The terrorist attack on the World Trade Center on September 11, 2001. The subway bombings in Madrid and London in 2004 and 2005, respectively. Atlantic hurricanes Katrina and Harvey that hit in 2005 and 2017. The current public health emergency of COVID-19 that has caused more than 4.6 million reported deaths worldwide to date. 

Disasters are occurring with alarming frequency, and hospitals must have an emergency preparedness plan in place for anything and everything. This article provides a checklist for creating a hospital disaster plan and provides resources to supplement and refresh your healthcare organization’s emergency preparedness procedures.

Disaster defined

In healthcare, emergency operations planning begins with getting everyone on the same page about what constitutes a disaster—a high-impact event that causes many people to become ill or injured and/or causes extensive damage to a structure or geographic location. Some hospitals may define it as any event causing a major, short-term spike in the demand for emergency department services. Disasters can be natural (e.g., earthquakes and floods) or man-made (e.g., transportation incidents). 

Disease control following a natural disaster also requires planning, as disasters may lead to infectious disease outbreaks that can result in displacement of populations. What all disasters have in common is their potentially catastrophic effects on a healthcare facility’s ability to continue operating normally.

Terrorist attacks in particular have been occurring with greater frequency during the last few years. The federal government categorizes these attacks into the following sectors: Chemical, biological, radiological, nuclear, and explosive. In addition, instances of cybersecurity attacks on health systems continue to spike, posing significant threats to clinical operations, communications, telemetry, records, and many other critical functions. 

A recent report from a cloud security firm states that cyberattacks against U.S. healthcare entities rose by more than 55% in 2020 compared with the previous year. The report also states there was more than a 16% increase in the average cost to recover each patient record in 2020 versus 2019. Restoration of systems to pre-attack status took an average 236 days last year.

Both natural disasters and man-made ones have the potential to place a significant strain on a healthcare organization’s ability to care properly for patients—making disaster preparedness paramount. An emergency preparedness plan based on best practices helps healthcare facilities weather the storm of any and all types of emergencies.

Use our checklist to assess your disaster response plans.

 1. Acknowledge the role your hospital plays during a disaster

Hospitals must be able to respond quickly during any type of disaster. This means focusing on saving as many lives as possible. However, they also play an important role before and after the disaster. For example, they must also:

  • Plan and coordinate with the wider health and public safety communities
  • Conduct training and disaster drills
  • Protect patients and staff
  • Perform surveillance 

But here’s the biggest challenge: finite resources. 

Many healthcare organizations today grapple with staffing shortages, shortages of personal protective equipment, and much more—and that’s true even during normal times. To complicate matters, hospitals in COVID-19 hotspots are already operating at full or near-full capacity due to the pandemic. Patient surges due to any other disasters exacerbate already-crowded emergency departments and stretch the healthcare workforce to dangerously thin numbers. 

Fortunately, emergency preparedness can help hospitals and health systems plan for unforeseen circumstances. For example, hospitals may decide to use emergency medical services personnel as physician extenders to alleviate staffing shortages during a surge, or halt elective procedures and discharge noncritical patients. They may also choose to use emergency department hallways, inpatient hallways, and nonclinical areas to house patients until rooms become available. 

During COVID-19, health systems worked with local and city governments to create overflow facilities—some in buildings, but others in parking lots, under tents, and more. Making these decisions in advance helps avoid confusion and sets the wheels in motion for seamless patient care.

2. Define your hospital disaster plan and document staff roles

A hospital disaster plan—also known as a hospital emergency operations plan—serves as a guide to help staff move confidently through a crisis situation. The Department of Health and Human Services leads the nation in preventing, preparing for, and responding to the adverse health effects of public health emergencies and disasters, and provides role-based guidance.

And not only do The Joint Commission, the Centers for Medicare & Medicaid Services, and other accrediting bodies enforce emergency preparedness requirements, but they're also an insurance policy for maintaining operations amid uncertainty. 

It’s not a matter of whether a disaster will occur—it’s about when it will happen and what type of disaster it will be. Because disasters are inevitable and often come with no warning, hospital staff must be prepared and trained to change course immediately. A hospital disaster plan provides specific instructions so no one at any level of the organization or in any role is left wondering what to do during a time when it’s extremely difficult to think clearly and act expeditiously.

3. Detail the factors influencing how your hospital will prioritize its response efforts

While an emergency operations plan should prepare a healthcare facility for every type of disaster, organizations may choose to prioritize certain ones. Many healthcare facilities focus on the most likely and potentially serious scenarios—particularly region-specific natural disasters. For example, the New England region is at high risk for hurricanes and winter storms, while the Midwest is at high risk for tornados, earthquakes, and wildfires. 

Other types of natural disasters (e.g., floods, lightning strikes, home fires, and windstorms) can occur anywhere. In terms of man-made disasters, bombing is the most common type of terrorist attack followed by facility/infrastructure attack and armed assault.

4. Identify key pillars of your hospital disaster plan

The Joint Commission’s Emergency Management Standard states that a hospital’s emergency operations plan must include six key elements. Consider the elements below along with organizational-specific emergency preparedness questions to consider.

  • Communication: Who must be contacted internally to disseminate information as quickly as possible? Which external agencies handle emergencies, and who are the appropriate contacts at each agency? How will the healthcare facility ensure detailed records of incoming and outgoing communications throughout the emergency?
  • Resources and assets: Where will the healthcare facility acquire and restore its stock of nonmedical supplies such as food, water, and clean bedding? How will staff obtain transportation to and from work, appropriate shelter, and emotional counseling? How will the healthcare facility continually monitor the demand on supply chains and find alternative vendors when needed? What procedures will the healthcare facility implement to conserve resources and assets?
  • Safety and security: How will the healthcare facility maintain the safety and security of patients and staff? For example, what potential safety and security hazards could arise, and what is the mitigation plan for each one? This includes procedures for hazardous and biological waste disposal, biological/chemical decontamination, and isolation. Can the healthcare facility quickly arrange for law enforcement to maintain order around the facility? What is the facility’s ability to lock down as needed and control and/or minimize points of access? How will the healthcare facility prioritize routes of internal traffic? What about establishing evacuation routes depending on the specific type of emergency?
  • Staff responsibilities: What is each staff member’s role in executing the emergency operations plan? Will the healthcare facility revise its sick leave and vacation policies during a disaster? How will the healthcare facility track each onsite staff member during the emergency? For example, does everyone use an identification key card?
  • Utilities: What are the essential utilities required to keep the healthcare facility functioning smoothly? This could include water, electricity, telecommunications, fuel, ventilation, medical gas, vacuum systems, and more. What are the potential utility disruptions that the healthcare facility could face? Many disasters can impact multiple utilities at once, and healthcare facilities should prepare for a worst-case scenario. For example, will the healthcare facility obtain generators, water filtration systems, and additional fuel sources? How will the healthcare facility obtain and protect backup utilities and repair parts? How will it ensure updates to include new equipment and other changes in facility composition and protocol?
  • Clinical and support activities: What clinical activities must be maintained during the disaster? How will staff perform these activities within a dynamic environment? For example, will it grant temporary privileges that terminate once the situation is under control? How will it formulate a scalable triage system and address the needs of the elderly and disabled? How will the healthcare facility provide critical support services for sanitation and mortuary? What additional areas of support might be needed?

5. Determine parties involved in creating and maintaining the hospital disaster plan

Everyone plays a role in disaster preparedness, which is why it’s important to involve a diverse team in creating the plan itself. This team should include subject-matter experts from a variety of departments as well as anyone else who might be affected by the plan such as patients, emergency responders, external agencies, and others.

6. Identify next steps after creating the emergency operations plan

Plan to revise your organization’s disaster plan regularly as new potential disasters and public health emergencies emerge, new staff are hired, and internal protocols change. Second, test it. Does it actually work? Consider using tabletop exercises or formal drills to help staff understand what procedures they’re expected to know and whether they’re able to perform them during a critical time. Third, try to resume some sense of normalcy.

There are special considerations for certain clinical areas in the aftermath of disasters as well. For example:

  • Do any providers require reappointment of special privileges based on disaster allowances?
  • Can you start preparing for the next Joint Commission survey by taking note of credentialing, privileging, or clinical circumstances that went into effect in the disaster, yet might fall through the cracks once the emergency order ends?
  • How can your organization revise or refocus on improving the patient experience based on what occurred during the disaster? 

Learn from the disaster, and grow from it—but don’t let it cloud your progress going forward. Have confidence in knowing that you’re already better prepared for the next disaster when it occurs.


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