title: Ready or not: does household preparedness prevent absenteeism among emergency department staff during a disaster?
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Assistant Professor, University of California San Francisco, San Francisco, California.
authors.forename: Mary P
authors.initials: MP
authors.lastname: Mercer
authors.affiliation: Fellow, Department of Internal Medicine, Kaiser Permanente Medical Center, San Francisco, California.
authors.forename: Benedict
authors.initials: B
authors.lastname: Ancock
authors.affiliation: Attending Physician, Department of Emergency Medicine, Kaiser Permanente Medical Center, Santa Clara, California.
authors.forename: Joel T
authors.initials: JT
authors.lastname: Levis
authors.affiliation: Attending Physician, Department of Emergency Medicine, Kaiser Permanente Medical Center, San Francisco, California.
authors.forename: Vivian
authors.initials: V
authors.lastname: Reyes
mesh_terms: D000041:Absenteeism; D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004190:Disasters; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005191:Family Characteristics; D005260:Female; D006801:Humans; D008297:Male; D010564:Personnel, Hospital