The Readiness Estimate
and Deployability Index- CIVILIAN
(READI-CIV- Initial Version)

A.

Please rate your level of competency
According to the following scale

1 = I need theory, demonstration & supervised practice
2 = I would need review & supervised practice
3 = I would need some review & little supervision
4 = I would need review only
5 = I would need no review or supervision

Please select the circle to indicate your response

1 = Not Competent
2 = Minimally Competent
3 = Moderately Competent
4 = Highly Competent
5 = Totally Competent

1.

How competent are you in your role as a nurse in a mass casualty (MASCAL) situation?
1 2 3 4 5
2.
How competent are you to perform in emergency situations, such as those of patient in cardiac arrest?
1 2 3 4 5
3.
How competent are you taking care of life threatening injuries?
1 2 3 4 5
4.
How competent are you in providing nursing care to a multiple trauma patient?
1 2 3 4 5
5.
How competent are you in the care of patients with ballistics injuries?
1 2 3 4 5
6.
How competent are you in recognition of a patient with tension pneumothorax?
1 2 3 4 5
7.
How competent are you in the fluid resuscitation of a burn patient?
1 2 3 4 5
8.
How competent are you in performing resuscitation with blood products?
1 2 3 4 5
9.
How competent are you with performing airway management?
1 2 3 4 5
10.
How competent are you in implementing triage or sorting?
1 2 3 4 5
11.
How competent are you with evacuation of patients?
1 2 3 4 5
12.
 How competent are you with your ability to set up tents and field equipment?
1 2 3 4 5

13.

 How competent are you in dealing with
the unexpected (i.e. patient death is immediate)?
1 2 3 4 5
14.
 How competent are you with the nursing care required for patients injured by weapons of mass destruction (i.e. weapons used by terrorists)?
1 2 3 4 5
15.
 How competent are you with what is required of you to protect yourself and/or your patient(s) if called upon to do so?
1 2 3 4 5
16.
 How competent are you in your ability to perform nursing skills while in the protective gear due to possible biological/chemical threats?
1 2 3 4 5
17.
 How competent are you with decontamination procedures of a patient exposed to chemical or biologic agents?
1 2 3 4 5
18.
 How competent are you in your ability to perform your specialty under adverse environmental or staffing conditions?
1 2 3 4 5
19.
 How competent are you in your ability to decontaminate yourself using standard personal decontamination equipment?
1 2 3 4 5
20.
 How competent are you with use of communication equipment (e.g. field radio)?
1 2 3 4 5
21.
 How competent are you with actions you must take during warning alarms?
1 2 3 4 5

B.

For the following, please indicate your level of agreement according to this scale by indicating the circle for your response:

1 = Totally Disagree
2 = Minimally Agree
3 = Moderately Agree
4 = Highly Agree
5 = Totally Agree

23.

 If I am terrorist environment, I have confidence that my support system
(i.e. family, friends or family support group) will maintain communication with me.
1 2 3 4 5
24.
 I am confident in my ability to manage stress related to my primary job.
1 2 3 4 5
25.
 I am confident in my ability to manage stress related to my family.
1 2 3 4 5
26.
 I am confident in my ability to manage stress related to my finances.
1 2 3 4 5
27.
 I am confident I will know how to access mental health services if needed during a stressful time.
1 2 3 4 5
28.
 I believe there is a real need for hospital rules and regulations to be adapted to a terrorist situation.
1 2 3 4 5
29.
 I think it is possible for the staff to compensate for a supervisor who does not put into practice the leadership principle: "Know your people and look out for their well-being".
1 2 3 4 5
30.
 I believe I could perform successfully in a terrorist situation in the absence of realistic and relevant training.
1 2 3 4 5
31.
 I believe I will be provided with sufficient training prior to any situation.
1 2 3 4 5
32.
 If my supervisor is unable to keep me informed of all pertinent information, I could still perform successfully.
1 2 3 4 5
33.
 I am prepared to deal with crowded, co-ed, and diverse persons in sleeping in quarters while in a terrorist situation.
1 2 3 4 5
34.
 Understanding my hospital's mission, vision and values is critical to my ability to perform successfully.
1 2 3 4 5

35.

 I am confident I will be able to function as a leader in a terrorist situation if needed.
1 2 3 4 5
36.
 It is critical for me to have a healthy working relationship with members of my work group.
1 2 3 4 5

C.
 Demographic Data
1.

What is your current primary nursing specialty? (Check all that apply)
  a Mental Health Nurse m Oncology Nurse
  b Perioperative Nurse n Rehabilitation Nurse
  c Post-Anesthesia Care Unit Nurse o Staff Development/Resource Management
  d Advanced Practice Nurse p Nurse Educator
  e Community Health Nurse q Critical Care Nurse - Adult
  f Medical Surgical Nurse r Critical Care Nurse - Neonatal or Pediatric
  g Obstetric/L&D Nurse s Nurse Manager/Director/Executive
  h Newborn Nursery Nurse t Academic Dean or Associate
  i Pediatric Nurse u Case Manager
  j Emergency Nurse v Nurse Researcher
  k Home Health Nurse w Other (please specify below)
  l Ambulatory Care Nurse  

3.
How many years of professional nursing experience do you have?

4.
Do you have prior technical healthcare experience (e.g. medical assistant)? Yes No

5.
What is your gender? Male Female

6.
If you are a civilian nurse who is also an armed forces reserve or a guard member, please indicate that here:
 Yes, I am a civilian nurse also serving in the reserve or guard.
No, I am not also serving in the reserve or guard.

7.
What is your highest education level?
  Associate Degree in Nursing
Associate Degree in another field
Diploma in Nursing
Bachelors in Nursing
Bachelors in other than nursing		 Masters in Nursing
Masters in other than nursing
Doctorate in Nursing
Doctorate in other than nursing

8.
When was the last time you provided direct patient care? (Check one)
  More than 4 years ago
Within the most recent 1-4 years		 Within the last year, but more than 6 months ago
Within the last 6 months

9.
What type(s) of triage experiences and education have you had? (Check all that apply)
I have not learned about triage yet
Learned through formal courses
Learned through inservices, nursing journals, handouts, etc.
Practiced triage in an Emergency Department setting
Practiced triage in a field environment on real and/or moulaged patients

10.
Are you currently working in an Emergency Department or emergency environment that requires you to triage patients? yes no


12.


Have you ever practiced nursing in a country outside the United States? (If No, proceed to question 15)
yes no


13.
What was the length of time for your overseas nursing experience (longest, if more than one)?

up to 2 weeks
more than 90 days
NA
 more than two weeks but less than 30 days
30-90 days

14.
What were the dates of your most recent overseas nursing experience?
 
From:
 (mm/dd/yyyy)
To:
(mm/dd/yyyy)

15.

What is your age?
 

16.

How frequently do you exercise? 		 

at least 3-5 times a week
twice a week
once a week
 less than once a week
not at all

17.
Check the box that represents how long ago it was that you had a physical exam.
1-12 months ago
1-5 years ago
longer than 5 years ago

18.
Are you up to date on routine gender specific (i.e. mammogram for women; prostate exam for men), health related exams? yes no

19.
If indicated, do you have arrangements for your children if you are a way for a long time?
yes no not applicable

20.
If single, do you have a support plan for your children, pets, finances or elder dependents?
yes no not applicable

21.

Which of the following would you use to help you in coping with stress? (Check all that apply)
a Tobacco g Talking with Friends
b Alcohol h Religious Faith
c Physical Exercise i Eating
d Reading j Sleeping
e Relaxation/Meditation Techniques k Other (please specify below)
f Music

22.

Do you have a will? yes no

You have completed the questionnaire Thank you.

Last modified: 10/03/03 


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