COMBAT MEDIC/CORPSMAN TACTICAL COMBAT CASUALTY CARE

SKILLS ASSESSMENT CHECKLIST

INDIVIDUAL SKILLS ASSESSMENT
MODULE 14: Eye Injuries

DATE: _____________________

STUDENT NAME: _________________________________ RANK: __________________________

INSTRUCTOR NAME: _______________________________ ROSTER#: _______________________

INSTRUCTION: This Skills Assessment Checklist should be used by a trainer to grade a student’s ability to
perform the individual SKILLS for the TCCC Combat Medic/Corpsman (TCCC-CMC) Course. A trainer should
use this form when performing the optional individual skills assessment associated with completing a skills
station. To successfully demonstrate proficiency, the student should “PASS (P)” all the critical tasks (marked as
“C”) on the checklist.

This checklist may also be used as a teaching tool at the skills station if the trainer chooses to grade students
only during the culminating exercise tactical trauma assessment. Grading during the culminating exercise is
mandatory for successful course completion, while grading individual skills during the skill stations is optional.

1st Attempt 2nd Attempt

PERFORMANCE STEPS
P F P F
PENETRATING EYE INJURY
1. Considered body substance isolation.
2. Placed the casualty in a comfortable position, one that allowed access to their
eyes (head). Removed their headgear, if necessary.
3. Examined the eyes for any deformities, contusions, abrasions, penetrating
objects, bruising (black eye(s)), lacerations, or swelling.
4. Performed a rapid field test of visual acuity. C
5. Covered the casualty's injured eye with a rigid eye shield (not a pressure
C
patch).
6. Secured the rigid eye shield with tape at a 45-degree angle across the
C
forehead and cheek.
7. If the casualty was conscious and able to swallow, administered all pills in the
Combat Wound Medication Pack (CWMP). If unable to take the oral antibiotic C
in the CWMP, then administered intravenous or intramuscular antibiotics.
8. Documented all findings and treatments on a DD Form 1380 TCCC Casualty
C
Card and attached it to the casualty.
Demonstrated TCCC Proficiency: Yes No
Notes:

TCCC CMC SKILLS ASSESSMENT CHECKLIST – INDIVIDUAL SKILLS #TCCC-CMC-12-01 MAR 2022
 COMBAT MEDIC/CORPSMAN TACTICAL COMBAT CASUALTY CARE

SKILLS ASSESSMENT CHECKLIST

STUDENT NAME: _________________________________

1st Attempt 2nd Attempt

PERFORMANCE STEPS
P F P F
EYE TRAUMA RAPID FIELD TEST OF VISUAL ACUITY
1. Considered body substance isolation.
2. Had the casualty cover the unaffected eye. C
3. At an arm’s length, assessed the casualty’s ability to:
(a) Read something with text on it (that was held up by the medic)
(b) Counted fingers
(c) Identified hand motion C
(d) Identified light versus dark
NOTE: If casualty is unable to do a, then move on to b, if unable to do b, then
move on to c, if unable to do c, then move on to d.
Evaluator must provide student with the appropriate guidance as to what the
casualty sees for number 3.

4. Repeated the procedure for the other eye.

5. Documented all findings and treatments on a DD Form 1380 TCCC Casualty
C
Card and attached it to the casualty.
Demonstrated TCCC Proficiency: Yes No
Notes:

TCCC CMC SKILLS ASSESSMENT CHECKLIST – INDIVIDUAL SKILLS #TCCC-CMC-12-01 MAR 2022