Intermediate/99 Recertification Form 2010 - The National Registry Of Emergency Medical Technicians Page 3
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4Dear Emergency Medical Services Colleague:
The NREMT is currently conducting a research survey of EMS professionals. The purpose of this study is to learn more about your perception of
research in EMS as well as your experience with Emergency Department (ED) crowding and ambulance diversion.
Your participation in this study is completely voluntary. The NREMT does not mandate/require participation in this project, as such there are no direct
benefits or penalties associated with your choice to participate or not participate. You will receive no payment for participating in the study. If you
choose to participate, please complete the following survey and return it to the NREMT with your re-certification paperwork. We anticipate the survey
will take 10-15 minutes to complete.
Because your privacy is very important to us, the information that you give in the study will be anonymous. Your name will not be collected or linked to
the data. This survey will be physically separated from all re-certification paperwork and demographic information prior to processing your re-certification
or providing researchers with electronic survey responses. Because of the nature of the data, if you are from an area with low numbers of nationally
certified EMS professionals it may be possible to identify you; however, there will be no attempt to do so and your data will be reported in a way that will
not identify you.
If you have questions about the study, contact Antonio R. Fernandez at (614) 888-4484 or . If you have questions regarding your
rights as a project participant, you may contact Dr. Greg Gibson at (614) 888-4484 or . Thank you for your participation.
Please answer the following items about your current EMT job. If you have more than one current EMT job,
answer these questions about the EMT job with the most patient transports per week. If you have recently
changed jobs, answer these questions about the EMT job you have spent the most time on in the last 12 months.
1. What is the 5-digit zip code of the community in which you do most
2. Which one of the following best describes the type of EMS service
of your EMT work?
for which you do most of your work?
If the EMS agency with which you are
O
Fire-based
primarily affiliated does not transport
O
County or municipal (for example, third service)
patients in the United States please
O
Private, for profit
enter 00000.
O
Private, not for profit
0
0
0
0
0
O
Hospital-based
1
1
1
1
1
O
Military or US Federal Government
2
2
2
2
2
O
I am not affiliated with any organization
3
3
3
3
3
O
Other
4
4
4
4
4
5
5
5
5
5
3. About how many EMS calls do you respond to during a typical week?
6
6
6
6
6
7
7
7
7
7
O
0
O
10-19
O
30-39
8
8
8
8
8
O
1-9
O
20-29
O
40 or more
9
9
9
9
9
4. Are you a volunteer EMT?
5. Is EMS your primary career?
O
Yes
O
No
O
Yes
O
No
6. How many years have you been an EMT?
7. Which best describes your primary role at your main EMT job?
O
I am not an EMT
O
3 - 4 years
O
11 - 15 years
O
Clinician (EMT or Paramedic)
O
Administrator
O
Less than one year
O
5 - 7 years
O
16 - 20 years
O
Educator
O
Fire Suppression
O
1 - 2 years
O
8 - 10 years
O
21 or more
O
Manager
O
Sales Representative
years
O
Supervisor
O
Other______________
9. At what level are you currently practicing?
8. What is the highest level of education that you have completed?
O
First Responder
O
EMT-Paramedic
O
Didn’t complete high school
O
EMT-Basic
O
Permanently not practicing
O
High school graduate/ GED
O
EMT-Intermediate
O
Temporarily not practicing
O
Some college
O
Associate’s Degree (A.A., A.S.)
O
Bachelor’s Degree (B.A., B.S.)
O
Graduate Degree (M.A., M.S., Ph.D.)
10. Please share your ideas about medical research in the following questions:
Strongly
Slightly
Slightly
Strongly
Disagree
Agree
Disagree
Disagree
Agree
Agree
Research in EMS care is
important.O
O
O
O
O
O
Investigators involved in medical research will act in the patient’s best interest.
O
The right of research subjects to make their own choices is more important than
the interests of the general community.
O
O
O
O
O
There are times when it is so important to learn about a potential new treatment
that it would be okay to enroll patients in a study before they are able to
consent.O
There are enough safeguards in place to assure that research is done in an
ethical manner.
O
O
O
O
O
EMTs/paramedics should have the individual right to refuse to enroll patients
in EMS
research.O O
O
O
O
O
Page 3
(continued on the back)
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