Equipment for Ambulances revision June 10, 2012 1

2
3
4
5
American College of Surgeons Committee on Trauma 6
American College of Emergency Physicians 7
National Association of EMS Physicians 8
Emergency Medical Services for Children 9
(EMSC) 10
American Academy of Pediatrics 11
12
National Association of EMS Officials 13
14
Four decades ago, the Committee on Trauma (COT) of the American College of Surgeons (ACS) developed 15
a list of standardized equipment for ambulances. Beginning in 1988, the American College of Emergency 16
Physicians (ACEP) published a similar list. The two organizations collaborated on a joint document 17
published in 2000, and the National Association of EMS Physicians (NAEMSP) participated in the 2005 18
revision. The 19
2005 revision included resources needed on ambulances for appropriate homeland security. All three 20
organizations adhere to the principle that Emergency Medical Services (EMS) providers at all levels 21
must have the appropriate equipment and supplies to optimize prehospital delivery of care. The 22
document was written to serve as a standard for the equipment needs of emergency ambulance services 23
both in the United 24
States and Canada. 25
26
EMS providers care for patients of all ages, who have a wide variety of medical and traumatic conditions. 27
The 28
2009 revision included updated pediatric recommendations developed by members of the federal 29
Emergency Medical Services for Children (EMSC) Stakeholder Group and endorsed by the American 30
Academy of Pediatrics (AAP). The EMSC Program has developed several performance measures for the 31
Programs State Partnership grantees. One of the performance measures evaluates the availability of 32
essential pediatric equipment and supplies for Basic Life Support and Advanced Life Support patient care 33
units. This document is used as the standard for this performance measure. 34
35
36
37
For purposes of this document, the following definitions have been used: a neonate is 0-28 days old, an 38
infant is 29 days to 1 year old, and a child is >1 year through 11 years old with delineation into the 39
following developmental stages: 40
41
Toddlers (1-3 years old) 42
Preschoolers (3-5 years 43
old) 44
Middle Childhood (6-11 years 45
old) Adolescents (12-18 years 46
old) 47
48
These standard definitions are age based. Length based systems have been developed to more accurately 49
estimate the weight of children and predict appropriate equipment sizes, medication doses, and guidelines 50
for fluid volume administration. 51
Principles of Prehospital Care 52
53
The goal of prehospital care is to minimize further systemic insult or injury and manage life-threatening 54
conditions through a series of well-defined and appropriate interventions, and to embrace principles that 55
ensure patient safety. High quality, consistent emergency care demands continuous quality improvement 56
and is directly dependent on the effective monitoring, integration, and evaluation of all components of the 57
patients care. 58
59
Integral to this process is medical oversight of prehospital care by using preexisting patient care protocols 60
(indirect medical oversight), which are evidence-based when possible, or by medical control via voice 61
and/or video communication (direct medical oversight). The protocols that guide patient care should be 62
established collaboratively by medical directors for ambulance services, adult and pediatric emergency 63
medicine physicians, adult and pediatric trauma surgeons, and appropriately trained basic and advanced 64
emergency medical personnel. Current Institute of Medicine (IOM) recommendations encourage each 65
EMS Agency to have a pediatric coordinator to specifically coordinate the capability of the service to care 66
for non-adult patients. 67
68
Equipment and Supplies 69
70
The guidelines list the supplies and equipment that should be stocked on ambulances to provide the 71
accepted standards of patient care. Previous documents regarding ambulance equipment referred to 72
essential or minimal equipment necessary to adequately equip an ambulance. Equipment requirements will 73
vary, depending on the certification levels of the providers, population densities, geographic and economic 74
conditions of the region, and other factors. Item expiration dates should be checked on a periodic basis 75
with strict adherence. 76
77
THE FOLLOWING LIST IS DIVIDED INTO EQUIPMENT FOR BASIC LIFE SUPPORT (BLS) AND 78
ADVANCED LIFE SUPPORT (ALS) AMBULANCES. ALS AMBULANCES MUST HAVE ALL OF 79
THE EQUIPMENT ON THE REQUIRED BLS LIST AS WELL AS EQUIPMENT ON THE REQUIRED 80
ALS LIST. THIS LIST REPRESENTS A CONSENSUS OF RECOMMENDATIONS FOR EQUIPMENT 81
AND SUPPLIES THAT WILL FACILITATE PATIENT CARE IN THE OUT-OF-HOSPITAL SETTING. 82
83
84
Required Equipment: Basic Life Support (BLS) 85
Ambulances 86
87
A. Ventilation and Airway Equipment 88
1. Portable and fixed suction apparatus with a regulator per Federal specifications or standard 89
90
Wide-bore tubing, rigid pharyngeal cur ved suction tip; tonsil and flexible suction catheters, 6F16F 91
are commercially available (have one between 6F and 10F and one between 12F and 16F) 92
2. Portable oxygen apparatus, capable of metered flow with adequate tubing 93
3. Portable and fixed oxygen supply equipment 94
Variable flow regulator 95
4. Oxygen administration equipment 96
Adequate length tubing; transparent mask (adult and child sizes), both non-rebreathing 97
and valveless; nasal cannulas (adult, child) 98
99
100
101
102
5. Bag-valve mask (manual resuscitator) 103
Hand-operated, self- expanding bag; adult (>1000 ml) and child (450 104
750 ml) sizes, with oxygen reservoir/accumulator; valve (clear, operable in cold weather); and mask 105
(adult, child, infant, and neonate sizes) 106
6. Air ways 107
Nasopharyngeal (16F34F; 108
adult and child sizes) 109
Oropharyngeal (sizes 05; 110
adult, child, and infant sizes) 111
7. Pulse oximeter with pediatric and adult probes 112
8. Saline drops and bulb suction for infants 113
114
115
b. Monitoring and Def ibrillation 116
All ambulances should be equipped with an automated external defibrillator (AED) unless staffed 117
by advanced life support personnel who are carrying a monitor/defibrillator. The AED should 118
have pediatric capabilities, including child- sized pads and cables or dose attenuator with adult pads. 119
120
c. Immobilization Devices 121
1. Cervical collars 122
Rigid for children ages 2 years or older; child and adult sizes (small, medium, large, and other 123
available sizes) 124
2. Head immobilization device (not sandbags) 125
Firm padding or commercial device 126
3. Pelvic immobilization device 127
4. Upper and lower extremity immobilization devices 128
129
Joint-above and joint-below fracture (sizes appropriate for adults and children), rigid-support constructed 130
with appropriate material (cardboard, metal, pneumatic, vacuum, wood, or plastic) 131
5. Impervious backboards (long, short; radiolucent preferred) and extrication device 132
Short extrication/immobilization device (e.g. KED) 133
Long (transport, head-tofeet length) with at least three appropriate restraint straps (chin strap alone should 134
not be used for head immobilization) and with padding for children and handholds for moving patients 135
136
d. Bandages 137
1. Commercially-packaged or sterile burn sheets 138
2. Bandages 139
Triangular bandages (minimum two safety pins each) 140
ACE bandages 141
3. Dressings 142
Sterile multitrauma dressings (various large and small sizes) 143
ABDs, 10x12 or larger 144
4x4 gauze sponges or suitable size 145
4. Gauze rolls 146
Various sizes 147
5. Occlusive dressing or equivalent 148
Sterile, 3x8 or larger 149
6. Adhesive tape 150
Various sizes (including 1 and 2) hypoallergenic 151
Various sizes (including 1 and 2) adhesive 152
7. Arterial tourniquet (commercial preferred) 153
154
155
E. C ommunication 156
Two-way communication device between EMS provider, dispatcher, and medical control 157
158
f. Obstetrical Kit (commercially packaged is available) 159
1. Kit (separate sterile kit) 160
Towels, 4x4 dressing, umbilical tape, sterile scissors or other cutting utensil, bulb suction, clamps 161
for cord, sterile gloves, blanket 162
2. Thermal absorbent blanket and head cover, aluminum foil roll, or appropriate 163
heat-reflective material 164
(enough to cover newborn) 165
166
g. Miscellaneous 167
1. Access to patient care protocols 168
2. Sphygmomanometer (pediatric and adult regular and large 169
size cuffs) 170
3. Adult stethoscope 171
4. Thermometer with low temperature capability 172
5. Heav y bandage or paramedic scissors for cutting clothing, belts, and boots 173
6. Cold packs 174
7. Sterile saline solution for irrigation (1-liter bottles or bags) 175
8. Flashlights (2) with extra batteries and bulbs 176
9. Blankets 177
10. Sheets (minimum 4), linen or paper, and pillows 178
11. Towels 179
12. Triage tags 180
13. Emesis bags or basins 181
14. Bedpan 182
15. Urinal 183
16. Wheeled cot (conforming to national standard at the time of manufacture) 184
17. Folding stretcher 185
18. Stair chair or carry chair 186
19. Patient care charts/forms 187
20. Lubricating jelly (water soluble) 188
189
h. Infection Control* 190
191
192
193
*Latex-free equipment should be available 194
2
195
1. Eye protection (full peripheral glasses or goggles, face shield) 196
2. Face protection (for example, surgical masks per applicable local or state guidance) 197
3. Gloves, nonsterile (must meet NFPA 1999 requirements found at http://www.nfpa.org/ ) 198
4. Coveralls or gowns 199
5. Waterless hand cleanser, commercial antimicrobial (towelette, spray, liquid) 200
6. Disinfectant solution for cleaning equipment 201
7. Standard sharps containers, fixed and portable 202
8. Trash bags for disposing of biohazardous waste 203
9. Respiratory protection (for example, N95 or N100 maskper applicable local or state guidance) 204
205
206
207
208
i. Injur y Prevention Equipment 209
1. All individuals in an ambulance need to be restrained; this includes using Federally approved child safety seats 210
2. Protective helmet/ jackets or coats/ pants/ boots 211
3. Fire extinguisher 212
4. Hazardous material reference guide 213
5. Reflective safety wear for each crewmember (must meet or exceed ANSI/ISEA performance class II or III if working 214
within the right of way of any federal-aid highway. Visit http://www.reflectivevest. com/federalhighwayruling.html for 215
more information). 216
217
218
Required Equipment: Advanced Life 219
Support: (ALS) Ambulances 220
221
For EMT-Paramedic ser vices, include all of the required equipment listed for the basic level provider, plus the 222
following additional equipment and supplies. For EMT-Intermediate ser vices (and other nonparamedic 223
advanced levels), include all of the equipment for the basic level provider and selected equipment and supplies 224
from the following list, based on local need and consideration of prehospital characteristics and budget. 225
226
A. Airway and V entilation Equipment 227
228
1. Laryngoscope handle with extra batteries and bulbs 229
2. Laryngoscope blades, sizes 230
0 4, straight (Miller); sizes 231
24, curved, (MacIntosh) 232
3. Endotracheal tubes (if ALS service scope of practice includes tracheal intubation) 233
sizes 2.5 5.5 mm c u ff e d a n d /o r uncuffed and 234
6 8 mm cuffed (1 each), other sizes optional 235
4. 10 -mL non-Luerlock syringes 236
5. Stylettes for endotracheal tubes, adult and pediatric 237
6. Magill (Rovenstein) forceps, adult and pediatric 238
239
7. End-tidal CO 240
241
242
detection capability (adult and pediatric) 243
8. Alternative airway devices (for example, a rescue airway device such as the ETDLA [esophageal- 244
tracheal double lumen airway], laryngeal tube, or laryngeal mask airway) as approved by local medical 245
direction. 246
247
248
249
250
251
252
b. Vascular Access 253
1. Cr ystalloid solutions, such as Ringers lactate or normal saline solution (1,000 -mL bags x 254
4); fluid must be in bags, not bottles; type of fluid may var y depending on state and 255
local requirements 256
2. Antiseptic solution (alcohol wipes and 257
povidone- iodine wipes preferred) 258
3. IV pole or roof hook 259
4. Intravenous catheters 14G 24G 260
5. Intraosseous needles or devices appropriate for children and adults 261
6. Venous tourniquet, rubber bands 262
7. Syringes of various sizes 263
8. Needles, various sizes (one at least 1 for IM injections) 264
9. Intravenous administration sets (microdrip and macrodrip) 265
10. Intravenous arm boards, adult and pediatric 266
267
c. Cardiac 268
1. Portable, battery-operated monitor/defibrillator 269
With tape write-out/ recorder, defibrillator pads, quick-look paddles or electrode, 270
or hands- free patches, ECG leads, adult and pediatric chest attachment electrodes, 271
adult and pediatric paddles 272
2. Transcutaneous cardiac pacemaker, including pediatric pads and cables 273
Either stand-alone unit or integrated into monitor/defibrillator 274
275
D. Other Advanced Equipment 276
1. Nebulizer 277
2. Glucometer or blood glucose measuring device 278
With reagent strips 279
3. Large bore needle (should be at least 3.25 in length for needle chest decompression in large adults) 280
4. A length based pediatric dosing tape or appropriate reference material that converts length to estimated ideal 281
body weight in kilograms for pediatric drug dosing and equipment sizing, based on the most current 282
guidelines. 283
284
E. M edications 285
Medications used on advanced level ambulances should be compatible with current guidelines as 286
published by the American Heart Associations Committee on Emergency Cardiovascular Care, as 287
reflected in the Advanced Cardiac Life Support and Pediatric Advanced Life Support Courses, or other 288
such organizations and publications (ACEP, ACS, NAEMSP, and so on). Medications may var y 289
depending on state requirements and/or local medical control. Drug dosing in children should use processes 290
minimizing the need for calculations, preferably a length-based system. In general, medications may 291
include: 292
293
Cardiovascular medication, such as 1:10,000 epinephrine, atropine, antidysrhythmics 294
(for example, adenosine and 295
amiodarone), calcium channel blockers, beta-blockers, nitroglycerin tablets, aspirin, vasopressor 296
for 297
infusion 298
299
Cardiopulmonary/respiratory medications, such as albuterol (or other inhaled beta agonist) 300
and ipratropium bromide, 301
1:1,000 epinephrine, 302
furosemide 303
50% dextrose solution (and sterile diluent or 25% dextrose solution for pediatrics) 304
Analgesics, narcotic and nonnarcotic 305
Anti-epileptic medications, such as diazepam or midazolam 306
Sodium bicarbonate, magnesium sulfate, glucagon, naloxone hydrochloride, calcium chloride 307
Bacteriostatic water and sodium chloride for injection 308
Additional medications as per local medical director 309
310
Optional Equipment 311
312
This section is intended to assist EMS providers in choosing equipment that can be used to ensure 313
delivery of quality prehospital care. Use should be based on local resources. The equipment in this 314
section is not mandated or required. 315
316
A. Optional Basic Equipment 317
318
1. Glucometer or blood glucose test strips (per state protocol) 319
2. Elastic bandages 320
Nonsterile (various 321
sizes) 322
3. Cellular phone 323
4. Infant oxygen mask 324
5. Infant self-inflating resuscitation bag 325
6. Air ways 326
Nasopharyngeal (12, 14 Fr) 327
Oropharyngeal (size 00) 328
8. Hot/cold packs 329
9. Neonatal blood pressure cuff 330
10. Infant blood pressure cuff 331
11. Pediatric stethoscope 332
12. Femur traction device (adult and child sizes) 333
12. Infant cervical immobilization device 334
13. Pediatric backboard and extremity splints 335
14. Topical hemostatic agent/bandage 336
15. Appropriate CBRNE PPE (chemical, biological, radiological, nuclear, explosive 337
personal protective equipment), including respiratory 338
andbody 339
protection 340
16. Applicable chemical antidote autoinjectors (at a minimum for crew members 341
protection; additional for victim treatment based on local or regional 342
protocol; appropriate for adults and children) 343
344
345
346
347
348
349
350
351
352
b. Optional Advanced Equipment 353
1. Respirator 354
Volume-cycled, on/off operation, 100% oxygen, 40 50 psi pressure (child/infant 355
capabilities) 356
2. Blood sample tubes, adult and pediatric 357
3. Automatic blood pressure device 358
4. Nasogastric tubes, pediatric feeding tube sizes 5F and 8F, sump tube sizes 8F16F 359
5. Pediatric laryngoscope handle 360
6. Size 1 curved (MacIntosh) laryngoscope blade 361
7. 3.5 5.5 mm cuffed endotracheal tubes 362
8. Gum elastic bougies 363
9. Longer angiocatheters or needles for chest decompresson 364
9. Needle cricothyrotomy capability and/or cricothyrotomy capability (surgical cricothyrotomy can 365
be performed in older children in whom the cricothyroid membrane is easily palpable, usually by 366
the age of 12 years) 367
10. Alternative airway devices for children (few alternative airway devices that are FDA approved have 368
been studied in children. Those that have been studied, such as the LMA, have not been adequately 369
evaluated in the prehospital setting). 370
11. Atomizers for administration of intranasal medications 371
372
373
374
Optional Medications 375
376
A. Optional Basic Life Support Medications 377
378
1. Albuterol 379
2. Epi pens 380
3. Oral glucose 381
4. Nitroglycerin (sublingual tablet or paste) 382
383
384
b. Optional Advanced Life Support Medications 385
1. Anxiolytics 386
2. Intubation adjuncts including neuromuscular blockers 387
Interfacility Transport 388
389
Additional equipment may be needed by ALS and BLS prehospital care providers who transport patients 390
between facilities. Transfers may be done to a lower or higher level of care, depending on the specific need. 391
Specialty transport teams, including pediatric and neonatal teams, may include other personnel such as 392
respiratory therapists, nurses, and physicians. Training and equipment needs may be different depending on 393
the skills needed during transport of these patients. There are excellent resources available that provide 394
detailed lists of equipment needed for interfacility transfer such as the American Academy of Pediatrics 395
Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients. 396
397
Any ambulance that, either by formal agreement or circumstance, may be called into service during a 398
disaster or mass casualty incident to treat and/or transport any patient from the scene to the hospital, or to 399
transfer between facilities any patient other than those within their designated specialty population should 400
carry, at a minimum, all equipment, adult and pediatric, listed under Required Equipment: Basic Life 401
Support (BLS) Ambulances. 402
403
404
Extrication Equipment 405
Adequate extrication equipment must be readily available to the emergency medical services responders, 406
but is more often found on heav y rescue vehicles than on the primar y responding ambulance. 407
408
In general, the devices or tools used for extrication fall into several broad categories: disassembly, 409
spreading, cutting, pulling, protective, and patient-related. 410
411
The following is necessar y equipment that should be available either on the primar y response vehicle or 412
on a heav y rescue vehicle. 413
414
Disassembly Tools 415
Wrenches (adjustable) 416
Screwdrivers (flat and Phillips head) 417
Pliers 418
Bolt cutter 419
Tin snips 420
Hammer 421
Spring-loaded center punch 422
Axes (pry, fire) 423
Bars (wrecking, crow) 424
Ram (4 ton) 425
426
Spreading Tools 427
Hydraulic jack/spreader/cutter combination 428
429
Cutting Tools 430
Saws (hacksaw, fire, windshield, pruning, reciprocating) 431
Air-cutting gun kit with air supply 432
433
Pulling Tools/Devices 434
Ropes/chains 435
Come-along 436
Hydraulic truck jack 437
Air bags with air supply 438
439
440
441
442
443
444
445
Protective Devices 446
Reflectors/flares 447
Protective helmet 448
Safety goggles 449
Fireproof blanket 450
Leather gloves 451
Jackets/coats/boots 452
453
Patient-Related Devices 454
Stokes basket 455
SKED rescue stretcher 456
457
Miscellaneous 458
Shovel 459
Lubricating oil 460
Wood/wedges 461
Generator 462
Floodlights 463
Adsorbent 464
Local extrication needs may necessitate additional equipment for water, aerial, or mountain rescue. 465
466
467
468
469
SELECTED REFERENCES 470
471
472
American Academy of Pediatrics Section on Transport Medicine. Guidelines for Air and Ground Transport 473
of Neonatal and Pediatric Patients, 3rd edition. George A. Woodward, MD, MBA, FAAP (ed.), 2007. 474
475
476
American College of Surgeons Committee on Trauma, Advanced Trauma Life Support Student Course 477
Manual (Eighth Edition), 2008. 478
479
480
American Heart Association 481
482
Pediatric Advanced Life Support Provider Manual, 2006. 483
484
485
Brennan JA, Krohmer J (eds), Principles of EMS Systems. Jones and 486
487
Bartlett Publishers, Sudbury, Ma. 2005. 488
489
490
Brown MA, Daya MR, Worley JA: Experience with chitosan dressings in a civilian EMS system. J Emerg 491
Med 2007: Nov 14 (doi:10.1016/j.jemermed.2007.05.043). 492
493
494
Cervical spine immobilization before admission to the hospital. Neurosurgery. 2002; 50(3 Suppl):S7-17. 495
496
497
Doyle GS, Taillac PP. Tourniquets: a review of current use with proposals for expanded prehospital use. 498
Prehosp Emerg Care 2008; 12(2):241-56. 499
SELECTED REFERENCES 500
(WE WILL NEED TO RECONCILE THE TWO LISTS AND PARE DOWN TO THE ESSENTIAL) 501
(I HAVE HIGHLIGHTED REFERENCES IN GREEN THAT I THINK COULD COME OUT) 502
(I HAVE HIGHLIGHTED REFERENCES IN GRAY THAT COULD BE UPDATED OR ELIMINATED 503
IF NEWER REFERENCES ARE AVAILABLE) 504
505
506
THESE ARE THE ORIGINAL REFERENCES 507
508
509
ACEP Policy Statement, American College of Emergency Physicians 510
and Medical Direction of Emergency Medical Services 511
http://www.acep.org 512
513
514
Federal Specifications for the Star-of-Life Ambulance KKK-A-1822F, August 1, 2007. 515
516
517
Future of EMS in the US Health Care System 518
Institute of Medicine, May 17, 2007 519
520
www.iom.edu. 521
522
523
James I: Cuffed tubes in children (editorial). Paediatric Anaesthesia 2001; 11(3):259-63. 524
525
526
Kwan I, Bunn F: Effects of prehospital spinal immobilization: a systematic review of randomized trials on 527
healthy subjects. Prehosp Disaster Med 2005; 20(1):47-53. 528
529
530
National Highway Traffic Safety Association: www.nhtsa.gov 531
Child Restraint Re-use After Minor Crashes. 532
www.nhtsa.dot.gov/people/injury/childps/ChildRestraints/ReUse/RestraintReUse.htm - 5k - 2004-02-05 533
534
535
Orliaguet G, Renaud E, Lejay M, et al: Postal survey of cuffed or uncuffed 536
tracheal tubes used for paediatric tracheal intubation. Paediatric Anaesthesia 2001; 537
11(3):277-281. 538
539
540
Federal Highway Administration, DOT 541
CFR-634.2 and 634.3 Worker Visibility 542
Use of High-Visibility Apparel When Working on Federal-Aid Highways 543
http://www.reflectivevest.com/federalhighwayruling.html 544
545
546
Resources for Optimal Care of the Injured Patient 547
American College of Surgeons Committee on Trauma 548
Chicago 1999, 2006, 2009. 549
550
551
Rumball CJ, MacDonald D: The PTL, combitube, laryngeal mask, and oral airway: a randomized 552
prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of 553
cardiorespiratory arrest. Prehosp Emerg Care 1997; 1(1):1-10. 554
555
NAEMT. Prehospital Trauma Life Support, 7
TH
ed. St. Louis: Elsevier, 2011. 556
557
558
Treloar OJ. Nypaver M: Angulation of the pediatric cervical spine with and without cervical collar. Prehosp 559
Emerg Care 1997; 13(1):5-8. 560
561
562
Wedmore I, McManus JG, Pusateri AE, Holcomb JB: A special report on the chitosan-based hemostatic 563
dressing: experience in current combat operations. J Trauma 2006; 60(3):655-8. 564
565
566
Youngquist S, Gausche-Hill M, Burbulys D: Alternative airway devices for use in children requiring 567
prehospital airway management: Update and case discussion. Pediatr Emerg Care 2007; 23:1-10. 568
569
570
THESE ARE PROPOSED NEW REFERENCES 571
(Prior publication of Equipment for Ambulances ACEP is listed in the original list above) 572
Bulletin of the American College of Surgeons 94(7):23-29, 2009. 573
Pediatrics 124(1):e166-e171, 2009. 574
Prehospital Emergency Care 13(3):364-369, 2009. 575
576
577
* REFERENCES FOR REMOVAL OF TRACTION SPLINT 578
1. Agrawal Y, Karwa J, Shah N. Traction splint: to use or not to use. BJPN. 2009; 19(9): ISSN 1467- 579
1026. 580
2. Bledsoe BE, Barnes D. Traction splint: an EMS relic? J of EMS. 2004; 29(8): 64-69. 581
582
583
** REFERENCES FOR HEMOSTATIC BANDAGES (CAN WE PICK 2 OR 3?) 584
585
1. Margolis J. Initiation of blood coagulation by glass and related surfaces. Journal Physiol 1957;137:95-109. 586
2. Margolis J. Activation of plasma by contact with glass: evidence for a common reaction which releases plasma 587
kinin and initiates coagulation. Journal Physiol 1958;144:1-22. 588
3. Margolis J. The kaolin clotting time; a rapid one-stage method for diagnosis of coagulation defects. J Clin 589
Pathol 1958;11:406-409. 590
4. Griffin JH. Role of surface in surface-dependent activation of Hageman factor (blood coagulation factor XII). 591
Proceedings of the National Academy of Sciences of the United States of America 1978;75:1998-2002. 592
5. Griffin JH, Cochrane CG. Mechanisms for the involvement of high molecular weight kininogen in surface- 593
dependent reactions of Hageman factor. Proceedings of the National Academy of Sciences of the United States 594
of America 1976;73:2554-2558. 595
6. Sugo T, Kato H, Iwanaga S, Takada K, Sakakibara S. Kinetic studies on surface-mediated activation of bovine 596
factor XII and prekallikrein. Effects of kaolin and high-Mr kininogen on the activation reactions. Eur J Biochem 597
FEBS 1985;146:43-50. 598
7. Mackman N. Role of tissue factor in hemostasis and thrombosis. Blood Cell Mol Dis 2006;36:104-107. 599
8. Mann KG, Brummel-Ziedins K, Orfeo T, Butenas S. Models of blood coagulation. Blood Cell Mol Dis 600
2006;36:108-117. 601
9. Kheirabadi BS, Mace JE, Terrazas IB, et al. Safety evaluation of new hemostatic agents, smectite granules, and 602
kaolin-coated gauze in a vascular injury wound model in swine. J Trauma. 2010;68: 269278. 603
604
605
606
*** REFERENCES FOR REMOVAL OF MECONIUM ASPIRATOR 607
1. Kattwinkel J, Perlman JM, Aziz K, et al. Part 15: Neonatal resuscitation: 2010 American Heart 608
Association guidelines for cardiopulmonary resuscitation and emergency cardiac care. Circulation: 609
J of the AHA. 2010. 610
REFERENCE SUPPORTING PEDIATRIC AED CAPABILITIES 611
612
1. Berg MD, Schexnayder SM, Chameides L, et al. Part 13: pediatric basic life support: 2010 613
American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency 614
Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S862-75. 615
2. From the American Academy of Pediatrics. Section on Cardiology and Cardiac Surgery. Policy 616
Statement: Pediatric sudden cardiac arrest. Pediatrics 2012; 129:4 e1094-e1102; published ahead 617
of print March 26, 2012, doi:10.1542/peds.2012-0144. 618
619
REFERENCE SUPPORTING CERVICAL IMMOBILIZATION COLLARS FOR 2 YEARS AND 620
OLDER: 621
1. Leonard JC, Kuppermann N, Olsen C, et al. Factors associated with cervical spine injury in 622
children after blunt trauma. Ann Emerg Med. 2011;58(2):145-55. 623
REFERENCE FOR TRANPORT OF CHILDREN IN AN AMBULANCE 624
625
1. NHTSA. Recommendations for the safe transportation of children in ground ambulances. Best- 626
practice recommendations developed by an expert working group convened by the National 627
Highway Traffic Safety Administration. May 2012. Prepared under Contract DTNH22-08-C00085 628
with Maryn Consulting, Inc. 629
REFERENCE FOR ADVANCED OUT OF HOSPITAL AIRWAY CONTROL FOR ALS SERVICES 630
631
1. Gausche M, Lewis RJ, Stratton SJ, et al. Effect of out-of-hospital pediatric endotracheal intubation 632
on survival and neurological outcome. JAMA. 2000;283(6):783-790. 633
2. Lecky F, Bryden D, Little R, et al. Emergency intubation for acutely ill and injured 634
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