2016-2017 LCPS CPR and AED Skill Check Off Sheets

2016-2017 LCPS CPR and AED Skill Check Off Sheets

2016-2017 LCPS CPR and AED Skill Check Off Sheets

Student Name: ______Block: ______Teacher:______

Skill Check Off Sheet: Scene Size Up

No. / Skill Steps / Needs Practice / Pass
1 / Are dangerous hazards present?
If yes, stay away and call 9-1-1 as soon as possible.
2 / How many people are involved?
Most emergency scenes involve only one person. If two or more people are present, refer to Chapter 7, Emergency Rescues, Moves, and Priorities, forinstructions on prioritizing and sorting multiple people.
3 / What is wrong?
Form a first impression of the person. Is he or she:
1. Injured or ill?
2. Responsive or unresponsive?
3. Breathing normally? Talking?
4. Bleeding severely?
4 / What happened?
Look for clues about what might have caused the injury or the nature of the illness.
5 / Are bystanders available to help?
Bystanders may help by:
• Telling you what happened.
• Calling 9-1-1 while you help the person.
Depending upon their relationship with the person, bystanders could (a)
provide you with the person’s medical history, (b) inform you whether the
person has been ill, and (c) calm the person.

Skill Checkoff Sheet 2-1: Placing an Unresponsive Breathing Person in the Recovery Position

No. / Skill Steps / Needs Practice / Pass
1 / Kneels next to the person’s side. Straightens both legs. Places the arm nearest him or her out form the body, with the elbow bent and palm facing up.
2 / Brings other arm across the person’s chest, and places the back of the hand against the cheek nearest him or her.
3 / Grabs and raises the far knee until it is bent, keeping the foot flat on the ground or floor.
4 / Grabs the person’s bent knee and shoulder , and with a smooth motion rolls the person toward him or her, without twisting the body onto the side.
5 / Adjusts the top leg so that both the knee and hip are bent at right angles.
6 / Keeps the top hand under the person’s cheek to cushion it, keep the airway open and allows fluid to drain.

Skills Checkoff Sheet 2-2: Modified: Adult CPR Compressions Only

No. / Skill Steps / Needs Practice / Pass
1 / R = Responsive? Taps the person on the shoulder and shouts,
“Are you okay?”
2 / A = Activate EMS. If a cell phone is not available, participant
leaves the person to activate EMS and get an AED before starting
CPR. If another person arrives or is nearby, participant has him or
her activate EMS and get an AED.
3 / B = Breathing? Places the person face-up on a flat, firm surface.
Observes the person’s chest for movement; takes 5 seconds but
no more than 10 seconds.
4 / C = Compressions.
• Places the heel of one hand on the center of the person’s
chest and on the lower half of his or her breast bone.
• Places the other hand on top of the first one with fingers
• Keeps arms straight and elbows locked, with shoulders
positioned directly over hands.
• Pushes hard (at least 2 inches [5 cm] to 2.4 inches [6 cm] for
an adult and pushes fast (100—120 compressions per minute).
• Allows the chest to fully recoil after each compression.
5 / Continues sets of 30 chest compressions until an
AED arrives

Skills Checkoff Sheet 3-1:Adult Choking

No. / Skill Steps / Needs Practice / Pass
1 / Asks, “Are you choking?” Shouts for help to alert others of the emergency.
2 / Stands behind the adult. Wraps arms around the person’s waist. Locates the person’s navel with a finger.
3 / Makes a fist with the other hand and places the thumb side of the hand just above the person’s navel and below the tip of the breast bone.
4 / Grasps the fist with the other hand. Thrusts the fist into the person’s abdomen with a quick upward motion. (Uses chest thrusts on a person who is choking and obese or pregnant). Each thrust is a separate and distinct effort to dislodge the object. Continues without interruption until the person coughs up the object, speaks, moves, or breathes, or EMS or a person who is trained takes over.
5 / Instructor asks, “What do you do if the person becomes unresponsive or a person is found unresponsive?
Give 30 chest compressions
Look into the person’s mouth for an object; if seen, removes it.

Skills Checkoff Sheet 4-1: Using an AED

No. / Skill Steps / Needs Practice / Pass
1 / Turns on the AED
2 / Attaches the pads to the person’s bare, dry chest (as shown on the pads). If needed, plugs the cables into the AED.
3 / Stays clear of the person. Makes sure no one is touching the person. Says, “Clear!” Allows the AED to analyze the heart rhythm. (pushes the Analyze button, if necessary) and prompt one of the three actions:
•Press shock button,
•Stay clear while the AED automatically delivers a shock.
•Do nor shock but give CPR, with the pads staying in place.
4 / After any one of the three actions, give sets of CPR unless the person moves, begins to breath, or wakes up.

MODIFIED FROM © 2017 Jones & Bartlett Learning, LLC, an Ascend Learning Company

Student Name: ______Block: ______Teacher: ______

2016-2017 LCPS FIRST AID Skill Check Off Sheets

Skills Checkoff Sheet 2-2: Finding Out What is Wrong

No. / Skill Steps / Needs Practice / Pass
Primary Assessment
1 / Makes eye contact, introduces self, and asks if he or she can help.
2 / Asks, “What happened?” and “Where do you hurt?” Scans the body for any severe bleeding; if found, controls it.
3 / Instructor asks, “What do you do if the person is severely injured?
4 / Instructor asks, “What do you do if a neck, back, or pelvic injury is NOT suspected?” Participant answers, “Have the person move to a comfortable position (lying down or leaning against a stable object).”
Secondary Assessment
5 / Checks the person from head to toe while looking, asking, andfeeling for DOTS:
• D = Deformities
• O = Open wounds
• T = Tenderness (pain)
• S = Swelling
Looks for a medical identification necklace or bracelet.
6 / Uses the SAMPLE mnemonic to help identify what could be wrong.
Asks about:
• S = Signs and symptoms (chief complaint)
• A = Allergies
• M = Medications
• P = Pertinent past medical history
• L = Last oral intake
• E = Events leading up to the illness or injury

Skills Checkoff Sheet 3-1: Bleeding Control

No. / Skill Steps / Needs Practice / Pass
1 / Puts on gloves and exposes the wound.
2 / Covers the wound with a dressing.
3 / Applies direct pressure using the flat part of his or her fingers orpalm of hand to press on the wound until the bleeding stops.
4 / Instructor asks, “What do you do if the bleeding does not stop?”
Participant answers, “Add more dressings onto the first one and press harder over a wider area.”
5 / Instructor asks, “What do you do if the bleeding stops?” Participant
answers, “Apply a bandage over the dressing. Dispose of the gloves
and wash hands with soap and running water.”
6 / Instructor asks, “What do you do if the bleeding stops?” Participant
answers, “Apply a bandage over the dressing. Dispose of the gloves
and wash hands with soap and running water.”

Skill Checkoff Sheet 3-4: Applying a Roller Bandage on a Forearm (Spiral Method)

No. / Skill Steps / Needs Practice / Pass
1 / Starts below and at the edge of the dressing. Makes two straight anchoring turns with the bandage.
2 / Wraps upward toward the wider part of the arm or leg to make the
bandage more secure.
3 / Makes a series of crisscross (figure-eight) turns, progressing up
the arm or leg. Each turn overlaps the previous wrap.
4 / Finishes with two straight turns and secures (tape) the bandage.

Skill Checkoff Sheet 3-5: RICE Procedure for Bone, Joint, and Muscle Injuries

No. / Skill Steps / Needs Practice / Pass
1 / R = Rest
DO NOT use or move the body part.
2 / I = Ice
Apply cold for 20 min (or 10 min if uncomfortable) every 2–3 hours during the first 24–48 hours.
Put crushed orcubed ice in a plastic bag and place a paper towelor thin cloth between the ice pack and skin forprotection or put ice wrapped in a damp towel.
3 / C = Compression
Apply an elastic bandage when not applying ice.
4 / E = Elevation
Keep the injured part raised higher than the heart asmuch as possible.

Skill Checkoff Sheet 3-6: Applying a Rigid Splint to the Forearm

No. / Skill Steps / Needs Practice / Pass
1 / Place a rigid object (e.g., cardboard, wood board, folded newspaper or magazine) underthe forearm. Place padding (e.g., towel, T-shirt)
between the rigid object and the skin and place padding in the palm (e.g., roller bandage, wad ofcloth).
2 / Secure the splint onto the arm by using either a roller bandage or folded triangular bandages(known as cravat bandages).
3 / Place the arm in a sling with a binder.

Skill Checkoff Sheet 3-8: Applying an Arm Sling

No. / Skill Steps / Needs Practice / Pass
1 / Place a triangular bandage between the forearm and chest with the point of the bandage toward theelbow of the injured arm and stretching beyondthe elbow.
2 / Pull the upper end of the bandage over the uninjured shoulder.
3 / Bring the lower end of thebandage over the forearm.
4 / Bring the end of the bandage around the neck to the uninjured side and tie to the other end at the hollowabove the collar bone (clavicle) on the uninjured
5 / If possible, secure the point of the bandage at the elbow with a safety pin or twist it into a pigtail,which can be tied into a knot or tucked inside thesling.
6 / Place a binder around the upper arm and body. The center of the binder should be placed over thearm. The hand should be in thumb-up position withinthe sling and slightly above the level of the elbow.

Skills Checkoff Sheet 4-1: Using an Epinephrine Auto-Injector

No. / Skill Steps / Needs Practice / Pass
1 / Finds the injection site on the side of the person’s thigh, halfway between the knee and the hip. Checks for coins, keys, and pantseams, which could obstruct the needle.
2 / Takes off the safety cap of the epinephrine auto-injector
3 / Holds the epinephrine auto-injector without touching either end of
the pen. Pushes the auto-injector firmly against the thigh until youhear a click. Holds in place for about 10 seconds.
4 / Pulls the auto-injector straight out from the leg.
5 / Rubs the injection site for about 10 seconds.

MODIFIED FROM © 2017 Jones & Bartlett Learning, LLC, an Ascend Learning Company