Vehicle Inspection Form For Registered Ambulances Page 2
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2
3
4BANDAGES / DRESSINGS
COMPLIANT
QTY
ITEM / DESCRIPTION
Y
N
PRI
2
3
Triangular Bandages
2
3
Universal Dressings, approximately 10 inches by 30 inches
12
3
Gauze Pads, 4 inches by 4 inches
Bandages, soft roller, self-adhering type, 2 inches to 4 inches by 5 yards
4
3
2
3
Bandages, soft roller, self-adhering, 6 inches by 5 yards
4
3
Bandages, elastic, of assorted sizes
Petroleum gauze pads, sterile, individually wrapped, 4 inches by 3 inches or 9
4
3
inches by 3 inches
4
3
Rolls of adhesive tape
DIAGNOSTIC EQUIPMENT
COMPLIANT
QTY
ITEM / DESCRIPTION
Y
N
PRI
1
Aneroid Sphygmomanometer, with pediatric, adult, and obese size cuffs
2
1
1
Stethoscope
1
3
Glucose Monitoring Instrument
IMMOBILIZATION DEVICES
COMPLIANT
QTY
ITEM / DESCRIPTION
Y
N
PRI
4
3
Extremity Immobilization Devices: 2 full arms and 2 full legs, or equivalent
1
1
Short Spinal Extrication Device (KED or equivalent)
1
1
Pediatric Immobilization Device (must be manufactured for pediatric use only)
Spine Boards, long, at least 16 inches wide by 72 inches in length, with 3 straps
2
1
for each board or equivalent
Lateral Cervical Immobilization Devices, commercial devices, foam blocks, or
2
1
sheet / blanket rolls
Cervical Immobilization Collars, hard type, 2 adult, 2 medium, 2 child
6
1
1
3
Traction Splint, adult, lower extremity, adjustable
1
3
Traction Splint, pediatric, lower extremity, adjustable
Equipment for the safe transport of pediatric patients, as approved by the local
1
3
EMS medical director with guidelines provided by the department
MISCELLANEOUS EQUIPMENT
COMPLIANT
QTY
ITEM / DESCRIPTION
Y
N
PRI
Automatic External Defibrillator when only EMT-Is and/or EMT-B is on the
ambulance or 1 cardiac monitor / defibrillator when Cardiac Technicians and/or
1
1
EMT-Paramedics are on the unit
Pillow, disposable, or pillow with vinyl cover. Rolled sheets are acceptable
1
3
substitutes.
Multi-Level Stretcher with at least one pair of shoulder / chest straps and one set of
1
1
straps for the lower extremities, capable of securing adult and pediatric patients
2
3
Blankets
2
3
Waterproof Patient Covers (e.g. plastic sheets) or Rescue Blanket
Vehicle Inspection Form for Ambulances – Revised 06/01/2010 – Form R-E-01-A – Page 2 of 4 – VID #____________
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