Perceptions of hospital medical personnel on disaster preparedness

Introduction

“There's no harm in hoping for the best as long as you're prepared for the worst.” – Stephen King.

The World Health Organization defines a disaster as “A serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources”¹.

Terrorist attacks, natural catastrophes, infectious epidemics, and other forms of disasters, though rare, pose a significant public health challenge when they do occur. Healthcare providers are the receiving end of casualties from a disaster in the community, and they must ensure the necessary training to lead disaster preparedness initiatives in the scenario that one does occur.

Instances such as the 2001 New York City September 11th terrorist attacks, the 2005 New Orleans Hurricane Katrina, the 2010 Haiti Earthquake, the 2011 Tohoku Earthquake and Tsunami, the 2012 Hurricane Sandy, and more recently the 2014 Ebola Virus outbreak, all reveal that mass casualties do not enter the hospital all at once. Rather, most of these victims entered over a protracted period of time ranging from acute traumas within hours of the event to symptoms of post-traumatic stress disorder presenting months to years after. This can tremendously exhaust understaffed and undertrained hospital personnel.

Disaster management initiatives have more often emphasized pre-hospital protocols and personnel preparation while insufficient resources have been placed on the education and training of the healthcare providers in tertiary medical institutions that receive disaster victims. This has been previously termed “ambulances to nowhere”^2,3. Disaster training is rarely incorporated in neither undergraduate nor graduate medical education.

We intend to assess the current state of knowledge and interest in disaster preparedness among different tiers of hospital staff and training levels in order to identify potential barriers and areas for further training.

Materials and Methods

A cross-sectional online survey was given to hospital attending physicians, subspecialty fellows, residents, nurses, physician assistants, respiratory therapists and their respective students. The survey questions were disseminated using a cloud based company, Monkey Survey, throughout the Society of Critical Care Medicine (SCCM) Members and the North Shore Long Island Jewish (NSLIJ) hospital system e-mail newsletters in October 2013. Participants were given an explanation of the intentions of the survey, which included agreement to the publication of the data. All project expenses were funded by Lenox Hill Hospital, a part of the NSLIJ health system.

There is no standardized test for preparedness. The survey questions were designed to assess the current level of medical training of the participants in their respective fields and asked about their perception of disasters occurring in their healthcare system (Dataset 1). Specifically, participants were asked if they had to deal with a disaster in the past or thought they would have to deal with a disaster in the future and which disaster they thought would be likely to occur. The survey also assessed for the participants’ current level of disaster management training, in what form they had received it, and if they would feel comfortable being involved in a disaster management scenario. The survey then further evaluated if the participants would like additional training for disaster management and gauged what type of training they would find most effective. Finally the survey assessed for any barriers to achieving this training.

The responses to the survey were electronically collected from October 2013 to May 2014. The results were generated in percentages and analyzed by the authors of the study and the Monkey Survey Company.

Results

Survey demographics

A total of 572 individuals participated between October 2013 and May 2014. Over 83% of respondents were not NSLIJ employees and over 60% were physicians, of which 83% identified themselves as attending physicians. 62% of attending physicians identified themselves as critical care physicians. The remainder of participants consisted of 79 nurses (two of which were students), 25 physician assistants, and eight respiratory therapists (one of which was a student) (Table 1). Greater than 90% of respondents identified their current or planned future practice locale as urban or suburban (Figure 1).

Table 1. Responders location of work by profession.

Responders were able to select more than one location of work.

Location of work	Profession
	Nurse		Physician Assistant		Respiratory Therapist
	Certified	Student	Certified	Student	Certified	Student
	77	2	25	0	7	1
Emergency	10		4		6
Regional	4		4		6
Step Down	1		0		2
ICU/CCU	36		12		16
OR	0		1		3
Other	35		8		7
Location of Work	Physician
	Attending		Fellow	Resident		Student
	291		33	22		3
Emergency	11			0
Internal Medicine	9			20
OB/GYN	1			0
Surgery (CTS, Vasc, Gen)	17			2
Cardiology	1		1
Critical Care	158		21
Endocrine	0		0
GI	0		0
Heme/Onc	1		0
ID	0		0
Nephrology	1		0
Pulm/Crit	22		11
Pulmonary	1		0
Other	69

Figure 1. Respondents location of Practice, both current and future.

Experience and perceptions

A vast majority of participants had managed victims of disaster situations in the past. Just over half of participants (52%) stated they had treated victims of natural disasters; 57% had treated victims of transportation disasters; 35% - of structural collapses; 28% - of industrial catastrophes; 15% - of terrorist attacks and 16% had treated victims of warfare (Figure 2). When asked of future expectations, 85% of respondents expected to deal with a disaster during their career, choosing natural disasters as the most likely expected culprit (3.69 on a scale of 0–5, with 5 being most likely). This was followed by industrial catastrophes at 3.16 and terrorist attacks at 2.66 (Figure 3a and 3b). When considering terrorist threats, most participants believed explosives (2.87 on a scale of 0–5, with 5 being most likely) were most likely to be the cause of harm in their areas, followed by biological weapons (2.39), chemical weapons (2.35) and nuclear radiation (2.15).

Figure 2. Respondents experience of having to treat patients of disasters by type.

Figure 3.

(a) Types of disasters expected to be encountered on a scale of 1 (least likely) to 5 (most likely). (b) Do hospital personnel expect to treat patients of disasters?

Preparedness

Of the surveyed participants, only 38% felt comfortable leading and directing a local disaster management initiative; however nearly all participants (90%) felt they would be able to participate in a disaster management scenario. A large majority of respondents (87%) expressed their interest in participating in a disaster management-training workshop. Of these, 78% were interested in learning focused ultrasound exams, 92% wanted to learn procedures that may be needed during a disaster and 92% wished to participate in simulation training (Figure 4). The major identified barrier to training was lack of time (80% of respondents), followed by availability of resources (63%), access to experts (45%), obtaining scenario exercises (36%) and lack of interest (22%). The preferred methods of training were via live lectures with accompanied scenario exercises (66%), on-line courses (24%) and live lectures only (3%); 6% of participants were not interested in a training workshop.

Figure 4. Comfort and interest in participation in disaster management trainings.

question
1 -current employer	Northshore - Lenox Hill	Northshore - not Lenox Hill	Not Northshore
	53	38	476
2- Nurse type	Student nurse	Certified Nurse
	2	77
3- Nurse-Work location	Medical Regional Floor	Surgical Regional Floor	ER	Special procedures	Operating room	SICU	MICU	CCU	Step-down	Other
	2	2	10	1	0	19	13	4	1	34
4- PA type	Student	Certified
	0	25
5- PA work location	Medical Regional Floor	Surgical Regional Floor	ER	Special procedures	Operating room	SICU	MICU	CCU	Step-down	Other
	2	2	4	0	1	8	3	1	0	8
6- Respiratory therapist type	Student	Certified
	1	7
7-Respiratory therapist work location	Medical Regional Floor	Surgical Regional Floor	ER	Special procedures	Operating room	SICU	MICU	CCU	Step-down	Other
	3	3	6	3	2	6	6	4	3	4
8- Please choose a level of position that best describes you as a PHYSICIAN�	Medical student year 3	Medical student year 4	Emergency Medicine Resident Year-1	Emergency Medicine Resident Year-2	Emergency Medicine Resident Year-3	Emergency Medicine Resident Year-4	Internal Medicine Resident Year-1	Internal Medicine Resident Year-2	Internal Medicine Resident Year-3	Obstetrics & Gynecology Resident Year-1	Obstetrics & Gynecology Resident Year-2	Obstetrics & Gynecology Resident Year-3	Obstetrics & Gynecology Resident Year-4	Surgery Resident Year-1	Surgery Resident Year-2	Surgery Resident Year-3	Surgery � Resident Year-4	Surgery Resident Year-5	Cardiology Fellow Year-1	Cardiology Fellow Year-2	Cardiology Fellow Year-3	Critical Care Fellow Year-1	Critical Care Fellow Year-2	Endocrinology Fellow Year-1	Endocrinology Fellow Year-2	Endocrinology Fellow Year-3	Gastroenterology Fellow Year-1	Gastroenterology Fellow Year-2	Gastroenterology Fellow Year-3	Hematology & Oncology Fellow Year-1	Hematology & Oncology Fellow Year-2	Hematology & Oncology Fellow Year-3	Infectious Disease Fellow Year-1	Infectious Disease Fellow Year-2	Nephrology Fellow Year-1	Nephrology Fellow Year-2	Pulmonary Fellow Year-1	Pulmonary Fellow Year-2	Pulmonary & Critical Care Fellow Year-1	Pulmonary & Critical Care Fellow Year-2	Pulmonary & Critical Care Fellow Year-3	Cardiology Attending	Cardiothoracic Surgery Attending	Critical Care Attending � Medicine	Critical Care Attending � Surgery	Emergency Medicine Attending	Endocrinology Attending	Gastroenterology Attending	General Surgery Attending	Hematology & Oncology Attending	Infectious Disease Attending	Internal Medicine Attending	Nephrology Attending	Obstetrics & Gynecology Attending	Pulmonary Attending	Pulmonary & Critical Care Attending	Vascular Surgery Attending	Other
	2	1	0	0	0	0	7	6	7	0	0	0	0	0	0	0	0	2	0	0	1	14	7	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	2	2	7	1	4	97	61	11	0	0	13	1	0	9	1	1	1	22	0	69
9 - Pick your current location of practice.	Urban	Suburban	Rural	International setting
	335	97	30	13
10 - Pick your future planned location of practice.	Urban	Suburban	Rural	International setting
	323	104	27	21
11- Do you expect to be dealing with disasters at any point in your career?	Yes	No
	406	69
12 - Using a point scale (1: No risk to 5: High Risk) - In your opinion what is the likelihood of occurrence in your area:	Terrorist attack	Natural Disaster	Industrial catastrophe
1	94	11	27
2	151	67	112
3	107	104	147
4	69	168	136
5	54	125	53
13 - Using a point scale (1: No threat to 5: High threat) - In your opinion, how likely are the following types of terrorist threats to occur in your area:	Chemical (e.g. sarin gas)	Biological (e.g. anthrax)	Explosive (e.g. car bomb)	Nuclear Radiation (e.g. atomic bomb)
1	134	122	77	168
2	164	168	139	161
3	84	92	96	78
4	63	66	97	41
5	30	27	66	27
14- In the context of being a healthcare provider, have you ever had to treat victims of�	a natural disaster?	a transportation disaster?	a structural collapse?	an industrial catastrophe?	a terrorist attack?	warfare
Yes	246	268	164	134	70	77
No	228	206	307	337	402	393
15 - What is your level of formal disaster management training?	None	0-12 hours	12-24 hours	24-48 hours	>48 hours
	131	157	48	22	117
16- If you had any disaster management training please identify the type of training: (more than one answer can apply or if none choose "no training")	No training	Individual study	part of graduate curriculum	Separate disaster management seminar	Lecture & hands-on scenario exercises	Real-life experience
	130	98	61	163	195	141
17- Where was your training offered? (if none choose "no training")	No training	Graduate school	Residency	Fellowship	Separate course	Other
	141	18	30	28	167	91
18- Pick the answer that best applies to you�	Would you feel comfortable leading and directing a local disaster management initiative?	Would you be able to participate in a disaster management scenario?	Would you be interested in participating in a disaster management training workshop?
Yes	182	422	409
No	291	46	63
19 - Would you be interested in �	learning focused ultrasound exams?	learning procedures that may be needed during a disaster?	participating in simulation training?
Yes	368	437	435
No	105	37	37
20 - What do you consider as barriers to disaster management training? (pick as many as apply)	Interest	Time	access to experts	scenario exercises	availability of resources
	105	379	213	169	299
21 - If you are interested in participating in a disaster management training workshop... what would be your preferred venue:	Not interested	On-line course	live lectures	Live lectures with scenarios
	30	116	14	315

Dataset 1.Assessing perceptions of disaster preparedness survey.

Survey questions distributed to each participant are provided.