Willingness of Health Care Personnel to Work in a Disaster: An Integrative Review of the Literature

Nursing students' willingness to respond in disasters: a cross sectional study of facilitators and barriers

INTRODUCTION

The preparedness of the healthcare system to address emergency situations is contingent on the inclination of healthcare personnel. Nursing students can serve as valuable resources to supplement the workforce during major incidents and disasters. This study investigated the facilitators and barriers of nursing students' willingness to respond to disasters at the Alborz University of Medical Sciences in 2022.

METHODS

In this cross-sectional descriptive study, 234 nursing students were recruited using convenience sampling. A deductive-inductive questionnaire was developed and distributed through an online self-administered survey comprising demographic information and questions on barriers, facilitators, various disaster scenarios, preferred activities, and reasons for pursuing a nursing career.

RESULTS

The mean willingness scores of nursing students in response to various disasters were as follows: 3.15 for natural disasters, 2.60 for man-made disasters, 2.94 for pandemics, and 3.32 overall. Among the disaster scenarios, the earthquake response obtained the highest willingness score, while infectious disease epidemics received the lowest score. The most and least willingness to perform activities during disaster response were related to bedside care and participation in patients' personal hygiene, respectively. Key determinants of participation included the possibility of immunization and concerns for family safety.

CONCLUSION

The findings indicated that nursing students are generally willing to assist as members of the healthcare team during disasters. However, the willingness to respond to infectious disease epidemics and man-made disasters was below the norm. Concerns about family health and the risk of disease transmission were identified as primary barriers. Addressing these concerns is crucial to enhance nursing students' participation in disaster response.

Inactive nurses' willingness to return to active nursing during the COVID-19 pandemic: A qualitative study

AIMS

To investigate factors that influence the willingness of inactive nurses to return to nursing in a crisis situation and to identify aspects that need to be considered with regard to a possible deployment.

DESIGN

A deductive and inductive qualitative content analysis of semi-structured focus group interviews.

METHODS

Semi-structured focus group interviews with inactive or marginally employed nurses, nurses who have been inactive for some time and nursing home managers in October and November 2021. The participating inactive nurses had declared their willingness for a deployment during the COVID-19 pandemic or not. Data were analysed using qualitative content analysis.

RESULTS

Communication was seen as essential by the participants for an informed decision for or against a temporary return to nursing and to potential or actual deployments. To make them feel safe, inactive nurses need to know what to expect and what is expected of them, for example, regarding required training and responsibilities. Considering their current employment status, some flexibility in terms of deployment conditions is needed. A remaining attachment to care can trigger a sense of duty. Knowledge of (regular) working conditions in nursing can lead to both a desire to support former colleagues and a refusal to be exposed to these conditions again.

CONCLUSION

Past working experiences and the current employment situation play a major role in the willingness of inactive nurses to return to nursing in a crisis situation. Unbureaucratic arrangements must be provided for those who are willing to return.

SUMMARY STATEMENT

What already is known - In crisis situations, not every inactive nurse is willing or able to return to nursing and therefore, the 'silent reserve' may not be as large as suspected. What this paper adds - Inactive nurses need to know what to expect and what is expected of them for their decision regarding a return to active patient care during a crisis situation. Implications for practice/policy - Inactive nurses need to be informed and should be offered free training and refresher courses to ensure patient safety.

IMPACT

This research shows that the group of inactive nurses are not a silent workforce which can be activated anytime. Those who are able and willing to return to direct patient care in crisis situations need the best possible support - during and between crises.

REPORTING METHOD

This study adhered to COREQ guidelines.

NO PATIENT OR PUBLIC CONTRIBUTION

The involvement of patients or members of the public did not apply for the study, as the aim was to gain insight into the motivations and attitudes of the group of inactive nurses.

Are the healthcare providers willing and able to respond to disasters: An assessment of tertiary health care system of Khyber Pakhtunkhwa

For the tertiary health care system to provide adequate care during disasters, willing and able healthcare providers must be available to respond to the abnormal surge of the patients. Health care professionals (HCPs) constantly face a dilemma because of their profession to either respond to disasters or protect themselves. This study was conducted to assess the willingness and ability of HCPs working in the tertiary healthcare system of Khyber Pakhtunkhwa to respond to disasters. This cross-sectional survey was conducted in all the 8 tertiary care hospitals of the Khyber Pakhtunkhwa province of Pakistan. For different disaster scenarios, between 6% and 47% of HCP indicated their unwillingness, and between 3% & 41% of HCPs indicated that they were unable to respond to the given disaster scenarios. HCPs with childcare obligation indicated significantly lower willingness (p<0.05) to respond to earthquakes, MCIs, and an outbreak of Influenza, and SARS. Male HCPs showed a significantly (p<0.05) higher willingness to respond to earthquakes, MCIs, and an outbreak of Influenza as compared to their female counterparts. The overall ability indicated by HCPs for various disaster scenarios ranged between 54.1% [95% CI 0.503,0.578] for responding to victims of nuclear war and 96.4% [95% CI 0.947,0.976] for responding to conventional war. The HCPs who indicated childcare obligation showed a significantly lower ability (p<0.05) to respond to environmental disaster, influenza outbreak, and responding to victims of nuclear war. Female HCPs indicated significantly higher ability (p<0.05) as compared to their male counterparts. This survey provides an opportunity for the tertiary healthcare system to build on the findings and develop disaster mitigation plans to address the barriers to improving the HCPs' availability during disasters.

Factors Affecting the Intervention of Health-Care Professionals in Radiological Events: A Systematic Review

This research aims to explore the factors affecting the intervention of health-care professionals regarding a radiological event and to determine what actions they cause. In line with the keywords determined, a search was conducted on Cochrane, Scopus, Web of Science, and PubMed until March 2022. Eighteen peer-reviewed articles that met the inclusion criteria were reviewed. This systematic review was conducted using the PICOS and PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses)guidelines. Of the 18 studies included in the study, 8 were cross-sectional studies, 7 were descriptive studies, 2 were interventional studies, and 1 was a systematic review. As a result of the qualitative analysis, 7 factors affecting the intervention of health-care professionals in a radiological event were identified as follows: rarity of the event; inadequacy of health-care professionals against the radiological event; sensory responses; dilemma and ethical concern; communication, workload; and other factors. The most important factor affecting the intervention of health-care professionals in a radiological event is inadequate education about a radiological event, which influences the formation of other factors. These and other factors cause actions such as delayed treatment, death, and disruption of health services. Further studies are needed on the factors affecting the intervention of health-care professionals.

COVID-19 Pandemic Response Preparedness and Risk Perceptions Among Peruvian Veterinarians and Animal Care Workers

Peruvian veterinarians and animal care workers (VACW) are primary responders in the event of disasters or emergencies, yet they face unique concerns that could impede or block their essential functions in public health preparedness in comparison with VACWs in other countries. In this study, we used the Ready, Willing, and Able model via electronic survey to evaluate the perception of risks and barriers that Peruvian VACWs faced when deciding whether to continue working during the COVID-19 pandemic between July and December 2020. We used logistic regression models to evaluate associations between demographic characteristics, perceived role, and contact scores with 8 outcomes: knowledge of COVID-19; confidence in safety protocols; perceived threat; perceived job efficacy; perceived barriers; and readiness, willingness, and ability to respond to the COVID-19 pandemic. Less than 50% of respondents reported barriers to report to work during the pandemic. Respondents who reported higher contact with coworkers had an increased confidence in safety protocols (OR 5.16; 95% CI, 1.36 to 19.61) and willingness (OR 3.76; 95% CI, 1.14 to 12.47) to respond to the pandemic. Close contacts with essential workers and higher economic income were associated with higher reported knowledge of COVID-19. Respondents with higher perceived job efficacy had higher odds of reporting being ready, willing, and able to respond to COVID-19, while those who identified more barriers to report to work had lower odds of being ready, willing, and able to respond. The findings from this study, which showed differences from VACWs in the United States, can be used by individuals designing programs to improve pandemic and disaster preparedness in this essential, yet understudied and vulnerable, workforce.

Evaluating Nebraska EMS Providers' Ability and Willingness to Respond to Emergencies Resulting from Bioterrorist Attacks

OBJECTIVE

Previous studies have found that public health systems within the United States are inadequately prepared for an act of biological terrorism. As the coronavirus disease (COVID-19) pandemic continues, few studies have evaluated bioterrorism preparedness of Emergency Medical Services (EMS), even in the accelerating environment of biothreats.

METHODS

This study utilized an Internet-based survey to assess the level of preparedness and willingness to respond to a bioterrorism attack and identify factors that predict preparedness and willingness among Nebraska EMS providers. The survey was available for 1 month in 2021 during which 190 EMS providers responded to the survey.

RESULTS

Only 56.8% of providers were able to recognize an illness or injury as potentially resulting from exposure to a biological agent. The provider Clinical Competency levels ranged from a low of 13.6% (ability to initiate patient care within his/her professional scope of practice and arrange for prompt referral appropriate to the identified condition(s)) to a high of 74% (the ability to respond to an emergency within the emergency management system of his/her practice, institution, and community). Only 10% of the respondents were both willing and able to effectively function in a bioterror environment.

CONCLUSION

To effectively prepare for and respond to a bioterrorist attack, all levels of the health care system need to have the clinical skills, knowledge, and abilities necessary to treat patients exposed to biological agents. Policy changes and increased focus on training and drills are needed to ensure a prepared EMS system, which is crucial to a resilient state. EMS entities need to be aware of the extent of their available workforce so that the country can be prepared for the increasing threat of bioterrorism or other novel emerging infectious disease outbreaks. A resilient nation relies on a prepared set of EMS providers who are willing to respond to biological terrorism events.

Societal vulnerability in the context of population aging-Perceptions of healthcare students' in Saudi Arabia

Background and objective

Healthcare professionals have an important role in increasing awareness and protecting populations from natural disasters. This study aimed to assess the perception of healthcare students toward societal vulnerability in the context of population aging.

Methods

This is a cross-sectional questionnaire-based study conducted among students from two different health colleges over 4 months from February to May 2021. Descriptive analysis was used to assess the perception, and inferential testing was used to assess the various association of knowledge toward societal vulnerability using SPSS.

Results

The majority of respondents were male (69.2%), between 20 and 24 years of age (91.2%), and studying for a nursing degree (76.6%). Only 4.7% had previously completed a previous degree. The mean score of perceptions on the Aging and Disaster Vulnerability Scale among nursing students was 42.5 ± 10.3 (0-65) while for paramedicine 48.1 ± 9.7 (0-65). Similarly, the mean score among male students was 44.1 ±10.5. The mean PADVS total score for the cohort was 43.8 (SD = 10.5). The mean PADVS total score for nursing students was significantly lower than paramedic students (42.5 vs. 48.1; p < 0.001). There was no correlation between PADVS total score and gender, age, area of residence, or previous degree.

Conclusion

Our results indicate that Saudi healthcare students perceive older adults are somewhat vulnerable to disasters with significant differences between nursing and paramedic students. Furthermore, we suggest informing emergency services disaster response planning processes about educational intervention to overcome disasters in Saudi Arabia and other countries.

The development and psychometric evaluation of COVID-19 staff questionnaire for infectious disease outbreak readiness and preparedness (SQIDORP)

Background

The COVID-19 pandemic has inundated the capacity of hospitals across the globe, exhausting resources, and placing extreme burden on health care workers (HCWs). Hospital preparedness during infectious disease outbreak involves development and implementation of appropriate strategies, procedures, and adequate training for HCWs. Reliable and valid tools to evaluate the perception of HCWs on the effectiveness of hospital preparedness strategies are imperative and literature is yet to fill that gap.

Methods

Items for ‘The Staff Questionnaire for Infectious Disease Outbreak Readiness and Preparedness (SQIDORP)’ were selected from literature that addressed hospital preparedness during novel pandemic outbreaks. The SQIDORP was distributed within a regional hospital in Victoria, Australia. Psychometric evaluation included estimates of reliability and factor analysis while factors associated with the questionnaire were explored using regression analysis.

Results

Omega coefficient of 0.89, Cronbach’s alpha coefficient of 0.88 and item-total correlations (> 0.3) indicated adequate reliability of the SQIDORP. Factor Analysis yielded three meaningful latent factors that are effectiveness of training (Factor 1), self-confidence (Factor 2) and risk to self and stress (Factor 3). Demographic factors did not influence the correlation with SQIDORP. However, rating ‘the current plan for management of COVID-19 in your ward’ and ‘personal knowledge/skills in caring for patients with COVID-19’ had significant positive correlation and accounted for 33% of the variance in readiness and preparedness using SQIDORP (R2 = 0.33, F = 10.227, P < 0.001).

Conclusion

Most of the items of SQIDORP questionnaire achieved adequate internal consistence reliability. This is a valuable tool that can be utilized by hospitals to explore aspects of preparedness and give insights to the knowledge, skills, and mental health of HCWs, as perceived by the HCW themselves.

The psychological outcomes of COVID-19 affected the pandemic-after risk perceptions of nurse clinicians: a latent profile analysis

Background

Risk perception among nurses after the COVID-19 pandemic is a crucial factor affecting their attitudes and willingness to work in clinics. Those with poor psychological status could perceive risks sensitively as fears or threats that are discouraging. This article aimed to determine whether psychological outcomes, including post-traumatic stress disorder (PTSD), depression, anxiety, and insomnia, following the COVID-19 pandemic were differentially related to the risk perceptions of nurses working in clinics and increased perceived risk.

Method

The participants were 668 nurse clinicians from five local hospitals. Risk perceptions and psychological outcomes were measured by adapted questionnaires via the Internet. Latent profile analysis (LPA) identified subgroups of individuals who showed similar profiles regarding the perceived risks in nursing. Multinomial regression and probit regression were used to examine the extent to which sociodemographic and psychological outcomes predicted class membership.

Results

LPA revealed four classes: groups with low-, mild-, moderate-, and high-level risk perceptions. Membership of the high-level risk perception class was predicted by the severity of psychological outcomes. Anxiety significantly accounted for a moderate increase in risk perceptions, while the symptoms of insomnia, depression, and PTSD accelerated the increase to the high level of risk perception class.

Conclusions

By classifying groups of nurse clinicians sharing similar profiles regarding risk perceptions and then exploring associated predictors, this study shows the psychological outcomes after COVID-19 significantly impacted pandemic-associated risk perceptions and suggests intervening in nurses' psychological outcomes while simultaneously focusing on work-related worries is important following the outbreak of COVID-19.

Psychosocial support for providers working high-risk exposure settings during a pandemic: A critical discussion

Psychological first aid is a form of support designed to lessen disaster-related distress. In a pandemic, providers may need such support but with the high risk of exposure, such a program is offered only virtually. The research is scant for traditional post-disaster support and non-existent for virtual; therefore, by using related research this discussion considers the likelihood of providers accessing and benefiting from this program. The virtual platform is heralded as the responsible way to provide support in a pandemic but this standard may be ineffective and is inherently inequitable. As a global event, pandemics require containment strategies applicable on an international level; therefore, psychosocial support should also be developed with an international audience in mind. Online psychosocial support falls short of being such a strategy as it incorrectly assumes global internet access. Many low-income areas such as Sub-Saharan Africa will need support strategies which compliment local frontline staff and fit with community-driven initiatives, whereas wealthier countries may use a combination of onsite and online support. Provider psychosocial support needs in a pandemic, if articulated, are globally similar but how this support is offered requires contextually sensitive considerations not yet found in the literature.

Burnout and peritraumatic distress of healthcare workers in the COVID-19 pandemic

BACKGROUND

To evaluate the current status of emotional exhaustion and peritraumatic distress of healthcare workers (HCWs) in the COVID-19 pandemic, and identify factors associated with their mental health status.

METHODS

An online survey involving 1068 of consented HCWs that included nurses, physicians, and public health officers was conducted in May 2020. Descriptive statistics and multivariate regression analyses were performed on the collected data.

RESULTS

Although no significant difference in peritraumatic distress was observed among the surveyed HCWs, the workers' experience of emotional exhaustion varied according to work characteristics. Respondents who were female, older, living with a spouse, and/or full-time workers reported higher levels of emotional exhaustion. Public health officers and other medical personnel who did not have direct contact with confirmed patients and full-time workers had a higher level of peritraumatic distress. Forced involvement in work related to COVID-19, worry about stigma, worry about becoming infected, and perceived sufficiency of organizational support negatively predict emotional exhaustion and peritraumatic distress.

CONCLUSIONS

Job-related and emotional stress of HCWs should not be neglected. Evidence-based interventions and supports are required to protect HCWs from mental illness and to promote mental health of those involved in the response to the COVID-19 pandemic.

Reinforcement and Maintenance of Human Resources for Health Systems during Long-Term Crises: A Systematic Review of Systematic Reviews

BACKGROUND

Human resources are one of the most critical organizational resources, the reinforcement and maintenance of whom require much energy in health organizations, particularly in long-term crises. Many methods have been suggested in this regard; however, there is a need for their integration and clarification.

METHODS

We systematically searched the international databases, including PubMed, Scopus, and Web of Science, from 2003 to April 2021by using some relevant keywords. The quality of the included studies was assessed using the AMSTAR checklist.

RESULTS

The search resulted in 1613 papers, among which there were 16 systematic reviews. The studies addressed a wide range of problems and solutions. Twelve items and four items were classified with moderate quality (AMSTER score 5-8) and high quality (AMSTER score 9-11), respectively. Half of the studies (n = 8) dealt with mental and psychological problems resulting from crises as the most important factor in the decline of health system staff's durability in organizations. They also provided different solutions such as mental health counselling during and after the crisis, flexible work schedule, promoted trust in the organization, support of staff's family, and enhanced awareness to support employees. And the other articles addressed managerial problems as the most critical factor in the decline of health system staff's durability in organizations and proposed solutions such as suitable planning before, during, and after the crisis and the use of material and spiritual incentives to increase the employees' motivation and organizational resilience to maintain the staff.

CONCLUSION

In the present review study, three dimensions (namely, resilience, motivation-hygiene measures, and development of manager's soft skills) are considered as the main factors reinforcing and maintaining human resources in the health systems in long-term crises and disasters.

Systematic review of medical student willingness to volunteer and preparedness for pandemics and disasters

OBJECTIVE

This systematic review aimed to estimate the willingness of students to volunteer during a disaster, and how well-prepared medical students are for volunteering by assessing their knowledge and medical school curriculum of disaster and pandemic medicine.

RESULTS

A total of 37 studies met inclusion criteria including 11 168 medical students and 91 medical schools. 24 studies evaluated knowledge (64.9%), 16 evaluated volunteering (43.2%) and 5 evaluated medical school curricula (13.5%). Weighted mean willingness to volunteer during a disaster was 68.4% (SD=21.7%, range=26.7%-87.8%, n=2911), and there was a significant difference between those planning to volunteer and those who actually volunteered (p<0.0001). We identified a number of modifiable barriers which may contribute to this heterogeneity. Overall, knowledge of disasters was poor with a weighted mean of 48.9% (SD=15.1%, range=37.1%-87.0%, n=2985). 36.8% of 76 medical schools curricula included teaching on disasters. However, students only received minimal teaching (2-6 hours).

CONCLUSIONS

This study demonstrates that there is a large number of students who are willing to volunteer during pandemics. However, they are unlikely to be prepared for these roles as overall knowledge is poor, and this is likely due to minimal teaching on disasters at medical school. During the current COVID-19 pandemic and in future disasters, medical students may be required to volunteer as auxiliary staff. There is a need to develop infrastructure to facilitate this process as well as providing education and training to ensure students are adequately prepared to perform these roles safely.

Motivators of Continued Participation in Public Health Emergency Response Among Federal Public Health Workers: A Qualitative Study

The purpose of this study was to identify factors that motivate public health workers to deploy to the field during an emergency event. We conducted 25 semistructured interviews with employees at the US Centers for Disease Control and Prevention, all of whom had deployed to the field for the 2014-2016 Ebola, 2016-2017 Zika, and 2017 hurricane responses. We used a grounded theory approach in our analysis of the data. Themes that emerged from the interviews related to responder autonomy, competence, and relatedness, which are consistent with self-determination theory. Motivating factors included having clarity about the response role, desire to be challenged, ability to apply existing skills in the field (or apply new skills learned during deployment to their home office), desire to be helpful, and feeling rewarded by working with affected populations, communities, and other response staff. These preliminary findings suggest that introjected and identified motivating factors may form the foundation of willingness among public health workers to assist during an emergency event. Understanding what motivates staff at public health agencies to participate in emergency deployment can inform the development of recruitment strategies, strengthen effectiveness of response activities, and improve overall agency preparedness.

Barriers and Facilitators of Nurses' and Physicians' Willingness to Work during a Respiratory Disease Outbreak: A Mixed-Methods Systematic Review

This review was undertaken to identify the perceived barriers and facilitators of nurses’ and physicians’ willingness to work during a respiratory disease outbreak. This mixed-methods systematic review involved the extraction of data from the electronic databases PubMed, Web of Science, CINAHL, and PsycINFO and from a manual search of articles published between 2003 and April 2021. The quality of the included studies was assessed using a mixed-method appraisal tool. A total of 29 studies were eligible for inclusion: 21 quantitative and 8 qualitative. Using the Integrated Behavioral Model, perceived barriers and facilitators were identified under seven categories: demographics, attitude, perceived norm, personal agency, knowledge and skills to perform the behavior, environmental constraints, and habit. The results of this study broaden the understanding of various factors that affect nurses’ and physicians’ willingness to work during a respiratory disease outbreak. These findings will facilitate the modification of current pandemic workplace staffing strategies and practices and will inform preparedness planning for similar situations in the future.

Attitudes towards COVID-19 precautionary measures and willingness to work during an outbreak among medical students in Singapore: a mixed-methods study

BACKGROUND

The COVID-19 pandemic has revealed challenges that medical students face when healthcare systems are under intense pressure. There is a need to assess medical students' education needs in pandemic preparedness. The objective of this mixed-methods study was threefold: (1) to assess COVID-19 perceived efficacy, susceptibility, and anxiety in relation to health literacy; (2) to describe attitudes towards a policy of precautionary measures against COVID-19 and willingness to work during an outbreak; and (3) to examine multilevel factors associated with willingness to work.

METHODS

An online survey was conducted among 263 medical students in Singapore during the lockdown period in July 2020. Participants were surveyed on COVID-19 related literacy, perceptions, anxiety, attitudes towards a policy of precautionary measures, and willingness to work during an outbreak. Bivariate and multivariate analyses were used to determine the factors associated with the key outcome variable of willingness to work. In addition, open-ended questions were used to assess medical education needs, which were reported using thematic analysis.

RESULTS

Perceived adequacy of COVID-19 information was associated with higher perceived efficacy, lower perceived susceptibility, and lower anxiety levels among the students. Medical students were mostly supportive of COVID-19 precautionary measures except for relatively intrusive measures like in-home surveillance. The degree of willingness to work during an outbreak varied based on certain conditions, in particular family's health and safety, and was associated with self-efficacy, perceived susceptibility, and hospital capacity of outbreak management.

CONCLUSIONS

Medical students' attitudes towards a policy of precautionary measures varied depending on legality, financial and psychological support, and privacy concerns. Health literacy played an important role in increasing the efficacy of protection against COVID-19 and reducing pandemic-related anxiety among medical students. Their willingness to work during an outbreak was increased by an effective policy of precautionary measures, hospital capacity to manage a pandemic, and assurance of family safety. Medical education should include pandemic preparedness to better prepare students to aid in pandemics, with emphasis on public health policy and ethics coupled with clinical training targeted to managing outbreaks.

Factors Influencing Health Care Workers' Willingness to Respond to Duty during Infectious Disease Outbreaks and Bioterrorist Events: An Integrative Review

BACKGROUND

Infectious disease emergencies are increasingly becoming part of the health care delivery landscape, having implications to not only individuals and the public, but also on those expected to respond to these emergencies. Health care workers (HCWs) are perhaps the most important asset in an infectious disease emergency, yet these individuals have their own barriers and facilitators to them being willing or able to respond.

AIM

The purpose of this review was to identify factors affecting HCW willingness to respond (WTR) to duty during infectious disease outbreaks and/or bioterrorist events.

METHODS

An integrative literature review methodology was utilized to conduct a structured search of the literature including CINAHL, Medline, Embase, and PubMed databases using key terms and phrases. PRISMA guidelines were used to report the search outcomes and all eligible literature was screened with those included in the final review collated and appraised using a quality assessment tool.

RESULTS

A total of 149 papers were identified from the database search. Forty papers were relevant following screening, which highlighted facilitators of WTR to include: availability of personal protective equipment (PPE)/vaccine, level of training, professional ethics, family and personal safety, and worker support systems. A number of barriers were reported to prevent WTR for HCWs, such as: concern and perceived risk, interpersonal factors, job-level factors, and outbreak characteristics.

CONCLUSIONS

By comprehensively identifying the facilitators and barriers to HCWs' WTR during infectious disease outbreaks and/or bioterrorist events, strategies can be identified and implemented to improve WTR and thus improve HCW and public safety.

Medical Staff Work Burnout and Willingness to Work during COVID-19 Pandemic Situation in Pakistan

Medical staff is vital for helping society through a health crisis, human-made or natural disaster, and pandemic. This study aims to investigate the medical staff's work-related burnout during Covid-19 and their willingness to work when they are most needed. The cross-sectional design was used, and an online survey was conducted through snowball sampling. Sample comprised on 250 participants (male = 89 & female= 161). The study's inclusion criteria were that only those medical staff of different hospitals was approached to collect data performed inwards isolated for Covid-19 treatment corona isolation wards. Maslach burnout inventory (MBI-HSS) and willingness to work (WTW) tools were used to collect data. Descriptive and Partial least square analysis was utilized to evaluate the relationships. The Coefficient of determination or R-Square value was 0.299, which means 29.9% or 30% of the work burnout variation was due to the impact of emotional exhaustion and personal accomplishment. Perceived danger, Role Competence, Self-Efficacy, and Sense of duty significantly impacted the willingness to work. Despite the workload and perceived risk, 42.6% of participants agreed to work if their department had to need their services, while 55.2% of participants agreed to work whether their department asked them or not. Government and hospital management should adopt a proactive and positive response during the pandemic to eradicate the employee stress and adopt adequate steps to improve the willingness to work with medical staff.

Nursing work intention, stress, and professionalism in response to the COVID-19 outbreak in Iran: A cross-sectional study

BACKGROUND

Professionalism, stress and demographic factors are the three key influences in nurses' intention to provide care.

OBJECTIVES

This study examined the levels of work intention, stress and professionalism of nurses and determine the relationship between nursing work intention and factors in response to COVID-19.

METHODS

This cross-sectional study was conducted on 362 nurses from COVID-19-devoted hospitals in Iran. A self-administered electronic-based questionnaire was developed and used to determine levels of stress, professionalism, and nursing intention. Multiple regression analysis was carried out to analyze the correlation between nursing intention with respect to stress and professionalism.

RESULTS

The overall stress, professionalism, and nursing intention scores were 48.56, 21.46, and 17.83 respectively. There were significant differences in nursing intention scores between gender, marital status, and having training groups (p < 0.05). The regression analysis revealed that nursing intention had a significant relationship with older age (p < 0.001,S.E = 1.11,B = 17.02), higher income level (p < 0.001,S.E = 1.81,B = 6.98), having previous training (p = 0.008,S.E = 1.22,B = 3.27), higher stress level (p < 0.001,S.E = 2.37,B = -21.39), and high professionalism level (p < 0.001,S.E = 1.16,B = 11.99).

CONCLUSION

Having an adequate staff requirement plan, planning appropriate training for nurses, and proactive psychological support are crucial to prevent burnout and continue to provide nursing services.

Becoming virtual: a preliminary experience of outpatient primary care during COVID-19 pandemic

The World Health Organization (WHO) has declared COVID-19 outbreak as a pandemic. This pandemic is transforming the world and has posed exceptional challenges to health care delivery. Saudi Arabia has exerted unprecedented efforts and measures to fight the pandemic. Appreciating the value of primary health care during this crisis the family and community medicine department reorganized the services. We discuss the problems faced, solutions and lessons learned in the hope others may find it helpful.

Healthcare Professionals' Willingness and Preparedness to Work During COVID-19 in Selected Hospitals of Southwest Ethiopia

BACKGROUND

Many healthcare professionals are dying of COVID-19 while trying to save others. The loss in the healthcare workforce due to sickness and absence will double the risk of a crisis. Identifying barriers of willingness to work during epidemics outbreak and preparedness of healthcare professionals is important to minimize the shortage of human power.

METHODS

Facility-based cross-sectional study was conducted among healthcare professionals working in the selected hospitals of Southwest Ethiopia from June 1-30/2020. The data entry was done by Epi-Data Manager version 4.4.1.0 and exported to SPSS version 23 for analysis. Multivariable logistic regression analysis with a backward stepwise approach was done to identify independent predictors of poor preparedness and willingness of the healthcare professionals to work during COVID-19 and Variables with P-value <0.05 were considered as a statistically significant determinant.

RESULTS

Of 407 healthcare professionals who participated in the study, 246 (60.4%) were male. The mean age of the respondents was 28.47±5.60 years. Forty-seven (11.55%) Physicians, 59 (14.50%) pharmacy personnel, 52 (12.78%) Laboratory personnel, 31 (7.62%) Midwives, and 195 (47.91%) Nurses were included in the study. The healthcare professionals who were not prepared for the provision of services during COVID-19 and not willing to work during COVID-19 were 165 (40.5%) and 86 (21.1%) respectively. Having 6 to10 years' experience (AOR=4.046, CI: 1.05-15.58), and divorced marital status (AOR=7.855, CI: 1.781-34.65) were independent predictors of not willing to work during COVID-19. Similarly, lack of personal protective equipment (AOR=28.089, CI: 13.9-56.67) and shortage of infrastructure at the work place (AOR=28.1, CI: 13.9-56.67) were independent predictors of poor preparedness.

CONCLUSION AND RECOMMENDATIONS

Healthcare professionals' willingness and preparedness to work during COVID-19 was low. Use of Telemedicine, provision of personal protective equipment, increasing hospital's safety with adequate infection control policy, and assigning staff who have experience of more than ten years in the risky wards of the hospitals may decrease staffs absentee and increase in the provision of continuous service.

Ability and willingness to work during COVID-19 pandemic:Perspectives of front-line hotel employees

This research note reports the results of a qualitative study exploring front-line hotel employees' views about working during the COVID-19 pandemic in order to identify factors that may influence their ability and willingness to report to work. Findings from online focus-groups reveal that front-line hotel employees generally felt a sense of duty to work during the pandemic. However, there were also a number of perceived barriers to working that impacted on this sense of duty. These emerged as barriers to ability and barriers to willingness, but the distinction is not clear-cut. Instead, most barriers seem to form a continuum ranging from negotiable barriers to insuperable barriers. Following this coneptualisation, the key to reducing absenteeism during the pandemic is likely to take remedial action so that barriers to willingness do not become perceived as barriers to ability to work. Practical implications towards this direction are offered.

Hospital Nurses' Willingness to Respond in a Disaster

OBJECTIVE

This study examined the factors associated with nurses' willingness to respond in a disaster.

BACKGROUND

Nurses are key personnel in case of disasters, and therefore, understanding factors associated with willingness to respond is important.

METHODS

Questionnaires were distributed to 200 nurses recruited from 2 public hospitals in Seoul, Korea. Data were collected in January and February 2018 and 181 responses were analyzed.

RESULTS

Factors predicting willingness to respond in a disaster among public hospital nurses were level of education, self-efficacy, and disaster management competency.

CONCLUSIONS

Providing well-organized disaster preparedness and response training programs would enhance nurses' level of knowledge about disasters. In addition, training could improve nurses' self-efficacy and disaster management competency, which should enhance willingness to respond in a disaster.

Attitudes and Preparedness of Non-Frontline Physicians in Saudi Arabia Toward the COVID-19 Pandemic

OBJECTIVE

This study assesses the attitudes (willingness) and preparedness of non-frontline physicians across different specialties in the Kingdom of Saudi Arabia (KSA) toward the management of hospitalized coronavirus disease (COVID-19) patients.

METHODS

This cross-sectional study conducted between April 15, 2020, and May 5, 2020, included 6209 physicians working in KSA. An electronic questionnaire was designed and validated for the assessment of 3 categorical outcome variables, namely, attitudes, confidence, and knowledge levels. Pearson's chi-square test was used for comparing the distribution of the proportions of these 3 categorical variables.

RESULTS

Most participants (63.2%) were willing and prepared to treat COVID-19 patients. A significantly large proportion of participants specializing in anesthesiology (78.2%) had higher knowledge levels, followed by those from plastic surgery (71.1%), pediatrics (69.7%), and obstetrics and gynecology (69.1%) (P < 0.0001). Lower confidence levels were found for airway management skills (38.1%), particularly among dermatologists and radiologists.

CONCLUSION

Higher knowledge levels about personal protective equipment (PPE) use and confidence in airway management skills were proportionally related to the level of willingness to participate in COVID-19 patient management. There is an urgent need to train doctors from certain specialties on PPE use and airway management to enable their frontline support of severely ill COVID-19 patients.

Disaster Preparedness among Emergency Medical Service Providers: A Systematic Review Protocol

Background. The emergency medical service (EMS) provides first-line medical care to people who require urgent medical care in emergency and disaster situations. Preparedness is the most effective approach for the management of disaster risks, and it is essential for the emergency medical service (EMS) providers, such as paramedics, emergency medical technicians (EMT), and other EMS personnel. This systematic review will explore evidence on the preparedness of emergency medical service providers in emergency and disaster situations by reviewing peer-reviewed journal articles. Methods/Design. This study will be conducted on peer-reviewed articles published between 2005 and 2019 to explore the preparedness of emergency medical service providers in emergencies and disasters. Scopus, Web of Science, PubMed, and Google Scholar will be thoroughly searched to identify published studies on emergency and disaster preparedness. The following keywords will be used for searching the databases: “Medical Technician,” “Paramedic,” “Emergency Paramedic,” “Emergency Medicine Technician,” “Emergency Medical Technician,” “Emergency Prehospital Provider,” “Emergency Preparedness,” “Disaster Preparedness,” “Hospital Preparedness,” “Disaster management,” “Disaster Competencies,” “Disaster Readiness,” “Disaster,” “Disaster Role,” “Readiness, Preparedness, Terrorist,” “Mass Casualty Incident,” “Major incidents,” “Mass Casualty,” “Mass Gathering,” “CBRNE,” “Weapons of Mass Destruction,” and “Chemical, Biological, Radiological, Nuclear, and Explosive Event.” Discussion. To the best of our knowledge, no comprehensive review study has been conducted on the preparedness of emergency medical service providers in disaster situations. This study is the first attempt to address this gap. It will also explore the key dimensions in disaster preparedness of EMS providers and the strategies to enhance their preparedness. Identifying the key dimensions of disaster preparedness is the first step in designing and developing valid instruments to evaluate EMS provider's disaster preparedness and as well as adopting appropriate strategies to improve the level of their preparedness (This systematic review is registred in PROSPERO with CRD42020149689).

Emergency Healthcare Providers' Perceptions of Preparedness and Willingness to Work during Disasters and Public Health Emergencies

This study evaluates the perceptions of preparedness and willingness to work during disasters and public health emergencies among 213 healthcare workers at hospitals in the southern region of Saudi Arabia by using a quantitative survey (Fight or Flight). The results showed that participants’ willingness to work unconditionally during disasters and emergencies varied based on the type of condition: natural disasters (61.97%), seasonal influenza pandemic (52.58%), smallpox pandemic (47.89%), SARS/COVID-19 pandemic (43.56%), special flu pandemic (36.15%), mass shooting (37.56%), chemical incident and bombing threats (31.92%), biological events (28.17%), Ebola outbreaks (27.7%), and nuclear incident (24.88%). A lack of confidence and the absence of safety assurance for healthcare workers and their family members were the most important reasons cited. The co-variation between age and education versus risk and danger by Spearman’s rho confirmed a small negative correlation between education and danger at a 95% level of significance, meaning that educated healthcare workers have less fear to work under dangerous events. Although the causes of unsuccessful management of disasters and emergencies may vary, individuals’ characteristics, such as lack of confidence and emotional distractions because of uncertainty about the safety issues, may also play a significant role. Besides educational initiatives, other measures, which guarantee the safety of healthcare providers and their family members, should be established and implemented.

Willingness and Self-Perceived Competence of Final-Year Medical Students to Work as Part of the Healthcare Workforce During the COVID-19 Pandemic

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic may increase demand for healthcare professionals (HCPs), either because of a HCP shortage due to illness or because of the need to increase surge capacity. Final-year medical students are one of the resources potentially available to expand the workforce. There is a need to explore the willingness of final-year medical students to meet this demand, examine their perceived competence, and determine how their overall perceived competence correlates with their willingness.

METHODS

A cross-sectional study using a self-administered electronic questionnaire was used. The questionnaire included demographic data, students' self-perceived competence derived from the patient care theme of the Saudi Medical Education Directives (SaudiMED) framework, and their willingness to be measured on a 5-point Likert scale. The study targeted final-year medical students at King Saud University, Riyadh, Saudi Arabia.

RESULTS

The number of participants was 134 (56.1% response rate), of whom 47 students (34.3%) were willing to work, while 31 (23.1%) were somewhat willing. The mean total self-perceived-competence score was 58.36/88 (66.3%). Demonstration of essential clinical skills had the highest mean score 11.48/16 (71.8%) among learning outcomes. There was a positive moderate correlation between willingness and mean perceived-competence score (Spearman correlation coefficient=0.45, p<0.001).

CONCLUSION

Fifty-seven percent of medical students were willing to work as part of the healthcare workforce during the COVID-19 pandemic. Better overall self-perceived competence appeared to correlate with more willingness. Students perceive themselves to be more competent in essential clinical skills. Appropriate training and supervision are suggested in all tasks assigned to them, with additional care required in areas with a lower perceived competence, such as prescription writing and essential clinical procedures.

Emergency Preparedness Competencies Among Nurses: Implications for Nurse Administrators

OBJECTIVE

The aim of this study was to examine current levels of self-reported professional emergency preparedness competence among nurses. In addition, relationships between nurse professional emergency preparedness competence, personal preparation for a disaster, and perceived likelihood of reporting to work after a disaster are examined.

BACKGROUND

Evidence suggests wide gaps in nurses' familiarity with the dimensions of professional emergency preparedness competence and their likelihood to report, potentially impacting human life after a disaster.

METHODS

An exploratory, cross-sectional survey design was used with a sample of 186 RNs and licensed practical nurses.

RESULTS

Results indicate significant weaknesses in nurses' professional emergency preparedness competence. There are positive correlations between likelihood to report, personal preparedness, and professional emergency preparedness competence.

CONCLUSIONS

Nurses across the United States lack sufficient competence in professional emergency preparedness. Results demonstrate the need to improve the education of nurses to meet the demands of populations in urgent situations. Action items nurse administrators can take are provided.

Factors Associated With the Work Intention of Hospital Workers' in South Korea During the Early Stages of the COVID-19 Outbreak

OBJECTIVE

This study aims to explore factors associated with the work intention of hospital workers in the early stages of the coronavirus disease (COVID-19) outbreak in South Korea.

METHODS

An online self-reported survey was conducted in a tertiary hospital. Respondents were asked to report their perceived threat and perceived risk of infection, evaluation of hospital response, demographics, and job-related factors. Descriptive statistics and multivariate regression analyses were performed.

RESULTS

A total of 441 employees participated in this study. Of respondents, 60% were willing to accept their work during an infectious disease outbreak and 12.5% were unwilling to accept the work. In addition, 8% of respondents reported that they had considered quitting their job, 54.4% reported that their job was dangerous, and 50.1% of respondents perceived the severity of COVID-19 as high. Perceived threat and effectiveness of hospital response were associated with hospital employees' intention to work.

CONCLUSIONS

Hospital workers are at the front line of the COVID-19 outbreak. This study highlighted hospital workers' perceived effectiveness of organizational response to the outbreak, and perceived threats were found to be important factors for whether they continued to work or not in the fight against the outbreak.

Preparing medical students for a pandemic: a systematic review of student disaster training programmes

OBJECTIVE

To identify pandemic and disaster medicine-themed training programmes aimed at medical students and to assess whether these interventions had an effect on objective measures of disaster preparedness and clinical outcomes. To suggest a training approach that can be used to train medical students for the current COVID-19 pandemic.

RESULTS

23 studies met inclusion criteria assessing knowledge (n=18, 78.3%), attitude (n=14, 60.9%) or skill (n=10, 43.5%) following medical student disaster training. No studies assessed clinical improvement. The length of studies ranged from 1 day to 28 days, and the median length of training was 2 days (IQR=1-14). Overall, medical student disaster training programmes improved student disaster and pandemic preparedness and resulted in improved attitude, knowledge and skills. 18 studies used pretest and post-test measures which demonstrated an improvement in all outcomes from all studies.

CONCLUSIONS

Implementing disaster training programmes for medical students improves preparedness, knowledge and skills that are important for medical students during times of pandemic. If medical students are recruited to assist in the COVID-19 pandemic, there needs to be a specific training programme for them. This review demonstrates that medical students undergoing appropriate training could play an essential role in pandemic management and suggests a course and assessment structure for medical student COVID-19 training.

REGISTRATION

The search strategy was not registered on PROSPERO-the international prospective register of systematic reviews-to prevent unnecessary delay.

Working During Pandemic Disasters: Views and Predictors of EMS Providers

OBJECTIVES

This study aims to assess the perception and attitude of emergency medical services (EMS) providers toward working during disease outbreaks, and the factors that may influence their decisions to ultimately work or not.

METHODS

This is a cross-sectional study assessing the attitude of EMS providers to work during disease outbreaks. Descriptive statistics and regression analyses were performed to assess attitudes toward reporting for duty and factors that influence providers' decisions.

RESULTS

Of the 500 surveys distributed, 466 (93.2%) were complete and included for analysis. The majority of participants (70.2%) are male with a mean age of 27 (SD 4.3) years. The study found that the majority (71.1%) of participants are willing to come to work during disease outbreaks. The study found 7 predictors of reporting for duty. Confidence that employer will provide adequate protective gear was the most significant predictor (odds ratio [OR], 3.95; 95% confidence interval [CI] = 2.31-5.42). Concern for family safety was the most important barrier against coming to work (OR, 0.40; 95% CI = 0.21-0.73).

CONCLUSIONS

Providing adequate supplies of protective gear along with knowledge and training for disease outbreak are the main factors that enhance providers to fulfill their work expectations.

COVID-19: Notes From the Front Line, Singapore's Primary Health Care Perspective

Coronavirus disease 2019 (COVID-19) is a rapidly progressing global pandemic against which nations are struggling for containment. Singapore is known to have promptly instituted aggressive public health and containment measures. A key pillar sustaining this is the response of its primary health care network. It is important for health care systems worldwide to recognize the value of a strong coordinated response to this crisis from a primary health perspective. There are best practices for early isolation and containment of suspect cases while protecting health care workers and limiting cross infections that are transferable across nations. We describe our framework for how our primary care clinics respond to this pandemic in the hope others may find solutions to their unique needs. Moving forward, there is a pressing need for more studies to enhance our understanding of the response of primary care during these public health crises.

Responding to natural disasters vs. disease outbreaks: Do emergency medical service providers have different views?

INTRODUCTION

Our planet has been experiencing a huge burden of natural disasters and public health emergencies in the last three decades. Emergency medical service providers are expected to be in the frontlines during such emergencies. Yet, this system is badly understudied when it comes to its roles and performance during disasters and public health emergencies. This study is designed to enhance understanding by assessing a sample U.S EMS providers' views about working during natural disasters and disease outbreaks and explores whether they are coming to work during such conditions.

METHODS

This study utilized a qualitative approach using face-to-face interviews with EMS workers from the State of Delaware, USA. Participants were asked about their views, insights, and potential behavior of working during natural disasters and disease outbreaks. Data collected were transcribed and coded using ATLAS.ti software to develop themes of the study using an inductive approach.

RESULTS

Three themes were emerged from interviews regarding working during natural disasters; respondents expressed excitement, concern, or no real differences. For disease outbreaks, however, the two themes were concerned and no additional risk. While participants expressed varying concerns about working during disasters and pandemic conditions, everyone felt willing and obligated to come to work despite the perceived high risk for some of them to work in some conditions.

CONCLUSION

This study helps to provide the base upon which EMS, public health, and emergency management agencies can formulate actions that emerged from the views of EMS providers concerning work during disasters and public health emergencies.

Supporting Staff Through a Complete Hospital Evacuation and Extended Displacement Period

EXECUTIVE SUMMARY

Complete hospital evacuations due to natural or man-made disasters can have repercussions on all levels of hospital operations. An extended displacement period following an evacuation exacerbates the situation. Retaining a healthy, employed workforce following a disaster is a crucial step in ensuring that a facility is effectively staffed when it returns to normal operations. In this article, the authors address the issue of staff support during evacuation and extended displacement by examining the actions taken by the leadership of the VA New York Harbor Health Care System, a Veterans Health Administration facility, in response to the evacuation and displacement caused by Superstorm Sandy in 2012. As staff began to realize that the displacement would be extensive, frustration, complaints, and a sense of disenfranchisement emerged. The authors' findings suggest that the most valuable tool to allay staffs' fears were monthly forums, whereby staff had the opportunity to meet face-to-face with leadership and ask questions. An important consideration when staff are displaced is the role that cultural differences between host and displaced facility staff plays, even when those facilities are part of the same system. Significant attention must be given to cultural differences, in both acknowledging and resolving them. The study suggests that direct communication with leadership, support from upper and middle management, and an understanding that sharing best practices across facilities strengthens the entire team are key approaches to addressing these challenges.

Factors associated with healthcare workers willingness to participate in disasters: a cross-sectional study in Sana'a, Yemen

OBJECTIVES

Willingness to participate in disasters is usually overlooked and not addressed in disaster preparedness training courses to ensure health service coverage. This will lead to issues during the disaster's response. This study, therefore, aims to assess healthcare workers willingness to participate in biological and natural disasters, and to identify its associated factors.

DESIGN

This is a cross-sectional study using a self-administered questionnaire. The questionnaire was distributed to 1093 healthcare workers. The data were analysed using multiple logistic regression with significance level p<0.05. Ethical clearance and consent of the participants were duly obtained.

SETTING

In three public hospitals that provide tertiary-level healthcare in Sana'a City, Yemen.

PARTICIPANTS

There were 692 nurses and doctors (response rate 63.3%) completed the questionnaires.

RESULTS

Almost half of the participants 55.1% were nurses and 44.9% were doctors. The study found that self-efficacy was associated with willingness to participate in disaster response for any type of disasters (OR 1.319, 95% CI 1.197 to 1.453), natural disasters (OR 1.143, 95% CI 1.069 to 1.221) and influenza pandemic (OR 1.114, 95% CI 1.050 to 1.182). The results further show that willingness is associated with healthcare workers being young, male and having higher educational qualifications.

CONCLUSION

Self-efficacy has been found to be an important factor associated with willingness. Improving self-efficacy through training in disaster preparedness may increase willingness of healthcare workers to participate in a disaster.

Companion Animals Welfare in Non-Epidemic Emergencies: The Case of Central Italy, Post-Earthquake 2016/2017

Among the several factors affecting animal welfare, non-epidemic emergencies are very stressful events. In the aftermath of earthquakes or during flooding, snowstorms and wildfires, companion animals are subject to injuries and deep stress, abandonment or loss resulting in the overcrowding of animal shelters, or in emergent free-roaming populations representing a potential public health threat to the affected communities. The loss of animals often also results in significant psychological trauma for their guardians. For these reasons in all phases of calamities, the care of companion animals becomes essential. This paper describes the activities that were carried out for the veterinary care of dogs and cats affected by the earthquakes that occurred in central Italy from August 2016 to January 2017. These disasters provided an opportunity to test an integrated emergency management system in which several actors participated to aid, assist and accommodate the companion animals, whether owned or strays, affected by the catastrophic events.

Healthcare workers' willingness to respond following a disaster: a novel statistical approach toward data analysis

BACKGROUND

The willingness of healthcare workers (HCW) to respond is an important factor in the health system's response capacity during emergencies. Although much research has been devoted to exploring this issue, the statistical methods employed have been predominantly traditional and have not enabled in-depth analysis focused on absenteeism-prone employees during emergencies. The present study employs an innovative statistical approach for modeling HCWs' willingness to respond (WTR) following an earthquake.

METHODS

A validated questionnaire measuring knowledge, perceptions, and attitudes toward an earthquake scenario was distributed among Israeli HCWs in a hospital setting. Two regression models were employed for data analysis - a traditional linear model, and a quantile regression model that makes it possible to examine associations between explanatory variables across different levels of a dependent variable. A supplementary analysis was performed for selected variables using broken line spline regression.

RESULTS

Females under the age of forty, and nurses were the most absenteeism-prone sub-groups of employees (showed low WTR) in earthquake events. Professional commitment to care and perception of efficacy were the most powerful predictors associated with WTR across all quantiles. Both marital status (married) and concern for family wellbeing, designated as statistically significant in the linear model, were found to be statistically significant in only one of the WTR quantiles (the former in Q10 and the latter in Q50). Gender and number of children, which were not significantly associated with WTR in the linear model, were found to be statistically significant in the 25th quantile of WTR.

CONCLUSIONS

This study contributes to both methodological and practical aspects. Quantile regression provides a more comprehensive view of associations between variables than is afforded by linear regression alone. Adopting an advanced statistical approach in WTR modeling can facilitate effective implementation of research findings in the field.

Perceived Facilitators and Barriers to Local Health Department Workers' Participation in Infectious Disease Emergency Responses

CONTEXT

Local health departments play a key role in emergency preparedness and respond to a wide range of threats including infectious diseases such as seasonal influenza, tuberculosis, H1N1, Ebola virus disease, and Zika virus disease. To successfully respond to an infectious disease outbreak, local health departments depend upon the participation of their workforce; yet, studies indicate that sizable numbers of workers would not participate in such a response. The reasons why local health department workers participate, or fail to participate, in infectious disease responses are not well understood.

OBJECTIVE

To understand why local health department workers are willing, or not willing, to report to work during an infectious disease response.

DESIGN

From April 2015 to January 2016, we conducted 28 semistructured interviews with local health department directors, preparedness staff, and nonpreparedness staff.

SETTING

Interviews were conducted with individuals throughout the United States.

PARTICIPANTS

We interviewed 28 individuals across 3 groups: local health department directors (n = 8), preparedness staff (n = 10), and nonpreparedness staff (n = 10).

MAIN OUTCOME MEASURES

Individuals' descriptions of why local health department workers are willing, or not willing, to report to work during an infectious disease response.

RESULTS

Factors that facilitate willingness to respond to an infectious disease emergency included availability of vaccines and personal protective equipment; flexible work schedule and childcare arrangements; information sharing via local health department trainings; and perceived commitments to one's job and community. Factors that hinder willingness to respond to an infectious disease emergency included potential disease exposure for oneself and one's family; logistical considerations for care of children, the elderly, and pets; and perceptions about one's role during an infectious disease response.

CONCLUSION

Our findings highlight opportunities for local health departments to revisit their internal policies and engage in strategies likely to promote willingness to respond among their staff. As LHDs face the persistent threat of infectious diseases, they must account for response willingness when planning for and fielding emergency responses. Our findings highlight opportunities for local health departments to revisit their internal policies and engage in strategies likely to promote response willingness to infectious disease emergencies among their staff.

Burden and Management of Noncommunicable Diseases After Earthquakes and Tsunamis

This integrative review examines extant literature assessing the burden and management of noncommunicable diseases 6 months or more after earthquakes and tsunamis. We conducted an integrative review to identify and characterize the strength of published studies about noncommunicable disease-specific outcomes and interventions at least 6 months after an earthquake and/or tsunami. We included disasters that occurred from 2004 to 2016. We focused primarily on the World Health Organization noncommunicable disease designations to define chronic disease, but we also included chronic renal disease, risk factors for noncommunicable diseases, and other chronic diseases or symptoms. After removing duplicates, our search yielded 6,188 articles. Twenty-five articles met our inclusion criteria, some discussing multiple noncommunicable diseases. Results demonstrate that existing medical conditions may worsen and subsequently improve, new diseases may develop, and risk factors, such as weight and cholesterol levels, may increase for several years after an earthquake and/or tsunami. We make 3 recommendations for practitioners and researchers: (1) plan for noncommunicable disease management further into the recovery period of disaster; (2) increase research on the burden of noncommunicable diseases, the treatment modalities employed, resulting population-level outcomes in the postdisaster setting, and existing models to improve stakeholder coordination and action regarding noncommunicable diseases after disasters; and (3) coordinate with preexisting provision networks, especially primary care.

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.

Keeping Communications Flowing During Large-scale Disasters: Leveraging Amateur Radio Innovations for Disaster Medicine

Medical facilities may struggle to maintain effective communications during a major disaster. Natural and man-made disasters threaten connectivity by degrading or crippling Internet, cellular/mobile, and landline telephone services across wide areas. Communications among staff, between facilities, and to resources outside the disaster area may be lost for an extended time. A prototype communications system created by the National Library of Medicine (NLM) provides basic communication services that ensure essential connectivity in the face of widespread infrastructure loss. It leverages amateur radio to provide resilient email service to local users, enabling them to reach intact communications networks outside the disaster zone. Because amateur radio is inexpensive, always available, and sufficiently independent of terrestrial telecommunications infrastructure, it has often augmented telecommunications capabilities of medical facilities. NLM's solution is unique in that it provides end-user to end-user direct email communications, without requiring the intervention of a radio operator in the handling of the messages. Medical staff can exchange email among themselves and with others outside the communications blackout zone. The technology is portable, is deployable on short notice, and can be powered in a variety of ways to adapt to the circumstances of each crisis. (Disaster Med Public Health Preparedness. 2018;12:257-264).