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Warrior Intelligence Project - Crisis Tracker

SECTION 0 — CONSENT

Before We Begin

I understand and agree that my anonymous responses may be used for:

Community reports and health equity briefs shared publicly Anonymized data shared with hospital partners for quality improvement Academic research and publications where data remains anonymous Advocacy with policymakers and health systems

My name is never collected. My Warrior ID cannot be traced back to me. I can stop participating at any time.

I understand and agree that my anonymous responses may be used for: Community reports and health equity briefs shared publicly Anonymized data shared with hospital partners for quality improvement Academic research and publications where data remains anonymous Advocacy with policymakers and health systems My name is never collected. My Warrior ID cannot be traced back to me. I can stop participating at any time.

SECTION 1: THE CRISIS

When did this crisis start?

Is this crisis still ongoing?

Is this crisis still ongoing?

Pain level right now (1-10)

Pain level right now (1-10)

Compared to your typical crisis, this pain is:

Compared to your typical crisis, this pain is:
A
B
C

Where is the pain? (Select all that apply)

Where is the pain? (Select all that apply)
A
B
C
D
E
F
G
H

What did this crisis force you to stop doing? (Select all that apply)

What did this crisis force you to stop doing? (Select all that apply)
A
B
C
D
E
F
G

How old are you?

If tracking for a child, enter their age.

SECTION 2: WHAT HAPPENED BEFORE

Help us find the patterns

In the 24-48 hours before this crisis, did you experience: (Select all that apply)

In the 24-48 hours before this crisis, did you experience: (Select all that apply)
A
B
C
D
E
F
G
H
I

Current temperature where you are (in °F):

SECTION 3: WHAT YOU'RE DOING ABOUT IT

Your treatment strategy

Have you been to the ER for this crisis?

Have you been to the ER for this crisis?
A
B
C

Which hospital?

How long did you wait (in hours)?

From the time you were triaged (checked in and assessed), how long did it take to receive your first pain treatment? (in hours)

Triage is when a nurse takes your vitals and assesses your pain level. First treatment is when you received your first medication or IV.

If you saw a specific doctor or provider, what was their name?

Provider and institution names are used exclusively for internal pattern tracking by Sickle Cell Warriors of Buffalo. They are never published, never used to make individual accusations, and never shared outside of SCWB's data governance process. When patterns emerge across multiple reports, SCWB follows a formal community advocacy process — we document facts, not judgments.

Did they follow your pain protocol?

Did they follow your pain protocol?
A
B
C

If "No" is selected, Why was it not followed?

If "No" is selected, Why was it not followed?
A
B
C
D

What are you using to manage this crisis? (Select all that apply)

What are you using to manage this crisis? (Select all that apply)
A
B
C
D
E
F
G
H

Is this treatment working?

Is this treatment working?
A
B
C
D

Were you admitted to the hospital (stayed overnight or longer)?

Were you admitted to the hospital (stayed overnight or longer)?

If you were treated and released, what happened in the 72 hours after discharge?

If you were treated and released, what happened in the 72 hours after discharge?
A
B
C
D
E

SECTION 4: YOUR WARRIOR ID

Anonymous tracking - we never collect your real name

Privacy statement
We need a way to track YOUR patterns without knowing who you are.
Create a unique Warrior ID using: First name + birth month + favorite number
Example: "Marcus07-23"
Your data is private. We never collect names, addresses, or medical record numbers.

Your Warrior ID:

Are you tracking this for:

Are you tracking this for:
A
B
C

Which community are you part of?

Which community are you part of?
A
B
C
D
E

SECTION 5: OPTIONAL - COMMUNITY CARE

We're not just collecting data—we're building community

Would you like us to check in on you?

Would you like us to check in on you?

Your phone number (so we can reach you)

Comments or concerns

Privacy note: Your responses are collected anonymously under the Warrior Intelligence Project data governance policy. Data is owned by Sickle Cell Warriors of Buffalo and the Warrior community. It is never sold, never shared with insurers or employers, and never used to identify individual Warriors. By submitting this form you confirm your consent as indicated above. For questions: scwbuffalo@gmail.com