Supplementary Files
Keywords
Mass casualty incident
Willingness to work
Healthcare workers
Fight or flight
How to Cite
Abstract
Aim: This study evaluates the willingness of HCWs in the Zealand region, Denmark to work during MCIs, exploring influencing factors and conditions in comparison to previously published studies.
Methods: A cross-sectional, survey was conducted in two emergency departments across three hospitals in Zealand, Denmark. Data collection utilized an online questionnaire based on the “Fight or Flight” questionnaire developed by the University of Leuven, Belgium.
Results: Out of 508 invited HCWs (nurses, doctors, and secretaries), 103 fully answered the questionnaire (response rate 20.3%). Among them, willingness to work (WTW) unconditionally was highest for influenza pandemics (68%), SARS/COVID-19 (63%), and mass shootings (53%). The lowest WTW occurred during nuclear incidents (28%) and dirty bombs (29%). Key conditions for WTW included family safety (84%) and personal protective equipment (79%). Doctors showed higher WTW than nurses, and prior disaster training significantly influenced WTW for specific scenarios (p < 0.05).
Conclusion: High WTW rates suggest a self-evaluated readiness among Danish HCWs in the Zealand Region, especially during pandemics. However, WTW was lower for some scenarios, such as nuclear and radiological events. We suggest, based on the results, that targeted training could enhance preparedness and WTW.
References
A Significant Year of Disaster Impact 399 [Internet]. [cited 2024 Dec 29] Available from: https://files.emdat.be/reports/2023_EMDAT_report.pdf
Lessons from the COVID-19 pandemic to avert the next global crisis [Internet]. [cited 2024 Dec 29] Available from: https://www.ifrc.org/sites/default/files/2023-03/2022_IFRC-WDR_EN.0.pdf.pdf
Krankenhausalarm- und -einsatzplanung (kurz: KAEP) [Internet]. BBK. BBKWEB; 2024 [cited 2024 Dec 29]. Available from: https://www.bbk.bund.de/DE/Themen/Gesundheitlicher-Bevoelkerungsschutz/Krankenhausalarmplanung/krankenhausalarmplanung_node.html
Nationalt Risikobillede [Internet]. Beredskabsstyrelsen. 2023. [cited 2024 Dec 24] Available from: https://www.brs.dk/da/redningsberedskab-myndighed/krisestyring2-og-beredskabsplanlagning/nationalt-risikobillede/
Retningslinjer for indsatsledelse [Internet]. 2023 [cited 2026 May 29]. Available from: https://www.brs.dk/globalassets/brs---beredskabsstyrelsen/dokumenter/indsats---retningslinjer-o.l/2023/-retningslinjer-for-indsatsledelse-.pdf
Mass Casualty Management [Internet]. Who.int. 2025. Available from: https://www.who.int/teams/integrated-health-services/clinical-services-and-systems/emergency-and-critical-care/mass-casualty-management
Mangel på sygeplejersker truer sundhedsvæsenet [Internet]. dsr.dk. Available from: https://dsr.dk/dsr-mener/mangel-paa-sygeplejersker-truer-sundhedsvaesenet/
ABOUT [Internet]. EMDM. 2017 [cited 2026 May 29]. Available from: https://www.dismedmaster.com/about/
Dewolf, P.; Mortelmans, L.J.M.; Luyts, J.; De Cauwer, H.G.; Sabbe, M. Fight or flight: Will nurses and ambulance personnel go to work in disaster situations? Acta Clin. Belg.,2010, 65, 146. DOI:10.1017/S1049023X15001740
Sultan MAS, Løwe Sørensen J, Carlström E, Mortelmans L, Khorram-Manesh A. Emergency Healthcare Providers’ Perceptions of Preparedness and Willingness to Work during Disasters and Public Health Emergencies. Healthcare. 2020 Oct 29;8(4):442. DOI: 10.3390/healthcare8040442
Google Translate: Verify content in 100+ languages. - Google News Initiative [Internet]. 2026 [cited 2026 May 29]. Available from: https://newsinitiative.withgoogle.com/resources/trainings/google-translate-verify-content-in-100-languages/
Sørensen JL, Mortelmans L, Gray L, Khorram‐Manesh A, Hertelendy AJ, Stray KN, et al. “Fight or flight”—A study of frontline emergency response workforce’s perceived knowledge, and motivation to work during hazards. Risk, Hazards & Crisis in Public Policy. 2024 Aug 12;
Hendrickx C, Pieter Van Turnhout, Luc Mortelmans, Sabbe M, Lieve Peremans. Willingness to Work of Hospital Staff in Disasters: A Pilot Study in Belgian Hospitals. Prehospital and disaster medicine. 2017 Apr 1;32(S1):S21–1. DOI:10.13140/RG.2.2.16923.46889
Lindsy M.J. Engels, et al Fight or Flight: Emergency Healthcare Workers’ Willingness to Work during Crises and Disasters: A cross-sectional multicentre study in the Netherlands | medRxiv DOI: 10.1101/2023.07.25.23293139
Ny rapport: Sammenligning af sundhedsvæsenets organisering i seks lande [Internet]. Www.ism.dk. 2024 [cited 2026 May 30]. Available from: https://www.ism.dk/nyheder/2023/december/sammenligning-af-sundhedsvaesenets-organisering-i-seks-lande
OECD. Health at a Glance: Europe 2024 [Internet]. OECD. 2024. [cited 2026 Jan 06] Available from: https://www.oecd.org/en/publications/health-at-a-glance-europe-2024_b3704e14-en.html
Health care system in Saudi Arabia [Internet]. Emro.who.int. 2011 [cited 2026 Jan 06]. Available from: http://www.emro.who.int/emhj-volume-17/volume-17-issue-10/article-11.html
Interactive Application Guide [Internet]. Researchethics.dk. 2022 [cited 2024 Dec 24]. Available from: https://researchethics.dk/information-for-researchers/interactive-application-guide
UCLA. What does Cronbach’s alpha mean? [Internet]. stats.oarc.ucla.edu. 2021. Available from: https://stats.oarc.ucla.edu/spss/faq/what-does-cronbachs-alpha-mean/
Bind MA . C, Rubin DB. When possible, report a Fisher-exact P value and display its underlying null randomization distribution. Proceedings of the National Academy of Sciences. 2020 Jul 23;117(32):19151–8.
FreeTools.org. Roasoft Sample Size Calculator [Internet]. FreeTools. 2025. Available from: https://www.freetools.org/data-tools/roasoft-sample-size-calculator
COVID-19 [Internet]. En.ssi.dk 2024 [cited 2026 Jan 06]. Available from: http://en.ssi.dk/surveillance-and-preparedness/surveillance-in-denmark/covid-19
Influenza – overvågning [Internet] ssi.dk [cited 2026 Jan 06] Available from: http://www.ssi.dk/sygdomme-beredskab-og-forskning/sygdomsovervaagning/i/influenza-ugens-opgoerelse
EUROSTAT. EUROPEAN STATISTICAL RECOVERY DASHBOARD [Internet]. EUROPEAN STATISTICAL RECOVERY DASHBOARD. 2026 [cited 2026 May 29]. Available from: https://ec.europa.eu/eurostat/cache/recovery-dashboard/archive/
Peter Martin Hansen, Mikkelsen S, Henrik Alstrøm, Anders Damm-Hejmdal, Rehn M, Peter Anthony Berlac. The Field’s mass shooting: emergency medical services response. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2023 Nov 2;31(1). doi: 10.1186/s13049-023-01140-7.
Gunviolence | Denmark [Internet]. Gunviolence. 2023 [cited 2026 Jan 6]. Available from: https://gunviolence.eu/country/denmark/
Danske katastrofer [Internet]. mitcfu. 2026 [cited 2026 Jan 6]. Available from: https://mitcfu.dk/MaterialeInfo/?series=Danske%20katastrofer
Reports | IAEA [Internet]. Iaea.org. 2024. [cited 2024 Dec 24] Available from: https://www.iaea.org/Publications/Reports
Saudi Arabia - Historical Natural Disasters | Climate Change Knowledge Portal [Internet]. Climate ChangeKnowledge Portal. 2025 [cited 2026 Jan 6]. Available from: https://climateknowledgeportal.worldbank.org/country/saudi-arabia/natural-disasters-historical
Karimi Dehkordi N, Abbasi AF, Radmard Lord M, Soleimanpour S, Goharinezhad S. Interventions to Improve the Willingness to Work Among Health care Professionals in Times of Disaster: A Scoping Review. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 2021 Jan;58:004695802110599.
COSMIN - Improving the selection of outcome measurement instruments [Internet]. COSMIN. Available from: https://www.cosmin.nl/
Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures [Internet]. ISPOR | International Society For Pharmacoeconomics and Outcomes Research. Available from: https://www.ispor.org/heor-resources/good-practices/article/principles-of-good-practice-for-the-translation-and-cultural-adaptation-process-for-patient-reported-outcomes-(pro)-measures
csi. Translations - EORTC - Quality of Life [Internet]. EORTC - Quality of Life. 2017. Available from: https://qol.eortc.org/translations/
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Gerhard Tiwald, Yohan Robinson