Modul 3 Strukturdan Fungsi Dna Dan Rna1

7/1/12 Who Will Show Up?
Estimating Ability and Willingness of Essential Hospital Personnel to Report to Work…
Who Will Show Up? Estimating Ability and Willingness of Essential

Hospital Personnel to Report to Work in Response to a Disaster
Lavonne M. Adams, PhD, RN, C C RN

Devon Berry, PhD, RN
Abstract
Disaster planning in the healthcare setting requires consideration of surge capacity, specifically
the community’s ability to provide care for a rapid increase in numbers of patients having varied
conditions. Adequate staffing is a key component of surge capacity. If fewer than anticipated
healthcare personnel report to work in response to a disaster, safety and sustainability of the
care provided may be jeopardized. In this article we discuss the need for essential personnel
following a disaster, review the literature related to adequate disaster staffing, and share our
study examining both the ability and willingness of healthcare personnel to report to work during
a disaster and identified barriers to this reporting. We conclude by noting that healthcare
personnel experience multiple barriers affecting ability and willingness to report to work during a
disaster, with responsibility for children producing the greatest number of significant differences.
Strategies for addressing these barriers are provided.
Citation: Adams, L., Berry, D., (March 26, 2012) "Who Will Show Up? Estimating Ability and Willingness of
Essential Hospital Personnel to Report to Work in Response to a Disaster" OJIN: The Online Journal of Issues in
Nursing Vol. 17 No. 2.
DOI: 10.3912/OJIN.Vol17No02PPT02
Keywords: surge, surge capacity, disaster planning, disaster preparedness, emergency preparedness, report
to work, hospital staff, staffing, ability to report, willingness to report, essential personnel, healthcare system
preparedness, survey design
Disaster planning in the healthcare setting requires consideration of surge capacity, specifically the
community’s ability to provide care for a rapid increase in numbers of patients having varied conditions.
Adequate staffing is a key component of surge capacity. If fewer than anticipated healthcare personnel report
to work in response to a disaster, safety and sustainability of the care provided may be jeopardized.
If fe we r than anticipate d
he althcare pe rsonne l re port
to work in re sponse to a
disaste r, safe ty and
sustainability of the care
provide d m ay be
je opardize d.
Healthcare organizations routinely develop disaster plans. Embedded in most plans is the assumption that
sufficient staff will be available to carry out the details of the disaster plans. Yet researchers have only recently
begun to address the staff-sufficiency component of surge capacity (Balicer, Omer, Barnett, & Everly, 2006;
C one & C ummings, 2006; Davidson, et al., 2009; Grimes & Mendias, 2010; Masterson, Steffen, Brin, Kordick,
& C hristos, 2009; Qureshi, et al., 2005). Failure to address the basic question of ‘who will be available to
nursingworld.org/MainMenuCategories/…/Essential-Hospital-Personnel-and-Response-to-Disaster.html 1/18
7/1/12 Who Will Show Up? Estimating Ability and Willingness of Essential Hospital Personnel to Report to Work…
perform necessary care during the disaster’ will limit the effectiveness of disaster planning and will ultimately
affect the health and safety of patients.
In this article we will discuss the need for essential personnel following a disaster, review the literature related
to adequate disaster staffing, and share our study examining the ability and willingness of healthcare personnel
to report to work during a disaster. We will conclude by noting that healthcare personnel experience multiple
barriers affecting their ability and willingness to report to work during a disaster, with responsibility for children
being the dominant barrier. Strategies for addressing these barriers are provided.
Need for Essential Personnel Following a Disaster
Disaster planning in the healthcare setting requires consideration of the

community’s ability to provide care for increased numbers of patients in
O rganizations have varied conditions. This ability is referred to as ‘surge capacity,’ which
be gun to re cognize that has been described as the “ability to expand care capabilities in
e nsuring ade quate response to sudden or more prolonged demand” on the healthcare
he althcare system (The Joint C ommission, 2003, p.19). Key components of surge
pe rsonne l is e sse ntial for capacity are the ‘four S’s,’ which are personnel (staff), supplies and
surge capacity. equipment (stuff), facilities (structure), and integrated management
policies and processes (systems) (Adams, 2009; Barbisch & Koenig,
2006).
Organizations have begun to recognize that ensuring adequate healthcare personnel is essential for surge
capacity. The Office of the Assistant Secretary for Preparedness and Response (ASPR) has established a
Medical Surge C apacity and C apability (MSC C ) project to promote public health and medical system resiliency
and to maximize the ability to meet health care demands during a surge event (ASPR, n.d.). The Agency for
Healthcare Research and Quality (AHRQ) and disaster planning experts have previously issued calls for the
prioritization of research addressing healthcare system preparedness (AHRQ, n.d.; Phillips, 2006), as well as
behavioral studies of personnel involved in surge response (Rothman, Hsu, Kahn, & Kelen, 2006; Schultz &
Koenig, 2006). With the exception of increasing interest in exploration of staff availability during an influenza
pandemic, little research has focused on the staff component of surge capacity and barriers related to staff
responding in time of disaster and public health emergencies. Additionally, most research studies have been
limited to specific settings, such as the emergency department (ED), public health department, or a single
hospital. Hence, our research sought to focus on factors influencing staff decision making with regards to
disaster scenarios precipitating a patient surge in a large, multi-hospital network.
Review of Literature
Adequate staffing throughout the various continuum-of-care settings is essential in the event of a disaster or
other public health emergency. Findings of several research studies have revealed both that healthcare
workers experience a variety of barriers regarding their reporting to work during an emergency and also that
the number of available staff will likely be less than anticipated (See Table 1) (Balicer, Omer, Barnett, & Everly,
2006; Davidson, et al., 2009; Grimes & Mendias, 2010; Masterson, Steffen, Brin, Kordick, & C hristos, 2009;
Qureshi, et al., 2005; Qureshi, Merrill, Gershon, & C alero-Breckheimer, 2002). Most studies have focused
either on a specific scenario, such as pandemic influenza, or on a specific practice setting and population, such
as emergency department personnel.
Barrie rs to ability... include

transportation proble m s,
childcare , e lde rcare ,
and/or pe t care obligations.
Barrie rs to willingne ss...
include fe ar and conce rn
for fam ily and se lf and
pe rsonal he alth proble m s.
Researchers studying healthcare workers’ ability and willingness to report to work during time of disaster have
identified barriers for both ability and willingness (Qureshi, et al., 2005). Barriers to ability to report to work in
time of disaster include transportation problems, childcare, eldercare, and/or pet care obligations. Barriers to
willingness to report to work in time of disaster include fear and concern for family and self and personal health
problems (Qureshi, et al., 2005). These findings are consistent with other studies in which nurses have reported
concerns related to conflict between family and work roles, family safety, pet care, and personal safety in the
event that they are required to respond during a disaster (Davidson, et al., 2009; French, Sole, & Byers, 2002;
Mitani, Kuboyama, & Shirakawa, 2003; O'Boyle, Robertson, & Secor-Turner, 2006). ‘Ability’ involves a capacity
to respond, while ‘willingness’ is an attitude and implies an element of personal choice (Qureshi, et al., 2005).
Researchers have suggested that willingness is affected by multiple factors, including perceived threat and
perceived efficacy. Perceived threat relates to the specific scenario. Perceived efficacy is healthcare workers’
feeling that their response will make a difference in the disaster (response efficacy) and that the healthcare
workers have the confidence that they can carry out the necessary behavior (self-efficacy) (Barnett, et al.,
2009). Various forms of risk perception theory and the extended parallel process model have been suggested
for use in the beginning exploration of response willingness in specific scenarios (Barnett, et al., 2005; Barnett,
et al., 2009).
If fewer healthcare workers than anticipated report to work following a disaster, patient care and safety, staff
health and safety, and sustainability of surge capacity will be jeopardized. Additional research in this arena is
therefore essential to ensure adequate preparedness, care quality, and safety for patients and staff.
The Study
In this study we sought to identify ability, willingness, and barriers regarding the reporting of essential
personnel to the work setting following a disaster. Specific aims of this study were to:
a. determine ability and willingness of healthcare personnel in a Midwestern healthcare system to report
to work in time of disaster, and
b. identify barriers to the ability and willingness of healthcare personnel in a Midwestern healthcare
system to report to work in time of disaster.
Method
This descriptive, exploratory study utilized survey methodology to examine the ability and willingness of
healthcare personnel in a Midwestern healthcare network to report to work in a variety of disaster scenarios
(See Table 2) in order to identify factors that would pose significant barriers to their reporting to work and to
identify demographic factors that might influence these barriers. The survey was based on the ‘Disaster
Survey’ created by Qureshi et al. (2005) and was modified with permission. Qureshi’s Disaster Survey has
been used with many subjects in a variety of hospitals and consistent results have been obtained (Qureshi,
personal communication, October 20, 2006). The survey assesses participants’ ability and willingness, based on
an answer of ‘yes,’ ‘no,’ or ‘not sure,’ to report to work during various disaster scenarios. Qureshi’s Disaster
Survey includes a broad range of scenarios consistent with the ‘all hazards’ approach to hospital disaster
planning; we believed it was important to utilize a comparable range of scenarios in our study. The first author
had previously modified Qureshi’s Disaster Survey for use in Southwestern United States (U.S.) hospitals, while
adding both a pandemic influenza scenario to be consistent with current trends and also a tornado with flooding
scenario to be consistent with hazard vulnerability analysis in the region. Nurses familiar with hospital disaster
planning examined the scenarios to determine face validity, and an online version of this survey was piloted
with practicing nurses to obtain feedback on ease of completing the online format.
A similar modification process took place with the current study. Working from the initially modified survey, the
second author of this article worked with members of the Kettering Health Network Nursing Research C ouncil to
develop comparable scenarios that were reflective of the unique vulnerabilities of the geographic region that
the healthcare network served and to determine face validity. The survey was distributed in both online and
paper formats during the research study reported below.
The study’s setting was a Midwestern, community-based, healthcare network located near a high-value
terrorism target, specifically the flagship Military Base for the U.S. Air Force which is within 10 to 20 miles of
most of the acute care centers that make up the health network in which the survey was conducted. Although
not officially confirmed by the military, area hospitals and local disaster planners ‘understand’ that this base is
a primary military target for terrorism. The network is one of two major health networks in the area servicing a
population of approximately 1.6 million people spread over nine counties. At the time of data collection, the
network consisted of six inpatient facilities ranging in size from 60 to 420 beds.
The sample consisted of nurses and other clinical and non-clinical healthcare staff, including personnel from
respiratory therapy, radiology, social services, admissions, security, plant engineering, systems operation,
nutrition services, and environmental services, who were employed by this Midwestern healthcare network, and
who were considered to be ‘essential personnel’ during a disaster. Determination of who was considered
essential personnel was gleaned through examination of the network’s Hospital Incident C ommand System
(HIC S) management chart for disaster response. Permission was obtained from the Kettering Health Network
Institutional Review Board and Texas C hristian University Institutional Review Board prior to implementation of
the study. Over 2700 employees, of which approximately 1500 were RNs representing groups critical to a
disaster response, were invited to participate in the survey. Power analysis indicated a sample size of 898 was
needed to detect a small effect size (< .01) when performing statistics to test for differences among groups.
To maximize participation, we decided to invite all members of the ‘essential’ workgroups to participate in the
survey. The workgroups known to have organizational email accounts that were regularly accessed, based on
supervisor report of department norms, were emailed an online survey link. Those who did not have an email
account or did not access an email account regularly were asked to complete a paper version of the survey.
Surveys were introduced by an information sheet that explained the study’s purpose, benefits, risks, and the
participant’s privacy and rights protections. C ompletion of the survey implied consent to participate. All
responses to the survey were anonymous. After initial distribution, three reminders were sent to employees to
encourage participation. Ultimately 1342 employees responded to the survey, for a response rate of 50%
based on the known number of surveys distributed.
An additional sampling technique occurred serendipitously. As results began to come back, it became obvious
that ‘snowballing’ had occurred, since participants indicated positions that were not included in the original
sample of essential personnel, such as staff educators, faculty, chaplains, pharmacists, and physicians. Since
the majority of invitations were sent via email, it is possible that participants forwarded the email and/or the
survey link to other staff whom they thought should be included or might be interested. Our actual response
rate is thus somewhat unclear, since we do not know how many staff actually came into contact with the survey
link. Despite this potential limitation to our statistical analysis, a potential benefit of the snowball sample was
that it resulted in an even greater cross section of personnel than was originally intended.
Findings
The majority of participants was employed fulltime (80.3%) and on an 8- or 12-hour day shift (71.3%). Nearly
half (49.8%) reported being responsible for children and a majority (70.1%) were responsible for pets or
livestock (See Table 3). We will present below the details of our findings related both to ability and willingness
to report, along with barriers to reporting.
Ability and willingness to report. Ability to report (for all participants) ranged from a low of 71.1% (n=972)
for tornado/flooding to 90.6% (n=1216) for an explosion with mass casualties (See Table 4). Willingness to
report (for all participants) ranged from a low of 69.1% (927) for a radiologic event to 93% (n=1248) for an
explosion with mass casualties (See Table 5).
To determine if various obligations, family situations, or type of position

produced a difference in ability or willingness to report to work during a
disaster, we tested for differences between each scenario and responsibility R e sponsibility for
for children, responsibility for pets/livestock, responsibility for elders, type of childre n produce d
position, and having a spouse or partner expected to report to work during the highe st num be r
the same scenario using X 2 .Participants in other studies have identified these of significant and
obligations as potential barriers to disaster response, and different response m e aningful
rates in personnel in clinical positions have been noted (Qureshi et al., 2005). diffe re nce s...
Responsibility for children produced the highest number of significant and
meaningful differences, including both ability to report to work during all
scenarios except winter weather, and willingness to report to work during all
scenarios except winter weather and an influenza pandemic (See Tables 6
and 7). Other significant and meaningful differences occurred with
responsibility for elders and ability to report during a chemical terrorism
event; spouse/partner required to report to work with ability to report during
a chemical terrorism event; and clinical position with ability and willingness to report during a chemical
terrorism event and smallpox outbreak. No significant and meaningful differences were noted with
responsibility for pets/livestock and any of the scenarios.
For the purpose of this study, significance was considered to be any p value less than .05 and a meaningful
difference was 5% or greater. C ramer’s V was calculated to determine the strength of the effect (See Tables 6
and 7). Any C ramer’s V < 0.1 indicates a weaker effect, suggesting that such results could be due to the large
sample size. Because not all calculations produced significant and meaningful differences, however, we felt that
it was still important to examine and discuss any results that were both significant and meaningful even when
C ramer’s V indicated a weaker effect.
A greater proportion of those with no responsibility for children were found to be able and willing to report for
multiple scenarios. A greater proportion of those with responsibility for children were ‘not sure’ if they would be
able to report during multiple scenarios compared with those without responsibility for children (See Tables 6
and 7).
The relationship between ability to report during a chemical terrorism event and whether the participant had
responsibility for elders was significant, Χ 2(2) = 15.45, p = .000. A greater proportion of those who had no
responsibility for elders indicated they would be able to report (86.7%) compared to those with responsibility
for elders (81.3%).
Participants re porte d m ultiple

barrie rs to the ir ability and
willingne ss to
re port to work . C om m on
the m e s e x pre sse d in
re sponse to an ope n-e nde d
prom pt of
‘othe r’ include d the safe ty of
fam ily and significant othe rs,
re sponsibility for
a spouse with he althcare
ne e ds and/or disability, the
e ffe ct of the disaste r on
se lf and/or fam ily,
transportation lim itations,
and concurre nt work or
voluntary
obligations.
The relationship between ability to report during a chemical terrorism event and whether the participant had a
spouse/partner expected to report to work during a disaster was significant, Χ 2(2) = 10.16, p = .006. A greater
proportion of those who did not have a spouse/partner expected to report to work during a disaster would be
able to report (87.5%) compared to those whose spouse/partner would be expected to report to work (81.7%).
In addition, a greater proportion of those whose spouse/partner would be expected to report to work during a
disaster were not sure if they would be able to report to work during a chemical terrorism event (16.6%)
compared to those whose spouse/partner was not expected to report to work (10.4%).
The relationship between ability to report during a chemical terrorism event and whether the participant had a
clinical position was significant, Χ 2 (2) = 8.53, p = .014. A greater proportion of those who held a non-clinical
position indicated they would be able to report (88.8%) compared to those who held a clinical position (83.5%).
The relationship between willingness to report during a chemical terrorism event and whether the participant
held a clinical position was significant, Χ 2 (2) = 8.54, p = .014. A greater proportion of those who held a non-
clinical position indicated they would be willing to report (85%) compared to those who held a clinical position
(79.2%).
The relationship between ability to report during a smallpox outbreak and whether the participant had a clinical
position was also significant, Χ 2(2) = 7.76, p = .021. A greater proportion of those who held a non-clinical
position would be able to report (89.4%) compared to those who held a clinical position (84%). Additionally, a
greater proportion of those who held a clinical position were not sure they would be able to report (13.6%)
compared to those who held a non-clinical position (8.8%).
Finally, the relationship between willingness to report during a smallpox outbreak and whether the participant
held a clinical position was significant, Χ 2 (2) = 12.39, p = .002. A greater proportion of those who held a non-
clinical position indicated they would be willing to report (84.8%) compared to those who held a clinical position
(77.1%).
Barriers to reporting. Participants reported multiple barriers to their ability and willingness to report to work.
C ommon themes expressed in response to an open-ended prompt of ‘other’ included the safety of family and
significant others, responsibility for a spouse with healthcare needs and/or disability, the effect of the disaster
on self and/or family, transportation limitations, and concurrent work or voluntary obligations. In response to
specific prompts related to reasons they would be unable to report to work, 30.1% (n= 404) of participants
reported childcare responsibilities and 19.3% (n = 259) reported pet/livestock care as potential barriers (See
Table 8). In response to specific prompts related to reasons they would be unwilling to report to work,
concern/fear for family (45.8%, n = 615) and concern/fear for self (30%, n= 402) were the most frequently
reported barriers (See Table 8).
Discussion
...between 10-30% of
personnel were either
unwilling or unable to
report to work
in various disaster
scenarios.
The purpose of the study was to examine the ability and willingness of healthcare personnel in a Midwestern
healthcare system to report to work in time of disaster and to identify barriers to their ability and willingness to
report. We found that between 10-30% of personnel were either unwilling or unable to report to work in various
disaster scenarios. Additionally, participants identified multiple factors that would affect their decision to report
to work. Among these factors were concern for safety of family and significant others, concern for personal
safety, responsibility for children or other family members, responsibility for pets or livestock, transportation
limitations, and concurrent work obligations.
...a gre ate r proportion of

non-clinical pe rsonne l,
com pare d to clinical
pe rsonne l, indicate d be ing
able and willing to work
during a che m ical
te rrorism
e ve nt or sm allpox
e pide m ic.
Our study found that a greater proportion of non-clinical personnel, compared to clinical personnel, indicated
being able and willing to work during a chemical terrorism event or smallpox epidemic. One potential reason
for this difference is that non-clinical essential personnel, such as security, plant engineering, and
administration, may have fewer people per department and thus have a greater expectation that each
individual is critical to a disaster response. Perhaps these personnel are socialized to anticipate their
‘essentialness’ to a greater extent than clinical and clinical support staff who know their numbers are greater,
resulting in more options for their being replaced. Another possibility is that clinical staff will have a greater
prospect of exposure to infectious disease or chemical contamination due to their close proximity to patients.
Future studies should explore these questions, especially since other study findings have differed from ours.
C one and C ummings (2006) found that clinical personnel were willing to respond to more disaster types than
were non-clinical personnel. Qureshi et al. (2005) found that physicians and emergency medical technicians
were more likely to be both willing and able to report for work during a disaster than any other personnel,
including administrators, nurses, and clinical support staff.
C onsistent with the findings of Qureshi et al. (2005), our study indicated that responsibility for childcare posed
a significant barrier both to the ability and willingness of participants to report to work. Because significant
differences in ability and willingness to respond in most disaster scenarios occurred with those who were
responsible for children, the participating healthcare network would be well advised to consider the potential
impact of an employee’s childcare responsibility on its overall surge capacity. Offering onsite childcare or
partnering with childcare providers may need to be considered.
Be cause significant diffe re nce s in

ability and willingne ss to re spond
in m ost
disaste r sce narios occurre d with
those who we re re sponsible for
childre n...
O ffe ring onsite childcare or
partne ring with childcare provide rs
m ay ne e d to be
conside re d.
When the various obligations were tested with the scenarios, the chemical terrorism scenario was associated
with the greatest number of significant and meaningful differences. In future research, it would be useful to
explore whether the participants were more concerned about the chemical event or about the prospect of
terrorism in their community. Given that concern for safety of family and significant others was an important
consideration for participants, study into the impact of the word ‘terrorism’ on participants’ responses could be
valuable.
It is of interest that the concern for the safety of family and significant others was often repeated by
participants as an ‘other reason’ that would affect either their ability or willingness to report to work. Some
memorable comments echoing this concern included “May be dead,” “I may be getting out of Dodge with
husband/pets,” and “My first priority is to make sure my family is safe.”
Limitations and Recommendations
Because these findings represent the responses of participants within a single health network in a specific
geographic region, the findings have limited generalizability to the general population. Future research that
includes random selection of participants in a variety of health networks and geographic regions may therefore
be valuable.
Despite providing a hard copy option for staff without email access, participation from staff without email
access was limited. Participation from staff working evening or night shifts was also limited. Therefore, our
findings may not be representative of these subgroups.
Additionally, a survey may not be powerful enough to accurately predict actual behavior. Self-report of what
one anticipates doing may be different from what one will actually do. Intention and planned behavior as
described in the theory of planned behavior (Aizen, 1991) are influenced by multiple factors, including attitudes
about behavior, beliefs related to subjective norms, and perceived behavioral controls. Although the theory of
planned behavior has been used to predict actual behavior based on self-reported data, researchers
acknowledge that such data are vulnerable to self-presentational bias (Armitage & C onner, 2001).The ‘halo
effect’ (Nisbett & DeC ampo Wilson, 1977) could have caused participants to report what might be considered
heroic or what they thought the researchers or employers would like to hear. Despite anonymity of the survey,
participants may have been afraid to report honestly for fear of employer retaliation, especially if their
responses to ability or willingness to come to work would have been ‘no.’
...disaste r plans that are

not te ste d rigorously
e nough to e x pose gaps
will only
be plans on pape r that
offe r an illusion of
pre pare dne ss.
Although behavior in disaster drills may offer an indication of actual behavior in future disasters, disaster plans
that are not tested rigorously enough to expose gaps will only be plans on paper that offer an illusion of
preparedness (Adams, 2009; Milsten, 2000). It is possible that some participant responses were influenced by
participation in previous disaster drills that lacked rigor and hence did not adequately simulate a real
disaster.The need for drills to be realistic was emphasized by a study participant who contacted the
investigators with the suggestion that disaster drills should be held without notification so that “people are truly
going on with their personal lives as if their day was done” or on the weekend “when families are busy and it is
not part of their work day” rather than “waiting at home because they know a drill is coming and [they] have to
be available” (study participant, personal communication, 2010). The participant went on to observe that
“disaster drills where people have a week or two to get a disaster manual out and review are just too
predictable and easy and so not real life” (study participant, personal communication, 2010).
Another potential limitation is that the winter scenario was too mild for a Midwestern locale and thus did not
provide an adequate estimate of the effect of severe winter weather on staff availability. Although the Kettering
Health Network Nursing Research C ouncil revised the instrument that had been used in North C entral Texas to
be more consistent with Midwestern locations, the actual description of the scenarios remained unchanged. In
future surveys conducted in locations accustomed to harsher winters, we recommend presenting a more
severe winter scenario.
Participant responses may also have been biased, especially in the case of the snowball sample. Those who
participated may have been more interested in the topic of disaster preparedness than those who did not
participate and therefore their responses may not be reflective of the larger group.
Exploring ‘ability’ and ‘willingness’ to report to work involves the inherent challenge of being able to measure
these qualities reliably. Providing only three options of ‘yes,’ ‘no,’ and ‘not sure’ does not allow for variations in
the degree of uncertainty. Participants who were ‘not sure’ may be able or willing to report to work during an
actual event; but without facing the actual circumstances, they may not have been willing to commit to doing
so. A Likert scale approach might have provided greater insight into degrees of uncertainty.
Future Research
A growing body of literature discusses the duty and legal obligations of healthcare professionals to care for
others during disasters, including pandemics (American Nurses Association, 2010; Davies & Zlotnik Shaul,
2010; Kane-Urrabazo, 2007; Malm, et al., 2008; Rolls & Thompson, 2007). In addition to caring for patients,
however, healthcare professionals are obligated to care for themselves (ANA, 2001). They often have multiple
roles, such as parent and spouse, with each role requiring its own obligations (Sokol, 2008). The competing
obligations of duty to patients and duty to self and family produce an ethical dilemma for healthcare
professionals when disaster occurs, particularly if the situation puts the healthcare professional at risk (ANA,
2010; Schroeter, 2008; Sokol, 2008; Stokowski, 2009; Twedell, 2009). Little ethical guidance has been
provided for nurses to help them make a decision about which competing obligation outweighs another,
especially if personal risk is increased due to a shortage of protective resources (Schroeter, 2008). Legal
requirements for responding in a disaster vary from state to state and offer little assistance in making an
informed decision about assumption of personal risk (ANA, 2010). ANA (2010) therefore had advocated for
further efforts to develop legal protections for nurses practicing in disasters. In our study, liability concerns
were not a major barrier to willingness to report (4.1%), but concern/fear for family safety (45.8%) and
personal safety (30%) appeared to be important. Future researchers are encouraged to ask study participants
what would compel them to come to work during a disaster.
Another area for further research is the differentiation between barriers to an immediate response and barriers
to a sustained response to disaster. Those who have responsibilities, such as childcare, would find it difficult to
report to work immediately but might be able to do so given sufficient lead time to make arrangements. On the
other hand, temporary solutions that allow individuals to respond to a disaster in the short term may not be
sustainable over extended periods of time. Further study in this area would be helpful in determining solutions
that would enhance both short term and longer term surge capacity.
Conclusions and Recommendations
This study has increased our knowledge about the ability and willingness of clinical and non-clinical personnel of
a Midwestern health network, a geographic region that has received limited attention in the literature, to report
to work following a disaster. This study also offers the perspective of a broader scope of participants than have
most studies in this arena because we obtained participation from personnel in clinical and non-clinical areas in
multiple hospitals of a health network rather than restricting participation to a single practice setting or hospital.
C onsistent with other study findings, we, too, have concluded that staff experience multiple barriers that affect
their ability and willingness to respond when called during a disaster, with responsibility for children producing
the greatest number of significant differences. Because of this, we recommend that to enhance surge capacity,
healthcare institutions explore potential barriers that affect willingness and ability of staff to respond and
consider ways to mitigate these barriers. Adams (2009) has suggested the following strategies for mitigating
barriers:
Personal disaster preparedness planning by all employees

Disaster drills that include questions and answers about potential barriers
Development of supportive services for staff, such as childcare
Provision of safety precautions for staff, and
Understanding of concurrent employment and voluntary obligation
Based on this study, the authors are considering additional studies to determine ability and willingness of
healthcare staff to report to work in times of disaster, to identify barriers to their ability and willingness to
report to work, and to explore the effect of potential solutions to barriers to staff ability and willingness to
report to work.
Authors
Lavonne M. Adams, PhD, RN, CCRN

E-mail: L.adams2@tcu.edu
Dr. Adams is an Associate Professor in the Texas C hristian University Harris C ollege of Nursing & Health
Sciences. She is a Disaster Health Services Volunteer and an Instructor for the American Red C ross. Her
clinical background includes critical care and emergency nursing; she is also an instructor in Basic Life Support
and Advanced C ardiac Life Support. Dr. Adams holds a degree with a focus in Leadership from Andrews
University (Michigan), an MS in Nursing from Andrews University, a BSN from Wright State University (Ohio),
and an AS in Nursing from Kettering C ollege (Ohio).
Devon Berry, PhD, RN

E-mail: devon.berry@wright.edu
Dr. Berry is the Director of Innovation and C ommunity Partnerships in the Wright State University C ollege of
Nursing and Health. In addition to his work in academia, he also works as a research consultant for a mid-sized
health network. In this role he regularly designs and implements research projects that create the data needed
to support evidence-based practices.
Table 1. Summary of Previous Literature
Reference Population Response rate Scenario/Event Report to Work

and/or sample
size
Grimes & RNs completing N=313 Infectious diseases 8-20% extremely

Mendias, 2010 bioterrorism training likely to report; 21-
64% highly likely to
report
Masterson et ED physicians, 82%, N=204 Airplane crash 98% likely to report

al., 2009 nurses, support staff
Biological agent 54% likely to report
Radioactive bomb 85.3% likely to

report
Balicer et al., Public health N=140 Pandemic influenza 48% not likely to
2006 employees report
Qureshi et al., Public health nurses N=50 Emergency 70% likely to report
2002
C one & Hospital and ED N=1711 Fire, rescue, 87% willing to report
C ummings, employees collapse, mass
2006 casualty
Biological 58% willing to report
C hemical 58% willing to report
Radiation 57% willing to report
Snowstorm 83% willing to report
Flood 81% willing to report
Earthquake 79% willing to report
Hurricane 78% willing to report
Tornado 77% willing to report
Ice storm 75% willing to report
Influenza 72% willing to report
Qureshi et al., Healthcare workers N=6428 Small pox 69% able to report
2005
Radiation 64% able to report
SARS 64% able to report
Snow storm 49% able to report
C hemical 68% willing to report
Small pox 61% willing to report
Radiation 57% willing to report
SARS 48% willing to report
Table 2. Disaster Scenarios used for Midwestern Facilities
Type of Event Scenario
Weather emergency Winter mix of 1 inch of ice and snow in a 24-hour

period where you live
Bioterrorism Smallpox outbreak in Springfield. 200 patients

admitted to 5 hospitals
C hemical terrorism C hemical terrorism attack at Dayton International

Airport with 500 victims brought to hospitals
throughout the Dayton area
Weather emergency/environmental disaster Tornadoes injure hundreds of people in Kettering,

Dayton, and Oakwood. Flash flooding has been
reported throughout the Dayton area and is
expected to worsen
Mass casualty incident Explosion at The Nutter C enter in Beavercreek with

2000 seriously injured brought to hospitals in the
Dayton area
Radiation terrorism Radioactive bomb explodes at The Greenes in

Beavercreek. Thousands of people flocking to ER’s
in the Dayton area
Untreatable infectious disease outbreak Outbreak of 15 cases of SARS in the facility in which
you work
Treatable infectious disease outbreak Outbreak of pandemic influenza in the Miami Valley
area
Table 3. Description of Participants *
% (N) % (N)
Employment status
Full time 80.3 (1077)
Part time 12.2 (164)
PRN 4.3 (25)
Other 1.9 (25)
Shift
Day (8 or 12 hour) 71.3 (957)
Evening (8 or 12 hour) 6.8 (92)
Night (8 or 12 hour) 9.5 (128)
Other 11.8 (159)
Type of position
C linical 60.2 (817)
Non-clinical 39.8 (534)
Age range (years)
18-29 12.0 (161)
30-39 18.8 (252)
40-49 26.6 (357)
50-59 31.1 (417
60+ 10.2 (137)
Yes No
Responsible for children 49.8 (668) 46.6 (626)
Responsible for elders 21.6 (290) 76.7 (1029)
Responsible for pets/livestock 70.1 (941) 29.2 (392)
Spouse/partner expected to work in disaster 31.1 (417) 68.0 (912)
*Not all participants answered all questions, therefore percentages do not all add up to 100%
Table 4. Healthcare Workers’ Ability to Report to Work During Disaster
Scenario Able Not Able Not Sure

% (N) % (N) % (N)
Explosion with mass casualties

90.6 (1216)
Total 1 (13) 8.1 (109)
90.0 (742)
C linical 1.1 (9) 9.0 (74)
Nonclinical 92.5 (472) 0.6 (3) 6.9 (35)
Influenza pandemic
Total 87.9 (1179) 2.3 (31) 9.2 (124)
C linical 87.9 (724) 2.3 (19) 9.8 (81)
Nonclinical 89.5 (454) 2.0 (10) 8.5 (43)
Winter weather
Total 86.6 (1162) 2.8 (38) 10.4 (139)
C linical 87.0 (719) 2.4 (20) 10.5 (87)
Nonclinical 86.5 (441) 3.3 (17) 10.2 (52)
Smallpox epidemic
Total 85.8 (1151) 2.2 (30) 11.7 (157)
C linical 84.0 (693) 2.4 (20) 13.6 (112)
Nonclinical 89.4 (456) 1.8 (9) 8.8 (45)
C hemical event
Total 85.2 (1144) 2.0 (27) 12.4 (167)
C linical 83.5 (689) 2.5 (21) 13.9 (115)
Nonclinical 88.8 (453) 1.0 (5) 10.2 (52)
SARS outbreak
Total 82.3 (1105) 3.1 (42) 13.9 (187)
C linical 82.7 (682) 3.5 (29) 13.8 (114)
Nonclinical 83.4 (422) 2.2 (11) 14.4 (73)
Radiologic event
Total 72.4 (972) 5.8 (78) 21.4 (287)
C linical 71.4 (589) 6.3 (52) 22.3 (184)
Nonclinical 74.9 (381) 4.9 (25) 20.2 (103)
Tornado/flooding
Total 71.1 (954) 5.4 (72) 23.1 (310)
C linical 72.0 (593) 5.6 (46) 22.5 (185)
Nonclinical 70.5 (359) 4.9 (25) 24.6 (125)
Table 5. Healthcare Workers’ Willingness to Report to Work During Disaster
Scenario Willing Not Willing Not Sure

% (N) % (N) % (N)
Explosion with mass casualties
Total 93.0 (1248) 1.4 (19) 5.1 (68)
C linical 92.4 (763) 1.7 (14) 5.9 (49)
Nonclinical 95.5 (483) 0.8 (4) 3.8 (19)
Winter weather
Total 92.8 (1245) 2.1 (28) 4.3 (58)
C linical 93.1 (766) 1.7 (14) 5.2 (43)
Nonclinical 94.7 (478) 2.4 (12) 3.0 (15)
Influenza pandemic
Total 85.1 (1142) 4.2 (56) 10.4 (139)
C linical 86.2 (711) 4.0 (33) 9.8 (81)
Nonclinical 84.5 (430) 4.1 (21) 11.4 (58)
C hemical event
Total 80.9 (1068) 5.0 (67) 13.6 (182)
C linical 79.2 (654) 6.1 (50) 14.8 (122)
Nonclinical 85.0 (430) 3.2 (3.2) 11.9 (60)
Tornado/flooding
Total 80.4 (1079) 5.7 (76) 13.8 (180)
C linical 82.1 (677) 5.6 (46) 12.4 (102)
Nonclinical 78.9 (400) 5.7 (29) 15.4 (78)
Smallpox epidemic
Total 79.4 (1065) 6.2 (83) 13.8 (185)
C linical 77.1 (636) 7.4 (61) 15.5 (128)
Nonclinical 84.8 (428) 4.0 (20) 11.3 (57)
SARS outbreak
Total 74.6 (1001) 7.0 (94) 18.0 (242)
C linical 74.5 (614) 7.5 (62) 18.0 (148)
Nonclinical 75.7 (386) 5.9 (30) 18.4 (94)
Radiologic event
Total 69.1 (927) 9.2 (124) 21.2 (285)
C linical 67.4 (557) 10.5 (87) 22.0 (182)
Nonclinical 72.6 (368) 7.1 (36) 20.3 (103)
Table 6. Responsibility for Children and Healthcare Workers’ Ability to Report to Work During
Disaster
Scenario Able Not Able Not Sure Χ2 df p Cramer’s

% (N) % (N) % (N) V
Winter weather
Responsible for C hildren
Yes 86.2 (576) 2.5 (17) 11.2 (75) 2.97 2 .226 .048
No 88.0 (548) 3.4 (21) 8.7 (54)
Smallpox epidemic
Yes 83.0 (553) 2.9 (19) 14.1 (94) 12.29 2 .002 .098
No 89.7 (560) 1.6 (10) 8.7 (54)
C hemical event
Yes 81.9 (547) 2.4 (17) 15.6 (104) 15.39 2 .000 .109
No 89.5 (557) 1.6 (10) 8.8 (55)
Tornado/flooding
Yes 68.1 (455) 6.1 (41) 25.7 (172) 6.11 2 .047 .069
No 74.4 (461) 4.8 (30) 20.8 (129)
Explosion with mass

casualties
Yes
88.5 (591) 1.0 (7) 10.5 (70) 11.8 2 .003 .096
No
93.7 (583) 1.0 (6) 5.3 (33)
Radiologic event
Yes 68.7 (458) 7.3 (49) 24.0 (160) 10.59 2 .005 .091
No 76.5 (476) 4.7 (29) 18.8 (117)
SARS outbreak
Yes 79.0 (527) 4.0 (27) 16.9 (113) 15.45 2 .000 .110
No 87.2 (540) 2.3 (14) 10.5 (65)
Influenza pandemic
Yes 85.9 (573) 3.0 (20) 11.1 (74) 9.71 2 .008 .087
No 91.4 (566) 1.8 (11) 6.8 (42)
Table 7. Responsibility for Children and Healthcare Workers’ Willingness to Report to Work During
Disaster
Scenario Willing Not Not Sure Χ2 df p Cramer’s

% (N) Willing % (N) V
% (N)
Winter weather
Yes 92.9 (615) 2.3 (15) 4.8 (32) 1.06 2 .590 .029
No 94.2 (585) 2.1 (13) 3.7 (23)
Smallpox epidemic
Yes 74.9 (499) 8.6 (57) 16.5 (110) 21.78 2 .000 .130
No 85.2 (528) 4.2 (26) 10.6 (66)
C hemical event
Yes 77.4 (515) 5.9 (39) 16.7 11.23 2 .004 .093

(111)
No 84.7 (527) 4.3 (27)
10.9 (68)
Tornado/flooding
Yes 77.3 (514) 7.2 (48) 15.5 (103) 10.02 2 .007 .088
No 84.1 (523) 4.3 (27) 11.6 (72)
Explosion with mass

casualties
Yes
91.4 (608) 1.7 (11) 5.9 (46) 10.4 2 .006 .090
No
95.7 (595) 1.3 (8) 3.1 (19)
Radiologic event
Yes 65.2 (434) 11 (73) 23.9 (159) 9.44 2 .009 .086
No 73.0 (454) 7.9 (49) 19.1 (119)
SARS outbreak
Yes 69.5 (462) 9.2 (61) 21.4 (142) 19.4 2 .000 .123
No 80.0 (499) 5.1 (32) 14.9 (93)
Influenza pandemic
Yes 83.6 (557) 5.4 (36) 11.0 (73) 4.42 2 .110 .059
No 87.0 (542) 3.2 (20) 9.8 (61)
Table 8. Barriers to Healthcare Workers’ Ability and Willingness to Report to Work During
Disaster
Reasons Not Able to Report to Work Frequency

% (N)
C hildcare 30.1% (404)
Pet/livestock care 19.3% (259)
Transportation 14.9% (200)
Health issues 13.7% (184)
Elder care 11.2% (150)
Other job 3.4% (45)
Reasons Not Willing to Report to Work
C oncern/Fear for family 45.8% (615)
C oncern/Fear for self 30.0% (402)
Health issues 11.0% (147)
Liability 4.1% (55)
References
Adams, L.M. (2009). Surge ready. Nurse Leader, 7, 8-10.
Agency for Healthcare Research and Quality (AHRQ). (n.d.) AHRQ Research Relevant to Bioterrorism
Preparedness. Retrieved from http://archive.ahrq.gov/news/focus/bioterror.htm.
American Nurses Association (ANA). (2010). Who will be there? Ethics, the law, and a nurse’s duty to respond
in a disaster. Retrieved from www.nursingworld.org/MainMenuC ategories?HealthcareandPolicyIssues/Issues-
Briefs/Disaster-Preparedness.aspx.
ANA. (2001). Code of ethics for nurses with interpretive statements. Retrieved from
www.nursingworld.org/MainMenuC ategories/EthicsStandards/C odeofEthicsforNurses/C ode-of-Ethics.aspx
Balicer, R.D., Omer, S.B., Barnett, D.J., & Everly Jr., G.S. (2006). Local public health workers’ perceptions
toward responding to an influenza pandemic. BMC Public Health, 6(99). doi:10.1186/1471-2458-6-99.
Barbisch, D.F., & Koenig, K.L. (2006). Understanding surge capacity: Essential elements. Academic Emergency
Medicine, 13, 1098-1102.
Barnett, D.J., Balicer, R.D., Blodgett, D.W., Everly, Jr, G.S., Omer, S.B., Parker, C .L., & Links, J.M. (2005).
Applying risk perception theory to public health workforce preparedness training. Journal of Public Health
Management Practice, 11(6), S33-S37.
Barnett, D.J., Balicer, R.D., Thompson, C .B, Storey, J.D., Omer, S.B., Semon, N.L., Bayer, S.,…Links, J.M.
(2009). Assessment of local public health workers’ willingness to respond to pandemic influenza through
application of the Extended Parallel Process Model. PLoS ONE, 4(7), e6365. Doi:10.1371/journal.pone.0006365.
C one, D.C ., & C ummings, B.A. (2006). Hospital disaster staffing: If you call, will they come? American Journal
of Disaster Medicine, 1, 28-36.
Davidson, J.E., Sekayan, A., Agan, D., Good, L., Shaw, D., & Smilde, R. (2009). Disaster dilemma: Factors
affecting decision to come to work during a natural disaster. Advanced Emergency Nursing Journal, 31, 248-
257.
Davies, C .E., & Zlotnik Shaul, R. (2010). Physicians’ legal duty of care and legal right to refuse to work during
a pandemic. Canadian Medical Association Journal (CMAJ), 182, 167-170.
French, E.D., Sole, M.L., & Byers, J.F. (2002). A comparison of nurses’ needs/concerns and hospital disaster
plans following Florida’s Hurricane Floyd. Journal of Emergency Nursing, 28, 111-117.
Grimes, D.E., & Mendias, E.P. (2010). Nurses’ intentions to respond to bioterrorism and other infectious disease
emergencies. Nursing Outlook, 58, 10-16.
The Joint C ommission. (2003). Health care at the crossroads. Retrieved from
www.jointcommission.org/NR/rdonlyres/5C 138711-ED76-4D6F-909F-
B06E0309F36D/0/health_care_at_the_crossroads.pdf.
Kane-Urrabazo, C . (2007). Duty in a time of disaster: A concept analysis. Nursing Forum, 42 56-64.
Malm, H., et al. (2008). Ethics, pandemics, and the duty to treat. The American Journal of Bioethics, 8(8), 4-19.
Masterson, L., Steffen, C ., Brin, M., Kordick, M.F., & C hristos, S. (2009). Willingness to respond: Of emergency
department personnel and their predicted participation in mass casualty terrorist events. The Journal of
Emergency Medicine, 36, 43-49.
Milsten, A. (2000). Hospital responses to acute-onset disasters: A review. Prehospital Disaster Medicine, 15, 32-
40.
Mitani, S, Kuboyama, K., & Shirakawa, T. (2003). Nursing in sudden-onset disaster: Factors & information that
affect participation. Prehospital and Disaster Medicine, 18 359-366.
Nisbett, R.E., Decamp-Wilson, T. (1977). The halo effect: Evidence for unconscious alteration of judgments.
Journal of Personality and Social Psychology, 35, 250-256.
O’Boyle, C ., Robertson, C ., & Secor-Turner, M. (2006). Nurses’ beliefs about public health emergencies: Fear of
abandonment. American Journal of Infection Control, 34 351-357.< /p>
Office of the Assistant Secretary for Preparedness and Response (ASPR). (n.d). Medical Surge C apacity and
C apability. Retrieved from www.phe.gov/preparedness/planning/mscc/pages/default.aspx.
Phillips, S. (2006). C urrent status of surge research. Academic Emergency Medicine, 13, 1103-416.
Qureshi, K.A., Merrill, J.A., Gershon, R.R.M., & C alero-Breckheimer, A. (2002). Emergency preparedness
training for public health nurses: A pilot study. Journal of Urban Health: Bulletin of the New York Academy of
Medicine, 79, 413-16.
Qureshi, K.A., et al.(2005). Health care workers’ ability and willingness to report to duty during catastrophic
disasters. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 82, 378-388.
Rebmann, T., English, J.F., & C arrico, R. (2007). Disaster preparedness lessons learned and future directions
for education: Results from focus groups conducted at the 2006 APIC C onference. American Journal of
Infection Control, 35,374-381.
Rolls, S., & Thompson, C . (2007, November). Nurses’ obligations in a pandemic or disaster. Kai Tiaki Nursing
New Zealand,, 13(10), 27-31.
Rothman, R.E., Hsu, E.B., Kahn, C .A., & Kelen, G.D. (2006). Research priorities for surge capacity. Academic
Schroeter, K. (2008). Duty to care versus duty to self. Journal of Trauma Nursing, 15, 3-4.
Schultz, C .H., & Koenig, K.L. (2006). State of research in high-consequence hospital surge capacity. Academic
Sokol, D.K. (2008). Ethics and epidemics. The American Journal of Bioethics, 8(8)¸ 28-29.
Stokowski, L. (2009). Ethical dilemmas for healthcare professionals: C an we avoid influenza? Medscape
Infectious Diseases. Retrieved from www.medscape.com/viewarticle/702371_print
Twedell, D., (2009). Duty to care. The Journal of Continuing Education in Nursing, 40(2), 53-54.
Acknowledgements
This study was made possible in part through an Alma and Robert D. Moreton Research Award (2009 – 2010).
The authors wish to acknowledge Dr. Wyndy L. Wiitala, PhD, and Dr. Jacquelyn Pennings, PhD, for statistical
planning and analysis; Pam Lamb, BSN, RN, C EN, Laura C orrell, BSN, RN, Nancy Jones, MS, C , RN, Elizabeth
Jobson, RN, Emily Treffinger, C NP, RN, and other members of The Kettering Health Network Nursing Research
C ouncil for survey revision, distribution, and collection; Brandi Palmer, MS, for facilitation of the project;
Orpheulia Davis, BSN, RN, for assistance with the literature search; C uong Nguyen, BBA, for data entry and
management; and personnel of The Kettering Health Network for their participation in the study.
© 2012 OJIN: The Online Journal of Issues in Nursing

Article published March 26, 2012
Related Articles
Be Safe, Be Prepared: Emergency System for Advance Registration of Volunteer Health
Professionals in Disaster Response
C heryl A. Peterson, MSN, RN (September 30, 2006)
A Proposed Model for Military Disaster Nursing

C hristine A. Wynd, PhD, RN, C NAA (September 30, 2006)
Nutrition and Disaster Preparedness: Focusing on Vulnerability, Building Capacities

Marion E. Wright, BSc, MSc, PhD, RN, RM, RHV; Maija Vesala-Husemann, MSc, RN, RHV, QNT (September 30,
2006)
Preparing Nurses Internationally for Emergency Planning and Response

Elizabeth Weiner, PhD, RN, BC , FAAN (September 30, 2006)
A Historical Challenge: Nurses and Emergencies

Kristine M Gebbie, DrPH, RN, Kristine A. Qureshi, DNSc, RN (September 30, 2006)
Disaster Readiness: A Community - University Partnership

Lavonne M. Adams, PhD, RN, C C RN; Sharon B. C anclini, MS, RN, FC N (August 29, 2008)
Manmade Disasters: A Historical Review of Terrorism and Implications for the Future
C atherine Wilson C ox, RN, Ph.D., C C RN, C EN, C C NS (January 31, 2008)
Exploring the Concept of Surge Capacity

Lavonne M. Adams, PhD, RN, C C RN (March 31, 2009)
Follow Us on:
© 2012 The American Nurses Association, Inc. All Rights Reserved

American Nurses Association - 8515 Georgia Avenue - Suite 400 - Silver Spring, MD 20910
ISSN: 1091-3734 | 1-800-274-4ANA | C opyright Policy | Privacy Statement
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Modul 3 Strukturdan Fungsi Dna Dan Rna1

Transféré par

Informations du document

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Modul 3 Strukturdan Fungsi Dna Dan Rna1

Transféré par

Droits d'auteur :

Formats disponibles

7/1/12 Who Will Show Up?

Estimating Ability and Willingness of Essential Hospital Personnel to Report to Work…

Who Will Show Up? Estimating Ability and Willingness of Essential

Lavonne M. Adams, PhD, RN, C C RN

Need for Essential Personnel Following a Disaster

Disaster planning in the healthcare setting requires consideration of the

Barrie rs to ability... include

To determine if various obligations, family situations, or type of position

Participants re porte d m ultiple

...a gre ate r proportion of

Be cause significant diffe re nce s in

Limitations and Recommendations

...disaste r plans that are

Conclusions and Recommendations

Personal disaster preparedness planning by all employees

Lavonne M. Adams, PhD, RN, CCRN

Devon Berry, PhD, RN

Table 1. Summary of Previous Literature

Reference Population Response rate Scenario/Event Report to Work

Grimes & RNs completing N=313 Infectious diseases 8-20% extremely

Masterson et ED physicians, 82%, N=204 Airplane crash 98% likely to report

Biological agent 54% likely to report

Radioactive bomb 85.3% likely to

Biological 58% willing to report

C hemical 58% willing to report

Radiation 57% willing to report

Snowstorm 83% willing to report

Flood 81% willing to report

Earthquake 79% willing to report

Hurricane 78% willing to report

Tornado 77% willing to report

Ice storm 75% willing to report

Radiation 64% able to report

SARS 64% able to report

Snow storm 49% able to report

C hemical 68% willing to report

Small pox 61% willing to report

Radiation 57% willing to report

SARS 48% willing to report

Table 2. Disaster Scenarios used for Midwestern Facilities

Type of Event Scenario

Weather emergency Winter mix of 1 inch of ice and snow in a 24-hour

Bioterrorism Smallpox outbreak in Springfield. 200 patients

C hemical terrorism C hemical terrorism attack at Dayton International

Weather emergency/environmental disaster Tornadoes injure hundreds of people in Kettering,

Mass casualty incident Explosion at The Nutter C enter in Beavercreek with

Radiation terrorism Radioactive bomb explodes at The Greenes in

Table 3. Description of Participants *

Full time 80.3 (1077)

Part time 12.2 (164)

PRN 4.3 (25)

Other 1.9 (25)

Day (8 or 12 hour) 71.3 (957)

Evening (8 or 12 hour) 6.8 (92)

Night (8 or 12 hour) 9.5 (128)

Other 11.8 (159)

C linical 60.2 (817)

Non-clinical 39.8 (534)

Age range (years)

18-29 12.0 (161)

30-39 18.8 (252)

40-49 26.6 (357)

50-59 31.1 (417

60+ 10.2 (137)