County of Santa Clara Emergency Medical Services System

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1 County of Santa Clara Emergency Medical Services System Policy # 302: Prehospital Care Asset - Minimum Inventory Requirements PREHOSPITAL CARE ASSET MINIMUM INVENTORY REQUIREMENTS Effective: November 4, 2016 Replaces: June 11, 2015 Review: November 1, 2017 Resources: None I. Purpose The purpose of this policy is to establish minimum inventory requirements for all prehospital care assets in Santa Clara County. II. Definitions (Prehospital Assets) Air Ambulance Any Santa Clara County permitted air ambulance, either basic or advanced life support in accordance with Title 22 Regulations. This unit is staffed with one nurse and one additional nurse or paramedic. Ambulance Any Santa Clara County approved advanced life support ambulance staffed by at least one paramedic and one EMT or paramedic. Unit (Non-) Any unit charged with emergency medical response at the advanced life support level that is not designed for the transport of a patient including fire engines, trucks, quick response vehicles, etc. Staffing must include at least one paramedic. BLS Ambulance Any Santa Clara County approved basic life support ambulance staffed with at least two EMT s. BLS Unit (Non-) Any unit charged with emergency medical response at the basic life support level that is not designed for the transport of a patient including fire engines, trucks, supervisors units, etc. Staffing must include at least one EMT. Critical Care (CCT) Ambulance Any Santa Clara County approved critical care transport ambulance staffed with at least one nurse meeting the requirements of Policy 207 Mobile Intensive Care Nurse Accreditation, and two additional crew members with EMT certification and county accreditation at minimum. Additional equipment not identified in this policy may be carried as authorized by the provider s medical director for use by the nurse. If a critical care transport unit nurse has completed a system orientation and is trained to the same operational level as Santa Clara County EMT s; the unit may be alternately staffed by one EMT or paramedic, and one nurse who is responsible for all patient care. Page 1 of 24

2 EMS Field Supervisor A non-transport unit utilized for filling command and control responsibilities. This unit may or may not be utilized for the provision of patient care. Only permitted EMS supervisor vehicles, staffed with accredited personnel, may fill ICS positions and/or serve as an ambulance strike team unit leader. III. Requirements The quantities identified below represent the minimum supply that must be carried at all times in order for a unit to be in service. Providers may exceed the minimums required quantities at their discretion but may never drop below it. The EMS Agency may authorize exceptions to the minimum requirements in times of disaster, during multicasualty incidents, etc. Page 2 of 24

3 Table of Contents I. Minimum Inventory Requirements... 4 A. Medications... 4 B. Medication Infusion Supplies and Equipment... 5 C. Airway Management Supplies and Equipment... 6 D. Patient Assessment Supplies and Equipment... 7 E. Trauma Supplies and General Equipment... 7 F. General Equipment... 8 G. Personal Protective Equipment... 9 II. Air Ambulance Inventory Requirements...10 A. Air Ambulance Medications B. Air Ambulance Medication Infusion Supplies & Equipment C. Air Ambulance Airway Management Supplies & Equipment D. Air Ambulance Patient Assessment Supplies & Equipment E. Air Ambulance Trauma Supplies & Equipment F. Air Ambulance General Equipment G. Air Ambulance Personal Protective Equipment III. BLS Minimum Inventory Requirements...14 A. BLS Medication / Medical Infusion Supplies and Equipment / Airway Management Supplies & Equipment / Patient Assessment Supplies / Equipment B. BLS Trauma Supplies and Equipment C. BLS General Equipment D. BLS Personal Protective Equipment IV. Critical Care Ambulance Minimum Inventory Requirements...17 A. CCT Medications B. CCT Medication Infusion Supplies & Equipment C. CCT Airway Management Supplies & Equipment D. CCT Patient Assessment Supplies & Equipment E. CCT Trauma Supplies & Equipment F. CCT General Equipment G. CCT Personal Protective Equipment V. EMS Field Supervisor Inventory Requirements...22 A. EMS Field Supervisor Inventory Requirements B. EMS Field Supervisor General Equipment C. Personal Protective Equipment Page 3 of 24

4 I. Minimum Inventory Requirements A. Medications Medications Non- Activated Charcoal in Aqueous Solution 50 mg 50 mg Adenosine 30 mg 30 mg Albuterol 2.5 mg in 3 ml NS (bullet) 6 bullets 4 bullets Atropine Sulfate 20 mg 20 mg Calcium Chloride 3 g 3 g Chewable Aspirin 648 mg 648 mg Dextrose 50% and/or Dextrose 10% 25 g in 250 ml bag for a total of 50 g 50 g 50 g Diazepam (if midazolam is not available) 20 mg 20 mg Diphenhydramine 100 mg 50 mg Dopamine 400 mg or 400 mg or 400 mg or (premix bag in D5W or NS; or vial/preload to mix) 1 bag 1 bag Epinephrine 1:1,000 3 mg 2 mg Epinephrine 1:10,000 preload or equivalent (1mg/preload) 5 mg 3 mg Glucagon 2 mg 1 mg Lidocaine Infusion 1 g or (Premixed Bag) 1 g 1 g Lidocaine 500 mg 300 mg Lorazepam (if midazolam and diazepam are not available) 20 mg 15 mg Mark I Auto-injector or DuoDote 6 devices 6 devices Midazolam 15 mg 10 mg Morphine Sulfate 20 mg 20 mg Naloxone 8 mg 4 mg Nitroglycerine: Oral Spray or Oral Dissolving Tablets 2 bottles 2 bottles Nitroglycerine Paste: 1 tube or 1 tube or Tube or Individual Packets 4 packets 4 packets Normal Saline 0.9% 4000 ml 2000 ml Ondansetron 16 mg 16 mg Oral Glucose (25 g tube) 2 tubes 2 tubes Sodium Bicarbonate 8.4% 100 meq 50 meq Page 4 of 24

5 B. Medication Infusion Supplies and Equipment Medication Infusion Supplies & Equipment Non- Alcohol Preparation Pads Arm board (adult size, may be cut for smaller needs) 1 Glucose Reagent Strips (bottle) (electronic meter and strips permissible, venous/capillary samples) 1 Injection Needles (size 21 G and 25 G) 2 2 Intraosseous Needles (16G) 2 2 Intraosseous (IO) Needle Insertion Device (FDA Approved) 1 Intraosseous (IO) Needle (for FDA Approved Device) 1 - Large Adult 1 - Adult 1 - Child 1 ea 1 ea IV Catheters (sizes 14, 16, 18, 20, 22, 24 G) 3 ea 2 ea IV Tubing Sets (each of micro and macro) 2 ea 1 ea IV extension tubing 2 Lancets (must auto secure lancet after use) 5 2 Sharps Container 1 3-way Stop Cock 1 Syringes with Luer-Lock (1cc, 3cc, 10cc, and 30cc) 2 ea 2 ea Tourniquets Band Elastic (for use with IV insertion) 1 Page 5 of 24

6 C. Airway Management Supplies and Equipment Airway Management Supplies & Equipment Non- Adult Nasal Cannula 2 2 Bag Valve Mask Resuscitator (suitable for pediatrics, children, and adults with connection tubing) 2 ea 1 ea Boussignac Continuous Positive Airway Pressure (CPAP) Device 1 Capnography Device (colorimetric or waveform) 2 Cuffed Endotracheal Tubes with Stylet (each size: 6.0, 7.0, 8.0, 9.0 mm) 2 ea 1 ea (0.5 sizes also recommended / not required) Endotracheal Tube Inducer (County approved) 2 Handheld Nebulizer (Inspiratory-activation style recommended) 3 French Suction Catheters (Qty 1 of any Size 6-10 and 12-18) 2 ea 2 ea Laryngoscope (assorted straight/curved blades for infants, children, and 1 adults with a spare set of batteries/bulb) Perilaryngeal Airway Device (County approved) each size 2 ea 1 ea Magill Forceps (adult & pediatric) 1 ea 1 ea Nasopharyngeal Airways Kit 2 Non-Rebreather Oxygen Masks Adult 3 Non-Rebreather Oxygen Masks Pediatric 1 Oropharyngeal Airways Kit 1 Oxygen Regulator (capable of delivering oxygen at flow rates from 2-25 LPM to support use of the Boussignac 1 Continuous Positive Airway Pressure (CPAP) device) Portable Oxygen Cylinder (D or E size with at least 500 PSI of Oxygen) 1 Portable Suction Device (a bulb syringe is not sufficient for this requirement) 1 Suction Wands 2 Uncuffed Endotracheal Tubes with Stylet (2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5 mm) 1 ea 1 ea Vehicle mounted oxygen delivery system, including regulators capable of dispensing oxygen at a flow rate of 2 to 25 liters per minute in support of the Boussignac Continuous Positive Airway Pressure (CPAP) device. Must carry at least 500 PSI of Oxygen in an M or H size oxygen cylinder or an onboard liquid oxygen system (LOX) Page 6 of 24

7 D. Patient Assessment Supplies and Equipment Patient Assessment Supplies and Equipment Non- Blankets (Disposable Acceptable) 2 Blood Pressure Cuff: Thigh, Adult, Child, and Infant 1 ea 1 ea Chemical Activated Cold Packs 3 2 Chemical Activated Heat Packs (exempt if electric warming blanket used) 2 0 Conductive Gel or Pads (moist 4 X 4 pads not acceptable, not required if using multifunction pads) 2 2 Disposable Sheets 4 0 ECG Electrodes Adult ECG Electrodes - Pediatrics Length Base Resuscitation Tape 1 OB Kit 1 Portable Cardiac Monitor/Defibrillator with one spare battery & paper 1 Pulse Oximeter ( assets may use a device that is included in the cardiac monitor) 1 - Adult 1 - Pediatric 1 Stethoscope (Latex Free) 1 Thermometer Digital Oral or Tympanic 1 Set of Ankle and Wrist Restraints (hard leather or velcro) E. Trauma Supplies and General Equipment Trauma Supplies & Equipment Non- Adhesive Tape Rolls (1 inch and 2 inch) 3 ea 1 ea Lateral Head Support Devices 2 Long Plastic Radio Translucent Spine Board (see Schedule B) 2 Mechanical Tourniquet Device (County Approved Commercial Vendor) 2 2 Occlusive Dressings 2 2 Rigid Cervical Collars (infant, child and adult or if unisize, a total of 4 are required) 2 ea 2 ea Splints (Pneumatic or rigid extremity) 4 2 Sterile 4 Inch Gauze Rolls 6 2 Sterile 4 X 4 Inch Gauze Pads 12 6 Traction Splint (Adult & Pedi required may be one device) Trauma Dressings (10 x30 or larger) 2 2 Trauma Shears 2 2 Triage Tags (DMS version) (County Approved) Triangular Bandages 4 2 Webbed Belt or Strapping Device 2 2 Page 7 of 24

8 F. General Equipment General Equipment Page 8 of 24 Non- 2A, 10BC Fire Extinguisher (air unit equivalent acceptable, fire service apparatus exempt) 1 Bed Pan Blue Helmets (Fire/Public Safety exempt) 2 2 Collapsible gurney with straps to secure the patient to the gurney and fastening device to secure to the ambulance County Approved 800 MHz Mobile Radio (private ambulance services only) County Approved 800 MHz Portable Radio (private ambulance services only - includes a spare battery per portable) County Approved 800 MHz Portable Radio (EOA Contractor ambulances must be equipped with 2 spare batteries) County Approved UHF Radio Pager (Private ground ambulance services only) County Approved UHF Radio Pager (EOA Contractor ambulances) 2 0 County Approved UHF Mobile Radio (EOA Contractor Requirement Only) County Approved VHF Mobile Radio (EOA Contractor Requirement Only) Disposable Sheets 4 0 DOT Approved Child Safety Restraint (may or may not be a child seat) DOT Emergency Response Guidebook (must be current edition, may be electronic) 1 Drinking Water in 8-12oz Individual Containers or equivalent (for patient use and secondary rehab functions) 5 2 Fire Scope Field Operations Guide (FOG) (must be hardcopy of current edition) 1 Flat Stretcher (includes Redibed, flats, scoops) ICS 219 Resources Status Cards (T-Cards) 2 2 Map covering all of Santa Clara County that utilizes the same grid coordinate system used by County 1 Communications (air unit exempt) Mobile Cellular Phone 1 Multiple Patient Management Plan (EMS#811) (hardcopy is required) 1 Pillows (must be disposable or have disposable covers) 2 0 Portable Battery Operated Light or Rechargeable Light (includes at least one set of spare batteries) 2 2 Quick Reference Guide Fire Service Officers 1 Quick Reference Guide Private EMS Service Providers 1

9 General Equipment (continued) Non- Santa Clara County Approved Patient Care Report (PCR) (Hardcopy for disaster/mci response) 20 5 Santa Clara County Prehospital Care Manual (may be electronic or kept in quarters) 1 State of California Thomas Brothers Map (hardcopy required) Towels 2 0 Urinal 0.5% bleach solution (sufficient quantities for equipment disinfection) 1 G. Personal Protective Equipment Personal Protective Equipment (PPE) Non- Bactericidal / Virucidal Hand Wipes or equivalent (box of 25 or equivalent) 1 Eye protection (glasses or goggles) 1 per crewmember 1 per crewmember Face shield 2 per crewmember Impermeable gown or coveralls or suits (with surgical hood extending to shoulders) 2 per crewmember Impermeable leg and shoe covers (exempt if provided by coveralls or suits) 2 per crewmember Infectious Waste Bags 5 2 Pair of Leather Work Gloves (recommend one pair provided to each employee to ensure sizing) Nitrile Gloves (assorted sizes to fit all crew members) 1 box ea size 1 box ea size P100 Masks 2 per crewmember N95 particulate respirator 2 per crewmember Page 9 of 24

10 II. Air Ambulance Inventory Requirements A. Air Ambulance Medications Air Ambulance Medications Adenosine 18 mg Albuterol 2.5 mg in 3 ml NS (bullet) 4 bullets Atropine Sulfate 20 mg Calcium Chloride 2 g Chewable Aspirin 648 mg Dextrose 50% and/or Dextrose 10% 25 g in 250 ml bag for a total of 50 g 50 g Diazepam (if midazolam is not available) 20 mg Diphenhydramine 50 mg Dopamine 400 mg (premix bag in D5W or NS; or vial/preload to mix) 400 mg or 1 bag Epinephrine 1:1,000 2 mg Epinephrine 1:10,000 Preload or equivalent (1 mg/preload) 3 mg Glucagon 1 mg Lidocaine Infusion 1 g or (Premixed Bag) 1 g Lidocaine 200 mg Lorazepam (if midazolam and diazepam are not available) 20 mg Mark I Auto-injector or DuoDote 6 devices Midazolam 10 mg Morphine Sulfate 10 mg Naloxone 8 mg Nitroglycerine: Oral Spray or Oral Dissolving Tablets 1 bottle Nitroglycerine Paste: Tube or Individual Packets 1 tube or 4 packets Normal Saline 0.9% 2000 ml Sodium Bicarbonate 8.4% 100 meq B. Air Ambulance Medication Infusion Supplies & Equipment Air Ambulance Medication Infusion Supplies & Equipment Alcohol Preparation Pads 10 Glucose Reagent Strips (bottle) (electronic meter & strips permissible, venous/capillary samples) 4 strips Injection Needles 25G 2 Intraosseous (IO) Needle Insertion Device (FDA Approved) Intraosseous (IO) Needle (for FDA Approved Device) 1 Large Adult 1 - Adult 1 - Child 1 ea IV Catheters (sizes 14, 16, 18, 20, 22, 24 G) 2 ea IV Tubing Sets 2 Lancets (must auto secure lancet after use) 5 Sharps Container Syringes with Luer-Lock (size appropriate for med concentration or equipment) 2 ea Tourniquets Band Elastic (for use with IV insertion) Page 10 of 24

11 C. Air Ambulance Airway Management Supplies & Equipment Air Ambulance Airway Management Supplies & Equipment Bag Valve Mask Resuscitator (suitable for pediatrics, children, adults with connection tubing) 1 ea Boussignac Continuous Positive Airway Pressure (CPAP) Device (CPAP device requires O2 regulator capable of delivering 25 LPMs) Capnography Device (colorimetric or waveform) Endotracheal Tubes with Stylet (Assorted sizes for Neonate, Pediatric and adult) 2 ea Endotracheal Tube Inducer (County Approved) 2 French Suction Catheters (Assorted sizes for Pediatric and Adult) 1 ea Handheld Nebulizer (Inspiratory-activation style recommended) Laryngoscope (assorted straight/curved blades for infants, children, and adults with a spare set of batteries/bulb) Magill Forceps (adult & Pediatric) 1 ea Non-Rebreather Oxygen Masks Adult 2 Non-Rebreather Oxygen Masks Pediatric Oropharyngeal Airways Kit Oxygen Regulator (capable of delivering oxygen at flow rates from 2-25 LPM to support use of the Boussignac Continuous Positive Airway Pressure (CPAP) device) Perilaryngeal Airway Device (County Approved) each size 1 ea Portable Oxygen Cylinder (D or E size with at least 500 PSI of Oxygen) Portable Suction Device (bulb syringe is not sufficient for this requirement) Suction Wands 2 Mounted oxygen delivery system, including regulators capable of dispensing oxygen at a flow rate of 2 to 25 liters per minute in support of the Boussignac Continuous Positive Airway Pressure (CPAP) device. Must carry at least 500 PSI of Oxygen to last at least 30 min. D. Air Ambulance Patient Assessment Supplies & Equipment Air Ambulance Patient Assessment Supplies & Equipment Blankets (Disposable Acceptable) Blood Pressure Cuff: Thigh, adult, Child, and infant 1 ea Conductive Gel or Pads 2 (moist 4 X 4 pads not acceptable, not required if using multifunction pads) ECG Electrodes Adult 6 ECG Electrodes - Pediatrics 6 Length Base Resuscitation Tape OB Kit Portable Cardiac Monitor/Defibrillator with one spare battery & paper Pulse Oximeter ( assets may use a device that is included in the 1 cardiac monitor) 1 - Adult 1 - Pediatric Stethoscope (Latex Free) Thermometer Digital Oral or Tympanic Page 11 of 24

12 E. Air Ambulance Trauma Supplies & Equipment Air Ambulance Trauma Supplies & Equipment Adhesive Tape Rolls (1 inch and 2 inch) 2 ea Lateral Head Support Devices Long Plastic Radio Translucent Spine Board (see Schedule B) Mechanical Tourniquet Device (County Approved Commercial Vendor) Occlusive Dressings Rigid Cervical Collars (infant, child and adult or if unisize, a total of 2 required) 1 ea Splints (Pneumatic or rigid extremity) Sterile 4 Inch Gauze Rolls Sterile 4 X 4 Inch Gauze Pads 4 Traction Splint (Adult & Pedi required may be one device) Trauma Dressings (Minimum 10 x 30 or larger) Trauma Shears Triage Tags (DMS version) (County Approved) 5 Webbed Belt or Strapping Device 2 F. Air Ambulance General Equipment Air Ambulance General Equipment 2A, 10BC Fire Extinguisher (air unit equivalent acceptable, fire service apparatus exempt) FAA approved patient securing device County Approved 800 MHz Mobile Radio (private ambulance services only) County Approved 800 MHz Portable Radio (private ambulance services only - includes a spare battery per portable) DOT Emergency Response Guidebook (must be current edition, may be electronic) ICS 219 Resources Status Cards (T-Cards) 3 Multiple Patient Management Plan (EMS#811) (a hardcopy is required) Portable Battery Operated Light or Rechargeable Light (includes at least one set of spare batteries) Quick Reference Guide Private EMS Service Providers Santa Clara County Prehospital Care Manual (may be electronic or kept in quarters) 0.5% bleach solution (sufficient quantities for equipment disinfection) Page 12 of 24

13 G. Air Ambulance Personal Protective Equipment Personal Protective Equipment (PPE) Bactericidal/Virucidal Hand Wipes or equivalent (box of 25 or equivalent) Eye protection (glasses or goggles) 1 per crewmember Face shield Impermeable gown or coveralls or suits (with surgical hood extending to shoulders) Impermeable leg and shoe covers (exempt if provided by coveralls or suits) Infectious Waste Bags 2 Nitrile Gloves (assorted sizes to fit all crew members) 1 box of each P100 Masks N95 particulate respirator Page 13 of 24

14 III. BLS Minimum Inventory Requirements A. BLS Medication / Medical Infusion Supplies and Equipment / Airway Management Supplies & Equipment / Patient Assessment Supplies / Equipment BLS Medications / Infusion Supplies & Equipment BLS BLS Non- Oral Glucose (25 g tube) 2 tubes 2 tubes Alcohol Preparation Pads 5 5 BLS Airway Management Supplies & Equipment BLS BLS Non- Adult Nasal Cannula 2 2 Bag Valve Mask Resuscitator (suitable for pediatrics, children, adults with connection tubing) 2 ea 1 ea French Suction Catheters (Qty 1 of any size 6-10) (Qty 1 of any size 12-18) 2 ea 0 Nasopharyngeal Airways Kit 1 Non-Rebreather Oxygen Masks Adult 3 Non-Rebreather Oxygen Masks Pediatric 1 Oropharyngeal Airways Kit 1 Oxygen Regulator (capable of delivering oxygen at flow rates from 2-25 LPM) 1 Portable Oxygen Cylinder (D or E size with at least 500 PSI of Oxygen) 1 Portable Suction Device (bulb syringe is not sufficient for this requirement) 1 Suction Wands 2 Vehicle mounted oxygen delivery system (including regulators capable of dispensing oxygen at a flow rate of 2 to 25 liters per minute, must carry at least 500 PSI of Oxygen in an M or H size oxygen cylinder or an onboard liquid oxygen system (LOX) BLS Patient Assessment Supplies & Equipment Page 14 of 24 BLS BLS Non- Automatic External Defibrillator (AED) (Must be compliant with AHA 2010 Guidelines for CPR & Emergency Cardiovascular Care) 1 Automatic External Defibrillation Pads (Adult / Pedi) 2/1 1/ Blankets (Disposable Acceptable) 2 Blood Pressure Cuff: thigh, adult, child, and infant 1 ea 1 ea Chemical Activated Cold Packs 3 2 Chemical Activated Heat Packs (exempt if electric warming blanket used) 2 0 Disposable Sheets 4 0 OB Kit 1 Set of Ankle and Wrist Restraints (Hard leather or Velcro) Stethoscope (Latex Free) 1 Thermometer Digital Oral or Tympanic

15 B. BLS Trauma Supplies and Equipment BLS Trauma Supplies & Equipment BLS BLS Non- Adhesive Tape Rolls (1 inch and 2 inch) 3 ea 1 ea Lateral Head Support Devices 2 Long Plastic Radio Translucent Spine Board (see Schedule B) 2 Mechanical Tourniquet Device (County Approved Commercial Vendor) 2 2 Occlusive Dressings 2 2 Rigid Cervical Collars (infant, child and adult or if unisize, a total of 4 are required) 2 ea 2 ea Splints (Pneumatic or rigid extremity) 4 2 Sterile 4 Inch Gauze Rolls 6 2 Sterile 4 X 4 Inch Gauze Pads 12 6 Traction Splint (Adult & Pedi required may be 1 device) Trauma Dressings (10 x 30 or larger) 2 2 Trauma Shears 2 Triage Tags (DMS version) (County Approved) Triangular Bandages 4 2 Webbed Belt or Strapping Device 2 2 C. BLS General Equipment BLS General Equipment BLS BLS Non- 2A, 10BC Fire Extinguisher (air unit equivalent acceptable, fire service apparatus exempt) 1 Bed Pan Blue Helmets (Fire/Public Safety exempt) 2 2 Collapsible gurney with straps to secure the patient to the gurney and fastening device to secure to the ambulance County Approved 800 MHz Mobile Radio (private ambulance services only) 1 County Approved 800 MHz Portable Radio (private ambulance services only- includes a spare battery per portable) 1 County Approved UHF Radio Pager (Private ground ambulance services only) Disposable Sheets 4 0 DOT Approved Child Safety Restraint (may or may not be a child seat) DOT Emergency Response Guidebook (must be current edition, may be electronic) 1 Drinking Water in 8-12oz Individual Containers or equivalent (for patient use and secondary rehab functions) 5 2 Fire Scope Field Operations Guide (FOG) (must be hardcopy of current edition) 1 Page 15 of 24

16 BLS General Equipment BLS BLS (continued) Non- Flat Stretcher (includes Redibed, flats, scoops) ICS 219 Resources Status Cards (T-Cards) 2 2 Map covering all of Santa Clara County that utilizes the same grid coordinate system used by County 1 Communications (air unit exempt) Mobile Cellular Phone Multiple Patient Management Plan (EMS#811) (hardcopy is required) 1 Pillows (must be disposable or have disposable covers) 2 0 Portable Battery Operated Light or Rechargeable Light (includes at least one set of spare batteries) 2 2 Quick Reference Guide Fire Service Officers 1 Quick Reference Guide Private EMS Service Providers 1 Santa Clara County Approved Patient Care Report (PCR) (Hardcopy for disaster/mci response) 20 5 Santa Clara County Prehospital Care Manual (may be electronic or kept in quarters) 1 State of California Thomas Brothers Map (hardcopy required) Towels 2 0 Urinal 0.5% bleach solution (sufficient quantities for equipment disinfection) D. BLS Personal Protective Equipment 1 BLS Personal Protective Equipment (PPE) BLS BLS Non- Bactericidal / Virucidal Hand Wipes or equivalent (box of 25 or equivalent) 1 Eye protection (glasses or goggles) 1 per crewmember 1 per crewmember Face shield 2 per crewmember Impermeable gown or coveralls or suits (with surgical hood extending to shoulders) 2 per crewmember Impermeable leg and shoe covers (exempt if provided by coveralls or suits) 2 per crewmember Infectious Waste Bags 5 2 Pair of Leather Work Gloves (recommend one pair provided to each employee to ensure sizing) 2 0 Nitrile Gloves (assorted sizes to fit all crew members) 1 box of each 1 box of each P100 Masks 2 per crewmember N95 particulate respirator 2 per crewmember Page 16 of 24

17 IV. Critical Care Ambulance Minimum Inventory Requirements A. CCT Medications CCT Medications Activated Charcoal in Aqueous Solution 50 mg Adenosine 30 mg Albuterol 2.5 mg in 3 ml NS (bullet) 6 bullets Atropine Sulfate 20 mg Calcium Chloride 3 g Chewable Aspirin 648 mg Dextrose 50% and/or Dextrose 10% 25 g in 250 ml bag (for a total of 50 g) 50 g Diazepam (if midazolam is not available) 20 mg Diphenhydramine 100 mg Dopamine 400 mg 400 mg or (premix bag in D5W or NS; or vial/preload to mix) premixed bag Epinephrine 1:1,000 3 mg Epinephrine 1:10,000 Preload or equivalent (1 mg/preload) 5 mg Furosemide 80 mg Glucagon 2 mg Lidocaine Infusion 1 g or Premixed Bag 1 g or premixed bag Lidocaine 500 mg Lorazepam (if midazolam and diazepam is not available) 20 mg Mark I Auto-injector or DuoDote 6 devices Midazolam 15 mg Morphine Sulfate 20 mg Naloxone 8 mg Nitroglycerine: Oral Spray or Oral Dissolving Tablets 2 bottles Nitroglycerine: Paste Tube or Individual Packets 1 tube or 4 packets Normal Saline 0.9% 3000 ml Ondansetron 16 mg Oral Glucose (25 g tube) 2 tubes Sodium Bicarbonate 8.4% 100 meq Page 17 of 24

18 B. CCT Medication Infusion Supplies & Equipment CCT Medication Infusion Supplies & Equipment Alcohol Preparation Pads 10 Armboard (adult size, may be cut for smaller needs) Glucose Reagent Strips (bottle) (electronic meter & strips permissible, venous/capillary samples) Infusion Pump, Mechanical (County Approved) Injection Needles (size 21 G and 25 G) 2 Intraosseous Needles (16G) 2 IV Catheters (sizes 14, 16, 18, 20, 22, 24 G) 3 ea IV Tubing Sets (each of micro and macro 1 ea IV extension tubing 2 Lancets (must auto secure lancet after use) 5 Sharps Container Syringes with Luer-Lock (1, 3, 10, and 30ccm) 2 ea Tourniquets Band Elastic (for use with IV insertion) 3-way stop cock C. CCT Airway Management Supplies & Equipment CCT Airway Management Supplies & Equipment Adult Nasal Cannula 2 Bag Valve Mask Resuscitator (suitable for pediatrics, children, adults with connection tubing) 2 ea Capnography Device (colorimetric or waveform) 2 Cuffed Endotracheal Tubes with Stylet (each size: 6.0, 7.0, 8.0, 9.0 mm) (0.5 sizes also recommended/not required) 2 ea French Suction Catheters (Qty 1 of any size 6-10) (Qty 1 of any size 12-18) 2 ea Handheld Nebulizer (Inspiratory-activation style recommended) 3 Laryngoscope (assorted straight/curved blades for infants, children, and adults with a spare set of batteries/bulb) Perilaryngeal Airway Device (County Approved) each size 2 ea Magill Forceps (adult & pediatric) 1 ea Nasopharyngeal Airways Kit 2 Non-Rebreather Oxygen Masks Adult 3 Non-Rebreather Oxygen Masks Pediatric Oropharyngeal Airways Kit Oxygen Regulator (capable of delivering oxygen at flow rates from 2-25LPM to support use of the Boussignac Continuous Positive Airway Pressure (CPAP) device) Page 18 of 24 Portable Oxygen Cylinder (D or E size with at least 500 PSI of Oxygen) Portable Suction Device (bulb syringe is not sufficient for this requirement) Suction Wands 2 Uncuffed Endotracheal Tubes with Stylet (2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5mm) 1 ea Ventilator, Mechanical (County Approved)

19 D. CCT Patient Assessment Supplies & Equipment CCT Patient Assessment Supplies & Equipment Blankets (Disposable Acceptable) 2 Blood Pressure Cuff: Thigh, adult, Child, and infant 1 ea Chemical Activated Cold Packs 3 Chemical Activated Heat Packs (exempt if electric warming blanket used) 2 Conductive Gel or Pads (moist 4 X 4 pads not acceptable, not required if using multifunction pads) 2 Disposable Sheets 4 ECG Electrodes Adult 15 ECG Electrodes - Pediatrics 15 Length Base Resuscitation Tape OB Kit Portable Cardiac Monitor/Defibrillator with one spare battery & paper Pulse Oximeter ( assets may use a device that is included in the cardiac monitor) 1 - Adult 1 Pediatric Set of Ankle and Wrist Restraints (Hard leather or Velcro) Stethoscope (Latex Free) Thermometer Digital Oral or Tympanic E. CCT Trauma Supplies & Equipment CCT Trauma Supplies & Equipment Adhesive Tape Rolls (1 inch and 2 inch) 3 ea Lateral Head Support Devices 2 Long Plastic Radio Translucent Spine Board (see Schedule B) 2 Mechanical Tourniquet Device (County Approved Commercial Vendor) 2 Occlusive Dressings 2 Rigid Cervical Collars (infant, child and adult or if unisize, a total of 4 are required) 2 ea Splints (Pneumatic or rigid extremity) 4 Sterile 4 Inch Gauze Rolls 6 Sterile 4 X 4 Inch Gauze Pads 12 Traction Splint (Adult & Pedi required may be one device) Trauma Dressings (10 x 30 inches in dimension or larger) 2 Trauma Shears 2 Triage Tags (DMS version) (County Approved) 20 Triangular Bandages 4 Webbed Belt or Strapping Device 2 Page 19 of 24

20 F. CCT General Equipment CCT General Equipment 2A, 10BC Fire Extinguisher (air unit equivalent acceptable, fire service apparatus exempt) AC Power Inverter Bed Pan Blue Helmets (Fire/Public Safety exempt) 2 Collapsible gurney with straps to secure the patient to the gurney and fastening device to secure to the ambulance. County Approved 800mHz Mobile Radio (private ambulance services only) County Approved 800 MHz Portable Radio (private ambulance services only - includes a spare battery per portable) County Approved UHF Radio Pager (private ground ambulance services only) Disposable Sheets 4 DOT Approved Child Safety Restraint (may or may not be a child seat) DOT Emergency Response Guidebook (must be current edition, may be electronic) Drinking Water in 8-12oz Individual Containers or equivalent (for patient use and secondary rehab functions) 5 Fire Scope Field Operations Guide (FOG) (must be hardcopy of current edition) Flat Stretcher (includes Redibed, flats, scoops) ICS 219 Resources Status Cards (T-Cards) 3 Map covering all of Santa Clara County that utilizes the same grid coordinate system used by County Communications (air unit exempt) Multiple Patient Management Plan (EMS#811) (a hardcopy is required) Pillows (must be disposable or have disposable covers) 2 Portable Battery Operated Light or Rechargeable Light (includes at least one set of spare batteries) 2 Quick Reference Guide Private EMS Service Providers Santa Clara County Approved Patient Care Report (PCR) (Hardcopy for disaster/mci response) 5 Santa Clara County Prehospital Care Manual (may be electronic or kept in quarters) State of California Thomas Brothers Map (hardcopy required) Towels 2 Urinal 0.5% bleach solution (sufficient quantities for equipment disinfection) Page 20 of 24

21 G. CCT Personal Protective Equipment CCT Personal Protective Equipment (PPE) Bactericidal/Virucidal Hand Wipes or equivalent (box of 25 or equivalent) Eye protection (glasses or goggles) 1 per crewmember Face shield Impermeable gown or coveralls or suits (with surgical hood extending to shoulders) Impermeable leg and shoe covers (exempt if provided by coveralls or suits) Infectious Waste Bags 5 Leather Work Gloves (pair - recommend one pair provided to each employee to ensure sizing) 2 Nitrile Gloves (assorted sizes to fit all crew members) 1 box of each P100 Masks N95 particulate respirator Page 21 of 24

22 V. EMS Field Supervisor Inventory Requirements A. EMS Field Supervisor Inventory Requirements Medications / Supplies & Equipment Mark I Auto-injector or DuoDote 20 Normal Saline 0.9% 1000 ml Oral Glucose (25 grams) 2 tubes Alcohol Preparation Pads 10 IV Tubing Sets (macro) Sharps Container Airway Management Supplies & Equipment Adult Nasal Cannula Bag Valve Mask Resuscitator (suitable for pediatrics, children, adults with connection tubing) 1 ea Nasopharyngeal Airways Kit Non-Rebreather Oxygen Masks Adult Non-Rebreather Oxygen Masks Pediatric Oropharyngeal Airways Kit Oxygen Regulator (capable of delivering oxygen at flow rates from 2-25 LPM) Portable Oxygen Cylinder (D or E size with at least 500 PSI of Oxygen) Patient Assessment Supplies & Equipment Automatic External Defibrillator (AED) (Must be compliant with AHA 2010 Guidelines for CPR & Emergency Cardiovascular Care) Automatic External Defibrillation Pads (Adult / Pedi) 1/ Blankets (Disposable Acceptable) 2 Blood Pressure Cuff: thigh, adult, child, and infant 1 ea OB Kit Stethoscope (Latex Free) Adhesive Tape Rolls (1 inch and 2 inch) 3 ea Mechanical Tourniquet Device (County Approved Commercial Vendor) 5 Occlusive Dressings 4 Sterile 4 Inch Gauze Rolls 6 Sterile 4 X 4 Inch Gauze Pads 12 Trauma Dressings (10 x 30 or larger) 2 Trauma Shears Triage Tags (DMS version) (County Approved) 50 Triangular Bandages 4 Page 22 of 24

23 B. EMS Field Supervisor General Equipment EMS Field Supervisor General Equipment 2A, 10BC Fire Extinguisher (air unit equivalent acceptable, fire service apparatus exempt) Blue Helmets (Fire/Public Safety exempt) 2 County Approved 800 MHz Mobile Radio (private ambulance services only) County Approved 800 MHz Portable Radio (private ambulance services only - includes a spare battery per portable) 6 County Approved UHF Radio Pager (private ground ambulance services only) County Approved UHF Mobile Radio (EOA Contractor Requirement Only) County Approved VHF Mobile Radio (EOA Contractor Requirement Only) DOT Emergency Response Guidebook (must be current edition, may be electronic) Drinking Water in 8-12oz Individual Containers or equivalent (for patient use and secondary rehab functions) 1 case of 24 bottles Fire Scope Field Operations Guide (FOG) (must be hardcopy of current edition) Handheld GPS (with spare batteries) 1 ICS 219 Resources Status Cards (T-Cards) 2 Map covering all of Santa Clara County that utilizes the same grid coordinate system used by County Communications (air unit exempt) Meals Ready to East (MRE s) 36 Mobile Cellular Phone Multiple Patient Management Plan (EMS#811) (a hardcopy is required) Portable Battery Operated Light or Rechargeable Light (includes at least one set of spare batteries) 2 Quick Reference Guide Fire Service Officers Quick Reference Guide Private EMS Service Providers Santa Clara County Approved Patient Care Report (PCR) (Hardcopy for disaster/mci response) 100 Santa Clara County Prehospital Care Manual (may be electronic or kept in quarters) Sleeping Bags 2 State of California Thomas Brothers Map (hardcopy required) 6 0.5% bleach solution (sufficient quantities for equipment disinfection) Page 23 of 24

24 C. Personal Protective Equipment Personal Protective Equipment (PPE) Bactericidal/Virucidal Hand Wipes or equivalent (box of 25 or equivalent) Eye protection (glasses or goggles) 1 per crewmember Face shield Impermeable gown or coveralls or suits (with surgical hood extending to shoulders) Impermeable leg and shoe covers (exempt if provided by coveralls or suits) Infectious Waste Bags 2 Leather Work Gloves (pair - recommend one pair provided to each employee to ensure sizing) Nitrile Gloves (assorted sizes to fit all crew members) 1 box of each size P100 Masks N95 particulate respirator Page 24 of 24

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