DA Form 7595-1-12 "Control Bleeding"

What Is DA Form 7595-1-12?

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 7595-1-12, 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 7595-1-12 "Control Bleeding"

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CONTROL BLEEDING
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task: 081-833-0124, Control Bleeding.
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:
You arrive on the scene of an improvised explosive device explosion. You notice two vehicles have been involved. One
vehicle has rolled onto the passenger side. The driver has just helped his passenger out of the vehicle and you notice
the passenger's left leg is covered with blood. The scene has been secured. 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. Determined if bleeding was life threatening. If so, immediately applied a Combat Application Tourniquet®.
b. If bleeding is not life threatening, applied direct pressure.
c. Applied a pressure dressing or emergency bandage if wound continued to bleed.
d. Applied a tourniquet if the wound continued to bleed.
e. Applied a hemostatic dressing to pack wounds not amenable to tourniquet use (neck, inguinal, axillary).
f. Initiated treatment for shock, as needed.
g. Documented care on a DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
h. Evacuated the patient.
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 7595-1-12, APR 2014
APD LC v1.00
CONTROL BLEEDING
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task: 081-833-0124, Control Bleeding.
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:
You arrive on the scene of an improvised explosive device explosion. You notice two vehicles have been involved. One
vehicle has rolled onto the passenger side. The driver has just helped his passenger out of the vehicle and you notice
the passenger's left leg is covered with blood. The scene has been secured. 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. Determined if bleeding was life threatening. If so, immediately applied a Combat Application Tourniquet®.
b. If bleeding is not life threatening, applied direct pressure.
c. Applied a pressure dressing or emergency bandage if wound continued to bleed.
d. Applied a tourniquet if the wound continued to bleed.
e. Applied a hemostatic dressing to pack wounds not amenable to tourniquet use (neck, inguinal, axillary).
f. Initiated treatment for shock, as needed.
g. Documented care on a DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
h. Evacuated the patient.
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 7595-1-12, APR 2014
APD LC v1.00