With the attacks of September 11, 2001, Hurricane Katrina, and more recently the potential of a flu pandemic, public attention has increasingly focused on the ability of our Nation's health care system to respond to mass casualty incidents. In response to this concern, the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) and Health Resources and Services Administration (HRSA), developed Preparedness for Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Events: Questionnaire for Health Care Facilities.
The questionnaire, funded by HRSA, was developed through an AHRQ contract with Booz Allen Hamilton, with the advice and consultation of an expert panel. The panel consisted of medical subject matter experts trained and experienced in the hospital care of victims of chemical, biological, radiological, nuclear, and/or explosive events. While the questionnaire covers major areas of hospital preparedness, it should not be considered definitive. Each hospital must take into account specific preparedness needs related to its own environment, facilities, staff, and patient population.
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Note: AHRQ is offering this questionnaire for States, localities, and hospitals to use in assessing emergency preparedness. AHRQ is not administering this questionnaire and will not be collecting data compiled from it. Please do not send completed questionnaires or compiled data to AHRQ. |
The CBRNE questionnaire is designed to collect information on CBRNE preparedness activities and, in particular, response activities that are the responsibility of and under the control of hospital leadership. The questionnaire covers activities that could be executed by both large and small hospitals.
This questionnaire was developed for two types of users:
Primarily, States, localities, and multi-hospital systems, which can administer the survey to hospitals and health care facilities in their jurisdictions to assess overall hospital emergency preparedness.
This Respondent's Guide is intended for the individual at the hospital or health care facility who will complete the questionnaire. (States or localities that are administering this questionnaire should go to the Administrator's Guide.)
The Respondent's Guide provides an overview of the questionnaire and details on its use. It covers:
The questionnaire has 43 questions that fall into eight categories:
It is recommended that the disaster coordinator, director of safety and security, or someone in a similar role complete this questionnaire. However, if a facility does not have such positions, others can complete the questionnaire. Appendix B contains a matrix that indicates all the questions in the questionnaire and designates who in a facility might be best positioned to provide the answer to each question. Note that the matrix is provided as a guide and may not pertain to each facility.
This questionnaire is available both as a static version and an interactive Web version. The static version is included in Appendix A, or it can be printed out from the home page of the Web version. The interactive Web version will come from the State, region, or hospital system that is administering the questionnaire.
If you are completing the questionnaire as a self-assessment for an individual hospital or other health care facility, you can fill out the static version, or you can use the interactive Web version and print out your answers after you have completed the questionnaire.
If you are a respondent in a State, regional, or hospital system-wide survey, you will be using the Web-based questionnaire, but you should print out the static version to gather information in advance of filling out and submitting the Web questionnaire.
The Web-Based Questionnaire
Systems requirements for the Web-based questionnaire can be found on the main page of the Web site under the link titled, "System Requirements."
No username and password is required to access the questionnaire.
A Note Before Beginning: The questionnaire has a 120-minute "time-out" user session feature. This means that after 120 minutes of non-use, the system will no longer be accessible. This feature is to ensure the integrity and security of the entered data. When entering the data, you should make certain that you can complete the data within that timeframe. If you are "timed out," then you will be directed back to the beginning of the survey. You will not be able to begin where you previously ended. To ensure that all data can be entered in one sitting, it is strongly recommended that you print out a hard copy of the questionnaire (go to Appendix A or print from the screen on the electronic survey), review the questions, and be familiar with the answers before beginning the electronic data entry. Again, if the data is precollected on the paper instrument, it will be easier and quicker to electronically enter data, eliminating the risk of being "timed out" and having to start the questionnaire over again.
To download the paper version, select the "Download paper version of survey as a PDF file" link on the home page.
To begin the questionnaire, select the "Begin Survey" link on the home page.
The system will begin to display the questions. After you answer each question and select the "Next" button, the system will save your answers and display the next question.
The first section of the questionnaire collects information on the responding hospital's demographics and contact information. Some fields in this section are mandatory and must be completed before filling out the rest of the questionnaire. If you do not enter mandatory data or if you enter text when the field requires a numeric value, the system will generate an error message and will not save the data or move to the next question until you have corrected the error.
After completing the demographic portion of the questionnaire, you will be directed to the first question. The system will prompt you if any required questions on the screen are not answered. The questionnaire allows only one answer for each question. You must consider the institution's current status and choose the best answer.
Some questions will have a second part. If you select an answer to a question that requires more input, you will be redirected to a screen with the second part of the question. This is in the form of a drop-down list, and you can choose as many answers as apply.
You can skip a question and go back by using the "Back" button at anytime during the session.
At the completion of the questionnaire, select the "Submit and Close Out of Survey" link.
After you select the "Submit and Close Out of Survey" button, you will receive a confirmation that the questionnaire was successfully completed and your answers have been recorded. This confirmation notice will contain the questionnaire with your answers indicated. You can print out this document for your records.
As you are completing this questionnaire, if you have questions, you are encouraged to contact (insert name of contact individual) at the (insert name of State Health Department or Corporation). His/Her phone number is (xxx) xxx – xxxx and his/her E-mail address is xxx@xxx.com).