hospital_response
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are you responding on behalf of a Hospital?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
hcc_response
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Are you responding on behalf of a VC Health Care Coalition facility?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
do_you_have_a_burn_surge_plan
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 1. Do you have a burn surge plan?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [dont_know: I don't Know]
)
how_could_your_facility_access
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: 2. How could your facility access real-time expert assistance via consultation with a Burn Center Physician, either through a nearby Burn Center or through a state or regional Burn Coordination Center, Medical Operations Coordination Center, etc.?, type: esriFieldTypeString
)
are_you_familiar_with_the_natio
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 3. Are you familiar with the National Western Region Burn Disaster Consortium?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [dont_know: I don't Know]
)
does_your_facility_have_telehea
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 4. Does your facility have telehealth / telemedicine agreements with a Trauma Center for additional assistance?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [dont_know: I don't Know]
)
field_7
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 5. Does your facility have telehealth / telemedicine agreements with a Burn Center for additional assistance?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [dont_know: I don't Know]
)
does_your_facility_have_burn_tr
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 6. Does your facility have Burn Triage cards or other quick reference resources?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [dont_know: I don't Know]
)
if_yes_1
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 6a. What resources do you have?, type: esriFieldTypeString
)
how_many_burn_patients_is_your
(
nullable: true, editable: true, defaultValue: null, alias: 7. How many burn patients is your facility prepared to handle?, type: esriFieldTypeInteger
)
what_burn_care_training_does_yo
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: 7a.What burn care training does your hospital emergency department and inpatient staff have?, type: esriFieldTypeString
)
do_you_have_a_plan_to_provide_j
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 7b. Do you have a plan to provide just-in-time burn care training?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [dont_know: I don't Know]
)
are_there_any_changes_to_your_f
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 8. Are there any changes to your facility disaster plan that are needed to accommodate a burn surge?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [dont_know: I don't Know]
)
if_yes_2
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 8a. What are those changes?, type: esriFieldTypeString
)
case_reference
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: 9. How would you refer these cases to a larger and/or burn specialty hospital?, type: esriFieldTypeString
)
how_would_your_current_referral
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: 9a. How would your current referral process for critically ill patients change in this incident?, type: esriFieldTypeString
)
does_your_facility_have_written
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 9b. Does your facility have written agreements with burn referral centers to expedite patient transfer?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
, [dont_know: I don't Know]
)
alerts_notifications
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: 1. What alerts and notification mechanisms are in place to ensure that the coalition members and partners are aware of the incident?, type: esriFieldTypeString
)
hcc_support
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 2. How does the HCC support this response?, type: esriFieldTypeString
)
hcc_assistance
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 3. What type of assistance (staff, space, resources, systems) could the HCC and its members provide? Are there other partners that you should coordinate with? Is this different from Emergency Support Function (ESF)8 support?, type: esriFieldTypeString
)
request_assistance
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 4. How would you request assistance from emergency management?, type: esriFieldTypeString
)
supplies_resources
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 5. What supplies or resources would you anticipate needing for a burn surge?, type: esriFieldTypeString
)
ems_transport
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 6. What EMS transport resources are available (both public safety and private services including local, mutual aid, state resources / ambulance strike teams)?, type: esriFieldTypeString
)
how_would_you_refer_these_cases
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: 7. Is there a role for bringing a burn provider and supplies to the community to assist / support? How would that be managed?, type: esriFieldTypeString
)
burn_annex
(
nullable: true, editable: true, defaultValue: null, length: 1000, alias: 1. How does the HCC Burn Surge Annex address this kind of scenario?, type: esriFieldTypeString
)
patient_information
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 2. How will the team coordinate sharing patient information across multiple facilities for patient tracking and family re-unification?, type: esriFieldTypeString
)
patient_transfer
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 3. How will hospitals and EMS coordinate transfer and transportation of patients?, type: esriFieldTypeString
)
responsible_patient_transfers
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 4. Who will be responsible for prioritizing patient transfers to the burn center and what criteria will be used to make that determination (i.e., which patients will benefit most from burn center care)? How will the receiving burn center participate in those decisions?, type: esriFieldTypeString
)
patient_tracking
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: 5. What is the mechanism for tracking these patients through the referral process?, type: esriFieldTypeString
)
module_1_question_note
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Only respond if you are responding on behalf of a hospital. Non-Hospital HCC Members, please review this as information., type: esriFieldTypeString
)
respondent_name
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What is your name?, type: esriFieldTypeString
)
hospital
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: What hospital you are affiliated with? Please select below., type: esriFieldTypeString
, Coded Values:
[ahsv: Adventist Health Simi Valley]
, [cmh: Community Memorial Hospital]
, [lr: Los Robles Regional Medical Center]
, ...5 more...
)
mod_2_info_review
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: HCC Members, please review the information and answer the questions below. Hospital Partners are not required to answer the Module 2 questions., type: esriFieldTypeString
)
mod_3_info_review
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Hospital Partners only are required to answer the Module 3 questions. HCC Members, please review the information., type: esriFieldTypeString
)