DA Form 7595-4-8 "Operate an Automated External Defibrillator"

What Is DA Form 7595-4-8?

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 7595-4-8, 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 7595-4-8 "Operate an Automated External Defibrillator"

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OPERATE AN AUTOMATED EXTERNAL DEFIBRILLATOR
For use of this form see TC 8-800; the proponent agency is TRADOC.
IV
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task 081-833-0014 Operate an Automated External Defibrillator
PRIVACY ACT STATEMENT
AUTHORITY:
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
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.
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 demonstrating the clinical signs of cardiac arrest. According to the combat lifesaver, the
patient collapsed about 5 minutes ago; Cardiopulmonary resuscitation (CPR) was initiated immediately. As your assistant takes over CPR, you must set
up an automated external defibrillator (AED), attach the defibrillator pads, initiate rhythm analysis, and, as appropriate, administer shocks to the patient to
restore an effective cardiac rhythm.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Briefly questioned the combat lifesaver about the arrest events.
c. Directed rescuer to stop CPR to verify pulselessness and apnea.
d. Directed the assistant to resume CPR.
e. Turned on the AED.
f. Attached the defibrillator pads to the chest.
g. Directed the assistant to stop CPR and stated "clear the patient".
h. Initiated analysis of the rhythm.
i. If shock is indicated by the AED, stated "clear the patient" again.
j. Delivered shock.
k. Directed resumption of CPR.
l. Confirmed effectiveness of CPR.
m. Inserted an oropharyngeal or nasopharyngeal airway.
n. Directed the assistant to resume CPR.
o. Re-evaluated patient/CPR in 2 minutes.
p. Reanalyzed the rhythm.
q. Repeated steps i through k.
r. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
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
THIS FORM SUPERSEDES DA FORM 7595-21-R, MAY 2009.
DA FORM 7595-4-8, MAR 2014
APD LC v1.00
OPERATE AN AUTOMATED EXTERNAL DEFIBRILLATOR
For use of this form see TC 8-800; the proponent agency is TRADOC.
IV
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task 081-833-0014 Operate an Automated External Defibrillator
PRIVACY ACT STATEMENT
AUTHORITY:
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
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.
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 demonstrating the clinical signs of cardiac arrest. According to the combat lifesaver, the
patient collapsed about 5 minutes ago; Cardiopulmonary resuscitation (CPR) was initiated immediately. As your assistant takes over CPR, you must set
up an automated external defibrillator (AED), attach the defibrillator pads, initiate rhythm analysis, and, as appropriate, administer shocks to the patient to
restore an effective cardiac rhythm.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Briefly questioned the combat lifesaver about the arrest events.
c. Directed rescuer to stop CPR to verify pulselessness and apnea.
d. Directed the assistant to resume CPR.
e. Turned on the AED.
f. Attached the defibrillator pads to the chest.
g. Directed the assistant to stop CPR and stated "clear the patient".
h. Initiated analysis of the rhythm.
i. If shock is indicated by the AED, stated "clear the patient" again.
j. Delivered shock.
k. Directed resumption of CPR.
l. Confirmed effectiveness of CPR.
m. Inserted an oropharyngeal or nasopharyngeal airway.
n. Directed the assistant to resume CPR.
o. Re-evaluated patient/CPR in 2 minutes.
p. Reanalyzed the rhythm.
q. Repeated steps i through k.
r. Documented treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
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
THIS FORM SUPERSEDES DA FORM 7595-21-R, MAY 2009.
DA FORM 7595-4-8, MAR 2014
APD LC v1.00
OPERATE AN AUTOMATED EXTERNAL DEFIBRILLATOR
GRADING SHEET
(cont'd)
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
15. Evaluator's Comments
Page 2 of 2
DA FORM 7595-4-8, MAR 2014
APD LC v1.00
Page of 2