For the Quarterly Triage Day on 06/19/2018, please provide the following feedback. You may fill this out for a hospital or a shift at a hospital, or for an EMS Agency, or for each EMS Unit, whichever is most appropriate for your case.

* 1. Hospital or EMS Agency:

* 2. This exercise was a valuable learning opportunity for our personnel.

* 3. Position of person completing survey:

* 4. Hospital Shift or EMS Unit (optional)

* 5. For both hospitals and EMS:  Approximately how many patients did YOUR hospital or EMS Agency "triage" (i.e., APPLY triage ribbons and tags to) during the QTD?

* 6. HOSPITALS ONLY:  Approximately how many patients did you receive from EMS during the QTD with a Triage Ribbon and Triage Tag applied by EMS?

* 7. HOSPITALS ONLY:  Were there EMS agencies that did not participate, i.e., who consistently brought patients without a ribbon or tag? Which agencies?

* 8. HOSPITALS ONLY:  Were there EMS agencies that consistently did not use the MCI Radio Talk Group during the two hour block for radio usage? If so, which agencies?

* 9. HOSPITALS ONLY:  approximately how many radio calls did you receive from EMS on HSR3-MCI (or HSR6-MCI)?

* 10. For both hospitals and EMS:  Were there any issues or challenges with use of the MCI radio talk groups?

* 11. EMS ONLY:  were there hospitals your agency attempted to call on the MCI radio talk group during the two hour block that did not answer the radio call?  If so, which hospitals?

* 12. Did your hospital or EMS agency use OHTrac during this Quarterly Triage Day Drill?

* 13. Further Comments, Questions, or Concerns regarding Quarterly Triage Days:

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