The purpose of emergency planning is to provide the basis for systematic responses to emergencies that threaten an organization and the records and information necessary for continuing operations. Being prepared for a natural disaster, infectious disease outbreak or other emergency where many injured or ill people need medical care while maintaining ongoing operations is a significant challenge for local health systems.
Challenges to developing and sustaining community coalitions may reflect the structure of preparedness activities, which are typically administered by designated staff in hospitals or large medical practices. Health care providers’ focus on emergency-preparedness activities waxes and wanes, reflecting the many pressures and competing demands they face.
Providers and policy makers alike increasingly have recognized the value of collaboration through community-based preparedness initiatives to minimize the amount of redundant capacity each provider must maintain. Using the lens of the 2009 H1N1 influenza pandemic, this study examined the activities of emergency-preparedness coalitions in 10 U.S. A number of different federal, state and local organizations work with health care providers individually and collectively to promote collaboration in preparedness activities.
In contrast, much less attention and funding have focused on involving other health care providers, such as independent physician practices, ambulatory care centers, specialty care centers and long-term care facilities, in community-based preparedness activities. While hospitals and public health departments participated in all emergency-preparedness coalitions in the communities studied, involvement of nonhospital providers and other stakeholders varied significantly across the communities (see Table 1). When working with nontraditional partners, community coalitions reported difficulty in aligning goals and securing buy in from those who view emergency management as outside their scope of responsibility. Most primary care respondents agreed that physicians are focused mainly on their patients’ day-to-day needs and do not see preparedness as part of their mission. A few respondents reported that competition did affect preparedness collaborations, particularly when hospital leaders are guarded about sharing capabilities and needs with peers at other institutions. During the H1N1 pandemic, for example, some coalitions developed plans to distribute supplies in advance. Nearly all hospitals working with both hospital-employed physicians and independent community-based physicians reported that hospital-employed physicians are easier to engage, suggesting that markets with larger physician groups and more hospital employment of physicians would be better positioned to build integrated surge-capacity plans. Because of the generally collegial approach to preparedness activities, respondents reported that tighter hospital affiliations in consolidated markets had little impact. While all providers felt the strain of competing demands in allocating resources for emergency preparedness, rural providers were particularly strapped. Respondents did report that local partnerships and emergency response in small towns were more cohesive because of strong day-to-day relationships among health care providers, first-hand knowledge of the population they serve and a strong community feel. Across sites, respondents consistently reported that hospitals and hospital-owned physician practices typically are much more involved in emergency-preparedness coalitions than other stakeholders, reflecting both the federal financial support hospitals receive for preparedness activities and their size, structure and resources. There are two general approaches policy makers could consider to broaden participation in emergency-preparedness coalitions: providing incentives for more stakeholders to join existing preparedness coalitions or building preparedness into activities providers already are pursuing.
Consider building preparedness into activities providers already are pursuing.An alternative approach to traditional preparedness coalitions would be to leverage activities providers already are pursuing unrelated to preparedness activities. One option would be to incorporate preparedness activities into existing incentive programs aimed at underrepresented stakeholders, including independent physicians and nursing homes. Other opportunities might include incorporating community-level preparedness activities into care-coordination activities that can count toward patient-centered medical home certification or encouraging electronic health record vendors to include features that facilitate electronic submission of important data to local, state and federal authorities during a disaster.
If collaborative preparedness activities leveraged existing affiliations and activities among stakeholders, the resulting coalitions might look very different from community to community. For example, nursing homes owned by or closely affiliated with hospitals may use the hospitals’ preparedness staff, making it easy to develop collaborative approaches to preparedness.
This study examined the activities of community-based emergency-preparedness coalitions in 10 communities.
Main ContentIn the past, the HCO EOP was commonly (and inaccurately) referred to as the disaster plan. The management structure and methodology that will be used in an emergency, including the organization and operation of the internal HCO Incident Command Post (ICP). Methods for adequately processing and disseminating information during an emergency, including names and contact information for external liaisons and contacts at other HCOs and the jurisdictional level (Tier 3).
Guidance on how to develop and release public messages during emergencies, including coordination with the jurisdiction (Tier 3) public information function.
The structure of the EOP in emergency management is becoming more standardized, and HCOs should consider conforming to this structured approach. EOP Base Plan - Provides an understanding of how the organization responds and how it interfaces with the outside environment during response. The approach to emergency preparedness and response for these Tier 1 assets can be relatively simple. Where to obtain information on whether public health emergency powers have been invoked, allowing release of private patient information, and other deviations from standard medical practice. A SEMP establishes a federal government institution's objectives, approach and structure for protecting Canadians and Canada from threats and hazards in their areas of responsibility and sets out how the institution will assist the coordinated federal emergency response. The development and employment of a SEMP is an important complement to such existing plans, because it promotes an integrated and coordinated approach to emergency management planning within federal institutions and across the federal government. Federal government institutions in the early stages of developing a SEMP may find it useful to read the material in Sections One and Two, while other institutions with more established plans may wish to proceed directly to Section Three. Supporting templates and tools can contribute to effective emergency management planning and are provided with this Guide. The Emergency Management Planning Guide uses a step-by-step approach and provides instructions that are supplemented by the Blueprint and the Strategic Emergency Management Plan (SEMP) template provided in Annexes A and B, respectively. The Emergency Management Planning Unit, Public Safety Canada, is responsible for producing, revising and updating this Guide. The purpose of this Guide is to assist federal officials, managers and coordinators responsible for emergency management (EM) planning. The EM plans of federal government institutions should address the risks to critical infrastructure within or related to the institution's areas of responsibility, as well as the measures for protecting this infrastructure.
The SEMP is the overarching plan that provides a comprehensive and coordinated approach to EM activities. Given this variety of EM planning documents, the distinctions between them are summarized in the following table.
A SEMP establishes a federal government institution's objectives, approach and structure for protecting Canadians and Canada from threats and hazards in their areas of responsibility, and sets out how the institution will assist the coordinated federal emergency response. It outlines the processes and mechanisms to facilitate an integrated Government of Canada response to an emergency and to eliminate the need for departments to coordinate a wider Government of Canada response.
It includes 13 emergency support functions that the federal government can implement in response to an emergency. Operational plans may be based on all four pillars of EM planning, or focus on the specific activities of a single pillar. The National Strategy and Action Plan for Critical Infrastructure establishes a public-private sector approach to managing risks, responding effectively to disruptions, and recovering swiftly when incidents occur.
Emergency management (EM) refers to the management of emergencies concerning all hazards, including all activities and risk management measures related to prevention and mitigation, preparedness, response and recovery. The Emergency Management Continuum is depicted in a wheel diagram where all four risk-based functions of emergency management are interconnected and interdependent in a system from prevention and mitigation to preparedness, response, and recovery. In the center of the wheel are the main elements that influence the development of a Strategic Emergency Management Plan (SEMP). Figure 1 highlights the four interdependent risk-based functions of EM: prevention and mitigation of, preparedness for, response to, and recovery from emergencies. The SEMP should ideally be reviewed on a cyclical basis as part of a federal government institution's planning cycle, as presented in Figure 2 below.
This figure represents the optimal planning cycle federal institutions should consider for undertaking their emergency management planning activities. This step involves starting the formal planning process in recognition of the responsibility to prepare a SEMP. Consider having members of the EM planning team designated by your institution's senior management. One of the most crucial steps in the EM planning process is to identify appropriate members for the EM planning team.
Consider including a member of your institution's corporate planning area on the EM planning team in order to help align the EM planning cycle with the institution's overall business planning cycle.


Federal government institutions should consider identifying the range of experience and skill sets required in the EM planning team.
The composition of the EM planning team will vary depending on institutional requirements; however, it is important that clear terms of reference (TOR) for the team be established and that individual assignments be clearly defined. After the EM planning team has clear authority and direction, the next step is to review any relevant existing legislation and policies. As noted in Section Two, the EM planning process should be carried out as part of an institution's overall strategic and business planning processes—this will support their alignment. Developing the SEMP can be supported by a formal work or project plan to ensure that established timelines for plan development are met. As a next step, federal government institutions should consider developing a comprehensive understanding of the planning context. Additional supporting planning tools and templates as well as an EM glossary are provided in Annexes C and D, respectively. The Planning Context is represented in a target diagram that consists of three circles representing the factors federal institutions should consider in order to understand the context in which it operates and how it could potentially be affected. An inventory of critical assets and services will assist the planning team in identifying the associated threats, hazards, vulnerabilities and risks unique to their institution.
Risk assessment is central to any risk management process as well as the EM planning cycle.
Consider gathering a list of institutional risks and cross-referencing the existing plans (as identified in Step 2-1c) that address each risk.
Each institution should establish an EM governance structure to oversee the management of emergencies. It is important that the planning team confirm the strategic priorities of the institution and of senior management so that they can be reflected in the SEMP. The planning team should aim to clearly identify the planning constraints and institutional limitations that will influence the SEMP building blocks and the subsequent development of the SEMP. Emergency preparedness requires coordination of diverse entities at the local, regional and national levels.
There are two general approaches policy makers could consider to broaden participation in emergency-preparedness coalitions: providing incentives for more stakeholders to join existing coalitions or building preparedness into activities providers already are pursuing. 11, 2001, terrorist attacks, many health care providers have adopted emergency-preparedness plans, including participation in such activities as community-wide drills and tabletop exercises, to strengthen their ability to respond to a disaster. By April 26, the government determined that H1N1 represented a national public health emergency and began releasing stores of personal-protective equipment and antiviral medications to states from the strategic national stockpile. First, preparedness activities, such as planning, training and participating in drills, do not generate revenue for health care providers but have costs in staff time and materials. Nonmedical stakeholders, such as police, fire, coroners, school systems and employers, have varying degrees of involvement in medical emergency planning collaboration. According to respondents, state and local medical societies generally have not played an important role to date in helping small practices to collaborate with each other or other stakeholders. In some hospital systems, the system’s preparedness plan directly encompassed physician practices owned by the hospital system. Rural respondents reported depending on buy in from a smaller pool of institutional leaders, and these leaders did not always perceive value in allocating limited funding and staff time for emergency management and participation in coalitions. For example, outside Seattle, three small rural hospitals pooled funds to hire a shared emergency manager across the facilities. As one rural South Carolina respondent noted, a small town in which people know and look after their neighbors can help responders identify and protect more vulnerable community members in an emergency situation.
However, most attention has focused on population-level management of obesity or chronic illness rather than disaster preparedness and response.
Other stakeholders, particularly smaller and independent primary care practices, could potentially contribute to preparedness efforts, but there are significant barriers to involving them in traditional coalitions in a sustainable way. Policy makers could encourage groups whose participation is currently limited in most communities, such as independent physician practices, to join traditional preparedness coalitions that meet regularly to develop joint plans or coordinate responses. For example, programs that offer extra payment to primary care practices to coordinate care of patients with specific chronic conditions might also encourage and reward coordination related to emergency preparedness or the creation of business continuity plans. Similarly, hospitals and physician practices using a common electronic health record platform may find it easier to share real-time information about utilization and to prepare jointly for surges. Fortunately, this has begun to change as the EOP evolves into a guide to address less overwhelming emergencies and hazard threats.
Figure 2-1 provides a synopsis of the EOP structure demonstrated in the National Response Plan (NRP)[8] and the example below provides an EOP structure and format specifically for HCOs.
The organizing body must have the ability to manage ongoing EMP activities and, during response, to perform incident management processes, such as incident action planning and disseminating information to its participants. Emergencies can quickly escalate in scope and severity, cross jurisdictional lines, take on international dimensions and result in significant human and economic losses.
Federal government institutions are increasing their focus on emergency management (EM) activities, given the evolving risk environment in their areas of responsibility.
This is why Public Safety Canada has developed this Emergency Management Planning Guide, which is intended to assist all federal government institutions in developing their all-hazards Strategic Emergency Management Plans (SEMPs).
Many federal government institutions already have specific planning documents or processes to deal with aspects of emergency management that relate to their particular mandates; many also have a long track record of preparing and refining BCPs.
As a matter of process, the Emergency Management Planning Guide will be reviewed annually or as the situation dictates, and amendments will be made at that time. The Guide includes a Blueprint (see Annex A), a Strategic Emergency Management Plan (SEMP) template (see Annex B), and supporting step-by-step instructions, tools and tips to develop and maintain a comprehensive SEMP—an overarching plan that establishes a federal government institution's objectives, approach and structure, which generally sets out how the institution will assist with coordinated federal emergency management, including response. As such, federal institutions are to base EM plans on mandate-specific all-hazards risk assessments, as well as put in place institutional structures to provide governance for EM activities and align them with government-wide EM governance structures.
It reflects leading practices (such as those provided by the International Organization for Standardization (ISO) and Canadian Standards Association) and procedures within the Government of Canada, and should be read in conjunction with the Federal Emergency Response Plan, the Emergency Management Framework for Canada and the Federal Policy for Emergency Management.
It should integrate and coordinate elements identified in operational plans and business continuity plans (BCPs). Each of these functions addresses a need that may arise before or during an emergency. It is intended that governments and industry partners will work together to assess risks to the sector, develop plans to address these risks, and conduct exercises to validate the plans. This work at the sector level will inform, and will be informed by, work at the organizational level such as EM plans and their component parts. In order to effectively depict the cycle, the four seasons are placed in a wheel diagram showing how spring, summer, fall, and winter are interconnected and continuously flow into one circle. Emergency Management resource requirements should be identified as early as possible to integrate into plans.
Inputs should ideally be assembled, reviewed and well understood prior to engaging in each distinct planning activity as they form an important foundation for the work to be completed.
The SEMP should be central to the federal government institution's EM activities and provide clear linkages for integrating and coordinating all other intra-departmental and inter-departmental emergency management plans.
The size and composition of the team may vary between federal government institutions; however, the planning team should ideally have the skill and experience necessary to develop the SEMP.
Training is available to address EM requirements at the Canadian Emergency Management College (CEMC) and the Canada School of Public Service. Training is available to address EM requirements at the Canadian Emergency Management College (CEMC) and the Canada School of Public Service. After completing the above steps, the planning team should consider developing a detailed work plan that includes a schedule with realistic timelines, milestones that reflect the institutional planning cycle, and a responsibility assignment matrix with assigned tasks and deadlines. It entails a process of gathering and analyzing information and typically considers both internal and external factors (see Figure 3: The Planning Context for additional information on the factors to consider).
The key to any emergency planning is awareness of the potential situations that could impose risks on the organization and on Canadians and to assess those risks in terms of their impact and potential mitigation measures. If gaps are identified, these should ideally be gathered and presented as part of Step 3 when developing the EM Planning Framework and confirming the institution's strategic EM priorities. It provides improved insight into the effectiveness of risk controls already in place and enables the analysis of additional risk mitigation measures.
These treatment options, forming recommendations, would be used to develop the risk treatment step in the risk management or emergency management cycle.


A sample cross-reference table of existing plans by identified institutional risks is provided in Annex C, Appendix 4.
The resulting SEMP building blocks will reflect strategic priorities—the desired balance between developing measures that respond to emergencies versus mitigating the risk. The EM planning governance structure may include representatives of an institution's senior management team, from all functional areas (such as programs) and all corporate areas (including communications, legal services and security).
For example, an institution can be constrained by the availability of training for EM planning team members and by the number of EM positions they have staffed. Survival also means maintaining the competitive position and financial stability of an organization immediately following and continuing long after an emergency. Given the diversity of stakeholders, fragmentation of local health care systems and limited resources, developing and sustaining broad community coalitions focused on emergency preparedness is difficult.
Maintaining preparedness is a daunting task, given that emergencies can spring up at a national, regional or local level and take forms as varied as a global pandemic, a regional hurricane or a local outbreak of food-borne illness. While there is limited funding for preparedness activities, hospitals are not subsidized to keep beds empty and supplies stockpiled for a disaster, and it is impractical for trained staff to sit idle until a disaster strikes. The H1N1 influenza pandemic was the most recent national event that required large-scale preparedness and response. Given the low probability of certain events, stockpiling supplies and committing staff to emergency preparedness often are not high institutional priorities.4 In addition, community coalitions require competitors to work collaboratively.
Regional or specialty-based medical societies may maintain similar lists and can provide basic training in disaster planning through continuing medical education.
A hospital respondent in another community coalition cited reluctance to work with nursing homes because of the perception that they are primarily looking for a place to offload patients in an emergency.
However, respondents across all sites generally agreed that providers put normal competitive dynamics aside for preparedness efforts and meet and share information on capacity and supply chains when needed. At the same time, public health preparedness experts have sought to develop methods to evaluate community coalitions.
Likewise, hospital efforts to work with physician practices and long-term care facilities to prevent avoidable readmissions might incorporate preparedness activities.
Each of these factors may affect how planning responsibilities, staff and information are most efficiently shared in preparation for and during a disaster. It does not lay out the requirements for preparing related EM protocols, processes, and standard operating procedures (SOP) internal to the institution; however, these should be developed in support of the SEMP and related plans. As outlined in the Preface, many federal government institutions already have specific plans or processes to deal with aspects of emergency management; many also have a long track record of preparing and refining BCPs, which endeavour to ensure the continued availability of critical services. Planning can be triggered by the EM planning cycle or it can be initiated in preparation for, or in response to, an event that is induced either by nature or by human actions. Those federal government institutions that have mandated emergency support functions (ESFs) under the FERP should have these clearly identified. An emergency management plan is a unique, detailed guide for times of great stress and crisis. As a prolonged, low-mortality event, H1N1 tested community preparedness, clarified the challenges different stakeholders face, and pointed to ways to broaden and strengthen local collaboration.
And, unlike other events that health care organizations must prepare for, such as Joint Commission inspections, there are no predictable, short-term consequences for failing to engage in collaborative, community-level disaster planning.
The focus on hospitals reflects their historic importance in providing staff, space for planning and response, and treatment of emergency victims, including such specialized services as decontamination or burn care.
Some health systems did expect employed physicians in community practices to work collaboratively in disaster planning. This study’s findings suggest that preparedness work could be integrated with broader care delivery, with possible implications for how to evaluate coalitions. EM planning, in particular, aims to strengthen resiliency by promoting an integrated and comprehensive approach that includes the four pillars of EM: prevention and mitigation, preparedness, response and recovery.
In addition, there are other existing EM planning documents and initiatives that apply to a range of federal government institutions, such as the Federal Emergency Response Plan (FERP) and deliverables under the National Strategy for Critical Infrastructure. Stakeholders may include First Nations, emergency first responders, the private sector (both business and industry), and volunteer and non-government organizations. The aim is to develop a SEMP that integrates and coordinates elements identified in hazard-specific plans and BCPs. Physicians and other clinicians employed by hospitals or working in community-based practices owned by hospitals usually fall under the umbrella of hospital preparedness activities. Even in a disaster where victims seek care at hospitals, community-based clinicians can play a role. In some cases, this reflected a commitment at the highest levels of organizations, but, in other cases, it reflected rapport among preparedness staff.
High levels of physician participation in those markets were attributed to hospital systems setting the expectation that physicians would participate and paying them for their efforts, and, in some cases, even allotting them administrative time to participate in preparedness or other system-level work. No rural respondents described working with their state office of rural health on emergency preparedness. Two additional sites were added: New York City because of significant investment in preparedness and Chicago to increase Midwestern representation.
Sixty-seven telephone interviews were conducted between June 2011 and May 2012 with representatives of state and local emergency management agencies and health departments, emergency-preparedness coalitions, hospital emergency preparedness coordinators, primary care practices and other organizations working on emergency preparedness and response.
Other respondents reported frequent communication among competing hospitals on shared pandemic plans and hospital policies for emergencies.
The result of the planning process is a written records and information emergency management plan. Management approves this plan and provides the necessary authority, structure, policies, procedures, and resources to guide the organization through an emergency.
Refer to the sample emergency management plan in the sidebar as you read the following sections.
The Components of an Emergency Management Plan Policy Statement Emergency plans should include the policy established in the development process. Task Organization Organizational size may dictate that several teams be involved in plan activities. If several teams will be involved, each team and respective member responsibilities should be included in the plan. If citizen or corporate partners are included in the emergency process, list them in the plan. Information Distribution Procedures The emergency plan should explain the methods [by which] employees would communicate if an emergency event occurs. For example, emergency or vital records and information may be transferred to the requestor via a special color-coded mail pouch.
Preparedness Checklist The emergency plan must address specific emergencies and how to handle them. It must provide for both major and minor emergencies and should include both site-specific and community-wide events. Organizations should have a checklist covering each emergency and the steps necessary to prepare for and control the emergency. These steps should be continuous or sequential from the preparedness phase to the response phase for each emergency addressed. The plan should show when an emergency status is upgraded from one phase to the next phase. Training Programs Employees will not follow the plan properly if they have not been trained how to use it. A training program outline should be included in the plan to document subjects in which employees have been trained and the frequency the training was administered.
Testing Procedures The plan must include goals, objectives, and schedules for conducting exercises or simulations. Specific types of exercises to be used for the most likely emergencies should also be in the plan.




Earthquake emergency preparedness checklist
Internal crisis communication plan template
Red cross earthquake emergency kits


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