NIH Disaster Research Response

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Academic Network for Sexual and Reproductive Health and Rights Policy [Ghent University] (ANSER) (2)
Achenbach System of Empirically Based Assessment (ASEBA) (2)
Action Against Hunger (ACF) (1)
Agency for Toxic Substances and Disease Registry (ATSDR) (3)
American Academy of Orthotists and Prosthetists (1)
American Academy of Pediatrics (AAP) (1)
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American Medical Association (AMA) (1)
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Arizona State University (ASU) (1)
Association for Contextual Behavioral Science (ACBS) (2)
Australian Mental Health Outcomes and Classification Network (AMHOCN) (1)
Boston Children's Hospital (1)
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Brandeis University (1)
Brigham and Women’s Hospital (BWH) (1)
COVID-19 Prevention Network Statistical and Data Management Center (CoVPN) (1)
California Health Care Foundation (CHCF) (1)
Carnegie Mellon University (1)
Cengage (1)
Center for Economic and Social Research [University of Southern California Dornsife] (CESR) (1)
Center for Health Security [Johns Hopkins University, Bloomberg School of Public Health] (1)
Center for Pediatric Traumatic Stress [Children's Hospital of Philadelphia, Nemours A.I. duPont Hospital for Children] (1)
Centers for Disease Control and Prevention (CDC) (18)
Centers for Disease Control and Prevention, Center for Preparedness and Response (CDC CPR) (1)
Centers for Disease Control and Prevention, National Center for Environmental Health (CDC NCEH) (6)
Centers for Disease Control and Prevention, National Center for Health Statistics (CDC NCHS) (4)
Centers for Disease Control and Prevention, Office of Infectious Diseases (CDC OID) (1)
Centers for Medicare & Medicaid Services (CMS) (1)
Children and War Foundation (5)
Children's Hospital of Eastern Ontario (1)
Children’s Hospital of Michigan (1)
Christopher Newport University (CNU) (2)
City of New York, Department of Health and Mental Hygiene (NYC DOHMH) (3)
Columbia University (6)
Columbia University, Mailman School of Public Health (1)
Compassion Fatigue Awareness Project (1)
Connor-Davidson Resilience Scale (1)
Cornell University (2)
Disaster Research Response Program [National Institutes of Health] (DR2) (7)
Disaster and Community Crisis Center [University of Missouri] (DCC) (1)
Duke University (8)
EuroQol (1)
European Monitoring Centre for Drugs and Drug Addiction (1)
European Union, European Commission (2)
FACIT Measurement System (1)
Family Behavior Systems (1)
Family Practice Notebook (1)
Federal Emergency Management Agency [Department of Homeland Security] (FEMA) (1)
Fordham University (2)
Fort Refuge (1)
Freie Universitat Berlin (1)
GL Assessment (1)
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Global Consortium for Chemosensory Research (GCCR) (1)
Government of Western Australia (1)
Green’s Publishing (1)
HIV Vaccine Trial Network Statistical and Data Management Center (HVTN) (1)
Harvard College (1)
Harvard Program in Refugee Trauma (HPRT) (2)
Harvard University (1)
Harvard University, Harvard Medical School (HMS) (1)
Harvard University, Harvard T.H. Chan School of Public Health (5)
Heartland Forgiveness Project (1)
Icahn School of Medicine at Mount Sinai (ISMMS) (1)
Imperial College London (1)
Institute for Work and Health (IWH) (1)
International Academies of Emergency Dispatch (IAED) (1)
International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) (4)
International Union Against Tuberculosis and Lung Disease (1)
Iowa State University (1)
Johns Hopkins Center for Public Health Preparedness [Johns Hopkins University] (1)
Johns Hopkins School of Medicine (1)
Johns Hopkins University (1)
Johns Hopkins University, Bloomberg School of Public Health (3)
Kaiser Family Foundation (KFF) (3)
Kandilli Observatory And Earthquake Research Institute [Bogazici University] (1)
Kennedy Krieger Institute (1)
Kent State University (1)
King's College of London (1)
Kyoto University (1)
Langer Research Associates (1)
Levenson Institute for Training (1)
Louisiana State University (LSU) (1)
Loyola University Chicago, Stritch School of Medicine (SSOM) (1)
Mapi Research Trust (4)
Medical Research Council (MRC) (1)
Michigan State University (MSU) (2)
Monell Chemical Senses Center (1)
Mongan Institute [Massachusetts General Hospital] (2)
Montreal Behavioural Medicine Centre (MBMC) (1)
Mount Sinai Hospital [Canada] (1)
Multi-Ethnic Study of Atherosclerosis (MESA) [National Heart Lung and Blood Institute] (1)
Multi-Health Systems, Inc. (MHS) (6)
NORC at the University of Chicago (NORC) (3)
National Alzheimer’s Coordinating Center (NACC) (2)
National Association of County and City Health Officials (NACCHO) (1)
National Center for PTSD [Post-Traumatic Stress Disorder] [U.S. Department of Veterans Affairs] (14)
National Child Traumatic Stress Network (NCTSN) (3)
National Environmental Education Foundation (NEEF) (1)
National Heart, Lung, and Blood Institute [National Institutes of Health] (NHLBI) (2)
National Human Genome Research Institute [National Institutes of Health] (NHGRI) (1)
National Institute for Children's Health Quality (NICHQ) (1)
National Institute for Occupational Safety and Health [Centers for Disease Control and Prevention] (CDC NIOSH) (10)
National Institute of Allergy and Infectious Diseases [National Institutes of Health] (NIAID) (1)
National Institute of Child Health and Human Development [National Institutes of Health] (NICHD) (2)
National Institute of Environmental Health Sciences [National Institutes of Health] (NIEHS) (8)
National Institute of Mental Health [National Institutes of Health] (NIMH) (3)
National Institute of Neurological Disorders and Stroke [National Institutes of Health] (NINDS) (1)
National Institute on Aging (NIA) (2)
National Institute on Drug Abuse (NIDA) (2)
National Institutes of Health (NIH) (11)
National Integrated Health Associates (NIHA) (1)
National Jewish Health (1)
Natural Hazards Center [University of Colorado at Boulder] (1)
New York State Department of Health (1)
New York University (NYU) (2)
New Zealand Government, Ministry of Social Development (1)
North Carolina Department of Health and Human Services (1)
North Carolina Institute of Public Health [University of North Carolina, Gillings School of Global Public Health] (NCIPH) (1)
Northwestern University (4)
Nottingham Trent University (1)
OQ Measures (1)
Occupational Safety and Health Administration [U.S. Department of Labor] (OSHA) (1)
Ohio State University (OSU) (1)
Oklahoma State Department of Health (3)
Old Dominion University (1)
Optum, Inc. (3)
Oregon State University (2)
Orthopaedic Scores (1)
Pearson Assessments (12)
Pennington Biomedical Research Center [Louisiana State University] (PBRC) (1)
Pfizer, Inc. (2)
Prepare/Enrich Insights (1)
Princeton University (1)
Prosthetics Research Study (PRS) (1)
Psychological Assessment Resources, Inc. (PAR) (7)
Psychology Foundation of Australia (1)
QOL Tech (2)
RAND Corporation (12)
RP Group (1)
Radboud University Medical Center (2)
Rare Diseases Clinical Research Network [National Center for Advancing Translational Sciences] (RDCRN) (2)
Resilience Center (1)
River Centre Foundation (1)
SKB (1)
Save the Children International (1)
Spectrum Assessments (1)
St. George's, University of London (SGUL) (1)
St. James University Hospital (1)
Stanford University (5)
Trier University (1)
Trinity College Dublin (1)
Tulane University (3)
U Conn Health (1)
U.S. Census Bureau (1)
U.S. Department of Agriculture (USDA) (1)
U.S. Department of Defense (DOD) (9)
U.S. Department of Defense, Defense Health Agency (DHA) (1)
U.S. Department of Homeland Security (DHS) (1)
U.S. Department of Veterans Affairs (VA) (2)
U.S. Environmental Protection Agency (EPA) (1)
U.S. National Response Team (NRT) (1)
UT Health Rio Grande Valley (1)
United Kingdom Department of Health (DH) (1)
Universidade do Porto (1)
University Medical Center Groningen (UMCG) (1)
University of Arizona (1)
University of Auckland (1)
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University of California, Berkeley (4)
University of California, Davis (3)
University of California, Los Angeles (UCLA) (2)
University of California, Los Angeles, UCLA Center for Public Health and Disasters (7)
University of California, Riverside (UCR) (1)
University of California, San Diego (UCSD) (3)
University of California, San Francisco (UCSF) (5)
University of Cambridge (1)
University of Central Florida (UCF) (1)
University of Connecticut School of Medicine (1)
University of Denver (DU) (2)
University of Edinburgh (2)
University of Florida (UF) (2)
University of Illinois at Chicago, School of Public Health (1)
University of Illinois at Urbana-Champaign (1)
University of Iowa (UI) (4)
University of Melbourne (1)
University of Miami (UM) (8)
University of Michigan (6)
University of Minnesota (1)
University of Missouri (MU) (2)
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University of Nebraska Medical Center (UNMC) (1)
University of New Hampshire (UNH) (1)
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University of North Carolina at Chapel Hill (UNC) (3)
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University of Oregon (UO) (1)
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Vanderbilt University Medical Center (VUMC) (1)
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Washington University in St. Louis (WUSTL) (3)
Wellcome Trust (1)
Western Psychological Services (2)
Winterberry Press (1)
World Health Organization (WHO) (12)
World Health Organization, Regional Office for Europe (1)
Yale University (1)

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- Center for Domestic Preparedness Medical Screening Form

Source: Federal Emergency Management Agency [Department of Homeland Security] (FEMA)

Format: PDF

Annotation: The Federal Emergency Management Agency (FEMA)'s Center for Domestic Preparedness (CDP) identifies, develops, tests, and delivers training to state, local, and tribal emergency response providers and provides on-site and mobile training at the performance, management, and planning levels. The CDP Medical Screening Form is used to assess whether or not a responder requires additional health screening and is fit to perform training tasks for deployment. This resource was identified by the NIH Disaster Research Response Program (DR2) for researchers looking for pre- and post-disaster data collection instruments.

Ease of Use in Disaster Setting: Easy
Population: First Responders, Emergency Medical Services (EMS) Personnel, Police/Fire Departments
Length: One questions asking about eight conditions
Time to Complete: Not specified/given
Administered by: Self Administered/Self Report, Lay Interviewer, Specialist/Doctor/Expert
Language: English...[See more] [See less]

URL: https://training.dps.mo.gov/trainingwebsite.nsf/str/Homeland%20Documents/%24file/medical_screening_form_electronic_Feb_12.pdf

Type: Guideline/Assessment Tool

Access Notes: Free/Publicly Available

Citation(s):
Greenberg MI, Hendrickson RG; CIMERC; Drexel University Emergency Department Terrorism Preparedness Consensus Panel. Report of the CIMERC/Drexel University Emergency Department Terrorism Preparedness Consensus Panel. Acad Emerg Med. 2003 Jul;10(7):783-8. Review. PubMed PMID: 12837654. https://www.ncbi.nlm.nih.gov/pubmed/12837654. Subscription not required.

Contact information:

Institution: Center for Domestic Preparedness/Federal Emergency Management Agency
Address: 61 Responder Dr., Anniston, AL 36205
Phone: 1-866-213-9553
Web: https://cdp.dhs.gov/

For more information:
Institution: National Institute for Occupational Safety and Health
Web: https://www.cdc.gov/niosh/topics/erhms/predeploy.html

Includes Research Tools: Yes.

ID: 8637. From: Disaster Lit^®a database of the U.S. National Library of Medicine.

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NIH Public Health Emergency and
Disaster Research Response (DR2)

COVID-19 Information

Refine Your Results

Data Collection on

COVID-19 Main Topics

Publication Type

Source

REDCap

Results from:

NIH Public Health Emergency and Disaster Research Response (DR2)

COVID-19 Information

Refine Your Results

Data Collection on

COVID-19 Main Topics

Publication Type

Source

REDCap

Results from:

NIH Public Health Emergency and
Disaster Research Response (DR2)