DA Form 7595-1-2 Perform an Emergency Medical Technician Trauma Assessment

DA Form 7595-1-2 or the "Perform An Emergency Medical Technician Trauma Assessment" is a Department of the Army-issued form used by and within the United States Military.

The form - often incorrectly referred to as the DD form 7595-1-2 - was last revised on February 1, 2014. Download an up-to-date fillable DA Form 7595-1-2 down below in PDF-format or look it up on the Army Publishing Directorate website.

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PERFORM AN EMERGENCY MEDICAL TECHNICIAN TRAUMA ASSESSMENT
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLES:
STP 8-68W13-SM-TG, Task: 081-833-0053, Perform an EMT Trauma Assessment
REFERENCES:
PRIVACY ACT STATEMENT
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army training Leadership and Development.
AUTHORITY:
S
To ensure that accomplishment of training is properly credited to the correct individual for NREMT certification
PRINCIPAL PURPOSE:
Used by Unit personnel to monitor training. The DOD “Blanket Routine uses” set forth at the beginning of the
ROUTINE USES:
Voluntary. Failure to provide your name may result in a loss of credit for accomplishing the training or error in
DISCLOSURE:
1. Soldier (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
You are responding to an emergency call for a motor vehicle collision with injuries. You must perform a thorough and systematic primary and rapid
trauma assessment for this trauma patient in order to guide your decision-making process as to how to best manage this patient.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Performed a scene size-up.
(1). Took body substance isolation precautions
(2). Determined if the scene is safe.
(3). Determined the mechanism of injury.
(4). Determined the number of patients.
(5). Requested additional assistance if deemed necessary.
(6). Considered stabilization of C-spine based on evaluation of the Mechanism of injury.
b. Performed a primary assessment.
(1). Formed a general impression of the patient.
(2). Determined responsiveness/assessed the patient's mental status.
(3). Assessed the airway
(look, listen, feel).
Suctioned and placed airway adjunct, as necessary.
(4). Assessed the breathing (rate, rhythm, quality).
(5). Assessed circulation
(controlled life threatening bleeding, checked pulse, treated shock).
(6). Made a status/transport priority decision.
c. Performed a rapid trauma assessment.
(1). Continued spinal immobilization.
(2). Assessed the head.
This form was prepared by U.S. Government employees for use in the 68W MOS. Although it contains, in part, copyright material from National
Registry of Emergency Medical Technicians, Inc. (NREMT) skill sheets ©2011, this form has neither been prepared nor approved by NREMT.
Use is restricted to guidelines contained in the Preface to TC 8-800.
THIS FORM SUPERSEDES DA FORM 7595-34-R, MAY 2009
Page 1 of 3
DA FORM 7595-1-2, FEB 2014
APD LC v1.00
PERFORM AN EMERGENCY MEDICAL TECHNICIAN TRAUMA ASSESSMENT
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLES:
STP 8-68W13-SM-TG, Task: 081-833-0053, Perform an EMT Trauma Assessment
REFERENCES:
PRIVACY ACT STATEMENT
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army training Leadership and Development.
AUTHORITY:
S
To ensure that accomplishment of training is properly credited to the correct individual for NREMT certification
PRINCIPAL PURPOSE:
Used by Unit personnel to monitor training. The DOD “Blanket Routine uses” set forth at the beginning of the
ROUTINE USES:
Voluntary. Failure to provide your name may result in a loss of credit for accomplishing the training or error in
DISCLOSURE:
1. Soldier (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
You are responding to an emergency call for a motor vehicle collision with injuries. You must perform a thorough and systematic primary and rapid
trauma assessment for this trauma patient in order to guide your decision-making process as to how to best manage this patient.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Performed a scene size-up.
(1). Took body substance isolation precautions
(2). Determined if the scene is safe.
(3). Determined the mechanism of injury.
(4). Determined the number of patients.
(5). Requested additional assistance if deemed necessary.
(6). Considered stabilization of C-spine based on evaluation of the Mechanism of injury.
b. Performed a primary assessment.
(1). Formed a general impression of the patient.
(2). Determined responsiveness/assessed the patient's mental status.
(3). Assessed the airway
(look, listen, feel).
Suctioned and placed airway adjunct, as necessary.
(4). Assessed the breathing (rate, rhythm, quality).
(5). Assessed circulation
(controlled life threatening bleeding, checked pulse, treated shock).
(6). Made a status/transport priority decision.
c. Performed a rapid trauma assessment.
(1). Continued spinal immobilization.
(2). Assessed the head.
This form was prepared by U.S. Government employees for use in the 68W MOS. Although it contains, in part, copyright material from National
Registry of Emergency Medical Technicians, Inc. (NREMT) skill sheets ©2011, this form has neither been prepared nor approved by NREMT.
Use is restricted to guidelines contained in the Preface to TC 8-800.
THIS FORM SUPERSEDES DA FORM 7595-34-R, MAY 2009
Page 1 of 3
DA FORM 7595-1-2, FEB 2014
APD LC v1.00
PERFORM AN EMERGENCY MEDICAL TECHNICIAN TRAUMA ASSESSMENT
GRADING SHEET (cont'd)
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
(cont'd)
P
F
P
F
P
F
c. Performed a Rapid Trauma Assessment (cont'd)
(3). Assessed the neck.
(4). Assessed the chest.
(5). Assessed the abdomen.
(6). Assessed the pelvis.
(7). Assessed the extremities.
(8). Assessed the posterior (log rolls with spinal precautions).
d. Obtained SAMPLE History/Transport/Vital Signs
(1). Obtained a SAMPLE History (prior to leaving the scene).
(2). Transported the casualty within 10 minutes.
(3). Obtained vital signs (pulse, respirations, blood pressure).
e. Performed a Detailed Physical Examination During Transport
(1). Assessed the scalp and cranium (DCAP-BTLS / TIC).
(2). Assessed the ears (DCAP-BTLS / fluid drainage).
(3). Assessed the face (DCAP-BTLS).
(4). Assessed the eyes (DCAP-BTLS / pupils).
(5). Assessed the nose (DCAP-BTLS / fluid drainage).
(6). Assessed the mouth (DCAP-BTLS / tongue / odors).
(7). Assessed the neck (DCAP-BTLS / JVD / tracheal deviation).
(8). Assessed the chest (DCAP-BTLS / TIC / auscultates).
(9). Assessed the abdomen (DCAP-BTLS / TRD).
(10). Assessed the pelvis (DCAP-BTLS / crepitus or instability).
(11). Assessed the extremities (DCAP-BTLS /pulse, motor, sensation x 4).
(12). Assessed the posterior (DCAP-BTLS / rectal bleeding).
(13). Managed secondary injuries found during survey.
(14). Reassessed vital signs (pulse, respirations, blood pressure).
(15). Documented the assessment on the appropriate medical form.
Page 2 of 3
DA FORM 7595-1-2, FEB 2014
APD LC v1.00
PERFORM A PATIENT ASSESSMENT ( E MT-B): TRAUMA
GRADING SHEET (cont'd)
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. Initial Evaluator
8. Start Time
9. Stop Time
10. Retest Evaluator
12. Stop Time
13. Final Evaluator
11. Start Time
14. Remarks
Page 3 of 3
DA FORM 7595-1-2, FEB 2014
APD LC v1.00

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