# Assessing healthcare professional wellness during natural and man-made mass casualty incidents: a retrospective study

## TL;DR

This study compares the mental health of healthcare workers during the pandemic and a war, finding differences in burnout and stress based on the type of crisis.

## Contribution

The study provides empirical evidence on how different types of mass casualty incidents affect healthcare professional wellness differently.

## Key findings

- Healthcare workers during the pandemic showed higher burnout compared to those during the war.
- War-exposed healthcare workers experienced higher secondary traumatic stress.
- Direct patient contact was linked to increased resilience and burnout in war-exposed workers.

## Abstract

Mass Casualty Incidents (MCIs) represent a unique challenge to both healthcare systems and staff, however, limited quantitative research exists to describe the variable impact of natural and manmade MCIs on healthcare professional wellness (HCPW) measures.

To compare resilience, burnout and secondary traumatic stress (STS) outcomes between health care professional (HCP) respondents during the Covid-19 (C-19) pandemic and post October 7th War (MM23). We considered factors such as direct patient contact (DPC) and the role of non-clinical activities and previous experiences on HCPW measures.

A retrospective cross-sectional survey-based study. Continuous variables were summarized as means and standard deviations with analysis including Mann–Whitney U and Kruskal–Wallis tests. Categorical variables were assessed via Chi-square or Fisher’s exact test.

We found no statistically significant difference in resilience between the cohorts (C-19 7.17 vs. MM23 7.01, p < 0.112). In contrast, there were significantly higher levels of burnout (C-19 3.59 vs. MM23 3.36, p < 0.010) in the C-19 cohort with higher levels of STS (C-19 3.13 vs. MM23 3.36, p < 0.020) in the MM23 cohort. When compared to those HCP who did not participate in DPC, those who did engage in DPC in the MM23 cohort reported higher levels of both resilience (DPC 7.21 vs. No DPC 6.8, p < 0.001) and burnout (DPC 3.6 vs. No DPC 3.11, p < 0.021).

In our retrospective study we found no difference in rates of HCP resilience but did find variable differences in rates of burnout and STS based on the type of MCI. An analysis, considering the association between DPC and HCPW metrics, demonstrated significant differences in the rates of resilience, burnout and STS between the two cohorts. Furthermore, subgroup analysis demonstrated that factors such as non-clinical military service, volunteerism, previous MCI experience and a history of prior military service were all associated with higher levels of respondent resilience during a manmade MCI. These findings demonstrate that differences in HCPW experiences may exist between varying types of MCIs, and that some individual-based, and interpersonal, variables may be associated with differing rates of impact.