DA Form 7595-1-7 "Apply an Occlusive Dressing"

What Is DA Form 7595-1-7?

This is a military form that was released by the U.S. Department of the Army (DA) on April 1, 2014. The form, often mistakenly referred to as the DD Form 7595-1-7, 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 7595-1-7 "Apply an Occlusive Dressing"

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APPLY AN OCCLUSIVE DRESSING
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
REFERENCES:
STP 8-68W15-SM-TG, Task: 081-833-0069, Apply an Occlusive Dressing.
PRIVACY ACT STATEMENT
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army Training Leadership and
AUTHORITY:
S
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
ROUTINE USES:
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's (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
While responding to an emergency call, you encounter a patient with penetrating chest trauma. You must apply an occlusive dressing.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Exposed the injury.
c. Covered the injury (on patient expiration) with large occlusive material dressing (either a commercial chest
seal or improvised); covering the first wound encountered.
d. Ensured material extends 2 inches beyond the edge of the injury. If using improvised dressing, taped all four
sides of the material down.
e. Log rolled the patient or had the patient sit up and examined the back for an exit wound.
f. Covered the exit wound on expiration, if present with a large occlusive dressing.
g. Placed the patient in a sitting position or with his injured sided down in the recovery position.
h. Continued assessment of the patient for signs of progressive respiratory distress.
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. Initial Evaluator
9. Stop Time
8. Start 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 7595-1-7, APR 2014
APD LC v1.00
APPLY AN OCCLUSIVE DRESSING
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
REFERENCES:
STP 8-68W15-SM-TG, Task: 081-833-0069, Apply an Occlusive Dressing.
PRIVACY ACT STATEMENT
10 U.S.C. S 3013 Secretary of the Army; AR 350-1, Army Training Leadership and
AUTHORITY:
S
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
ROUTINE USES:
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's (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
While responding to an emergency call, you encounter a patient with penetrating chest trauma. You must apply an occlusive dressing.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Exposed the injury.
c. Covered the injury (on patient expiration) with large occlusive material dressing (either a commercial chest
seal or improvised); covering the first wound encountered.
d. Ensured material extends 2 inches beyond the edge of the injury. If using improvised dressing, taped all four
sides of the material down.
e. Log rolled the patient or had the patient sit up and examined the back for an exit wound.
f. Covered the exit wound on expiration, if present with a large occlusive dressing.
g. Placed the patient in a sitting position or with his injured sided down in the recovery position.
h. Continued assessment of the patient for signs of progressive respiratory distress.
4. Demonstrated Proficiency
Yes
No
5. Start Time
6. Stop Time
7. Initial Evaluator
9. Stop Time
8. Start 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 7595-1-7, APR 2014
APD LC v1.00