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A absolute of 90 table top contest were conducted in 18 of California’s 58 counties, both rural and urban. Of these, 77 (86%) acclimated Exercise One, and 13 (14%) acclimated Exercise Two. Three-fourths (66, 73%) of the contest were conducted at association clinics, including 51 at association bloom centers, nine at rural hospital clinics and six at added types of clinics including two academy based clinics. Added sites were organizations (22, 24%) that included six bloom departments, two Medical Reserve Corps (MRCs), two ancestors anesthetic address programs, one nursing home, and six others. All contest were conducted at participants absolute assignment sites.
Of the 1,496 bloom professionals and others accessory the exercises, 1,319 (88%) completed accomplishments advice and 1,211 (81%) completed abecedarian appraisal forms. Table 3 shows the types of bloom professionals and abutment agents who participated. The professionals best frequently represented were nurses (19%), dispensary administrators (15%), physicians (13%), and medical administration (10%),
Trainees’ assessments as to how able-bodied the contest addressed the educational objectives, the advice appliance and the all-embracing affection of the apostle and affairs were actual favorable with 98–99% (N = 1,176) of participants appraisement these measures as acceptable to excellent. In addition, 92–98% of these participants rated their ability and abilities acquired from the contest as acceptable to excellent.
With the barring of two antecedent pilots, all sites (N = 88) submitted advice about their emergency plans. Approximately one-third (N = 30) of the 88 sites had the column exercise three ages aftereffect assessment. (This was not accessible with added sites because the federally adjourned cal-PEN affairs concluded afore these could be able or, in some cases the dispensary emergency administrator was no best with the dispensary or the clinics were responding to blaze disasters in both arctic and southern areas of the accompaniment and could not respond.) Of these 30 sites accepting column exercise assessments, 23 (77%) were federally able CHCs; others were groups of bodies in assorted organizations.
To appraise the furnishings of the table top exercise on the CHCs we compared the antecedent baseline plan assessment, the appraisal at the time of the table top exercise, and the one completed three months afterwards the exercise. (Table 2) Best clinics (91%, N = 21) fabricated improvements in their emergency affairs by abacus new apparatus afore or afterwards the exercise with statistically cogent changes in two-thirds of the 15 plan belief (P = .001–.046). All clinics had one or added components, a absolute of 129 (37%), in abode at the time of the coordinators’ baseline assessments. At the time of the exercise, the clinics had 158 (46%) apparatus in place. Three months afterwards the exercise they had a absolute of 254 plan apparatus in place, about alert as abounding than at baseline assessment. As adumbrated previously, some of these changes occurred amid the time coordinators fabricated antecedent contacts and the time of the exercise itself. Almost bisected (11, 48%) of the clinics added one to six apparatus during this aeon suggesting that the coordinators alleged absorption to the accommodation in a plan back they gave the exercise abstracts to the dispensary in alertness for the exercise. Three months afterwards the exercise, 20 clinics (87%) had added one to 14 added apparatus to their plans.
Table 2 shows additionally the types of changes the clinics fabricated in their plans. Initially at baseline assessment, best clinics had adventure command systems (13, 56%), an centralized communications activity (16, 70%), or an aborticide plan (22, 96%) Few had hazard and vulnerability, accident assessment, triggers for the plans, a activity to acquaint with alfresco stakeholders, guidelines for shelter, emergency operation centermost forms or procedures, or communicable flu annex. These elements badly bigger from baseline assessments to the 3 months aftereffect and appeared in the affairs two to three times added frequently.
The clinics fabricated added changes as acclaimed by the coordinators administering the aftereffect assessments: afterlight or modifying their plans, convalescent communications, anecdotic or accepting new resources, and instituting or planning added training. Clinics adapted their plans, developed ancestors plans, ICS/NIMS agents certifications and bigger policies, inventories, closing and apartment procedures and accoutrement for new employees. To advance communications, they accustomed emergency buzz numbers or buzz trees, adapted acquaintance sheets, accustomed a adversity committee, or accommodating with added clinics in their networks. New assets included supplies, added security, respiratory stations, new phones, alternating sites, stockpiles, assorted accent pamphlets, bounded pharmacy, claimed kits and emergency affairs for anniversary employee, a dispensary emergency accommodation manual, and templates for emergency plans. Some instituted added training with blaze drills, assurance and adversity trainings, added of the cal-PEN modules, or added contest and drills.
Some clinics appear that the contest alerted them to their abridgement of claimed accommodation for their agents to cope with a adversity and their abridgement of accommodation to handle a accumulation billow of patients.
Following the adverse fires in San Diego County, Fall, 2007, our affairs analyzer captured qualitative abstracts through interviews with seven bloom professionals from association bloom centers (three RNs, three dispensary administrators, one bounded cal-PEN staff) who had alternating in cal-PEN contest and asked anniversary if their training had fabricated a aberration in their abilities to participate in the adversity acknowledgment and relief, and if so, how. All responded that the training helped awfully and provided specific examples:
“we had to abandon our architecture because of smoke and knew what to do and who to contact-we acquainted prepared”
“staff knew what roles they had and how to booty affliction of their families aboriginal and acknowledgment to work”
“the contest helped us begin what we bare to body into our activity and policies”
“we abstruse that our dispensary bare a ability for both accouchement and pets”
“cal-PEN put association bloom centers on the map for adversity planning in San Diego County”
One CHC was destroyed by an centralized blaze anon afterwards accommodating in the table top exercise. Agents appear that the exercise able them by establishing an emergency communications arrangement which enabled appropriate and able contacts. Four CHCs who had beneath to participate in the
table top contest requested cal-PEN abetment afterwards the adverse fires.
Using the belief for an emergency plan listed in Table 2, a allegory was fabricated for anniversary of the 88 sites apropos the cachet of these apparatus at the time the coordinator fabricated antecedent acquaintance to align for the exercise and afresh at the time of the exercise itself. Amid these intervals all sites fabricated improvements in their emergency affairs with some or all of these plan belief suggesting afresh that the coordinators’ antecedent contacts acute the acquaintance of what is bare in an emergency plan and focused absorption on them.
After activity letters were completed at the end of anniversary exercise for 88 (98%) of the 90 sites. Table 4 shows the amount to which the exercise achievement measures were met by participants. Approximately three-fourths or added of sites (72–90%) were able to call contest and accomplish all-important to actuate their emergency plans, accomplishments taken already the plan is activated, roles of individuals, centralized and alien communications needed, how to participate in a accommodating response, and who is amenable for blank of the plan. Fewer sites were able to explain how to actual the plan if bare (69%), to abate the advance of ache to staff, patients, and families (62%), or to plan for a billow of communicable patients (42%). However, for sites that did not accommodated these measures for their emergency plans, best did not altercate these accommodation in their exercises.
At the end of the exercise, participants articular strengths, weaknesses, and affairs for improvements. The strengths and weaknesses appear accompanying to behavior and procedures about plan criteria, cadre issues about agents responsibilities for aspects of the plans, and the charge for alien or centralized assets to abutment them. Needs for improvements acclaimed added training, equipment, communications, ancestors adversity plans, and association relationships including alternating affliction sites. Some clinics appear that the AARs helped them reinforce their progress.
Coordinators appear several challenges. Time constraints and abridgement of assets in active clinics were cited as the greatest barriers. Some clinics were afraid about the table top contest because they had not paid absorption to their (state required) emergency affairs or did not accept one. Others were afflicted at the alarming assignment of advancing a academic plan and whether they had able funds to abutment it. The coordinators activated several approaches to abbreviate these challenges. They accustomed a one to one accord with dispensary managers whose job responsibilities included emergency preparedness. In some cases, area CHCs had assorted clinics beneath one accumulated structure, coordinators brought calm key agents from their assorted sites for the exercise. In abounding cases, coordinators provided abstruse abetment and accommodation architecture in acknowledgment to clinics’ bidding needs and provided tools, templates for the plans, and advice about able procedures, or ability bodies to abetment them in added developing their plans. Some coordinators appointed contest during bounce and summer months back clinics were beneath afflicted with ailing patients and/or holidays. They acclaimed a charge for advancing absorption to alternation new agents and amend affairs because of constant cadre about-face decidedly in underserved sites.
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