Facility Survey: Interest in Stop the Bleed Kits

Service Area 5 Healthcare Coalition is a network of health care organizations and partners in 16 Iowa counties that are committed to strengthening the health care system for emergencies. The purpose of the Coalition is to develop a coordinated and effective medical and public health system response to all hazards. 

Currently the Service Area 5 Healthcare Coalition has received funding to provide Stop the Bleed kits to non-profit high-traffic community locations. Please complete this survey to indicate if you would like to participate in this activity and receive bleeding control kits or training. One kit per trained individual can be provided. If you are interested in training more individuals please indicate this on page two of this survey. 

Stop the Bleed and other bleeding control kits contain non-expiring items necessary to control serious bleeding and prevent further blood loss including, but not limited to, tourniquet, gauze, trauma shears, gloves, and instructions for kit use.

Facilities that will receive priority for receiving kits are Public Schools, Private Schools, Community Centers, Churches, and Places of Public Gatherings.  Other non-profit facilities will be considered.

For more information view the Program Guidelines Here

Question Title

* 1. Are you interested in receiving Stop the Bleed kits for your facility? 

Question Title

* 2. If yes, how many individuals at your facility are currently trained in Stop the Bleed techniques?

Question Title

* 3. How many bleeding control kits do you currently have at your facility?

Question Title

* 4. Facility Name

Question Title

* 5. Type of Facility (e.g., public school, private school, church, community center)

Question Title

* 6. County Facility is located

Question Title

* 7. City Facility is located

T