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SCT BAG-MAIN COMPARTMENT
Transducer Setup
IV Pressure Infusers
ET CO2 Adapters (ETT)
ET CO2 Monitor/Nasal Cannula
IV Roll
EA 1000cc IV Fluid Bag
10 gtt/mL Dripset
Saline Lock
Alcohol Preps
2 X 2's
Tegaderms
Tourniquet
20 Gauge Catheter
18 Gauge Catheter
16 Gauge IV Catheter
14 Gauge IV Catheter
250 cc IV Fluid Bag
Propofol 50 mL 10mg/mL
SCT Narcotics Box Seal Number
Expiration Date
FRONT OUTER POCKET
Alaris Half Sets
Alaris Full Sets
60 cc Syringes
20 cc Syringes
10 cc Syringes
3 cc Syringes
1 cc Syringes
Needleless Adapters
Dispensing Pins
18 ga Needles
25 ga Needles
Alcohol Preps
Please check this box if you have an immediate issue with your ambulance that needs attention by the management staff. The comments
box will be sent by email.
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DRUG BOX
10mg Vecuronium
150mg Amiodarone
1 mg Terbutaline
5 mg Metoprolol
1 g Methylprednisolone
Tube NTG Paste
NTG Paste Applicators
100 mg Dexamethasone
250 mg Dobutamine
4 mg Norepinephrine
LEFT OUTER POCKET
Seal Number
Transducer Monitoring Cable
RIGHT OUTER POCKET
Large Adult NIBP Cuff
Thigh NIBP Cuff
Pediatric NIBP Cuff
REAR POCKET
DISS Oxygen Hose
Envelope w/Medication Labels
COMPARTMENTS OVER BENCH SEAT
Saline Flushes
10 gtt/mL Dripset
60 gtt/mL Dripset
1000 cc IV Fluid Bag
250 cc IV Fluid Bag
60 cc Syringes
20 cc Syringes
Alaris Half Sets
Alaris Full Sets
Transducer Setup
AC Adapter for IV Pump
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ACTION AREA SHELF
Eagle Ventilator
Alaris IV Pump
12 volt DC Adapter- Ventilator
QUESTIONS:
Which vehicle are you in?
What is your employee number?
What is your partners employee number?
Was your ambulance clean at the beginning of shift?
Is there a gas card in your ambulance?
Was your vent plugged in?
Did you complete a user test?
Did you do a defibrillator shock test?
Shock test at:
Shock test Successful?
Comments:
By submitting this form you're affirming that you have completed an entire
check of your supplies and equipment.
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