DA Form 7595-2-6 "Perform Oral Suctioning"

DA Form 7595-2-6 - also known as the "Perform Oral Suctioning" - 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 7595-2-6 - was last revised on March 1, 2014. Download an up-to-date fillable PDF version of the DA 7595-2-6 below or request a copy through the chain of command.

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PERFORM ORAL SUCTIONING
For use of this form see TC 8-800; the proponent agency is TRADOC.
ll
TABLE:
STP 8-68W13-SM-TG, Task: 081-833-0021, Perform Oral Suctioning.
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:
While responding to an emergency call, you encounter a patient with altered level of consciousness and gurgling sounds coming from their airway. You
must suction the patient's oropharynx to establish a clear airway.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Positioned the conscious patient in a semi-Fowler's position, or in the case of trauma, rolled the patient onto his
side.
c. Turned on/prepared suction unit.
d. Selected the appropriate size catheter.
e. Pre-oxygenated the patient, if oxygen is available.
f. Suctioned the patient. Did not apply suction for more than 15 seconds at one time
(adult).
g. Re-oxygenated the patient, if oxygen is available.
h. Documented the procedure on the appropriate medical form.
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, 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.
DA FORM 7595-2-6, MAR 2014
APD LC v1.00
Supersedes DA Form 7595-4-R, MAY 2009
PERFORM ORAL SUCTIONING
For use of this form see TC 8-800; the proponent agency is TRADOC.
ll
TABLE:
STP 8-68W13-SM-TG, Task: 081-833-0021, Perform Oral Suctioning.
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:
While responding to an emergency call, you encounter a patient with altered level of consciousness and gurgling sounds coming from their airway. You
must suction the patient's oropharynx to establish a clear airway.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Positioned the conscious patient in a semi-Fowler's position, or in the case of trauma, rolled the patient onto his
side.
c. Turned on/prepared suction unit.
d. Selected the appropriate size catheter.
e. Pre-oxygenated the patient, if oxygen is available.
f. Suctioned the patient. Did not apply suction for more than 15 seconds at one time
(adult).
g. Re-oxygenated the patient, if oxygen is available.
h. Documented the procedure on the appropriate medical form.
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, 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.
DA FORM 7595-2-6, MAR 2014
APD LC v1.00
Supersedes DA Form 7595-4-R, MAY 2009
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