This study examined whether hospitals that participated more frequently in emergency preparedness exercises performed better during a statewide hazardous materials tabletop exercise . Hospitals that had taken part in three or more exercises in the previous three years scored significantly higher on objective performance measures than those with fewer exercises. Performance was not related to hospital size, teaching status, years of preparedness experience, or number of recent trainings attended. The findings suggest that repeated, scenario-based exercises—rather than classroom training alone—help organizations identify gaps, refine plans, and improve real-time response capabilities. Frequent exercising appears to strengthen overall preparedness performance

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