Testing: Adult CPR Participant Name: Date: Result (circle): Pass Redo. Action Description Notes

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1 Testing: Adult CPR Result (circle): Chest further hazards to the victim. Participant is close to victim and speaks loudly and clearly; instructor will respond with either a yes or no response. Participant must enlist a bystander to call 911, or perform this step themselves. and/or will go to location in facility where this person would be. Participant will kneel beside victim near shoulders and place the palm of one hand on the forehead and the fingers of the other hand under the chin of the victim. Obvious movement of the chin being raised must be noted. Participant places face directly near victims mouth and looks at the chest for a minimum of 5 sec. and no more than 10 sec. they will provide 2 rescue. If mannequin is being used, instructor must see chest rise. If it doesn t, head participant whether or not first breath went in. If first breath does not go in (mannequin or simulated victim), instructor must see participant reposition head and attempt to ventilate again. from victim s chest and place heel of one hand in the centre of the chest between the nipples. The other hand is placed on top of this hand. The first cycle of 30 seconds must be done. Instructor will use a stopwatch to determine if again attempts to give 2 rescue with proper head tilt/chin lift. Second bystander arrives, and 2-rescuer CPR can now be performed

2 Testing: Adult/Child CPR with 2-Rescuers Result (circle): begin Chest begin Second Rescuer further hazards to the victim Participant is close to victim and speaks loudly and clearly; instructor will respond with either a yes or no response Participant must enlist a bystander to call 911, or perform this step themselves and/or will go to location in facility where this person would be Participant will kneel beside victim near shoulders. He or she will place the palm of one hand on the forehead and the fingers of the other hand under the chin of the victim. Obvious movement of the chin being raised must be noted. Participant places face directly near victims mouth and looks at the chest for a minimum of 5 sec. and no more than 10 sec. they will provide 2 rescue. If mannequin is being used, instructor must see chest rise. If it doesn t, head needs to be repositioned and rescue breath attempted again. If no mannequin is being used, instructor can determine if head tilt/chin lift was effective by telling participant whether or not first breath went in. If first breath does not go in (mannequin or simulated victim), instructor must see participant reposition head and attempt to ventilate again. from victim s chest and place heel of one hand in the centre of the chest between the nipples. The first cycle of 30 seconds must be done. Instructor will use a stopwatch to determine if again attempts to give 2 rescue with proper head tilt/chin lift. Second rescuer enters the scene and identifies as CPR trained. Second rescuer will confirm that EMS has been activated. One rescuer will provide compressions and other rescuer will provide rescue Rescuers switch positions as required (due to fatigue) Transition of positions will be as seamless as possible. Treatment will end when: EMS arrives An rescuer arrives Victim starts breathing

3 Testing: Infant/Child CPR Result (circle): AEDtrained Chest further hazards to the victim. Participant is close to victim and speaks loudly and clearly while tapping or rubbing foot; instructor will respond with either a yes or no response. Participant must enlist a bystander to call 911. If no bystander is present, they will begin providing first aid to infant. Participant will loudly ask if any bystander is a trained AED. Participant will move victim to a table if appropriate. Participant will stand or kneel beside victim near shoulders and place the palm of one hand on the forehead and the fingers of the other hand under the chin of the victim. Obvious movement of the chin being raised must be noted. Participant places face directly near victims mouth and looks at the chest for a minimum of 5 sec. and no more than 10 sec. they will provide 2 rescue. If mannequin is being used, instructor must see chest rise. If it doesn t, head participant whether or not first breath went in. If first breath does not go in (mannequin or simulated victim), instructor must see participant reposition head and attempt to ventilate again. Participant will demonstrate that the breath for an infant is much less ( puff ) from victim s chest and place 2 fingers on the breastbone, shortly below the nipple line. The first cycle of 30 seconds must be done. Instructor will use a stopwatch to determine if compression rate is correct. Instructor is looking for 30 compressions to take less than 23 seconds. again attempts to give 2 rescue with proper head tilt/chin lift If no bystander was available to call 911, participant will indicate that at the completion of 5 cycles of compressions :, he or she is calling 911, then returning to victim. A second bystander has arrived, and 2-rescuer CPR can now be performed

4 Testing: Choking Victim Conscious (Adult/Child) Result (circle): Assess environment severity of obstruction begin abdominal thrusts End of treatment further hazards to the victim Participant will ask victim if they are okay. If victim can nod or make sounds, and can continue to cough, participant will encourage he or she to continue coughing and reassure them. If victim is unable to talk and making minimal to no sound, participant will shout for help Participant will place the thumb side of his or her fist just above the belly button of the victim and grab this fist with his or her other hand. Participant will demonstrate quick, upward thrusts. Participant will continue to perform abdominal thrusts until: Object is forced out Victim is able to breathe or cough with force Victim becomes unconscious

5 Testing: Choking Victim Conscious (Infant) Result (circle): Assess environment severity of obstruction begin back blows begin chest thrusts End of treatment further hazards to the victim Participant will note if infant is able to breathe, cough, cry or make any other sound. If infant can do any of the above, participant will let the infant continue to cough and stay with victim to continually assess degree of obstruction. If infant is unable to do any of the above, participant will place infant face down while supporting the infant s neck and head. Participant will give 5 back blows to the infant by placing the heel of his or her hand between the infants shoulder blades After completion of 5 back blows, participant will turn infant onto his or her back while supporting his or her head and neck. 5 chest thrusts will be performed by the participant placing his or her middle and index finger on the infant s breastbone between the nipples. should be ½ - 1 inch ( cm). Participant will continue to perform back blows and chest thrusts until: Object is forced out Victim is able to breathe or cough with force Victim becomes unconscious

6 Testing: Choking Victim Unconscious (Adult/Child) Result (circle): Chest Look for object and provide rescue breath further hazards to the victim. Participant is close to victim and speaks loudly and clearly; instructor will respond with either a yes or no response. Participant must enlist a bystander to call 911, or perform this step themselves. and/or will go to location in facility where this person would be. Participant will kneel beside victim near shoulders and place the palm of one hand on the forehead and the fingers of the other hand under the chin of the victim. Obvious movement of the chin being raised must be noted. Participant places face directly near victims mouth and looks at the chest for a minimum of 5 sec. and no more than 10 sec. they will provide 2 rescue. If mannequin is being used, instructor must see chest rise. If it doesn t, head participant whether or not first breath went in. If first breath does not go in (mannequin or simulated victim), instructor must see participant reposition head and attempt to ventilate again. Instructor will indicate that breath did not go in. from victim s chest and place heel of one hand in the centre of the chest between the nipples. The other hand is placed on top of this hand. The first cycle of 30 seconds must be done. Instructor will use a stopwatch to determine if will look in victim s mouth to see if object was dislodged. If object is seen, they will indicate that they are removing object then providing a rescue breath. If no object is seen, they will indicate that they are attempting to provide a rescue breath with proper head tilt/chin lift. Instructor will indicate whether or not breath went in. Object is dislodged, but victim is still not responding

7 Testing: Choking Victim Unconscious (Infant) Result (circle): Chest Look for object and provide rescue breath further hazards to the victim Participant is close to victim and speaks loudly and clearly while tapping or rubbing foot; instructor will respond with either a yes or no response Participant must enlist a bystander to call 911. If no bystander is present, they will begin providing first aid to infant.. Participant will kneel beside victim near shoulders. He or she will place the palm of one hand on the forehead and the fingers of the other hand under the chin of the victim. Obvious movement of the chin being raised must be noted. Participant places face directly near victims mouth and looks at the chest for a minimum of 5 sec. and no more than 10 sec. they will provide 2 rescue (puffs). If mannequin is being used, instructor must see chest rise. If it doesn t, head participant whether or not first breath went in. If first breath does not go in (mannequin or simulated victim), instructor must see participant reposition head and attempt to ventilate again. Instructor will indicate that breath did not go in. from victim s chest and place 2 fingers on the breastbone, shortly below the nipple line. The first cycle of 30 seconds must be done. Instructor will use a stopwatch to determine if will look in victim s mouth to see if object was dislodged. If object is seen, they will indicate that they are removing object then providing a rescue breath. If no object is seen, they will indicate that they are attempting to provide a rescue breath with proper head tilt/chin lift. Instructor will indicate whether or not breath went in. If no bystander was available to call 911, participant will indicate that at the completion of 5 cycles of compressions:, he or she is calling 911, then returning to victim. Object is dislodged, but victim is still not responding