1.  How long have you been in EMS?

2.  What is the highest level of formal education you have completed?

Not Graduated from High School
High School Diploma or Equivalency
One to Three Years of College
Bachelor's Degree
Master's Degree
Ph.D
Other
No Response

3.  What level of training or certification have you received?

Fire Fighter
First Responder
EMT
EMT-Paramedic
Physician
Registered Nurse
Other
No Response

4.  Are you

Volunteer
Career
Both
No Response

5.  If you are both volunteer and career EMS/Fire Fighter, in which capacity were you when the assault took place?

Volunteer
Career
No Response

6.  How old were you when the assault took place?

7.  What gender are you?

Female
Male
No Response

8.  Have you ever been assaulted in the past while performing first responder type duties?

Yes
No
No Response

9.  If your answer to Question 8 was YES, what types of assaults(s) were they?

No Response

10.  Have you ever received self defense training that would help you if you were assaulted while performing your EMS duties?

Yes
No
No Response

11.  Do you feel that you have sufficient training to defend yourself if you were physically attacked while performing your EMS/Fire Fighter duties?

Yes
No
No Response

12.  Do you feel that your agency should provide training that prepares you for physical assaults as part of your EMS/Fire Fighter training?

Yes
No
No Response

13.  What types of physical assaults are you most fearful of occurring to you when responding to EMS calls? (i.e., being shot, stabbed, beaten, etc.)

No Response

14.  What was the time of day when you were assaulted? (Use military time format)

15.  What was the day of the week that the assault occurred?

16.  What month of the year did the assault occur?

17.  How many assailants were there?

18.  How many EMS response personnel were present at the scene?

19.  What was the gender of the assailant(s)?

20.  What were the ages of the assailant(s)?

21.  Describe the extent of your injuries as a result of the assault.

No Response

22.  Did you require medical attention?

Yes
No
No Response

23.  Did you require hospitalization?

Yes
No
No Response

24.  What was the length of time you were hospitalized?

25.  Were you off of work due to injuries sustained from the assault?

Yes
No
No Response

26.  If you were off of work, for how long?

27.  Were you on alcohol or drugs when the assault occurred?

Yes
No
No Response

28.  Were you intoxicated by alcohol or drugs when the assault occurred?

Yes
No
No Response

29.  Describe the extent of any injuries sustained by the assailant(s) as a result of defending yourself.

No Response

30.  Did your assailant require medical attention as a result of you defending yourself?

Yes
No
Don't Know
No Response

31.  Did your assailant require hospitalization as a result of you defending yourself during the assault?

Yes
No
Don't Know
No Response

32.  If the assailant was hospitalized, for how long?

33.  Was your assailant off of work due to injuries sustained from the assault?

Yes
No
Don't Know
No Response

34.  If they were off of work, for how long?

35.  Was your assailant on alcohol or drugs when the assault occurred?

Yes
No
Don't Know
No Response

36.  Was your assailant intoxicated by alcohol or drugs when the assault occurred?

Yes
No
Don't Know
No Response

37.  Was the assailant in a disturbed state of mind at the time of the assault?

Yes
No
Don't Know
No Response

38.  If the answer to Question 37 was YES, describe the assailant's state of mind.

No Response

39.  If your assailant was not the victim of the original call for service, were they related to the original victim?

Yes
No
Don't Know
No Response

40.  If they were related to the original victim, what is the relationship?

41.  Describe how the assailant attacked you.

No Response

42.  Describe any technique(s) you used to defend yourself and detail if they were effective.

No Response

43.  Were there any arrests made by law enforcement as a result of the assault?

Yes
No
Don't Know
No Response

44.  If there were arrests made indicate who was arrested and charges filed.

No Response

45.  What was the original nature/type of call you were responding to?

No Response

46.  Was this run:

Advanced Life Support
Basic Life Support
First Responder
  Medical Helicopter
  Fire Scene
  Other
  No Response

47.  What type of location was the call at:

Single Family Dwelling
 Apartment
 Parking Lot
 Open Field
 Office Building
 Tavern or Bar
Sporting Arena or Similar Area
 Retail Business
 Roadway
 Yard Space
Other
 No Response

48.  Where there any environmental conditions that may have effected your safety at the time of the assault?

  Raining
  Gravel on the Ground
  Snow or Ice on the Ground
  Debris on the Ground
  Low Lighting Conditions
  Other
  None
  No Response

49.  Does your agency have a written policy on using force to defend yourself?

Yes
No
Don't Know
No Response

50.  What is the geographical area where the assault took place?

Urban
Suburban
Rural
Metropolitan Area
No Response

51.  What country did the assault take place in? (i.e., USA, England, Australia, Canada, etc.)
           

52.   What part of the country do you live in?  (i.e., Midwest, South, Eastern Seaboard, Great Lakes area, etc.)

53.  Did you complete a narrative report, other than the standard run reports, after your assault?

Yes
No
No Response

54.  What is the number of personnel working in your agency?

55.  What is annual number of calls for service that your agency receives?

Please include any other information that you feel would be important for the researchers to know about your assault.

No Response

Thank you for your help.   Stay safe.