DA Form 7595-4-9 Initiate Treatment for Chest Pain

DA Form 7595-4-9 - also known as the "Initiate Treatment For Chest Pain" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 7595-4-9 - was last revised on May 1, 2014. Download an up-to-date fillable PDF version of the DA 7595-4-9 down below or look it up on the Army Publishing Directorate website.

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INITIATE TREATMENT FOR CHEST PAIN
For use of this form see TC 8-800; the proponent agency is TRADOC.
IV
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task: 081-833-0011 Initiate Treatment for Chest Pain
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:
While working in a battalion aid station, a civilian contractor arrives with a chief complaint of chest pain that started 30 minutes ago. You must initiate
treatment for chest pain.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Identified signs and symptoms of possible cardiac emergency or compromise.
b. Administered the appropriate treatment.
c. Obtained baseline vital signs.
d. Assisted the patient in taking their prescribed nitroglycerin, if available and in accordance with local protocol.
e. Transported promptly to the next higher medical facility.
f. Performed an ongoing assessment while en route.
g. Documented all interventions on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card] or SF 600
(Medical Record - Chronological Record of Medical Care).
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 7595-4-9, MAY 2014
INITIATE TREATMENT FOR CHEST PAIN
For use of this form see TC 8-800; the proponent agency is TRADOC.
IV
TABLE:
REFERENCE:
STP 8-68W13-SM-TG, Task: 081-833-0011 Initiate Treatment for Chest Pain
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:
While working in a battalion aid station, a civilian contractor arrives with a chief complaint of chest pain that started 30 minutes ago. You must initiate
treatment for chest pain.
GRADING SHEET
TASK
COMPLETED
1ST
2ND
3RD
3. Performance Measures
P
F
P
F
P
F
a. Identified signs and symptoms of possible cardiac emergency or compromise.
b. Administered the appropriate treatment.
c. Obtained baseline vital signs.
d. Assisted the patient in taking their prescribed nitroglycerin, if available and in accordance with local protocol.
e. Transported promptly to the next higher medical facility.
f. Performed an ongoing assessment while en route.
g. Documented all interventions on DD Form 1380 [Tactical Combat Casualty Care (TCCC) Card] or SF 600
(Medical Record - Chronological Record of Medical Care).
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 7595-4-9, MAY 2014
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