Column # |
Column ID |
Question Category |
Question # |
Question |
Additional Question |
Column Value |
Answer |
Sub |
Link to Column |
1 |
Survey ID |
Demographic |
sys (system) |
|
|
|
|
|
Survey ID |
2 |
Begin Time |
Demographic |
sys (system) |
|
|
|
|
|
Begin Time |
3 |
End Time |
Demographic |
sys (system) |
|
|
|
|
|
End Time |
4 |
D01 |
Demographic |
Demo |
Hospital Name |
|
Varchar |
|
|
D01 |
5 |
D02 |
Demographic |
Demo |
Street Address |
|
Varchar |
|
|
D02 |
6 |
D03 |
Demographic |
Demo |
City |
|
Varchar |
|
|
D03 |
7 |
D04 |
Demographic |
Demo |
State |
|
Varchar |
|
|
D04 |
8 |
D05 |
Demographic |
Demo |
Zip |
|
Varchar |
|
|
D05 |
9 |
D06 |
Demographic |
Demo |
Telephone Number of primary contact |
|
Varchar |
|
|
D06 |
10 |
D07 |
Demographic |
Demo |
Primary Contact for this Survey |
|
Varchar |
|
|
D07 |
11 |
D08 |
Demographic |
Demo |
Title of Primary Contact |
|
Varchar |
|
|
D08 |
12 |
D09 |
Demographic |
Demo |
Telephone Number of primary contact |
|
Varchar |
|
|
D09 |
13 |
D10 |
Demographic |
Demo |
E-mail address of primary contact |
|
Varchar |
|
|
D10 |
14 |
D11 |
Demographic |
Demo |
Licensed beds |
|
int |
|
|
D11 |
15 |
D12 |
Demographic |
Demo |
Staffed beds |
|
int |
|
|
D12 |
16 |
D13 |
Demographic |
Demo |
Funds |
|
Varchar |
|
|
D13 |
17 |
D14 |
Demographic |
Demo |
Funding agency |
|
Varchar |
|
|
D14 |
18 |
D15 |
Demographic |
Demo |
In kind |
|
Varchar |
|
|
D15 |
19 |
D16 |
Demographic |
Demo |
Trauma |
|
True/False |
Yes/No |
|
D16 |
20 |
D17A |
Demographic |
Demo |
General medical, surgical |
|
True/False |
Yes/No |
|
D17A |
21 |
D17B |
Demographic |
Demo |
Burn center |
|
True/False |
Yes/No |
|
D17B |
22 |
D17C |
Demographic |
Demo |
Trauma center |
|
True/False |
Yes/No |
|
D17C |
23 |
D17D |
Demographic |
Demo |
Psychiatric |
|
True/False |
Yes/No |
|
D17D |
24 |
D17E |
Demographic |
Demo |
Children's |
|
True/False |
Yes/No |
|
D17E |
25 |
D17F |
Demographic |
Demo |
Long-term care/skilled nursing facility |
|
True/False |
Yes/No |
|
D17F |
26 |
D17G |
Demographic |
Demo |
Rehabilitation |
|
True/False |
Yes/No |
|
D17G |
27 |
D17H |
Demographic |
Demo |
Other |
|
True/False |
Yes/No |
|
D17H |
28 |
D18 |
Demographic |
Demo |
Type of hospital |
|
1 |
Rural (non-Metropolitan Statistical Area (MSA)) hospital |
|
D18 |
2 |
Urban (MSA) hospital |
|
D18 |
3 |
Don't know |
|
D18 |
29 |
D19 |
Demographic |
Demo |
Type of hospital |
|
1 |
Private for-profit |
|
D19 |
2 |
Private not-for-profit |
|
D19 |
3 |
Military |
|
D19 |
4 |
Veterans Administration |
|
D19 |
5 |
Indian Health Service |
|
D19 |
6 |
Other public (Federal, State, local government) |
|
D19 |
7 |
Other |
|
D19 |
30 |
D20 |
Demographic |
Demo |
Is your hospital an academic/teaching facility? |
|
True/False |
Yes/No |
|
D20 |
31 |
D21 |
Demographic |
Demo |
Is your hospital in a network or system with other hospitals? |
|
True/False |
Yes/No |
|
D21 |
32 |
Q01 |
Administration and Planning |
1 |
Has the hospital designated a coordinator (or group/committee)
who is responsible for overseeing all of the hospital's chemical, biological, radiological, nuclear, and explosive events (CBRNE) preparedness efforts? |
|
1 |
No, and not planned within the next 6 months. |
|
Q01 |
2 |
No, but the hospital plans to designate a coordinator within the next 6 months. |
|
Q01 |
3 |
Yes. |
|
Q01 |
4 |
Other. |
|
Q01 |
33 |
Q02 |
Administration and Planning |
2 |
Has the hospital designated a medical director (or group) for its
CBRNE preparedness efforts? |
|
1 |
No, and not planned within the next 6 months. |
|
Q02 |
2 |
No, but the hospital plans to designate a medical director within the next
6 months. |
|
Q02 |
3 |
Yes. |
|
Q02 |
4 |
Other. |
|
Q02 |
34 |
Q03 |
Administration and Planning |
3 |
Does the hospital use an Incident Command System (ICS) to manage
events that impact normal operations? |
|
1 |
No, and not planned within the next 6 months. |
|
Q03 |
2 |
No, but the hospital plans to use an ICS within the next 6 months. |
|
Q03 |
3 |
ICS is currently being developed. |
|
Q03 |
4 |
Yes, but all hospital staff are not trained on their roles in the system. |
|
Q03 |
5 |
Yes, and all hospital staff are trained on their roles in the system. |
|
Q03 |
6 |
Other. |
|
Q03 |
35 |
Q034A |
Administration and Planning |
3 |
Is the ICS used on a near daily basis to manage events that impact normal
operations? |
|
True/False |
Yes/No |
Y |
Q034A |
36 |
Q034B |
3 |
Is the ICS practiced routinely in exercises/drills? |
|
True/False |
Yes/No |
Y |
Q034B |
37 |
Q034C |
3 |
Is the ICS updated as needed after exercises/drills? |
|
True/False |
Yes/No |
Y |
Q034C |
38 |
Q034D |
3 |
Is the ICS incorporated into existing training programs? |
|
True/False |
Yes/No |
Y |
Q034D |
39 |
Q034E |
3 |
Is the ICS formally incorporated into the emergency operations plan (EOP)? |
|
True/False |
Yes/No |
Y |
Q034E |
40 |
Q034F |
3 |
Is the ICS coordinated with local entities? |
|
True/False |
Yes/No |
Y |
Q034F |
41 |
Q04 |
Administration and Planning |
4 |
Has the hospital designated an individual to manage and maintain
its decontamination capability? |
|
1 |
No, and not planned within the next 6 months. |
|
Q04 |
2 |
No, but planned within the next 6 months. |
|
Q04 |
2 |
Yes, and their responsibilities include (check all that apply): |
|
Q04 |
4 |
Other. |
|
Q04 |
42 |
Q043A |
Administration and Planning |
4 |
Inspecting, inventorying, storing, and purchasing personal protective
equipment (PPE) when needed. |
|
True/False |
Yes/No |
Y |
Q043A |
43 |
Q043B |
4 |
Upkeep and maintenance of the decontamination equipment. |
|
True/False |
Yes/No |
Y |
Q043B |
44 |
Q043C |
4 |
Maintenance of training records. |
|
True/False |
Yes/No |
Y |
Q043C |
45 |
Q043D |
4 |
Ongoing training. |
|
True/False |
Yes/No |
Y |
Q043D |
46 |
Q043E |
4 |
Recruitment of new team members. |
|
True/False |
Yes/No |
Y |
Q043E |
47 |
Q043F |
4 |
Maintenance of exposure records. |
|
True/False |
Yes/No |
Y |
Q043F |
48 |
Q05 |
Administration and Planning |
5 |
Does the hospital have a plan for a CBRNE event that is
reviewed and updated? |
|
1 |
No, and not planned within the next 6 months. |
|
Q05 |
2 |
No, but the hospital intends to begin to draft a CBRNE plan within the
next 6 months. |
|
Q05 |
3 |
The plan is currently being drafted. |
|
Q05 |
4 |
Yes, the plan includes the following but is not updated every 2 years. |
|
Q05 |
5 |
Yes, the plan includes the following and is updated at least 2 years. |
|
Q05 |
6 |
Other. |
|
Q05 |
49 |
Q54A |
Administration and Planning |
5 |
Hospital's roles and responsibilities in a community CBRNE event |
|
True/False |
Yes/No |
Y |
Q54A |
50 |
Q54B |
5 |
Scenario in which the hospital itself is the target of a CBRNE event |
|
True/False |
Yes/No |
Y |
Q54B |
51 |
Q54C |
5 |
Plan activation and staff notification procedures |
|
True/False |
Yes/No |
Y |
Q54C |
52 |
Q54D |
5 |
Shelter in place |
|
True/False |
Yes/No |
Y |
Q54D |
53 |
Q54E |
5 |
Evacuation |
|
True/False |
Yes/No |
Y |
Q54E |
54 |
Q54F |
5 |
Initial recognition and presumptive diagnosis of symptomatic CBRNE patients |
|
True/False |
Yes/No |
Y |
Q54F |
55 |
Q54G |
5 |
Communication to and notification of staff of suspected CBRNE cases |
|
True/False |
Yes/No |
Y |
Q54G |
56 |
Q54H |
5 |
Diagnostic procedures or tests to make presumptive diagnosis |
|
True/False |
Yes/No |
Y |
Q54H |
57 |
Q54I |
5 |
Means to access age-specific CBRNE medical management guidelines from
the public health departments and other appropriate agencies |
|
True/False |
Yes/No |
Y |
Q54I |
58 |
Q54J |
5 |
Provision of mental health services for affected patients |
|
True/False |
Yes/No |
Y |
Q54J |
59 |
Q54K |
5 |
Provision for controlling hospital access to limit contamination of the
facility and individuals |
|
True/False |
Yes/No |
Y |
Q54K |
60 |
Q54L |
5 |
Capability to isolate CBRNE patients from general inpatient population |
|
True/False |
Yes/No |
Y |
Q54L |
61 |
Q54M |
5 |
Capability to isolate CBRNE patients from general outpatient population |
|
True/False |
Yes/No |
Y |
Q54M |
62 |
Q54N |
5 |
Provisions for handling suspected CBRNE agents brought to the hospital
or sampled within the hospital |
|
True/False |
Yes/No |
Y |
Q54N |
63 |
Q54O |
5 |
Patient care expansion areas usable for assessing and treating potential
victims of CBRNE events |
|
True/False |
Yes/No |
Y |
Q54O |
64 |
Q54P |
5 |
Memorandums of understanding with external treatment facilities for overflow
in the event of treatment site contamination or capacity shortages |
|
True/False |
Yes/No |
Y |
Q54P |
65 |
Q54Q |
5 |
Receipt and management of surge caches of pharmaceuticals and supplies |
|
True/False |
Yes/No |
Y |
Q54 |
66 |
Q54R |
5 |
Means to access additional supplies of blood and blood products |
|
True/False |
Yes/No |
Y |
Q54R |
67 |
Q54S |
5 |
Follow up instructions for patients and their home care providers that
consider published guidelines from public health departments or the Centers
for Disease Control and Prevention (CDC) |
|
True/False |
Yes/No |
Y |
Q54S |
68 |
Q54T |
5 |
Cost recovery plan coordinated with third party payers |
|
True/False |
Yes/No |
Y |
Q54T |
69 |
Q54U |
5 |
After-action evaluation of hospital's response to CBRNE event |
|
True/False |
Yes/No |
Y |
Q54U |
70 |
Q54V |
5 |
Disaster Recovery Procedures |
|
True/False |
Yes/No |
Y |
Q54V |
71 |
Q06 |
Administration and Planning |
6 |
Are funds for CBRNE preparedness (i.e., planning, training,
operations, etc.) included into the hospital's budget? |
|
1 |
No, and not planned within the next 6 months. |
Y |
Q06 |
2 |
No, but the hospital plans to include CBRNE preparedness funds into the
budget within the next 6 months. |
Y |
Q06 |
3 |
Budgetary items are currently being evaluated. |
Y |
Q06 |
4 |
Yes, but only those received from NBHPP. |
Y |
Q06 |
5 |
Yes, and there are funds over and above those received from NBHPP. |
Y |
Q06 |
6 |
Other. |
Y |
Q06 |
72 |
Q07 |
Administration and Planning |
7 |
Does the hospital participate in a regional planning group
(i.e., local/State public health department) or other groups responsible
for regional CBRNE preparedness? |
|
1 |
No, and not planned within the next 6 months. |
Y |
Q07 |
2 |
No, but the hospital plans to participate in a regional planning group
within the next 6 months. |
Y |
Q07 |
3 |
Involvement in a regional planning group is being considered. |
Y |
Q07 |
4 |
Yes, but there is relatively infrequent interaction between the regional
planning group and the hospital. |
Y |
Q07 |
5 |
Yes, and there is ongoing interaction between the regional planning group
and the hospital. |
Y |
Q07 |
6 |
Other |
Y |
Q07 |
73 |
Q074A |
Administration and Planning |
7 |
Hospitals in local area |
|
True/False |
Y/N |
Y |
Q074A |
74 |
Q074B |
7 |
Department of Homeland Security |
|
True/False |
Y/N |
Y |
Q074B |
75 |
Q074C |
7 |
Health department |
|
True/False |
Y/N |
Y |
Q074C |
76 |
Q074D |
7 |
Local emergency planning committee |
|
True/False |
Y/N |
Y |
Q074D |
77 |
Q074E |
7 |
Local fire department |
|
True/False |
Y/N |
Y |
Q074E |
78 |
Q074F |
7 |
Local emergency medical service(s) (EMS) |
|
True/False |
Y/N |
Y |
Q074F |
79 |
Q074G |
7 |
Local law enforcement |
|
True/False |
Y/N |
Y |
Q074G |
80 |
Q074H |
7 |
Other (please list) |
|
True/False |
Y/N |
Y |
Q074H |
81 |
Q08 |
Education and Training |
8 |
Does the hospital provide competency-based training on CBRNE
events to clinical staff? |
|
1 |
No, and not planned within the next 6 months. |
|
Q08 |
2 |
No, but hospital plans to provide competency-based training to clinical
staff within the next 6 months. |
|
Q08 |
3 |
Some clinical staff has been trained. |
|
Q08 |
4 |
Yes, all clinical staff has been trained, but less frequently than
every 2 years. |
|
Q08 |
5 |
Yes, all clinical staff is trained at least every 2 years. |
|
Q08 |
6 |
Other. |
|
Q08 |
82 |
Q09 |
Education and Training |
9 |
Does the hospital provide competency-based training on
CBRNE events to non-clinical staff? |
|
1 |
No, and not planned within the next 6 months. |
|
Q09 |
2 |
No, but hospital plans to provide competency-based training to non-clinical
staff within the next 6 months. |
|
Q09 |
3 |
Some non-clinical staff have been trained. |
|
Q09 |
4 |
Yes, all non-clinical staff have been trained, but less frequently
than every 2 years. |
|
Q09 |
5 |
Yes, all non-clinical staff are trained at least every 2 years. |
|
Q09 |
6 |
Other. |
|
Q09 |
83 |
Q10 |
Education and Training |
10 |
Does the hospital provide training in accordance with
Occupational Safety and Health Administration (OSHA) standards to personnel
who may be part of the decontamination response? |
|
1 |
No, and not planned within the next 6 months. |
|
Q10 |
2 |
No, but the hospital plans to provide training according to OSHA standards
within the next 6 months. |
|
Q10 |
3 |
Training curriculum is currently being developed. |
|
Q10 |
4 |
Yes, training on the following is provided, but not on an annual basis. |
|
Q10 |
5 |
Yes, and training on the following is provided annually. |
|
Q10 |
6 |
Other. |
|
Q10 |
84 |
Q104A1 |
Education and Training |
10 |
OSHA-level operations training for all staff with designated roles
in the hospital decontamination zone (area where contamination may be
found and decontamination performed) |
Conducted training |
True/False |
Yes/No |
Y |
Q104A1 |
85 |
Q104A2 |
10 |
OSHA-level operations training for all staff with designated roles in the
hospital decontamination zone (area where contamination may be found and
decontamination performed) |
Tested in Exercise/drill |
True/False |
Yes/No |
Y |
Q104A2 |
86 |
Q104B1 |
Education and Training |
10 |
OSHA-level awareness training for all staff assigned to areas proximate
to the decontamination zone where contact with contaminated may occur |
Conducted training |
True/False |
Yes/No |
Y |
Q104B1 |
87 |
Q104B2 |
10 |
OSHA-level awareness training for all staff assigned to areas proximate
to the decontamination zone where contact with contaminated may occur |
Tested in Exercise/drill |
True/False |
Yes/No |
Y |
Q104B2 |
88 |
Q104C1 |
Education and Training |
10 |
Agent identification |
Conducted training |
True/False |
Yes/No |
Y |
Q104C1 |
89 |
Q104C2 |
10 |
Agent identification |
Tested in Exercise/drill |
True/False |
Yes/No |
Y |
Q104C2 |
90 |
Q104D1 |
Education and Training |
10 |
Selection and use of PPE |
Conducted training |
True/False |
Yes/No |
Y |
Q104D1 |
91 |
Q104D2 |
10 |
Selection and use of PPE |
Tested in Exercise/drill |
True/False |
Yes/No |
Y |
Q104D2 |
92 |
Q104E1 |
Education and Training |
10 |
Decontamination area setup |
Conducted training |
True/False |
Yes/No |
Y |
Q104E1 |
93 |
Q104E2 |
|
|
Decontamination area setup |
Tested in Exercise/drill |
True/False |
Yes/No |
Y |
Q104E2 |
94 |
Q104F1 |
Education and Training |
10 |
Patient decontamination |
Conducted training |
True/False |
Yes/No |
Y |
Q104F1 |
95 |
Q104F2 |
10 |
Patient decontamination |
Tested in Exercise/drill |
True/False |
Yes/No |
Y |
Q104F2 |
96 |
Q104G1 |
Education and Training |
10 |
Decontamination area cleanup |
Conducted training |
True/False |
Yes/No |
Y |
Q104G1 |
97 |
Q104G2 |
10 |
Decontamination area cleanup |
Tested in Exercise/drill |
True/False |
Yes/No |
Y |
Q104G2 |
98 |
Q104H1 |
Education and Training |
10 |
Radiation contamination/exposure management |
Conducted training |
True/False |
Yes/No |
Y |
Q104H1 |
99 |
Q104H2 |
10 |
Radiation contamination/exposure management |
Tested in Exercise/drill |
True/False |
Yes/No |
Y |
Q104H2 |
100 |
Q104I1 |
Education and Training |
10 |
Equipment inspection, maintenance, and storage |
Conducted training |
True/False |
Yes/No |
Y |
Q104I1 |
101 |
Q104I2 |
10 |
Equipment inspection, maintenance, and storage |
Tested in Exercise/drill |
True/False |
Yes/No |
Y |
Q104I2 |