Ambulance Checkout Sheet - BLS - Ventura
| Description | Part Number | BLS Unit Minimum Amount | BLS Command Minimum Amount |
||
| A. ALL BLS AND ALS RESPONSE AND/OR TRANSPORT UNITS | |||||
| Bag valve units with appropriate masks Adult (1,000 mL) | 523 211 000 | 1 each | 1 each | ||
| Bag valve units with appropriate masks Child (500 mL) | 530 213 000 | 1 each | 1 each | ||
| Bag valve units with appropriate masks Adult Infant (240 mL) | 540 212 000 | 1 each | 1 each | ||
| Nasal cannula - Adult | 30345 | 3 | 3 | ||
| Nasopharyngeal airway - 14 French | 2021-14630 | 1 | 1 | ||
| Nasopharyngeal airway - 18 French | 2021-14640 | 1 | 1 | ||
| Nasopharyngeal
airway 20 French 22 French 24 French 26 French 28 French 32 French 34 French 36 French |
30335 | 1 each | 1 each | ||
| Continuous positive airway pressure / Bi-level Positive Airway Pressure (CPAP/BiPap) device - Child | 2430-57320 | 1 | Optional | ||
| Continuous positive airway pressure / Bi-level Positive Airway Pressure (CPAP/BiPap) device - Small Adult | 20050 | 1 | Optional | ||
| Or | |||||
| 2430-57319 | |||||
| Continuous positive airway pressure / Bi-level Positive Airway Pressure (CPAP/BiPap) device - Adult | 20051 | 1 | Optional | ||
| Or | |||||
| 20030 | |||||
| Nerve Agent Antidote DuoDote Auto-Injector |
N/A | Optional | Optional | ||
| Blood glucose determination devices | MPH4540 | 1 | Optional | ||
| Glucomter Test Strips | MPH4550 | - | |||
| Glucometer Calibration Solution | MPH4560 | - | |||
| Occlusive Dressing | 3040 | 5 | 5 | ||
| or | or | ||||
| Chest Seal | 10-0037 | 5 | 5 | ||
| Oral glucose 15gm unit dose | 20001 | 1 | 1 | ||
| Oropharyngeal Airways 40 mm (Size 00) 50 mm (Size 0) 60mm (Size 1) 70 mm (Size 2) 80 mm (Size 3) 90 mm (Size 4) 100 mm (Size 5) 110 mm (Size 6) |
Browse | 1 each size | 1 each size | ||
| Or | |||||
| 30340 | |||||
| Oxygen with appropriate adjuncts (portability required) | 36391 | 15 L/min for 20min (40min for transport units) |
15 L/min
for 20min |
||
| Portable suction equipment | 30370 | 1 | 1 | ||
| Nonrebreather oxygen masks - Adult | 30355 | 3 | 2 | ||
| Nonrebreather oxygen masks - Child | 30356 | 3 | 2 | ||
| Nonrebreather oxygen masks - Infant | 30357 | 2 | 2 | ||
| Bandage scissors | 30325 | 1 | 1 | ||
| Bandages: 4"x4" sterile compresses | 3354 | 12 | 12 | ||
| Bandages: 2",3",4" or 6" roller bandages | 3114 | 6 | 2 | ||
| Bandages: 10"x 30" or larger dressing | 3531 | 2 | 0 | ||
| Blood pressure cuff: Thigh | 30334 | 1 | 1 | ||
| Blood pressure cuff: Adult | 30330 | 1 | 1 | ||
| Blood pressure cuff: Child | 30332 | 1 | 1 | ||
| Blood pressure cuff: Infant | 30333 | 1 | 1 | ||
| Emesis Basin | 30318 | 1 | 1 | ||
| or | or | ||||
| Emesis Bag | 30319 | 1 | 1 | ||
| Flashlight | 30320 | 1 | 1 | ||
| Traction splint or equivalent device | 303425 | 1 | N/A | ||
| Pneumatic or rigid splints (capable of splinting all extremities) | Browse | 4 | N/A | ||
| Water | 2F7114 | 4 liters | N/A | ||
| or | or | ||||
| Saline Solution | 2F7124 | 4 liters | N/A | ||
| Cervical collar | 000 281 000 | 2 | N/A | ||
| Spinal immobilization backboard 60" minimum | 30305 | 1 | N/A | ||
| Backboard Straps | 303415 | 3 | N/A | ||
| Sterile obstetrical kit | 1732 | 1 | 1 | ||
| Tongue depressor | 4314 | 4 | Optional | ||
| Cold packs | 4512 | 4 | 2 | ||
| Eye Shield | 81258 | 2 | N/A | ||
| Tourniquet | 3139 | 2 | 2 | ||
| 1 mL - syringes with IM needles | 13094 | N/A | N/A | ||
| 5 mL syringes with IM needles | 6989 | N/A | N/A | ||
| 10 mL syringes with IM needles | 6990 | N/A | N/A | ||
| Automated External Defibrillator | ZOLLAED+ | 1 | 1 | ||
| Manual Defibrillator | N/A | N/A | N/A | ||
| Defibrillator pads - Adult | 16381 | 2 | 2 | ||
| Defibrillator pads - Pediatric | 16380 | 2 | 2 | ||
| Stethoscope | 30312 | 1 | 1 | ||
| Cellular telephone | N/A | 1 | 1 | ||
| CO2 monitor Infant (<0.5 mL sidestream or <1 mL mainstream adaptor) Pediatric / Adult ( 6.6 mL sidestream or < 5 mL mainstream adaptor) |
N/A | Optional | Optional | ||
| CO2 Monitor Adult size EtCO2 sampling nasal cannula Pediatric size EtCO2 sampling nasal cannula |
N/A | Optional | Optional | ||
| Pediatric length and weight tape | 50021 | 1 | 1 | ||
| Intranasal mucosal atomization device | MAD300 | Optional | Optional | ||
| SpO2 Monitor (If not attached to cardiac monitor) | N/A | 1 | 1 | ||
| SpO2 Adhesive Sensor (Adult, Pediatric, Infant) | Browse | Optional | Optional | ||
| Thermometer | 5610 | 1 | Optional | ||
| Thermometer Sheaths | 5614 | 1 | Optional | ||
| or Disposable Thermometer | 5122NS | ||||
| Rescue Helmet | 64051012 | 2 | N/A | ||
| EMS Jacket | RAD64056018 | 2 | N/A | ||
| Goggles | HONS3960HS | 2 | N/A | ||
| Tyvek Suit | DPPTY127SWH2X00 | 2 L / 2XXL | N/A | ||
| Tychem Hooded Suit | DPPQC122BYL2X00 | 2 L / 2XXL | N/A | ||
| Nitrile Gloves | Browse | ||||
| Disposable Footwear Covers | 18005 | 1 | N/A | ||
| Leather Work Gloves | 10975 | 1 | N/A | ||
| OPTIONAL EQUIPMENT (No minimums apply) | |||||
| Hemostatic gauze per EMSA guidelines | 1214-47548 | Optional | Optional | ||
| B. TRANSPORT UNIT REQUIREMENTS | |||||
| Ambulance gurney | N/A | 1 | N/A | ||
| Collapsible stretcher or flat | 30350 | 1 | N/A | ||
| KED or equivalent (One required for transport units) | 13142 | 1 | N/A | ||
| Straps to secure the patient to the stretcher or ambulance cot and means of securing the stretcher or ambulance cot in the vehicle. | 303417 | 1 set | N/A | ||
| Powered portable suction unit | 88005102 | 1 | N/A | ||
| Soft ankle and wrist restraints. | 501110 | 1 set of each | N/A | ||
| Sheets | 30300 | 1 | N/A | ||
| Pillow Cases | 30301 | 1 | N/A | ||
| Blankets | 30310 | 1 | N/A | ||
| Towels | N/A | 1 | N/A | ||
| Pillows | 30309 | 1 | N/A | ||
| Bedpan | 30317 | 1 | N/A | ||
| Urinal | 30316 | 1 | N/A | ||