QUEENSLAND AMBULANCE SERVICE NEANN SPO FEEDBACK FORM
This feed back form is for the QAS Soft Pack Oxygen Resuscitator.
Name Rank/Position Years of Service Stationed at
How long has the kit been in service?
Approximately how many times has the unit been used for therapy?
Approx. how many times has the unit been used to ventilate a patient (IPPV)?
Before you used the QAS SPO were you given training on:
Design features of the unit? Yes No
Cleaning the unit? Yes No
Use and care of the oxygen regulator/flow controller? Yes No
Use and care of the oxygen powered suction/aspirator? Yes No
Use and care of the manually powered suction unit? Yes No
Use and care of the B.V.M. refill valve? Yes No
Any Comments
Is the quality of manufacture of the SPO satisfactory? Yes No Unsure
If you answered No or Unsure please outline issues and offer suggestions.
Is the quality of the materials used in the SPO satisfactory? Yes No Unsure
Are the zips coping with the work load? Yes No Unsure
Is the waterproof base protecting the base from liquids, weather and dirt? Yes No Unsure If you answered No or Unsure please outline issues and offer suggestions.
Are the carry handles comfortable to use? Yes No Unsure If you answered No or Unsure please outline issues and offer suggestions.
Have you used the backpack harness yet? Yes No How many times? Longest time worn as a backpack?
Was the harness comfortable? Yes No If you answered No please outline issues and offer suggestions.
Is there enough reflective tape on the kit for your safety? Yes No
If you answered No please outline issues and offer suggestions.
Are you pleased with the way how the SPO opens? Yes No Unsure
Are you pleased with the oxygen cylinder holder? Yes No Unsure If you answered No or Unsure please outline issues and offer suggestions. Is the cylinder easy to change? Yes No Unsure If you answered No or Unsure please outline issues and offer suggestions.
If you have a lift up end pocket soft pack version which allows access to the cylinder valve, do you like it? Yes No Unsure
Have you used the new brass regulator? Yes No
If you answered No please outline issues and offer suggestions. Do you like the new brass regulator? Yes No Unsure If you answered No or Unsure please outline issues and offer suggestions.
Do you like the external suction pocket? Yes No Unsure If you answered No or Unsure please outline issues and offer suggestions.
Do you like the oxygen powered suction unit? Yes No Unsure
Do you like the Res-Q-Vac? Yes No Unsure If you answered No or Unsure please outline issues and offer suggestions.
Do you like the internal pocket labels? Yes No Unsure
Are you pleased with the layout of the unit? Yes No Unsure If you answered No or Unsure please outline issues and offer suggestions.
Are you allowed to intubate? Yes No If answered No skip next 4 questions
Do you use the QAS intubation kit? Yes No Skipped
Is the intubation kit big enough? Yes No Unsure Skipped If you answered No or Unsure please outline issues and offer suggestions.
Do you store the intubation kit inside the resuscitator? Yes No Unsure Skipped
Do you carry the intubation kit between the handles of the resuscitator? Yes No Unsure Skipped If you answered No or Unsure please outline issues and offer suggestions.
What is the name of the company that services your resuscitator? Are they accredited to service the unit? Yes No Unsure Would you like us to confirm for you if they are accredited? Yes No
Do you have access to the operators manual sent out with all resuscitator units? Yes No Unsure Would you like a manual sent out to you? Yes No Please indicate your address where we will send the manual to: It will either go via the post, or we can email it. Recipients Name Street Address Suburb/Town/City State Post Code or E-mail to:
Are there any specific improvements you would like to see in the kit?
Please add your personal details below so we can follow up any issues
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