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Rural Health Information Hub

Rural Community Planning for an Emergency or Disaster

Planning is a necessary step to ensuring the preparedness and response capacity of rural communities. In the 2016 National Mitigation Framework document, FEMA refers to planning as follows:

“The planning process is a tool to integrate risk analysis and assessment of local capabilities and authorities into community priorities and decision making.”

There are multiple ways to approach planning for emergency preparedness and management.

  • Capabilities-based planning – focuses on developing plans to perform a specific preparedness function
  • Function-based planning – focuses on developing plans based on organizational roles and responsibilities
  • Scenario-based planning – focuses on developing plans to address specific risks and threats

Community capabilities for preparedness and response are built through clearly defined preparedness plans and established system-level capacities. The Centers for Disease Control and Prevention (CDC) established the Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health, which define the national standards for public health agencies at the state, local, tribal, and territorial level. The Federal Emergency Management Agency (FEMA) established the 32 Core Capabilities, which are the key activities that address the greatest community risks in an emergency or disaster situation.

Typically, the steps in the planning process are to form a planning team, understand the community and risks, develop a plan, and review and update the plan.

Form a Planning Team

It is important to establish a planning team that involves multiple partners and collaborators. A collaborative and team-based approach to planning ensures that all voices in the community are heard, enhances relationships, and sparks innovation in the planning process. Successful rural preparedness programs prioritize community collaboration and involve partners from local organizations, the school community, healthcare organizations, people with disabilities, and all levels of government. Not only are multiple perspectives important, but various stakeholders can provide a more complete inventory of resources available to the community. For more information, see Partners and Collaborators for Emergency Preparedness and Response.

A core planning team should be involved in all planning efforts. Establishing a core planning team will ensure continuity and consistency to preparedness planning and the subsequent implementation of that plan. Additional partners and collaborators, including those identified above, may be involved throughout the planning process to address specific topics and community capabilities.

It is also important to engage community members in planning, using a Whole Community approach. This will ensure that individual community members support preparedness plans, and it will ultimately build community resilience. Community members may be involved in planning by supporting the core planning team, providing public outreach on specific topics, or establishing a community emergency response team (CERT).

Understand the Community and Risks

After establishing a planning team, it is necessary to confirm understanding of the community's needs and risks. A needs assessment can provide this information. The demographics, health statistics, and location of the community members are key characteristics to consider. It is also important to understand the existing resources and assets in the community, such as critical transportation routes and communication services and capabilities. This information will help inform specific approaches in the preparedness plan.

Rural communities may be able to use existing data sources for needs assessments. These include, for example:

  • Community health needs assessments (CHNAs) – Nonprofit hospitals must conduct a CHNA at least once every three years and adopt a strategy for addressing identified needs, as required by the Internal Revenue Service (IRS).
  • Community health assessment (CHA) – Public health agencies, in order to be accredited by the Public Health Accreditation Board (PHAB), must complete a CHA at least once every five years.

The Community Assessment for Public Health Emergency Response (CASPER) is a specific type of rapid needs assessment that generates information on a community's resources, gaps, and needs. CASPER is intended for use by emergency managers and public health practitioners. It is designed to be quick, low-cost, and flexible. It uses a sampling methodology to gather information from households within a community. It is commonly used to support planning for emergency response.

Rural communities can also use a variety of approaches and tools to identify and plan for assisting populations at increased risk of adverse outcomes. Examples of strategies for identifying at-risk groups include:

  • Registries – These are databases that compile information on individuals with specific needs. Common types include access and functional needs registries, medical needs registries, and transportation registries. Communities can use registries to support emergency planning and response activities, such as resource allocation.
  • Community Outreach Information Network (COIN) – This process, created by CDC, involves creating a grassroots network of community leaders and people who can assist in emergency planning and response activities for at-risk individuals. There are three phases to the process: define at-risk groups, locate at-risk groups, and reach at-risk groups.
  • Social Vulnerability Index (SVI) – This tool, created by CDC, uses census-tract data to identify and visualize communities that may need additional support before, during, and after an emergency. The SVI ranks social factors within four themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation.

Rural communities can conduct a risk assessment, also referred to as a hazard vulnerability analysis, to assess community hazards and risks. It is important to identify the hazards a community is more prone to and how those hazards may affect the population. Risk assessment can include examining historical disasters or events in the area, analyzing disasters in similar geographic areas, and planning for future implications of current vulnerabilities. A matrix is one tool that rural communities can use to judge the severity and likelihood of a disaster and to prioritize planning efforts.

The HHS Administration for Strategic Preparedness and Response Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) provides additional information, resources, and tools for hazard vulnerability analysis and risk assessment.

Develop a Plan

A preparedness plan serves as a playbook during an emergency or disaster. It is crucial to develop a comprehensive and well-documented plan that addresses all hazards in order to ensure rural community readiness for response and recovery. The preparedness plan should identify activities and approaches for achieving specific goals and objectives. Goals and objectives may be connected to capabilities, functions, and scenarios. The plan must account for the specific needs and risks identified in the community.

The key components of a preparedness plan include:

  • Courses of action for achieving specific goals and objectives, including timeline, decision points, operational tasks, and responsible parties (individuals or organizations)
  • Resources (available and required), including personnel, facilities, equipment, financial, communications, and operational resource needs
  • Information needs for all participants, including communication with individuals (staff, partners, general public, vulnerable populations), organizations (businesses, nonprofits, community organizations), and all levels of government
  • Responsibilities, roles, and chain of command across sectors

A comprehensive preparedness plan will integrate best practices and evidence-based approaches. It will also address planning for skills and training, surge, continuity of operations, and recovery. The plan should be housed in a centralized and accessible location for all organizations involved in emergency response.

Case Study

August Complex Wildfire and the Round Valley Indian Reservation
Residents struggled to find sanctuaries for their animals during the wildfire. An animal/livestock emergency management plan would assist residents and reduce anxiety in future disasters. This is particularly important in rural areas where there is an abundance of livestock.

Best Practices and Evidence-Based Approaches

The Incident Command System (ICS) is a best practice for organizational emergency management. It is a proven system for ensuring accountability, communication, and management during emergency planning and response. It is a standardized and flexible approach that can be used to address one or multiple emergency or disaster events. Rural communities should determine where the ICS will be located (Incident Command), other organizations and partners involved, and point(s) of contact for each agency involved.

Actively engaging community members is an effective planning practice. This includes community members who represent populations with access and functional needs and different racial and ethnic backgrounds. Ensuring active and ongoing engagement of diverse communities ensures that rural community preparedness plans provide specificity around issues of race, ethnicity, culture, language, and trust.

Skills and Training Planning

Preparedness plans should include practical training and exercises for the organizations in the ICS, including all emergency responder personnel, practitioners, and community members.

Tabletop exercises include evolving hypothetical scenarios, facilitated group discussion, group decision-making, post-exercise discussion to evaluate performance, identifying strengths and weaknesses, and connecting the exercise to relevant experiences. Working through tabletop exercises will help ensure that staff, organizations, and the community know and understand their roles. A tabletop exercise will help delineate who is responsible for contacting partners or government representatives, who is responsible for and how to relay information to the public, and resource and infrastructure decisions (for example, how to have power cut when lines are down).

Mock drills are a larger-scale exercise that can involve multiple partners and the whole community. These drills should integrate the ICS and establish responsibilities across participants. A post-drill discussion is crucial to help identify strengths and weaknesses and improve the approach.

Case Study

Historic Flood Cuts Off All Roadways to Rural Fremont, Nebraska
Methodist Fremont Health, the local hospital located in rural Dodge County, Nebraska, cited the biggest factor contributing to their successful response to the flood was the continual training in incident command and emergency response that the hospital implemented for staff. Staff regularly participated in live drills and exercises, gaining a better, practical, and hands-on understanding of response procedures and practices.

Surge Planning

A key component of preparedness planning is ensuring surge capacity, which is the ability to fill gaps quickly during an emergency event. Surge capacity should be treated as a fixed cost because it assumes that some component is normally idle because of fluctuations in demand. Surge planning should address approaches for recruiting staff, strategies for obtaining materials, and specific locations and facilities. Surge planning should also account for resources needed to recruit, train, and mobilize volunteers. Some rural communities should consider planning for population surge following an urban disaster.

Continuity Planning

A continuity plan outlines how an organization will continue to operate if services are disrupted during an emergency or disaster. A continuity plan helps ensure that organizations can continue to perform their essential functions during a response and resume operations in the recovery phase. Essential functions are those functions and activities that must be continued during an emergency. A 2018 FEMA document, Continuity Plan Template and Instructions for Non-Federal Entities and Community-Based Organizations, provides instructions and sample text for developing a continuity plan.

Recovery Planning

A recovery plan outlines steps to take after the initial response phase. A recovery plan also includes long-term strategies to improve the organization or community. This focuses on not only returning to a pre-disaster state but also ensuring that a community builds back better, as described in the Sendai Framework on Disaster Risk Reduction, and resiliency is improved. Because recovery actions should often begin during a response, it is important that preparedness plans provide information on specific activities and approaches for short- and long-term recovery.

Review and Update the Plan

It is essential that dedicated staff routinely review and update the plan. Preparedness planning is ongoing. The resources available to support a response will constantly fluctuate, and the risk and hazards that may present within a community will also evolve. Engaging in regular review and evaluation will help ensure that the details in the plan remain relevant to the current community context. It will also help confirm how many staff, resources, and volunteers will be available in the event of an emergency or disaster.

Resources to Learn More

Center for Domestic Preparedness – Training the Best for the Worst
Provides all-hazards trainings for use by state, tribal, local, and territorial health departments; the federal government; and other entities involved in preparedness and response. Resources are designed to prepare emergency responders on aspects of preparedness, protection, and response.
Organization(s): Center for Domestic Preparedness (CDP), Federal Emergency Management Agency (FEMA)

The CLEAR Field Guide for Emergency Preparedness
Provides all-hazards models that healthcare providers, public health, and first responders can implement together. Includes strategies, resources, field examples, and actionable next steps focused on cross-sector collaboration, workforce capacity and resilience, information sharing and managing misinformation, and building a culture of preparedness.
Organization: CLEAR (Convening Leaders for Emergency and Response) Collaborative

FEMA Emergency Management Institute
Shares free and accessible training modules and online education courses for a variety of emergency preparedness activities and concepts.
Organization(s): Federal Emergency Management Agency (FEMA)

Homeland Security National Training Program (HSNTP)
Offers no-cost trainings to state, tribal, local, and territorial health departments to support preparedness and response efforts.
Organization(s): Louisiana State University (LSU) Academy of Counter-Terrorist Education

Partnering to Achieve Rural Emergency Preparedness: A Workbook for Healthcare Providers in Rural Communities
Serves as a guide to aid rural health systems in creating an emergency preparedness plan. Shares guidelines, tools, best practices, and resources for rural healthcare providers to create an all-hazards emergency plan and update and/or expand an existing emergency plan. Provides steps to strengthen collaborations with local, regional, and state partners. Encourages the integration and coordination of emergency response plans, planning efforts, and other activities in rural healthcare and public health systems.
Organization(s): USA Center for Rural Public Health Preparedness, Texas A&M Health Science Center School of Rural Public Health
Date: 2007

Rural Domestic Preparedness Consortium
Provides training, technical assistance, and information-sharing services specifically for rural and tribal emergency preparedness stakeholders. It is composed of six academic members who offer expertise and resources to support rural emergency responders.
Organization(s): The Center for Rural Development, Rural Domestic Preparedness Consortium

Resilient Rural America Project
Provides training modules designed to accelerate rural resilience with trained climate service providers and empowered rural leaders and stakeholders.
Organization(s): Model Forest Policy Program, NOAA Climate Programs Office, EcoAdapt, International City/County Management Association, Geos Institute

Strategies for Rural Health Leaders' Success in a Post-COVID-19 World
Presents planning, response, and recovery considerations and strategies based on lessons learned from COVID-19, with case studies included.
Organization(s): American Hospital Association
Date: 5/2022

Tribal Course Descriptions
Provides links to trainings designed to increase preparedness and resiliency of tribal governments.
Organization(s): Federal Emergency Management Agency (FEMA)