conducted

Community Consul tat ion
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
,4-----h
‘[ Yes ,!!
XL-.,
NO
/’
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
/--\
Yes
;‘..7:..
- No ,)
: A....----A’
3. TC,-~~el~we
by the paramedics, would you want him or her to be excluded from this study?
../=Y
Yes
pfJp-/
4.
Do you have any comments or concerns you wish to share with the investigators?
____________________------------------------
Age:
Ethnic background:
LTL
Gender:
OPTIONAL
Male
.y
______________________________ - _______-_---------
&d*c?
-
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MX 55902
(507) 2557003
Polvheme.triat @mayo.edu
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/researcNtrials/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circlC your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
Yi?
c
NO
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
3. If a familv member of yours were severely injured and bleeding and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
r Ia-2
L.
4. Do you hale any comments or concerns you wish to share with the investigators?
,‘. 4 ,, y h- ;/, c&&.&2’-\,
3
Yes
____________________----------------
--------OPTIONAL ------_-----________-----------------------------
Ethnic background:
Gender:
Male
: ii,e~6
i I c ry-.~~~~~
Female $
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 255-7003
Polvheme.trial @mavo.edu
Mayo Clinic Chnical Trails
http://mayoresearch.mayo.edu/mayo/researcNtrials/index.cfm
\
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
No
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
Nd ’
I- /
3. If a family member of yours were severely injured and bleeding and were to be treated
by the paramedics,would you want him or her to be excluded from this study‘?
Yes
No;
-*’
4. Do you have any comments or concerns you wish to share with the investigators?
OPTIONAL
__-_________________------------------------
Ethnic background: C’k- r&-
Age: 67
Gender:
-_________c_________-----------------------------
Male
Female J
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 2557003
Polvheme.trial @mavo.edu
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/research/trials/index.cfm
Community Consultation
Kiwanis CIub of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
CT
No
Yes
2. If you were severely injured and bleeding and were being treated by the paramedicsin
your community, would you wish to be excluded?
-arm-r
nf yours were severely injured and bleeding and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
Yes
/
0 No/
4. Do you have any comments or concerns you wish to share with the investigators?
Age:
Gender:
Ethnic background:
67A
Male
LcJ~;J-p
Female -8
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 255-7003
Polvheme.trialO mayo.edu
Mayo Clinic Clinjcal Trails
http://mayoresearch.mayo.edu/mayo/researc~trials/index.cfm
Community Consultation
Kiwanis CIub of Rochester
March 30,2004
Please circle yozrr answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specificaIIy, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
, ‘i,NO
Yes 1;’
c
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
3. If a family member of yours were severely injured and bleeding and were to be treated
by the paramedics, w-ould you want him or her to be excluded trom thusstudy.!
Yes
4. Do you have any comments or concerns you wish to share with the investigators?
______-____~_______-------------------------
Ethnic background: PJ7VW
Age: 67
Gender:
OPTIONAL ----_-_-__-_-*______---------------------~-------
Male
/’
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester,MN 55902
(507) 255-7003
[email protected]
Mayo Clinic Clinical Trails
http:Nmayoresearch.mayo.edu/mayo/researc~t~als/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please tide
your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
wouId be enrolled without giving their informed consent?
No
Yes
c7
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
0
No
Yes
3. If a familv member of vours were severelyin-@redand bleeding and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
-I
Yes
c No /
4, Do you have any comments or concernsyou wish to share with the investigators?
________________________________________---OPTIONAL--
Ethnic background:
Age: 6.7.3
Gender:
Male
----------_-_---____---------------------------
-LAro~&)
I
;XX Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester,MN 55902
(507) 255-7003
Polvheme.trial Omavo.edu
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/researc~t~als/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specificahy, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
No
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
L~rfrely
. .
qured and bleeding and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
Yes
dNO
4. Do you have any comments or concerns you wish to share with the investigators?
OPTIONAL
__-----_________----------------------------
__________________ - ____________________----------
Ethnic background:
Age: 67
:’
Gender:
Male
/’
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester,MN 55902
(507) 255-7003
[email protected]
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/researcNtrials/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your alzswers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
.!G
d
No
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
0No
Yes
d were to be treated
by the paramedics, would you want him or her to be excluded from this study?
2
J.
Yes
4. Do you have any comments or concerns you wish to share with the investigators?
---___--____^--_____------------------------
____________________
_ ________________________
Ethnic background:
Age: 6 2k
Gender:
OPTIONAL----
Male
*
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 255-7003
[email protected]
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/reseach/triaIs/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30, 2004
Please circle your amwers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
0
Yes
NO
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
. .
nd bleeding and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
3
Tfa
I
flmjjq
Yes
wp.~e spwlureda
cia
4. Do you have any comments or concerns you wish to share with the investigators?
________________________________________---OPTIONAL
Ethnic background: KU-L&T-
Age: 6 ]3
Gender:
________________________________________---------
Male J
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 2557003
[email protected]
Mayo Ciinic Clinkal Trails
http://mayoresearch.mayo.edu/mayo/researcNtrials/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
I. WouId you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
Yes
No
0
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
..
‘3.
) Tlf e-w-rprrprpl\re
tobetreated
by the paramedics, would you want him or her to be excluded from this study?
‘Nb
0
4. Do you have any comments or concerns you wish to share with the investigators?
Yes
___-________________------------------------
OPTJONAL
____________________----------------------------.
Ethnic background:
Age: bfz
Gender:
Male
4-
FemaIe)(
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 255-7003
[email protected]
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/research/trials/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
Yes
0
?
No
2. If you were severeIy injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
ble&ingand were to be treated
by the paramedics, would you want him or her to be excluded from this study?
No
0
4. Do you have any comments or concerns you wish to share with the investigators?
Yes
__--________________------------------------
____________________-----------------------------
Ethnic background:
Age: b5
Gender:
OPTIONAL
Male
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 2.557003
Pol [email protected]
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/researc~t~als/index.cfm
Community Consultation
Kiwanis Club of Rocheste
March 30,2004
Please circle your answers
1. Would you support a study such as the one described a: this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
Y&s
CT
NO
2. If you were severely injured and bleeding and were be.ng treated by the paramedics in
munity, would you wish to be excluded?
’ No
0
3. If a family member of yours were severely injured and bleeding and were to be treated
paramedics, would you want him or her to be excluded from this study?
4, Do you have any comments or concerns you wish to hare with the investigators?
Gender:
Male 1%
Female
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
(7
No
Yes
2. If you were severely injured and bleedin,(3and were being treated by the paramedics in
your community, would you wish to be excluded?
QNo
Yes
5. ifa
by the paramedics, would you want him or her to be excluded from this study?
Yes
__---__________---__------------------------
OPTIONAL
/
Age: kk
Ethnic bat kground:
Gender:
Female
Male
____________________-----------------------------
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 255-7003
[email protected]
Mayo Clinic Clinica TraiIs
http://mayoresearch.mayo.edu/mayo/researc~t~als/index.cfm
ted
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
I. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
Yes ’
NO
.o
. 2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
? Tf qer
of vours
were severelv iniured and bleedinp and were to be treated
,
by the paramedics, would you want him or her to be excluded from this study?
Yes
0
No
’
4. Do you have any comments or concernsyou wish to share with the investigators?
OPTIONAL
____-______---------------------------------
Ethnic background:
Age: ‘??LT1
Gender:
Male ,x,
________________________________________---------
& &--&ud
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D:
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester,MN 55902
(507) 255-7003
[email protected]
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/researc~t~aIs/index.cf~
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
..
Yes ““,.
No
L
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
I’
3. If a familv member of yours were severely injured and bleeding and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
:‘No ‘:!
L.2
4. Do you have any comments or concerns you wish to share with the investigators?
Yes
-_--____-____~_____-------------------------
Ethnic background: ,:,cLL$-&&~
Age: qc
Gender:
OPTIONAL------ ----_---________-___-----------------------
Male
Female &
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 255-7003
[email protected]
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/research/trials/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
PZease circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patjents
would be enrolled without giving their informed consent?
/ ---\
0
Yes
No
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
ured and bleedinp and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
2
Tf
Yes
____________________------------------------
Ethnic background:
Age: -I 3
Gender:
OPTIONAL
Male
__________-__--_-_--_____-____-------------------
c/$-l/ c../J-fj /s/t/
I&% Female -
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Chnic
200 First St SW
Rochester, MN 55902
(507) X5-7003
[email protected]
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/research/trials/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1_ Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
No
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
<No
3
were to be treated
by the paramedics, would you want him or her to be excluded from this study?
2
Tfo
Yes
cl No
4. Do you have any comments or concerns you wish to share with the investigators?
____--__---_____-___------------------------
Age:
Ethnic background:
72
Gender:
OPTIONAL----- -____-___-_________-------------------------
Male
t&4/ohLd
Female s
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 2557003
Polvheme.trial @mavo.edu
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/researcNtrials/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
es
0
NO
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
p:to be&eated
by the paramedics, would you want him or her to be excluded from this study?
9
TC
Yes
1 of
a No
4. Do you have any comments or concernsyou wish to share with the investigators?
________________________________________---OPTIONAL ____________________-----------------------------
Ethnic background:
Age: 71
Gender:
Male t/
w+&.
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester,MN 55902
(507) 255-7003
[email protected]
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/researc~t~als/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
2. If you were severely injured and bleeding and were being treated by the paramedicsin
your community, wouId you wish to be excluded?
were to be treated
4. Do you have any comments or concerns you wish to share with the investigators?
_______________
______________-______________
OPTIONAL
Gender:
MaIe
L’
_______-___--___---_-----------------------------
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 255-7003
[email protected]
Mayo Clinic Clinical Traiis
http://mayoresearch.mayo.edu/mayo/researcNtrials/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
No
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
?Tfer
of yours were severely injured and bleeding and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
No
4. Do you have any comments or concerns you wish to share with the investigators?
____________________------------------------
____________- ____________________----------------
Ethnic background: GF;4A
Age: zc
Gender:
OPTIONAL
Male y
@+d
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester,MN 55902
(507) 2557003
Polvheme.trial @mayo.edu
Mayo Clinic Clinical Trails
http:Nmayoresearch.mayo.edu/mayo/researc~t~als/jndex.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please cirde your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
/-I-\
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
and bleeding and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
f -- ‘..,
No //
Yes
L
4. Do you have any comments or concerns you wish to share with the investigators?
l?lV
--___-__________--__-----------------------L7
Age:
Ethnic background:
,/ 4 -
Gender:
OPTIONAL
Male
v
i
____________________-----------------------------
/:
i
Lk/Ycc.-!Q I.& -Ij?,L
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester,MN 55902
(507) 255-7003
[email protected]
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/researc~t~als/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
NO
Yes
0 - I--:
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
?Tf..a
nf pm were severely injured and bleeding and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
Yes
4. Do you h&e any comments or concerns you wish to share with the investigators?
____________________------------------------
OPTIONAL
Ethnic background:
Gender:
Male
____e----- -_-----__----_-__--_-------------------
I
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester,MN 55902
(507) 255-7003
Polyheme.triaf @mayo.edu
Mayo Clinic Cljnical Trails
http://mayoresearch.mayo.edu/mayo/research/triaIs/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specificahy, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
0
Yes
No
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
0
0
3. If a familv member of vours were severely iniured and bleeding and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
No
0
4. Do you have any comments or concerns you wish to share with the investigators?
Yes
-__-_________~_____----------------
____________________________t___________---------
Ethnic background: Gwfli/
Age: *??z
Gender:
_________
OPTIONAL
Male
c//
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 25.57003
Polyheme.triai @mayo.edu
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/research/t~als/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
cl
No
Y&G
2. If you were severely injured and bleedin,* and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
3. If a family member of yours were severely injured and bleeding and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
Yes
4.
you wish to share with the investigators?
Do you have any comments fit
tii rnncerns
-
-w----v -w-s_-..- ----_____-_----_-------------
OPTIONAL
__________________________
_ ______________________
Ethnic background: t/UK
Gender:
Male
%.
Female __I
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 2557003
Polvheme.rrial @mayo.edu
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edulmayo/researchltrials/index.cfm
Community Consultation
Kiwanjs Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
0
Yes
No
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
3. If a famiIy member of yours were severely injured and bleeding and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
Yes
4. Do you have any comments or concerns you wish to share with the investigators?
_________________
____________________________________
OPTIONAL
________
Ethnic background:
Gender:
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 255-7003
Polvheme.trial @mavo.edu
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/research/trials/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support q study such as the one described at this meeting being conducted
in this community, specifically, a study in which severeIy injured and bleeding patients
would be enrolled without giving their informed consent?
es
NO
D
2. If you were severely injured and bleeding and were being treated by the paramedicsin
your community, would you wish to be excluded?
Yes
0
NO
3. If a family member of yours were severely injured and bleeding and were to be treated
by the paramedics, would you want him or her to be excluded trom this study’!
Yes
NO
0
4. Do you have any comments or concerns you wish to share with the investigators?
_____________-.__________________________----
Age:
7d’
Gender:
OPTIONAL
________________________________________---------
Ethnic background: wa2
Male
%.
’
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester,MN 55902
(507) 25.57003
[email protected]
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/researchltrials/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
c7i
Yes
No
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
3. If a family member of yours were severely injured and bleeding and were to be treated
by the paramedics,would you want him or her to be excluded from this study?
No
4. Do you have any comments or concernsyou wish to share with the investigators?
________________________________________----
Age:
Gender:
7:
OPTIONAL
Ethnic background:
Male
v
________________________________________---------
tr/d
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester,MN 55902
(507) 2.557003
[email protected]
Mayo Clinic Cfinical Trails
http://mayoresearch.mayo.edu/mayo/researchltrials/index.cfm
Community Consultation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
No
GJ
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
0N
3. If a family member of yours were severely injured and bleeding and were to be treated
by the paramedics, would you want him or her to be excluded from this study?
Yes
0N
4. Do you have any comments or concerns you wish to share with the investigators?
_______-_____-----___________________
Age: *‘g’
Gender:
_ _____- OPTIONAL
________________________________________---------
Ethnic background:
Male
i/
Female
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Maye, Clinic
200 First St SW
Rochester, MN 55902
(587) 255-7003
Polvheme.trial @mavo.edu
Mayo Clinic Clinical Trails
http:Nmayoresearch.mayo.edu/mayolresearch~t~alslindex.cfm
Community ConsuItation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enrolled without giving their informed consent?
No
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
3. If a family member of yours were severely injured and bleeding and were to be treated
oy the pal v
or herto%e exdyy
.
,
Yes
No
0
4. Do you have any comments or concerns you wish to share with the investigators?
______________________________
-
Age:
Ethnic background:
72
Gender:
Male
____________
OPTIONAL
_____________________L_________
- _________________
Female )(:
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
DO First St SW
Rochester,MN 55902
(507) 255-7003
[email protected]
Mayo Clinic Clinical Trails
http://mayoresearch.mayo.edu/mayo/researc~t~a~s/index.cfm
z
0
ti
Community ConsuItation
Kiwanis Club of Rochester
March 30,2004
Please circle your answers
1. Would you support a study such as the one described at this meeting being conducted
in this community, specifically, a study in which severely injured and bleeding patients
would be enroIled without giving their informed consent?
0
No
es
2. If you were severely injured and bleeding and were being treated by the paramedics in
your community, would you wish to be excluded?
Yes
3. If a family member of yours were severely injured and bleeding and were to be treated
by the paramedics,WOUld you want hiIII or her t0 be excluded IrOiII thlS StUdy’!
Yes
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uNo
4. Do
,- you have any comments or concerns you wish to share with the investigators?
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P
_____________-__________________________----OPTIONAL
Ethnic background: f fi ti c Q Si’a H
Age: 2!!L
Gender:
________________________________________---------
‘Male
Female x
Thank you for your participation today.
Questions?
Andy Boggust, M.D.
Department of Emergency Medicine
Mayo Clinic
200 First St SW
Rochester, MN 55902
(507) 255-7003
[email protected]
Mayo Clinic Clinical Trails
http:Nmayoresearch.mayo.edu/mayolresearc~t~als/~ndex.cfm