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Hawaii Veterinary Emergency Response
Seeking input from Hawaii's veterinary workforce on interest and capabilities in local emergency and disaster response
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Name (optional)
Your answer
Email Contact (optional)
Your answer
Phone Contact (optional)
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Clinic Name (optional)
Your answer
Island
*
Your answer
Are you willing to volunteer during disaster response? (You may not be paid for services provided)
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Yes, from home (e.g. making calls, planning, and preparation before or after a disaster)
Yes, by providing treatment for animals in your hospital under the direction of the emergency response team
Yes, deployed onsite at a field clinic working within the local/state emergency response system
No (you may skip the rest of the questions or send additional feedback below)
Other:
Required
As a volunteer, are you willing to complete online FEMA ICS (emergency protocol) training? ICS Modules 100 and 200 are free, take approximately 5 hours, and can be scheduled at your convenience.
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Yes
No
Other:
As a volunteer, are you willing to meet 1-4 times per year for training?
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Yes, meeting in person preferred
Yes, meeting remotely preferred (via phone or video conferencing)
No
Other:
As a volunteer, what other training or information would you require to feel prepared to assist in an emergency?
Your answer
If deployed to a shelter, what equipment/resources could you provide? Please check all that apply and elaborate below if needed.
Consumable goods donations (e.g. bandage supplies, syringes, medication)
Consumable goods only if reimbursed for their costs after the disaster event
Equipment (e.g. stethoscope, surgical instruments, anesthetic machine)
Additional staff (veterinary technicians or assistants)
Other:
HVMA is working with HI-EMA to support local and state disaster preparedness pertaining to animals. Are you interested in being part of this working group? We will be developing a set of guidelines for animal care and treatment and considering the formation of a Veterinary Medical Reserve Corps or Companion Animal Response Team.
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Yes
No
Other:
Please enter any additional feedback or questions regarding animal care disaster response in Hawaii:
Your answer
Thank you very much for your feedback!
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