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Rural Emergency Preparedness and Response

When emergencies happen in rural communities, especially if they are severe or prolonged, the resource demands on local response agencies and healthcare facilities will quickly be consumed and these events become disasters. Disasters have complex impacts whether they are natural or man-made and can occur without warning.

Rural communities can deal more effectively with large-scale emergencies by planning and preparing for emergencies before they happen. This process should involve many different people and community organizations.

Rural areas face challenges in emergency preparedness and response. These include:

  • Resource limitations
  • Remoteness
  • Low population density
  • Communication issues

As stated in the Federal Office of Rural Health Policy's document Rural Communities and Emergency Preparedness, rural communities depend on hospitals, public health departments, and emergency medical services (EMS) providers for emergency preparedness. Some rural areas lack public health departments and must rely on state public health agencies. Where rural health departments do exist, many operate with small budgets and limited staffing. Similarly, many rural hospitals face chronic financial challenges and constraints of other resources. As a result, rural public health departments and hospitals may be unable to respond adequately to emergencies, leaving communities vulnerable and dependent on volunteer responders.

Frequently Asked Questions

What is the difference between emergency preparedness and emergency response?

Emergency preparedness refers to actions performed before an emergency. This includes holding planning and coordination meetings, writing procedures, training staff and volunteers, scheduling emergency drills and exercises, and ensuring that emergency equipment is available, in good repair, and ready to use. Emergency preparedness can help ensure a good outcome.

Emergency response refers to actions taken in response to an unexpected and potentially dangerous event. Emergency response can help to minimize negative effects of emergencies and disasters.

What are some challenges in rural emergency management?

Problems in rural emergency preparedness and response include:

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

Rural communities have traditions of collective action to accomplish public improvements and provide for public safety. These cooperative activities build social capital, an asset in emergency preparedness activities in rural communities. Strong relationships between people and organizations in the community, and a willingness to volunteer, may help compensate for some challenges rural communities experience and contribute to resilience.

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 coordination and communication across regions and numerous types of organizations. Healthcare facilities should be included in emergency planning.

Rural healthcare providers and organizations should be familiar with local-, regional-, and state-level emergency management systems. By forming professional relationships with key personnel in various health-related or civic organizations and government agencies, rural healthcare providers will be better positioned to work effectively in the event of a disaster. These groups can include state and public health departments, primary care associations, mental health facilities and agencies, correctional facilities, and disaster relief agencies such as the American Red Cross.

The Rural Domestic Preparedness Consortium offers training and resources to rural emergency responders. Free courses are available in-person and online, and are certified by the Department of Homeland Security. The training uses an all-hazards approach to prepare responders for many different types of emergencies, threats, and hazards. Additional trainings are available through the TRAIN Learning Network from the Public Health Foundation.

It is important to connect with emergency management agencies in your state. For a list of state agencies, see FEMA: Emergency Management Agencies. Your state agency can direct you to county, tribal, and local emergency management agencies.

How can community members be engaged and trained in disaster preparedness and response?

Community members can play important roles in preparedness and response to emergencies and disasters. Volunteers can help with fundraising for equipment and can train staff at schools, nursing homes, and daycare centers. In addition, people of all ages should learn what to do if disasters occur.

FEMA's Community Emergency Response Team (CERT) program offers training in disaster response skills, such as:

  • Basic search and rescue
  • Fire safety
  • Team organization
  • Disaster medical operations

CERT volunteers can provide aid if professional responders are not immediately available. They can also help emergency response agencies by supporting local emergency preparedness projects.

Other programs include:

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

Some public health departments offer courses in rural emergency preparedness and response. To find your public health department, see State Health Departments.

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

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

When doing preparedness planning, it is common to focus on the needs of the immediate community. However, people in rural areas should consider the effect that urban disasters might have on their communities. If residents of larger cities evacuate during natural disasters, terrorist attacks, or disease outbreaks, they will likely travel to or through rural areas.

According to Urban to Rural Evacuation: Planning for Rural Population Surge,

  • Urban residents' behavior will depend to some degree on the way the media and government officials describe the event, and on the recommendations they make. Some residents will choose to shelter in place, while others will choose to evacuate to another urban area or a rural community.
  • Increased traffic in rural areas will result in a need for additional food, fuel, water, and sanitation resources.
  • Rural healthcare workers providing emergency care would likely be overwhelmed. As a result, rural residents might find that their own routine healthcare needs are not being met.

The National Association of County & City Health Officials' publication Responding to Medical Surge in Rural Communities: Practices for Immediate Bed Availability offers guidance for ensuring that 20% of hospital beds within a healthcare coalition can promptly be made available for high-needs patients in the aftermath of a disaster.

Rural planning to address population surge issues should include:

  • Estimating numbers of evacuees who might arrive during a disaster, including those with special needs, such as children, the elderly, people with pets, people with limited English proficiency, and those with medical conditions
  • Mitigating the impact on overwhelmed rural healthcare systems, including the potential for further spread of diseases
  • Planning a way to share resources with urban counterparts
  • Shelter planning, as unexpected travelers may need a place to stay overnight
  • Establishing a plan to communicate with urban emergency agencies
  • Investigate alternative communication methods to inform evacuees about shelter locations and access to healthcare needs
  • Mobilization of volunteers and reallocation of resources

What resources are available for communication planning in a rural area?

It is important to identify strategies for communicating with rural communities during emergencies and disasters. Sharing key information through verbal or written means is important for effective response. Selected resources for emergency communication include:

How can rural hospital staff members prepare for disasters and large-scale emergencies?

Preparation can include:

  • Conducting emergency preparedness training and drills, and updating the hospital's emergency plans
  • Discussing potential challenges, such as security and supply limitations
  • Cross training employees to perform support services to enhance capacity
  • Participating in regularly-scheduled regional planning activities with their urban counterparts
  • Assigning to one person the tasks of monitoring use of supplies during a disaster and anticipating other needs

According to the American College of Physicians' document Disaster Preparedness, hospital professionals should consider their resources, size, and surroundings when planning for disaster management. Critical Access Hospitals with few beds may need to transition to crisis response mode sooner than a larger urban hospital.

The Centers for Disease Control and Prevention publication Long-Term, Home Health, and Hospice Care Planning Guide for Public Health Emergencies notes the importance of maintaining information technology in healthcare facilities, and makes the following suggestions for coping with possible interruptions of service during and after an emergency:

  • Decide how to maintain computer access and storage in a crisis.
  • Find backup services or alternate information technology.
  • Enable employees to work remotely while performing essential duties.
  • Test systems before they are needed.

The same report offers ideas for ensuring a plan exists in case of damage to infrastructure:

  • Consider which parts of the facility are at greatest risk of breakdown.
  • Choose personnel who will do repairs, if needed.
  • Find alternate or backup utilities (such as electricity, plumbing, and phone service).

The document also includes suggestions for developing policies about who may volunteer to work in a healthcare facility after a disaster:

  • Know the laws and regulations relating to medical and nonmedical volunteers.
  • Identify resources that may be needed by volunteers.
  • Develop plans for screening (which may include criminal background checks and infectious disease screening) and training.
  • Understand liability issues and confirm that the facility's insurance covers volunteers.

More than 90% of hospitals in the United States use some form of the Hospital Incident Command System (HICS), which helps them to prepare for and react to disasters. HICS establishes a clear chain of command and can be used for hospitals of all sizes.

The Missouri Hospital Association has published Preparedness and Partnerships: Lessons Learned from the Missouri Disasters of 2011, a document designed to provide guidance to organizations designing emergency preparedness plans. The Minnesota Department of Health also offers a bulletin titled Information and Guidelines for Healthcare Facilities and Providers in the Event of Spring Flooding or Other Natural Disasters.

How can rural communities plan for addressing residents’ mental health needs after a disaster?

According to the Maine Rural Health Research Center's policy brief Encouraging Rural Health Clinics to Provide Mental Health Services: What are the Options?, many rural areas experience shortages in mental health services. In the aftermath of a disaster, these deficiencies may become more pronounced.

An article published in a 2014 issue of Public Health Reports notes that most disaster-related injuries and trauma are psychological, not physical. For that reason, it is important that rural communities plan ahead so that they can provide mental health services not only for patients but also for staff members who will experience stress during a crisis.

Rural healthcare providers may find that they must tailor mental health services to the specific type of disaster that their patients have experienced. Researchers who published A Tale of Two Studies of Two Disasters: Comparing Psychosocial Responses to Disaster Among Oklahoma City Bombing Survivors and Hurricane Katrina Evacuees found that people who had survived the mass casualty were more likely to suffer from post-traumatic stress disorder, whereas the hurricane evacuees tended to need treatment for serious, persistent, preexisting psychiatric disorders. The University of Missouri's Disaster and Community Crisis Center's publication Mental Health Response to Community Disasters: A Fact Sheet for Disaster Mental Health Planners, Responders, and Providers reviews the mental health implications of disasters and offers recommendations for response.

Many Red Cross Disaster Services teams include independently-licensed mental health professionals who work at the local level, supporting people affected by the disaster as well as volunteers working as part of the relief operation. These mental health providers have master's degrees or more, and can include:

  • Psychiatrists and psychologists
  • Clinical social workers and counselors
  • Marriage and family therapists
  • Nurses with mental health specialty certification
  • School psychologists and counselors

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 provide mental health services.

SAMHSA's publication Tips for Disaster Responders: Cultural Awareness When Working in Indian Country Post Disaster offers suggestions for helping Native American disaster victims in a culturally sensitive manner.

Our community has experienced a disaster. Where can we get help?

The American Red Cross can provide services to rural communities that have experienced a disaster. These include:

  • Providing food, temporary shelter, and first aid
  • Conducting outreach and home visits
  • Organizing volunteer processing centers

Public health departments can also provide help after a disaster. To find your public health department, see State Health Departments.

In addition, help may be available from the Medical Reserve Corps (MRC), a national network established to provide support for recruiting, training, and activating medical professionals, public health workers and officials, and community members, who are willing to volunteer after disasters and emergencies.

FEMA's website includes information on Disaster Survivor Assistance and Response & Recovery, and provides a list of Emergency Management Agencies.

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

For a list of funding programs that provide capital funding, see RHIhub's Capital Funding for Rural Healthcare, Funding & Opportunities.

The National Academies of Sciences, Engineering, and Medicine's report Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery offers suggestions for improving infrastructure and delivery systems in the aftermath of a disaster. In this way, rural communities may emerge from the recovery process stronger than ever.

What disasters are more likely to affect rural areas?

Though disease outbreaks and natural disasters can occur anywhere, some risks may be greater in rural areas. Institutions and structures that may be more vulnerable include:

  • Power plants, including nuclear facilities
  • Military bases and missile launch facilities
  • Dams
  • Agricultural chemical facilities
  • Food production facilities and aquifers
  • Companies and people involved in transportation of hazardous materials
  • Mining, oil and gas drilling, and other natural resource extraction, transportation, storage, and processing activities
  • Railroads and highways

What are the emergency preparedness requirements for rural healthcare facilities?

In an effort to ensure that healthcare facilities prepare adequately for disasters, the Centers for Medicare and Medicaid Services (CMS) has established Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. All affected facilities and agencies must meet the requirements by the implementation date of November 15, 2017. The 17 types of Providers/Suppliers/Facilities Impacted by the Emergency Preparedness Rule include healthcare facilities often found in rural areas, such as:

  • Critical Access Hospitals
  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Hospices
  • Long-Term Care Facilities
  • Home Health Agencies

In order to fulfill CMS requirements, the emergency plans must:

  • Specify a definite course of action, rather than simply list operational guidelines
  • Document efforts to cooperate and collaborate with officials from emergency preparedness agencies
  • Address 4 core elements of emergency preparedness, including:
    • Risk Assessment and Emergency Planning
    • Communication Plan
    • Policies and Procedures
    • Training and Testing

Facility representatives must be able to provide documentation of these policies and procedures upon request, and be able to show where they are located.

CMS’s Emergency Preparedness Rule section contains checklists and downloadable resources to help surveyors, providers, and suppliers comply with the new regulations. It includes FAQs, names of healthcare coalitions by state, requirements by provider type, and a sample facility transfer agreement.

Last Reviewed: 6/29/2017