Vehicle Checkout/Inventory Sheet

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redcrossemt

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Does anyone have a checkout or inventory sheet they'd be willing to share with me?

I am revamping our service's checkout sheet and don't necessarily need to reinvent the wheel, but am looking for good ideas.

You can post here or PM for my email. Thanks in advance!
 
I don't know if MI has something like this but...

in NM we had a list of what was reqiured on an ambulance by the NMPRC. I'd find out if there's a division that has a list of reqiurements and start from there
 
jtpaintball70 said:
I don't know if MI has something like this but...

in NM we had a list of what was reqiured on an ambulance by the NMPRC. I'd find out if there's a division that has a list of reqiurements and start from there
Click to expand...

Yeah, we have requirements set by the Department of Community Health (MDCH) and I have a copy of those.

However, moreso looking at different form layouts and the like.
 
Here ya go. Sorry, PDF doesn' translate well when copy/pasted.

Inventory Item Required In-Service Minimum

Miscellaneous
DOT Guide book 1
Emergency warning device (warning triangles, etc.) 1 set
Fire extinguisher 1
Flashlight 1
Hand Cleaner 1 bottle
Hydrogen Peroxide 1 bottle
Rubbing Alcohol 1 bottle
Cold packs 3
Hot packs 3
Infection control kits w/gowns 3
No smoking signs 1
Protective gloves (various sizes) 1 box
Protective goggles/glasses 2 pair
Protocols 1 set
Respiratory protection S/M/L 2 each
Two-way radio 1
Ring cutter 1
Waste Disposal Equipment
Biohazard waste bags 1
Sharps container 1

Airway Equipment
Adult BVM w/tubing 2
Child BVM w/tubing 1
Infant BVM w/tubing 1
Airway adjuncts oropharyngeal 2 sets
Airway adjuncts nasopharyngeal 2 sets
Nasal cannula 5
Non-rebreather, Adult 5
Non-rebreather, Pedi 5
Non-rebreather, Infant 4
Capnography side stream sampler (if available) 2
Oxygen humidifier 2
Oxygen driven nebulizers 4

Suctioning Equipment
Portable suction (i.e. V-Vac) 1
Ridged suction tip 2
Soft suction catheters 2
Suction tubing 2
Dallas (March 2010) Page 193 of 196
Vehicle mounted unit with power cord 1
Gastric Tube 10,12,14,16,18 1 each

Splinting & Bandaging Supplies
Adhesive tape 2
Adhesive Bandages 12
Scoop stretcher 1
Backboard, long 2
Bandage scissors 2
Abd Pads 5X9 6
Burn sheet 4
Extremity splints (various sizes) 2 each
Multi-Trauma dressing 2
Meconium Aspiration 1
Foil Baby Blunting 2
Obstetric kit 2
Occlusive dressing 6
Head Blocks 4
Ridged cervical collar, (various sizes) 4 sets
KED 1
Soft roller bandages (Kerlix) 12
Unsterile gauze pads 20
Sterile gauze pads 60
Sterile water 1000mL
Straps 6
Traction splint 1
Triangle bandages 12
Pair soft restraints 1

Patient Care Equipment
Blankets (seasonal) 1
Glucometer 1
Penlight 1
Sheets 6
Sphygmomanometer 1
B/P Cuff Infant, Child, Adult, and XL 1 each
Stethoscope 1
Stretcher w/straps 1
Thermometer w/sheaths 1

ALS Equipment
IO Access needle or kit As Applicable
LP 12, Zoll M series or LP 11, LP 10 and AED with spare batteries 1
Combo pads for LP 12 and Zoll M series or pacer pads for LP 11, LP 10 with AED 1 set
Conductive Jelly 1
Dallas (March 2010) Page 194 of 196
Electrodes set Adult/Pedi 2 set each
Combitube/King Airway 1 each
ET tubes, 2.5-9.0 2 each
Buretrol set 1
IV administration Set, 10 & 60 gtts/mL 6 each
IV catheters, 14,16,18,20,22,24,ga 8
IV solution, 0.9% normal saline 100mL 2
IV solution, 0.9% normal saline 500mL 5
IV solution, 0.9% normal saline 1000mL 6
Tourniquets 6
Tegaderm / VeniGuard 6
Nail polish remover 10
Iodine prep pads 10
Alcohol prep pads 20
Laryngoscope Kit (handle, McIntosh blades, Miller blades 1
End-Tidal CO2 Detectors 2
Becker Airway Airflow Monitor (BAAM) 2
3 way stop cocks 2
Mucosal Atomizer Delivery Device 2
Carpujet 1
CPAP As Applicable

MICU Equipment
Scalpel 1
Needle decompression kit 2
Needles, 18,20,22,25 ga 5
Stylette, Pedi & adult 1
Syringes 1,3,10,30 cc 4 each
Tube check (i.e. EDD) 1
Tube securing device 2

Medications
Adenosine (12 mg/4 mL) 24 mg
Albuterol (2.5 mg/3mL) 7.5 mg
Amiodorone (150 mg/3mL) 450 mg
ASA (81 mg tablets) 1 bottle
Atropine (1mg/10mL) 6 mg
Calcium chloride (1g/10mL) 1 g
Dextrose 50% (25g/50mL) 50 g
Diazepam (10mg/2mL) 20 mg
Diphenhydramine (50 mg/mL) 100 mg
Dopamine (400 mg/5mL) 800 mg
Epinephrine 1:1000 (1 mg/mL) 4 mg
Epinephrine 1:10,000 (1 mg/10mL) 6 mg
Dallas (March 2010) Page 195 of 196
Epi-pen, Adult As Applicable
Epi-pen, Child As Applicable
Furosemide (10 mg/mL) 120 mg
Glucagon (1 mg/mL) 2 mg
Haloperidol (5 mg/1mL) 10 mg
Ipratropium Bromide (.5 mg/2.5mL) 1.5 mg
Labetalol (5 mg/mL) 100 mg
Lidocaine (1 gm/250 mL) 2 gm
Lidocaine 2% (20 mg/1 mL) 10 mL
Magnesium Sulfate (5 g /10 mL) 5 g
Methylprednisolone (125 mg) 250 mg
Morphine Sulfate (10 mg/mL) 20 mg
Naloxone (2mg/2mL) 8 mg
Nitroglycerine (0.04 mg) 400 mcg
Oral Glucose paste (15 g) 30 g
Sodium Bicarbonate (50 mEq/50mL) 300 mEq
Thiamine (100 mg/mL) 200 mg
Zofran (4 mg/mL) 8 mg
Oxygen, “D” cylinder w/regulator 2
Oxygen, “M” cylinder/regulator 1
Click to expand...
 
redcrossemt said:
Does anyone have a checkout or inventory sheet they'd be willing to share with me?

I am revamping our service's checkout sheet and don't necessarily need to reinvent the wheel, but am looking for good ideas.

You can post here or PM for my email. Thanks in advance!
Click to expand...

my agency uses the checklist in a PDF format.. we open the original file.. use the stylus on our toughbook to mark the checklist and enter our crew names and such.. then we save it with the date the checklist was done.. then we upload it to our dept intranet. all electronic.. very simple..and very paperless B)

If you want I will gladly email you the PDF of our ALS & BLS checklists, and even our pediatric bag checklist if you wish. PM me with your email
 
I copied and pasted from our stocking list so sorry if it doesn't look exactly like it does on paper.

Airway/Breathing Equipment (BLS/ALS)
l-Each OralAirways sizes 5.5, 6,7,8, 10, 11, 12
l-2-EachNasal Airways sizes 28 Fr, 30 Fr, 32 Fr
l-Each Adult, Pedi, Infant Bag Valve Mask
4-Endotrachel Tubes (ET Tubes) size 2.5
Intubation roll
l-Each ET Tubes sizes 3, 3.5, 4, 4.5, 5, 5.5
2-Each ET Tubes sizes 6, 7, 8
1-Each Adult/pedi ET Tube Inducer/bougie
2-Each Adult and Pediatric ET Tube Restraint
1 -Laryngoscope Handle w/spare batteries
1-Each Miller Blades sizes 0, l, 2, 3, 4
1 -Each Macintosh Blades sizes 7, 2, 3, 4
1-Each Magill Forceps sizes small and large
1-Needle/Surgical Cricothyrotomy Kit (see list)
1-Each King LT sizes2,3,4,5
1 -lmpedance Threshold Device (ITD)
1- BAAM device
2-Decompression 3 inch needle
2-Infant Oxygen Masks
2-Pediatric Non-rebreathers
4-6-Nasal Cannulas (c/ or c/oETCO2)
2-Adult Non-rebreathers
1-Oxygen K Tank with wall mount regulator
2-Oxygen D Tanks with 2 portable regulators
1-Each Oxygen K & D Tank Wrench
l-CPAP Kit + l0cm peep valve
Suction Equipment
l-Each Portable & Mounted Suction Unit
1-Each Flexible Suction Catheters 6Fr, 8Fr, 14Fr
I -Rigid Suction Catheters
l-Suction Canisters with lids and elbow adaptors
l-Suction Tubing
1-Meconium Aspirator
1-Each NG tube sizes: 8, 10,12,14,16, and 18
1-Toomy 60cc syringe
Bandaging/Splinting Equipment
10-20 each of Sterile and Non-Sterile 4x4's
2-Sterile Trauma Dressings
2-Sterile Burn Sheets
1-Ace Wrap
l-Kendrick Traction Device (KTD)
l -2-Short Board Splints
I -2-Medium Board Splints
l-SAM splints
2-Long Back boards
2-Cervical lmmobilization Blocks (CID)
2-Adjustable Adult Cervical Collars
2-Pediatric Cervical Collars
1 -2-lnfant Cervical Collars
4-Backboard Straps
1-Each Pelvic Binder sizes sm, lg
ooSpecial Patient Needso' Equipment
2-Posey Limb Restraints
I -Pediatric Immobil izer
Monitoring Equipment (BLS/ALS)
1 - 1 2 Lead Monitor/Defibrilator
1-Packs Adult / Pedi EKG Electrodes
2-Adult Defibrillation Pads
1 -Pediatric Defibrillation Pad
1-benzoin spray can
1-Razors
1-Rolls Monitor Paper
2-Monitor Batteries
l-LP12 Load Tester
1-ETCO2Inline Cannula
I -ETCO2 Capno Filter line set
l-ETCO2 Adaptor
l-Each Adult & Pedi disposable SpO2
l-Stethoscope
I -Each Adult (lg & reg.), Pediatric, Infant BP
Cuffs
I container Glucose Check Strips
5-Lancets
5-Bandaids
Medications
I -Acetaminophen 80mg/2.5m1
3-Adensosine 12mgl4ml
1-2 each-Adult/Pediatric Combo Neb Kits (see
item list)
Paul R. Hinchey,
Medical Director
4-6-Albutero I 2. 5mgl 3ml
l-Albuterol MDI*Special Operations Only
2-Amiodarone 1 50 mg/3ml
1-Aspirin bottles 81mg tabs
4-Atropine Sulfate 1mg/l0m1
1-Atropine Sulfate 8mg/20m1
1 -Benzocaine 20o/o 2oz spray bottle
1 -Calcium Gluconate 4.65mEQ/ I Oml
1 Cyanide KitxHazmat only
o Amyl Nitrite*Hazmat only
. Sodium nitrite xHazmat only
r Sodium Thiosulfate xHazmat only
2-D50 25gl50m1
2-4-Diazepam l0my'2m1
2-Diphenhydramine 25mg caps
2-Diphenhydramine 5 0mg/ I m I
2-Dopamine 200mg/5ml
2-Epinephrine 1 : 1,000 1mg/lml
8-Epinephrine 1 : I 0,000 1mg/l Oml
4-8-Fentanyl Citrate 100 mcg/2 ml
2-Furosemide 40mg/4ml
2-Glucagon lmg
2-Ipratroprium Bromide 0.5mg/2. 5ml
2-Lidocaine 2o/o I 00mgl 5m1
2-Lidocaine 4mglml 25Occ premix bags
4-Magnesium Su lfate 1 gml2ml
2-Methylprednisolone 125mgl 2m1
2-4-Midazolam 5mg/lml
2-Naloxone 4mgl10m1
l-Neo-Synephrine 0.5% 3ml (COG: A-A-3)
1 -N itro-Bid 2oh 3 0 gm ointment w/paper
I -Nitroglycerin bottles 0.4mg tabs
I -Ondansetron 4mgl I Oml
2-Oral glucose 15gm
2-Pr oparacaine hydrochloride * Hazmat on ly
3-Pralidoxime 600mg/2ml (WMD Kit)
I -Py'idoxine I 00mg/ml*H azmat only
I -3-Sodium Bicarbonate 8.4o/o 50ml
I -Terbutaline 1 mg/ml * Special Operations Only
2- Vecuronium Bromide 1Omg
1-Xylocaine gel (COG A-A-3)
IV Equipment
3-5-0.9o/o NaCL l0 ml
l0-Alcohol preps
2-BD Twin Packs
2-Each Comector Loops & Reflux Valves
2-Dial-a-flows
2-lY arm boards
2-Leverlock Cannula
4-Microdrip 60 gtt/ml
4-Macrodrip 10 gtt/ml
4-NAC1 1000cc
2-NAC125Occ
1-NACL 5Occ
2-Needles each size: l9g,2lg,22g
2-EachSize2" IV catheters 14g, l69, 18g
2-Each Size IV catheters 229,24g
2-Each Size 1 x 1/q" IY catheters l4g, I 69, 1 8g,20g
2-Syringes l2cc
2-Syringes lcc
l-Syringes 35cc
2-Each 3cc Syringes & BD 3cc Syringes
5-Tegaderms
4-Tourniquets
5-Veni-gards
l-VidaCare EZ IO system wl lea
adu ltlpedi/bariatric needle
1-Manual IO needle
1-Pressure Infusion Bag
Additional Required Equipment
1-Signed Clinical Operating Guideline (COG)
3 -Refl ective Warning Triangl es
2-Safety Glasses
4-Particulate respirator masks
4-Fluid shield mask
2-Splash protection gowns
2-Pairs Shoe covers
4-Biohazard (red) Waste Bags
l-Box Ea Sm, Med, Lg, XLg Non-Sterile Gloves
5 -Hand-cleans ing towelettes
I -Sharps container
2-Sharp shuttles
1- Stretcher
1-Fire extinguisher
2-No Smoking Signs (cab and patient area)
M iscellaneous Equipment
6-Acetone nail polish remover pads
1-Airway Combination bag (see item list)
5-Ammonia lnhalants
1-Bite Stick
1-Cervical Collar Bag
Current Vehicle Inspection Sticker
2-Thermometers (can be glass, digital or
temporal)
5-Digital Thermometer Protective Sheaths
1-Drug Box or CPR bag
4-Emesis Containers
6-Fitted Sheets
1-Flashlight
6-Flat sheets
1-Mucosal Atomization Device (MAD)
1-OB Container (see list of items)
2-Paper bags
1-Pedi Airway bag (see list of items)
1-Pediatric Car Seat
l-Pillow
2-6 Cold packs
1-2 Heat packs
1-Port-a-warmer
I Scoop stretcher
1-Stair Chair
3-Surgilube
2-Trash Bags
1-Misc Rehab Supplies (drink powder, towels,
stirsticks)
l-Trash Can
I -Trauma bag (see list of items)
I -2-Wool blanket
Paperwork & Resource Material
1- EPCR tablet*
1O-Advanced Care Supplement Forms
1-Emergency Response Guide Book (ERG)
1 -"Jane's Chem-Bio" Handbook
10-Multi Patient Refusals
l0-Each PCR's, Billing Forms, & HIPPA Forms
I 0-Family Violence Forms
Specialty Equipment
2-Ballistic Vests
1-Bolt Cutter
2- Sets Bunker Gear
6-Disposable Towels
7-Hazmat kit (see item list)
1-Hooligan Tool
1-Mega Mover*
2-Nerve Agent Antidote Kits (1/medic)
2-Personal Floatation Devices (PFD)
l-Pin-in Pack (see list of items)
l-Radiation Dosimeter DMC 2000S pager*
2-4-Reflective Vests
1-Ring Cutter-in trauma bag
1-Sealed WMD Kit (see item list)
2-Throw bags
2-Triage Fanny Packs
2-Water Rescue Helmets
Communication Equipment:
1-AWACS Pager
1-Cell Phone
2-Portable 800 Mhz radios
NOTE: Some units will carry additional
equipment not listed i.e. Special Ops or
research. Refer to updated advisories.
. * These items are gradually being
distributed to each field unit as supplies
allow
 
Last edited by a moderator:
JPINFV said:
Airborne Warning And Control System pager?
Click to expand...

I assume this is a pager set to the civil defense system (or now the Emergency Alert System EAS) frequency to get weather and other updates...?
 
Thank you all for your help, but what I'm looking for is more form ideas and not so much of a list. We have a list of equipment that should be on our trucks, but wondering if you all use just a straight checklist, or diagrams per cabinet, or a list organized by cabinet...? Posting or emailing forms is the best, but ideas posted here are good too.
 
I think it's good to have a sheet that people can refer to, but once I had learned what we were supposed to have I would check out the rig from memory. If you are just going off a sheet you are less likely to memorize what you should have and where it is supposed to be. And people will make sure they have the big stuff, and if you have 5 bags of LS rather than 7 it doesn't really matter.

It might not work for some people, but I would have gone crazy if I had to do a full inventory sheet every morning.
 
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