Having a workforce that is willing to respond is a critical component of mitigating the effects of any disaster, and our study results are a clear call for action. While work is being done by disaster planners to improve “readiness” or “ability” to respond during disasters, such as encouraging personal preparedness planning, more needs to be done to address beliefs and attitudes that may hinder “willingness” to respond. It is thus critically important for us to understand why some healthcare workers are unwilling to perform their duties during a radiological emergency in order to implement changes in disaster training, education and messaging. Survey responses suggest that more attention is needed to address healthcare workers’ basic knowledge level with regard to radiation events. In fact, 58% of respondents disagreed with the statement “I am knowledgeable about the potential medical impacts of a dirty bomb emergency.” Two thirds of the staff surveyed did not feel educated enough to address public questions, and less than one third of the staff knew their role-specific responsibilities. Indeed, in a recent study of 668 emergency nurses in New York, the existing knowledge in regards to radiological emergencies was determined to be poor. In that study, knowledge level and clinical ability had a positive association with nurses’ level of willingness to respond to a radiological terrorism event. Quantitative results from our hospital-based study also echo a qualitative study that assessed the views and perspectives of emergency department clinicians in regard to radiologic terrorism. Researchers found through a series of ten focus groups that study participants clearly and consistently felt that their facilities were not adequately prepared for such an event, due to inadequacy of response protocols, potential for staffing shortages, and concerns about contamination and self-protection. When considering the fear of potential staffing shortages indeed, in our study, staff who felt that their peers are unlikely to respond to duty, were 17 times more likely to refrain from reporting to duty themselves in our study. This finding lends us a potentially powerful tool to impact willingness to respond, by targeted education campaigns to change subjective norms regarding response to such an emergency. One construct that was strongly and independently associated with WTR was belief that the workplace will be safe. kinase inhibitors Perception of personal safety was identified as a primary determinant of willingness to respond in a radiological disaster in other previous work as well. This concern about personal protection is not unique among responders to the potential scenario of radiological terrorism events; in one study the question of “Will the hospital protect me?” was the most important factor in determining the workers willingness to respond. First responders must be educated as to the minimal risk of contamination from radiologic materials in such an attack if universal precautions are used, as well as in specific strategies of mitigating and minimizing personal risk in such events. Thus, it is not surprising that requiring the staff to report will not be enough to address the worker shortage.