Naloxone Actions Identified X2 Adrenaline Resuscitation Hydrochloride High Emergency Cd on action sheet Ambu Face size Guedel Airway Tough Emerade 2mg/2ml concentration Oxygen cylinders Grab bag bag Small, Medium Size: 2,3 and 4 cut Auto-Injectors Pre-filled syringe Non-breathe X3 checked/secure/ (Yes/No) and Large (Yes/No) Plastic intact X 5 Safety Day Oxygen Mask (1 in Grab bag Signature and Date location identified Expiry date handled Hypodermics Expiry date (Yes/No) plus 2 spare) designation (Sealed if Scissors Seals intact Expiry date (Yes/No) required) (Yes/No) Expiry date Expiry date (Yes/No) 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Day Date Resuscitation Grab bag checked/secure/ location identified (Sealed if required) (Yes/No) Ambu bag (Yes/No) Face size Small, Medium and Large High concentration Non-breathe Oxygen Mask (Yes/No) Expiry date Guedel Airway Size: 2,3 and 4 (Yes/No) Expiry date Emergency Cd Oxygen cylinders X3 (1 in Grab bag plus 2 spare) (Yes/No) Expiry date Tough cut Plastic handled Scissors (Yes/No) X2 Adrenaline Emerade Auto-Injectors intact Expiry date Naloxone Hydrochloride 2mg/2ml Pre-filled syringe X 5 Safety Hypodermics Seals intact Expiry date Actions Identified on action sheet Signature and designation 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
NTWC01-App5a-ResusEqStdMonitorTool-V05-Iss-1-Apr-18.docx