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The valve must operate in cold weather and the unit must be capable of use with an oxygen supply. The unit must be capable of delivering approximately 100 oxygen. mask. The valve must operate in cold weather and the unit must be capable of use with an oxygen supply. The unit must be capable of delivering approximately 100 oxygen. Rescue Airway Tracheal / Pharyngeal Airway Adjunct device not intended to be placed into the trachea 1 Oxygen Mask with Reservoir Adult 3 Oxygen Mask Pediatric 3 Nasal Cannula Adult 3 Oxygen Supply Tubing may be attached to BVM 1 Oropharyngeal Airways Assorted Sizes 1 Nasopharyngeal Airways Assorted Sizes 1 Oxygen Delivery System with Regulator D Cylinder or Larger 1 Oxygen Cylinder Spare D Cylinder or Larger BANDAGES / DRESSINGS Triangular Bandages Universal Dressings 10 x 30 Sterile Gauze Pads 4 x 4 Non-Sterile Bulk Gauze Pads 4 x 4 Bandages - Soft Roller 2 - 4 x 5 yards Elastic Bandages Assorted Sizes Petroleum Gauze Pads sterile individually wrapped 4 inches by 3 inches or 9 inches by 3 inches Adhesive Tape Rolls Assorted Sizes R-E-01-C Vehicle Inspection Form for First Responder Units Revised 06/01/2010 Page 1 of 3 DIAGNOSTIC EQUIPMENT Aneroid Sphygmomanometer with pediatric adult and obese size cuffs Stethoscope Glucometer or Visual Read Strips IMMOBILIZATION DEVICES Short Spinal Extrication Device KED or equivalent Long Spine Board 16 x 72 with 3 straps Lateral Cervical Immobilization Device commercially manufactured or equivalent Cervical Immobilization Collars hard type 2 adult 2 pediatric adjustable Blanket Extremity Immobilization Devices 1 Set 1 full arm and 1 full leg MISCELLANEOUS EQUIPMENT Y N PRI Waterproof Patient Cover Salvage Tarp / Rolled Plastic or Rescue Flashlight Fire Extinguisher 10 ABC or functionally equivalent Shears Clean Wrapped Sheets or Burn Sheets Non-porous Infant Insulating Device foil swaddler or equivalent Obstetrical Kit U. S. Department of Transportation Emergency Response Guidebook current edition Duct Tape Sharp s Container Defibrillation Capability Exam Gloves Assorted Sizes Splash Protection gowns EMS turnout gear etc. assorted Goggles N-95 or Particulate Mask Hospital communications capability If ALS Radio or Cell Phone Mark I Plus Kits CHECK IF PRESENT BUT NOT REQUIRED Escape Hoods SCBA or equivalent / higher CHECK IF PRESENT BUT NOT REQUIRED as defined by DHR Chapter 290-5-30 Emergency Medical Services EXTRICATION EQUIPMENT Extrication equipment is required to be on each vehicle except where the provider has written verification from the Regional EMS Program Director that this equipment is immediately available from sources within the zone. Extrication equipment that falls into that category is listed below. Spring Loaded Center Punch Rescue Ax / Halligan Tool Flathead Screwdriver 6 or 8 Hammer 3 pound Hacksaw with 2 extra blades or other equivalent cutting tool 1-ton Come-a-long or Hydraulic Rescue Tools Rescue Rated Chains or Straps - n/a when Hydraulic Tools Present Safety Goggles or helmet w/shield Priority 1 1 Critical Essential Equipment - Item must be on the unit at the time of the inspection or the unit will be taken out of service. The valve must operate in cold weather and the unit must be capable of use with an oxygen supply. The unit must be capable of delivering approximately 100 oxygen. Rescue Airway Tracheal / Pharyngeal Airway Adjunct device not intended to be placed into the trachea 1 Oxygen Mask with Reservoir Adult 3 Oxygen Mask Pediatric 3 Nasal Cannula Adult 3 Oxygen Supply Tubing may be attached to BVM 1 Oropharyngeal Airways Assorted Sizes 1 Nasopharyngeal Airways Assorted Sizes 1 Oxygen Delivery System with Regulator D Cylinder or Larger 1 Oxygen Cylinder Spare D Cylinder or Larger BANDAGES / DRESSINGS Triangular Bandages Universal Dressings 10 x 30 Sterile Gauze Pads 4 x 4 Non-Sterile Bulk Gauze Pads 4 x 4 Bandages - Soft Roller 2 - 4 x 5 yards Elastic Bandages Assorted Sizes Petroleum Gauze Pads sterile individually wrapped 4 inches by 3 inches or 9 inches by 3 inches Adhesive Tape Rolls Assorted Sizes R-E-01-C Vehicle Inspection Form for First Responder Units Revised 06/01/2010 Page 1 of 3 DIAGNOSTIC EQUIPMENT Aneroid Sphygmomanometer with pediatric adult and obese size cuffs Stethoscope Glucometer or Visual Read Strips IMMOBILIZATION DEVICES Short Spinal Extrication Device KED or equivalent Long Spine Board 16 x 72 with 3 straps Lateral Cervical Immobilization Device commercially manufactured or equivalent Cervical Immobilization Collars hard type 2 adult 2 pediatric adjustable Blanket Extremity Immobilization Devices 1 Set 1 full arm and 1 full leg MISCELLANEOUS EQUIPMENT Y N PRI Waterproof Patient Cover Salvage Tarp / Rolled Plastic or Rescue Flashlight Fire Extinguisher 10 ABC or functionally equivalent Shears Clean Wrapped Sheets or Burn Sheets Non-porous Infant Insulating Device foil swaddler or equivalent Obstetrical Kit U. S. Department of Transportation Emergency Response Guidebook current edition Duct Tape Sharp s Container Defibrillation Capability Exam Gloves Assorted Sizes Splash Protection gowns EMS turnout gear etc. assorted Goggles N-95 or Particulate Mask Hospital communications capability If ALS Radio or Cell Phone Mark I Plus Kits CHECK IF PRESENT BUT NOT REQUIRED Escape Hoods SCBA or equivalent / higher CHECK IF PRESENT BUT NOT REQUIRED as defined by DHR Chapter 290-5-30 Emergency Medical Services EXTRICATION EQUIPMENT Extrication equipment is required to be on each vehicle except where the provider has written verification from the Regional EMS Program Director that this equipment is immediately available from sources within the zone. Extrication equipment that falls into that category is listed below. Spring Loaded Center Punch Rescue Ax / Halligan Tool Flathead Screwdriver 6 or 8 Hammer 3 pound Hacksaw with 2 extra blades or other equivalent cutting tool 1-ton Come-a-long or Hydraulic Rescue Tools Rescue Rated Chains or Straps - n/a when Hydraulic Tools Present Safety Goggles or helmet w/shield Priority 1 1 Critical Essential Equipment - Item must be on the unit at the time of the inspection or the unit will be taken out of service. DHR window decal will not be applied. The only exception is EXTRICATION EQUIPMENT where the provider has written verification from the Regional EMS Program Director that this equipment is immediately available from sources within the zone or county. VEHICLE INSPECTION FORM FOR REGISTERED FIRST RESPONDER UNITS SERVICE NAME DATE VIN VID RESPIRATORY EQUIPMENT QTY COMPLIANT ITEM / DESCRIPTION Y N PRI 1 Portable Suction Aspirator Hand Operated or Battery Power 3 Irrigation Liquids 1000 ml or equivalent Bag-Valve-Resuscitator disposable with transparent adult mask. The valve must operate in cold weather and the unit must be capable of use with an oxygen supply. The unit must be capable of delivering approximately 100 oxygen. mask. The valve must operate in cold weather and the unit must be capable of use with an oxygen supply. The unit must be capable of delivering approximately 100 oxygen. Rescue Airway Tracheal / Pharyngeal Airway Adjunct device not intended to be placed into the trachea 1 Oxygen Mask with Reservoir Adult 3 Oxygen Mask Pediatric 3 Nasal Cannula Adult 3 Oxygen Supply Tubing may be attached to BVM 1 Oropharyngeal Airways Assorted Sizes 1 Nasopharyngeal Airways Assorted Sizes 1 Oxygen Delivery System with Regulator D Cylinder or Larger 1 Oxygen Cylinder Spare D Cylinder or Larger BANDAGES / DRESSINGS Triangular Bandages Universal Dressings 10 x 30 Sterile Gauze Pads 4 x 4 Non-Sterile Bulk Gauze Pads 4 x 4 Bandages - Soft Roller 2 - 4 x 5 yards Elastic Bandages Assorted Sizes Petroleum Gauze Pads sterile individually wrapped 4 inches by 3 inches or 9 inches by 3 inches Adhesive Tape Rolls Assorted Sizes R-E-01-C Vehicle Inspection Form for First Responder Units Revised 06/01/2010 Page 1 of 3 DIAGNOSTIC EQUIPMENT Aneroid Sphygmomanometer with pediatric adult and obese size cuffs Stethoscope Glucometer or Visual Read Strips IMMOBILIZATION DEVICES Short Spinal Extrication Device KED or equivalent Long Spine Board 16 x 72 with 3 straps Lateral Cervical Immobilization Device commercially manufactured or equivalent Cervical Immobilization Collars hard type 2 adult 2 pediatric adjustable Blanket Extremity Immobilization Devices 1 Set 1 full arm and 1 full leg MISCELLANEOUS EQUIPMENT Y N PRI Waterproof Patient Cover Salvage Tarp / Rolled Plastic or Rescue Flashlight Fire Extinguisher 10 ABC or functionally equivalent Shears Clean Wrapped Sheets or Burn Sheets Non-porous Infant Insulating Device foil swaddler or equivalent Obstetrical Kit U. S. Department of Transportation Emergency Response Guidebook current edition Duct Tape Sharp s Container Defibrillation Capability Exam Gloves Assorted Sizes Splash Protection gowns EMS turnout gear etc. assorted Goggles N-95 or Particulate Mask Hospital communications capability If ALS Radio or Cell Phone Mark I Plus Kits CHECK IF PRESENT BUT NOT REQUIRED Escape Hoods SCBA or equivalent / higher CHECK IF PRESENT BUT NOT REQUIRED as defined by DHR Chapter 290-5-30 Emergency Medical Services EXTRICATION EQUIPMENT Extrication equipment is required to be on each vehicle except where the provider has written verification from the Regional EMS Program Director that this equipment is immediately available from sources within the zone.