DA Form 7595-1-1 "Perform a Combat Casualty Assessment"

DA Form 7595-1-1 or the "Perform A Combat Casualty Assessment" is a Department of the Army-issued form used by and within the United States Military.

The form - often incorrectly referred to as the DD form 7595-1-1 - was last revised on May 1, 2014. Download an up-to-date fillable DA Form 7595-1-1 down below in PDF-format or look it up on the Army Publishing Directorate website.

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PERFORM A COMBAT CASUALTY ASSESSMENT
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
STP 8-68W13-SM-TG, Task: 081-833-0067 Perform a Combat Casualty Assessment
REFERENCE:
PRIVACY ACT STATEMENT
AUTHORITY:
10 U.S.C.
3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
To ensure that accomplishment of training is properly credited to the correct individual for NREMT certification IAW AR
PRINCIPAL PURPOSE:
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.
2. Date (YYYYMMDD)
1. Soldier (Last Name, First Name, MI)
SCENARIO:
On a patrol in Afghanistan, you have a patient who has sustained multiple injuries. Perform a combat casualty assessment.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Performed care under fire.
(1) Returned fire.
(2) Directed patient to return fire, move to cover and apply self-aid, if possible.
(3) Treated only life-saving extremity hemorrhage in care under fire.
b. Performed tactical field care.
(1) If tactical situation permits, took body substance isolation precautions.
(2) Noted general impression of the patient using AVPU.
(3) Performed blood sweep of neck, axillary, inguinal and extremity areas. Assessed effectiveness of
previously placed tourniquets.
(4) Assessed and secured the airway.
(5) Assessed breathing and performed medical care to correct problems.
(6) Identified and controlled major bleeding not previously controlled.
(7) Determined if patient required fluid resuscitation.
(8) Notified the tactical leader for patient evacuation.
(9) Reassessed prior interventions.
(10) Administered pain medication as needed.
(11) Performed a detailed physical examination.
(a) Head.
(b) Neck.
(c) Chest.
(d) Abdomen/Pelvis.
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 7595-1-1, MAY 2014
Page 1 of 2
APD LC v1.00
PERFORM A COMBAT CASUALTY ASSESSMENT
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
STP 8-68W13-SM-TG, Task: 081-833-0067 Perform a Combat Casualty Assessment
REFERENCE:
PRIVACY ACT STATEMENT
AUTHORITY:
10 U.S.C.
3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
To ensure that accomplishment of training is properly credited to the correct individual for NREMT certification IAW AR
PRINCIPAL PURPOSE:
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.
2. Date (YYYYMMDD)
1. Soldier (Last Name, First Name, MI)
SCENARIO:
On a patrol in Afghanistan, you have a patient who has sustained multiple injuries. Perform a combat casualty assessment.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Performed care under fire.
(1) Returned fire.
(2) Directed patient to return fire, move to cover and apply self-aid, if possible.
(3) Treated only life-saving extremity hemorrhage in care under fire.
b. Performed tactical field care.
(1) If tactical situation permits, took body substance isolation precautions.
(2) Noted general impression of the patient using AVPU.
(3) Performed blood sweep of neck, axillary, inguinal and extremity areas. Assessed effectiveness of
previously placed tourniquets.
(4) Assessed and secured the airway.
(5) Assessed breathing and performed medical care to correct problems.
(6) Identified and controlled major bleeding not previously controlled.
(7) Determined if patient required fluid resuscitation.
(8) Notified the tactical leader for patient evacuation.
(9) Reassessed prior interventions.
(10) Administered pain medication as needed.
(11) Performed a detailed physical examination.
(a) Head.
(b) Neck.
(c) Chest.
(d) Abdomen/Pelvis.
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 7595-1-1, MAY 2014
Page 1 of 2
APD LC v1.00
PERFORM A COMBAT CASUALTY ASSESSMENT
Grading Sheet (continued)
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
(11) Performed a detailed physical examination.
(e) Lower extremities.
(f) Upper extremities.
(g) Posterior thorax, lumbar and buttocks
(12) Prepared patient to prevent hypothermia and placed on an evacuation device.
(13) Elicited AMPLE history, baseline vital signs and completed patient care documentation.
(14) If evacuation to higher role of care is delayed over 3 hours, administered appropriate antibiotic for
penetrating trauma.
(15) Secured patient to evacuation device and prepared for transport.
(16) Continued reassuring and reassessing patient until medical evacuation arrives.
Yes
No
4. Demonstrated Proficiency
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
DA FORM 7595-1-1, MAY 2014
Page 2 of 2
APD LC v1.00
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