Are We Ready? Evidence of Support Mechanisms for Canadian Health Care Workers in Multi-Jurisdictional Emergency Planning
O'Sullivan, Tracey L., Amaratunga, Carol A., Hardt, Jill, Dow, Darcie, Phillips, Karen P., Corneil, Wayne, Canadian Journal of Public Health
Background: Federal, provincial and municipal leaders in Canada have adopted a culture of preparedness with the development and update of emergency plans in anticipation of different types of disasters. As evident during the 2003 global outbreak of Severe Acute Respiratory Syndrome (SARS), it is important to provide support for health care workers (HCWs) who are vulnerable during infectious outbreak scenarios. Here we focus on the identification and evaluation of existing support mechanisms incorporated within emergency plans across various jurisdictional levels.
Methods: Qualitative content analysis of 12 emergency plans from national, provincial and municipal levels were conducted using NVIVO(TM) software. The plans were scanned and coded according to 1) informational, 2) instrumental, and 3) emotional support mechanisms for HCWs and other first responders.
Results: Emergency plans were comprised of a predominance of informational and instrumental supports, yet few emotional or social support mechanisms. All the plans lacked gender-based analysis of how infectious disease outbreaks impact male and female HCWs differently. Acknowledgement of the need for emotional supports was evident at higher jurisdictional levels, but recommended for implementation locally.
Conclusions: While support mechanisms for HCWs are included in this sample of emergency plans, content analysis revealed few emotional or social supports planned for critical personnel; particularly for those who will be required to work in extremely stressful conditions under significant personal risk. The implications of transferring responsibilities for support to local and institutional jurisdictions are discussed.
MeSH terms: Communicable diseases; occupational health; public health; health personnel; health services administration; disease outbreaks; health policy
The vulnerability of canada's public health system was exposed during the 2003 global outbreak of severe acute Respiratory syndrome (saRs), with 251 confirmed cases in canada, and 44 deaths including three health care workers (hcWs).1 human resources were stretched as many hcWs were quarantined and/or asked to work extra shifts to manage patient loads.2
It is now widely recognized that mitigation and preparedness are necessary for effective disaster management.3 national, provincial, municipal, and institutional emergency plans are being developed or updated in anticipation of different types of disasters; many specifically focus on pandemic influenza.3-5
The public health agency of canada published the canadian pandemic influenza plan (cpip, 2004)5 based on, and in accordance with, the World health Organization (WhO, 2005) Global influenza preparedness plan,6 which defines the responsibilities of national authorities in the event of an influenza pandemic, and provides guidelines for pandemic planning. Cpip requires that all provinces and territories develop their respective pandemic influenza contingency plans based on cpip and WhO guidelines. Furthermore, in canada, six provinces and three territories now have legislation requiring municipalities to file official emergency plans, although few plans were complete or available at the time of this study.7-19
In canada, the provision of health services is a priority in pandemic planning.5,20 emergency plans include strategies to enhance human resource pools by drawing on employee rosters, retirees, students and professionals from relevant health disciplines. However, to ensure effective implementation and adequate response capacity, these reserve hcWs must have the necessary skills and training, and they must be available and willing to work.
Support mechanisms for hcWs are essential to enable them to stay healthy and perform their roles as critical personnel during disasters, while simultaneously coping with personal loss and trauma.21 emotional, informational and instrumental supports have a protective health effect by buffering the negative effects of stress. …