October 5th Needs Assessment

Name *

First

Last

Email *

Which of the following make up your current/future practice. (Select all that apply) *

How would you rate your comfort with the following non-technical Crisis Resource Management Skills *

	Very Uncomfortable	Somewhat Uncomfortable	Neutral	Somewhat Comfortable	Very Comfortable
Act as an effective leader in crisis	Very UncomfortableAct as an effective leader in crisis Very Uncomfortable	Somewhat UncomfortableAct as an effective leader in crisis Somewhat Uncomfortable	NeutralAct as an effective leader in crisis Neutral	Somewhat ComfortableAct as an effective leader in crisis Somewhat Comfortable	Very ComfortableAct as an effective leader in crisis Very Comfortable
Act as an effective helper in crisis	Very UncomfortableAct as an effective helper in crisis Very Uncomfortable	Somewhat UncomfortableAct as an effective helper in crisis Somewhat Uncomfortable	NeutralAct as an effective helper in crisis Neutral	Somewhat ComfortableAct as an effective helper in crisis Somewhat Comfortable	Very ComfortableAct as an effective helper in crisis Very Comfortable
Maintain effective situational awareness in crisis	Very UncomfortableMaintain effective situational awareness in crisis Very Uncomfortable	Somewhat UncomfortableMaintain effective situational awareness in crisis Somewhat Uncomfortable	NeutralMaintain effective situational awareness in crisis Neutral	Somewhat ComfortableMaintain effective situational awareness in crisis Somewhat Comfortable	Very ComfortableMaintain effective situational awareness in crisis Very Comfortable
Make effective decisions in crisis	Very UncomfortableMake effective decisions in crisis Very Uncomfortable	Somewhat UncomfortableMake effective decisions in crisis Somewhat Uncomfortable	NeutralMake effective decisions in crisis Neutral	Somewhat ComfortableMake effective decisions in crisis Somewhat Comfortable	Very ComfortableMake effective decisions in crisis Very Comfortable
Communicate effectively in crisis	Very UncomfortableCommunicate effectively in crisis Very Uncomfortable	Somewhat UncomfortableCommunicate effectively in crisis Somewhat Uncomfortable	NeutralCommunicate effectively in crisis Neutral	Somewhat ComfortableCommunicate effectively in crisis Somewhat Comfortable	Very ComfortableCommunicate effectively in crisis Very Comfortable
Manage your stress in crisis	Very UncomfortableManage your stress in crisis Very Uncomfortable	Somewhat UncomfortableManage your stress in crisis Somewhat Uncomfortable	NeutralManage your stress in crisis Neutral	Somewhat ComfortableManage your stress in crisis Somewhat Comfortable	Very ComfortableManage your stress in crisis Very Comfortable
Prioritize and manage tasks in crisis	Very UncomfortablePrioritize and manage tasks in crisis Very Uncomfortable	Somewhat UncomfortablePrioritize and manage tasks in crisis Somewhat Uncomfortable	NeutralPrioritize and manage tasks in crisis Neutral	Somewhat ComfortablePrioritize and manage tasks in crisis Somewhat Comfortable	Very ComfortablePrioritize and manage tasks in crisis Very Comfortable
Anticipate and plan in crisis	Very UncomfortableAnticipate and plan in crisis Very Uncomfortable	Somewhat UncomfortableAnticipate and plan in crisis Somewhat Uncomfortable	NeutralAnticipate and plan in crisis Neutral	Somewhat ComfortableAnticipate and plan in crisis Somewhat Comfortable	Very ComfortableAnticipate and plan in crisis Very Comfortable
Manage your environment in crisis	Very UncomfortableManage your environment in crisis Very Uncomfortable	Somewhat UncomfortableManage your environment in crisis Somewhat Uncomfortable	NeutralManage your environment in crisis Neutral	Somewhat ComfortableManage your environment in crisis Somewhat Comfortable	Very ComfortableManage your environment in crisis Very Comfortable
Debrief your team following a critical incident	Very UncomfortableDebrief your team following a critical incident Very Uncomfortable	Somewhat UncomfortableDebrief your team following a critical incident Somewhat Uncomfortable	NeutralDebrief your team following a critical incident Neutral	Somewhat ComfortableDebrief your team following a critical incident Somewhat Comfortable	Very ComfortableDebrief your team following a critical incident Very Comfortable

Please indicate how helpful each of the following workshops would be for your practice *

	Not at all helpful	Not Very Helpful	Neutral	Helpful	Very Helpful
Deliberate practice for high quality ACLS	Not at all helpfulDeliberate practice for high quality ACLS Not at all helpful	Not Very HelpfulDeliberate practice for high quality ACLS Not Very Helpful	NeutralDeliberate practice for high quality ACLS Neutral	HelpfulDeliberate practice for high quality ACLS Helpful	Very HelpfulDeliberate practice for high quality ACLS Very Helpful
Deliberate practice for high quality Neonatal Resuscitation	Not at all helpfulDeliberate practice for high quality Neonatal Resuscitation Not at all helpful	Not Very HelpfulDeliberate practice for high quality Neonatal Resuscitation Not Very Helpful	NeutralDeliberate practice for high quality Neonatal Resuscitation Neutral	HelpfulDeliberate practice for high quality Neonatal Resuscitation Helpful	Very HelpfulDeliberate practice for high quality Neonatal Resuscitation Very Helpful
Difficult Vascular access (ultrasound/Intraosseous)	Not at all helpfulDifficult Vascular access (ultrasound/Intraosseous) Not at all helpful	Not Very HelpfulDifficult Vascular access (ultrasound/Intraosseous) Not Very Helpful	NeutralDifficult Vascular access (ultrasound/Intraosseous) Neutral	HelpfulDifficult Vascular access (ultrasound/Intraosseous) Helpful	Very HelpfulDifficult Vascular access (ultrasound/Intraosseous) Very Helpful
Improving first pass intubation success	Not at all helpfulImproving first pass intubation success Not at all helpful	Not Very HelpfulImproving first pass intubation success Not Very Helpful	NeutralImproving first pass intubation success Neutral	HelpfulImproving first pass intubation success Helpful	Very HelpfulImproving first pass intubation success Very Helpful
Emergency Front of the Neck Airway	Not at all helpfulEmergency Front of the Neck Airway Not at all helpful	Not Very HelpfulEmergency Front of the Neck Airway Not Very Helpful	NeutralEmergency Front of the Neck Airway Neutral	HelpfulEmergency Front of the Neck Airway Helpful	Very HelpfulEmergency Front of the Neck Airway Very Helpful
Chest Tube Insertion	Not at all helpfulChest Tube Insertion Not at all helpful	Not Very HelpfulChest Tube Insertion Not Very Helpful	NeutralChest Tube Insertion Neutral	HelpfulChest Tube Insertion Helpful	Very HelpfulChest Tube Insertion Very Helpful
Ultrasound Guided Central Venous Access	Not at all helpfulUltrasound Guided Central Venous Access Not at all helpful	Not Very HelpfulUltrasound Guided Central Venous Access Not Very Helpful	NeutralUltrasound Guided Central Venous Access Neutral	HelpfulUltrasound Guided Central Venous Access Helpful	Very HelpfulUltrasound Guided Central Venous Access Very Helpful
Bipap and Ventilators in the first hour	Not at all helpfulBipap and Ventilators in the first hour Not at all helpful	Not Very HelpfulBipap and Ventilators in the first hour Not Very Helpful	NeutralBipap and Ventilators in the first hour Neutral	HelpfulBipap and Ventilators in the first hour Helpful	Very HelpfulBipap and Ventilators in the first hour Very Helpful
Management of the contaminated airway	Not at all helpfulManagement of the contaminated airway Not at all helpful	Not Very HelpfulManagement of the contaminated airway Not Very Helpful	NeutralManagement of the contaminated airway Neutral	HelpfulManagement of the contaminated airway Helpful	Very HelpfulManagement of the contaminated airway Very Helpful
Vascular access in NRP	Not at all helpfulVascular access in NRP Not at all helpful	Not Very HelpfulVascular access in NRP Not Very Helpful	NeutralVascular access in NRP Neutral	HelpfulVascular access in NRP Helpful	Very HelpfulVascular access in NRP Very Helpful
Ultrasound guided nerve blocks	Not at all helpfulUltrasound guided nerve blocks Not at all helpful	Not Very HelpfulUltrasound guided nerve blocks Not Very Helpful	NeutralUltrasound guided nerve blocks Neutral	HelpfulUltrasound guided nerve blocks Helpful	Very HelpfulUltrasound guided nerve blocks Very Helpful
Awake intubation techniques	Not at all helpfulAwake intubation techniques Not at all helpful	Not Very HelpfulAwake intubation techniques Not Very Helpful	NeutralAwake intubation techniques Neutral	HelpfulAwake intubation techniques Helpful	Very HelpfulAwake intubation techniques Very Helpful

Please indicate how helpful each of the following simulation themes would be for your practice *

	Not at all helpful	Not very helpful	Neutral	Helpful	Very Helpful
Medical Emergency	Not at all helpfulMedical Emergency Not at all helpful	Not very helpfulMedical Emergency Not very helpful	NeutralMedical Emergency Neutral	HelpfulMedical Emergency Helpful	Very HelpfulMedical Emergency Very Helpful
Respiratory Emergency	Not at all helpfulRespiratory Emergency Not at all helpful	Not very helpfulRespiratory Emergency Not very helpful	NeutralRespiratory Emergency Neutral	HelpfulRespiratory Emergency Helpful	Very HelpfulRespiratory Emergency Very Helpful
Trauma Emergency	Not at all helpfulTrauma Emergency Not at all helpful	Not very helpfulTrauma Emergency Not very helpful	NeutralTrauma Emergency Neutral	HelpfulTrauma Emergency Helpful	Very HelpfulTrauma Emergency Very Helpful
Airway Emergency	Not at all helpfulAirway Emergency Not at all helpful	Not very helpfulAirway Emergency Not very helpful	NeutralAirway Emergency Neutral	HelpfulAirway Emergency Helpful	Very HelpfulAirway Emergency Very Helpful
Pediatric Emergency	Not at all helpfulPediatric Emergency Not at all helpful	Not very helpfulPediatric Emergency Not very helpful	NeutralPediatric Emergency Neutral	HelpfulPediatric Emergency Helpful	Very HelpfulPediatric Emergency Very Helpful
Toxicologic Emergency	Not at all helpfulToxicologic Emergency Not at all helpful	Not very helpfulToxicologic Emergency Not very helpful	NeutralToxicologic Emergency Neutral	HelpfulToxicologic Emergency Helpful	Very HelpfulToxicologic Emergency Very Helpful
Anesthetic Emergency	Not at all helpfulAnesthetic Emergency Not at all helpful	Not very helpfulAnesthetic Emergency Not very helpful	NeutralAnesthetic Emergency Neutral	HelpfulAnesthetic Emergency Helpful	Very HelpfulAnesthetic Emergency Very Helpful
Cardiac Emergency	Not at all helpfulCardiac Emergency Not at all helpful	Not very helpfulCardiac Emergency Not very helpful	NeutralCardiac Emergency Neutral	HelpfulCardiac Emergency Helpful	Very HelpfulCardiac Emergency Very Helpful
Neonatal Emergency	Not at all helpfulNeonatal Emergency Not at all helpful	Not very helpfulNeonatal Emergency Not very helpful	NeutralNeonatal Emergency Neutral	HelpfulNeonatal Emergency Helpful	Very HelpfulNeonatal Emergency Very Helpful

Do you have any other signifiant educational goals that may be amenable to a simulation experience?

Are there any simulation cases that you have already done that you would not want to repeat?

Are there an cases/scenarios that may trigger you in an unpleasant way and should therefore be avoided?

Do you have any food allergies or dietary requirements?

Message

October 5th Needs Assessment

Follow Us

Subscribe to our mailing list