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Background\ud The threat of chemical, biological, radiological, nuclear, and explosive incidents has increased because of technological advancements and the willingness of terrorists to use unconventional weapons. Emergency responders can use interventions such as decontamination and quarantine during such incidents. However, when emergency responders do not communicate effectively, public anxiety could increase and compliance with decontamination could be poor, reducing the efficacy of decontamination and creating a secondary contamination hazard for receiving hospitals. There is a need to examine whether current procedures sufficiently acknowledge public communication needs.\ud Methods\ud First, a systematic review of published decontamination guidance for responders was undertaken. Second, semistructured telephone interviews were carried out with a convenience sample of 13 responders from the UK Fire and Rescue Service who had similar training but different amounts of decontamination experience. A thematic framework was developed to analyse the findings for previously identified issues, such as perceptions of public compliance with the need for decontamination, excessive public anxiety, and orderly behaviour. Relevant passages were coded into one or more of the themes. Care was taken to document the full variety of responses given; contradiction in interview accounts was actively sought. The potential for interviewer bias was reduced with a semistructured interview schedule and telephone interviews, thereby eliminating the effect of non-verbal cues. Finally, data from five emergency preparedness exercises involving decontamination were analysed. All participants who underwent decontamination during these exercises (n=402) completed questionnaires. Numbers of men and women were roughly equal; ages ranged from 18 years to 85 years. Quantitative data were analysed with correlational and path analysis, and qualitative data with the framework approach. A second researcher coded a subsection of the data, producing an inter-rate reliability rate of 89%.\ud Findings\ud The systematic review showed poor planning for communication with members of the public. The interview study established that responders who had previous experience of decontamination perceived communication with the public to be important. Responders who did not have experience of decontamination did not recognise the role of communication, and instead emphasised the importance of controlling members of the public who were said to be vulnerable to mass panic. Analysis of qualitative data from emergency preparedness exercises showed that most participants felt that they had not been given adequate communication from responders. A path model based on the results from the quantitative data had good overall fit (χ2 test; p=0·607). Poor perceived communication contributed to decreased levels of reassurance (r=0·28, p=0·006) and willingness to comply with decontamination (r=0·31, p=0·007).\ud Interpretation\ud Effective communication is a key intervention through which emergency responders can contribute to the successful management of decontamination. The small number of responders in the interview study could reduce the ability to generalise results. However, 12 interviews is usually enough for data saturation and hence an understanding of common perceptions and experiences in homogeneous sample groups. Additionally, exercises attempt to replicate a real situation, but some variables (especially anxiety) can differ significantly in real incidents. However, the relation between variables should not be different; successful communication would probably be even more important during a real incident than in exercises.

Background During the early stages of the 2009 swine flu (influenza H1N1) outbreak, the large majority of patients who contacted the health services about the illness did not have it. In the UK, the NHS Direct telephone service was used by many of these patients. We used qualitative interviews to identify the main reasons why people approached NHS Direct with concerns about swine flu and to identify aspects of their contact which were reassuring, using a framework approach. Methods 33 patients participated in semi-structured interviews. All patients had telephoned NHS Direct between 11 and 14 May with concerns about swine flu and had been assessed as being unlikely to have the illness. Results Reasons for seeking advice about swine flu included: the presence of unexpectedly severe flu-like symptoms; uncertainties about how one can catch swine flu; concern about giving it to others; pressure from friends or employers; and seeking 'peace of mind.' Most participants found speaking to NHS Direct reassuring or useful. Helpful aspects included: having swine flu ruled out; receiving an alternative explanation for symptoms; clarification on how swine flu is transmitted; and the perceived credibility of NHS Direct. No-one reported anything that had increased their anxiety and only one participant subsequently sought additional advice about swine flu from elsewhere. Conclusions Future major incidents involving other forms of chemical, biological or radiological hazards may also cause large numbers of unexposed people to seek health advice. Our data suggest that providing telephone triage and information is helpful in such instances, particularly where advice can be given via a trusted, pre-existing service.

Background When disasters occur, there are many different occupational groups involved in rescue, recovery and support efforts. This study aimed to conduct a systematic literature review to identify social and occupational factors affecting the psychological impact of disasters on responders. Methods Four electronic literature databases (MEDLINE®, Embase, PsycINFO® and Web of Science) were searched and hand searches of reference lists were carried out. Papers were screened against specific inclusion criteria (e.g. published in peer-reviewed journal in English; included a quantitative measure of wellbeing; participants were disaster responders). Data was extracted from relevant papers and thematic analysis was used to develop a list of key factors affecting the wellbeing of disaster responders. Results Eighteen thousand five papers were found and 111 included in the review. The psychological impact of disasters on responders appeared associated with pre-disaster factors (occupational factors; specialised training and preparedness; life events and health), during-disaster factors (exposure; duration on site and arrival time; emotional involvement; peri-traumatic distress/dissociation; role-related stressors; perceptions of safety, threat and risk; harm to self or close others; social support; professional support) and post-disaster factors (professional support; impact on life; life events; media; coping strategies). Conclusions There are steps that can be taken at all stages of a disaster (before, during and after) which may minimise risks to responders and enhance resilience. Preparedness (for the demands of the role and the potential psychological impact) and support (particularly from the organisation) are essential. The findings of this review could potentially be used to develop training workshops for professionals involved in disaster response. Electronic supplementary material The online version of this article (doi:10.1186/s40359-016-0120-9) contains supplementary material, which is available to authorized users.

Background Disasters are becoming more prevalent across the world and people are frequently exposed to them as part of their occupational groups. It is important for organisations to understand how best to support employees who have experienced a trauma such as a disaster. The purpose of this study was to explore employees’ perceptions of workplace support and help-seeking in the context of a disaster. Methods Forty employees in England took part in semi-structured interviews. Thematic analysis was used to extract recurring themes from the data. Results Participants reported both positive and negative psychological outcomes of experiencing a disaster or emergency at work. Most had little training in how to prepare for, and cope with, the psychological impact. They perceived stigma around mental health and treatment for psychological issues which often made them reluctant to seek help. Many reported that the psychological support available in the workplace was insufficient and tended to be reactive rather than proactive. Interpersonal relationships at work were viewed as being important sources of support, particularly support from managers. Participants suggested that psychosocial training in the workplace could be beneficial in providing education about mental health, encouraging supportive workplace relationships, and developing listening skills and empathy. Conclusions Organisations can take steps to reduce the psychological impact of disasters on employees. This could be done through provision of training workshops incorporating mental health education to reduce stigma, and team-building exercises to encourage supportive workplace relationships.