DA Form 7595-2-2 Insert an Oropharyngeal Airway

DA Form 7595-2-2 or the "Insert An Oropharyngeal Airway" 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 7595-2-2 - was last revised on March 1, 2014. Download an up-to-date fillable DA Form 7595-2-2 down below in PDF-format or look it up on the Army Publishing Directorate website.

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INSERT AN OROPHARYNGEAL AIRWAY
For use of this form see TC 8-800; the proponent agency is TRADOC.
II
TABLE:
STP 8-68W15-SM-TG, Task: 081-833-0016, Insert an Oropharyngeal Airway (J Tube)l
REFERENCE:
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:
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.
Voluntary. Failure to provide your name may result in a loss of credit for accomplishing the training or error in
DISCLOSURE:
processing applicable favorable personnel actions. For Official Use Only.
1. Soldier (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
While responding to an emergency call, you encounter an apneic patient. An airway must be established immediately. You must insert an oropharyngeal
airway.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Selected the appropriate size oropharyngeal airway.
c. Performed the head-tilt/chin-lift or jaw thrust maneuver.
d. Opened the patient's mouth using the scissors technique.
e. Inserted the oropharyngeal airway.
f. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
g. Evacuated the patient.
h. 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
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
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.
DA FORM 7595-2-2, MAR 2014
Supersedes DA Form 7595-2-R, MAY 2009
APD LC v1.00
INSERT AN OROPHARYNGEAL AIRWAY
For use of this form see TC 8-800; the proponent agency is TRADOC.
II
TABLE:
STP 8-68W15-SM-TG, Task: 081-833-0016, Insert an Oropharyngeal Airway (J Tube)l
REFERENCE:
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:
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.
Voluntary. Failure to provide your name may result in a loss of credit for accomplishing the training or error in
DISCLOSURE:
processing applicable favorable personnel actions. For Official Use Only.
1. Soldier (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
While responding to an emergency call, you encounter an apneic patient. An airway must be established immediately. You must insert an oropharyngeal
airway.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Selected the appropriate size oropharyngeal airway.
c. Performed the head-tilt/chin-lift or jaw thrust maneuver.
d. Opened the patient's mouth using the scissors technique.
e. Inserted the oropharyngeal airway.
f. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
g. Evacuated the patient.
h. 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
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
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.
DA FORM 7595-2-2, MAR 2014
Supersedes DA Form 7595-2-R, MAY 2009
APD LC v1.00

Download DA Form 7595-2-2 Insert an Oropharyngeal Airway

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