DA Form 7595-1-5 Perform a Needle Chest Decompression

DA Form 7595-1-5 - also known as the "Perform A Needle Chest Decompression" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 7595-1-5 - was last revised on March 1, 2014. Download an up-to-date fillable PDF version of the DA 7595-1-5 below or request a copy through the chain of command.

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PERFORM A NEEDLE CHEST DECOMPRESSION
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
STP 8-68W13-SM-TG, Task: 081-833-0075, Perform Needle Chest Decompression; Prehospital Trauma
REFERENCE:
Life Support (PHTLS), Revised Military 7th Edition.
PRIVACY ACT STATEMENT
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
AUTHORITY:
S
PRINCIPAL PURPOSE:
To ensure that accomplishment of training is properly credited to the correct individual for NREMT certification
IAW AR 40-68, AR 220-1 and AR 350-1.
Used by Unit personnel to monitor training. The DOD "Blanket Routine uses" set forth at the beginning of the
ROUTINE USES:
Army's compilation of system of records notices may apply to this system.
DISCLOSURE:
Voluntary. Failure to provide your name may result in a loss of credit for accomplishing the training or error in
processing applicable favorable personnel actions. For Official Use Only.
1. Soldier (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
During a night patrol, your platoon receives intense small arms fire. As your platoon returns fire and takes up defensive positions, the second squad leader
calls for your attention regarding a fallen Soldier. Once the area is secured, you assess the patient and apply an occlusive dressing. The patient continues
to have increasing respiratory distress. You determine the patient requires a needle chest decompression.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Steps
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Located the second intercostal space on the anterior chest wall at the midclavicular line on the same side as
the injury; approximately in line with the nipple.
c. Thoroughly cleansed a 3 to 4 inch area around the insertion site.
d. Inserted a 3 ¼-inch, 14-gauge needle over the top of the rib at a 90-degree angle to the chest wall, to the hub.
e. Removed the needle, leaving the catheter in place. Placed the needle in a sharps container.
f. Stabilized the catheter hub to the chest with adhesive tape.
g. Placed the patient in a sitting position or in the recovery position with the injured side down.
h. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
i. Did not cause further injury to the patient.
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. Initial Evaluator
8. Start Time
9. Stop Time
10. Retest Evaluator
11. Start Time
12. Stop Time
13. Final Evaluator
14. Evaluator's Comments
This form was prepared by U.S. Government employees for use in the 68W MOS. Although it contains, in part, copyrighted material from National
(NREMT)
Registry of Emergency Medical Technicians, Inc.
, 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.
Supersedes DA Form 7595-14-R, MAY 2009
DA FORM 7595-1-5, MAR 2014
APD LC v1.00
PERFORM A NEEDLE CHEST DECOMPRESSION
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
STP 8-68W13-SM-TG, Task: 081-833-0075, Perform Needle Chest Decompression; Prehospital Trauma
REFERENCE:
Life Support (PHTLS), Revised Military 7th Edition.
PRIVACY ACT STATEMENT
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
AUTHORITY:
S
PRINCIPAL PURPOSE:
To ensure that accomplishment of training is properly credited to the correct individual for NREMT certification
IAW AR 40-68, AR 220-1 and AR 350-1.
Used by Unit personnel to monitor training. The DOD "Blanket Routine uses" set forth at the beginning of the
ROUTINE USES:
Army's compilation of system of records notices may apply to this system.
DISCLOSURE:
Voluntary. Failure to provide your name may result in a loss of credit for accomplishing the training or error in
processing applicable favorable personnel actions. For Official Use Only.
1. Soldier (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
During a night patrol, your platoon receives intense small arms fire. As your platoon returns fire and takes up defensive positions, the second squad leader
calls for your attention regarding a fallen Soldier. Once the area is secured, you assess the patient and apply an occlusive dressing. The patient continues
to have increasing respiratory distress. You determine the patient requires a needle chest decompression.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Steps
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Located the second intercostal space on the anterior chest wall at the midclavicular line on the same side as
the injury; approximately in line with the nipple.
c. Thoroughly cleansed a 3 to 4 inch area around the insertion site.
d. Inserted a 3 ¼-inch, 14-gauge needle over the top of the rib at a 90-degree angle to the chest wall, to the hub.
e. Removed the needle, leaving the catheter in place. Placed the needle in a sharps container.
f. Stabilized the catheter hub to the chest with adhesive tape.
g. Placed the patient in a sitting position or in the recovery position with the injured side down.
h. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
i. Did not cause further injury to the patient.
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. Initial Evaluator
8. Start Time
9. Stop Time
10. Retest Evaluator
11. Start Time
12. Stop Time
13. Final Evaluator
14. Evaluator's Comments
This form was prepared by U.S. Government employees for use in the 68W MOS. Although it contains, in part, copyrighted material from National
(NREMT)
Registry of Emergency Medical Technicians, Inc.
, 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.
Supersedes DA Form 7595-14-R, MAY 2009
DA FORM 7595-1-5, MAR 2014
APD LC v1.00

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