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Interdisciplinary Approach to All-Hazards Preparedness. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2009; 15:S8-12. [DOI: 10.1097/01.phh.0000345979.67724.80] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Seale H, Leask J, Po K, MacIntyre CR. "Will they just pack up and leave?" - attitudes and intended behaviour of hospital health care workers during an influenza pandemic. BMC Health Serv Res 2009; 9:30. [PMID: 19216792 PMCID: PMC2661074 DOI: 10.1186/1472-6963-9-30] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 02/13/2009] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There is a general consensus that another influenza pandemic is inevitable. Although health care workers (HCWs) are essential to the health system response, there are few studies exploring HCW attitudes to pandemic influenza. The aim of this study was to explore HCWs knowledge, attitudes and intended behaviour towards pandemic influenza. METHODS Cross-sectional investigation of a convenience sample of clinical and non-clinical HCWs from two tertiary-referral teaching hospitals in Sydney, Australia was conducted between June 4 and October 19, 2007. The self-administered questionnaire was distributed to hospital personal from 40 different wards and departments. The main outcome measures were intentions regarding work attendance and quarantine, antiviral use and perceived preparation. RESULTS Respondents were categorized into four main groups by occupation: Nursing (47.5%), Medical (26.0%), Allied (15.3%) and Ancillary (11.2%). Our study found that most HCWs perceived pandemic influenza to be very serious (80.9%, n = 873) but less than half were able to correctly define it (43.9%, n = 473). Only 24.8% of respondents believed their department to be prepared for a pandemic, but nonetheless most were willing to work during a pandemic if a patient or colleague had influenza. The main determinants of variation in our study were occupational factors, demographics and health beliefs. Non-clinical staff were significantly most likely to be unsure of their intentions (OR 1.43, p < 0.001). Only 42.5% (n = 459) of respondents considered that neuraminidase inhibitor antiviral medications (oseltamivir/zanamivir) would protect them against pandemic influenza, whereas 77.5% (n = 836) believed that vaccination would be of benefit. CONCLUSION We identified two issues that could undermine the best of pandemic plans - the first, a low level of confidence in antivirals as an effective measure; secondly, that non-clinical workers are an overlooked group whose lack of knowledge and awareness could undermine pandemic plans. Other issues included a high level of confidence in dietary measures to protect against influenza, and a belief among ancillary workers that antibiotics would be protective. All health care worker strategies should include non clinical and ancillary staff to ensure adequate business continuity for hospitals. HCW education, psychosocial support and staff communication could improve knowledge of appropriate pandemic interventions and confidence in antivirals.
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Affiliation(s)
- Holly Seale
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Julie Leask
- National Centre for Immunization Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Discipline of Pediatrics and Child Health and School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kieren Po
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- National Centre for Immunization Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, Discipline of Pediatrics and Child Health and School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Ives J, Greenfield S, Parry JM, Draper H, Gratus C, Petts JI, Sorell T, Wilson S. Healthcare workers' attitudes to working during pandemic influenza: a qualitative study. BMC Public Health 2009; 9:56. [PMID: 19216738 PMCID: PMC2654560 DOI: 10.1186/1471-2458-9-56] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 02/12/2009] [Indexed: 12/02/2022] Open
Abstract
Background Healthcare workers (HCWs) will play a key role in any response to pandemic influenza, and the UK healthcare system's ability to cope during an influenza pandemic will depend, to a large extent, on the number of HCWs who are able and willing to work through the crisis. UK emergency planning will be improved if planners have a better understanding of the reasons UK HCWs may have for their absenteeism, and what might motivate them to work during an influenza pandemic. This paper reports the results of a qualitative study that explored UK HCWs' views (n = 64) about working during an influenza pandemic, in order to identify factors that might influence their willingness and ability to work and to identify potential sources of any perceived duty on HCWs to work. Methods A qualitative study, using focus groups (n = 9) and interviews (n = 5). Results HCWs across a range of roles and grades tended to feel motivated by a sense of obligation to work through an influenza pandemic. A number of significant barriers that may prevent them from doing so were also identified. Perceived barriers to the ability to work included being ill oneself, transport difficulties, and childcare responsibilities. Perceived barriers to the willingness to work included: prioritising the wellbeing of family members; a lack of trust in, and goodwill towards, the NHS; a lack of information about the risks and what is expected of them during the crisis; fear of litigation; and the feeling that employers do not take the needs of staff seriously. Barriers to ability and barriers to willingness, however, are difficult to separate out. Conclusion Although our participants tended to feel a general obligation to work during an influenza pandemic, there are barriers to working, which, if generalisable, may significantly reduce the NHS workforce during a pandemic. The barriers identified are both barriers to willingness and to ability. This suggests that pandemic planning needs to take into account the possibility that staff may be absent for reasons beyond those currently anticipated in UK planning documents. In particular, staff who are physically able to attend work may nonetheless be unwilling to do so. Although there are some barriers that cannot be mitigated by employers (such as illness, transport infrastructure etc.), there are a number of remedial steps that can be taken to lesson the impact of others (providing accommodation, building reciprocity, provision of information and guidance etc). We suggest that barriers to working lie along an ability/willingness continuum, and that absenteeism may be reduced by taking steps to prevent barriers to willingness becoming perceived barriers to ability.
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Affiliation(s)
- Jonathan Ives
- Centre for Biomedical Ethics, The University of Birmingham, Birmingham, UK.
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Abstract
Nurses are the largest group of healthcare providers and will be at the forefront during a response to a bioterrorism attack in the U.S. However, nurses' bioterrorism risk perceptions and their participation in bioterrorism preparedness activities, such as bioterrorism-related exercises or drills, have not been evaluated. We mailed a survey to all members of the Missouri Nurses Association in July 2006, consisting of 1,528 registered nurses. The instrument measured risk perception, perceived susceptibility, perceived seriousness, bioterrorism education received, participation in exercises/drills, and personal response plan thoroughness. The response rate was 31% (474/1,528). Most respondents believe that a bioterrorism attack will occur in the U.S. (82.3%; n = 390), but few (21.3%; n = 101) believe that one will occur in their community. The majority of nurses reported that they believe that a bioterrorism attack would have serious consequences (96.1%, n = 448), including having a serious impact on U.S. citizens' safety (90.7%, n = 446) and on their own safety (84.3%, n = 379). Most (60%, n = 284) reported that they had not received any bioterrorism-related education nor participated in any drills/exercises (82.7%, n = 392). Of those who had received education, most had participated in 3 or fewer programs and in only 1 drill. Few nurses (3.6%, n = 15) reported having all aspects of a personal bioterrorism response plan; approximately 20% (19.4%, n = 81) did not have any components of a plan. Most of the registered nurses in Missouri who were surveyed are not receiving bioterrorism education, participating in bioterrorism exercises, or developing thorough personal response plans. Nurses need to be aware of and encouraged to participate in the many education and training opportunities on bioterrorism and infectious disease disasters.
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Affiliation(s)
- Terri Rebmann
- Institute for Biosecurity, Saint Louis University School of Public Health, Saint Louis, MO 63104, USA.
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Improving hospital preparedness for radiological terrorism: perspectives from emergency department physicians and nurses. Disaster Med Public Health Prep 2009; 2:174-84. [PMID: 18813129 DOI: 10.1097/dmp.0b013e31817dcd9a] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospital emergency department (ED) clinicians will play a crucial role in responding to any terrorist incident involving radioactive materials. To date, however, there has been a paucity of research focusing specifically on ED clinicians' perspectives regarding this threat. METHODS At the request of the Centers for Disease Control and Prevention, researchers at the University of Alabama at Birmingham conducted a series of 10 focus groups (total participants, 77) with ED physicians and nurses at hospitals in 3 US regions. Participants considered a hypothetical "dirty bomb" scenario and discussed their perceptions, concerns, information needs, preferred information sources, and views of current guidance and informational materials. RESULTS Study participants consistently expressed the view that neither EDs nor hospital facilities are sufficiently prepared for a terrorist event involving radioactive materials. Key clinician concerns included the possibility of the hospital being overwhelmed, safety of loved ones, potential staffing problems, readiness problems, and contamination and self-protection. Participants also expressed a need for additional information, strongly disagreed with aspects of current response guidance, and in some cases indicated they would not carry out current protocols. CONCLUSIONS This study is the first to examine the views, perceptions, and information needs of hospital ED clinicians regarding radiological terrorism. As such, the findings may be useful in informing current and future efforts to improve hospital preparedness.
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Abstract
In recent years, emergency preparedness has continued to be a major focus for many health care providers. This study measured public health workers' opinions on disaster preparedness, assessed workers' likelihood of reporting to various types of disasters, and evaluated conditions that will encourage workers to report to work. A focus group and literature search were conducted to inform a survey that would assess attitudes about disasters. Frequencies were calculated on survey responses. Most respondents believed other employees could perform their jobs during a disaster; however, fewer than two thirds thought their coworkers would report to work under such circumstances. Fewer than three fourths of respondents would report to work during an emergency involving a known chemical, an unknown biological, a radiological, a biological incurable, or an unknown chemical agent. These results indicate training gaps that should be addressed in future training sessions at the two health departments surveyed.
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Casman EA, Fischhoff B. Risk communication planning for the aftermath of a plague bioattack. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2008; 28:1327-1342. [PMID: 18564992 DOI: 10.1111/j.1539-6924.2008.01080.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We create an influence diagram of how a plague bioattack could unfold and then use it to identify factors shaping infection risks in many possible scenarios. The influence diagram and associated explanations provide a compact reference that allows risk communicators to identify key messages for pre-event preparation and testing. It can also be used to answer specific questions in whatever unique situations arise, considering both the conditions of the attack and the properties of the attacked populations. The influence diagram allows a quick, visual check of the factors that must be covered when evaluating audience information needs. The documentation provides content for explaining the resultant advice. We show how these tools can help in preparing for crises and responding to them.
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Affiliation(s)
- Elizabeth A Casman
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA 15213 USA.
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Crawford SO, Reich NG, An MW, Brookmeyer R, Louis TA, Nelson KE, Notari EP, Trouern-Trend J, Zou S. Regional and temporal variation in American Red Cross blood donations, 1995 to 2005. Transfusion 2008; 48:1576-83. [DOI: 10.1111/j.1537-2995.2008.01755.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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259
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Schluger NW. Suppose they gave an epidemic and nobody came? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2008; 8:23-25. [PMID: 18802852 DOI: 10.1080/15265160802318188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Neil W Schluger
- Columbia University Medical Center, PH-9 East, Room 101, 622 West 168th Street, New York, NY 10032, USA.
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Ehrenstein BP. Pandemic influenza: are we prepared to face our obligations? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:165. [PMID: 18638362 PMCID: PMC2575555 DOI: 10.1186/cc6938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
After decades of low personal risk for contracting lethal diseases, physicians are suddenly facing the possibility of a substantial increase in occupational risk during an influenza pandemic. If they are not confronted before the onset of an influenza pandemic, feelings of unease and fear or ignorance about physicians' professional obligations could profoundly hinder individual physicians in fulfilling their professional duties. Such feelings could therefore undermine institutional and societal preparations. In their review published in Critical Care, Anantham and coworkers outline the ethical framework that forms the basis of the professional obligations of physicians who respond to health care emergencies, such as an influenza pandemic.
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261
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Anantham D, McHugh W, O'Neill S, Forrow L. Clinical review: influenza pandemic - physicians and their obligations. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:217. [PMID: 18598380 PMCID: PMC2481470 DOI: 10.1186/cc6918] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
An influenza pandemic threatens to be the most lethal public health crisis to confront the world. Physicians will have critical roles in diagnosis, containment and treatment of influenza, and their commitment to treat despite increased personal risks is essential for a successful public health response. The obligations of the medical profession stem from the unique skills of its practitioners, who are able to provide more effective aid than the general public in a medical emergency. The free choice of profession and the societal contract from which doctors derive substantial benefits affirm this commitment. In hospitals, the duty will fall upon specialties that are most qualified to deal with an influenza pandemic, such as critical care, pulmonology, anesthesiology and emergency medicine. It is unrealistic to expect that this obligation to treat should be burdened with unlimited risks. Instead, risks should be minimized and justified against the effectiveness of interventions. Institutional and public cooperation in logistics, remuneration and psychological/legal support may help remove the barriers to the ability to treat. By stepping forward in duty during such a pandemic, physicians will be able to reaffirm the ethical center of the profession and lead the rest of the healthcare team in overcoming the medical crisis.
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Affiliation(s)
- Devanand Anantham
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Duke-NUS Graduate Medical School, Outram Road, Singapore 169608, Singapore.
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262
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Wong TY, Koh GCH, Cheong SK, Sundram M, Koh K, Chia SE, Koh D. A Cross-sectional Study of Primary-care Physicians in Singapore on Their Concerns and Preparedness for an Avian Influenza Outbreak. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2008. [DOI: 10.47102/annals-acadmedsg.v37n6p458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Introduction: During an avian influenza (AI) pandemic, primary-care physicians (PCPs) are expected to play key roles in the prevention and control of the disease. Different groups of PCPs could have different concerns and preparedness level. We assessed the concerns, perceived impact and preparedness for an outbreak among PCPs in Singapore.
Materials and Methods: A cross-sectional survey of PCPs working in private practice (n = 200) and public clinics (n = 205) from March to June 2006 with an anonymous self-administered questionnaire on concerns (12- items), perceived impact (10 items) and preparedness (10 items) for an outbreak.
Results: Two hundred and eighty-five PCPs responded – 149 (response rate: 72.7%) public and 136 (response rate: 67.3%) private. The majority were concerned about risk to their health from their occupation (95.0%) and falling ill with AI (89.7%). Most (82.5%) accepted the risk and only 33 (11.8%) would consider stopping work. For perceived impact, most felt that people would avoid them (69.6%) and their families (54.1%). The majority (81.3%) expected an increased workload and feeling more stressed at work (86.9%). For preparedness, 78.7% felt personally prepared for an outbreak. Public PCPs were more likely to be involved in infection-control activities and felt that their workplaces were prepared.
Conclusions: Most PCPs felt personally prepared for an outbreak but were concerned about their exposure to AI and falling ill. Other concerns included social ostracism for themselves and their families. Public PCPs appeared to have a higher level of preparation. Addressing concerns and improving level of preparedness are crucial to strengthen the primary-care response for any AI outbreak.
Key words: Impact, Bird flu, Planning, Response
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Affiliation(s)
| | | | | | | | | | | | - David Koh
- National University of Singapore, Singapore
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263
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Draper H, Wilson S, Ives J, Gratus C, Greenfield S, Parry J, Petts J, Sorell T. Healthcare workers' attitudes towards working during pandemic influenza: a multi method study. BMC Public Health 2008; 8:192. [PMID: 18518971 PMCID: PMC2423372 DOI: 10.1186/1471-2458-8-192] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 06/02/2008] [Indexed: 11/16/2022] Open
Abstract
Background Healthcare workers (HCWs) will be key players in any response to pandemic influenza, and will be in the front line of exposure to infection. Responding effectively to a pandemic relies on the majority of medical, nursing, laboratory and hotel services staff continuing to work normally. Planning assumes that during a pandemic normal healthcare service levels will be provided, although it anticipates that as caseloads increase only essential care will be provided. The ability of the NHS to provide expected service levels is entirely dependent upon HCWs continuing to work as normal. Methods/design This study is designed as a two-phase multi-method study, incorporating focus groups and a questionnaire survey. In phase one, qualitative methods will be used to collect the views of a purposive sample of HCWs, to determine the range of factors associated with their responses to the prospect of working through pandemic influenza. In phase two, the findings from the focus groups, combined with the available literature, will be used to inform the design of a survey to determine the generalisability of these factors, enabling the estimation of the likely proportion of HCWs affected by each factor, and how likely it is that they would be willing and/or able to continue to work during an influenza pandemic. Discussion There are potentially greater than normal health risks for some healthcare workers working during a pandemic, and these workers may be concerned about infecting family members/friends. HCWs will be as liable as other workers to care for sick family members and friends. It is vital to have information about how motivated HCWs will be to continue to work during such a crisis, and what factors might influence their decision to work/not to work. Through the identification and subsequent management of these factors it may be possible to implement strategies that will alleviate the concerns and fears of HCWs and remove potential barriers to working.
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Affiliation(s)
- Heather Draper
- Centre for Biomedical Ethics, Department of Primary Care and General Practice, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Christian MD, Devereaux AV, Dichter JR, Geiling JA, Rubinson L. Definitive care for the critically ill during a disaster: current capabilities and limitations: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest 2008; 133:8S-17S. [PMID: 18460503 PMCID: PMC7094433 DOI: 10.1378/chest.07-2707] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Accepted: 03/03/2008] [Indexed: 12/27/2022] Open
Abstract
In the twentieth century, rarely have mass casualty events yielded hundreds or thousands of critically ill patients requiring definitive critical care. However, future catastrophic natural disasters, epidemics or pandemics, nuclear device detonations, or large chemical exposures may change usual disaster epidemiology and require a large critical care response. This article reviews the existing state of emergency preparedness for mass critical illness and presents an analysis of limitations to support the suggestions of the Task Force on Mass Casualty Critical Care, which are presented in subsequent articles. Baseline shortages of specialized resources such as critical care staff, medical supplies, and treatment spaces are likely to limit the number of critically ill victims who can receive life-sustaining interventions. The deficiency in critical care surge capacity is exacerbated by lack of a sufficient framework to integrate critical care within the overall institutional response and coordination of critical care across local institutions and broader geographic areas.
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Affiliation(s)
- Michael D Christian
- FRCPC, Mount Sinai Hospital, 600 University Ave, Suite 18-206, Toronto, ON, Canada M5G 1X5.
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265
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Iserson KV, Heine CE, Larkin GL, Moskop JC, Baruch J, Aswegan AL. Fight or flight: the ethics of emergency physician disaster response. Ann Emerg Med 2008; 51:345-53. [PMID: 17950487 PMCID: PMC7124291 DOI: 10.1016/j.annemergmed.2007.07.024] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 07/27/2007] [Accepted: 07/30/2007] [Indexed: 11/21/2022]
Abstract
Most disaster plans depend on using emergency physicians, nurses, emergency department support staff, and out-of-hospital personnel to maintain the health care system's front line during crises that involve personal risk to themselves or their families. Planners automatically assume that emergency health care workers will respond. However, we need to ask: Should they, and will they, work rather than flee? The answer involves basic moral and personal issues. This article identifies and examines the factors that influence health care workers' decisions in these situations. After reviewing physicians' response to past disasters and epidemics, we evaluate how much danger they actually faced. Next, we examine guidelines from medical professional organizations about physicians' duty to provide care despite personal risks, although we acknowledge that individuals will interpret and apply professional expectations and norms according to their own situation and values. The article goes on to articulate moral arguments for a duty to treat during disasters and social crises, as well as moral reasons that may limit or override such a duty. How fear influences behavior is examined, as are the institutional and social measures that can be taken to control fear and to encourage health professionals to provide treatment in crisis situations. Finally, the article emphasizes the importance of effective risk communication in enabling health care professionals and the public to make informed and defensible decisions during disasters. We conclude that the decision to stay or leave will ultimately depend on individuals' risk assessment and their value systems. Preparations for the next pandemic or disaster should include policies that encourage emergency physicians, who are inevitably among those at highest risk, to "stay and fight."
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Affiliation(s)
- Kenneth V. Iserson
- Department of Emergency Medicine, and the Arizona Bioethics Program of the University of Arizona College of Medicine, Tucson, AZ,Address for correspondence: Kenneth V. Iserson, MD, MBA, University of Arizona, 1501 N. Campbell Avenue, POB 245057, Tucson, AZ 85724; 520-626-2398
| | | | | | - John C. Moskop
- The Brody School of Medicine at East Carolina University, and Bioethics Center, University Health Systems of Eastern Carolina, Greenville, NC
| | - Jay Baruch
- Department of Emergency Medicine, Brown University, and Ethics Curriculum at the Warren Alpert Medical School of Brown University, Elkton, MD
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266
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Community Health Centers and Emergency Preparedness: An Assessment of Competencies and Training Needs. J Community Health 2008; 33:241-7. [DOI: 10.1007/s10900-008-9093-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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267
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Bryce E, Forrester L, Scharf S, Eshghpour M. What do healthcare workers think? A survey of facial protection equipment user preferences. J Hosp Infect 2008; 68:241-7. [PMID: 18295373 DOI: 10.1016/j.jhin.2007.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 12/18/2007] [Indexed: 10/22/2022]
Abstract
Data on healthcare workers'(HCWs) self-reported knowledge regarding selection of facial protection equipment, usage preferences and compliance are limited. We used a questionnaire on the use of facial protection equipment at a 700-bed adult tertiary care hospital employing approximately 7000 HCWs. Clinical areas targeted were those with frequent users of N95 respirators: intensive care unit, emergency room, respiratory services, and internal medicine. Respiratory therapists were also invited. In all, 137 questionnaires (68.5%) were returned. Most (72.8%) reported that training on the use of facial protection equipment was 'sufficient' to 'excellent'. The PFR95 and 3M 1860 Cone were used most frequently (56%) followed by the 3M 1870 Pocket (42%). While 95% reported having been fit-tested, only 60% were tested annually. PRF95 use exceeded the number of HCWs fit-tested for the item. Overall comfort and compliance scores were 13.6/20 and 21.5/25, respectively, for respirators and 7.7/10 and 18.5/25 for protective eyewear. No relationship between comfort and years of use of either respirators or protective eyewear was found. The results highlight potential failures in effectiveness in the use of personal protective equipment that could compromise HCW safety, and support observations that compliance in the workplace is usually less than in the research setting.
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Affiliation(s)
- E Bryce
- Vancouver Coastal Health, Vancouver, British Columbia, Canada.
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269
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Preparing Medical Personnel to Work a Chemical or Biological Incident: a ‘Readiness and Resiliency’ Model. Psychiatr Ann 2007. [DOI: 10.3928/00485713-20071101-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Miller CW, Whitcomb RC, Ansari A, McCurley C, Guinn A, Tucker F. The roles of medical health physicists in a medical radiation emergency. HEALTH PHYSICS 2007; 93:S187-S190. [PMID: 18049249 DOI: 10.1097/01.hp.0000281180.96259.a8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Medical health physicists working in a clinical setting will have a number of key roles in the event of a nuclear or radiological emergency, such as a terrorist attack involving a radiological dispersal device or an improvised nuclear device. Their first responsibility, of course, is to assist hospital administrators and facility managers in developing radiological emergency response plans for their facilities and train staff prior to an emergency. During a hospital's response to a nuclear or radiological emergency, medical health physicists may be asked to (1) evaluate the level of radiological contamination in or on incoming victims; (2) help the medical staff evaluate and understand the significance to patient and staff of the levels of radioactivity with which they are dealing; (3) orient responding medical staff with principles of dealing with radioactive contaminants; (4) provide guidance to staff on decontamination of patients, facilities, and the vehicles in which patients were transported; and (5) assist local public health authorities in monitoring people who are not injured but who have been or are concerned that they may have been exposed to radioactive materials or radiation as a result of the incident. Medical health physicists may also be called upon to communicate with staff, patients, and the media on radiological issues related to the event. Materials are available from a number of sources to assist in these efforts. The Centers for Disease Control and Prevention (CDC) is developing guidance in the areas of radiological population monitoring, handling contaminated fatalities, and using hospital equipment for emergency monitoring. CDC is also developing training and information materials that may be useful to medical health physicists who are called upon to assist in developing facility response plans or respond to a nuclear or radiological incident. Comments on these materials are encouraged.
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Affiliation(s)
- Charles W Miller
- Radiation Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Levin PJ, Gebbie EN, Qureshi K. Can the health-care system meet the challenge of pandemic flu? Planning, ethical, and workforce considerations. Public Health Rep 2007; 122:573-8. [PMID: 17877303 PMCID: PMC1936949 DOI: 10.1177/003335490712200503] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The federal pandemic influenza plan predicts that 30% of the population could be infected. The impact of this pandemic would quickly overwhelm the public health and health-care delivery systems in the U.S. and throughout the world. Surge capacity for staffing, availability of drugs and supplies, and alternate means to provide care must be included in detailed plans that are tested and drilled ahead of time. Accurate information on the disease must be made available to health-care staff and the public to reduce fear. Spokespersons must provide clear, consistent messages about the disease, including actions to be taken to contain its spread and treat the afflicted. Home care will be especially important, as hospitals will be quickly overwhelmed. Staff must be prepared ahead of time to assure their ability and willingness to report to work, and public health must plan ahead to adequately confront ethical issues that will arise concerning the availability of treatment resources. The entire community must work together to meet the challenges posed by an epidemic. Identification and resolution of these challenges and issues are essential to achieve adequate public health preparedness.
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Affiliation(s)
- Peter J Levin
- School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA.
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272
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Cheong SK, Wong TY, Lee HY, Fong YT, Tan BY, Koh GC, Chan KM, Chia SE, Koh D. Concerns and preparedness for an avian influenza pandemic: a comparison between community hospital and tertiary hospital healthcare workers. INDUSTRIAL HEALTH 2007; 45:653-661. [PMID: 18057808 DOI: 10.2486/indhealth.45.653] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Little is known about differences in levels of concerns or preparedness for an avian influenza (AI) pandemic among healthcare workers (HCWs) in different types of hospitals. We compared these concerns and preparedness between 326 HCWs of two community hospitals (CHs) and 908 HCWs from a tertiary hospital (TH) using a self-administered questionnaire between March-June 2006. Response rates were 84.2% and 80.0% from the CHs and TH. Most HCWs (71.6%) felt prepared for an AI outbreak and had significant concerns. They perceive an AI pandemic having adverse impacts on their personal life and work, such as people avoiding them (57.1%). A greater percentage of TH compared to CH HCWs expressed concerns such as feeling their jobs put them at great AI exposure (78.3% vs 67.5%, p=0.012). TH HCWs were more likely to report participating in readiness preparation activities, such as training for infection control (90.0% vs 82.2%, p=0.014) and feel that they (74.1% vs 64.7%, p=0.045) and their hospital (86.8% vs 71.8%, p=0.000) were prepared for an outbreak. Healthcare institutions need to include personal, psychological and family concerns on the agenda and increase participation in readiness preparation activities among HCWs to help prepare for such future crises.
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Affiliation(s)
- Seng Kwing Cheong
- Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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273
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Eastman AL, Rinnert KJ, Nemeth IR, Fowler RL, Minei JP. Alternate site surge capacity in times of public health disaster maintains trauma center and emergency department integrity: Hurricane Katrina. ACTA ACUST UNITED AC 2007; 63:253-7. [PMID: 17693820 DOI: 10.1097/ta.0b013e3180d0a70e] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospital surge capacity has been advocated to accommodate large increases in demand for healthcare; however, existing urban trauma centers and emergency departments (TC/EDs) face barriers to providing timely care even at baseline patient volumes. The purpose of this study is to describe how alternate-site medical surge capacity absorbed large patient volumes while minimizing impact on routine TC/ED operations immediately after Hurricane Katrina. METHODS From September 1 to 16, 2005, an alternate site for medical care was established. Using an off-site space, the Dallas Convention Center Medical Unit (DCCMU) was established to meet the increased demand for care. Data were collected and compared with TC/ED patient volumes to assess impact on existing facilities. RESULTS During the study period, 23,231 persons displaced by Hurricane Katrina were registered to receive evacuee services in the City of Dallas, Texas. From those displaced, 10,367 visits for emergent or urgent healthcare were seen at the DCCMU. The mean number of daily visits (mean +/- SD) to the DCCMU was 619 +/- 301 visits with a peak on day 3 (n = 1,125). No patients died, 3.2% (n = 257) were observed in the DCCMU, and only 2.9% (n = 236) required transport to a TC/ED. During the same period, the mean number of TC/ED visits at the region's primary provider of indigent care (Hospital 1) was 346 +/- 36 visits. Using historical data from Hospital 1 during the same period of time (341 +/- 41), there was no significant difference in the mean number of TC/ED visits from the previous year (p = 0.26). CONCLUSIONS Alternate-site medical surge capacity provides for safe and effective delivery of care to a large influx of patients seeking urgent and emergent care. This protects the integrity of existing public hospital TC/ED infrastructure and ongoing operations.
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Affiliation(s)
- Alexander L Eastman
- Section of EMS, Disaster Management and Homeland Security and Division of Burns, Trauma and Critical Care, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-8890, USA.
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274
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275
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Mackler N, Wilkerson W, Cinti S. Will first-responders show up for work during a pandemic? Lessons from a smallpox vaccination survey of paramedics. ACTA ACUST UNITED AC 2007; 5:45-8. [PMID: 17517362 PMCID: PMC7110586 DOI: 10.1016/j.dmr.2007.02.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 02/12/2007] [Accepted: 02/13/2007] [Indexed: 11/17/2022]
Abstract
Background The presence of H5N1 influenza in Southeast Asia has reawakened fears of a worldwide influenza pandemic of the sort that occurred in 1918. It is estimated that up to 1.9 million people in the United States could die if such an outbreak occurs. It is unlikely that a vaccine for a pandemic strain will be available quickly enough to protect first-responders. Similar concerns existed in 2002 when the United States attempted to vaccinate first-responders against smallpox, a potential biologic weapon. Method We conducted a survey of one group of first-responders, paramedics, to determine if fear of infection would compromise their ability to care for persons potentially infected with smallpox. Results Three hundred paramedics were given the survey, and 95 (32%) responded. More than 80% of paramedics polled would not remain on duty if there were no vaccine and no protective gear. Even if protective gear was available but the vaccine was unavailable, only 39% of respondents would remain on duty. Finally, although 91% of paramedics would remain on duty if they were fully protected, this number falls to 38% if the respondent believed that his or her immediate family was not protected. The results of this survey are relevant to current concerns about an influenza pandemic. Every effort must be made to protect first-responders from pandemic influenza and educate them about it.
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Affiliation(s)
| | | | - Sandro Cinti
- Reprint requests: Sandro Cinti, MD, Assistant Professor, Infectious Diseases, University of Michigan Hospitals/Ann Arbor VA Medical Center, 2215 Fuller Rd, Ann Arbor, MI 48105.
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276
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Affiliation(s)
- Robert Nash
- University of Oxford Medical School, John Radcliffe Hospital, Oxford OX3 9DU, UK.
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277
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Affiliation(s)
- Geraldine A Coyle
- Emergency Management Strategic Healthcare Group, Department of Veterans Affairs, Martinsburg, WV, USA
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278
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Rogers B, Lawhorn E. Disaster preparedness: occupational and environmental health professionals' response to Hurricanes Katrina and Rita. ACTA ACUST UNITED AC 2007; 55:197-207; quiz 208-9. [PMID: 17526297 DOI: 10.1177/216507990705500506] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In disaster-related events such as these, this survey demonstrates clear need for improved preparedness efforts and communication strategies to help reduce health risks for at-risk populations. The role of occupational health nurses and occupational and environmental medicine physicians requires knowledge and skills in many areas. This includes not only clinical skills related to illness and injury that will occur, but also skills in such areas as surveillance, management, community coordination, risk management and risk communication, and health protection. The psychological impact of disasters will have far-reaching effects resulting in emotional and behavioral changes requiring both immediate and long-term interventions. Comprehensive disaster management guidance should be in place to assist health care providers and workers in pre-event, event, and post-event phases of the disaster.
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Affiliation(s)
- Bonnie Rogers
- North Carolina Occupational Safety and Health Education and Research Center and Occupational Health Nursing Program, University of North Carolina, School of Public Health, Chapel Hill, USA
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279
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Blessman J, Skupski J, Jamil M, Jamil H, Bassett D, Wabeke R, Arnetz B. Barriers to at-home-preparedness in public health employees: implications for disaster preparedness training. J Occup Environ Med 2007; 49:318-26. [PMID: 17351518 DOI: 10.1097/jom.0b013e31803225c7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To assess "at-home" preparedness and barriers to preparedness in a cohort of public health employees. METHOD Conducted a cross-sectional survey involving 100 employees attending emergency preparedness training that emphasized incident command training and included a segment on "at-home" preparedness. RESULTS Fifteen percent of participants were rated as "better prepared," and only 8% of participants would be considered "most prepared." There was no relationship between the concern for bioterrorism and other disasters and preparedness. The principal barrier involved challenges in getting the task done versus lack of desire or knowledge. CONCLUSIONS There is great potential for distraction of public health workers during an emergent event if they are not prepared at home and have concern for family members. At-home preparedness training efforts that emphasize what should be done and why are likely to have limited impact on changing behavior. Strategies that ensure that small steps are taken are likely to be more successful.
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Affiliation(s)
- James Blessman
- Wayne State University, Department of Family and Community Health Sciences, Detroit, MI, USA.
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280
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Bracha HS, Burkle FM. Utility of fear severity and individual resilience scoring as a surge capacity, triage management tool during large-scale, bio-event disasters. Prehosp Disaster Med 2007; 21:290-6; discussion 297-8. [PMID: 17297897 DOI: 10.1017/s1049023x00003897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Threats of bioterrorism and emerging infectious disease pandemics may result in fear-related consequences. If left undetected and untreated, fear-based signs and symptoms may be extremely debilitating and lead to chronic problems with a risk of permanent damage to the brain's locus coeruleus and stress response circuits. The triage management of susceptible, exposed, and infectious victims seeking care must be sensitive and specific enough to identify individuals with excessive levels of fear in order to address the nuances of fear-based symptoms at the initial point of contact. These acute conditions, which include hyper-vigilant fear, are managed best by timely and effective information, rapid evaluation, and possibly medications that uniquely address the locus-coeruleus-driven noradrenalin over-activation. It is recommended that a Fear and Resilience (FR) Checklist be included as an essential triage tool to identify those most at risk. The use of this checklist facilitates an enhanced capacity to respond to limitations brought about by surge capacity requirements. Whereas the utility of such a checklist is evident, predictive validity studies will be required. In addition to identifying individuals who are emotionally, medically, and socially hypo-resilient, the FR Checklist simultaneously identifies individuals who are hyper-resilient and can be asked to volunteer, and thus, rapidly expand the surge capacity.
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Affiliation(s)
- H Stefan Bracha
- National Center for Post-Traumatic Stress Disorder, Pacific Islands Division, Department of Veterans Affairs, Pacific Islands Health Care System, Spark M. Matsunaga Medical Center, Honolulu, Hawaii 96819, USA
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281
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Dosa DM, Grossman N, Wetle T, Mor V. To Evacuate or Not to Evacuate: Lessons Learned From Louisiana Nursing Home Administrators Following Hurricanes Katrina and Rita. J Am Med Dir Assoc 2007; 8:142-9. [PMID: 17349942 DOI: 10.1016/j.jamda.2006.11.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 11/10/2006] [Accepted: 11/23/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the "lessons learned" by Louisiana Nursing Home (NH) administrative directors (ADs) forced to make decisions relating to resident evacuation before Hurricanes Katrina and Rita and determine how emergency planning has changed in those NHs. DESIGN Twenty in-depth telephone interviews followed by a focus group conducted in New Orleans. SETTING Louisiana NHs in parishes affected by Hurricanes Katrina and Rita. PARTICIPANTS Twenty ADs employed by affected NHs during August and September 2005. MEASUREMENTS Qualitative data sources consisted of transcribed telephone and focus group interviews. Data were analyzed using narrative summary analysis and descriptive data were tabulated using an abstraction tool. RESULTS Nine of 20 NHs evacuated before the hurricanes and 11 sheltered in place. Six additional NHs evacuated following the storms. The most common perceived consequences related to the evacuation process were resident morbidity or mortality (6 of 15), transportation issues (5 of 15), and staffing deficiencies (3 of 15). Common findings among the NHs that sheltered in place included supply shortages (8 of 11), facility damage (5 of 11), and staffing issues (4 of 11). CONCLUSION Respondents noted 4 general themes during the interviews and focus group session: (1) ADs felt abandoned by the state and federal emergency response apparatus during and after the hurricanes, and continue to feel that they are not a priority; (2) there is substantial physical and technical difficulty in evacuating frail NH residents; (3) staff retention remains a critical problem regardless of the evacuation decision; (4) there are key "lessons learned" that can be incorporated into future disaster planning.
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Affiliation(s)
- David M Dosa
- Department of Medicine and Community Health, Brown University, Providence, RI, USA.
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282
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Malone JD. Pre-event smallpox vaccination for healthcare workers revisited--the need for a carefully screened multidisciplinary cadre. Int J Infect Dis 2007; 11:93-7. [PMID: 17306582 PMCID: PMC7110476 DOI: 10.1016/j.ijid.2006.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 11/02/2006] [Accepted: 11/08/2006] [Indexed: 01/13/2023] Open
Abstract
As healthcare institutions are a focus of smallpox transmission early in an epidemic, several mathematical models support pre-event smallpox vaccination of healthcare workers (HCWs). The deciding factor for HCW voluntary vaccination is the risk of disease exposure versus the risk of vaccine adverse events. In a United States military population, with careful screening to exclude atopic dermatitis/eczema and immunosuppression, over 1 million vaccinia (smallpox) vaccinations were delivered with one fatality attributed to vaccination. Among 37901 United States civilian volunteer HCWs vaccinated, 100 serious adverse events were reported including 10 ischemic cardiac episodes and six myocardial infarctions - two were fatal. This older population had a higher rate of adverse events due to age-related coronary artery disease. T-cell mediated inflammatory processes induced by live vaccinia vaccination may have a role in the observed acute coronary artery events. With exclusion of individuals at risk for coronary artery disease, atopic dermatitis/eczema, and immunosuppression, HCWs can be smallpox vaccinated with minimal risk. A carefully screened multidisciplinary cadre (physician, nurse, infection control practitioner, technician), pre-event vaccinated for smallpox, will supply the necessary leadership to alleviate fear and uncertainty while limiting spread and initial mortality of smallpox.
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Affiliation(s)
- John D Malone
- Center for Biological Monitoring and Modeling, Pacific Northwest National Laboratory, MSIN:P7-51, 902 Battelle Boulevard, PO Box 999, Richland, WA 99352, USA.
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283
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Ehrenstein BP, Hanses F, Salzberger B. Influenza pandemic and professional duty: family or patients first? A survey of hospital employees. BMC Public Health 2006; 6:311. [PMID: 17192198 PMCID: PMC1764890 DOI: 10.1186/1471-2458-6-311] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 12/28/2006] [Indexed: 11/17/2022] Open
Abstract
Background Conflicts between professional duties and fear of influenza transmission to family members may arise among health care professionals (HCP). Methods We surveyed employees at our university hospital regarding ethical issues arising during the management of an influenza pandemic. Results Of 644 respondents, 182 (28%) agreed that it would be professionally acceptable for HCP to abandon their workplace during a pandemic in order to protect themselves and their families, 337 (52%) disagreed with this statement and 125 (19%) had no opinion, with a higher rate of disagreement among physicians (65%) and nurses (54%) compared with administrators (32%). Of all respondents, 375 (58%) did not believe that the decision to report to work during a pandemic should be left to the individual HCP and 496 (77%) disagreed with the statement that HCP should be permanently dismissed for not reporting to work during a pandemic. Only 136 (21%) respondents agreed that HCW without children should primarily care for the influenza patients. Conclusion Our results suggest that a modest majority of HCP, but only a minority of hospital administrators, recognises the obligation to treat patients despite the potential risks. Professional ethical guidelines allowing for balancing the needs of society with personal risks are needed to help HCP fulfil their duties in the case of a pandemic influenza.
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MESH Headings
- Absenteeism
- Adult
- Attitude of Health Personnel
- Disease Outbreaks
- Employment/ethics
- Female
- Germany
- Health Knowledge, Attitudes, Practice
- Hospital Administrators/education
- Hospital Administrators/ethics
- Hospital Administrators/psychology
- Hospitals, University/ethics
- Humans
- Influenza A Virus, H5N1 Subtype/pathogenicity
- Influenza, Human/epidemiology
- Influenza, Human/therapy
- Influenza, Human/transmission
- Influenza, Human/virology
- Male
- Medical Staff, Hospital/education
- Medical Staff, Hospital/ethics
- Medical Staff, Hospital/psychology
- Middle Aged
- Moral Obligations
- Nursing Staff, Hospital/education
- Nursing Staff, Hospital/ethics
- Nursing Staff, Hospital/psychology
- Refusal to Treat/statistics & numerical data
- Social Responsibility
- Surveys and Questionnaires
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Affiliation(s)
- Boris P Ehrenstein
- Dept. of Internal Medicine I, University Medical Center Regensburg, Germany
| | - Frank Hanses
- Dept. of Internal Medicine I, University Medical Center Regensburg, Germany
| | - Bernd Salzberger
- Dept. of Internal Medicine I, University Medical Center Regensburg, Germany
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284
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Rubinson L, Branson RD, Pesik N, Talmor D. Positive-pressure ventilation equipment for mass casualty respiratory failure. Biosecur Bioterror 2006; 4:183-94. [PMID: 16792486 DOI: 10.1089/bsp.2006.4.183] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In the event of an influenza pandemic, patients with severe acute respiratory failure (ARF) due to influenza will require positive-pressure ventilation (PPV) in order to survive. In countries with widely available critical care services, PPV is delivered almost exclusively through use of full-feature mechanical ventilators in intensive care units (ICUs) or specialized hospital wards. But the supply of these ventilators is limited even during the normal course of hospital functioning. Purchasing and maintaining additional full-feature mechanical ventilators to be held in reserve and used only during mass casualty events is too expensive to allow the stockpiling of such equipment. Consequently, planning and preparedness efforts to respond to a severe influenza pandemic have stimulated consideration of limited-feature, less-expensive ventilation devices to augment traditional PPV capacity. This article offers guidance to authorities charged with preparing for mass casualty PPV in deciding which PPV equipment would be adequate for ventilating patients for days, weeks, or even months during a medical catastrophe.
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Affiliation(s)
- Lewis Rubinson
- Deschutes County Health Department and Pulmonary and Critical Care Medicine, Bend Memorial Clinic, Bend, Oregon 97701, USA.
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285
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Hanfling D. Equipment, supplies, and pharmaceuticals: how much might it cost to achieve basic surge capacity? Acad Emerg Med 2006; 13:1232-7. [PMID: 16801633 DOI: 10.1197/j.aem.2006.03.567] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The ability to deliver optimal medical care in the setting of a disaster event, regardless of its cause, will in large part be contingent on an immediately available supply of key medical equipment, supplies, and pharmaceuticals. Although the Department of Health and Human Services Strategic National Stockpile program makes these available through its 12-hour "push packs" and vendor-managed inventory, every local community should be funded to create a local cache for these items. This report explores the funding requirements for this suggested approach. Furthermore, the response to a surge in demand for care will be contingent on keeping available staff close to the hospitals for a sustained period. A proposal for accomplishing this, with associated costs, is discussed as well.
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Affiliation(s)
- Dan Hanfling
- Emergency Management and Disaster Medicine, Inova Health System, Falls Church, VA, USA.
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286
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Burkle FM. Population-based triage management in response to surge-capacity requirements during a large-scale bioevent disaster. Acad Emerg Med 2006; 13:1118-29. [PMID: 17015415 DOI: 10.1197/j.aem.2006.06.040] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Both the naturally occurring and deliberate release of a biological agent in a population can bring catastrophic consequences. Although these bioevents have similarities with other disasters, there also are major differences, especially in the approach to triage management of surge capacity resources. Conventional mass-casualty events use uniform methods for triage on the basis of severity of presentation and do not consider exposure, duration, or infectiousness, thereby impeding control of transmission and delaying recognition of victims requiring immediate care. Bioevent triage management must be population based, with the goal of preventing secondary transmission, beginning at the point of contact, to control the epidemic outbreak. Whatever triage system is used, it must first recognize the requirements of those Susceptible but not exposed, those Exposed but not yet infectious, those Infectious, those Removed by death or recovery, and those protected by Vaccination or prophylactic medication (SEIRV methodology). Everyone in the population falls into one of these five categories. This article addresses a population approach to SEIRV-based triage in which decision making falls under a two-phase system with specific measures of effectiveness to increase likelihood of medical success, epidemic control, and conservation of scarce resources.
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Affiliation(s)
- Frederick M Burkle
- Center for Disaster and Refugee Studies, Department of Emergency Medicine, School of Medicine, Johns Hopkins University Medical Institutions, Baltimore, MD, USA.
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287
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Abstract
The spread of H5N1, an avian influenza A virus, to many countries and the direct infection of humans by this virus have increased awareness of the likelihood of a pandemic among humans. The potential impact of pandemic influenza on the safety of the blood supply should be small because of the limited viremia and the nature of respiratory tract infection of influenza viruses. However, the potential impact of pandemic influenza on the availability of the blood supply could be significant because of reduced donation from blood donors and reduced staff capacity at blood centers during a pandemic. On the other hand, there could be reduced hospital admissions and reduced transfusions, at least for certain blood products, which should result in reduced demand for blood products. Studies are needed to further assess the likely impact of a pandemic on the blood supply and also of the possible intervention options.
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Affiliation(s)
- Shimian Zou
- Jerome H. Holland Laboratory for the Biomedical Sciences, American Red Cross Biomedical Services, Rockville, MD 20855, USA.
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288
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289
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O'Boyle C, Robertson C, Secor-Turner M. Nurses' beliefs about public health emergencies: fear of abandonment. Am J Infect Control 2006; 34:351-7. [PMID: 16877103 DOI: 10.1016/j.ajic.2006.01.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Revised: 01/06/2006] [Accepted: 01/09/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Since the events of September 11, 2001, subsequent anthrax mailings, world political events, and natural disasters such as Hurricane Katrina and the recent tsunami, public health emergencies including bioterrorism events are viewed as realistic possibilities. Public health emergencies would stress the current health care system. OBJECTIVE The objective was to identify beliefs and concerns of nurses who work in hospitals designated as receiving sites during public health emergencies. METHODS A qualitative study using focus groups with a total of 33 hospital nurses in 2003 was used. Audiotapes were analyzed, and codes, categories, and a theme were identified. RESULTS Fear of abandonment was the overarching theme. Nurses believed that clinical settings would be chaotic, without a clear chain of command, and with some colleagues refusing to work. Limited access to personal protective equipment, risk of infection, unmanageable numbers of patients, and possibly being assaulted for their personal protective equipment resulted in the sense that they would be in unsafe clinical environments. Loss of freedom to leave the hospital and fears that hospitals would not provide treatment to nurses who become ill as a result of caring for patients contributed to the sense of abandonment. CONCLUSION Although these nurses worked in hospitals with comprehensive public health emergency plans, they believed that they would not have readily accessible material and human resources to cope with a bioterrorism event. Readiness plans should include a systematic assessment of nurses' concerns. Health care readiness plans should incorporate focused interventions to improve safety, a sense of control, and facilitate coping in public health emergencies.
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Affiliation(s)
- Carol O'Boyle
- University of Minnesota, School of Nursing, Minneapolis, 55455, USA.
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290
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Balicer RD, Omer SB, Barnett DJ, Everly GS. Local public health workers' perceptions toward responding to an influenza pandemic. BMC Public Health 2006; 6:99. [PMID: 16620372 PMCID: PMC1459127 DOI: 10.1186/1471-2458-6-99] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Accepted: 04/18/2006] [Indexed: 11/14/2022] Open
Abstract
Background 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. Results 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). Conclusion 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.
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Affiliation(s)
- Ran D Balicer
- Epidemiology Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Saad B Omer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel J Barnett
- Johns Hopkins Center for Public Health Preparedness, Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - George S Everly
- Johns Hopkins Center for Public Health Preparedness, Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Dimaggio C, Markenson D, T Loo G, Redlener I. The Willingness of U.S. Emergency Medical Technicians to Respond to Terrorist Incidents. Biosecur Bioterror 2005; 3:331-7. [PMID: 16366842 DOI: 10.1089/bsp.2005.3.331] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A nationally representative sample of basic and paramedic emergency medical service providers in the United States was surveyed to assess their willingness to respond to terrorist incidents. EMT's were appreciably (9-13%) less willing than able to respond to such potential terrorist-related incidents as smallpox outbreaks, chemical attacks, or radioactive dirty bombs (p<0.0001). EMTs who had received terrorism-related continuing medical education within the previous 2 years were twice as likely (OR=1.9, 95% CI 1.9, 2.0) to be willing to respond to a potential smallpox dissemination incident as those who indicated that they had not received such training. Timely and appropriate training, attention to interpersonal concerns, and instilling a sense of duty may increase first medical provider response rates.
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Affiliation(s)
- Charles Dimaggio
- Columbia University Mailman School of Public Health, New York, NY 10032, USA.
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292
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Case Report: Cyanide as an Unrecognized Cause of Neurological Sequelae in a Fire Victim. Prehosp Disaster Med 2005. [DOI: 10.1017/s1049023x00015442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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293
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Wilson N, Baker M, Crampton P, Mansoor O. The potential impact of the next influenza pandemic on a national primary care medical workforce. HUMAN RESOURCES FOR HEALTH 2005; 3:7. [PMID: 16092972 PMCID: PMC1215505 DOI: 10.1186/1478-4491-3-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Accepted: 08/11/2005] [Indexed: 05/03/2023]
Abstract
BACKGROUND Another influenza pandemic is all but inevitable. We estimated its potential impact on the primary care medical workforce in New Zealand, so that planning could mitigate the disruption from the pandemic and similar challenges. METHODS The model in the "FluAid" software (Centers for Disease Control and Prevention, CDC, Atlanta) was applied to the New Zealand primary care medical workforce (i.e., general practitioners). RESULTS At its peak (week 4) the pandemic would lead to 1.2% to 2.7% loss of medical work time, using conservative baseline assumptions. Most workdays (88%) would be lost due to illness, followed by hospitalisation (8%), and then premature death (4%). Inputs for a "more severe" scenario included greater health effects and time spent caring for sick relatives. For this scenario, 9% of medical workdays would be lost in the peak week, and 3% over a more compressed six-week period of the first pandemic wave. As with the base case, most (64%) of lost workdays would be due to illness, followed by caring for others (31%), hospitalisation (4%), and then premature death (1%). CONCLUSION Preparedness planning for future influenza pandemics must consider the impact on this medical workforce and incorporate strategies to minimise this impact, including infection control measures, well-designed protocols, and improved health sector surge capacity.
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Affiliation(s)
- Nick Wilson
- Department of Public Health, Wellington School of Medicine & Health Sciences, Otago University, Wellington, New Zealand
| | - Michael Baker
- Department of Public Health, Wellington School of Medicine & Health Sciences, Otago University, Wellington, New Zealand
| | - Peter Crampton
- Department of Public Health, Wellington School of Medicine & Health Sciences, Otago University, Wellington, New Zealand
| | - Osman Mansoor
- Public Health Consulting Ltd, Wellington, New Zealand
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294
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Patterns of Facial Bone Fractures following Road Traffic Crashes: A Benin City Experience. Prehosp Disaster Med 2005. [DOI: 10.1017/s1049023x00013765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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295
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Development of a Quantitative Assessment Score for Analyzing Emergency Department Disaster Preparedness. Prehosp Disaster Med 2002. [DOI: 10.1017/s1049023x00010633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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