DA Form 7595-1-10 "Apply a Combat Application Tourniquet"

What Is DA Form 7595-1-10?

This is a military form that was released by the U.S. Department of the Army (DA) on March 1, 2014. The form, often mistakenly referred to as the DD Form 7595-1-10, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

Form Details:

  • A 2-page document available for download in PDF;
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Download DA Form 7595-1-10 "Apply a Combat Application Tourniquet"

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APPLY A COMBAT APPLICATION TOURNIQUET®
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
STP 8-68W13-SM-TG, Task: 081-833-0065 Apply a Combat Application Tourniquet
REFERENCE:
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:
Your infantry squad has been assigned the task to patrol the outskirts of a village. To your front, a mortar round impacts near your squad's point man; you
drag the Soldier behind cover and perform your initial assessment. The patient is conscious and has a severe mutilating injury of his left lower leg. You
must apply a combat application tourniquet®
to control the bleeding.
(C-A-T)
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Exposed the wound by cutting away the patient's clothing.
c. Removed the C-A-T® from the patient’s individual first aid kit.
d. Placed the C-A-T® 2 to 3 inches above the wound around the injured extremity.
e. Pulled the free end of the self-adhering band through the buckle and routed it through the friction adapter
buckle. It is not necessary to route through the friction adapter on an arm wound.
f. Pulled the self-adhering band tight around the extremity and fastened it back on itself as tightly as possible.
g. Twisted the windlass until bleeding stopped. This should occur in three rotations of the windlass.
h. Locked the windlass in place with the windlass clip.
i. Secured the windlass in the windlass strap.
j. Assessed for absence of a distal pulse.
k. Placed a “T” and the time of application on the patient.
l. Secured the C-A-T® in place with tape.
m. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
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
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.
Page 1 of 2
DA FORM 7595-1-10, MAR 2014
Supersedes DA FORM 7595-26-R, MAY 2009
APD LC v1.00
APPLY A COMBAT APPLICATION TOURNIQUET®
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
STP 8-68W13-SM-TG, Task: 081-833-0065 Apply a Combat Application Tourniquet
REFERENCE:
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:
Your infantry squad has been assigned the task to patrol the outskirts of a village. To your front, a mortar round impacts near your squad's point man; you
drag the Soldier behind cover and perform your initial assessment. The patient is conscious and has a severe mutilating injury of his left lower leg. You
must apply a combat application tourniquet®
to control the bleeding.
(C-A-T)
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Exposed the wound by cutting away the patient's clothing.
c. Removed the C-A-T® from the patient’s individual first aid kit.
d. Placed the C-A-T® 2 to 3 inches above the wound around the injured extremity.
e. Pulled the free end of the self-adhering band through the buckle and routed it through the friction adapter
buckle. It is not necessary to route through the friction adapter on an arm wound.
f. Pulled the self-adhering band tight around the extremity and fastened it back on itself as tightly as possible.
g. Twisted the windlass until bleeding stopped. This should occur in three rotations of the windlass.
h. Locked the windlass in place with the windlass clip.
i. Secured the windlass in the windlass strap.
j. Assessed for absence of a distal pulse.
k. Placed a “T” and the time of application on the patient.
l. Secured the C-A-T® in place with tape.
m. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
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
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.
Page 1 of 2
DA FORM 7595-1-10, MAR 2014
Supersedes DA FORM 7595-26-R, MAY 2009
APD LC v1.00
APPLY A COMBAT APPLICATION TOURNIQUET
GRADING SHEET (cont'd)
14. Evaluator's Comments
Page 2 of 2
DA FORM 7595-1-10, MAR 2014
APD LC v1.00
Page of 2