Title:New YorkMOLST Emergency Medical TechnicianSurvey
Designer: Stanley Sam, MD et al. Please cite this reference in any future work.
Sam S, Pekmezaris R, Nouryan CN, Tan R, Conrardy A, Ward MF, Schwalberg A, Vij B, Silverman H, Guzik HJ, Lesser ML, Wolf-Klein GP.Survey of emergency medical services professionals' experience with advance directives and medical orders for life-sustaining treatment.J Am Geriatr Soc. 2011 Dec;59(12):2383-4.
Suitable for Quality Improvement? Yes, modified to fit your state.
Suitable for research? Yes.
Description of Instrument:Thiswritten survey is to be completed by EMTs and Paramedics and has been successfully used for a research project in New York City and Long Island. The authors used this survey to show that there were significant knowledge deficits among EMTs (MOLST had only been in place for a few years at the time of the survey) and that younger EMTs were less likely to honor MOLST DNR orders than those with 6 or more years of experience.
How to use:
Step 1:Consider modifying the form to suit your purposes. If you are doing research you may want to keep the survey intact as muchas possible—this survey has proven itself and would facilitate comparison to the NY data. See also Toolkit Instrument R the Oregon Emergency Medical Services Survey which asked different but equally useful questions. Decide whether you really need each item and keep items that you have a planned use for or believe may be important to have even though you are not sure what to do with them.You may also add items that are missing or that address questions that you are trying to answer.
Step 2: Select which EMTs you want to survey. You may wish to survey all of them, or just a cross-section. See the FAQ section on ‘Sampling’. In general, as long as you choose subjects in a random fashion (for example, by choosing numbers out of a hat) and get a decent response rate to your survey (30-50%+ for QA and 50-75%+ for research) and survey enough subjects so that you get to 30 usable responses (more for research), that may be enough for most QA purposes.
Step 3: There is a well described methodology for mailed surveys that is beyond the scope of this toolkit, but you should include a self-addressed, stamped envelope and plan on doing more than one mailing. It also helps to have as much institutional support as you can muster to encourage busy people to complete your survey.
Step 4: Analyze the results. Some of results include:
- Demographic information about the EMTs, including their own preferences for resuscitation.
- Experiences with family members trying to reverse a DNR order, and attitudes toward CPR and DNR orders.
- Experiences with MOLST and out of hospital DNR orders
- Two scenarios asking the question ‘what would influence your decision to initiate CPR/to transfer the patient to the hospital’.
- Attitudes toward and familiarity with MOLST