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Richmond Fire Department Medical Supply Request Form
Leave This Blank:
Please fill out this form to request medical supplies.
Name
*
Station
*
61
62
63
64
66
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68
AIRWAY
Adult Non-Rebreather Mask
1
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5
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7
8
9
10
Pedi Non-Rebreather Mask
1
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9
10
Adult Bag-Valve-Mask
1
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5
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8
9
10
Pedi Bag-Valve-Mask
1
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5
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9
10
Nasal Cannula
1
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5
6
7
8
9
10
V-Vac Suction Handle
1
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5
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10
V-Vac Suction Cartridge
1
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5
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8
9
10
Oropharyngeal Airway (OPA) #5
1
2
3
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5
6
7
8
9
10
Oropharyngeal Airway (OPA) #6
1
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9
10
Oropharyngeal Airway (OPA) #7
1
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7
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9
10
Oropharyngeal Airway (OPA) #8
1
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8
9
10
Oropharyngeal Airway (OPA) #9
1
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9
10
Oropharyngeal Airway (OPA) #10
1
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9
10
Oropharyngeal Airway (OPA) #11
1
2
3
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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
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
1
2
3
4
5
6
7
8
9
10
Gauze Roll
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
Triple Antibiotic Ointment (Box)
1
2
3
4
5
6
7
8
9
10
SPLINTS & C-SPINE
Leg Splint-Cardboard
1
2
3
4
5
6
7
8
9
10
Flexible Sprint Roll (4.5"x36")
1
2
3
4
5
6
7
8
9
10
Adult Cervical Collar
1
2
3
4
5
6
7
8
9
10
Pedi Cervical Collar
1
2
3
4
5
6
7
8
9
10
Pedi Immobilization Board
1
2
3
4
5
6
7
8
9
10
TAPE
2" White Cloth (Box)
1
2
3
4
5
6
7
8
9
10
BIO-HAZ
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 Case (SM)
1
2
3
4
5
6
7
8
9
10
Medical Gloves Case (MED)
1
2
3
4
5
6
7
8
9
10
Medical Gloves Case (LG)
1
2
3
4
5
6
7
8
9
10
Medical Gloves Case (XL)
1
2
3
4
5
6
7
8
9
10
Disinfectant Spray
1
2
3
4
5
6
7
8
9
10
Antiseptic Handwipes (Box)
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
Tecnu Poison Oak Cleaner
1
2
3
4
5
6
7
8
9
10
Folding Respirator (Mask)
1
2
3
4
5
6
7
8
9
10
DIAGNOSTIC & EQUIPMENT
B/P Cuff Adult
1
2
3
4
5
6
7
8
9
10
B/P Cuff Pedi
1
2
3
4
5
6
7
8
9
10
Stethoscope
1
2
3
4
5
6
7
8
9
10
Pen Light
1
2
3
4
5
6
7
8
9
10
Trauma Sheers
1
2
3
4
5
6
7
8
9
10
Ring Cutter
1
2
3
4
5
6
7
8
9
10
BURN
Burn Sheet
1
2
3
4
5
6
7
8
9
10
Water Jel Burn Dressing (4"x16")
1
2
3
4
5
6
7
8
9
10
Water Jel Burn Jel-Single Packets
1
2
3
4
5
6
7
8
9
10
MISCELLANEOUS
After Bite
1
2
3
4
5
6
7
8
9
10
Cold Pack
1
2
3
4
5
6
7
8
9
10
O.B. Kit
1
2
3
4
5
6
7
8
9
10
Oral Glucose Tube
1
2
3
4
5
6
7
8
9
10
Sterile Water
1
2
3
4
5
6
7
8
9
10
Triage Tags
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
OTHER
Item
QTY
1
2
3
4
5
6
7
8
9
10
Item
QTY
1
2
3
4
5
6
7
8
9
10
Item
QTY
1
2
3
4
5
6
7
8
9
10
* indicates required fields.
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