EMS Professional Survey

Form Approved

OMB No. 0920-XXXX

Exp. Date xx/xx/20xx

ATTACHMENT F:

EMS Professional Survey

EMS Professional Survey

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Public reporting burden of this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information, unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

e would appreciate your feedback to help us evaluate the “Field Triage Decision Scheme: The National Trauma Triage Protocol.” This brief survey should take no more than 15 minutes to complete. Your responses will be kept private to the extent allowed by law and will be combined with other responses for reporting results. Thank you for taking the time to complete this survey.

Background

1. How would you describe your current job (select all that apply)?

   1. EMS Management 

Select level:

1. State 

2. Regional 

3. County 

4. Local 

1. Medical director 

Select level:

1. State 

2. Regional 

3. County 

4. Local 

1. EMS educator 

Select level:

1. State 

2. Regional 

3. County 

4. Local 

1. Trauma system leadership 

Specify:

1. Trauma surgeon 

2. Trauma nurse 

3. Trauma coordinator 

4. Trauma administration 

5. Other 

1. EMS provider 

2. Physician 

3. Other___ 

2. How many years have you worked in this field?

   1. Less than 5 years 

   2. 5-10 years 

   3. 10-20 years 

   4. 20 + years 

3. How would you best describe the region in which you work (select all that apply)?

   1. Urban 

   2. Suburban 

   3. Rural 

   4. Frontier 

4. The Centers for Disease Control and Prevention (CDC) mailed resources called the “Field Triage Decision Scheme: The National Trauma Triage Protocol” to members of several professional organizations. CDC also distributed these resources at professional conferences. Have you received a copy of any of the materials that are blue and silver in color and include a resource guide, posters, pocket card, badge, binder insert, PowerPoint presentation, and MMWR article “Guidelines for Field Triage of the Injured Patients, Recommendations of the National Expert Panel on Field Triage”?

   1. Yes 

   2. No End Survey

5. Have you reviewed any of these Decision Scheme materials, even if only briefly?

   1. Yes 

   2. No  End Survey

6. How did you receive the Decision Scheme materials?

   1. I ordered the Decision Scheme materials online and received them through the mail. 

   2. I received the Decision Scheme materials in the mail, but did not place an order for them. 

   3. I received the Decision Scheme materials at a conference. 

   4. Other: ___________________________________

7. How long have you had the Decision Scheme materials?

   1. 1 month or less 

   2. 2-5 months 

   3. 6-9 months 

   4. 10 months or more 

Feedback on Materials

This section will focus on specific Decision Scheme materials. If you have a hard copy of the materials available, you may want to refer to them at this time.

8. Select from the following list of materials the ones you have reviewed and then rate their usefulness.

	Extremely Useful	Very Useful	Somewhat Useful	Not Very Useful	Not Useful	Did Not Use/Review
Resource Guide for EMS administrators and medical directors						
Large Decision Scheme poster (not laminated)						
Decision Scheme ambulance poster (laminated)						
Decision Scheme binder insert (one-page laminated)						
Pocket card for EMS providers						
Badge with Decision Scheme						
PowerPoint presentation (on CD-ROM or online)						
MMWR article “Guidelines for Field Triage of the Injured Patients, Recommendations of the National Expert Panel on Field Triage”						

9. Have you used Decision Scheme materials to educate others about field triage protocols?

   1. Yes With whom? (Check all that apply.)

      1. EMS medical directors 

Select level:

1. State 

2. Regional 

3. County 

4. Local 

1. Public health professionals 

Select level:

1. State 

2. Regional 

3. County 

4. Local 

1. EMS providers 

2. EMS trainees 

3. Other:__________________________ 

1. No 

10. Based on your review of the Decision Scheme materials, which resources do you plan to use in the future?

    1. Resource guide for EMS administrators and medical directors 

    2. Large Decision Scheme poster (not laminated) 

    3. Decision Scheme ambulance poster (laminated) 

    4. Decision Scheme binder insert 

    5. Badge with Decision Scheme 

    6. Pocket card for EMS providers 

    7. PowerPoint presentation 

    8. MMWR article “Guidelines for Field Triage of the Injured Patients, Recommendations of the National Expert Panel on Field Triage”

    9. None 

    10. Do not know/ Unsure 

Knowledge

11. Did you learn something new about field triage procedures from the Decision Scheme materials?

    1. Yes 

What did you learn from the materials? ______________________

2. No 

12. Have the Decision Scheme materials changed your field triage practices or the practices of your EMS agency?

    1. Yes 

 How have your practices or those of your EMS agency changed?

2. No 

Implementation

13. Is use of the “Field Triage Decision Scheme: The National Trauma Triage Protocol” currently being mandated in your state/region/county/local area?

    1. Yes 

    2. No 

14. Do you play a role in determining your state/region/county/local area’s field triage policy?

1. Yes ------------------------------------------------------------------------

2. No 

Skip to question 17

15. Have you implemented the Decision Scheme as your state/region/county/local area’s field triage policy?

    1. Yes ------------------------------------------------------------------------

Skip to question 17

2. No -------------------------------------------------------------------------

16. Do you plan to implement the Decision Scheme as your state/region/county/local area’s field triage policy in the future?

    1. Yes ------------------------------------------------------------------------

    2. No -------------------------------------------------------------------------

Why not? ___________________________

17. Since you have had the Decision Scheme materials, have you had to conduct field triage on a patient or patients?

    1. Yes 

    2. No 

18. Have you utilized the Decision Scheme for triage with patients in the field?

    1. YesHow did the Decision Scheme materials affect your triage practices? _______________________________________

    2. NoWhy not? ___________________________________

19. Are you aware of any changes or modifications been made to the Decision Scheme in your state/region/county/local area?

1. Yes 

What changes or modifications have been made? _________

2. No 

3. Don’t know 

20. Which of the following were barriers you have encountered in using, implementing, or planning to implement the Decision Scheme?

    1. Lack of support among other staff for Decision Scheme----------

    2. Lack of resources (e.g., time, money) -------------------------------

    3. Decision Scheme is difficult to understand/use---------------------

    4. Decision Scheme is not practical for our situation------------------

Please explain ________________________

5. No barriers encountered---------------------------------------------------------

6. Not applicable (did not use or implement Decision Scheme)---------------

7. Other__________________-------------------------------------------

Comments

21. If you have any additional feedback on the “Field Triage Decision Scheme: The National Trauma Triage Protocol” materials, please provide it here:

Follow-Up

22. CDC would like to conduct group interviews with people that complete the survey to gain additional input and feedback on the “Field Triage Decision Scheme: The National Trauma Triage Protocol” and accompanying materials. You will receive compensation for your time if you participate in a group interview. Can we contact you for this purpose?

    1. Yes 

Name:________________________________________

Business E-mail Address:_______________________________________

Business Phone Number:_______________________________________

2. No-------------------------------------------------------------------------