Program Description and Confidentiality Statement

You have reached the old version of the Smooth Transitions surveys. Please do not fill this out. Our new surveys can be found on the Smooth Transitions website at https://www.qualityhealth.org/smoothtransitions/surveys-2/

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* 1. What was the date of the emergency response to a community midwife?

Date

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* 2. Was the transport from a home or a birth center?

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* 3. Receiving Facility and County

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* 4. Was the patient you transported:

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* 5. What type of transport was this?

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* 6. Why was the 911 call initiated?  Please check all that apply.

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* 7. What did you find with the patient(s) upon arrival?

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* 8. Did the short report from dispatch match what you found on the scene?

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* 9. Did you receive a short report from the community midwife?

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* 10. Did the community midwife's short report include:  Please check all that apply.

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* 11. Was there any information you did not receive that you felt would have been helpful/necessary for patient care?

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* 12. What was your estimation of time on the scene (in minutes)?

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* 13. What, in your opinion, would have shortened the time on scene?

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* 14. Did the community midwife accompany the client to the hospital?

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* 15. Do you have any general comments about the interactions between the community midwife and EMS during the course of care?   (professional, respectful, helpful, clear roles, collaborative)

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* 16. What went well during this transport process?  And how can this experience help inform future tranports?

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* 17. Have you participated in any of the PRONTO/Smooth Transitions LM-EMS simulation trainings?

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* 18. Would you like further contact with your local community midwives to build a better working relationship? Examples of this could be skills trainings/drills or informational sessions.

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* 19. Is there anything else you would like to share about this particular transport or with maternal/neonatal transports in general?

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* 20. How did you know about this survey, please explain?

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* 21. How do you feel about being given the opportunity to provide your feedback on this experience?

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* 22. Do you have any recommendations on how to improve this survey?

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