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46 APPENDIX A Survey Questionnaires NCHRP 43-15 EMS Response to Motor Vehicle Crashes in Rural Areas (EMS Agency Survey) Dear State EMS Director: The Transportation Research Board (TRB) is preparing a synthesis of practice on Emergency Medical Services Response to Motor Vehicle Crashes in Rural Areas. This is being done for the National Cooperative Highway Research Program (NCHRP), under the sponsorship of the American Association of State Highway and Transportation Officials (AASHTO), in cooperation with the Federal Highway Administration (FHWA). The synthesis will collect data on emergency medical response practices in rural areas, focused on effective, innovative practices. This survey will gather information from your state and will be the basis for a series of follow-up interviews to col- lect more detailed data on specific approaches or study results. This survey questionnaire is being distributed to state Emergency Medical Service directors. If you are not the appropriate person at your agency to complete this survey, please forward it to the correct person. Please complete and submit this survey questionnaire by July 13, 2012. If you have any questions, please do not hesitate to contact our principal investigator Erik Minge at eminge@srfconsulting.com or 763-475-0010. Questionnaire Instructions: 1. To view the entire questionnaire before you begin, click on the following link: http://surveygizmolibrary.s3.amazonaws. com/library/64484/NCHRP_4315_EMS.pdf. 2. To print the survey, click on the link above and print using âcontrol p.â 3. To save your partial answers, or to forward a partially completed questionnaire to another party, click on the âSave and Continue Laterâ link at the top of your screen. A link to the partially completed questionnaire will be e-mailed to you from SurveyGizmo. To return to the questionnaire later, open the email from SurveyGizmo and click on the link. To invite a colleague to complete part of the survey, simply click on the âSave and Continueâ link and enter your colleagueâs e-mail address. Please note that the questionnaire can be saved and passed around multiple times, but respondents must use the link e-mailed from SurveyGizmo. We suggest using the âSave and Continue Laterâ feature if there will be more than 15 minutes of inactivity while the survey is opened, as some firewalls may terminate because of inactivity. 4. To view and print your answers before submitting the survey, click forward to the page following question 39. Print using âcontrol p.â 5. To submit the survey, click on âSubmitâ on the last page. When responding to the survey, please focus to the extent possible on practices for crash response in rural areas. For the purpose of this survey, the U.S. Census definition of âruralâ is recommended, meaning areas outside of urban clusters with a population of 50,000 or more. Thank you very much for participating in this survey! Contact Information Please enter the date (MM/DD/YYYY).*
47 Please enter your contact information. First Name*: __________________________________________________ Last Name*: __________________________________________________ Title*: _______________________________________________________ Agency/Organization*: __________________________________________ Street Address: ________________________________________________ Suite: ________________________________________________________ City*: ________________________________________________________ State*: _______________________________________________________ Zip Code*: ____________________________________________________ Country: _____________________________________________________ E-mail Address*: ______________________________________________ Phone Number*: _______________________________________________ Fax Number: __________________________________________________ Mobile Phone: _________________________________________________ URL: ________________________________________________________ Data 1) For motor vehicle crashes, does your agency collect data on any of the following (check all that apply)? [ ] Urban versus rural location of crash [ ] Crash cause [ ] Injury severity [ ] Responder type [ ] Number of responding units [ ] Response times [ ] Patient destination [ ] Patient transfers [ ] Patient transport times [ ] Patient outcomes (by injury severity or other metric) [ ] Costs or cost-effectiveness of crash-related emergency medical care [ ] Charges billed to patients [ ] Charges collected [ ] Compensation of agencies/providers 2) Do you link crash data to other data management systems, such as (check all that apply)? [ ] Driver licensing [ ] Vehicle registration [ ] Pavement condition management [ ] Hospital patient information
48 [ ] Insurance records [ ] Other (please specify): Response Enhancement InitiativesâDispatch Coordination 3) Are you aware of specific state initiatives or existing multidisciplinary public safety answering points (PSAPs) (i.e., 911 call center) coordination programs to address rural crash dispatching, routing, response, patient care and roadway maintenance activities?   Yes (please describe): _____________________   No 4) What tools are used to route responders to rural crash scenes (check all that apply)? [ ] Guided by dispatchers [ ] Dispatch software [ ] Agency provided in-vehicle GPS guidance devices (including smart phones) [ ] Personal GPS guidance devices (including smart phones) [ ] Paper maps [ ] Other (please specify): 5) In a rural area of your state that you consider typical, by what means could an EMS provider at a crash scene directly communicate with a local âhighway operations responder,â such as signing, electrical or bridge repair crews (check all that apply)? [ ] Through an interoperable radio system [ ] Through a system of âpatchedâ or interconnected radio systems [ ] Instant, text or e-mail messages [ ] Cell phones [ ] Other (please specify): 6) Is there a state-level, regional-level, or multi-disciplinary organization that works toward improving PSAP functions?   Yes (please describe): _____________________   No Response Enhancement InitiativesâTelemedicine 7) Do EMS providers in your state use telemedicine/telepresence technologies for medical treatment?   Yes   No 8) Who are the typical telemedicine user groups (check all that apply)? [ ] Emergency department staff [ ] Trauma center staff [ ] Other physician specialists (please specify): [ ] Medical scene responders (i.e., EMT/paramedic/nurse, please specify): [ ] Other scene responders (i.e., fire/law enforcement, please specify):
49 9) What sort of data are typically exchanged by telemedicine applications (check all that apply)? [ ] Images [ ] Audio recordings [ ] Live audio [ ] Video recordings [ ] Live video [ ] Text messages [ ] Biometric data (EKG, etc.) 10) Where is telemedicine typically used (check all that apply)? [ ] Scene to nearest emergency department [ ] Scene to trauma center [ ] Scene to dispatch center or central communications center [ ] Emergency department to trauma center [ ] Emergency department to other specialty care facility (please specify): 11) How is data transported for the telemedicine applications in rural areas (check all that apply)? [ ] Dedicated radio network [ ] Cellular network [ ] Satellite phone [ ] Dedicated fiber optic connection [ ] Leased data services (T-1/DS-1/EOC, etc.) [ ] Other (please specify): 12) How is telemedicine typically used (check all that apply)? [ ] Guidance for field responders [ ] Preparation for receiving emergency physicians [ ] Consultation by physicians with specialists [ ] Record-keeping/training [ ] Other (please specify): Response Time Reduction 13) Is there an active effort by your agency to reduce the response times for rural crashes?   Yes   No 14) Does your rural crash response time reduction program focus on (check all that apply)? [ ] Crash detection or reporting [ ] Identifying crash locations [ ] Expediting dispatch [ ] Improved responder stationing
50 [ ] Improved responder guidance [ ] Other (please describe): 15) Please rank the following options based on your experience as having the greatest effect on response times (1 is largest effect, 7 is smallest effect): ______________________ Crash detection or reporting ______________________ Identifying crash locations ______________________ Expediting dispatch ______________________ Improved responder stationing ______________________ Improved responder guidance ______________________ Improved coordination of available responders ______________________ Other (please describe in next question): 16) If you ranked an âotherâ category on the question above, please describe the option here: 17) Through your agencyâs response time reduction program, have you been able to quantify impacts for (check all that apply)? [ ] Time to arrival on-scene [ ] Patient outcomes [ ] Costs [ ] Other (please describe): 18) Are response times used as a measurement in a system quality assurance process?   Yes   No On-site Care Procedures and Protocols 19) Does your state mandate local use of trauma triage, treatment, and transport procedures and protocols?   Yes   No 20) If uniform procedures and protocols are mandated, are these uniform for all jurisdictions?   Yes   No   N/A 21) Is there an active effort by your agency to evaluate or revise on-site care procedures and protocols?   Yes   No 22) If there is an active effort to evaluate or revise on-site procedures and protocols, does your effort focus on (check most applicable)? [ ] Patient treatment and stabilization procedures [ ] Patient triage
51 [ ] Destination routing [ ] Pre-arrival (EMD) instructions [ ] N/A [ ] Other (please describe): ____________________ Air Transport Use 23) Is air transport of crash victims commonly used in your area?   Yes   No 24) Do you collect information on the total annual number of air transports used for rural crash response?   Yes   No 25) When air transport is used, what is it used for (check all that apply)? [ ] Crash scene to local or regional emergency department [ ] Crash scene to trauma center [ ] Emergency department to trauma center [ ] Other (please describe): 26) Have any studies been conducted in your state to determine the effect of air transport on patient outcomes?   Yes (please describe): _____________________   No 27) Who is able to cancel a request for air transport (check all that apply)? [ ] PSAP dispatcher or EMD [ ] Scene commander [ ] On-scene medical personnel [ ] Other (please specify): 28) What medical personnel typically fly on aircraft (check all that apply)? [ ] EMT [ ] Paramedic [ ] Flight nurse [ ] Flight physician [ ] Other (please specify): Responder Preparation/Pre-Dispatch Activities 29) Is there a standard checklist used by emergency responders to ensure proper equipment is available for crash response?   Yes   No
52 30) Are responders able to quickly check for road conditions and closures before departing for the scene?   Yes   No 31) If responders are able to check conditions, how is this most commonly done? [ ] Voice communication with dispatch [ ] Telephone call to information service (511, etc.) [ ] Web-based or other information service [ ] Other (i.e., built into GPS, please describe): _____________________ 32) Has vehicle or equipment condition ever affected the time needed to respond to a crash?   Yes (please describe): _____________________   No Staffing 33) Are most EMS responders: [ ] Full-time staff [ ] Part-time staff [ ] Volunteer 34) How are responders (EMT, emergency vehicle operator, paramedic) recruited (check all that apply)? [ ] Partnering with public agencies [ ] Advertising in community publications [ ] Advertising in industry publications [ ] Other (please describe): 35) Are there any programs or incentives to encourage employees of other disciplines (e.g., highway operations responders) to acquire EMS certifications or licensure?   Yes   No 36) Has staffing levels frequently affected response quality or time?   Yes   No 37) Do you partner with any of the following groups to improve crash-related response (check all that apply)? [ ] State departments of transportation [ ] Public health agencies [ ] PSAPs [ ] Other local emergency responders [ ] Other local emergency medical services providers [ ] Hospitals [ ] Other (please describe):
53 Innovative Practices Used or Under Development 38) Is your agency engaged in using, developing, or testing new practices in any of the following areas (check all that apply)? [ ] Real-time road/weather data [ ] Vehicle telematics (such as automatic vehicle location, traffic signal pre-emption, etc.) [ ] Incident/crash detection [ ] Incident/crash severity determination [ ] Training or recruitment practices [ ] Triage and destination routing and decision making [ ] Funding or budgeting [ ] Other (please describe): Follow-up Information 39) Would you be available to provide additional information through a follow-up interview?   Yes   No Contact Information Review Thank You! Thank you for taking our survey. Your response is very important to us. If you have any questions or comments, please feel free to contact Erik Minge at: E-mail: eminge@srfconsulting.com Phone: 763-475-0010 Mailing Address: SRF Consulting Group, One Carlson Parkway, Suite 150, Minneapolis, MN 55447
54 NCHRP 43-15 EMS RESPONSE TO MOTOR VEHICLE CRASHES IN RURAL AREAS (DOT SURVEY) Dear State Safety Engineer, The Transportation Research Board (TRB) is preparing a synthesis for practices on Emergency Medical Services Response to Motor Vehicle Crashes in Rural Areas. This is being done for the National Cooperative Highway Research Program (NCHRP), under the sponsorship of the American Association of State Highway and Transportation Officials (AASHTO), in cooperation with the Federal Highway Administration (FHWA). The synthesis will collect data on emergency medical response in rural areas, focused on effective, innovative practices. This survey will also form the basis for a series of follow-up interviews to collect more detailed data on specific approaches or study results. This survey questionnaire is being distributed to members of the AASHTO Highway Traffic Safety Subcommittee on Safety Management. If you are not the appropriate person at your agency to complete this survey, please forward it to the correct person. Please complete and submit this survey questionnaire by July 13, 2012. If you have any questions, please do not hesitate to contact our principal investigator Erik Minge at eminge@srfconsulting.com or 763-475-0010. Questionnaire Instructions 1. To view the entire questionnaire before you begin, Click on the following link: http://surveygizmolibrary.s3.amazonaws. com/library/64484/NCHRP_4315_DOT.pdf 2. To print the survey, click on the link above and print using âcontrol p.â 3. To save your partial answers, or to forward a partially completed questionnaire to another party, click on the âSave and Continue Laterâ link at the top of your screen. A link to the partially completed questionnaire will be e-mailed to you from SurveyGizmo. To return to the questionnaire later, open the e-mail from SurveyGizmo and click on the link. To invite a colleague to complete part of the survey, simply click on the âSave and Continueâ link and enter your colleagueâs e-mail address. Please note that the questionnaire can be saved and passed around multiple times, but respondents must use the link e-mailed from SurveyGizmo. We suggest using the âSave and Continue Laterâ feature if there will be more than 15 minutes of inactivity while the survey is opened, as some firewalls may terminate owing to inactivity. 4. To view and print your answers before submitting the survey, click forward to the page following question 39. Print using âcontrol p.â 5. To submit the survey, click on âSubmitâ on the last page. When responding to the survey, please focus to the extent possible on practices for crash response in rural areas. For the purpose of this survey, the U.S. Census definition of âruralâ is recommended, meaning areas outside of urban clusters with a population of 50,000 or more. Thank you very much for participating in this survey! Contact Information Please enter the date (MM/DD/YYYY).* Please enter your contact information. First Name*: __________________________________________________ Last Name*: __________________________________________________
55 Title*: _______________________________________________________ Agency/Organization*: __________________________________________ Street Address: ________________________________________________ Suite: ________________________________________________________ City*: ________________________________________________________ State*: _______________________________________________________ Zip Code*: ____________________________________________________ Country: _____________________________________________________ E-mail Address*: ______________________________________________ Phone Number*: _______________________________________________ Fax Number: __________________________________________________ Mobile Phone: _________________________________________________ URL: ________________________________________________________ Data Collected 1) Does your agency collect data on any of the following (check all that apply)? [ ] Number of rural crashes [ ] Cause of rural crashes [ ] Rural crash fatality rates [ ] Number of emergency medical responses to rural crashes [ ] Ambulance or rescue unit response times [ ] Patient outcomes [ ] Emergency or trauma related patient transfers [ ] Costs or cost-effectiveness of crash-related emergency medical care Response Enhancement InitiativesâDispatch Coordination 2) Does your department co-locate maintenance dispatch functions with emergency response dispatch?   All   Some (please specify approximate percent): ___________________   None 3) Does your department use communication systems that interoperate directly with emergency response?   Yes   No 4) How does your department communicate with emergency responders from different agencies or jurisdictions (check all that apply)? [ ] Through an interoperable radio system [ ] Through a system of âpatchedâ or interconnected radio systems
56 [ ] Instant, text or e-mail messages [ ] Cell phones [ ] Other (please describe): 5) Does your department provide real-time roadway condition information?   Yes   No 6) If real-time information is provided, how is it made available (check all that apply)? [ ] 511 telephone service [ ] Web-based information service [ ] Dedicated mobile applications [ ] Dedicated hotline for EMS [ ] Voice radio system broadcasts [ ] Other (please specify): 7) How do emergency responders from different agencies or jurisdictions typically communicate in rural areas (check all that apply)? [ ] Through an interoperable radio system [ ] Through a system of âpatchedâ or interconnected radio systems [ ] Instant, text or e-mail messages [ ] Cell phones [ ] Other (please describe): 8) Does your department participate in an on-going effort to improve rural crash response or care?   Yes   No Response Enhancement InitiativesâResponse Coordination 9) Does your state use the FHWA Traffic Incident Management Handbook for training and procedure development?   Yes   No 10) Have you implemented strategies outlined in the National Unified Goal for traffic incident management?   Yes   No 11) Do department maintenance staffs regularly assist with rural crash response?   Yes   No 12) If staff assists with response, do they commonly perform (check all that apply): [ ] Traffic control
57 [ ] Crash site management assistance [ ] Traffic control device/roadway and bridge repair when needed [ ] Other (please describe): Innovative Practices Used or Under Development 13) Is your department engaged in using, developing or testing new practices in any of the following areas (check all that apply)? [ ] Real-time road/weather data [ ] Vehicle telematics (such as vehicle location, traffic signal pre-emption, etc.) [ ] Incident detection [ ] Incident severity determination [ ] Training or recruitment practices [ ] Funding or budgeting [ ] Crash scene safety [ ] Crash scene clearing [ ] Other (please describe): Follow-up Information 14) Would you be available to provide additional information through a follow-up interview?   Yes   No Answer Review Thank You! Thank you for taking our survey. Your response is very important to us. If you have any questions or comments, please feel free to contact Erik Minge at: E-mail: eminge@srfconsulting.com Phone: 763-475-0010 Mailing Address: SRF Consulting Group, One Carlson Parkway, Suite 150, Minneapolis, MN 55447
