Attachment D
Local EMS Provider Survey – Computer Assisted Telephone Interview
Form Approved
OMB No. 0920-XXXX
Exp. Date XX/XX/XXXX
Local EMS Provider Survey--Computer Assisted Telephone Interview
[Screening Script – See Attachment C]
[Consent Script: Verbal – See Attachment D-1]
BEGIN SURVEY QUESTIONS
ORGANIZATION
CONFIRMATION
Before I ask you the survey questions I first need to confirm your organization’s information.
Our records show that your organization name is:
< Organization Name > is this correct?
YES GO TO QUESTION 1b
NO ASK Q1a
DK ASK Q1a
REF ASK Q1a
1a. What is your organization name?
________________________________
ENTER REVISED ORGANIZATION NAME
DK
REF
Public reporting 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 Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX)
1b. CODE BELOW OR IF NOT OBVIOUS THEN ASK: Is this organization a Fire Department?
YES
NO
DK
REF
And our records show that the home base address for your service is <Organization Address including zip code> is this correct?
YES IF STATE IS AR, FL or OR, THIS STATE HAS NO SUB-STATE STRUCTURE SKIP TO Q4 OTHERWISE GO TO Q3
NO ASK Q2a
DK SKIP TO Q3
REF SKIP TO Q3
2a. What is your organization’s address? (The home station.)
________________________________
ENTER REVISED STREET ADDRESS
____ ____ ____ ____ ____ ____ ____
STATE ZIPCODE
IF STATE IS AR, FL or OR, THIS STATE HAS NO SUB-STATE STRUCTURE SKIP TO Q4 OTHERWISE GO TO Q3
SERVICE
AREA AND SERVICE
In this first set of questions I will ask you about your organizations service area and services.
Within the state, which state EMS administrative region are you in?
REGION __________________
DK
REF
4. What counties are included in your service area, including the home station county? As you provide each name, I will ask you if that entire county is within your service area or only part of it.
ENTER FIPS STATE AND COUNTY CODE FOR EACH COUNTY: CHECK AGAINST HARD COPY LIST FOR CORRECT CODES. MAKE SURE TO INCLUDE THE CORRECT STATE CODE IF THEIR SERVICE AREA CROSSES STATE LINES AND IS NOT WITHIN THE SAME STATE AS THE HOME STATION.
DON’T KNOW COUNTY NAMES
REFUSED TO GIVE COUNTY NAMES
(Home Station) FIPS STATE1 ___ ___ FIPS COUNTY1 ___ ___ ___ All Part
FIPS STATE2 ___ ___ FIPS COUNTY2 ___ ___ ___ All Part
FIPS STATE3 ___ ___ FIPS COUNTY3___ ___ ___ All Part
FIPS STATE4 ___ ___ FIPS COUNTY4___ ___ ___ All Part
FIPS STATE5 ___ ___ FIPS COUNTY5___ ___ ___ All Part
FIPS STATE6 ___ ___ FIPS COUNTY6___ ___ ___ All Part
FIPS STATE7 ___ ___ FIPS COUNTY7___ ___ ___ All Part
FIPS STATE8 ___ ___ FIPS COUNTY8___ ___ ___ All Part
FIPS STATE9 ___ ___ FIPS COUNTY9___ ___ ___ All Part
FIPS STATE10 ___ ___ FIPS COUNTY10___ ___ ___ All Part
5. Approximately how large is your service area in sq. miles?
RECORD PARTS OF MILES IN DECIMALS
IF R SAYS THEIR SERVICE AREA IS LESS THAN 1 SQ MILE, BUT IS NOT SURE OF THE EXACT SIZE, ENTER 0.5 BELOW. DO NOT PROBE FOR EXACT FRACTIONS OF A MILE IN THIS CASE.
______ # OF SQUARE MILES (approximate)
DON’T KNOW
REF
6. Would you say the population of your service area is…?
10,000 or fewer
Greater than 10,000 up to 50,000
Greater than 50,000 up to 100,000
Greater than 100,000
DK
REF
7. Which of the following descriptions best matches the population distribution of your service area?
All rural
Mixed—more rural than urban
Mixed—more urban than rural
All urban
OTHER (Please describe)__________________
DK
REF
[FOR NON FIRE DEPARTMENTS]
8a. What was your total EMS call volume in 2006? (An estimate is OK.)
[FOR FIRE DEPARTMENTS]
8b. What was your total EMS call volume in 2006? Please include only EMS calls. Do not include fire or other calls where there was no EMS response. (An estimate is OK.)
IF THE FIRE DEPARTMENT R SAYS THEY CANNOT SEPARATE FIRE VS. EMS CALLS RECORD THE NUMBER OF CALLS THEN NOTE THIS IN BLAISE COMMENTS ON THIS Q
[PROBES AND DEFINITIONS FOR ALL TYPES OF ORGANIZATIONS]
IF RESPONDENT DOESN’T KNOW 2006 VOLUME, ASK:Can you please tell me the call volume for some other recent 12 month period (e.g., the last 12 months or the most recent Fiscal year)?
IF THEY KNOW SOME OTHER RECENT 12 MONTH PERIOD THEN CHECK THE ”# OF CALLS PER YEAR BOX” AND RECORD THE NUMBER OF CALLS.
IF THEY STILL DON’T KNOW ANY OTHER 12 MONTH PERIOD THEN PROBE WITH OTHER RESPONSE CATEGORIES AS LISTED IN ORDER BELOW AND CHECK THE APPROPRIATE BOX FOR THE NUMER OF CALLS RECORDED
Number of calls_________
2006 call volume
# of calls per Year (this includes the last 12 months or the most recent Fiscal Year)
# of calls in the last Quarter
# of calls per Month
# of calls per Week
Other time period (Please describe):____________________________________
DK – VOLUME OF CALLS OR TIME PERIOD
REF
9. What is the funding basis of your EMS service?
PROBE: READ THE RESPONSE CATEGORIES ALOUD TO R TO SEE IF THEIR DESIGNATION FITS INTO ONE OF THE DEFINITIONS BELOW. IF NONE OF THEM FIT, THEN YOU MAY CODE IT AS OTHER AND SPECIFY THE TYPE. CHECK ALL THAT APPLY
Private for-profit
Private not-for-profit
Public/government
Public/private partnership (mix of public and private funds)
OTHER (specify): ____________________
DK
REF
10. Is your service considered a volunteer service?
YES
NO
OTHER_________________
DK
REF
11. Which of the following categories best describes the organizational placement of your EMS service? READ THE RESPONSE CATEGORIES TO THE RESPONDENT
PROBE: IF AFTER YOU READ THE RESPONSE CATEGORIES TO THE RESPONDENT AND THEY ANSWER “VOLUNTEER RESCUE SQUAD”, ASK THEM AGAIN. “Is your rescue squad (READ RESPONSE CATEGORIES)” TO SEE IF IT MIGHT FIT WITHIN ONE OF THESE CATEGORIES. IF THEY STILL INSIST ON “VOLUNTEER RESCUE SQUAD” THEN RECORD THIS IN OTHER.
Hospital-based GO TO Q13
Fire department-based GO TO Q12
Stand-alone service, e.g., not based in another organization or agency (NOTE: this includes for-profit ambulance companies as well as public stand-alone services, known as “Third Service” in some places) GO TO Q13
OTHER (specify): ____________________ GO TO Q13
DK GO TO Q14
REF GO TO Q14
PERSONNEL
IF AGENCY IS NOT LOCATED IN A FIRE DEPARTMENT (Q1B=NO), SKIP Q12 AND GO TO Q13:
[IF AGENCY IS LOCATED IN A FIRE DEPARTMENT]
12. Approximately what percent of your response personnel (fire or medical) have dual-training as firefighters and EMTs or paramedics?
______ % DK REF
[FOR ALL TYPES OF AGENCIES]
This next set of questions I will ask you about your organizations personnel.
13. I am going to read you a list of types of EMT personnel, Basics, Intermediate and Paramedics. About how many volunteers of each type did your organization have, at the end of last month?
PROBE: IF R SAYS THERE IS SOME OTHER CATEGORY OF EMT PERSONNEL ASK:
Is that another level between Basic and Paramedic?
IF THE R SAYS ‘YES’ THEN INCLUDE THIS TOTAL WITHIN THE INTERMEDIATE CATEGORY UNDER 13B.
IF THE R SAYS ‘NO’ THEN SELECT ‘NO’ FOR Q13D , SPECIFY THIS OTHER LEVEL UNDER Q13E AND RECORD THE THE NUMBER OF THIS OTHER LEVEL IN 13G.
IF NECESSARY PROBE: How many volunteer <TYPE>’s did your organization have at the end of last month?
13a. # Volunteer EMT-Basic_______ DK REF
13b. # Volunteer EMT-Intermediate (or AEMT)_____ DK REF
13c. # Volunteer EMT-Paramedic_______ DK REF
13d. Does that cover all of the EMT volunteers in your organization?
YES GO TO Q14
NO What is/are the other EMT volunteer designation(s)?
13e. Volunteer—other designation - e (specify)_______________ DK REF GO TO 13g
13f. Volunteer—other designation - f (specify) _______________ DK REF GO TO 13h
13g. How many volunteer <OTHER DESIGNATION (13e)> personnel did your organization have at the end of last month?
# VOLUNTEER OTHER DESIGNATION (e)________ DK REF GO TO 14
13h. How many volunteer <OTHER DESIGNATION (13f)> personnel did your organization have at the end of last month?
# VOLUNTEER OTHER DESIGNATION (f)________ DK REF GO TO 14
14. Now, I am going to ask you how many paid FTEs of each type of EMT personnel your organization had at the end of last month? And how many of each type were you actively recruiting, at the end of last month?
ESTIMATES ARE OKAY
PROBE: IF R SAYS THERE IS SOME OTHER CATEGORY OF EMT PERSONNEL ASK:
Is that another level between Basic and Paramedic?
IF THE R SAYS ‘YES’ THEN INCLUDE THIS TOTAL WITHIN THE INTERMEDIATE CATEGORY UNDER 15A.
IF THE R SAYS ‘NO’ THEN SELECT ‘NO’ FOR Q17 , SPECIFY THIS OTHER LEVEL UNDER Q17A AND ANSWER Q18A&B.
14a. How many paid FTEs EMT-Basic personnel did your organization have at the end of last month?
# PAID FTEs EMT-Basic’s ______
DK # PAID EMT-BASIC
REF # PAID EMT-BASIC
14b. And how many EMT-Basic’s were you actively recruiting at the end of last month?
# EMT-BASIC’S ACTIVELY RECRUITING ______
DK # RECR EMT-BASIC
REF# RECR.EMT-BASIC
15a. How many paid FTEs EMT-Intermediate (or AEMT) personnel did your organization have at the end of last month?
# PAID FTEs EMT-Intermediate ______
DK # PAID EMT-INTERMEDIATE
REF # PAID EMT-INTERMEDIATE
15b. And how many EMT-Intermediate’s (or AEMT) were you actively recruiting at the end of last month?
# EMT-INTERMEDIATE ACTIVELY RECRUITING ______
DK # RECR EMT-INTERMEDIATE
REF# RECR.EMT-INTERMEDIATE
16a. How many paid FTEs EMT-Paramedic personnel did your organization have at the end of last month?
# PAID FTEs EMT-PARAMEDIC ______
DK # PAID EMT-INTERMEDIATE
REF # PAID EMT-INTERMEDIATE
16b. And how many EMT-Paramedic’s were you actively recruiting at the end of last month?
# EMT-PARAMEDIC ACTIVELY RECRUITING ______
DK # RECR EMT-PARAMEDIC
REF# RECR.EMT-PARAMEDIC
17. Does that cover all of the paid EMTs in your organization?
PROBE: IF R SAYS THERE IS SOME OTHER CATEGORY ASK:
Is that another level between Basic and Paramedic?
IF THE R SAYS ‘YES’ THEN GO BACK TO 15A AND INCLUDE THIS TOTAL WITHIN THE INTERMEDIATE CATEGORY AND REASK 15B TO MAKE SURE THEY HAVE INCLUDED THIS LEVEL IN THEIR ACTIVELY RECRUITING NUMBERS UNDER THE INTERMEDIATE CATEGORY.
IF THE R SAYS ‘NO’ THEN SELECT ‘NO’ FOR Q17 , SPECIFY THIS OTHER LEVEL UNDER Q17A AND ANSWER Q18A&B
YES GO TO Q19
NO What is/are the other EMT designation(s)?
DK GO TO Q19
REF GO TO Q19
17a. Paid—other designation – a (specify)_____________________
17b. Paid—other designation – b (specify) _____________________
18a. How many paid FTEs <OTHER DESIGNATION (17A)> personnel did your organization have at the end of last month?
# PAID FTE’S —OTHER DESIGNATION (a)________ GO TO 18b
DK # PAID OTHER A
REF # PAID OTHER A
18b. How many <OTHER DESIGNATION (17A)> were you actively recruiting at the end of last month?
# OTHER A ACTIVELY RECRUITING ______ _
DK # PAID OTHER B
REF # PAID OTHER B
IF THERE IS A RESPONSE IN 17B THEN CONTINUE WITH 18C, IF NOT THEN GO TO Q19
18c. How many paid FTEs <OTHER DESIGNATION (17B)> personnel did your organization have at the end of last month?
# PAID FTE’S —OTHER DESIGNATION (B)________ GO TO 18d
DK # RECR OTHER B
REF# RECR.OTHER B
18d. And how many <OTHER DESIGNATION (17B)> were you actively recruiting at the end of last month?
# OTHER B ACTIVELY RECRUITING ______
DK # RECR OTHER B
REF# RECR.OTHER B
DISPATCH
In the next set of questions I will be asking you about how your organization is contacted and how calls are dispatched.
19. Which of the following describe the system capabilities for how your EMS unit is typically accessed in your service area for emergency calls? Is it typically accessed by a(n) …. ?(CHECK ONLY ONE)
READ ALL CATEGORIES.
PROBE: IF R INDICATES MORE THAN ONE MEANS OF ACCESS, PROBE FOR THE ONE MOST COMMONLY USED. IF RESPONDENT SAYS THAT DIFFERENT AREAS HAVE DIFFERENT LEVELS OF ACCESS, THEN INDICATE THIS IN “OTHER.” IF R SAYS E-911-2, CODE THIS UNDER ENHANCED 9-1-1, IF YOU ARE NOT SURE OF THE TERM THEY ARE USING, CODE THIS UNDER OTHER.
Basic 9-1-1 system
Enhanced 9-1-1 system (include wireless 9-1-1 if call shows location) (AKA E-911)
OTHER (specify):_________________
DK
REF
20. I am going to read you a list of activities that the dispatch center for your service area may or may not routinely do. Please say “yes” if the dispatch center routinely does this activity for your service area, or “no” if it does not routinely do this communication activity for your service area.
For your service area, does your communication center routinely… |
YES |
NO |
DON’T KNOW |
REF |
a. Prioritize dispatching (that is, ask a series of questions to determine the proper level of EMS system response)? |
|
|
|
|
b. Provide the caller with specific CPR instructions? |
|
|
|
|
c. Provide the caller with pre-arrival instructions other than CPR? |
|
|
|
|
d. Keep track of responder vehicles with automatic vehicle location technology (e.g., GPS/GIS)? |
|
|
|
|
EMS
SERVICE/SKILLS
Now I would like to ask you a few questions about the level of service and skills that your organization provides
21. What is the highest EMS level of life support for the transport vehicle(s) that supports your emergency medical runs? (SELECT ONE)
BLS (Basic Life Support)
Intermediate or advanced BLS (a level between BLS and ALS)
ALS (Advanced Life Support) or ACLS (Advanced Cardiac Life Support)
DK
REF
22. Do your emergency medical responders (EMTs, paramedics) always have on-line immediate access to medical consultation when they are on an emergency call? (e.g., real time consultations during patient care, whether by radio, telephone, or electronic two-way communication).
Yes, 24 hours a day, 7 days a week
No, less than 24 hours a day
Never
DK
REF
23. Which of the following best describes the medical oversight or control for your service?
Full-time Paid medical director
Part-time Paid medical director
Volunteer medical director
No medical director SKIP TO Q26
DK
REF
24. Is this medical control provided by one physician or by a group, such as an EMS Council or physician advisory board? CHECK ALL THAT APPLY
IF R SAYS THAT SEVERAL PHYSICIANS PROVIDE MEDICAL CONTROL BUT JUST ONE IS ON CALL THEN CODE THIS AS ONE PHYSCICIAN.
One physician
Council or advisory board
OTHER (specify):_________________
DON’T KNOW
REF
25. During the previous four weeks, has a medical director or advisor directly observed or participated in your unit’s EMS activity, such as through training, testing, or accompanying the unit on an emergency call?
YES
NO
DON’T KNOW
REF
HEART
ATTACK AND STROKE
Now I am going to ask you about how your organization handles heart attack and stroke patients.
26. About how many of your patients in a typical month present with each of the following conditions:
IF RESPONDENT GIVES A RANGE, ASK FOR THE AVERAGE IN A TYPICAL MONTH. IF RESPONDENT STILL ONLY GIVES A RANGE CALCULATE AVERAGE AND CONFIRM THIS WITH RESPONDENT BEFORE RECORDING THE AVERAGE.
a. chest pain _______(average number) DK REF
b. cardiac arrest (non-trauma) _______(average number) DK REF
c. suspected stroke _______(average number) DK REF
27. What is the on-scene time benchmark (or: goal) for your service, for each of the following:
(i.e., on scene with patient before transport begins)
a. Chest Pain or Suspected Heart Attack: # of Minutes ______
DON’T HAVE ONE
DON’T KNOW
REF
b. Cardiac Arrest # of Minutes ______
DON’T HAVE ONE
DON’T KNOW
REF
c. Stroke # of Minutes ______
DON’T HAVE ONE
DON’T KNOW
REF
28. When a patient with a suspected heart attack is being transported to a hospital, which of the following is the most commonly used basis for the hospital choice?
There is only one Hospital
Nearest Hospital (when more than one)
Patient request (for a specific hospital)
Hospital with special capabilities such as angioplasty (cardiac catheterization lab)
Other_(specify)_____________________________
DK
REF
29. When a patient with a suspected stroke is being transported to a hospital, which of the following is the most commonly used basis for the hospital choice?
There is only one Hospital
Nearest Hospital (when more than one)
Patient request (for a specific hospital)
Hospital designated as a specialized stroke center
Other_(specify)_____________________________
DK
REF
30. Do you report patient information to the receiving hospital in advance of arrival?
YES
NO
DON’T KNOW
REF
31. I am going to read a list of interventions that are commonly used for pre-hospital care of patients with either non-trauma chest pain or suspected stroke. I will ask whether each level of provider in your organization is authorized to do the following, when appropriate.
First I am going to ask you questions related to medications |
EMT-Basic |
EMT-Intermediate |
Paramedic |
As appropriate for non-trauma chest pain or suspected stroke, please tell me if each of the following provider levels in your organization is authorized to give or do the following: |
|||
a. Assistance with patient’s own aspirin (ASA) |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
b. Aspirin (ASA) from your supply |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
c. Morphine or equivalent |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
d. Assistance with patient’s own nitroglycerin |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
e. Nitroglycerin from your supply |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
f. Anti-arrhythmic (also called “anti-dysrhythmic”) medication |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
g. Beta blocker |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
h. Pressor agent (i.e., a substance that elevates blood pressure) |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
i. Thrombolytic agent (intravenous clot busting medication) |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Now I am going to ask you about tests and procedures |
EMT-Basic |
EMT-Intermediate |
Paramedic |
As appropriate for non-trauma chest pain or suspected stroke, please tell me if each of the following provider levels in your organization is authorized to give or do the following: |
|||
j. 12-lead ECG (or EKG) |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
k. Pulse oximetry |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
l. Glucometry (to test blood sugar)
|
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
m. Obtain peripheral IV access (extremities, e.g., arm, foot, hand) |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
n. Obtain central IV access (e.g., internal jugular, femoral, or subclavian) (CVC; central venous) |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
o. Endotracheal intubation |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
p. An alternate mechanical airway such as Combi-tube, PtL, or LMA (laryngeal mask airway) |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
q. Surgical airway (involving an incision or needle: e.g., cricothyrotomy) |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
r. Monitor end-tidal CO2 (ETCO2); e.g. Capnography |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
Yes No DON’T KNOW REF |
32. Do you use a stroke scale for diagnosing suspected stroke cases?
NO - DO NOT USE ANY GO TO Q33
YES GO TO Q32a
DK GO TO Q33
REF GO TO Q33
32a. [IF YES] Which one? CHECK ONE
CODE SPONTANEOUS RESPONSE. READ RESPONSE CATEGORIES IF NECESSARY
IF R SAYS THEY USE MORE THAN ONE, PROBE: Which one does your organization use the most?
BREMSS Stroke Observation Scale
Cincinnati Stroke Scale
Dallas Area Stroke Council Stroke Evaluation Sheet
Los Angeles Prehospital Stroke Scale
Miami Emergency Neurologic Deficit (MEND) Prehospital Checklist
West Central Florida EMS Stroke Checklist
Something else (specify):____________________
DK
REF
33a. Do the practicing paramedics in your service have to meet specific requirements to remain eligible to perform endotracheal intubation?
YES ASK 33b
NO GO TO Q34a
DK GO TO Q34a
REF GO TO Q34a
33b. Which of the following are required at least annually for paramedics to maintain eligibility to perform endotracheal intubation? CHECK ALL THAT APPLY
Written examination
Practical examination (hands-on)
Perform on a minimum number of patients during a specific time period (e.g., quarterly, annually)
Something else at least annually (specify)_______________________________
Nothing required annually or required less than annually
Do nothing at all to maintain eligibility
DK
REF
34a. Do the practicing paramedics in your service have to meet specific requirements to remain eligible to perform central IV access procedures?
YES ASK 31b
NO GO TO Q32
DK GO TO Q32
REF GO TO Q32
34b. Which of the following are required at least annually for paramedics to maintain eligibility to perform central IV Access (i.e., Central Line; also called: CVC; Central Venous Catheter or CV Line)? CHECK ALL THAT APPLY
Written examination
Practical examination (hands-on)
Perform on a minimum number of patients during a specific time period (e.g., quarterly, annually)
Something else at least annually (specify)_______________________________
Nothing required annually or required less than annually
Do nothing at all to maintain eligibility
DK
REF
35. Are there any therapies, techniques, or technologies for managing cardiac or stroke patients that your service has adopted within the last year?.
YES ASK 35A and B
NO (SKIP TO END)
DK (SKIP TO END)
REF (SKIP TO END)
FOR 35A AND B BE SURE TO PROBE FOR NEW THERAPIES, TECHNOLOGIES AND TECHNIQUES IF THEY ONLY MENTION THINGS WITHIN ONE OR TWO OF THESE CATAGORIES
35a. What has your service adopted for cardiac patients (please list all)?
NEW THERAPIES, TECHNOLOGIES, OR TECHNIQUES FOR CARDIAC PATIENTS:
_______________________________________________________________________
NOTHING NEW FOR CARDIAC PATIENTS GO TO 35b
DK
REF
35b. What has your service adopted for stroke patients (please list all)?
NEW THERAPIES, TECHNOLOGIES OR TECHNIQUES FOR STROKE PATIENTS:
_______________________________________________________________________
NOTHING NEW FOR STROKE PATIENTS
DK
REF
END
That was my last question. Thank you for your time to speak with me today. Do you have any other questions or comments about the survey you would like me to note?
NOTE RESPONDENTS COMMENTS
_____________________________________________________
______________________________________________________
______________________________________________________
Thank you, good bye.
| File Type | application/msword |
| File Title | Attachment D |
| Author | Battelle |
| Last Modified By | arp5 |
| File Modified | 2007-12-26 |
| File Created | 2007-12-18 |