Strengthening hospital preparedness for chemical, biological, radiological, nuclear, and explosive events: Clinicians’ opinions regarding physician/physician assistant response and training

Abstract

Objectives: This research explores the attitudes of physicians and physician assistants (PA) regarding response roles and responsibilities as well as training opinions to understand how best to partner with emergency department physicians and to effectively apply scarce healthcare dollars to ensure successful emergency preparedness.Design: Physicians and PAs representing 21 specialties in two level I trauma public hospitals were surveyed. Participants scored statements within four categories regarding roles and responsibilities of clinicians in a disaster; barriers to participation; implementation of chemical, biological, radiological, nuclear, and explosive training; and training preferences on a Likert scale of 1 (strongly agree) to 5 (strongly disagree). Additional open-ended questions were asked.Results: Respondents strongly feel that they have an ethical responsibility to respond in a disaster situation and that other clinicians would be receptive to their assistance. They feel that they have clinical skills that could be useful in a catastrophic response effort. They are very receptive to additional training to enable them to respond. Respondents are neutral to slightly positive about whether this training should be mandated, yet requiring training as a condition for licensure, board certification, or credentialing was slightly negative. Therefore, it is unclear how the mandate would be encouraged or enforced. Barriers to training include mild concerns about risk and malpractice, the cost of training, the time involved in training, and the cost for the time in training (eg, lost revenue and continuing medical education time). Respondents are not concerned about whether they can learn and retain these skills. Across all questions, there was no statistically significant difference in responses between the medical and surgical subspecialties.Conclusions: Improving healthcare preparedness to respond to a terrorist or natural disaster requires increased efforts at organization, education and training. Physicians are willing to increase their knowledge base if it is possible to create a mutually positive win-win environment to minimize cost and disruption while maximizing preparedness. There is no clear consensus on the implementation of this training, but to most efficiently and effectively use scare homeland security dollars, a dialogue must begin between the medical profession, medical societies, and US Department of Health and Human Services to determine the best training strategies.