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Emergency Preparedness Information Questionnaire (EPIQ)

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

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Emergency Preparedness Information Questionnaire (EPIQ) A Cross sectional Study of Disaster Preparedness at the Regional Hospitals in Zanzibar (Unguja and Pemba). Principal Investigator: Dr. Aisha Ahmed Himid
1

Hospital Name

2

Location

3

Designation

4

Age

Use digits only
5

Gender

6

Years of experience in emergency department

7

Disaster preparedness training? Yes/No?

8

Worked during a disaster? YES/NO?

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Emergency Preparedness Information Questionnaire (EPIQ) A Cross sectional Study of Disaster Preparedness at the Regional Hospitals in Zanzibar (Unguja and Pemba). Principal Investigator: Dr. Aisha Ahmed Himid

A: Incident Command System

9

The function group of the incident command system (ICS) to which you are assigned during large-scale emergency events.

Select 1 answer
10

The physical location to which you would report if a large-scale emergency event would occur

Select 1 answer
11

Your hospital’s preparedness level for responding to large-scale emergency events.

Select 1 answer
12

The content of the emergency operations plan, or major incident plan, in your hospital/organization.

Select 1 answer
13

The strategic rationale used to develop the ICS response and action plan.

Select one answer
14

Assessing site safety for yourself, co-workers, and victims during large-scale emergency events

Select one answer
15

Differences between the ICS's decision-making processes for large-scale emergency and non-emergency events.

Select one answer
16

Tasks that should not be delegated to volunteers during large-scale emergency events.

Select one answer
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Emergency Preparedness Information Questionnaire (EPIQ) A Cross sectional Study of Disaster Preparedness at the Regional Hospitals in Zanzibar (Unguja and Pemba). Principal Investigator: Dr. Aisha Ahmed Himid

B: TRIAGE

17

Performing a rapid physical assessment of a victim of large-scale emergency events.

Select 1 answer
18

Assisting with triage during large-scale emergency events

Select one or more answers
19

Basic first aid, including oxygen administration and ventilation during large-scale emergency events

Select 1 answer
20

Performing a rapid mental health assessment of a victim of large-scale emergency events.

Select 1 answer
21

Evaluating the effectiveness of your actions during large-scale emergency events

Select one answer

COMMUNICATION AND CONNECTIVITY

22

The chain of custody during large-scale emergency events.

Select one answer
23

Identifying the different abilities of key partners in your emergency operation or major incident plans.

Select one answer
24

The procedure for documenting provision of care during large-scale emergency events.

Select one answer
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Emergency Preparedness Information Questionnaire (EPIQ) A Cross sectional Study of Disaster Preparedness at the Regional Hospitals in Zanzibar (Unguja and Pemba). Principal Investigator: Dr. Aisha Ahmed Himid

B: TRIAGE

25

Process of gaining access to the Strategic National Stockpile

Select one or more answers
26

Effectively presenting information about degree of risk to different audiences.

Select one or more answers
27

Appropriate debriefing activities following a large-scale emergency event.

Select one or more answers
28

Procedures for communicating critical patient information to people transporting patients.

Select 1 answer
29

The use of all types of communication devices

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Emergency Preparedness Information Questionnaire (EPIQ) A Cross sectional Study of Disaster Preparedness at the Regional Hospitals in Zanzibar (Unguja and Pemba). Principal Investigator: Dr. Aisha Ahmed Himid

C: Psychological Issues and Special Populations.

30

Signs of post-traumatic stress in patients who have been seen for routine healthcare checks following a large-scale event.

Select 1 answer
31

Detecting and evaluating post-traumatic stress or other mental health problems in a child or teenager.

32

Appropriate psychological support for all parties involved in a large-scale emergency event.

33

Providing health counseling and education to patients in the long-term impact of chemical, biological, radiological, nuclear, and explosive (CBRNE) agents.

34

The appropriate care of sensitive/vulnerable patients during large-scale emergency events.

35

Procedures for providing care to children and younger people during large-scale emergency events when consent cannot be obtained from their parents or legal guardians.

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Emergency Preparedness Information Questionnaire (EPIQ) A Cross sectional Study of Disaster Preparedness at the Regional Hospitals in Zanzibar (Unguja and Pemba). Principal Investigator: Dr. Aisha Ahmed Himid

D: ISOLATION, DECONTAMINATION AND QUARANTINE FACTOR

36

Selecting the appropriate personal protective equipment when caring for patients exposed to chemical, biological, radiological, nuclear and explosive (CBRNE) agents.

Select 1 answer
37

Isolation procedures for people exposed to biological or chemical agents.

Select 1 answer
38

Your facility's isolation and quarantine procedures.

Select 1 answer
39

The decontamination procedures stated in your facility's emergency operations or major incident plans.

Select 1 answer
40

The impact on the environment of large-scale emergency events.

Select 1 answer
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Emergency Preparedness Information Questionnaire (EPIQ) A Cross sectional Study of Disaster Preparedness at the Regional Hospitals in Zanzibar (Unguja and Pemba). Principal Investigator: Dr. Aisha Ahmed Himid

E: Epidemiology and Clinical Decision-Making Factor

41

Match antidote and prophylactic medications to specific biological/chemical agents.

Select one or more answers
42

Assessing history and physical assessment surveillance data, when there is for creating a high index of suspicion that a patient has been exposed to a category A, B or C biological agent.

Select one or more answers
43

Ability to identify the exacerbation of underlying diseases due to exposure to chemical, biological, radiological, nuclear and explosive (CBRNE) agents.

Select one or more answers
44

The ethical, legal, cultural, and safety issues relating to the proper handling of the dead during large-scale emergency events.

Select one or more answers
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Emergency Preparedness Information Questionnaire (EPIQ) A Cross sectional Study of Disaster Preparedness at the Regional Hospitals in Zanzibar (Unguja and Pemba). Principal Investigator: Dr. Aisha Ahmed Himid

F: Reporting and Accessing Critical Resources

45

The diseases that are immediately reportable to the local and state departments of health

Select one answer
46

When unusual symptoms should be reported to local and state departments.

Select one or more answers
47

Determining the appropriate agency to which reportable diseases are to be directed.

Select one or more answers
48

Where to quickly access up-to-date resources quickly about specific chemical, biological, radiological, nuclear and explosive (CBRNE) agents.

Select one or more answers

G: BIOLOGICAL AGENTS

49

Signs and symptoms of anthrax inhalation

Select one or more answers
50

Modes of transmission for different types of biological agents such as anthrax and small pox

51

Possible adverse reactions to smallpox vaccination.

52

Signs and symptoms attributable to exposure to different biological agents.

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