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Rural Health Information Hub

Population Considerations for Emergency Preparedness and Response

Some populations may need additional help during an emergency or disaster, such as those at higher risk and those likely to be disproportionately affected by emergencies and disasters. Using a Whole Community approach, rural communities can consider the needs of certain populations and ensure that preparedness planning, response, and recovery activities meet the actual needs of all populations in the community.

Tribal Communities

The Federal Emergency Management Agency (FEMA) works with tribal governments to support preparedness, response, and recovery. FEMA maintains a nation-to-nation relationship with tribal governments and recognizes tribal sovereignty and self-governance.

The FEMA Tribal Affairs website links to resources and policies, including the FEMA Tribal Policy that describes FEMA's relationship with tribal governments, and the FEMA Tribal Consultation Policy describes how FEMA communicates and collaborates with tribal governments.

Organizations working in an emergency response capacity with tribal communities must consider the unique cultural needs of Native American populations. Tips for Disaster Responders: Cultural Awareness When Working in Indian Country Post-Disaster, produced by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2022, provides cultural awareness tips for working with Native American populations before, during, and after a disaster, including the importance of understanding cultural values such as traditional teachings and community healing.

For more information and considerations related to tribal governance and cross-jurisdictional issues, see Legal Considerations for Emergency Preparedness and Response.

Populations with Access and Functional Needs

People with access and functional needs have a limited ability to act during an emergency. These individuals may require assistance or accommodations during an emergency. Populations with access and functional needs may include:

  • Older adults
  • People with disabilities
  • People with limited access to transportation
  • People with limited English language proficiency

Rural communities can establish procedures for supporting populations with access and functional needs using the CMIST Framework. The five categories of the CMIST Framework address common and cross-cutting considerations for people with access and functional needs:

  • Communication – ability to hear announcements, see signage, understand visual cues, or express concerns
  • Maintaining Health – resources and services needed, such as medications, durable medical equipment, and assistive technology
  • Independence – continued access to services that support independence, such as mobility devices and communication aids
  • Support – additional support, such as personal care assistance or trauma-informed care, to reduce the negative impacts of a disaster
  • Transportation – accessibility of mass transit or other transportation service providers

FEMA's video, Preparing Makes Sense for People with Disabilities and Other Access and Functional Needs, provides guidance and considerations for people with access and functional needs. This includes, for example, taking a proactive approach to personal preparedness by assembling a support team, identifying essential resources and services for health, or building a customized emergency kit.

Case Study

Healthcare Coalition Coordinates Emergency Response Training in Frontier and Remote Areas of Wyoming
The Big Horn Basin Healthcare Coalition compiled an access and functional needs list so responders in the community would know where to focus resources for a potential response.

Older Adults

Older adults (people aged 65 or older) are more likely to have functional limitations, meaning their medical conditions affect their ability to do specific activities of daily living. For example, approximately half of older adults have two or more chronic conditions, which increases the risk of adverse outcomes before, during, and after an emergency. The Administration for Community Living (ACL) provides information and resources on emergency preparedness for older adults, including best practices and resources for individual preparedness, service provider preparedness, community preparedness, and community-based organization preparedness. The U.S. Department of Homeland Security (DHS) providers planning and preparedness resources for older adults and for individuals working with older populations online. For more information on services and supports for older adults in rural communities, see the Community Supports for Rural Aging in Place and Independent Living topic guide.

Case Study

Wildfire Forces Evacuation of Critical Access Hospital in Estes Park, Colorado
In Estes Park, Colorado, just over 40% of the population is age 65 or older. When residents were evacuated, the town supplemented digital communication, including social media and email, with direct communication, such as phone calls and other more traditional outreach methods, to reach older adults.

People with Disabilities

People with disabilities may have more access and functional needs and require greater support during an emergency. For example, people with disabilities may have mobility impairments, require assistive devices or medical equipment, and have specific transportation needs. Rural communities should ensure that shelter facilities are accessible to people with disabilities and stocked with items that help maintain independence. It is also important to avoid separating people with disabilities from caregivers or sources of support such as service animals and medical equipment. Several resources for creating inclusive emergency preparedness plans are available from the Centers for Disease Control and Prevention (CDC). DHS also provides information on emergency planning and building emergency kits for people with disabilities.

People with Limited Transportation Access

Transportation needs in rural areas will vary depending on the type of emergency or disaster. For example, many natural disasters, such as hurricanes and earthquakes, require evacuation. Rural communities must plan for and prepare to address some of the barriers that may prevent people from evacuating. These barriers include, among others, lack of access to a personal vehicle, inability to drive, and lack of public transportation. Plans may address coordination of existing local transportation services; provision of transportation services for evacuation; and allocation of other resources, such as food, water, and medication, to those who are unable to evacuate.

People with Limited English Language Proficiency

Emergency responders in rural communities must address the needs of people with limited English language proficiency before, during, and after an emergency. Recommendations for doing so include identifying the languages and dialects spoken in the community; preparing emergency messages in multiple formats; and providing appropriate language assistance, such as qualified interpreters and translation services. The Department of Health and Human Services (HHS) checklist Ensuring Language Access and Effective Communication During Response and Recovery provides specific recommendations, action steps, and best practices for working with interpreters.

People with Healthcare Needs

Individuals with healthcare needs may require prescription medications, medical supplies and equipment, and transportation. It is important for rural communities to ensure continuity of care for a range of patients and conditions, such as dialysis patients. Key considerations may include delivering healthcare services without utilities (power outages, no water), ensuring access to prescription medications, delivering in-home care, and continuing routine appointments via telemedicine or in-home visits, if necessary. Rural communities should plan for these needs by:

  • Identifying potential healthcare delivery system supports
  • Designating alternative treatment settings or facilities for care delivery
  • Determining strategies for reducing stress on hospitals
  • Establishing strategies and conducting medical planning to enable individuals to remain in their homes when possible
  • Coordinating with partners to determine medical transport needs
  • Assessing specific treatment and access needs

Pregnant Women and Parents and Caregivers of Infants

Pregnant women have special healthcare needs in an emergency or disaster event. They may need access to obstetrical and infant care services, including labor and delivery, breastfeeding services, and neonatal intensive care units (NICUs). Pregnant women with high-risk conditions, such as diabetes, high blood pressure, twin gestation, and preterm labor, may need additional support services. Parents and caregivers of infants will need additional supplies, such as formula, bottles, and diapers. It is important that rural communities identify community supports and communicate effectively with pregnant women, parents and caregivers of infants, and community partners. For more information, see Disaster Safety for Expecting and New Parents.


Rural communities must consider the unique needs of children and youth during an emergency. This includes developing plans for children in childcare settings, including childcare centers and in-home care; developing an emergency operations plan (EOP) for children in schools and educational facilities; and developing plans for family reunification in healthcare and medical settings. Support for family reunification may extend beyond the healthcare setting. In rural communities, nonprofit and nongovernmental organizations may provide assistance to individuals separated from their families. During Presidential disaster declarations, the National Center for Missing and Exploited Children (NCMEC) activates the National Emergency Child Locator Center (NECLC) to support family reunification.

In addition, children and youth with special healthcare needs may have extra care requirements and support needs during an emergency or disaster. This includes medical services, transportation, and coping support for mental and emotional health.

People Without Housing

People without housing may be at higher risk of negative outcomes before, during, and after an emergency or disaster, due to having limited resources and having experienced past trauma. Rural communities can use a trauma-informed approach when planning for and responding to the needs of people without housing. A 2009 National Health Care for the Homeless Council publication, Disaster Planning For People Experiencing Homelessness, provides guidance for addressing needs of people without housing when planning for disasters and emergencies. During the recovery phase, communities should ensure that people without housing are aware of and have access to resources and support. The Disaster Recovery Homelessness Toolkit includes strategies and tools for ensuring that the needs of people without housing are met in the aftermath of a disaster.

Resources to Learn More

Disaster Resilience Tool Kit: A Guide for How Local Leaders Can Reduce Risks and Better Protect Older Adults
Toolkit for local emergency management professionals and other organizations working to build, support, and improve emergency planning and disaster resiliency in older adult populations. Discusses the impacts and risks older adults experience when disasters and emergencies happened. Provides resources and strategies to address these issues.
Organization(s): AARP and Federal Emergency Management Agency (FEMA)
Date: 2022

Youth and Emergency Planning
Describes the importance of involving youth in emergency preparedness, response, and recovery. Provides information and links to resources on starting a youth preparedness program including planning and policy guides.
Organization(s): Federal Emergency Management Agency (FEMA)

Guide to Expanding Mitigation: Making the Connection to Older Adults
Shares resources and mitigation strategies to help emergency preparedness professionals working with older adults and communities serving older populations plan, prepare, and respond to disasters.
Organization(s): Federal Emergency Management Agency (FEMA) and AARP
Date: 2022

HHS/ASPR Access and Functional Needs (AFN) Web-Based Training
Discusses the importance of addressing access and functional needs (AFN) when disaster planning for an entire community that is inclusive of at-risk populations. Highlights how AFN training offers information on compliance with federal laws and executive orders. Provides a link to a free AFN web-based training with additional tools and resources.
Organization(s): HHS Administration for Strategic Preparedness and Response (ASPR)
Date: 7/2020

HHS Maternal-Child Health Emergency Planning Toolkit
Presents information, resources, and promising practices to address maternal and child health during emergency planning and response.
Organization(s): HHS Administration for Strategic Preparedness and Response (ASPR)
Date: 5/2021

People with Access and Functional Needs
Offers information and resources to support populations with access and functional needs during various stages of a disaster. Includes suggestions for working with individuals during a disaster who have hearing, vision, speech, mobility, intellectual or developmental, and non-apparent disabilities.
Organization(s): Substance Abuse and Mental Health Services Administration (SAMHSA)

Planning for an Emergency: Strategies for Identifying and Engaging At-Risk Groups: A Guidance Document for Emergency Managers
Helps emergency managers identify, plan for, and assist populations who are at greater risk of adverse outcomes during an emergency or disaster.
Organization(s): Centers for Disease Control and Prevention (CDC)
Date: 2015

ASPR TRACIE Topic Collection: Access and Functional Needs
Provides resources addressing populations with access and functional needs during emergency planning, response, and recovery. Provides links to case studies, tools, promising practices, and lessons learned.
Organization(s): HHS Administration for Strategic Preparedness and Response (ASPR)