NERA Daily ALS Medication Checklist

Enter NER Forms

NERA Daily ALS Medication Checklist
Date*
Crew 1 Last Name*
Crew 2 Last Name*
Truck #*
Drug Box #*
Adenosine 6MG - 5*

FailPass
Albuterol 3mg in 3mL- 6*

FailPass
Amiodarone 150mg - 2*

FailPass
Baby Aspirin 81mg - 1*

FailPass
Atropine 1MG 1:10,000 - 2*

FailPass
Atrovent - 6*

FailPass
Benadryl 25mg - 2*

FailPass
Calcium Chloride 10% - 1*

FailPass
Cardizem 100mg in 100ml NS- 1*

FailPass
Dextrose 50% - 1*

FailPass
Dextrose 25% - 1*

FailPass
Dopamine Premix - 1*

FailPass
D-10 Premix - 1*

FailPass
Epinephrine 1mg 1:1,000 - 2*

FailPass
Epinephrine 1mg 1:10,000 - 6*

FailPass
Glucagon 1mg - 1*

FailPass
Haldol 5mg - 1*

FailPass
Lasix 100mg - 1*

FailPass
Lidocaine 100mg - 1*

FailPass
Lidocaine Pre-mix - 1*

FailPass
Lidocaine Jelly - 1*

FailPass
Hurricaine - 1*

FailPass
Mag Sulfate - 1*

FailPass
Metoprolol 5mg - 1*

FailPass
Motrin- 1*

FailPass
Narcan 2mg - 6*

FailPass
Nitro Paste 1mg - 3*

FailPass
Nitro Spray - 1*

FailPass
Racepinephrine - 2*

FailPass
Solu-Cortef -1*

FailPass
Tetracaine - 1*

FailPass
Toradol- 1*

FailPass
Tylenol - 1*

FailPass
Zofran 4mg - 1*

FailPass
Sodium Bicarb 8.4% - 1*

FailPass
Nasal Atomizers - 2*

FailPass
Micro Dripset 60gtt - 1*

FailPass
Syringes 1,3,5,10 - 3 ea*

FailPass
Syringes 30ml - 1 ea*

FailPass
Needles 18,21,23,25g - 3*

FailPass
What is missing?
Final
Drug Box Inspection Result*

Unsatisfactory (Notify Dispatch Immediately)Satisfactory
MA EMT # of Person Completing Form
Should be Empty: