Please fill out this form to request medical supplies.
Please send requests the 1st of each month
Check ALL expirable items monthly.
Do not order extra expiring items.
Always try to re-stock with ambulance company first.

Name*

Station*

61 62 63 64 66 67 68

AIRWAY

Nasal Cannula Adult

1 2 3 4 5 6 7 8 9 10

Nasal Cannula Pediatric

1 2 3 4 5 6 7 8 9 10

Adult Non-Rebreather Mask

1 2 3 4 5 6 7 8 9 10

Pediatric Non-Rebreather Mask

1 2 3 4 5 6 7 8 9 10

Adult Bag-Valve-Mask

1 2 3 4 5 6 7 8 9 10

Pediatric Bag-Valve-Mask

1 2 3 4 5 6 7 8 9 10

Infant Bag-Valve-Mask

1 2 3 4 5

BVM Viral Filter

1 2 3 4 5

V-Vac Suction Handle

1 2 3 4 5 6 7 8 9 10

V-Vac Suction Cartridge

1 2 3 4 5 6 7 8 9 10

Oropharyngeal Airway (OPA) #5

1 2 3 4 5 6 7 8 9 10

Oropharyngeal Airway (OPA) #6

1 2 3 4 5 6 7 8 9 10

Oropharyngeal Airway (OPA) #7

1 2 3 4 5 6 7 8 9 10

Oropharyngeal Airway (OPA) #8

1 2 3 4 5 6 7 8 9 10

Oropharyngeal Airway (OPA) #9

1 2 3 4 5 6 7 8 9 10

Oropharyngeal Airway (OPA) #10

1 2 3 4 5 6 7 8 9 10

Oropharyngeal Airway (OPA) #11

1 2 3 4 5 6 7 8 9 10

Oropharyngeal Airway (OPA) #12

1 2 3 4 5 6 7 8 9 10

Nasopharyngeal Airway (NPA) #20

1 2 3 4 5 6 7 8 9 10

Nasopharyngeal Airway (NPA) #22

1 2 3 4 5 6 7 8 9 10

Nasopharyngeal Airway (NPA) #24

1 2 3 4 5 6 7 8 9 10

Nasopharyngeal Airway (NPA) #26

1 2 3 4 5 6 7 8 9 10

Nasopharyngeal Airway (NPA) #28

1 2 3 4 5 6 7 8 9 10

Nasopharyngeal Airway (NPA) #30

1 2 3 4 5 6 7 8 9 10

Nasopharyngeal Airway (NPA) #32

1 2 3 4 5 6 7 8 9 10

Nasopharyngeal Airway (NPA) #34

1 2 3 4 5 6 7 8 9 10

Nasopharyngeal Airway (NPA) #36

1 2 3 4 5 6 7 8 9 10

NPA Lubricating Jelly

1 2 3 4 5 6 7 8 9 10

Pet Oxygen Mask

1 2 3

Intubation Kit Bag (Red Airway Bag)

1 2 3 4

BANDAGE / DRESSING

Trauma Dressing

1 2 3 4 5 6 7 8 9 10

5x9 Dressing

1 2 3 4 5 6 7 8 9 10

4x4 Dressing (Sterile)

1 2 3 4 5 6 7 8 9 10

4x4 Dressing (Non Sterile)

1 2 3 4 5 6 7 8 9 10

Gauze Roll (Sterile)

1 2 3 4 5 6 7 8 9 10

Triangular Bandage

1 2 3 4 5 6 7 8 9 10

Ace Elastic Bandage

1 2 3 4 5 6 7 8 9 10

Large Band-Aid (Box)

1 2 3 4 5 6 7 8 9 10

Small Band-Aid (Box)

1 2 3 4 5 6 7 8 9 10

Occlusive Dressing

1 2 3 4 5 6 7 8 9 10

Combat Gauze

1 2 3

Cloth Tape

1 2 3 4 5

SPLINTS & C-SPINE

Large Splint (Cardboard)

1 2 3

Small Splint (Cardboard)

1 2 3

Flexible Sprint Roll

1 2 3 4 5 6 7 8 9 10

Adult Cervical Collar

1 2 3

Pediatric Cervical Collar

1 2 3

Infant Cervical Collar

1 2 3

Traction Splint

1 2

Pediatric Immobilization Board

1 2 3 4 5 6 7 8 9 10

INTERVENTION MEDICATION/ITEMS

Oral Glucose

1 2 3 4 5

Narcan (Naloxone)

1 2 3 4

Atomization Device (For Narcan)

1 2 3 4 5

Aspirin

1 2 3 4

Adult Epi (0.3)

1 2 3 4

Pediatric Epi (0.15)

1 2 3 4

Combat Tourniquet

1 2 3 4

Adult AED Pads

1 2 3 4

Pediatric AED Pads

1 2

AED Carry Case

1 2

Lucas Case

1 2

Lucas Battery

1 2 3 4 5 6

O.B. Kit

1 2 3 4

Cold Packs

1 2 3 4 5 6 7 8 9 10

Sterile Water

1 2 3 4 5

Tecnu Poison Oak Cleaner

1 2 3 4 5 6 7 8 9 10

Poison Oak Pre-Exposure Lotion

1 2 3 4 5 6 7 8 9 10

Ring Cutter

1 2 3 4

Trauma Shears

1 2 3 4 5

INFECTION CONTROL

Red Bags (Sm)

1 2 3 4 5 6 7 8 9 10

Red Bags (Med)

1 2 3 4 5 6 7 8 9 10

Red Bags (Lg)

1 2 3 4 5 6 7 8 9 10

Medical Gloves (Sm)

1 2 3 4 5 6 7 8 9 10

Medical Gloves (Med)

1 2 3 4 5 6 7 8 9 10

Medical Gloves (Lg)

1 2 3 4 5 6 7 8 9 10

Medical Gloves (XL)

1 2 3 4 5 6 7 8 9 10

Disinfectant Spray

1 2

Disinfectant Solution (Gallon)

1 2

Disinfectant Wipes (surface cleaning)

1 2 3 4

Antiseptic Handwipes (Box)

1 2 3 4

Hand Sanitizer

1 2 3 4 5 6 7 8 9 10

N-95 Mask

1 2 3 4 5 6 7 8 9 10

Simple Face Mask (box)

1 2 3 4

Face Shields

1 2 3 4 5 6 7 8 9 10

Safety Glasses

1 2 3 4 5 6

Blue Disposable Gown

1 2 3 4 5 6 7 8 9 10

Sharps Dart

1 2 3 4 5 6

Sharps Box

1 2 3 4 5

Computer Mouse Covers

1 2 3 4 5 6 7 8 9 10

Keyboard Covers

1 2 3 4 5 6 7 8 9 10

DIAGNOSTIC & EQUIPMENT

B/P Cuff Adult

1 2 3 4 5

B/P Cuff Bariatric

1 2 3 4 5

B/P Cuff Pediatric

1 2 3 4 5

Stethoscope

1 2 3 4 5 6 7 8 9 10

Glucometer

1 2 3

Glucose Test Strip Tub (50 count)

1 2 3

Lancets (case)

1 2

Alcohol Prep Pads (case)

1 2 3

Pen Light

1 2 3 4 5 6 7 8 9 10

SPO2 Monitor

1 2 3

Non Contact Thermometer

1 2

BURN

Burn Sheet

1 2 3 4 5 6 7 8 9 10

Water Jel Burn Dressing

1 2 3 4 5 6

Water Jel Burn Jel-Single Packets

1 2 3 4 5 6 7 8 9 10

MISCELLANEOUS

EMS Bag

1 2

Triage Tags

1 2 3 4 5 6 7 8 9 10

Triage Bag

1 2 3 4 5

After Bite

1 2 3 4 5 6 7 8 9 10

Yellow Blanket

1 2 3 4 5 6 7 8 9 10

Blue Patient Lifting Tarp

1 2 3 4 5 6 7 8 9 10

Patient Hauler Tarp (Disposable)

1 2 3 4 5

Ear Plugs (case)

1 2

Trauma Shear Holder

1 2 3 4 5

OTHER

Other Requests/Questions: