small gauze, and Band-Aids) (Qty: 1)
1.23 Lancets (single use, self-retracting) (Qty: 8)
1.24 Sharps Container (self- closing) (Qty: 1)

PORTABLE OXYGEN UNIT

2.1 Oxygen cylinder D oe E. (Qty: 1)
2.2 Oxygen cylinder pressure gauge and regulator capable of delivering a range of 0-25 LPM (Qty: 1)
2.3 Bag-valve mask with oxygen supply reservoir (hand-operated, single use, with HEPA filter, pediatric/infant must include PEEP) ADULT/CHILD/INFANT (Qty: 1)
2.4 Pulse Oximetry (Qty: 1)
2.5 Non-Rebreather: High concentration oxygen masks (transparent, disposable) with delivery tubes ADULT/PEDI (Qty 2ea.)
2.6 Nasal cannula with delivery tube ADULT (Qty: 2)
2.7 Cylinder wrench or wheel secured to unit (Qty: 1)
2.8 Spare oxygen cylinder. All spare cylinders to be maintained in vehicle, but not part of a kit or stretcher. All spare cylinders must be stored in crash stable devices per AR 2-405 minimum specifications for ambulance vehicles. D or E (Qty: 1)

SUCTION EQUIPMENT

3.1 Portable suction apparatus (battery powered) capable of delivering a minimum vacuum of 600 millimeters of mercury.(Qty: 1)
3.2 Wide bore suction tubing (transparent/translucent, non-kinking) (Qty: 1)
3.3 Semi-rigid pharyngeal suction tip (Qty: 1)
3.4 Collection bottle or bag (non-breakable, disposable transparent) 500 ml. (Qty: 1)
3.5 Exam-type gloves (single use, latex-free) (1 pair)
3.6 French suction catheter 14 Fr (Qty: 1 ea)

AUTOMATIC EXTERNAL DEFIRIBILLATOR

4.1 AED appropriate to ambulance staffing configuration, with appropriate accessories to provide care in accordance with the Statewide Treatment Protocols and ILCOR/COSTR standards (Qty: 1)
4.2 AED Pads ADULT/PEDI (Qty: 2 ea)
4.3 Razor (single-use) (Qty: 1)

DIAGNOSTIC EQUIPMENT

5.1 ADULT Sphygmomanometer LG-ADULT/ADULT (Qty: 1 ea)
5.2 PEDI Sphygmomanometer CHILD/INFANT (1 ea)
5.3 Stethoscope (Qty: 1)
5.4 Penlight-type flashlight (Qty: 2)

ISOLATION OXYGEN SYSTEM

6.1 An installed oxygen system conforming to AR 2-405 minimum specifications for ambulance vehicles. (Qty: 1)
6.2 Flow meters capable of delivering a range of 0- 15 LPM (min.) (Qty: 2)

INSTALLED SUCTION

7.1 Electrically powered suction aspirator system furnished with an illuminated switch, and panel mounted (as required by AR 2-405 minimum specifications for ambulance vehicles.) (Qty: 1)
7.2 Collection bottle or bag (non-breakable, disposable transparent) 1000 ml capacity (Qty: 1)
7.3 Spare collection bags when bag-type system is furnished (Qty: 4)
7.4 Semi-rigid pharyngeal suction tip (Qty: 2)
7.5 Wide-bore suction tubing (transparent/translucent, non-kinking) 1/4" diameter (Qty: 2)
7.6 French suction catheters 5 Fr. 8 Fr. 14 Fr. (Qty: 2 ea)

AIRWAY MANAGEMENT

8.1 Big-valve mask with oxygen supply reservoir (hand operated, single use, with HEPA filter, pediatric/infant must include PEEP) ADULT/CHILD/INFANT (Qty: 1 ea)
8.2 Non-Rebreather: High concentration oxygen masks (transparent, disposable) with delivery tubes ADULT/PEDI/INFANT (Qty: 3 ea)
8.3 Nasal cannula with delivery tube ADULT/PEDI (Qty: 3 ea)
8.4 Oropharyngeal airways (individually wrapped) ADULT/CHILD/INFANT (Qty: 2 ea)
8.5 Neonate oxygen delivery masks NEONATE9 Qty: 2ea)
8.6 Nasopharyngeal airways (individually wrapped) 20F, 22F, 24F, 26F, 28F 30F 32F 34F (Qty: 1 ea)
8.7 PEDI Nasopharyngeal airways (individually wrapped) 12F, 14F, 16F, 18F (Qty: 1 ea)
8.8 Water soluble lubricant (single use package)(Qty: 12)

GLUCOMETER KIT

9.1 Glucometer (with control solution; antiseptic wipes; small gauze; bandages) (Qty: 1)
9.2 Glucometer test strips (Qty: 8)
9.3 Lancets (single use, self-retracting) (Qty: 8)

WOUND CARE

10.1 Small dressings gauze (sterile) 4" x 4" (Qty: 4)
10.2 Medium dressings gauze (sterile) 5" x 9" (Qty: 4)
10.3 Large dressings gauze (sterile) 10" x 30" (Qty: 2))
10.4 Soft roller, self-adhering bandage 4" x 5 yds (Qty: 2)
10.5 cravats / triangular bandages 4" wide (Qty: 4)
10.6 Adhesive tape (1") hypoallergenic 5 yds (Qty: 2)
10.7 Adhesive tape (2") hypoallergenic 5 yds (Qty: 2)
10.8 Bandage scissors (7") or equivalent (Qty: 2)
10.9 Sterile water or saline solution (in an unbreakable container 3000 cc (Qty: 3 minimum)
10.10 Bioclusive dressing with 1-way release valve (individually packaged) (Qty: 1)
10.11 Cold packs (instant) (Qty: 4)

BURN KIT

11.1 Burn sheets ( sterile) linen or disposable (Qty: 2)

OBSTETRICAL KIT

12.1 Obstetrical kit (sterile) containing the following: (Qty: 2)
12.2 Large towel (Qty: 1)
12.3 Receiving blanket, or equivalent (Qty: 1)
12.4 Sterile disposable plastic or rubber gloves (Qty: 1 pair)
12.5 Sterile gauze pads 3" x 3" (Qty: 6)
12.6 Kelly clamps or sterile ties (Qty: 2)
12.7 Sanitary napkins (Qty: 6)
12.8 Infant bulb syringe (Qty: 1)
12.9 Bandage or surgical blade scissors (Qty: 1)
12.10 Container with lid for carrying placenta (Qty: 1)
12:11 Newborn swaddle system (i.e., space blanket, foil swaddle, or equivalent to retain body temperature (Qty: 1)

SPLINTS or EQUIVALENT IMMOBILIZATION DEVICES

13.1 Traction splint (femur) device or equivalent; with ankle hitch and legs ties or equivalent. All accessory items to be stored with splints ADULT/PEDI (Qty: 1 ea)
13.2 4.5' x 3' covered padded board splint (single use) or equivalent (impervious to saturation) (Qty: 2)
13.3 3' x 3' covered padded board splint (single use) or equivalent (impervious to saturation) (Qty: 2)
13.4 15" x 3" covered padded board splint (single use) or equivalent (impervious to saturation) (Qty: 2)

SPINAL IMOBILIZATION

14.1 Full spine board, with easily cleanable 9' straps or functional equivalent and sufficient padding to maintain in-line head & cervical support/stabilization with head strap (2" tape or equivalent) Qty: 1 board, 4 straps)
14.2 ADULT Cervical Collar (rigid) NO-NECK: SM/MED/LG (Qty: 2 ea). **adjustable collar is equivalent to all 4 sizes**
14.3 PEDI Cervical Collar (rigid) CHILD/TODDLER/INFANT(Qty: 2 ea). **adjustable collar is equivalent to all 4 sizes**

**Accessories must be stored together near boards; all must be antbacterial/impervious to contaminates, or disposable**

STRETCHER

15.1 4-wheeled, multi-level ambulance cot (Qty: 1)
15.2 Standard cot mattress with waterproof cover (Qty: 1)
15.3 Patient restraining devices at chest (commercial shoulder harness or equal) hip, and knee to prevent lateral or longitudinal displacement of the patient during transport (Qty: 1 set each)
15.4 IV holder, capable of being cot mounted and holding 2 IV bags (Qty: 1)
15.5 Padded wrist and ankle restraints (Qty: 1 set)
15.6 For power - type units, one extra battery, and charger (as recommended by manufacturer) (Qty: 1)

Stair Chair

16.1 Stair chair with patient restraint straps (Qty: 1)
16.2 For power - type units, one extra battery, and charger (as recommended by manufacturer) (Qty: 1)

AUXILLIARY STRETCHER

17.1 Auxilliary stretcherwith patient restraint straps, or equivalent (i.e.. orthpedic "scoop" stretcher, "Reeves"- type stretcher, long spine board) (Qty: 1)

TRANSFER SHEET

18.1 Transfer sheet with a minimum of six (6) handles, or equivalent (Qty: 1)

ACCESSORIES

19.1 ADULT bed pan urinal, large basin or equivalent (Qty: 1 ea)
19.2 Motion sickness bags, or equivalent, capable of being sealed (Qty: 2)
19.3 Sheets (disposable or linen) (Qty: 4 - class I, II & CC)
19.4 Blankets (Qty: 4 - class I, II & CC) (Qty: 1 - class IV & V)
19.5 Towels (Qty: 4)
19.6 Paper tissues (disposable) (Qty: 1 package)
19.7 Drinking cups (disposable or individually wrapped) (Qty: 2)
19.8 Trash bin liners, plastic (with ties) (Qty: 2)
19.9 Biohazard bags (with ties) (Qty: 2)
19.10 Ring cutter (with extra blade (Qty: 1)
19.11 CPR oard or functionality equivalent(i.e., short board or back plate of a mechanical CPR device): must have hard washable surface for patient torso, and be accessible in patient compartment. (Qty: 1)
19.12 Child appropriate restraint device to provide safe transport of an infant/pediatric patient >5kg on stretcher (Qty: 1)

PERSONAL PROTECTION

20.1 Exam - type gloves (single use, latex-free) SM/MED/LG/XL (Qty: 1 box each)
20.2 NIOSH approved N95 Mask or better (disposable). All sizes per mfr. (Qty: 3 ea)
20.3 Facemask and protective eye wear (combination face mask/eye shield equivalent) (Qty: 4 ea)
20.4 Antiseptic hand sanitizer dispenser or 25 individually wrapped antiseptic hand wipes (Qty: 1)
20.5 Infection control kit containing two (2) each of disposable, fluid resistant gowns, masks, caps, protective eye wear, and two (2) different sizes of gloves. (Qty: 1 kit)

SAFETY/ACCESS EQUIPMENT

21.1 ANSI vest or equivalent (Class II/III) (Qty: 2)

VEHICLE EQUIPMENT

22.1 Warning Lights: Emergency warning beacon, visible 360 degrees, as permitted by M.G.L c.90, s.7, or as required per AR 2-405 minimum specifications for ambulance vehicles
22.2 Audible Warning Device: A siren, per AR 2-405 minimum specifications for ambulance vehicles & AMD Standard 023
22.3 Global positioning system (GPS) navigation system, street directories and road maps for primary and backup areas served
22.4 Fire extinguishers: CO2 or dry powder, UL approved. Mounted in patient compartment. 5lbs. (Qty: 2 - I, II, CC). (Qty: 1 - IV, V) 1
22.5 Handlights: (6-volt/4.5-volt if rechareable) bulb or LED or equivalent (Qty: 2)
22.6 Road reflectors(US DOT approved triangles or equivalent) (Qty: 3)
22.7 US DOT Emergency Respobse Guidebook (current edition) or electronic equivalent (Qty: 1)
22.8 National Institte of Occupational Health & Safety (NIOSH) pocket guide to Chemical Hazards (current edition) or electronic equivalent) (Qty: 1)
22.9 Binoculars 7 x 35 mm (Qty: 1)
22.10 SMART triage tags (Qty: 25)
22.11 Additional protective equipment to adequately safeguard crew from anticipated exposures as defined by the lecensee