title: Anticipated behaviors of emergency prehospital medical care providers during an influenza pandemic.
abstract: BACKGROUND
  Emergency prehospital medical care providers are frontline health workers during emergencies. However, little is known about their attitudes, perceptions, and likely behaviors during emergency conditions. Understanding these attitudes and behaviors is crucial to mitigating the psychological and operational effects of biohazard events such as pandemic influenza, and will support the business continuity of essential prehospital services.
  
  
  OBJECTIVE
  This study was designed to investigate the association between knowledge and attitudes regarding avian influenza on likely behavioral responses of Australian emergency prehospital medical care providers in pandemic conditions.
  
  
  METHODS
  Using a reply-paid postal questionnaire, the knowledge and attitudes of a national, stratified, random sample of the Australian emergency prehospital medical care workforce in relation to pandemic influenza were investigated. In addition to knowledge and attitudes, there were five measures of anticipated behavior during pandemic conditions: (1) preparedness to wear personal protective equipment (PPE); (2) preparedness to change role; (3) willingness to work; and likely refusal to work with colleagues who were exposed to (4) known and (5) suspected influenza. Multiple logistic regression models were constructed to determine the independent predictors of each of the anticipated behaviors, while controlling for other relevant variables.
  
  
  RESULTS
  Almost half (43%) of the 725 emergency prehospital medical care personnel who responded to the survey indicated that they would be unwilling to work during pandemic conditions; one-quarter indicated that they would not be prepared to work in PPE; and one-third would refuse to work with a colleague exposed to a known case of pandemic human influenza. Willingness to work during a pandemic (OR = 1.41; 95% CI = 1.0-1.9), and willingness to change roles (OR = 1.44; 95% CI = 1.04-2.0) significantly increased with adequate knowledge about infectious agents generally. Generally, refusal to work with exposed (OR = 0.48; 95% CI = 0.3-0.7) or potentially exposed (OR = 0.43; 95% CI = 0.3-0.6) colleagues significantly decreased with adequate knowledge about infectious agents. Confidence in the employer's capacity to respond appropriately to a pandemic significantly increased employee willingness to work (OR = 2.83; 95% CI = 1.9-4.1); willingness to change roles during a pandemic (OR = 1.52; 95% CI = 1.1-2.1); preparedness to wear PPE (OR = 1.68; 95% CI = 1.1-2.5); and significantly decreased the likelihood of refusing to work with colleagues exposed to (suspected) influenza (OR = 0.59; 95% CI = 0.4-0.9).
  
  
  CONCLUSIONS
  These findings indicate that education and training alone will not adequately prepare the emergency prehospital medical workforce for a pandemic. It is crucial to address the concerns of ambulance personnel and the perceived concerns of their relationship with partners in order to maintain an effective prehospital emergency medical care service during pandemic conditions.
authors.affiliation: Australian Centre for Prehospital Research, Brisbane.
authors.forename: Vivienne C
authors.initials: VC
authors.lastname: Tippett
authors.forename: Kerrianne
authors.initials: K
authors.lastname: Watt
authors.forename: Steven G
authors.initials: SG
authors.lastname: Raven
authors.forename: Heath A
authors.initials: HA
authors.lastname: Kelly
authors.forename: Michael
authors.initials: M
authors.lastname: Coory
authors.forename: Frank
authors.initials: F
authors.lastname: Archer
authors.forename: Konrad
authors.initials: K
authors.lastname: Jamrozik
mesh_terms: D000818:Animals; D001291:Attitude of Health Personnel; D001315:Australia / Q000453:epidemiology; D001717:Birds; D016001:Confidence Intervals; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006285:Health Planning; D006801:Humans; D005585:Influenza in Birds / Q000453:epidemiology / Q000517:prevention & control*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D016015:Logistic Models; D016017:Odds Ratio; D011361:Professional Competence / Q000706:statistics & numerical data; D011594:Psychometrics; D011634:Public Health; D012938:Social Perception; D011795:Surveys and Questionnaires