Questionnaire Questionnaire Step 1 of 3 33% HOSPITAL COMMUNICATION DATAHOSPITAL NAMEADDRESSHOSPITAL SSL PROJECT COORDINATOR NAMEHOSPITAL SSL PROJECT COORDINATOR PHONEHOSPITAL DIRECTOR NAMEHOSPITAL DIRECTOR PHONEER DIRECTOR NAMEER DIRECTOR PHONEHEAD OF CARDIOLOGY DEPT NAMEHEAD OF CARDIOLOGY DEPT PHONECath-Lab DIRECTOR NAMECath-Lab DIRECTOR PHONEEMS OF THE CLUSTER COORDINATOR NAMEEMS OF THE CLUSTER COORDINATOR TEL.CLUSTER WHATSAPP GROUP TEL.STEMI HOT LINE TEL # IN THE HUB. HOSPITAL TYPETYPE OF SERVICE PROVIDED A B C D IF SPOKE, DISTANCE TO HUB (km)IF SPOKE, DRIVING TIME TO HUB (MIN)IF SPOKE, Specify the name of the HUB(S)IF HUB, Specify the name of the SPOKE(S)Catchment area (in Km2)# of populations served (millions/area)# of STEMI patients served per year HOSPITAL STEMI MANAGEMENT CAPABILITIES# of ER BEDS# of CCU BEDS# of CARDIOLOGIST IN ER 24/7 Yes No # of Interventional CARDIOLOGIST IN ER 24/7 Yes No 12 Channel ECG IN ER Yes No Number(Required)Number(Required)Number(Required)DC CARDIOVERTER IN ER Yes No ECG MONITORED BEDS IN ER Yes No ECG TRANSMISSION VIA ECG MACHINE Yes No EMS AVAILABLE FOR Patient TRANSFER TO HUB Yes No PPCI CAPABLE 24/7 Yes No PPCI CAPABLE not 24/7 Yes No (9AM-5PM ONLY or 5PM-9AM Only) Number of Cath-Labs
