Southwest Region Training Equipment/Materials

On-line Check-Out Form

Phone: 360-576-8197       Fax:  360-576-8485       E-mail: swems.assist@comcast.net


Please fill out your contact information below.

 

 

       Check-Out Date/Pick Up Date:*          Due Date (2 weeks) 

 

      First/Last Name*   Agency*    County

 

       Address*          City*       State

 

       Phone     E-Mail*    

 

       Name of Class*           Course Date*    

 

       On behalf of the agency I represent, I assume all responsibility for returning Regional materials and/or equipment in the condition

       that it was loaned, on/or before the due date specified.  The material and/or equipment replacement cost will be charged to the individual

       or agency indicated above in the event the equipment/materials loaned are lost or damaged. 

 

Equipment/Materials reserved are not guaranteed available.  You will be contacted as soon as possible after your request is submitted

if any of the item(s) you selected are on a reservation received prior to your submission.

 Thank You for your cooperation.

 

                                                                                     I agree to these terms               I do not agree to these terms      


 

                     Make your Equipment/Material selection below, then submit.

 

Title/Item Description Qty   Title/Item Description Qty
Airway     Kits  

Adult Airway Management Manikins

  

 

Basic Life Support (BLS) Kits (stocked)

  

Demo Model of Trachea

    

 

GEMS Secure Project Sensitivity Kit(s)

 

Laerdal Compact Suction Units & Adaptors

 

 

Manikins/Simulator Units

 

Laerdal Infant Intubation Manikins

    

 

Arrhythmia Generators/Simulator Units

 

Oxygen Cylinders with Regulators

  

 

Central Venus Catheterization Manikin

 

V-Vac Hand-Powered Suction Units

   

 

Fast IO Trainer

 

BVM Adult

 

Cricothyrotomy Simulator Manikins

  

BVM Child

  

 

Obstetric (O.B.) Manikins

 

BVM Infant

 

Infant Intraosseous Infusion Manikin

 

Oxygen Supply Tubing

 

 

Zoll Trainer AEDs (Auto. Ext. Defrib.)

 

Adult Oxygen Masks NRB-NC

 

IV Trainer Arm

 

Nasopharyngeal Airway Sets

   

 

Teaching Aids

 

Oral Pharyngeal Airway Sets

    

 

Dell Laptop Computer (CD & DVD)

  

OPA Large

 

 

Dell LCD Projector w/Case

  

OPA Medium

 

 

13" TV/VCR Combination w/Remote

  

OPA Small

 

Overhead Projector w/cord

 

OPA Child

 

 

Slide Projector Carousel w/Slide Tray/Cord

  

OPA Infant

 

 

Projector Screen w/Stand

  

Combitubes

 

 

Nimlock Table Top Cloth Display Booths

 

CPR

   

Clipboards

Adult CPR Manikins - Resusci Anne

 

 

Misc.

 

Junior CPR Manikin - Resusci Junior

    

 

Stethoscopes

 

Trauma Manikins - Resusci Jennifer

  

 

Laryngoscopes w/Blades Roll (sets)

 

Child Trauma Manikins - Rescue Timmy 

  

 

BP Cuff - Newborn

Infant (ALS) Manikins (2 in bags)

 

 

BP Cuff - Infant

 

Infant (BLS) Manikins (In Hard Cases)

    

 

BP Cuffs - Child

 

Immobilization

   

BP Cuffs - Adult

(sets) Head Immobilizers w/Base & Straps

 

Wool Blankets

   

Plastic Back Boards 

    

 

Traffic Cones

Spider Straps

     

 

ReviveEasy PtL Airways

Pneumatic Anti-Shock Garments Adult

     

 

Casualty Simulation Kit/Moulage Kit

Pneumatic Anti-Shock Garments Pediatric

     

 

Grabber Tubes w/Bases (sets)

 

Motorcycle Helmets

        

  Car Seats

Stifneck Cervical Collars (Various Sizes)

 

  Pen Light

Ferno Traction Splints

   

  Gauze Pads/Rolls (amount varies)