Primary care medical staffs are gatekeepers to health care success and are also the first response to public health emergency. They play an important role in public health emergency preparedness and response
. Besides, their knowledge, attitude and behavior about health emergencies and the response capacity are directly related to the control and prevention of public health emergencies. However, research have indicated that primary care medical staffs of many countries are not ready to deal with the public health emergencies
[8, 9, 14, 15], which mainly due to the lack of training and experience about public health emergencies
[16–18]. The public health emergencies are usually sudden, unpredictable and with considerable severity. Thus, it put forward higher requirements to the primary care professionals and health institutions to prevent and control the emergencies
. There were only a few reports about health emergencies response in China. In our study, anonymous questionnaire investigation of 3410 primary care medical staffs of Guangdong was performed to explore their risk awareness, knowledge, attitude and behavior, training needs about emergency response, the emergency response capacity and its main related factors.
Of the 3410 doctors surveyed, primary care medical staffs were mostly women and represented a shortage of medical staffs with higher titles or education. Regarding to risk awareness, 62.4% of the medical staffs believed that public health emergencies would happen in the region. Influenza (3.86 ± 0.88), food poisoning (3.35 ± 0.75), and environmental pollution events (3.23 ± 0.80) were considered most likely to occur in 18 kinds of public health emergencies (the total score was 5). These results suggested the low awareness of risk of medical staffs in Guangdong. The urban primary hospital medical staff had a poor risk awareness of cholera, typhoid, encephalitis, plague and anthrax and the rural medical staffs were lack of risk awareness about avian influenza and AIDs, which was similar to the results of Jiangou Shen
. Risk awareness is the starting point of crisis early warning. A low awareness of risk would affect collection of information related to the crisis, in turn, hampers the identification and early warning
. Therefore, the cultivation of a sense of crisis should be strengthened.
Furthermore, the investigation results of knowledge, attitude and behavior of primary care medical staffs were not optimistic. Regarding to the grasp of emergency knowledge, only 11.0% of the respondents knew the concept of risk management and 24.2% of the medical staffs grasped the diagnosis/judge of public emergencies. The total score of emergency response skills was 4 and all the skills surveyed were less than 3. The skills of public health emergency risk management, monitoring and warning, plan making were the weakest. Only a few medical staffs had the response skills of public health emergencies. Most medical staffs grasped only a small part of the knowledge and skills related to emergency response. The attitude evaluation showed 66.1% of the medical staffs believed that the community awareness of risk management were ordinary. 71.1% of the medical staffs considered that the propaganda of health emergency was not doing enough. 71.9% of the medical staffs suggested that the response capacity of health emergency was ordinary and it would show the weakest response capacity when facing diseases of unknown causes. Only 25.7% of respondents had participated in treatment of public health emergency cases which indicated the poor response capacity and the lack of experience
Training plays an important role for the development of public health emergency response capacity
, but the investigation has shown that the training was apparently not enough. About a third of the respondents have never participated in primary care training and the rate of rural medical staffs (40.1%) was even higher. Training needs analysis indicated that 85.3% of the respondents suggested it was necessary to provide public health emergency training. 78.4% of the medical staffs believed it was necessary to implement training for all medical staff. Health care medical staffs suggested that most appropriate training methods were practical exercise. These indicated a wide demand for training, however the opportunities of training were few and present training is usually lack of new ideas. The physicians are willing to participate in practical training rather than classroom teaching which in accordance with previous reports
It has been shown that the response capacity of medical staffs in Beijing
 was weak which was similar to the results of Guangdong. Evaluation of response capacity of health emergency (the total score of 100 points) showed that the score of primary care medical staff was 67.23 and the response capacity of senior medical staffs, public health physicians and physicians with relatively long-term practice were relatively better. Stepwise multiple regression analysis showed that the influence of the factors related to response capacity was ranked in descending order as follows: emergency response training, length of service, position, job type, gender, title, suggesting that training was the most needed method for improvement of response capacity
. In the past, it was mainly required for clinical medical diagnosis and treatment of clinical disease in China, and the requirements of health emergency response capacity were low. Therefore, it is essential to carry out targeted training to enhance the prevention and control capabilities of primary care practitioners. The second main factor was the length, indicating that health emergency response capacity is positively related to the experience of physicians
. Position and job type ranked the 3rd and 4th, indicating that the position of a medical staff and his responsibilities directly affected the emergency response capacity. Therefore, the head of the hospital are usually having higher risk awareness. Similarly, public health physicians who are responsible for community public health work show significantly higher response capacity than other health care staff.
Although this study included a large sample and have obtained quantitative results, limitations still exist: the paper only focused on Guangdong Province, China and the results can only applied in China; The results from the questionnaire survey showed the knowledge, attitude, behavior and they may not be consistent with the prevention and control during public health emergencies which need further verification.