Self-Assessment Survey: RAC Administrative Requirements

CATRAC has organized the DSHS Self-Assessment tool by four categories:
1. Emergency Healthcare Systems Plan
2. Research & Data
3. System Requirements
4. RAC Administrative requirements

The Self-Assessment tool has been broken into four surveys. You are currently taking the RAC Administrative Requirements portion of the Self-Assessment Survey.

The following survey is the exact language from the Self-Assessment tool presented by each category. My apologies. Please score each element according to service line using the 0-5 scale to the best of your ability. The accuracy of identifying gaps in the region relies on the accuracy of this survey.

The Element number corresponds directly to the RAC Self-Assessment Scoring Tool.

Taking this survey on a mobile device is not recommended.

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* First and last name

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* Agency/Facility

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* What service line are you representing? (check all that apply)

Prehospital- Ground Service Line

Prehospital- Air Medical Service Line

Hospital- Trauma Service Line

Hospital- Cardiac Service Line

Hospital- Stroke Service Line

Hospital- Perinatal Service Line

LTACH/Rehab/Psych/FSED/Specialty facility

Non-designated Hospital

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* Email address

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* Element 5: REGIONAL LEADERSHIP

The regional advisory council leadership in collaboration with its members prepares and disseminates an annual report which reflects the activities, successes, and challenges encountered by the RAC. The annual report can be written, electronic, in newsletter format, or a formal document.

Be sure to read each rating description as they vary for each question.

0. Not known or N/A

1. No regional annual report is available.

2. Annual reports are developed by the RAC leadership.

3. Annual reports are developed in collaboration between the RAC leaders, RAC committees, and RAC members then disseminated to the general members of the RAC.

4. In addition to #3, the strategic accomplishments, injury and disease outcomes, challenges encountered, are included in the annual report; and it is disseminated to all RAC stakeholders and membership.

5. In addition to #4, the annual report is shared with regional coalitions, partner organizations, public health, local government entities, and the department.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5

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* Element 9: SYSTEM PLAN

As new evidence-based guidelines and standards of care are published the regional system develops process to review the documents and an implementation plan to ensure all stakeholders have an opportunity to attend an educational overview and are knowledgeable of the new guidelines or standards-of-care prior to their implementation, including the elements that will be integrated into the system performance improvement process.

Be sure to read each rating description as they vary for each question.

0. Not known or N/A

1. A structured process for evaluating new evidence-based practice guidelines or standards-of-care for implementation with the regional stakeholders does not exist.

2. A structured mechanism is in place to inform regional stakeholders of new evidence-based guidelines for implementation in the region but does not define how it will be integrated regionally.

3. A structured mechanism is in place to inform the regional stakeholders of new evidence-based guidelines and standards-of-care for evaluation to include processes for implementation of the guidelines for the regional system.

4. In addition to #3, the guidelines are integrated into the system performance improvement process.

5. In addition to #4, the plan includes the system capabilities to collected, monitored, analyzed and when reports reflecting the compliance and outcomes of the guideline or standard is shared with the regional stakeholders, and included in the annual report.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5

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* Element 15: BUSINESS/FINANCE

The RAC leaders provide the general membership meetings with a financial report, which includes funds expended, planned expenditures, and remaining balances of funding for RAC operations, and the funding allocated to specific projects specific to the development and advances in the regional trauma and emergency healthcare system.
Be sure to read each rating description as they vary for each question.

0. Not known

1. There are no RAC operational budgets or regional financial reports shared with the RAC stakeholders.

2. The RAC operational budget to support the regional trauma and emergency healthcare system is limited. There is no evidence of budget reports being shared with the general membership.

3. The RAC operational budget and the regional trauma and emergency healthcare system funds allocations and priorities are shared with general members.

4. In addition to #3, all financial audit findings are shared with the finance committee members and Board with appropriate action plans as necessary.

5. In addition to #4, RAC stakeholders have an opportunity to provide input and recommendations for the annual financial decisions before the final approval of the budget.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5

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* Element 27: EMERGENCY RESPONSE

The regional leaders and stakeholders assist with sharing and disseminating local, regional, and state emergency response and preparedness Initiatives, and priorities within the RAC. RAC stakeholders are integrated into the emergency response training and educational opportunities through the identified Health Care Coalition.

Be sure to read each rating description as they vary for each question.

0. Not known or N/A

1. There is no evidence of a working relationship or the sharing of data between the RAC leadership, members, stakeholders, and other partners.

2. The regional leadership collaborates with hospitals preparedness stakeholders including the department and the Health Care Coalition, other ESF agencies and partners but RAC members are not updated on planning, preparedness, and activities.

3. The regional leaders disseminate planning and preparedness information, sharing the data needs and equipment tracking needs with the regional members and stakeholders in collaboration with the identified Health Care Coalition.

4. In addition to #3, the regional leaders share information regarding public health surveillance data, public health threats, and emergency response needs with the regional stakeholders in collaboration with the Health Care Coalition.

5. In addition to #4, the regional stakeholders continually assess resources, capabilities, and solutions to respond to the identified regional hazards sharing the status of needs with the regional stakeholders, public health, local officials, business community stakeholders, the department, and the Health Care Coalition.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5

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* Element 28: EMERGENCY RESPONSE

The RAC leaders share information with regional stakeholders to assist in completing a resource assessment of the system’s capabilities and capacity to expand for mass casualty incidents (MCIs) in an all-hazards approach.

Be sure to read each rating description as they vary for each question.

0. Not known or N/A

1. A resource assessment of the regional system’s capabilities and capacity to expand its resources to respond to mass casualty incidents in an all-hazards approach has not been completed.

2. The RAC leaders and stakeholders complete a limited assessment of the system’s capabilities and capacity to expand resources to respond to a mass casualty incident in limited areas of the RAC.

3. The RAC leaders and stakeholders completed an assessment of the system’s capabilities and capacity to expand resources to respond to an all-hazard mass casualty incident for all areas of the region within the last twenty-four months.

4. In addition to #3, assessment of the system’s capabilities includes medical reserve personnel, facility surge capacity plans, additional equipment age-specific resources, caches, communication interoperability, overall management structure to ensure integration with the local government and the emergency management district and EMTF teams.

5. In addition to #4, the region disseminates educational information to ensure stakeholders are trained and prepared to respond to no-notice events as well as events with notification.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5

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* Element 29: EMERGENCY RESPONSE

The RAC leaders and stakeholders establish and Implement system communications for an all hazard response or a major EMS incident that are effectively coordinated.

Be sure to read each rating description as they vary for each question.

0. Not known or N/A

1. Guidelines for regional system communications in the event of an all hazards incident are not in place.

2. Local EMS systems have written procedures for EMS communications in the event of an all-hazards or major EMS incident. However, there is no coordination among the local jurisdictions or regional stakeholders.

3. The regional leaders and stakeholders develop guidelines for implementing system communications for an all-hazard response or major EMS incident that are effectively coordinated with existing systems, processes, and plans.

4. In addition to #3, the region facilitates a coordinated communications system with other jurisdictions and partners within the developed regional all-hazards response plan, following the incident management system, and in collaboration with the Health Care Coalition.

5. In addition to #4, the region develops communication system redundancies, and these communication procedures are regularly tested by regional stakeholders through simulated incident drills. Changes or revisions in the procedures are based on the outcomes of these drills. RAC leadership shares the findings of these drills with the regional stakeholders and Health Care Coalition.

Please rate each service line below.

	0	1	2	3	4	5
PREHOSPITAL	PREHOSPITAL 0	PREHOSPITAL 1	PREHOSPITAL 2	PREHOSPITAL 3	PREHOSPITAL 4	PREHOSPITAL 5
TRAUMA	TRAUMA 0	TRAUMA 1	TRAUMA 2	TRAUMA 3	TRAUMA 4	TRAUMA 5
PERINATAL	PERINATAL 0	PERINATAL 1	PERINATAL 2	PERINATAL 3	PERINATAL 4	PERINATAL 5
STROKE	STROKE 0	STROKE 1	STROKE 2	STROKE 3	STROKE 4	STROKE 5
CARDIAC	CARDIAC 0	CARDIAC 1	CARDIAC 2	CARDIAC 3	CARDIAC 4	CARDIAC 5