Questionnaire for Interested EMS Sites

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Please provide your name, job title, and contact information (e-mail and phone number).*

What is the official name of your organization?*

What is your call volume? How many cardiac arrests do you respond to monthly?*

We require that all arrests be confined to a defined geography boundary/area. What is your geographic boundary?*

CARES requires all transporting agencies within this defined boundary to participate. Are you the sole transporting agency in this boundary? If not, who are the other providers?*

How many hospitals do you transport to? What are the names of these hospitals?*

CARES prefers that you establish a contact at each hospital. Once a contact is established, we will train them on CARES data entry. Do you have established contacts at these hospitals? *

Are you currently collecting any cardiac arrest data? If so, how?*

Do you utilize an ePCR (Electronic Patient Care Record) system? Who is your vendor?*

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