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Respondent's Guide

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

1.0. Introduction

With the attacks of September 11, 2001, Hurricane Katrina, and more recently the potential of a flu pandemic, public attention has increasingly focused on the ability of our Nation's health care system to respond to mass casualty incidents. In response to this concern, the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) and  Health Resources and Services Administration (HRSA), developed Preparedness for Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Events: Questionnaire for Health Care Facilities.

The questionnaire, funded by HRSA, was developed through an AHRQ contract with Booz Allen Hamilton, with the advice and consultation of an expert panel. The panel consisted of medical subject matter experts trained and experienced in the hospital care of victims of chemical, biological, radiological, nuclear, and/or explosive events. While the questionnaire covers major areas of hospital preparedness, it should not be considered definitive. Each hospital must take into account specific preparedness needs related to its own environment, facilities, staff, and patient population.

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1.1. Purpose of the CBRNE Questionnaire


Note: AHRQ is offering this questionnaire for States, localities, and hospitals to use in assessing emergency preparedness. AHRQ is not administering this questionnaire and will not be collecting data compiled from it. Please do not send completed questionnaires or compiled data to AHRQ.

The CBRNE questionnaire is designed to collect information on CBRNE preparedness activities and, in particular, response activities that are the responsibility of and under the control of hospital leadership. The questionnaire covers activities that could be executed by both large and small hospitals.

This questionnaire was developed for two types of users:

  1. Primarily, States, localities, and multi-hospital systems, which can administer the survey to hospitals and health care facilities in their jurisdictions to assess overall hospital emergency preparedness. 

  2. Also, individual hospitals or health care facilities. For this user, the questionnaire can serve as a checklist of areas that should be considered as a facility develops or improves emergency preparedness and response plans. Hospitals can also use the questionnaire as a checklist for planning, performing, and evaluating drills or exercises.

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1.2. Purpose of the Respondent's Guide

This Respondent's Guide is intended for the individual at the hospital or health care facility who will complete the questionnaire. (States or localities that are administering this questionnaire should go to the Administrator's Guide.)

The Respondent's Guide provides an overview of the questionnaire and details on its use. It covers:

  • Information on who in the facility may be best positioned to complete the questionnaire.
  • Questionnaire design features.
  • How to access completed data.
  • Ongoing respondent support.

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1.3. Contents of the Questionnaire

The questionnaire has 43 questions that fall into eight categories:

  1. Administration and planning.
  2. Education and training.
  3. Communication and notification.
  4. Patient (surge) capacity.
  5. Staffing and support.
  6. Isolation and decontamination.
  7. Supplies, pharmaceuticals, and laboratory support.
  8. Surveillance.

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2.0. How to Complete the Questionnaire

2.1. Who Should Complete the Questionnaire?

It is recommended that the disaster coordinator, director of safety and security, or someone in a similar role complete this questionnaire. However, if a facility does not have such positions, others can complete the questionnaire. Appendix B contains a matrix that indicates all the questions in the questionnaire and designates who in a facility might be best positioned to provide the answer to each question. Note that the matrix is provided as a guide and may not pertain to each facility.

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2.2. Questionnaire Design Features

This questionnaire is available both as a static version and an interactive Web version. The static version is included in Appendix A, or it can be printed out from the home page of the Web version. The interactive Web version will come from the State, region, or hospital system that is administering the questionnaire.

If you are completing the questionnaire as a self-assessment for an individual hospital or other health care facility, you can fill out the static version, or you can use the interactive Web version and print out your answers after you have completed the questionnaire.

If you are a respondent in a State, regional, or hospital system-wide survey, you will be using the Web-based questionnaire, but you should print out the static version to gather information in advance of filling out and submitting the Web questionnaire.

The Web-Based Questionnaire

Systems requirements for the Web-based questionnaire can be found on the main page of the Web site under the link titled, "System Requirements."   

No username and password is required to access the questionnaire.

A Note Before Beginning: The questionnaire has a 120-minute "time-out" user session feature. This means that after 120 minutes of non-use, the system will no longer be accessible. This feature is to ensure the integrity and security of the entered data. When entering the data, you should make certain that you can complete the data within that timeframe. If you are "timed out," then you will be directed back to the beginning of the survey. You will not be able to begin where you previously ended. To ensure that all data can be entered in one sitting, it is strongly recommended that you print out a hard copy of the questionnaire (go to Appendix A or print from the screen on the electronic survey), review the questions, and be familiar with the answers before beginning the electronic data entry. Again, if the data is precollected on the paper instrument, it will be easier and quicker to electronically enter data, eliminating the risk of being "timed out" and having to start the questionnaire over again. 

To download the paper version, select the "Download paper version of survey as a PDF file" link on the home page.

A screen shot shows the questionnaire home page with the link for 'Download paper version of survey as a PDF file' circled.

To begin the questionnaire, select the "Begin Survey" link on the home page.

A screen shot shows the questionnaire home page with descriptive information on it. At the bottom of the page there is a link that reads 'Begin Survey'. This screen shot is shown to demonstrate that step.

The system will begin to display the questions. After you answer each question and select the "Next" button, the system will save your answers and display the next question.

The first section of the questionnaire collects information on the responding hospital's demographics and contact information. Some fields in this section are mandatory and must be completed before filling out the rest of the questionnaire. If you do not enter mandatory data or if you enter text when the field requires a numeric value, the system will generate an error message and will not save the data or move to the next question until you have corrected the error. 

A screen shot shows the first section of the questionnaire. It has a heading of 'Hospital Demographics and Contact Information (Part 1 of 3)'. The following fields are shown with their text boxes to enter information: Hospital Name (mandatory field), Street Address, City, State (mandatory field), Zip, Telephone, Primary Contact for this Survey (mandatory field), Title of Primary Contact, Telephone Number of Primary Contact (mandatory field), and E-mail Address of Primary Contact. A few of the fields have fictitious data entered in them.

After completing the demographic portion of the questionnaire, you will be directed to the first question. The system will prompt you if any required questions on the screen are not answered. The questionnaire allows only one answer for each question. You must consider the institution's current status and choose the best answer. 

A screen shot shows Question 4 of the Administration and Planning section as an example of how the questionnaire is displayed online. The top of the screen reads 'Administration and Planning (Part 4 of 6)'. Below that is the heading 'Administration and Planning'. Question 4 reads 'Has the hospital designated an individual to manage and maintain its decontamination capability?' The respondent will then choose one of the checkbox options: No, and not planned within the next six months; No, but planned within 6 months; Yes, and their responsibilities include; and Other. The option of Yes has a checkmark shown. Choosing Yes then brings up an additional subpart to Question 4 which is displayed underneath. Underneath the options for Question 4, is the heading 'Responsibilities.' Six options are provided with each option having a radio button for No or Yes as the answer. The options are: Inspecting, inventorying, storing, and purchasing personal protective equipment (PPE) when needed; Upkeep and maintenance of the decontamination equipment; Maintenance of training records; Ongoing training; Recruitment of new team members; and  Maintenance of exposure records

Some questions will have a second part. If you select an answer to a question that requires more input, you will be redirected to a screen with the second part of the question. This is in the form of a drop-down list, and you can choose as many answers as apply. 

You can skip a question and go back by using the "Back" button at anytime during the session.

A screen shows the final page of the questionnaire once the survey has been completed. At the top of the screen text reads 'Thank You!' Underneath text reads 'You have successfully completed the survey. Again, thank you very much for devoting your valuable time.' Underneath that is a link that reads 'Submit and Close Out of Survey'. This link is circled.

At the completion of the questionnaire, select the "Submit and Close Out of Survey" link. 

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2.3 Accessing Completed Data

After you select the "Submit and Close Out of Survey" button, you will receive a confirmation that the questionnaire was successfully completed and your answers have been recorded. This confirmation notice will contain the questionnaire with your answers indicated. You can print out this document for your records. 

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2.4 Ongoing Respondent Support

As you are completing this questionnaire, if you have questions, you are encouraged to contact (insert name of contact individual) at the (insert name of State Health Department or Corporation). His/Her phone number is (xxx) xxx - xxxx and his/her E-mail address is xxx@xxx.com).

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The information on this page is archived and provided for reference purposes only.

 

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