Critical condition or crisis is a specific situation in which the participation and cooperation of all members and trained healthcare personnel are required. The occurrence of various events needs an experienced workforce with adequate knowledge, skills, and attitudes to apply clinical skills [13–14]. The present study demonstrated that the ability and willingness of employees to continue working in crises varies, taking into account the type of event. Some components associated with the obstacles of ability and willingness are different. This indicates that ability and willingness have, indeed, two separate structures. The results of this study can be discussed in several categories:
1- The level of willingness and ability of the participants indicates that the highest willingness and ability are related to natural disasters (floods, earthquakes), and the lowest level of willingness and ability are associated with the disease epidemic. The least amount of ability and willingness is reported for the events that employees are most likely to perceive as the highest degree of danger to themselves or their family (epidemic, chemical, nuclear scenarios). In the study of Masterson et al., the tendency to provide services to patients with biological accidents was in the last place compared to providing services to patients with trauma and the patients with radioactive agents [7], which is in line with the present study concerning the willingness of participants to continue working in a crisis. In a survey conducted by Boyle et al. in 2005, working during a bioterrorism incident would be difficult and horrible from the nurses' perspective, and some nurses have refused to stay in the clinical setting [15]. Moghadam et al. in 2016, by examining the knowledge and attitude of volunteers and rescuers of the Red Crescent Society of the Islamic Republic of Iran in a bioterrorism attack in West Azerbaijan province indicated that only one person had a proper attitude (willingness) to participate in providing relief to affected areas. Besides, six volunteers expressed that they were ready to continue working and be sent to the crisis-hit region [16]. In this study, 25.3% of participants exhibited their willingness to participate in responding to the epidemic and 52.9% their ability. Hamzeh pour in the study of the level of knowledge and performance (readiness) of the members of the medical groups of the Basij Organization of the Medical Society of West Azerbaijan Province in the face of biological accidents showed that the members participating in the study did not have necessary preparation (ability and skill) to respond to the critical situation arisen, and the results indicated their poor performance [17].
2- The prioritization of the participants in this study in connection with the most critical barriers to responding to the crisis demonstrated that caring for children in natural disasters and Mass Casualty Incident, concern for family health in chemical disasters, fear of contamination in nuclear disasters, and fear of Infection in epidemic of diseases are among the most significant obstacles. A study by carried out by French et al. in 2002 on 30 nurses in four hospitals after the Florida storm revealed that the primary concerns of the nurses included their own safety and that of their family during work, and their secondary concerns included the provision of basic needs such as food, water, shelter, sleep, and rest [19]. The results of studies conducted by DiMaggio et al. and Stevens et al. represented that biological (bioterrorism) and chemical events are an unfamiliar study scope for most healthcare professionals. This may be due to fear of infectious, toxic agents, hazardous radiation and its transmission to family and relatives, which leads to low awareness and unpreparedness to respond appropriately to such events to natural disasters such as floods and earthquakes [20–21]. In a study by Rocach et al. in 2010 on 76 nurses and physicians working in the emergency department of a hospital in Israel, it was found that those who had the highest awareness in the field of anthrax were 50% more willing than others to attend their workplace in the event of a bioterrorist attack. 37% were more willing than others to treat patients suspected of having anthrax, and 28% more than those who were not trained were willing to treat patients who definitely suffered from anthrax [22]. In this study, the lack of proper training is one of the barriers to the willingness and ability of participants to attend the crisis. The findings of Shapira et al. indicated that providing appropriate personal protective equipment can be beneficial in facilitating the readiness of healthcare workers to continue working during a critical event, and all employees should receive ongoing training with regard to critical events and emerging dangerous pathogens [23].
3- In examining the factors influencing the willingness and ability of study participants in dealing with the disasters raised, the factors of gender, age, marital status, and health level affected the level of willingness and ability of individuals so that the willingness and ability of men, age group under 35 years, married people, and people with a high level of health to participate in different types of disasters were higher. The components of income level, care for the elderly, and care for the disabled have only affected the willingness of people to participate in various types of disasters. This means that people with incomes below 4 million, lack of care for the elderly and disabled exhibited a greater willingness to participate in disaster response. In the study performed by Qureshi et al., the factors of the female gender, marital status, care of children or commitments related to the elderly, issues associated with personal health, and lack of transportation were indicated to reduce the probability of respondents' ability to work during disasters for a variety of events. Moreover, factors such as female gender, marital status, care of children, and commitments were pointed out to reduce the likelihood of the willingness to continue working in the occurrence of disasters for most events [18].