Informed Consent

Documentation of Informed Consent to Participate in Research

 Project Title: Mental Health Assessment of Emergency Medical Services (EMS) Providers

Researcher(s): Douglas Bohl, Brenton Faber, Jennifer Knack, Mariama Jawo, Breanna Hamilton

Institutional Review Board (IRB) approval number: 20-63     Approval valid until: N/A: Continuing Review Waived

You have been asked to be a part of the research described here. Participation is voluntary.

Summary of the study: The purpose of this study is to document the effects of the EMS/EMT response during the COVID crisis in terms of mental health and impact to the profession. Participants will complete a 10 - 15 minute survey on SurveyMonkey with questions about participants’ demographic information, experiences as an EMT/EMS provider, and mental health. Participants in this study may also be invited to take part in optional additional follow-up studies. The possible risks and/or discomforts that you may experience as part of this study are no more than you may experience in everyday life.

Please read the material below if you are interested in participating in this study.

What to expect: You will complete a series of questions online via a Survey Monkey survey including demographic information, experiences as an EMT/EMS provider, and mental health. The survey should take approximately 10 - 15 minutes to complete. Participation in this research study is completely voluntary and you can quit filling out the survey at any time or choose to not answer questions if you are uncomfortable responding. You will be assigned an identification number and your identifying information will be separated from your survey responses in order to maintain confidentiality. Jennifer Knack, who is not an EMS/EMT provider, will be the only person with access to the identifiable data; she will separate participants’ names and email addresses from the data prior to the other PIs accessing the data.

If you have any questions about this research, you may contact Dr. Jennifer Knack by email at or by phone at 315-268-4315, Dr. Douglas Bohl by email at or by phone at 315-268-6683, or Dr. Brenton Faber by email at

Risks and discomforts to you if you take part in this study: The possible risks and/or discomforts that you may experience as part of this study are no more than you may experience in everyday life. However, it is possible that you may experience some discomfort while answering some of the questions. Please remember that you are free to select “prefer not to answer” for any question you do not want to answer.

The benefits to you if you take part in this study: There are no direct benefits to participants for taking part in this study.

What will you receive for taking part in this study: Participants who provide their name and email address at the end of the survey will be entered into a raffle for one of six $100 Amazon gift cards.
What will happen to the information collected in this study: The information collected will be kept confidential as much as is permitted by law. The researchers may post portions or all of the de-identified data publicly or with other researchers. If there are less than 5 people in a group (which would make the data identifiable) we will exclude that data from being publicly available or shared. Your name or other identifying information will not be reported in any publications, presentations, or any context related to the study.

All participants will be assigned a unique identification number. We will keep a record of all participants on a password protected computer that contains the participant names, assigned identification code, and contact information. Since Doug Bohl and Brent Faber are part of the EMS/EMT community, Jen Knack will be responsible for creating and storing this record so that Doug and Brent never see the data when participants’ names and emails are linked. Moreover, your name will never be used in any presentation of the results or at scientific meetings or publications.

 What rights you have when you take part in this study: Participation in this research is voluntary. Deciding not to take part or to stop being a part of this research will result in no penalty, fine, or loss of benefits that you otherwise have a right to. If you have questions about your rights as a research participant or if you wish to report any harm, injury, risk or other concern, please contact the Clarkson University Institutional Review Board (IRB) for human subjects research at or (315) 268-6475. If you stop participating partway through the study, we will exclude your data from analyses.

Conflict of Interest: The researchers have no financial interest in performing this study.

Question Title

* 1. By clicking "I agree" you are indicating that you have had the purpose of this research explained, you have been informed of what to expect and your rights, and you are over 18 years of age. You should have all your questions answered to your satisfaction. Your response shows that you agree to take part in this research and that you understand you can stop participating at any point.

If you do not agree to participate, please exit now.