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Rural Health Information Hub

Legal Considerations for Emergency Preparedness and Response

Rural communities must account for national, state, tribal, and local statutes and regulations related to public health emergencies. Federal laws and legal authorities address many topics relevant to public health emergencies. These include healthcare delivery systems, quarantine and isolation, emergency medical treatment, public safety, volunteer protection, communicable disease control, transportation management, worker liability and protection, and personal health information.

The Public Health Emergency Preparedness Clearinghouse, from the Centers for Disease Control and Prevention (CDC), compiles statutes, regulations, orders, reports, and legal tools that rural communities can use to clarify their legal preparedness capacity. This includes the resource Selected Federal Legal Authorities Pertinent to Public Health Emergencies, updated August 2017, that outlines federal laws relevant to public health emergencies.

Rural communities must consider legal authorities during the planning, response, and recovery phases.


Governance and legal authorities differ across states and localities. Rural communities must understand the legal authorities in place that may dictate elements of emergency preparedness planning efforts.

Key planning considerations include:

  • Healthcare delivery systems – legal authorities that apply to healthcare providers and institutions during a public health emergency
  • Staffing adjustments – requirements for adjusting staffing during an emergency, such as hiring new or temporary staff, reassigning staff, or coordinating volunteers
  • Credentialing – credentialing agreements with other institutions, jurisdictions, and states for healthcare workers to work in emergency situations
  • Volunteers – agreements with volunteer groups that describe management of volunteers and liability structures and understanding institutional liability for volunteers
  • Procurement – policies and procedures for procurement of goods and services, based on state and local procurement practices
  • Partnerships – legal agreements, such as contracts, mutual aid agreements, or memoranda of understanding (MOU), that apply to partners, including those in a lead or supporting role, to support response
  • Countermeasure dispensing and administration – legal guidelines for handling controlled substances and medical countermeasures, including registration with the U.S. Drug Enforcement Administration

When working with tribal communities, it is important to leverage existing partnerships with tribal governments. FEMA offers a training course on building partnerships with tribal governments. Partners should understand cultural practices and linguistic considerations and respect the autonomy of tribal governance. It is important to consult with tribal leadership before making decisions that may affect tribal communities. Ensuring active, regular, and meaningful participation of partners during preparedness planning will ensure an effective response in the event of a disaster.

Tribal governments may choose to enter into an intergovernmental agreement with local, state, or federal governments and agencies to outline expectations in an emergency response. Resource, data, and staff sharing are some of the things that should be discussed when creating an agreement.


Even at the height of response efforts, organizations involved in the response must be aware of laws and regulations with which they must comply, as well as those that either provide them with or limit legal authority. Legal considerations during the response phase include:

  • Communication – legal guidelines for communicating information and avoiding the dissemination of protected information
  • Information exchange – regulations for surveillance information exchange, such as medical information
  • Resource sharing – mutual aid agreements that establish the legal basis for sharing of resources across two or more entities, such as between communities, states, and federal agencies, during a response
  • Medical surge – legal guidelines and liability considerations to support medical surge operations
  • Nonpharmaceutical interventions (NPIs) – authorities and policies that enable or limit the implementation of NPIs (such as mask mandates or temporarily closing childcare centers)
  • Isolation and quarantine – state laws governing isolation and quarantine for communicable diseases, including authority to impose and enforce orders; personal liability of healthcare workers and others who are expected to enforce isolation and quarantine orders
  • Stabilizing treatment for hospital patients – Emergency Medical Treatment and Active Labor Act (EMTALA) compliance during a public health emergency
  • Emergency declaration – legal authority within the state or locality to declare a public health emergency

Case Study

Mass Casualty Incident Occurs when Duck Boat Sinks in Rural Missouri
In 2018, a duck boat holding 31 passengers capsized in rural Missouri during a severe thunderstorm, resulting in 17 casualties. Table Rock Lake, where the accident occurred, spans 2 counties. Fire protection districts from the counties coordinated a response based on previous territorial understanding, and other organizations also provided support through existing mutual aid agreements.


After a disaster, there are a number of health-harming legal needs that may arise among individuals in the affected community. These include:

  • Housing and consumer issues – Examples include evictions, foreclosures, landlord disputes related to repairs and security deposits, insurance claims and disputes, and scams and price gouging by contractors and businesses related to home repairs and utilities.
  • Income and financial issues – Examples include lost documents such as birth certificates and social security cards, bankruptcy, applications for public benefits, and applications for federal assistance and loan programs.
  • Family and educational issues – Examples include issues related to custody and guardianship, power of attorney, and domestic violence.

Resources to Learn More

2022-2026 FEMA National Tribal Strategy
Offers a roadmap and plan for enhancing coordination between FEMA and federal recognized tribes.
Organization(s): Federal Emergency Management Agency (FEMA)
Date: 8/2022

Administrative Preparedness Legal Guidebook
Offers legal guidance to help public health professionals strengthen their administrative preparedness capacity and establish emergency response activities by encouraging collaborative preparatory work.
Organization(s): National Association of County and City Health Officials (NACCHO)

Public Health Emergency Preparedness Clearinghouse
Provides emergency preparedness resources including statutes, regulations, toolkits, handbooks, publications, trainings, and webinars to help entities clarify and update the legal aspects of their emergency preparedness and response activities.
Organization(s): Centers for Disease Control and Prevention (CDC)
Date: 3/2021