Air Ambulance Patient Experience Survey

Should you experience any problems with this questionnaire please contact Bob Johnston at bobjohnston@nhs.net

Please answer as many questions as possible.

General Information

1. Your Name Please: (Optional)

Name:

Your Air Ambulance Journey

4. In which Type Of Aircraft Did You Travel In On This Occasion?

	Fixed Wing Aircraft
	Helicopter

6. If you were given a time for your flight, did the aircraft arrive within an acceptable margin of that time?

	Yes go to question 11
	No go to question 7
	Not Given a time go to question 11

11. Recalling your journey from the pick-up location to your arrival at the destination hospital, how would you describe the quality of the communications between the Scottish Air Ambulance Service and yourself or your carers?

	Very Poor
	Quite Poor
	Neither Good nor Poor
	Quite Good
	Very Good

13. Can you please give an indication of how satisfied you were overall with your latest Air Ambulance experience?

	Very Dissatisfied
	Quite Dissatisfied
	Neither Satisfied nor Dissatisfied
	Quite Satisfied
	Very Satisfied

14. If you answered ' Very Dissatisfied or Quite Dissatisfied' to the previous question, can you please briefly describe the cause of your dissatisfaction?

16. If YES to the previous question, can you please give an indication of how your latest experience with the Air Ambulance compared with previous ones?

	Was a much worse experience
	Was a slightly worse experience
	Was neither a worse nor better experience
	Was a slightly better experience
	Was a much better experience

17. If you answered 'Much worse or Slightly worse' to the previous question can you briefly describe in what way(s) the experience was a worse one?

18. Thinking about future Air Ambulance Services what, in your opinion, would be the top three requirements to improve the Service?

1.
2.
3.

19. If You have any further comments on the any aspect of the Air Ambulance Service, please do so in the space below.

YOUR ROAD AMBULANCE JOURNEY (If applicable)

20. Did you require a ROAD AMBULANCE journey before or after the Air Ambulance Journey?

	Yes - before the Air Ambulance flight only go to question 21
	Yes - After the Air Ambulance Flight only go to question 22
	Yes - Before and after the air ambulance flight go to question 21
	No - I did not require an ambulance before or after the Air Ambulance Flight (Please go to end and submit this form)

21. How would you describe the ROAD ambulance journey that took place BEFORE your flight?

	Very Poor
	Quite Poor
	Neither Poor Nor Good
	Quite Good
	Very Good
	Not Applicable

22. How would you describe the ROAD ambulance journey that took place AFTER your flight?

	Very Poor
	Quite Poor
	Neither Good Nor Poor
	Quite Good
	Very Good
	Not applicable

23. Can you please give an indication of your satisfaction with the combined air and land ambulance experience?

	Very Dissatisfied
	Quite Dissatisfied
	Neither Satisfied nor Dissatisfied
	Quite Satisfied
	Very Satisfied

24. If you answered 'Very Dissatisfied or Quite Dissatisfied' can you briefly describe the cause of your dissatisfaction?

25. If you have any further comments to make on any aspect of your road ambulance journey, please do so in the space below