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.
A number of different federal, state and local organizations work with health care providers individually and collectively to promote collaboration in preparedness activities. 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. 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. One option would be to incorporate preparedness activities into existing incentive programs aimed at underrepresented stakeholders, including independent physicians and nursing homes. 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.
EOP Base Plan - Provides an understanding of how the organization responds and how it interfaces with the outside environment during response. Emergency preparedness requires coordination of diverse entities at the local, regional and national levels. 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.
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. 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. 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. 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. Regional or specialty-based medical societies may maintain similar lists and can provide basic training in disaster planning through continuing medical education. 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. 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.
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. No rural respondents described working with their state office of rural health on emergency preparedness. 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. The result of the planning process is a written records and information emergency management plan. Refer to the sample emergency management plan in the sidebar as you read the following sections. Information Distribution Procedures The emergency plan should explain the methods [by which] employees would communicate if an emergency event occurs. Preparedness Checklist The emergency plan must address specific emergencies and how to handle them.

The plan should show when an emergency status is upgraded from one phase to the next phase.
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. 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. 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. However, such stakeholders as schools and employers can and do influence medical treatment during disasters. 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. 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. 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.
Business Continuity and Disaster Recovery Plan for small businesses need effectual strategies to deal with and to recover from disrupting occurrences. Failure to prepare for it can give an otherwise ideal model a theoretical name and spell disaster for those associated with the discharge of its responsibilities. The California Specialized Training Institute (CSTI) provides training in all phases of emergency management: preparedness, response, recovery, and mitigation.
This policy defines acceptable methods for disaster recovery planning, preparedness, management and mitigation of IT systems and services at Weill Cornell Medical College. The approach to emergency preparedness and response for these Tier 1 assets can be relatively simple. 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. Nonmedical stakeholders, such as police, fire, coroners, school systems and employers, have varying degrees of involvement in medical emergency planning collaboration.
However, most attention has focused on population-level management of obesity or chronic illness rather than disaster preparedness and response.
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. 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. 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. 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. Each of these factors may affect how planning responsibilities, staff and information are most efficiently shared in preparation for and during a disaster.
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. In some cases, this reflected a commitment at the highest levels of organizations, but, in other cases, it reflected rapport among preparedness staff.

Two additional sites were added: New York City because of significant investment in preparedness and Chicago to increase Midwestern representation.
Other respondents reported frequent communication among competing hospitals on shared pandemic plans and hospital policies for emergencies. Management approves this plan and provides the necessary authority, structure, policies, procedures, and resources to guide the organization through an emergency. The Components of an Emergency Management Plan Policy Statement Emergency plans should include the policy established in the development process.
Training Programs Employees will not follow the plan properly if they have not been trained how to use it.
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.
Few communities involve independent practitioners other than maintaining a list of those willing to volunteer in the event of a disaster, for which no special training or expertise in disaster response is required. In some hospital systems, the system’s preparedness plan directly encompassed physician practices owned by the hospital system. Main ContentIn the past, the HCO EOP was commonly (and inaccurately) referred to as the disaster plan. 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. An emergency management plan is a unique, detailed guide for times of great stress and crisis. Some health systems did expect employed physicians in community practices to work collaboratively in disaster planning.
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.
Task Organization Organizational size may dictate that several teams be involved in plan activities. These steps should be continuous or sequential from the preparedness phase to the response phase for each emergency addressed. 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.
It is important to note that collaborations based on existing affiliations and less-formal relationships would still require some oversight to avoid situations where disparities in market position may leave some providers at a disadvantage in securing needed information and supplies during a disaster.
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. This study’s findings suggest that preparedness work could be integrated with broader care delivery, with possible implications for how to evaluate coalitions.
If several teams will be involved, each team and respective member responsibilities should be included in the plan. Testing Procedures The plan must include goals, objectives, and schedules for conducting exercises or simulations. If citizen or corporate partners are included in the emergency process, list them in the plan. Specific types of exercises to be used for the most likely emergencies should also be in the plan. Even in a disaster where victims seek care at hospitals, community-based clinicians can play a role. Lack of time, training and sometimes simply awareness that they have a role in disaster response also are important factors.
For example, in a disaster, hospitals generally try to discharge as many inpatients as possible, and community-based providers could help by seeing or contacting discharged patients to ensure they are receiving needed follow-up care.

Be prepared for earthquake
Risk assessment is best described by


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