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CLINCON 2022 Conference Evaluation
Please use the
CME Allocation document
to tally the credits you plan to claim.
*
1.
Attendee Contact
(Required.)
First Name
Last Name
Email Address
*
2.
How did you hear about CLINCON 2022?
(Required.)
Email Advertisement
FCEP/EMLRC Weekly eNews
Colleague
Employer
Internet Advertisement/emlrc.org
Past Attendee
Other (please specify)
*
3.
Why did you register for and attend CLINCON 2022?
(Required.)
Educational programs/CME
Networking & social events with colleagues
Business with vendors/Exhibit Hall
All of the above
*
4.
What is the primary responsibility in your occupation?
(Required.)
Patient Care
Educator
Leadership/Management
Administration
Other (please specify)
*
5.
The overall conference format was conducive to my learning needs.
(Required.)
Yes
No
*
6.
On a scale of 1 - 5, with 5 being the highest/best, how would you rate the conference venue in terms the learning environment?
(Required.)
1 - Poor
2
3 - Satisfactory
4
5 - Excellent
1 - Poor
2
3 - Satisfactory
4
5 - Excellent
*
7.
On a scale of 1 - 5, with 5 being the highest/best, to what extent were the learning objectives of the educational activity achieved?
(Required.)
1 - Poor
2
3 - Satisfactory
4
5 - Excellent
1 - Poor
2
3 - Satisfactory
4
5 - Excellent
*
8.
Overall, the content of the educational material presented at CLINCON 2022 was:
(Required.)
Too advanced.
Just right.
Too basic.
*
9.
Will you make changes in your practice as a result of this activity?
(Required.)
Yes
No
If yes, please describe.
*
10.
Did you perceive any commercial bias in this program?
(Required.)
Yes
No
If yes, please describe.
*
11.
What was the most valuable information gained from this conference?
(Required.)
*
12.
Please list any speakers/topics you would like to see in the future.
(Required.)
*
13.
Please provide any additional comments about the conference that would assist in future program planning:
(Required.)
*
14.
Did you visit the Exhibit Hall?
(Required.)
Yes
No
If no, why not?
15.
Please answer the following questions based on the individual speaker presentation listed. You are required to complete individual evaluations for presentations you claim and will receive credit for.
Presentation: EMS Town Hall (9/15 at 1:30 pm)
Speaker(s): Dr. Christian Zuver, Dr. Deborah Biedel, Dr. Angus Jameson, Sheriff Dennis Lemma, Steve McCoy
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Effectiveness of presenters:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Overall content of the material presented during this track was:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The learning objectives for this track were achieved.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The presentation was free from commercial bias.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
To what extent did the activity enhance your knowledge of the subject area?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
What was your overall satisfaction with this track?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Comments
16.
Please answer the following questions based on the individual speaker presentation listed. You are required to complete individual evaluations for presentations you claim and will receive credit for.
Presentation: EMS Guide to Mentoring New Employees: Don't Eat Our Young (9/15 at 3:00 pm)
Speaker(s): Kevin Binnall, PMD
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Effectiveness of presenters:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Overall content of the material presented during this track was:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The learning objectives for this track were achieved.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The presentation was free from commercial bias.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
To what extent did the activity enhance your knowledge of the subject area?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
What was your overall satisfaction with this track?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Comments
17.
Please answer the following questions based on the individual speaker presentation listed. NOTE: You are required to complete individual evaluations for presentations you claim and will receive credit for.
Presentation: What We Learned From Playing Together in the Proverbial Sandbox (9/15 at 4:00 pm)
Speaker(s): Angel Nater, Starla Lowry, Jaime Magnetico-Walsh, Susan Bitar, Shahin Kanani
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Effectiveness of presenters:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Overall content of the material presented during this track was:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The learning objectives for this track were achieved.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The presentation was free from commercial bias.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
To what extent did the activity enhance your knowledge of the subject area?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
What was your overall satisfaction with this track?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Comments
18.
Please answer the following questions based on the individual speaker presentation listed. You are required to complete individual evaluations for presentations you claim and will receive credit for.
Presentation: Saving Face: NIV versus Intubation... and Other Bedside Decisions in Critical Care Transport (9/16 at 9:00 am)
Speaker(s): Jon Inkrott, RRT
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Effectiveness of presenters:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Overall content of the material presented during this track was:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The learning objectives for this track were achieved.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The presentation was free from commercial bias.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
To what extent did the activity enhance your knowledge of the subject area?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
What was your overall satisfaction with this track?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Comments
19.
Please answer the following questions based on the individual speaker presentation listed. You are required to complete individual evaluations for presentations you claim and will receive credit for.
Presentation: Stress, Distress and PTSD - Recognizing and Reaching Out (9/16 at 10:00 am)
Speaker(s): Shaun Fix, PMD
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Effectiveness of presenters:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Overall content of the material presented during this track was:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The learning objectives for this track were achieved.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The presentation was free from commercial bias.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
To what extent did the activity enhance your knowledge of the subject area?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
What was your overall satisfaction with this track?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Comments
20.
Please answer the following questions based on the individual speaker presentation listed. You are required to complete individual evaluations for presentations you claim and will receive credit for.
Presentation: Crisis Stress Teams and Stress First Aid (9/16 at 11:00 am)
Speaker(s): Richard Clinchy, PhD, EMT-P
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Effectiveness of presenters:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Overall content of the material presented during this track was:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The learning objectives for this track were achieved.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The presentation was free from commercial bias.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
To what extent did the activity enhance your knowledge of the subject area?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
What was your overall satisfaction with this track?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Comments
21.
Please answer the following questions based on the individual speaker presentation listed. NOTE: You are required to complete individual evaluations for presentations you claim and will receive credit for.
Presentation: Fluids, Pressors, Blood and Diesel (9/16 at 1:00 pm)
Speaker(s): Austin Johnson, RN, EMT-P
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Effectiveness of presenters:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Overall content of the material presented during this track was:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The learning objectives for this track were achieved.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The presentation was free from commercial bias.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
To what extent did the activity enhance your knowledge of the subject area?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
What was your overall satisfaction with this track?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Comments
22.
Please answer the following questions based on the individual speaker presentation listed. NOTE: You are required to complete individual evaluations for presentations you claim and will receive credit for.
Presentation: Tips & Tricks for Difficult Intubations (9/16 at 1:30 pm)
Speaker(s): Shaun Fix, PMD
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Effectiveness of presenters:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Overall content of the material presented during this track was:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The learning objectives for this track were achieved.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The presentation was free from commercial bias.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
To what extent did the activity enhance your knowledge of the subject area?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
What was your overall satisfaction with this track?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Comments
23.
Please answer the following questions based on the individual speaker presentation listed. NOTE: You are required to complete individual evaluations for presentations you claim and will receive credit for.
Presentation: Skills Lab: Tips & Tricks for Difficult Intubations (9/16 at 2:30 pm)
Speaker(s): Shaun Fix, PMD
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Effectiveness of presenters:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Overall content of the material presented during this track was:
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The learning objectives for this track were achieved.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
The presentation was free from commercial bias.
1 - Poor
2
3 - Satisfied
4
5 - Excellent
To what extent did the activity enhance your knowledge of the subject area?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
What was your overall satisfaction with this track?
1 - Poor
2
3 - Satisfied
4
5 - Excellent
Comments
*
24.
Do you need a CME certificate emailed to you?
(Required.)
Yes - please email me my certificate.
No - I do not need a certificate.
THE FOLLOWING INFORMATION IS REQUIRED for the issuance of CME/CEH/CEU credits. EMLRC reports your continuing education credits to CE Broker. Please note that not fully complying with our request for your license information can delay issuance of your course certificate and/or credit reporting to various accreditation bodies (i.e. CAPCE, Florida Bureaus of EMS, Florida Board of Nursing, ACCME).
25.
# of credits claimed:
NOTE: a maximum of 9.5 credits can be claimed.
26.
License #:
27.
License State:
28.
License Type:
29.
License Expiration Date:
Expiration Date
Date
January
February
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30.
NREMT #:
31.
NREMT Certification Expiration Date:
Expiration Date
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
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1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
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Th
Thursday
Fr
Friday
Sa
Saturday
01
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*
32.
City of Residence
(Required.)
*
33.
Continuing Education Attestation
(Required.)
By checking this box, I attest that the above information is true and I have spent the hours claimed for CME in the educational activity.