Please take a few minutes to participate in the Office of EMS & Trauma Systems Coordination EMS survey. This survey will allow for greater situational awareness regarding the challenges Hurricane Harvey and its aftermath may have posed (or is still currently posing) to your entity’s ability to provide service.  As needed, the office may follow-up next week with an additional brief survey.

Entity Name

Question Title

* Entity Name

DSHS License Number

Question Title

* DSHS License Number

Name of person responding to the survey

Question Title

* Name of person responding to the survey

Contact email

Question Title

* Contact email

Contact phone

Question Title

* Contact phone

Is your entity open?

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* Is your entity open?

How many of your ambulances are currently operational (Please answer # out of total)?

Question Title

* How many of your ambulances are currently operational (Please answer # out of total)?

Were vehicles or equipment destroyed or damaged due to Hurricane Harvey?

Question Title

* Were vehicles or equipment destroyed or damaged due to Hurricane Harvey?

If so, please describe

Question Title

* If so, please describe

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