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Ambulance Service Questionnaire

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Ambulance Service Questionnaire CALLING THE AMBULANCE Please remember, this questionnaire is about your most recent experience of the ambulance emergency or urgent services. Ambulance Service 1. Where were you when the ambulance was Questionnaire called? 1 At my home Emergency and Urgent 999 Calls 2 In a public place 3 Somewhere else What is the survey about? 4 Don’t know/ Can’t remember This survey is about your most recent experience of the ambulance emergency or urgent services. 2. Who called the ambulance? Who should complete the questionnaire? 1 I did Î Go to 3 The questions should be answered by the person named on the front of the envelope. If that person 2 A friend or relative Î Go to 3 needs help to complete the questionnaire, the answers should be given from his/her point of view – 3 A doctor/NHS Direct Î Go to 7 not the point of view of the person who is helping. 4 The police Î Go to 7 5 A stranger Î Go to 7 Completing the questionnaire. 6 Other Î Go to 7 For each question please tick clearly inside one box using a black or blue pen. 7 Don’t know/ Can’t remember Î Go to 7 Sometimes you will find the box you have ticked has an instruction to go to another question. By following the instructions carefully you will miss out questions 3. Did the ambulance call taker listen carefully? that do not apply to you. 1 Yes, definitely Don’t worry if you make a mistake; simply cross out the mistake and put a tick in the correct box. 2 Yes, to some extent Please do not write your name or address anywhere 3 No on the questionnaire. 4 Don’t know/ Can’t remember Your participation in this survey is voluntary. 4. Did the ambulance call taker easily understand If you choose not to take part in this survey it will not your location? affect the care you receive from the NHS in any way. If you do not wish to take part, or you do not 1 Yes want to answer some of the questions, you do not 2 No have to give us a reason. 3 Don’t know/ Can’t remember Your answers will be treated in confidence. National Survey Programme. Ambulance Emergency and Urgent Questionnaire v5. 21/11/03 Page 1 5. Did the ambulance call taker give advice on the 10. Were the ambulance crew reassuring? phone about what to do before the ambulance arrived? 1 Yes, definitely 1 Yes 2 Yes, to some extent 2 No 3 No 3 Don’t know/ Can’t remember 4 Don’t know/ Can’t remember 4 No advice was wanted/ needed 11. Did the ambulance crew explain your care and treatment in a way you could understand? 6. Was the ambulance call taker reassuring? 1 Yes, definitely 1 Yes, definitely 2 Yes, to some extent 2 Yes, to some extent 3 No 3 No 4 Don’t know/ Can’t remember 4 Don’t know/ Can’t remember 12. Did the ambulance crew talk in front of you as if THE AMBULANCE CREW you weren’t there? 7. Did the ambulance crew listen carefully? 1 Yes, definitely 2 Yes, to some extent 1 Yes, definitely 3 No 2 Yes, to some extent 4 Don’t know/ Can’t remember 3 No 4 Don’t know/ Can’t remember 13. Did the ambulance crew do everything they could to help control your pain? 1 Yes, definitely 8. Did the ambulance crew ask about your previous medical history? 2 Yes, to some extent 1 Yes 3 No 2 No 4 I did not have any pain 3 Don’t know/ Can’t remember 14. If friends or relatives were with you, were they given enough information about your care and treatment? 9. Did you have trust and confidence in the ambulance crew’s professional skills? 1 Yes 2 No 1 Yes, definitely 3 No friends or relatives were with me 2 Yes, to some extent 4 Don’t know/ Can’t remember 3 No 4 Don’t know/ Can’t remember National Survey Programme. Ambulance Emergency and Urgent Questionnaire v5. 21/11/03 Page 2 TRANSFER TO HOSPITAL IF YOU WERE NOT TAKEN TO HOSPITAL Still thinking about the last time you used the emergency and urgent ambulance services… Please answer questions 20-22 if the last time you used the emergency and urgent ambulance services 15. Were you taken to a hospital in the ambulance? you were NOT taken to hospital. 1 Yes Î Go to 16 20. Did the ambulance crew advise you to go to hospital? 2 No Î Go to 20 1 Yes, but I refused 16. Was the way you got into the ambulance 2 No suitable? (e.g. by walking, on a stretcher etc.) 21. Did you agree with the decision not to go to 1 Yes hospital? 2 No 1 Yes 3 Don’t know/ Can’t remember 2 No 3 Not sure 17. How clean was the ambulance? 1 Very clean 22. Did the ambulance crew give you advice about what to do if you felt unwell again? 2 Fairly clean 1 Yes 3 Not very clean 2 No 4 Not at all clean 3 Don’t know/ Can’t remember 5 Don’t know/ Can’t remember 4 No advice was wanted/ needed 18. Did the ambulance driver take care to make the OVERALL journey as comfortable as possible? 23. Overall, how would you rate the care you 1 Yes, definitely received from the ambulance service? 2 Yes, to some extent 1 Excellent 3 No 2 Very good 4 Don’t know/ Can’t remember 3 Good 4 Fair 19. As far as you know, did the ambulance crew give 5 Poor hospital staff all the necessary information about you? 6 Very poor 1 Yes 24. Overall, did the ambulance crew treat you with 2 No respect and dignity? 3 Don’t know/ Can’t remember 1 Yes, definitely 2 Yes, to some extent Î Now please go to Question 23 3 No 4 Don’t know/ Can’t remember National Survey Programme. Ambulance Emergency and Urgent Questionnaire v5. 21/11/03 Page 3 ABOUT YOU 26. Are you male or female? 25. To which of these ethnic groups would you say 1 Male you belong? (Tick ONE only) 2 Female a. WHITE 1 British 27. What was your year of birth? 2 Irish (Please write in) e.g. 1 9 3 4 3 Any other White background (Please write in box) 1 9 OTHER COMMENTS b. MIXED If there is anything else you would like to tell us 4 White and Black Caribbean about your experiences of the ambulance emergency and urgent services, please do so here. 5 White and Black African 6 White and Asian Was there anything particularly good about 7 Any other Mixed background your care? (Please write in box) c. ASIAN OR ASIAN BRITISH 8 Indian 9 Pakistani Was there anything that could have been 10 Bangladeshi improved? 11 Any other Asian background (Please write in box) d. BLACK OR BLACK BRITISH Anything else? 12 Caribbean 13 African 14 Any other Black background (Please write in box) e. CHINESE OR OTHER ETHNIC GROUP THANK YOU VERY MUCH FOR YOUR HELP Please check that you answered all the 15 Chinese questions that apply to you. 16 Any other ethnic group Please post this questionnaire back in the (Please write in box) FREEPOST envelope provided. No stamp is needed. National Survey Programme. Ambulance Emergency and Urgent Questionnaire v5. 21/11/03 Page 4 CALLING THE AMBULANCE Please remember, this questionnaire is about your most recent experience of the ambulance emergency or urgent services. Ambulance Service 1. Where were you when the ambulance was Questionnaire called? 1 At my home Emergency and Urgent 999 Calls 2 In a public place 3 Somewhere else What is the survey about? 4 Don’t know/ Can’t remember This survey is about your most recent experience of the ambulance emergency or urgent services. 2. Who called the ambulance? Who should complete the questionnaire? 1 I did Î Go to 3 The questions should be answered by the person named on the front of the envelope. If that person 2 A friend or relative Î Go to 3 needs help to complete the questionnaire, the answers should be given from his/her point of view – 3 A doctor/NHS Direct Î Go to 7 not the point of view of the person who is helping. 4 The police Î Go to 7 5 A stranger Î Go to 7 Completing the questionnaire. 6 Other Î Go to 7 For each question please tick clearly inside one box using a black or blue pen. 7 Don’t know/ Can’t remember Î Go to 7 Sometimes you will find the box you have ticked has an instruction to go to another question. By following the instructions carefully you will miss out questions 3. Did the ambulance call taker listen carefully? that do not apply to you. 100 1 Yes, definitely Don’t worry if you make a mistake; simply cross out the mistake and put a tick in the correct box. 50 2 Yes, to some extent Please do not write your name or address anywhere 0 3 No on the questionnaire. - 4 Don’t know/ Can’t remember Your participation in this survey is voluntary. 4. Did the ambulance call taker easily understand If you choose not to take part in this survey it will not your location? affect the care you receive from the NHS in any way.
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