Wednesday, April 02, 2008

It's a Pandemic! Get to Work!

I found this post in Effect Measure to be thought-provoking. The question at hand is whether states are well-served by legislating penalties against healthcare workers (HCWs) who refuse to show up for work during a pandemic:

In at least two states, Maryland and South Carolina, those HCWs can be ordered to work. The two states in question took as their starting point a Model State Emergency Health Powers Act (MSEHPA) ... [but] the Maryland law goes beyond MSEHPA by providing fines or jail if a HCW disobeys a direct order to report for work.

Laws or no laws, we know it will happen in a pandemic. Surveys suggest a significant proportion of HCWs would not report for work. But these surveys are done before the event and present hypotheticals. It is historical experience that in emergencies ordinary people rise to the occasion and do extraordinary things. This was true of HCWs in Hong Kong and Canada during the SARS outbreak and will, I have no doubt, be true if and when there is a catastrophic influenza pandemic.

In the meantime health care institutions can maximize the incentives for any critical worker to report to work in a pandemic by providing adequate social service support for families, adequate facilities and resources, including workplace protection and personal protective equipment for HCWs, and protection of brave volunteers from liability.

Not least, we can talk encouragingly and positively about how we are all bound together as a community and owe a duty to each other. You don't promote that idea by threatening people with sanctions.
There's a broader question being raised here: What responsibility do we have for protecting each other, at risk to ourselves? Preparedness depends on people. Almost every profession relies on people willing to risk their own safety to protect the broader community.

In times of crisis, our lower brain stem screams at us that we need to protect ourselves and our families. Those who respond have to overrule this primal urge. As such, a system of preparedness can't take people for granted. (And there are not only people who won't respond - in a disaster situation there will also be people who are unable to respond because they are themselves in danger, or their lines of communication and/or transportation have been cut.)

In spite of all this, a system of preparedness can try to ensure that the lower-brain-stem voice is as quiet as possible, reducing the likelihood that responders will refuse to show up. The personal safety of responders and - importantly - their families has to be a priority.

I'm not sure social service support, advocated above, is enough. You're looking to create peace of mind - or the closest thing to it, given tough circumstances.

The U.S. military has incorporated this idea into its force protection doctrine. The Army's protective regime is remarkably broad:
The Army Strategy for Protection (ASP) integrates force protection across the entire Army spectrum: doctrine, organization, training, materiel, leadership and education, personnel, and facilities. This strategy protects Soldiers, Civilians, their Families, infrastructure, and information against all hazards, including asymmetric threats.
I'm not aware of any private or government agency with a protective mandate so all-encompassing. But it's an idea...

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