Washoe County Needs Assessment
of Medical Providers
Prepared by
Wayne Enanoria, Ph.D., M.P.H.
Andrew Anglemyer
Tomás Aragón, M.D., Dr.P.H.
Center for Infectious Disease Preparedness
University of California at Berkeley
Prepared for
Washoe County District Health Department
Public Health Preparedness Program
Washoe County District Health Center for Infectious Disease
Department Preparedness
P.O. Box 11130 1918 University Avenue, 4th Floor
Reno, Nevada 89520-0027 Berkeley, California 94704
August 2005
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For questions regarding the details of this survey, please contact:
Amy Weiss, MPH
Education and Training Coordinator
Public Health Preparedness Program
Washoe County District Health Department
Phone : 775-328-2432
Email: aweiss@washoecounty.us
This report was supported by the Nevada State Health Division through Grant Number
U90/CCU916964-05 from the Centers for Disease Control and Prevention (CDC). Its
contents are solely the responsibility of the authors and do not necessarily represent the
official views of the Nevada State Health Division nor the Centers for Disease Control
and Prevention (CDC).
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Table of Contents
Introduction......................................................................................................................... 5
Methods............................................................................................................................... 5
Results................................................................................................................................. 6
Recommendations............................................................................................................. 11
Appendix A: Washoe County Needs Assessment Survey (Hardcopy) ........................... 21
Appendix B: Letters and Emails Distributed .................................................................... 29
Addendum......................................................................................................................... 34
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List of Tables
Table 1. Demographic and Work Characteristics of the Survey Respondents. ................ 12
Table 2. Medical Provider Training.................................................................................. 13
Table 3. Additional Training Interests Among All Respondents ..................................... 14
Table 4. Training Interests Among Physicians ................................................................. 15
Table 5. Training Interests Among Registered Nurses..................................................... 16
Table 6. Preferred Characteristics for Training ............................................................... 17
Table 7. In-person Training Preferences.......................................................................... 18
Table 8. Recognition and Treatment of Infectious Diseases (n=330) ............................. 19
Table 9. Recognition and Treatment of Chemical Threats (n=330) ................................ 20
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Introduction
The purpose of this education and training needs assessment was to collect information on
medical providers in order to design trainings on public health preparedness that meet their
needs. The survey was designed to collect information about their training and expertise, their
ability to detect and treat various infectious diseases, and information regarding their preferences
for trainings (e.g., format, availability of continuing medical education units, etc.). The target
population of this survey was a group of medical providers who were identified by a previous
survey conducted by the Washoe County District Health Department (WCDHD), Public Health
Preparedness Program. In the previous survey, these providers indicated that they were
interested in training or serving as a volunteer/consultant in the event of a public health
emergency.
Methods
In January 2005, the WCDHD contacted the Center for Infectious Disease Preparedness (CIDP)
at UC Berkeley in order to request technical assistance with the design and conduct of a public
health survey regarding medical providers. CIDP in conjunction with WCDHD pulled existing
needs assessments that were completed among medical providers as well as public health
professionals in order to identify existing survey instruments.
At a meeting in March, 2005, the following items were considered to be the important pieces of
information to collect from the respondents:
• Demographics (age and gender only)
• Contact information (address and phone number)
• Advanced training
• Areas of board certification
• Areas of board eligibility
• Work setting
• Preferences for learning
• Language capacity
Assuming that these medical providers will be involved in recognizing, responding to, and
reporting an “event”, we also wanted to know the following:
Recognizing an event:
• Know more about Infectious Diseases
• Know more about chemical exposures
• Know more about nuclear threats
• Know more about infection control practices
Responding to an event:
• Infection control
• Diagnosis
• Treatment
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• Referral
Reporting an event:
• Do they know how to report?
A draft of the survey was created in May 2005 and finalized on June 3, 2005. The final survey is
given in Appendix A. In addition, an online survey was created using Survey Monkey
(http://www.surveymonkey.com) so that respondents could complete the survey online as well.
Emails were sent on Friday, June 10, 2005 using the emails included in Appendix B. On this
day, surveys were sent by mail as well.
There were two emails that were sent: one to the list of those who were interested in training
only (n=74 individuals) and one to the list of those who were willing to volunteer and/or serve as
a consultant (n=715 individuals).
Results
Demographics
We received n=330 surveys (156 online and 174 hardcopy) as of June 27, 2005. If we assume
that everyone who was mailed a survey received it and those who were sent an email requesting
completion of the survey received the email, the response rate for this needs assessment was
41.8% (330/789 total). Females made up over three-quarters of the total surveyed with 76.4%
(n=252), males made up 21.2% (n=70), and for 2.4% (n=8) the gender was not known (Table 1).
The majority (69.7%, n=230) of respondents were between the ages 41 and 65. The next
frequent age group was under 40 years with 20.6% (n=68), while the least frequent group was
over 65 years with 7.6% (n=25). Approximately 2.1% (n=7) of the respondents were of
unknown age.
Registered nurses (RN) comprised 65.8% (n=217) of all respondents, while the next frequent
degree was Medical Doctor (MD) comprising 19.4% (n=64), and 13.9% (n=46) named other
degrees not listed on the survey. The two most frequent other degrees named were: Bachelor’s
of Science in Nursing (BSN) with 1.8% (n=6) and Master’s of Science in Nursing (MSN) with
1.5% (n=5). Males made up the majority of MDs surveyed, comprising 70.3% (n=45), while
females made up the RN majority with 88.0% (n=191). Nearly two-thirds (62.5%) of all MDs
were between the ages of 41 and 65, while nearly three quarters (73.3%) of RNs were in the
same age group. Among certified nurse assistants (CNAs), the majority (52.3 %, n=11) were
younger than 40 years, while the majority of people who had advanced practice nursing (APN)
degrees and licensed practical nurse (LPN) degrees (60.0% n=6; 90.9% n=10, respectively) were
in the 41-65 years of age group. Over 97% (n=322) of the medical providers surveyed (n=330)
were licensed in Nevada, while 25.5% (n=84) were licensed in California, as well. Specifically,
over 37% (n=24) of MDs and 24% (n=52) of RNs were licensed in California. According to the
survey, 14.8% (n=49) of all providers were fluent in a second language. Specifically, 29.7%
(n=19) of MDs spoke a language other than English, while 11.5% (n=25) of RNs spoke another
language. Listed most frequently among the other languages spoken were Spanish with 7.9%
(n=26) and Filipino with 2.4% (n=8).
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The most frequent work setting was in the hospital with 42.4% (n=140), followed by the clinic
setting with 19.7% (n=65) and public health with 5.2% (n=17). Additionally, 28.8% (n=95)
named other work settings not listed on the survey. The two most frequent settings named were
school or research with 2.1% (n=7) and private office with 1.5% (n=5).
Specialty Training and Board Certifications
Medical providers most frequently listed critical care (21.2%, n=70) as a field they have had two
or more years of training in (Table 2). Pediatric training was the second most frequent training
listed with 12.4% (n=41). Nearly a third of RNs (30.4%, n=66) were trained in critical care,
though only one MD indicated critical care training. Specifically within pediatrics, 15.6%
(n=10) of MDs and 11.1% (n=24) had two or more years of training. Over half (51.8%, n=171)
of all medical providers listed specialty training in another area not listed on the survey. The two
most frequently listed trainings under other specialty trainings were ER/emergency with 8.5%
(n=28) and family practice with 4.8% (n=16).
Board certified providers most frequently listed board certifications not listed on the survey
(29.1%, n=96) (Table 2). Among the most frequent type of certification listed were family
practice with 5.5% (n=18) and internal medicine with 3.3% (n=11). The next most frequently
noted board certifications were pediatrics with 2.7% (n=9) and psychiatry with 1.5% (n=5).
Interest in Public Health Exercise
Among the respondents (n=330), 69.7% (n=230) of the medical providers in Washoe County
expressed an interest in participating in a public health disaster exercise (data not shown).
Among the MDs, 53% (n=34) expressed an interest, while 72.8% (n=158) of the RNs expressed
an interest in participating. For providers who worked at a hospital (n=140), 74.3% (n=104)
expressed an interest to participate, those who worked at a clinic (n=65), 60.0% (n=39)
expressed an interest, while providers who worked in the public health field (n=17), 58.8%
(n=10) were interested in a public health disaster exercise. The age group with the greatest
proportion of interested providers was 41-65 years (75.7%, n=168), followed by the under 25
group (69.2%, n=45) and the over 65 group (67.7%, n=16).
Confidence in Reporting Procedures
Specifically with confidence in infectious disease reporting procedures, 17.6% (n=58) of all
surveyed stated that they were “confident” in their reporting responsibilities, 49.7% (n=164)
stated that they were “somewhat confident”, and 28.5% (n=94) were “not confident” (data not
shown). Among hospital-based providers (n=140), 19.3% (n=27), 41.4% (n=58), and 33.6%
(n=47) stated that they were “confident”, “somewhat confident”, and “not confident”
respectively. It is interesting to note that 94.1% (n=16) of public health-based providers were
either “confident” or “somewhat confident” in infectious disease (ID) reporting, while 33.6%
(n=47) of hospital-based providers were “not confident”. Additionally, 75% (n=48) of MDs
were either “confident” or “somewhat confident” in reporting procedures, while nearly a third
(31.8%) of RNs were “not confident”.
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Additional Training Interests
When asked to indicate public health topics they would like to receive more training on, the
majority of providers (51.2% n=169) listed “epidemiology of emerging infectious agents” (Table
3). “Mass vaccination and prophylaxis” was also a very popular topic indicated by 47.6%
(n=157) as an interest. Other notable public health topics indicated are “epidemiology and
bioterrorism agents” which was noted by 37.6% (n=124) of all providers, “isolation and
quarantine” with 32.7% (n=108) and “disaster and mental health” with 32.4% (n=107).
Among the clinical topics, nearly two-thirds of providers (62.4% n=206) indicated “emerging
infectious diseases” as a topic they would like to receive more training on. Additionally, “mass
casualty response” was indicated by 56.1% (n=185) of all providers. Also of note, “bioterrorism
agents” and “infection control”, 42.4% (n=140) and 43.0% (n=142) respectively, were both
popular clinical topics.
Among the MDs, the top three public health topics reflected the choices made by all providers
with 45.3% (n=29) for “epidemiology of emerging infectious diseases”, 34.4% (n=22) for
“epidemiology and bioterrorism agents”, and 29.7% (n=19) for “mass vaccination and
prophylaxis” (Table 4). Also of note, “isolation and quarantine” was a topic indicated by 25.0%
(n=16) of MDs.
The majority of MDs would like more clinical training in “emerging infectious diseases” and
“bioterrorism agents” (57.8%, n=37 and 51.6%, n=33 respectively), while “mass casualty
response” was noted by 39.1% (n=25) of physicians.
Among the public health topics, RNs preferred “mass vaccination and prophylaxis” (53.9%
n=117) slightly more than “epidemiology of emerging infectious agents” (53.0% n=115), while
“epidemiology of bioterrorism agents” was noted by 38.2% (n=83) of RNs (Table 5). “Disaster
and mental health” and “isolation and quarantine” were topics also highly desired by RNs with
34.1% (n=74) for each.
The majority of RNs indicated “emerging infectious diseases” and “mass casualty response” as
clinical topics they would like to receive more training in (63.1%, n=137 and 59.9%, n=130
respectively). Another clinical topic popular among RNs was “infection control” (44.7%, n=97).
Preferences and Characteristics for Training
Over a third (39.0%, n=129) of all providers stated that limited staff at work could be a reason
they would not be able to attend trainings (Table 6). Only 11.5% (n=38) stated they had no
interest to attend, while 27.0% (n=89) listed other reasons not specifically listed on the survey.
Among these other reasons, the two most frequent listed were time constraints with 14% (n=47)
and child or family member care with 3% (n=10).
When asked to indicate which format of trainings they would like to use, the majority of
providers indicated “in-person” (74.5%, n=246) and “online” (51.5%, n=170) trainings. A DVD
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or CD-ROM format was also highly recommended with 40.0% (n=132) of all providers stating
they would use it.
“Online trainings” was a format preferred most by the “under 25 years” group (66.2%, n=45),
while 51.7% (n=119) of those in the “41-65 years” group, and 24% (n=6) in the “over 65 years”
group indicated “online training” as a preference (data not shown). The majority of providers
whose work setting was in a hospital (53.6% n=75) indicated “online training” as an option.
Similarly, 47.7% (n=31) of providers based in clinics noted “online training” as an acceptable
format. Just over a third (35.3% n=6) of public health workers, however, would use “online
training” as a format.
Notably, “in-person trainings” was a format indicated more often by women (80.6%, n=203)
than by men (60.0%, n=42). Also of note, “in person trainings” was a format indicated more
often by RNs (79.3%, n=172) than by MDs (57.8%, n=37). The setting a provider worked in did
not seem to indicate a notable difference in preference for “in person trainings”. The vast
majority of public health-based providers (82.4% n=14) indicated “in person training” as an
accepted format, while 75.0% (n=105) and 70.8% (n=46) of hospital and clinic-based providers
would use “in person training” as a format.
The importance of CME/CEU credits was rated highly among all providers with 44.2% (n=146)
stating that they were “very important”, while 18.5% (n=61) agreed that they were “important”
and 26.4% (n=87) stated the credits were “somewhat important” (Table 6). Only 7.5% (n=25) of
all providers stated that the CME/CEU credits were “less important” or “not important”.
The view of importance of CME/CEU credits varied slightly between MDs and RNs. When
rating the importance of receiving CME/CEU credits for education and training programs, 70.3%
(n=45) of MDs answered “very important” or “important”, while 61.3% (n=133) of RNs
answered “very important” or “important”. An equal percentage of RNs and MDs (7.8%)
answered “not very important” or “not important”, while 26.6% (n=17) and 27.6% (n=60) of
MDs and RNs respectively answered “somewhat important”.
In-Person Training Preferences
Regarding “in-person training”, nearly all (96.1%, n=273) medical providers indicated their
availability for “half-day trainings”, 87.6% (n=226) indicated “one day trainings”, while 52.7%
(n=98) were available for “two day trainings” (Table 7).
Recognition and Treatment of Infectious Diseases
Table 8 summarizes providers’ answers for identification and treatment of selected diseases. Of
notable interest, 73.6% (n=243) selected “I somewhat disagree” or “I disagree” when asked
about their confidence in identifying tularemia. When asked about viral hemorrhagic fever or
plague, 63.1% (n=208) and 59.7% (n=197) selected “I somewhat disagree” or “I disagree”
respectively. Over 80% (n=258) of all medical providers stated that they “agree” or “somewhat
agree” that they knew how to identify influenza. For smallpox and meningococcal
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disease, 59.6% (n=187) and 63.0% (n=196) of all providers stated “agree” or “somewhat agree”
that they knew how to identify the signs and symptoms.
Providers stated that they “somewhat disagree” or “disagree” that they knew how to treat
tularemia (76.3% n=235) and viral hemorrhagic disease (76.1% n=236). The majority of
providers (70.3% n=232), however, stated they “agree” or “somewhat agree” they knew how to
treat influenza, while approximately half (49.1% n=162) “agree” or “somewhat agree” they knew
how to treat meningococcal disease.
When asked about selected chemical threats, 60.3% (n=199) indicated “somewhat disagree” or
“disagree” with their ability to identify blood agents (Table 9). For the remaining chemical
threats, choking, nerve, and blister agents, approximately half of all providers indicated that they
“agree” or “somewhat agree” that they could identify them. Over 65% of all providers stated
that they “somewhat disagree” or “disagree” that they are confident they could treat any of the
chemical threats.
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Recommendations
Format and Expectations
Assuming the respondents from this survey are representative of medical providers in Washoe
County, we should expect many more RNs than MDs or any other degree at any training or
exercise. Furthermore, board certifications among providers are very wide ranging and not
significantly suggestive of any particular field. However, many providers with critical care and
pediatric training experience can be expected at any training or exercise offered.
Half- or one-day in-person training would be an ideal format, satisfying the wishes of the vast
majority of providers. While an online training format would be a viable option also, this can be
offered as an alternative for those who cannot attend in-person training on the decided dates.
This alternative training format may end up being very beneficial since limited staffing issues are
a significant deterrent for many providers. Based on the providers’ impressions of the
importance of CME/CEU credits, we can expect the availability of credits to be a motivating
factor in attending an exercise or training. Additionally, though we can expect a greater
proportion of RNs than MDs, participation in a public health disaster exercise should be very
well attended.
Training Content
Training should review infectious disease reporting procedures for all providers in Nevada not
only because of a lack of stated confidence, but also because “emerging and infectious agents”
was the most popular public health training topic noted. Mass vaccination, prophylaxis, and the
epidemiology of bioterrorism should all play significant roles in the public health training of all
providers. As expressed by the medical providers, emerging infectious diseases and mass
casualty response should be the focus of the clinical training topics. Though preferred mainly by
RNs, infection control should be incorporated in the clinical training topics.
If at all possible, a review of identification and treatment of all diseases included in this survey
(Appendix A) should be implemented. For more focused infectious disease training, several
specific diseases should be addressed, including tularemia, viral hemorrhagic fever, and plague.
The identification and treatment of all the listed chemical threats should also be reviewed
thoroughly. Specifically, however, the identification of blood agents and the treatment of all
chemical threats should be prioritized.
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Table 1. Demographic and Work Characteristics of the Survey Respondents.
Characteristic Number %
(n=330) Total
Age
Under 40 years 68 20.6
41-65 years 230 69.7
Over 65 years 25 7.6
Missing 7 2.1
Gender
Male 70 21.2
Female 252 76.4
Missing 8 2.4
Degree
MD 64 19.4
DO 0 0.0
RN 217 65.8
PHN 14 4.2
CAN 21 6.4
LPN 11 3.3
APN 10 3.0
Other 46 13.9
Fluent in a Language
Other than English
Yes 49 14.8
No 281 85.2
Other Language
Spanish 26 7.9
Filipino 8 2.4
Work Setting
Clinic 65 19.7
Hospital 140 42.4
Public Health 17 5.2
Home Health 8 2.4
Other 95 28.8
Missing 5 1.5
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Table 2. Medical Provider Training
Medical Provider Training Number %
(n=330) Total
Areas of Two or More Years
Of Specialty Training
Infectious Disease 19 5.8
Dermatology 3 0.1
Neurology 8 2.4
Pediatrics 41 12.4
Pulmonary Medicine 17 5.2
Critical Care 70 21.2
Anaesthesiology 3 0.1
Psychiatry 20 6.1
Other 171 51.8
Board Certification
Infectious Disease 3 0.9
Dermatology 1 0.3
Neurology 3 0.9
Pediatrics 9 2.7
Pulmonary Medicine 2 0.6
Critical Care 3 0.9
Anaesthesiology 2 0.6
Psychiatry 5 1.5
Other 96 29.1
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Table 3. Additional Training Interests Among All Respondents
Topic Areas Number %
(n=330) Total
Public Health Topics
Epidemiology of Bioterrorism Agents 124 37.6
Epidemiology of Emerging Infectious Diseases 169 51.2
Incident Command Systems 72 21.8
Outbreak Investigations 98 29.7
Isolation and Quarantine 108 32.7
Mass Vaccination and Prophylaxis 157 47.6
Risk Communication 74 22.4
Public Health Law 90 27.3
Special Populations 58 17.6
Disaster and Mental Health 107 32.4
Clinical Topics
Bioterrorism Agents 140 42.4
Emerging Infectious Diseases 206 62.4
Infection Control 142 43.0
Chemical Injuries 105 31.8
Injuries from Explosives 94 28.5
Injuries from Radiological Agents 100 30.3
Mass Casualty Response 185 56.1
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Table 4. Training Interests Among Physicians
Topic Areas Number %
(n=64) Total
Public Health Topics
Epidemiology of Bioterrorism Agents 22 34.4
Epidemiology of Emerging Infectious Diseases 29 45.3
Incident Command Systems 13 20.3
Outbreak Investigations 12 18.8
Isolation and Quarantine 16 25.0
Mass Vaccination and Prophylaxis 19 29.7
Risk Communication 14 21.9
Public Health Law 12 18.8
Special Populations 5 7.8
Disaster and Mental Health 13 20.3
Clinical Topics
Bioterrorism Agents 33 51.6
Emerging Infectious Diseases 37 57.8
Infection Control 21 32.8
Chemical Injuries 23 35.9
Injuries from Explosives 18 28.1
Injuries from Radiological Agents 23 35.9
Mass Casualty Response 25 39.1
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Table 5. Training Interests Among Registered Nurses
Topic Areas Number %
(n=217) Total
Public Health Topics
Epidemiology of Bioterrorism Agents 83 38.2
Epidemiology of Emerging Infectious Diseases 115 53.0
Incident Command Systems 49 22.6
Outbreak Investigations 72 33.2
Isolation and Quarantine 74 34.1
Mass Vaccination and Prophylaxis 117 53.9
Risk Communication 48 22.1
Public Health Law 60 27.6
Special Populations 40 18.4
Disaster and Mental Health 74 34.1
Clinical Topics
Bioterrorism Agents 84 38.7
Emerging Infectious Diseases 137 63.1
Infection Control 97 44.7
Chemical Injuries 65 30.0
Injuries from Explosives 61 28.1
Injuries from Radiological Agents 62 28.6
Mass Casualty Response 130 59.9
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Table 6. Preferred Characteristics for Training
Characteristic Number %
(n=330) Total
Reasons for Not Attending Training
Supervisor won’t approve 15 4.5
Limited staff at work 129 39.0
Can’t commute 2 0.6
No interest to attend 38 11.5
Other 89 27.0
Format of Trainings
Online 170 51.5
DVD or CD-ROM 132 40.0
In-person 246 74.5
Other 4 1.2
Importance of CME/CEU credits‡
1 Very Important 146 44.2
2 61 18.5
3 Somewhat Important 87 26.4
4 15 4.5
5 Not Important 10 3.0
Missing 11 3.3
‡ The answers were given on a likert scale: 1 to 5; 1= Very important, 5 = Not Important.
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Table 7. In-person Training Preferences
Characteristic Yes No Missing
n (%) n (%) n (%)
Availability to Attend
Half-day trainings 273 (96.1) 11 (3.9) 46 (13.9)
One-day trainings 226 (87.6) 32 (12.4) 72 (21.8)
Two-day trainings 98 (52.7) 88 (47.3) 144 (43.6)
Other 9 (2.7) 11 (3.3) 310 (93.9)
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Table 8. Recognition and Treatment of Infectious Diseases (n=330)
Disease I agree I somewhat I somewhat I disagree Missing
agree disagree
n (%) n (%) n (%) n (%) n (%)
I can recognize the signs and symptoms of the following diseases:
Anthrax 27(8.2%) 102(30.9%) 30(9.1%) 103(31.2%) 18(5.5%)
Botulism 46(13.9%) 99(30.0%) 71(21.5%) 93(28.2%) 21(64%)
Influenza 153(46.4%) 105(31.8%) 29(8.8%) 30(9.1%) 13(3.9%)
Plague 27(8.2%) 86(26.1%) 87(26.4%) 110(33.3%) 20(6.1%)
SARS 37(11.2%) 114(34.5%) 75(22.7%) 86(26.1%) 18(5.5%)
Smallpox 71(21.5%) 116(35.3%) 60(18.2%) 67(20.3%) 16(4.8%)
Tularemia 13(3.9%) 52(15.8%) 99(30.0%) 144(43.6%) 22(6.7%)
West Nile Virus 36(10.9%) 78(23.6%) 94(28.5%) 101(30.6%) 21(6.4%)
Meningococcal 85(25.8%) 111(33.6%) 50(15.2%) 65(19.7%) 19(5.8%)
Disease
Viral Hemorrhagic 21(6.4%) 80(24.2%) 84(25.5%) 124(37.6%) 21(6.4%)
Fever
I know how to treat the following diseases:
Anthrax 48(14.5%) 76(23.0%) 57(17.3%) 132(40.0%) 17(5.2%)
Botulism 45(13.6%) 78(23.6%) 62(18.8%) 124(37.6%) 21(6.4%)
Influenza 138(41.8%) 94(28.5%) 26(7.9%) 58(17.6%) 14(4.2%)
Plague 40(12.1%) 73(22.1%) 64(19.4%) 134(40.6%) 19(5.8%)
SARS 36(10.9%) 90(27.3%) 62(18.8%) 124(37.6%) 18(5.5%)
Smallpox 46(13.9%) 78(23.6%) 65(19.7%) 122(37.0%) 19(5.8%)
Tularemia 14(4.2%) 59(17.9%) 71(21.5%) 164(49.7%) 22(6.7%)
West Nile Virus 41(12.4%) 68(20.6%) 66(20.0%) 135(40.9%) 20(6.1%)
Meningococcal 78(23.6%) 84(25.5%) 48(14.5%) 100(30.3%) 20(6.1%)
Disease
Viral Hemorrhagic 16(4.8%) 58(17.6%) 79(23.9%) 157(47.6%) 20(6.1%)
Fever
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Table 9. Recognition and Treatment of Chemical Threats (n=330)
Disease I agree I somewhat I somewhat I disagree Missing
agree disagree
n (%) n (%) n (%) n (%) n (%)
I can recognize the signs and symptoms of the following chemical threats:
Blister 42(12.7%) 112(33.9%) 57(17.3%) 105(31.8%) 14(4.2%)
agents/vesicants
Blood agents 21(6.4%) 94(28.5%) 81(24.5%) 118(35.8%) 16(4.8%)
Choking/pulmonary 45(13.6%) 121(36.7%) 57(17.3%) 92(27.9%) 15(4.5%)
agents
Nerve agents 30(9.1%) 108(32.7%) 69(20.9%) 105(31.8%) 18(5.5%)
I know how to treat the following chemical threats:
Blister 23(7.0%) 70(21.2%) 75(22.7%) 147(44.5%) 15(4.5%)
agents/vesicants
Blood agents 17(5.2%) 60(18.2%) 88(26.7%) 148(44.8%) 17(5.2%)
Choking/pulmonary 26(7.9%) 81(24.5%) 74(22.4%) 133(40.3%) 16(4.8%)
agents
Nerve agents 27(8.2%) 54(16.4%) 87(26.4%) 146(44.2%) 16(4.8%)
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Appendix A: Washoe County Needs Assessment Survey
(Hardcopy)
21
Washoe County Needs Assessment of Medical Providers
Thank you for participating in this survey. Your feedback is important for designing public
health training in Washoe County, Nevada. The survey has six pages and takes less than ten
minutes to complete.
If you would like to complete this survey online, please go to:
http://www.surveymonkey.com/s.asp?u=667611122442
1. Please complete the following information:
First Name __________________________________
Last Name __________________________________
Organization __________________________________
Address __________________________________
Street
__________________________________
City State Zip
This is a: Home Address Work Address
2. Degrees (check all that apply):
MD
DO
RN
PHN
CNA
LPN
APN
Other (please specify)
______________________________________
22
3. Please indicate the area(s) in which you received two or more years of specialty training.
Select all that apply.
Infectious disease
Dermatology
Neurology
Pediatrics
Pulmonary medicine
Critical care medicine
Anaesthesiology
Psychiatry
Other (please specify)
______________________________________
4. Please indicate the area(s) in which you are board-certified. Select all that apply.
Infectious disease
Dermatology
Neurology
Pediatrics
Pulmonary medicine
Critical care medicine
Anaesthesiology
Psychiatry
Other (please specify)
______________________________________
5. What state(s) do you currently have an active medical or nursing license? Select all that
apply.
Nevada
California
Other (please specify)
______________________________________
6. What is your primary work setting (> 50% time)? Select one answer.
Clinic
Hospital
Public health
Home health
Other (please specify)
______________________________________
23
7. Are you fluent in a language other than English?
Yes
No
8. If you are fluent in another language, please list:
_____________________________________________
9. Please indicate the areas in which you would like additional training. Select all that apply.
Public Health Topics
a. Epidemiology and control of bioterrorism agents
b. Epidemiology and control of emerging infectious agents
c. Incident Command Systems
d. Conducting an outbreak investigation
e. Isolation and quarantine
f. Mass vaccination and prophylaxis
g. Risk communication
h. Public health law
i. Working with special populations
j. Disaster and mental health issues
Clinical Topics
a. Bioterrorism agents
b. Emerging infectious diseases
c. Infection control
d. Chemical injuries
e. Injuries from explosives
f. Injuries from radiological agents
g. Mass casualty response
10. What might cause you to not attend trainings in Reno? Select all that apply.
Supervisor won’t approve
Limited staffing issues in my workplace
Not able to commute
No interest to attend
Other (please specify)_________________________________
24
11. What format of trainings would you prefer? Select all that apply.
Online training
DVD or CD-ROM
In-person training
Other (please specify)_________________________________
12. For in-person trainings, would you be available to attend:
Yes No
a. half-day trainings?
b. one-day trainings?
c. two-day trainings?
d. other?
If other, please specify ____________________________
13. Would you be interested in participating in a public health emergency response exercise as a
representative of community providers?
Yes
No
14. In your current position, do you:
Yes No
a. provide training to other medical providers?
b. give lectures at local and/or national events?
15. If you currently provide trainings, in what areas?
_____________________________________________________________
25
16. Please rate the importance of receiving CME/CEU credits for education and training
programs. Circle the appropriate rating (1 through 5, 1= “Very Important” and 5=”Not
Important”).
Very Important Somewhat Important Not Important
1 2 3 4 5
__________________________________________
17. Please indicate your level of confidence in your knowledge of the requirements to report
infectious diseases in Nevada. Select one answer.
I am confident that I know my responsibilities for reporting in Nevada.
I am somewhat confident that I know my responsibilities for reporting in Nevada.
I am not confident that I know my responsibilities for reporting in Nevada.
________________________________________
18. Please answer whether you agree or disagree with the following statements.
I somewhat
I somewhat
I disagree
disagree
I agree
agree
I can recognize the signs and symptoms of the following diseases:
Anthrax (Bacillus anthracis)
Botulism
Influenza
Plague (Yersinia pestis)
SARS
Smallpox (Variola major)
Tularemia (Franciella tularensis)
West Nile Virus Disease
Meningococcal Disease
Viral Hemorrhagic Fever (e.g., Ebola, Marburg, etc.)
26
I somewhat
I somewhat
I disagree
disagree
I agree
agree
I know how to treat the following diseases:
Anthrax (Bacillus anthracis)
Botulism
Influenza
Plague (Yersinia pestis)
SARS
Smallpox (Variola major)
Tularemia (Franciella tularensis)
West Nile Virus Disease
Meningococcal Disease
Viral Hemorrhagic Fever (e.g., Ebola, Marburg, etc.)
I somewhat
I somewhat
I disagree
disagree
I agree
agree
I can recognize the signs and symptoms of the following chemical threats:
Blister agents/vesicants
Blood agents
Choking/pulmonary agents
Nerve agents
I know how to treat the following chemical threats:
Blister agents/vesicants
Blood agents
Choking/pulmonary agents
Nerve agents
27
19. What is your age?
under 40 years
41-65 years
over 65 years
20. What is your gender?
Female
Male
Thank you for completing the survey. If you have any questions regarding this survey, please
contact Amy Weiss, MPH at (775) 328-2432.
Please mail this survey to:
Center for Infectious Disease Preparedness
Attn: Wayne Enanoria, PhD, MPH
1918 University Avenue, 4th Floor
Berkeley, California 94704
or fax to (775) 328-3750. Thank you!!!
28
Appendix B: Letters and Emails Distributed
29
June 10, 2005
Dear Washoe County Medical Provider,
We are very appreciative that last fall you responded to a survey we sent you regarding public
health preparedness training and expertise. In order to fully understand what further training and
education opportunities would be most beneficial we ask that you please complete this brief
questionnaire. We are conducting this needs assessment with the assistance of the University of
California, Berkeley, School of Public Health, Center for Infectious Disease Preparedness.
As you may know, the Washoe County District Health Department is relatively small (under 200
employees) – less than one-quarter are licensed medical providers. In the event of a public health
emergency requiring large-scale vaccination or medication dispensing campaigns we would need
your help. Even if you cannot commit to serve in an emergency, it is still our goal to support a
provider workforce with expertise in areas relating to public health preparedness. We invite you
to complete this survey and participate in future educational offerings.
It is important to us that any workshops or trainings we offer serve your needs and interests and
are structured to encourage your participation, so we need your input! This survey will take
less than 10 minutes to complete. You might receive this survey in multiple formats (email/web-
based or paper), please complete it only once in whichever format is most convenient. You may
return the paper survey by mail in the enclosed postage-paid, self-addressed envelope or by fax
to 775-328-3750.
All information we collect is kept confidential and only used by Washoe County public health
staff for preparedness planning and to assess training needs. Any reports will only contain
summary statistics and no individual-level information.
If you have any questions, please feel free to contact Amy Weiss at 775-328-2432 or
aweiss@washoecounty.us. Thank you for your participation!
Sincerely,
Debra Brus, DVM Amy Weiss, MPH
Acting Director, EPI Center Education & Training Coordinator
Public Health Preparedness Program
30
From: "Center for Infectious Disease Prep"
Subject: Washoe County Survey
Date: Fri, 10 Jun 2005 09:40:49 -0700
June 10, 2005
Dear Washoe County Medical Provider,
We are very appreciative that last fall you responded to a survey we sent you regarding public
health preparedness training and expertise. In order to fully understand what further training and
education opportunities would be most beneficial we ask that you please complete this brief
questionnaire. We are conducting this needs assessment with the assistance of the University of
California, Berkeley, School of Public Health, Center for Infectious Disease Preparedness.
As you may know, the Washoe County District Health Department is relatively small (under 200
employees) less than one-quarter are licensed medical providers. In the event of a public health
emergency requiring large-scale vaccination or medication dispensing campaigns we would need
your help. Even if you cannot commit to serve in an emergency, it is still our goal to support a
provider workforce with expertise in areas relating to public health preparedness. We invite you
to complete this survey and participate in future educational offerings.
It is important to us that any workshops or trainings we offer serve your needs and interests and
are structured to encourage your participation, so we need your input! This survey will take less
than 10 minutes to complete. You might receive this survey in multiple formats (email/web-
based or paper), please complete it only once in whichever format is most convenient. You may
return the paper survey by mail to the address listed at the end of the survey or by fax to 775-
328-3750. If you would like to complete the survey online, you can do so at
http://www.surveymonkey.com/s.asp?u=667611122442 . Please complete the survey by 5pm,
Monday, June 27, 2005.
All information we collect is kept confidential and only used by Washoe County public health
staff for preparedness planning and to assess training needs. Any reports will only contain
summary statistics and no individual-level information.
If you have any questions, please feel free to contact Amy Weiss at 775-328-2432 or
aweiss@washoecounty.us. Thank you for your participation!
Sincerely,
Debra Brus, DVM
Acting Director, EPI Center
Amy Weiss, MPH
Education & Training Coordinator
Public Health Preparedness Program
31
June 10, 2005
Dear Washoe County Medical Provider,
We are very appreciative that last fall you responded to our survey in which you indicated your
willingness to serve as a volunteer or medical consultant in the event of a public health
emergency in our area. In order to fully understand what further training and education
opportunities would be most beneficial we ask that you please complete this brief questionnaire.
We are conducting this needs assessment with the assistance of the University of California,
Berkeley, School of Public Health, Center for Infectious Disease Preparedness.
As you may know, the Washoe County District Health Department is relatively small (under 200
employees) – less than one-quarter are licensed medical providers. In the event of a public health
emergency requiring large-scale vaccination or medication dispensing campaigns we would need
your help. Even if you cannot commit to serve in an emergency, it is still our goal to support a
provider workforce with expertise in areas relating to public health preparedness. We invite you
to complete this survey and participate in future educational offerings.
It is important to us that any workshops or trainings we offer serve your needs and interests and
are structured to encourage your participation, so we need your input! This survey will take
less than 10 minutes to complete. You might receive this survey in multiple formats (email/web-
based or paper), please complete it only once in whichever format is most convenient. You may
return the paper survey by mail in the enclosed postage-paid, self-addressed envelope or by fax
to 775-328-3750.
All information we collect is kept confidential and only used by Washoe County public health
staff for preparedness planning and to assess training needs. Any reports will only contain
summary statistics and no individual-level information.
If you have any questions, please feel free to contact Amy Weiss at 775-328-2432 or
aweiss@washoecounty.us. Thank you for your participation!
Sincerely,
Debra Brus, DVM Amy Weiss, MPH
Acting Director, EPI Center Education & Training Coordinator
Public Health Preparedness Program
32
From: "Center for Infectious Disease Prep"
Subject: Washoe County Survey
Date: Fri, 10 Jun 2005 09:44:01 -0700
June 10, 2005
Dear Washoe County Medical Provider,
We are very appreciative that last fall you responded to our survey in which you indicated your
willingness to serve as a volunteer or medical consultant in the event of a public health
emergency in our area. In order to fully understand what further training and education
opportunities would be most beneficial we ask that you please complete this brief questionnaire.
We are conducting this needs assessment with the assistance of the University of California,
Berkeley, School of Public Health, Center for Infectious Disease Preparedness.
As you may know, the Washoe County District Health Department is relatively small (under 200
employees) less than one-quarter are licensed medical providers. In the event of a public health
emergency requiring large-scale vaccination or medication dispensing campaigns we would need
your help. Even if you cannot commit to serve in an emergency, it is still our goal to support a
provider workforce with expertise in areas relating to public health preparedness. We invite you
to complete this survey and participate in future educational offerings.
It is important to us that any workshops or trainings we offer serve your needs and interests and
are structured to encourage your participation, so we need your input! This survey will take less
than 10 minutes to complete. You might receive this survey in multiple formats (email/web-
based or paper), please complete it only once in whichever format is most convenient. You may
return the paper survey by mail to the address listed at the end of the survey or by fax to 775-
328-3750. If you would like to complete the survey online, you can do so at
http://www.surveymonkey.com/s.asp?u=667611122442 . Please complete the survey by 5pm,
Monday, June 27, 2005.
All information we collect is kept confidential and only used by Washoe County public health
staff for preparedness planning and to assess training needs. Any reports will only contain
summary statistics and no individual-level information.
If you have any questions, please feel free to contact Amy Weiss at 775-328-2432 or
aweiss@washoecounty.us. Thank you for your participation!
Sincerely,
Debra Brus, DVM
Acting Director, EPI Center
Amy Weiss, MPH
Education & Training Coordinator
Public Health Preparedness Program
33
Addendum
Demographics
As of August 23, 2005, n=27 hardcopy surveys were received after the June 27 deadline. The
updated response rate for this survey as a result is 45.2% (357/789 total). Females made up
85.1% (n=23), males made up 11.1% (n=3), and for 3.8% (n=1) the gender was not known
(Table 1). The majority (69.2%, n=18) of respondents were between the ages 41 and 65. The
next frequent age group was under 40 years with 26.9% (n=7), while the least frequent group
was over 65 years with 3.8% (n=1). Approximately 3.8% (n=1) of the respondents were of
unknown age.
Registered nurses (RN) comprised 77.8% (n=21) of all respondents, while the next frequent
degree was Medical Doctor (MD) comprising 11.1% (n=3). Females made up the RN majority
with 90.0% (n=18). The majority (n=16, 88.9%) of RNs were between the ages of 41 and 65.
All (n=27) of the medical providers submitting late surveys were licensed in Nevada, while
18.5% (n=5) were licensed in California, as well. According to the survey, 11.1% (n=3) of the
providers were fluent in a second language.
The most frequent work setting was in the hospital with 40.7% (n=11), followed by the clinic
setting with 14.8% (n=4). Additionally, 37.0% (n=10) named other work settings not listed on
the survey.
Interest in Public Health Exercise
Among the respondents (n=27), 70.4% (n=19) of the medical providers in Washoe County
expressed an interest in participating in a public health disaster exercise (data not shown). The
majority (83.3%, n=15) of the RNs expressed an interest in participating. For providers who
worked at a hospital (n=11), 81.8% (n=9) expressed an interest to participate in a public health
disaster exercise. The two main age groups (under 40 years and between 41-65 years) expressed
similar interest in the exercise with 83.3% (n=5) and 81.3% (n=13), respectively.
Additional Training Interests
When asked to indicate public health topics they would like to receive more training on, the
majority of providers (70.4% n=19) listed “epidemiology of emerging infectious agents”, “mass
vaccination and prophylaxis” (70.4% n=19), and “epidemiology and bioterrorism agents” (59.3%
n=16) (Table 2). “Outbreak investigations” was also a very popular topic indicated by 48.1%
(n=13) as an interest.
Among the clinical topics, the majority of all providers wanted more training in every clinical
topic listed. The most popular topic was “mass casualty response”, indicated by 74.1% (n=20) of
respondents. Among the public health topics, RNs preferred “mass vaccination and prophylaxis”
(85.7% n=18) slightly more than “epidemiology of emerging infectious agents” (76.2% n=16).
The majority of RNs (76.2% n=16) indicated “emerging infectious diseases” and “mass casualty
response” as clinical topics they would like to receive more training on. Other clinical topics
popular among RNs were “infection control” and “bioterrorism agents” which comprised 71.4%
(n=15) of registered nurses.
34
Table 1. Demographic and Work Characteristics of the Survey Respondents.
Characteristic Number %
(n=27) Total
Age
Under 40 years 7 26.9
41-65 years 18 69.2
Over 65 years 1 3.8
Missing 1 3.8
Gender
Male 3 11.1
Female 23 85.1
Missing 1 3.8
Degree
MD 3 3.8
DO 0 0.0
RN 21 77.8
PHN 0 0.0
CNA 2 7.4
LPN 1 3.8
APN 0 0.0
Other 0 0.0
Fluent in a Language
Other than English
Yes 3 3.8
No 24 88.9
Other Language
Spanish 1 3.8
Guamanian 1 3.8
Work Setting
Clinic 4 14.8
Hospital 11 40.7
Public Health 0 0.0
Home Health 2 7.4
Other 10 37.0
Missing 0 0.0
35
Table 2. Additional Training Interests Among All Respondents
Topic Areas Number %
(n=27) Total
Public Health Topics
Epidemiology of Bioterrorism Agents 16 59.3
Epidemiology of Emerging Infectious Diseases 19 70.4
Incident Command Systems 11 40.7
Outbreak Investigations 13 48.1
Isolation and Quarantine 9 33.3
Mass Vaccination and Prophylaxis 19 70.4
Risk Communication 10 37.0
Public Health Law 12 44.4
Special Populations 10 37.0
Disaster and Mental Health 12 44.4
Clinical Topics
Bioterrorism Agents 19 70.4
Emerging Infectious Diseases 19 70.4
Infection Control 19 70.4
Chemical Injuries 15 55.5
Injuries from Explosives 14 51.9
Injuries from Radiological Agents 15 55.6
Mass Casualty Response 20 74.1
36