ABSTRACT
| FIGURES AND TABLES
| EXAMPLE USE | CONTACT INFO
Assessment of the Community Healthcare Providers' Ability
and Willingness to Respond to a Bioterrorism Attack
by Dr. Jeffrey S.
Crane
ABSTRACT
Previous findings have demonstrated that the preparedness
and infrastructure of the public health system is
inadequately developed for a biological and/or chemical
terrorism attack. Chen et al. reported that those primary
care providers that would have to respond to such an attack
do not feel prepared to diagnose and manage such an event.
This research was an observational study using an e-mail/web-based survey to assess the levels of preparedness (PL) and
willingness to respond (WTR) to a bioterrorism attack, and
to identify factors that predict PL and WTR of Florida
community healthcare providers. The conceptual framework and
questionnaire was designed based on empirical studies and
the use of an expert panel to assess the providers’
administrative and clinical competencies, WTR, and PL. The
questionnaire was pilot tested in 30 subjects. Reliability
was high (Cronbach’s alpha =.82). The emailed invitation
letters were sent to 22,800 healthcare providers in Florida.
The questionnaire was posted for 7 days on the website
during December, 2004.
There were 2,279 respondents of 9,124 who received the
e-mails. Response rate was 28%, with 86% completed
questionnaires. The subjects included physicians (n=604),
nurses (n=1,152), and pharmacists (n=486). The results
demonstrated that only 32% of the Florida providers were
competent and willing to respond to a bioterrorism attack.
82.7% of providers were willing to respond in their local
community and 53.6% within the State. The subjects were more
competent in administrative skills than clinical knowledge
(62.8% vs. 45%) The most competent areas were the initiation
of the treatment and recognition of their clinical and
administrative roles. The least competent areas were
identifying the cases and communicating risks to the others.
About 55% of the subjects had previous bioterrorism training
and 31.5% had emergency drills. Gender, race, previous
training and drills, perceived threats of bioterrorism
attack, and perceived benefits of training and drills and
“feeling” prepared were the predictors of overall
preparedness.
The findings suggest that only one-third of Florida
community healthcare providers were prepared for a
bioterrorism attack. To effectively plan for a bioterrorism
attack it is important to target the interventions to
improve clinical knowledge in every healthcare profession.
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Sample Tables and Figures (click
picture to enlarge)
Willingness-to-Respond Table
Administrative Core Competency Levels
Clinical Core Competency Levels (Table)
Clinical Core Competency Levels (Figure)
Provider’s Participation in Preparedness Drills
Provider Preparedness Level Conceptual Model
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Practical Uses of the Study
Findings (Examples).
Planning |
Preparedness & Competency
Levels |
Targeted Training Sessions
| Provider Assessment
The following are examples for
translating the study findings from academic jargon to NIMS
compliant English, i.e. practical uses for emergency management
and planning. Within the Downloadable Study, you
should use the Table of Contents to find the subject areas
that interest you; otherwise it may be too much for you to
read in one sitting (180 pages). You are welcome to contact me if you
have questions about the findings and/or its practical
applications.
EXAMPLE 1. FOR
PLANNING PURPOSES:
STUDY FINDINGS: This study
determined that only 32.5% of licensed community healthcare
providers were willing and able to effectively
respond to a bioterrorism event.
PRACTICAL USE: When writing
emergency plans, only 32.5% of the community’s providers
should be used in the staffing models for the activation of
the Strategic National Stockpile (SNS) and Mass Casualty
Incident (MCI) Plans. If your BT Plans call for more than
32.5% of healthcare providers with the basic public health
emergency competencies coming from your local community
(provider volunteers), your plan may not be activated
successfully in a large event.
EXAMPLE 2. FOR
PROVIDER PREPAREDNESS AND COMPETENCY LEVELS:
STUDY FINDINGS: The results of this
study suggested that providers who have had previous
trainings and/or drills were over 2.5 times more likely to
be prepared than providers not trained or drilled. The
results from this study also indicated that previous
trainings and drills were significant predictors of the
willingness to respond. So, it is suggestive that healthcare
providers that had attended bioterrorism drills were 1.55
times more likely to be willing to respond to a bioterrorism
attack compared with providers who have never participated
in drills, or if that healthcare provider has had a previous
emergency preparedness training, they were 1.33 times more
likely to be willing to respond to a bioterrorism attack
compared with no previous trainings.
PRACTICAL USE: Since the
community healthcare providers are 2.5 times (250%) more
likely to be prepared and 1.55 times (155%) more likely to
volunteer during a bioterrorism event if included in local
trainings and exercises, it is necessary to
regularly involve the community healthcare providers in the
BT trainings, drills and exercises, especially if your plan
calls for a large number of volunteer providers to activate
it.
EXAMPLE 3. FOR
TARGETED CLINICAL TRAINING SESSIONS:
STUDY FINDINGS: This study found that within the
provider subgroups, physicians and pharmacists were the most
competent at clinical competency 1 (CC1) and CC2, the
ability to describe his/her expected clinical role in
bioterrorism response for the specific practice setting as a
part of the institution or community response and the
ability to respond to an emergency within the emergency
management system of his/her practice, institution and
community (CC1, 76.5% and 73.3%, and CC2, 76.5% and
71.6%, respectively). The nurses were also the most
competent at CC1 (72.5%) and showed a strength in CC4
(67.8%), the ability to report identified cases or events
to the public health authorities to facilitate surveillance
and investigation using the established institutional or
local communication protocol. As with the all provider
competency level, the provider subgroups all demonstrated
the lowest competency level in CC5, the ability to
initiate patient care within his/her professional scope of
practice and arrange for prompt referral appropriate to the
identified condition(s) (physician 25.7%, nurse 17.4%
and pharmacist 9.2%). Physicians demonstrated deficits in
their ability to communicate risks and actions taken to
patients and concerned others clearly and accurately
(CC6, 29.1%) and in their ability to recognize an illness
or injury as potentially resulting from exposure to a
biological, chemical or radiological agent possibly
associated with a terrorist event (CC3, 34.6%). The
nurses also have major deficits in CC3 (18.4%) and CC6
(22.3%).
PRACTICAL USE: When you develop
and provide training to community healthcare providers, the
trainer may use the results of this study to target the
training on the identified weak administrative and clinical
competency areas (see Sample Tables above). These competency
areas can be adjusted dependant upon the trainees
(physician, nurses, pharmacist or a mixed group).
EXAMPLE 4. FOR
PROVIDER ASSESSMENT PURPOSES:
THE CONCEPTUAL FRAMEWORK was created for this study.
It consisted of three domains, the first two were based on
the core competency sets (administrative and clinical) whose
development was sponsored by the CDC and used by numerous
entities across the nation, and the third is the providers’
willingness to respond. This framework also included a
methodology to calculate the bioterrorism competency and
preparedness levels based on the importance of several
leading experts in the field of public health preparedness
at the time of this study. This was the first study that
attempted a methodology to actually measure the provider’s
preparedness levels, and to examine physicians, nurses and
pharmacist as a single provider grouping. Past provider
studies have mainly examined physicians or nurses, but in a
real event all licensed providers will be called upon.
THE SURVEY INSTRUMENT (QUESTIONNAIRE) was developed
and tested for this study and its framework. It has been
proven effective for policy assessment and planning
purposes. This questionnaire and its methodology can be
easily adjusted for use in other healthcare provider groups
and provider settings. The Questionnaire is not provided
online but may be requested via email.
THE STUDY’S RESULTS are useful identifying critical
areas for bioterrorism preparedness training and education,
and the improving of bioterrorism planning and preparedness.
The conceptual framework and its measurements, can be used
to benchmark between provider groupings, between states and
between organizations of all sizes. It also could be used
as a base line of preparedness levels, which can be used to
document changes over set periods of time. These changes can
be used to monitor whether interventions are successful and
justify the continuation of federal funded projects. Finally
and most important, this study can guide emergency planners/
coordinators better project in the pre-disaster phase, the
number of healthcare providers that are willing and able to
respond to a bioterrorist attack.
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Bibliography
PLEASE REFERENCE:
All information contained on this page and the Downloadable
Report has been published and copyrighted in 2005. Please
reference, if used in any publication such as journal
articles emergency plans, presentations and/or reports.
Reference info:
Crane, Jeffrey S.
Assessment of the Community Healthcare Providers' Ability
and Willingness to Respond to a Bioterrorism Attack in
Florida. 1 ed. UMI Publishing, Ann Arbor, MI. 2005
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Download
Full Report
For more information on this
assessment model and survey instrument, contact Dr. Jeffrey
Crane at
jcrane@jscrane.com.
