DEPARTMENT OF HEALTH SERVICES
  COUNTY OF LOS ANGELES
           
 

 SUBJECT: M/SS CACHE INVENTORY AND CHECKLIST FOR ITEMS DEPLOYED

REFERENCE NO. 1107.1  


FACILITY:

Bandages and Dressings
Quantity On Hand
Number Checked Out
Adhesive strip, 1" X 3"
100/box
5 boxes
Alcohol pads
200/box
5 boxes
Bandage elastic 2"
10/box
2 boxes
Bandage elastic 4"
10/box
2 boxes
Bandage elastic 6"
10/box
2 boxes
Bandage, gauze non sterile 4” X 10’
96/case
1 case
Bandage, gauze non sterile 4X4
200/pkg,
10 pkgs/case
1 case
Bandage 4" X 4" sterile
2/pkg,
1200 pkgs/case
2 case
Bandage 2X2 sterile
2/pkg,
3000 pkgs/case
1 case
Eye pad, oval sterile
50/box
2 boxes
Eye shields
Each
50
Morgan Lens
12/box
4 boxes
Petroleum gauze 5" X 9"
50/box
2 boxes
Vaseline gauze
50/box
1 box
Gauze Pad 5" X 9" sterile
400/case
1 case
Tape 1" transparent
12/box 10
boxes/case
1 case
Transparent dressing 4 X 4
50/box
2 boxes
Non-adhesive Gauze (Various Sizes)
100/box
10 boxes
Wound packing gauze
10 bottles/case
1 case
Triangular bandages
12/box
8 boxes
Disposable ice packs
24/case
10 cases
 
Surgical Supplies
Quantity On Hand
Number Checked Out
Scalpel with blade, disposable #10
Each
48
Scalpel with blade, disposable #15
Each
48
Sterile gloves, sizes 6.5, 7.0, 7.5, and 8.0
50 pairs/box
4 boxes each size
Surgical scrub brushes with betadine
144/case
1 case

EFFECTIVE: 06-01-14
REVISED: 10-01-20
SUPERSEDES: 04-01-19
  

PAGE 1 OF 6   

 SUBJECT: M/SS CACHE INVENTORY AND CHECKLIST FOR ITEMS DEPLOYED

REFERENCE NO. 1107.1  
Surgical Supplies
Quantity On Hand
Number Checked Out
Suture set (disposable)
20/case
3 cases
Suture removal kit
50/case
1 case
Suture (nylon sutures various sizes)
12/box
6 boxes
Steri-strips (assorted sizes)
50/box
3 boxes
Disposable skin stapler and remover
72/case
3 cases
Orthopedic Supplies
Quantity On Hand
Number Checked Out
Splint, cardboard 12"
25/case
1 case
Splint, cardboard 18"
25/case
1 case
Splint, cardboard 24"
25/case
1 case
Splint, cardboard 34"
25/case
1 case
Splint, fiberglass 3"
5/case
1 case
Splint, fiberglass 4"
5/case
1 case
Splint, fiberglass 5"
5/case
1 case
IV Sets, Needles and Syringes
Quantity On Hand
Number Checked Out
IV start kits
Each
200
IV catheter, 18 gauge
50/box
2 boxes
IV catheter, 20 gauge
50/box
2 boxes
IV catheter, 22 gauge
50/box
2 boxes
IV catheter, 24 gauge
50/box
1 box
IV administration set, adult
48/box
2 boxes
IV administration set, pediatric
48/box
2 boxes
IV piggyback tubing
50/box
1 box
Needle disposable, 18 gauge
100/box
3 boxes
Needle disposable, 22 gauge
100/box
3 boxes
Needle disposable, 25 gauge
100/box
3 boxes
Butterfly needles 25 gauge
50/box
1 box
Syringe, 1ml
100/box
3 boxes
Syringe, 3 ml
100/box
5 boxes

  

PAGE 2 OF 6   

 SUBJECT: M/SS CACHE INVENTORY AND CHECKLIST FOR ITEMS DEPLOYED

REFERENCE NO. 1107.1  
IV Sets, Needles and Syringes
Quantity On Hand
Number Checked Out
Syringe, 5 ml
100/box
2 boxes
Syringe, 10 ml
100/box
2 boxes
Syringe, 20 ml
25/box
1 box
Syringe, 35cc, for wound irrigation
Each
25
Syringe/needle, U100 insulin syringe 28 gauge, 1cc, 1/2" needle
100/box
1 box
Syringe/needle, 3 ml, 22gauge X 1 1/2"
100/box
2 boxes
Syringe/needle, 1 ml, 25 gauge X 5/8"
100/box
1 box
Syringe/needle 1 ml, 29 gauge X 1/2" (May substitute U100 insulin syringe, 28G X 1/2" or tuberculin syringe 26G X 3/8")
200/box
1 box
Sharps container

8/case
1 case
Airway Management
Quantity On Hand
Number Checked Out
Bag-valve-mask, adult
12/case
1 case
Bag-valve-mask, pediatric
6/case
2 cases
Airway adjunct, OP Airway
-
50 assorted size
Airway adjunct, NP Airway
-
50 assorted sizes
Cricothyrotomy / Shiley 4
Each
5
Endotracheal tube, cuffed 8mm
10/box
2 boxes
Endotracheal tube, cuffed, 7.5mm
10/box
4 boxes
Endotracheal tube, cuffed 7mm
10/box
2 boxes
Endotracheal tube, cuffed, 6mm
10/box
2 boxes
Endotracheal tube, cuffed 2.5mm
10/box
1 box
Endotracheal tube, cuffed 3mm
10/box
1 box
Endotracheal tube, cuffed, 4mm
10/box
2 boxes
Endotracheal tube, cuffed, 4.5mm
10/box
2 boxes
Endotracheal tube, cuffed, 5mm
10/box
2 boxes
Endotracheal tube, cuffed, 5.5mm
10/box
2 boxes
Endotracheal tube, non-cuffed, 2.5mm
10/box
1 box
Endotracheal tube, non-cuffed, 3mm
10/box
1 box

  

PAGE 3 OF 6   

 SUBJECT: M/SS CACHE INVENTORY AND CHECKLIST FOR ITEMS DEPLOYED

REFERENCE NO. 1107.1  

Airway Management
Quantity On Hand
Number Checked Out
Endotracheal tube, non-cuffed, 4mm
10/box
1 box
Endotracheal tube, non-cuffed, 5mm
10/box
1 box
Endotracheal tube holders
Each
50
Intubation kit, incl. Blades, medium handle, stylet and case - including magill forceps
Each
1 kit
Intubation kit (Pediatrics) , incl. Blades, medium handle, stylet and case - including magill forceps
Each
1 kit
Nasal cannula, adult
50/case
2 cases
Nasal cannula, pediatric
50/case
2 cases
02 mask with tubing, pediatric
Each
25
02 mask with tubing, adult
Each
50
02 mask - non-rebreather, adult
Each
25
Nebulizers - hand held
50/case
2 cases
Nebulizers - masks
50/case
2 cases
Ventilator circuits
10/case
2 cases
Suction machine, portable
Each
3 each
Suction catheters 10 French
50/case
1 case
Suction catheters 12 French
50/case
1 case
Suction catheters 14 French
50/case
1 case
Yankauer suction
20/case
2 cases
Suction tubing
Each
100
Suction Canisters
Each
100
NG Tubes
Each
50
Thoracostomy Tubes, assorted sizes
-
10 various sizes
Pleurivac & Heimlich valves
1/each
10
Infection Control Supplies
Quantity On Hand
Number Checked Out
Cover/Isolation gowns
100/case
3 cases
Splash guard for wound irrigation
Each
100
Masks surgical
50/box 6 boxes/case
24 cases
Face shield with eye shield
25/box 4 boxes/case
1 case

     

PAGE 4 OF 6   

 SUBJECT: M/SS CACHE INVENTORY AND CHECKLIST FOR ITEMS DEPLOYED

REFERENCE NO. 1107.1  
Infection Control Supplies
Quantity On Hand
Number Checked Out
Masks N-95
35/box 6 boxes/case
18 cases
Patient exam gloves, small
100/box
2 boxes
Patient exam gloves, medium
100/box
4 boxes
Patient exam gloves, large
100/box
4 boxes
Shoe covers
150 pairs/case
2 cases
Surgical caps
100/box 6 boxes/case
1 case
Wipes, disposable
40/box
4 boxes
Hand sanitizer gel
8 oz
12 bottles
Child face masks (various sizes)
75/box
4 boxes
Miscellaneous Supplies
Quantity On Hand
Number Checked Out
Bags, plastic 30 gallon, 8 mil
100/pkg
1 pkg
Batteries, C for laryngoscope handle
Each
6
Batteries, D for flashlights
Each
24
Blankets lightweight
Each
48
Clipboards
Each
48
Diapers, disposable large
120/case
1 case
Diapers, disposable medium
168/case
1 case
Diapers, disposable small
216/case
1 case
Diapers, disposable, large, peds
120/case
3 cases
Diapers, disposable, medium, peds
168/case
3 cases
Diapers, disposable, small, peds
216/case
3 cases
Emesis basins, plastic
250/case
1 case
Facial tissues
30boxes/case
4 cases
Flashlights
Each
12
Gloves work type leather/canvas
Each
12
OB kits, disposable
Each
5
Paper towel rolls
Each
12
Patient ID bands
250/box
1 box

  

PAGE 5 OF 6   

 SUBJECT: M/SS CACHE INVENTORY AND CHECKLIST FOR ITEMS DEPLOYED

REFERENCE NO. 1107.1  
Miscellaneous Supplies
Quantity On Hand
Number Checked Out
Styrofoam cups
25/bag 40 bags/case
1 case
Tongue depressors, non-sterile
500/box
1 box
Disposable temperature strips
100/ Box
5 boxes
Crutches (assorted sizes)
1 pair
50 pairs
Body bags
5/case
20 cases
Non-Disposable Medical Supplies
Quantity On Hand
Number Checked Out
Blood pressure multi-cuff kit with adult, pediatric, infant and thigh cuff
Each
2
Glucometer kit with lancets, test strips and battery
Each
2
Portable otoscope/ophthalmoscope set with batteries
Each
2
Pulse oximetry, portable
Each
2
Stethoscope
Each
12
Tourniquets 1"
100/pkg
1 pkg
Trauma/paramedic scissors
Each
6

Notes/Comments
 


Released by: 
Date released:
Received by: 
 Facility:
Returned by:
 Date returned:
Returned Items received by:
Statement of Verification

I hereby verify that an inventory of all Grant funded pharmaceuticals listed above has been completed and all items are up to PAR and available for deployment.

Verified By:    Date:
(Printed Name and Signature)

Should any item on the above list fall below PAR levels, notify the EMS Agency immediately.

Notification to EMS Agency by:     Date:

 

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