Name: _____________________________ YR/SEC: ________________

BLS GRADING SHEET
1 2 3 4 5

BASIC LIFE SUPPORT
SCENE SURVEY
1. Survey the scene 2. Introduce self “I am _____, a trained aider, Can I help?”

ACTIVATE MED ASSISTANCE
3. “Phone first” 4. Ask by stander to call for help 5. Ask by stander to come back after the call

ABC’s
6. Checks for unresponsiveness “Hey, hey are you okay?” (2x) 7. Open airway: Head tilt-chin lift. Inspect for airway obstruction. 8. Check breathing for 5 seconds. Count: “1, 1002, 1003, 1004, 1005” if breathless, give 2 RB. 9. Check for circulation: 10 seconds. “1, 1002,1003,…1010.” *If no signs of CIRCULATION proceed to CPR

CPR 10. Counting: 30 chest compression, RB; x 5 cycle 1, 2, 3, 4, 5,
6, 7, 8, 9, 10,…15, 20, 1, 2,…9&1 then 2 RB 11. Check circulation for 10 seconds COUNT: “1, 1002, 1003,…1010” ***Victim has No breathing but with signs of circulation. “Perform RB” RESCUE BREATH 12. RB- 1 Rescue breath: 5 seconds: 12 cycles ( Start and ends with breathing )

13. COUNT: “Breathe, 1, 1002, 1003, 1001, breathe, 1, 1002,
1003, 1002, breathe, 1, 1002,1003, 1003, breathe until 1012, breathe”

14. Check circulation for 10 seconds.
COUNT: “1, 1002, 1003…1010”

15. If victim has regained breathing and pulse, do the
recovery position. Check breathing with dorsal aspect of palm for 5 seconds. Do secondary survey

TOTAL SCORE

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