Almost five years after SARS, a broad-ranging University of Ottawa study that asked front-line health workers about their ability to cope with large-scale health crises found that many still don’t feel prepared to respond.

And many have little confidence in the system’s ability to handle a public health emergency.
The study, to be released today, began about two years after the SARS outbreak of 2003 claimed 44 lives in the Toronto area.
 
It took more than three years to complete and included five focus groups comprised of 100 registered nurses, registered practical nurses and nurse managers.

The sessions were conducted in Ottawa, Toronto, Vancouver and Halifax between November 2005 and February 2006.

The study also included a web-based survey of 1,500 emergency and critical-care nurses.
About half had worked during an outbreak of an infectious disease, such as C. difficile, since the SARS outbreak.

The study’s range was from coast to coast, but perceptions were the same across Canada, said lead researcher Carol Amaratunga, a professor with the Institute of Population Health.

The study found that while almost three-quarters of the workers said they were “a little” or “somewhat” prepared for an infectious disease outbreak, 18 per cent were “not at all” ready.

Meanwhile,  21.1 per cent were “not at all” prepared for a natural disaster; 69.4 per cent for a chemical weapons attack and 69.5 per cent for a biological weapons attack.

“Three years post-SARS, they really didn’t know what was happening, even in their own institutions,” said project co-ordinator Patricia Thille.

The findings are important, because there will be another public health crisis like SARS, she said. “It’s just a question of when.”  

During a crisis, the health of front-line workers must be protected to meet “surge capacity” needs.
 If it’s not, the health care workforce will shrink due to illness, quarantine and refusal to work, the study found.

But the nurses surveyed said they were already working at maximum capacity.
 
“The terrible secret is that there is no surge capacity,” one participant told the researchers.   
Among the issues identified:

. Of three emergency rooms examined by  researchers, none had a plan or requirement for regular fit testing of masks and other safety equipment such as gloves, gowns and face shields. One nurse commented that most workers had been fitted for a mask, but the testing certificate had expired six months ago.

. While doctors are provided with “scrubs” in most hospitals, nurses have to provide and launder their own. Wearing uniforms out of the hospital and bringing them home to be laundered poses a risk to the public and workers’ families, the study noted.

. Support for quarantined workers was an issue, especially the delivery of food, medications, masks and other protective equipment to workers who have no family member to bring them these items.

“One person was quarantined and had no groceries, no one to walk the dog,” said a participant.

. Workers also reported getting conflicting orders.
“I was in quarantine, called Friday afternoon and had a three-way phone conversation. Under no circumstances should I come in,” said one nurse.

“Someone would contact me from Public Health. Didn’t happen. Said they would send food. Didn’t happen. Next day called and asked me to come in.”

. More than 27 per cent of the workers reported having multiple jobs. Many nurses work on contract and as casual and part-time workers and have no guarantee that they would be compensated for lost time if they get sick.

“I am part-time. I have no benefits,” said one participant. “Should I put myself at risk? What if I get sick for a long time?”

. About 90 per cent of nurses in the field of emergency and critical care are women, and many found their duty as parents and spouses conflicted with their duty as nurses.

 About 53 per cent of the workers in the study had dependent children living with them. Many were caught between their duty to care for patients and personal and family safety.

While existing guidelines mention vaccinating children, spouses and dependent children of health care workers, it would not be logistically feasible or ethically justifiable to do so, according to the Public Health Agency of Canada.

Some of the nurses said concern about infecting a relative may be enough to tip the balance between their commitment to nursing and their family  responsibilities.

. Some nurses reported that managers and other nurses kept their distance from front-line SARS workers, leaving them feeling angry, demoralized and abandoned.

“In our hospital, we were told that our hospital would be a SARS hospital, and within two weeks all the management offices were moved to another location – another hospital.” said one participant.

“We were told it was all because of amalgamation and it was going to happen anyways, but it sent a strong message.”

Another noted that no one would talk to emergency nurses.

“Co-workers stigmatized each other – and moved to the next table.”

Ms. Amaratunga said her research team was impressed by the high degree of professionalism of Canada’s nurses.

“They care a great deal about their profession, but they are caught in divided loyalties,” she said.  
The report will be sent to occupational health and safety committees at hospitals, as well as being posted on the Canadian Policy Research Networks website.

There had been a significant investment in emergency preparedness since SARS. The gaps in the system can be fixed, but they need attention, said Ms Amaratunga.
“We can do better and we should do better,” she said.  

SARS came to Canada five years ago this spring, noted Ms. Amaratunga. “This is a good time to reflect back on our progress.”
In their own words:

Some of the comments made by participants surveyed as part of a broad-ranging University of Ottawa study that asked front-line health workers about their ability and that of the system to cope with large-scale health crises:

“Isolation, abandonment – friends, family, bus passengers, co-workers, community, management – it’s like the plague, like a mark on your door, because everyone in the neighbourhood knows you work at the hospital.”

“Anticipate that not all of your health care workers are going to work – you need to know who’s going to stay on board, and need to figure this out at the very beginning.”

“A warm body isn’t much use if they don’t know what needs to happen.”

“Lots of guilt – should I have chosen a profession that would have protected me better? The guilt stays. If I bring it home and they (my family) get sick, it’s because of me.”

“In terms of going to work – I don’t have the right to make those decisions on behalf of my children and my husband.”

“We need preventative medication and vaccines for the whole family, not just the health care workers.”

“You’re probably going to get me coming to work if I know my children are vaccinated.”

“I want to be able to change and decontaminate before I go home.”

“During SARS, people were making decisions up high and you were sort of there in the trenches.”

“I called up infection control and asked someone to come and watch activity response and was asked, ‘Can we do it in September?’” http://www.canada.com/ottawacitizen/news/story.html?id=a3c91df5-77c6-46bb-84c8-0c2d1d2b1eb3&k=47417 

© Ottawa Citizen 2008