DA Form 7595-1-13 Apply a Hemostatic Dressing

DA Form 7595-1-13 - also known as the "Apply A Hemostatic Dressing" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 7595-1-13 - was last revised on March 1, 2014. Download an up-to-date fillable PDF version of the DA 7595-1-13 down below or look it up on the Army Publishing Directorate website.

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APPLY A HEMOSTATIC DRESSING
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
STP 8-68W13-SM-TG, Task: 081-833-0211, Apply a Hemostatic Dressing.
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 squad is moving through a built-up area when a sniper opens up on the rear guard striking him in the leg. Once the sniper has been eliminated, you
move back to the patient's position. He appears alert and is screaming in pain. The squad automatic weapon gunner is applying direct pressure to a large
gunshot wound in the patient's upper thigh. You determine that this type of bleeding is best controlled by a hemostatic agent. You must apply a
hemostatic dressing to control the hemorrhage.
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 injury by cutting away the patient's clothing.
c. Opened the sterile package and removed the dressing without contaminating the cream-colored portion.
d. Placed the cream-colored sponge portion of the dressing directly onto the wound and packed the wound where
the bleeding is the heaviest.
e. Held pressure on the dressing for 3 minutes or until the dressing adhered to the wound and bleeding stopped.
f. Applied a pressure dressing over the hemostatic dressing to secure it in place.
g. 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
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 7595-27-R, MAY 2009
DA FORM 7595-1-13, MAR 2014
APD LC v1.00
APPLY A HEMOSTATIC DRESSING
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
STP 8-68W13-SM-TG, Task: 081-833-0211, Apply a Hemostatic Dressing.
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 squad is moving through a built-up area when a sniper opens up on the rear guard striking him in the leg. Once the sniper has been eliminated, you
move back to the patient's position. He appears alert and is screaming in pain. The squad automatic weapon gunner is applying direct pressure to a large
gunshot wound in the patient's upper thigh. You determine that this type of bleeding is best controlled by a hemostatic agent. You must apply a
hemostatic dressing to control the hemorrhage.
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 injury by cutting away the patient's clothing.
c. Opened the sterile package and removed the dressing without contaminating the cream-colored portion.
d. Placed the cream-colored sponge portion of the dressing directly onto the wound and packed the wound where
the bleeding is the heaviest.
e. Held pressure on the dressing for 3 minutes or until the dressing adhered to the wound and bleeding stopped.
f. Applied a pressure dressing over the hemostatic dressing to secure it in place.
g. 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
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 7595-27-R, MAY 2009
DA FORM 7595-1-13, MAR 2014
APD LC v1.00

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