CRITICAL Response Group
Stock Request Form
CRITICAL Response Group
*
Please Select
Deansgrange
Douglas (Cork)
Balbriggan
Macroom
Carrick-on-Suir
Blackwater
Youghal
Ennis
West Limerick
Killaloe-Ballina
Kilkennny
Ruan-Dysart
Midleton
Dublin Airport Fire & Rescue CFR
NAS Off Duty Responder (ODR)
NAS Uniformed Public Responder Scheme (UPRS)
TEST ACCOUNT DO NOT USE!
Name
*
First Name
Last Name
NAS ODR- CRITICAL Unique ID
*
This is the Unique ID given to you by CRITICAL
NAS UPRS- CRITICAL Unique ID
*
This is the Unique ID given to you by CRITICAL
Your Email
*
Contact No.
*
-
Shipping Address
*
Street Address
Street Address Line 2
City
County
EIRCODE
Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
CRITICAL PCR ID.
This ID. number is found on your follow-up email. If you don't have it please leave the box blank!
NAS Incident Number
*
This can be found in the CFR app, ‘Incident History’. If replacing expired stock please input ‘Expired Stock’.
Responder Bag Number
*
CRITICAL CFR- What stock do you require?
*
ZOLL AED Parts
Mediana AED Parts
BLS Response Bag Consumables
Green Trauma Bag
First Aid Kit Consumables
Burns Kit Consumables
Airway Consumables
Training Consumables
DAFRS- What stock do you require?
*
Mediana AED Parts
General Pouch
Airway Consumables
Trauma Consumables
NAS ODR/ UPRS- What stock do you require?
*
Mediana AED Parts
ZOLL AED Parts
Airway Consumables
PPE Consumables
ZOLL AED Parts
Rows
Required
ZOLL AED Adult Pads
ZOLL AED Paediatric Pads
ZOLL AED Battery
Mediana AED Parts
Rows
Required
Mediana AED Adult/Paediatric Pads
Mediana AED Battery
Responder Bag Consumables
Rows
Required
QTY Required
Aspirin 300mg Tablets
PHECC ACR Report Forms
CPR Pocket Mask
Cloth/Towel
Razors
Thermometer
Stethoscope
Pulse Oximeter
Blood Pressure Cuff
Glucometer
Glucometer Test Strips
Glucometer Lancets
Sharps Container
Trauma Shears
Yellow Clinical Waste Bag
PPE Kit
First Aid Kit Consumables
Rows
Required
QTY Required
Large Trauma Dressing 15cm x 18cm
Medium Trauma Dressing 10cm x 18cm
Crepe Bandage 10cm x 4.5m
Conforming Bandage 20cm x 4.5m
10cm x 12cm Dressing Pad
20cm x 40cm Dressing Pad
10cm x 20cm Dressing Pad
6cm x 7cm Self Adhesive Dressing
8cm x 10cm Self Adhesive Dressing
9cm x 15cm Self Adhesive Dressing
Gauze Swab
Sterile Saline Wash/Spray
Wound Cleaning Wipes
Adhesive Tape
Burns Kit Consumables
Rows
Required
QTY Required
Spray Burn Gel
Sterile Hydrogel Burn Dressing (10cm x 40cm)
Sterile Hydrogel Burn Dressing (10cm x 10cm)
Foil Blanket
Airway Consumables
Rows
Required
QTY Required
Laryngeal Tube (Size 3)
Laryngeal Tube (Size 4)
Laryngeal Tube (Size 5)
Laryngeal Tube Syringe
OPA (Size 0)
OPA (Size 1)
OPA (Size 2)
OPA (Size 3)
OPA (Size 4)
OPA (Size 5)
Adult BVM
Paediatric BVM
Manual Suction Device
Green Trauma Bag
Rows
Required
QTY Required
No.2 Ambulance Dressing
No.3 Ambulance Dressing
No.4 Ambulance Dressing
7.5cm x 4.5cm Crepe Bandage
10cm x 4.5cm Crepe Bandage
10cm x 20cm Dressing Pad
10cm x 12cm Dressing Pad
9cm x 15cm Self Adhesive Dressing
8cm x 10cm Self Adhesive Dressing
Gauze Swabs (7.5cm x 7.5cm)
Sterile Saline Wash/Spray
Plaster Strip
Adhesive Tape
Wound Cleaning Wipes
Pocket Face Mask
Triangular Bandage
Foil Blanket
Bottle Burn Gel
10cm x 10cm Burn Dressing
10cm x 40cm Burn Dressing
Nitrile Gloves (S)
Nitrile Gloves (M)
Nitrile Gloves (L)
Nitrile Gloves (XL)
Trauma Shears
Training/In Service Consumables
Rows
Required
QTY Required
FFP2 Face Mask (1 Box)
AED Trainer Pads- Adult
AED Trainer Pads- Paediatric
AED Trainer Batteries- AA
AED Trainer Remote Batteries - AAA
Green Pocket Mask Training Valves (25 Single Valves)
Green Universal Cleaning Wipes (2 Packets)
NAS Infection PPE Packs (1 Box)
Surgical Masks (1 Box)
Laerdal Manikins Training Lungs (1 Set)
DAFRS- General Pouch
Rows
Required
QTY Required
Sphygnamometer
Stethoscope
Pulse Oximeter
Green AED BLS Pouch
Sharps Container
DAFRS- Airway Consumables
Rows
Required
QTY Required
Adult BVM
Paediatric BVM
Infant BVM
iGel Size 3
iGel Size 4
iGel Size 5
OPA Size 0
OPA Size 1
OPA Size 2
OPA Size 3
OPA Size 4
OPA Size 5
Manual Suction Device
DAFRS- Trauma Consumables
Rows
Required
QTY Required
ChitoSAM Haemostatic Dressing
Trauma Tourniquet
Burn Dressing 10cm x 10cm
Burn Dressing 5cm x 15cm
Burn Dressing 10cm x 40cm
Burn Gel 120ml Bottle
Cling Film Roll
No.1 Ambulance Dressing
No.2 Ambulance Dressing
No.3 Ambulance Dressing
No.4 Ambulance Dressing
Adhesive Dressing 9cm x 15cm
Adhesive Dressing 8cm x 10cm
Sterile Pad 10cm x 12cm
Sterile Pad 10cm x 20cm
Conforming Bandage 10cm x 4.5m
Crepe Bandage 10cm x 4.5m
Trauma Dressing 10cm x 18cm
Trauma Dressing 15cm x 18cm
Saline Wipes
Surgical Tape
PPE Consumables
Rows
Required
QTY Required
NAS PPE Pack
Any additional comments/requests?
Submit
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