EVAC CPR Program Heartsaver Adult CPR and AED Skills Testing Checklist

Adult CPR and AED Skills Testing Checklist

Heartsaver CPR/AED/First Aid
Student Name*
Date of Test*

MonthDayYear
Date
Scenario: “You arrive at 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 responsivenessShouts for help/Sends someone to phone 9-1-1 and get an AEDChecks breathing
Once student shouts for help, instructor says, “Here's the barrier device. I am going to phone 9-1-1 and get the AED.”
Cycle 1 of CPR (30:2)
Adult Compressions*

Performs high-quality compressions*:
- Hand placement on lower half of breastbone
- 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
- Gives 2 breaths in less than 10 seconds
Cycle 2 of CPR (repeats steps in Cycle 1) Only check box if step is successfully performed*

Gives 30 high-quality compressionsGives 2 effective breaths
Instructor says, "Here is the AED!"
AED (follows prompts of AED)*

Powers on AEDCorrectly attaches padsClears for analysisClears to safely deliver a shockPresses button to deliver shockStudent immediately resumes compressions
AED trainer says, "The shock has been delivered.
Cycle 3 of CPR (repeats steps in Cycle 1) Only check box if step is successfully performed*

Gives 30 high-quality compressionsGives 2 effective breaths
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:

Adult CPR and AED Skills Testing Checklist

Cycle 1 of CPR (30:2)

STOP TEST