Aortic Dissection Triage Taskforce Signup

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* 1. Contact

Name *

Organization *

Title/Role

Email Address

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* 2. Do you/your facility currently manage aortic dissection cases?

No

Yes

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* 3. What are the biggest challenges your program faces when accepting or transferring aortic dissection patients?

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* 4. Do you/your institution have existing protocols or pathways for dissection triage that could be shared?

Yes

No

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* 5. If yes, please share if permitted.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 6. Are you willing to serve as a Champion for this workgroup?

Yes

No