EVAC CPR Program BLS Provider Adult CPR and AED Skills Testing Checklist

EVAC CPR Program Adult CPR and AED Skills Testing Checklist

Basic Life Support (BLS)
Student Name*
Date of Test*

MonthDayYear
Date
Hospital Scenario: “You are working in a hospital or clinic, and you see a person who has suddenly collapsed in the hallway. You check that the scene is safe and then approach the patient. Demonstrate what you would do next.”

Prehospital Scenario: “You arrive on the scene for a suspected cardiac arrest. No bystander CPR has been provided. You approach the scene and ensure that it is safe. Demonstrate what you would do next.”
Assessment and Activation*

Checks responsivenessChecks breathingShouts for help/Activates emergency response system/Sends for AEDChecks pulse
Once student shouts for help, instructor says, “Here’s the barrier device. I am going to get the AED.”
Cycle 1 of CPR (30:2) *CPR feedback devices are required for accuracy Adult Compressions*

Performs high-quality compressions*:
- Hand placement on lower half of sternum
- 30 compressions in no less than 15 and no more than 18 seconds
- Compresses at least 2 inches (5 cm)
- Complete recoil after each compression
Adult Breaths*

Gives 2 breaths with a barrier device:
- Each breath given over 1 second
- Visible chest rise with each breath
- Resumes compressions in less than 10 seconds
Cycle 2 of CPR (repeats steps in Cycle 1) Only check box if step is successfully performed*

CompressionsBreathsResumes compressions in less than 10 seconds
Rescuer 2 says, “Here is the AED. I’ll take over compressions, and you use the AED.
AED (follows prompts of AED)*

Powers on AEDCorrectly attaches padsClears to safely deliver a shockClears for analysisSafely delivers a shock
Resumes Compressions*

Ensures compressions are resumed immediately after shock delivery: Student directs instructor to resume compressions or Second student resumes compressions
STOP TEST
Instructor Notes:
- Place a check in the box next to each step the student completes successfully.
- If the student does not complete all steps successfully (as indicated by at least 1 blank check box), the student must receive remediation. Make a note here of which skills require remediation (refer to instructor manual for information about remediation
Test Results Check PASS or NR to indicate pass or needs remediation:*

PASSNR
Instructor Name & Number*
Date*

MonthDayYear
Date
Should be Empty:

EVAC CPR Program Adult CPR and AED Skills Testing Checklist

STOP TEST