Ambulance Checkout Sheet - ALS - Los Angeles
| Medications | ||
| Adenosine | 24mgs | N/A |
| Albuterol (pre-mixed w/ NS) | 20mgs | N/A |
| Amiodarone | 900mgs | N/A |
| Aspirin (chewable 81mg) | 648mgs | N/A |
| Atropine sulfate (1mg/10mL) | 3mgs | N/A |
| Calcium chloride | 1gm | N/A |
| Dextrose 10% / Water 250mL | 3 bags | N/A |
| Dextrose - glucose paste/gel | 45gms | N/A |
| Diphenhydramine | 100mgs | N/A |
| Disaster Cache 1 | 1 | N/A |
| Epinephrine (1mg/mL) | 5mgs | N/A |
| Epinephrine (0.1mg/mL) | 7mgs | N/A |
| Fentanyl 2, 3 | 500mcgs | N/A |
| Glucagon | 1mg | N/A |
| Ketorolac 15mg/mL | 4 | N/A |
| Or | ||
| Ketorolac 30mg/2mL | 2 | N/A |
| Lidocaine 2% 4 | 200mgs | N/A |
| Midazolam 5 | 20mgs | N/A |
| Morphine sulfate 6 | 20mgs | N/A |
| Naloxone | 4mgs | N/A |
| Normal saline (for injection) | 2 vials | N/A |
| Nitroglycerin (SL) spray, tablets, or single dose powder packets | 1 pump/ bottle/ or 36 packets |
N/A |
| Olanzapine 10mg ODT | 40mgs | N/A |
| Ondansetron 4mg ODT | 16mgs | N/A |
| Ondansetron 4mg IV | 16mgs | N/A |
| Sodium bicarbonate | 50mLs | N/A |
| Intravenous Fluids | ||
| Normal saline 1000 mL | 6 bags | 731360 |
| Normal saline 250 mL | 2 bags | 731359 |
| or | ||
| Normal saline 500 mL | 2 bags | N/A |
| Supplies | ||
| Adhesive dressing (Band-Aids®) | 1 box | 3602 |
| Airways – Nasopharyngeal: | ||
| Large (34-36) | 1 | 30335 |
| Medium (26-28) | 1 | 30335 |
| Small (20-22) | 1 | 30335 |
| Airways – Oropharyngeal: | ||
| Large | 1 | 30340 |
| Medium | 1 | 30340 |
| Small Adult/Child | 1 | 30340 |
| Infant | 1 | 30340 |
| Neonate | 1 | 30340 |
| Alcohol prep pads | 1 box | 1113 |
| Backboards | 2 | 20008 |
| Bag-Mask-Ventilation (BMV) device w/ O2 inlet & reservoir: | ||
| Bag Volume 650-1000 mL7 | 1 | 530 213 000 |
| Bag Volume 400-700 mL7 | 1 | 845121 |
| Bag Volume 200-450 mL7 | 1 | 540 212 000 |
| Bag-Mask-Ventilation (BMV) Masks: | 000 252 SET | |
| Large | 1 | 000 252 056 |
| Medium | 1 | 000 252 055 |
| Small Adult/Child | 1 | 000 252 054 |
| Toddler | 1 | 000 252 053 |
| Infant | 1 | 000 252 052 |
| Neonate | 1 | 000 252 051 |
| Burn pack or burn sheet | 1 | 30391 |
| Cervical collars (rigid): | ||
| Adult (adjustable) | 4 | 000 281 000 |
| Pediatric | 2 | 000 281 106 |
| Cardiac Monitor-Defibrillator w/ oscilloscope | 1 | N/A |
| Defibrillator pads or paste (Adult) | 2 each | 16381 |
| Defibrillator pads or paste (Pediatric) | 2 each | 16380 |
| ECG electrodes: | ||
| Adult | 6 | 8900-0004 |
| Pediatric | 6 | 31439766 |
| Pulse oximeter | 1 | 7088 |
| Transcutaneous pacing | 1 | N/A |
| Waveform capnography | 1 | N/A |
| ECG, 12-lead & transmission capable | 1 | 8300-0804-01 |
| 4 Lead Cable | 1 | 8300-0803-01 |
| Color Code Drug Doses, Ref. No. 1309 | 1 | N/A |
| Commercial Catheter-Over-Needle Chest Decompression Needles 3.0-3.5” 14G | 2 | ZZ-0056 |
| Contaminated needle container | 1 | Browse |
| Continuous Positive Airway Pressure (CPAP) device: 3 | ||
| Small | 1 | 20050 |
| Medium | 1 | 20051 |
| Large | 1 | 20052 |
| Endotracheal tubes w/ stylets Sizes 6.0-8.0 | ||
| 6.0 | 2 | 4560-36249 |
| 6.5 | 2 | 4561-36250 |
| 7.0 | 2 | 4562-36251 |
| 7.5 | 2 | 4563-36252 |
| 8.0 | 2 | 4564-36253 |
| Tube introducer | 2 | 4583 |
| End Tidal CO2 Detector or Aspirator (Adult) | 1 | 30074 |
| Extrication device or short board | 1 | 13142 |
| Or | ||
| Short Board | 1 | 35955 - NO PINS |
| Filter, viral HEPA 11 | 2 | 12155 |
| Flashlight or penlight | 1 | 4781 |
| Gauze bandages | 6 | 3113 |
| Gauze sponges 4x4 (sterile) | 12 | 3354 |
| Gloves, sterile | 2 pair | 6538 |
| Gloves, unsterile | 1 box | 70002 |
| Glucometer | 1 | MPH4540 |
| Glucometer Strips | 1 | MPH4550 |
| Lancets (automatic retractable) | 5 | MPHSAFETY281 |
| Hand-held nebulizer pack | 2 | 5602-34105 |
| Hemostats, padded | 1 | 50022 |
| Intraosseous device: 3 | ||
| Adult | 1 | Call For Pricing |
| Pediatric | 1 | Call For Pricing |
| Intravenous catheters: Sizes 16G - 22G | 5 each | 13223 |
| Intravenous tubing - Macrodrip | 12 | 13194 |
| i-gel (Disposable Supraglottic Airway): | ||
| Neonate (size 1) | 1 | 8201 |
| Infant (size 1.5) | 1 | 8215 |
| Small pediatric (size 2) | 1 | 8202 |
| Large pediatric (size 2.5) | 1 | 8225 |
| Small adult (size 3) | 1 | 8703000 |
| Medium Adult (size 4) | 1 | 8704000 |
| Large adult+ (size 5) | 1 | 8705000 |
| Laryngoscope blades: | ||
| Adult: Curved | 1 each | 7064 |
| Adult: Straight | 1 each | 6043 |
| Pediatric: Miller #1 & #2 | 1 each | 6041 |
| Laryngoscope handle: | ||
| Adult (compatible w/ pediatric blades) | 1 | 7862 |
| Magill forceps: | ||
| Adult | 1 | 7338 |
| Pediatric | 1 | 7337 |
| Mucosal Atomization Device (MAD) | 3 | MAD300 |
| Needle, filtered-5micron 8 | 2 | SYR110022FZ |
| Normal saline for irrigation | 1 bottle | 1531434 |
| OB pack & bulb syringe 9 | 1 | 1732 |
| Oxygen cannulas: | ||
| Adult | 3 | 30345 |
| Pediatric | 3 | 30346 |
| Oxygen masks – (non-rebreather): | ||
| Adult | 4 | 30355 |
| Pediatric | 2 | 30356 |
| Infant | 2 | 30357 |
| Oxygen masks – (simple): | ||
| Adult | 2 | MS-26041 |
| Pediatric | 2 | MS-26042 |
| Infant | 2 | MS-26043 |
| Standardized Pediatric Length-Based Resuscitation Tape, approved by the EMS Agency (e.g., Broselow 2011A or newer) | 1 | 50021 |
| Personal Protective Equipment: | ||
| Mask | 40000 | |
| Gown | 10015 | |
| Eye protection | 11054 | |
| Radio transmitter receiver (Hand-Held) 10 | 1 | N/A |
| Saline locks | 4 | 13200 |
| Scissors | 1 | 30386 |
| Sphygmomanometer: | ||
| Thigh | 1 | 30334 |
| Adult | 1 | 30330 |
| Pediatric | 1 | 30332 |
| Infant | 1 | 30333 |
| Splints: | ||
| Long | 1 | 61036M |
| Long | 1 | 61024M |
| Short | 1 | 61018M |
| Short | 1 | 61012M |
| Splints – traction: | ||
| Adult | 1 | EP-800 |
| Pediatric | 1 | 70021 |
| Stethoscope | 1 | 30311 |
| Suction unit (portable) w/adapter | 1 | 30370 |
| Suction catheters: | ||
| Size 8Fr. | 1 | 4808 |
| Size 10Fr. | 2 | 4810 |
| Size 12Fr. | 4 | 4812 |
| Tonsillar tip | 1 | 30322 |
| Syringes sizes: 1mL – 60mL w/ luer adapter | assorted | 13094 |
| Tape (various types, must include cloth) | 1 | 3563 |
| Thermometer (Oral or axillary) | 1 | 5122 |
| Tourniquets (IV) | 2 | 3139 |
| Tourniquets (commercial for bleeding control) | 2 | 30-0001 |
| Vaseline gauze | 2 | 3040 |
| APPROVED OPTIONAL EQUIPMENT | ||
| Hemostatic dressings–EMS Authority approved dressings only | 1214-47548 | |
| Intravenous tubing, blood | 13194 | |
| Mechanical CPR device 3 | N/A | |
| Metered-Dose-Inhaler (MDI) Spacer 12 | 10009 | |
| Pediatric laryngoscope handle FDA-Approved | 7861 | |
| Resuscitator w/ positive pressure demand valve (flow rate not to exceed 40L/min) | N/A | |
| Albuterol / Metered Dose Inhaler (MDI) 12 | N/A | |
| Metered-Dose-Inhaler (MDI) Mask 12 | 10009 | |