Raven EMS Education Program Manual
Breathing Rescue Infant Evaluation Form

Date:

Student name:

Evaluator name:

Steps:

• Establish the patient’s level of responsiveness.
• Simultaneously check for circulation and breathing.
• Open the infant’s airway using the head tilt‒chin lift maneuver.
• Perform infant rescue breathing.

Passing criteria:

• Pass: At least 70% (? of ?) successfully completed above. Currently at 0% completed.
• Fail.

Comments:

Evaluator signature:
Clear

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