Minimum Essential (E) MISCELLANEOUS Quantity Available Desired (D) Necessary 1. (not pounds) E N/A □ □ Weight scale locked in kilograms Yes No 2. External heat source must include each of the following: E 1 □ □ □ Blanket warmer Yes No □ E 1 Infrared lamps □ □ Yes No □ E 1 □ □ Overhead warmer (Available within the hospital) Yes No □ D 1 □ □ Bair Hugger Yes No Medication tape, or other system to ensure ready 3. □ □ E 1 Yes No access to information on proper per kilogram doses for resuscitation drugs and equipment sizes # Type your facility uses: □ Broselow® Pediatric Emergency Tape® (Current Edition) □ Pedi-Wheel®
MISCELLANEOUS Essential (E) Desired (D) Minimum Quantity Necessary Available 1. Weight scale locked in kilograms (not pounds) E N/A □ Yes □ No 2. External heat source must include each of the following: □ Blanket warmer E 1 □ Yes □ No □ Infrared lamps E 1 □ Yes □ No □ Overhead warmer (Available within the hospital) E 1 □ Yes □ No □ Bair Hugger D 1 □ Yes □ No 3. Medication tape, or other system to ensure ready access to information on proper per kilogram doses for resuscitation drugs and equipment sizes # E 1 □ Yes □ No Type your facility uses: □ Broselow® Pediatric Emergency Tape® (Current Edition) □ Pedi-Wheel®
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