The Willingness of U.S. Emergency Medical Technicians to Respond to Terrorist Incidents

Abstract

A nationally representative sample of basic and paramedic emergency medical service providers in the United States was surveyed to assess their willingness to respond to terrorist incidents. EMT's were appreciably (9-13%) less willing than able to respond to such potential terrorist-related incidents as smallpox outbreaks, chemical attacks, or radioactive dirty bombs (p<0.0001). EMTs who had received terrorism-related continuing medical education within the previous 2 years were twice as likely (OR=1.9, 95% CI 1.9, 2.0) to be willing to respond to a potential smallpox dissemination incident as those who indicated that they had not received such training. Timely and appropriate training, attention to interpersonal concerns, and instilling a sense of duty may increase first medical provider response rates.

Determinants of Paramedic Response Readiness for CBRNE Threats

“…However, recent evidence indicates that this worker population may not always feel prepared, or willing, to respond to such incidents. [2][3][4] Their reluctance could undermine the ability of the healthcare system to meet surge capacity needs anticipated for incidents of this kind. 5 A recent nationally representative sample of paramedics showed that concern about infection or contamination predicted significantly lower response willingness, compared to natural disasters such as earthquakes or floods.…”

“…5 A recent nationally representative sample of paramedics showed that concern about infection or contamination predicted significantly lower response willingness, compared to natural disasters such as earthquakes or floods. 2 Medical staff surveyed about their willingness to work in field hospitals during mass casualty incidents were less willing to do so if CBRNE agents were involved. 6 Perceived risk, knowledge of the operating environment, and self-assessed capacity to provide the care required were the factors that most strongly affected willingness to work in such environments.…”

“…8 For example, inadequate personal protective equipment (PPE) and training have been identified as key constraints of paramedics' CBRNE preparedness and response willingness. [2][3] This was illustrated during the 1991 Gulf War when Israeli responders faced the prospect of attacks with ballistic missiles potentially armed with chemical and biological warheads. While 42% of healthcare workers indicated willingness to work in this context, this increased to 86% where it was perceived that adequate ''safety measures'' and ''protective equipment'' would be provided.…”

“…7 Moreover, response willingness generally increases as training quality increases. 2,3 Reilly and colleagues observed that paramedics' CBRNE response ''comfort level'' increased with progressive levels of training-that is, awareness level, simulation, and ''hands-on'' practice, with the latter format associated with significantly better outcomes for biological and chemical incidents. 3 It has been argued that clear risk assessment frameworks and practical information about how to protect self and family represent key training outcomes likely to increase response willingness.…”

“…3 It has been argued that clear risk assessment frameworks and practical information about how to protect self and family represent key training outcomes likely to increase response willingness. 2 Dispositional factors such as fear or concern have also been shown to adversely affect the readiness of emergency responders, while factors such as personal resilience-that is, the capacity to adapt and respond under conditions of stress or threat-may be associated with higher readiness. Qureshi et al found that fear for self and family was the factor associated with the lowest willingness to work during disaster events among healthcare workers, who also rated biological and chemical incidents as the event types of greatest concern.…”