Question Title

* 1. Who is your current EMS employer?

Thinking about the hospital ER you indicated above select the statement that best applies.

Question Title

* 3. Emergency room physicians are courteous to me.

Strongly Agree Neutral Strongly Disagree
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 4. I would take my family to this emergency room for care.

Strongly Agree Neutral Strongly Disagree
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 5. A room or bed is immediately available to receive my patient.

Strongly Agree Neutral Strongly Disagree
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 6. The Emergency Department Nurses and Physicians listen to my report and value my input.

Strongly Agree Neutral Strongly Disagree
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 7. The EMS workroom is easily accessible and generally clean and tidy.

Strongly Agree Neutral Strongly Disagree
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 8. The EMS workroom is consistently stocked with snacks and drinks.

Strongly Agree Neutral Strongly Disagree
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 9. If your agency utilizes the ESO Health Data Exchange, please rate how valuable the HDE feedback tool is to you as a pre-hospital provider.

Extremely Useful Not Useful
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 10. The hospital provides useful clinical outcomes information to EMS personnel.

Strongly Agree Neutral Strongly Disagree
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 11. Radio communication with this hospital ED is consistently positive and effective.

Strongly Agree Neutral Strongly Disagree
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 12. What service do you feel needs more attention by hospital administration?

Question Title

* 13. We are committed to supporting your education needs; please rank your preference of the following learning formats? (1) = most preferred / three (3) = least preferred; please circle your choice)

Question Title

* 14. Considering your educational needs, please rank the following topics from highest to lowest priority with one (1) being highest. 

Question Title

* 15. Additional areas of education not mentioned above:

Question Title

* 16. Additional Comments?

Thank you for your time and service to our community!

T