Name of center
Address of center
Telephone
Fax
Email
Contact person (surname and name)
Contact person email
Contact person phone
Contact person cellphone
Date of visit
Visit performed by
Emergency & Transport
Inhabitants area served
<200.000
200.000-500.000
>500.000
Central collection of rescue calls?
yes
no
Rescue vehicles
ambulances
medical ambulances
helicopters
others
Patient management pre-hospital
intubated
ventilated
sedated
fluid infusion
cervical protection
chest tubes
arterial saturation mon.
ET CO2 mon.
Rescue personnel
untrained volunteers
trained volunteers (40-100h training)
nurses or professionals
general doctors
emergency doctors
Emergency Room capabilities
Abdominal ecography immediate
CT immediate
Bloodbank
Warm fluids
General surgeon in situ
General surgeon consulting
Neurosurgeon in situ
Neurosurgeon consulting
Anesthesiologist in situ
Anesthesiologist consulting
In case emergency surgery is necessary, how long it takes to start the OR procedure from the admission?
neurosurgery < 1h
neurosurgery 2h
neurosurgery > 2h
abdominal surgery < 1h
abdominal surgery 2h
abdominal surgery > 2h
Comments and notes (optional)
Patient management
Who manages the ICU?
intensivist
neurosurgeon
neuroanesthesist
other
Total available CT-scans (fill out number)
CT-scans available 24h/day (fill out number)
NMR
yes
no
DICOM files available?
yes
no
Neurosurgical adult beds (fill out number)
Neurosurgical pediatric beds (fill out number)
ICU beds for neurosurgical patients (fill out number)
Post-ICU beds (fill out number)
Number of head injuries admitted per year (fill out number)
Number of head injuries admitted <6h after trauma (fill out number)
Number of ICP in head injuries admitted per year (fill out number)
Participation in previous head injury trial (fill out name(s) of study)
Notes (optional)