Medical Rescue Certification Inspection Form (New Mexico Dept. Of Health, Emergency Medical Systems Bureau)

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New Mexico Dept. of Health
Emergency Medical Systems Bureau
Medical Rescue Certification Inspection Form
Name of Service: ____________
Location of Service:__________
Unit #: _________________
MEDICAL RESCUE - MINIMUM REQUIRED EQUIPMENT
Inspector:
Date:
All items shall be in quantities suitable for a Multiple Incident Response
ITEM DESCRIPTION
COMMENTS
Forward Compartment
Vehicle Registration
Y / N / NA
U. S. DOT, Emergency Response Guidebook
Y / N / NA
*EDITION:
Maps or Navigational equipment
Y / N / NA
Service specific protocols and resource guides
Y / N / NA
Patient Care Reports or Reporting System
Y / N / NA
Hand Sanitizer
Y / N / NA
Flashlight
Y / N / NA
*Battery Powered, Hand Crank, Mounted Batt. Chrg. Sys.
Fire Extinguisher
Y / N / NA
*10 pound, ABC type or functional equivalent, charged
Spotlight or auxillary lighting system
Y / N / NA
Roadway Warning Devices
Y / N / NA
*Safety Flares, Emergency Lights, Safety Cones
Vehicle Jack
Y / N / NA
Spare tire
Y / N / NA
Tire wrench
Y / N / NA
COMMUNICATIONS EQUIPMENT
Radio Communications (Portable or Affixed):
Equipment sufficient to Establish and Maintain direct or repeated
communications with:
Area Dispatch
Y / N / NA
Secondary Providers
Y / N / NA
N.M. EMSCOM Radio System
Y / N / NA
Capable of Cellular and/or Text/Data Transmissions (optional)
Y / N / NA
Spare batteries / charger system
Y / N / NA
Personal Protective Equipment (PPE)
EMS turnout gear
Y / N / NA
Helmets with Face Shield
Y / N / NA
Gloves
Y / N / NA
*Work gloves or Leather gloves
Eye Protection
Y / N / NA
*Glasses or Goggles
Hearing Protection
Safety Vest / Jacket (ANSI 2008 Compliant)
Y / N / NA
*Break-away, reflective, High visibility Coloration
Exam Gloves
Y / N / NA
*assorted sizes
Disposable Splash Protection
Y / N / NA
*(Gowns, Scrubs, Eye Shieding, etc.)
Tyvex coveralls (optional)
Y / N / NA
N-95 mask (or > particulate mask )
Y / N / NA
DIAGNOSTIC EQUIPMENT
Aneroid Sphygmomanometer, BP Cuffs
Y / N / NA
*with infant, pediatric, adult, and obese sizes
Stethoscope
Y / N / NA
*more than 1
Glucose Monitoring Instrument
Y / N / NA
*Portable
Pulse Oximeter
Y / N / NA
*Portable
End-tidal CO2 monitoring device
Y / N / NA
*Disposable, Colormetric
Penlights
Y / N / NA
Shears
Y / N / NA
*Trauma or Equivalent
PATIENT COMPARTMENT
Multi-Level Stretcher
Y / N / NA
*may be power assisted, 2 person
Revision 5/7/2010
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