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Characterizing public health emergency perceptions and influential modifiers of willingness to respond among pediatric healthcare staff

Christopher M. Watson, MD, MPH, Daniel J. Barnett, MD, MPH, Carol B. Thompson, MS, Edbert B. Hsu, MD, MPH, Christina L. Catlett, MD, Howard S. Gwon, MS, Natalie L. Semon, MSEd, Ran D. Balicer, MD, MPH, Jonathan M. Links, PhD


Objectives: The aim of this study was to characterize the public health emergency perceptions and willingness to respond (WTR) of hospital-based pediatric staff and to use these findings to propose a methodology for developing an institution-specific training package to improve response willingness.
Methods: A prospective anonymous web-based survey was conducted at the Johns Hopkins Hospital, including the 180-bed Johns Hopkins Children’s Center, between January and March 2009. In this survey, participants’ attitudes/beliefs regarding emergency response to a pandemic influenza and a radiological dispersal device (RDD or “dirty bomb”) event were assessed.
Results: Of the 1,620 eligible pediatric staff, 246 replies (15.2 percent response rate) were received, compared with an overall staff response rate of 18.4 percent. Characteristics of respondent demographics and professions were similar to those of overall hospital staff. Self-reported WTR was greater for a pandemic influenza than for an RDD event if required (84.6 percent vs 75.1 percent), and if asked, but not required (74.4 percent vs 64.5 percent).The majority of pediatric staff were not confident in their safety at work (pandemic influenza: 51.8 percent and RDD: 76.6 percent), were far less likely to respond if personal protective equipment was unavailable (pandemic influenza: 33.5 percent and RDD: 21.6 percent), and wanted further pre-event preparation and training (pandemic influenza: 89.6 percent and RDD: 82.6 percent). The following six distinct perceived attitudes/beliefs were identified as having institution-specific high impact on response willingness: colleague response, skill mastery, safety getting to work, safety at work, ability to perform duties, and individual response efficacy.
Conclusions: Children represent a uniquely vulnerable population in public health emergencies, and pediatric hospital staff accordingly represent a vital subset of responders distinguished by specialized education, training, clinical skills, and disaster competencies. Even though the majority of pediatric hospital staff report WTR, nearly 15 percent for a pandemic influenza emergency and 25 percent for an RDD event would not respond if required. Other institutions can apply the methodology used here to identify particularly influential response willingness modifiers for pediatric care providers. These insights can inform customized preparedness training for pediatric healthcare workers, through identification of high-impact attitudes/beliefs, and training initiatives focused on addressing these modifiers.


willingness to respond, disaster perceptions, pandemic influenza, radiological dispersal device, pediatric staff

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Markenson D, Redlener I: Pediatric Preparedness for Disasters and Terrorism: National Consensus Conference. New York City, New York: National Center for Disaster Preparedness, Columbia University, 2007.

American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American Academy of Pediatrics Committee on Medical Liability, Task Force on Terrorism: The pediatrician and disaster preparedness. Pediatrics. 2006; 117: 560-565.

Markenson D, Redlener I: Pediatric terrorism preparedness national guidelines and recommendations: Findings of an evidencedbased consensus process. Biosecur Bioterror. 2004; 2: 301-319.

Institute of Medicine of the National Academies: Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press, 2006.

Cone DC, Cummings BA: Hospital disaster staffing: If you call, will they come? Am J Disaster Med. 2006; 1: 28-36.

Dimaggio C, Markenson D, T Loo G, et al.: The willingness of U.S. emergency medical technicians to respond to terrorist incidents. Biosecur Bioterror. 2005; 3: 331-337.

Balicer RD, Omer SB, Barnett DJ, et al.: Local public health workers’ perceptions toward responding to an influenza pandemic. BMC Public Health. 2006; 6: 99.

Qureshi K, Gershon RR, Sherman MF, et al.: Healthcare workers’ ability and willingness to report to duty during catastrophic disasters. J Urban Health. 2005; 82: 378-388.

Irvin CB, Cindrich L, Patterson W, et al.: Survey of hospital healthcare personnel response during a potential avian influenza pandemic:Will they come to work? Prehosp Disaster Med. 2008; 23: 328-335.

Ehrenstein BP, Hanses F, Salzberger B: Influenza pandemic and professional duty: Family or patients first? A survey of hospital employees. BMC Public Health. 2006; 6: 311.

Butsashvili M, Triner W, Kamkamidze G, et al.: Knowledge and anticipated behaviour of health-care workers in response to an outbreak of pandemic influenza in Georgia. World Hosp Health Serv. 2008; 44: 24-26.

Martinese F, Keijzers G, Grant S, et al.: How would Australian hospital staff react to an avian influenza admission, or an influenza pandemic? Emerg Med Australas. 2009; 21: 12-24.

Chokshi NK, Behar S, Nager AL, et al.: Disaster management among pediatric surgeons: Preparedness, training and involvement. Am J Disaster Med. 2008; 3: 5-14.

Barnett DJ, Balicer RD, Blodgett DW, et al.: Applying risk perception theory to public health workforce preparedness training. J Public Health Manag Pract. 2005; November (Suppl): S33-S37.

Sandman PM, Miller PM, Johnson B, et al.: Agency communication, community outrage, and perception of risk: Three simulation experiments. Risk Anal. 1993; 13: 585-598.

McMahan S,Witte K, Meyer J: The perception of risk messages regarding electromagnetic fields: Extending the extended parallel process model to an unknown risk. Health Commun. 1998; 10: 247-259.

Witte K. Putting the fear back into fear appeals: The extended parallel process model. Commun Monogr. 1992; 59: 329-349.

Barnett DJ, Balicer RD,Thompson CB, et al.: Assessment of local public health workers’ willingness to respond to pandemic influenza through application of the extended parallel process model. PLoS ONE. 2009; 4(7): e6365.

Balicer RD, Barnett DJ, Thompson CB, et al.: Characterizing hospital workers’ willingness to report to duty in an influenza pandemic through threat- and efficacy-based assessment. BMC Public Health. 2010; 10: 436.

StataCorp: Stata Statistical Software; Release 10. College Station, TX: StataCorp, 2007.

Abramson D, Redlener I, Stehling-Ariza T, et al.: The Legacy of Katrinas Children: Estimating the Number of At-risk Children in the Gulf Coast States of Louisiana and Mississippi. New York: Mailman School of Public Health, Columbia University, 2007; Research Brief 2007_12.

Baldwin S, Robinson A, Barlow P, et al.: Moving hospitalized children all over the southeast: Interstate transfer of pediatric patients during Hurricane Katrina. Pediatrics. 2006; 117: S416- S420.

Centers for Disease Control and Prevention (CDC): Novel influenza A (H1N1) virus infections among health-care personnel—United States, April-May 2009. Morb Mortal Wkly Rep. 2009; 58: 641-645.

National Commission on Children and Disasters: 2010 Report to the President and Congress. AHRQ Publication No. 10-M037. Rockville, MD: Agency for Healthcare Research and Quality, October 2010. Available at Accessed September 1, 2011.

Ablah E, Tinius AM, Konda K: Pediatric emergency preparedness training: Are we on a path toward national dissemination? J Trauma. 2009; 67: S152-S158.

Aghababian R (ed.): Pediatric Disaster Life Support Course. 2nd ed.Worcester, MA: University of Massachusetts, 2008.

McCabe OL, Barnett DJ, Taylor HG, et al.: Ready, willing, and able: A framework for improving the public health emergency preparedness system. Disaster Med Public Health Prep. 2010; 4(2): 161-168.



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