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[EMS Responders Survey]                                     [Hospital Setting Survey]

Your participation in this research project will enable us to develop realistic responses to the most common types of physical assaults that EMS/Firefighter responders and Health Care workers experience in the performance of their duties.

For the purpose of this research, an assault is defined as any confrontation, either verbal or physical, where the health care provider felt that their safety was in jeopardy.   Actual physical contact or injury is not necessary to be considered a victim of an assault.

There are two questionnaires.  One is designed for the EMS/Firefighter responder in the field and the second is designed for the clinical setting such as an Emergency Department, Physician's Clinic or Psychiatric Ward.  Please select the one that best fits your particular job assignment at the time you were assaulted.

If you were assaulted more than one time during your career you can either select the one assault that you consider would benefit the research project or you can complete one survey form for each assault.  You can only provide detailed information for one assault on the survey form.

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