# Where is your gear?



## Melclin (Jul 5, 2011)

I got a bit of a surprise in another thread when usal said the drugs have to be taken out of the safe on every call. It got me to thinking in general about the distribution of gear because I don't like how ours is spread out.

How is your gear, specifically your drugs, spread out? 

I'll give a run down of how ours is as an example:

We have three main bags:
- Our closed circuit ventilation/suction with oxygen and a few other masks and bits and pieces. 
- Monitor.
- (I think you guys would call it a drop bag): This one pisses me off - First aid bits, bp cuff, steth, bsl, thermometer, drugs, cannulation gear, fluid, LMAs, bvm.

There is another oxygen bag without all the closed circuit and suction for less sick pts. Collars and spinal gear are in two different bags in two different compartments. 

Everything in the bags (drugs, first aid, cannulation, airway, bp etc) is duplicated in the truck with the exception of the monitor and closed circuit/suction.

I find this all to be a fairly frustrating and illogical lay out. Airway spread across two bags, assessment gear in lots of different spots. If we have a not particularly sick pt, we still have to carry all the advanced airway and drug stuff with along with the first aid stuff. It s*** me and my back. Although not having your drugs on you sounds worse, usal. 

How's it done in your parts?


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## STXmedic (Jul 5, 2011)

I'm pretty sure what usal was saying was that he has to pull his Narcs out of the lock box, as per law. All of our other drugs are typically carried with us in a med or jump bag. What I bring in:

Jump bag with:
-Bandaging supplies and trauma management
-IV equipment
-Drug kit

Airway bag w/o2 and assorted delivery devices

Monitor


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## TransportJockey (Jul 5, 2011)

At work we have the following on the truck separated:
Portable Vent
Portable Suction
First in Bag (IV kit, ETI kit, MLA, BP cuff, pulse ox, CBG kit, airway supplies, bandaging materials)
Trauma bag (head blocks and c-collars)
Drug bag (IV kit, non controlled drugs eg Zofran, Benedryl, D50, etc)
Narcotics (in safe, has MS, Fent, and Valium)
Zoll M-series (the usual electrodes and paper, also has ASA and NTG in the side pocket)


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## mycrofft (Jul 5, 2011)

*Due to theft, we couldn't shelf stock any PO or IM/IV meds.*

Not only none in the kits, but none in the exam rooms. Had to go to the IMED computerized drug box (size of a Neptune clothes washer on a stand) for anything (including advil or syringes), there was only one, and it was at one end of a 100 ft long building behind three levels of locked doors.
No Fooling.


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## Shishkabob (Jul 5, 2011)

At usal's and mine agency, we have Versed and Fentanyl inside of a safe that ONLY the Paramedic has the code to, and our Ativan and Roc are in a cooler witha  lock that only the Paramedic has a key to.





As for gear, we have a giant red bag which holds pretty much all of the gear needed to stabilize any critical patient we may come across on a call.  Every bag in every station is set up the same way.  It's a duffle-bag type of style, pretty big and hefty;

One compartment on the front holds all of our ACLS meds.
A second compartment on the same side holds all the IV stuff, such as start kits, needles, syringes, catheters, and combat TQs and trauma dressings.
A side compartment holds our sharps container.
The other side holds our BP cuff, steth, and glucometer.
The back holds our intubation roll (with all the required intubation equipment), LMAs and King tubes.  We also have an adult and pedi C-collar in that pouch.
The main compartment holds our medication box, our cric kit, our suction unit, our EZ-IO, adult and pedi BVMs, our respiratory stuff such as NRB, nebs and the like, IV fluid bag, and other misc. stuff.  
The drugs are in a box in the main compartment, and it holds a small supplement of main medications that could be used on a call when not in the truck, such as NTG, ASA, etomidate, Roc, pepcid, Epi, etc etc



We also have our EKG on the cot with the red bag, and the O2 is on the cot as well.  We have a trauma bag which can be used on MCIs or remote trauma things.  It's a backpack with trauma bandages and IV supplies.


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## usalsfyre (Jul 6, 2011)

Yep, only narcotics are in the safe.

Otherwise we have 

Gigantic heavy as all get out first in bag with drugs, IV/IO supplies, airway kit with ETT, backup airways, cric kit, portable suction, basic trauma supplies, tourniquets, BVMs, oxygen administration...I'll put it this way, on critical calls I often never even open a cabinet.

Cardiac monitor with typical supplies. 

We also have a "trauma" bag that tends to take up space and gather dust, it has a few more bandaging supplies than the first in bag.

Other than the fact that the first in bag is far to heavy for the single shoulder strap provided, it's really a good setup.

P.S. Linuss beat me to it with a far more complete description...dang parapup


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## Melclin (Jul 6, 2011)

Is all your gear duplicated inside the truck or do you use the stuff out of your bags? 

Do you just carry an O2 bottle with a reg on top? Does it go into every job?

Seems like you guys have a similar problem although I think our problem sprung from adding more and more gear into a set-up that was designed around not carrying that much stuff. I wish someone would spring for some roller bags or backpacks or something.


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## Shishkabob (Jul 6, 2011)

Yes, everything that's in the bag is in the truck, with the exception of a single EZ-IO gun, which is in the bag.

Some medics refuse to touch the bag if they're in the truck.  I don't care.  I grab whatever is closest.


We have an O2 tank, with reg, on the cot.  I tend to leave the cot at the front door until we know if we're transporting or not, but it's company policy that the red bag and monitor goes next to every patient.


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## Chief Complaint (Jul 6, 2011)

Bue airway bag
Green trauma bag
Red drug bag

The LifePak comes in on every call, and a decision is made when we arrive on scene as to which bags need to be loaded on the cot to go into the patient's house.


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## NomadicMedic (Jul 6, 2011)

We carry all of our meds, an iv set up, bp cuff and what not in a Pelican 1550 box. Narcs and benzos are locked in the safe. We also have an airway bag with o2, intubation gear and other airway flotsam and jetsam. Monitor is standard. We have a portable suction, ez-io and pediatric bag all separate. We also have a c spine bag with collars, headbeds, straps, duct tape. I love the pelican box. It makes a handy seat.


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## DesertMedic66 (Jul 6, 2011)

One bag with everything in it including drugs. Narcs are in the medics pocket. And then the monitor has the pulse ox in a pouch.


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## shfd739 (Jul 6, 2011)

We have 4 pieces that comprises our take in scene stuff.

LP12 with a custom pouch that holds all the monitor stuff
E size portable O2 bottle
Small BLS/Trauma bag that has various bandages,BP Cuff,cold packs,sam splints,oral airways etc. 

Main ALS bag-2 front pouches have glucometer kit and shears/BP cuff/crappy stethoscope.

Side pouch 1 has hand held suction,O2 masks,cannula,nebulizer,manual IO needle,30cc syringes. 

Side pouch 2 has ET tubes and associated supplies,laryngoscope,combitube,chest decompression needles.
Main compartment has Stat Pack with all our meds, EZIO pouch with 4 needles and drugs to run an arrest,adult/pedi bvms, 1000cc and 500cc bag NS,250cc bag D5, inside lid has IV caths, Saline locks, prefill NS syringes, 4x4s, vaseline gauze, veniguards, 1cc/3cc/10cc syringes and straight needles, MAD devices.

Medic carries morphine and versed on a belt pouch and either hands it off to relief or locks it back station safe if not a continuous unit.


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## Melclin (Jul 6, 2011)

Wow you guys have some crazy strict rules about the narcs. 

So typically the stretcher is carrying your stuff in a lot of the time? We don't tend to get the stretcher until we know we're taking the pt. 

What would you change about the lay out if you could choose?


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## DesertMedic66 (Jul 6, 2011)

Melclin said:


> Wow you guys have some crazy strict rules about the narcs.
> 
> So typically the stretcher is carrying your stuff in a lot of the time? We don't tend to get the stretcher until we know we're taking the pt.
> 
> What would you change about the lay out if you could choose?



Yeah we take the gurney in on every call. The O2 bottle is connected to the gurney and the rest of the stuff is seatbelted to the gurney. 

The only thing I would change is to make our bag a little bigger so that everything isn't crammed in so tightly.


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## Shishkabob (Jul 6, 2011)

Melclin said:


> Wow you guys have some crazy strict rules about the narcs.


  DEA rules, apparently.  "Double locked", which is funny since when I was at AMR I carried morphine and valium in my pockts since we had no lock box.




> So typically the stretcher is carrying your stuff in a lot of the time? We don't tend to get the stretcher until we know we're taking the pt.
> 
> What would you change about the lay out if you could choose?




That's why I leave the stretcher at the front door.  Close enough that if needed we can get it, but far enough that it's out of the patients mind and they don't instantly think they're going to the hospital.    But officially, I leave it there because I'd rather go in and assess the patient then spend 10 minutes trying to find the best way to get the damn thing through the door.


Only thing I'd do different is make it a backpack... easier to carry when there's only two of you.  MedStar in Ft Worth uses (used?) backpacks when I rode with them.  One was airway with drugs, other was trauma.


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## MrBrown (Jul 6, 2011)

We have it amazingly simple and Brown loves it .... 

Inside the ambulance in the top lockers on the left are drawer sheets, blankets and pillow cases.  On the right (above the stretcher) are oxygen supplies, an IV kit, first aid bits and pieces, glad wrap and one or two other things minor.

In the side locker is the scoop stretcher, traction splints, KED and stair chair 

All of our supplies for going into a job are in a big green backpack and Brown means everything - IV kit, drug roll, intubation gear, bag masks, LMAs, everything.

Oxygen is in the portable cylinder and so is entonox on vehicles that still carry it 

Morphine, ketamine, suxamethonium and vecuronium are carried in a hip pouch, we do not have a safe.


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## fast65 (Jul 6, 2011)

We have ours broken down into 3 bags:
-first in bag with bandaging supplies, IV supplies, BP cuffs, CBG kit, drug box (excluding narcs and benzos), etc.
-airway kit (oxygen bottle, ETI supplies, Kings, etc.)
-C-spine bag (c-collars, spider straps)

Then of course we have our portable vent., suction unit, and Zoll. We keep our morphine, stadol and versed in the safe, and we have our succinylcholine and rocuronium in the first-in bag and we have some more on the wall.


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## MrBrown (Jul 6, 2011)

Brown should add it is rare to take the stretcher into a job (Brown has done it ONCE) on every job Brown takes the cardiac monitor, oxygen and backpack.

A lot of places our stretcher just won't fit or it's easier to carry the patient out on the scoop if they are acutely unwell or stair chair if not.


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## i5adam8 (Jul 6, 2011)

-EMS Jump bag- contains adult BVM,Intubation kit,2 IV bags with stick kits,pulse ox,BGL,assortment of b/p cuff sizes with stethoscope, NRB masks and nasal cannulas, trauma side with assortment of trauma dressing,cravats,ect. tube of oral glucose,pen light,trauma shears,and window punch. Plus the jump bag has a large circular hole in the center. Someone decided we should put our portable o2 tank in this hole so we would have less to carry. So basically this bag weighs a ton and is a real pain to carry.

-Drug box- which contains all medications that we carry including all narcotics. The drug box is stored in a double locked cabinet on the truck.

-Monitor(LP-12) with spo2 sensor,NIBP cuff,12 lead cables and patches with defib pads in side pouch.

-Portable suction unit.

Our longboards are stored on a side compartment on the truck along with c-collars,headblocks and straps.  We have a pediatric jump bag that contains peds intubation equipment along with some IV suppliies and child/pediatric b/p cuff. Along with trauma dressings.

Cric kit and EZ-IO are not in scene bags(although I think they should be). And just about all of the equipment listed above in bags are duplicated on the Ambulance.

This is not everything of course,just a quick run down.


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## katgrl2003 (Jul 6, 2011)

Our first in stuff is in 2 bags plus a Zoll monitor.

Airway/first in bag: O2 bottle, CPAP, cric kit, nebs, BVM, combitube, intubation equipment, bp cuff, steth, plus wound care including tourniquets, 4x4s, kerlix, etc.  Heaviest bag I've ever carried... thank god for firefighters!

Drug box: EZIO, glucometer, bp cuff, steth, and most drugs we carry on the ambo, except for narcs.

Narcs are kept in a lock box, which is then locked in a cabinet in the truck, only the paramedic has the keys to both.

We also have a c-collar bag and portable suction, but those rarely go on scene with us.

And the world is coming to an end, because I agree with Linuss. I would LOVE if our Airway/first in bag would be a backpack.


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## MrBrown (Jul 6, 2011)

katgrl2003 said:


> I agree with Linuss. I would LOVE if our Airway/first in bag would be a backpack.









You mean like ours?


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## shfd739 (Jul 6, 2011)

Melclin said:


> Wow you guys have some crazy strict rules about the narcs.
> 
> So typically the stretcher is carrying your stuff in a lot of the time? We don't tend to get the stretcher until we know we're taking the pt.
> 
> What would you change about the lay out if you could choose?



Yep. We tend to take the stretcher with our main bag,O2 and monitor into every call. If we find the patient looking bad we can put them on it and get out. It also keeps me from leaving the patient and my partner from fighting a heavy power cot on their own.

And ours is a backpack as well. Ill take a pic tonight if I can remember. I think our bags are custom made by a company in Canada.


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## TxParamedic (Jul 6, 2011)

One big bag with backpack straps, o2 mounted on the cot, narcs in a locked box on the rig, LP12. pretty much everything on the bag duplicated on the shelf except EZ IO, first line drugs are in the bag more of everything in a large drug box on the truck.


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## dixie_flatline (Jul 6, 2011)

I think I've stated our breakdown before, but I'll do it again since I am also fascinated by the organizational thought process (or lack thereof) that goes into distributing all this stuff.

*BLS Bag (The Red Bag, big old red duffel)*

O2 Cylinder
Airway Adjuncts (NPA/OPA)
BVMS, NCs, NRBs
Glucose, A Charcoal, Epi-Pens
Pulse Ox, steth+sphygmomanometer
Trauma gear (shears, tape, 4x4, 2x2, a trauma dressing or 2)

*ALS Bag (The Blue Bag, slightly smaller than the BLS kit)*

Basic(?) ALS drugs - not entirely sure whats in there - D50, Narcan, Zofran?
Intubation kit
Glucometer (hopefully this will soon be a true BLS skill)
IV kit
portable sharps container
possibly missing some stuff here

*Trauma Bags[x3] (Much smaller, about the size of a small cooler. one for each of the 3 LSBs we have on board)*

Adult, Peds, Infant Collars+Headblocks
Straps
Tape, some bandages and assorted other basic trauma/bleeding control supplies

*"Loose" on the unit*

EZ-IO
Glidescope
CPAP
Nebs
Portable Suction
Lifepak-12
Splints
Thermometer
Electric razor
Peds kit
"loose" surplus of almost everything in the bags - some extra collars, a spare O2 cylinder, plenty of NC/NRBs...

As to the original crux of the question, the controlled meds are in a locked drawer that only paramedics have access to and which inventory is closely monitored at all times.


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## jjesusfreak01 (Jul 6, 2011)

Wake County EMS

Blue Bag (Jump Bag)
Trauma Supplies
Tympanic Thermometer
Penlight
IO Supplies (Including Drill)
Steth and Adult BP Cuff
Triage Tags
PPE (N95s, facemasks) and Biohazard Bags
Small Drug Box (Versed, Haldol, Asthma meds, Tylenol, Toradol, Benadryl, etc)
Large Drug Box (rest of the drugs excluding narcs)
Code Bottle (epinephrine, atropine, vasopressin, don't quote me on that)
IV Kit (all necessary IV supplies)
IV Set (a start pack, 3-way, and liter of saline taped together for quick access; the only saline in the bag besides the 250ml in the IV kit)

Red Bag (Airway Bag)
D tank
OPAs
NPAs
ET Trigger tube and BAM whistle
Laryngoscopes
King Airways
ITD
BVMs
NRBs
NCs
Neb Mask

We have separate intubation kits that are kept on the truck and brought with us only if necessary, as intubation is only attempted if simple ventilation with a BVM fails and then a King airway cannot be placed successfully. We have a pediatric jump bag that contains pediatric sizes of all the airway and assessment equipment. Narcs are double locked, but our one benzo isn't unless the truck is out of service, in which case its locked in a safe at the station with the narcs.


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## CANMAN (Jul 8, 2011)

I understand Wake County to be a top notch EMS system but I am surprised that you guys aren't even attempting intubation anymore unless a King airway fails? IMO thats kinda backwards. It's already a skill that studies show a decrease in the amount of tubes you place obviously decreases the success rate, and now you guys are only using it if a King can't be placed? IMO the King Airway is the backup to ETT, and if I can't intubate or place a King and ventilate then I am looking at surgical airway as a possibility.....

With the above airway algorithm you are only decreasing the amount of attempts your providers have at ETT and with that being said I wouldn't be using that as your backup to the King Airway.


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## STXmedic (Jul 8, 2011)

CANMAN13 said:


> I understand Wake County to be a top notch EMS system but I am surprised that you guys aren't even attempting intubation anymore unless a King airway fails? IMO thats kinda backwards. It's already a skill that studies show a decrease in the amount of tubes you place obviously decreases the success rate, and now you guys are only using it if a King can't be placed? IMO the King Airway is the backup to ETT, and if I can't intubate or place a King and ventilate then I am looking at surgical airway as a possibility.....
> 
> With the above airway algorithm you are only decreasing the amount of attempts your providers have at ETT and with that being said I wouldn't be using that as your backup to the King Airway.



But there are very few scenarios that a King, if used appropriately, isn't suitable for. Kings are not "failed airway devices." They're a very effective and quick tool for managing an airway. I understand the thought of losing the skill, but there are other ways to stay proficient. Mannequins to keep technique, a procedure lab every now and then if available, etc.


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## CANMAN (Jul 8, 2011)

I agree that you can sink a King in most situations and I am also aware that the King is not just a backup airway but with that being said ETT is STILL the gold standard in airway management and if I can drop a tube without issue vs. putting a King in I am going to intubate. It shouldn't take much more time to tube then to sink a King, seconds at best.

I am sorry but I disagree with "staying proficient" with intubating harry the head a few times and dropping some tubes in a cadaver once every two years. Those should also be included in the training regiment but to say those two things along will keep you proficient is a false statement. I will continue to practice DL and intubation unless I cannot get the tube in an acceptable timeframe. 

12 Tubes a year maintains a roughly 90% success rate. If I needed to be intubated I would much rather prefer the gentleman who is intubating on a regular basis vs. the medic who drops a King instead of intubating every chance he gets but he has tubed hairy the head successfully in the last year.....


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## usalsfyre (Jul 8, 2011)

CANMAN13 said:


> 12 Tubes a year maintains a roughly 90% success rate. If I needed to be intubated I would much rather prefer the gentleman who is intubating on a regular basis vs. the medic who drops a King instead of intubating every chance he gets but he has tubed hairy the head successfully in the last year.....



We beat this subject to death on another board recently. "Intubating every chance he gets" is a crappy way of looking at it (system should serve the patient and not the other way around) but I get the sentiment. Simple answer? Restrict the number of people doing DL.


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## TransportJockey (Jul 8, 2011)

With the new guidelines on CPR, ETI is going away here on codes. Most of the time, especially if my ILS unit is first on scene for the code, I'll have a combi in place before my medic gets on scene. Minimizing gap in compressions is the name of the game now for codes.


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## Shishkabob (Jul 8, 2011)

TransportJockey said:


> With the new guidelines on CPR, ETI is going away here on codes.



Any agency who completely gets rid of ETI, be it on codes or any call, is stupid.


There are times it's called for, even on codes, and to completely disregard it due to some idiot providers does not fix the problem.


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## usalsfyre (Jul 8, 2011)

Linuss said:


> Any agency who completely gets rid of ETI, be it on codes or any call, is stupid.



I disagree. Any agency who keeps it without putting the commitment needed behind it is stupid. It's needed and important, but has the potential to do a lot mor harm than good.


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## Shishkabob (Jul 8, 2011)

usalsfyre said:


> I disagree. Any agency who keeps it without putting the commitment needed behind it is stupid. It's needed and important, but has the potential to do a lot mor harm than good.




The issues with ETI, the vast majority of the time, are due to providers not doing their job /being lazy, and not an issue with the actual act or device itself.


This rests on both the providers AND agency for allowing it to happen.


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## usalsfyre (Jul 8, 2011)

Linuss said:


> The issues with ETI, the vast majority of the time, are due to providers not doing their job /being lazy, and not an issue with the actual act or device itself.
> 
> 
> This rests on both the providers AND agency for allowing it to happen.



Yep...but there are agencies within spitting distance of both of our areas who may or may not have the commitment to do ETI right.

Based on your experiences there, did  Evil Empire, Big D division have the equipment, training and average level of "give a crap" among their medics on every unit to be doing ETI?


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## Shishkabob (Jul 8, 2011)

usalsfyre said:


> Based on your experiences there, did  Evil Empire, Big D division have the equipment, training and average level of "give a crap" among their medics on every unit to be doing ETI?



Not at all.  When I was first hired I told them my concerns about ETI due to my lack of tubes, and while they offered to send me to a local hospital with their medic school students to do the tubes, that was it.  There was no  incentive to drive out there for a few hours on my day off, no threat of job loss, or being demoted to a BLS level only until competence was proven.

They had colorimetric detectors, but no waveform capnography.  They don't allow medics to transport intubated patients just so they can bill Crit Care level, which lessens even more the amount of exposure to airway control the medics get.

They don't do any actual testing of intubation skills when hired.  They didn't do any follow up to see if people were competent with it.  The only 'rescue' device was a combi-tube, and no actual protocols on crics.




And I know of atleast 2 instances in my time there where patients died from lack of airway control.


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## ah2388 (Jul 8, 2011)

Our layout

In our first in bag, we have:

Main compartment: Adult BVM, Glucometer, Sharps container, EZIO, IV start kit, Airway Kit.

Airway Kit includes:
everything for ETI, bougie, King tubes, NPA/OPA

Side compartment:
Trauma supplies, splints, kerlex, triangular bandage

Other side:
Nasal Cannula, NRB:-(, and a neb mask with meds

Top compartment:
Surgical cric kit, quick trach, chest decompression kit, port access kit
(Vacuum sealed)


In the lid of the bag, we carry 3x Epi, 1 Atropine, 1 D50, 3x Naloxone, 1 Glucagon, and in a small container we have 1 benadry, 1 epi 1:1, syringes for both.

Then we have a locked compartment, and a locked refridgerator.

We carry MS, Fent, Valium, Versed, Etomidate, Toradol, Haldol in the locked compartment

Ativan, and RSI meds in the fridge.

We have duplicates for all of the above supplies, excluding the narcotics/locked stuff, and we have 1 quick trach.

In other bags we have:
CPAP, Vent, Ped/Broselow bag, Suction equipment.


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## NREMTroe (Jul 9, 2011)

In our narc box, we have our Narcs, and IO.

Our bag has airway/suction, intubation, iv supplies, drugs etc.. Everything is duplicated in the truck.


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## the_negro_puppy (Jul 9, 2011)

We have 3 large bags and 1 small-


Drug/primary kit- has 2 comaprtments, hold all bandages, temp, BSL, cuffs, cold packs, IV gear, syringes, and the drugs

Oxygen kit- Cylinder, regulator, masks, OPAs, suction

Monitor - Lifepak 12

AIrway kit- a small bag containing laryngoscope, LMAS, NPA, OPA, Magill forceps


Most jobs we take primary kit and monitor into. If suspected resp problems/requiring 02 then it comes in. A


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## Anjel (Jul 9, 2011)

We have for basics

Blue jump bag. Little duffel looking thing. Has dressings, bandaids, oral glucose, combitube, airway stuff. No o2 tank thats on the stretcher. 

Our medics have their jump bag which has the same thing as ours plus their airway intubation kit, etc.

Then they have a small little red bag with iv supplies. Needles tubing saline etc.

Then they have.an A-pack which has some meds like d50, commonly used stuff I think. Not to sure. Its a county pack so they dont have to bust the seal on the drug box. 

Then we have the big orange and white tackle box drug box. That has every medication in it that we have.


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