Portable Equipment Check Sheet

Date*
MM slash DD slash YYYY
Unit #*
Shift*
Crew*
** + Should be used with a number to indicate quanities needed (EX: + 3) / - Should be used with a number to indicate overstock that YOU HAVE REMOVED (EX: -3) **
BLS BAG
Main Compartment | Reg. (+/-)
Adult NRB | 2*
Adult NC | 2*
Adult Nebulizer | 1*
Pedi NRB | 1*
Trauma Shears | 1*
Penlight | 1*
Sterile 4x4 | 8*
Non Sterile 4x4 | 1 bg.*
Kerlix | 4*
Hydrogent Peroxide | 1
Sterile H20 | 1
Cold Pack | 1
Coban Bandage or Roller Guaze | 1
Triangular Bandage | 2*
Tape 1" | 1*
Tape 2" | 1*
ASA (81mg) Chewable | 1 btl*
Albuterol 2.5mg | 2*
Oral Glucose | 2*
Narcan | 1 mg*
Atomizer | 1*
Anaphylaxis Kit | 1*
Left or Side Compartment | Reg. (+/-)
Stethoscope | 1*
Adult BP Cuff | 1*
Front or Rear Compartment | Reg. (+/-)
Pulse Oximeter #*
Pulse Oximeter | 1*
Glucometer #*
Glucometer | 1*
Glucometer Strips | 10*
Lancets | 10*
Band-Aid's | 10*
Anaphylaxis Kit | Reg. (+/-)
Epinephrine 1:1000 (1cc) | 2*
Filter Needle | 1*
1 ml Syringe w/ needle | 1*
Alcohol Prep Pads | 10*
AED | Reg. (+/-)
Adult Defib Pads | 2*
Pedi Defib Pads | 2*
Razor | 2*
Paralytic Kit (optional) | Reg. (+/-)
Vecuronium Bromide (10mg) | 1*
10cc Syringe | 2*
18ga or Blunt Tip Needle | 2*
10cc Sterile H20 (reconstitution) | 2*
Bougie Airway Device | 1*
King Airway Set (Size 3,4, & 5) | 1 ea*
SALT Airway | 1*
Cardiac Monitor | Reg. (+/-)
Electrodes | 1 pk*
Spare Paper | 1*
Spare Battery | 1*
Razors | 2*
Adult Defib Pads | 2*
Pedi Defib Pads | 1*
Quick Combo Cable | 1*
SpO2 Probe & Cable (if capable) | 1*
ETCO2 Cannula (if capable) | 1
ECTO2 for BVM/ETT (if capable) | 2*
ALS BAG
Front Compartment | Reg. (+/-)
Adult NRB | 2*
Adult NC | 2*
Adult Nebulizer | 1*
Pedi NRB | 1*
Trauma Shears | 1*
Penlight | 1*
Sterile 4x4 | 8*
Non Sterile 4x4 | 1 bg*
Kerlix | 4*
Tape 1" | 1*
Tape 2" | 1*
Left Compartment | Reg. (+/-)
Stethoscpe | 1*
Adult BP Cuff | 1*
Right Compartment | Reg. (+/-)
Pulse Oximeter #*
Pulse Oximeter | 1*
Glucometer #*
Glucometer | 1*
Glucometer Strips | 10*
Lancets | 10*
Band-Aid's | 10*
Small Sharps Container | 1*
Lid / Rear Compartment | Reg. (+/-)
10 gtts/set | 2*
Extension Set (locks) | 4*
Saline Flush | 4*
Yankhauer Tip | 1*
8,10, 12, or 14 Fr. Suction Cath | 1
Main Compartment | Reg. (+/-)
IV Kit | 1*
Intubation Kit | 1*
Multi Trauma Dressing | 1*
Burn Sheet | 1*
Dextrose (10 or 50%) 25g | 1*
Normal Saline (500cc Total) | 1
IV Kit | Reg. (+/-)
14ga & 16ga IV Caths | 2 ea*
18ga & 20ga IV Caths | 6 ea*
22ga & 24ga IV Caths | 4 ea*
Saline Flush | 6*
10 ml Syringe | 2*
3 or 5 ml Syringe | 2*
1 ml Syringe w/ needle | 1*
18 or 20 ga needle | 4*
22, 23, or 25 ga needle | 2*
Filter needle for ampules | 2*
Atomizer | 2*
1" Tape | 1*
IV Tourniquets | 4*
Alcohol Prep Pads | 20*
Tagaderms | 6*
Albuterol | 4*
Ipratropium Bromide | 4*
Oral Glucose | 30g*
Oral Glucose | 30g*
ASA (81 mg) Chewable | 1 btl*
Narcan | 1 mg*
Epinephrine 1:1000 (1cc) | 2*
Diphenhydramine | 50 mg*
Ondansetron (Zofran) | 8 mg*
Intubation Kit | Reg. (+/-)
Laryngoscope Handle (Adult & Pedi) | 1 ea*
Mac Blades 1-4 | 1 ea*
Miller Blades 1-4 | 1 ea*
Spare "C" Batteries | 2*
Bite Stick | 1*
Adult & Pedi Magill Forceps | 1 ea*
Adult & Pedi Stylette | 1 ea*
Lubricating Jelly | 4*
OPA set 1-6 | 1*
Adult & Pedi ETT Holder | 1 ea*
1" Tape | 1*
10 ml Syringe | 2*
ET Tubes 2.5-6.0 | 1 ea*
Vent Bag Green (Auto Vent)
Front Compartment | Reg. (+/-)
Adult BVM | 2*
Child BVM | 1*
Left Compartment | Reg. (+/-)
Stethoscope | 1*
Rear Compartment | Reg. (+/-)
Vent Circuits | 4*
Lid Compartment | Reg. (+/-)
O2 Wrench | 1*
Peep Valve | 4*
ETCO2 BVM/ETT for LifePak | 2*
Main Compartment | Reg. (+/-)
Adult ETT Holder | 2*
Pedi ETT Holder | 1*
O2 w/ Regulator (MIN: 800 PSI) | 1*
Vent Box w/ Ventilator | 1*
Vent Bag Orange (AHP)
Side Compartment (1) | Reg. (+/-)
Adult BVM | 2*
Side Compartment (2) | Reg. (+/-)
AHP Circuits | 2*
End Compartment | Reg. (+/-)
O2 Wrench | 1*
ETCO2 BVM/ETT for LifePak | 2*
Stethoscope | 1*
Main Compartment | Reg. (+/-)
Vent Filters | 2*
Adult ETT Holder | 2*
BiPAP Set | 2*
CPAP Set | 2*
Oxygen Tubing | 2*
O2 w/ Regulator (MIN: 800 PSI) | 2*
MICU Box | Reg. (+/-)
Aceteminophen | 1500 mg*
Adenosine | 24 mg*
Amiodarone | 450 mg*
Atropine | 3 mg*
Dopamine | 400 mg*
EPI 1:10,000 | 4 mg*
Ketorolac | 30 mg*
Lidocaine 2% Bolus | 300 mg*
Lidocaine (Premix or vial) | 1 gm*
Mag Sulfate | 2 g*
NTG 0.4 mg (spray or tabs) | 1 btl*
NTG Paste 1gm | 2 gm*
Normal Saline (250cc) | 1*
Pedi IO Needle | 1*
10ml Syringe | 4*
3 or 5ml Syringe | 2*
1ml Syringe w/ needle | 1*
18ga needle | 2*
20ga needle | 2*
22ga needle | 2*
CAPTCHA

74961

BLS BAG

Main Compartment | Reg. (+/-)

Left or Side Compartment | Reg. (+/-)

Front or Rear Compartment | Reg. (+/-)

Anaphylaxis Kit | Reg. (+/-)

AED | Reg. (+/-)

Paralytic Kit (optional) | Reg. (+/-)

Cardiac Monitor | Reg. (+/-)

ALS BAG

Front Compartment | Reg. (+/-)

Left Compartment | Reg. (+/-)

Right Compartment | Reg. (+/-)

Lid / Rear Compartment | Reg. (+/-)

Main Compartment | Reg. (+/-)

IV Kit | Reg. (+/-)

Intubation Kit | Reg. (+/-)

Vent Bag Green (Auto Vent)

Front Compartment | Reg. (+/-)

Left Compartment | Reg. (+/-)

Rear Compartment | Reg. (+/-)

Lid Compartment | Reg. (+/-)

Main Compartment | Reg. (+/-)

Vent Bag Orange (AHP)

Side Compartment (1) | Reg. (+/-)

Side Compartment (2) | Reg. (+/-)

End Compartment | Reg. (+/-)

Main Compartment | Reg. (+/-)

MICU Box | Reg. (+/-)