91W Healthcare Specialist

Front 1

Skill Level 1
Subject Area 1: Vital Signs

MEASURE A PATIENT'S RESPIRATIONS

Back 1

Evaluation Preparation:

Setup: You must count the rate with the soldier. If you are using a simulated patient, you may test step 2 by having him or her purposely exhibit abnormal breathing characteristics. A tolerance of plus or minus two counts will be allowed.

Brief soldier: Tell the soldier to count, evaluate, and record a patient's respirations.

Performance Measures GO NO GO
1. Counted the number of times the chest rose in 1 minute. —— ——
2. Evaluated the respirations. —— ——
3. Checked for the physical characteristics of abnormal respirations. —— ——
4. Recorded the rate of respirations and any observations noted on the appropriate forms. —— ——
5. Reported any abnormal respirations to the supervisor immediately. —— ——

Evaluation Guidance: Score each soldier according to the performance measures in the evaluation guide. Unless otherwise stated in the task summary, the soldier must pass all performance measures to be scored GO. If the soldier fails any step, show what was done wrong and how to do it correctly.

Front 2

MEASURE A PATIENT'S PULSE

Back 2

Setup: While the soldier is palpating a pulse site, you must palpate the corresponding site. Specify which site the soldier is to palpate. If the apical site is chosen, either a double stethoscope or separate stethoscopes may be used. A tolerance of plus or minus two beats will be allowed.

Brief soldier: Tell the soldier to count, evaluate, and record the patient's pulse.

Performance Measures GO NO GO
1. Positioned the patient so that the pulse site is accessible. —— ——
2. Palpated the pulse site. —— ——
3. Counted for 1 full minute and evaluated the pulse. —— ——
4. Recorded the rate, rhythm, strength, and any significant deviations from normal on the appropriate forms. —— ——
5. Reported any significant pulse abnormalities to the supervisor immediately. —— ——

Front 3

MEASURE A PATIENT'S BLOOD PRESSURE

Back 3

Evaluation Preparation:

Setup: A double stethoscope should be used if available. A tolerance of ± 4 mm Hg will be allowed. If other methods are used, such as independent measurements on different sites or at different times, the evaluator must apply discretion in applying the ± 4 mm Hg standard. You will allow the soldier to retake the blood pressure at least once if the soldier feels that it is necessary to obtain an accurate reading. You will use discretion in allowing additional repetitions based upon the difficulty of obtaining a reading on the patient.

Brief soldier: Tell the soldier to take a patient's blood pressure. Tell the soldier that the blood pressure may be retaken, if necessary, to obtain an accurate reading.

Performance Measures GO NO GO
1. Explained the procedure to the patient, if necessary. —— ——
2. Selected the proper size of sphygmomanometer cuff. —— ——
3. Checked the equipment. —— ——
4. Positioned the patient. —— ——
5. Placed the cuff just tightly enough to prevent slippage. —— ——
6. Positioned the stethoscope, if used. —— ——
7. Inflated the cuff until the gauge read at least 140 mm Hg or 10 mm Hg higher than the usual range for that patient, if known. —— ——
8. Determined the blood pressure. —— ——
9. Recorded the blood pressure on the appropriate forms. —— ——
10. Evaluated the blood pressure. —— ——
11. Reported any abnormal readings to the supervisor. —— ——

Front 4

MEASURE A PATIENT'S TEMPERATURE

Back 4

Evaluation Preparation:

Setup: To test step 1 for evaluation purposes, create a scenario in which the patient's condition will dictate which site the soldier must choose.

Brief soldier: Tell the soldier to measure, evaluate, and record a patient's temperature.

Performance Measures GO NO GO
1. Determined which site to use. —— ——
2. Selected the proper thermometer. —— ——
3. Explained the procedure and positioned the patient. —— ——
4. Measured the temperature. —— ——
5. Removed the thermometer and wiped it down with a gauze square. —— ——
6. Read the scale. —— ——
7. Placed the thermometer in the proper "used" canister or disposed of the plastic sheath as appropriate. —— ——
8. Recorded the temperature to the nearest 0.2° F on the appropriate forms and reported any abnormal temperature change immediately to the supervisor. —— ——

Front 5

MEASURE A PATIENT'S PULSE OXYGEN SATURATION

Back 5

NOTE: Monitors come with preset limits. These limits can be changed per physician's order.
b. Move clip sensors every 2 hours. Move adhesive sensors every 4 hours.


Performance Measures GO NO GO
1. Selected the appropriate size of sensor. —— ——
2. Selected the appropriate sensor location. —— ——
3. Cleaned and dried the site. —— ——
4. Applied the sensor. —— ——
5. Attached the sensor cable to the monitor and turned it on. —— ——
6. Notified the MD or PA of abnormal readings. —— ——
7. Documented the oximeter reading, the location of the device, and the amount of oxygen being delivered. —— ——
8. Performed measures for continuous monitoring. —— ——

Front 6

Subject Area 2: Emergency Medical Treatment

OPEN THE AIRWAY

Back 6

Evaluation Preparation:

Setup: Place a CPR mannequin or another soldier acting as the casualty face down on the ground. For training and evaluation, you may specify to the soldier whether the casualty has a spinal injury to test step 2, or you may create a scenario in which the casualty's condition will dictate to the soldier how to treat the casualty. After step 3 tell the soldier whether the casualty is breathing or not and ask what should be done.

Brief soldier: Tell the soldier to open the casualty's airway.

Performance Measures GO NO GO
1. Rolled the casualty onto his or her back, if necessary. —— ——
2. Established the airway using the head-tilt/chin-lift or jaw thrust method. —— ——
3. Checked for breathing within 3 to 5 seconds. —— ——
4. Took appropriate action. —— ——
5. Did not cause further injury to the casualty. —— ——

Front 7

CLEAR AN UPPER AIRWAY OBSTRUCTION

Back 7

Brief soldier: Describe the symptoms of a casualty with good air exchange, poor air exchange, or a complete airway obstruction. Ask the soldier what should be done and score step 1 based on the answer. Then, tell the soldier to clear an upper airway obstruction. Tell the soldier to demonstrate how to position the casualty, where to stand, and how to position his or her hands for the thrusts. The soldier must tell you how they should be done and how many thrusts should be performed. Ensure that the soldier understands that he or she must not actually perform the thrusts. After completion of step 5, ask the soldier what must be done if the casualty becomes unconscious.

Performance Measures GO NO GO
1. Determined whether the casualty needs help. —— ——
2. Moved the casualty to a sitting or standing position, if necessary. —— ——
3. Stood behind the casualty. —— ——
4. Positioned arms and hands properly to perform the thrusts. —— ——
5. Stated how to perform the thrusts and how many should be performed. —— ——
6. Stated that the following actions would be taken if the casualty becomes unconscious. —— ——
a. Reposition the casualty.
b. Perform a finger sweep.
c. Open the airway.
d. Perform rescue breathing procedures.
7. Completed all necessary steps in order. —— ——

Front 8

ADMINISTER EXTERNAL CHEST COMPRESSIONS

Back 8

Brief soldier: If two soldiers are involved, tell them about their roles as rescuer #1 and #2. Ask rescuer #1 on what kind of surface the casualty should be positioned. Then, tell the soldier(s) to perform one-rescuer or two-rescuer CPR, as appropriate.

Performance Measures GO NO GO
1. Positioned the casualty on a hard flat surface. —— ——
2. Properly positioned the hands during chest compressions. —— ——
3. Administered the correct number of chest compressions. —— ——
4. Gave the chest compressions at the rate of 80 to 100 per minute. —— ——
5. Administered the correct number of breaths. —— ——
6. Gave the breaths at the correct rate. —— ——
7. Checked the carotid pulse for about 5 seconds approximately 1 minute after starting CPR. —— ——
8. Rechecked the carotid pulse every 3 to 5 minutes. —— ——
9. Performed the transition to two-rescuer CPR correctly, if applicable. —— ——
10. Changed positions during two-rescuer CPR correctly, if applicable. —— ——
11. Continued CPR as stated in the task standard. —— ——

Front 9

PERFORM RESCUE BREATHING

Back 9

Setup: For training and evaluation, a CPR mannequin must be used. Position the mannequin on its back. To test step 3, you may specify to the soldier whether to use the mouth-to-mouth or mouth-to-nose method, or you may create a scenario in which the casualty's condition dictates which method is to be used. You may determine how much of the task is tested by telling the soldier whether the airway is clear or a pulse is found as the soldier proceeds through the task. However, you should ensure that the soldier is routed through the task far enough to continue rescue breathing after checking the carotid pulse.

Brief soldier: Tell the soldier to perform rescue breathing.

Performance Measures GO NO GO
1. Opened the airway —— ——
2. Ventilated the casualty using the mouth-to-mouth, mouth-to-nose, mouth-to-mask, BVM, or FROPVD method, as appropriate. —— ——
3. Repositioned the head to ensure an open airway and repeated ventilation attempt, if necessary. —— ——
4. Cleared an airway obstruction, if necessary. —— ——
5. Checked the carotid pulse for 5 to 10 seconds. —— ——
6. Continued rescue breathing. —— ——
7. Completed all necessary steps in order. —— ——

Front 10

CONTROL BLEEDING

Back 10

Performance Measures GO NO GO
1. Determined the type of bleeding (internal or external). —— ——
2. Performed measures to control external bleeding. —— ——
a. Applied direct pressure to the wound.
b. Elevated the extremity.
c. Applied additional dressings to the wound, if needed.
d. Located and applied pressure to the appropriate arterial pressure point, if needed.
e. Applied a tourniquet, if needed.
3. Initiated treatment for shock. —— ——
4. Assessed the need for transport. —— ——
5. Performed measures for continuous monitoring. —— ——
6. Caused no further injury. —— ——

Front 11

PLACE A PATIENT ON A CARDIAC MONITOR

Back 11

Performance Measures GO NO GO
1. Identified the patient. —— ——
2. Prepared the equipment. —— ——
3. Attached the patient to the monitor. —— ——
4. Documented the procedure. —— ——

Front 12

MANAGE CARDIAC ARREST USING AED

Back 12

Performance Measures GO NO GO
1. Questioned the rescuer about the arrest event. —— ——
2. Directed the rescuer to stop CPR. —— ——
3. Determined whether the patient was a candidate for an AED. —— ——
4. Directed the rescuer to resume CPR. —— ——
5. Turned the AED on. —— ——
6. Attached the monitoring-defibrillation pads to the cables, if necessary. —— ——
7. Attached the AED to the patient. —— ——
8. Directed the rescuer to stop CPR. —— ——
9. Ensured all individuals were standing clear of the patient. —— ——
10. Initiated analysis of rhythm. —— ——
11. Pressed the button to deliver shock if advised by the AED. —— ——
12. Repeated steps 9 through 11 until three shocks were delivered. —— ——
13. Checked for pulse. —— ——
14. Directed the assistant and rescuer to resume CPR if no pulse was found. —— ——
15. Checked the pulse during CPR to confirm effectiveness. —— ——
16. Inserted an airway adjunct. —— ——
17. Ventilated the patient. —— ——
18. Repeated steps 9 through 12 after 1 minute of CPR. —— ——
19. Checked for pulse. —— ——
a. If the patient had a pulse, checked for breathing.
(1) If the patient was breathing, provided oxygen via nonrebreather mask.
(2) If breathing was inadequate or absent, ventilated the patient using a bag-valve-mask.
b. If the patient was pulseless, resumed CPR.
20. Performed ongoing assessment. —— ——

Front 13

Subject Area 3: Basic Medical Care

PERFORM A PATIENT CARE HANDWASH

Back 13

Setup: None

Brief soldier: Tell the soldier to perform a patient care handwash. You may specify which method to use. The soldier need not perform both.

Performance Measures GO NO GO
1. Removed wristwatch and jewelry, if applicable. —— ——
2. Rolled shirt sleeves to above the elbows, if applicable. —— ——
3. Prepared to perform the handwash. —— ——
4. Wet the hands, wrists, and forearms. —— ——
5. Covered the hands, wrists, and forearms with soap. —— ——
6. Washed the hands, wrists, and forearms. —— ——
7. Rinsed the hands, wrists, and forearms. —— ——
8. Dried the hands, wrists, and forearms. —— ——
9. Used a towel to turn off the running water, if applicable. —— ——
10. Reinspected the fingernails and cleaned them and rewashed the hands, if necessary. —— ——

Front 14

PUT ON STERILE GLOVES

Back 14

Performance Measures GO NO GO
1. Selected and inspected the package. —— ——
2. Performed a patient care handwash. —— ——
3. Opened the sterile package. —— ——
4. Positioned the inner package. —— ——
5. Unfolded the inner package. —— ——
6. Exposed both gloves. —— ——
7. Put on the first glove. —— ——
8. Put on the second glove. —— ——
9. Adjusted the gloves to fit properly. —— ——
10. Removed the gloves. —— ——
11. Discarded the gloves IAW local SOP. —— ——
12. Performed a patient care handwash. —— ——

Front 15

INITIATE A FIELD MEDICAL CARD

Back 15

Setup: For training and evaluation have another soldier act as a casualty and have him or her respond to the soldier's questions on personal data.

Brief soldier: Tell the soldier to complete the FMC by asking appropriate questions of the casualty. Tell the soldier being tested any necessary information such as the nature of the wound and the treatment given. To test step 2, you may either have the soldier complete the minimum required blocks, or you may require the completion of all blocks. After step 2 ask the soldier what must be done with each copy of the FMC.

Performance Measures GO NO GO
1. Removed the protective sheet from the carbon copy. —— ——
2. As a minimum, completed blocks 1, 3, 4, 7, 9, and 11. —— ——
3. Made proper distribution of the FMC copies. —— ——

Front 16

APPLY RESTRAINING DEVICES TO PATIENTS

Back 16

Performance Measures GO NO GO
1. Applied wrist and ankle restraints, as applicable. —— ——
2. Applied mitt restraints, as applicable. —— ——
3. Applied sheet restraints, as applicable. —— ——
4. Applied field expedient restraints, as applicable. —— ——
5. Checked the patient. —— ——
6. Changed the patient's position. —— ——
7. Evacuated the patient, if necessary. —— ——
8. Did not cause further injury to the patient. —— ——

Front 17

MEASURE A PATIENT'S INTAKE AND OUTPUT

Back 17

Performance Measures GO NO GO
1. Explained procedures to the patient. —— ——
2. Told the patient what types of items require intake and/or output measurement. —— ——
3. Told the patient to use specific containers, such as a bedpan or urinal, to save all fluid. —— ——
4. Measured the intake. —— ——
5. Recorded, in cubic centimeters (cc), the fluid intake. —— ——
6. Measured the output. —— ——
7. Removed gloves and performed a patient care handwash. —— ——
8. Recorded, in cc, the amount and characteristics of output under the appropriate headings on DD Form 792. —— ——
9. Computed accumulated intake and output totals at the end of the 24-hour period and recorded on the appropriate forms IAW local SOP. —— ——

Front 18

ESTABLISH A STERILE FIELD

Back 18

Performance Measures GO NO GO
1. Obtained sterile equipment and supplies IAW local SOP. —— ——
2. Selected a flat, clean, dry surface. —— ——
3. Created a sterile field with a double-wrapped sterile package. —— ——
4. Added sterile items to the sterile field. —— ——
5. Opened sterile liquids. —— ——
6. Poured sterile liquids. —— ——
7. Did not violate aseptic technique. —— ——

Front 19

CHANGE A STERILE DRESSING

Back 19

Performance Measures GO NO GO
NOTE: Under combat conditions, dressings are not normally changed but are reinforced. The second dressing is labeled "Reinforcement." The date and time and the medic's initials are written on the dressing.
1. Identified the patient. —— ——
2. Gathered the equipment. —— ——
3. Prepared the patient. —— ——
4. Prepared the work area. —— ——
5. Put on a mask and exam gloves. —— ——
6. Removed the outer dressing. —— ——
7. Performed a patient care handwash. —— ——
8. Established a sterile field. —— ——
9. Put on a mask and sterile gloves. —— ——
10. Removed the inner dressings. —— ——
11. Checked the wound. —— ——
12. Cleaned the wound with sterile gauze soaked with a sterile cleaning solution. —— ——
13. Changed gloves. —— ——
14. Removed adhesive from around the wound, if necessary. —— ——
15. Removed sterile gloves and face mask. —— ——
16. Applied a sterile dressing. —— ——
17. Secured the dressing with tape. —— ——
18. Disposed of contaminated materials in the appropriate waste container. —— ——
19. Performed a patient care handwash. —— ——
20. Recorded the procedure on the appropriate form. —— ——
21. Did not violate aseptic technique. —— ——

Front 20

PERFORM A WOUND IRRIGATION

Back 20

Performance Measures GO NO GO
1. Identified the patient. —— ——
2. Explained the procedure to the patient. —— ——
3. Provided privacy, if possible, and positioned the patient to provide maximum wound exposure. —— ——
4. Placed a protective pad directly under the wound area. —— ——
5. Prepared the irrigation equipment. —— ——
6. Put on a mask and exam gloves. —— ——
7. Removed the soiled outer dressing. —— ——
8. Removed the exam gloves. —— ——
9. Placed a catch basin on the protective pad, against the body, to collect the used solution. —— ——
10. Put on sterile gloves. —— ——
11. Used sterile forceps to remove the inner dressings. —— ——
12. Irrigated the wound. —— ——
13. Dried the wound and applied a sterile dressing. —— ——
14. Removed the mask and gloves. —— ——
15. Repositioned the patient for comfort, if necessary. —— ——
16. Cleaned and stored the equipment IAW local SOP. —— ——
17. Performed a patient care handwash. —— ——
18. Recorded the procedure on the appropriate form. —— ——
19. Did not violate aseptic technique. —— ——
20. Did not cause further injury to the patient. —— ——

Front 21

PERFORM ORAL AND NASOPHARYNGEAL SUCTIONING OF A PATIENT

Back 21

Performance Measures GO NO GO
1. Positioned the patient. —— ——
2. Checked the pressure on the suctioning apparatus. —— ——
3. Prepared the materials. —— ——
4. Explained the procedure to the patient. —— ——
5. Oxygenated the patient, if necessary. —— ——
6. Removed the catheter from the package. —— ——
7. Attached the suction connecting tube to the catheter. —— ——
8. Tested the patency of the catheter. —— ——
9. Suctioned the patient (10-15 seconds). —— ——
10. Observed the patient for hypoxemia. If patient suctioning needed to be performed again, reoxygenated the patient. —— ——
11. Disconnected the catheter and removed the gloves. —— ——
12. Made the patient comfortable. —— ——
13. Discarded, cleaned, or stored used items. —— ——
14. Recorded the procedure on the appropriate form. —— ——
15. Did not cause further injury to the patient. —— ——

Front 22

IRRIGATE AN OBSTRUCTED EAR

Back 22

Performance Measures GO NO GO
1. Gathered the irrigation equipment. —— ——
2. Performed a patient care handwash. —— ——
3. Warmed and tested the solution. —— ——
4. Identified the patient and explained the procedure. —— ——
5. Inserted the otoscope speculum into the external ear canal. —— ——
6. Checked for abnormalities. —— ——
7. Positioned the patient. —— ——
8. Draped the patient's shoulder and upper arm area under the affected ear. —— ——
9. Cleaned the external ear and the entrance to the ear canal. —— ——
10. Filled the irrigating syringe. —— ——
11. Tested the flow of solution. —— ——
12. Positioned the catch basin. —— ——
13. Straightened the external ear canal. —— ——
14. Irrigated the patient's ear. —— ——
15. Removed the catch basin and dried the external ear. —— ——
16. Instructed the patient to continue tilting the head toward the affected side. —— ——
17. Removed the drapes from the patient. —— ——
18. Disposed of, or cleaned and stored, the equipment. —— ——
19. Performed a patient care handwash. —— ——
20. Documented the procedure on the appropriate forms IAW local SOP. —— ——
21. Did not cause further injury to the patient. —— ——

Front 23

DOCUMENT PATIENT CARE USING SUBJECTIVE, OBJECTIVE, ASSESSMENT, PLAN (SOAP) NOTE FORMAT

Back 23

Performance Measures GO NO GO
1. Recorded patient information. —— ——
2. Documented subjective data. —— ——
3. Documented objective data. —— ——
4. Wrote the assessment. —— ——
5. Wrote the plan. —— ——
6. Signed the entry. —— ——
7. Corrected errors, if applicable. —— ——
8. Made legible entries (typed or handwritten). —— ——
9. Used black or blue-black ink. —— ——
10. Did not skip lines or leave space between lines. —— ——

Front 24

PERFORM PATIENT HYGIENE

Back 24

Performance Measures GO NO GO
1. Verified the activity with doctor's orders or nursing care plan. —— ——
2. Provided a bedbath. —— ——
3. Provided oral care. —— ——
4. Provided hair care. —— ——
5. Provided foot and nail care. —— ——
6. Changed the patient's linen. —— ——
7. Assisted the client to a position of comfort and placed needed items within reach. —— ——
8. Raised the siderails and lowered the bed. —— ——
9. Removed soiled supplies. —— ——
10. Documented the procedures and the patient's response. —— ——

Front 25

OBTAIN AN ELECTROCARDIOGRAM

Back 25

Performance Measures GO NO GO
1. Prepared the equipment. —— ——
2. Prepared the patient. —— ——
3. Applied the limb electrodes. —— ——
4. Applied the chest electrodes. —— ——
5. Obtained the EKG tracing. —— ——
6. Assessed the EKG tracing. —— ——
7. Calculated the heart rate. —— ——
8. Removed the electrodes. —— ——
9. Asked or assisted the patient to dress. —— ——
10. Prepared the report. —— ——
11. Stored the equipment. —— ——
12. Documented the procedure. —— ——

Front 26

INSERT AN OROPHARYNGEAL AIRWAY (J TUBE)

Back 26

Performance Measures GO NO GO
1. Selected the correct size of airway. —— ——
2. Performed head-tilt/chin-lift. —— ——
3. Opened the casualty's mouth. —— ——
4. Inserted the airway. —— ——
5. Evacuated the casualty. —— ——
6. Did not cause further injury to the casualty. —— ——

Front 27

SET UP AN OXYGEN TANK

Back 27

Performance Measures GO NO GO
1. Obtained the necessary equipment. —— ——
2. Secured the oxygen cylinder. —— ——
3. Removed the cylinder valve cap. —— ——
4. Used either the handwheel or a nonsparking wrench to "crack" (slowly open and quickly close) the cylinder to flush out any debris. —— ——
5. Attached the regulator to the cylinder. —— ——
6. Filled the humidifier bottle to the level indicated (about two-thirds full) with sterile water. —— ——
7. Attached the humidifier to the flowmeter. —— ——
8. Attached the oxygen administration device. —— ——
9. Posted warning signs. —— ——
10. Reported and/or recorded completion of the procedure. —— ——

Front 28

INSERT A NASOPHARYNGEAL AIRWAY

Back 28

Performance Measures GO NO GO
1. Positioned the casualty. —— ——
2. Measured and selected the appropriate size of airway. —— ——
3. Lubricated the nasal airway. —— ——
4. Fully inserted the airway —— ——

Front 29

ADMINISTER OXYGEN

Back 29

Performance Measures GO NO GO
1. Explained the procedure to the patient. —— ——
2. Prepared the equipment. —— ——
3. Positioned the patient. —— ——
4. Selected the proper delivery device. —— ——
5. Applied the delivery device. —— ——
6. Monitored the patient. —— ——
7. Checked the equipment. —— ——
8. Calculated the duration of flow of the oxygen cylinder. —— ——
9. Followed safety precautions. —— ——

Front 30

INSERT A COMBITUBE

Back 30

Performance Measures GO NO GO
1. Oxygenated the casualty. —— ——
2. Prepared the tube. —— ——
3. Put on gloves. —— ——
4. Kneeled at the casualty's head. —— ——
5. Inserted the tube within 20 seconds. —— ——
6. Ventilated the casualty and checked placement. —— ——
7. Removed the tube. —— ——

Front 31

PERFORM A NEEDLE CRICOTHYROIDOTOMY

Back 31

Performance Measures GO NO GO
1. Hyperextended the casualty's neck. —— ——
2. Put on gloves, if available. —— ——
3. Located the cricothyroid membrane. —— ——
4. Stabilized the larynx. —— ——
5. Inserted a large bore needle into the cricothyroid membrane. —— ——
6. Listened and felt for free airflow through the needle. —— ——
7. Inserted a second needle, if necessary and rechecked for air flow. (If the airway formed by the first needle is not sufficient, a second needle may be inserted next to the first one following the procedure in step 5.) —— ——
8. Stabilized the needle(s). —— ——
9. Completed steps 3 through 8 in order. —— ——
10. Kept the casualty's head immobilized. —— ——

Front 32

PERFORM NEEDLE CHEST DECOMPRESSION

Back 32

Performance Measures GO NO GO
1. Verified the presence of tension pneumothorax. —— ——
2. Located the insertion site. —— ——
3. Thoroughly cleaned the area. —— ——
4. Inserted a large bore needle. —— ——
5. Decompressed the affected chest. —— ——
6. Initiated closed chest drainage or applied a flutter valve. —— ——
7. Secured the needle or catheter to the chest. —— ——
8. Recorded the treatment on the Field Medical Card. —— ——
9. Completed all steps in order. —— ——

Front 33

Subject Area 5: Venipuncture and IV Therapy

OBTAIN A BLOOD SPECIMEN USING A VACUTAINER

Back 33

Performance Measures GO NO GO
1. Selected the proper blood specimen tube. —— ——
2. Labeled the blood specimen tube. —— ——
3. Performed a patient care handwash. —— ——
4. Assembled the vacutainer unit, needle, and blood specimen tube. —— ——
5. Identified the patient. —— ——
6. Explained the procedure and purpose for collecting the blood. —— ——
7. Positioned the patient. —— ——
8. Exposed the venipuncture site. —— ——
9. Selected and palpated the vein. —— ——
10. Prepared sponges for use. —— ——
11. Applied the constricting band. —— ——
12. Palpated the selected vein. —— ——
13. Cleaned the venipuncture site. —— ——
14. Prepared to puncture the vein. —— ——
15. Punctured the vein. —— ——
16. Collected the specimen. —— ——
17. Withdrew the needle. —— ——
18. Removed the specimen tube from the vacutainer. —— ——
19. Applied an adhesive bandage strip to the site. —— ——
20. Provided for the patient's safety and comfort. —— ——
21. Disposed of and/or stored equipment. —— ——
22. Removed the gloves. —— ——
23. Performed a patient care handwash. —— ——
24. Completed the laboratory request. —— ——
25. Forwarded the specimen to the laboratory. —— ——
26. Performed a patient care handwash. —— ——
27. Recorded the procedure on the appropriate form. —— ——
28. Did not violate aseptic technique. —— ——
29. Did not cause further injury to the patient. —— ——

Front 34

INITIATE AN INTRAVENOUS INFUSION

Back 34

Performance Measures GO NO GO
1. Inspected the equipment. —— ——
2. Prepared the equipment. —— ——
3. Identified the patient and explained the procedure. —— ——
4. Selected the infusion site. —— ——
5. Prepared the infusion site. —— ——
6. Prepared to puncture the vein. —— ——
7. Punctured the vein. —— ——
8. Confirmed the puncture. —— ——
9. Advanced the needle or the catheter. —— ——
10. Connected the tubing to the catheter or needle hub. —— ——
11. Released the constricting band. —— ——
12. Unclamped the IV tubing and adjusted the flow rate TKO. —— ——
13. Checked the site for infiltration. —— ——
14. Secured the site. —— ——
15. Readjusted the flow rate. —— ——
16. Prepared and placed the appropriate labels. —— ——
17. Rechecked the site for infiltration. —— ——
18. Performed a patient care handwash. —— ——
19. Recorded the procedure on the appropriate form. —— ——
20. Did not violate aseptic technique. —— ——
21. Did not cause further injury to the patient. —— ——

Front 35

MANAGE A PATIENT WITH AN INTRAVENOUS INFUSION

Back 35

Performance Measures GO NO GO
1. Assessed for signs and symptoms of IV therapy complications. —— ——
2. Performed the nursing interventions for IV therapy complications. —— ——
3. Documented the IV therapy. —— ——
4. Replaced the solution container, as necessary. —— ——
5. Changed the dressing, as required. —— ——
6. Replaced the solution container and tubing, as necessary. —— ——
7. Discontinued the infusion, as required. —— ——
8. Recorded the procedure on the appropriate form. —— ——
9. Did not violate aseptic technique. —— ——
10. Did not cause further injury to the patient. —— ——

Front 36

INITIATE A SALINE LOCK

Back 36

Performance Measures GO NO GO
1. Prepared to establish a saline lock. —— ——
2. Established a saline lock. —— ——
3. Maintained a saline lock. —— ——
4. Maintained the IV site. —— ——
5. Removed or converted a saline lock. —— ——
6. Documented all procedures on the appropriate forms IAW local SOP. —— ——

Front 37

Subject Area 6: Casualty Management

MANAGE A CONVULSIVE AND/OR SEIZING PATIENT

Back 37

Performance Measures GO NO GO
1. Identified the type of convulsions and/or seizures. —— ——
2. Maintained the airway of a patient exhibiting tonic-clonic movement. —— ——
3. Placed the patient on his or her side, if possible. —— ——
4. Prevented injury to tissue and bones by padding or removing objects on which the patient may injure himself or herself. —— ——
5. Managed the patient after the convulsive state ended. —— ——
6. Recorded the seizure activity. —— ——
7. Evacuated the patient. —— ——
8. Did not cause further injury to the patient. —— ——

Front 38

TREAT A CASUALTY WITH AN OPEN ABDOMINAL WOUND

Back 38

Performance Measures GO NO GO
1. Treated for shock. —— ——
2. Positioned the casualty. —— ——
3. Exposed the wound. —— ——
4. Stabilized any protruding objects. —— ——
5. Applied a sterile abdominal dressing. —— ——
6. Prepared the casualty for evacuation. —— ——
7. Recorded the treatment given on the Field Medical Card. —— ——
8. Did not cause further injury to the casualty. —— ——

Front 39

APPLY A DRESSING TO AN IMPALEMENT INJURY

Back 39

Performance Measures GO NO GO
1. Prepared the casualty. —— ——
2. Immobilized the impaled object. —— ——
3. Applied the support bandages. —— ——
4. Immobilized the affected area with a splint or sling, if applicable. —— ——
5. Checked for a pulse distal to the injury site. —— ——
6. Provided oxygen. —— ——
7. Treated for shock, if necessary. —— ——
8. Recorded the treatment on the Field Medical Card. —— ——
9. Evacuated the casualty. —— ——
10. Did not cause further injury to the casualty. —— ——

Front 40

MANAGE AN UNCONSCIOUS CASUALTY
081-833-0048

Back 40

Performance Measures GO NO GO
1. Established unresponsiveness. —— ——
2. Established and maintained an open airway. —— ——
3. Assessed the casualty. —— ——
4. Positioned the casualty. —— ——
5. Observed the casualty. —— ——
6. Obtained the casualty's history. —— ——
7. Initiated an IV. —— ——
8. Administered oxygen, if available. —— ——
9. Recorded the treatment. —— ——
10. Evacuated the casualty. —— ——

Front 41

TREAT A CASUALTY WITH A CLOSED CHEST WOUND

Back 41

Performance Measures GO NO GO
1. Checked the casualty for signs and symptoms of closed chest injuries. —— ——
2. Determined the type of injury. —— ——
3. Initiated treatment for a closed chest injury. —— ——
4. Treated the casualty for shock. —— ——
5. Recorded the care provided on the appropriate form. —— ——
6. Evacuated the casualty. —— ——
7. Did not cause further injury to the casualty. —— ——

Front 42

TREAT A CASUALTY WITH AN OPEN CHEST WOUND

Back 42

Performance Measures GO NO GO
1. Checked the casualty for signs and symptoms of an open chest wound. —— ——
2. Exposed the wound. —— ——
3. Checked for an exit wound. —— ——
4. Sealed the wound(s), covering the larger wound first. —— ——
5. Dressed the wound. —— ——
6. Placed the casualty on the injured side. —— ——
7. Monitored the casualty. —— ——
8. Recorded the treatment on the appropriate form. —— ——
9. Did not cause further injury to the casualty. —— ——

Front 43

TREAT A CASUALTY WITH AN OPEN OR CLOSED HEAD INJURY

Back 43

Performance Measures GO NO GO
1. Took appropriate body substance isolation procedures. —— ——
2. Checked for the signs and symptoms of head injuries. —— ——
3. Directed manual stabilization of the casualty's head. —— ——
4. Checked the casualty's vital signs. —— ——
5. Assessed the casualty's level of consciousness using the AVPU scale. —— ——
6. Assessed the casualty's pupil size. —— ——
7. Assessed the casualty's motor function. —— ——
8. Treated the head injury. —— ——
9. Continued to monitor the casualty at 5 minute intervals. —— ——
10. Recorded the treatment on the appropriate form. —— ——
11. Evacuated the casualty. —— ——
12. Did not cause further injury to the casualty. —— ——

Front 44

ADMINISTER INITIAL TREATMENT FOR BURNS

Back 44

Performance Measures GO NO GO
1. Determined the cause of the burns. —— ——
2. Stopped the burning process. —— ——
3. Maintained the airway, if necessary. —— ——
4. Determined the percent of BSA burned. —— ——
5. Determined the degree of the burns. —— ——
6. Treated the casualty for shock, if necessary. —— ——
7. Stabilized the casualty and performed a secondary assessment. —— ——
8. Removed potentially constricting items. —— ——
9. Applied cold soaks, if applicable. —— ——
10. Dressed the burns. —— ——
11. Administered oxygen, if available. —— ——
12. Recorded the treatment given. —— ——
13. Evacuated the casualty. —— ——
14. Did not cause further injury to the casualty. —— ——

Front 45

PROVIDE CARE FOR A SOLDIER WITH SYMPTOMS OF BATTLE FATIGUE

Back 45

Performance Measures GO NO GO
1. Identified contributing causes of battle fatigue. —— ——
2. Checked the soldier for signs and symptoms of battle fatigue. —— ——
3. Classified the battle fatigue case. —— ——
4. Used basic treatment principles for battle fatigue. —— ——
5. Performed appropriate treatment interventions for battle fatigue. —— ——

Front 46

ASSIST IN VAGINAL DELIVERY

Back 46

Performance Measures GO NO GO
1. Assisted with the first stage of labor assessment. —— ——
a. Interviewed the pregnant woman.
b. Assessed general appearance and behavior.
c. Checked vital signs.
d. Assessed the labor pattern status.
e. Assessed fetal status.
f. Assessed amniotic membranes status.
2. Assisted with the second stage of labor assessment. —— ——
a. Monitored continuously.
b. Maintained intravenous fluids.
c. Assisted to provide safety and positions of comfort to the patient.
3. Assisted with the third stage of labor assessment. —— ——
a. Recognized precautions.
b. Assisted with delivery of infant as directed by health care provider.
4. Assisted with the fourth stage of labor assessment. —— ——
a. Provided care to the mother.
b. Provided initial care for the newborn.
5. Monitored for complications during labor. —— ——
a. Identified prolapsed cord.
b. Identified abruptio placentae.
c. Identified placenta previa.
6. Identified additional gynecological emergencies. —— ——
a. Ectopic pregnancy.
b. Miscarriage and abortion.

Front 47

TREAT A POISONED CASUALTY

Back 47

Performance Measures GO NO GO
1. Determined the type of poisoning. —— ——
2. Maintained the airway. —— ——
3. Initiated an IV. —— ——
4. Administered proper medical intervention. —— ——
a. Ingested poisons - administered activated charcoal.
b. Absorbed poisons - brushed off powder and flushed, if appropriate.
c. Inhaled poisons - administered high concentration of oxygen.
5. Provided suctioning, if necessary. —— ——
6. Documented the procedure. —— ——

Front 48

TREAT A DIABETIC EMERGENCY

Back 48

Performance Measures GO NO GO
1. Identified the type of diabetic emergency (hypoglycemia or hyperglycemia). —— ——
2. Administered appropriate treatment for hypoglycemia (conscious patient). —— ——
a. Administered oral glucose.
b. Monitored the patient for complications.
3. Administered appropriate treatment for hypoglycemia (unconscious patient). —— ——
a. Secured the airway and administered oxygen, if necessary.
b. Started an IV at TKO rate.
c. Placed the patient in a recovery position.
d. Documented all treatment given.
e. Transported the patient to the nearest medical treatment facility.
4. Administered appropriate treatment for hyperglycemia. —— ——
a. Maintained an open airway and administered oxygen, if necessary.
b. Started an IV at TKO rate.
c. Placed the patient on a cardiac monitor, if available.
d. Documented all treatment given.
e. Transported the patient to the nearest medical treatment facility.

Front 49

PERFORM A TRAUMA CASUALTY ASSESSMENT

Back 49

Performance Measures GO NO GO
1. Took body substance isolation precautions. —— ——
2. Performed a Scene Assessment. —— ——
3. Assessed for spinal protection. —— ——
4. Performed an Initial Assessment. —— ——
5. Administered high concentration of oxygen, if necessary. —— ——
6. Managed problems associated with the airway, breathing, hemorrhage, or shock (hypovolemic). —— ——
7. Differentiated the patient's need for transportation versus continued assessment at the scene. —— ——
8. If the mechanism of injury was significant, performed a Rapid Trauma Assessment. —— ——
9. If there was no significant mechanism of injury, performed a Focused History and Physical Exam. —— ——
10. Obtained baseline vital signs. —— ——
11. Obtained the SAMPLE history. —— ——
12. Performed a Detailed Physical Exam. —— ——
13. Performed the assessments in order. —— ——

Front 50

PERFORM A MEDICAL PATIENT ASSESSMENT

Back 50

Performance Measures GO NO GO
1. Took body substance isolation precautions. —— ——
2. Performed a scene size up. —— ——
3. Obtained medical direction or used standing orders for medical interventions. —— ——
4. Provided high concentration of oxygen. —— ——
5. Found and managed problems associated with the airway, breathing, hemorrhage, or shock. —— ——
6. Differentiated the patient's need for transportation versus continued assessment at the scene. —— ——
7. Performed a detailed or focused history/physical examination before assessing the airway, breathing, and circulation. —— ——
8. Asked questions concerning the present illness. —— ——
9. Administered appropriate interventions. —— ——

Front 51

TREAT A CARDIAC EMERGENCY

Back 51

Performance Measures GO NO GO
1. Identified the signs and symptoms of cardiac emergency or compromise. —— ——
2. Administered the appropriate treatment. —— ——
3. Transported promptly to the nearest medical treatment facility. —— ——
4. Performed an ongoing assessment while en route. —— ——
5. Documented all interventions. —— ——

Front 52

TREAT A RESPIRATORY EMERGENCY

Back 52

Performance Measures GO NO GO
1. Examined the casualty. —— ——
2. Performed a focused physical examination. —— ——
3. Obtained a focused history. —— ——
4. Assisted the casualty in using a metered dose inhaler. —— ——
5. Administered a nebulizer treatment. —— ——
6. Documented the procedure. —— ——

Front 53

DETERMINE A PATIENT'S LEVEL OF CONSCIOUSNESS USING THE GLASGOW COMA SCALE

Back 53

Performance Measures GO NO GO
1. Determined best eye response. —— ——
2. Determined best verbal response. —— ——
3. Determined best motor response. —— ——
4. Determined the total consciousness level score by adding the points determined in steps 1 through 3. —— ——
5. Recorded and/or graphed the patient's response. —— ——
6. Reported any changes in level of consciousness to the charge nurse immediately. —— ——
7. Documented significant nursing observations on the appropriate forms IAW local SOP. —— ——

Front 54

Subject Area 7: Eye Injuries

IRRIGATE EYES

Back 54

Performance Measures GO NO GO
1. Identified the casualty and explained the procedure. —— ——
2. Verified the type, strength, and expiration date of the medication, as appropriate. —— ——
3. Asked the casualty to remove contact lenses or glasses, if necessary. —— ——
4. Positioned the casualty. —— ——
5. Positioned the equipment. —— ——
6. Put on gloves. —— ——
7. Cleaned the eyelids with gauze or cotton balls, and rinsed debris from the outer eye. —— ——
8. Separated the eyelids using the thumb and forefinger, and held the lids open. —— ——
9. Irrigated the eye. —— ——
10. Dried the area around the eye by gently patting with gauze sponges. —— ——
11. Removed the gloves and performed a patient care handwash. —— ——
12. Recorded the treatment given on the appropriate form. —— ——
13. Did not injure or contaminate the eye. —— ——

Front 55

TREAT FOREIGN BODIES OF THE EYE

Back 55

Performance Measures GO NO GO
1. Located the foreign bodies. —— ——
2. Removed the foreign bodies. —— ——
3. Obtained details about the injury. —— ——
4. Recorded the procedure on the appropriate form. —— ——
5. Evacuated the casualty, as required. —— ——
6. Did not cause additional injury to the eye. —— ——

Front 56

TREAT LACERATIONS, CONTUSIONS, AND EXTRUSIONS OF THE EYE

Back 56

Performance Measures GO NO GO
1. Positioned the casualty. —— ——
2. Examined the eyes. —— ——
3. Categorized the injury. —— ——
4. Treated the injury. —— ——
5. Recorded the procedure on the appropriate form. —— ——
6. Evacuated the casualty. —— ——
7. Did not cause further injury to the casualty. —— ——

Front 57

TREAT BURNS OF THE EYE

Back 57

Performance Measures GO NO GO
1. Reassured the casualty and checked for signs and symptoms to determine the type of burns. —— ——
2. Treated the burn. —— ——
3. Recorded the treatment given on the appropriate forms. —— ——
4. Evacuated the casualty. —— ——

Front 58

Subject Area 8: Skeletal Dysfunction

APPLY A PNEUMATIC SPLINT TO A CASUALTY WITH A SUSPECTED FRACTURE OF AN EXTREMITY

Back 58

Performance Measures GO NO GO
1. Checked the equipment both visually and manually. —— ——
2. Opened the splint completely and placed it next to the injured extremity. —— ——
3. Lifted and supported the injured extremity. —— ——
4. Placed the splint under the injured extremity and positioned the splint around the injured area. —— ——
5. Inflated the splint. —— ——
6. Monitored the splint. —— ——
7. Checked for peripheral circulation. —— ——
8. Did not cause further injury to the casualty. —— ——

Front 59

APPLY A ROLLER BANDAGE

Back 59

Performance Measures GO NO GO
1. Selected the appropriate bandage material. —— ——
2. Prepared the patient for bandaging. —— ——
3. Applied the anchor wrap. —— ——
4. Applied the bandage wrap. —— ——
5. Checked circulation. —— ——
6. Checked for irritation. —— ——
7. Elevated the injured extremity, if appropriate. —— ——
8. Recorded the treatment given. —— ——
9. Did not cause further injury to the casualty. —— ——

Front 60

IMMOBILIZE A SUSPECTED FRACTURE OF THE ARM OR DISLOCATED SHOULDER

Back 60

Performance Measures GO NO GO
1. Positioned the injury. —— ——
2. Checked the radial pulse. —— ——
3. Immobilized the injury. —— ——
4. Recorded the treatment on the FMC. —— ——
5. Evacuated the casualty. —— ——
6. Did not cause further injury to the casualty. —— ——

Front 61

IMMOBILIZE A SUSPECTED DISLOCATED OR FRACTURED HIP

Back 61

Performance Measures GO NO GO
1. Checked for the signs and symptoms of a hip injury. —— ——
2. Checked for circulation in the affected leg. —— ——
3. Checked for impaired sensation. —— ——
4. Immobilized the injury. —— ——
5. Checked for complications. —— ——
6. Recorded the treatment given. —— ——
7. Evacuated the casualty. —— ——
8. Did not cause further injury to the casualty. —— ——

Front 62

TRANSPORT A CASUALTY WITH A SUSPECTED SPINAL INJURY

Back 62

Performance Measures GO NO GO
1. Checked for signs and symptoms of a spinal injury. —— ——
2. Secured the casualty on a short spine board or KED, if appropriate. —— ——
3. Placed the casualty on the long spine board. —— ——
4. Secured the casualty on the long spine board. —— ——
5. Recorded the treatment on the Field Medical Card. —— ——
6. Evacuated the casualty. —— ——
7. Did not cause further injury to the casualty. —— ——

Front 63

APPLY A TRACTION SPLINT

Back 63

Performance Measures GO NO GO
1. Took body substance isolation precautions. —— ——
2. Directed the assistant to manually stabilize the injured leg. —— ——
3. Assessed distal circulation, motor function, and sensation of the injured leg. —— ——
4. Adjusted the splint to the proper length. —— ——
5. Positioned the splint. —— ——
6. Applied the ankle hitch. —— ——
7. Applied manual traction. —— ——
8. Applied the ischial strap. —— ——
9. Applied mechanical traction. —— ——
10. Secured the leg straps. —— ——
11. Reevaluated the ankle hitch and ischial strap. —— ——
12. Assessed distal circulation, motor function, and sensation of the injured leg. —— ——
13. Secured the torso to the long board to immobilize the hip. —— ——
14. Secured the splint to the long board to prevent movement of the splint. —— ——

Front 64

PROVIDE BASIC EMERGENCY TREATMENT FOR A PAINFUL, SWOLLEN, DEFORMED EXTREMITY

Back 64

Performance Measures GO NO GO
1. Identified the signs and symptoms of a musculoskeletal injury. —— ——
2. Splinted the extremity. —— ——
3. Treated for shock. —— ——
4. Considered administration of pain medication. —— ——
5. Transported to the nearest medical treatment facility. —— ——
6. Documented all care given. —— ——

Front 65

Subject Area 9: Environmental Injuries

TREAT A CASUALTY FOR A HEAT INJURY

Back 65

Performance Measures GO NO GO
1. Identified the type of heat injury. —— ——
2. Provided the proper first aid for the heat injury. —— ——
3. Recorded the treatment given. —— ——

Front 66

TREAT A CASUALTY FOR A COLD INJURY

Back 66

Performance Measures GO NO GO
1. Identified the type of cold injury. —— ——
2. Provided proper first aid treatment for the injury. —— ——
NOTE: Although not evaluated, the soldier would record the treatment given on the appropriate form and evacuate the casualty as necessary.

Front 67

INITIATE TREATMENT FOR ANAPHYLACTIC SHOCK

Back 67

Performance Measures GO NO GO
1. Checked the casualty for signs and symptoms of anaphylactic shock. —— ——
2. Transported the casualty to the aid station, if feasible. —— ——
3. Opened the airway, if necessary. —— ——
4. Administered oxygen. —— ——
5. Administered epinephrine. —— ——
6. Initiated an IV. —— ——
7. Provided supportive measures for the treatment of shock, respiratory failure, circulatory collapse, or cardiac arrest. —— ——
8. Checked the casualty's vital signs every 3 to 5 minutes until the casualty was stable. —— ——
9. Recorded the procedure on the appropriate form. —— ——
10. Evacuated the casualty and provided supportive measures en route. —— ——

Front 68

TREAT A CASUALTY FOR INSECT BITES OR STINGS

Back 68

Performance Measures GO NO GO
1. Exposed the bite or sting site. —— ——
2. Asked the casualty what bit or stung him or her. —— ——
3. Checked for the signs and symptoms of the insect bite or sting. —— ——
4. Treated the bite or sting. —— ——
5. Recorded the treatment on the appropriate form. —— ——
6. Evacuated the casualty, if necessary. —— ——

Front 69

TREAT A CASUALTY FOR SNAKEBITE

Back 69

Performance Measures GO NO GO
1. Exposed the injury site. —— ——
2. Determined the type of snakebite. —— ——
3. Checked the casualty for signs and symptoms of a poisonous bite. —— ——
4. Initiated treatment. —— ——
5. Recorded the procedure on the appropriate form. —— ——
6. Evacuated the casualty, if necessary. —— ——

Front 70

Subject Area 10: Chemical Agent Injuries

TREAT A NERVE AGENT CASUALTY IN THE FIELD
255

Back 70

Performance Measures GO NO GO
1. Assessed the casualty for the signs and symptoms of nerve agent poisoning. —— ——
2. Masked the casualty. —— ——
3. Checked the casualty's pocket flaps and the area around the casualty for expended autoinjectors. —— ——
4. Administered the antidote. —— ——
5. Checked the casualty for signs of effectiveness of treatment. —— ——
6. Administered additional atropine or CANA, if needed. —— ——
7. Provided assisted ventilation for severely poisoned casualties, if equipment was available. —— ——
8. Recorded the number of injections given and all other treatment given on the FMC. —— ——
9. Evacuated the casualty. —— ——
10. Did not kneel while treating the casualty. —— ——
11. Did not cause further injury to the casualty. —— ——