Activity survey

The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit North American phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

27SenEDyjn7X4FhcBCHfAx8KuyJaSGWR2VUU4SxaMpjYULEGdNcUjxQArtci4WE2w8nva2qFZ6WiUakupwMvCQCDh55zQwZYL5KfIhydf

Thank you for taking part in SECURE, we value your time. Please only proceed if:

- RSI or modified RSI (as judged by the intubating team)
- Patient is ≥18 years old (adult)
- RSI occurs in-hospital (within hospital grounds including ED)
Do not include if intubated during cardiac arrest - unless after ROSC (return of spontaneous circulation) or unless cardiac arrest occured after RSI induction.

Do not include if patient had tracheostomy in situ.
The form should take approximately 5-10 minutes. Note that the form does not save changes.

SECTION1: SITUATION FACTORS

Site (please select 'Other' if the site is not on the list)

* must provide value

Site - Other

* must provide value

Day of RSI

* must provide value

Weekday

Weekend including bank holidays

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Timing of RSI

* must provide value

DAYTIME (8am-6pm)

EVENING (6pm-8pm)

NIGHT (8pm-8am)

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Hospital area

* must provide value

Theatre (non-obstetric) / anaesthetic room

Obstetric theatre / anaesthetic room

Recovery area / PACU

ICU / HDU

Emergency Department

Ward

Cardiac catheter laboratory

Interventional radiology / hybrid theatre

Radiology suite (e.g. CT, MRI)

Endoscopy

Psychiatric unit for ECT

Non-clinical area

Other

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Other - Details

* must provide value

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.