Attachment 5 - Version B Question-By-Question Justification

ATTACHMENT 5:

QUESTION-BY-QUESTION JUSTIFICATION

VERSION B QUESTIONNAIRE

Driving Activity

Q1 Each respondent in this survey will be asked a screening question to determine whether he or she is a driver. Question 1 establishes how often the respondent usually drives a motor vehicle. Those who drive even a few times a year qualify for the driving portions of the survey.

Respondents who report they never drive will be skipped out of the parts of the interview about driving behaviors, since the questions are not appropriate for them.

Vehicle Type

Q2 This question identifies the respondent's "usual" driving vehicle. It focuses the respondent on a particular vehicle when answering ensuing questions on restraint type and use. Anchoring these later questions to a specific vehicle is designed to improve the accuracy of the collected data. The data will also be used to ascertain if restraint use patterns vary by vehicle type.

Seat Belt Type

Belt use patterns may relate to the type of restraint system within the vehicle. These items will identify the seat belt system in the respondent's usual driving vehicle. The information will be compared to reported belt use.

Q3 Question 3 asks if the seat belts installed in the vehicle are lap only, shoulder only, or both lap and shoulder.

Q4 In those cases where the restraint is comprised of both a lap and shoulder belt, Question 4 asks if they are one piece or two separate belts.

Seat Belt Use

These questions obtain basic data on seat belt use that will be related to other areas addressed in the questionnaire.

Q5 This question asks how often respondents wear their seat belt when driving. The obtained data will provide a general measure of seat belt use.

Q6/7 Historically, seat belt use is over-reported in surveys; i.e., persons typically say they "always" wear the belt. This also occurred during questionnaire testing. Yet subsequent probing often revealed that the same respondent had failed to wear his/her seat belt at some point within the last couple of days. This led to inclusion of the probe question into the questionnaire (Question 6).

Question 6 asks respondents when was the last time they did not wear a seat belt while driving. The item will provide information on the over-reporting of belt use in the previous question. Question 7 asks those who ‘don’t know’ when they last failed to wear their belt to say whether they ever did not wear it in the past year. This will determine whether they are true ‘all the time’ belt users or else occasional users.

Children In Household

Data on the children in the household is required to determine which questionnaire items on child restraint use it is appropriate to administer to the respondent. Moreover, the data will be used to select a specific child about whom to ask restraint usage questions.

Q8 The series starts by asking respondents the number of children living in the household. This question will screen out from later child-related questions those respondents who do not live with children.

Q9a/b/c Respondents living with children will be asked the age (Q9a), sex (Q9b), and their relationship (Q9c) to each child in the household. Those not reporting children under age 13 will be skipped out of all car seat questions except a short series asking if they ever drive with a young child in the vehicle (Q12-15) and a later series about child restraint laws and their enforcement (Q89-92).

The respondent's relationship to each child in the household will be obtained to determine if the respondent is a parent. Parents of children under age 13 will be directed to a module asking questions on car seat use. If there is more than one child under age 13 in the household, the survey will randomly select one child about whom to ask car seat questions, using the child’s age as the variable for random selection. The survey will also be able to assess child restraint use by age, and whether there are differences in restraint use by boys and girls.

Non-Parent of Young Child in Household

Non-parents of young children living in the household may or may not be actively involved with the children. The appropriateness of administering later questions on child car seats to respondents will depend on whether their relationship includes driving with the children in the vehicle with them.

Q10 Question 10 asks if the respondent ever drives with the child(ren) in the vehicle. If the answer is "yes," then the respondent is directed to the detailed question series on car seat use. If "no," then the respondent does not go through the detailed module on car seat use (unless the respondent is the parent of a young child with whom the respondent does not live but whom the respondent occasionally drives).

Q11 Question 11 identifies the children whom the respondent drives in cases where there are multiple children in the household. The information will be used to select a specific child upon whom to focus ensuing car seat questions.

No Child Under Age 13 In Household

Respondents not having children under age 13 in the household, or who have children of that age in the household but do not drive them, will be asked a few questions to ascertain if they ever drive with a young child or infant in the vehicle with them. This information will be used to identify groups who may be appropriate targets for car seat information campaigns, but are not conspicuous targets because they do not live with children.

Q12 Question 12 identifies whether the respondent has driven a child under age 13 in the past year. If "yes," then the respondent is asked Questions 13 through 15. If "no," then the respondent is skipped past most of the extensive child restraint module. Those respondents will only be administered a few final questions about attitudes toward the law.

Q13/14a Question 13 asks respondents how frequently they drive with children under age 13 and Q14a asks their relationship to the children. This again facilitates development of targeting strategies by identifying which categories of adults most frequently drive children that they don’t live with.

Q14b/c Respondents who are parents that do not live with their children, but still drive them, will be included among those respondents administered the detailed series of questions on child restraint use. If the respondent records “child” or “stepchild” in Q14a, then the respondent will be directed to the child restraint module. But first the respondent must indicate the age (Q14b) and sex (Q14c) of the child so that the survey can select a specific child about whom to ask questions if there is more than one eligible child within the household.

Q15 Question 15 asks respondents the frequency of restraint use by children riding with them. This will identify if there is a safety problem when non-household members drive young children. Moreover, data will be analyzed to determine if respondents who report infrequent restraint use by children comprise distinct groups.

Parents and Caregivers of Young Children

Parents of children under age 13, as well as non-parents living with a child in that age range that they drive, will be asked a detailed set of questions about child restraint use. The remainder of the sample will skip to Question 89. If there are multiple children in that age range in the household, a single child will be randomly selected as the referent for the questions.

Height And Weight

These questions collect data on children's weight and height. This information will be compared to type of restraint use to determine if respondents are using the appropriate restraint system for the child's size. If substantial inappropriate use is found, this would suggest the need for an educational program teaching adults how to select appropriate car seats for their children.

Q16-17 These questions obtain the selected child’s weight. If respondents can’t give a specific weight (Q16), then they are asked to respond according to given ranges so that later analysis can obtain some general assessment as to whether the child is using the appropriate restraint. In obtaining review comments by professionals working in the child passenger safety (CPS) area, interest was expressed in learning how people determined the given weight of the child (Q17). Since the appropriateness of a child restraint is dependent on the child’s size, the reliability of parents’ methods of determining size is important.

Q18-19 These questions obtain the selected child’s height. They parallel the Q16 and Q17 weight questions, and are asked for the same purposes.

Frequency of Car Seat Use

Q20/21/a Question 20 obtains the frequency with which children under age 13 use car seats when riding in a vehicle. Besides providing a fundamental safety measure, this item also serves as a screener question for entry into an extensive series of car seat questions. As with Q6 for seat belts, Q21 will ask the last time the child did not use a car seat while riding with the respondent. This is particularly important to make sure that respondents are not inadvertently skipped out of later questions about non-use of car seats because their response to the previous question masked instances of non-use. If respondents can’t pinpoint an exact time, Q21a asks if there was an instance of non-use in the past year. If there was, then the respondent will later receive non-use of car seat questions.

If the child never rides in a car seat, respondents will be skipped past car seat usage questions to Question 76, which asks the reasons why the child does not ride in a car seat.

Type Of Car Seat: Booster Versus Other

It is important to determine the type of car seat being used by the child in order to assess whether respondents are placing the child in the correct type of seat for the child's size. This will be analyzed by comparing the type of car seat reported by the respondent to the child's age, weight, and height. Evidence of incorrect use would signal a serious problem requiring programmatic attention.

Q22-25 Question 22 asks if the child uses a buckled harness when riding in the car seat. If “yes,” then the respondent is asked whether the seat is used in a front facing or rear facing position (Q23), which will allow the survey to determine if the child is using an infant seat or a front facing car seat. If the child isn’t using a buckled harness, then the respondent is asked if the child is using a booster seat (Q24). These questions should encompass the different types of child restraints. However, determining the type of seat used by a child is difficult in a survey, and some respondents may not be able to give an answer to one or more of these questions. Question 25 poses an open-ended question to respondents asking the type of seat the child uses, which should allow determination of the remaining seats and a check of the responses given to the preceding questions.

Usual Position in Vehicle

NHTSA strongly urges the public to place car seats in the back seat because that is where children are safest. The following questions will be used to assess how effective NHTSA has been in communicating that message.

Q26 This question identifies the seating positions available in the usual vehicle. This includes identifying whether the usual vehicle even has a back seat.

Q27 Question 27 asks if the car seat is usually placed in the front or back seat. The relationship of this data to other data collected by the survey will be assessed to see if predictors of front versus back seat positioning can be identified.

Q27a If respondents indicate "back seat" in Question 27, they then will be asked if the car seat typically is behind the driver, behind the passenger, or in the middle.

Frequency Of Transporting Own Child

Q28 Question 28 asks the frequency with which the respondent has driven the child in a recent time period (past 30 days). This will permit segmentation of the sample into high frequency and low frequency transporters of children so that those two groups can be compared on other factors related to child occupant protection. In addition, frequency of parent/caregiver transporting of children will be compared to the frequency that non-household members transport the children.

Others Transporting Child

It is important to assess the extent to which persons outside the household drive young children so that it can be determined if there is a need to target educational messages to additional audiences. Earlier in the survey, respondents not living with a child under age 13 in the household were asked how often they drive young children (Q12). The present sequence of questions, asked of persons living with a young child, collects information on ‘outsiders’ transporting children from the vantage of the individual child.

Q29/29a These questions are designed to get as accurate an estimate as possible about the frequency with which young children are driven by persons outside the household. Question 29 restricts the time period under consideration to the past 30 days while Question 29a asks how many days during that 30-day time period the child was transported by someone outside the household.

Q29b This question asks the relationship of the outside driver(s) to the child. The data will be used for targeting decisions.

Perception of Safe Placement

Q30 Question 30 asks respondents where they believe it is safest to place the car seat in the vehicle. The data will show whether the public is aware of the increased safety of back seat positioning. In addition, comparison of responses to this item with responses to Question 27 will indicate if people are knowingly placing children in less safe seating positions. If respondents are found to be placing children in less safe seating positions out of ignorance, this would suggest a need for education. If it occurs, but not as a result of ignorance, then other types of interventions are needed.

Acquisition Of Car Seat

This series of questions identifies the channels through which persons acquired car seats. As indicated below, the methods and channels of acquisition can have safety and targeting implications.

Q31 Question 31 asks if the car seat was acquired new or used. Older seats could cause safety problems as they are more likely to be damaged or built to lesser standards.

Q32 Question 32 identifies how respondents acquired the car seat, which has implications for educational and targeting strategies.

Q33-35 New car seats typically come with instructions for registering the car seat so that the manufacturers have an address to which they can later send new safety information, as well as contact the owner if a recall becomes necessary. This series of questions asks if the car seat came with a registration card (Q33) or provided an online address for registration (Q34), and whether the respondent registered the car seat (Q35).

Q36 Despite the importance of car seat registration, many parents fail to register the car seats they purchase. NHTSA would like to find out what could be done to motivate parents to register the seats. This question directly solicits that information by asking parents and others that drive young children for their suggestions.

Q37 This item checks the respondents’ awareness of an expiration date or manufacture date on the car seat.

Acquisition Of Knowledge on Car Seat Safety and Use

Q38a-i Question 38 asks respondents where they obtained their information on the need to use car seats. This item will identify channels of communication that the safety community may be able to tap into for distribution of safety information to the public. NHTSA may also find that these information sources require education themselves.

Q39 Child passenger safety campaigns to increase child restraint use and educate the public about the correct restraint for the child rely on messages transmitted through the media to intended targets. NHTSA, particularly its Office of Consumer Information, has a need to know if its national campaign messages are reaching the public. This is a placeholder question that will ask respondents if they have seen or heard NHTSA’s CPS campaign message current as of the time of the survey.

Q40/a Question 40 asks how respondents learned to attach the car seat. The data will be analyzed to determine if there is any relationship between how respondents learned to attach the seats and reported problems they have in making the attachment. If they learned from a video, NHTSA staff involved in CPS and communication campaigns would like to be able to identify the source of the video (Q40a) in order to determine if it was a video sponsored by the agency, or a video of which NHTSA is not aware.

Q41-43 Written instructions are a primary method for communicating proper use to consumers. Consequently much thought and effort is applied to their development. Data collected by Questions 41-44 will indicate if that effort is effectively achieving its objective, or whether the method for instructing persons on proper use of car seats needs to be improved. Question 40 will have identified those respondents who learned how to attach the car seat by reading the instructions. For those respondents who did not say they learned to attach the seat from the instructions, Question 41 asks if they read the instructions at all. If they had read the instructions (as determined by Questions 40 and 41), Question 42 asks the source of the instructions (i.e., instruction manual, instructions on car seat box, instructions on label of car seat, online instructions, or video). This item will clarify responses to Question 43, which asks the basic question of whether the instructions were easy to understand. If, for example, respondents say that the instructions were not easy, it would be important to know which instructions they were reading.

Q44 If respondents said they never read the instructions, Question 44 asks if any instructions were available in order to gauge whether it was personal choice or unavailability that was causing people not to read the instructions.

Ease of Attaching Seat

Q45/46 These questions ask if the respondent finds it difficult to attach the car seat to the vehicle (Q45), and if so, what makes it difficult (Q46). The items will identify technical, logistical, and human factor problems.

Q47 This item asks what parents are using to attach the car seat to the vehicle. If they are not using the current lower anchors technology, as determined by responses to questions 67 through 69, this question will identify what they are using.

Q48/48a An alternative approach to obtaining information on difficulty in seat attachment is to focus the question on a particular outcome that denotes difficulty or ease of use. Question 48 does so by asking respondents if they have ever driven with the child in the car seat and later found that the seat was not securely attached. This moves respondents away from looking at the question as a possible assessment of their own skills, which could affect responses. If respondents say that this had occurred, a follow-up question (Q48a) asks the reason why this happened.

Q49 During NHTSA review of the questionnaire, there was an interest by those involved in CPS in learning the overall confidence that parents have in attaching the car seat to the vehicle. That confidence level has implications for the ability to encourage change in behavior if a needed change is detected, and how messages would have to be constructed.

Q50-52 Use of tethers that are on current car seat systems enhances the safety of the child. An important question that safety professionals want answered is whether parents are using the tethers. Question 50 initiates the question sequence by asking if the car seat that the respondent is using has a tether on the back of the car seat, near the top. If it does, then the next question asks the frequency that the respondent attaches the tether when the child is riding in the seat (Q51). If the tether is not attached on all trips, respondents are asked why the tether is not used (Q52)

Ease of Buckling In Child

Q53/54 These questions ask if the respondent finds it difficult to buckle the child into the car seat (Q53), and if so, what makes it difficult (Q54). As with the attachment-related items above, the data will indicate if there are problems that need to be addressed.

Q55 Question 55 asks if the child has ever gotten himself or herself out of the car seat while the vehicle was being driven. This will provide information on the extent to which parents experience difficulties in keeping their children restrained.

Transferring Car Seat From Vehicle To Vehicle

Q56 Some parents and caregivers have to continually move car seats from vehicle to vehicle in order to transport their children. This could affect the quality of car seat installation, the diligence of car seat use, and at times the availability of the car seat. Question 56 asks the frequency with which the respondent moves child car seats from motor vehicle to motor vehicle in order to help identify parents and caregivers who may need more assistance and attention.

Inspection Stations

A development in child occupant protection has been the establishment of inspection stations, which are specific places where parents and others can go to have a trained person inspect whether they are correctly installing their car seats and buckling in their children. However, there are many unknowns about how this is being done nationally, particularly with respect to the quality of service being provided. This survey will obtain basic data concerning this activity.

Q57/58 Respondents will be asked if they ever have used an inspection station (Q57), and if so, who sponsored it (Q58). The first item will provide a measure of the extent to which these facilities are being used. The second item will provide information that can be compared to the agency’s current knowledge as to who is providing inspection station services.

Q59 It is important for NHTSA to determine the most effective channels for communicating to the public the presence of inspection stations. This item will provide information on that subject by asking respondents who had gone to an inspection station where they had learned about it.

Q60-62 Question 60 asks if the checker (technician) found anything wrong with how the respondent was using the car seat. Studies of misuse of child restraints have found large majorities of all child restraints misused in some way. If respondents tend to report that nothing was found that needed correction (as has occurred on previous administrations of this survey), this might suggest a communication problem between technicians and parents. To explore this further, Question 61 asks respondents if the checker suggested they do anything differently. If respondents say that there was nothing wrong with how they attached the seat, but that the technicians asked them to do something differently, this may mean that parents are not interpreting their errors in the way the technicians intended. Question 61a asks respondents what the technicians recommended they do differently in order to assess what type of corrective information the public is absorbing. Question 62 specifically asks if the technician suggested getting a different car seat in order to get a measure of how many people were coming in using the wrong restraint for the child.

Q63 An important part of a car seat check is having the parent or caregiver demonstrate to the checker how to attach the seat. Question 63 asks whether this was done.

Q64 The Standardized Child Passenger Safety Training Course specifies that parents should be the last ones to secure the child and install the seat at the car seat check. This question checks whether that is being done by asking if the respondent was the last person to adjust the car seat.

Q65-66 Question 65 asks the basic question of whether parents/caregivers felt they got anything of value from going through the inspection station. Respondents are asked to identify which of three statements best describes how they felt when they left the station. The statements range from “zero” benefit to full confidence in knowing how to attach the seat correctly. If respondents express less than full confidence, then the next question asks what they are most unsure about (Q66).

Use of Lower Anchor System

Current car seat technology uses lower anchors to secure the car seat in place. This section examines use of lower anchors.

Q67 This question explores if there is a compatibility issue with the respondent’s vehicle by asking if the vehicle has lower anchors. It’s possible that a respondent’s vehicle may pre-date the implementation date when lower anchors for a specified number of seating positions were required in new passenger cars, light trucks, and multipurpose passenger vehicles. However, because the implementation date was more than 10 years ago, a negative response may mean that the respondent is unaware that the anchors are present.

Q68 Respondents who have vehicles with lower anchors are asked how often the car seat is attached to the lower anchors when they are driving in order to get a measure of the likelihood of usage.

Q69 The last question in the series asks if they have had difficulties fastening the car seat into the lower anchors. If there are difficulties, some detail about them should have been entered earlier in response to Q46, which is an open-ended question asking what is difficult about attaching the car seat to the vehicle.

Children That Use Car Seats, But Less Than All The Time

Q70a-h If the referent child rides in a car seat, but not all the time, respondents are shown a list of possible reasons for the car seat non-use. These reflect hypotheses and common anecdotal justifications for non-use. The respondent agrees or disagrees with each as to whether it is a reason why the respondent’s child on occasion does not ride in a car seat. The respondent is then given an opportunity to add reasons to the list. Analyses will assess the prevalence of the specified reasons, and identify distinct problems requiring attention.

Q71 This question asks the location of the child in the vehicle when not riding in a car seat. It will identify whether the child usually sits in the back seat or in the more dangerous front seat. Information obtained by some of the early MVOSSs showed a quick response by the public to move children to the back seat following media attention about front seat child injuries and fatalities from deploying air bags. This question tracks whether further progress is being made, or whether progress has stopped, or whether the situation has retrogressed.

Q72-74a-f This series of questions asks about seat belt use by children when they are not riding in car seats. Question 72 asks how often the child is buckled in a seat belt when not riding in the car seat. It will show the breakout as to what proportion of children rotate between the car seat and a seat belt, and what proportion are allowed to ride unrestrained. Based on past MVOSSs, most of the children will likely be said to be using a seat belt when not riding in the car seat. The following questions (Q73/Q74a-h) will check if the seat belt appropriately fits the child. Question 73 will first identify the type of belt. Question 74a-f will then refer to specific indicators of correct or incorrect fit, such as the shoulder belt going across the child’s neck or face (incorrect). For each item, respondents will indicate whether or not this is something that usually happens when the child wears a seat belt.

Q75 The last question in this series will ask respondents at what age they believe a child is ready to begin wearing a seat belt. The response to this question will be compared to current knowledge about appropriate fit to assess the extent to which parents may have unreasonable expectations.

Child Never Uses Car Seat

This series of items will be asked only of respondents whose referent child never uses a car seat.

Q76a-j Respondents will be shown a list of possible reasons why the respondent's referent child never rides in a car seat. The respondent agrees or disagrees with each, and lastly is given an opportunity to add reasons to the list. The results will identify deterrents to proper child restraint use that need to be addressed. If one reported reason for non-use of a car seat is that the respondent doesn’t have a car seat, then Question 76j will follow up by asking why the respondent doesn’t have one. This will identify impediments to ownership.

Q77 This item asks if the child usually sits in the front seat or the back. As with Question 71, it provides a measure of the continuing effectiveness of the message championed by NHTSA and other safety organizations to have children sit in the back seat for safety reasons. It does so for a different group of children.

Q78-80f These questions serve the same purpose as the Question 72 through 74f series (measure of restraint use and appropriateness of belt fit), but this time for children that never ride in a car seat.

Q81 The last question in this series will ask the respondents at what age they believe a child is ready to begin wearing a seat belt. As with Question 75, the response will be compared to current knowledge about appropriate fit to assess the extent to which parents may have unreasonable expectations.

Booster Seats

Results from the baseline survey showed that children are being prematurely graduated from car seats to seat belts, before the belts fit them properly. This raised the question as to whether parents and other caregivers are adequately knowledgeable about booster seats.

Q82 This item asks parents and caregivers the basic question of whether they have ever seen or heard of booster seats. If not, this means a major educational effort is needed.

Q83-85 Here, the respondents are asked if they have ever used booster seats (Q83) and, if so, at what age (Q84) and weight (Q85) did they begin using them for their children. From this data, NHTSA will be able to determine if people are not using booster seats even when they are aware they exist, and how old and large children typically are when usage begins to occur.

Q86 Past information obtained from parents indicated that a number of them didn’t understand the purpose of booster seats and how they function. This question will measure the extent to which this is the case by asking respondents the most important reason for using the seat to see if they give a safety-related reason.

Q87 This question will ask respondents how they would decide that a child is ready to be graduated from a car seat to riding in a seat belt only. It will assess the extent to which parents are basing the decision on appropriateness of fit, which is the message communicated by the CPS community.

Next Restraint System For Child

There is a sequence of safety restraint devices through which children should progress over time. It is important that NHTSA determine if parents and caregivers are breaking this sequence and thereby increasing the risks to the child. If they are breaking the sequence, NHTSA must also determine where in the sequence this is occurring in order to pinpoint intervention points.

Q88 This item, administered only to respondents whose child at least on occasion uses a car seat, asks what type of restraint system the child will be using next. Combined with earlier collected data on the type of car seat currently being used, this information will help to identify whether the respondent plans to skip the child past the next appropriate restraint device.

Attitudes Toward Child Restraint Laws And Enforcement

Success in enacting or strengthening safety legislation is heavily dependent on the level of public support for the laws. Building public support thus becomes an important element in strategies undertaken by the safety community. Strategic decisions on how best to build this support require knowledge of where the public stands in its attitudes toward the laws, including appropriate penalties for violations. The following questions collect that information.

Q89 General deterrence strategy heavily relies on the perception of a credible threat of negative consequences for committing proscribed behavior. Question 89 assesses whether respondents perceive a reasonable likelihood that a driver will be ticketed if driving a child that is not riding in a car seat or using a seat belt.

Q90 Question 90 asks what the fine should be for violation of car seat laws. This information will gauge public support for strengthening sanctions for car seat violations, and provide a measure of the seriousness with which the public views car seat laws.

Q91/92 These questions examine the level of public support for extending mandatory restraint use to children too large to sit in a car seat. Question 91 focuses on the transition period by asking if children should be required by law to wear seat belts when they have outgrown car seats. Question 92 asks if there is any age limit after which children should not be required by law to wear seat belts.

Emergency Medical Services (EMS)

This section of the questionnaire will obtain information important to the efforts of the EMS community. People involved with the functioning of the EMS system, including NHTSA's Office of Emergency Medical Services, are concerned about resources available to the system, the effectiveness and efficiency of interaction between the public and the EMS system, the public’s expectations regarding EMS, and the public’s response to emergency situations.

Q94-95 Many communities treat EMS differently than they treat law enforcement and fire department services. In particular, while most communities pay all costs for their police and fire department services, many do not reimburse EMS for the full cost of EMS services. In those cases, the EMS systems must seek funding from additional sources. But they still may run deficits or be forced to reduce services. These questions will document whether the majority of the public agrees or disagrees with communities treating EMS in a manner different from other critical community services. Question 94 asks if EMS should be considered an essential government service similar to police and fire. Question 95 asks if communities should fully fund their EMS services, similar to police and fire.

Q96-98 These questions collect data on the public’s personal experience with 9-1-1, or other local emergency numbers. The series will obtain information on whether respondents ever called the system (Q96), how recently they last called (Q97), and the emergency service provider needed (Q98). These questions will provide national estimates of demand on the 9-1-1 system for various types of services.

Q99 While 911 Call Centers can automatically identify the location and phone numbers of incoming calls from landline phones, this is not necessarily the case with cell phones. Question 99 explores whether the public is aware at all of this issue.

Q100 Question 100 asks if the respondent would expect 911 to give instructions on how to provide care while the caller is waiting for an ambulance to arrive. This is a capability for which Emergency Medical Dispatch would require training and certification, but it doesn’t exist everywhere. The question in effect is asking if the respondent believes it important that they have this capability.

Q101 Question 101 asks the respondent how acceptable it is for the 911 operator, after applying a standardized protocol to assess the situation called in, to decide not to send an ambulance but instead turn the call over to a certified nurse to provide medical instructions. The question addresses expectations of the public regarding how 911 should respond and confidence in its decision making.

Q102 Question 102 is another item that addresses confidence in the system, this time asking about a situation where an ambulance is dispatched. Respondents are asked how confident they would be in the competence of the emergency workers that arrive. Confidence in the local EMS system may affect whether persons immediately call EMS during a medical emergency.

Q103 The EMS field would like to know the public’s opinions regarding expanding the role of Paramedics and Emergency Medical Technicians to perform non-emergency activities if the situation to which they have been called is determined not to be a medical emergency. This question poses several non-emergency activities to assess whether the public approves or disapproves of the expanded role.

Q104-107 There is renewed interest in the EMS field in bystander care. This series of questions asks respondents for details regarding their past experience in situations where someone else was having a medical emergency in order to understand how people react in different situations. Respondents are first asked how long ago they were in a situation where someone else was having a medical emergency (Q104) and the cause of the medical emergency (Q105). They then are asked about the presence of other people in the situation (Q106). The presence of multiple people could affect responding in some way. Lastly, they are asked what they did (Q107).

Q108 Events such as the Boston Marathon bombing have generated an interest in how people respond to disaster situations involving injuries. That information is important to know in developing plans for crisis response and area management. Question 108 posits a hypothetical situation involving an explosion where the respondent is physically capable of offering assistance. It asks what the respondent would likely do during the first few minutes after the explosion.

Q109-110 These questions identify impediments to people offering assistance to injured individuals. Question 109 asks what concerns the respondent would have in helping an injured person in the hypothetical situation previously described. Question 110 explores the benefit of having a Good Samaritan law in removing a barrier to providing assistance.

Q111 In a large disaster, the system will overload from too many calls. If people couldn’t get through to 911 due to a system overload, it’s important for the EMS system to know the first alternative that people would use to obtain help so that the system can respond. This question asks respondents the communication method they would use.

Q112-115 This section of the survey asks respondents if they would be willing to pay more than they currently pay for 911 call services (Q112), and if so, how much more (Q113). Respondents are then asked if they are willing to pay more for the EMS system (Q114), and if so, how much more (Q115). As with the initial questions in the EMS module, these items speak to concerns about the availability of resources to the EMS system. They explore whether the public is willing to entertain a small hike in their payments to support EMS.

Q116 This question asks if the respondent would be interested in receiving training to become an emergency medical services provider. The information will be useful in developing recruitment strategies for service providers.

Use of Car or Cellular Phones

Cell phones are an important tool for reporting emergencies on the road. At the same time, there are concerns that their use during the operation of the vehicle may distract the driver from critical driving tasks. This series of questions collects national statistics related to both issues.

Q117 This item is a general screener question to determine if the respondent tends to carry a cell phone in the vehicle s/he usually drives. If no, then the respondent skips out of the remainder of the series.

Q118-120 A major issue regarding phone use while driving is the level of distraction to which drivers subject themselves. Question 118 asks how often the phone is left on to receive calls while driving, while Question 119 asks how often the respondent answers those calls, providing an indication of the extent to which drivers are open to interruptions in the driving task. Question 120 gauges the general proportion of trips that the respondent tends to talk on the phone while driving.

Q121-123 Enactment of laws prohibiting cell phone use while driving, and their enforcement, have become major components in campaigns to prevent this behavior. But enforcement requires an observed infraction that can be subjected to enforcement, which is why laws have been written for handheld use. This raises the question as to whether people are gravitating to hands free use, even though this still produces distraction for the driver. These questions provide information on hands free use versus holding the phone by hand (Q121), including their frequency of hands free use (Q121a), their use of headsets or speakerphones for talking (Q122), the time during the driving task when they put the earpiece or headset on (Q122a), and how they typically dial the phone while driving (Q123).

Q124 This question will identify the proportion of the population that believes they are living in a State having a law prohibiting talking on a handheld cell phone while driving.

Q125/a The safety benefits of car phones also need to be quantified. These items ask respondents if they have ever used a cell phone to report an emergency while they were driving or riding in a motor vehicle (Q125), and if so, what kind of emergency did they call about (Q125a). The results will provide a national statistic of public use of cell phones to reach the EMS system while traveling in a motor vehicle.

Bystander Care at a Vehicle Crash Scene

Q126 This question obtains information on impediments to bystander care specific to a motor vehicle crash situation.

Crash Experience

Crash experience may play a profound role in influencing attitudes and behavior related to driving and occupant protection. This section of the questionnaire obtains information to test that hypothesis. Moreover, the data will be used to identify high risk groups in need of targeted programmatic activity, as well as stress points on the emergency response and rehabilitation services infrastructure.

Q.127 The section begins with a question (Q127) asking if the respondent had ever been injured in a motor vehicle crash. Respondents are instructed to only count injuries that required medical attention. Those never having been injured are skipped past all remaining crash injury questions.

Q128 Question 128 identifies the number of times that respondents have been injured in crashes. The data will be used to identify high risk groups, and linked to other data in the survey for targeting purposes.

Q.129 Question 129 asks how long ago the (most recent) crash occurred. The data will be used to assess crash recency effects on attitudes and behavior, and to develop crash injury rates for specific periods of time.

Q130-131 Question 130 asks whether the respondent was a driver, passenger, pedestrian, bicyclist or motorcyclist when involved in the crash. Question 131 then asks the drivers and passengers if the respondent was wearing a seat belt at the time of the crash. Combined with data collected by ensuing survey questions, these items provide information about injury outcomes associated with seat belt use for both drivers and passengers.

Q.132-135 These items collect data on the immediate medical treatment received by the respondent. Information on the source of treatment (Q132), use of emergency medical transport (Q133), and hospitalization (Q134/135) allow NHTSA to assess the demand placed on emergency medical services by vehicle crashes.

Q136/a Besides immediate medical treatment, crash injuries can require continuing medical treatment and rehabilitation. Question 136 asks if follow-up treatment for their crash injuries was needed, while Question 136a asks where this follow-up treatment was obtained. Besides providing information on the extent to which crash injuries require follow-up attention and where that medical treatment occurs, this data will be combined with data from the previous questions to determine if seat belt use made a difference in whether follow-up care was needed.

Q.137 This question provides data on the seriousness of the injuries experienced by the respondent. It asks if the crash caused short term and long term incapacitation. This information will allow NHTSA to assess the impact of crash injuries on life activities.

Q.139 The previous question was asked in reference to the respondent’s most recent crash injury experience. This question will find out if the respondent was ever physically incapacitated from a vehicle crash. Thus Question 137 will provide the likelihood of being incapacitated from a crash injury, while Question 139 will show what proportion of the population has at some time experienced a crash injury that led to their being unable to perform some basic life activities.

Demographic Data

Most of the remaining questions collect demographic information on respondents. The gathered data will be cross-tabulated against selected attitudes and behaviors to identify differences between major population groups. The results will provide NHTSA with the knowledge it needs to make decisions on how best to target programmatic activity towards specific audiences. The data also will be used to weight the sample so that it accurately represents the population of the United States.

Q142 Question 142 will record the respondent’s sex.

Q.143 Question 143 will record the respondent's age.

Q.144-145 These questions will record the respondent's ethnicity (i.e., Hispanic origin, Q144) and race (Q145).

Q146 Question 146 will record the respondent's education level.

Q147 Question 147 will record the respondent's household income.

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