OAEMS Instructor Survey

  We are currently attempting to compile a directory of instructors from within and outside of the OAEMS membership. If you are a certified instructor or a licensed medical professional and would like to help out with future classes, we ask that you take a moment and complete the following survey.

Name: ________________________________________________________________

Address: _____________________________________________________________

City: ______________________ State: __________ Zip Code: __________________

Contact phone number: (_____) _______________________

Email address: _____________________________________

I am a/an:

____ EMTB   ____ EMTI   ____ EMTP

____ Ohio EMSI *

____ Out of State EMSI *

____ Special Topics Instructor * (Please specify topic(s) :

1)      _______________________________________________

2)      _______________________________________________

3)      _______________________________________________

4)      _______________________________________________

5)      _______________________________________________

____ A Physician (please specify if you are a specialist) _________________________

____ A Physician’s Asst (specialty) _________________________________________

____ LPN

____ RN

____ BSN

____ MSM

____ Nurse Practitioner

____ Flight Nurse

____ Nurse Anestosist

____ Other specialty: _____________________________________________________

____ Respiratory Therapist

____ BLS/CPR Instructor *

____ ACLS Instructor *

____ BTLS Instructor *

____ PHTLS Instructor *

____ Neonatal ACLS Instructor *

____ Other allied field(s)

1)  _______________________________________________

2)      _______________________________________________

3)      _______________________________________________

* Please attach a copy of your instructor certification when returning survey

After you have completed the survey, please return it to:

Pat Roberts

4033 Springfield-Xenia Road

Springfield, Ohio 45506

or

Email to: PMEDICPAT@ AOL.Com

or 

bring it with you to the next conference that you attend

  Thank you for your time and cooperation. Your assistance is greatly appreciated by both me and the Association as a whole.

Pat