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2012 East Region Prehospital TrainingAssessmentEducation Edit

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1. Agency Information

EMS Training Needs Assessment for September 2012 - June 2013

Thank you for participating in the East Region Prehospital Training Needs Assessment. Thissurvey will take about five minutes to complete. Your input is critical to improving prehospitalEMS training across the East Region.

If you have questions at any time please contact the East Region Office at 509-326-6499.

Q 1 [Edit Qu~~;;;;;;TiJr:~~;';lrco~~JL?~~J*1. Agency InformationOfficial Agency ,--------------,Name:Agency License #Agency MailingAddress:CitylTown:State: - select state-

ZIP:CountyAgency EmailAddress:Agency Phone:

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*2. EMSlTraining Contact InfoEMSlTraining 1'---------,Officer's Name:Address:CitylTown:State: - select state-

ZIP:Email Address:Phone Number(cell phonepreferred):

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2. Initial EMS Classes

Please indicate your initial training needs by identifying the class and number of students belowin order of priority.

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*3. Prioritize your top 3 Initial EMS Class NeedsIdentify Initial Classes

~Approx. # of Students

Priority 1Priority 2Priority 3

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3. OTEP (On-Going Training & Education Program) Classes

The East Region EMS Council currently funds a portion of OTEP training for EMS agencies.

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*4. Enter Total Number of (EMS) Providers to be trained that are registeredwith your agency and listed as primary?

For your agency I Ionly:

*5. Please prioritize your OTEP needs below.Class Names

Priority 1Priority 2Priority 3Priority 4Priority 5

Other (please specify)

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\4. Prehospitallnstructor TrainingI

Please identify all of the training classes your agency may need.

*6. Prehospitallnstructor ClassesClass Names # of Students

Priority 1 ; . iPriority 2

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5. Other EMS Education

Please identify and prioritize your other training choices including number of students and level ofthe class.

Question Explanation and Student Cost Information

> (PHTLS) Prehospital Trauma Life Support (Approx. Cost $275/student includes books)> (BTLS) Basic Trauma Life Support (Approx. Cost $200/student)> BLS (PEPP) Pediatric Educatioon for Prehospital Providers (Cost is approx $150/student)> ALS (PEPP) Pediatric Education for Prehospital Providers) Cost is approx $200/student> Emergency Pediatric Care (Basic 8 hour class) Cost is approx $150/student

*7. Please prioritize other EMS Training opportunities.

Class #ofStudents Level

Priority1Priority2

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6. Thank you for your participation!

Thank you taking the time to participate in this important survey. Your input is greatly appreciatedand will be used to help us improve Prehospital Training in the East Region. The East Regiononly funds BLS OTEP.

By pressing "DONE" below your survey will be automatically submitted. If you have changes aftesubmitting the survey, please call the East Region EMS Office at 509-326-6499.

Rod Heimbigner,ChairEast Region Training & Education Committee

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