Provider/Vehicle ID: Date: VIN: Inspected by: SAINT FRANCIS EMS SYSTEM Alternate Response Vehicles DRUG, SUPPLY, AND INVENTORY LIST 2014 Version ALL EXCHANGE ITEMS MUST BE IMMEDIATELY AVAILABLE TO ALL PRE-HOSPITAL EMERGENCY CARE PERSONNEL SO AS NOT TO DELAY THEIR RETURN TO SERVICE. It is the responsibility of all Associate and Participating Hospitals to replace all drugs, supplies and exchange equipment items. Exceptions are those items marked with an asterisk (*). Equipment left with a patient at the hospital shall be cleaned by the hospital before returning it to the provider. Any exchanges must have approval of the Resource Hospital. This list represents the minimum to be carried. Updated May 2014 Supersedes April 2013
The Resource Hospital recognizes that individual responding agencies have different deployment and staffing objectives. The establishment of ambulance assistance vehicles is strictly voluntary. However, when one is established, it shall adhere to Definitions as referenced in EMS Rules Subpart F; Section 515.825 Alternate Response Vehicle (December 15, 2000). I. A. Ambulance assistance vehicles are dispatched simultaneously with an ambulance and assist with patient care prior to the arrival of the ambulance. These assistance vehicles include fire engines, trucks, squad cars or chief s cars that contain and staff equipment required by the EMS rules. These vehicles shall not function as assist vehicles if staff and equipment required by the Rules are not available. These vehicles shall be identified by the agency as a program amendment outlining the type and level of response that is planned. The vehicle shall not be a primary response vehicle but a supplementary vehicle to support EMS services. The vehicle shall be classified as either: 1. Advanced ambulance assistance vehicle these vehicles shall be staffed with a minimum of one EMT-P and shall have all of the required equipment; or 2. Intermediate ambulance assistance vehicle these vehicles shall be staffed with a minimum of one EMT-I and shall have all of the required equipment; or 3. Basic ambulance assistance vehicle these vehicles shall be staffed with a minimum of one EMT- B and shall have all of the required equipment; or 4. First Responder assistance vehicle these vehicles shall be staffed with a minimum of one First Responder and shall have all of the required equipment. B. Non-transport vehicles: Non-transport vehicles are dispatched prior to dispatch of a transporting ambulance. These vehicles include ambulances and fire engines that contain the staff and equipment required by the EMS Rules. These vehicles shall be identified by the agency as a program plan amendment outlining the type and level of the response that is planned. These vehicles shall be staffed 24 hours a day, every day of the year. Updated December 2014
OXYGEN & AIRWAY EQUIPMENT 1 Pocket mask or Microshield 1 ea Nasal cannulas Adult and Pediatric 1 Adult non-rebreather mask 1 Pediatric non-rebreather mask 1 Infant mask 1 ea Aerosol masks Adult and Pediatric 1 ea Oropharyngeal airway Size 110 mm, 100 mm, 90 mm, 80mm, 70 mm, 60 mm, 50mm, 40mm 1 ea Nasopharyngeal airway Sizes 12-30 Fr 1* Portable suction unit (IDPH approved - manual or electric) 1 Semi-rigid Catheter (yankauer) 1 Suction Canister 1 Suction connector tubing 1* Oxygen cylinders D or E size (each with regulator) 1* Oxygen Tank wrench 1 each Disposable Bag-Valve-Mask (BVM) device, clear type mask (Adult, Child, Infant) ALS / ILS Designation additional required equipment 1 Cricothyrotomy Kit Containing: 2 14 gauge catheter or larger-over-the-needle-device 1 3.5 Endotracheal tube connector 1 3.0 Endotracheal tube connector 1 3cc syringe 1 Needle Pleural Decompression Kit: 2 14 gauge 2 needles 2 10cc syringes 1* Adult laryngoscope handle 1* Pediatric laryngoscope handle 2* Spare batteries for laryngoscope handles (alkaline type) 1* #0 Straight laryngoscope blade 1* #1 Straight or curved laryngoscope blade 1* #2 Straight or curved laryngoscope blade 1* #3 Straight or curved laryngoscope blade 1* #4 Straight or curved laryngoscope blade 2* Spare laryngoscope blade bulbs (one for each blade) 1ea Sterile Endotracheal tube 2.5 to 8.5 mm 1 ea Endotracheal tube stylette Adult and Pediatric
1 6-8 Fr Suction catheter 1 10-12 Fr Suction catheter 1 14-18 Fr Suction catheter 1* Adult Magill forceps 1* Pediatric Magil forceps 1 End-tidal CO2 detector (one adult, one pediatric) or capnography 1 Meconium aspirator Nebulizer (acorn type) with "T" adaptor, oxygen tubing, mouthpiece and 1 flextube 1 Nebulizer adaptor kit for BVM/ET (preassembled in labeled bag) 1 FlowSafe II CPAP DIAGNOSTIC EQUIPMENT 1* Stethoscope (diaphragm type) 1* each Blood pressure cuff Adult, Child, Infant, 1* Penlight 1* Flashlight with batteries Automatic External Defibrillator (AED) - optional if vehicle has ALS / ILS designation and equipped accordingly 1* 2* each AED defibriallator pads - adult and pediatric ALS / ILS Designation additional required equipment 1* AED with Paramedic Override or Cardiac monitor/defibrillator (Optional: NIBP, SpO2, ETCO2, Pacing and 12-lead capabilities) 2 ea Defibrillator pads Adult and Pediatric (or paddles) 1* Patient electrode cable (3 or 4-lead type) 1* Roll or pad of ECG paper 8 Monitoring electrodes Adult 4 Monitoring electrodes Pediatric 1 Tube of conduction jelly or defibrillation gel pads (if paddles are used) 1* Pulse Oximeter with adult and pediatric monitoring capability 1 Bottle Glucose test strips or Equivalent RADIO EQUIPMENT 1 Capability to communicate with the hospital
DRESSINGS and Tourniquets 2 Kling or self-adhering soft roller gauze (minimum of 4 ) 6 Sterile 4x4 gauze pads 4 ABD dressings 1 Trauma dressing, 10x30 minimum required 2 Vaseline gauze dressings, 3x8 minimum required 2 Rolls adhesive tape, 1 minimum 1 Sterile Burn sheet 10 Band Aid type dressings - 1" width 2 Combat Applied Tourniquet (CAT) ADMINISTRATION SUPPLIES 1 250 ml.9 Normal Saline IV 1 1000 ml.9 Normal Saline IV ALS / ILS Designation additional required equipment 1 Mini-drip needleless IV tubing (60 gtts/cc) 1 Regular drip needleless IV tubing (10 gtts/cc) 2 ea IV Catheter 24 g, 22 g, 20 g, 18 g, 16 g, 14 gauge 1 ea Needles 25 g, 20 g, 18 gauge 2 ea Syringes 1cc, 3-6cc, 10-12cc, 20cc, 60cc (luer lock not irrigation tip) 4 ea Mucosal Atomization Device 1 Padded armboard short 1 Tourniquet 10 Alcohol preps 1 Male luer lock adapter 1 Tubex holder 1 EZ IO Drill 1 ea EZ IO Needles Adult, Bariatric & Pediatric PATIENT CONVEYANCE DEVICES 1 Body bag or shroud pack
IMMOBILIZATION EQUIPMENT 1* Full back board radiolucent 1 set* Straps for full back boards 2 Adult adjustable cervical collars 1 ea Cervical collar Pediatric and Infant 1 set Head/Cervical spine immobilization device/blocks 2 ea* Extremity splints Upper and Lower extremities 1 Triangular bandage or adjustable sling MISCELLANEOUS 1 Box of non-porous disposable gloves 1 Box on non-porous disposable latex free gloves 1 per responding crew member Disposable paper masks with eye shields, or paper mask used in conjunction with splash protective eyewear, and gown 1 Needle syringe disposal container, puncture resistant (OSHA approved) 2 Impermeable RED biohazard labeled isolation bags (10 gallon size minimum) 1 Disposable sterile OB kits 1 Silver swaddler with head cover 1* Broselow tape or equivalent pediatric dosing chart 2 Cold packs 1 Blanket 1* Trauma shears 1* Multi-use trauma box/bag 1* Multi-use drug box/bag 1* Quick response airway bag 1* Protected copy of standard operating procedures and policy and procedure manual 5 SFH EMS System Patients Care Reports (PCRs) 5 SFH EMS Prehospital Provider Communicable Disease report forms 5 SFH EMS Multiple Patient Release report forms
ALS / ILS Designation MEDICATIONS - Drug & Preparation 3 Adenosine (Adenocard) 6 mg/2 ml vial 1 Albuterol 2.5 mg/3 ml 1 Ipratropium Bromide (Atrovent) 0.5mg/2.5ml 2 Amiodarone (Cordorone) 150 mg/3 ml amp 8 tablets Aspirin baby chewable 81 mg/tablet 4 Atropine 1 mg/10 ml preload syringe 2 Dextrose 50% 50 ml preload syringe 1 Dextrose 25% 10 ml preload syringe 2 Diazepam (Valium) 10 mg/2 ml preload syringe 1 D5W 100 ml bag 1 Diphendramine (Benadryl) 50 mg/1 ml preload syringe 1 Dopamine (Intropin) 400 mg/ 250 ml D5W premix IV bag 4 Epinephrine 1:10,000 1 mg/10 ml preload syringe 3 Epinephrine 1:1,000 1 mg/1 ml ampule 1 Etomidate 20mg 2 Fentanyl 100mcg 2 Furosemide (Lasix) 40 mg/ 4 ml preload syringe 1 Glucagon 1 mg powder/1 ml diluent 2 Lidocaine (Xylocaine) 100 mg/5 ml preload syringe 2 Midazolam (Versed) 10 mg/10 ml vial (or 20 mg equivalent) 2 Morphine Sulfate 10 mg/2 ml preload syringe 2 Naloxone (Narcan) 2 mg/2 ml preload syringe 1 bottle Nitroglycerine tabs 0.4 mg (1/150 gr) for sublingual usage 6 0.9 Normal Saline 10 ml for injection 1 Oral Glucose Gel 1 Ondansetron Hydrochloride (Zofran) 4mg vial 1 Ondanestron Hydrochloride (Zofran) 4mg ODT