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Rural Health Information Hub

Formerly the
Rural Assistance Center


Rural Emergency Preparedness and Response

Emergencies happen every day in rural communities across the nation, but when they exceed the capabilities of local response agencies and healthcare facilities – they become disasters. Disasters can be natural or man-made and can occur with or without warning.

Rural communities can increase their ability to deal effectively with larger-scale emergencies by undertaking initiatives to prepare and plan for emergencies before they happen. Ideally, preparedness planning should involve many different people and organizations across the community.

Rural communities face challenges regarding emergency preparedness and response. These challenges may include:

  • resource limitations
  • remoteness
  • separation
  • low population density
  • communication issues

As stated in the Federal Office of Rural Health Policy’s document, Rural Communities and Emergency Preparedness, emergency preparedness in rural communities depends on hospitals, public health departments, and emergency medical services providers. Some rural areas do not have public health departments so must rely on centralized state public health capacities. Where rural health departments do exist, many have faced significant budget and staffing cuts as a result of the economic downturn. Similarly, many rural hospitals face chronic financial challenges and constraints of other resources. As a result, both the public health and hospital sectors may lack needed surge capacity to respond adequately to emergencies, leaving communities vulnerable and more reliant on volunteer responders.

Frequently Asked Questions

What’s the difference between emergency preparedness and emergency response?

Emergency preparedness refers to actions that can and should be performed prior to an emergency, such as planning and coordination meetings, procedure writing, team training, emergency drills and exercises,and prepositioning of emergency equipment. Preparedness activities can change the impact of an emergency if performed prior to the event.

Emergency response refers to actions taken in response to an actual, ongoing event.

What are some of the challenges of rural emergency management?

There are several challenges in rural communities regarding emergency preparedness and response. According to Challenges of Rural Emergency Management, these challenges include:

  • Limited funding and other resources of rural responding agencies such as EMS and fire departments
  • Longer travel distances between residents and emergency personnel resulting in longer response times
  • Out-migration of young people, which is a factor in workforce and staffing issues
  • Communication for public education is more expensive per capita, and warning systems may be substandard or even non-existent

The same article identifies social capital as an advantage for emergency preparedness activities in rural communities, due to strong relationships between people and organizations in the community, as well as a stronger sense of volunteerism. This strength can be leveraged to compensate for some of the challenges rural communities experience.

How can community members receive training to prepare them to volunteer and assist others in a disaster situation?

The Community Emergency Response Team (CERT) Program focuses on educating people on disaster preparedness for hazards that may impact their communities and trains them in disaster response skills, such as:

  • basic search and rescue
  • fire safety
  • team organization
  • disaster medical operations

CERT members can assist others following an event when professional responders are not immediately available. CERT members can also support emergency response agencies by taking an active role in emergency preparedness projects in their community.

Other programs for community members include:

  • Citizen Corps, which provides many educational resources to support local preparedness activities.
  • Map Your Neighborhood, which is an innovative program that can be implemented in any community.
  • American Red Cross, which has local chapters throughout the nation, and provides disaster and emergency shelter, disaster recovery guides, and a variety of training and certification courses.

The Rural Domestic Preparedness Consortium provides training and resources to rural first responders. These courses are provided free of charge and are available both in-person and online. All courses are certified by the Department of Homeland Security.

Public health departments may offer courses in rural emergency preparedness and response. To find your public health department, please see Public Health Resources: State or Territorial Health Departments.

FEMA provides a listing of all State Offices and Agencies of Emergency Management. These agencies provide programs in homeland security, emergency management, operations and drills, hazards planning, strategic planning and community preparedness, and disaster recovery.

Who should be involved in emergency preparedness and response in rural communities?

According to Partnering to Achieve Rural Emergency Preparedness: A Workbook for Healthcare Providers in Rural Communities, effective emergency preparedness planning requires a team effort. Communicating and networking with leaders in your town, county, surrounding towns and counties, and region is essential. Healthcare facilities should be integrated into community planning.

Rural healthcare providers and organizations should understand the emergency management system at all levels, including local, regional, and state. Collaboration with other agencies and professional relationships with key personnel should be established in advance of an emergency.

These agencies include:

  • Professional volunteer registries housed in State Departments of Health
  • Emergency medical services systems
  • Public health departments
  • Hospitals
  • Mental health agencies
  • Penal institutions
  • National organizations
  • State Primary Care Associations
  • Local chapters of the American Red Cross
  • Other health and social service organizations

Rural communities all have a county emergency management director that they can call for a central point of coordination. For a listing of these agencies, see FEMA: State Offices and Agencies of Emergency Management.

Preparedness efforts should also include community members, as they can play important roles in both preparedness and response. For instance, volunteers may be needed to help with fundraising for necessary equipment or to help schools, nursing homes, and daycares prepare and respond. In addition, community members of all ages and abilities should receive education about how to prepare for and what to do in the event of disasters.

How can disasters in urban areas affect rural communities? How can rural communities prepare?

When doing preparedness planning, rural communities typically focus on how to respond to disasters that occur in their own communities. Many communities fail to plan for the effect that incidents such as natural disasters, terrorism events, or disease outbreaks in urban areas could have on them. In the event that urban residents flee the city, they will migrate to or through rural areas, and rural areas need to be prepared for such an influx.

According to Urban to Rural Evacuation: Planning for Rural Population Surge, rural emergency planning efforts have not accounted for population surge from urban areas in the event of disaster. Key considerations include:

  • Urban residents’ behavior will depend on how the media and government presents the threat, and on the content and delivery of official recommendations.
  • Traffic increase will be an issue, including limited access or road capacity, as well as the traffic through rural areas resulting in consumption of food, fuel, water, and sanitation resources.
  • The Urban to Rural Evacuation project states that 40% of urban residents plan to evacuate against advice while 77-91% will evacuate, if ordered.
  • Among those who plan to evacuate, 55% are likely to evacuate to a rural destination.
  • Rural healthcare providers would likely be overwhelmed.

Rural planning to address population surge issues should include:

  • Estimating numbers of evacuees that might arrive during a disaster.
  • Considering the characteristics of those evacuees including ages of children, elderly, those with medical needs, and pets
  • Mitigating the impact on potentially overwhelmed rural healthcare systems, including the potential for further spread of diseases.
  • Leveraging urban resources through regional planning to combine resources with urban counterparts.
  • Cultural competency training to address the needs of diverse urban populations.
  • Shelter planning, as unexpected travelers may need a place to stay overnight.
  • Crisis communication in collaboration with urban emergency agencies, as a way to prevent or reduce the uncontrolled evacuation.

What do rural hospitals need to know and do to prepare for disasters and large-scale emergencies?

Rural hospitals can prepare for disasters by:

  • Conducting in-house disaster emergency preparedness training and drills, which includes going over the hospital’s emergency plans and updating as needed.
  • Discussing potential challenges, such as security and supply limitations
  • Participating in regional planning activities with urban counterparts on all issues of preparation, on a regular basis.           

According to Disaster Preparedness, hospital professionals should adjust their crisis indicators to fit their resources, size, and surroundings. If a Critical Access Hospital has 25 beds that are quickly taken, with more patients seeking care, they may need to transition to a crisis response mode sooner than an urban hospital.

Rural hospitals should identify what supplies and workforce they are lacking and plan how to access these resources in a disaster. One solution might be telemedicine, which would allow a rural physician to electronically consult with specialists.

More than 90% of hospitals in the United States use some form of Hospital Incident Command System (HICS). This was created as a way for hospitals to prepare for and react to disasters. HICS establishes a clear chain of command and can be customized to fit small healthcare facilities. For further information on HICS, see U.S. Department of Health & Human Services: Hospital (Emergency) Incident Command System: H(E)ICS.

How can rural communities plan for addressing the mental health needs of its residents during and after a disaster?

It is important to provide support, care and comfort to individuals who have experienced a disaster. According to Disaster Mental Health Handbook: Disaster Services, mental health services during a disaster response tend to be short-term, immediate, and can last from minutes to hours. Activities focused on problem solving and addressing basic needs and reduce stress are most effective. Some mental health services may be less available in rural communities, making it important to develop plans for the provision of disaster mental health services.

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides resources for disaster preparedness, response, and recovery. In particular, SAMHSA: Disaster Technical Assistance Center (DTAC) helps states, territories, tribes, and local entities prepare in delivering mental health services in response to disasters.

Our community has experienced a disaster, where can we get help?

In the wake of a disaster, communities may have a variety of critical needs, including providing significant healthcare and public health services to residents, providing shelter, maintaining public safety, and sometimes rebuilding key infrastructure, such as healthcare facilities. There are agencies and organizations that can assist communities with these efforts. The American Red Cross can provide numerous services to rural communities who have experienced a disaster. These services include:

  • Providing shelters
  • Mobile feeding sites
  • Emergency aid stations
  • Bulk distribution sites
  • Outreach and home visits
  • Disaster relief operations
  • Volunteer processing centers

Public health departments provide help after a disaster. To find your public health department, please see Public Health Resources: State or Territorial Health Departments.

FEMA provides a listing of all State Offices and Agencies of Emergency Management. FEMA also has information on their website on Disaster Survivor Assistance and Response and Recovery.

For a listing of funding programs that provide emergency assistance, see:
RHIhub Emergency Preparedness and Response Funding & Opportunities.

For a listing of RHIhub funding programs that provide capital funding, see:
RHIhub Capital Funding, Funding & Opportunities.

The National Academies report, Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery, may be useful for community planning efforts and decision-making, both before and after a disaster strikes. It outlines how a community can use the disaster recovery process, not just to return to pre-disaster conditions, but as an opportunity to improve infrastructure and service delivery systems, and ultimately create healthier and more resilient communities.

What are some risks for disasters that are more likely to impact rural areas?

Disease outbreaks can occur anywhere, as can natural disasters. There are some risks that may be greater in rural areas, however, due to the fact that many key resources housed in rural areas are important for national security, making them vulnerable to terrorist threats. In addition, some industries located in rural areas present higher risks for disasters. Key resources and industries that may put rural areas at increased risk include:

  • Power plants, including nuclear facilities
  • Military bases and missile launch facilities
  • Dams
  • Agricultural chemical facilities
  • Food production and aquifers (potential for food and water supply contamination)
  • Transportation of hazardous materials
  • Natural resource production

Last Reviewed: 12/8/2014