* 1. What is your ZIP code (optional)?

* 2. When was the last time you requested or required the services of one of the ambulance services in Kossuth County?

* 3. If you needed an ambulance service's assistance, which of the following skills and services would you expect them to be able to provide?

* 4. Some emergency medical services (EMS) consist of trained medical personnel who respond in an ambulance capable of transporting patients to the hospital.  Other EMS services consist of trained medical personnel who respond to the scene and provide on-scene care until the nearest ambulance arrives to transport the patient.  

How important is it to you that in your community there is:

  Not important at all Slightly important Somewhat important Very important Absolutely necessary
An ambulance stationed in your community, ready to respond.
A trained EMS crew ready to respond and provide medical care until the nearest ambulance arrives.

* 5. Currently, the State of Iowa requires counties to provide for law enforcement, fire protection, cemetery maintenance, and resolution of fence line disputes, but not emergency medical services (EMS).

How strongly do you feel that EMS should be a mandatory essential service for all citizens of Kossuth County? 

* 6. Across Kossuth County, EMS agencies are funded by a variety of sources including billing for services provided (Medicare, Medicaid, insurance, and/or patients), township taxes, city contributions, county contributions, and donations and fundraisers.

If additional funding is required, from where should that funding come?

* 7. Please indicate the level to which you agree with the following statements about your local EMS service:

  Strongly Disagree Disagree Neutral Agree Strongly Agree N/A or Uncertain
Our EMS personnel respond in a prompt manner.
Our EMS personnel are courteous and polite.
Our EMS personnel are professional.
Our EMS personnel are competent.
Our EMS personnel are respected members of our community.
Our local EMS service has enough personnel to guarantee they can respond when called.
Our local EMS service has sufficient equipment to perform their job.
Our local EMS service is adequately funded.

* 8. If you needed to request assistance for a medical emergency in your community, what concerns might you have?

* 9. What other comments or questions do you have about EMS services in Kossuth County?

* 10. Are you interested in Volunteering for your local Ambulance Service? Please enter contact information below:

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