HS0233A (2007/06)

Page 1
4. Safety equipment
(a) ____ ____ shovel
(b) ____ ____ flashlight
(c) ____ ____ crowbar (90-cm) or equivalent
(d) ____ ____ service area map
(e) ____ ____ fire extinguisher, 5#ABC
(f) ____ ____ minimum of four fusee flares (20 min.)
(g) for each member of the crew
(i) ____ ____ one hard hat
(ii) ____ ____ goggles
(iii) ____ ____ safety vest
(iv) ____ ____ gloves
(h) ____ ____ jack and tire-changing tools
(i) ____ ____ 3-m booster cables
(j) ____ ____ fan belt
(k) one set of hand tools, consisting of
(i) ____ ____ combination screw driver
(ii) ____ ____ crescent wrench
(ii) ____ ____ pliers
(iv) ____ ____ hammer
(v) ____ ____ hacksaw and three spare blades
(m) ____ ____ tow rope or chain
Section 2
Advance Life Support Medical Equipment
1. Each ambulance operated at the advanced life support level
of service must be equipped with all equipment specified in
Section 1 plus the following:
(b) ____ ____ cardiac monitor defibrillator
(c) ____ ____ medications, drugs, I.V. solutions and admin.
(d) ____ ____ endrotracheal intubation equipment
Ambulance Vehicle Standards
2(h) ____ ____ kit/equipment securement
2(i) ____ ____ upholstery condition
3 ____ ____ emergency lights
6(b) ____ ____ siren
6(c) ____ ____ door ajar lights
19(c) ____ ____ no smoking/O
2
signs
19(d) ____ ____ main O
2
system (leaks)
19(e) ____ ____ main suction (30mm Hg <4 src)
19(f) ____ ____ sharps container
Standards of Ambulance Equipment and Supplies
Operator ID: License #: EHS Unit #: Operator Name:
Section 1: All Ambulances
Patient care equipment and supplies
1. Each ambulance must be equipped with the following:
(a) ____ ____ one or more primary elevating cot
(b) ____ ____ one auxiliary stretcher or stair chair
(c) ____ ____ one sterile maternity kit
(d) ____ ____ one adult bag-valve mask with reservoir
(e) ____ ____ one pediatric bag-valve mask with reservoir
(f) ____ ____ one adult/pediatric or combination traction splint
(g) ____ ____ six extremity splints of assorted sizes
(h) ____ ____ portable 0
2
system
(i) ____ ____ portable suction unit
(j) ____ ____ one infant bulb suction in addition to the one in the
maternity kit
(k) ____ ____ one head immobilizer
(l) ____ ____ two sets of rigid c-collars (min 4 per set)
(m) ____ ____one upper body immobilization device
(n) ____ ____ one bed pan
(o) ____ ____ one urinal
(p) ____ ____ two K-basins or self sealing emesis bags
(q) ____ ____ PCR forms
(r) ____ ____ one long spine board with straps
(s) ____ ____ one scoop stretcher with straps
(t) ____ ____ one sterile burn kit
2. Supplies, in a quantity, type and size as determined by the
operator
(a) ____ ____ roller, triangular and adhesive bandages
(b) ____ ____ sterile and clean dressings
(c) ____ ____ tape
(d) ____ ____ surgical gloves
(e) ____ ____ surgical masks
(f) ____ ____ clean linen and blankets, pillows with fluid occlusive
covers
(g) ____ ____ nasal cannulae, adult and pediatric oxygen masks
(h) ____ ____ suction caths
(i) ____ ____ cold packs
(j) ____ ____ gowns/aprons
3. Supplies to be carried in a Trauma Kit, Airway Kit or on the
attendants person
(a) ____ ____ one set of airways, sizes 00-6
(b) ____ ____ one adult B/P cuff
(c) ____ ____ one pediatric B/P cuff
(d) ____ ____ one stethoscope
(e) ____ ____ one penlight
(f) ____ ____ one pair of bandage scissors or super shears
(g) ____ ____ supply of sterile 4 x 4s
(h) ____ ____ supply of ABD or 4 x 8 dressings
(i) ____ ____ supply of clean 4 x 4s
(j) ____ ____ supply of roller or triangular bandages
(k) ____ ____ supply of adhesive bandages
(l) ____ ____ supply of tape
E.H.S. Branch - White, Ambulance Service - Canary EHS Website: www.health.gov.ab.ca/ehs
Emergency Health Services
Date:
Signature of operator
Comments
Signature (Alberta Health and Wellness)
X X
Deficiencies
14(c) Expiry (Include any expired items below.)
Key: ( ) OK
( x )Rej ect
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