Health System Compliance Division Inspection Department Ambulance Inspection Checklist Class III Advanced Life Support (ALS)

Transcription

1 Health Authority - Abu Dhabi ھيئة الصحة - أبو ظبي Health System Compliance Division Inspection Department Ambulance Inspection Checklist Class III Advanced Life Support (ALS) A- Ventilation and Airway Equipment - Suction Apparatus and accessories: Portable Suction Installed (fixed) suction Wide bore tubing Rigid Pharyngeal or tonsillar curved suction tip (adult & pediatric) Flexible suction catheters F -4F Min Qty each each Yes No - Portable oxygen equipment Portable oxygen cylinder Constant flow regulator with adjustable flow rate 3- Installed fixed oxygen equipment (Min patients) Fixed oxygen tank Remaining tank- pressure gauge Variable flow regulator Wall mounted standard oxygen port with quick disconnect 4- Oxygen administration equipment Laryngoscope handle with extra batteries & bulbs, adult & pediatric. Laryngoscope blades, straight & curved, adult, child, & infant sizes. Endotracheal tubes (cuffed, un-cuffed) adult, child, & infant sizes. 0-mL non-luerlock syringes Stylettes for endotracheal tubes, adult & pediatric Magill forceps, adult & pediatric Nasogastric tubes, adult & pediatric sizes. End-tidal CO detectors (colorimetric or quantitative Nasal cannula (adult, child, & infant sizes) Transparent non-re-breathing and valve-less mask (adult, child, & infant sizes) Oxygen mask (adult, child, & infant sizes) & oxygen tubing (adequate length) Pocket mask with one way valve each each 0 each each each each each each

2 - Bag valve mask resuscitators hand operated self b re-expanding bag with O reservoir/ accumulator (adult & infant sizes) each clear mask (adult, child, & infant sizes) each Clear disposable valves 6- Airways Nasopharyngeal sizes (adult, child, & infant) Oropharyngeal sizes (adult, child, & infant) each each B- Monitoring and Defibrillation (licensed trained team) - Portable, battery-operated monitor/defibrillator With tape write-out/recorder, defibrillator pads, quicklook paddles or hands-free patches, ECG leads, adult & pediatric chest attachment electrodes, adult & pediatric paddles, with capability to provide electrical discharge below watt-seconds. Transcutaneous cardiac pacemaker (either standalone unit or integrated into monitor/defibrillator) 3. Pulse oximetry with adult & pediatric probes sets C- Immobilization Devices -Rigid cervical collars for adult, child, & infant (small, medium, & large sizes) or adjustable. - Head immobilization device (not sand bag) firm padding or commercial device 3- Lower extremity (femur) traction devices supporting slings/ padded ankle hitch/ padded pelvic support / traction strap (adult & child sizes) 4- Upper and lower extremity immobilization devices joint above and joint below fracture (adult & child sizes) rigid support appropriate material (cardboard, metal, pneumatic, vacuum, wood or plastic) each each sets packs - Radiolucent backboards (long, short) and extraction device used for head immobilization,spine immobilization, head to feet immobilization. sets D- Dressings and Bandages - Sterile burn sheets - Triangular bandages

3 3- Sterile Dressings abdominal pad. 4x4 gauze sponges 4- Sterile gauze rolls (various sizes) - Non sterile Elastic bandages (various sizes) 6- Sterile occlusive dressing 3x8 or larger 7- Adhesive tape Various sizes of or 3 hypo-allergic Various sizes of or 3 adhesive E- Communication - Installed two-way radio communication 0 each each 0 each each each - Cellular phone F- Obstetrical - Separate sterile kit containing at least : towels, 4 4 dressing, sterile scissors, bulb suction, towels, blanket, surgical gloves, sterile disposable scalpel, cord clamps, and plastic bag for placenta disposal. - Thermal absorbent blanket and head cover, aluminum foil roll, or appropriate heat-reflective material (enough to cover new born). G- Compartment - Clean - A/C and humidity control 3- Electric (internal/ external) supply bulbs 4- Spacious - Secure 6- Fridge or ice container for refrigerated medications 7- Fire extinguisher 8- Flash lights with extra batters and bulbs. kits 0- Stair chair or equivalent seated transport device. - Ambulance wheeled cot with mounted cot fastening system - Folding stretcher H- Miscellaneous - Sphygmomanometer (cuff size for infant, pediatric, adult) - Stethoscope (pediatric/adult) 3- Length/weight based chart for pediatric equipment sizing 4- Thermometer with low temperature capability 3

4 - Heavy bandage or paramedic scissors for cutting clothing, belts and boots. 6- Cold packs 7-Sterile saline solution for irrigation. 8- I.V administration set (microdrip & macrodrip). 9- Blankets, sheets, linen, or paper, pillows pillowcase, and towels 0- Disposable standard sharps containers - Disposable emesis bags or basins - Disposable bedpan 3- Disposable urinal 4- Patient care charts/ forms - Syringes (0ml x, 30ml x,0ml x, 3ml x,ml x) 6- Gauge needles (various sizes). 7- Glucometer or blood glucose measuring device (with reagent strips) 8- Tourniquet 9- Intravenous arm boards, adult & pediatric 0- Intravenous catheters different sizes - Alcohol & povidone-iodine wipes - Crystalloid solutions, Ringer's lactate or normal saline, & dextrose % in water. 3. Nebulizer 4- Blank Labels I- Infection Control (all equipments should be latex-free) - Eye protection (full peripheral glasses or goggles, or face Shield - Masks and or HEPA masks 3- Gloves non sterile/ sterile, Jumpsuits or gowns, Shoe Covers. 4- Disinfectant hand wash - Disinfectant solution for cleaning equipments 6- Disposable trash bags and biohazard bags pack /each each each each each packet each each J- Medication. Activated Charcoal (Suspension). Albuterol nebulization (Ventolin ) 3. Antibacterial lubricating jelly (Sterile Lubricating Jelly). 4. Aromatic Ammonia. Glucose (Oral/ IV) 6. IV Fluids (Various dissolution, sizes and concentration) 7. Sulfadiazine silver (burn cream) 8. Paracetamol!gm IV 9. Metochlorpopramide and or Ondansetrone bottles vial 0 boxes Vial 0 Vials 4

5 * Sealed code box supervised and controlled by the EMT-P, verifying content after each trip, checked by the pharmacist for expired items, arranged inside as per attached chart mainly including the following; - Adenosine 6mg/ml - Aminophylline 0mg/0ml 3- Amiodarone 0mg 4- Aspirin 300mg tablets ( EC) - Atropine sulfate 0.6mg/ml 6- Calcium Chloride 0% (0ml) 7- Calcium Gluconate 0% (g/0ml) 8- Dextrose 0% (g/0ml) 9- Dextrose 0% in water (0, 00, 000 ml) 0- Diazepam 0mg injection -Diazoxide 300mg/0ml - Digoxin 0.mg/ml (0.mg/ml) 3- Diphenhydramine 0mg/ml 4- Dobutamine 0mg - Dopamine 00mg/ml 6- Epinephrine mg/0 (IV) 7- Furosemide 0mg/ml 8- Glucagon -mg vial 9- Haldol mg/ml 0- Heparin Sodium 0units/ ml - Hydrocortisone 0mg/ml - Insulin soluble (Human) 3- Labetolol 00mg/0ml 4- Lidocaine 00mg/ ml (preload) -Magnesium Sulfate 0% (g/ml) 6- Methylpresnisolone 80mg/ml 7- Morphine Sulfate 0mg/ml 8- Naloxone 0.4mg/ml X amp 9- Nitroglycerin Spray (Sublingual) 30- Norepinephrine mg/ml (4ml) 3- Normal Saline injection 3- Phentolamine 0mg/Vial 33- Phenytoin 0mg/ ml 34- Pralidoxine Chloride g/vial 3- Procainamide 000mg/ 0ml 36- Propranolol mg/ml 37- Sodium Bicarbonate 0 Meq/0 ml Syrin (8.4%) 38- Sodium Bicarbonate 0ml Ped Syringe 39- Sterile Water for injsection 0ml 40-Thiamine 00mg/ml 4- Verapamil mg/ml Vials vials 3 Amp 3 vials 3 Amp amp amp syrin Bags syrin vials Amp Amp 0 tabs vials Tubex 4 Amp amp amp Vials 4 vials vials Vials Vials Vials Syri Vials Amp Vial Amp Cans Amp Bags Vials Vials Vial Vials Vials 3 Amp Syrin Syrin

6 K-Optional Advanced Equipment - Portable automatic ventilator - Alternative airway devices (double lumen tube airway) 3- Umbilical vein catheters different sizes L- Operating personnel (EMT-P and EMT-) Certified Well trained each each NOTE: All perishable and heat sensitive materials (plastic and silicon items, e.g. oxygen masks, intubation tubes, syringes, etc.) should be stored in appropriate labeled transport bags in an easily accessible location, i.e. Emergency Department and maintained in a complete and prepared condition. M- Facility Name: Ambulance Tag #: N-Comments:... O- Inspectors Name/ Signature: - Name: Sig: Date: - Name: Sig: Date: P- Inspection Department Manager Opinion/Conclusion: Name: Sig: Date: 6

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