DA Form 7595-2-7 "Insert a Nasopharyngeal Airway"

What Is DA Form 7595-2-7?

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 7595-2-7, 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.

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Download DA Form 7595-2-7 "Insert a Nasopharyngeal Airway"

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INSERT A NASOPHARYNGEAL AIRWAY
For use of this form see TC 8-800; the proponent agency is TRADOC.
ll
TABLE:
STP 8-68W13-SM-TG, Task: 081-833-0142, Insert a Nasopharyngeal Airway.
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 an altered level of consciousness, but has an active gag reflex. An airway must be
established immediately. You must insert a nasopharyngeal 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 patient.
c. Measured and selected the appropriate size of nasopharyngeal airway.
d. Lubricated the nasopharyngeal airway.
e. Fully inserted the nasopharyngeal airway.
f. Placed the patient in the recovery position.
g. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
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, 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 7595-2-7, MAR 2014
Supersedes DA Form 7595-3-R, MAY 2009
APD LC v1.00
INSERT A NASOPHARYNGEAL AIRWAY
For use of this form see TC 8-800; the proponent agency is TRADOC.
ll
TABLE:
STP 8-68W13-SM-TG, Task: 081-833-0142, Insert a Nasopharyngeal Airway.
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 an altered level of consciousness, but has an active gag reflex. An airway must be
established immediately. You must insert a nasopharyngeal 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 patient.
c. Measured and selected the appropriate size of nasopharyngeal airway.
d. Lubricated the nasopharyngeal airway.
e. Fully inserted the nasopharyngeal airway.
f. Placed the patient in the recovery position.
g. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
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, 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 7595-2-7, MAR 2014
Supersedes DA Form 7595-3-R, MAY 2009
APD LC v1.00