| 1. Age: | |||||
| a. 20–29 | b. 30–39 | c. 40–49 | d. 50–59 | e. 60–69 | f. 70+ |
| 2. Gender | |||||
| a. Male | b. Female | ||||
| 3. Current profession: | |||||
| a. Nurse | |||||
| b. Advanced Practice Provider (NP/PA) | |||||
| c. Physician | |||||
| d. Pharmacist | |||||
| e. Respiratory Therapist | |||||
| f. Physical therapy | |||||
| g. Occupational therapy | |||||
| h. Emergency Medical Trans port | |||||
| i. Other | |||||
| 4. Years of clinical practice in current profession | |||||
| a. <5 years | b. 5–10 years | c. 11–15 years | d. 16–20 years | e. 20+ years | |
| 5. In what type of facility do you practice? Select all that apply: | |||||
| a. Level 1 trauma center | |||||
| b. Level 2 trauma center | |||||
| c. Level 3 trauma center | |||||
| d. Level 4 trauma center | |||||
| e. Community hospital | |||||
| f. Academic medical center | |||||
| g. Emergency medical trans port | |||||
| 6. What is the size of the institution? | |||||
| a. <100 beds | |||||
| b. 100–200 beds | |||||
| c. 201–499 beds | |||||
| d. 500–749 beds | |||||
| e. 750–999 beds | |||||
| f. N/A | |||||