Student Name __________________________________________________ Date of Test _______________________________
Hospital Scenario: “You are working in a hospital or clinic, and you see a child 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 child who is not breathing. 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
Cycle 1 of CPR (30:2)
*CPR feedback devices preferred for accuracy
Child 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 one third the depth of the
chest, about 2 inches (5 cm)
• Complete recoil after each compression
Child 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
AED (follows prompts of AED)
☐
Powers on AED
☐
Correctly attaches pads
☐
Clears for analysis
☐
Clears to safely deliver a shock
☐
Safely delivers a shock
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
Resumes Compressions
☐
Ensures compressions are resumed immediately after shock delivery
• Student directs instructor to resume compressions or
• Student resumes compressions
Once student shouts for help, instructor says, “Here’s the barrier device. I am going to get the AED.”
Rescuer 2 says, “Here is the AED. I’ll take over compressions, and you use the AED.”
STOP TEST
Instructor Notes
• Place a ✓ 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
