Iloilo Doctors’ College

College of Nursing
West Avenue, Molo, Iloilo City

Basic First Aid to Manage Bleeding

PERFORMANCE CHECKLIST

Student’s Name: ______________________________Score/ Equivalent: ________________

Year & Section: _______________________________Date Performed: _________________

PERFORMANCE RATING
4 – Demonstrates a very high level of performance
3 – Consistently demonstrates high level of performance.
2 – Satisfactorily achieves and perform according to standards.
1 – Quality of performance is made inadequate.

Procedure 4 3 2 1
1 Surveyed the scene and safety of the location by checking for hazards or
personal dangers.
2 Anticipated if the victim is at risk for unexpected bleeding, including traumatic
injury.
3 Prepared multiple thickness gauze, adhesive tape and elastic roller bandage.
4 Looked for visible presence of blood.
5 Assessed patient’s anxiety level.
6 Obtained patient’s baseline vital signs before the onset of heavy bleeding.
7 Performed hand hygiene and applied clean gloves.
8 Identified external bleeding site. Turned patient, log roll if necessary.
9 Used hands and pressed as hard as possible to apply immediate manual
pressure to the bleeding site with multiple thickness gauze.
10 Placed adhesive strips 7-10 cm beyond the width of gauze dressing with even
pressure to the central bleeding source.
11 Secured tape on the distal end.
12 Placed and pulled tape across dressing and kept firm pressure.
13 Elevated affected body part if possible.
14 Washed hands and discarded used materials.
15 Continued in observing the dressing for control of bleeding.
16 Evaluated adequacy of circulation (distal pulse, skin temperature and color)
17 Estimated volume of blood loss.
18 Evaluated patient’s response to management.
19 Monitored vital signs.
20 Documented and recorded the following:
a. Location of bleeding
b. Application and type of pressure dressing
c. Effectiveness of applied pressure dressing
Total

Student’s Signature: _________________ Instructor’s Signature: _______________