Attachment E2 - Informed Consent Script

Attachment E-2

Informed Consent Script:

Semi-Structured Interview with

Sub-State EMS Region Respondent

[This script is provided as part of a message to each respondent to confirm the date and time of the interview (see Attachment E-1) and provide the statement for informed consent.]

Informed Consent Script: Sub-State EMS Region Respondent

Purpose. The purpose of this study is to gain a better understanding of the capabilities and distribution of pre-hospital heart attack and stroke care provided by local EMS responders. The purpose of the interview with you is to get a description of the function and activities of this sub-state EMS region in relation to local providers and state level authorities, and to activities related to pre-hospital EMS practices for heart attack and stroke. The interview will take about 45 minutes. This is not an evaluation.

How the Study is Being Conducted. Battelle is an independent, non-profit research organization conducting the study under contract to the Centers for Disease Control and Prevention (CDC), Division for Heart Disease and Stroke Prevention. The study involves a telephone survey of the local EMS provider organizations in nine states, including this one. It also includes interviews with two administrators such as yourself in each of five states, for a total of 10, and discussions with state-level EMS authorities in the same states. All the interviews in the study focus on the characteristics and activities of the various organizations. You will be asked to describe the purpose and activities for your EMS region. You will not be asked questions of a personal nature. Your participation in this interview is voluntary. There is no impact to you or your organization if you decline to answer certain questions or ask to suspend the interview.

Use of the Information: The information you provide about the activities of your EMS region will be included in the final report as part of the organizational description of the EMS system in the state along with the survey data collected from the local EMS provider organizations in the states. The CDC intends to use the information from all the states in the study to better understand variations in pre-hospital EMS care for heart attack and stroke.

You will not be quoted by name, nor will statements be attributed to you by name. The notes from the interview will be treated in a confidential manner as follows: Only the identification number assigned to this interview will appear on notes from this interview. The list of respondent names associated with interview identification numbers will be kept in a separate location from interview notes and accessible only to project staff. However, the final report will indicate the states and specific regions that were included in the study which is information that may make it possible for others to guess the source of the information.

If you have any questions regarding the study or your interview that you want to ask in advance of the interview, please contact the project director, Dr. Patricia Bolton (206) 528-3310. If you have any questions about your rights as a research participant, please contact the Chairperson of Battelle’s Institutional Review Board at 1-877-810-9530, x 500.