EVAC CPR Program Heartsaver Infant CPR Skills Testing Checklist

Infant CPR Skills Testing Checklist

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

MonthDayYear
Date
Scenario: “While you are pushing a baby in a stroller at the park, you notice something is wrong with the baby. You do not have a phone nearby. You ensure that the scene is safe and take the baby out of the stroller. Demonstrate what you would do next.
Assesses and Shouts for Help*

Checks responsivenessShouts for helpChecks breathing
Once student shouts for help, instructor says, “No one is around to help.”
Cycle 1 of CPR (30:2)
Infant Compressions*

Performs high-quality compressions*:
- Uses 2 fingers or 2 thumbs of 1 hand, or the heel of 1 hand, to give compressions in the center of the chest, just below the nipple line
- 30 compressions in no less than 15 and no more than 18 seconds
- Compresses at least one third the depth of the chest, about 1½ inches (4 cm)
- Complete recoil after each compression
Infant 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
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
Instructor says, "You have just completed 5 sets of 30 compressions and 2 breaths.
Activates Emergency Response System (9-1-1)*

Verbalizes the need to leave to phone 9-1-1
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:

Infant CPR Skills Testing Checklist

Cycle 1 of CPR (30:2)

Instructor says, "You have just completed 5 sets of 30 compressions and 2 breaths.

STOP TEST