Health workers scarce in flu outbreak

[DB]

http://www.upi.com/HealthBusiness/view.php?StoryID=20060417-044414-8673r

Health workers scarce in flu outbreak

WASHINGTON, April 17 (UPI) -- Nearly half of public health workers doubted they would report to work in the event of a flu pandemic, a recent survey said.

In a study by Johns Hopkins University and Ben-Gurion University in Israel, over 40 percent of U.S. public health workers, including clinical staff, nurses and clerical workers said they would stay home if widespread flu broke out.

That could mean a shortage of local public health workers needed to play a vital role in responding to a pandemic, from monitoring the spread of illness, to organizing the distribution of medications, to communicating critical health information to the public.

The survey also found that 66 percent of public health workers felt they would put themselves at risk of infection if they were to report to work during a pandemic.

Clinical staff members, such as physicians and nurses, were more likely to say they would report for work. Technical or support staff, which included computer entry staff and clerical workers, were the most nervous to report to work, the polling showed.

According to the results, the willingness to report to work was strongest among employees who perceived an importance in their work and responsibilities during a pandemic. This perception was lowest among technical and support workers. Fewer than one-third of all public health workers felt they would have an important role in the response to a pandemic.

The results of the survey are published in the April 2006 edition of the journal BMC Public Health.

[DB]

Re: Health workers scarce in flu outbreak

http://www.macleans.ca/topstories/ne...ntent=n041749A

April 17, 2006 - 20:17
Many public health workers wouldn't work in a pandemic, study suggests
HELEN BRANSWELL
TORONTO (CP) - A disconcerting proportion of public health employees think their services would not be needed during an influenza pandemic and say they are unlikely to show up for work, a new study has found.
The study, based on a survey in the state of Maryland, reports that 46 per cent of public health workers were unlikely to report to work during a pandemic. Many erroneously thought staff who don't typically work in infectious disease containment operations would not be required during a disease emergency.
That underscores the need to educate staff in all facets of a public health organization - and the health system at large - that their help will be critical when a pandemic occurs, the lead author said.
"Training programs are usually focused at . . . increasing the workers' capabilities to perform their duties during an extreme event," said Dr. Ran Balicer, an epidemiologist at Ben-Gurion University of the Negev in Israel.
"But what we see here is that we should perhaps focus even more on increasing the willingness to come to work in the first place."
While the study focused only on public health workers, the findings suggest there are likely still gaps in understanding throughout the health delivery system of the roles people will need to play in a flu pandemic, said Dr. Allison McGeer, one of Canada's leading infectious disease specialists.
"I think most pandemic planners have assumed that people in public health departments know they're going to be needed," said McGeer, head of infection control at Toronto's Mount Sinai Hospital. She was not involved in this study.
"And the fact that a great majority of them don't know that is a marker for how much people need to learn about the response and how much discussion we need to have about the response."
The paper, authored by Balicer and three researchers at Johns Hopkins School of Public Health in Baltimore, was published Tuesday in the journal BMC Public Health.
The study has limitations. The sample size was small - 308 employees from three public health departments in a single U.S. state. And it was conducted from March to July last year, before the issue of pandemic flu hit the public radar in a serious and sustained fashion.
But the findings are statistically significant. And the data are among the first from which planners can attempt to glean an answer to a question they dread asking: Will workers in the health delivery system put themselves at risk by showing up for work when the system and society needs them most?
Some will and some won't, many planners assume, based on post-mortems done on the responses to crises like SARS.
It's been assumed personal safety and the safety of family are key factors health-care workers consider when making that decision. And this study supports the notion those issues will weigh heavily on deliberations.
But to his surprise, Balicer and his co-authors found that the single most important factor playing into the decision appears to be whether the employee felt his or her job was important to the operation and the response.
"They would feel that their personal safety is an issue on one hand and on the other hand, not all of them feel that the impact of their role would be significant enough to justify coming to work," Balicer said in an interview from Israel.
McGeer noted in most public health departments, the majority of staff aren't involved in battling communicable diseases and have no experience working a disease outbreak. Public health operations cover a lot of turf: healthy baby programs, pollution mitigation, chronic disease control.
But there will be an "all hands on deck" need during a flu pandemic - and that must be conveyed and understood before the event starts, said Toronto bioethicist Dr. Ross Upshur.
"If all the IT guys don't show up, it's going to completely hamstring your response," explained Upshur, a physician at Sunnybrook Health Sciences Centre and a researcher with the University of Toronto's Joint Centre for Bioethics.
Upshur is not an author of the study.
The study raises questions about how well others in the health delivery system have been brought into pandemic planning, McGeer suggested.
Some physicians, like plastic surgeons, won't be able to continue their normal operations during a pandemic and could be pressed into service to fill other roles. But many operate out of clinics; if they are not approached in advance and trained by hospitals, their services could go untapped during an emergency, she noted.
"I think overwhelmingly Canadians when faced with a crisis like this will pitch in and help," McGeer said.
"But if we're going to be asking people to do things that are different from what they normally do, they can't pitch in and help unless they know where they're going to be helpful."
Upshur said it's time for hospitals and public health departments to educate staff throughout their operations about the planned response to a pandemic.
"I think the message here is the need to get buy-in from virtually everybody in a complex health-care organization," Upshur said. "Which means that management needs to be incredibly proactive and win the hearts and minds in their planning."

[DB]

Re: Health workers scarce in flu outbreak

"...If all the IT guys don't show up, it's going to completely hamstring your response..."

Consider your response hamstrung.

This is just ass backwards thinking.

If we wanna get real lets talk about the staff that is going to be showing up at your local convention center, football stadium or school gym. That is where the bulk of the patients are going to be.

Are you going to have IT show up there? No.

Who is going to show up at the places I listed above???

[GhostRN]

Re: Health workers scarce in flu outbreak

Hospital administration must decide, act and communicate how they have prepared to take care of staff?..so they will not only show up for work?.but stay once they experience the conditions in which they are expected to work under. But then again?.until HCW & support staff start asking questions?..don?t expect administrators to invest any real time or money on this topic.

[Goju]

Re: Health workers scarce in flu outbreak

In "the movie" even the most dedicated HCW walked off the job.

[Snowy Owl]

Re: Health workers scarce in flu outbreak

GhostRN & DB,

Internet medical decisions can save many lives.

[Niko]

Re: Health workers scarce in flu outbreak

Older article dredged up from my archives. Still relevant and just as disturbing as the above studies...

Healthcare workers may be unable or unwilling to report to work during certain disasters
Healthcare News
Published: Monday, 12-Sep-2005

In a first study of its kind, researchers at the Mailman School of Public Health assessed the ability and willingness of healthcare workers to report to work in the event of disasters involving weapons of mass destruction or virulent infectious disease outbreaks.

Eighty-seven percent of healthcare workers from 47 facilities in and around New York City, indicate that they would be able to report for work in the event of a mass casualty incident and 81% would be able to go to work if there was an environmental disaster. However, only 69% of the workers said that they would be able to reporting for work during a smallpox epidemic.

When it comes to willingness to report for work, only 48% of healthcare workers stated that they would be willing to come to work during a SARS outbreak; 57% during a radiological event; or 61% in the event of a smallpox epidemic. The researchers found that a very large proportion of healthcare workers intended to report to duty if the disaster involved mass causalities (86%) or some type of environmental disaster (84%). In addition, while 80% of workers said they would be willing to come to work during severe weather, such as a major snowstorm, a much lower proportion (less than 50%) felt that they would be able to do so.

Over 6,000 healthcare workers in the greater New York metropolitan area participated in the anonymous survey.

Information on healthcare workers' ability and willingness to respond is invaluable not only to healthcare administrators, but to emergency planners and government agencies, as well. "Ability" refers to being physically being able to report to duty. In New York City, this is especially important since workers rely on public transportation to get to work, and any major disruption in mass transit might prevent large numbers of workers from commuting to work. "Willingness" on the other hand, refers more to the personal decision to report to work and this may be influenced by safety concerns or fear of contagion.

The barriers respondents most often cited as affecting their ability to report to work included transportation problems, child or elder care, or pet obligations. With respect to willingness, healthcare workers' fear for their own safety and that of their family members influenced them the most.

These data suggest that healthcare workers' responsiveness may vary depending on the type of situation involved. According to Kristine Qureshi, RN, DNSc, a researcher in the Department of Epidemiology at the Mailman School and lead author, "Although we might assume that healthcare employees have an obligation to respond to these high impact events, our findings indicate that personal obligations, as well as concerns for their own safety play a pivotal role in workers' willingness to report to work."

Similarly, Robyn Gershon, DrPH, associate professor of Sociomedical Sciences, senior investigator at the Mailman School's National Center for Disaster Preparedness, and co-author of the study points out that "Employers must recognize that their healthcare workers are likely to be as concerned or even more concerned about their safety than the average citizen, because they have a greater understanding of the risks involved." Furthermore, she cautions that their concerns for their family members must also be considered.

These findings are of practical importance, since a catastrophic event would result in the need for a fully-activated healthcare workforce. A less than full contingency of healthcare workers on the job could have far-reaching implications, according to the researchers. In addition to the number of sick already being treated, facilities could find themselves inundated with large numbers of victims of a mass casualty incident or other disaster. If adequate numbers of staff members do not report to work, it could result in a situation where hospitals are unable to meet surge capacity needs.(Ya think? )

"These survey results reinforce the idea that workplaces, especially healthcare work settings, should discuss personal emergency planning with their employees. These discussions should take place upon hire and conducted annually," states Dr. Gershon. The researchers point out that these findings provide us with the opportunity to enhance healthcare workers' ability and willingness to respond by addressing those barriers that are amenable to intervention. The healthcare facility can help support both the ability and willingness of their employees though careful planning--for example, arranging for emergency transportation and child and elder care. Adds Dr. Qureshi, "In terms of addressing workers fears, and therefore, their willingness to work, healthcare administrators should talk to their workers about their concerns regarding exposure and contagion, and, importantly, reassure them by describing in detail all of the steps the facility is planning to take to assure their safety."

http://www.mailman.hs.columbia.edu/