EMS Prehospital/Telehealth Burn Question Title * 1. What level of care does your service routine provide? First Responder/ Basic Advanced ALS Paramedic Critical Care Question Title * 2. What type of agency? Volunteer/Paid Volunteer Municipal (city/government/fire/county/third agency, Private Hospital Flight Other (please specify) Question Title * 3. Approximately how many of those patients would be classified as MAJOR burns does your service treat per year? <less than 5 >more than 10 >more than 25 > more than 50 >greater than 100 Question Title * 4. Does your service have specific burn protocols? Yes, local provider Yes, we utilize the State EMS protocols No specific protocols Do not know Question Title * 5. Patients categorized with major burns are usually transported : Local hospital first for stabilization Utilize specific protocols for by-passing and transport to a regional trauma center Directly to regional burn center Utilize air EMS and they will determine transport destination Other (please specify) Question Title * 6. Other than curriculum/ refresher training, what type of burn education have you or your service have participated in within the past two years? Conference(s) Lecture Video Specific course(s) such as PHTLS/ITLS,, ABLS, etc. Other (please specify) Question Title * 7. Trauma patients with associated burns are usually transported to: Local Emergency Department Regional designated trauma center then if need be to burn center Regional designated burn center then if need be to trauma center Unknown Question Title * 8. Approximately how many burn transfers from hospital to hospital (if your service provides this) does your service perform yearly? < five a year > 10 a year > 25 a year > 50 year Do not perform transfers Question Title * 9. In regards to communication, transporting crew provides patient information per the way of : per TREC or designated transfer center direct line per cell/mobile device radio WAC incode Other (please specify) Question Title * 10. In regards to providing burn care, what level of competency would you rate yourself/or service protocols according to the National Standards for burn care? Poor Moderate Competent Excellent Level of Care Level of Care Poor Level of Care Moderate Level of Care Competent Level of Care Excellent Question Title * 11. What is your normal transport time of burn patients for intra facility transfers? Less than 20 minutes More than 30 minutes Greater than one hour Question Title * 12. Please list your name, contact information, and service you represent (Optional) Done
