Health care workers' ability and willingness to report to duty during catastrophic disasters

Examination of Hospital Workers' Emotional Responses to an Infectious Disease Outbreak: Lessons From the 2015 MERS Co-V Outbreak in South Korea

ABSTRACTHospital workers are critical for a successful response to an infectious disease outbreak and for preventing disease transmission to the community. Therefore, hospital crisis management should implement efforts to improve hospital workers' preparedness in responding to public health emergencies caused by infectious diseases. Traditionally, preparedness and skill of hospital workers have been emphasized, but awareness of the importance of the emotional mindset of hospital workers in dealing with disease outbreaks has only recently increased; therefore, empirical approaches to examining emotional responses of hospital workers has been limited. This study analyzed qualitative data of the 2015 Middle East Respiratory Syndrome outbreak in South Korea. In particular, negative emotions and stress experienced by hospital workers who treated patients were characterized, as were the events that triggered such experiences. These events were categorized into four themes (eg, Mistake, Missing, Delay Due to Communication Failure). Identifying events that trigger negative emotions in hospital workers has important implications for hospitals' management guidance in relation to an infectious disease outbreak. (Disaster Med Public Health Preparedness. 2019;13:504-510).

Obstetrician-Gynecologists’ Role Conflict in a Natural Disaster: Professional Versus Family Responsibilities

Objective

The purpose of this study was to evaluate role conflict between professional and familial responsibilities among obstetric health care providers during a natural disaster between those required to stay in the hospital versus those who were at home during a catastrophic weather event.

Methods

A survey was used of obstetric attending and resident physicians in the Baylor College of Medicine, Department of Obstetrics and Gynecology following Hurricane Harvey on August 26, 2017.

Results

Ninety one of 103 physicians (88%) completed the survey. Survey responses were compared between physicians who worked in the hospital (n = 47) versus those who were at home (n = 44) during the storm and its immediate aftermath. Physicians in the hospital and at home agreed (47% and 48%, respectively, P = 0.94) that professional duties conflicted with family obligations and felt torn (49% and 55%, respectively, P = 0.48) regarding family obligations. A majority of homebound health care providers disagreed with the statement that professional duties override family responsibilities, whereas less than half of in-hospital providers felt the same (68% at-home versus 47% of the hospital-team, P = 0.10).

Conclusion

As organizations prepare for possible catastrophic situations, institutions must realize that obstetric health care providers will experience role conflict between professional and family responsibilities. (Disaster Med Public Health Preparedness. 2019;13:33–37)

Brief, Web-based Education Improves Lay Rescuer Application of a Tourniquet to Control Life-threatening Bleeding

OBJECTIVE

The objective was to determine whether brief, Web-based instruction several weeks prior to tourniquet application improves layperson success compared to utilizing just-in-time (JiT) instructions alone.

BACKGROUND

Stop the Bleed is a campaign to educate laypeople to stop life-threatening hemorrhage. It is based on U.S. military experience with lifesaving tourniquet use. While previous research shows simple JiT instructions boost laypeople's success with tourniquet application, the optimal approach to educate the public is not yet known.

METHODS

This is a prospective, nonblinded, randomized study. Layperson participants from the Washington, DC, area were randomized into: 1) an experimental group that received preexposure education using a website and 2) a control group that did not receive preexposure education. Both groups received JiT instructions. The primary outcome was the proportion of subjects that successfully applied a tourniquet to a simulated amputation. Secondary outcomes included mean time to application, mean placement position, ability to distinguish bleeding requiring a tourniquet from bleeding requiring direct pressure only, and self-reported comfort and willingness to apply a tourniquet.

RESULTS

Participants in the preexposure group applied tourniquets successfully 75% of the time compared to 50% success for participants with JiT alone (p < 0.05, risk ratio = 1.48, 95% confidence interval = 1.21-1.82). Participants place tourniquets in a timely fashion, are willing to use them, and can recognize wounds requiring tourniquets.

CONCLUSIONS

Brief, Web-based training, combined with JiT education, may help as many as 75% of laypeople properly apply a tourniquet. These findings suggest that this approach may help teach the public to Stop the Bleed.

Disaster Preparedness in Primary Care: Ready or Not?

PurposeTo assess perceptions and attitudes toward disasters and disaster planning among outpatient primary care leaders.

METHODS

Written surveys and semi-structured interviews of non-physician clinical managers and physician medical directors were conducted using the 2009 H1N1 pandemic as a case-based scenario at 5 university-affiliated family medicine clinics. Domains assessed included perceived pandemic threat; value, existence, and barriers to creating personal disaster plans; staff absenteeism estimates; barriers to work attendance. Quantitative and qualitative data were analyzed using descriptive statistics and content analysis with identification and coding of common themes, respectively.

RESULTS

All 12 invited leaders participated and believed a personal disaster plan was important but only 2 had plans. None had ever discussed with their staff the importance of having a personal disaster plan. Two common barriers in creating a plan were low threat perception level and never considering the possibility of pandemic influenza. Only half of respondents could list common barriers preventing staff from working. Staff were confident employees would come to work during a disaster.

CONCLUSION

Outpatient primary care leaders may hold misconceptions regarding future disasters, underestimate their potential impact on clinics, and lack personal preparedness. Further investigation and interventions are needed to ensure clinics can be prepared so they can function and help hospital and emergency services when disasters strike. (Disaster Med Public Health Preparedness. 2018;12:644-648).

Emergency Physicians' Preparedness for CBRNE Incidents in Hong Kong

Background

Recent terrorist attacks with biological and chemical weapons have caused much concern for the public. The purpose of this study was to assess emergency doctors' preparedness in handling Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) incidents.

Methods

This is a cross sectional survey of all emergency doctors working in public emergency departments (ED) in Hong Kong. Apart from the experience and confidence to handle these events, data on participants' willingness to participate in CBRNE incidents and training motivations were also analysed.

Results

Biological and radiological events were found to be the least commonly encountered. Few respondents reported they were confident to manage biological events (10.6% to 29.8%), despite 66% of respondents reported having prior training in CBRNE management.

Conclusions

This study demonstrates ED doctors' low confidence in managing specific CBRNE incidents. Current strengths identified include the good awareness of hospital emergency plans and high motivation to get more training.

Willingness of Firefighting Program Students to Work in Disasters—Turkey

Introduction

Firefighting is an important profession during disasters. Firefighters are on duty for many vital functions, including fire extinguishing, search and rescue work, and evacuation of disaster victims to a safe zone. In case of a disaster situation, it is vital to have willing personnel to work in disasters. In the literature, type of disaster, individual demographic factors, family factors, and workplace factors have been identified as factors that influence health care personnel’s willingness to work during a disaster. However, little is known about firefighters and firefighter candidates’ willingness to work in a disaster.

Hypothesis/Problem

This study was aimed to identify the willingness of civil defense and firefighting program students to work in different disasters after graduation and the factors associated with their willingness.

Methods

The universe of this descriptive, epidemiological study was 1,116 students of civil defense and firefighting programs in Turkey. They were from 11 different universities. In the research study, a sample was not chosen as it was aimed at reaching the whole universe. A standardized survey form of 58 questions, prepared by researchers, was used to gather data.

Results

The rate of participation was 65.5%. Of the students, 82.8% said that after graduation they would like to work in disasters, whereas 16.2% were indecisive. The students were less willing to work in nuclear accidents (42.4%) and epidemic disasters (32.1%). In chi-square analysis, “willingness of students to work in disasters after graduation” (dependent variable) and the independent variables: “university of student,” “exercising regularly,” “having a hobby related to disaster,” “having been educated about disaster,” and “being satisfied from the received education” were found statistically significant. When students’ willingness to work in disasters after graduation (ref=unwilling) was analyzed with multi-variate analysis, only “university of students” and “having a hobby related to disasters” were found statistically significant.

Conclusion

Overall, 16.2% of the students stated that they were indecisive to work in disasters in the future, and 1.0% of them stated that they did not want to work in disasters. Moreover, willingness of students to work in nuclear accident and contagious disease disasters has been found to be lower compared to other disaster types.

KayaE, AltintasH. Willingness of firefighting program students to work in disasters—Turkey. Prehosp Disaster Med. 2018;33(1):13–22.

Disappearing everyday materials: The displacement of medical resources following disaster in Fukushima, Japan

This study draws upon interviews of medical staff working in the city of Minamisoma, Japan, following the 2011 Triple Disaster. It investigates staff responses to the disruption of material resources as a consequence of the disaster and its management. The disruption of spaces, and the loss of oxygen supplies, food, and medications impacted upon staff experience and the ability of institutions to care for patients. This resulted in a restructuring of spaces and materials as workers made efforts to reconfigure and reestablish healthcare functions. This is one of the few qualitative studies which draws upon the experience and perspectives of health workers in understanding material disruption following disaster. This is particularly important since this case did not involve the breakdown of lifeline infrastructure, but rather, brought to attention the way everyday material objects shape social experience. In highlighting these effects, the paper makes the case for the social scientific investigation of the impact of disasters on healthcare, shedding light on an area of research currently dominated by disaster medicine.

Survey of Hospital Employees' Personal Preparedness and Willingness to Work Following a Disaster

OBJECTIVES

Little is known about the personal readiness of hospital staff for disasters. As many as 30% of hospital staff say that they plan not to report for work during a large-scale disaster. We sought to understand the personal disaster preparedness for hospital staff.

METHODS

Surveys were distributed to the staff of a large academic tertiary-care hospital by either a paper-based version distributed through the departmental safety coordinators or a Web-based version distributed through employee e-mail services, depending on employee familiarity with and access to computer services. Surveys assessed the demographic variables and characteristics of personal readiness for disaster.

RESULTS

Of the individuals who accessed the survey, 1334 (95.9%) enrolled in it. Women made up 75% of the respondents, with a mean age of 43 years. Respondents had worked at the hospital an average of 9 years, with the majority (90%) being full-time employees. Most households (93%) reported ≤4 members, 6% supported a person with special medical needs, and 17% were headed by a single parent. A small number (24%) of respondents reported an established meeting place for reuniting households during a disaster. Many reported stockpiling a 3-day supply of food (86%) and a 3-day supply of water (51%). Eighteen percent of respondents were not aware of workplace evacuation plans. Most respondents were willing to report to work for natural disasters (eg, tornado, snowstorm; all categories >65%), but fewer respondents were willing to report during events such as an influenza epidemic (54%), a biological outbreak (41%), a chemical exposure, (40%), or a radiation exposure (39%). Multivariate analysis revealed being female, having a child in the household younger than 6 years old, and having a child in school lowered the likelihood of being willing to report to work in two or more event types, whereas pet ownership, being a clinical healthcare worker, and being familiar with the work emergency plan increased the likelihood.

CONCLUSIONS

Despite being employed at the same facility for a prolonged period, employees reported being willing to report for work at a low rate in a variety of disasters. Subjects reported suboptimal personal preparedness for disaster, which may further limit the number of staff who will report for work. Hospitals should promote personal disaster preparedness for staff and explore staffing models with an understanding of reduced staff availability during disasters.

How Do Doctors and Nurses in Emergency Departments in Hong Kong View Their Disaster Preparedness? A Cross-Sectional Territory-Wide Online Survey

Objectives

To assess the level of all-hazards disaster preparedness and training needs of emergency department (ED) doctors and nurses in Hong Kong from their perspective, and identify factors associated with high perceived personal preparedness.

Design

This study was a cross-sectional territory-wide online survey conducted from 9 September to 26 October, 2015.

Participants

The participants were doctors from the Hong Kong College of Emergency Medicine and nurses from the Hong Kong College of Emergency Nursing.

Methods

We assessed various components of all-hazards preparedness using a 25-item questionnaire. Backward logistic regression was used to identify factors associated with perceived preparedness.

Results

A total of 107 responses were analyzed. Respondents lacked training in disaster management, emergency communication, psychological first aid, public health interventions, disaster law and ethics, media handling, and humanitarian response in an overseas setting. High perceived workplace preparedness, length of practice, and willingness to respond were associated with high perceived personal preparedness.

Conclusions

Given the current gaps in and needs for increased disaster preparedness training, ED doctors and nurses in Hong Kong may benefit from the development of core-competency-based training targeting the under-trained areas, measures to improve staff confidence in their workplaces, and efforts to remove barriers to staff willingness to respond. (Disaster Med Public Health Preparedness. 2018; 12: 329–336)

Readiness for Radiological and Nuclear Events among Emergency Medical Personnel

Background

Among medical providers, even though radiological and nuclear events are recognized as credible threats, there is a lack of knowledge and fear about the medical consequences among medical personnel which could significantly affect the treatment of patients injured and/or contaminated in such scenarios. This study was conducted to evaluate the relative knowledge, willingness to respond, and familiarity with nuclear/radiological contamination risks among U.S. and Japanese emergency medical personnel.

Methods

An institutional review board-approved anonymous paper survey was distributed at various medical and disaster conferences and medicine courses in Japan and in the U.S. The surveys were written in Japanese and English and collected information on the following four categories: generalized demographics, willingness to manage, knowledge of disaster systems, and contamination risks.

Results

A total of 418 surveys were completed and collected. Demographics showed that physicians and prehospital responders were the prevalent survey responders. The majority of responders, despite self-professed disaster training, were still very uncomfortable with and unaware how to respond to a radiological/nuclear event.

Conclusion

Despite some educational coverage in courses and a limited number of disaster events, it is concluded that there is a lack of comfort and knowledge regarding nuclear and radiological events among the medical community. It is recommended that considerable development and subsequent distribution is needed to better educate and prepare the medical community for inevitable upcoming radiological/nuclear events.

The role of risk perception in willingness to respond to the 2014-2016 West African Ebola outbreak: a qualitative study of international health care workers

Background

The 2014–2016 West Africa Ebola Virus Disease (EVD) outbreak was an unprecedented public health event, and in addition to claiming over 11,000 lives, it resulted in the deaths of more healthcare workers than any outbreak in recent history. While a cadre of willing and able health workers is essential for an effective epidemic response, health workforce capacity in times of crisis may be significantly impacted by how risks are perceived by health staff. This study aimed to explore how risk perceptions influenced healthcare workers’ willingness to respond during this outbreak.

Methods

Through in-depth interviews with 11 front-line international health care workers who chose to respond to the West Africa outbreak, this qualitative study explores how perceptions of risk developed and subsequently mediated the decision to respond to the outbreak. Data was thematically organized using NVivo 10.

Results

We found that numerous individual and social-level factors played a role in modifying risk perception in health workers. Institutional trust emerged as a key risk attenuator, as did past experience, self-efficacy, duty of care, humanitarian ethos, and cognitive heuristics. Feelings of risk were amplified by infections of co-workers, and risk perceptions of family members and the public, which were mainly informed by media reports, also hampered willingness to respond in some cases.

Conclusions

Understanding the risk perceptions of health workers, institutions, and the public, while complex and interdependent, are each crucial to understand for an effective public health response to epidemics, and as such should be taken into consideration in future program planning and research.

Hospital Administration and Nursing Leadership in Disasters: An Exploratory Study Using Concept Mapping

Strong leadership is critical in disaster situations when "patient surge" challenges a hospital's capacity to respond and normally acceptable patterns of care are disrupted. Activation of the emergency operations plan triggers an incident command system structure for leadership decision making. Yet, implementation of the emergency operations plan and incident command system protocols is ultimately subject to nursing and hospital leadership at the service- and unit level. The results of these service-/unit-based leadership decisions have the potential to directly impact staff and patient safety, quality of care, and ultimately, patient outcomes. Despite the critical nature of these events, nurse leaders and administrators receive little education regarding leadership and decision making during disaster events. The purpose of this study is to identify essential competencies of nursing and hospital administrators' leadership during disaster events. An integrative mixed-methods design combining qualitative and quantitative approaches to data collection and analysis was used. Five focus groups were conducted with nurse leaders and hospital administrators at a large urban hospital in the Northeastern United States in a collaborative group process to generate relevant leadership competencies. Concept Systems Incorporated was used to sort, prioritize, and analyze the data (http://conceptsystemsinc.com/). The results suggest that participants' institutional knowledge (of existing resources, communications, processes) and prior disaster experience increase leadership competence.

Anesthesiologists and Disaster Medicine: A Needs Assessment for Education and Training and Reported Willingness to Respond

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.

Health Care Student Knowledge and Willingness to Work in Infectious Disease Outbreaks

OBJECTIVE

Health care workers are critical first responders. Understanding which factors motivate their willingness to work (WTW) during infectious disease outbreaks may guide improvements in preparedness. The perspective of health care students, the future workforce, remains largely unexplored. This study compared factors influencing WTW among medical, nursing, and pharmacy students.

METHODS

A printed survey was administered to 631 medical, nursing, and pharmacy students. The questionnaire elicited information regarding prior disaster training, disease-related knowledge, and WTW in the setting of infectious diseases with contact or respiratory transmission.

RESULTS

Analyses of the 579 respondents (92% response rate) demonstrated that students were less fearful for their health and more willing to work during outbreaks with contact transmission than during those with respiratory transmission. Medical students were the most fearful for their health, but they demonstrated the greatest WTW, followed by nursing students, and then pharmacy students. Medical students were also the most knowledgeable about infectious diseases. Prior disaster training was associated with greater WTW.

CONCLUSIONS

Extent of disease-related knowledge and prior disaster training appear to influence WTW. Our findings, taken in the context of a remarkable underemphasis on disaster preparedness in health care curricula, call for a broader incorporation of disaster training to improve the WTW of health care students, and, ultimately, health care workers. (Disaster Med Public Health Preparedness. 2017;11:694-700).

Companion Animals in Natural Disasters: A Scoping Review of Scholarly Sources

During a disaster, people may make evacuation decisions based on their companion animal's welfare, therefore exposing themselves, their companion animals, and emergency responders to increased risk for injury or death. The loss and suffering of companion animals in disasters causes deep distress, diminishing people's capacity to rebuild their lives. This scoping review presents scholarly research studies and reviews relating to people and their companion animals in the context of disasters, with an aim of informing researchers, policymakers, and practitioners and providing direction for future research. Using the Arksey and O'Malley framework, articles in scholarly journals from 2004 to 2014 are discussed. Analysis included 38 articles: 20 research studies, 12 reviews, and 6 editorials. Findings revealed 2 central themes: companion animals as a risk factor to human health and safety and companion animals being "at risk" themselves. An emerging theme was "responsibility": Who is responsible for companion animals in disasters and how? Understanding the implications of human-nonhuman animal relationships for disaster response and having a broader public consensus on what is owed to animals at times of emergency are important to community preparedness and resilience.

The Emotional Well-Being of Nurses and Nurse Leaders in Crisis

In a world after 9/11, Hurricane Katrina, and Sandy Hook, plenty of literature has emerged on the subject of disaster management, but little is specific to the emotional well-being of the health care staff dedicated to serve during a crisis. Disasters, whether natural or man-made, are episodic but becoming more frequent. Nurses may find themselves in hospitals affected by a disaster, awaiting a surge of patients while supplied with only limited resources. Or, they may be deployed to austere environments where they are challenged to operate clinics, surrounded by the rubble of an earthquake. In these situations, nurse leaders need to ensure that staff members are trained to be effective disaster health care resources before crises occur. Training includes education on what nurses may observe, how they will be utilized in an emergency situation, and how they can best handle a chaotic environment, both during and after the event, in a manner that will help them keep their emotions in balance. Training before a disaster will help nurse responders develop a plan for their personal responsibilities so they can focus on the mission. The time to start training is not when the disater occurs. In a chaotic environment, most nurses will not have the necessary reserves to begin learning new concepts. Prepared nurses and their leaders must be ready to use their training prior to any crisis. They need to be able to assess that their colleagues are not suffering because of lack of sleep, food, or emotional support. Even after a disaster has initially been resolved, and nurse responders have returned to their families, nurse leaders need to follow up with their team. It may actually be during the postcrisis period that nurse responders need the most emotional support.

Development, Testing, and Psychometric Qualities of the Nash Duty to Care Scale for Disaster Response

Background and Purpose: Although nurses struggle with the decision to report for work during disaster events, there are no instruments to measure nurses’ duty to care for disaster situations. The purpose of this study was to describe the development, testing, and psychometric qualities of the Nash Duty to Care Scale. Methods: A convenience sample of 409 registered nurses were recruited from 3 universities in the United States. Results: Exploratory factor analysis resulted in a 19-item, 4-factor model explaining 67.34% of the variance. Internal consistency reliability was supported by Cronbach’s alpha ranging from .81 to .91 for the 4-factor subscales and .92 for the total scale. Conclusions: The psychometrically sound instrument for measuring nurses’ perceived duty to care for disasters is applicable to contemporary nursing practice, institutional disaster management plans, and patient health outcomes worldwide.

Addressing Hospital Nurses' Fear of Abandonment in a Bioterrorism Emergency

Most hospitals' disaster plans are extensive and effective at establishing an incident command center, directing material and personnel resources, and triaging patients. However, few organizations have assessed caregivers' needs and fears related to disaster response. When nurses have been interviewed on this topic, findings indicated complex concerns involving fear of loss (e.g., loss of order in their work environment, loss of safe work conditions, loss of freedom to come and go at will, and loss of trust in their hospital's commitment to their best interest). The sobering result of anticipating these losses is fear of abandonment. The purpose of this article is to address factors identified by hospital-based nurses that contribute to their fears of abandonment in a bioterrorism emergency. Hospitals that choose to respond to these concerns will exemplify best practice toward care of the community and care of their own nurses.

Public Health Emergencies

During a public health emergency such as an influenza pandemic or a bioterrorism attack, nurses may be at risk for exposure to lethal infectious diseases when caring for victims. The aim of this study was to identify interventions nurses believe will support their ability to cope during public health emergencies. A qualitative research design was used with 33 nurses from designated bioterrorism-receiving hospitals. Nurses recommended adequate protective equipment, education, drills, accessible information and available content experts, and available administrators. Other recommendations included increased security to protect nurses, emotional and physical support, communication with nurses' families, and commitment from institutions to care for ill or injured nurses. Preparations for emergencies should include assessments of nurses' and other stakeholders' concerns. These nurses proposed specific measures to improve safety, reduce anxiety, increase trust in hospitals, and provide physical and emotional support.

Hospital Staff Shortage after the 2011 Triple Disaster in Fukushima, Japan-An Earthquake, Tsunamis, and Nuclear Power Plant Accident: A Case of the Soso District

Introduction

In 2011, Fukushima was struck by a triple disaster: an earthquake, tsunamis, and a nuclear accident. In the aftermath, there was much fear among hospital staff members about radiation exposure and many staff members failed to report to work.

Objectives

One objective is to measure this shortage in hospital staff and another is to compare the difference in recovery by hospital types and by categories of hospital staff.

Design

The monthly records of the number of staff members from May 2011 to September 2012 were extracted anonymously from the records of 7 local hospitals in the Soso district in Fukushima. Change in the number of staff was analyzed.

Results

Staff shortages at hospitals reached a maximum within one month after the disaster (47% reported to work). The shortage of clerks was the most severe (38% reported to work), followed by nurses (48% reported to work). The shortages remained even 18 months after the disaster.

Conclusion

After a disaster in which the damage to hospital functions surpasses the structural damage, massive support of human resources in the acute phase and a smaller volume of support in the mid-term phase appear to be required, particularly for non-medical staff.

Radiation Injury Treatment Network®: Preparedness Through a Coalition of Cancer Centers

This article provides an overview of Radiation Injury Treatment Network® (RITN), its preparedness activities and capabilities, including training and educating over 11,500 hospital staff, coordinating over 500 exercises, developing treatment guidelines, developing standard operating procedures, and being recognized by the U.S. federal government as a national response asset. The RITN provides comprehensive evaluation and treatment for victims with marrow toxic injuries. Many of the casualties from the detonation of an improvised nuclear device (IND) (a.k.a. terrorist nuclear bomb) with only radiation injuries will be salvageable; however, they would require outpatient and/or inpatient care. Recognizing this, the U.S. National Marrow Donor Program (NMDP), U.S. Navy, and American Society for Blood and Marrow Transplantation (ASBMT) collaboratively developed RITN, which comprises medical centers with expertise in the management of bone marrow failure. The medical community will undoubtedly be taxed by the resulting medical surge from an IND despite the well-defined United States emergency medical system, the National Disaster Medical System; however, one area that is unique for radiological disasters is the care for casualties with acute radiation syndrome. Hematologists and oncologists purposefully expose their cancer patients to high doses of radiation and toxic chemicals for chemotherapy as they treat their patients, resulting in symptoms not unlike casualties with exposure to ionizing radiation from a radiological disaster. This makes the staff from cancer centers ideal for the specialized care that will be required for thousands of casualties following a mass casualty radiological incident. The RITN is a model for how a collaborative effort can fill a readiness gap-through its network of 76 hospitals, blood donor centers, and cord blood banks, the RITN is preparing to provide outpatient care and specialized supportive care to up to 63,000 radiological casualties.

Quantifying Supply of Home Health Services for Public Health Emergencies

The number of persons seeking medical treatment during a public health emergency could quickly overwhelm the capacity of hospitals and emergency rooms. The amount of surge capacity home health care could provide during a public health emergency is unknown. The purpose of this research is to quantify the surge capacity of the home health sector in four emergency scenarios. According to the model developed, routine demand will exceed scenario capacity for almost all home health agencies in all pessimistic cases for the four scenarios discussed. However, home health agencies have the surge capacity to contribute to the provision of care for patients during times of demand under routine operating conditions as well as in conditions where demand may be moderately increased.

Ebola Virus Preparedness: Emerging Viruses and Ethics in Laboratory Medicine

CONTEXT

Emerging pathogens have affected, and will continue to affect, the health care system in diverse ways. Clinical laboratories face ethical challenges in responding to emerging pathogens. We use the 2014-2015 outbreak of Ebola virus disease as a model to explore some of the ethical issues in laboratory medicine related to emerging infectious disease.

OBJECTIVE

To describe the major ethical concerns raised in the clinical laboratory environment by emerging infections.

DATA SOURCES

We assessed current guidelines and practices in the Ebola outbreak in developed-world clinical laboratories, reviewed risk assessment practices and the role of the clinical laboratory in providing care for patients with potential or confirmed Ebola, and reviewed the relevant literature on duty to provide care in the laboratory context.

CONCLUSIONS

Clinical laboratories in developed countries have to rely more on expert guidelines and theoretical risk assessments than on practice in less-developed areas. Risk minimization for clinical laboratory workers is essential but may conflict with the laboratory's duty to provide standard of care. Patients can be put at risk not only from loss of laboratory services from restriction of testing but also from impairment of laboratory services in cases of spills or accidents. Significant discrepancies in guidelines from professional and governmental sources exacerbate the difficulty and confusion inherent in dealing with a dynamic, emerging infectious disease crisis. The duty to provide care for laboratory workers is ill-defined. Balancing risks to patients and laboratory workers and benefits to patients presents challenges to laboratory professionals at all levels.

Home Health Care Challenges and Avian Influenza

Recent public health disasters, both nationally and internationally, have underscored the importance of preparedness in effectively responding to these events. Within the home health care sector, preparedness is especially critical, as home care patients may be at increased risk of disaster-related morbidity and mortality because of their age, disability, or other vulnerability. Importantly, the home health care population is growing, with an estimated 7 million patients currently receiving home health care services. Yet the degree of preparedness at all levels of the home care sector (agency, health care worker, and patient and/or family) is largely unknown. Without this knowledge, important first steps toward development and implementation designed to address barriers to preparedness cannot be taken. To help address some of these knowledge gaps, one aspect of preparedness, namely the willingness of home health care workers to respond during an avian influenza outbreak, was recently examined. Findings revealed very low levels of willingness. Preliminary recommendations designed to address this issue are presented following a general discussion of the issue.

Survey of Nursing Students' Self-Reported Knowledge of Ebola Virus Disease, Willingness to Treat, and Perceptions of their Duty to Treat

The purpose of this study was to explore nursing students' self-reported knowledge of Ebola Virus Disease (EVD), willingness to treat patients with EVD, and student perceptions of duty to treat patients with EVD. The researchers developed the Survey of Nursing Student Self-Reported Knowledge of EVD, Willingness to Treat, and Perceptions of Duty to Treat, a quantitative tool with open-ended questions to inform the responses. On-line survey software was used for gathering anonymous data. A mixture of descriptive, nonparametric, and parametric statistics were used to describe, compare, and examine relationships between variables. Results demonstrated that licensed students scored significantly higher on self-reported knowledge of EVD than their prelicensure student counterparts (P=.039). Licensed students and prelicensure students did not differ on self-assessed willingness to treat (P>.05). The students had significantly higher willingness-to-treat scores when self-reported knowledge scores were higher (P=.007) and when they were older (P=.004). Willingness to treat was not influenced by whether one was partnered or single (P>.05) or had children or did not have children (P>.05). In conclusion, basic EVD knowledge and training appears to be critical to ensure willingness to treat. However, it is imperative that students have an indepth understanding of the principles of infectious diseases in general.

Personal and professional challenges confronted by hospital staff following hurricane sandy: a qualitative assessment of management perspectives

Background

Adequate hospital staffing during and after a disaster is critical to meet increased health care demands and to ensure continuity of care and patient safety. However, when a disaster occurs, staff may become both victim and responder, decreasing their ability and willingness to report for work. This qualitative study assessed the personal and professional challenges that affected staff decisions to report to work following a natural disaster and examined the role of management in addressing staff needs and concerns.

Methods

Semi-structured interviews were conducted with individuals who filled key management roles in the United States Department of Veterans Affairs New York Harbor Healthcare System’s response to Superstorm Sandy and during the facility’s initial recovery phase. All interviews were audio recorded and transcribed. Three major themes were identified: 1) Barriers to reporting (“Barriers”), 2) Facilitators to reporting (“Facilitators”), and 3) Responses to staff needs and concerns (“Responses”). Atlas.ti 7.1.6 software program was used for the management and analysis of the transcripts.

Results

Results indicated that staff encountered several barriers that impeded their ability to report to work at mobile vans at the temporarily nonoperational Manhattan campus or at two other VA facilities in Brooklyn and the Bronx in the initial post-Sandy period including transportation problems, personal property damage, and communication issues. In addition, we found evidence of facilitators to reporting as expressed through descriptions of professional duty. Our findings also revealed that management was aware of the challenges that staff was facing and made efforts to reduce barriers and accommodate staff affected by the storm.

Conclusions

During and after a disaster event, hospital staff is often confronted with challenges that affect decisions to report for work and perform effectively under potentially harsh conditions. This study examined barriers and facilitators that hospital staff encountered following a major natural disaster from the management perspective. Insights gained from this study can be used to inform future disaster planning and preparedness efforts, and help ensure that there is adequate staffing to mount an effective response when a disaster occurs, and to recover from its aftermath.

Preparing for an influenza pandemic: healthcare workers' opinions on working during a pandemic

The aim of this study was to solicit opinions from healthcare workers (HCWs) as to their attitude to working during a pandemic. A cross-sectional survey of HCWs using a self-administered, anonymous survey was conducted between February 2007 and April 2007. The setting was a large Victorian metropolitan health service, employing over 10 000 staff. Sixty-seven percent of HCWs stated they would be available to work during a pandemic, 26% stated they would stay at home to care for their children, whereas 10% admitted they would stay away because of fear of catching influenza. The majority of employees expected to be provided with personal protective equipment, antivirals and vaccine (92%, 90% and 89%, respectively). HCWs also believed that family members should be supplied with antivirals and vaccine (64% and 63%, respectively), 20% believed they needed a place of residence while working, 45% were prepared to be relocated to another site, and 36% were prepared to change to another duty. The survey highlights several areas that need attention in preparing for a pandemic. Targeted education is required now for all those HCWs who will be expected to work during a pandemic. How we cope with the next inevitable pandemic depends on the depth of our preparation.

Willingness of Future Nursing Workforce to Report for Duty During an Avian Influenza Pandemic

Nursing students are the future nursing workforce. Exploring factors associated with nursing students' willingness to report for duty during an avian influenza (flu) pandemic, might help nurse managers develop strategies in advance for efficient management of personnel during a pandemic of avian flu.

AIM

To examine the factors associated with the willingness of future nursing workforce to report for duty during an avian flu pandemic, using the theory of self-efficacy.

METHODS

The study employed a cross-sectional quantitative correlational design. A convenience sample of 200 Israeli nursing students completed a questionnaire based on the theory and the literature review.

RESULTS

Approximately one-half (49%) of the students intended to report for duty during an avian flu pandemic in the future. Perceived self-efficacy and working conditions were found associated with this willingness. Male students and students from the Arab Muslim sector were more willing to report for duty during a pandemic than female students or students from the Jewish sector.

DISCUSSION

These finding may have implications for disaster planning and staffing management in health care settings during an avian flu pandemic, with the aim to ensure optimal nursing care and an efficient functioning of the entire health care system.

Are We Ready for Mass Fatality Incidents? Preparedness of the US Mass Fatality Infrastructure

Objective

To assess the preparedness of the US mass fatality infrastructure, we developed and tested metrics for 3 components of preparedness: organizational, operational, and resource sharing networks.

Methods

In 2014, data were collected from 5 response sectors: medical examiners and coroners, the death care industry, health departments, faith-based organizations, and offices of emergency management. Scores were calculated within and across sectors and a weighted score was developed for the infrastructure.

Results

A total of 879 respondents reported highly variable organizational capabilities: 15% had responded to a mass fatality incident (MFI); 42% reported staff trained for an MFI, but only 27% for an MFI involving hazardous contaminants. Respondents estimated that 75% of their staff would be willing and able to respond, but only 53% if contaminants were involved. Most perceived their organization as somewhat prepared, but 13% indicated “not at all.” Operational capability scores ranged from 33% (death care industry) to 77% (offices of emergency management). Network capability analysis found that only 42% of possible reciprocal relationships between resource-sharing partners were present. The cross-sector composite score was 51%; that is, half the key capabilities for preparedness were in place.

Conclusions

The sectors in the US mass fatality infrastructure report suboptimal capability to respond. National leadership is needed to ensure sector-specific and infrastructure-wide preparedness for a large-scale MFI. (Disaster Med Public Health Preparedness. 2016;10:87–97)

Emergency Childcare for Hospital Workers During Disasters

OBJECTIVES

The objectives were to determine the impact of emergency childcare (EC) needs on health care workers' ability and likelihood to work during a pandemic versus an earthquake as well as to determine the anticipated need and expected use of an on-site, hospital-provided EC program.

METHODS

An online survey was distributed to all employees of an academic, urban pediatric hospital. Two disaster scenarios were presented (pandemic influenza and earthquake). Ability to work based on childcare needs, planned use of proposed hospital-provided EC, and demographics of children being brought in were obtained.

RESULTS

A total of 685 employees participated (96.6% female, 79.6% white), with a 40% response rate. Those with children (n = 307) reported that childcare needs would affect their work decisions during a pandemic more than an earthquake (61.1% vs 56.0%; t = 3.7; P < 0.001). Only 28.0% (n = 80) of those who would need childcare (n = 257) report an EC plan. The scenario did not impact EC need or planned use; during scheduled versus unscheduled shifts, 40.7% versus 63.0% reported need for EC, and 50.8% versus 63.2% reported anticipated using EC.

CONCLUSIONS

Hospital workers have a high anticipated use of hospital-provided EC. Provisions for EC should be an integral part of hospital disaster planning.

Preparing to respond: Irish nurses' perceptions of preparedness for an influenza pandemic

INTRODUCTION

The aim of this research was to garner opinion on: the concerns of nurses in respect of the key issues that they may face in the event of an influenza pandemic; the perceived impact of an influenza pandemic on these nurses; and the current level of perceived preparedness in their hospital. Of particular significance is the fact that data for this study were gathered from nursing staff during a period when there was a heightened risk of an outbreak.

METHODS

The data for this study were gathered using a structured, self-administered questionnaire, which was distributed to 127 nurses. A response rate of 72% was achieved. The questionnaire was based on the instrument used by Wong et al. in their 2008 study of preparedness for an avian influenza pandemic in Singapore.

RESULTS

Although the results reveal a number of concerns raised by nurses, it is clear that the majority (90%) view treating and caring for influenza patients as core to their role. While recognising their professional responsibilities, they reveal apprehension about certain aspects of their work, such as an increased likelihood of infection, added workload and pressures, an increased concern for those close to them who could become infected as well as the overall increase in stress levels at work. The extent of professional and personal preparedness, together with the concerns and perceptions of nurses, could affect the hospital's overall capacity to respond and these concerns should be addressed by those responsible for the development of pandemic response plan.

Assessing the Capacity of the US Health Care System to Use Additional Mechanical Ventilators During a Large-Scale Public Health Emergency

OBJECTIVE

A large-scale public health emergency, such as a severe influenza pandemic, can generate large numbers of critically ill patients in a short time. We modeled the number of mechanical ventilators that could be used in addition to the number of hospital-based ventilators currently in use.

METHODS

We identified key components of the health care system needed to deliver ventilation therapy, quantified the maximum number of additional ventilators that each key component could support at various capacity levels (ie, conventional, contingency, and crisis), and determined the constraining key component at each capacity level.

RESULTS

Our study results showed that US hospitals could absorb between 26,200 and 56,300 additional ventilators at the peak of a national influenza pandemic outbreak with robust pre-pandemic planning.

CONCLUSIONS

The current US health care system may have limited capacity to use additional mechanical ventilators during a large-scale public health emergency. Emergency planners need to understand their health care systems' capability to absorb additional resources and expand care. This methodology could be adapted by emergency planners to determine stockpiling goals for critical resources or to identify alternatives to manage overwhelming critical care need.

Perceptions of the utility and acceptability of an emergency child minding service for health staff

OBJECTIVE

Tropical Cyclone Yasi in North Queensland activated the disaster management plans at The Townsville Hospital, including the establishment of an emergency child minding service to facilitate the return of staff to work.

METHODS

This report describes the establishment of this service and the results of brief electronic surveys that were distributed in the 2 weeks following the cyclone to gather feedback from staff who had placed their children in the care of the service (consumers), staff who had manned the service (staff), and allied health managers whose staff had manned the service (managers).

RESULTS

Overall, approximately 94 episodes of care were provided by the child minding service. All consumers responded "'yes'" in answer to the question of whether the emergency child minding service facilitated their return to work in the immediate post-disaster period. The survey also identified that a lack of effective advertising may have prevented further uptake of the child minding service.

CONCLUSIONS

The provision of an emergency child minding service facilitated the return to work of health care staff immediately after Tropical Cyclone Yasi. More research is needed to understand the effect disaster type has on the uptake of a child minding service.

Preparing an Academic Medical Center to Manage Patients Infected With Ebola: Experiences of a University Hospital

As Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population’s health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered to become an Ebola Treatment Center as part of the US effort to manage the threat. We developed detailed policies and procedures for Ebola patient management at our university hospital. Both the EMS system and county public health made significant contributions during the development process. This article shares information about this process and the outcomes to inform other institutions facing similar challenges of preparing for an emerging threat with limited resources. The discussion includes information about management of (1) patients who arrive by ambulance with prior notification, (2) spontaneous walk-in patients, and (3) patients with confirmed Ebola who are interfacility transfers. Hospital management includes information about Ebola screening procedures, personal protective equipment selection and personnel training, erection of a tent outside the main facility, establishing an Ebola treatment unit inside the facility, and infectious waste and equipment management. Finally, several health policy considerations are presented. (Disaster Med Public Health Preparedness. 2015;9:558–567)

Hospital Employee Willingness to Work during Earthquakes Versus Pandemics

BACKGROUND

Research indicates that licensed health care workers are less willing to work during a pandemic and that the willingness of nonlicensed staff to work has had limited assessment.

OBJECTIVE

We sought to assess and compare the willingness to work in all hospital workers during pandemics and earthquakes.

METHODS

An online survey was distributed to Missouri hospital employees. Participants were presented with 2 disaster scenarios (pandemic influenza and earthquake); willingness, ability, and barriers to work were measured. T tests compared willingness to work during a pandemic vs. an earthquake. Multivariate linear regression analyses were conducted to describe factors associated with a higher willingness to work.

RESULTS

One thousand eight hundred twenty-two employees participated (15% response rate). More willingness to work was reported for an earthquake than a pandemic (93.3% vs. 84.8%; t = 17.1; p < 0.001). Significantly fewer respondents reported the ability to work during a pandemic (83.5%; t = 17.1; p < 0.001) or an earthquake (89.8%; t = 13.3; p < 0.001) compared to their willingness to work. From multivariate linear regression, factors associated with pandemic willingness to work were as follows: 1) no children ≤3 years of age; 2) older children; 3) working full-time; 4) less concern for family; 5) less fear of job loss; and 6) vaccine availability. Earthquake willingness factors included: 1) not having children with special needs and 2) not working a different role.

CONCLUSION

Improving care for dependent family members, worker protection, cross training, and job importance education may increase willingness to work during disasters.

Trends in the geographic distribution of nursing staff before and after the Great East Japan Earthquake: a longitudinal study

BACKGROUND

Medical care systems in Iwate, Miyagi and Fukushima prefectures were greatly damaged by the Great East Japan Earthquake (GEJE), which struck on 11 March 2011. The shortage of nurses in this area was concerning; however, temporal trends have not been investigated. This study aimed to investigate the trends in the geographic distribution of total nursing staff per population in the secondary medical areas (SMAs) of these prefectures before and after the GEJE. We also aimed to qualify the above trends.

METHODS

We conducted a longitudinal study at four time points (July 2007, 2010, 2011 and 2013) over 6 years using reports of basic hospitalization charges from all hospitals within Iwate, Miyagi and Fukushima prefectures that experienced severe damage from the GEJE. We calculated the number of total nursing staff per population in the SMAs and compiled descriptive statistics. Changes from 2010 to 2013 were qualified and mapped.

RESULTS

In coastal SMAs, the ratios of total nursing staff per population decreased immediately after the GEJE. In most SMAs in 2013, the ratios increased and exceeded the pre-GEJE level. However, the changes in total nursing staff per population from 2010 to 2013 were negative in Ryouban (-4.0%), Ishinomaki-Tome-Kesennuma (-1.9%), Sousou (-47.7%) and Iwaki (-1.9%). In Sousou, which is closest to the Fukushima Daiichi Nuclear Power Plant, the changes in total nursing staff per population qualified by job role were -33.7% for nurses, -57.7% for associate nurses and -63.2% for nursing aides.

CONCLUSIONS

Our study indicated that the temporal trends in the number of total nursing staff per population due to the GEJE differed between the physically damaged areas and those affected by radiation. We also found the difference in the trend by qualifications: the reduction in total nursing staff per population was larger in Sousou, the area most affected by radiation, than in any other SMAs. Moreover, the number of nursing aides was most affected among the three types of staff. To promote the post-GEJE reconstruction of medical care systems, it might be necessary to develop policies to secure both nurses and nursing aides after nuclear disasters.

Ebola Knowledge and Attitudes Among Pediatric Providers Before the First Diagnosed Case in the United States

The 2014 Ebola virus disease outbreak triggered concerns about health-care worker (HCW) readiness. Two hundred and forty-five HCWs at a children's hospital were surveyed. Knowledge scores were lower for nurses than physicians (50-61%, P = 0.001). Despite HCWs lacking Ebola virus disease knowledge, their perceived lack of institutional preparedness and their own lack of training, most HCWs wanted to believe that they would be safe and were willing to provide care.

Professionalism under fire: Conflict, war and epidemics

Today's medical students (tomorrow's doctors) will be entering a world of conflict, war and regular outbreaks of infectious diseases. Despite numerous international declarations and treaties protecting human rights, the last few decades has been fraught with reports of "lapses" in medical professionalism involving torture and force-feeding of detainees (e.g. captured during the War on Terror) and health care professionals refusing to treat infected patients (e.g. HIV and Ebola). This paper provides some historical background to the changing status of a physician's duty to treat and how medical practitioners came to be involved in the inhumane treatment of detainees during the War on Terror, culminating in reports of "lapses" in professionalism. The Theory of Planned Behavior, which takes into account the individual, the environment and the social context, is used to explain the factors that might influence an individual's behavior in challenging situations. The paper concludes with some recommendations for medical and health professions education. The recommendations include selecting students who, as a minimum, can provide evidence of "basic" professionalism, engaging them in exploring the history of the medical profession, exposing them to contexts of uncertainty and moral dilemmas and challenging them to reflect on their responses.

Ethical issues in the response to Ebola virus disease in United States emergency departments: a position paper of the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine

The 2014 outbreak of Ebola virus disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged U.S. emergency departments (EDs) to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to U.S. acute care facilities, ethical questions have been raised in both the press and medical literature as to how U.S. EDs, emergency physicians (EPs), emergency nurses, and other stakeholders in the health care system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to U.S. EPs, emergency nurses, and other stakeholders in the health care system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to U.S. EDs in how they approach preparation for and management of potential patients with EVD.

Do shared barriers when reporting to work during an influenza pandemic influence hospital workers' willingness to work? A multilevel framework

OBJECTIVE

Characteristics associated with interventions and barriers that influence health care workers' willingness to report for duty during an influenza pandemic were identified. Additionally, this study examined whether workers who live in proximal geographic regions shared the same barriers and would respond to the same interventions.

METHODS

Hospital employees (n=2965) recorded changes in willingness to work during an influenza pandemic on the basis of interventions aimed at mitigating barriers. Distance from work, hospital type, job role, and family composition were examined by clustering the effects of barriers from reporting for duty and region of residence.

RESULTS

Across all workers, providing protection for the family was the greatest motivator for willingness to work during a pandemic. Respondents who expressed the same barriers and lived nearby shared common responses in their willingness to work. Younger employees and clinical support staff were more receptive to interventions. Increasing distance from home to work was significantly associated with a greater likelihood to report to work for employees who received time off.

CONCLUSIONS

Hospital administrators should consider the implications of barriers and areas of residence on the disaster response capacity of their workforce. Our findings underscore communication and development of preparedness plans to improve the resilience of hospital workers to mitigate absenteeism.

Ethical issues in the response to Ebola virus disease in US emergency departments: a position paper of the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine

The 2014 outbreak of Ebola Virus Disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged US emergency departments to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to US acute care facilities, ethical questions have been raised in both the press and medical literature as to how US emergency departments, emergency physicians, emergency nurses and other stakeholders in the healthcare system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to US emergency physicians, emergency nurses and other stakeholders in the healthcare system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to US emergency departments in how they approach preparation for and management of potential patients with EVD.

Nursing Education for Disaster Preparedness and Response

Catastrophic mass casualty events (MCEs), such as pandemic influenza outbreaks, earthquakes, or large-scale terrorism-related events, quickly and suddenly yield thousands of victims whose needs overwhelm local and regional health care systems, personnel, and resources. Such conditions require deploying scarce resources in a manner that is different from the more common multiple casualty event. This article presents issues associated with providing nursing care under MCE circumstances of scarce resources and the educational needs of nurses to prepare them to effectively respond in these emergencies. J Contin Educ Nurs. 2015;46(x):xxx-xxx.

Mass fatality preparedness among medical examiners/coroners in the United States: a cross-sectional study

Background

In the United States (US), Medical Examiners and Coroners (ME/Cs) have the legal authority for the management of mass fatality incidents (MFI). Yet, preparedness and operational capabilities in this sector remain largely unknown. The purpose of this study was twofold; first, to identify appropriate measures of preparedness, and second, to assess preparedness levels and factors significantly associated with preparedness.

Methods

Three separate checklists were developed to measure different aspects of preparedness: MFI Plan Elements, Operational Capabilities, and Pre-existing Resource Networks. Using a cross-sectional study design, data on these and other variables of interest were collected in 2014 from a national convenience sample of ME/C using an internet-based, anonymous survey. Preparedness levels were determined and compared across Federal Regions and in relation to the number of Presidential Disaster Declarations, also by Federal Region. Bivariate logistic and multivariable models estimated the associations between organizational characteristics and relative preparedness.

Results

A large proportion (42%) of respondents reported that less than 25 additional fatalities over a 48-hour period would exceed their response capacities. The preparedness constructs measured three related, yet distinct, aspects of preparedness, with scores highly variable and generally suboptimal. Median scores for the three preparedness measures also varied across Federal Regions and as compared to the number of Presidential Declared Disasters, also by Federal Region. Capacity was especially limited for activating missing persons call centers, launching public communications, especially via social media, and identifying temporary interment sites. The provision of staff training was the only factor studied that was significantly (positively) associated (p < .05) with all three preparedness measures. Although ME/Cs ranked local partners, such as Offices of Emergency Management, first responders, and funeral homes, as the most important sources of assistance, a sizeable proportion (72%) expected federal assistance.

Conclusions

The three measures of MFI preparedness allowed for a broad and comprehensive assessment of preparedness. In the future, these measures can serve as useful benchmarks or criteria for assessing ME/Cs preparedness. The study findings suggest multiple opportunities for improvement, including the development and implementation of national strategies to ensure uniform standards for MFI management across all jurisdictions.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-1275) contains supplementary material, which is available to authorized users.