Form: Burn Resource CHECKLIST.html,Burn Resource CHECKLIST Viewer.html
To:

Subject:BURN RESOURCE CENTER CHECKLIST LIST, <var facility>

Msg:  
DEPARTMENT OF HEALTH SERVICES COUNTY OF LOS ANGELES
REFERENCE NO. 1138.1

SUBJECT: BURN RESOURCE CENTER REQUIRED
EQUIPMENT/SUPPLIES/PHARMACEUTICALS

FACILITY: <var facility>
------------
** EQUIPMENT    [REQUIRED MINIMUM QUANTITY*]
ACTUAL QUANTITY

Video equipment for bronchoscope   [1 each] 
<var CO1>

Fluid Infusion Warmer   [3 each] 
<var CO3>

IV Pumps (dual channel)    [12 each] 
<var CO5>

Thermal Mylar Blanket   [24]
<var CO7>

Thermal Blanket  Forced Air Warming Blanket (Bair HuggarTM)   [2 each]
<var CO9>

Video laryngoscope  (Glidescope) with Pediatric & Adult blades   [2 each] 
<var CO11>

Cauterizer (Bovie)   [1]
<var CO13>

Cautery Disposable Tips   [12]
<var CO15>

Cautery Grounding Pads   [24]
<var CO17>
-------

** PHARMACEUTICALS   [REQUIRED  MINIMUM QUANTITY*]
ACTUAL QUANTITY

Silver Sulfadiazine 1%  Any Size   [14,400grams]
<var CO2>

Bacitracin (28.4 gm tube)   [36 each] 
<var CO4>

Cyanide Antidote Kit or CyanoKit   [5 kits] 
<var CO6>

Midazolam 5mg/ml   [360 vials/ampules]
<var CO8>

Naloxone 0.4mg/ml   [360 vials/ampules]
<var CO10>

Morphine Sulfate 10mg/ml   [720 vials/ampules]
<var CO12>

Lactated Ringers Solution 1 liter bags   [250 bags]
<var CO14>

D5 Lactated Ringers Solution  500 cc bags    [100 bags] 
<var CO16>
----
** BURN WOUND CARE SUPPLIES

SUPPLIES    [REQUIRED  MINIMUM QUANTITY*]

Burn Debridement/ Escharotomy Tray    [24 trays]
<var CO18>

Dry Burn Dressing (32X36)    [600 each] 
<var CO19>

Gauze Bandage Rolls (Kerlix) 4"    [400 each] 
<var CO20>

Tubular Elastic Net Bandage (Burn Net)  (Size #1, 5, 6, 7, 10, 22)    [36 each size] 
<var CO21>
-----
Notes/Comments
<var CO22>

--
Approved by Name: <var Approvedby>
Received by: <var Receivedby>

------------------------------------
Express Sending Station: <MsgSender>
Senders Express Version: <ProgramVersion>
Senders Template Version: <var Templateversion>