Vehicle Inspection Form For Registered Air Ambulances Page 2
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1
2
3DIAGNOSTIC EQUIPMENT
COMPLIANT
QTY
ITEM / DESCRIPTION
Y
N
PRI
Equipment suitable to determine blood pressure of the adult, pediatric and
1
1
infant patient(s) during flight; automatic
1
1
Stethoscope for both adult and pediatric patients
3
1
Penlight / Flashlight
1
1
Glucose Monitoring Device or equivalent
1
1
Pulse Oximeter
MISCELLANEOUS EQUIPMENT
COMPLIANT
QTY
ITEM / DESCRIPTION
Y
N
PRI
FAA approved stretcher system, capable of being secured in the aircraft; with
restraining devices capable of providing adequate restraint of all patients
including those under 60 pounds or 36 inches in height and an adult, 6 feet tall
weighing 212 pounds; head of stretcher shall be capable of elevating up to 30
1
1
degrees; stretcher shall be sturdy and rigid enough so that it can support
cardiopulmonary resuscitation and / or if a backboard or equivalent device is
required to achieve this, such device will be readily available; pad or mattress
shall be impervious to moisture and easily cleaned and disinfected.
2
2
Blankets or other types of hypothermic precautions
1
1
Hearing protection for patients, as applicable
2
1
Waterproof Patient Covers (rescue blanket, plastic sheet, etc.)
3
1
Emesis Basins and / or Emesis Bags
2
1
Restraints, 2 ankle and 2 wrist
Obstetrical Kit (when applicable) with receiving blanket, sterile bulb aspirator,
wrapped sanitary napkin, sterile scissors or scalpel blade, 4” gauze pads,
2
1
one pair of sterile gloves, 2 cord clamps, nonporous infant insulating device,
and plastic bag for placenta. All items are to be in a container with
identifying label showing contents.
3
1
Irrigation Liquids, 1000 ml each or equivalent
1
1
Flashlight
1
20
Exam Gloves, assorted sizes
1
4
N-95 or > Particulate Mask
2
1
Sharps Container
Disposable Personal Protective Devices (gloves, gowns, eye wear, masks,
1
2
etc.) for protection from infectious diseases
Resource Handbook providing information on chemical, biological, and
2
1
nuclear agents
U. S. Department of Transportation Emergency Response Guidebook,
2
1
current edition
1
1
Fire Extinguisher per FAA Regulations
R-E-01-D: Vehicle Inspection Form for Air Ambulance Units – Revised 06/01/2010 – Page 2 of 3 – VID #_____
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