Health Authority - Abu Dhabi ‫ أبو ظــبي‬- ‫ھــيئـــــة الصحة‬

Health System Compliance Division –Inspection Department

Ambulance Inspection Checklist
Class III Advanced Life Support (ALS)

A- Ventilation and Airway Equipment Min Qty Yes No

1- Suction Apparatus and accessories:
●Portable Suction 1 □ □
● Installed (fixed) suction 1 □ □
●Wide bore tubing 2 □ □
●Rigid Pharyngeal or tonsillar curved suction tip 2 □ □
(adult & pediatric) 1 each □ □
● Flexible suction catheters 5F -14F 2 each □ □
2- Portable oxygen equipment □ □
●Portable oxygen cylinder 2 □ □
●Constant flow regulator with adjustable flow rate
2 □ □
3- Installed fixed oxygen equipment (Min 2 patients)
●Fixed oxygen tank 2 □ □
● Remaining tank- pressure gauge 1 □ □
●Variable flow regulator 2 □ □
●Wall mounted standard oxygen port with quick 2 □ □
disconnect
4- Oxygen administration equipment
●Laryngoscope handle with extra batteries & bulbs, adult 1 □
& pediatric.
●Laryngoscope blades, straight & curved, adult, child, & 1each □
infant sizes.
●Endotracheal tubes (cuffed, un-cuffed) adult, child, & 2 each □
infant sizes.
●10-mL non-Luerlock syringes 10 □
●Stylettes for endotracheal tubes, adult & pediatric 1each □
●Magill forceps, adult & pediatric 1each □
●Nasogastric tubes, adult & pediatric sizes. 2 each □
●End-tidal CO2 detectors (colorimetric or quantitative 1 □
●Nasal cannula (adult, child, & infant sizes) 2 each □
●Transparent non-re-breathing and valve-less mask 1each □
(adult, child, & infant sizes)
●Oxygen mask (adult, child, & infant sizes) & oxygen 2 each □
tubing (adequate length)
●Pocket mask with one way valve 1 □

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 5- Bag valve mask resuscitators
●hand operated
● self b re-expanding bag with O2 reservoir/ accumulator 1 each □ □
(adult & infant sizes)

●clear mask (adult, child, & infant sizes) 1 each □ □

●Clear disposable valves 1 □ □

6- Airways
●Nasopharyngeal sizes (adult, child, & infant) 2 each □ □
● Oropharyngeal sizes (adult, child, & infant) 2 each □ □

B- Monitoring and Defibrillation (licensed trained team)

1- Portable, battery-operated monitor/defibrillator 1 □ □
●With tape write-out/recorder, defibrillator pads, quick- 2 sets □ □
look paddles or hands-free patches, ECG leads, adult &
pediatric chest attachment electrodes, adult & pediatric
paddles, with capability to provide electrical discharge below
25 watt-seconds
2. Transcutaneous cardiac pacemaker (either stand- 1 □ □
alone unit or integrated into monitor/defibrillator)
3. Pulse oximetry with adult & pediatric probes 1 □ □

C- Immobilization Devices
1-Rigid cervical collars for adult, child, & infant 1 each □ □
(small, medium, & large sizes) or adjustable.
2- Head immobilization device (not sand bag)
●firm padding or commercial device 1 □ □
3- Lower extremity (femur) traction devices
●supporting slings/ padded ankle hitch/ padded pelvic 1 each □ □
support / traction strap (adult & child sizes)
4- Upper and lower extremity immobilization devices
●joint above and joint below fracture (adult & child 2 sets □ □
sizes)
●rigid support appropriate material (cardboard, metal, 2 packs □ □
pneumatic, vacuum, wood or plastic)

5- Radiolucent backboards (long, short) and extraction 2 sets □ □

device used for head immobilization ,spine
immobilization, head to feet immobilization.

D- Dressings and Bandages

1- Sterile burn sheets 2 □ □
2- Triangular bandages 2 □ □

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 3- Sterile Dressings
●abdominal pad. 10 □ □
●4x4” gauze sponges 15 □ □
4- Sterile gauze rolls (various sizes) 5 each □ □
5- Non sterile Elastic bandages (various sizes) 5 each □ □
6- Sterile occlusive dressing 3x8” or larger 10 each
7- Adhesive tape □ □
●Various sizes of 2” or 3” hypo-allergic 2 each □ □
●Various sizes of 2” or 3” adhesive 2 each □ □
E- Communication
1- Installed two-way radio communication 1 □ □

2- Cellular phone 1 □ □

F- Obstetrical
1- Separate sterile kit containing at least : towels, 4×4 2 kits □ □
dressing, sterile scissors, bulb suction, towels, blanket,
surgical gloves, sterile disposable scalpel, cord clamps, and
plastic bag for placenta disposal.
2- Thermal absorbent blanket and head cover, aluminum 2 □ □
foil roll, or appropriate heat-reflective material (enough to
cover new born).
G- Compartment
1- Clean □ □
2- A/C and humidity control □ □
3- Electric (internal/ external) supply bulbs □ □
4- Spacious □ □
5- Secure □ □
6- Fridge or ice container for refrigerated medications 1 □ □
7- Fire extinguisher 1 □ □
8- Flash lights with extra batters and bulbs. 1 □ □

10- Stair chair or equivalent seated transport device. 1 □ □

11- Ambulance wheeled cot with mounted cot fastening 1 □ □
system
12- Folding stretcher 1 □ □

H- Miscellaneous
1- Sphygmomanometer (cuff size for infant, 1 □ □
pediatric, adult)
2- Stethoscope (pediatric/adult) 1 □ □
3- Length/weight based chart for pediatric equipment 1 □ □
sizing
4- Thermometer with low temperature capability 2 □ □

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 5- Heavy bandage or paramedic scissors for cutting 2 □ □
clothing, belts and boots.
6- Cold packs 2 □ □
7-Sterile saline solution for irrigation. 2 □ □
8- I.V administration set (microdrip & macrodrip). 5 □ □
9- Blankets, sheets, linen, or paper, pillows pillowcase, 2 pack □ □
and towels
10- Disposable standard sharps containers 1/each □ □
11- Disposable emesis bags or basins 5 □ □
12- Disposable bedpan 1 □ □
13- Disposable urinal 1 □ □
14- Patient care charts/ forms 5 □ □
15- Syringes (50ml x1, 30ml x1 ,10ml x5, 3ml x5,1ml x5) 5 each □ □
16- Gauge needles (various sizes). 5 each □ □
17- Glucometer or blood glucose measuring device (with 1 □ □
reagent strips)
18- Tourniquet 2 □ □
19- Intravenous arm boards, adult & pediatric 1 each □ □
20- Intravenous catheters different sizes 2 each □ □
21- Alcohol & povidone-iodine wipes 1 packet □ □
22- Crystalloid solutions, Ringer's lactate or normal 2 each □ □
saline, & dextrose 5% in water.
23. Nebulizer 1 □ □
24- Blank Labels 20 □ □
I- Infection Control (all equipments should be latex-free)
1- Eye protection (full peripheral glasses or goggles, or 2 □ □
face Shield
2- Masks and or HEPA masks 3 □ □
3- Gloves non sterile/ sterile, Jumpsuits or gowns , Shoe 10 each □ □
Covers.
4- Disinfectant hand wash 2 □ □
5- Disinfectant solution for cleaning equipments 2 □ □
6- Disposable trash bags and biohazard bags 5 □ □

J- Medication
1. Activated Charcoal (Suspension)
2. Albuterol nebulization (Ventolin®) 2 □ □
3. Antibacterial lubricating jelly (Sterile Lubricating bottles □ □
Jelly). 2 vial □ □
4. Aromatic Ammonia 2 □ □
5. Glucose (Oral/ IV) 2 □ □
6. IV Fluids (Various dissolution, sizes and 20 □ □
concentration) 2 boxes
7. Sulfadiazine silver (burn cream) 1 Vial □ □
8. Paracetamol !gm IV 20 □ □
9. Metochlorpopramide and or Ondansetrone 2 Vials □ □

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* 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;
1- Adenosine 6mg/2ml 2 Vials □ □
2- Aminophylline 250mg/10ml 2 vials □ □
3- Amiodarone 150mg 3 Amp □ □
4- Aspirin 300mg tablets ( EC) 3 vials □ □
5- Atropine sulfate 0.6mg/ml 3 Amp □ □
6- Calcium Chloride 10% (10ml) 1 amp □ □
7- Calcium Gluconate 10% (1g/10ml) 2 amp □ □
8- Dextrose 50% (25g/50ml) 2 syrin □ □
9- Dextrose 10% in water (250, 500, 1000 ml) 2 Bags □ □
10- Diazepam 10mg injection 2 syrin □ □
11-Diazoxide 300mg/20ml 2 vials □ □
12- Digoxin 0.1mg/ml (0.5mg/2ml) 2 Amp □ □
13- Diphenhydramine 50mg/ml 2 Amp □ □
14- Dobutamine 250mg 20 tabs □ □
15- Dopamine 200mg/5ml 2 vials □ □
16- Epinephrine 1mg/10 (IV) 2 Tubex □ □
17- Furosemide 20mg/2ml 4 Amp □ □
18- Glucagon 1-mg vial 1 amp □ □
19- Haldol 5mg/ml 2 amp □ □
20- Heparin Sodium 10units/ ml 2 Vials □ □
21- Hydrocortisone 250mg/2ml 4 vials □ □
22- Insulin soluble (Human) 2 vials □ □
23- Labetolol 100mg/20ml 2 Vials □ □
24- Lidocaine 100mg/5 ml (preload) 2 Vials □ □
25 -Magnesium Sulfate 50% (1g/2ml) 2 Vials □ □
26- Methylpresnisolone 80mg/2ml 2 Syri □ □
27- Morphine Sulfate 10mg/ml 2 Vials □ □
28- Naloxone 0.4mg/ml X 2 amp 2 Amp □ □
29- Nitroglycerin Spray (Sublingual) 1 Vial □ □
30- Norepinephrine 1mg/ml (4ml) 2 Amp □ □
31- Normal Saline injection 2 Cans □ □
32- Phentolamine 10mg/Vial 2 Amp □ □
33- Phenytoin 50mg/ ml 2 Bags □ □
34- Pralidoxine Chloride 1g/Vial 2 Vials □ □
35- Procainamide 1000mg/ 10ml 2 Vials □ □
36- Propranolol 1mg/ml 1 Vial □ □
37- Sodium Bicarbonate 50 Meq/50 ml Syrin (8.4%) 2 Vials □ □
38- Sodium Bicarbonate 10ml Ped Syringe 2 Vials □ □
39- Sterile Water for injsection 10ml 3 Amp □ □
40-Thiamine 100mg/ml 2 Syrin □ □
41- Verapamil 5mg/2ml 1 Syrin □ □

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K-Optional Advanced Equipment
1- Portable automatic ventilator 1 □ □
2- Alternative airway devices (double lumen tube 2 each □ □
airway) □
3- Umbilical vein catheters different sizes 1 each □
L- Operating personnel (EMT-P and EMT-1) 2 □ □
●Certified □ □
●Well trained □ □

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:……………………………………………………………………………...
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O- Inspectors Name/ Signature:

1- Name: Sig: Date:

2- Name: Sig: Date:

P- Inspection Department Manager Opinion/Conclusion:

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Name: Sig: Date:

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