Fillable Adult CPR and AED Skills Testing Checklist (City of Oakland)

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Adult CPR and AED Skills Testing Checklist (City of Oakland)

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Basic Life Support
Adult CPR and AED
Skills Testing Checklist
Student Name __________________________________________________  Date of Test __________________________
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 responsiveness ☐ Shouts for help/Activates emergency response system/Sends for AED
☐ Checks breathing ☐ Checks 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
☐ Compressions  ☐ Breaths  ☐ Resumes 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 AED  ☐ Correctly attaches pads ☐ Clears for analysis
☐ Clears to safely deliver a shock ☐ Safely 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:
☐ PASS ☐ NR
Instructor Initials __________ Instructor Number _____________________________ Date _________________________
© 2020 American Heart Association
Basic Life Support
Adult CPR and AED
Skills Testing Critical Skills Descriptors
1. Assesses victim and activates emergency response system (this must precede starting compressions)
within 30 seconds. After determining that the scene is safe:
• Checks for responsiveness by tapping and shouting
• Shouts for help/directs someone to call for help and get AED/defibrillator
• Checks for no breathing or no normal breathing (only gasping)
 – Scans from the head to the chest for a minimum of 5 seconds and no more than 10 seconds
• Checks carotid pulse
 – Should be done simultaneously with check for breathing
 – Checks for a minimum of 5 seconds and no more than 10 seconds
2. Performs high-quality chest compressions (initiates compressions immediately after recognition of
cardiac arrest)
• Correct hand placement
 – Lower half of sternum
 – 2-handed (second hand on top of the first or grasping the wrist of the first hand)
• Compression rate of 100 to 120/min
 – Delivers 30 compressions in 15 to 18 seconds
• Compression depth and recoil—at least 2 inches (5 cm) and avoid compressing more than 2.4 inches (6 cm)
 – Use of a commercial feedback device or high-fidelity manikin is required
 – Complete chest recoil after each compression
• Minimizes interruptions in compressions
 – Delivers 2 breaths so less than 10 seconds elapses between last compression of one cycle and first
compression of next cycle
 – Compressions resumed immediately after shock/no shock indicated
3. Provides 2 breaths by using a barrier device
• Opens airway adequately
 – Uses a head tilt–chin lift maneuver or jaw thrust
• Delivers each breath over 1 second
• Delivers breaths that produce visible chest rise
• Avoids excessive ventilation
• Resumes chest compressions in less than 10 seconds
4. Performs same steps for compressions and breaths for Cycle 2
5. AED use
• Powers on AED
 – Turns AED on by pushing button or lifting lid as soon as it arrives
• Correctly attaches pads
 – Places proper-sized (adult) pads for victim’s age in correct location
• Clears for analysis
 – Clears rescuers from victim for AED to analyze rhythm (pushes analyze button if required by device)
 – Communicates clearly to all other rescuers to stop touching victim
• Clears to safely deliver shock
 – Communicates clearly to all other rescuers to stop touching victim
• Safely delivers a shock
 – Resumes chest compressions immediately after shock delivery
 – Does not turn off AED during CPR
6. Resumes compressions
• Ensures that high-quality chest compressions are resumed immediately after shock delivery
 – Performs same steps for compressions
© 2020 American Heart Association
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Adult CPR and AED Skills Testing Checklist (City of Oakland)

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Completed 20 November 2021

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