Raven EMS Education Program Manual
Circulation Infant CPR Evaluation Form

Date:

Student name:

Evaluator name:

Steps:

• Take BSI precautions.
• Position the infant on a firm surface and establish the infant’s level of responsiveness. If the infant has no pulse and is not breathing or only gasping, begin chest compressions using two middle fingers in the middle of the chest just below the nipple line. Compress the chest at least one-third the depth of the chest (about 1.5 inches [4 cm]) at a rate of 100 to 120 compressions per minute.
• Open the airway to a neutral or slight sniffing position using the head tilt-chin lift maneuver. Give two slow breaths (1 second per breath) and watch for chest rise.
• Continue cycles of 30 chest compressions and two rescue breaths until the infant moves or until other EMS providers arrive to take over the care of the patient.
• If you are by yourself with no communications device, perform 2 minutes of CPR before leaving the victim to activate the EMS system.

Passing criteria:

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

Comments:

Evaluator signature:
Clear

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