Radiological events are those that involve exposure to radiation from a radioactive source. 1 These events occur intentionally and unintentionally. Intentional or unintentional release of radiation, natural disasters, misuse of radioactive resources, exposure to uncontrolled (abandoned, lost, or stolen) radiation source, devastating attacks on national energy resources such as radiological dispersal devices and nuclear power plants, large-scale industrial releases, and covert placement of radioactive substances can be given as the examples. 2 Important events in history include the Chernobyl Nuclear Power Plant disaster as a result of an accident in 1986 and the Fukushima Nuclear Power Plant disaster as a result of a natural disaster in 2011. 3,Reference Yanagawa, Miyawaki and Shimada4 In the recent history, there are reports recording the release of radioactive material as a result of the attack on the Zaporizhzhia Nuclear Power Plant in Ukraine during the war between Russia and Ukraine in 2022. Reference Stallard and Gill5 Again, in an analysis of terrorist attack weapons that took place between 1970 and 2019, only 12 of approximately 700,000 terrorist incidents were of radiological origin. Reference Tin, Margus and Ciottone6 According to these data, although radiological release is rare, current geopolitical tensions and proliferation of nuclear weapons have raised concerns about the resumption of targeted radiological or nuclear events. Reference Bowen, Veenema and Schneider-Firestone7 Radiological events result in large-scale evacuations, hospitalizations, deaths from radiation sickness, and long-term deaths. Reference Veenema, Walden and Feinstein8 Considering the radiological events in the past, it is seen that limited and decreasing resources, high number of victims seeking treatment for physical trauma, thermal burns and acute radiation, and high morbidity and mortality rates emerged as the problems that increased the demand on the health system and the health workforce. Reference Bowen, Veenema and Schneider-Firestone7,Reference Hopmeier, Abrahams and Carr9,Reference Blumenthal, Bader and Christensen10
In disasters and emergencies, health-care professionals should manage victims of extraordinary events as well as maintain routine medical care in the field. For example, health-care professionals should have competencies such as identifying exposures and contamination in mass radiological releases, managing scarce resources, enforcing crisis care standards, protecting the workforce, creating a general message, understanding the victim’s need, stabilizing the victim, helping decontamination, having knowledge of how to take medical precautions against danger, and taking part in coordinated cooperation with various health professionals for effective intervention. Reference Bowen, Veenema and Schneider-Firestone7,Reference Blumenthal, Bader and Christensen10 In this direction, it generally requires health-care professionals to be aware of the difficulties they experience at the basic level to develop their preparation, skills, or self-efficacy and to cope with the difficulties caused by radioactive events. In addition to the high awareness of health-care professionals in combating such events, it is also necessary to determine the limiting factors that affect their intervention in radiological events. There are many factors that affect the intervention of health-care professionals in radiological events. For example, after the explosion Reference News Türkçe11 in the Fukushima nuclear power plant on March 11, 2011, many factors were observed such as the personal safety concerns of health professionals due to the high radiation level of the casualties, the discussion among employees due to the lack of organization, and the availability of the appropriate hospital and ambulance. However, a study summarizing and evaluating these factors together was not found in the literature. In this systematic review, it was aimed to determine the factors affecting the intervention of health professionals in radiological events and to determine what actions they may cause.
Methods
Descriptive Concepts, Protocol, and Record
In this study, a systematic review of the articles and documents related to the factors affecting the intervention of health-care professionals in incidents involving radiological threats was conducted. An integrative review methodology, which is argued to include a variety of perspectives on a topic, is the broadest type of research review, and is currently important to health science and research, was used. Reference Whittemore and Knafl12 This review includes problem identification, literature search, data evaluation, data analysis, and data presentation. A protocol and record regarding the analysis methods and inclusion criteria of the study were not established. However, this systematic review follows The PICOS and PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Reference Liberati, Altman and Tetzlaff13
Information Source and Search Strategy
Database searching was conducted with the combination of the following keywords: ((“Radiation” AND “health care workers”) OR (“Radiation” AND “health care providers”)) AND (“disaster*” OR “emergency*” OR “terrorism*” OR “accident*” OR “attack*” OR “crisis*” OR “catastrophe*” OR “hazard*” OR “nuclear*”) AND (“management*” OR “response*” OR “radioactive materials*” OR “ionizing*” OR “medical*” OR “plan*” OR “program*” OR “preparedness*”). The key terms were determined in consultation with researchers with studies on disaster management and CBRN (chemical, biological, radiological, nuclear). The search strategy was developed in partnership with a research team of experts in the fields of disaster medicine, disaster management, and public health. An extensive search was performed for relevant articles. Articles and reports published on Cochrane, Scopus, Web of Science, and PubMed until March 2022 were received. The references of the publications obtained within the scope of the research related to the research question were accessed through the Google scholar database. There was no publication date or publication restriction. The problem statement was determined as follows: “What are the factors affecting the intervention of health-care professionals in radiological events?”.
Within the scope of the determined question, the participants of the research (Participation) consisted of health-care professionals (P). The factors affecting the intervention of health-care professionals in radiological events (Intervention) were examined (I). A comparison (Comparison) of the actions of health staff toward these factors was conducted (C). The factors obtained from different articles and reports constituted the outcome of the research (Outcomes) (O). All studies published in English (Study designs) were included in the research.
Eligibility Criteria
Inclusion criteria:
1. Articles or reports addressing health-care professionals,
2. Articles or reports intentionally including at least 1 of the types of radiological hazards,
3. Articles or reports focusing on at least 1 of the factors affecting the intervention of health-care professionals in radiological events,
4. Articles or reports that are accessible and free of charge,
5. Articles or reports written in English.
Exclusion criteria:
1. Articles and reports that do not cover radiological disaster/accident events,
2. Articles and reports that do not meet the inclusion criteria.
Study Selection
The titles and abstracts of the articles were independently evaluated and screened by 3 referees in terms of suitability. The full text of the accessed articles was carefully and critically examined by the referees.
Data Extraction
A form (title, author, purpose, methods, factor, and action) was created to extract data from publications by content analysis.
Quality Assessment and Bias Risk
The Mixed Methods Appraisal Tool (MMAT) 2018 version was used to assess the quality of the articles included in the systematic review, which allows the assessment and inclusion of a variety of studies, including quantitative, qualitative, and mixed methods research designs. This assessment tool consists of 5 categories, each of which has 5 relevant specific criteria, including a qualitative set, a random set, a nonrandom set, an observational descriptive set, and a mixed method set. The 2018 version of the MMAT does not recommend scoring based on category criteria, but rather an explanation of what is met and what is not. Reference Hong, Pluye and Fàbregues14
The 2 authors reviewed each article according to the MMAT categories for risk of bias. The articles reviewed by a third author in case of any disagreement were resolved through negotiation or consultation. The results of the critical evaluation of the articles using the MMAT 2018 version included those articles meeting 3 to 5 (out of 5) criteria.
Data Synthesis and Analysis
It is not possible to use statistical methods, such as quantitative meta-analysis to analyze data due to the heterogeneity of results and the number of replicated or non-independent samples. For this reason, descriptive analysis and content/thematic analysis were used in the analysis of the data. The data from the reviewed literature were extracted independently with a form created by 1 of the authors. The accuracy and completeness of the extracted data were checked by 3 other authors.
Results
Characteristics of the “Included Studies”
By searching the Web of Science, Scopus, Cochrane, and PubMed databases with the keywords of the research, 210 studies were found. Because 51 of these studies were duplications and the abstracts of 135 studies did not meet the inclusion criteria of the study, their full texts were not read. The full texts of the remaining 24 studies were read, and 11 of them were included in the findings of the study. In addition, 7 studies found in the gray literature review were included in the findings of the study (Figure 1). The publication dates of the 18 studies included in the research findings range from 2004 to March 2022. Eight of these studies are cross-sectional survey studies, 7 are descriptive studies, 2 are interventional studies, and 1 is a systematic review.
Figure 1. Flow of information through different phases of a systematic review.
Factors Affecting the Intervention of Health-Care Professionals in Radiological Events
In this study, the limiting factors affecting the intervention of health-care professionals in disaster/accident events involving radiological threats are summarized under 7 categories: rarity of the event; inadequacy of health-care professionals against the radiological event; sensory responses; dilemma and ethical concerns; communication, workload; and other factors (Table 1).
Table 1. Analysis of 18 included articles
1. Rare occurrence of radiological emergencies
Health-care professionals face with many emergencies originating from nature, humans, and technology. Health-care professionals are responsible for diagnosis, treatment, and rehabilitation of the casualty in such emergencies. However, health-care professionals are less likely to encounter radiological events compared with many emergencies. Reference Veenema, Moran and Kazzi15 Rare occurrence of radiological events compared with other conditions is identified as a limiting factor affecting the intervention of health-care professionals. Reference Blumenthal, Bader and Christensen10,Reference Veenema, Moran and Kazzi15–Reference Tominaga, Hachiya and Tatsuzaki18 This factor causes actions such as the lack or absence of experienced health staff to respond to the radiological emergency, difficulty in managing the event, unwillingness to receive training, and not providing medical support to the contaminated victim who needs therapeutic intervention. Reference Blumenthal, Bader and Christensen10,Reference Veenema, Moran and Kazzi15
2. Inadequacy of health-care professionals against radiological events
Insufficient equipment, hospital, and staff
In the study, the factors affecting the intervention of health-care professionals in radiological threats were determined as some inadequacies regarding staff, equipment, and hospital. In 1 of the quantitative studies, it was mentioned that health staff did not have the appropriate medical evaluation and care capacity for a large number of injured people who needed medical intervention after a radiological exposure. Reference Murray, Kim and Ralston16 Another qualitative study suggested that the limited availability of appropriate care capacity and standard hospital protective clothing may result in inadequate emergency treatment of contaminated casualties. Reference McGann, Miaullis and Page19 Similarly, in 2 separate qualitative studies, a radiological accident in the past was mentioned. It was stated that in this accident, the contamination levels of the injured were higher than the ambulance contamination limit level criterion, which caused the ambulance staff to refuse to transport the patients. Reference Tominaga, Hachiya and Tatsuzaki18,Reference Hachiya and Akashi20 It was also seen that their hospitals did not accept the injured because of the high contamination levels. Reference Tominaga, Hachiya and Tatsuzaki18,Reference Hachiya and Akashi20,Reference Nagata, Arishima and Yamaguchi21 Based on these reasons, it is understood that the medical intervention of ambulances and hospitals in high contamination casualties was insufficient. In addition, in another study, it was emphasized that the number of specialist personnel to respond to the injured was insufficient when such events occurred. Reference Hachiya and Akashi20
Lack of organization
There are many occupational groups in the health service system. Each of these occupational groups is responsible for fulfilling a different function. However, to perform these functions well, it requires all occupational groups to be organized in a team understanding. Among the studies included in the research, organizational inadequacy of health-care professionals against threatening radiological events was determined. A quantitative study called Nuclear Emergency Core Hospitals mentioned that it was difficult to organize medical intervention in radiological events. Reference Nagata, Arishima and Yamaguchi21 In 2 qualitative studies describing the radiological events experienced in the past, it was stated that the ambulance staff had problems with the hospital supervisor and that the occupational groups responsible for such incidents in the hospital could not reach a common decision on accepting contaminated patients. Therefore, it is seen that patients could not access treatment for a long time. Reference Tominaga, Hachiya and Tatsuzaki18,Reference Hachiya and Akashi20 Similarly, in another intervention study, it was mentioned that health staff was inadequate in organizing the flow of patients. Reference Robert Schleipman, Gerbaudo and Castronovo22 Finally, in a systematic analysis study, it was mentioned that medical teams did not have a global consensus on such events. Reference Tin, Granholm and Hart23
Insufficient education (knowledge, skills, and experience)
Training of health-care professionals against radiological events helps them understand the effects of radiation on the health system, provide treatment, and make clinical decisions during the event. In the studies examined, it was found that there was a lack of knowledge, skills, and experience against radiological events, because technical knowledge was not included in the training of health-care professionals against such events. One of the main reasons for this deficiency was that radiological disaster was not included in the emergency medicine education curriculum. Reference Tominaga, Hachiya and Tatsuzaki18 In addition, the striking findings were that radiologists specialized in the field were not properly trained to medically respond to a tragic radiological event. Reference McGann, Miaullis and Page19 In addition, it was mentioned that health-care professionals did not want to receive training due to the rare occurrence of radiological disasters or the low probability of encountering them, that they could not receive training, and that additional training/technical support was not provided. Reference Blumenthal, Bader and Christensen10,Reference Veenema, Moran and Kazzi15,Reference Murray, Kim and Ralston16,Reference Tominaga, Hachiya and Tatsuzaki18,Reference Nagata, Arishima and Yamaguchi21,Reference Shah, Shahzad and Sohail24 For this reason, it was stated that health-care professionals did not know where the personal protective equipment was, that they were afraid of risking their own health, and that they could not provide the medical treatment that the victim affected by the radiological release needed. Reference Christensen, Jenkins and Sugarman17,Reference Tin, Granholm and Hart23–Reference Dallas, Klein and Lehman26 In 1 study, it was expressed that health-care professionals did not have sufficient experience due to the rare occurrence of a radiological event. Reference Murray, Kim and Ralston16 In other words, it was mentioned that the rare occurrence of the event makes medical management difficult. Reference McGhee, Praetzel and Medley27 In particular, the insufficient knowledge and experience of health-care professionals in determining the level of contamination of victims and the depth and extent of contamination of patients with penetrating injuries made it difficult to decontaminate patients. Reference Tominaga, Hachiya and Tatsuzaki18,Reference McGhee, Praetzel and Medley27
3. Emotional reactions (anxiety, fear, stress, and panic)
Because radiation cannot be perceived by the human emotional and does not reveal symptoms early, it can cause anxiety, fear, stress, and panic in people. From the studies included in the research, it was determined that health-care professionals gave such emotional responses to radiological events. However, the reasons why health-care professionals felt anxiety, fear, stress, and panic about such events were that such events could not be perceived by the human emotional and did not cause sudden signs or symptoms, and that they lacked knowledge and skills. In 2 qualitative studies describing radiological accidents in the past, it was mentioned that ambulances could not reach the scene due to fear and anxiety about the effects of radiation on health. Reference Tominaga, Hachiya and Tatsuzaki18,Reference Hachiya and Akashi20 Ambulances arriving at the scene were hesitant to accept patients for the same reason. In a qualitative study aimed at determining the exposure of health-care professionals in a mass radiological event, it was mentioned that health-care professionals were anxious to treat patients who could not be completely decontaminated. Reference Smith, Ansari and Harper28 In addition, in 2 qualitative studies, it was mentioned that these fears and concerns of health-care professionals affected their treatment decisions and that they had difficulty in continuing their operations. Reference Nagata, Arishima and Yamaguchi21,Reference McGhee, Praetzel and Medley27 In a survey conducted after the Fukushima earthquake in 2011, it was determined that health professionals had concerns about exposure to radiation. Reference Matsuoka, Nishi and Nakaya29 It was mentioned that this concern caused stress and psychological problems among health-care professionals. In another quantitative study, it was mentioned that disasters of radiological origin could cause stress for health-care professionals both in daily life and at work. Reference Bouillon-Minois, Roux and Pereira25 Finally, such psychological reactions of health-care professionals to radiological events were described as radiophobia. Reference McGann, Miaullis and Page19
4. Dilemma and ethical concerns
It was mentioned in the previous sections that health-care professionals may face fear, anxiety, and stress of endangering their own health due to lack of knowledge, skills, and experience against radiological events. In this section, the dilemmas and ethical concerns experienced by health-care professionals in treating patients were included. One of the main dilemmas of health-care professionals in a quantitative study was whether it was necessary to force the contaminated casualty to participate in decontamination practices. In addition, in this study, it was mentioned that there was an ethical dilemma between the patient responsibilities of health-care professionals and their own safety. Reference Bouillon-Minois, Roux and Pereira25 In a qualitative study addressing the responsibilities of health-care professionals, it was mentioned that radiologists, who are known as experts in a radiological event, were faced with a dilemma about how to intervene when needed. Reference McGann, Miaullis and Page19 In the quantitative study, in which another dilemma was addressed, it was emphasized whether an effective intervention could be given as a result of receiving basic-but-impractical radiological education in the early stages of the education process. Reference Shah, Shahzad and Sohail24
5. Workload
In the studies examined, it was concluded that the workload of health professionals increased due to the massive occurrence of radiological events. In 2 studies, it was mentioned that radiological events could affect a large number of people and that most of the injured needed medical attention. For this reason, it was stated that an efficient medical intervention would be difficult with limited resources. Reference Shah, Shahzad and Sohail24,Reference McGhee, Praetzel and Medley27 Another workload was the need for medical staff to quickly assess and treat the injured in the active hot zone. Reference Tin, Granholm and Hart23 In 1 quantitative study, lack of sleep, insufficient food intake, accumulated fatigue, and burnout due to excessive workload were mentioned. Reference Bouillon-Minois, Roux and Pereira25
6. Communication
Communication problems of health professionals in radiological events were addressed in 3 survey studies included in the findings of the study. In 1 of these studies, it was mentioned that health-care professionals had difficulties in explaining the health risks of exposure to radiation in a language that the public could understand. Reference Goto, Rudd and Lai30 In another study, although it was stated that risk communication was important among health-care professionals, it was mentioned that such an infrastructure did not exist. Reference Nagata, Arishima and Yamaguchi21 Finally, it was observed that health professionals had difficulty in communicating with each other due to having to wear protective clothing, and that they could not communicate quickly and effectively due to the problems experienced in the communication networks at the scene. Reference Robert Schleipman, Gerbaudo and Castronovo22
7. Other factors
Among the studies included in the findings of the study, the factors affecting radiological intervention were classified under 6 categories, and the remaining factors were collected in this section. One of these factors was the inability to predict how health-care professionals would react during an incident, even though it was included in planning and training against radiological hazards. Reference Bouillon-Minois, Roux and Pereira25 Another factor was that first responders referred to local hospitals before arriving at the scene, as contaminated patients were unaware of the seriousness of their condition. Reference McGann, Miaullis and Page19
Discussion
In this study, a total of 18 articles were examined in detail. In these articles, the factors affecting the intervention of health-care professionals in an event involving a radiological threat were investigated. These factors are rarity of the event; inadequacy of health-care professionals against a radiological event (equipment, training, organization); sensory responses (anxiety, stress, panic); dilemma and ethical concerns; communication, workload; and other factors. However, under the title of inadequacy of health professionals against radiological events, equipment, organization, and training are summarized under 3 subheadings, while sensory reactions are summarized under a single heading.
Insufficient training was considered as 1 of the limiting factors affecting the intervention of health-care professionals in 11 of the 18 articles included. Reference Veenema, Walden and Feinstein8,Reference Blumenthal, Bader and Christensen10,Reference Veenema, Moran and Kazzi15–Reference McGann, Miaullis and Page19,Reference Shah, Shahzad and Sohail24–Reference McGhee, Praetzel and Medley27 This factor causes health professionals not to understand the risks at the scene, to be worried, not to give medical attention or to be hesitant to give medical attention, and to endanger their own health, which leads to a shortage of staff who can provide appropriate treatment. Thus, it is necessary to make various improvements in training, which is located at the intersection of the factors affecting the intervention of health professionals in radiological events. In this direction, for example, after the Fukushima accident, the Science Council of Japan (2014) published recommendations for radiation health risk education to include health professionals in their curricula. The Council emphasizes that health-care professionals approached the event inconsistently and inappropriately because of their insufficient knowledge of radiation health risks. 31 Park and Yang (2021) found that being more knowledgeable about radiation protection affected the quality of health care, which is associated with better performance in radiation protection-related behaviors. Reference Park and Yang32 Especially such studies and the measurement of their outputs with different applications have the potential to reveal the relationship between education and other factors in a better way.
In the findings of the study, the most common factor after the lack of education of health professionals against radiological events is sensory reactions (fear and anxiety). Reference Blumenthal, Bader and Christensen10,Reference Tominaga, Hachiya and Tatsuzaki18,Reference Hachiya and Akashi20,Reference Nagata, Arishima and Yamaguchi21,Reference McGhee, Praetzel and Medley27,Reference Smith, Ansari and Harper28 A health-care professional’s emotional response to a radiological event results from lack of information, radiology being unavailable or confusing, Reference Becker33 few or no experienced staff members, and potentially inadequate protective equipment. Reference Balicer, Catlett and Barnett34 In a study, the personal safety concern of health-care professionals against a radiological event was accepted as the primary determinant of their willingness to intervene in a radiological event. Reference Becker and Middleton35 With the CBRN courses developed especially in this direction, a positive interaction can be ensured between the knowledge and experience of health-care professionals and the feeling of safety against a radiological event and their willingness to intervene in the event. For example, it is known that special courses were developed in Japan to inform first responders in decontamination, triage, personal safety, and other areas in CBRN incidents under the all-hazards approach. Reference Anan, Otomo and Kondo36 Improvements can be achieved in the sensory responses of health-care professionals that can be experienced in a real event, with courses developed in this way and the exercises embedded in their content.
There are many factors that cause the victim’s treatment delay. One of these factors is the organizational inadequacy of health professionals. The main reasons for organizational inadequacy are the lack of education and practice of health workers, and their fear and anxiety about the event. One study highlights that, even if a well-organized system against a radiological incident is established, the lack of basic radiological knowledge among employees cannot effectively run the organization. Reference Tominaga, Hachiya and Tatsuzaki18 In addition, the proper functioning of this organization depends on previous plans, as well as the reaction of the health professional during an event. Reference Hachiya and Akashi20,Reference Rebera and Rafalowski37 This reaction of the health-care professional during a radiological event strongly affects the ethical and dilemma factor. Health-care professionals organize with many different intervention teams in a radiological event. However, the rare occurrence of a radiological event may cause a lack of organization among intervention teams. However, the rarity of a radiological event, the lack of experienced health staff, Reference Murray, Kim and Ralston16,Reference Tominaga, Hachiya and Tatsuzaki18 and their unwillingness to receive training cause health professionals to feel unsafe Reference Chaffee38 and similar actions. Reference Blumenthal, Bader and Christensen10,Reference Veenema, Moran and Kazzi15 These actions affect the health professional’s response to a radiological event. International emergency plans have been developed to reduce the negative actions of health professionals against such incidents and to perform effective intervention. 39 However, the World Health Organization (WHO) recommends that existing operational and procedural arrangements, including occupational exposure assessment, monitoring, and training in emergency exposure situations, should be added to emergency plans to ensure health professionals’ preparedness for a radiological event. 40
Another factor that causes inadequate or delayed treatment of the injured is the lack of appropriate equipment, hospital, and staff. With this factor, problems such as the difficulty of decontaminating penetrating wounds and the death of the injured during transport arise. Reference Nagata, Arishima and Yamaguchi21,Reference McGhee, Praetzel and Medley27 In addition, the lack of equipment, hospitals, and staff causes an increase in the workload of health-care professionals. The main reason for the lack of staff is that the health workers do not come to work or leave the job because they do not want to intervene in such an event due to personal safety concerns. Reference Murray, Mason and Cont41,Reference Cone and Cummings42 In addition, although it was stated in many studies, Reference Simon43–Reference Bushberg, Seibert and Leidholdt45 negative perceptions may also be caused by the lack of knowledge about the critical role of radiation protective personal equipment in protecting health-care professionals from ionizing radiation. To mitigate these actions, personal protective equipment must be available in the work area based on known or anticipated levels of contamination, expected work activity, worker health considerations, and radiological hazards that may be present. Another factor that causes an increase in the workload of health professionals is the massive occurrence of the event. In such a case, triage, care of patients with trauma, and subsequent evaluation of radiation and initiation of patient transfers will cause the hospital capacity to be exceeded. 46 This leads to problems such as fatigue, unhealthy diet, and mental deterioration of health professionals.
Finally, the factor affecting the intervention of the health-care professional in a radiological event is communication. Communication systems are formal or informal structures that organizations use to support their communication needs. Reference Coiera47 There are multiple communication systems to ensure proper and efficient communication of health managers and professionals in health care. A small malfunction in these communication systems can endanger the safety of both the patient and the staff. However, an effective communication and information flow between institutions and the public at the right time can reduce negative medical outcomes. Reference Becker33 For this purpose, both national and international disaster communication systems have been developed. 48–52 However, since health professionals have to wear personal protective equipment in a radiological event, Reference Nagata, Arishima and Yamaguchi21 they have difficulty in communicating with each other and cannot communicate quickly and effectively due to the lack of infrastructure. Reference Robert Schleipman, Gerbaudo and Castronovo22 Communication systems that allow health-care professionals to collaborate quickly and easily both within the same organization and between multiple organizations should be implemented. 53
Limitations
This systematic review has limitations. The keywords determined by the researchers were limited to 4 electronic databases containing the academic literature. However, the studies that met the inclusion criteria of the study were included in the findings by scanning the gray literature. Another limitation is that the studies included in the findings were mostly qualitative. The lack of empirical studies makes it difficult to determine the factors affecting the intervention of health-care professionals in radiological release. Again, because the relevant literature evaluates the first response to radiological events within the scope of prehospital health professionals, a health professional discipline was not differentiated. Finally, most of the studies in the findings identified the factors affecting the intervention of health professionals in the radiological release events experienced in the past. However, it is thought that there may be other factors affecting the intervention of health professionals in such events. Such limitations are, in fact, typical of such studies in general.
Conclusions
There are 7 limiting factors that affected the intervention of health-care professionals in radiological events. Among the studies included in the findings, the factor that most affected the intervention was the insufficient education of health-care professionals. However, due to the rarity of radiological events, there was little or no education about this event, and it negatively affected the participation of health-care professionals in education. Thus, due to the rarity of the event, it was concluded that the insufficient education factor was seen as the factor that most affected the intervention of health-care professionals. These 2 factors cause many actions such as the fear of the health professional in intervening in the casualty, being worried and stressed because of not feeling safe, having difficulty in managing the scene, increasing the workload, and being in dilemma in responding to the casualty. In addition, these actions were considered as limiting factors affecting the intervention of health-care professionals.
In order for health professionals to give appropriate treatment to the casualty, studies should be carried out on other factors, especially on insufficient education. Thus, the actions caused by these factors and also detailed in the findings of the research can be prevented in the future. As a result of the literature review, it was determined that there were few studies related to the radiological event and that these studies were insufficient to address the factors affecting the intervention of health-care professionals. For this reason, it is recommended to carry out studies that explore the ways of finding solutions for the limiting factors affecting the intervention of health-care professionals in radiological events.
Author contributions
Nihal Dağ: conceptualization, data curation, formal analysis, investigation, methodology, writing – original draft. Cüneyt Çalışkan: conceptualization, data curation, formal analysis, investigation, methodology, visualization, supervision, writing – review & editing. Hüseyin Koçak: writing – review & editing. Gülcan Demir: writing – review & editing. İsmet Çelebi: revision.
Conflict of interests
The listed authors declare no conflict of interest in the production or publication of this manuscript.
