**4. Results**

The results are presented in four sections. All conclusions about capabilities and barriers that pertain to a specific category of facilities of interest are presented in Section 4.4.

#### *4.1. Central Measurements, Phase One*

Roughly 42% of respondents answered the questionnaire (41/97). The response rate was higher in a smaller city than in a larger city (86% vs. 34%, respectively). Reliability analysis was performed on the 14 items of questionnaire data. The value for Cronbach's alpha was acceptable at 0.739 [28], and the questionnaire could be deemed a valid instrument. All returned questionnaires had comments and notes written on them. About half of the respondents answered several questions in the comment section. Some respondents did not answer all the items in the questionnaire. Two questionnaires, both belonging to sports facilities, were not returned due to absent mailboxes.

#### *4.2. Central Measurements, Phase Two*

Several interviews had to be rescheduled due to the social distancing strategy implemented to counter the COVID-19 outbreak. Three face-to-face interviews were conducted with one Primary Health Care Center (PHCC) physician, two school nurses (from one school), and one chief veterinary surgeon from a major veterinary clinic. Nine more interviews were conducted via telephone: with one PHCC physician, three chief dentists, one manager for dental care development in the regional council for dental care, two more chief veterinary surgeons, one school nurse, one sports facility administrator, and two hotel managers. The average duration of an interview was approximately 28 min. The face-to-face interviews were notably longer than telephone interviews. They were more beneficial to this study because the meetings took place at the potential ACFs, allowing for visual inspection of facilities.

## *4.3. General Results*

The majority of interview respondents from investigated facilities of interest indicated that their workplace could be converted into an ACF to care for affected persons from a MID. Some could also accept patients not affected by the emergency to alleviate pressure on the nearest hospitals. Many respondents had materials in limited amounts for minor surgery, while some facilities only had small first aid kits. Many respondents indicated that additional resources were needed for a further developed capacity and preparedness. The most common materials missing for an increased capability were suture kits and first aid packages (basic and advanced). Many potential ACFs would accept a package or cache with more advanced medical equipment (e.g., tracheal tube, thoracic drainage system, etc.) if proper education was provided and the FSC-response system managed maintenance of the cache. Many respondents and interviewees expressed enthusiasm for the ACF concept; however, they also mentioned a need for an overarching organization governing the planning processes for the FSC response system and a need for educational exercises and drills to further develop their capabilities as well as a clear legal definition of the role they may have during a MID response [29]. The suggested educational initiatives were CPR, first aid, advanced first aid, basic trauma care, ATLS-based courses, disaster management, scene managemen<sup>t</sup> and task-specific training (e.g., cast appliances, intubation techniques). Most respondents indicated a need for financial support and reimbursement for any invested time and e ffort into the FSC-response system.

#### *4.4. ACF Specific Results*

The following section presents a summary of ACF-specific results. The triage colors mentioned in the text are standard triage models used in MID and are widely used in many countries. The colors define the type of injury and the acuity of medical management. Red stands for immediate managemen<sup>t</sup> (life-threatening injuries), yellow for delayed managemen<sup>t</sup> (non-life-threatening injuries) and green for minimal supervision (minor injuries) [30].

#### 4.4.1. Primary Healthcare Centers (PHCCs)

Eight out of 11 sampled PHCCs answered the questionnaire, and two key informant physicians were interviewed before the point of saturation. One interview was conducted in person and another over telephone. All eight clinics indicated an interest in taking part in a FSC-response system, and various levels of involvement were suggested in both questionnaire comments and notes and interviews. All clinics reported capability to receive green patients, and one clinic indicated the ability to stabilize yellow patients before transport to a major hospital. Three clinics stated that they could receive patients from a hospital, unrelated to the type of MID, to alleviate emergency departments. Half of the PHCCs could offer psychosocial support to people affected by a major incident.

#### 4.4.2. Dental Clinics

Ten out of 12 questionnaires were returned with answers outlining capabilities useful to SC planning. Two interviews were conducted with chief dental officers at two clinics before the point of saturation was reached. All responding dental clinics reported both interest and a type of ability to participate in a FSC-response system. Nonetheless, some significant barriers were also reported regarding missing competence to care for injuries other than dental. Three clinics indicated that they could care for green patients from a major incident to alleviate hospital emergency wards. One clinic did not want to fully answer the questionnaire because it was perceived to obligate competency that was absent at the clinic and instead referred the issue to the regional level. At the regional level, one key informant was identified and interviewed. This key informant confirmed the data from both questionnaires and interviews but also shed new light on possible implementation procedures to involve the public dental care resources in a FSC-response system. The results from the interview with the regional informant contextualized and corroborated findings from both phases one and two of this study that pertain to all components of SC.

## 4.4.3. Veterinary Clinics

All responding veterinary clinics reported interest in participating to some extent in a FSC-response system. All clinics offered to make equipment and facilities available to the FSC-response system, and five out of six indicated capability to receive green patients from a MID. Two clinics also reported the ability to receive yellow patients and other patients from hospitals, unrelated to the type of emergency. Most clinics indicated the ability to treat minor surgical injuries, clean and suture wounds, administer intravenous fluids, and diagnose acute conditions. Many clinics reported to house diagnostic resources that can be useful during a disaster or major incident, such as ultrasonography and radiology, and capabilities to monitor patients for respiratory distress or other somatic deterioration. One clinic indicated that they could not provide healthcare to humans without having to close their veterinary operations. Barriers for veterinary clinics to partake in a FSC-response include the lack of competence to care for humans, legal hindrances for providing healthcare to humans, and the degree of difference between human and veterinary medicine in terms of beds, materials, and equipment. Some veterinarians had different views on how they can be involved in a FSC-response system. One interviewee expressed the belief that similar anatomy amongs<sup>t</sup> all mammals makes trauma surgery similar for both human and veterinary medicine. Another veterinarian expressed his concerns about the legal aspects and emphasized the need for clear and transparent legislation to enable their participation in a FSC-response system.
