Date / Time Completed *

Date

Time

Unit *Rescue / Medic 34Rescue / Medic 35

GENERAL: *

• Current State Inspection
• Exterior Clean
• Interior Clean
• Current VOEMS Permit
• Seatbelts for All
• Meds protected from climate extremes

Warning Devices / Tools *

• Adjustable Wrench, 10" (1)
• Standard Screwdriver (1)
• Phillips Screwdriver (1)
• Center Punch (1)
• Flares or Cones / Triangles (3)
• Current USDOT ERG (1)
• Emergency Lights All Sides
• Min. 2 Flashing in Grill
• Audible Warning Device

Markings *

• Agency Contrast / Reflective
• 3" Minimum Lettering
• 4" Minimum Reflective Band

Communications *

• Vehicle to Base
• Vehicle to Vehicle
• AIC to Med Control (ALS Only)

Safety Equipment *

• D-Cell Flashlight (1)
• ABC Extinguisher (5#) (2)
• Traffic safety apparel (2)
• Sharps Container
• Stretcher w/3 straps min. (1)
• No Smoking Sign

Linens: *

• Towels (2)
• Blankets (2)
• Pillows (2)
• Pillow cases (2)
• Sheets (4)
• Male Urinal (1)
• Bedpan and toilet paper (1)

BLS Equipment *

• AED w/ Set of Pads (2) OR 1 Combination device w/manual option
• Pocket Masks (2)
• O/P Airways (6) (Sizes 0 --- 5, 1 ea.)
• N/P Airways (4) (1 ea of var sizes)
• Soluble Lube
• Adult BVM w/ Adult/Peds Mask (1 ea)
• Infant BVM w/ Infant Mask (1)

Oxygen Apparatus: *

• Portable O2 --- 1150 psi min
• Adult HC (NRB) Masks (4)
• Peds HC (NRB) Masks (4)
• Adult Nasal Cannulae (4)
• Child Nasal Cannulae (4)

Suction Apparatus *

• Battery Powered Portable Suction
• Suction Catheters: Rigid Tonsil Tip, FR 18, FR 14, FR 8, & FR 6 (2 ea.)

Patient Assessment Equipment *

• Adult Stethoscope (2)
• Peds Stethoscope (1)
• B/P Cuffs: Child, Adult, LG (1 ea)
• Vinyl Triage Tape Rolls: Red, Black, Green and Yellow (1 ea)
• OEMS Approved Triage Tags (25)
• Penlight (1)
• Current Medical Protocols (1)

EMT-A/ I / P: (EMT-E Plus) *

• Drug Kit (EMT---A/I/PM) (1)
• ECG Mon/Defib/Cardio/Pac (1)
• Electrodes, Adult & Peds (2 ea)
• Defib Electrodes, A&P (2 ea)
• Pace Electrodes, A&P (2 ea)
• Sterile Needles, Syringes, IV Solutions/Tubing & IV Start Kits as determined by OMD
• Pediatric Assessment Guide (1)

Advanced Airway (EMT-E/A/I/P): *

• Supra-glottic Airway (1)
• Complete ETT Kit (1)

Dressing / Supplies: *

• Durable First Aid Kit
• Trauma Dressings (8x10) (4)
• Sterile 4x4's (24)
• Occlusive Dressings (3x8) (4)
• Assorted Roller Gauze (12)
• Cravats (10)
• Tape 1" and 2" (4 rolls)
• Trauma Scissors (1)
• Emesis Basins (2)
• NS for Irrigation (4 L)
• Oral Glucose (2)
• Alcohol Preps (12)

Obstetrical Kit (2) containing: *

• Pair of sterile surgical gloves (2)
• Scissors or other cutting inst (1)
• Umbilical cord ties (4)
• Sanitary pads (1)
• Cloth / Disposable hand towels (2)
• Soft tip bulb syringe

Splinting: *

• Rigid Collars, SA, MA, LA & Peds (3ea) OR Adjustable (3)
• Traction splint w/ ankle hitch adult and pediatric (1 ea)
• Padded board splint upper ext. (2)
• Padded board splint lower ext. (2)
• Backboard (2)
• Short spine board (1)
• Peds immobilization device (1)
• Cervical immobilization device set (2)

PPE: *

• Waterless Antiseptic Hand Wash (1)
• Exam Gloves -10 pr/ea size
• Disposable Gowns (4)
• Face---shield/Eyewear (4)
• Infectious Waste Bags (4)

Name *

First

Last

Signature *

Clear Signature

Website

Submit