Patient Survey Question Title * 1. What was the date of your incident? Date Date OK Question Title * 2. Where was your incident? Worcestershire West Midlands Staffordshire Shropshire Gloucestershire Herefordshire Other (please specify) OK Question Title * 3. What was the nature of your accident? RTC car RTC motorbike RTC pushbike RTC pedestrian RTC other Sports-related Equine Industrial/agricultural Fall Stabbing Heart-related Neurological-related (eg stroke/epilepsy) Burn Other (please specify) OK Question Title * 4. Were you conscious at the incident scene? Yes No OK Question Title * 5. Were other people involved in the incident? Yes - people I know Yes - both people I know and don't know Yes - people I didn't know beforehand No Don't recall OK Question Title * 6. Were you airlifted or taken by land ambulance? Land ambulance Airlifted Didn't require hospital transfer by land or air OK Question Title * 7. Were you conscious during the transfer to hospital? Yes No Don't recall Not applicable OK Question Title * 8. At the time of your incident, were you aware of the medical care provided included the Midlands Air Ambulance Charity (MAAC)? Yes No Don't recall OK Question Title * 9. Roughly, how long were you at the incident scene before being transferred to hospital? Under 30 minutes Under 1 hour Under 2 hours Over 2 hours Don't recall OK Question Title * 10. Did the MAAC aircrew put you at ease? Yes No Don't recall Other (please specify) OK Question Title * 11. Did the MAAC aircrew tell you what they were doing? Yes No I can't remember Other (please specify) OK Question Title * 12. How did you find the experience in the helicopter? Please include noises, sights, comfort, smells and temperature. OK Question Title * 13. Did you feel safe in the helicopter? Yes I can't remember No (please specify) OK Question Title * 14. Which hospital were you taken to? OK Question Title * 15. What injuries did you sustain? OK Question Title * 16. How long did you remain in hospital? OK Question Title * 17. To help raise awareness of MAAC, would you be happy for us to contact you regarding taking part in a case study? Yes - by telephone Yes - by post Yes - by email No Possibly - would like more information first If you are happy for MAAC to contact you regarding taking part in a case study, please leave your preferred contact details below. If you’d prefer not to be contacted, simply type no in the box. OK Question Title * 18. Please leave your name if you consented to us contacting you, or type no in the box below to proceed. OK Question Title * 19. Overall, how would you rate your experience with MAAC? Excellent Good Fair Poor Don't Recall OK Question Title * 20. In your view, is there any way MAAC can improve its patient experience? No Yes (please specify) OK Question Title * 21. Before your incident, did you know MAAC was a charity? Yes No I did not before, but since my incident I do now OK Question Title * 22. Since your incident, have you learnt that MAAC is a charity? Yes No OK Question Title * 23. Would you like to know more about Midlands Air Ambulance Charity? No Yes (please provide contact details...) OK Question Title * 24. Would you consider supporting Midlands Air Ambulance Charity in the future? Yes – e.g. donate / support / event attendance / subscribe to mailers No Not sure OK Question Title * 25. Gender of patient Male Female Prefer not to disclose OK Question Title * 26. Age of patient Up to 1 year 1-4 5-15 16-25 26-35 36-45 46-55 56-65 66+ OK Question Title * 27. Nationality British European Other (please specify) OK DONE