Hepatitis A EMS Immunization Program Interest Survey

Question Title

* 1. Contact Information

Name of Person Completing the Survey

EMS Agency

County

Email Address

Phone Number

Question Title

* 2. Is your organization interested in starting a Hepatitis A immunization program?

Yes

Need more information

Question Title

* 3. What type of EMS Immunization Program are you considering starting?

EMS Community Paramedicine Immunization Programs: These programs perform vaccination clinics in the community events such as footballs games, fairs, festivals, etc…..

EMS Community Paramedicine Integrated Into 911 Response Immunization Program: These programs identify high risks patients during their 911 emergency calls and then send community paramedics to their location to vaccinate soon after the 911 encounter.

EMS/Fire Station Based Immunization Programs: These programs maintain the vaccine and perform vaccinations on patients that wish to be vaccinated at the EMS/Fire Stations.

911 Response Immunization Program: These programs carry refrigerated vaccine on 911 responding ambulances and perform vaccinations in non-emergency situations.

Other (please specify)