DA Form 7595-4-3 "Manage a Seizing Patient"

What Is DA Form 7595-4-3?

This is a military form that was released by the U.S. Department of the Army (DA) on May 1, 2014. The form, often mistakenly referred to as the DD Form 7595-4-3, 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 7595-4-3 "Manage a Seizing Patient"

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MANAGE A SEIZING PATIENT
For use of this form see TC 8-800; the proponent agency is TRADOC.
IV
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task 081-833-0002 Manage a Seizing Patient
PRIVACY ACT STATEMENT
10 U.S.C.
3013 Secretary of the Army; AR 350-1, Army Training Leadership and
AUTHORITY:
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 (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
You are working in a battalion aid station; one of the patients starts to seize. You must assess and manage this patient.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Maintained the airway.
c. Placed the patient on his side, if possible.
d. Prevented injury to the patient by removing objects with which the patient may hurt himself.
e. Administered oxygen via non-rebreather, if available.
f. Recorded the seizure activity.
g. Evacuated the patient on his side, in the recovery position.
h. Did not cause further injury to the patient.
4. Demonstrated Proficiency
Yes
No
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
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.
APD LC v1.00
DA FORM 7595-4-3, MAY 2014
MANAGE A SEIZING PATIENT
For use of this form see TC 8-800; the proponent agency is TRADOC.
IV
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task 081-833-0002 Manage a Seizing Patient
PRIVACY ACT STATEMENT
10 U.S.C.
3013 Secretary of the Army; AR 350-1, Army Training Leadership and
AUTHORITY:
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 (Last Name, First Name, MI)
2. Date (YYYYMMDD)
SCENARIO:
You are working in a battalion aid station; one of the patients starts to seize. You must assess and manage this patient.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Took body substance isolation precautions.
b. Maintained the airway.
c. Placed the patient on his side, if possible.
d. Prevented injury to the patient by removing objects with which the patient may hurt himself.
e. Administered oxygen via non-rebreather, if available.
f. Recorded the seizure activity.
g. Evacuated the patient on his side, in the recovery position.
h. Did not cause further injury to the patient.
4. Demonstrated Proficiency
Yes
No
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
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.
APD LC v1.00
DA FORM 7595-4-3, MAY 2014