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How will responders respond?

Study identifies barriers to health care workers reporting for work during disasters

Temple University

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IMAGE: Linda Kruus, Ph.D., assistant professor of emergency medicine, Temple University School of Medicine view more

Credit: Ryan Brandenberg, Temple University photography

When disaster strikes, taking care of the victims is the top priority. But who will provide that care" In a study presented at the 2007 Society for Academic Emergency Medicine Annual Meeting, Temple University researchers uncovered psychological barriers that might keep doctors, nurses and support staff from reporting to work in a disaster.

"Workers want to know that the role they play will be meaningful. And, if they put themselves out there for the benefit of others, that their institution will, in turn, be taking care of them and their families," said lead author Linda Kruus, Ph.D., assistant professor of emergency medicine at Temple's School of Medicine.

Hospital staffing is key in disaster planning, especially within the emergency department. Yet, mandatory assignment does not guarantee attendance. This study tested the hypothesis that healthcare workers (HCWs) perceptions and expectations about their role in disaster response influence their willingness and ability to work during disasters.

Other related factors include:

  • Believing that the workplace will be safe

  • Believing that travel to and from work will be safe

  • Perceiving that the likelihood of contracting illness would be low

  • Being less worried about exposing one's family to the illness

  • Anticipating family support to working during the event

  • Feeling confident that protective equipment will be available

The researchers surveyed 306 healthcare workers from five urban hospitals on three hypothetical scenarios: a public riot, an infectious disease outbreak and a regional power outage. The workers included doctors and nurses (47%), support staff (29%) and administration (23%), 68 percent of whom had undergone a minimum of awareness level disaster training.

"Health care workers (HCWs) were more willing and able to work during a disaster when they felt that they could be effective in their job and believed it was important for them to work under crisis conditions," said Kruus.

Given the potential for gaps in staffing, hospital crisis planners must prepare for possible shortfalls. The researchers recommend that hospital disaster plans address HCWs perceptions and expectations about their role in disaster response.

This study is the first to specifically investigate key psychological factors important in the decision-making process of HCWs on whether or not to go to work. Additionally, most studies survey only doctors and nurses. This study focused on all personnel that may be considered essential to work during a disaster, including support staff and administrators who provide essential services during disasters.

The researchers will now be investigating more closely the dynamic interrelationships among these key factors, as well as how they may be influenced by specific incentives and by disaster preparedness education.

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Kruus' co-authors on the abstract, "Healthcare Worker Response to Disaster Conditions" were David J Karras, MD, Brenda Seals, PhD, MPH, Chad Thomas, MPH, and Gerald Wydro, MD. The study was conducted in collaboration with the Temple University Center for Preparedness Research, Education and Practice and the Temple University Health System Emergency Response & Preparedness Institute. This project was funded, in part, under a grant with the Pennsylvania Department of Health. The Department specifically disclaims responsibility for any analyses, interpretations or conclusions.

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