PART IV - LEVEL 2 HOSPITAL

Instruction: In the appropriate box, place a check mark (√) if the hospital is compliant or X-mark if not compliant.

ATTACHMENT 2.A - PERSONNEL

NUMBER /
POSITION QUALIFICATION EVIDENCE COMPLIED REMARKS
RATIO
TOP MANAGEMENT (Should be full-time)
Chief of  Licensed physician DOCUMENT REVIEW 1
Hospital/Medical  Have completed at  Diploma/Certificate of
Director least twenty (20) units earned
units towards a  Updated Physician PRC
Master’s Degree in license
Hospital  Certificates of
Administration or Trainings attended
related course  Proof of Employment/
(MPH, MBA, MPA, Appointment
MHSA, etc.) AND (notarized)
at least five (5)  Service
years hospital Record/Certificate of
experience in a Employment (proof of
supervisory or hospital
managerial position supervisory/managerial
experience)
Chief of Clinics /  Licensed physician DOCUMENT REVIEW 1
Chief Medical  Fellow/diplomate of  Diploma/Certificate
Professional a specialty/ from Specialty society
Services subspecialty society  Updated PRC license
 At least five (5)  Certificates of Trainings
years hospital
attended
experience in a
clinical supervisory  Proof of Employment /
or managerial Appointment
position (notarized)
 Service
Record/Certificate of
Employment (proof of
clinical
supervisory/managerial
experience in hospital)

Department Head  Licensed physician DOCUMENT REVIEW 1 per

(Specialty)  Fellow / diplomate  Diploma/Certificate department
in a specialty / from Specialty society
Subspecialty society  Updated PRC license
of the department  Certificates of Trainings
he/ she heads
attended
 Proof of Employment /
Appointment
(notarized)
Chief Nurse/  Licensed nurse DOCUMENT REVIEW 1
Director of Nursing  Master’s Degree in  Diploma
Nursing AND at  Updated PRC license
least five (5) years  Certificates of
of clinical Trainings attended
experience in a  Proof of Employment /

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 NUMBER /
POSITION QUALIFICATION EVIDENCE COMPLIED REMARKS
RATIO
supervisory or Appointment (notarized)
managerial position  Service
in nursing Record/Certificate of
(R.A. No. 9173) Employment (proof of
supervisory/managerial
experience in nursing)
Chief Have completed at DOCUMENT REVIEW 1
Administrative least twenty (20) Units  Diploma/Certificate of
towards Master’s units earned
Officer/Hospital
Degree in Hospital  Updated PRC license
Administrator
 Certificates of
Administration or
Trainings attended
related course (MPH,  Proof of Employment /
MBA, MPA, MHSA, Appointment
etc.) AND at least five (notarized)
(5) years hospital  Service
experience in a Record/Certificate of
supervisory / Employment (proof of
managerial position. hospital
supervisory/managerial
experience)
ADMINISTRATIVE SERVICES
Certified Public DOCUMENT REVIEW 1
Accountant
Accountant (may be  Diploma/Certificate of
outsourced) units earned
With Bachelor’s  Updated PRC 1
Billing Officer license (if
Degree relevant to the
applicable) 1
Book keeper job  Certificates of
Budget / Finance Trainings attended 1
Officer  Proof of Employment/
Appointment
Cashier 1
(notarized)
Human Resources 1
Management
Officer / Personnel
Officer
Engineer (full Licensed Engineer DOCUMENT REVIEW 1
time)  Diploma
 Updated PRC license
 Proof of Employment
/ Appointment
(notarized)
Supply Officer/- With appropriate DOCUMENT REVIEW 1
Storekeeper training and  Certificates of
experience Trainings attended 1
 Proof of Employment
Laundry Worker
/ Appointment
(notarized)
Medical Records  Bachelor's Degree DOCUMENT REVIEW 1
officer  Training in ICD 10  Diploma
 Training in Medical  Certificates of
Records Trainings attended
Management
 Proof of Employment /
Appointment

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 NUMBER /
POSITION QUALIFICATION EVIDENCE COMPLIED REMARKS
RATIO
(notarized)
Medical Social Licensed Social DOCUMENT REVIEW 1
worker (Full Time) Worker  Diploma / Certificate of
units earned
 Updated PRC license
Nutritionist- Licensed Nutritionist- Certificates of 1
Dietician (Full Dietician Trainings attended
Time)  Proof of Employment
/ Appointment
(notarized)

Building May be outsourced. DOCUMENT REVIEW 1 per shift

Maintenance  Relevant Training
Man/Utility Security guard must be  License, if applicable
licensed.  Proof of Employment/
Worker
Security Guard Appointment 1 per shift
(notarized) if
(licensed) employed by hospital
 Notarized MOA if
outsourced
CLINICAL SERVICES
Consultant Staff in  Licensed physician DOCUMENT REVIEW At least 50% of
Ob-Gyn,  Fellow/Diplomate  Certificate from the consultants
Pediatrics,  ACLS certified (for Specialty society, if per specialty
Medicine, Surgeons and applicable (for Board are board
Surgery, and Anesthesiologists) Certified)
Anesthesia certified
 Residency Training
Certificate (for Board
*Hospital may have Eligible)
additional  Certificate of
consultants from
other specialties.
Residency Training
/ Medical Specialists
Intensive Care  Licensed physician A team
(*DOH Medical
Unit:  Fellow/Diplomate composed of at
Specialist, last exam
Multidisciplinary least 1 per
was in 1989)
specialty
Team composed  Updated PRC license (May be part
of, but not limited  Certificates of
time or visiting
to, board certified Trainings
attended consultant/s)
Cardiologist,
 Proof of Employment/ OR an
Pulmonologist,
Appointment intensivist
Neurologist,
(notarized)
Pulmonologist
Preferably OR an
intensivist
Neonatal Intensive  Licensed physician A team
Care Unit:  Fellow/Diplomate composed of at
A multidisciplinary least 1 per
specialty
team composed of,
(May be part
but not limited to,
time or visiting
pediatric
consultant) OR
cardiologist,
a neonatologist
pediatric
nephrologist,
pediatric

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 NUMBER /
POSITION QUALIFICATION EVIDENCE COMPLIED REMARKS
RATIO
pulmonologist OR
a neonatologist DOCUMENT REVIEW
High Risk  Licensed physician General
Pregnancy Unit:  Fellow/Diplomate  Certificate from Obstetricians,
Specialty society, if preferably with
General
applicable (for Board a
Obstetricians, Certified) Perinatologist,
preferably with a  Residency Training and a referral
Perinatologist, and Certificate (for Board team of IM
a referral team of Eligible) specialists
IM specialists  Certificate of (May be part
Residency Training time or visiting
/ Medical Specialists consultant)
(*DOH Medical
Specialist, last exam
was in 1989)
 Updated PRC license
 Certificates of
Trainings
attended
 Proof of Employment/
Appointment
(notarized)
Resident Physician Licensed physician DOCUMENT REVIEW Wards - 1:20
on Duty (Shall not  Updated PRC license beds at any
go on duty for  Certificates of given time
Trainings PLUS
more than 48
attended ER – at least 1
hours straight).
 Proof of Employment/ at any given
Appointment time
(notarized) *This ratio does
 Schedule of duty not include
approved by Medical Resident
Director/Chief of Physicians on
Hospital Duty that shall
be required for
add-on services
such as dialysis
facility. It shall
be counted
separately.
NURSING SERVICES
Assistant Chief  Licensed nurse DOCUMENT REVIEW 1:100 Beds
Nurse  At least twenty (20)  Diploma/Certificate of
units towards Units Earned
 Updated PRC license
Master’s Degree in
 Certificates of
Nursing
Trainings
 At least three (3) attended
years-experience in  Proof of Employment/
supervisory/ Appointment
managerial position (notarized)
in nursing  Service
Record/Certificate of
Employment (proof of
supervisory/
managerial experience
in nursing)

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 NUMBER /
POSITION QUALIFICATION EVIDENCE COMPLIED REMARKS
RATIO
Supervising  Licensed nurse DOCUMENT REVIEW 1 per
Nurse/Nurse  With at least nine  Diploma/Certificate of Department –
Managers (9) units of Master's Units Earned Office hours
Degree in Nursing  Updated PRC license only (8am –
 At least two (2)  Certificates of 5pm)
years-experience Trainings
in general nursing attended
service  Proof of Employment/
administration. Appointment
(notarized)
 Service
Record/Certificate of
Employment (Proof of
general nursing
service administration
experience)
Head Nurse/Senior  Licensed nurse DOCUMENT REVIEW 1 per shift per
Nurse  With at least 2 clinical
years-hospital  Diploma department
experience  Updated PRC license
 BLS certified  Certificate of
Staff Nurse  Licensed nurse trainings attended Ward - 1:12
 BLS certified  Proof of beds at any
employment time (1 reliever
(notarized) for every 3
 If nursing staffing is
RNs)
outsourced: Validity of
Staff Nurse in  Licensed nurse the contract of 1:3 beds at any
every Critical Unit  Certificate of employment should be time per shift
(CCU, ICU, Training in Critical at least one (1) year (plus 1 reliever
NICU, PICU, Care Nursing, and within the validity per 3 CCU
ACLS period of the hospital’s
SICU, RNs)
LTO.
HRPU etc.)
 Schedule of duty
approved by Chief
Nurse
Nursing Attendants  Highschool DOCUMENTS REVIEW 1:24 beds at
in wards graduate  Certificates of any time(1
 With relevant Trainings attended reliever for
health-related  Proof of every 3 NAs)
training Employment
Nursing Attendant (may be in ( notarized ) 1:12 beds at
house training)
in CCUs any time (plus
1 reliever for
every 3
NA/MWs)
Operating Room  Licensed nurse DOCUMENT REVIEW 1 SN and 1 CN
Nurses:  Training in per functioning
-Scrub Nurse (SN) OR Nursing  Diploma OR per shift
-Circulating Nurse  Training in BLS  Updated PRC license (plus 1 reliever
and ACLS  Certificate of
(CN) for every 3
trainings attended
nurses)
 Proof of
Delivery Room  Licensed nurse employment 1 per 3
Nurse  Training in (notarized) delivery table
Maternal and  If nursing staffing is per shift
Child Nursing outsourced: Validity of (plus 1 reliever

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 (may be in house the contract of for every 3
training or

NUMBER /
POSITION QUALIFICATION EVIDENCE COMPLIED REMARKS
RATIO
training in Essential employment should be nurses)
Integrated Newborn at least one (1) year and
Care [EINC]) within the validity
 Training in BLS period of the hospital’s
and ACLS LTO.
 Schedule of duty
Emergency Room  Licensed nurse approved by 1:3 beds per
Nurse  Training in Trauma Chief Nurse shift
Nursing, ACLS and (plus 1 reliever
other relevant for every 3
training nurses)
Outpatient  Licensed nurse 1
Department Nurse  Training in BLS Office hours
only
(8am – 5pm)
Dentist – MOA if Licensed dentist DOCUMENT REVIEW 1
outsourced but the  Diploma Office hours
dental service  Updated PRC license only
should be within  Certificates of (8am – 5pm)
the vicinity of Trainings
hospital attended
Respiratory Licensed respiratory  Proof of 1 per shift
Therapist therapist or licensed Employment/
nurse with respiratory Appointment
therapy training (notarized)
 If outsourced: Validity
of the contract of
employment should be
at least one (1) year
and within the validity
period of the
hospital’s LTO.

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 ATTACHMENT 2.B - PHYSICAL PLANT

DOCUMENTS COMPLIED REMARKS

1. DOH -Approved PTC

2. DOH Approved Floor Plan

3. Checklist for Review of Floor Plans

(accomplished)

OBSERVATIONS/FINDINGS (may use separate additional sheets if needed):

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 ATTACHMENT 2.C –EQUIPMENT/INSTRUMENT

EQUIPMENT/INSTRUMENT
QUANTITY AREA COMPLIED REMARKS
(Functional)

ADMINISTRATIVE SERVICE
Ambulance
 Available 24/7
1 Parking
 Physically present if not being used
during time of
inspection/monitoring
Administrative
Computer with Internet Access 1
Office
lobby,
hallway,
Emergency Light
nurses' station,
office/unit and
stairways
lobby,
1 per unit or hallway,
Fire Extinguishers
area nurses' station,
office/unit and
stairways
Generator set with Automatic Transfer
1 Genset house
Switch (ATS)
KITCHEN/DIETARY
Exhaust fan 1
Food Conveyor or equivalent (closed-
1
type)
Food Scale 1
Blender/Osteorizer 1
Oven 1
Kitchen
Stove 1

Refrigerator/Freezer 1

Utility cart 1
Garbage Receptacle with Cover (color- 1 for each
coded) color
EMERGENCY ROOM
Bag-valve-mask Unit
- Adult 1
- Pediatric 1
Calculator for dose computation 1

Clinical Weighing scale 1

Defibrillator with paddles 1

Delivery set, primigravid 2 sets ER

Delivery set, multigravid 2 sets

ECG Machine with leads 1
EENT Diagnostic Set with
1 set
Ophthalmoscope and Otoscope
Emergency Cart (for contents, refer to
1
separate list)
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 EQUIPMENT/INSTRUMENT
QUANTITY AREA COMPLIED REMARKS
(Functional)

Examining table 1
Examining table (with Stirrups for OB-
1
Gyne)
Glucometer with strips

Gooseneck lamp/Examining Light 1

Instrument/Mayo Table 1
Minor Instrument Set (May be used for
Tracheostomy, Closed Tube 2 sets
Thoracostomy, Cutdown, etc.)
Nebulizer 1
Negatoscope 1 ER
Neurologic Hammer 1
OR Light (portable or equivalent) 1
Oxygen Unit
Tank is anchored/chained/ strapped or 2
with tank holder if not pipeline
Pulse Oximeter 1
Sphygmomanometer, Non-mercurial 1
- Adult Cuff 1
- Pediatric Cuff 1
Stethoscope 1

Suction Apparatus 1

Suturing Set 2 sets

Thermometer, non-mercurial
- Oral 1
- Rectal 1
1 for each
Vaginal Speculum, Different Sizes
different size
Wheelchair 1
Wheeled Stretcher with guard/side rails
1
and wheel lock or anchor.
OUT- PATIENT DEPARTMENT
Clinical Height and Weight Scale 1
EENT Diagnostic Set with
1 set
ophthalmoscope and otoscope
Gooseneck lamp/Examining Light 1
Examining table with wheel lock or OPD
1
anchor
Instrument/Mayo Table 1

Minor Instrument Set 1 set

Neurologic Hammer 1

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 EQUIPMENT/INSTRUMENT
QUANTITY AREA COMPLIED REMARKS
(Functional)
Oxygen Unit
Tank is anchored/chained/ strapped or 1
with tank holder if not pipeline
Peak flow meter
- Adult 1
- Pediatric 1 OPD
Sphygmomanometer, Non-mercurial
- Adult cuff 1
- Pediatric cuff 1
Stethoscope 1
Thermometer, non-mercurial
- Oral 1
- Rectal 1
Suture Removal Set 1 set
Wheelchair / Wheeled Stretcher 1
OPERATING ROOM
Air conditioning Unit 1
Anesthesia Machine 1
Cardiac Monitor with Pulse Oximeter 1
Ceasarian Section Instrument 1
Defibrillator with paddles 1
Electrocautery machine 1
Emergency Cart (for contents, refer to
1
separate list)
Glucometer with strips
Instrument / Mayo Table 1
Laparotomy pack (Linen pack) 1 per OR
Laparotomy / Major Instrument Set 1 per OR
Laryngoscopes with different sizes of
1
blades
Operating room light 1 per OR
Operating room table 1 per OR
Orthopedic Instrument Set 1
Oxygen Unit
Tank is anchored/chained/ strapped or 1 per OR OR
with tank holder if not pipeline
Rechargeable Emergency Light (in case
1 per OR
generator malfunction)
Sphygmomanometer, Non-mercurial
- Adult cuff 1 per OR
- Pediatric cuff 1 per OR
Spinal Set 1 set
Stethoscope 1
Suction Apparatus 1
Thermometer, non-mercurial
- Oral 1
- Rectal 1
Wheeled Stretcher with guard/side rails
and wheel lock or anchor.
1

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 EQUIPMENT/INSTRUMENT
QUANTITY AREA COMPLIED REMARKS
(Functional)
POST ANESTHESIA CARE UNIT / RECOVERY ROOM
Air conditioning Unit 1
Cardiac Monitor 1
1 (if separate
Defibrillator with paddles from the OR
Complex ) PACU/RR
1 (if separate
Emergency Cart (for contents, refer to
from the OR
separate list)
Complex )
Mechanical / patient bed, with guard side
1
rails and wheel lock or anchored
Oxygen Unit
Tank is anchored/chained/ strapped or 1
with tank holder if not pipeline
Sphygmomanometer, Non-mercurial
- Adult cuff 1 PACU/RR
- Pediatric cuff 1
Stethoscope 1
Thermometer, non-mercurial 1
LABOR ROOM
Fetal Doppler 1
Oxygen Unit
Tank is anchored/chained/ strapped or 1
with tank holder if not pipeline
Patient Bed 1 Labor Room
Pulse Oximeter 1
Sphygmomanometer, Non-mercurial 1
Stethoscope 1
Thermometer, Non-mercurial 1
DELIVERY ROOM
Air-conditioning Unit 1
Bag valve mask unit (Adult and
1
pediatric)
Bassinet 1
Clinical Infant Weighing Scale 1
1 ( if DR is
separate from DR
Defibrillator with paddles
the OR
Complex )
Delivery set, primigravid 1 set
Delivery set, multigravid 2 sets
Delivery room light 1

Delivery room table 1

Dilatation/Curettage set 1 set

1
Emergency Cart (for contents, refer to (if DR is
separate list). separate from
OR Complex)

EQUIPMENT/INSTRUMENT
QUANTITY AREA COMPLIED REMARKS
(Functional)

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Instrument/Mayo Table 1

Kelly Pad or equivalent 1

Laryngoscope with different sizes of
1
blades
Oxygen Unit
Tank is anchored/chained/ strapped or 1
with tank holder if not pipeline
Rechargeable Emergency Light (In case
1 DR
of generator malfunctions)
Sphygmomanometer -Non-mercurial 1

Stethoscope 1

Suction Apparatus 1

Wheeled Stretcher 1
HIGH RISK PREGNANCY UNIT
Cardiac Monitor with Pulse Oximeter 1
Cardiotocography (CTG) Machine 1
Fetal doppler 1
Oxygen Unit
Tank is anchored/chained/ strapped or 1 HRPU
with tank holder if not pipeline
Patient bed with side rails 1
Suction Apparatus 1
Sphygmomanometer -Non-mercurial 1
NEONATAL INTENSIVE CARE UNIT (NICU)
Air conditioning unit 1
Bassinet 1
Bilirubin Light / Phototherapy machine
1
or equivalent
Cardiac Monitor with Pulse Oximeter 1
Clinical Infant Bag-valve mask unit 1
Clinical Infant weighing scale 1
Defibrillator with paddles 1
EENT Diagnostic Set with
1 set
ophthalmoscope and otoscope
Emergency Cart (for contents, refer to NICU
1
separate list)
Glucometer 1
Incubator 1
Infusion pump / Syringe pump 1
Laryngoscope with neonatal blades of
1
different sizes
Mechanical Ventilator (May be
1
outsourced)
Neonatal Stethoscope 1
Oxygen Unit
Tank is anchored/chained/ strapped or 1
with tank holder if not pipeline
Refrigerator for Breast milk storage 1

EQUIPMENT/INSTRUMENT
QUANTITY AREA COMPLIED REMARKS
(Functional)
Sphygmomanometer, Non-mercurial
1
- for neonate

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Suction apparatus 1
Thermometer, Non-mercurial 1
Umbilical Cannulation set 1 set
INTENSIVE CARE UNIT (ICU) – For all types of ICU (PICU, SICU, Medical ICU,
etc.)
Air conditioning unit 1
Bag-valve-mask Unit
- Adult 1
- Pediatric 1
Cardiac Monitor with Pulse Oximeter 1
Defibrillator with paddles 1
Emergency Cart (for contents, refer to
1
separate list)
EENT Diagnostic Set with
1 set
ophthalmoscope and otoscope
Infusion pump 1
Laryngoscope with different sizes of
1
blades
Depending on
Mechanical Bed the number of
beds declared ICU
Mechanical Ventilator / Respirator (May
1
be outsourced)
Minor Instrument Set (May be used for
Tracheostomy, Closed Tube 1 set
Thoracostomy, Cutdown, etc.)
Oxygen Unit
Tank is anchored/chained/ strapped or 1
with tank holder if not pipeline
Sphygmomanometer, non-mercurial
(reserved for sudden breakdown of
cardiac monitor)
- Adult cuff for adult unit 1
- Pediatric cuff for pediatric unit 1
Stethoscope 1
Suction Apparatus 1
NURSING UNIT/WARD
Bag-Valve-Mask Unit
- Adult 1
- Pediatric 1
Clinical Height and Weight Scale 1
Nursing units located on
the same floor may share
the defibrillator and the E-
Defibrillator with paddles 1 NURSING cart, provided that they are
UNIT/ WARD not more than 50 meters
away from each other.
Emergency cart or equivalent (refer to
1
separate list for the contents)
EENT Diagnostic Set with
1 set
ophthalmoscope and otoscope
Laryngoscope with different sizes of
1
blades

EQUIPMENT/INSTRUMENT
QUANTITY AREA COMPLIED REMARKS
(Functional)
Mechanical/Patient bed with lock, if
ABC
wheeled; with guard or side rails

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 Bedside Table ABC

Nebulizer 1

Neurologic Hammer 1
Oxygen Unit
1
tank is anchored/chained if not pipeline
Sphygmomanometer, Non- Mercurial
- Adult cuff 1
- Pediatric cuff 1
Stethoscope 1

Suction Apparatus 1
Thermometer, non-mercurial
- Oral 1
- Rectal 1
RESPIRATORY/PULMONARY UNIT
ABG Machine 1
Pulmonary Function Test (PFT) or Peak
Expiratory Flow Rate (PEFR) Tube Respiratory /
Spirometer Pulmonary Unit
1
Nebulizer 1
DENTAL CLINIC
Air compressor 1
Autoclave 1
Bone file, stainless 1
Cotton pliers 1
Cowhorn Forceps 1
Dental Chair unit 1
Explorer, double-end 1
Forceps, No. 8 1
Forceps, No. 17 Upper molar 1
Forceps, No. 18 Upper molar 1
Forceps, No. 150 Maxillary Universal 1
Forceps, No. 150 S Primary Teeth 1
DENTAL
Forceps, No. 151 Lower Universal 1
CLINIC
Forceps, No. 151 Mandibular Pre-molar 1
Forceps, No. 151 S Lower Primary Teeth 1
Gum separator 1
High speed handpiece with Burr remover 1
Low speed handpiece, Angled head 1
Mouth mirror explorer 1
Periosteal elevator No. 9, double-end 1
Rongeur 1
Root elevator 1
Scaler Jacquettes Set No. 1, 2, and 3 1
Surgical Chisel 1

EQUIPMENT/INSTRUMENT
QUANTITY AREA COMPLIED REMARKS
(Functional)
Surgical Malette
1
CENTRAL STERILIZING & SUPPLY ROOM
Autoclave/Steam Sterilizer 1 CSSR

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 CADAVER HOLDING AREA/ROOM
CADAVER
Bed or stretcher for cadaver 1 HOLDING
AREA

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 ATTACHMENT 2.D - EMERGENCY CART CONTENTS FOR LEVEL 2 HOSPITAL

EMERGENCY CART CONTENTS ER OR DR ICU NICU HRPU NS 1 NS 2 NS 3 NS 4 NS 5 NS 6 NS 7 OTHERS OTHERS REMARKS

Adenosine 6 mg/2mL vial

Amiodarone 150mg/3mL ampule
Anti-tetanus serum (either equine-based
antiserum or human antiserum)
Aspirin USP grade (325 mg/tablet)
Atropine 1mg/ml ampule
Β-adrenergic agonists (i.e. Salbutamol 2mg/ml)
Benzodiazipine (Diazepam 10mg/2ml ampule
and/or Midazolam) (in high alert box )
Calcium (usually calcium gluconate 10%
solution in 10 mL ampule)
Clopidogrel 75 mg tablet
D5W 250 mL
D50W 50mg/vial
Digoxin 0.5mg/2mL ampule
Diphenhydramine 50mg/mL ampule
Dobutamine 250mg/5mL ampule
Dopamine 200 mg/5mL ampule/vial
Epinephrine 1mg/ml ampule
Furosemide 20mg/2ml ampule
Haloperidol 50mg/mL ampule
Hydrocortisone 250mg/2mL vial
Lidocaine 10% in 50mL spray
Lidocaine 2% solution vial 1g/50ml
Magnesium sulfate 1g/2mL ampule
Mannitol 20% solution in 500ml/bottle
Methylprednisolone 4mg/tablet
Metoclopramide 10mg/2mL ampule
Morphine sulfate 10mg/mL ampule (in high

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 EMERGENCY CART CONTENTS ER OR DR ICU NICU HRPU NS 1 NS 2 NS 3 NS 4 NS 5 NS 6 NS 7 OTHERS OTHERS REMARKS
alert box )
Nitroglycerin inj. 10 mg/10mL ampule or
Isosorbide dinitrate 5mg SL tablet or 10
mg/10mL ampule
Noradrenaline 2mg/2mL ampule
Paracetamol 300mg/ampule (IV preparation)
Phenobarbital 120mg/ml ampule IV or 30mg
tablet (in high alert box )
Phenytoin 100mg/capsule or 100 mg/2mL
ampule
Plain LRS 1L/bottle
Plain NSS 1L/bottle – 0.9% Sodium Chloride
Potassium Chloride 40mEq/20mL vial (in high
alert box )
Vitamin B1/6/12 vial (1g B1, 1g B6, 0.01gB12
in 10 mL vial)
Sodium bicarbonate 50mEq/50mL ampule
Verapamil 5 mg/2 ml ampule
EQUIPMENT/SUPPLIES
Airway adjuncts
Airway / Intubation Kit ( with stylet and bag
valve masks )
Alcohol disinfectant
Aseptic bulb syringe
Calculator
Capillary Blood Glucose (CBG ) Kit
Cardiac Board
Endotracheal Tubes, all sizes
Flashlights or Pen lights
Gloves , sterile
Gloves, non-sterile

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 EMERGENCY CART CONTENTS ER OR DR ICU NICU HRPU NS 1 NS 2 NS 3 NS 4 NS 5 NS 6 NS 7 OTHERS OTHERS REMARKS

Laryngoscope with different sizes of blades

Nasal cannula
Protective face shield or mask or goggles
Standard face mask
Sterile gauze (pre-folded and individually
packed )
Syringes (different volumes)
Urethral catheter
Urine collection bag
Waterproof aprons

*Notes:
ER – Emergency Room
OR – Operating Room
DR – Delivery Room
NS – Nurses’ Station

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Revision:01
04/23/2018
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