DA Form 7595-3-3 Initiate an Intraosseous Infusion (Fast 1)

DA Form 7595-3-3 - also known as the "Initiate An Intraosseous Infusion (fast 1)" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 7595-3-3 - was last revised on March 1, 2014. Download an up-to-date fillable PDF version of the DA 7595-3-3 down below or look it up on the Army Publishing Directorate website.

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®
INITIATE AN INTRAOSSEOUS INFUSION
(FAST1
)
For use of this form see TC 8-800; the proponent agency is TRADOC.
III
TABLE:
®
STP 8-68W13-SM-TG, Task: 081-833-0185, Initiate a FAST 1
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
DISCLOSURE:
processing applicable favorable personnel actions. For Official Use Only.
1. Soldier (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
The lead Bradley infantry fighting vehicle traveling directly in front of your vehicle has been struck by an IED. After securing the immediate area, the
patients are moved to safety. Following your initial assessment, you determine that you must establish peripheral intravenous access for one of the
patients in order to initiate fluids. After two attempts at initiating a peripheral intravenous (IV), you are unable to establish venous access. You must
establish vascular access by a sternal intraosseous (first access for shock and trauma
[FAST1®]
device; you have been provided the necessary medical
equipment.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Assembled the necessary equipment.
b. Spiked the IV bag and properly prepared the IV tubing.
c. Took body substance isolation precautions.
d. Located the suprasternal notch.
e. Cleaned site with alcohol.
f. Placed the target patch at landmark.
g. Rechecked the location of the target patch.
h. Placed the bone needle cluster into the target zone of the target patch; maintained perpendicular aspect of
the introducer to the manubrium.
i. Applied firm, increasing pressure along the axis of the introducer until a distinct release was felt and heard.
j. Gently removed the introducer by pulling straight back.
k. Connected the infusion tube to the right angle connector on the target patch.
l. Connected the syringe and flushed the infusion tube with 5 ml of sterile saline.
m. Connected the IV infusion tubing; opened IV line.
n. Attached the protective dome to target patch and secured with tape.
o. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. Initial 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.
, skill sheets ©2011, this form has neither been prepared nor approved by NREMT. Use is
(NREMT)
restricted to guidelines contained in the Preface to TC 8-800.
Page 1 of 2
Supersedes DA Form 7595-30-R, MAY 2009
DA FORM 7595-3-3, MAR 2014
APD LC v1.00

Download DA Form 7595-3-3 Initiate an Intraosseous Infusion (Fast 1)

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