Mercer Mary P, Ancock Benedict, Levis Joel T, Reyes Vivian
Assistant Professor, University of California San Francisco, San Francisco, California.
Fellow, Department of Internal Medicine, Kaiser Permanente Medical Center, San Francisco, California.
Am J Disaster Med. 2014 Summer;9(3):221-32. doi: 10.5055/ajdm.2014.0174.
During major disasters, hospitals experience varied levels of absenteeism among healthcare workers (HCWs) in the immediate response period. Loss of critical hospital personnel, including Emergency Department (ED) staff, during this time can negatively impact a facility's ability to effectively treat large numbers of ill and injured patients. Prior studies have examined factors contributing to HCW ability and willingness to report for duty during a disaster. The purpose of this study was to determine if the degree of readiness of ED personnel, as measured by household preparedness, is associated with predicted likelihood of reporting for duty. Additionally, the authors sought to elucidate other factors associated with absenteeism among ED staff during a disaster.
ED staff of five hospitals participated in this survey-based study, answering questions regarding demographic information, past disaster experience, household disaster preparedness (using a novel,15-point scale), and likelihood of reporting to work during various categories of disaster. The primary outcome was personal predicted likelihood of reporting for duty following a disaster.
A total of 399 subjects participated in the study. ED staffs were most likely to report for duty in the setting of an earthquake (95 percent) or other natural disaster, followed by an epidemic (90 percent) and were less likely to report for work during a biological, chemical, or a nuclear event (63 percent). Degree of household preparedness was determined to have no association with an ED HCW's predicted likelihood of reporting for duty. Factors associated with predicted absenteeism varied based on type of disaster and included having dependents in the home, female gender, past disaster relief experience, having a spouse or domestic partner, and not owning pets. Having dependents in the home was associated with predicted absenteeism for all disaster types (OR 0.30-0.66). However, when stratified by gender, the presence of dependents at home was only a significantly associated with predicted absenteeism among women as opposed to men (OR 0.07-0.59 versus OR 0.41-1.02).
Personal household preparedness, while an admirable goal, appears to have no effect on predicted absenteeism among ED staff following a disaster. Having responsibilities for dependents is the most consistent factor associated with predicted absenteeism among female staff. Hospital and ED disaster planners should consider focusing preparedness efforts less toward household preparedness for staff and instead concentrate on addressing dependent care needs in addition to professional preparedness.
在重大灾难期间，医院在应急初期会经历医护人员不同程度的缺勤情况。在此期间，包括急诊科工作人员在内的关键医院人员流失会对医院有效治疗大量伤病患者的能力产生负面影响。先前的研究探讨了影响医护人员在灾难期间报到的能力和意愿的因素。本研究的目的是确定以家庭准备情况衡量的急诊科人员的准备程度是否与预测的报到可能性相关。此外，作者试图阐明与灾难期间急诊科工作人员缺勤相关的其他因素。
五家医院的急诊科工作人员参与了这项基于调查的研究，回答了有关人口统计学信息、过去的灾难经历、家庭灾难准备情况（使用一种新颖的15分制量表）以及在各类灾难期间报到工作的可能性等问题。主要结果是个人预测的灾难后报到可能性。
共有399名受试者参与了该研究。急诊科工作人员在地震（95%）或其他自然灾害情况下最有可能报到，其次是疫情（90%），而在生物、化学或核事件期间报到工作的可能性较小（63%）。家庭准备程度被确定与急诊科医护人员预测的报到可能性无关。与预测缺勤相关的因素因灾难类型而异，包括家中有受抚养人、女性、过去的救灾经验、有配偶或同居伴侣以及没有养宠物。家中有受抚养人与所有灾难类型的预测缺勤相关（比值比0.30 - 0.66）。然而，按性别分层时，家中有受抚养人仅与女性而非男性的预测缺勤显著相关（比值比0.07 - 0.59对0.41 - 1.02）。
个人家庭准备虽然是一个值得称赞的目标，但似乎对灾难后急诊科工作人员的预测缺勤没有影响。对受抚养人的责任是与女性工作人员预测缺勤最一致的因素。医院和急诊科灾难规划者应考虑减少针对工作人员家庭准备的工作重点，转而除了专业准备外，专注于解决受抚养人的照料需求。
