DA Form 7595-2-11 "Measure a Patient's Respiration"

What Is DA Form 7595-2-11?

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 7595-2-11, 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.

Form Details:

  • A 1-page document available for download in PDF;
  • The latest version available from the Army Publishing Directorate;
  • Editable, free, and easy to use;

Download an up-to-date fillable DA Form 7595-2-11 down below in PDF format or browse hundreds of other DA Forms stored in our online database.

ADVERTISEMENT
ADVERTISEMENT

Download DA Form 7595-2-11 "Measure a Patient's Respiration"

604 times
Rate (4.3 / 5) 152 votes
MEASURE A PATIENT’S RESPIRATIONS
For use of this form see TC 8-800; the proponent agency is TRADOC.
II
TABLE:
STP 8-68W13-SM-TG, Task: 081-831-0010, Measure a Patient's Respirations.
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.
ROUTINE USES:
Used by Unit personnel to monitor training. The DOD “Blanket Routine uses” set forth at the beginning of the 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 processing
DISCLOSURE:
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 a medical illness or trauma-related injury. During your assessment and management
of this patient, you must obtain a baseline set of vital signs. You must demonstrate the techniques for measuring respirations.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Positioned the patient, seated or lying supine.
b. Had the patient remove any overgarments that obstructed the ability to observe the patient's chest rise and fall
with each breath.
c. Observed the rise and fall of the patient's chest as they breathe. Each cycle of inhalation and exhalation equates
to one respiration.
d. Counted the number of respirations (rate) in a 30-second period and multiplied times two. EVALUATOR: If the
patient is demonstrating an irregular breathing pattern, the Soldier Medic must measure the number of respirations
for a full 60 seconds.
e. Evaluated the depth of the respirations
(unlabored, shallow, labored).
f. Evaluated the quality
(character)
of the respirations
(normal, noisy , etc.).
g. Documented the respiration rate, depth, and quality and the time obtained on the appropriate medical form.
h. Reported any abnormal respirations.
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 7595-2-11, MAR 2014
Supersedes DA Form 7595-11-R, May 2009
APD LC v1.01
MEASURE A PATIENT’S RESPIRATIONS
For use of this form see TC 8-800; the proponent agency is TRADOC.
II
TABLE:
STP 8-68W13-SM-TG, Task: 081-831-0010, Measure a Patient's Respirations.
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.
ROUTINE USES:
Used by Unit personnel to monitor training. The DOD “Blanket Routine uses” set forth at the beginning of the 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 processing
DISCLOSURE:
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 a medical illness or trauma-related injury. During your assessment and management
of this patient, you must obtain a baseline set of vital signs. You must demonstrate the techniques for measuring respirations.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Positioned the patient, seated or lying supine.
b. Had the patient remove any overgarments that obstructed the ability to observe the patient's chest rise and fall
with each breath.
c. Observed the rise and fall of the patient's chest as they breathe. Each cycle of inhalation and exhalation equates
to one respiration.
d. Counted the number of respirations (rate) in a 30-second period and multiplied times two. EVALUATOR: If the
patient is demonstrating an irregular breathing pattern, the Soldier Medic must measure the number of respirations
for a full 60 seconds.
e. Evaluated the depth of the respirations
(unlabored, shallow, labored).
f. Evaluated the quality
(character)
of the respirations
(normal, noisy , etc.).
g. Documented the respiration rate, depth, and quality and the time obtained on the appropriate medical form.
h. Reported any abnormal respirations.
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 7595-2-11, MAR 2014
Supersedes DA Form 7595-11-R, May 2009
APD LC v1.01