DA Form 7595-2-9 "Insert a King Lt"

What Is DA Form 7595-2-9?

This is a military form that was released by the U.S. Department of the Army (DA) on May 1, 2014. The form, often mistakenly referred to as the DD Form 7595-2-9, 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 7595-2-9 "Insert a King Lt"

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INSERT A KING LT
®
For use of this form see TC 8-800; the proponent agency is TRADOC.
II
TABLE:
STP 8-68W15-SM-TG, Tasks: 081-833-0169, Insert a King LT®;
REFERENCE:
PRIVACY ACT STATEMENT
§
AUTHORITY:
10 U.S.C.
3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
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 Army's
ROUTINE USES:
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:
On a humanitarian medical mission, one of the civilian contractors has suffered a cardiac arrest. He is pulseless and apneic. You must establish and
maintain an airway using a King LT®.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Assessed the upper airway for visible obstruction.
c. Directed assistant to pre-oxygenate the patient.
d. Inspected and tested equipment.
e. Lubricated distal end of tube.
f. Performed a tongue-jaw lift with nondominate hand.
g. Inserted the King LT® until the base connector is aligned with the patient's teeth.
h. Inflated the cuffs with the appropriate amount of air based on the size of the tube.
i. Confirmed proper placement by auscultation and chest movement.
j. Assessed patient for spontaneous respirations, if any, for 10 seconds.
k. Attached pulse oximeter to patient, if available.
l. Directed the assistant to ventilate the patient with a Bag-Valve Mask when respirations are less than 8 or
more then 30 or a pulse oximeter reading less than 90%.
m. Secured the King LT® to the patient using tape.
n. Documented the procedure on the appropriate medical form.
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. First Evaluator
8. Start Time
9. Stop Time
10. Retest Evaluator
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 7595-2-9, MAY 2014
Page 1 of 2
APD LC v1.00
INSERT A KING LT
®
For use of this form see TC 8-800; the proponent agency is TRADOC.
II
TABLE:
STP 8-68W15-SM-TG, Tasks: 081-833-0169, Insert a King LT®;
REFERENCE:
PRIVACY ACT STATEMENT
§
AUTHORITY:
10 U.S.C.
3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
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 Army's
ROUTINE USES:
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:
On a humanitarian medical mission, one of the civilian contractors has suffered a cardiac arrest. He is pulseless and apneic. You must establish and
maintain an airway using a King LT®.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Assessed the upper airway for visible obstruction.
c. Directed assistant to pre-oxygenate the patient.
d. Inspected and tested equipment.
e. Lubricated distal end of tube.
f. Performed a tongue-jaw lift with nondominate hand.
g. Inserted the King LT® until the base connector is aligned with the patient's teeth.
h. Inflated the cuffs with the appropriate amount of air based on the size of the tube.
i. Confirmed proper placement by auscultation and chest movement.
j. Assessed patient for spontaneous respirations, if any, for 10 seconds.
k. Attached pulse oximeter to patient, if available.
l. Directed the assistant to ventilate the patient with a Bag-Valve Mask when respirations are less than 8 or
more then 30 or a pulse oximeter reading less than 90%.
m. Secured the King LT® to the patient using tape.
n. Documented the procedure on the appropriate medical form.
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. First Evaluator
8. Start Time
9. Stop Time
10. Retest Evaluator
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 7595-2-9, MAY 2014
Page 1 of 2
APD LC v1.00
INSERT A KING LT
®
Grading Sheet (continued)
12. Stop Time
13. Final Evaluator
11. Start Time
14. Evaluator's Comments
DA FORM 7595-2-9, MAY 2014
Page 2 of 2
APD LC v1.00
Page of 2