37. July 2022 Ambulance Stock List - Final.pdf

DEPARTMENT OF THE AIR FORCE

HEADQUARTERS UNITED STATES AIR FORCE

WASHINGTON DC

20 July 22

MEMORANDUM FOR ALL PREHOSPITAL TRANSPORT PRESONNEL

FROM: AFMRA/SG3

SUBJECT: Air Force Medical Services Ambulance Supply and Medication Standardization

1. The attached Minimum Stock List details minimum durable medical equipment, single use item, and medication stock levels required to deliver care in accordance with the 2022 Joint Prehospital Emergency Care Protocols. Durable medical equipment and single use items are listed according to level of service (Basic Life Support and Advanced Life Support). Medications are aligned under approriate skill levels specified in the Prehospital Protocols.

2. Installation EMS organizations must maintain the minimum medication stock levels published in the Stock List. Agencies may stock and utilize “Optional” medications at the discretion of the Local EMS Medical Director. Medication locations (e.g. “Jump Bag”, etc.) are recommendations offered by the Air Force State Office of EMS, with field variations authorized. Note: Vials and Bristojets are interchangeable, so long as the minimum stocked dose is maintained (e.g. requirement: three 6mg/2 mL adenosine Bristojets (a total of 18mg adenosine) = any combination of vials and Brostoject which equate to 18mg adenosine).

4. The Minimum Stock List applies to all ambulances operated by Air Force personnel under the guidance of a Local EMS Medical Director, to include Flight Medicine Clinics. This memorandum and attachment supersede all previously published information on the same topic.

5. For further information or questions, please contact the USAF EMS Program at (703) 681-7165 or via email at usaf.jbsa.afmoa.mbx.ems-program-manager@mail.mil.

TIMOTHY J. PITMAN, GS14, USAF

The Air Force Fire Chief

ERICA M. SIMON, Maj, USAF, MC, FS EMS Consultant to the AF Surgeon General

Attachment:

Minimum Stocklist July 2022

Cab of Ambulance QTY AED -or- Cardiac Monitor QTY

Fuel above ½ tank EKG Limb Lead Set (if carrying cardiac monitor)

Protocol Binder 1 12 Lead Cables (if carrying cardiac monitor) 1

Base Map 1 Razor 2

Gloves (S, M, L, XL (if needed)) 1 bx ea Adult/Ped SpO2 Finger Probe -or- Portable Pulse Oximeter

Form 1800 1 Extra Monitor Paper (if carrying cardiac monitor)

SF 91 MVA Report 2 Electrodes (if carrying cardiac monitor) 1 bag

DD Form 518 Accident ID Card 2 Adult D-Fib Pads 2

Flight Line Gate Codes (if providing IFE response)

Pediatric D-Fib Pads 2

Emergency Response Guide Book 1 Capnoline EtCO2 Ped Nasal Cannula (if carrying cardiac monitor)

Binoculars 1 Capnoline EtCO2 Adult Nasal Cannula (if carrying cardiac monitor)

Flashlight 1 Capnoline EtCO2 for ETT / SGA (if carrying cardiac monitor)

Reflective Vests 1/mbr Adult, XL Adult, Child & Thigh BP Cuff 1ea

Run Sheets or Approved ePCR 10 Near Captain’s Chair QTY

Ear Pro 4 Cavi Wipes (or similar approved cleaner) 1

Eye Pro (or in interior cabinets) 4 Portable Suction w/Tubing & Yankauer 1

Hand Sanitizer 1 Triage Kit 1

Mobile/Portable Radio 1/mbr Extra Monitor Paper (if carrying cardiac monitor)

Gurney QTY Extra Electrodes (if carrying cardiac monitor)

1 bag

Complete Patient Securing Straps 1 Adult, XL Adult, Child & Thigh BP Cuff 1 ea

Size "D" O2 Tank > 500 PSI 1 Thermometer w/ Probe Covers (or in jump bag)

Oxygen Regulator w/ Wrench 1 Oral Probe (Blue) (or in jump bag) 1

Broselow Bag (optional) 1

FES SL2 Operated BLS Ambulance

Near Captain’s Chair (cont.) QTY Airway Compartment (cont.) QTY

Spare Gurney Battery 1 CPAP (Ped, Sm, Reg, Lrg as applicable to manufacture)

1 Sm, 2 Reg, 1 Lrg, 1 Ped (if approved for carry)

Spare Monitor Batter (as applicable) 1 Oral Airway Set (size 0 – 5) 1

Fire Extinguisher 1 Nasal Pharyngeal Airway Set (size 16 – 34F)

Aviator’s Mask w/Full D Tank & Mask Regulator (if providing IFE response; may have any other approved device per Flight Med guidance)

1 Water soluble lubricant 5

Spare Adult D-Fib Pads 2 Adult BVM 2

Spare Ped D-Fib Pads 2 Pediatric BVM 1

Stethoscope 1 Infant BVM 1

Manual BP Cuff Set 1 ETT / SGA Securing Device 2

Spare O2 Tanks (if securing devices are installed)

2 Manual Suction Device (or in jump bag) 1

Gloves (S, M, L (XL if needed)) 1 bx ea Adult Nebulizer 2

Ped Length-Based Measuring Tape (IE Broselow) (or in jump bag)

1 Ped Nebulizer 2

Pen Light (or in jump bag) 1 Capnoline EtCO2 for ETT / SGA (if carrying cardiac monitor)

Glucometer w/Test Strips & Lancets (or in jump bag)

Ped NRB 4

Airway Compartment QTY Ped Nasal Cannula 2

Adult NRB 4 Bulb Suction 2

Adult Nasal Cannula 4 Trauma Compartment QTY

Capnoline EtCO2 Adult Nasal Cannula (if carrying cardiac monitor)

2 CAT or TCCC Approved Tourniquet 2

Capnoline EtCO2 Ped Nasal Cannula (if carrying cardiac monitor)

1 TCCC Approved Hemostatic Dressing 2 iGel Size 1 - 5 (if approved by Med Director)

1 ea Box of 4x4 1

Spare Suction Container w/Tubing/Yankauer

1 Box of 2x2 1

Trauma Compartment (cont) QTY Additional Requirements (cont) QTY

Cravats 4 1000cc Sterile Water -or- Sterile Saline 2

Ring Cutter (or in jump bag) 1 OB Kit 1

Trauma Sheers (or in jump bag) 1 Chux 1 pkg

Sam Splints 2 Wash Basin 2 Compression Dressing 3, 4 or 6 inch (e.g.

ACE) 2 Bed Pan 2

Band-Aids 10 Emesis Bags -or- Emesis Basin 4

Rigid Eye Shield (or in jump bag) 2 Large Red Biohazard Bag 2

Alcohol Pads (for med admin) 1 bx Infection Control Gowns 4

TCCC Approved Vented Chest Seal 2 N95 Masks (S, M, L) 3 ea Adult Needle Decompression (14g 3.25 Inch) 4 Surgical Masks 1 bx

Pelvic Binder 1 Soft / Leather Restraints 2 sets

1 Inch Tape 2 Hot Packs 4

2 or 3 Inch Tape 2 Cold Packs 4

Burn Sheet 2 Outside Compartments QTY

Abdominal Pads 4 Head Blocks 2 sets

Kerlix 4 Oxygen Size "M" Tank > 500 PSI 1

TCCC Approved Vented Chest Seal 2 Mortuary Bags (if required per MCRP) 2

Additional Requirements QTY Wheel Chalks 1 set

Blankets 2 Backboard w/ Securing Straps 2

HPMK, Space Blanket or Similar 2 Scoop Stretcher 1

Sheets for Gurney 2 Splint Set (Rigid, Air, etc) 1

Towels 2 Stair Chair (or inside compartment) 1 Pediatric Securing Device for Gurney (e.g.

Pedimate) 1

Kendrick Extrication Device (KED) -or- Pediatric Backboard

Outside Compartments (cont) QTY

Traction Splint (Sager, Slishman, Hare, etc.) 1

Adult C-Collar 4

Pediatric C-Collar 2

Triangle Road Reflectors 1 set

Near Captain’s Chair QTY Circulation Compartment (cont.) QTY

Rectal Probe (Red) 1 EZ-IO Needles (15mm, 25mm, 45mm) (or in jump bag) 1 ea

Circulation Compartment QTY Nasal Atomizer 4

Burette Set 1 Alcohol -or- ChloraPrep (move from trauma compartment above) 1 bx

IV Tubing (15gtt or 10gtt) 4 Saline Flushes 10

24 - 14g IV Catheters 4 ea 100mL NS Bag (if carrying Ertapenem) 2

1, 3, 5, 10mL Syringes 4 ea Filter Needles (if required) 5

18G Straight Needles 5 1L LR Bag 3

Med Admin Needles (21g - 25g) 5 of preferred EZ-IO Drill (or in jump bag) 1

Vein Guard / Tegaderm (or IV start kits) 5 Pressure Infusion Bag 1

IV Tourniquets (if not in IV start kits) 4 Coban 2

Saline Locks 5

Trauma Compartment QTY

Morgan Lens 2

This section intentionally left blank

This section intentionally left blank

4N / AEMT Operated BLS Ambulance (All FES Items Above Plus Items Below)

Circulation Compartment QTY Airway Compartment (cont.) QTY

60 gtt Microdrip Tubing 2 Cric Kit (1 may be in jump bag) 2

250mL NS Bag (for making drips) 2 Laryngoscope Handle (or in jump bag) 1 ea

100mL NS Bag (for making drips) 2 Mac Blades (size 1 - 4) (or in jump bag) 1 ea

Three-Way Stopcock 3 Miller Blades (size 0 - 4) (or in jump bag) 1 ea

Airway Compartment QTY Spare Laryngoscope Batteries / Bulb (or in jump bag)

10/14/18 FR Suction Catheters 1 ea Near Captain's Chair QTY

Sterile Gloves (for trach suctioning) 2 sets Infusion Pump (optional / if equipped) 1

ET Tubes Size 2.5 - 8.0

2.5 - 6.5; 2 ea of 7.0 - Video Laryngoscope (optional / if equipped) 1

Adult and Ped Stylet 2 ea

Adult and Ped Bougie (optional) 2 ea

Sm/Reg Magill Forceps (or in jump bag) 1 ea

This section intentionally left blank

ALS (SL4) Ambulance (All Above Items Plus Items Below)

Category Item Qty Notes Gloves (S, M, L, XL) 2 pair ea Face Shield or Eye Pro 2 CoTCCC approved Tourniquet 2 CoTCCC Approved Hemostatic Agent (e.g. Combat Gauze) 1 6" Compression dressing 1 NPA (Size 22 - 36FR) 1 ea OPAs (Size 0 - 5) 1 ea Water soluble lubricant 2

Adult Supraglottic Airways (iGel Size 3 - 5) 1 ea SL2 w/ Med Director approval SGA securing device 1 If carrying SGAs Adult and Pediatric BVM 1 ea CoTCCC Approved Vented Chest Seals 4

Needle Decompression 14g 3.75 inch 2 SL2 w/ Med Director approval Oxygen "D" Tank w/regulator (or on gurney) 1 Ped and Adult Nasal Cannula 1 ea Ped and Adult Non-Rebreather Mask 1 ea

Adult and Ped Nebulizer 1 ea SL2 w/ Med Director approval Sharps Shuttle (or equivalent) 1 IV Start Kit 2 16 - 24g IV Catheters 1 ea Tourniquet 1 Alcohol pad 2 2x2 2 IV Securing tape / tegaderm or vein-guard 1 ea Saline Lock 2 Saline Flush (5mL or 10mL) 2 1000mL LR or NS 1 IV drip Tubing (10 or 15gtt) 1 EZ-IO Drill 1 EZ-IO Needles (15mm / 25mm / 45mm) 1 ea 3 and 5mL syringe 2 ea 18g, 21g, 23g needles 2 ea Space Blanket 1 Rigid Eye Shield 2 Bandaids 5 4 & 6 inch compression dressing (e.g. ACE) 2 Abdominal Pad 1 Kerlix 2 1" Tape 1 4x4 Gauze 10 2" Coban 1

H

EMS Response Bag(s) - Medical/Trauma

PPE

M

A

R

C 4N / AEMT

Ambulances Only

W

SAM Splint (or equivalent) 2 Ice and Heat Pack 1 ea Cravat 2 Trauma Shears 1 Ring Cutter (or stocked in the ambulance) 1 Pen Light 1 Stethoscope 1 Thermometer (w/ probe covers if applicable) 1

Glucometer (w/test strips, EtOH pads, lancets, bandaids)

Must be operating under a laboratory CLIP (MTF or unit's own) before carrying

Regular / Large Adult Manual BP Cuff 1 ea SpO2 device (may be on monitor) 1 Ped Length-Based Tape 1 Emesis Bags 2

Laryngoscope Handle (Adult and Peds) 1 Laryngoscope Blades - Macintosh (size 1 - 4) 1 ea Laryngoscope Blades - Miller (size 0 - 4) 1 ea Spare batteries (Adult and Peds Handle) 1 set ea Magill Forceps (Large and Small) 1 ea ET Tubes (2.5 - 8.0) 1 ea Consider 2 ea of 7.0 - 8.0 10mL Syringe 2 ET Tube Holder 1 Adult / Peds Stylet 2 Adult / Peds Bougie 1 Optional Water Based Lubricant 2 Capnometry device (may use monitor if equipped) 1 Cricothyroidotomy Kit 1

S

Response Bag (cont.) - Medical/Trauma

Airway

Airway Kit for ALS Rigs (SL4 Providers ONLY)

V/S & Other

Patient Care

Items

Category Medication Qty Notes Chest Pain Aspirin (81mg) 1 bottle Chewable tablets

Epinephrine Autoinjector (0.3mg) 1 Auto-Injector Epinephrine Autoinjector (0.15mg) 1 Auto-Injector Oral Glucose (30g) Tube 1 Naloxone 4mg (Nasal Pre-load) 2 May substitute with Auto-Injector

Atro-Pen 2mg 3 Auto-Injector Atro-Pen Pediatric 0.5mg 3 Auto-Injector Mark I NAAK 3 Auto-Injector Pralidoxime Chloride, Inj. 3 Auto-Injector CANA (Diazepam) 3 Auto-Injector ATNAA (2.1mg Atropine/600mg 2-Pam) 3 Auto-Injector Oxymetazoline Nasal Spray 1 Ipratropium Bromide (0.5mg/3mL) 5 Pre-filled Albuterol (2.5mg/3mL) 5 Pre-filled Albuterol MDI w/Spacer 1

Other Optional Medications

SL2 - Minimum Medication Requirements

Altered Mental Status

Optional CBRN / Organophosphate

Optional SL2 Medications (Must be approved for carry/use by the Local EMS Medical Director)

Asthma / Allergic Reaction / Other

IV / IO Fluids 0.9% Lactated Ringers 500mL or 1000mL 3 If 500mL bags are stocked a min of 6 must be carried

Chest Pain Aspirin (81mg) 1 bottle Chewable tablets Albuterol (2.5mg/3mL) 5 Pre-filled Diphenhydramine (50mg/mL) 1 50mg vial Epinephrine Autoinjector (0.3mg) 1 Epinephrine Autoinjector (0.15mg) 1 Ipatropium Bromide (0.5mg/3mL) 5 Pre-filled D10W, Inj - 500mL 2 Glucagon Kit (1mg/1mL) 1 Oral Glucose (30g) Tube 1 Naloxone (0.4mg/mL) 4 1mL vial Naloxone (4mg/10mL) 1 Or 2 Bristojets Acetaminophen (160mg/5mL) 2 Pre-mixed cups Acetaminophen (500mg tablet) 2

Tranexamic Acid 1g/10mL 2 Optional unless average transport to trauma center exceeds 30min

Ondansetron 4mg ODT 2 Ondansetron (4mg/2mL) 2 4mg vial

Atro-Pen Pediatric 0.5mg 3 Auto-Injector Atropine (0.4mg/mL) 1 20mL vial Mark I NAAK 3 Auto-Injector Pralidoxime Chloride, Inj. 3 Auto-Injector CANA (Diazepam) 3 Auto-Injector ATNAA (2.1mg Atropine/600mg 2-Pam) 3 Auto-Injector Acetamenophen 650mg PR 1 Acetazolamide 250mg* tablet 2 *Immediate Release

Ertapenem 1g 1 Vial; must also carry 100mL NS bags to faciliate administration

Lidocaine 1% vial 1 For IM Ertapenem Naloxone 4mg (Nasal Pre-load) 1 Tetracaine 0.5%, Opthalmic Drops 1 Oxytocin (10 Unit/mL) 1 10 Unit vial Epinephrine 1:10,000 (1mg/10mL) 8 Bristojet Albuterol MDI w/Spacer 1 Dexamethasone (10mg/mL) 1 10mg vial 2% Cardiac Lidocaine (for IO pain relief) 1 100mg/5mL Bristojet

Hypertonic Saline 3%, 500mL

Highly encouraged if transport to a trauma center exceeds 30 min

Asthma / Allergic Reaction / Other

SL3 - Minimum Medication Requirements

Optional SL3 Medications (Must be approved for carry/use by the Local EMS Medical Director)

Optional CBRN / Organophosphate

Other Optional Medications

Other

Altered Mental Status

Oxymetazoline Nasal Spray 1 Meloxicam (15mg tablet) 2 Nifedipine 30mg* tablet 2 *Extended Release

Ketamine (500mg/10mL or 500mg/5mL) 1

Fentanyl (100mcg/2mL) 2 100mcg vial Fentanyl 400mcg OTFC 1 400mcg ONLY

*MUST have local EMS Medical Director approval and MUST be TCCC Tier 3 or above*

Controlled Optional

Medications

Optional SL3 Medications (cont.) (Must be approved for carry/use by the Local EMS Medical Director)

Other Optional Medications

0.9% Normal Saline 100mL 1 For medication drips 0.9% Normal Saline 250mL 1 For medication drips Lactated Ringers, Inj., 1000mL 3 If 500mL bags are stocked a min of 6 must be carried

Adenosine 6mg (6mg/2mL) 3 6mg pre-filled syringe or 6mg vial Amiodarone 150mg 4 150mg vial Atropine 1mg (1mg/10ml) 2 Bristojet Calcium Gluconate (1g/10mL) 2 Vial or Bristojet Epinephrine 1mg/10mL 8 Bristojet Magnesium Sulfate (5g/10mL) 1 Bristojet Norepinephrine (1mg/mL) 1 4mg vial Sodium Bicarbonate 8.4%, 50mEq/50mL 2 Bristojet Aspirin (81mg) 1 bottle Chewable tablets Nitroglycerin (0.4mg) sublingual tablets 1 bottle Albuterol (2.5mg/3mL) 5 Pre-filled Dexamethasone (10mg/mL) 1 10mg vial Diphenhydramine (50mg/mL) 1 50mg vial Epinephrine 1mg/mL 2 1mg vial Epinephrine Autoinjector (0.3mg) 1 Auto-Injector Epinephrine Autoinjector (0.15mg) 1 Auto-Injector Ipratropium Bromide (0.5mg/3mL) 5 Pre-filled D10W, Inj - 500mL 2 Glucagon Kit (1mg/1mL) 1 Oral Glucose (30g) Tube 1 Naloxone (0.4mg/mL) 4 1mL vial Naloxone (4mg/10mL) 1 Or 2 Bristojets Acetaminophen (160mg/5mL) 2 Pre-mixed cups Acetaminophen (500mg tablet) 2

Tranexamic Acid 1g/10mL 2 Optional unless average transport to trauma center exceeds 30min

Hypertonic Saline 3%, 500mL 1 Optional unless average transport to trauma center exceeds 30min

Ondansetron 4mg ODT 2 Ondansetron (4mg/2mL) 2 4mg vial Oxytocin (10 Unit/mL) 1 10 Unit vial 2% Cardiac Lidocaine (for IO pain relief) 1 100mg/5mL Bristojet

Fentanyl (100mcg/2mL) 2 100mcg vial Ketamine (500mg/10mL or 500mg/5mL) 1 Midazolam (5mg/mL) 2 5mg/mL vial; May carry 2mg/mL (4 qty)

SL4 - Minimum Medication Requirements

IV / IO Fluids

Cardiac

Asthma / Allergic

Reaction / Other

Altered Mental Status

Other

Controlled Medication

Atro-Pen 2mg 3 Auto-Injector Atro-Pen Pediatric 0.5mg 3 Auto-Injector Atropine (0.4mg.mL) 1 20mL vial Mark I NAAK 3 Auto-Injector Pralidoxime Chloride, Inj. 3 Auto-Injector CANA (Diazepam) 3 Auto-Injector ATNAA (2.1mg Atropine/600mg 2-Pam) 3 Auto-Injector Hydroxocobalamin (5g) Kit 1 Cyano-Kit Lidocaine 1% vial 1 For IM Ertapenem Naloxone 4mg (nasal Pre-Load) 1 Nifidipine 30mg* tablet 2 *Extended Release Albuterol MDI w/spacer 1 Oxymetazoline Nasal Spray 1 Metoclopramide (5mg/mL) 1 10mg vial Tetracaine 0.5%, Ophthalmic Drops 1 Acetazolamide 250mg* tablet 2 *Immediate Release Metoprolol (5mg/5mL) 1 5mg vial or ampule Ertapenem 1g 1 Vial

Acetaminophen 650mg PR 1 Fentanyl 400mcg OTFC 1 400mcg ONLY Meloxicam (15mg tablet) 2

Optional SL4 Medications (Must be approved for carry/use by the Local EMS Medical Director)

Optional CBRN / Organophosphate

Other Optional Medications