List of recommended essential equipment for BLS and ALS ground ambulances, 2020

Category	BLS		ALS (all BLS equipment plus the following)
	Adult	Pediatric	Adult	Pediatric
Airway, ventilation, and oxygenation	Oxygen supply, portable and on-board Devices capable of delivering oxygen in a titratable manner through nasal, partial face, or full-face mask routes in sizes to fit neonates through adults Oropharyngeal airways in sizes to fit neonates to adults Nasopharyngeal airways in sizes to fit neonates to adults Manual and/or powered suction device(s) with rigid oral and flexible pharyngeal/tracheal suction catheters in sizes to fit neonates to adults A device capable of providing noninvasive positive pressure ventilation Self-inflating manual ventilation devices and masks to fit neonates to adults		Direct and/or video laryngoscopy equipment appropriate for neonates to adults* Magill forceps Extraglottic airways in sizes to fit neonates to adults^¶
		Bulb suction
Bleeding, hemorrhage control, shock management, and wound care	Commercial arterial tourniquets Wound-packing material^Δ Gauze sponges Adhesive bandages Adhesive tape Fluid for irrigation of wounds Occlusive dressing (also known as "chest seal")		Chest decompression needles ≥14 g diameter, minimum length 3.25 in (8.25 cm) or commercial chest decompression device	Chest decompression needles: 14 g diameter, maximum length 1.5 in (3.8 cm) for patients <56 in (144 cm) long 23 g diameter, maximum length 0.75 inches (2 cm) for newborns
Cardiovascular and circulation care	Automatic external defibrillator with adult and pediatric or combination pads		A device capable of performing automatic and/or manual defibrillation, cardiac rhythm monitoring (in at least 3 leads), 12-lead ECG acquisition, and transcutaneous pacing
Diagnostic tools	Glucometer Pulse oximeter with sensors to fit neonates to adults Stethoscope Blood pressure cuffs in sizes to fit neonates to adults Thermometer		Continuous waveform capnography
Infection control	Items necessary for universal and standard precautions: Waterless hand cleanser Sharps container Supplies for collection or absorption of patient vomit, urine, and/or feces Biohazardous materials collection bags Products appropriate for cleaning and disinfecting surfaces and equipment Items necessary for the following transmission-based precautions: Contact precautions: examination gloves, eye protection, gowns Droplet precautions: surgical masks and eye protection Airborne precautions: N95 facemasks in provider-appropriate sizes and eye protection or powered air-purifying respirator (PAPR) General trash collection bags		No additional ALS recommendations
Medications	Medications that are germane to approved agency BLS protocols		Medications that are germane to approved agency ALS (and/or higher level) protocols
Medication delivery and vascular access	Devices and supplies needed to administer medications via routes (oral, inhaled, intramuscular, intranasal) included in locally approved scope of practice and locally applicable protocol(s) and in sizes to fit neonates to adults Supplies for application of antiseptic to skin		Devices and supplies needed to administer medications via routes (oral, inhaled, intramuscular, intranasal, intravenous, intraosseous) included in locally approved scope of practice and locally applicable protocol(s) in sizes to fit neonates to adults Isotonic crystalloid fluids and administration tubing capable of adjustable fluid delivery rate A device to provide pressure infusion of IV fluids
		Tools that provide precalculated weight-based dosing and preclude the need for calculation by EMS providers can reduce dosing errors.		A device suitable for administering a fluid bolus to pediatric patients that limits risk for inadvertent overadministration of fluid
Neonatal care		Newborn delivery supplies: 2 umbilical cord clamps, Tool for cutting umbilical cord, Bulb suction, Infant head cover, Towels, Blanket, Gauze dressings, Material or device intended to maintain body temperature	No additional ALS recommendations
Orthopedic injury care	Splinting material or commercial devices for immobilization of orthopedic extremity injuries including but not limited to: Femoral splinting materials, which may include either simple nontraction devices or devices that provide femoral traction.^◊ Pelvic splinting materials, which may include either a commercial pelvic circumferential compression device (PCCD) designed specifically to splint the pelvis or a dedicated bedsheet and towel clips to perform circumferential pelvic antishock sheeting. Cold packs Elastic bandages		No additional ALS recommendations
Patient packaging, evacuation, and transport	Extrication board or device^§ Materials or devices that can be used to provide spinal motion restriction of the cervical, thoracic, and lumbar spine for neonates to adults Portable stretcher or litter Collapsible "stair chair" Wheeled multilevel gurney		No additional ALS recommendations
		Pediatric-specific restraint system or age/size-appropriate car safety seat^¥
Safety	Fire extinguisher (5lb ABC) ANSI Class 2 or 3 reflective vest or outerwear Impact-resistant eye protection (ANSI Z87.1) Nonflammable reflective and/or illuminated roadside warning devices Portable reusable light source		No additional ALS recommendations
Temperature management and heat-loss prevention	Blankets Towels Heat packs		No additional ALS recommendations
Miscellaneous items	Bandage and trauma shears A device that allows for two-way communication between the field and EMS communications and dispatch centers, direct medical control, and receiving hospitals Triage marking system (colored tape, tags, or other system) that is interoperable with other local health care system entities and that follows recommendations from the US Department of Health and Human Services Assistant Secretary for Preparedness and Response		No additional ALS recommendations
Items that should no longer be carried on BLS or ALS ground ambulances because of evidence of harm or proven lack of clinical efficacy: Military antishock trousers (MAST), also called pneumatic antishock garment (PASG) Syrup of ipecac

ANSI: American National Standards Institute; ECG: electrocardiogram; IV: intravenous.
* Laryngoscopy equipment is included to facilitate ALS provider identification and mechanical removal of upper airway foreign bodies by using Magill forceps, regardless of whether the ALS agency includes pediatric or adult endotracheal intubation within their ALS provider scope of practice.
¶ Depending on locally approved scope of practice and locally applicable protocol(s), other invasive airways (endotracheal tubes or needle or surgical cricothyrotomy supplies) may also be carried but are not recommended to be universally required on all ALS ground ambulances.
Δ Wound-packing material may include plain gauze and/or hemostatic dressings.
◊ Traction is not a necessary or required element of prehospital stabilization of suspected femur fracture(s) and is often contraindicated.
§ Devices used for extrication, such as backboards, should not be used for transport. Whenever feasible, patients should be removed from extrication devices before transport. Spinal motion restriction can be maintained by securing the patient to the transport stretcher.
¥ Restraint devices should meet applicable crash-testing standards as they are developed and published and should appropriately meet individual patient weight, length, and developmental status needs.

Graphic 131782 Version 4.0

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List of recommended essential equipment for BLS and ALS ground ambulances, 2020