SIERRA-SACRAMENTO VALLEY EMS AGENCY PROGRAM POLICY REFERENCE NO. 701
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1 SIERRA-SACRAMENTO VALLEY EMS AGENCY PROGRAM POLICY REFERENCE NO. 701 SUBJECT: INVENTORY PURPOSE: To establish a standardized inventory on all S-SV approved Advanced Life Support EMS response vehicles. AUTHORITY: California Health and Safety Code, Division 2.5, Sections , California Code of Regulations, Title 22, Division 9, Section California Code of Regulations, Title 13 California Vehicle Code, Section Emergency Medical Services Authority Guidelines and Recommendations, Highway Patrol Handbook 82.4 POLICY: All S-SV approved EMS response vehicles shall carry the following equipment and supply inventory. Reasonable variations may occur; however, any exceptions or additions shall have prior approval of the S-SV EMS Agency. For inventory list see attached table Effective Date: 06/01/2012 Date last Reviewed / Revised: 06/12 Next Review Date: 06/2015 Page 1 of 1 Approved: SIGNATURE ON FILE S-SV EMS Medical Director SIGNATURE ON FILE S-SV EMS Regional Executive Director
2 INVENTORY REFERENCE NO. 701 EQUIPMENT AND SUPPLY SPECIFICATIONS - NON BIKES RADIO EQUIPMENT Mobile UHF Med-Net Radio Portable UHF Med-Net Radio OR Portable Cell Phone MISCELLANEOUS EQUIPMENT & SUPPLIES Map Book (covering the areas the ambulance provides service) 1 each 1 each 0 D.O.T Emergency Response Guidebook FIRESCOPE Field Operations Guide (FOG) Hazardous Materials medical management reference Approved epcr RAS / AMA Forms 10 each 5 each 5 each Triage Tags 10 each 10 each 0 Infection control packs (per crew member) 1 pk each 1 pk each 1 pk Antiseptic hand wipes or waterless hand sanitizer 10 / 1 10 / 1 10 / 1 Covered waste container (red bio hazard bags acceptable) Adult & Pediatric BP cuff 1 each 1 each 1 each Thigh BP cuff Stethoscope Flashlight or Penlight Bedpan or Fracture pan Urinal Sharps container Padded soft wrist & ankle restraints 1 set 1 set 0 Pillows, sheets, pillow cases, towels 2 each 0 0 Blankets Emesis basin / disposable emesis bags Length based Pediatric Resuscitation Tape (Broselow) Ambulance cot with straps to secure patient to cot and necessary equipment to properly secure cot in vehicle Collapsible stretcher (Breakaway Flat) with straps to secure patient Thermometer (optional) BIOMEDICAL EQUIPMENT & SUPPLIES Monitor / Defibrillator Equipment & Supplies Portable Monitor/Defibrillator - Battery operated, with ECG printout, capable of synchronized cardioversion. (Transcutaneous Pacing, Waveform Capnography, &/or 12 Lead capability optional). AED with cardiac monitoring and manual defibrillation capabilities (optional in place of portable monitor / defibrillator above for bike teams only) Spare monitor/ defibrillator battery 1 1 as needed Defibrillator paddles - adult & pediatric with defibrillation gel pads or paddle conduction gel OR Hands free defibrillator patches - adult & pediatric 1 set each 1 set each 1 set each Electrode leads (wires) 2 sets 2 sets 1 set ECG paper 2 rolls 2 rolls as needed Adult disposable ECG electrodes 4 sets 2 sets 2 sets Pediatric disposable ECG electrodes 2 sets 1 set 2 sets Miscellaneous Biomedical Equipment & Supplies Pulse Oximeter Capnometer (optional) Co-Oximeter (optional) Glucometer Glucometer test strips Lancets AIRWAY / OXYGEN EQUIPMENT & SUPPLIES Oxygen Delivery "H" or "M" oxygen tank mounted in ambulance Wall mounted oxygen regulator with liter flow mounted in ambulance Updated 06/01/2012 Page 1 of 4
3 INVENTORY REFERENCE NO. 701 EQUIPMENT AND SUPPLY SPECIFICATIONS - NON BIKES AIRWAY / OXYGEN EQUIPMENT & SUPPLIES (cont.) "D" or "E" portable oxygen cylinder ("C" size acceptable for bike teams) Portable oxygen regulator with liter flow Adult non-rebreather oxygen mask Pediatric oxygen mask Nasal cannula Hand held nebulizer Aerosol / nebulizer mask Bag-Valve Device (with 02 inlet, reservoir & one way valve) Adult (1000 cc bag vol.) Pediatric ( cc bag vol.) Bag-Valve Mask (transparent) Large (adult) Medium (adult) Small (adult) Child Neonatal BLS Airways Oropharyngeal Airways (sizes 0-6 or equivalent sizes) 2 each 2 each 1 each Nasopharyngeal Airways (sizes Fr.or equivalent sizes) 2 each 2 each 1 each Suction Equipment & Supplies Suction catheters - 6 fr, 8 fr, 10 fr, 14 fr 2 each 2 each 0 Tonsilar tip suction handle Portable mechanical suction unit (manual suction device including adult & pediatric suction tubes acceptable for bike teams) Advanced Airway Equipment & Supplies Laryngoscope handle Batteries - extra set Bulb - extra bulb for adult and pediatric blade 1 each 1 each 1 each Miller (straight blade) sizes each 1 each 1 each Macintosh (curved blade) sizes each 1 each 1 each Magill forceps - adult & pediatric 1 each 1 each 1 each Water soluble lubricant (K-Y jelly or equivalent) Topical vasoconstrictor (Neosynephrine or equivalent) % Lidocaine jelly 1 tube 1 tube 1 tube Uncuffed endotracheal tubes, sizes 2.5, each 2 each 1 each Cuffed endotracheal tubes, sizes 3.5, 4.0, 4.5, 5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0,8.5 2 each 2 each 1 each Cuffed endotracheal tube, size each 2 each 0 Endotracheal tube stylettes - neonatal, child & adult 1 each 1 each 1 each Flex Guide ETT introducer - caude tip 15 fr x 70 cm ET tube holder Esophageal Tracheal Airway Device - Adult 37 and 41 Fr OR King Airway Device - Size 3, Size 4, Size 5 1 each 1 each 0 End tidal CO2 detector device - disposable single patient use colorimetric device (adult & pediatric) or disposable capnography circuit 2 each 2 each 1 each Esophageal Intubation Detector Device (EDD) (optional for providers using waveform capnography) Meconium aspirator Airway airflow monitor (optional) Inspiratory Impedance Threshold Device (optional) S-SV approved CPAP equipment Manual Jet Ventilator device OR ENK Flow Modulator Kit Adult and Pediatric Transtracheal Catheter or minimum 12 ga x 3" catheter for use with the manual Jet Ventilator device (if carried) 1 each 1 each 1 each Updated 06/01/2012 Page 2 of 4
4 INVENTORY REFERENCE NO. 701 EQUIPMENT AND SUPPLY SPECIFICATIONS - NON BIKES AIRWAY / OXYGEN EQUIPMENT & SUPPLIES (cont.) Needle thoracostomy kit with minimum 14 ga X 3 " catheter specifically designed for needle decompression IMMOBILIZATION EQUIPMENT & SUPPLIES Ked Long spine board with straps Pediatric spine board Foam-filled or equivalent S-SV approved head immobilization device 2 pair 2 pair 0 Traction splint: Hare, Sager or equivalent Arm & leg splints (i.e. cardboard, SAM type, vacuum) 3 each 3 each 0 Tape (optional) *Type approved by SSV EMSA Medical Director 1 roll 1 roll 0 Cervical Collars (rigid) - large, medium, small, pediatric OR adjustable adult & pediatric 2 each 2 each 0 OBSTETRICAL EQUIPMENT & SUPPLIES OB Kit containing a minimum: sterile gloves, umbilical cord tape or clamps (2), dressings, towels, bulb syringe and clean plastic bags. 2 kits 1 kit 1 kit Stocking head cap (infant) BANDAGING EQUIPMENT & SUPPLIES Triangle bandages Adhesive tape rolls 1" & 2" rolls 2 each 2 each 1 each Sterile 4x4 compresses Non sterile 4x4 compresses Kling/Kerlix in 2", 3" or 4" rolls Trauma dressing (10"x30" or larger universal dressings) Surgipads (optional) Band-Aids 1 box 1 box 10 Sterile petroleum impregnated dressing Asherman Chest Seal (optional) Cold packs and heat packs 2 each 2 each 2 each Gloves (unsterile) various sizes 1 box each 10 each 2 pr each Sterile saline for irrigation 2 liters 2 liters 0 Potable water 2 liters 2 liters 0 Bandage shears 1 pr 1 pr 1 pr S-SV EMS Agency approved commercial tourniquet device (optional) IV / MEDICATION ADMINISTRATION EQUIPMENT & SUPPLIES Catheter over needle- 14 ga, 16 ga, 18 ga, 20 ga 6 each 4 each 2 each Catheter over needle- 22ga, 24ga 2 each 2 each 2 each Micro-drip & Macro-drip venosets OR 4 each 2 each 1 each Selectable drip tubing Blood administration tubing (optional) IV extension Saline Locks (optional) IV start pack or equivalent with tourniquets Alcohol wipes & Betadine swabs 20 each 10 each 8 each Chlorhexidine swabs/skin prep 5 each 5 each 2 each Syringes / Needles / Medication Administration Devices TB / 1 cc syringe cc syringe cc syringe cc syringe cc syringe ga, 25 ga safety injection needles 2 each 2 each 2 each Vial access Cannulas 2 each 2 each 2 each Mucosal Atomization Device (MAD) Arm boards - (short, long) 2 each 1 each 0 Updated 06/01/2012 Page 3 of 4
5 INVENTORY REFERENCE NO. 701 EQUIPMENT AND SUPPLY SPECIFICATIONS - NON BIKES IV / MEDICATION ADMINISTRATION EQUIPMENT & SUPPLIES (cont.) Blood Tubes (optional) Vacutainer holder (optional) Vacutainer needles (optional) Vials or pre-filled syringes - Sterile Normal Saline for injection (optional) INTRAOSSEOUS ACCESS EQUIPMENT & SUPPLIES providers must stock the equipment and supplies to establish IO access on both an adult and pediatric patient as indicated below: Pediatric IO Devices (providers must stock one of the following devices in the minimum quantity listed) Jamshidi Illinois device with 15 ga adjustable length needle Bone Injection Gun (B.I.G. ) - Pediatric EZ-IO 15 mm Pediatric Needle Set (including a minimum of 1 EZ-IO Power Driver used for both adult and pediatric patients) Adult IO Devices (providers must stock one of the following devices in the minimum quantity listed) Bone Injection Gun (B.I.G. ) - Adult EZ-IO Adult Needle Set (including a minimum of 1 EZ-IO Power Driver used for both adult and pediatric patients). At least one needle set shall be 45 mm length Lidocaine HCI 2% (100mg/5ml) IV SOLUTIONS Normal saline cc bag Normal saline cc bag MEDICATIONS Activated charcoal (50 gm) Adenosine 6 mg - vial or pre-filled syringe Albuterol - 2.5mg (pre-mixed w/ns). If not premixed; Normal Saline 2.5cc, without preservatives, is required for dilution of each dose Amiodarone 3 ml mg (50 mg/ml) Aspirin (chewable) 1 bottle 1 bottle 1 bottle Atropine 1 mg/1ml vial Benadryl (50 mg/ml) Benadryl elixir mg Calcium Chloride 10% - (1 gm/10ml) Dextrose 50% (25gm/50ml) Dextrose 25% (12.5gm/10ml) Dopamine 400 mg Epinephrine 1:1,000 5 mg 5 mg 5 mg Epinephrine 1:10,000 (1mg/10ml) Furosemide 40 mg (10mg/ml) Glucagon 1mg (1unit) Glucose paste OR Glucose solution (oral prepackaged) Mark-I / Duo Dote Nerve Agent Antidote Kits (optional) (Optional) (Optional) (Optional) Naloxone (Narcan) 2.0 mg Nitroglycerin 0.4 mg/tab (1/150) bottle OR Nitroglycerine spray actuation Pralidoxime Chloride (2-PAM) 1 gm / 20 ml vial (optional) (Optional) (Optional) (Optional) Sodium Bicarbonate (50mEq/50ml) Zofran (4mg/2ml vial) Zofran Oral Disentregrating Tablets (ODT) 4 mg Controlled Substances Midazolam (Versed) 5 mg/cc concentration mg mg 20 mg Morphine HCL 10 mg/ml unit dose mg mg (Optional) 20 mg (Optional) Double lock container system for controlled meds Controlled substance log sheet Updated 06/01/2012 Page 4 of 4
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