F12: Resuscitation Assessment

Candidate Name Date

Assessor Name Venue

The candidate is to manage a role play incident, providing care to a resuscitation manikin
which has no signs of normal breathing
Help is available and the assessor MUST act as a bystander IF summoned

Candidate
Result
(Please
Circle)
Competence Element Result Comments

Achieved

Achieved

Achieved
Partly
Fully

Not
Assess Danger
As found 3 2 1
(Visual Search)

Assess Response
No response 3 2 1
AVPU

Shout for help

Help is at Hand 3 2 1
(Shouted)

Open Airway Correct

3 2 1
(Chin lift, Head Tilt) procedure?

Check Breathing
Absent 3 2 1
(Look, listen and feel for 10 secs)

Send bystander for help

Ambulance Called 3 2 1
(Simulated emergency call made)

Give 30 chest compressions

(Correct location, 100 per minute, Maintained 3 2 1
depth 4-5 cm’s)

Give 2 rescue breaths Chest rises and

3 2 1
(Approx 3 second cycles) falls

Repeat sequence of 30
compressions and 2 breaths No Improvement 3 2 1
(Continuously)

Total score

18 -27 Pass 11-17 Ask candidate to retake 0-10 Referral

Assessors signature

Please note: The assessor role is not to re-teach according to their views – they
must assess according to the criteria set out above

©MG Training UK Ltd March 2006