TRADOC Form 7595-1-9 Initiate Treatment for Hypovolemic Shock

Form 7595-1-9 is a United States Army - Training and Doctrine Command form also known as the "Initiate Treatment For Hypovolemic Shock". The latest edition of the form was released in April 1, 2014 and is available for digital filing.

Download a fillable PDF version of the Form 7595-1-9 down below or find it on United States Army - Training and Doctrine Command Forms website.

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INITIATE TREATMENT FOR HYPOVOLEMIC SHOCK
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task: 081-833-0047, Initiate Treatment for Hypovolemic Shock
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:
On a patrol in Afghanistan, you have a patient who has sustained multiple injuries and has lost a significant amount of blood. He has altered mental
status and an absent radial pulse. Initiate treatment for hypovolemic shock.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Performed a combat casualty assessment.
b. Controlled bleeding.
c. Maintained an open airway.
d. Initiated one 18 gauge intravenous catheter.
e. Infused Hextend®.
f. Treated for hypothermia.
g. Monitored the patient.
h. Recorded the treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
i. Prepared the patient for evacuation.
4. Demonstrated Proficiency
Yes
No
6. Stop Time
7. Initial Evaluator
5. Start Time
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 7595-1-9, APR 2014
APD LC v1.00
INITIATE TREATMENT FOR HYPOVOLEMIC SHOCK
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task: 081-833-0047, Initiate Treatment for Hypovolemic Shock
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:
On a patrol in Afghanistan, you have a patient who has sustained multiple injuries and has lost a significant amount of blood. He has altered mental
status and an absent radial pulse. Initiate treatment for hypovolemic shock.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Performed a combat casualty assessment.
b. Controlled bleeding.
c. Maintained an open airway.
d. Initiated one 18 gauge intravenous catheter.
e. Infused Hextend®.
f. Treated for hypothermia.
g. Monitored the patient.
h. Recorded the treatment on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
i. Prepared the patient for evacuation.
4. Demonstrated Proficiency
Yes
No
6. Stop Time
7. Initial Evaluator
5. Start Time
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 7595-1-9, APR 2014
APD LC v1.00

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