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Anesthesiologists and Disaster Medicine: A Needs Assessment for Education and Training and Reported Willingness to Respond
Abstract
Background:
Anesthesiologists provide comprehensive health care across the emergency department, operating room, and intensive care unit. To date, anesthesiologists' perspectives regarding disaster medicine and public health preparedness have not been described.
Methods:
Anesthesiologists' thoughts and attitudes were assessed via a Web-based survey at 3 major academic institutions. Frequencies, percentages, and odds ratios (ORs) were used to assess self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, employee development, professional obligation, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond (WTR). Three representative disaster scenarios (natural disaster [ND], radiological event [RE], and pandemic influenza [PI]) were investigated. Results are reported as percent or OR (95% confidence interval).
Results:
Participants included 175 anesthesiology attendings (attendings) and 95 anesthesiology residents (residents) representing a 47% and 51% response rate, respectively. A minority of attendings indicated that their hospital provides adequate pre-event preparation and training (31% [23-38] ND, 14% [9-21] RE, and 40% [31-49] PI). Few residents felt that their residency program provided them with adequate preparation and training (22% [14-33] ND, 16% [8-27] RE, and 17% [9-29] PI). Greater than 85% of attendings (89% [84-94] ND, 88% [81-92] RE, and 87% [80-92] PI) and 70% of residents (81% [71-89] ND, 71% [58-81] RE, and 82% [70-90] PI) believe that their hospital or residency program, respectively, should provide them with preparation and training. Approximately one-half of attendings and residents are confident that they would be safe at work during response to a ND or PI (55% [47-64] and 58% [49-67] of attendings; 59% [48-70] and 48% [35-61] of residents, respectively), whereas approximately one-third responded the same regarding a RE (31% [24-40] of attendings and 28% [18-41] of residents). Fewer than 40% of attendings (34% [26-43]) and residents (38% [27-51]) designated who would take care of their family obligations in the event they were called into work during a disaster. Regardless of severity, 79% (71-85) of attendings and 73% (62-82) of residents indicated WTR to a ND, whereas 81% (73-87) of attendings and 70% (58-81) of residents indicated WTR to PI. Fewer were willing to respond to a RE (63% [55-71] of attendings and 52% [39-64] of residents). In adjusted logistic regression analyses, those anesthesiologists who reported knowing one's role in response to a ND (OR, 15.8 [4.5-55.3]) or feeling psychologically prepared to respond to a ND (OR, 6.9 [2.5-19.0]) were found to be more willing to respond. Similar results were found for RE and PI constructs. Both attendings and residents were willing to respond in whatever capacity needed, not specifically to provide anesthesia.
Conclusions:
Few anesthesiologists reported receiving sufficient education and training in disaster medicine and public health preparedness. Providing education and training and enhancing related employee services may further bolster WTR and help to build a more capable and effective medical workforce for disaster response.
... Although there is no consensus regarding the most effective methods of training healthcare workers in disaster preparedness, 1,[7][8][9] disaster training has been shown to improve preparedness knowledge 8,10,11 and increase the ability and willingness of healthcare workers to report to work during disasters. 1,[12][13][14][15] Such findings point toward the need to better understand which factors encourage healthcare workers to participate in disaster training. There is, however, a gap in the literature regarding the relation between sociodemographic, household, or workforce characteristics and the desire for additional disaster preparedness training. ...
... Healthcare workers who underwent disaster training or else believed that they were prepared to respond, have been reported to be more likely to report to work during a major disaster. 1,[12][13][14][15]24 Advanced training also has been shown to have a significant association with preparedness knowledge, 7,10,11,29 such as improved understanding of the hospital's disaster plan, incident command system, communication strategies, and their individual response roles, as well as increased confidence in selfprotection practices and use of firefighting equipment. 9,30 Most of the hospitals that did not report experiencing any substantial challenges during Hurricane Sandy in 2012 attributed their lack of problems to successful emergency planning and participation in preparedness activities. ...
... 9,30 Most of the hospitals that did not report experiencing any substantial challenges during Hurricane Sandy in 2012 attributed their lack of problems to successful emergency planning and participation in preparedness activities. 31 The majority of healthcare professionals have expressed their desire for additional training to prepare for a major disaster, 12,14,22,23,26 including >60% of VA employees surveyed in this study. The most frequently cited training needs include information about their specific response roles, 26,32 the incident command structure, 8,26 their hospital's disaster plan, 7 infection control, 15,26 personal preparedness, 26 and triage. ...
Objectives:
Training healthcare workers in disaster preparedness has been shown to increase their willingness and ability to report to work during disasters. Little is known, however, about the relation between sociodemographic, household, and workforce characteristics and the desire for such training. Accordingly, this study aimed to assess healthcare workers' desire for additional workforce preparedness training, and the determinants that influence the need for such training, for three types of disasters (natural, pandemic, manmade).
Methods:
The US Department of Veterans Affairs (VA) Preparedness Survey was a random, anonymous, Web-based questionnaire fielded nationwide (October-December 2018). Multivariate, logistic regression analyses were conducted.
Results:
In total, 4026 VA employees, clinical and nonclinical, responded. A total of 61% of respondents wanted additional training for natural, 63% for pandemic, and 68% for manmade disasters. VA supervisors (natural: odds ratio [OR] 1.28, pandemic: OR 1.33, manmade: OR 1.25, P < 0.05) and clinicians (natural: OR 1.24, pandemic: OR 1.24, manmade: OR 1.24, P < 0.05) were more likely to report the need for additional training. Those who reported that they understood their role in disaster response were less likely to report the need for training (natural: OR 0.25, pandemic: OR 0.27, manmade: OR 0.28, P < 0.001), whereas those who perceived their role to be important during response (natural: OR 2.20, pandemic: OR 2.78, manmade: OR 3.13, P < 0.001), and those who reported not being prepared at home for major disasters (natural: OR 1.85, pandemic: OR 1.92, manmade: OR 1.94, P < 0.001), were more likely to indicate a need for training.
Conclusions:
Identifying which factors encourage participation in disaster preparedness training can help hospitals and other healthcare providers create targeted training and educational materials to better prepare all hospital staff for future disasters.
... Several studies [28][29][30] reported that adequate preparedness to face a pandemic during an infectious disease showed more willingness of healthcare workers to respond. In this study, similarly, around 71.22% of participants were willing to volunteer if provided with specialized training to deal with the pandemic. ...
... In this study, similarly, around 71.22% of participants were willing to volunteer if provided with specialized training to deal with the pandemic. Training in preparedness and response, use of PPE and self-confidence in formulating appropriate diagnosis and treatment of infectious diseases were reported to be the factors involved in motivating their willingness to volunteer [28][29][30] . ...
Objective:
Healthcare outbreaks, especially infectious disease pandemics, often stretch the healthcare systems to its limits. Healthcare systems have no option other than being supported by the participation of young and motivated healthcare providers (HCPs) in their undergraduate medical studies during their prevention and control internship program during the outbreak. Understanding key motivation factors influencing HCPs are vital to ensure their effective participation in such situations.
Subjects and methods:
A cross-sectional study was conducted on 410 undergraduate medical students at Qassim University in Saudi Arabia with the aim to describe the motivation factors that affect their willingness to volunteer during a pandemic. An online survey questionnaire was conducted.
Results:
410 participants of which 239 (58.29%) were female, 108 (26.34%) were in their third academic year and 129 (31.46%) were between 21-22 years of age. More than 70% of participants showed willingness to volunteer during a pandemic. Their willingness to volunteer was motivated by distance of workplace to home, availability of transportation, being vaccinated, access to health care for self and family if affected, and provision of specialized training.
Conclusions:
Healthcare administrators and policy makers need to address these factors effectively to ensure the availability of skilled and motivated healthcare providers during a pandemic.
... Many healthcare workers, including those who directly or indirectly deliver care and services to patients [1], report that they often feel unprepared to effectively respond to major disasters [2][3][4][5][6][7][8][9][10]. Some of the concerns they express include: transportation problems, safety of self and family members, caretaking obligations, personal health issues, lack of personal preparedness, lack of confidence in medical facility's ability to respond effectively, insufficient training, and unwillingness to report to work [11][12][13][14][15][16][17][18][19]. ...
... Perceptions of physical safety and confidence in their facility's ability to handle and respond to a major disaster have also been reported to influence healthcare workers' willingness and ability to respond [8,17]. Prior studies have found that only one-half of respondents were confident that they would be safe at work during a natural disaster or pandemic influenza, whereas only one-third responded the same regarding a radiological event [10,16]. Non-clinical staff were typically more confident in their hospital's ability to provide safety precautions compared to clinical staff [35]. ...
Background:
Most U.S. studies on workforce preparedness have a narrow scope, focusing primarily on perceptions of clinical staff in a single hospital and for one type of disaster. In contrast, this study compares the perceptions of workplace disaster preparedness among both clinical and non-clinical staff at all U.S. Department of Veterans Affairs (VA) medical facilities nationwide for three types of disasters (natural, epidemic/pandemic, and manmade).
Methods:
The VA Preparedness Survey used a stratified simple random, web-based survey (fielded from October through December 2018) of all employees at VA medical facilities. We conducted bivariate and multivariate logistic regression analyses to compare the sociodemographic characteristics and perceptions of disaster preparedness between clinical and non-clinical VA staff.
Results:
The study population included 4026 VA employees (2488 clinicians and 1538 non-clinicians). Overall, VA staff were less confident in their medical facility's ability to respond to epidemic/pandemics and manmade disasters. Depending on the type of disaster, clinical staff, compared to non-clinical staff, were less likely to be confident in their VA medical facility's ability to respond to natural disasters (OR:0.78, 95% CI:0.67-0.93, p < 0.01), pandemics (OR:0.82, 95% CI:0.70-0.96, p < 0.05), and manmade disasters (OR: 0.74, 95% CI: 0.63-0.86, p < 0.001). On the other hand, clinicians, compared to non-clinicians, were 1.45 to 1.78 more likely to perceive their role in disaster response to be important (natural OR:1.57, 95% CI:1.32-1.87; pandemic OR:1.78, 95% CI:1.51-2.10; manmade: OR:1.45; 95% CI: 1.23-1.71; p's < 0.001), and 1.27 to 1.29 more likely to want additional trainings to prepare for all three types of disasters (natural OR:1.29, 95% CI:1.10-1.51; pandemic OR:1.27, 95% CI:1.08-1.49; manmade OR:1.29; 95% CI:1.09-1.52; p's < 0.01). Clinicians were more likely to be women, younger, and more educated (p's < 0.001) than non-clinicians. Compared to clinicians, non-clinical staff had been employed longer with the VA (p < 0.025) and were more likely to have served in the U.S. Armed Forces (p < 0.001).
Conclusions:
These findings suggest both a desire and a need for additional training, particularly for clinicians, and with a focus on epidemics/pandemics and manmade disasters. Training programs should underscore the importance of non-clinical roles when responding to disasters.
... Long-term formal training, such as undergraduate, graduate and postgraduate courses, is essential. Operational simulations involving key services and rescue formations, focusing on organizational training rather than individual training [13]. Analyzing work experience, very interesting findings were presented in their paper by Heather K Hayanga et al. ...
Background: The paper presents issues related to the deficit in medical student training in the field of disaster medicine. According to Polish medical educational standards , there is no obligation imposed by the legislator to educate future doctors in disaster medicine. However, there is the university's authorial capacity, which, as exemplified by Lazarski University in Warsaw, has been successfully implemented for teaching students disaster medicine and has demonstrated effectiveness in education in this field.
... The above questions were formulated after we had thoroughly reviewed the existing literature, (14)(15)(16)(17) and the questionnaire was converted into an online format (a Google form), which was emailed to surgical residents. A disclosure statement informing respondents that the survey responses would be anonymous and were only intended for research purposes preceded the questionnaire. ...
Background: The coronavirus disease (COVID-19) pandemic is an ongoing crisis. In light of mounting concerns about the training of surgical residents, we examined surgical residents perceptions regarding the pandemic's impact on their training. Methods: We developed an anonymous online questionnaire comprising 15 multiple-choice questions, which we sent via email to residents educated and employed in northern Greece hospitals. Our survey took place in January and February of 2021. Results: A total of 124 residents across a broad spectrum of surgical fields completed the questionnaire. The majority (51.6%) reported a significant decline in the number of operations performed weekly during the pandemic. Approximately 38% of the respondents stated that their surgical skills have been negatively affected to a significant extent, and 35.5% reported that their theoretical knowledge had deteriorated to a moderate extent. Almost half of them reported that they were satisfied with the online courses and a total of 67.7% affirmed the need to prolong their clinical training. Conclusions: The aims and scope of a surgical department include the provision of high-quality training to young surgeons. The impact of the pandemic on routine surgical activities has been dramatic. Our results clearly indicate that young surgeons have been significantly affected in terms of their training.
... 3 This was seen in another study, where few anesthesiologist residents believed that their residency education provided them with sufficient training in natural disasters (22%), radiologic (16%), or pandemic events (17%). 5 This deficiency is further pronounced, as less than half of medical students receive disaster medicine training before matriculation into residency. 4 The coronavirus disease 2019 (COVID-19) pandemic brought greater awareness to the impact of disasters across multiple clinical disciplines. ...
Objective
Assess the knowledge, confidence, and attitudes of residents towards disaster medicine education in the COVID-19 era.
Methods
Survey distributed to pediatric residents at a tertiary care center, assessing confidence in disaster medicine knowledge and skills and preferred educational methods. Based on residents’ responses, virtual and in-person educational session implemented with post-survey to analyze effectiveness of education.
Results
Distributed to 120 residents with a 51.6% response rate. Almost half (46.8%) of residents had less than 1 hour of disaster training, with only 9.7% having experience with a prior disaster event. However, most residents were motivated to increase their knowledge of disaster medicine due to COVID-19 and other recent disasters, with 96.8% interested in this education as a curriculum standard. Simulation and peer learning were the most preferred method of teaching. Subsequent virtual and in-person educational session demonstrated improvement in confidence scores. However, 66.7% of the virtual subset conveyed they would have preferred in-person learning.
Conclusion
COVID-19 has highlighted to trainees that disasters can affect all specialties, and pediatric residents are enthusiastic to close the educational gap of disaster medicine. However, residents stressed that although virtual education can provide a foundation, in-person simulation is preferred for effective training.
... tourniquet application during the Boston Marathon bombing [4], common civil-military training as reported for France [3], or introducing educational concepts such as a "terror and disaster surgical care" course in Germany [https:// www.dgu-online.de/bildung/fortbildung/tdscr.html]. While the importance of disaster preparedness is undisputed, many studies identified substantial deficits in physician readiness across all medical specialties [5], [6], [7], [8]. Data from the United States of America (USA) showed that even residency programs for emergency physicians struggled to provide standardized and sufficient disaster preparedness training [9]. ...
Objectives: Floods, earthquakes and terror attacks in recent years emphasize the importance of disaster preparedness for the medical community. To best prepare doctors for providing optimal care in disaster situations, specific education and training should start at the medical school level. This study containes an online survey among German medical schools to evaluate the status quo of teaching disaster medicine and to reveal potential obstacles.
Methods: The dean’s offices of 36 German medical schools were contacted from April 2016 to May 2017. Via an e-mail link, recipients could anonymously and voluntarily access an online questionnaire (74 items, 42 with a four-point “Likert-like” scale, 12 yes/no questions and 20
with listed items to choose from). The answers were analyzed by descriptive statistics.
Results: A total of 25 medical schools participated in the survey. Twenty
respondents were in favor of expanding disaster medicine teaching at
their institutions. Incorporating single topics ranging from triage (n=21)
to accidents involving radioactive materials (n=4) into the curriculum varied widely. Only two schools had established a teaching coordinator for disaster medicine and only one e-learning course had been established. Twenty-one respondents regarded funding issues and 18 regarded organizational matters to be major hurdles in the future.
Conclusion: Though most faculty representatives indicated that they
favor expanding and implementing disaster medicine education, German medical schools still have a lot of room for enhancement in this field.
The incorporation of e-learning tools could facilitate the expansion of
disaster medicine teaching while simultaneously addressing the expressed concerns of the survey’s participants and guarantee nationwide standardization.
... Survey items querying resident and attending perspectives on pandemic preparedness and their clinical response to the pandemic were based on previous surveys used to assess the perceptions of healthcare workers in response to infectious disease disasters. [5][6][7] Survey items querying J o u r n a l P r e -p r o o f perspectives on surgical education during the pandemic, including transitioning to a virtual curriculum, were based on content from informal interviews with residents and attendings. ...
Background
The COVID-19 pandemic has impacted surgical training nationwide. Our former curricula will likely not return, and training will need to adapt, so we are able to graduate residents of the same caliber as prior to the pandemic.
Methods
A survey evaluating perceptions of changes made in surgical training was conducted on surgery residents and attendings.
Results
Disaster medicine training has become more relevant and 85% residents and 75% attendings agreed it should be incorporated into the curriculum. Safety of family was the most significant concern of residents. Virtual curriculum was perceived to be acceptable by 82% residents and only 22% attendings (p < 0.01). Residents (37%) were less concerned than attendings (61%) of falling behind on their overall training (p = 0.04). Both groups agreed operative skills would be adversely affected (56%vs72%; p = 0.37).
Conclusions
To maintain an effective surgical curriculum, programs will need to implement new educational components to better prepare residents to become surgeons of the future.
... 16 Health education is necessary in order to raise awareness among health workers, 37 hence proposals have been made for greater investment in their training so that they can help mitigate the risks posed by disease outbreaks. 38 The task is not always easy, as there are technological, language and time barriers and, above all, no linkage to existing study plans, the contents of which are saturated (Fig. 5). Simulation-based knowledge acquisition can be found at practically all levels of medical training; investment can be high and it requires an economic evaluation to know if a system is capable of including it in its programs. ...
... The accumulated experience at Boston Hope may serve as a foundation for preparedness and training of anesthesia and other acute care providers. 28 limitations We delineated our single-center experience of rapid capacity expansion in the setting of a pandemic. It is likely that the logistic and safety considerations highlighted in our experience may have been influenced by local and regional factors and interventions and thus may not be completely extrapolated to other rapidly deployed systems developed for similar function. ...
Preparedness measures for the anticipated surge of coronavirus disease 2019 (COVID-19) cases within eastern Massachusetts included the establishment of alternate care sites (field hospitals). Boston Hope hospital was set up within the Boston Convention and Exhibition Center to provide low-acuity care for COVID-19 patients and to support local healthcare systems. However, early recognition of the need to provide higher levels of care, or critical care for the potential deterioration of patients recovering from COVID-19, prompted the development of a hybrid acute care-intensive care unit. We describe our experience of implementing rapid response capabilities of this innovative ad hoc unit. Combining quality improvement tools for hazards detection and testing through in situ simulation successfully identified several operational hurdles. Through rapid continuous analysis and iterative change, we implemented appropriate mitigation strategies and established rapid response and rescue capabilities. This study provides a framework for future planning of high-acuity services within a unique field hospital setting.
... 16 La educación sanitaria es necesaria para concientizar a los trabajadores de la salud, 37 de ahí que se han formulado propuestas para que exista mayor inversión en su formación y puedan ayudar a mitigar los riesgos que plantean los brotes de enfermedades. 38 La tarea no siempre es sencilla pues existen barreras tecnológicas, de idioma, tiempo y, sobre todo, vinculación a los planes de estudio existentes, cuyos contenidos están saturados (Figura 5). La adquisición de conocimientos basados en simulación se puede encontrar prácticamente en todos los niveles de la capacitación médica; la inversión puede ser alta y requiere una evaluación económica para saber si un sistema es capaz de incluirla en sus programas. ...
Medical specialties' teaching is an area of health systems that deserves special consideration in light of the lessons learned from influenza and COVID-19; educational programs and implementation of the training strategies that are used must be reevaluated, since the level of training of most specialty students does not allow to consider them as personnel who can face these global problems. The number of specialization courses has exponentially grown, and their main threat is the cancellation or partial execution of their academic programs as a consequence of not implementing functional operational strategies during a contingency.
... Preparedness of health care professionals is a hot topic in the field; a recent survey conducted among anesthesiologists revealed that few receive sufficient education and training in disaster medicine. 6 Similar results were also reported among Australian surgeons. 7 Even if cancer care professionals and oncologists are not the first clinicians called to face natural disasters and large-scale emergencies, they probably are crucial in later phases, when restoring the continuity of care becomes a priority. ...
... A survey examining anesthesiologists' experiences with emergency preparedness revealed that only a third of residency programs provided disaster education, and half no longer provided this training [53]. Hayanga and colleagues [73] reported similar results in a 2017 survey of anesthesiologists on disaster medicine; few respondents reported that their hospital provided sufficient emergency event preparation and training, and more than 70% expressed a desire for their hospital/department to provide such training. Anesthesiologists should know where to find resources pertaining to disaster management, and locate hospital emergency plans, MCE policies, and protocols. ...
The increased incidence of MCEs has reinforced the need to prepare and plan for a hospital response. The role of anesthesiologists is crucial in various environments beyond the OR, especially in disaster situations. Anesthesiologists should be familiar with their potential role during an MCE and their hospital emergency response system. They should participate in emergency response drills and complete courses on disaster management to maintain their knowledge and skills. Anesthesia departments should also make concerted efforts to perform disaster drills within the department to identify systems issues and promote education, teamwork, and communication. Anesthesiologists should be familiar with the various types of disasters and how to apply their knowledge and clinical skills to each situation.
Objective
To assess the level of neonatal intensive care unit (NICU) disaster preparedness among pediatric residents.
Methods
A mixed-methods study including qualitative interviews and quantitative surveys was used. Interviews guided survey development. Surveys were distributed to residents who rotated through Children’s National NICU. Questions assessed residents’ background in disaster preparedness, disaster protocol knowledge, NICU preparedness, roles during surge and evacuation, and views on training and education.
Results
Survey response was 62.5% (n = 80) with 51.3% of invited residents completing it. Pediatric residents (PGY-2 and PGY-3) (n = 41) had low levels of individual disaster preparedness, particularly evacuations (86%). None were aware of specific NICU disaster protocols. Patient acuity, role ambiguity, knowledge, and training deficits were major contributors to unpreparedness. Residents viewed their role as system facilitators (eg, performing duties assigned, recruiting other residents, and clerical work like documentation). Resident training requests included disaster preparedness training every NICU rotation (48%) using multidisciplinary simulations (66%), role definition (56%), and written protocols (50%). Despite their unpreparedness, residents (84%) were willing to respond.
Conclusion
Pediatric residents lacked knowledge of NICU disaster response but were willing to respond to disasters. Training should include multi-disciplinary simulations that can be refined iteratively to clarify roles, and residents should be involved in planning and execution.
Background
With the occurrence of a number of major disasters around the world, there is growing interest in chemical disaster medicine. In South Korea, there is a training program for mass casualty incidents (MCI) and backup by legal regulations by the Framework Act on the Management of Disasters and Safety. However, there is no program focusing on chemical disasters. Thus, the authors newly created a program, the Chemical-Mass Casualty Incident Response Education Module (C-MCIREM) in September 2019. This was a pilot study to verify the educational effect of the program.
Method
A pre/post study was conducted of a chemical MCI training program based on simulation. A total of 25 representative and qualified participants were recruited from fire departments, administrative staff of public health centers, and healthcare workers of hospitals in the Gyeonggi-do province of South Korea. They participated in a one-day training program. A knowledge test and confidence survey were provided to participants just before training, and again immediately following the training online. The authors compared improvements of pre/post-test results. In the tabletop drill exercise, quantified qualitative analyses were used to measure the educational effect on the participants.
Results
In the knowledge test, the mean (standard deviation) scores for all 25 participants at baseline and after training were 41.72 (15.186) and 77.96 (11.227), respectively (p < 0.001). In the confidence survey for chemical MCI response for all 25 participants, all the sub-items concerning personal protective equipment selection, antidote selection, antidote stockpiling and passing on knowledge to colleagues, zone setup and decontamination, and chemical triage were improved compared to the baseline score (p < 0.001). The tabletop exercise represented a prehospital setting and had 11 participants. The self-efficacy qualitative survey showed pre- and post-exercise scores of 64/100 and 84/100 respectively. For a hospital setting exercise, it had 14 participants. The survey showed pre/post-exercise scores of 26/100 and 73/100 respectively. Twenty-two (88%) participants responded to the final satisfaction survey, and their overall mean scores regarding willingness to recommend this training program to others, overall satisfaction with theoretical education, overall satisfaction with tabletop drill simulation, and opinion about whether policymakers need this training were all over 8 out of 10 respectively.
Conclusion
C-MCIREM, the newly created chemical MCI program, provided effective education to the selected 25 participants among Korean chemical MCI responders in terms of both knowledge and practice at a single pilot trial. Participants were highly satisfied with the educational material and their confidence in disaster preparedness was clearly improved. In order to prove the universal educational effect of this C-MCIREM in the future, more education is needed.
Objective
To examine the effects of household preparedness on perceptions of workplace preparedness during a pandemic among all employees at the US Department of Veterans Affairs (VA) medical facilities.
Methods
The VA Preparedness Survey (October–December 2018, Los Angeles, CA) used a stratified simple random, web-based survey. Multivariate statistical analyses examined the effect of household preparedness on perceptions of workforce preparedness during a pandemic: institutional readiness; desire for additional training; and understanding their role and its importance.
Results
VA employees totaling 4026 participated. For a pandemic, 55% were confident in their VA medical facility’s ability to respond, 63% would like additional training, 49% understood their role during a response, and 68% reported their role as important. Only 23% reported being “well prepared” at home during major disasters. After controlling for study-relevant factors, household preparedness was positively associated with perceptions of workforce preparedness during a pandemic.
Conclusions
Efforts to increase household preparedness for health care employees could bolster workforce preparedness during pandemics. Organizations should consider robust policies and strategies, such as flexible work arrangements, in order to mitigate factors that may serve as barriers to household preparedness.
The anesthesiologist, upon completion of their training, is expected to be the liaison to the operating room and the patient. Key components of the anesthesiologist's training and daily routine make them an ideal participant and leader when it comes to their potential involvement in a mass casualty event. Airway expertise, vascular access, ongoing triage, hemodynamic vigilance, resuscitation, and real-time adaptation to a changing and critical care environment are a few of the skills that encompass the daily routine and value the anesthesiologist brings to an emergency management team.
Background
Infectious disease emergencies are increasingly becoming part of the health care delivery landscape, having implications to not only individuals and the public, but also on those expected to respond to these emergencies. Health care workers (HCWs) are perhaps the most important asset in an infectious disease emergency, yet these individuals have their own barriers and facilitators to them being willing or able to respond.
Aim
The purpose of this review was to identify factors affecting HCW willingness to respond (WTR) to duty during infectious disease outbreaks and/or bioterrorist events.
Methods
An integrative literature review methodology was utilized to conduct a structured search of the literature including CINAHL, Medline, Embase, and PubMed databases using key terms and phrases. PRISMA guidelines were used to report the search outcomes and all eligible literature was screened with those included in the final review collated and appraised using a quality assessment tool.
Results
A total of 149 papers were identified from the database search. Forty papers were relevant following screening, which highlighted facilitators of WTR to include: availability of personal protective equipment (PPE)/vaccine, level of training, professional ethics, family and personal safety, and worker support systems. A number of barriers were reported to prevent WTR for HCWs, such as: concern and perceived risk, interpersonal factors, job-level factors, and outbreak characteristics.
Conclusions
By comprehensively identifying the facilitators and barriers to HCWs’ WTR during infectious disease outbreaks and/or bioterrorist events, strategies can be identified and implemented to improve WTR and thus improve HCW and public safety.
Objective
Anesthesiologists play a pivotal role in mass-casualty incidents management. Disaster medicine is part of the anesthesiologist’s core skills; however, dedicated training is still scarce and, often, it does not follow a standardized program.
Methods
We designed and delivered a crash course in disaster medicine for Italian anesthesiology residents participating in the nationwide program, Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) Academy Critical Emergency Medicine 2019. Residents totaling 145, from 39 programs, participated in a 75-minute workstation on the principles of disaster management. Following this, each participant was involved in a full-scale mass-casualty drill. A plenary debriefing followed to present simulation data, maximize feedback, and highlight all situations needing improvement.
Results
Overall, participant performance was good: Triage accuracy was 85% prehospital and 84% in-hospital. Evacuation flow respected triage priority. During the debriefing, residents were very open to share and reflect on their experiences. A narrative qualitative analysis of the debriefing highlights that many participants felt overwhelmed by events during the exercise. Participants in coordination positions shared how they appreciated the need to switch from a clinical mindset to a managerial role.
Conclusion
This was an invaluable experience for anesthesiology trainees, providing them with the skill set to understand the fundamental principles of a mass-casualty response.
From personal experience and available resources, such as the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness templates from the manual for department procedures, the authors describe the primarily flooding impact of Hurricane Harvey in their area of Texas. They review the necessary analysis, development, and implementation of logistics; staffing and relief models; coordination with hospital partners; and dissemination of the planned procedures. The authors emphasize the commitment of anesthesiologists to patient care and rescue efforts outside of the operating room.
There is limited research on preparation of health care workers for disasters. Prior research addressed systems-level responses rather than specific institutional and individual responses.
An anonymous online survey of hospital employees, who were grouped into clinical and non-clinical staff, was conducted. The objective of this study was to compare perceptions of clinical and non-clinical staff with regard to personal needs, willingness to report (WTR) to work, and level of confidence in the hospital's ability to protect safety and provide personal protective equipment (PPE) in the event of a disaster.
A total of 5,790 employees were surveyed; 41 % responded (77 % were women and 63 % were clinical staff). Seventy-nine percent either strongly or somewhat agreed that they know what to do in the event of a disaster, and the majority was willing to report for duty in the event of a disaster. The most common barriers included 'caring for children' (55 %) and 'caring for pets' (34 %). Clinical staff was significantly more likely than non-clinical staff to endorse childcare responsibilities (58.9 % vs. 48 %) and caring for pets (36 % vs. 30 %, respectively) as barriers to WTR. Older age was a significant facilitator of WTR [odds ratio (OR) 1.49, 95 % CI: 1.27-1.65]. Non-clinical staff was more confident in the hospital's ability to protect safety and provide PPE compared to clinical staff (OR 1.43, 95 % CI: 1.15-1.78).
Clinical and non-clinical staff differ in the types of barriers to WTR endorsed, as well as their confidence in the hospital's ability to provide them with PPE and guarantee their safety.
The all-hazards willingness to respond (WTR) of local public health personnel is critical to emergency preparedness. This study applied a threat-and efficacy-centered framework to characterize these workers' scenario and jurisdictional response willingness patterns toward a range of naturally-occurring and terrorism-related emergency scenarios.
Eight geographically diverse local health department (LHD) clusters (four urban and four rural) across the U.S. were recruited and administered an online survey about response willingness and related attitudes/beliefs toward four different public health emergency scenarios between April 2009 and June 2010 (66% response rate). Responses were dichotomized and analyzed using generalized linear multilevel mixed model analyses that also account for within-cluster and within-LHD correlations.
Comparisons of rural to urban LHD workers showed statistically significant odds ratios (ORs) for WTR context across scenarios ranging from 1.5 to 2.4. When employees over 40 years old were compared to their younger counterparts, the ORs of WTR ranged from 1.27 to 1.58, and when females were compared to males, the ORs of WTR ranged from 0.57 to 0.61. Across the eight clusters, the percentage of workers indicating they would be unwilling to respond regardless of severity ranged from 14-28% for a weather event; 9-27% for pandemic influenza; 30-56% for a radiological 'dirty' bomb event; and 22-48% for an inhalational anthrax bioterrorism event. Efficacy was consistently identified as an important independent predictor of WTR.
Response willingness deficits in the local public health workforce pose a threat to all-hazards response capacity and health security. Local public health agencies and their stakeholders may incorporate key findings, including identified scenario-based willingness gaps and the importance of efficacy, as targets of preparedness curriculum development efforts and policies for enhancing response willingness. Reasons for an increased willingness in rural cohorts compared to urban cohorts should be further investigated in order to understand and develop methods for improving their overall response.
Terrorist use of a radiological dispersal device (RDD, or "dirty bomb"), which combines a conventional explosive device with radiological materials, is among the National Planning Scenarios of the United States government. Understanding employee willingness to respond is critical for planning experts. Previous research has demonstrated that perception of threat and efficacy is key in the assessing willingness to respond to a RDD event.
An anonymous online survey was used to evaluate the willingness of hospital employees to respond to a RDD event. Agreement with a series of belief statements was assessed, following a methodology validated in previous work. The survey was available online to all 18,612 employees of the Johns Hopkins Hospital from January to March 2009.
Surveys were completed by 3426 employees (18.4%), whose demographic distribution was similar to overall hospital staff. 39% of hospital workers were not willing to respond to a RDD scenario if asked but not required to do so. Only 11% more were willing if required. Workers who were hesitant to agree to work additional hours when required were 20 times less likely to report during a RDD emergency. Respondents who perceived their peers as likely to report to work in a RDD emergency were 17 times more likely to respond during a RDD event if asked. Only 27.9% of the hospital employees with a perception of low efficacy declared willingness to respond to a severe RDD event. Perception of threat had little impact on willingness to respond among hospital workers.
Radiological scenarios such as RDDs are among the most dreaded emergency events yet studied. Several attitudinal indicators can help to identify hospital employees unlikely to respond. These risk-perception modifiers must then be addressed through training to enable effective hospital response to a RDD event.
Hospital-based providers' willingness to report to work during an influenza pandemic is a critical yet under-studied phenomenon. Witte's Extended Parallel Process Model (EPPM) has been shown to be useful for understanding adaptive behavior of public health workers to an unknown risk, and thus offers a framework for examining scenario-specific willingness to respond among hospital staff.
We administered an anonymous online EPPM-based survey about attitudes/beliefs toward emergency response, to all 18,612 employees of the Johns Hopkins Hospital from January to March 2009. Surveys were completed by 3426 employees (18.4%), approximately one third of whom were health professionals.
Demographic and professional distribution of respondents was similar to all hospital staff. Overall, more than one-in-four (28%) hospital workers indicated they were not willing to respond to an influenza pandemic scenario if asked but not required to do so. Only an additional 10% were willing if required. One-third (32%) of participants reported they would be unwilling to respond in the event of a more severe pandemic influenza scenario. These response rates were consistent across different departments, and were one-third lower among nurses as compared with physicians. Respondents who were hesitant to agree to work additional hours when required were 17 times less likely to respond during a pandemic if asked. Sixty percent of the workers perceived their peers as likely to report to work in such an emergency, and were ten times more likely than others to do so themselves. Hospital employees with a perception of high efficacy had 5.8 times higher declared rates of willingness to respond to an influenza pandemic.
Significant gaps exist in hospital workers' willingness to respond, and the EPPM is a useful framework to assess these gaps. Several attitudinal indicators can help to identify hospital employees unlikely to respond. The findings point to certain hospital-based communication and training strategies to boost employees' response willingness, including promoting pre-event plans for home-based dependents; ensuring adequate supplies of personal protective equipment, vaccines and antiviral drugs for all hospital employees; and establishing a subjective norm of awareness and preparedness.
Background:
Emergency Medical Services workers' willingness to report to duty in an influenza pandemic is essential to healthcare system surge amidst a global threat. Application of Witte's Extended Parallel Process Model (EPPM) has shown utility for revealing influences of perceived threat and efficacy on non-EMS public health providers' willingness to respond in an influenza pandemic. We thus propose using an EPPM-informed assessment of EMS workers' perspectives toward fulfilling their influenza pandemic response roles.
Methodology/principal findings:
We administered an EPPM-informed snapshot survey about attitudes and beliefs toward pandemic influenza response, to a nationally representative, stratified random sample of 1,537 U.S. EMS workers from May-June 2009 (overall response rate: 49%). Of the 586 respondents who met inclusion criteria (currently active EMS providers in primarily EMS response roles), 12% indicated they would not voluntarily report to duty in a pandemic influenza emergency if asked, 7% if required. A majority (52%) indicated their unwillingness to report to work if risk of disease transmission to family existed. Confidence in personal safety at work (OR = 3.3) and a high threat/high efficacy ("concerned and confident") EPPM profile (OR = 4.7) distinguished those who were more likely to voluntarily report to duty. Although 96% of EMS workers indicated that they would probably or definitely report to work if they were guaranteed a pandemic influenza vaccine, only 59% had received an influenza immunization in the preceding 12 months.
Conclusions/significance:
EMS workers' response willingness gaps pose a substantial challenge to prehospital surge capacity in an influenza pandemic. "Concerned and confident" EMS workers are more than four times as likely to fulfill pandemic influenza response expectations. Confidence in workplace safety is a positively influential modifier of their response willingness. These findings can inform insights into interventions for enhancing EMS workers' willingness to respond in the face of a global infectious disease threat.
Local public health agencies play a central role in response to an influenza pandemic, and understanding the willingness of their employees to report to work is therefore a critically relevant concern for pandemic influenza planning efforts. Witte's Extended Parallel Process Model (EPPM) has been found useful for understanding adaptive behavior in the face of unknown risk, and thus offers a framework for examining scenario-specific willingness to respond among local public health workers. We thus aim to use the EPPM as a lens for examining the influences of perceived threat and efficacy on local public health workers' response willingness to pandemic influenza.We administered an online, EPPM-based survey about attitudes/beliefs toward emergency response (Johns Hopkins approximately Public Health Infrastructure Response Survey Tool), to local public health employees in three states between November 2006-December 2007. A total of 1835 responses were collected for an overall response rate of 83%. With some regional variation, overall 16% of the workers in 2006-7 were not willing to "respond to a pandemic flu emergency regardless of its severity". Local health department employees with a perception of high threat and high efficacy--i.e., those fitting a 'concerned and confident' profile in the EPPM analysis--had the highest declared rates of willingness to respond to an influenza pandemic if required by their agency, which was 31.7 times higher than those fitting a 'low threat/low efficacy' EPPM profile.In the context of pandemic influenza planning, the EPPM provides a useful framework to inform nuanced understanding of baseline levels of--and gaps in--local public health workers' response willingness. Within local health departments, 'concerned and confident' employees are most likely to be willing to respond. This finding may allow public health agencies to design, implement, and evaluate training programs focused on emergency response attitudes in health departments.
Little is known about contemporary physicians' sense of preparedness for bioterrorism, willingness to treat patients despite personal risk, or belief in the professional duty to treat during epidemics. In a recent national survey few physicians reported that they or their practice are "well prepared" for bioterrorism. Still, most respondents reported that they would continue to care for patients in the event of an outbreak of "an unknown but potentially deadly illness," although only a narrow majority reported believing in a professional duty to treat patients in epidemics. Preparing physicians for bioterrorism should entail providing practical knowledge, preventive steps to minimize risk, and reinforcement of the profession's ethical duty to treat.
Catastrophic disasters create surge capacity needs for health care systems. This is especially true in the urban setting because the high population density and reliance on complex urban infrastructures (e.g., mass transit systems and high rise buildings) could adversely affect the ability to meet surge capacity needs. To better understand responsiveness in this setting, we conducted a survey of health care workers (HCWs) (N =6,428) from 47 health care facilities in New York City and the surrounding metropolitan region to determine their ability and willingness to report to work during various catastrophic events. A range of facility types and sizes were represented in the sample. Results indicate that HCWs were most able to report to work for a mass casualty incident (MCI) (83%), environmental disaster (81%), and chemical event (71%) and least able to report during a smallpox epidemic (69%), radiological event (64%), sudden acute respiratory distress syndrome (SARS) outbreak (64%), or severe snow storm (49%). In terms of willingness, HCWs were most willing to report during a snow storm (80%), MCI (86%), and environmental disaster (84%) and least willing during a SARS outbreak (48%), radiological event (57%), smallpox epidemic (61%), and chemical event (68%). Barriers to ability included transportation problems, child care, eldercare, and pet care obligations. Barriers to willingness included fear and concern for family and self and personal health problems. The findings were consistent for all types of facilities. Importantly, many of the barriers identified are amenable to interventions.
This study examined the content of hospital terrorism preparedness emergency response plans; whether those plans had been updated since September 11, 2001; collaboration of hospitals with outside organizations; clinician training in the management of biological, chemical, explosive, and nuclear exposures; drills on the response plans; and equipment and bed capacity.
The National Hospital Ambulatory Medical Care Survey (NHAMCS) is an annual survey of a probability sample of approximately 500 non-Federal general and short-stay hospitals in the United States. A Bioterrorism and Mass Casualty Supplement was included in the 2003 survey and provided the data for this analysis.
Almost all hospitals have plans for responding to natural disasters (97.3 percent). Most have plans for responding to chemical (85.5 percent), biological (84.8 percent), nuclear or radiological (77.2 percent), and explosive incidents (76.9 percent). About three-quarters of hospitals were integrated into community-wide disaster plans (76.4 percent), and 75.9 percent specifically reported a cooperative planning process with other local health care facilities. Despite these plans, only 46.1 percent reported written memoranda of understanding with these facilities to accept inpatients during a declared disaster. Hospitals varied widely in their plans for re-arranging schedules and space in the event of a disaster. Training for hospital incident command and smallpox, anthrax, chemical, and radiological exposures was ahead of training for other infectious diseases. The percentage of hospitals training their staff in any exposure varied from 92.1 percent for nurses to 49.2 percent for medical residents. Drills for natural disasters occurred more often than those for chemical, biological, explosive, nuclear, and epidemic incidents. More hospitals staged drills for biological attacks than for severe epidemics. Despite explosions being the most common form of terrorism, drills for these were staged by only one-fifth of hospitals. Hospitals collaborated on drills most often with emergency medical services, fire departments, and law enforcement agencies.
Current national preparedness plans require local health departments to play an integral role in responding to an influenza pandemic, a major public health threat that the World Health Organization has described as "inevitable and possibly imminent". To understand local public health workers' perceptions toward pandemic influenza response, we surveyed 308 employees at three health departments in Maryland from March-July 2005, on factors that may influence their ability and willingness to report to duty in such an event.
The data suggest that nearly half of the local health department workers are likely not to report to duty during a pandemic. The stated likelihood of reporting to duty was significantly greater for clinical (Multivariate OR: 2.5; CI 1.3-4.7) than technical and support staff, and perception of the importance of one's role in the agency's overall response was the single most influential factor associated with willingness to report (Multivariate OR: 9.5; CI 4.6-19.9).
The perceived risk among public health workers was shown to be associated with several factors peripheral to the actual hazard of this event. These risk perception modifiers and the knowledge gaps identified serve as barriers to pandemic influenza response and must be specifically addressed to enable effective local public health response to this significant threat.
Academic medical centers play a major role in disaster response, and residents frequently serve as key resources in these situations. Studies examining health care professionals' willingness to report for duty in mass casualty situations have varying response rates, and studies of emergency medicine (EM) residents' willingness to report for duty in disaster events and factors that affect these responses are lacking.
We sought to determine EM resident and faculty willingness to report for duty during 4 disaster scenarios (natural, explosive, nuclear, and communicable), to identify factors that affect willingness to work, and to assess opinions regarding disciplinary action for physicians unwilling to work in a disaster situation.
We surveyed residents and faculty at 7 US teaching institutions with accredited EM residency programs between April and November 2010.
A total of 229 faculty and 259 residents responded (overall response rate, 75.4%). Willingness to report for duty ranged from 54.1% for faculty in a natural disaster to 94.2% for residents in a nonnuclear explosive disaster. The 3 most important factors influencing disaster response were concern for the safety of the family, belief in the physician's duty to provide care, and availability of protective equipment. Faculty and residents recommended minimal or no disciplinary action for individuals unwilling to work, except in the infectious disease scenario.
Most EM residents and faculty indicated they would report for duty. Residents and faculty responses were similar in all but 1 scenario. Disciplinary action for individuals unwilling to work generally was not recommended.
Although the training of future physicians in disaster preparedness and public health issues has been recognized as an important component of graduate medical education, medical students receive relatively limited exposure to these topics. Recommendations have been made to incorporate disaster medicine and public health preparedness into medical school curricula. To date, the perspectives of future physicians on disaster medicine and public health preparedness issues have not been described.
A Web-based survey was disseminated to US medical students. Frequencies, proportions, and odds ratios were calculated to assess perceptions and self-described likelihood to respond to disaster and public health scenarios.
Of the 523 medical students who completed the survey, 17.2% believed that they were receiving adequate education and training for natural disasters, 26.2% for pandemic influenza, and 13.4% for radiological events, respectively; 51.6% felt they were sufficiently skilled to respond to a natural disaster, 53.2% for pandemic influenza, and 30.8% for radiological events. Although 96.0% reported willingness to respond to a natural disaster, 93.7% for pandemic influenza, and 83.8% for a radiological event, the majority of respondents did not know to whom they would report in such an event.
Despite future physicians' willingness to respond, education and training in disaster medicine and public health preparedness offered in US medical schools is inadequate. Equipping medical students with knowledge, skills, direction, and linkages with volunteer organizations may help build a capable and sustainable auxiliary workforce.
Modern theories in cognitive psychology and neuroscience indicate that there are two fundamental ways in which human beings comprehend risk. The "analytic system" uses algorithms and normative rules, such as probability calculus, formal logic, and risk assessment. It is relatively slow, effortful, and requires conscious control. The "experiential system" is intuitive, fast, mostly automatic, and not very accessible to conscious awareness. The experiential system enabled human beings to survive during their long period of evolution and remains today the most natural and most common way to respond to risk. It relies on images and associations, linked by experience to emotion and affect (a feeling that something is good or bad). This system represents risk as a feeling that tells us whether it is safe to walk down this dark street or drink this strange-smelling water. Proponents of formal risk analysis tend to view affective responses to risk as irrational. Current wisdom disputes this view. The rational and the experiential systems operate in parallel and each seems to depend on the other for guidance. Studies have demonstrated that analytic reasoning cannot be effective unless it is guided by emotion and affect. Rational decision making requires proper integration of both modes of thought. Both systems have their advantages, biases, and limitations. Now that we are beginning to understand the complex interplay between emotion and reason that is essential to rational behavior, the challenge before us is to think creatively about what this means for managing risk. On the one hand, how do we apply reason to temper the strong emotions engendered by some risk events? On the other hand, how do we infuse needed "doses of feeling" into circumstances where lack of experience may otherwise leave us too "coldly rational"? This article addresses these important questions.
To assess the change in prevalence of bioterrorism training among emergency medicine (EM) residencies from 1998 to 2005, to characterize current training, and to identify characteristics of programs that have implemented more intensive training methods.
This was a national cross sectional survey of the 133 U.S. EM residencies participating in the 2005 National Resident Matching Program; comparison with a baseline survey from 1998 was performed. Types of training provided were assessed, and programs using experiential methods were identified.
Of 112 programs (84.2%) responding, 98% reported formal training in bioterrorism, increased from 53% (40/76) responding in 1998. In 2005, most programs with bioterrorism training (65%) used at least three methods of instruction, mostly lectures (95%) and disaster drills (80%). Fewer programs used experiential methods such as field exercises or bioterrorism-specific rotations (35% and 13%, respectively). Compared with other programs, residency programs with more complex, experiential methods were more likely to teach bioterrorism-related topics at least twice a year (83% vs. 59%; p = 0.018), to teach at least three topics (60% vs. 40%; p = 0.02), and to report funding for bioterrorism research and education (74% vs. 45%; p = 0.007). Experiential and nonexperiential programs were similar in program type (university or nonuniversity), length of program, number of residents, geographic location, and urban or rural setting.
Training of EM residents in bioterrorism preparedness has increased markedly since 1998. However, training is often of low intensity, relying mainly on nonexperiential instruction such as lectures. Although current recommendations are that training in bioterrorism include experiential learning experiences, the authors found the rate of these experiences to be low.
To assess hospital employees' attitudes and needs regarding work commitments during disasters.
A 12-item survey was distributed to employees at nine hospitals in five states. Questions addressed willingness to work during a disaster or its aftermath, support services that could encourage employees to remain for extended hours, and conflicting emergency response obligations (e.g., being a volunteer firefighter) that might prevent employees from working at the hospital. Anonymity was assured, and approval was obtained from each hospital's institutional review board.
Of the 2004 surveys distributed, 1711 (85 percent) were returned. Eighty-seven percent of respondents were willing to work after a fire/rescue/collapse mass casualty incident. Respondents were otherwise less willing to work in response to a man-made disaster (biological event: 58 percent; chemical event: 58 percent; radiation event: 57 percent) than a natural disaster (snowstorm: 83 percent; flood: 81 percent; hurricane: 78 percent; earthquake: 79 percent; tornado: 77 percent; ice storm: 75 percent; flu epidemic: 72 percent) (p < 0.001 for all comparisons by chi2 testing). While 44 percent of respondents would come to work in response to any of the 11 disaster types listed, 19 percent were only willing to cover four or fewer types. Long-distance phone service (694, 41 percent), e-mail access (584, 34 percent), pet care (568, 33 percent), and child care (506, 30 percent) were the most common support needs, and 365 respondents (21 percent) reported a conflicting emergency response obligation.
The majority of hospital workers surveyed were willing to report to work in response to some types of disasters but not others, and some indicated they might not be available at all due to conflicting emergency response obligations.
Contemporary events in the United States (eg, September 2001, school shootings), Europe (eg, Madrid train bombings), and the Middle East have raised awareness of mass casualty events and the need for a capable disaster response. Recent natural disasters have highlighted the poor preparation and infrastructure in place to respond to mass casualty events. In response, public health policy makers and emergency planners developed plans and prepared emergency response systems. Emergency response providers include first responders, a subset of emergency professionals, including firemen, law enforcement, paramedics, who respond to the incident scene and first receivers, a set of healthcare workers who receive the disaster victims at hospital facilities. The role of pediatric surgeons in mass casualty emergency response plans remains undefined. The authors hypothesize that pediatric surgeons' training and experience will predict their willingness and ability to be activated first receivers. The objective of our study was to determine the baseline experience, preparedness, willingness, and availability of pediatric surgeons to participate as activated first receivers.
After institutional review board approval, the authors conducted an anonymous online survey of members of the American Pediatric Surgical Association in 2007. The authors explored four domains in this survey: (1) demographics, (2) disaster experience and perceived preparedness, (3) attitudes regarding responsibility and willingness to participate in a disaster response, and (4) availability to participate in a disaster response. The authors performed univariate and bivariate analyses to determine significance. Finally, the authors conducted a logistic regression to determine whether experience or preparedness factors affected the respondent's availability or willingness to respond to a disaster as a first receiver
The authors sent 725 invitations and received 265 (36.6 percent) completed surveys. Overall, the authors found that 77 percent of the respondents felt "definitely" responsible for helping out during a disaster but only 24 percent of respondents felt "definitely"prepared to respond to a disaster. Most felt they needed additional training, with 74 percent stating that they definitely or probably needed to do more training. Among experiential factors, the authors found that attendance at a national conference was associated with the highest sense of preparedness. The authors determined that subjects with actual disaster experience were about four times more likely to feel prepared than those with no disaster experience (p < 0.001). The authors also demonstrated that individuals with a defined leadership position in a disaster response plan are twice as likely to feel prepared (p = 0.002) and nearly five times more willing to respond to a disaster than those without a leadership role. The authors found other factors that predicted willingness including the following: a contractual agreement to respond (OR 2.3); combat experience (OR 2.1); and prior disaster experience (OR 2.0). Finally, the authors found that no experiential variables or training types were associated with an increased availability to respond to a disaster.
A minority of pediatric surgeons feel prepared, and most feel they require more training. Current training methods may be ineffectual in building a prepared and willing pool of first receivers. Disaster planners must plan for healthcare worker related issues, such as transportation and communication. Further work and emphasis is needed to bolster participation in disaster preparedness training.
Disaster medicine what is it? Can it be taught?
- Brown
Willingness to respond: of emergency department personnel and their predicted participation in mass casualty terrorist events.
- Masterson