DA Form 7595-1-14 Initiate Treatment for an Amputation

DA Form 7595-1-14 - also known as the "Initiate Treatment For An Amputation" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 7595-1-14 - was last revised on April 1, 2014. Download an up-to-date fillable PDF version of the DA 7595-1-14 down below or look it up on the Army Publishing Directorate website.

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INITIATE TREATMENT FOR AN AMPUTATION
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task: 081-833-0061, Initiate Treatment for an Amputation.
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:
Your infantry squad has been assigned the task to patrol the outskirts of a village. To your front, a mortar round impacts near your squad's point man;
you drag the Soldier behind cover and perform a casualty assessment. The patient is conscious and has a traumatic amputation of his left lower leg.
You must treat the amputation.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. If an obvious amputation exists, immediately applied a Combat Application Tourniquet®.
b. Using a marker, made a “T” on the patient's forehead.
c. Treated for shock.
d. Cared for the amputated part.
e. Dressed the stump.
f. Recorded all treatment on the patient's DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
g. 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 7595-1-14, APR 2014
APD LC v1.00
INITIATE TREATMENT FOR AN AMPUTATION
For use of this form see TC 8-800; the proponent agency is TRADOC.
I
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task: 081-833-0061, Initiate Treatment for an Amputation.
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:
Your infantry squad has been assigned the task to patrol the outskirts of a village. To your front, a mortar round impacts near your squad's point man;
you drag the Soldier behind cover and perform a casualty assessment. The patient is conscious and has a traumatic amputation of his left lower leg.
You must treat the amputation.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. If an obvious amputation exists, immediately applied a Combat Application Tourniquet®.
b. Using a marker, made a “T” on the patient's forehead.
c. Treated for shock.
d. Cared for the amputated part.
e. Dressed the stump.
f. Recorded all treatment on the patient's DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card].
g. 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 7595-1-14, APR 2014
APD LC v1.00

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