How might health care workers respond in the event of a disease pandemic?

Nurse, a key caregiver in health care emergencies

One of the tragedies of Hurricane Katrina had to do with the lack of responders in the emergency. This same sort of situation could well happen in the possibility of a pandemic of Ebola.  The same problem might occur in the event that Ebola becomes widespread in the United States, which most experts agree is at most a remote possibility.  What has research indicated might occur with health workers and what might be the overall response?

Approximately 1 in 6 public health workers completed a survey put out by the Centers for Disease Control in 2009, maintaining they would not report to work in the event of an emergency.  In that case the question was related to the potential of an H1N1 pandemic flu. Researchers at the time of the report declared that was a problem but also observed it was an improvement over a similar study made in 2005 where 40% of health care workers maintained they wouldn't respond to a pandemic emergency.

This is relevant as the world prepares for what the Centers for Disease Control and the World Health Organization maintain could be a major problem in adequately preparing health care workers and supporting them in responding to any disease emergency  For the individual hospital there may be a wait-and-see stance for some elements of preparation. The new study suggests ways of improving the response of the workforce in general that are essential in the preparation.of health care workers in the United States if there is a significant increase in the numbers identified with Ebola.

Daniel Barnett, MD, MPH, leading author of 2009 study, that took place under the aegis of the Department of Environmental Health Sciences at Bloomberg School of Public Health, underlined how important it is to understand the underlying factors involved in whether or not an employee will respond appropriately to an emergency." He goes on to say, "Overall, 16 percent of the workers surveyed said they would not report regardless of the severity of the outbreak."

1,835 public health workers participated in the online survey in Minnesota, Ohio and West Virginia during the period. What the survey found was those public health workers who were particularly concerned about what might happen in a pandemic threat and were confident they could fulfill their obligations were 31 times more likely to respond in an emergency then those
who perceived a threat was low or who didn't have confidence in their abilities to respond appropriately.

"We found belief in the importance of one's work was strongly associated with a willingness to report to work in an emergency. Our results could help preparedness planners to identify workforce needs and develop strategies for improving worker response," said Ran Balicer, MD, PhD, MPH, who is the senior lecturer in the Epidemiology Department at the Ben-Gurion University of the Negev in Israel, and Joint Editor of the Israeli Ministry of Health Pandemic Preparedness Plan.

According to OSHA the preparation of health care workers for a pandemic is especially difficult given travel restrictions and multiple emergency procedures that might need to be taken during a major catastrophe. It can increase the need for beds in hospitals, staffing, transportation and a host of other problems. The training across geographic locations, cultures, with communication issues makes the job of health care especially complex during emergencies. Add to this the pressures of time, the potential for health problems among those assigned to help others and personal needs, including families; and those who serve during emergencies will be under definite strain, according to experts.

On the other hand, many of the Ebola experts recommend regional centers for the treatment of Ebola patients as opposed to every individual hospital.  That being the case, the response could be different.  But again those involved in the study highlighted that attitude of health care workers is tied to how they perceive the disease, their training to deal with it and whether or not they believe they are well equipped to handle the emergencies that might occur.

The CDC has acknowledged it could have done better in its own initial responses to the Ebola health care personnel in Texas. The agency is underlining the importance of a more adequate and faster response in the future to any incident where a patient is identified with Ebola.  It is training that will help increase the potential for a good response from health care workers in the (remote) event of a major increase in Ebola cases in the United States.  Comprehensive training for those who care for others during a serious crisis can make a difference also in not just how health care workers respond but how the public responds in general, as avoiding a panic is also key to the management of the disease throughout any widespread geographic area.