When emergencies happen in rural communities, especially disasters that are severe or prolonged, the demands on
local response agencies and healthcare facilities can quickly consume available resources. Disasters have
complex effects, 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. Rural residents, communities, local governments, and others involved in
emergency preparedness and response face challenges that can include:
- Resource limitations, such as equipment and supplies, training, and infrastructure
- Access to healthcare for higher levels of care
- Remoteness and geography
- Low population density
- Communication issues
As stated in the Federal Office of Rural Health Policy's document Rural
Communities and Emergency Preparedness, rural communities preparing for and responding to emergencies
depend on assistance from healthcare facilities, local public health departments, law enforcement, fire
departments, and emergency medical services (EMS). Some rural areas lack local public health departments and
instead rely on state public health agencies. Where rural local public health departments do exist, many operate
with small budgets and limited staffing. Similarly, many rural hospitals face their own financial challenges and
resource constraints. As a result, rural public health departments and hospitals may lack the capability to
respond adequately to emergencies, leaving communities vulnerable. Rural residents can collectively decide to
implement a whole community approach to emergency preparedness and assign community members' tasks and
responsibilities based on knowledge, strengths, and abilities. For more information and resources on rural
public health agencies and the challenges they face, see RHIhub's Rural Public
Health Agencies topic guide.
Frequently Asked Questions
What is the difference between emergency preparedness and emergency response?
Emergency preparedness refers to actions performed before an emergency. Examples can include
planning and coordination meetings; writing communication or standard operating procedures; training staff,
volunteers, and community members; conducting emergency drills and exercises; and ensuring that emergency
equipment is available, in good repair, and ready to use.
Emergency response refers to actions taken after an emergency or natural disaster to help
minimize the negative effects. Examples can include emergency communications; coordinating first
responders and volunteers; providing emergency medical care to the injured; coordinating temporary shelter for
evacuated or displaced survivors; and organizing supplies and equipment for those assisting in and affected by
the emergency or disaster.
What is the “all hazards approach” to emergency preparedness?
The Centers for Medicare and Medicaid Services document Emergency
Preparedness Regulation offers this definition:
“An all-hazards approach is an integrated approach to emergency preparedness planning that focuses on
capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters,
including internal emergencies and a man-made emergency (or both) or natural disaster.”
All-hazards planning involves concentrating on the threat scenarios most likely to occur in specific locations
and ensuring that appropriate resources will be available. For example, most rural areas in the Midwest are at
greater risk of tornadoes than wildfires or earthquakes, and so their emergency preparedness plans would reflect
this. Planning could involve steps to be taken in the event of disruptions in electricity or communications,
equipment failures, cyberattacks, damage to facilities, and supply chain problems that would result in
shortages of food and water. All-hazards planning is not intended to cover every possible emergency, but rather
involves risk assessment to find vulnerabilities in local systems and strategies to limit damage to human life,
property, business operations, and the environment.
How can rural communities prepare for outbreaks, epidemics, and pandemics?
In order to lessen the severity of possible disasters, communities and public health agencies must plan ahead,
so that procedures are in place before they are needed. The University of Minnesota Center for Infectious
Disease Research and Policy’s Partnering
to Achieve Rural Emergency Preparedness: A Workbook for Healthcare Providers in Rural Communities offers
suggestions to help Rural Health Clinics, Community Health Centers, and rural hospitals create all-hazards
emergency plans and strengthen collaboration with response partners. Planning should include:
- Understanding operations of emergency management systems at the state, regional, and local levels, as most
disasters will not have an immediate federal response
- Preparing to work with agencies outside providers’ usual networks. These can include law enforcement,
schools, churches, and local businesses
- Becoming familiar with the National Incident
Management System, which promotes efficiency, coordination, and effective communication during
- Conducting drills to address scenarios such as clinic or hospital evacuation, continuity of operations, and
expansion of surge capacity
- Preparing for surveillance and contact tracing to find the sources of infectious disease
- Developing procedures for infection control and contingency plans for supply chain breakdowns
The U.S. Fire Administration’s March 2020 document Information
for First Responders on Maintaining Operational Capabilities During a Pandemic notes that contingency
planning on the part of local first responders will help lessen the effects of pandemics on their agencies and
communities. Suggestions for planning include:
- Acquiring personal protective equipment for first responders, so that they can do their jobs more safely
- Contacting former employees and community members who can serve as volunteers if needed
- Identifying skills that can be taught quickly to volunteers
- Teaching people basic techniques for care of ill family members, and explain the difference between
emergency and nonemergency care, so as to lessen reliance on emergency services
- Reviewing emergency health and operational policies, and modifying if needed
- Encouraging vaccination for all personnel and their families
- Defining who is eligible to work remotely, to minimize contagion
What are some challenges in rural emergency management?
Rural emergency preparedness professionals can experience many barriers or challenges related to the work they
Limited funding for rural response agencies, such as EMS, fire departments, or local public health
departments, that could affect the availability of staffing, equipment, training, public outreach and
education, and other emergency preparedness and response activities
Greater geographical coverage areas, which could result in longer response times during an emergency
Demographic challenges, such as rural areas with concentrations of elderly, disabled, and poor residents
Infrastructure for communication and warning systems may be substandard or non-existent
Coordination and cooperation among a complex network of local, state, and federal agencies during an
Strong relationships between people and organizations within a community, and a willingness to volunteer, may
help compensate for some challenges rural communities experience during emergencies. However, reliance on
volunteers for emergency medical services and fire departments may mean that there is greater turnover in
staffing and the possibility that there will be inadequate coverage for all shifts. The Institute for Rural
Emergency Management (IREM) provides technical assistance to rural communities and can help with
training, hosting workshops, and more. IREM conducts research in and shares best practices between rural
community and emergency preparedness and response managers and professionals.
Who should be involved in emergency preparedness and response in rural communities?
Many community members are responsible and should be involved with emergency preparedness and response for their
rural community. Partnering
to Achieve Rural Emergency Preparedness: A Workbook for Healthcare Providers in Rural Communities
describes effective emergency preparedness and response planning as the coordination and communication across
regions and numerous types of organizations, including healthcare facilities and service organizations.
Rural healthcare providers and organizations should be familiar with local-, regional-, and state-level
emergency management systems. Building professional relationships with key personnel in various health-related
or civic organizations and government agencies will better position rural healthcare providers to work
effectively and efficiently in the event of a disaster. Examples of these groups can include local and state
health departments, primary care associations, behavioral health facilities and agencies, clinics, long-term
care facilities, correctional facilities, law enforcement officials, first responders, and disaster relief
The Rural Domestic Preparedness Consortium (RDPC) offers rural
specific training and resources for emergency responders. Free courses are available in-person and online, and
are certified by the Department of Homeland Security. You can view the training schedule and course catalog online. RDPC utilizes an
all-hazards approach for emergency preparedness and response training to prepare responders for many types of
emergencies, threats, disasters, and hazards. The Public Health Foundation coordinates the TRAIN Learning Network, which provides education, training, and
resources to professionals at little or no cost. You can narrow your search of available courses by rural, course format,
date, selected public health competencies and capabilities, and more.
To be well prepared, it is important to connect with emergency management officials both at the county and state
level. To find your state emergency management agency, see the Federal Emergency Management Agency's (FEMA)
list of Emergency Management Agencies. Your state agency can direct
you to county, tribal, and local emergency management agencies. Ready.gov
offers emergency preparedness and response information for those living in Indian Country. For more information on Native American
health and wellness, see RHIhub's Rural Tribal Health topic guide.
How can community members be engaged and trained in disaster preparedness and response?
Community members can play an important role in a community's ability to plan, respond, and recover from
emergencies and disasters. Community members can participate in planning efforts, receive training, and also
serve as volunteers who support response and recovery efforts.
FEMA's Community Emergency Response Team (CERT) program offers
education and training in disaster response for community volunteers, such as:
- Basic search and rescue techniques
- Fire safety
- Disaster medical operations
- Procedures for hazardous materials and terrorist incidents
CERT trained volunteers can provide immediate aid and assistance if professional responders are not available.
They can also help emergency response agencies by supporting local emergency preparedness projects
The Medical Reserve Corps (MRC) is a national network of local
volunteer groups that engage communities to support public health, reduce vulnerability, build resilience, and
improve preparedness, response, and recovery capabilities. MRC volunteers play a large role in building
community resilience and preparing for and responding to disasters. MRC
training is free, but registration is required. The MRC TRAIN course catalog and guide for new members is available
online for community members to prepare and train for disasters.
Another program offering training for community volunteers interested in assisting with emergency preparedness
and response is provided through the Department of Homeland Security's website, Ready.gov.
This platform provides emergency preparedness and response education and training resources for a variety of
emergencies and disasters, such as flooding, power outages, fires, emergency alerts, active shooter situations,
and more. Ready.gov also includes information and resources on Citizen Corps, a national network for state, local, and
tribal members working to prepare their local communities for an emergency.
The Center for Food Security and Public Health (CFSPH) at Iowa State University developed and maintains a
website, All Hazards: Resources to Help Rural Communities Prepare for
Disasters and Other Hazards, that offers guidance, resources, and assistance for agricultural
to prepare for and recover from disasters and emergency situations, including dangers related to agrochemicals.
In 2016, CFSPH published a guide, All-Hazards
Preparedness for Rural Communities, for individuals, farmers, and businesses in rural agricultural
communities preparing for an all-hazards approach for their communities and commodities.
Some state-level public health departments offer courses in rural emergency preparedness and response. To find
yours, see the list of State
Health Departments. FEMA maintains a list of state Emergency
Management Agencies. These state agencies may provide programs in homeland security, emergency
management, emergency operations, conducting preparedness drills and exercises, hazard planning, strategic
planning and community preparedness, and disaster recovery.
How do disasters in urban areas affect rural communities? How can rural communities prepare?
Emergency preparedness and response planning tends to focus on the immediate needs of a community. However,
rural emergency planners should consider the effect an urban disaster might have on their community. If
residents of larger cities evacuate during an emergency or natural disaster, they would likely travel to or
through rural areas.
According to Urban
to Rural Evacuation: Planning for Rural Population Surge:
Urban residents' predicted behavior will depend on the messaging and language used by the media and
government to describe the event and make recommendations; urban residents could choose to shelter in place
or evacuate to another urban area or a rural community
Increased traffic in rural areas will result in a need for additional resources in rural areas, such as
food, fuel, water, and sanitation resources
Rural healthcare workers providing emergency care will likely be overwhelmed and, as a result, rural
residents' routine healthcare needs might not be able to be met
A 2014 NACCHO report, Responding
to Medical Surge in Rural Communities: Practices for Immediate Bed Availability, offers guidance for
ensuring 20% of hospital beds within a healthcare coalition can promptly be made available for high-needs
patients in the aftermath of a disaster.
Rural emergency preparedness planning to address population surge and related issues should include:
Estimating the number 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, or individuals
with medical conditions
Mitigating the effects of population surge on the rural healthcare systems, including the potential for
further spread of diseases
Planning to share resources with urban counterparts
Shelter planning for those traveling or unable to find housing
Establishing a communication plan with urban emergency preparedness and response agencies
Investigating alternative communication methods to inform evacuees about shelter locations and access to
Mobilization of volunteers and reallocation of resources
The Rural Preparedness Planning
Guide: Planning for Population Surge Following Urban Disasters, a rural preparedness guide from the NORC
Walsh Center for Rural Health Analysis, offers case studies and worksheets to guide pre-event, event, and
post-event population surge planning for rural communities.
What resources are available for communication planning in a rural area?
It is important to identify strategies for communicating and engaging with rural communities during emergency
preparedness and response planning. Sharing key information through verbal or written means is important for a
planned, coordinated, and appropriate response to an emergency or disaster. Resources for emergency
Emergency Preparedness and Response, Crisis and Emergency Risk Communication (CERC) Manual and Tools and Templates and Tools are offered
by the Centers for Disease Control and Prevention, Center for Preparedness and Response
ASPR Technical Resources, Assistance Center, and
Information Exchange (TRACIE) offers a variety of resources, tools, templates, and webinars to help
rural communities build emergency preparedness coalitions
and Emergency Risk Communication Tool Kit was created by the California Department of Health
Public Health Communications
is available from the U.S. Department of Health and Human Services, Office of the Assistant Secretary for
Preparedness and Response
Rural Risk Communication Toolkit, developed by the Southeast Health
District in Georgia, offers fillable templates and printed materials
Texting for Public Health: Emergency
Communication, Health Promotion, and Beyond was created by the Northwest Center for Public Health
Practice at the University of Washington
Social Media Preparedness Toolkits and Preparedness Videos are public service advertisements from
How can rural hospitals and other healthcare organizations prepare for disasters and large-scale emergencies?
Rural providers, professionals, and staff members in healthcare facilities and organizations can prepare for
disasters and emergencies in a variety of ways, including:
Conducting emergency preparedness training, drills, and exercises within the healthcare facility and with
its emergency response partners, such as a local public health department, EMS, and law enforcement
Reviewing and updating the healthcare facility's emergency response plans
Discussing hypothetical challenges and potential solutions, such as security and supply limitations
Cross training among employees so that any employee is able to perform support services and knows
procedure when responding to an emergency
Holding regularly-scheduled regional planning activities with their urban counterparts
Assigning tasks and responsibilities to employees during a disaster
Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and
Territorial Public Health, published in October 2018 by the Centers for Disease Control and Prevention
(CDC), describes the capabilities and functions of emergency preparedness and response standards. The 2018 CDC
report highlights the importance of working with partners and stakeholders when conducting emergency
preparedness and response planning, such as hospitals and other healthcare organizations.
A 2016 CDC planning guide, Long-Term, Home
Health, and Hospice Care Planning Guide for Public Health Emergencies, discusses the importance of
maintaining health information technology (HIT) in healthcare organizations and offers suggestions for preparing
for possible service interruptions during and after an emergency:
- Decide how to maintain computer access and data storage during an emergency
- Identify backup computer services or alternative HIT services
- Enable employees to work remotely while performing essential duties
- Conduct tests of systems and procedures before they are needed
The report offers ideas for ensuring a plan exists in case of damage to infrastructure:
- Identify areas of the facility at greatest risk of breakdown or in need of repair
- Designate personnel who will do repairs as needed
- Find alternate or backup utilities, such as electricity, plumbing, and communication services
Suggestions for developing policies regarding volunteers who may assist and work in a healthcare facility after
a disaster include:
- Review the laws and regulations related to medical and nonmedical volunteers
- Identify what resources volunteers may need
- Develop plans for screening and training that can include criminal background checks and infectious disease
- Understand liability issues and confirm the facility's insurance covers volunteers
Rural hospitals are required to have emergency operation plans (EOPs) per CMS requirements. This is explained
further below in What are
the emergency preparedness requirements for rural healthcare facilities? More than 90% of hospitals
in the United States use some form of the Hospital Incident
Command System (HICS). HICS helps hospitals and healthcare professionals prepare for and react to
disasters by establishing a clear chain of command. HICS can be used for hospitals of all sizes.
The Missouri Hospital Association's report, Preparedness
and Partnerships: Lessons Learned from the Missouri Disasters of 2011, offers guidance to organizations
developing emergency preparedness and response plans. The Minnesota Department of Health published a bulletin,
Guidelines for Healthcare Facilities and Providers in the Event of Spring Flooding or Other Natural Disasters,
outlining guidelines healthcare organizations and professionals can use to answer questions regarding standard
operating procedures during an emergency or natural disaster.
Another option for staff at rural healthcare organizations preparing for disasters and large-scale emergencies
is to complete free, online courses from FEMA's Emergency Management Institute (EMI). A list of EMI's
independent study courses is available online.
How can rural communities plan for addressing residents' mental health needs after a disaster?
According to a research and policy brief from the Maine Rural Health Research Center, Encouraging
Rural Health Clinics to Provide Mental Health Services: What Are the Options?, many rural areas
experience shortages in mental health services, and these deficiencies may become more pronounced after a
A 2014 Public Health Reports article, An
Academic-Government-Faith Partnership to Build Disaster Mental Health Preparedness and Community
Resilience, notes that most disaster-related injuries and trauma are psychological, not physical. For
that reason, it is important that rural communities plan and prepare before a disaster happens, so appropriate
mental health services are available after a disaster. Rural healthcare providers may find they must tailor
mental health services to the specific type of disaster their patients experienced. A Tale of Two Studies of Two Disasters: Comparing
Psychosocial Responses to Disaster among Oklahoma City Bombing Survivors and Hurricane Katrina Evacuees,
an article published in Rehabilitation Psychology, found that survivors of a mass casualty event were
more likely to suffer from post-traumatic stress disorder, whereas hurricane evacuees tended to need treatment
for serious, persistent, preexisting psychiatric disorders. A fact sheet from the Disaster and Community Crisis
Center at the University of Missouri, 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 mental health interventions.
The Medical Reserve Corps and FEMA's Community Emergency Response Team (CERT) can assist rural communities
with planning to address mental health needs after a disaster. Another option for some rural communities may be
the Red Cross
Disaster Services teams, which include independently-licensed mental health professionals who deploy to
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 professionals have master's degrees or higher-level graduate degrees and
Clinical social workers and counselors
Marriage and family therapists
Nurses with a psychiatric-mental health nursing certification or other mental health specialty
School psychologists and counselors
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides resources for emergency
preparedness, response, and recovery. In particular, SAMHSA's Disaster
Technical Assistance Center (DTAC) helps states, territories, tribes, and local entities prepare to
provide effective mental health services. SAMHSA also offers a Crisis Counseling Assistance and Training
Program that provides grants and technical assistance to help individuals and communities recover from
natural and man-made disasters through community outreach and access to mental health services.
SAMHSA's 2014 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 disaster relief and
recovery services to rural communities that may include:
- Providing food, temporary shelter, and emergency supplies
- Conducting outreach and home visits
- Organizing volunteer processing centers
- Health and mental health volunteers who can provide first aid or emotional support
Public health departments may be able to provide some assistance after a disaster. To find your public health
department or learn about services they can provide after a disaster, contact your state
health department. Additionally, help may be available from the Medical
Reserve Corps (MRC). MRC is a national volunteer 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 offers the Disaster Survivor Assistance Program, and provides a list
of emergency management agencies and offices.
See the Funding & Opportunities section of
this topic guide for a list of funding programs related to rural emergency preparedness and response. Capital
funding programs related to infrastructure improvements that will help facilities prepare for emergencies can
be found on RHIhub's Capital Funding for Rural Healthcare Funding and
The National Academies of Sciences, Engineering, and Medicine's 2015 report, Healthy, Resilient, and
Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery, offers
guidance to improve infrastructure and delivery systems in a community after a disaster and can assist rural
communities with the recovery process.
What disasters are more likely to affect rural areas?
While disease outbreaks and natural disasters can occur anywhere, some risks may be higher in rural areas.
Institutions and structures that may be vulnerable to disasters and emergencies, and are typically located in
rural areas, include:
Power plants, including nuclear facilities
Military bases and missile launch facilities
Agricultural chemical infrastructure
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
Railroads and highways
Recreational areas, which may bring large numbers of visitors unfamiliar with local hazards
What are the emergency preparedness requirements for rural healthcare facilities?
In 2016, in an effort to ensure healthcare facilities prepare adequately for disasters, the Centers for Medicare
and Medicaid Services (CMS) established an emergency
preparedness rule: Emergency Preparedness Requirements for Medicare and Medicaid Participating
Providers and Suppliers. All affected facilities and agencies must be in compliance and meet
the requirements. There are 17
types of providers, suppliers, and facilities impacted by the emergency preparedness rule including
healthcare facilities found in rural areas, such as:
- Critical Access Hospitals (CAHs)
- Rural Health Clinics (RHCs)
- Federally Qualified Health Centers (FQHCs)
- Hospice services
- Long-term care facilities
- Home health agencies
To fulfill CMS
requirements, the emergency preparedness plans must:
Document efforts to cooperate and collaborate with emergency preparedness agency officials
Define a course of action, rather than list operational guidelines, to address four factors of emergency
- Risk assessment and emergency planning
- Communication plan
- Policies and procedures
- Training and testing
Facility representatives must be able to provide documentation of emergency preparedness plan policies and
procedures upon request, and be able to show where they are located. CMS requires the emergency preparedness
plan is reviewed and updated on an annual basis.
CMS provides emergency
preparedness regulation guidance containing checklists and other resources to help surveyors, providers,
facilities, and suppliers comply with the new CMS rule. This resource bank includes frequently asked questions
(FAQs), names of healthcare coalitions by state, requirements by provider type, and a sample facility transfer